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Keywords

Clinical Practice in Athletic Training

Abstract

Introduction: Research has indicated an increased prevalence of low back pain (LBP) due to SIJ dysfunction, with some reports suggesting it is the main source of pain in 15- 30% of cases. Women are more prone to incidence of SIJ pain due to a wider, more uneven, less curved, and posteriorly rotated sacrum. Additionally, women have increased mobility at the SIJ which increases stress and shear loading. Repetitive loading such as running can further contribute to SIJ dysfunction. Research suggests that female runners with SIJ pain had common biomechanical patterns putting them at more risk for injury including decreased knee flexion, tibial overstride, and increased dorsiflexion at the point of initial contact. The purpose of this case is to outline the examination and treatment of a 53-year-old female distance runner with a chief complaint of left sided SIJ pain limiting her ability to run without pain and participate in other activities such as yoga and strength training. Patient Information: The patient is an otherwise healthy, Caucasian, active 53-year-old female distance runner. Subjective history indicates a history of back pain with no prior treatment or physical therapy. She presents with pain, tightness, and tenderness in the lumbosacral area, near the posterior superior iliac spine (PSIS). Initial observation reveals impaired mobility in the lumbar and thoracic spine, unstable weight transfers during gait, limited ankle dorsiflexion, limited hip extension, in addition to poor posture and body mechanics. The functional screening exam revealed altered running gait due to biomechanical impairments in strength, stability, and muscular restriction. Inspection and palpation showed a left upslip of the pelvis, a left unilateral flexion lesion of the sacrum, and a flexed sacrum. Interventions: The patient was seen a total of three times in the clinic. Manual techniques were used to correct pelvis and sacral positioning, and she was given a home exercise program to follow on her own to address strength and mobility deficits contributing to her altered running gait. Outcomes: The primary outcome of this case was an overall decrease of pain, the ability to return to all recreational activities without pain including running, strength training, and yoga. Clinical Bottom Line: There is a scarcity of research on SIJ dysfunction in women and even less looking specifically at the relationship of running gait on SIJ pain. Consequently, there is also insufficient evidence-based treatment for SIJ pain in female runners. The patient in the case improved with treatment in the short term but was only seen three times with no long-term follow-up. Further studies on female runners with SIJ pain are needed to determine if addressing biomechanical gait deficiencies will improve functional outcomes and reduce pain in the long term.

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