Management of sacroiliac dysfunction and lower extremity lymphedema using a comprehensive treatment approach: a case...

Sacroiliac joint (SIJ) dysfunction, a common source of low back and buttock pain, can occur from cumulative shear or torsional forces during activities such as walking that require weight to transfer from one extremity to the other. Individuals with lower extremity lymphedema may also experience SIJ dysfunction. The purpose of this article was to describe the examination, diagnosis, and intervention for a patient with lower extremity lymphedema and sacroiliac joint dysfunction. The patient was a 50-year-old female with increased left lower extremity lymphedema and left buttock and groin pain that was previously treated unsuccessfully with physical therapy. SIJ dysfunction was attributable to an alteration in gait pattern caused by increased limb volume associated with lymphedema. The patient was treated for 19 visits over six weeks with complete decongestive therapy (CDT), muscle energy techniques, core stabilization, and the application of a pelvic support belt. Objective changes include decreased lymphedema, increased lower abdominal and lumbar extension strength, and decreased Oswetry Disability Index ratings. The patient was able to ambulate community distances without an assistive device and to resume unsupervised strength and conditioning without pain.