Article

The relationship of the sacroiliac joint, stabilization musculature, and lumbo-pelvic instability

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  • L.A. Sports and Spine
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Abstract

The SI joints are an important source of pain and activity intolerances. Force closure of the SI joints requires appropriate muscular, ligamentous and fascial interaction. The ASLR test can help to determine if a specific treatment is effective. Advice about posture and support, manipulation of the SI joints along with manual therapy of related muscles and fascia, and exercise of key stabilizers are all important components in reestablishing lumbopelvic stability.

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... The EMM therapy for CPPS mobilised the fascia around the lumbopelvic area by following the fascial connectivity of the trunk's oblique chain system [23] and the abdomino-pelvic viscera [24] (Figure 1). The EMM treatment area extended from ipsilateral latissimus dorsi (LD), ipsilateral thoracolumbar fascia (TLF) and contralateral gluteus maximus (GMx) posteriorly, and ipsilateral external oblique (EO) and contralateral internal oblique (IO) and hip adductor complex (HAC) anteriorly. ...
... We further analysed the treatment effectiveness through determining change in symptom severity. Patients' symptom severity was classified as mild (0-15), moderate (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) or severe (>29) based on their total score (Table 4). Before the implementation of treatment, most patients had severe (42%) or moderate symptoms (45%). ...
... The techniques utilised include direct pressure, proprioceptive neuromuscular techniques, deep tissue mobilisation, myofascial and trigger point mobilisation procedures [8]. In a large study, involving 138 men with refractory CPPS, 72% reported Moderate severity (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) High Severity (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43) Pre, n (%) Post, n (%) Figure 4. Change in symptom severity before and after EMM. ...
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Objective: To evaluate the outcome of men with muscle spastic chronic pelvic pain syndrome (CPPS) who underwent a comprehensive five-session fascial connectivity based external myofascial mobilisation (EMM) approach. Patients and methods: A retrospective chart review of patients who underwent EMM for CPPS at the Pelvic Pain Unit of Hamad Medical Corporation, Qatar between January 2019 and October 2020 was conducted. Patient's symptoms were measured with the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scale and the numerical rating scale (NRS) before and after the completion of the sessions. The patients were given five EMM sessions as a 'once-a-week' programme. Results: A total of 31 patients who completed all the EMM sessions were included. The mean (range) age of patients was 38 (20-54) years. The mean (SD) NIH-CPSI score at initial evaluation was 29.41 (8.3) and decreased to 9.14 (3.45) after the fifth visit. All the patients in the study group had a reduction of >6 points in the NIH-CPSI score, indicating a robust treatment response. The NRS reading also revealed significant improvement in pain (P < 0.001). Conclusions: : An EMM approach based on fascial connectivity led to significant symptom improvement in all the studied patients. EMM may be an effective treatment option for muscle spastic type of CPPS. Future high-quality studies with control groups are needed to confirm the present findings. Durability and long-term results are yet to be determined. Abbreviations: CP/CPPS: chronic prostatitis/chronic pelvic pain syndrome; EMM: external myofascial mobilisation; EO: external oblique; FM: fascial manipulation; GMx: gluteus maximus; HAC: hip adductor complex; HMC: Hamad Medical Corporation; IO: internal oblique; LD: latissimus dorsi; MFR: myofascial release; MM: myofascial mobilisation; NIH-CPSI: National Institute of Health-Chronic Prostatitis Symptom Index; NRS: numerical rating scale; PFPT: pelvic floor physical therapy; QoL, quality of life; TLF: thoracolumbar fascia; UPOINT: urinary (U), psychosocial (P), organ-specific (O), infection (I), neurological/systemic (N) and tenderness of pelvic floor skeletal muscles (T).
... The anatomical and myofascial connections between the lumbopelvic region and contralateral glenohumeral region postulates for possibility of altered force transmission from SJD to contralateral GHJ. [20][21][22][23] The clinical reasoning for the above biomechanical force transmission lies through global muscle slings termed as posterior and anterior oblique muscular slings. 20,21 Posterior oblique sling is a myofascial muscular sling that runs from gluteus maximus toward the lumbopelvic region ascends up into the deep lamina of the posterior thoracolumbar fascia, crosses the mid body segment and attach to the contralateral humerus via lattisimus dorsi. ...
... [20][21][22][23] The clinical reasoning for the above biomechanical force transmission lies through global muscle slings termed as posterior and anterior oblique muscular slings. 20,21 Posterior oblique sling is a myofascial muscular sling that runs from gluteus maximus toward the lumbopelvic region ascends up into the deep lamina of the posterior thoracolumbar fascia, crosses the mid body segment and attach to the contralateral humerus via lattisimus dorsi. 20,21,24 Similarly, anterior oblique sling includes structures such as pectoralis fascia, pectoralis major, anterior fascia of trunk, internal and external oblique, transverse abdominis ending up with the contralateral pubic bone. ...
... 20,21 Posterior oblique sling is a myofascial muscular sling that runs from gluteus maximus toward the lumbopelvic region ascends up into the deep lamina of the posterior thoracolumbar fascia, crosses the mid body segment and attach to the contralateral humerus via lattisimus dorsi. 20,21,24 Similarly, anterior oblique sling includes structures such as pectoralis fascia, pectoralis major, anterior fascia of trunk, internal and external oblique, transverse abdominis ending up with the contralateral pubic bone. 20,22 It is through these muscle slings with myofascial tissues that the force transmission may occur between the lumbopelvic region and contralateral glenohumeral region by intra and inter-myofascial force transmission. ...
Article
Introduction Posterior and anterior oblique muscle slings contribute to the force closure mechanisms that provide stability to sacroiliac joint. These global muscle slings consist of myofascial network of fascia, muscles and tendons from global muscles. It links the lumbopelvic region to other joints of musculoskeletal system especially the contralateral glenohumeral joint (GHJ). Any sacroiliac joint dysfunction (SJD) may likely disrupt the force transmission across the oblique slings and it can affect the contralateral GHJ. Aim The current study aims to investigate the effects of SJD on the contralateral GHJ. Material and methods An experimental study is designed recruiting 20 participants with SJD and 20 healthy participants as matched controls to test the hypothesis that SJD may cause excessive anterior translation of humeral head (ATHH) in contralateral GHJ. Using real time ultrasonography, resting position of humeral head (RPHH), ATHH and posttranslation distance of humeral head (PDHH) are compared between the GHJs among participants with SJD and the matched controls. Paired sample t-test and independent sample t-test are used to analyze the data. Results and discussion The paired sample t-test result showed statistically significant increase in ATHH (P = 0.03) and PDHH (P = 0.01) in contralateral GHJs among participants with SJD. The independent sample t-test showed a significant increase in RPHH (P = 0.01) and PDHH (P = 0.01) in SJD participants when compared to matched controls. Conclusion SJD contributes to excessive ATHH in the contralateral GHJ. This may occur due to altered myofascial force transmission across oblique sling muscles.
... Manipulation and mobilization techniques are readily considered among manual therapists to improve SIJ function (Vanelderen et al., 2010;Foley & Buschbacher, 2007;Cohen, 2005;Liebenson, 2005;Sizer et. al., 2002;Lewit & Rosina, 1999), however, few modalities are supported by strong high quality evidence (Fryer et al., 2009;Liebenson, 2004). ...
... Education and pro vision of information remain strongly recom mended therapeutic agents for SIJ dys function (O'Sullivan, 2004). Postural (Liebenson, 2004) and lifting (Mitchell & Esler, 2009) advice and modifications should be discussed with all patients. An active participation by the patient in their recovery must be continually emphasised (Horton & Franz, 2007). ...
... Current literature suggests the use of advice, manipulation and mobilisation, medication, bracing, radiofrequency denervation, advice and exercise. Medication (Vleeming et al., 2008;Foley & Buschbacher, 2007;Forst et al., 2006), injections (Szadek et al., 2009;Rupert et al., 2009;Laslett, 2008;Foley & Buschbacher, 2006;Cohen, 2005) and radiofrequency denervation well supported by the evidence (Laslett, 2008;Vleeming et al., 2008;Liebenson, 2004), especially those aimed at stabi lizing the lumbopelvic unit when load transfer failure has been diagnosed (Cusi, 2010;Mitchell & Esler, 2009;Chaitow, 2007;Forst et al., 2006), strengthening of the stabilising mus culature (Pel et al., 2008;Liebenson, 2004;O"Sullivan, 2005;Liebenson, 2004;Hungerford et al., 2003;Franke, 2003;Van Wingerden et al., 2003;Richardson et al., 2002;Sizer et al., 2002;Snijdersad et al., 1998) and address ing functional patterns (Liebenson, 2004). SIJ dysfunction is addressed by a wide variation of therapies. ...
Article
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AbSTrAcT: The treatment of sacroiliac joint (SIJ) dysfunction presents a clinical challenge for physiotherapists. The aim of this study was to investigate current physiotherapy practise in the management of acute and chronic SIJ dysfunction. A chart audit of 677 SIJ patient reports (N=677) from 75 different private physiotherapy practises were analysed to determine the following: (1) the prevalence of the use of exercise therapy, and the types of exercise used in the management of SIJ dysfunction, and (2) the prevalence of other therapeutic modalities utilised alongside exercise therapy. The results of the study indicated that use of exercise therapy, specifically stretches and mobility exercises, is a popular treatment choice by physiotherapists. Joint mobilisations and soft tissue massage often accompanied exercise. Despite research outcomes suggesting both a strengthening and stabilisation program for the lumbo-pelvic complex, these approaches were less favoured.
... The anatomical evidence between the LP and the contralateral GHJ exists through two integrated myofascial sling systems, namely posterior and anterior oblique sling, which serves as an anatomical connection between the LP region and contralateral GHJ. [3][4][5] The posterior oblique muscle sling that lies in the posterior aspect of the trunk involves muscles such as biceps femoris, gluteus maximus, thoracolumbar fascia, latissimus dorsi and upper trapezius. It runs from the LP region via the gluteus maximus spans up into the superficial and deep lamina of the posterior thoracolumbar fascia, crossing the mid body segment connecting up with latissimus dorsi and ending up in the contralateral GHJ. ...
... The anterior oblique sling which consists of hip adductors, transverse abdominis, internal and external oblique, the anterior fascia of the trunk and pectoralis major runs from hip-lumbopelvic region to contralateral GHJ. [3][4][5] Fig. 1 indicates the anatomical relationship between the LP region and contralateral GHJ. The transfer of forces across anterior and posterior oblique sling muscles may assist to maintain the tensegrity of the GHJ. 3 On the other hand, any impairment of the two muscle slings may result in alteration of the accessory movement pattern and joint kinematics of GHJ. 6 ...
Article
Introduction: The clinical management of shoulder disorders do not commonly includes the myo-fascial-skeletal contributions from the lumbopelvic (LP) region. Nevertheless, a notable myofascial-biomechanical connection exists between LP and shoulder regions. Aim: The current paper proposes a quantifiable medical hypothesis that there will be an increased anterior humeral head translation (ATHH) in the glenohumeral joint (GHJ) due to altered myofascial force transmission that results from LP dysfunction. Material and methods: A literature search was conducted in Science Direct and PubMed databases for articles published from January 1990 to December 2015. Medical Subject Headings and other keywords for search were myofascial continuity, force transmission, muscle slings, lumbopelvic-glenohumeral joint and biomechanics. Results and discussion: The hypothesis suggests a clinical reasoning that impaired myofascial force transmission from LP region as one of the contributing factors for shoulder pathogenesis. The hypothesis is proposed based on the anatomical and biomechanical relationship between the LP region and the contralateral GHJ. Evidences of myofascial continuity between the LP and GHJ, myofascial force transmission and integrated energy transfer theory are explained to strengthen the proposed hypothesis. An experimental method to test the proposed hypothesis is recommended for researchers and clinicians. A theoretical understanding of the pre stressed spring system via the myofascial chains is applied to strengthen the reasoning on the current hypothetical connection between LP and contralateral GHJ. Conclusions: The implication of the new medical hypothesis may substantiate the understanding of the clinicians on the connections between the LP and the contralateral GHJ to consider a global myo-fascial-skeletal management of shoulder disorders.
... LBP. Pain arises because of the poor functioning of the structures (muscles, ligaments and thoracolumbar fascia) that normally stabilise the SIJs (Liebenson 2004). ...
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Aim: The aim of this study was to determine whether or not a measurable change in the angle of the innominate bone could be identified after a chiropractic sacroiliac adjustment using a 'PALM PALpation Meter'. Secondly, if a change in the angle of the innominate bone was identified, what was the degree of change in the angle of the innominate bone, induced by the sacroiliac joint (SIJ) adjustment. Method: This was a true experimental study that consisted of 100 participants who met the inclusion criteria. The participants were randomly allocated to either the treatment or control group. Each group had 50 participants: 25 females and 25 males. Informed consent was obtained from participants prior to commencement of treatment. The treatment group received a chiropractic adjustment based on their specific SIJ dysfunction. The control group was treated with detuned ultrasound therapy (sham treatment). Procedure: Treatment consisted of a once-off treatment. The angles of the innominate bones were measured bilaterally pre- and post-treatment in both groups. Objective data were collected using the PALM PALpation Meter. Once the dysfunctional SIJ was identified, participants in group 1 were treated with specific chiropractic adjustment techniques based on the restriction. Group 2 participants were treated with detuned ultrasound only. Results: The results of this study showed that a specific chiropractic adjustment resulted in a measurable change in the angle of the innominate bone (p ≤ 0.001). The change in angle was evident bilaterally; however, the side that was adjusted shows the greatest degree of change. The mean change in angle for the treatment group was 2.25° on the side of dysfunction. Conclusion: The results of this study showed that a specific chiropractic adjustment can have a positive effect on the angles of the innominate bone, resulting in the tilt of the pelvis levelling into what is considered to be its correct anatomical alignment.
... A 1-min rest period was allowed between exercises to prevent muscle fatigue. The elastic bag of the pressure biofeedback unit was inflated to 40 mmHg and the subjects were instructed to maintain the pressure within ± 10 mmHg from 40 mmHg target pressure during the exercises (26)(27)(28). ...
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Objectives: The purpose of this study was to investigate the effect of combined ankle dorsiflexion [DF] and straight leg raise with hip external rotation [SLRER] on the vastus medialis oblique [VMO] and vastus lateralis [VL] muscle activity and VMO/VL ratio in subjects with patellofemoral pain syndrome [PFPS] and healthy normal control [HNC] subjects. Methods: Twenty-six subjects [13 in the PFPS group and 13 in the HNC group] were recruited and all subjects performed two exercises; SLRER and SLRER with DF [SLRERDF]. Surface electromyography was used to collect data of the VMO and VL muscle activity. A two-way mixed analysis of variance was used to determine the statistical significance of VMO and VL muscle activity and VMO/VL ratio. Results: The VMO muscle activity during SLRERDF was significantly greater than SLRER in both groups and the VL muscle activity during SLRERDF was significantly greater than SLRER in both groups. For the VMO/VL ratio, there were no significant main effect of group and exercise. Conclusions: Although the findings of this study did not demonstrate that SLRERDF is effective for targeting the VMO over VL muscle activity in the PFPS group, SLRERDF could be recommended as activation strategy for subjects with the general quadriceps weakness. KEYWORDS: Irradiation, overflow effect, quadriceps exercise
... The exclusion criteria were: (1) limitations in range of motion of the bilateral hip, knee, and ankle joints; (2) a history of LBP or lower extremity dysfunctions such as iliotibial band friction syndrome, patellofemoral pain syndrome, anterior cruciate ligament sprains, or chronic ankle instability (Cichanowski et al., 2007;Fredericson et al., 2000;Friel et al., 2006;Hewett et al., 2006;Ireland et al., 2003) in the past 12 months; (3) iliopsoas, rectus femoris, or tensor fasciae latae tightness as evidenced by the Thomas test, Ely's test, or modified Ober's test, respectively (Kendall et al., 2005;Magee, 2007); and (4) lumbopelvic instability demonstrated by performing the active straight leg raising test with a pressure biofeedback unit (Liebenson, 2004;Mens et al., 1999). ...
... The local muscle system refers to the deep intrinsic transversely oriented abdominal muscles such as transverses abdominis and multifidus [2,7,8]. The global muscle system related to lumbopelvic stability refers to the larger, longitudinally oriented superficial abdominal muscles such as rectus abdominis, internal oblique, and external oblique [2,9]. Thus an optimal contractile effect of the local and global muscle system works continuously to maintain the function and stability of the sacroiliac joint. ...
Article
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Background: Altered motor patterns of the local muscle system (LS) and global muscle system (GS) is reported among low back pain patients. However, the pattern of changes in the LS and GS among individuals with sacroiliac joint dysfunction (SJD) is not clear. Objective: This study aimed to investigate the changes in the resting muscle thickness of LS and GS in SJD. Methods: A total of 40 individuals (20 participants with SJD and 20 healthy participants as matched controls) participated in this study. The resting thickness of the LS and GS such as rectus abdominis (RA), external oblique (EO), internal oblique (IO), transverses abdominis (TrA), and lumbar multifidus (LM) was measured using real time ultrasonography and the data were compared between the ipsilateral side and contralateral side among participants with SJD as well as healthy participants. Parametric and nonparametric statistics were used to analyse the data as appropriate. Results: The results showed that EO and IO were significantly reduced among SJD participants when compared with the contralateral side. Similarly, EO and LM were significantly reduced among the SJD group when compared with the controls. Conclusion: The findings of the study support a trend of reduced size in the resting thickness of the LS and GS in SJD.
... 천장관절의 관절면은 편평하고 수직면에 근접하게 정렬되어 있어서 부하를 이동시키기에는 적합하지만 수직정렬로 인해서 중력과 같은 수직적인 전단력(shear force)에 취약하다 (Pel 등, 2008;Snijders 등, 1998 (Hungerford 등, 2003;Snijders 등, 1998 (Pel 등, 2008;Vleeming 등, 1992). 또한 압박력을 통해 둔부 근육에 부가적인 고유수용성자극을 제공할 수 있다 (Prather와 Hunt, 2004;Slipman 등, 2001 (Liebenson, 2004;Mens 등, 2006 (Janssen 등, 2000). 근 육량이 증가할수록 티틴(titin)은 많아지고 증가된 티틴 에 의해 근육의 수동적 안정성이 제공되기 때문에 (Cynn 등, 2006) ...
Article
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The pelvic compression belt (PCB) contributes to improving sacroiliac joint stability, and it has been used as an additional therapeutic option for patients with sacroiliac joint pain (SIJP). This study aimed to investigate whether the muscle activation patterns of the supporting leg was different between asymptomatic subjects and subjects with SIJP during one-leg standing, and how it changes with the PCB. 15 subjects with SIJP and 10 asymptomatic subjects volunteered to participate in this study. Surface electromyography (EMG) data (reaction time [RT] and muscle activation) were collected from the internal oblique, lumbar multifidius, gluteus maximus and biceps femoris muscles during one-leg standing with and without the PCB. Without the PCB condition, in the SIJP group, the biceps femoris muscle showed the fastest RT among all muscles (p.05). Thus, this study supports the applying the PCB to patients with SIJP can be used as a helpful option to modify the activation patterns of the gluteus maximus and biceps femoris muscle.
... (the active straight leg rise) [15]. Celem wyeliminowania fałszywie dodatnich testów przed badaniem ocenie długości poddane zostały następujące grupy mięśniowe mogące wpłynąć na wynik: W związku z tym trzeba przyznać, że stosowane zabiegi w przypadku SIJD, czy skręcenia miednicy, którą uznać możemy jako jeden z objawów dysfunkcji, często stosowane są w " ciemno " , ponieważ opierają się na niejasnych kryteriach diagnostyki manualnej. ...
Research
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Introduction: The twist (torsion) of the pelvis is in physiotherapy and manual medicine based diagnosis is often posed mainly based on physical examination, and data the patient's history. More often they combine them and describes, together with dysfunction of the sacroiliac joints (SIJD), which is not accompanied by pain, only changes in the spatial functioning of pelvic complex. Aim: The purpose of this study is to assess the level of compliance reviews two manual therapists (MT) for selected diagnostic tests the sacroiliac joints. Research material: The research was conducted on 180 members of a group of students aged between 20 and 30 years. Results: The biggest compliance estimates, defined as significant was noted only in the ASLR test, with values of k = 0,62. Other tests were characterized by lower values of conformity. Conclusions: Most of the tests analyzed is characterized by moderate and lower the value of the compliance results. At the level of compliance assessments is affected by the type of physique considered.
... The pelvic and trunk regions form the proximal end of the lower kinetic chain and are routinely assessed due to their reputed relationship with pelvic, spinal and lower limb pathologies (Liebenson, 2004;Sahrmann, 2002;Herrington, 2011). The surrounding core musculature provides the control and stabilisation necessary for efficient gait with abnormal linear and/or angular oscillations of the pelvic and trunk regions during gait being implicated in, or symptomatic of, many musculoskeletal conditions (Saunders et al., 2005). ...
Article
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There is currently no suitable kinematic system for a large-scale prospective trial assessing risk factors of musculoskeletal disorders. A practical kinematic system is described which involves the use of a single low-cost depth-sensing camera for the real-time measurement of 3-dimensional linear and angular pelvic and trunk range-of-movement (ROM). The method is based on the creation and processing of dynamic point clouds taken from the posterior surface of the pelvis and trunk. Nine healthy participants performed 3 trials of treadmill locomotion when walking at self-selected speed (3.6-5.6km/h), running at 70% (10.9-14.0km/h) and 90% of maximal speed (14.0-18.0km/h). Stride-by-stride linear and angular ROM data were captured concurrently using the single depth-sensing camera running at 30Hz (Kinect(TM) for Windows, Microsoft, USA) and a six-camera motion capture system at 100Hz (Vicon MX13, Vicon Motion Systems, United Kingdom). Within subject correlation coefficients between the practical and criterion method ranged from very large to nearly perfect (r=0.87-1.00) for the linear ROM. Correlation coefficients for the angular ROM ranged from moderate to very large (r=0.41-0.80). The limits of agreement between the two systems for linear movements were ≤9.9mm at all velocities of gait and ≤4.6° at all velocities of gait. The single camera system using depth-sensing technology is capable of capturing linear pelvic and trunk ROM during treadmill locomotion with reasonable precision when compared to the criterion method. Further improvements to the measurement of angles and validation across a wider population are recommended.
... Pod koniec ubiegłego wieku, część badaczy zaczęła analizować dokładniej rolę miednicy jako stabilizatora oraz jako centrum transferu sił generowanych przez mięśnie, między kończynami dolnymi a górnymi podczas różnych aktów ruchowych (Liebenson, 2004; Pool-Goudzwaard i wsp., 1998; Vleeming i wsp., 1990) oraz upatrywać zaburzenie tego transferu, jako bezpośrednią przyczynę dolegliwości bólowych odcinka lędźwiowokrzyżowego (Vleeming i wsp., 2008). ...
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Cichosz Michał, Kochański Bartosz, Dziweżek Ireneusz, Kobylańska Marzena, Polczyk Artur, Kałużny Krystian, Zukow Walery. Aktualne standardy diagnostyki i leczenia dolegliwości bólowych miednicy ze źródłem w stawach krzyżowo-biodrowych = Current standards for diagnosis and treatment of pain with pelvis source in sactoiliac joints. Journal of Education, Health and Sport. 2016;6(11):125-136. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.164418 http://ojs.ukw.edu.pl/index.php/johs/article/view/3974 https://pbn.nauka.gov.pl/sedno-webapp/works/755525 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 22.10.2016. Revised 30.10.2016. Accepted: 31.10.2016. AKTUALNE STANDARDY DIAGNOSTYKI I LECZENIA DOLEGLIWOŚCI BÓLOWYCH MIEDNICY ZE ŹRÓDŁEM W STAWACH KRZYŻOWO-BIODROWYCH CURRENT STANDARDS FOR DIAGNOSIS AND TREATMENT OF PAIN WITH PELVIS SOURCE IN SACTOILIAC JOINTS Michał Cichosz1,2, Bartosz Kochański3, Ireneusz Dziweżek4, Marzena Kobylańska5,6, Artur Polczyk7, Krystian Kałużny3, Walery Zukow8 1 Oddział Rehabilitacji Neurologicznej Jolly Med. Popielówek 2 Fundacja Wsparcie Kowary 3 Katedra i Klinika Rehabilitacji, Wydział Nauk o Zdrowiu, Uniwersytet Mikołaja Kopernika w Toruniu 4 Wojewódzki Szpital Specjalistyczny we Wrocławiu ul. Kamińskiego. Zamiejscowy dział Rehabilitacji Leczniczej 5 Katedra Fizjoterapii i Terapii Zajęciowej w Dysfunkcjach Narządu Ruchu. Akademia Wychowania Fizycznego we Wrocławiu 6 Wrocławskie Centrum Rehabilitacji i Medycyny Sportowej 7 Katedra Fizjoterapii, Wydział Nauk o Zdrowiu Uniwersytet Medyczny im. Powstańców Śląskich we Wrocławiu 8 Wydział Kultury Fizycznej, Zdrowia i Turystyki, Uniwersytet Kazimierza Wielkiego w Bydgoszczy Streszczenie Stawy krzyżowo-biodrowe (SIJ) są specyficznymi, maziowymi stawami zlokalizowanymi między usznymi powierzchniami kości krzyżowej a dwoma kośćmi biodrowymi. Ich powierzchnia stawowa pokryta jest chrząstką szklistą, która jest szersza powyżej a węższa poniżej. Są one typowym stawem maziowym posiadającym przestrzeń wypełnioną płynem oraz otoczonym torebką stawową. Jednakże różnią się od innych stawów. Główną ich funkcją jest dostarczenie stabilności i zrównoważenie obciążeń występujących między tułowiem a kończynami dolnymi. Stawy te posiadają wysoki poziom stabilności oraz samowzmacniający się mechanizm, który jest związany z anatomicznym kształtem kości (ryglowanie strukturalne) oraz wspierającym działaniem mięśni (ryglowanie siłowe). W pracy przedstawiono aktualne standardy diagnostyki i leczenia dolegliwości bólowych ze źródłem w stawach krzyżowo-biodrowych. Słowa kluczowe: SIJ, PGP, SIJD, LBP Abstract The Sacroiliac Joint (SIJ) is a specyfic, synovial joint between the auricular surfaces of the sacrum bone and the two ilium bones. The auricular surfaces are covered in hyaline cartilage and are broader above and narrower below. The SIJ is also a true diarthrodial joint, as it has a joint space, filled with synovial fluid between the matching articulating surface and a fibrous capsule. However it is different to other diarthrodial joint. The SIJ main roles are to provide stability and offset the load of the trunk to the lower limbs. The SIJ has a high level of stability from the self locking mechanisms of the pelvis, which comes from the anatomy and shape of the bones in the SIJ (Form Closure) and also the muscles supporting the pelvis (Force Closure). The paper presents the current standards of diagnosis and treatment of pain with the source of the sacroiliac joints. Key words: SIJ, PGP, SIJD, LBP
... The SI joint is a true but not typical diarthrodial joint and is composed of fibrocartilage in addition to hyaline cartilage [27]. The synovial portion of the SI joint, shaped like an auricular "L", is more anterior in position and the syndesmotic portion is more posterior [28]. The SI joint acts as "self-bracing mechanisms" because of its corkscrew shape created by the different wedge angles in transverse cross-sections at the cranial and caudal ends of the joint, which provide resistance to sliding [29,30]. ...
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Objective Elevation of serum high sensitivity C-reactive protein (hs-CRP) level has been demonstrated as a risk factor for varying diseases, as well as a biomarker for predicting recovery after operation of lumber disc herniation. Our objective was to investigate the relationship between serum hs-CRP and sacroiliac (SI) joint inflammation in patients with undifferentiated spondyloarthritis (uSpA). Methods In this retrospective study, we enrolled patients with uSpA who underwent hs-CRP testing between January 2007 and September 2013. Serum hs-CRP was analyzed at our central laboratory. All enrolled patients underwent skeletal scintigraphic scan with quantitative sacroiliac measurement. Results A total of 29 patients were enrolled with mean age 32.27 years and female:male ratio of 6:23. Pearson’s correlation coefficient showed a significant difference between hs-CRP in serum and SI/S ratio in uSpA, particularly the middle part of the sacroiliac joint, either right side or left side. The significantly high concentration of serum hs-CRP might indicate a systemic inflammatory response to flare-up of the SI joint and might be an indicator of SI inflammation in uSpA.
... The pelvic compression belt is a tool that provides a certain amount of pressure [22], and relieves pain related to pelvic instability by increasing the passive stability of the pelvis and promotes pain reduction in patients with unstable lower backs and SI joints [23]. The study showed that the stability of the SI joint and the pelvic girdle was improved with application of a pelvic compression belt, which improved the performance of functional activities such as shooting, and shooting accuracy was also improved. ...
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Cichosz Michał, Chrapek Dominik, Kobylańska Marzena, Wójcik Bartosz, Kochański Bartosz, Zukow Walery. Analiza poziomu zgodności ocen dwóch terapeutów manualnych (MT) w diagnozie skręcenia miednicy na podstawie wybranych testów manualnych = Analysis of the level of compliance reviews two manual therapists (MT) in the diagnosis of pelvic twist on the basis of the selected manual tests. Journal of Education, Health and Sport. 2015;5(6):157-168. ISSN 2391-8306. DOI 10.5281/zenodo.18419 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%286%29%3A157-168 https://pbn.nauka.gov.pl/works/564475 http://dx.doi.org/10.5281/zenodo.18419 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011 – 2014 http://journal.rsw.edu.pl/index.php/JHS/issue/archive Deklaracja. Specyfika i zawartość merytoryczna czasopisma nie ulega zmianie. Zgodnie z informacją MNiSW z dnia 2 czerwca 2014 r., że w roku 2014 nie będzie przeprowadzana ocena czasopism naukowych; czasopismo o zmienionym tytule otrzymuje tyle samo punktów co na wykazie czasopism naukowych z dnia 31 grudnia 2014 r. The journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1089. (31.12.2014). © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 21.04.2015. Revised 28.05.2015. Accepted: 05.06.2015. Analiza poziomu zgodności ocen dwóch terapeutów manualnych (MT) w diagnozie skręcenia miednicy na podstawie wybranych testów manualnych Analysis of the level of compliance reviews two manual therapists (MT) in the diagnosis of pelvic twist on the basis of the selected manual tests Michał Cichosz1,2,3, Dominik Chrapek1,2, Marzena Kobylańska4, Bartosz Wójcik4, Bartosz Kochański5, Walery Zukow6 1Jolly Med Szpital rehabilitacyjny Popielówek. Oddział rehabilitacji ogólnoustrojowej 2Fundacja Wsparcie Kowary 3Delta Vital Resort Karpacz 4Wrocławskie Centrum Rehabilitacji i Medycyny Sportowej 5Katedra i Klinika Rehabilitacji, Wydział Nauk o Zdrowiu, Uniwersytet Mikołaja Kopernika w Toruniu 6Wydział Kultury Fizycznej, Zdrowia i Turystyki, Uniwersytet Kazimierza Wielkiego w Bydgoszczy Streszczenie Wstęp Skręcenie (torsja) miednicy jest w fizjoterapii oraz medycynie manualnej często stawianym rozpoznaniem opartym głównie na podstawie badania fizykalnego oraz danych z wywiadu pacjenta. Coraz częściej łączy się je i opisuje wspólnie z dysfunkcją stawów krzyżowo- biodrowych (SIJD), której nie towarzyszy ból, jedynie zmiany w przestrzennym funkcjonowaniu kompleksu miedniczego. Cel pracy: Celem niniejszej pracy jest ocena poziomu zgodności ocen dwóch terapeutów manualnych (MT) dla wybranych testów diagnostycznych stawów krzyżowo- biodrowych. Materiał badawczy: Badania przeprowadzono na 180 osobowej grupie studentów w wieku między 20 a 30 lat. Wyniki: Największą zgodność szacunków, określaną jako znaczną odnotowano jedynie w przypadku testu ASLR, przy wartości k= 0,62. Pozostałe testy charakteryzowały się niższymi wartościami zgodności. Wnioski: Większość analizowanych testów charakteryzuje się umiarkowana oraz niższą wartością zgodności wyników. Na poziom zgodności ocen ma wpływ typu budowy ciała badanego. Summary Introduction: The twist (torsion) of the pelvis is in physiotherapy and manual medicine based diagnosis is often posed mainly based on physical examination, and data the patient's history. More often they combine them and describes, together with dysfunction of the sacroiliac joints (SIJD), which is not accompanied by pain, only changes in the spatial functioning of pelvic complex. Aim: The purpose of this study is to assess the level of compliance reviews two manual therapists (MT) for selected diagnostic tests the sacroiliac joints. Research material: The research was conducted on 180 members of a group of students aged between 20 and 30 years. Results: The biggest compliance estimates, defined as significant was noted only in the ASLR test, with values of k = 0,62. Other tests were characterized by lower values of conformity. Conclusions: Most of the tests analyzed is characterized by moderate and lower the value of the compliance results. At the level of compliance assessments is affected by the type of physique considered. Słowa kluczowe: skręcenie miednicy, SIJD, rzetelność. Keywords: twisting of the pelvis, sacroiliac joints, reliability.
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Cichosz Michał, Chrapek Dominik, Kobylańska Marzena, Wójcik Bartosz, Kochański Bartosz, Zukow Walery. Analiza poziomu zgodności ocen dwóch terapeutów manualnych (MT) w diagnozie skręcenia miednicy na podstawie wybranych testów manualnych = Analysis of the level of compliance reviews two manual therapists (MT) in the diagnosis of pelvic twist on the basis of the selected manual tests. Journal of Education, Health and Sport. 2015;5(6):157-168. ISSN 2391-8306. DOI 10.5281/zenodo.18419 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%286%29%3A157-168 https://pbn.nauka.gov.pl/works/564475 http://dx.doi.org/10.5281/zenodo.18419 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011 – 2014 http://journal.rsw.edu.pl/index.php/JHS/issue/archive Deklaracja. Specyfika i zawartość merytoryczna czasopisma nie ulega zmianie. Zgodnie z informacją MNiSW z dnia 2 czerwca 2014 r., że w roku 2014 nie będzie przeprowadzana ocena czasopism naukowych; czasopismo o zmienionym tytule otrzymuje tyle samo punktów co na wykazie czasopism naukowych z dnia 31 grudnia 2014 r. The journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1089. (31.12.2014). © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 21.04.2015. Revised 28.05.2015. Accepted: 05.06.2015. Analiza poziomu zgodności ocen dwóch terapeutów manualnych (MT) w diagnozie skręcenia miednicy na podstawie wybranych testów manualnych Analysis of the level of compliance reviews two manual therapists (MT) in the diagnosis of pelvic twist on the basis of the selected manual tests Michał Cichosz1,2,3, Dominik Chrapek1,2, Marzena Kobylańska4, Bartosz Wójcik4, Bartosz Kochański5, Walery Zukow6 1Jolly Med Szpital rehabilitacyjny Popielówek. Oddział rehabilitacji ogólnoustrojowej 2Fundacja Wsparcie Kowary 3Delta Vital Resort Karpacz 4Wrocławskie Centrum Rehabilitacji i Medycyny Sportowej 5Katedra i Klinika Rehabilitacji, Wydział Nauk o Zdrowiu, Uniwersytet Mikołaja Kopernika w Toruniu 6Wydział Kultury Fizycznej, Zdrowia i Turystyki, Uniwersytet Kazimierza Wielkiego w Bydgoszczy Streszczenie Wstęp Skręcenie (torsja) miednicy jest w fizjoterapii oraz medycynie manualnej często stawianym rozpoznaniem opartym głównie na podstawie badania fizykalnego oraz danych z wywiadu pacjenta. Coraz częściej łączy się je i opisuje wspólnie z dysfunkcją stawów krzyżowo- biodrowych (SIJD), której nie towarzyszy ból, jedynie zmiany w przestrzennym funkcjonowaniu kompleksu miedniczego. Cel pracy: Celem niniejszej pracy jest ocena poziomu zgodności ocen dwóch terapeutów manualnych (MT) dla wybranych testów diagnostycznych stawów krzyżowo- biodrowych. Materiał badawczy: Badania przeprowadzono na 180 osobowej grupie studentów w wieku między 20 a 30 lat. Wyniki: Największą zgodność szacunków, określaną jako znaczną odnotowano jedynie w przypadku testu ASLR, przy wartości k= 0,62. Pozostałe testy charakteryzowały się niższymi wartościami zgodności. Wnioski: Większość analizowanych testów charakteryzuje się umiarkowana oraz niższą wartością zgodności wyników. Na poziom zgodności ocen ma wpływ typu budowy ciała badanego. Summary Introduction: The twist (torsion) of the pelvis is in physiotherapy and manual medicine based diagnosis is often posed mainly based on physical examination, and data the patient's history. More often they combine them and describes, together with dysfunction of the sacroiliac joints (SIJD), which is not accompanied by pain, only changes in the spatial functioning of pelvic complex. Aim: The purpose of this study is to assess the level of compliance reviews two manual therapists (MT) for selected diagnostic tests the sacroiliac joints. Research material: The research was conducted on 180 members of a group of students aged between 20 and 30 years. Results: The biggest compliance estimates, defined as significant was noted only in the ASLR test, with values of k = 0,62. Other tests were characterized by lower values of conformity. Conclusions: Most of the tests analyzed is characterized by moderate and lower the value of the compliance results. At the level of compliance assessments is affected by the type of physique considered. Słowa kluczowe: skręcenie miednicy, SIJD, rzetelność. Keywords: twisting of the pelvis, sacroiliac joints, reliability.
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An experimental study of respiratory function and kinematics of the diaphragm and pelvic floor in subjects with a clinical diagnosis of sacroiliac joint pain and in a comparable pain-free subject group was conducted. To gain insight into the motor control strategies of subjects with sacroiliac joint pain and the resultant effect on breathing pattern. The active straight-leg-raise test has been proposed as a clinical test for the assessment of load transfer through the pelvis. Clinical observations show that patients with sacroiliac joint pain have suboptimal motor control strategies and alterations in respiratory function when performing low-load tasks such as an active straight leg raise. In this study, 13 participants with a clinical diagnosis of sacroiliac joint pain and 13 matched control subjects in the supine resting position were tested with the active straight leg raise and the active straight leg raise with manual compression through the ilia. Respiratory patterns were recorded using spirometry, and minute ventilation was calculated. Diaphragmatic excursion and pelvic floor descent were measured using ultrasonography. The participants with sacroiliac joint pain exhibited increased minute ventilation, decreased diaphragmatic excursion, and increased pelvic floor descent, as compared with pain-free subjects. Considerable variation was observed in respiratory patterns. Enhancement of pelvis stability via manual compression through the ilia reversed these differences. The study findings formally identified altered motor control strategies and alterations of respiratory function in subjects with sacroiliac joint pain. The changes observed appear to represent a compensatory strategy of the neuromuscular system to enhance force closure of the pelvis where stability has been compromised by injury.
Sacroiliac Joint Dysfunction: The Can of Worms Update on Soft Tissue Pain and Rehabilitation
  • J Fortin
Fortin, J., 1998. Sacroiliac Joint Dysfunction: The Can of Worms. Update on Soft Tissue Pain and Rehabilitation. University of Manitoba and Manitoba Public Insurance, Winnipeg, Manito-ba, May 28–30.
Sacroiliac Joint Dysfunction: The Can of Worms. Update on Soft Tissue Pain and Rehabilitation. University of Manitoba and Manitoba Public Insurance
  • J Fortin
Fortin, J., 1998. Sacroiliac Joint Dysfunction: The Can of Worms. Update on Soft Tissue Pain and Rehabilitation. University of Manitoba and Manitoba Public Insurance, Winnipeg, Manitoba, May 28-30.
Update on Soft Tissue Pain and Rehabilitation. University of Manitoba and Manitoba Public Insurance
  • J Fortin
Insufficient lumbopelvic stability
  • Pool-Goudzwaard