Novel approaches to improve pain and function in those with sacro-iliac joint dysfunction

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Patients with low back pain who fulfil the diagnostic criteria for deficient load transfer through the sacro-iliac joint (SIJ) (Hungerford et al, 2004; Mens et al, 2001) (sacro-iliac joint dysfunction) and who do not respond to exercise therapy have deficient ligamentous function. 1. The primary hypothesis of this study is that the injection of 20% Glucose solution into the posterior ligaments of the SIJ will stimulate the formation of new collagen and increase ligament strength. Tis will be measured by improvement in the following tests: a) Stork test (Hungerford et al Spine 2004), b) Active straight leg raise (ASLR) (Mens et al, 2001 and 2002) , c) Posterior pelvic pain provocation test (PPPP) (Ostgaard et al, 1994, Vleeming et al, 2002) d) Palpation of the long dorsal sacro-iliac ligament (Vleeming at al, 1996) 2. The secondary hypothesis is that the improvement in the ligament function will lead to a decrease in symptoms and an improvement in quality of life measured by a) Quebec Back Pain Disability Scale (Kopek et al, 1995) and b) Patient Generated Index Questionnaire (PGI) Ruta at al, 1994 Both have been used previously in back pain studies. The aim of the study is to compare by randomised trial wether CT guided injection of 20% glucose solution into the ligaments of the sacroiliac joint as compared to a sham injection control results in a) A negative Stork test b) A negative ASLR test c) A negative PPPP test d) A lower Quebec score e) Improvement in the PGI, as measured three months after the intervention

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