A clinical evaluation of hip joint functional ability after sacroiliac joint manipulation in patients with sacroiliac joint syndrome
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The differential diagnosis of back and leg pain should include sacroiliac joint disease as the prevalence of sacroiliac joint pain appears to range from 13%-30%, thus making the sacroiliac joint a significant source of pain in patients with chronic low back pain. Sacroiliac syndrome is well-defined and usually presents with pain over the sacroiliac joint in the region of the posterior superior iliac spine, with possible referral to the buttock, groin, and leg. Most patients with sacroiliac syndrome seem to present with spastic or hyperactive muscles which leads to increased pain and decreased range of motion. Because of the close proximity of the Piriformis muscle to the sacroiliac joint, it is likely to be one of these hyperactive muscles. Various studies on low back pain, including a study on sacroiliac syndrome, have shown a correlation between low back pain, hip rotation range of motion asymmetry, and decreased hip mobility. In addition, the muscles responsible for movements of the hip have an overlapping innervation with the hip joint (L2 to S1) and sacroiliac joint (L2 to S3). It is assumed that the hypertonic muscles associated with sacroiliac syndrome decrease hip joint proprioception as the proprioceptors are facilitated erratically in a highly facilitated neuronal pool common to the innervation levels of the sacroiliac joint and the hip and associated with the level of the involved hypertonic muscle. This is thought to result in aberrant proprioceptive function at the identified levels, affecting the hip. Thus the aim of this study was to investigate the effect which sacroiliac joint manipulation had on hip functional ability in patients suffering from sacroiliac syndrome by means of various measurement tools: . Active hip joint ranges of motion were assessed using an Inclinometer, . Pressure threshold of the Piriformis muscle was measured by using an Algometer, and . Hip joint proprioception was assessed by measuring joint position sense of the hip joint using an Inclinometer.