Treatment of the sacroiliac joint in patients with leg pain: a randomized-controlled trial.
The sacroiliac joint (SIJ) is frequently overlooked as a possible source of radiating pain below the knee – otherwise known as sciatica. The aim of the current study was to prospectively determine the short-term effects of physiotherapy, manual therapy, and intra-articular cortisone injection in patients with SIJ-related leg pain.
51 patients were randomised into one of three intervention groups. SIJ-related leg pain was diagnosed following a physical, neurological examination, SIJ pain provocation tests, along with investigations of the lumbar spine, pelvis, and SIJ. Patients in the physiotherapy group underwent a 6-week protocol of exercises aiming to improve SIJ mobility and strength for the lumbar spine and pelvic floor. The manual therapy group received high-velocity thrust SIJ manipulations over a 2-week period. The primary outcomes of interest were pain scores – determined by the VAS and RAND-36 – conducted immediately, at 6-weeks, and 12-weeks post-intervention.
51% of the patients were successfully treated. Sub-group analysis revealed that physiotherapy, manual therapy, and intra-articular cortisone injection were successful in 20%, 72%, and 50% of patients respectively.
Despite the relatively small sample size and short-term follow-up, these results suggest that manual therapy may be the choice of treatment in patients with SIJ-related leg pain. However, future studies investigating more comprehensive outcomes, coupled with longer-term follow-ups would shed further light into the efficacy of the above interventions. > From: Visser et al., Eur Spine J (2013) (Epub ahead of print). All rights reserved to Springer-Verlag Berlin Heidelberg.
The Pubmed summary of the article can be found here.