The relative effectiveness of manipulation with and without the contract-relax-antagonist-contract technique of proprioceptive neuromuscular facilitation stretching of the piriformis muscles in the treatment of sacroiliac syndrome

Abstract

This study aims to provide insight into the relative effectiveness of two different approaches in the treatment of sacro - iliac syndrome. Until recently, the sacro - iliac joints were not commonly considered to be mobile enough to suffer from detectable restriction of motion (Panzer and Gatterman 1995:453). Kirkaldy - Willis et al. (1992:126) however, states that sacro - iliac syndrome is a well defined and common type of dysfunction. Frymoyer et al. (1991 :2114) also reports sacro - iliac syndrome to be common, although it is frequently overlooked as a source of low back pain. This study will attempt to determine whether manipulation of the sacro - iliac joints together with Proprioceptive Neuromuscular Facilitation (P.N.F.) stretching of the piriformis muscles is a more effective treatment for sacro - iliac syndrome, than manipulation alone. This will be accomplished by determining which approach yields the best patient response in terms of subjective and objective clinical findings. The study conducted was a randomised clinical trial consisting of two groups of 30 patients each. The patients were randomly allocated into the two groups. All patients received four treatments over a two - week period. Group one received manipulation of the sacro - iliac joints alone, while Group two received manipulation of the sacro - iliac joints together with P.N.F. stretching of the piriformis muscles. Only the sacro - iliac joint on the side of the sacro - iliac syndrome was manipulated, and only the piriformis muscle on the side of the sacro - iliac syndrome was stretched. If any patients became asymptomatic within the treatment period, then the treatment was terminated. The patients were however required to return for all the remaining consultations for observational purposes. The results of the Numerical Pain Rating Scale, Oswestry Low Back Disability Index questionnaire, inclinometer and algometer readings, as well as the sacro - iliac orthopaedic tests, were recorded before the first and second treatments, and immediately following the fourth (final) treatment.