Elsevier

The Spine Journal

Volume 21, Issue 11, November 2021, Pages 1890-1899
The Spine Journal

Clinical Study
Manipulative therapy of sacral torsion versus myofascial release in patients clinically diagnosed posterior pelvic pain: a consort compliant randomized controlled trial

https://doi.org/10.1016/j.spinee.2021.05.002Get rights and content

Abstract

BACKGROUND CONTEXT

Chronic low back pain represents a health care problem with substantial costs. It is generally accepted that approximately 10% to 25% of patients with persistent chronic low back pain may have pain arising from the sacroiliac joints.

PURPOSE

This study aimed to analyze the effects of manipulative therapy of sacral torsion versus myofascial release on disability, pain intensity, and mobility in patients with chronic low back pain and sacroiliac joints.

STUDY DESIGN/SETTING

A prospective, single-blinded randomized clinical trial.

PATIENT SAMPLE

Sixty-four patients (mean±SD age: 51±9; 60% female) with chronic low back pain and sacroiliac joints comprised the patient sample. No participant withdrew because of adverse effects.

OUTCOME MEASURES

Self-reported disability (primary), pain intensity, scale of kinesiophobia, quality of life, isometric endurance of trunk flexor muscles, and lumbar mobility in flexion were assessed at baseline, pos-treatment, and one month follow-up.

METHODS

Participants were randomly assigned to a sacral torsion manipulation group or myofascial release group, receiving a total of 12 sessions (once weekly).

RESULTS

ANCOVA did not showed a statistically significant difference between groups for disability (95% CI -2.40−1.90, p=.177). Effect sizes were large in both groups at both follow-up periods. Similar results were achieved for all secondary outcomes (p˂. 05). The linear model longitudinal analyses showed significant improvements in both groups over time for all outcomes with the exception of fear of movement (manipulative: Minimum within-groups change score 1.91, p˂.001; myofascial: 1.66, p˂.001).

CONCLUSION

Manipulative and myofascial release therapy in patients with clinically diagnosed sacroiliac joints 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.

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.

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