Sacroiliac joint dysfunction is an injury common among athletes that affects pelvic stability and alignment, often leading to symptoms on one side of the pelvis.
MET is an indirect therapy technique which involves isometric muscle contraction against an external counterforce to treat joint dysfunction, in this instance to try to get the ilium to rotate posteriorly. Researchers employed this approach in their attempt to achieve posterior rotation.
Symptoms
Sacroiliac (SI) joint dysfunction refers to stiffness or laxity in either of the SI joints located in the lower pelvis, leading to pain in either of them and/or both of them, typically manifested in low back or buttock pain on only one side, typically more prevalent among female patients and often only present on one side symptomatically. SI issues can also contribute to leg length discrepancies which can be painful for some individuals.
SI problems may result from genetics, pregnancy or physical injury; symptoms include muscle imbalances that hinder walking, running and standing activities. SI issues are especially prevalent among runners.
As well as strengthening and stretching exercises, manual techniques like soft tissue release or manipulation as well as core stability training may also help alleviate symptoms of SI joint dysfunction. Such techniques help ensure overall pelvic stability which limits movement at the SI joint.
Studies on treatments for sacroiliac joint dysfunction have demonstrated that using multiple therapies together is most effective. Muscle energy technique, for instance, employs voluntary muscle contraction against an external counterforce in order to directly treat the SI joint[1].
Your physical therapist will begin by carefully positioning an area of your body that requires treatment, then instruct you to push against his resistance in a specific direction until isometric muscle contraction occurs without pain. Finally, they’ll gently move you into new ranges of motion designed to decrease pain and increase mobility in that region.
Recent research has demonstrated the efficacy of Medical Electrotherapy (MET) as a treatment for SIJ dysfunction among chronic low back pain (CLBP) patients with leg length discrepancy (LLD). 42 CLBP patients were divided into either a treatment group or placebo control group and received either three sessions of MET or no treatment at all; treatment was found effective in terms of pain reduction, posture improvement and gait improvement as well as decreasing LLD.
Diagnosis
Sacroiliac (SI) dysfunction is a common complaint among runners and can be caused by abnormal motion of the joint, muscle imbalances or trauma. About 3 out of every 10 patients diagnosed with LBP report pain originating in their SI joint [1]. Correct muscle activation allows for normal load transmission across the lumbopelvic region, so any disruption to this can lead to symptoms like pain, stiffness and functional disability.
MET is a physical technique in which patients perform isometric contraction against resistance in order to mobilize joints and tight muscles, reduce pain, improve circulation, release trigger points and release tension in the antagonist muscle after its counterpart has undergone isometric contraction. Based on principles such as post-isometric relaxation and reciprocal inhibition – which happens after one muscle undergoes isometric contraction of another – MET can also release trigger points and has become popular with physical therapists treating pelvic and sacral dysfunctions.
One study demonstrated that combining muscle energy technique (MET) thrust technique with gluteus medius strengthening exercises led to more improvements in lumbar spine pain, disability and quality of life than traditional exercise alone. This may be attributable to its increased impact on quadratus lumborum involvement with sacroiliac joint dysfunction and treatability by this technique.
Study participants included middle-distance running athletes who were experiencing SI joint dysfunction and divided into two groups – control and experimental. Researchers performed thrust technique of MET on both groups before assessing results using daily activities and the visual analog scale (VAS) with one side representing minimum/no pain while the other represents worst pain from left to right on its 10 cm straight line scale.
At each session of this experiment, the therapist stood waist-level behind their side-lying patient and held their upper end of the table firmly. Once this process had begun, patients were then instructed to abduct their leg until a strong quadratus lumborum response could be detected; this process was repeated six times for twelve sessions; during these times other physical therapy techniques including myofascial release/stretching techniques as well as soft tissue manipulation/manipulation, dry needling and electrical stimulation may have also been implemented by this therapists during these 12 sessions as well.
Treatment
Sacroiliac joint dysfunction, or SIJ pain, occurs when one or both ilium (hip bones) become stuck in an abnormal rotation, leading to abnormal motion at the SI joint, and restricting other joints within the pelvis, leading to muscle compensation and discomfort. The primary purpose of the SI joint is weight transfer from trunk to lower limbs; with proper mobility and motion of this joint it allows even distribution across lower body weight distribution as well as protecting from injuries.
Physiotherapy treatment options may include muscle energy techniques, soft tissue mobilization and manipulation, closed kinetic chain strengthening and proprioceptive reeducation exercises to retrain multiple muscle groups to work in coordination and increase overall pelvic strength. Strong, balanced muscle groups help distribute weight evenly among all of the pelvic joints thereby decreasing stress on SIJ joints.
Muscle energy technique (MET) is a manual therapy technique which involves carefully positioning an affected area by a physical therapist, then instructing you to contract specific muscles by pushing against resistance provided by them in specific directions, followed by relaxation and passively moving into new range of motion gained through Muscle Energy Technique. Ultimately this will lengthen shortened muscles, relieve spasm and decrease tightness within tight muscle tissue.
Post Facilitation Stretch (PFS) and Reciprocal Inhibition MET are two additional muscular energy techniques used to treat SIJ pain. Both approaches involve stretching muscles to midrange range before having patients contract against restriction with effort for five to ten seconds before rapidly stretching back out into extended positions by their therapist and repeating the cycle.
PFS and MET manipulation techniques have been found to be more effective than other forms of SIJ manipulation for treating anterior dysfunction present with middle distance running athletes’ sacroiliac joint pain [1]. Furthermore, these approaches offer a safe alternative to more invasive therapies like intra-articular corticosteroid injections, radiofrequency ablation or joint fusion.
Recommendations
The sacroiliac joint connects the sacrum (a triangular bone at the base of your spine) with two iliac bones on either side of your pelvis. Under normal conditions, this joint moves minimally due to strong ligament support; however, injury, pregnancy, or changes in body weight can increase its mobility, leading to muscle imbalances that result in SI joint dysfunction and pain.
Your physical therapist may use muscle energy technique to restore normal movement of your SI joint. This treatment involves placing his/her hands over the area around the joint and asking you to contract certain muscles against resistance; this elicits isometric muscle contractions which help lengthen short muscles and decrease spasms, and may help realign it properly.
Physical therapists may prescribe exercises to increase mobility of pelvic/SI joint and tight muscles, including mobilization, soft tissue release and stretching techniques, muscle energy techniques or manual therapies such as muscle energy technique (MTC). MCT uses muscle contraction against resistance to promote relaxation, restoration of alignment and pain relief through autogenic inhibition and reciprocal inhibition principles.
Alternating heat or cold, electrical stimulation, and ice massage may also help alleviate pain and decrease inflammation. Your therapist may also teach exercises to strengthen muscles around the joint in order to help prevent SI joint dysfunction in the future, such as strengthening them against future injuries.
While more research needs to be conducted, some studies indicate that muscle energy technique may help relieve the pain from SIJ dysfunction. This treatment method involves realigning of the pelvis with key muscles to reposition the SI joint back to its natural position allowing natural movement of its joint. For optimal results this form of treatment should also be combined with manual therapy and functional training techniques for best results.
