Treating Subluxation of Sacroiliac Joint by Manipulation

The patient with the subluxation of acroiliac joint usually has the chief complaint of severe pain in the region of the sacroiliac joint radiating to the buttock and leg on the affected side, and marked limitation to the movement of the joint. In some cases, the pain radiated to the back of the thigh and the front and inner sides of the groin. The symptoms are easily mixed up with those of acute lumbar sprain, protrusion of lumbar intervertebral discs, trauma to the superior cluneal nerve, and sprain of the lumbosacral joint, causing misdiagnosis which in turn leads to improper treatments, then leaves the symptoms unattended for several weeks causing strain of the sacroiliac joint and chronic inflammation off and on afterwards.

Clinical Manifestations: Examination showed that the patient walked with a limping. There was tenderness around the superior posterior iliac spine. The superior posterior iliac spines on both sides were not on the same level, the spine on the affected side being higher than that of the other side when a forward subluxation was involved, and if it was a backward subluxation, the spine on the affected side was lower than the contralateral one and protruded slightly posteriorly. Erichsen's sign, Gaenslen's sign were positive.The pelvis X-ray film showed that the superior posterior iliac spines on the two sides were not on the same level. Anteroposterior radiography showed a broadening of the intra-articular space on the affected side.

Treatment Method: Gentle massage was done over the waist, sacroiliac joint, and buttocks by kneading and rolling maneuvers in order to relax the muscles. When a forward subluxation was present, the method was done with the patient lying supine. The hip and the knee were flexed to the utmost. Then the hip was turned, pulled and extended to make both the hip and the knee joints come to the position of full extension. The movements should be uninterrupted and the force applied adequately. When a backward subluxation was encountered, the method was performed with the patient lying in prone position. The therapist fixed the patient's sacrum with the left hand, while the affected leg, supported by the right hand, was raised backward. When a resistance was felt, a moderate explosive force was applied to make the ilium turn anteriorly. After the reduction, the manipulations such as kneading, rolling, pushing, and straightening the sinews were done to smooth out local soft tissues. After the treatment, the sacroiliac joint was fixed by winding elastic bandage in width round the waist twice. The patient was told to avoid moving too much and resting in bed as much as possible

Results: The authors used a series of manipulations to reduce 100 case’s subluxated joint and put the muscles and sinews in order, and obtained excellent results, the cure rate has been 100%. Over 90% of the cases were cured after one treatment. Cases with accompanying damage to ligaments might need 2 or 3 more treatments by gentle manipulation to completely recover.

Key Words: Subluxation of Sacroiliac Joint, manipulation

Writer: Xiaodong Guo, Yonggang Zhao
Institute of Orthopedics and Traumatology, China Academy ofTraditional Chinese medicine, Beijing 100700