Patients with sacroiliac joint dysfunction exhibit altered movement strategies when performing a sit-to-stand task

Effect of sacroiliac fusion on gait, standing balance, and pelvic mobility for unilateral sacroiliac joint dysfunction

Background

Sacroiliac joint fusion (SIF) has been shown to effectively alleviate pain and improve functional deficits associated with sacroiliac joint dysfunction (SIJD). Previous studies have demonstrated significant improvements in gait function, however, none have reported both over-ground walking and quiescent standing, and additionally, none have included analysis of pelvic kinematics which may contain important information regarding pain avoidant compensatory behaviors. The purpose of this study was to identify objective functional differences between symptomatic and asymptomatic sides of unilateral sacroiliac joint dysfunction (SIJD) patients and to demonstrate the effectiveness of unilateral sacroiliac fusion (SIF) to improve gait and balance function compared to matched controls.

Methods

Thirteen unilateral SIJD patients were evaluated before and 6 months after SIF and were compared to matched asymptomatic controls. Pain and disability were assessed using visual analog scales and the Oswestry disability index respectively. Over ground walking and standing balance were assessed using 3D joint kinematics and kinetic ground reaction force analyses.

Results

Preoperatively, SIJD patients reported high levels of pain and disability and exhibited significant deficits in gait including elevated step width, reduced hip flexion/extension, and elevated pelvic motion as well as elevated center of pressure sway characteristics during standing. After unilateral SIF, patients reported significant reductions in pain and demonstrated significant improvements in gait including normalization of step width between sides and improved hip motion however elevated pelvic obliquity and rotation motion remained. Improvements in standing balance included reduced coronal sway characteristics and normalization of loading symmetry between sides.

Conclusion

Unilateral SIF resulted in significant improvements in both gait and balance function among SIJD patients to levels comparable to matched controls, however elevated pelvic motion remained. These findings help inform surgeons on the effectiveness of SIF for unilateral SIJD and provide important information regarding interpretation of functional outcomes.

Initial Validation of a Sacroiliac Joint-Specific Disability Questionnaire

Low back pain is a multidimensional disorder that can originate from a variety of pain generators, including the sacroiliac (SI) joint. Although the Oswestry Disability Index (ODI) is often used in SI joint treatment studies, the effects of the SI joint on functional disability are likely different from those of other low back pain generators. Thus, we developed the Denver SI Joint Questionnaire (DSIJQ) and performed validation testing in patients (n=24) with SI joint-specific pain at baseline, +2 weeks, and +6 months. Psychometric analyses included test-retest reliability, internal consistency, content validity, convergent criterion validity, divergent criterion validity, and responsiveness. The DSIJQ showed good test-retest reliability (intraclass correlation coefficient=0.87), internal consistency (Cronbach's alpha=0.842), content validity (<30% floor/ceiling effects), convergent criterion validity (r=0.89; P<.001), and divergent criterion validity (r=-0.33; P=.12). The DSIJQ was correlated with performance on two physical function tests: Timed Upand-Go (r=0.53; P=.008) and 5 Minute Walk (r=-0.52; P=.009). The DSIJQ showed better responsiveness than the ODI (standardized response mean and effect size, 1.14 and 1.45 for DSIJQ and 0.75 and 0.81 for ODI). Overall, the DSIJQ performed well on all psychometrics. Importantly, we validated the DSIJQ with patients' ability to complete two tests of physical functioning. Moreover, the DSIJQ was more sensitive to changes in SI joint disability than the ODI. These psychometrics suggest the DSIJQ is appropriate for evaluating SI joint disability and detecting changes in disability after targeted SI joint treatment. [Orthopedics. 2023;46(6):345-351.].

Sacroiliac joint pain increases repositioning error during active straight leg-raising

PURPOSE

This study aimed to compare the repositioning error (RE) of patients with unilateral sacroiliac joint pain (SIJP) to that of patients with low back pain (LBP) and a healthy control (HC) group. Differences between the symptomatic and asymptomatic sides were also investigated.

METHODS

Sixty-six patients with SIJP, LBP, and HC were included in this study. An active straight leg-raising repositioning test (ASLR-Rt) was performed. ASLR was performed three times each on the left and right sides, targeting a set base angle. RE was calculated as the difference between the base angle and the participant's attempt to adjust the target angle. RE was expressed as constant error (CE) and absolute error (AE).

RESULTS

The CE of the SIJP group (median [interquartile range]) (6.9 [4.6‒10.4]) was significantly higher than that in the LBP group (3.2 [1.3‒7.1]) and the HC group (2.7 [0.3‒4.6]) (P = 0.009, d = 0.91, P < 0.001, d = 1.30). The AE of the SIJP group (7.3[5.0‒10.4]) was also significantly higher than that in the LBP (3.7[2.8‒7.1]) and HC groups (3.0[1.9‒4.2]) (P = 0.003, d = 1.04; P = 0.001, d = 1.57). Comparing the symptomatic and asymptomatic sides in the SIJP group, the symptomatic side (8.0[6.0‒10.6]) was significantly higher than the asymptomatic side (5.7[3.6‒8.1]) in terms of CE (P = 0.05, d = 0.51).

CONCLUSION

Patients with SIJP increased RE during ASLR, which may be related to impaired proprioception and decreased motor control.

Motion analysis in patients with postpartum sacroiliac joint dysfunction: A cross-sectional case-control study

BACKGROUND

Patients with sacroiliac joint dysfunction are limited in daily life activities such as gait, climbing stairs and rising from a chair. It is well known that individuals with chronic low back pain have impaired balance compared to healthy individuals. This cross-sectional case-control study aims to investigate spatiotemporal parameters, center of pressure and mass, pelvic angles and other joint angles in patients with sacroiliac joint dysfunction in comparison with healthy controls.

METHODS

Motion analysis existed of three tasks: (1) normal gait, (2) single-leg-stance, and (3) sit-to-stance. Spatiotemporal parameters, center of pressure, pelvic angles and other joint angles were measured using a twelve-camera, three-dimensional motion capture system and ground reaction force platforms.

FINDINGS

Thirty subjects were recruited for this study; ten patients, ten matched controls and ten healthy student controls. For gait, patients had a lower cadence, longer double support phase, shorter step length and slower walking speed than controls. For single-leg-stance, patients had a smaller hip angle of the risen leg than controls. Also, variability in center of pressure was larger in patients. For sit-to-stance, the total time to perform the task was almost doubled for patients compared to controls.

INTERPRETATION

This study demonstrates that patients with sacroiliac joint dysfunction have an impaired gait, more balance problems during standing and standing up compared to healthy controls. This novel information assists to further comprehend the pathology and disease burden of sacroiliac joint dysfunction, in addition, it may allow us to evaluate the effect of current therapies.

Quantitative study on the biomechanical mechanism of sacroiliac joint subluxation: A finite element study

The biomechanical mechanism of sacroiliac joint pain caused by sacroiliac joint subluxation is still unclear. And the purpose of this study is to elucidate the mechanism. In the present study, a finite element model of female lumbar spine-pelvis-femur was established. To simulate the sacroiliac joint subluxation quantitatively, the left ilium was shifted ±1, ±2, and ±3 mm along each axis, respectively. The stress and strain of articular surfaces and ligaments between the sacroiliac joint subluxation model and the normal model were compared. When the left ilium shifted along the positive direction of the X/Y/Z axis, the stress on most articular surfaces of the sacroiliac joint increased, of which the stress on the iliac surface of the right sacroiliac joint increased most obviously. The stress and strain of the ligaments increased most obviously when the left ilium shifted along the Y-axis, of which the left sacrospinous ligament increased the most, followed by the right sacrospinous ligament and right long posterior sacroiliac ligament. While the left long posterior sacroiliac ligament decreased the most, followed by the left short posterior sacroiliac ligament. The present study suggests that when the sacroiliac joint subluxation happens, even a slight shift, different biomechanical changes of different ligaments around the sacroiliac joint will happen. This may lead to an abnormal proprioceptive sensation of the ligaments, resulting in stress imbalance of the sacroiliac joint, and finally resulting in sacroiliac joint pain.

Computed tomography osteoabsorptiometry-based investigation on subchondral bone plate alterations in sacroiliac joint dysfunction

Sacroiliac joint dysfunction (SIJD) is an underappreciated source of back pain. Mineralization patterns of the sacroiliac (SIJ) subchondral bone plate (SCB) may reflect long-term adaptations to the loading of the joint. Mineralization densitograms of 27 SIJD patients and 39 controls, were obtained using CT osteoabsorptiometry. Hounsfield unit (HU) values of the SCB mineralization of superior, anterior and inferior regions on the iliac and sacral auricular surfaces were derived and statistically compared between SIJD-affected and control cohorts. Healthy controls showed higher HU values in the iliac; 868 ± 211 (superior), 825 ± 121 (anterior), 509 ± 114 (inferior), than in the sacral side; 541 ± 136 (superior), 618 ± 159 (anterior), 447 ± 91 (inferior), of all regions (p < 0.01). This was similar in SIJD; ilium 908 ± 170 (superior), 799 ± 166 (anterior), 560 ± 135 (inferior), sacrum 518 ± 150 (superior), 667 ± 151 (anterior), 524 ± 94 (inferior). In SIJD, no significant HU differences were found when comparing inferior sacral and iliac regions. Furthermore, HU values in the inferior sacral region were significantly higher when compared to the same region of the healthy controls (524 ± 94 vs. 447 ± 91, p < 0.01). Region mineralization correlated negatively with age (p < 0.01). SIJD-affected joints reflect a high mineralization of the sacral inferior region, suggesting increased SIJD-related mechanical stresses. Age-related SCB demineralization is present in all individuals, regardless of dysfunction.

Individuals with sacroiliac joint dysfunction display asymmetrical gait and a depressed synergy between muscles providing sacroiliac joint force closure when walking

Walking is often compromised in individuals with low back and hip disorders, such as sacroiliac joint dysfunction (SIJD). The disorder involves reduced coactivation of the gluteus maximus and contralateral latissimus dorsi, which together provide joint stability during walking. The purpose of our study was to compare the kinematics and contributions of selected muscles to identified synergies during walking between healthy individuals and those with SIJD. Six women with unilateral SIJD and six age-matched healthy controls walked on a force-measuring treadmill at 1 m/s while we recorded kinematics and the activity of 16 muscles with surface EMG. Non-negative matrix factorization was used to identify patterns of EMG activity (muscle synergies). Individuals with SIJD exhibited less hip extension and lower peak vertical ground reaction forces on the affected side than the unaffected side. In contrast to controls, the SIJD group also displayed a depressed muscle synergy between gluteus maximus on the affected side and the contralateral latissimus dorsi. The results indicate that individuals with SIJD exhibited both reduced activation of gluteus maximus during a loading synergy present in walking and greater asymmetry between legs when walking compared with age-matched controls.