Comparing the Effectiveness of the Muscle Energy Technique and Kinesiotaping in Mechanical Sacroiliac Joint Dysfunction: A Non-blinded, Two-Group, Pretest-Posttest Randomized Clinical Trial Protocol

The Sacroiliac Joint as a Cause of Pain - Review of the Sacroiliac Joint Morphology and Models for Pain Genesis

INTRODUCTION

In recent years, the sacroiliac joint has become increasingly important as a generator of low back pain with and without pseudo-radicular pain in the legs. Up to 27% of reported back pain is generated by disorders in the sacroiliac joint.

METHOD

This review is based on a selective literature search of the sacroiliac joint (SIJ) as a possible pain generator. It also considers the anatomical structures and innervation of the sacroiliac joint.

RESULTS

The SIJ is a complex joint in the region of the posterior pelvis and is formed by the sacrum and the ilium bones. The SIJ is very limited in movement in all three planes. Joint stability is ensured by the shape and especially by strong interosseous and extraosseous ligaments. Different anatomical variants of the sacroiliac joint, such as additional extra-articular secondary joints or ossification centres, can be regularly observed in CT scans. There is still controversy in the literature regarding innervation. However, there is agreement on dorsal innervation of the sacroiliac joint from lateral branches of the dorsal rami of the spinal nerves S I-S III with proportions of L III and L IV as well S IV. Nerve fibres and mechanoreceptors can also be detected in the surrounding ligaments.

CONCLUSION

A closer look at the anatomy and innervation of the SIJ shows that the SIJ is more than a simple joint. The complex interaction of the SIJ with its surrounding structures opens the possibility that pain arises from this area. The SIJ and its surrounding structures should be included in the diagnosis and treatment of back and leg pain. Published literature include a number of plausible models for the sacroiliac joint as pain generator. The knowledge of the special anatomy, the complex innervation as well as the special and sometimes very individual functionality of this joint, enhance our understanding of associated pathologies and complaints.

Comparison of sacroiliac joint degeneration between patients with sagittal imbalance and lumbar spinal stenosis

PURPOSE

The purpose of this study was to compare the degeneration of sacroiliac joints (SIJs) between adult spinal deformity (ASD) patients with sagittal imbalance and an age- and sex-matched lumbar spinal stenosis (LSS) patients without sagittal imbalance.

MATERIALS AND METHODS

The age- and sex-matched case-control study consists of two groups: the ASD group and the other group consisting of patients with LSS (LSS group). The study population consisted of 98 patients in each group. The spinopelvic parameters such as pelvic incidence (PI), sacral slope, pelvic tilt, lumbar lordosis, and sagittal vertical axis (SVA) were measured. To evaluate degeneration of SIJ, two protocols (Backlund's grade and Eno's classification) were used.

RESULT

SIJ degeneration in the ASD group was more severe than that in the LSS group, as assessed by both Backlund's grade and Eno's classification (P < 0.001 for both). Age correlated significantly with PI in both the ASD and LSS groups (r = 0.285; P = 0.005, r = 0.218; P = 0.031, respectively). The total Backlund's grading score and the SVA were significantly correlated with PI in the ASD group (r = 0.344; P < 0.001, r = 0.276; P = 0.007, respectively), but not in the LSS group (r = 0.156; P = 0.126, r = 0.189; P = 0.067, respectively).

CONCLUSIONS

ASD patients with sagittal imbalance demonstrated more severe SIJ degeneration compared to the age- and sex-matched LSS group. PI was significantly correlated with both SIJ degeneration and SVA only in the ASD group.

Effectiveness of the Muscle Energy Technique versus Osteopathic Manipulation in the Treatment of Sacroiliac Joint Dysfunction in Athletes

BACKGROUND

The study of injuries stemming from sacroiliac dysfunction in athletes has been discussed in many papers. However, the treatment of this issue through thrust and muscle-energy techniques has hardly been researched. The objective of our research is to compare the effectiveness of thrust technique to that of energy muscle techniques in the resolution of sacroiliac joint blockage or dysfunction in middle-distance running athletes.

METHODS

A quasi-experimental design with three measures in time (pre-intervention, intervention 1, final intervention after one month from the first intervention) was made. The sample consisted of 60 adult athletes from an Athletic club, who were dealing with sacroiliac joint dysfunction. The sample was randomly divided into three groups of 20 participants (43 men and 17 women). One intervention group was treated with the thrust technique, another intervention group was treated with the muscle-energy technique, and the control group received treatment by means of a simulated technique. A prior assessment of the range of motion was performed by means of a seated forward flexion test, a standing forward flexion test, and the Gillet test. After observing the dysfunction, the corresponding technique was performed on each intervention group. The control group underwent a simulated technique. A second intervention took place a month later, in order to ascertain possible increased effectiveness.

RESULTS

Statistically significant differences were found between the muscle energy technique (MET) and muscle energy groups compared with the placebo group in both interventions (p = 0.000), with a significant reduction in positive dysfunction (initially 20 in all groups, eight in MET group, and two in thrust group in the final intervention). Comparing the changes in time, only the thrust group obtained statistically significant differences (p = 0.000, with a reduction of positive dysfunction, starting at 20 positives, five positive in the initial intervention and two positive in the final intervention) and when comparing both techniques, it was observed that between the first intervention and the final intervention, the thrust technique was significantly higher than the MET technique (p = 0.032).

CONCLUSIONS

The thrust manipulation technique is more effective in the treatment of sacroiliac dysfunction than the energy muscle technique, in both cases obtaining satisfactory results with far middle-distance running athletes. Finally, the thrust technique showed positive results in the first intervention and also in the long term, in contrast to the MET technique that only obtained changes after the first intervention.