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Physical therapy - a quick fix for sacroiliac joint pain in manychildren and adolescents by icdenta icdenta






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Physical therapy - a quick fix for sacroiliac joint pain in manychildren and adolescents by
Article Posted: 07/07/2013
Article Views: 98
Articles Written: 1096
Word Count: 641
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Physical therapy - a quick fix for sacroiliac joint pain in manychildren and adolescents


 
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Investigators report that a simple bedside manual therapy tocorrect a painful misaligned sacroiliac joint was highly successfulin a group of 45 patients 10 to 20 years of age. Thirty-sixpatients (80 percent) obtained significant pain relief, whereasnine patients (20 percent) experienced minimal to no relief. In 24patients (53 percent) complete resolution of pain was experiencedimmediately upon treatment. Only two patients required a secondtreatment because of symptom recurrence. These findings arereported in a new article, "Sacroiliac joint pain in the pediatricpopulation.

Clinical article," by Stoev and colleagues, publishedin the June 2012 issue of the Journal of Neurosurgery: Pediatrics , now online. Investigators at Washington University in St. Louis and St. LouisChildren's Hospital conducted a retrospective analysis of patientrecords in children and adolescents with low back pain who had been referred to a single neurosurgeon, Jeffrey R.Leonard, M.D., between 2005 and 2011.

At the initial consultation,the patients performed a variety of physical maneuvers designed toevaluate whether their pain stemmed from misalignment of thesacroiliac joint. In 48 patients pain was attributed to thismisalignment. There were 37 female and 11 male patients with a meanage of 15.7 years (range 10 to 20.6 years). The average duration ofsymptoms was 7 months (range 0.25 to 48 months). Before treatmentthe patients' mean pain score was 5.7 (range 3 to 9.5) on a10-point visual analog scale ranging from 0 = no pain to 10 = mostextreme pain.

Three patient files were incomplete, and thereforethe investigators could only report results on pain relief in the45 pediatric patients in whom complete follow-up data wereaccessible. Treatment consisted of sacroiliac joint manipulation accomplishedby performing isometric hip contraction and extension. Physicaltherapists call this procedure the "muscle energy technique." Thepatient flexes and extends the hip while the physical therapistprovides resistance to the move. This forces the sacroiliac jointback into proper alignment. Most patients experienced improvementin their symptoms, and more than half of the patients had immediatepain relief following treatment.

When asked whether the investigators were surprised to find thatsuch a simple technique could bring about pain relief in so manypatients, Dr. Leonard said, "No we were not surprised. We weresurprised by the number of patients who actually presented withthis problem. These children have had prior imaging studies,procedures, or been in back pain for over a year." Following treatment, patients were given instructions for at-homeexercises to strengthen muscles in the region to ensure thatsacroiliac joint alignment would be maintained.

Dr. Leonardbelieves that patients were compliant with these exercises "becausea large number of patients were in significant debilitating painwhich kept them out of activities. This simple manipulation allowedthem to potentially leave clinic pain free." In this study only twopatients needed repeated treatment. The authors state that there are no clear estimates on how manychildren and adolescents suffer pain from misaligned sacroiliacjoints, but low back pain is fairly common. Unlike adults whosesacroiliac joint-related pain is usually related to discdeterioration or joint disease, children and adolescents are morelikely to experience pain due to repeated stress from athletic activities.

Girls are more susceptible (77% in thisstudy) because of the laxity of the female developing pelvicgirdle. As the authors point out, the source of low back pain is oftendifficult to identify, which can make patients face long periods ofpainful symptoms, drug dependency, and/or unnecessary surgicalprocedures. The take-away message from this study is that simplemanual manipulation should be tried in children and adolescentswhose low back pain is suspected to be caused by a misalignedsacroiliac joint. The therapy described in this paper iscost-effective, takes little time, and poses no negativeconsequences to the patient. The authors found that this simplemanipulation procedure can provide sustained relief in mostpatients.

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