A recent case report in the Journal of Physical Therapy Science describes the benefits of specific strengthening of the subdivisions of the gluteus medius in a patient with sacroiliac joint pain (SIJ). The intervention is based in prior research that demonstrated varied muscle firing patterns in the gluteus medius during different exercises. The author of the study suggests that the stabilizing role of the gluteus medius can influence sacroiliac joint pain.
The patient in the case report was a 32 year-old female who complained of pain in the left iliac crest area and sacroiliac joints for 6 months. Symptoms worsened with forward bending, standing for more than an hour or walking for more than thirty minutes. Before and after a 3 week intervention of specific strengthening exercises, objective tests included the Gaenslen, Patrick, and the resistive abduction (REAB) test. These tests were all positive for pain provocation. Exercises were instructed for gluteus medius strengthening and were performed over a period of three weeks. Following the 3 week exercise intervention focused on gluteus medius strengthening, the patient's Visual Analog Scale improved from a 7/10 to a 3/10, and repeated objective tests were negative. Exercises for the various portions of the gluteus medius (GM) were prescribed at 3 sets of 30 repetitions/day and are as below:
Keeping in mind that this case represents only one clinician/patient interaction, we can ask ourselves several questions about the positive results of the intervention. Are we currently challenging the hip abductors enough with our patients who have pelvic girdle pain, and is there enough specificity in the exercises to challenge the appropriate muscle fibers? Can isolated strengthening of hip abductors in absence of other interventions have a positive effect on sacroiliac joint pain in our patients? Are there other plausible rehabilitation concepts inherent in performing these open and closed chain activities that contributed to improvement in this particular patient, rather than an isolated increase in muscle training for the gluteus medius? The sacroiliac joint can be a confounding source of pain, and at the same time, successes in treating patients who have SIJ dysfunction can be very rewarding. If you would like to learn more about evaluation and treatment of sacroiliac dysfunction, the next opportunity to take faculty member Peter Philip's course Sacroiliac Joint & Pelvic Ring Dysfunction, offered next in Seattle in January.