Sacroiliac joint pain in the pediatric population

The sacroiliac (SI) joint can be a pain generator in 13%-27% of cases of back pain in adults. These numbers are largely unknown for the pediatric population. In children and especially girls, development of the pelvic girdle makes the SI joint prone to misalignment. Young athletes sustain repeated stress on their SI joints, and sometimes even minor trauma can result in lasting pain that mimics radiculopathy. The authors present a series of 48 pediatric patients who were evaluated for low-back pain and were found to have SI joint misalignment as the cause of their symptoms. They were treated with a simple maneuver described in this paper that realigned their SI joint and provided significant improvement of symptoms.

A retrospective review of the electronic records identified 48 patients who were referred with primary complaints of low-back pain and were determined to have SI joint misalignment during bedside examination maneuvers described here. Three patients did not have a record of their response to treatment and were excluded. Patients were evaluated by a physical therapist and had the realignment procedure performed on the day of initial consultation. The authors collected data regarding the immediate effect of the procedure, as well as the duration of pain relief at follow-up visits.

Eighty percent of patients experienced dramatic improvement in symptoms that had a lasting effect after the initial treatment. The majority of them were given a home exercise program, and only 2 of the 36 patients who experienced significant relief had to be treated again. Fifty-three percent of all patients had immediate and complete resolution of symptoms. Three of the 48 patients had missing data from the medical records and were excluded from computations.

Back pain is multifactorial, and the authors' data demonstrate the potential importance of SI joint pathology. Although the technique described here for treatment of misaligned SI joints in the pediatric patients is not effective in all, the authors have observed significant improvement in 80% of cases. Often it is difficult to determine the exact cause of back pain, but when the SI joint is suspected as the primary pathology, the authors have described a simple and effective bedside treatment that should be attempted prior to the initiation of further testing and surgery.