Diagnostic criteria of sacroiliac joint dysfunction in children and adolescents with pain in the lumbosacral region of the spine

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Abstract

BACKGROUND: Back pain is addressed by physicians of many specialties. In many ways, it is associated with a decreased volume of dynamic motor activity and increased static loading. In patients with an active lifestyle, back pain often develops when the technique of physical exercises or habitual movements are violated, often leading to secondary osteoarticular disorders. One of the most common causes of non-specific back pain is sacroiliac joint dysfunction. The ambiguity of information on the types, severity and significance of sacroiliac joint dysfunction has urged us to systematize the existing data so as to create an optimal diagnostic algorithm for the discussed pathology.

AIM: To develop a system for examining patients with back pain so as to make the diagnostics of sacroiliac joint dysfunction more accurate.

MATERIALS AND METHODS: 54 patients aged 7–18 (mean age 14.6±3.32) with pain in the lumbosacral spine were included in the study. All of them had the confirmed dysfunction of sacroiliac joint; specific causes of pain were excluded. The patients were divided into 2 groups, comparable in the number, sex, and age. The patients underwent a clinical neurological and neuroorthopedic examination with additional functional muscle testing, including the assessment of their overall and local muscle strength, elasticity, coordination, biomechanical characteristics, and muscle control. The state of the respiratory muscles (tonus, type of pain, irradiation, elasticity of ribs, etc.) was evaluated during the manual testing, too. A particular attention was paid to testing using an unstable support (redcord/exarta, fitballs and balancing pads). For the better objectivity of the findings, AlterG, TecnoBody, Oxiterra test devices were used additionally.

RESULTS: The anamnestic predictors for the development of sacroiliac joint dysfunction were revealed. The specifics of the postural and biomechanical disorders in children and adolescents with unspecific back pain were analyzed. Cervical disorders were found which promoted secondary osteoarticular dysfunction, including the sacroiliac joint block. A diagnostic algorithm has been developed to identify the underlying cause of back pain in the case of sacroiliac joint dysfunction.

CONCLUSION: The proposed diagnostic algorithm simplifies and systematizes the treatment of patients with sacroiliac joint dysfunction and complaints of back pain. The effectiveness of rehabilitation is improved due to a possibility to precisely select the rehabilitation technique.

About the authors

Nikolaevna N. Zadorina-Negoda

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: galinazadorina@gmail.com
ORCID iD: 0000-0002-0869-4591
SPIN-code: 9504-9352

Research Associate

Russian Federation, 20 Bolshaya Polyanka street, 119180 Moscow

Irina N. Novoselova

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma; Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: i.n.novoselova@gmail.com
ORCID iD: 0000-0003-2258-2913
SPIN-code: 1406-1334

MD, Dr. Sci. (Med.)

Russian Federation, 20 Bolshaya Polyanka street, 119180 Moscow; Moscow

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2. Fig. 1. Muscular-tonic syndrome of the scalene muscles with the formation of a "cervical arch" in the supine position (a); pronounced elevation of the shoulders (rise above the horizontal line) (b); pronounced muscular-tonic syndrome at the shoulder-scapular level does not allow to relax the muscles surrounding the scapula (c).

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3. Fig. 2. Functional hyper lordosis with the formation of a "lumbar arch" on the background of an expressed muscular-tonic syndrome of the lumbar muscles (a); regression of the "arch" of the lumbar owner against the background of recovery (b).

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4. Fig. 3. Analysis of walking on the Alter G apparatus with redistribution of weight on the leg from the side of sacroiliac joint dysfunction.

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5. Fig. 4. Carrying out testing of the movement stereotype on the Alter G apparatus in various modes of lightening the weight (from 20% of its own weight to 100%) with control of the movement speed from 0.1 to 15 km/h.

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6. Fig. 5. TecnoBody apparatus: assessment of vertical stability (a); assessment of muscle control when performing a given movement (b).

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7. Fig. 6. Analysis of graphs on the Oxyterra apparatus: when a spasm of the respiratory muscles with ladder retention of saturation is detected (a); graph obtained during training with stable saturation figures (b).

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8. Fig. 7. Diagnostic algorithm for detecting dysfunction of the sacroiliac joint (КПС). НБС — nonspecific back pain; КСУ — bone-articular level; МТС — musculo-tonic syndrome; КвМП — square muscle of the lower back; ППМ — iliopsoas muscle; ЛМ ― scalene muscles.

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9. Fig. 8. Self-diagnosis: inability to hold the leg and pelvis on the affected side due to increased pain or weakness of the gluteal muscles.

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