The PGM Method - Sacroiliac Belt and Patient Education: Difference between revisions

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Arumugam et al<ref name=":4">Arumugam A, Milosavljevic S, Woodley S, Sole G. Effects of external pelvic compression on form closure, force closure, and neuromotor control of the lumbopelvic spine–a systematic review. Manual therapy. 2012 Aug 1;17(4):275-84.</ref> (2012) conducted a systematic review on the effects of external pelvic compression on form closure, force closure, and neuromotor control of the lumbopelvic spine and reported moderate evidence for the role of pelvic compression in influencing lumbopelvic kinematic motion, reducing pain, SIJ laxity in individuals with and without lumbopelvic dysfunction.<ref name=":4" />
Arumugam et al<ref name=":4">Arumugam A, Milosavljevic S, Woodley S, Sole G. Effects of external pelvic compression on form closure, force closure, and neuromotor control of the lumbopelvic spine–a systematic review. Manual therapy. 2012 Aug 1;17(4):275-84.</ref> (2012) conducted a systematic review on the effects of external pelvic compression on form closure, force closure, and neuromotor control of the lumbopelvic spine and reported moderate evidence for the role of pelvic compression in influencing lumbopelvic kinematic motion, reducing pain, SIJ laxity in individuals with and without lumbopelvic dysfunction.<ref name=":4" />


Bertuit et al<ref name=":1" /> (2018) analysed the effect of a pelvic belt on pain in pregnancy-related pelvic girdle pain and found that the use of pelvic belts over an average duration of 9 weeks did reduce pelvic girdle pain, especially in the area of the SIJ. Daily activities such as standing, walking and sitting were easier in this study population. The study also suggested that different types of belts may have different effects on global, SIJ and back pain during pregnancy, but this hypothesis needs further investigation and confirmation.<ref name=":1" />
Bertuit et al<ref name=":1" /> (2018) analysed the effect of a pelvic belt on pain in pregnancy-related pelvic girdle pain and found that the use of pelvic belts over an average duration of 9 weeks did reduce pelvic girdle pain, especially in the area of the SIJ. Daily activities such as standing, walking and sitting were easier in this study population. The study also suggested that different types of belts may have different effects on global, SIJ and back pain during pregnancy, but this hypothesis needs further investigation and confirmation.<ref name=":1" />
 
The use of a pelvic compression belt has been shown to improve sitting to standing quality of movement<ref>Kim JM, Je HD, Kim HD. Effects of pelvic compression belts on the kinematics and kinetics of the lower extremities during sit-to-stand maneuvers. Journal of physical therapy science. 2017;29(8):1311-7.</ref> and improve motor control during bridging.<ref>Cha HG, Wu YT, Kim MK. The effects of a pelvic belt on trunk and lower extremity muscles in the bridge position. Journal of physical therapy science. 2016;28(12):3293-5.</ref>


In the clinical practice guidelines for pelvic pain in the antepartum population by Clinton et al<ref name=":5">Clinton SC, Newell A, Downey PA, Ferreira K. Pelvic girdle pain in the antepartum population: physical therapy clinical practice guidelines linked to the international classification of functioning, disability, and health from the Section on Women's Health and the Orthopaedic Section of the American Physical Therapy Association. Journal of Women's Health Physical Therapy. 2017 May 1;41(2):102-25.</ref> it is recommended that clinicians should consider the application or use of a support belt in the antepartum population with pelvic girdle pain, but the recommendation is based on conflicting evidence.<ref name=":5" />
In the clinical practice guidelines for pelvic pain in the antepartum population by Clinton et al<ref name=":5">Clinton SC, Newell A, Downey PA, Ferreira K. Pelvic girdle pain in the antepartum population: physical therapy clinical practice guidelines linked to the international classification of functioning, disability, and health from the Section on Women's Health and the Orthopaedic Section of the American Physical Therapy Association. Journal of Women's Health Physical Therapy. 2017 May 1;41(2):102-25.</ref> it is recommended that clinicians should consider the application or use of a support belt in the antepartum population with pelvic girdle pain, but the recommendation is based on conflicting evidence.<ref name=":5" />
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There are many different sacroiliac belts available on the market to choose from and it is recommended that patients try different ones before deciding which belt they feel most comfortable with.
There are many different sacroiliac belts available on the market to choose from and it is recommended that patients try different ones before deciding which belt they feel most comfortable with.


A good summary of the benefits of an SIJ belt as well as how a clinician can use the active straight leg raise test to determine how much compression is needed with the SI-belt can be read here: [https://www.groovimovements.co.za/the-groovi-si-belt-info-for-the-practitioner/ The Groovi-SI- Belt: Info for the practitioner]
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   <div class="col-md-4"> {{#ev:youtube|watch?v=vULEJCwvFnY|250}} <div class="text-right"><ref>DianeLeePT. Diane Lee's Unique Sacroiliac Belt- The Com-pressor. Available from https://www.youtube.com/watch?v=vULEJCwvFnY. (last accessed 30 January 2021) </ref></div></div>
   <div class="col-md-4"> {{#ev:youtube|watch?v=vULEJCwvFnY|250}} <div class="text-right"><ref>DianeLeePT. Diane Lee's Unique Sacroiliac Belt- The Com-pressor. Available from https://www.youtube.com/watch?v=vULEJCwvFnY. (last accessed 30 January 2021) </ref></div></div>
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Lee (2004) proposed that by varying the location of the compression during the ASLR, further information can be gained regarding which of the local stabilisers are compromised. For example:
Lee (2004) proposed that by varying the location of the compression during the ASLR, further information can be gained regarding which of the local stabilisers are compromised. For example:
 
* Manual compression to approximate the anterior superior iliac spine (ASIS) replicates force closure anteriorly as if the Transversus Abdominis activity is increased.
Manual compression to approximate the anterior superior iliac spine (ASIS) replicates force closure anteriorly as if the Transversus Abdominis activity is increased.
* Compression posteriorly to approximate the PSIS replicates force closure posteriorly as if multifidus activity is increased.
 
* Compression in the direction of medial femoral rotation approximates the pubic symphysis and replicates pubococcygeus (anterior pelvic floor) activity
Compression posteriorly to approximate the PSIS replicates force closure posteriorly as if multifidus activity is increased.
 
Compression in the direction of medial femoral rotation approximates the pubic symphysis and replicates pubococcygeus (anterior pelvic floor) activity
 
If the patient's pain is exacerbated  with compression and the ASLR is more difficult to perform, it is suggested that the patient has to much force closure and in these cases the patient will also not benefit from a SI - belt.
If the patient's pain is exacerbated  with compression and the ASLR is more difficult to perform, it is suggested that the patient has to much force closure and in these cases the patient will also not benefit from a SI - belt.


Revision as of 16:49, 30 January 2021

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Introduction[edit | edit source]

Use of a Sacroiliac Belt[edit | edit source]

The use of a sacroiliac belt is often prescribed for patients with pelvic girdle dysfunction.  Pelvic compression belts or sacroiliac belts are being used in the rehabilitation of pelvic pain in a a variety of populations such as sports people and peripartum women.[1] In athletes it is sometimes prescribed and applied when pain provocation tests for the sacroiliac joint (SIJ) are positive without the belt and negative when the belt is fitted with adequate tension.[2]

The application or use of a SIJ belt is often seen as a method to restore pelvic stability.[3] The mechanism by which external pelvic compression exerts any changes is still unclear.[1] Soisson et al[4] investigated the effects of a pelvic belt on pelvic morphometry, muscle activity and body balance in patients with sacroiliac joint dysfunction and found little evidence that compressive forces were exerted on the SIJ or pelvis. Although a majority of SIJ patients reported decreased pain intensity with a pelvic belt, the mean pain-altering affects averaged over all the patients in the study were minute in the short-term and non-significant. The authors suggest that further research is necessary to investigate and establish differences between SIJ patients and controls in a more long-term and dynamic setting to interpret the dynamic effects of pelvic belts.[4]

Other studies have shown that the use of a sacroiliac belt may provide SIJ and pelvic girdle stability by an increase in force closure[5][6], but this remains controversial.[4] Studies have also shown that pelvic compression belts can reduce SIJ laxity and improve neuromuscular performance in the stabilising muscles of the pelvis.[7][8] Kim et al[9] (2013) investigated effects of a pelvic belt on EMG activity of the abdominal muscles and found that the wearing of a pelvic belt decreased EMG activity of the rectus abdominis (RA), the external obliques (EO) and the internal obliques (IO), thus less effort was required to perform an active straight leg raise (ASLR) when wearing the belt. Furthermore, Kim et al[10] (2014) investigated patients with chronic low back pain and found that external pelvic compression resulted in a reduction of muscle exertion around the pelvis during hip extension in prone.[10] These results support the thought that persistent pain may be associated with greater activation of the muscles involved in force closure, rather than just SIJ instability.[1]

Arumugam et al[11] (2012) conducted a systematic review on the effects of external pelvic compression on form closure, force closure, and neuromotor control of the lumbopelvic spine and reported moderate evidence for the role of pelvic compression in influencing lumbopelvic kinematic motion, reducing pain, SIJ laxity in individuals with and without lumbopelvic dysfunction.[11]

Bertuit et al[3] (2018) analysed the effect of a pelvic belt on pain in pregnancy-related pelvic girdle pain and found that the use of pelvic belts over an average duration of 9 weeks did reduce pelvic girdle pain, especially in the area of the SIJ. Daily activities such as standing, walking and sitting were easier in this study population. The study also suggested that different types of belts may have different effects on global, SIJ and back pain during pregnancy, but this hypothesis needs further investigation and confirmation.[3]

The use of a pelvic compression belt has been shown to improve sitting to standing quality of movement[12] and improve motor control during bridging.[13]

In the clinical practice guidelines for pelvic pain in the antepartum population by Clinton et al[14] it is recommended that clinicians should consider the application or use of a support belt in the antepartum population with pelvic girdle pain, but the recommendation is based on conflicting evidence.[14]

Types of Sacroiliac Belts[edit | edit source]

There are many different sacroiliac belts available on the market to choose from and it is recommended that patients try different ones before deciding which belt they feel most comfortable with.

[15]
[16]
[17]

Sacroiliac Belt and the Active Straight Leg Raise Test[edit | edit source]

The active straight leg raise test (ASLR) assesses the ability of the pelvis to transfer load. It also assesses the functional integrity of the lumbopelvic force closure system in patients with pelvic girdle pain.[18]

With the patient lying in supine, the patient is asked to alternately actively lift each leg approximately 20 cm of the bed/plinth. Observe for substitution strategies such as: abdominal wall bulging, trunk rotation, breath holding, rib flaring, drawing in of the rib cage or overactivation of the contralateral hamstring to perform the lift. Determine whether the movement provokes any lumbopelvic pain. Ask the patient which leg feels heavier to lift. The physiotherapist can then apply a sustained passive compression and the patient repeats the ASLR. With the application of manual compression during the ASLR test the effort to lift the "heavy" leg can be reduced.[19] The test is positive if the patient reports a marked improvement in the amount of effort needed to perform the ASLR.

Lee (2004) proposed that by varying the location of the compression during the ASLR, further information can be gained regarding which of the local stabilisers are compromised. For example:

  • Manual compression to approximate the anterior superior iliac spine (ASIS) replicates force closure anteriorly as if the Transversus Abdominis activity is increased.
  • Compression posteriorly to approximate the PSIS replicates force closure posteriorly as if multifidus activity is increased.
  • Compression in the direction of medial femoral rotation approximates the pubic symphysis and replicates pubococcygeus (anterior pelvic floor) activity

If the patient's pain is exacerbated with compression and the ASLR is more difficult to perform, it is suggested that the patient has to much force closure and in these cases the patient will also not benefit from a SI - belt.

Sub Heading 3[edit | edit source]

Resources[edit | edit source]

  • bulleted list
  • x

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  1. numbered list
  2. x

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Booth J, Morris S. The sacroiliac joint–Victim or culprit. Best Practice & Research Clinical Rheumatology. 2019 Feb 1;33(1):88-101.
  2. ↑ Vleeming, A., Schuenke, M.D., Masi, A.T., Carreiro, J.E., Danneels, L. and Willard, F.H., 2012. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. Journal of anatomy, 221(6), pp.537-567.
  3. ↑ 3.0 3.1 3.2 Bertuit J, Van Lint CE, Rooze M, Feipel V. Pregnancy and pelvic girdle pain: analysis of pelvic belt on pain. Journal of clinical nursing. 2018 Jan;27(1-2):e129-37.
  4. ↑ 4.0 4.1 4.2 Soisson O, Lube J, Germano A, Hammer KH, Josten C, Sichting F, Winkler D, Milani TL, Hammer N. Pelvic belt effects on pelvic morphometry, muscle activity and body balance in patients with sacroiliac joint dysfunction. PloS one. 2015 Mar 17;10(3):e0116739.
  5. ↑ Mens JM, Damen L, Snijders CJ, Stam HJ. The mechanical effect of a pelvic belt in patients with pregnancy-related pelvic pain. Clinical biomechanics. 2006 Feb 1;21(2):122-7.
  6. ↑ Pool-Goudzwaard AL, Vleeming A, Stoeckart R, Snijders CJ, Mens JM. Insufficient lumbopelvic stability: a clinical, anatomical and biomechanical approach to ‘a-specific’low back pain. Manual therapy. 1998 Feb 1;3(1):12-20.
  7. ↑ Damen L, Spoor CW, Snijders CJ, Stam HJ. Does a pelvic belt influence sacroiliac joint laxity?. Clinical Biomechanics. 2002 Aug 1;17(7):495-8.
  8. ↑ Sole G, Milosavljevic S, Sullivan SJ, Nicholson H. Running-related hamstring injuries: a neuromuscular approach. Physical Therapy Reviews. 2008 Apr 1;13(2):102-10.
  9. ↑ Kim YR, Kim JW, An DH, Yoo WG, Oh JS. Effects of a pelvic belt on the EMG activity of the abdominal muscles during a single-leg hold in the hook-lying position on a round foam roll. Journal of physical therapy science. 2013;25(7):793-5.
  10. ↑ 10.0 10.1 Kim JW, Kwon OY, Kim TH, An DH, Oh JS. Effects of external pelvic compression on trunk and hip muscle EMG activity during prone hip extension in females with chronic low back pain. Manual Therapy. 2014 Oct 1;19(5):467-71.
  11. ↑ 11.0 11.1 Arumugam A, Milosavljevic S, Woodley S, Sole G. Effects of external pelvic compression on form closure, force closure, and neuromotor control of the lumbopelvic spine–a systematic review. Manual therapy. 2012 Aug 1;17(4):275-84.
  12. ↑ Kim JM, Je HD, Kim HD. Effects of pelvic compression belts on the kinematics and kinetics of the lower extremities during sit-to-stand maneuvers. Journal of physical therapy science. 2017;29(8):1311-7.
  13. ↑ Cha HG, Wu YT, Kim MK. The effects of a pelvic belt on trunk and lower extremity muscles in the bridge position. Journal of physical therapy science. 2016;28(12):3293-5.
  14. ↑ 14.0 14.1 Clinton SC, Newell A, Downey PA, Ferreira K. Pelvic girdle pain in the antepartum population: physical therapy clinical practice guidelines linked to the international classification of functioning, disability, and health from the Section on Women's Health and the Orthopaedic Section of the American Physical Therapy Association. Journal of Women's Health Physical Therapy. 2017 May 1;41(2):102-25.
  15. ↑ DianeLeePT. Diane Lee's Unique Sacroiliac Belt- The Com-pressor. Available from https://www.youtube.com/watch?v=vULEJCwvFnY. (last accessed 30 January 2021)
  16. ↑ Ask Doctor Jo. How to use a maternity belt or SI belt. Available from https://www.youtube.com/watch?v=MD9rOoM2muw&t=222s. (last accessed 30 January 2021)
  17. ↑ Sam Visnic. How to use an SI belt to relieve your sacroiliac joint pain. Available from https://www.youtube.com/watch?v=MjQyhJxniJk&t=265s. (last accessed 30 January 2021)
  18. ↑ Mens JM, Vleeming A, Snijders CJ, Koes BW, Stam HJ. Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy. Spine. 2001 May 15;26(10):1167-71.
  19. ↑ Mens JM, Vleeming A, Snijders CJ, Stam HJ, Ginai AZ. The active straight leg raising test and mobility of the pelvic joints. European Spine Journal. 1999 Dec;8(6):468-73.
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