Children with sharp, one-sided lower back pain that travels down the buttocks may be suffering from sacroiliac (SI) joint dysfunction. The condition is often caused by rigorous sports play in youth and is far more common in girls, given the general looseness of the developing female pelvic girdle.
The SI joints attach the large hip bones to the spine on each side. They typically allow for very little movement; SI joint dysfunction occurs when too much or too little movement is allowed. The repeated stresses of activities like dance or track and field, or impact injuries from sports like football or softball, can cause the joint to be either dislodged or locked in place.
SI joint dysfunction can be identified either by injecting a numbing agent into the joint to see if it stops the pain or by an assessment in which the child performs certain movements and indicates pain to an observing professional trained to identify SI joint dysfunction through movement patterns. This condition is increasingly thought to be a prevalent and overlooked cause of back pain in adults. It may also be prevalent among young people, whose bodies are still developing.
It may be frightening to imagine a child with a misaligned joint, but SI joint dysfunction may be very easily and safely treated among youth. One study sought to test the effectiveness of muscle energy technique in the realignment of the SI joint. Put simply, muscle energy technique involves the patient using his or her muscles to push against a counterforce. In the study, youth diagnosed with SI joint dysfunction did hip extension and flexion exercises while a physical therapist provided resistance. From a supine position, each patient first attempted to straighten their affected side's leg as the therapist resisted; this engaged the gluteus maximum muscle in the buttocks and pulled back on the pelvis. If this didn't realign the joint, the patients would attempt to re-bend the leg as the therapist resisted; this engaged the iliopsoas in the front of the hip and pulled the pelvis forward.
By using simple muscle engagement to change the position of the pelvis, 80% of the study's participants experienced significant relief of painful symptoms. 53% had complete, immediate resolution of pain. Average pain scale scores dropped nearly 4 points (within a 10-point scale) post-treatment. Of the 20% (9 patients) who did not experience relief, 2 had a spinal condition and 3 had histories of spinal surgeries. The full study can be viewed at http://thejns.org/doi/full/10.3171/2012.2.PEDS11220?prevSearch
