KRONİK BEL AĞRISINDA SAKROİLİAK EKLEM FONKSİYON BOZUKLUĞUNUN İNCELENMESİ

Öz

Amaç: Sakroiliak eklem fonksiyon bozukluğunun, bel ağrısının önemli bir nedeni olabileceği bildirilmektedir. Bu çalışma, kronik bel ağrısı olan katılımcılarda sakroiliak eklem fonksiyon bozukluğunun araştırılması ve sakroiliak eklem fonksiyon bozukluğunun travma öyküsü ile ilişkisini incelemek amacıyla gerçekleştirildi. Yöntem: Çalışmaya 25-60 yıl yaş aralığında kronik bel ağrısı şikâyeti olan 323 katılımcı (189 kadın, 134 erkek; yaş=47,58±11,78 yıl) dahil edildi. Katılımcıların demografik bilgileri, travma/ düşme geçmişi kaydedildi. Ağrı şiddeti Görsel Analog Skalası (GAS) ile değerlendirildi. Sakroiliak eklem fonksiyon bozukluğunu değerlendirmek amacıyla eklem provokasyon ve hareketlilik testleri kullanıldı. Sonuçlar: Çalışmaya alınan katılımcıların 174’ünde (% 53,9) sakroiliak eklem fonksiyon bozukluğu olduğu belirlendi. Travma/düşme geçmişinin, sakroiliak eklem fonksiyon bozukluğu görülme oranını olumsuz yönde etkilediği görüldü (p=0,001). Sakroiliak eklem fonksiyon bozukluğu olan katılımcıların ağrı şiddeti, eklem fonksiyon bozukluğu olmayanlara göre daha yüksek olarak bulundu (p=0,002). Tartışma: Çalışma sonuçlarımız, kronik bel ağrılı katılımcılarda sakroiliak eklem fonksiyon bozukluğu görülme oranının yüksek olduğunu ve eklem fonksiyon bozukluğu olan katılımcıların daha şiddetli ağrı deneyimlediklerini gösterdi. Ayrıca, travma/düşme geçmişinin sakroiliak eklem fonksiyon bozukluğunu artırdığı sonucuna ulaşıldı. Kronik bel ağrısı olan hastaların sakroiliak eklem fonksiyon bozukluğu yönünden de araştırılması ve tedavi programının bu doğrultuda düzenlenmesi gerektiğini düşünmekteyiz.

Anahtar Kelimeler

• Bel ağrısı
• sakroiliak eklem
• travma

INVESTIGATION OF SACROILIAC JOINT DYSFUNCTION IN CHRONIC LOW BACK PAIN

Abstract

Purpose: Sacroiliac joint dysfunction has been reported to be an important source of low back pain. The aim of this study was to investigate the presence of sacroiliac joint dysfunction in participants with chronic low back pain and to investigate the relationship between sacroiliac joint dysfunction and trauma history. Methods: Three hundred twenty-three participants with chronic low back pain, age between 25-60 years (189 females, 134 males; age=47.58±11.78 years) were included in the study. Demographic data, history of trauma/fall of the participants were recorded. Pain intensity was evaluated using Visual Analogue Scale (VAS). Joint provocation and mobility tests were used to evaluate sacroiliac joint dysfunction. Results: Sacroiliac joint dysfunction was detected in 174 (53.9%) of the participants included in the study. The history of trauma/fall was associated with a negative impact on the incidence of sacroiliac joint dysfunction (p=0.001). Pain severity of participants with sacroiliac joint dysfunction was higher than participants without joint dysfunction (p=0.002). Conclusion: Our results showed that participants with chronic low back pain had higher rates of sacroiliac joint dysfunction and participants with joint dysfunction experienced more severe pain. Trauma/fall history increases sacroiliac joint dysfunction. Patients with chronic low back pain should also be investigated in terms of sacroiliac joint dysfunction, and the treatment program should be planned accordingly.

Keywords

• Low back pain
• sacroiliac joint
• trauma

References

1. 1. Manek NJ, MacGregor AJ. Epidemiology of back disorders: prevalence, risk factors, and prognosis. Curr Opin Rheumatol.2005;17(2):134-140.
2. 2. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. The Lancet. 2017;389(10070):736-747.
3. 3. Borenstein DG. Low back pain: medical diagnosis and comprehensive management. WB Saunders Company;1995.
4. 4. Slipman CW, Patel RK, Shin C, Braverman D, Lenrow D. Pain Management: Studies probe complexities of sacroiliac joint syndrome. BioMechanics. 2000; 4:67-78.
5. 5. Zelle BA, Gruen GS, Brown S, George S. Sacroiliac joint dysfunction: evaluation and management. Clin J Pain. 2005;21(5):446-455.
6. 6. Bernard TN, Cassidy JD. The sacroiliac joint syndrome: pathophysiology, diagnosis, and management. In: Frymoyer JW, ed. The Adult Spine: Principles and Practice. New York, NY: Raven Press Ltd; 1991:2107–2130.
7. 7. Berthelot JM, Labat JJ, Le Goff B, Gouin F, Maugars Y. Provocative sacroiliac joint maneuvers and sacroiliac joint block are unreliable for diagnosing sacroiliac joint pain. Joint Bone Spine 2006;73:17-23.
8. 8. Szadek KM, van der Wurff P, van Tulder MW, Zuurmond WW, Perez RS. Diagnostic validity of criteria for sacroiliac joint pain: a systematic review. The Journal of pain. 2009;10(4):354-368.

9. 9. Laslett M, Young S, Aprill C, McDonald B. Diagnosing painful sacroiliac joints: a validity study of a McKenzie evaluation and sacroiliac provocation tests. Aust J Physiother. 2003;49:89-97.
10. 10. Vora AJ, Doerr KD, Wolfer LR. Functional anatomy and pathophysiology of axial low back pain: disc, posterior elements, sacroiliac joint, and associated pain generators. Phys Med Rehabil Clin N Am. 2010;21(4):679-709.
11. 11. Madani SP, Dadian M, Firouznia K, Alalawi S. Sacroiliac joint dysfunction in patients with herniated lumbar disc: a cross-sectional study. J Back Musculoskelet Rehabil. 2013;26(3):273-279.
12. 12. Robinson HS, Brox JI, Robinson R, Bjelland E, Solem S, Telje T. The reliability of selected motion-and pain provocation tests for the sacroiliac joint. Man Ther. 2007; 12(1):72-79.
13. 13. Laslett M. Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Man Manip Ther. 2008;16(3):142-152.
14. 14. Rashbaum RF, Ohnmeiss DD, Lindley EM, Kitchel SH, Patel VV. Sacroiliac joint pain and its treatment. J Spinal Disord Tech. 2016;29(2):42-48.
15. 15. Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther. 2005; 10(3):207-218.
16. 16. Soleimanifar M, Karimi N, Arab AM. Association between composites of selected motion palpation and pain provocation tests for sacroiliac joint disorders. J Bodyw Mov Ther. 2017;21(2):240-245.
17. 17. Cooperstein R, Truong F. Does the Gillet test assess sacroiliac motion or asymmetric one-legged stance strategies? J Can Chiropr Assoc. 2018;62(2):85.
18. 18. Sümbüloğlu K. Biyoistatistik, 9. Baskı, Ankara, 2000.
19. 19. Koes B, Van Tulder M, Thomas S. Diagnosis and treatment of low back pain. Bmj. 2006;332:1430-1434.
20. 20. Galm R, Fröhling M, Rittmeister,M, Schmitt E. Sacroiliac joint dysfunction in patients with imaging-proven lumbar disc herniation. Eur Spine J. 1998;7(6):450-453.
21. 21. Prather H, Hunt, D. Conservative management of low back pain, part I. Sacroiliac joint pain. Dis Mon. 2004;50(12):670.
22. 22. Maigne JY, Aivaliklis A, Pfefer F. Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine. 1996;21(16):1889-1892.
23. 23. Bernard TN, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop. 1987;(217):266–280.
24. 24. Sembrano JN, Polly DW. How often is low back pain not coming from the back? Spine. 2009;34(1):E27–E32.
25. 25. Liliang P-C, Lu K, Liang C-L, Tsai Y-D, Wang K-W, Chen H-J. Sacroiliac joint pain after lumbar and lumbosacral fusion: findings using dual sacroiliac joint blocks. Pain Med. 2011;12(4):565–570.
26. 26. Prather, H. Sacroiliac joint pain: practical management. Clin J Sport Med, 2003; 13(4):252-255.
27. 27. Haneline MT, Young M. A review of intraexaminer and interexaminer reliability of static spinal palpation: a literature synthesis. J Manipulative Physiol Ther. 2009; 32(5):379-386.
28. 28. Arab AM, Abdollahi I, Joghataei MT, Golafshani Z, Kazemnejad A, Inter- and Intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint, Man Ther. 2009;14(2):213-221.
29. 29. Slipman CW, Patel RK, Whyte II WS, Lenrow DA, Ellen MI, Chou LH, Vresılovıc EJ. Diagnosing and managing sacroiliac pain. J Musculoskelet Med. 2001;18(6): 325-325.
30. 30. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short‐form mcgill pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs), short form‐36 bodily pain scale (sf‐36 bps), and measure of intermittent and constant osteoarthritis pain (icoap). Arthritis Care Res (Hoboken). 2011;63(11):240-252.