Timeline Treatment Rehabilitation Progression PROMs & Home

Advice

Weeks 0-2 Acute treatment frequency – 3 visits per -Tissue sparing – -progression to 2 visits per -Visual Analogue Scale
week for the 1st week reducing to 2 visits adjustment of working week when VAS has performed every visit
per week in the 2nd week, pending position to limit reduced by 2 points to a -Oswestry low back
progression status extension(3G) 4/10 Disability questionnaire
performed every 3rd visit
-Manual therapy -Light duties (ADL & work) - home advise = use
- Myofascial release (Quadratis Reduction in activities that abdominal activation
Lumborum and hamstring) right create or worsen exercise in ADLs
Sided (4G) symptoms –
- Spinal manipulation therapy Running/Sports.
(SIJ & lumbar spine) (1, 2) (1G,5G) Avoidance of: sitting with
SMT of SIJ = Hypothenar/Ilium push knees crossed, sitting with
(PI Ilium) Right side {Bergmann, weight shifted eg/ sitting
2010 #29}(3)
on wallet {Prather, 2004 #30}(5).
SMT of the lumbar spine =
Hypothenar/Spinous push extension
Restriction. L5 – right side (3)

-patient education and advice – Patient

educated on ability to activate their
abdominal muscles and lumbar multifidus
in 4 positions – supine, prone, sitting,
standing and the positive effect of
stabilization of the lumbar spine it causes(4)
(6G)
Weeks 2-4 -Manual therapy
- Myofascial release (Quadratis
Lumborum and hamstring) (4G)
- Spinal manipulation therapy
(SIJ & lumbar spine) (1, 2) (1G,5G)
SMT of SIJ = Hypothenar/Ilium push
(PI Ilium) Right side
{Bergmann, 2010 #29}(3)
SMT of the lumbar spine =
Hypothenar/Spinous push extension
Restriction. L5 – right side (3)
- PNF stretching of piriformis, gluteus
Maximus / medius and hamstring
(6)
Weeks 4-6 -Manual therapy
(9)
- Spinal manipulation therapy
(SIJ & lumbar spine) (1, 2)
SMT of SIJ = Hypothenar/Ilium push
(PI Ilium) Right side
{Bergmann, 2010 #29}(3)
SMT of the lumbar spine =
Hypothenar/Spinous push extension
Restriction. L5 – right side (3)
- PNF stretching of piriformis, gluteus
Maximus / medius and hamstring
(6)
- Dry needling of the right L5-SIJ
-Rehabilitation exercises
of the SIJ & abdominals
(transverse abdominis) –
Quadruped, cat – dog, core
& contraction (2, 4, 7) (2G)
piriformis stretches, single
knee to chest
-Strengthening exercises
of the Gluteus Maximus (8)
(2G)
– glute bridge, body
weight squat, body weight
lunge
- return to play review
(PAR-Q+)
-Rehabilitation exercises
of the SIJ & abdominals
(transverse abdominis) –
Quadruped, cat – dog, core
& contraction (2, 4, 7) (2G)
piriformis stretches, single
knee to chest
-Strengthening exercises
of the Gluteus Maximus (8)
(2G)
– glute bridge, squat,
lunge, hip thrust
-Shift to 1 visit per week if
pain level reduces to 3/10
-review of light duties –
functional ROM testing and
PROM result
-Shift to 1 visit per fortnight
when Oswestry score has
reduced by 20% or VAS is at
2/10
- Home advice =
Rehabilitation exercises
performed at home 5
times per day – 3 sets of
each exercise for 15 reps
-VAS
- Fear avoidance
questionnaire
-VAS performed every
visit
-Oswestry low back
Disability questionnaire
performed every visit
- continue rehabilitation
exercises performed at
home/gym 5 times per
day – 3 sets of each
exercise for 15 reps
References

1. Shearar KA, Colloca CJ, White HL. A Randomized Clinical Trial of Manual Versus
Mechanical Force Manipulation in the Treatment of Sacroiliac Joint Syndrome. Journal of
Manipulative and Physiological Therapeutics. 2005;28(7):493-501.
2. Findings from Iran University of Medical Sciences Has Provided New Information
about Exercise Therapy (Effectiveness of Exercise Therapy and Manipulation on Sacroiliac
Joint Dysfunction: A Randomized Controlled Trial).(Report). Health & Medicine Week.
2019:1015.
3. Bergmann TF, Peterson DH. Chiropractic Technique. 3rd ed. ed: United States:
Mosby; 2010.
4. Richardson AC, Snijders JC, Hides AJ, Damen SL, Pas SM, Storm SJ. The Relation
Between the Transversus Abdominis Muscles, Sacroiliac Joint Mechanics, and Low Back
Pain. Spine. 2002;27(4):399-405.
5. Prather H, Hunt D. Conservative management of low back pain, part I. Sacroiliac joint
pain. Disease-a-month : DM. 2004;50(12):670-83.
6. Massoudarab A, Rezanourbakhsh M, Mohammadifar A. The relationship between
hamstring length and gluteal muscle strength in individuals with sacroiliac joint dysfunction.
Journal of Manual & Manipulative Therapy. 2011;19(1):5-10.
7. Al-Subahi M, Alayat M, Alshehri MA, Helal O, Alhasan H, Alalawi A, et al. The
effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: a systematic
review. J Phys Ther Sci. 2017;29(9):1689-94.
8. Added MAN, de Freitas DG, Kasawara KT, Martin RL, Fukuda TY. STRENGTHENING
THE GLUTEUS MAXIMUS IN SUBJECTS WITH SACROILIAC DYSFUNCTION. Int J Sports Phys
Ther. 2018;13(1):114-20.
9. Prather H. Sacroiliac Joint Pain: Practical Management. Clinical Journal of Sport
Medicine. 2003;13(4):252-5.

Reference - Intervention Guideline use & quote Level

guidelines
1G Thrust manipulation Low Back Pain Clinical Practice I, II
to the lumbar spine Guidelines Linked to the
International Classification of
Functioning, Disability, and Health
from the Orthopaedic Section of the
American Physical Therapy
Association
“Research has determined a subgroup
of patients likely to have dramatic
changes with application of thrust
manipulation to the lumbar spine “

‘Evidence-based Management of I
Acute Musculoskeletal Pain’
“There is conflicting evidence that spinal
manipulation provides pain relief compared to
placebo in the first two to four weeks of acute
low back pain.”
2G Mobility exercise, Low Back Pain Clinical Practice II, I
exercise therapy Guidelines Linked to the
International Classification of
Functioning, Disability, and Health
from the Orthopaedic Section of the
American Physical Therapy
Association
“advice to remain active “
“reported that exercise therapy was
effective in decreasing pain in the
chronic population, graded activity
improved absenteeism in the subacute
population”

3G Remaining active ‘Low Back Pain Clinical Practice II

Guidelines Linked to the
International Classification of
Functioning, Disability, and Health
from the Orthopaedic Section of the
American Physical Therapy
Association
“advice to remain active, and mobility
exercise “

‘Evidence-based Management of
I,II
Acute Musculoskeletal Pain’
“Advice to stay active provides a small beneficial
effect on pain, rate of recovery and function
compared to bed rest and compared to a
specific exercise regime in mixed (acute/chronic)
populations with low back pain.”
4G Massage therapy ‘Evidence-based Management of I,II
Acute Musculoskeletal Pain’
“Massage is superior to placebo (sham laser)
and acupuncture in mixed populations with low
back pain.”

5G Thrust manipulation ‘Low Back Pain Clinical Practice A

of the hip Guidelines Linked to the
International Classification of
Functioning, Disability, and Health
from the Orthopaedic Section of the
American Physical Therapy
Association
“Thrust manipulative and nonthrust
mobilization procedures can also be
used to improve spine and hip mobility
and reduce pain and dis- ability in
patients with subacute and chronic low
back and back-related lower extremity
 pain. “
6G Patient education ‘Low Back Pain Clinical Practice V
Guidelines Linked to the
International Classification of
Functioning, Disability, and Health
from the Orthopaedic Section of the
American Physical Therapy
Association
“Educate patient in home care
treatment program” and
“Recommends strategies to prevent
recurrent problems” ranked as the
high- est 2 out of a list of 12
intervention strategies “

‘Evidence-based Management of II
Acute Musculoskeletal Pain’
“Printed information provided through the mail
is less likely to have an effect on pain, disability
and sick leave compared to information
provided in person.”