How back pain works? - Sacroiliac Joint Strain #2 - Treatment
The Sacroiliac articulation may be effected by the following, with which the physiotherapists are concerned. The following conditions constitute strains and subluxations of the joint, rather than dislocations.
- During Pregnancy – (please refer my earlier article on Sacroiliac Joint Strain – Part – 1).
- Habitual poor posture.
- Strain or injury or subluxation – of the joint when the patient bends forward while carrying a heavy weight.
- Damage of the joint by an external force.
- Ligamentous lesions.
- Degenerative joint disease.
- Ankylosing Spondylitis.
Of the above mentioned pathological conditions, manipulation techniques can be applied for the relief of pain for the first five above mentioned conditions.
The four commonly used manipulation techniques for the Sacroiliac joint are the following.
- Posteroanterior Pressure Techniques.
- Backward Rotation of the Iliac Crest Techniques.
- orward Rotation of the Iliac Crest Techniques.
- Sacroiliac Manipulation Techniques.
1. Posteroanterior Pressure Techniques.
Starting Position – The patient lies prone with the arms by the sides. The physiotherapist stands by the patient’s left side and places his left hand over the sacrum. The left hand is reinforced with his right hand, both the arms being kept fully extended.
Method – ‘Posteroanterior Pressures’ are applied to the dorsal surface of the sacrum using small oscillations. The direction of this postroanterior pressures may be directed upwards, downwards, towards the right or towards the left or in a combination of all these directions. Even though this manipulative technique produces movement in the lumbosacral joints, this technique is very effective in solving the sacroiliac joint problems.
2. Backward Rotation of the Iliac Crest Techniques
Starting Position –The patient lies on the right side. The physiotherapist stands in front, places his left hand on the anterior superior iliac spine. He keeps the heel of the right hand against the posterior surface of the left ischial tuberosity. By leaning over the patient, the physiotherapist’s forearms are kept in such a way that hands are pointed in opposite direction but maintained parallel.
Method – The physiotherapist holds the patient’s pelvis firmly between his hands and rocks his body so that the ischial tuberosity moves posteroanteriorly and the anterior superior iliac spine moves anteroposteriorly. This produces a backward rotation of the iliac crest.
3. Forward Rotation of the Iliac Crest Techniques
Starting Position – The patient lies on the right side. The physiotherapist stands in front, places his left hand on the posterior surface of the iliac crest and the heel of his right hand under the ischial tuberosity, reaching as for as anteriorly as possible.
Method – Holding the pelvis between his hands, the therapist moves the anterior superior iliac spine posteroanteriorly and the ischial tuberosity anteroposteriorly by means of a swinging movement of his trunk.
4. Sacroiliac Manipulation
The technique for the manipulation of the Sacroiliac Joint involves rotation of the lumbar spine (as shown in the figure).
After the acute phase of Sacoiliac Joint Pain has subsided, the next phase of treatment is to prevent recurrence and to decrease residual pain and impairment. The treatment aims at reconditioning the individual by regaining flexibility and strength, retraining in proper body function, to improve posture, occupational habits and activities of daily living. The treatment also aims at correcting and modifying the psychological status of the individual’s life.
- Rest–Rest in bed until the acute symptoms have died down.
- Cryotherapy – Ice application is very helpful in the acute stage (24 – 48 hours). It reduces muscular spasm, relieves pain because of anaesthetic effect, enhances healing process as it increases blood circulation and stops internal bleeding if any. Prolonged icing is preferred. Crushed ice cubes wrapped in a thick towel is placed on the painful joint for 20 minutes. Remove it for 10 minutes. Apply it again for 20 minutes. This type of cryotherapy may be done thrice a day.
- Strapping – During the acute stage, strapping may be applied round the pelvis. This provides rest. This relieves pain and muscle spasm and helps recovery. The patient may wear a belt a belt or a band of adhesive plaster is applied round the pelvis. This plaster is about 4 inches wide and is put just below the iliac crest. It consists of two strips, one at the back and one at the front. The posterior strip is applied first and extends across the back to about 2 inches just in front of the anterior superior iliac spine. This is applied with the patient standing. The anterior strip stretches across the abdomen, its ends overlapping those of the posterior strip, and extending 2 or 3 inches behind the anterior superior spines. The anterior strip is applied with the patient lying, so that the abdominal organs may be relieved of the pull of gravity.
- Electrotherapy Modalities – Once the acute stage is over, Electrotherapy modalities are very helpful. Electrotherapy modalities like Short Wave Diathermy (SWD), Ultra Sound Therapy (UST), Transcutaneous Electrical Nerve Stimulator (TENS), Infra Red Radiation (IRR), LASER etc. are can also be included in the treatment regime for Sacroiliac Joint Strain.
- Gentle Massage – Gentle Massage can be given to the back and the hip. Effleurage, kneading and deep frictions may be given to the glutei and lumbar muscles in the later stage.
- Pelvic Tilt Exercises - The anterior aspect of the pelvis is elevated and the posterior aspect is lower (Please refer “How to Take Care of Your Back?” – My Earlier Article).
- Abdominal Strengthening Exercises – Strong abdominal muscles especially the Obliques, must be gained and maintained (Please refer “How to Take Care of Your Back?” – My Earlier Article).
- Spinal Extension Exercises – Strong spinal extensorsmust be gained and maintained so that bending and lifting activities rely on muscles as well as ligaments. Hence less strain on the Sacroiliac Joints.
- Low Back Stretching Exercises – The low back must be kept as much flexible as possible. Hence less stress on the Sacroiliac Joints (Please Refer “How to Take Care of Your Back?” – My Earlier Article).
- Range of Motion Exercises – Range of Movements of the hop joints, Sacroiliac Joints and the lumbar spine must be maintained. Range of Motion Exercises (Passive and Active Exercises) must be given to the joints of the lower limbs to prevent contractures and joint stiffness and to maintain the tone of the muscles.
- reathing Exercises – In the acute stage, when the patient is at rest, Breathing Exercises may be given. Breathing Exercises include Apical, Diaphragmatic, and Lateral Costal Breathing. The patient is advised to do these exercises at regular intervals. This is to maintain rib cage excursion as wellasabdominothoracic breathing.
- Postural Correction – Postural correction is very essential. The patient is advised to guard against assuming a bad posture with the spine in flexion.
- Corseting and bracing – The low back support in the form of corseting or bracing is indicated. It decreases the muscular spasm and hence the pain. It decreases the lordosis and maintains a good posture. The Corset uplifts and support the abdomen relieves the effect of gravity on the disc. It minimises excessive motion at the low back, allowing the pelvis and the hip joints to perform the major portion of bending and lifting activities. (Please refer my earlier article on ‘Corseting and Bracing’).
Prevention of recurrence is difficult. Principles of ‘how to take care of your back?’ plays an important role in preventing its recurrence. Teaching the susceptible person the mechanism of Sacroiliac Articulation and the pathological condition which is involved will help the patient to take care of himself. Instituting normal and proper body function in everyday activities is very important.