Clinical StudyManipulative therapy of sacral torsion versus myofascial release in patients clinically diagnosed posterior pelvic pain: a consort compliant randomized controlled trial
Introduction
Chronic low back pain (CLBP) represents a significant health care problem that results in substantial costs to society [1,2]. It is generally accepted that approximately 10% to 25% of patients with suspected sacroiliac joint (SIJ) pain have a subsequent positive diagnostic intra-articular SIJ injection with anesthetic [3]. SIJ syndrome is characterized by pain over the posterior aspect of SIJ varying in severity, which can also refer pain to the greater trochanter, groin, posterior thigh, knee, lateral or posterior calf to the ankle, foot, and toes [4]. The exact origin of SIJ related pain has not been clarified. One postulated origin is accidental minor subluxation and repeated movements of the SIJ may damage the joint capsule and the posterior ligamentous region [5].
Manipulative therapy has been used in the treatment of patients with CLBP and significant improvement has been reported with thrust manipulative techniques in disability versus non–thrust application [6]. Spinal manipulation has been also reported to be more effective than placebo in the treatment of CLBP, with high-velocity low-amplitude thrust manipulation the most effective modality [7]. In addition, myofascial therapy is an effective manual technique to release areas of impaired gliding fascial mobility and to improve pain perception over a short-term duration in CLBP [8]. Specifically, Ajimsha et al.[9] have reported that myofascial release reduces LBP in 53.3% and disability in 29.7% compared to placebo.
Conventional treatment for chronic SIJ pain includes manual therapy, activity modification, analgesic and anti–inflammatory medications, and arthrodesis [10]. It has been demonstrated that posterior pelvic tilt taping intervention favorably affected the pelvic indication and sacral horizontal angle, leading to beneficial effects on SIJ dysfunction and medial buttock pain [11]. Several studies have reported results in muscle inhibition, improved functional disability, gait symmetry, and decrease pain from SIJ manipulation techniques [[12], [13], [14], [15]]. Recently, a single session of SIJ and lumbar manipulation was more effective for improving functional disability than SIJ manipulation alone in patients with SIJ syndrome [13]. In spite of this, there are currently no definitive interventional, conservative, or surgical management options for managing SIJ pain [16], [17], [18], [19]. In addition, few randomized clinical trials have analyzed the effectiveness of SIJ manipulative therapy [12,15]. In our concern, there is neither previous research on the comparative effects between manipulative therapy and myofascial release in SIJ.
The purpose of the study was to analyze the effectiveness of manipulative therapy of sacral torsion versus myofascial approach on disability, pain intensity, kinesiophobia, quality of life, isometric endurance of trunk flexor muscles, and mobility in individuals with CLBP, and SIJ syndrome.
Section snippets
Study design and participants
A randomized single-blind clinical trial with intention-to treat analysis and subject masked to treatment allocation was designed and conducted following CONSORT guidelines. The protocol was approved by the local human research committee of the University of XXX (XXX). It was conducted following the declaration of Helsinki and was registered on clinicaltrials.gov (NCT02065531). All subjects signed an informed consent.
A total of 88 participants with CLBP and SIJ syndrome were recruited and
Results
Four hundred and ninety-one patients were eligible for screening, and eighty-eight (n=88) consecutive patients were screened for eligibility criteria. Sixty-four patients (mean±SD age: 51±9; 60% female) satisfied all the eligibility criteria and were randomized to either the manipulative therapy (n=32) or myofascial release group (n=32). Reason for ineligibility can be found in Fig. 3, which provides a flow diagram of patients. Baseline features between both groups were similar for all
Discussion
The results of this randomized controlled trial suggest that manipulative therapy of sacral torsion and myofascial release therapy resulted in a similar reduction in disability, and intensity of pain. Also, both therapies improved quality of life, and finger-to-floor distance immediately after and at one moth follow-up. The differences between groups were not clinical and statistically meaningful in any of the reported measures except for lumbar mobility in flexion, where manipulative therapy
Conclusion
Manipulative and myofascial release therapy in patients with clinically diagnosed SIJ syndrome resulted in a similar short-term benefits on patient reported disability. Both groups experienced similar decrease in the intensity of pain over time, although no clinically meaningful effects were demonstrated in either group. Only significant differences between groups were achieved for general health, social functioning, and finger-to-floor distance at one month follow-up.
Declarations of Competing Interests
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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Author disclosures: AMCS: Nothing to disclose. EGM: Nothing to disclose. MFS: Nothing to disclose. ICLP: Nothing to disclose. IN: Nothing to disclose. MAQZ: Nothing to disclose. MEAF: Nothing to disclose.