Evaluation and Management of Sacroiliac Dysfunction Utilizing an Evidence-Based Algorithmic Approach: A Case Study

Abstract

The sacroiliac joint (SIJ) is an important contributor to persistent and functionally limiting lower back pain. Despite extensive debate and research, there is no definitive treatment recommendation or high-level evidence to support a conservative care treatment approach, nor interventional or surgical management procedures for the alleviation of pain originating from the SIJ. Traditional physical therapy and conservative approaches to generalized lower back pain often fail in this patient subset prompting sub-specialty consultation to a pain management center. Diagnosis of the SIJ as the pain generator can be accomplished through physical exam maneuvers and comparative diagnostic blocks; however, upon diagnosis, management remains a challenge. After the diagnosis of SIJ dysfunction is made in our young and active patient population, we have seen significant success in the application of an interdisciplinary and evidence-based treatment algorithm similar to the presented case. To our knowledge, this treatment approach has not been previously described.

Piriformis Syndrome Masquerading as an Ischiofemoral Impingement

“…Conservative management of patients presenting with gluteal pain due to piriformis-mediated entrapment of the sciatic nerve or piriformis tightness generating gluteal pain can be successfully performed through a multimodal treatment program previously described by Newman and colleagues [ 18 ]. The initial treatment was designed to identify potential impairments of the SI joint and surrounding tissues.…”

A Novel Approach to Assessing and Treating Musculoskeletal-Mediated Atypical Abdominal Pain: A Case Study

“…While the patient did report no pain with jogging along the left upper quadrant, there was pain consistent with a left-sided sacroiliac joint dysfunction. While it is difficult to determine if this outcome was or was not contributory to the patient's rib and myofascial dysfunction, it was treated with OMT and exercise described in an evidenced-based algorithmic treatment approach [ 12 ].…”

“…Given signs and symptoms consistent with concomitant SIJ dysfunction, the patient was treated with a combination of SIJ OMT, deep tissue mobilization of the piriformis, and active release of the iliopsoas as described previously by Newman et al [ 12 ]. The patient was instructed in a lumbopelvic strengthening program directed at the hamstrings, hip adductors, and abdominals to be done every other day, as well as stretching of the piriformis and iliopsoas muscles daily.…”

Operative Behandlung von Patienten mit Iliosakralgelenksyndrom: Vergleichsstudie zweier Implantate

“…There is limited diagnostic accuracy in imaging and poor validity and reliability of individual provocations or specific tests during physical examination. Diagnostic clarification can best be achieved by an SIJ double anaesthetic block [6].…”

“…Es bestehen eine begrenzte diagnostische Genauigkeit bei der Bildgebung sowie eine schlechte Validität und Zuverlässigkeit einzelner Provokationen oder spezieller Tests während der körperlichen Untersuchung. Diagnostische Klarheit kann am besten durch eine ISG-Doppelanästhesieblockade erreicht werden [6].…”