Elsevier

Physical Therapy in Sport

Volume 13, Issue 4, November 2012, Pages 279-285
Physical Therapy in Sport

Case study
Application of posterior pelvic tilt taping for the treatment of chronic low back pain with sacroiliac joint dysfunction and increased sacral horizontal angle

https://doi.org/10.1016/j.ptsp.2011.10.003Get rights and content

Abstract

Objective

Kinesio Taping (KT) is a therapeutic method used by physical therapists and athletic trainers in combination with other treatment techniques for various musculoskeletal and neuromuscular problems. However, no research has evaluated the effect of KT in patients with low back pain (LBP). The purpose of this case was to describe the application of posterior pelvic tilt taping (PPTT) with Kinesio tape as a treatment for chronic LBP and to reduce the anterior pelvic tilt angle.

Design

Case report.

Case description

The patien was a 20-year-old female amateur swimmer with a Cobb’s angle (L1–S1) of 68°, a sacral horizontal angle of 45°, and pain in both medial buttock areas and sacroiliac joints. We performed PPTT with Kinesio tape for 2 weeks (six times per week for an average of 9 h each time).

Results

The patient’s radiographs showed that the Cobb’s angle (L1–S1) had decreased from 68° to 47° and that the sacral horizontal angle had decreased from 45° to 31°. Reductions in hypomobility or motion asymmetry, as assessed by the motion palpation test, and in pain, as measured by the pain-provocation tests, were observed. On palpation for both medial buttock areas in the prone position, the patient felt no pain. The patient experienced no pain or stiffness in the low back area while performing forward flexion in the standing position with knees fully extended when washing dishes in the sink.

Conclusions

The case study demonstrated that PPTT intervention favourably affected the pelvic inclination and sacral horizontal angle, leading to beneficial effects on sacroiliac joint dysfunction (SIJD) and medial buttock pain. Additional research on the clinical effects of this taping procedure requires greater numbers of athletes with SIJD or LBP who have inappropriate anterior pelvic tilt angles and hyperlordosis.

Introduction

Low back pain (LBP) is an important health problem that affects adults in general, and postural change is one of the risk factors for LBP (Evcik & Yücel, 2003). Clinical observations have suggested that maintenance of normal lumbar lordosis is important in the treatment of spinal disorders; therefore, measurement of the lumbar curve is important for making clinical decisions (Chen, 1999, Chernukha et al., 1998). Various studies have examined the relationship between back pain and changes in the angle of the lumbar spine (Lin, Jou, & Yu, 1992). Increased lordosis has been advocated as the major cause of postural pain, radiculopathy, and facet pain (Cailliet, 1995). The possible negative consequences of this excessive lordosis include increased compression of the apophyseal joint and increased anterior shear force at the lumbosacral junction, which may progress to spondylolisthesis (Neumann, 2009). L5–S1 segmental lordosis reportedly increases in patients with chronic low back pain (Korovessis, Stamatakis, & Baikousis, 1999). The degree of lumbar lordosis increases when the anterior pelvic tilt increases in the standing position (Levine & Whittle, 1996), and increases in lumbar lordosis lead to increases in sacral inclination and sacral horizontal and lumbosacral angles (Evcik and Yücel, 2003, Sarikaya et al., 2007).

The sacroiliac joint (SIJ) is a known source of LBP, conferring pain to the lower limbs (Maigne et al., 1996, Schwarzer et al., 1995) and buttock region (Hansen & Helm 2003). Previous studies have established the clinical reality that the SIJ may be a source of LBP by demonstrating symptomatic relief after intra-articular injection of the SIJ (Ilaslan et al., 2010, Rupert et al., 2009). SIJ-mediated pain can result from inflammatory arthritis, ankylosis (Berthelot et al., 2001, Braun et al., 2000), osteoarthritis, post-traumatic arthritis (Bernard & Cassidy, 1991), and infection (Grace, Sim, Shives, & Coventry, 1989). Although controversial, sacroiliac joint dysfunction (SIJD) is thought to be the primary source of SIJ pain (Dreyfuss et al., 1996, Elgafy et al., 2001). Levangie (1999) proposed two hypotheses with respect to the pain associated with SIJD. The first proposed that the pain is caused by nociceptive mechanical stress on the structures attached to the innominates or within the SIJ due to asymmetry of the pelvic ring. The second suggested painful mechanical stress on the surrounding and intervening tissues due to SIJ hypomobility, with or without positional abnormalities, within one or both SIJs. On the other hand, DonTigny (2005) defined SIJD as a pathological release of the self-bracing position with anterior pelvic rotation. In addition to bilateral SIJD, this patient showed increased lumbar lordosis, and the pelvis was tilted anteriorly (DonTigny, 2005).

The use of Kinesio Taping (KT) is gradually increasing in orthopedic, sports medicine, and neuromuscular rehabilitation (Yasukawa, Patel, & Sisung, 2006). Both lymph and blood circulation may be enhanced (Kase, Wallis, & Kase, 2003) and the muscular and affected myofascial functions may improve at the sites where KT is applied (Yoshida & Kahanov, 2007). The application of KT to the skin stimulates cutaneous mechanoreceptors (Chang, Chou, Lin, Lin, & Wang, 2010), increasing the isokinetic eccentric peak torque (Vithoulka, Beneka, Malliou, Aggelousis, Karatsolis, & Diamantopoulos, 2010) and relieving the pain of shoulder impingement syndrome (Kaya, Zinnuroglu, & Tugcu, 2011). According to previous studies, the application of KT in hemiplegia patients promoted the functional use of the upper extremities by supporting the weakened muscles, reducing pain (Jaraczewska & Long, 2006), and increasing the bioelectric activity of the low trapezius (Hsu, Chen, Lin, Wang, & Shih, 2009), vastus medialis (Slupik, Dwornik, Bialoszewski, & Zych, 2007), and scapular muscles (Lin, Hung, & Yang, 2011).

No studies to date have evaluated the effect of KT in patients with LBP. The purpose of this case report was to describe the application of posterior pelvic tilt taping (PPTT) with Kinesio tape as a treatment for chronic LBP and to reduce the anterior pelvic tilt angle.

Section snippets

Case description

A 20-year-old female amateur swimmer who complained of severe pain in both the medial buttock areas (e.g., approximately 5 cm lateral from both posterior superior iliac spines (PSIS)) and SIJs was assessed over a 1-month period. She complained of continuous LBP for 2 years, and an examination revealed that her pelvis was tilted anteriorly. She had not undergone any specific treatment for this condition. More recently, the SIJ and medial buttock pain had become severe following repeated lumbar

Results

Further assessments were carried out before and after the PPTT. After the initial application of the PPTT, the anterior pelvic tilt angles were reduced to 11° and 12° on the right and left sides (Fig. 5, Fig. 6), respectively. On palpation of both medial buttock areas, the VAS scores decreased to 7/10 in the prone position. The positive motion palpation test results of the right SIJ all reversed, becoming negative, as did the supine-sitting test result of the left SIJ. In the pain-provocation

Discussion

Application of PPTT was performed for 2 weeks to provide continuous mechanical correction to the posterior tilt of the innominates. After two applications of PPTT, all of the previously positive motion palpation test results had become negative, and the pain initially experienced in the pain-provocation tests was resolved; this status was maintained in the subsequent taping treatment period. Although subjective VAS scores were used as a method of measurement, the pain-relieving effect on both

Conclusion

We applied PPTT with Kinesio tape to an amateur swimmer with increased anterior pelvic tilt angles, sacral horizontal angles, and pain in both the medial buttock area and SIJs during a 2-week intervention. The present study demonstrated that PPTT favorably affected the pelvic inclination and sacral horizontal angles and displayed a positive effect on pain in the SIJ and the medial buttock areas. Additional research on the clinical effects of this taping procedure, investigating a greater number

Conflict of Interest Statements

None declared.

Ethical approval

The subject signed an informed consent document that was approved by the Human Ethics Committee of the Faculty of Health Sciences at Inje University.

Funding

None declared.

Acknowledgements

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (No. 2011-0005580).

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