[Radiographic clinical and functional diagnosis and treatment of low back pain associated with pelvic malposition]

Low back pain ist frequently associated with malposition of the pelvis due to an imbalance of the postural muscles. In these patients functional malposition of both the sacrum and the ileum can be observed, resulting in differences in the length of the legs. We investigated whether the return to a normal position correlated with pain relief.

A total of 40 control patients and 65 patients with low back pain were included in this retrospective study. Prior to the start and at the end of the treatment period the differences in the length of the legs were determined manually and radiographically at the ankles with the patient in the supine and sitting position. Furthermore, somatic dysfunctions at C0/C1 or C2/C3 were determined in all patients. In the low back pain group, 39 patients were treated with manual therapy at the cervico-occipital joints and/or infiltration of the iliosacral joint with local anaesthetics and 26 patients were treated with parenteral non-steroidal anti-inflammatory drugs (NSAIDs). The success of the treatment was determined after 6 months and correlated with a return to the normal pelvic position.

Somatic dysfunction at C0/C1 or C2/C3 and differences in the length of the legs were observed in 32 control patients and in all patients with low back pain. Manual therapy/lidocaine infiltration resulted in complete long-term pain relief in 23 patients (59 %), while in the NSAID group only 4 patients (15 %) became pain free (P < 0.05). Long-term pain relief significantly correlated with normalization of the pelvic position.

Differences in the length of the legs can be successfully treated by manual therapy at C0/C1 or C2/C3 in the majority of patients with pelvic malposition. However, infiltration of the iliosacral joints is often required as additional therapy for short-term and long-term pain relief. Treatment with NSAIDs alone is only seldom effective in cases of pelvic malposition and rarely affords long-term pain relief.