The Effect of Sacroiliac and Lumbar Mobilizations Applied in Addition to Conventional Physical Therapy

Summary

Femoroacetabular impingement (FAI) is defined as impingement caused by abnormal morphology between the femoral head-neck junction and the acetabulum in the hip joint (Aoyama et al., 2017). As a result of morphological changes, abnormal contact between the proximal femur and acetabulum leads to chondrolabral lesions and secondary hip osteoarthritis (Casartelli, Maffiuletti, Leunig, 2019; Pierannunzii L., 2017). Femoroacetabular impingement syndrome (FAIS) is a clinical condition characterized by movement-related hip-groin pain that limits daily and athletic activities, accompanied by clinical findings, symptoms, and radiological findings associated with morphological changes (Brown-Taylor et al., 2022; Griffin et al., 2016). Symptoms typically appear suddenly and are associated with rotational and hip flexion movements that place stress on the joint (Nepple et al., 2013). The primary symptom is hip and/or groin pain related to movement or position. Typically, pain is related to activity during the acute phase, but in the chronic phase, it can occur with daily living activities or even at rest (Byrd, 2014; Nepple et al., 2013).

In patients with FAIS, reduced hip range of motion can be compensated by the pubic symphysis and sacroiliac joint (SIJ), and as a result of this compensation, hip dysfunction may develop due to increased stress on these structures. Studies describing the relationship between SIJ and FAIS are available in the literature. SIJ dysfunction causes asymmetry between the right and left innominate bones, altering the pelvic tilt angle. Excessive coverage of the femoral head by the acetabulum increases compression and creates a basis for labral tears. A study comparing postoperative pain and hip function in FAIS patients with and without SIJ anomalies showed that the group with SIJ anomalies had worse outcomes (Krishnamoorty et al., 2019).

In recent years, studies suggesting that pelvic posture and kinematics influence acetabular orientation have been increasing alongside the hip-spine concept (Krishnamoorty et al., 2019; Pierannunzii L., 2017). Although there are many similar studies in the literature examining the relationship between FAIS and the lumbopelvic junction, studies examining treatment options do not include a treatment approach targeting this relationship. While many researchers accept the value of conservative treatment methods for FAIS, there is insufficient published evidence on how this treatment should be applied.

This study was planned to investigate the effects of sacroiliac and lumbar mobilization as additional interventions to conventional physiotherapy on pain, balance, neuromuscular control, hip range of motion and hip function in patients with FAIS. The aim of our study was to include the surrounding joints that affect hip joint mechanics, as described in the literature, in the treatment program alongside physiotherapy applications, which are one of the conservative treatment methods. We also aimed to address the biomechanical limitations contributing to hip pain and dysfunction through a patient-centered approach and to evaluate their effect on the overall integrity and function of the hip and lumbopelvic joints and to evaluate its effect on the overall integrity and function of the hip and lumbopelvic joints. This study is the first to our knowledge and aims to shed light on whether patients with FAIS require more comprehensive manual therapy approaches based on the data obtained from the research.

Conditions

• Femoroacetabular Impingement Syndrome

Interventions

OTHER

Lumbosacral Mobilization

Sacroiliac joint: anterior ilium technique. The practitioner stabilized the sacrum. The fingers of the hand on the same side as the affected side were placed on the anterior iliac spine and the ilium was pulled upward over the sacrum. Sacroiliac joint: posterior ilium technique. While the patient was lying prone, the affected side was determined using the spring test. The practitioner positioned the thenar eminence of the hand against the posterior protrusion of the ilium and applied a lateral push. While maintaining this push, the patient was asked to perform backward extension. Lumbar region: Maitland postero-anterior technique. Grade II-III mobilization was applied to the lumbar region (L1-L5) in the postero-anterior direction. The practitioner placed the ulnar side of their hand, on the spinous process of the of the relevant segment with the wrist in extension. Using body weight, passive oscillations were performed directly on the relevant segment in the posteroanterior direction.

OTHER

Conventional physical therapy

The conventional physical therapy applied to the control group included pain-targeted electrotherapy methods (Conventional transcutaneous electrical nerve stimulation, ice therapy, ultrasound therapy), hip mobilization techniques, hip strengthening exercises, core and trunk stabilization exercises, posture exercises, activity modification, and patient education.

Sponsors & Collaborators

• Fenerbahce University

  lead OTHER

Principal Investigators

• Dilber Karagözoğlu Coşkunsu, Dr. · Fenerbahce University

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Model

PARALLEL

Eligibility

Min Age

15 Years

Max Age

55 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2022-05-02

Primary Completion

2023-03-31

Completion

2023-03-31

Countries

• Turkey (Türkiye)

Study Locations