COMBINATION OF LATISSIMUS DORSI AND GLUTEAL STRENGTHENING IN SACROILIAC DYSFUNCTION

COMBINATION OF LATISSIMUS DORSI AND GLUTEAL STRENGTHENING ON CLINICAL SYMPTOMS AND PELVIC ALIGNMENT IN SACROILIAC DYSFUNCTION

The current study will try to answer the following research question:

In adults with sacroiliac joint dysfunction, what is the effect of combination LD strengthening exercises with gluteal strengthening exercises compared with gluteal strengthening exercises alone on the primary outcomes of this study (pain intensity during pressure on posterior superior iliac spine [PSIS] and neuropathic pain severity) and the secondary outcomes (disability, pelvic inclination, pelvic torsion, sacral inclination, GMax and LD strength)?

Participants will be devided equally into two groups:

1. Group A (Control group): will receive a gluteal strengthening exercise program.
2. Group B (Intervention group): will receive the same gluteal strengthening exercise program as group A, in addition to the LD strengthening exercise program.

Sacroiliac joint dysfunction (SIJD) is an underappreciated source of low back or buttock pain. It accounts for up to 40% of nonspecific low back pain cases. The prevalence of SIJD was 30% in students with LBP. The impact of SIJD on quality of life is comparable to that observed with osteoarthritis and spinal stenosis and is higher than many cardiovascular-related medical conditions.

One of the main risk factors associated with SIJD is inadequate force closure needed to stabilize the joint during movement, altered muscle coordination, and reduced muscle strength. The primary muscles responsible for force closure are the gluteus maximus (GMax) and latissimus dorsi (LD), as tension is transmitted from one side of the trunk to the other through their connection into the superficial layer of the thoracolumbar fascia (TLF).

GMax muscles showed a trend of reduced resting thickness of the muscles on the side of SJD when compared with the contralateral joint, as well as against the matched healthy individuals, while muscle thickness of LD reduced on the contralateral side as compared to the ipsilateral as well as against the matched healthy controls. On the other hand, the amplitude values of LD of the LBP group were significantly higher than those of the control group on both sides. But GMax amplitude was significantly lower than that of the control group on both sides.

To the best of the authors' knowledge, although both the latissimus dorsi (LD) and gluteal muscles play a crucial role in maintaining sacroiliac joint (SIJ) stability, limited studies compared the effect of incorporating LD activation exercises into gluteal strengthening programs for patients with sacroiliac joint dysfunction (SIJD).

This study will evaluate and compare between effect of adding LD activation exercises to the gluteal strengthening exercises and gluteal strengthening alone on neuropathic pain severity, pain intensity during pressure on PSIS, disability, pelvic inclination, pelvic torsion, and sacral inclination, GMax and LD strength.

Inclusion Criteria :

• Patient with clinical diagnosis of low back pain because of SIJD.
• Age between 35-55 years old.
• Numeric pain rating scale (NPRS) score of less than 8
• moderate disability score ranging from 5-14 on the Arabic version of Roland-Arabic Disability Questionnaire (ArRMDQ).
• Patients with unilateral chronic pain for more than 3 months below L5 overlap the posterior aspect of the SIJ around PSIS.
• Patients with gluteal pain with or without groin pain, with or without lower extremity pain that are not compatible with the lumbar nerve roots dermatome.
• ≥4 in the diagnostic scoring system.
• Two out of 4 positive tests in a cluster of Laslett.

Exclusion Criteria:

• Patients with any previous fractures or surgery in the lumbosacral or pelvic region before the study.
• Pregnancy and lactation during study.
• Radicular pain or radiculopathy.
• Spinal pathology.
• Participation in physiotherapy sessions within 6 months before enrollment in the study.
• Injection of corticosteroids or anaesthetics in the SIJ during the previous month.
• Sacroiliac infection or sacroiliitis.
• Neurological signs of spinal stenosis.
• Uncontrolled hyper-tension.
• Treatment, including non-steroidal anti-inflammatories and painkillers, during the study