3 REASONS WHY MANUAL THERAPY HELPS IN MANAGING SIJ PAIN
Sacroiliac joint (SIJ) dysfunction is a common source of low back pain. The prevalence of SIJ pain is approximately 25% (ranging from 10% to 62% based on setting) in patients with mechanical low back pain below the level of L5.
Source: Lecture of Thorvaldur Palsson at Trust me-Ed
If you want to learn more about this topic, you can watch Thorvaldur's lecture here:
Throughout the last decade, it has been heavily debated in conferences, social media platforms, etc. whether manual treatment should be abandoned, used more differently, only on particular groups, etc. This applies to almost all musculoskeletal conditions, including SIJ pain. We need to consider what the purpose of the approach is i.e identifying the mechanism underlying the pain condition and choosing an approach relevant to that.
Passive movement can reduce pain sensitivity
Many experimental studies have shown that if we move a joint structure passively, be it mobilization, high-velocity thrusts, or whatever type of stimuli you provide, we can get a reduction in pain sensitivity and pain, not only in and around the painful area but also at sites distant to the painful spot.
3 reasons why manual therapy helps in managing SIJ pain:
1) Changes at the supraspinal level
- Reduced activity in areas involved in central processing
- Placebo analgesia, expectations, and psychological factors
2) Changes at a spinal level
- The reduced activity of dorsal horn neurons
- Inhibition of motor neurons
3) Changes at a peripheral level
- Reduction in Pro-Inflammatory cytokines
- Altered concentration of B endorphins
- Reduced inflammation after training
- Reduced concentration of Substance P
Whatever approach we choose, it needs to be aimed at the person with the disease rather than the disease itself, bearing in mind that pain is an individual experience.
Sources:
1. ‘Sacroiliac joint pain’ Lecture by Thorvaldur Palsson at Trust me-ed
2. Evaluation and Management of Sacroiliac Dysfunction Utilizing an Evidence-Based Algorithmic Approach: A Case Study
David P Newman, Brian C McLean, and Alexandra M Scozzafava
If you want to learn more about this topic, you can watch Thorvaldur's lecture here:
