The study group consisted of 150 consecutive neurologic patients of the Helsinki University Central Hospital Department of Neurology referred to physiatrist consultation between June 2001 and June 2003. This study was approved by the Helsinki University Central Hospital Ethical Committee.
In addition to routine physiatric clinical examination, special attention was given to asymmetry of the pelvis and spine. Differences between the left side and the right side in the level of the inferior angles
The presenting symptoms of the patients were lumbosacral pain (n = 55, of whom 22 had pain radiating to the lower extremity), neck and shoulder pain (n = 31), headache (n = 25), extremity paresthesia (n = 23), dizziness (n = 12), other extremity pain (n = 15), thoracic pain (n = 9), pelvic pain (n = 6), facial paresthesia (n = 5), and limb weakness (n = 3). Duration of the symptoms varied: more than 10 years in 27 patients; 5 to 10 years in 18; 1 to 5 years in 57; and less than 1 year in 26.
Of
In the present study, most of the ambulatory neurologic patients remitted to physiatric consultation exhibited pelvic asymmetry and irritation of the SI joint on the side of the elevated iliac crest. Mild asymmetry of the pelvis is common,1, 7 and contradictory results have been published on the correlation between asymmetry and symptoms.4, 9 The prevalence of pelvic asymmetry in a population without SI-joint problems is only 5.3%. 13 The measure used in the study by Badii et al13 was the
These preliminary findings suggest that an acquired postural asymmetry of the SI joint is a common, although often neglected, cause of various neurologic and other pain-related symptoms and can be relieved by a simple and safe treatment. Practical Applications A reversible pelvic asymmetry was observed in 87% of 150 consecutive neurologic patients referred to physiatric consultation. C-type scoliosis was consistently associated with ipsilateral posterior rotation of the innominate and apparent leg
This study was funded by the Helsinki University Central Hospital through research grant no. T1050NL317.
The authors thank Mrs Tuuli Autio for drawing Figure 1, Ms Minni Lajunen for her secretarial help, and Ms Inari Soinila for revising the language.
As mentioned earlier, mechanical, biochemical, and neurophysiologic response to SMT may help account for the aforementioned clinical improvements. Although a topic of continued debate, a number of studies on cadavers (Gal et al., 1997) and live patients (Childs et al., 2004; Timgren and Soinila, 2006) have demonstrated a positional change of the arthokinemtic structures of the zygoapophyseal joint pre to post manipulation, which could help alter segmental biomechanics by releasing trapped meniscoids, breaking adhesions, and improving distortion of intervertebral discs (Lewit, 1991; Pickar and Bolton, 2012). According to Triano et al., the new positional equilibrium could reduce mechanical stress and strain on both soft tissue and bone (Triano, 2001).
Of greater interest is whether a rotational strength program would prove more efficacious if conducted under an unloaded spine condition. Likewise postural asymmetry of the SIJ which often presents as scoliosis, leg-length inequality or through neurological symptoms can be addressed with manual therapy [102]. Best current evidence suggests that the hip joint be considered in any LBP rehabilitation plan; the lower back is biomechanically related to the hip because of multiple shared muscles (psoas, gluteus maximus etc.) [32] with this joint carrying the load of the upper body singularly sometimes when bending and making postural changes as well as cyclically during walking and running.