Pelvic Belt Effects on Health Outcomes and Functional Parameters of Patients with Sacroiliac Joint Pain

Abstract

IntroductionThe sacroiliac joint (SIJ) is a common source of low back pain. However, clinical and functional signs and symptoms correlating with SIJ pain are widely unknown. Pelvic belts are routinely applied to treat SIJ pain but without sound evidence of their pain-relieving effects. This case-control study compares clinical and functional data of SIJ patients and healthy control subjects and evaluates belt effects on SIJ pain.Methods17 SIJ patients and 17 healthy controls were included in this prospective study. The short-form 36 survey and the numerical rating scale were used to characterize health-related quality of life in patients in a six-week follow-up and the pain-reducing effects of pelvic belts. Electromyography data were obtained from the gluteus maximus, biceps femoris, rectus femoris and medial vastus. Alterations of muscle activity, variability and gait patterns were compared in patients and controls along with the belts’ effects in a dynamic setting when walking.ResultsSignificant improvements were observed in the short-form 36 survey of the SIJ patients, especially in the physical health subscores. Minor declines were also observed in the numerical rating scale on pain. Belt-related changes of muscle activity and variability were similar in patients and controls with one exception: the rectus femoris activity decreased significantly in patients with belt application when walking. Further belt effects include improved cadence and gait velocity in patients and controls.ConclusionsPelvic belts improve health-related quality of life and are potentially attributed to decreased SIJ-related pain. Belt effects include decreased rectus femoris activity in patients and improved postural steadiness during locomotion. Pelvic belts may therefore be considered as a cost-effective and low-risk treatment of SIJ pain.Trial RegistrationClinicalTrials.gov NCT02027038

Pelvic orthosis effects on posterior pelvis kinematics An in-vitro biomechanical study

“…A number of experimental studies have postulated that orthoses may relieve pelvic ligaments 7 , 30 , 31 or decrease laxity of the SIJ, defined as an unphysiologic excessive movement within the joint 7 , 14 , 23 , 26 . These findings have been correlated to clinical findings on beneficial outcomes of orthosis applications 27 – 29 . However, to date, no study has shown how specifically SIJ kinematics become altered under orthosis application, and if the changes induced by orthoses are different in the healthy condition compared to the condition with insufficient ligaments.…”

“…An established non-surgical approach to treat the painful SIJ is to apply pelvic orthoses 14 , 25 – 29 . A number of experimental studies have postulated that orthoses may relieve pelvic ligaments 7 , 30 , 31 or decrease laxity of the SIJ, defined as an unphysiologic excessive movement within the joint 7 , 14 , 23 , 26 .…”

Sacroiliac joint pain: Where are we now?

“…However, since there is no single pain provocation test for SIJP, those who find relief using the belts may not have positive compression tests. Additionally, the belt may provide much wider dispersion of compression and therefore less localized compressive stress Hammer et al (2015) tested the use of pelvic belts on MRI confirmed non-inflammatory SIJP populations with age matched controls and saw improvements in pain scores after six weeks that were comparable to surgical fusion treatment. Additionally, rectus femoris muscle activity was decreased with moderate application and there were visible improvements in cadence and gait velocity (Hammer et al, 2015).…”

“…Additionally, the belt may provide much wider dispersion of compression and therefore less localized compressive stress Hammer et al (2015) tested the use of pelvic belts on MRI confirmed non-inflammatory SIJP populations with age matched controls and saw improvements in pain scores after six weeks that were comparable to surgical fusion treatment. Additionally, rectus femoris muscle activity was decreased with moderate application and there were visible improvements in cadence and gait velocity (Hammer et al, 2015). This decrease in rectus femoris muscle activity opposes results mentioned prior where manipulation caused an increase in activity (Barbosa et al, 2013).…”

“…Surgical interventions are only recommended for those who have failed to respond to conservative treatment (Hammer et al, 2015). With its first reported use in 1921, arthrodesis involves the fusion of the sacrum and ilium through the placement of surgical implants (Capobianco & Cher, 2015).…”