International Chiropractic Pediatric AssociationThe article was written by the combined efforts of the ChiroACCESS editorial staff.
From: ChiroACCESS ; Published on April 29, 2010
It is well documented that low back pain is the most common presenting complaint in a chiropractic office. A growing body of evidence has elevated the importance of the sacroiliac joint in low back pain and suggested a reduction in the role of the lumbar spine as likely the most common cause. This April 2010 study was supported by the Arthritis Society and conducted at Canadian Memorial Chiropractic College. Radiographs of 315 patients ages 18-60 with chronic low back pain greater than 3 months duration were included in the study. Two radiologists read the films and categorized the SI joint as normal, degenerative or inflammatory. The authors found that “a significantly large proportion of the cohort (23.8%) had degenerative changes in the SI joint. Degenerative change in the SI joint has received little attention in prior investigations and is clinically under-recognized…it appears unrelated to concurrent OA in the lumbar spine.”
A clinical review was created for ChiroACCESS that provides great detail related to the prevention, diagnosis and management of SI joint conditions. That review can be found here http://www.chiroaccess.com/Conditions/Biomechanical-Sacroiliac-Joint-Pain.aspx.
Inflammatory and degenerative sacroiliac joint disease in a primary back pain cohort.
Arthritis Care Res (Hoboken). 2010 Apr;62(4):447-54.
O’Shea FD, Boyle E, Salonen DC, Ammendolia C, Peterson C, Hsu W, Inman RD.
Toronto Western Hospital, Toronto, Ontario, Canada.
OBJECTIVE: The prevalence of sacroiliac (SI) joint abnormalities in a primary low back pain population remains unresolved. The aims of our study were to define the prevalence of SI joint disease in this cohort, and to identify clinical features that might accurately predict radiographic changes in the SI joint and spine.
METHODS: Lumbar spine and anteroposterior pelvis radiographs taken over a 3-year period for the evaluation of back pain at a major chiropractic college were scored for the presence of inflammatory or degenerative features. Data were subsequently extracted by means of a predetermined template from the clinical notes. The outcomes were correlated using Spearman’s correlation coefficients.
RESULTS: We identified 315 patients (173 men, 142 women), ages 18-60 years. Of these, 100 patients (31.7%) demonstrated SI joint abnormalities: 75 (23.8%) degenerative, 25 (7.9%) inflammatory. Sex was strongly associated with type of SI joint pathology; degenerative disease was predominantly found in women (68%), whereas inflammatory disease was predominantly found in men (63%). In women there was no correlation between degenerative SI joint abnormalities and degenerative changes in the lumbar spine. Of the clinical descriptors evaluated, none were associated with the radiographic findings with the exception of buttock pain, which was associated with inflammatory sacroiliitis. Neither being overweight nor pregnancy history was associated with degenerative changes in the SI joint.
CONCLUSION: In a primary back pain cohort, degenerative SI joint disease may be an under-recognized clinical entity. It is strongly influenced by sex but is unrelated to degenerative changes in the lumbar spine. Currently proposed clinical discriminators performed poorly in correlating with radiographic changes in the SI joint.
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Dr. Stacey: This study proves what I’ve been finding clinically and saying for years – the SI joint is just as, if not more important than the lumbar spine in cases of lower back pain and sciatica! Hence why I utilize the technique that I do!