ORIGINAL ARTICLE Frequency of Sacroiliitis in Low Back Pain due to Prolonged Sitting Nabiha Mujahid Faruq,1 Parkash Israni2 and Nosheen Zehra3 ABSTRACT Objectives: To assess the frequency of Sacroiliitis in patients with Low Back Pain (LBP) due to Prolonged Sitting Methodology: A cross-sectional study was conducted in Physiotherapy Department of Ziauddin University Hospital among patients with history of low back pain and continuous sitting for minimum 3 hours. Data was collected from 216 patients who were selected through convenience sampling technique. A pre tested and structured questionnaire was used to collect data. Data was entered and analyzed by using SPSS version 17. Results: It was found that out of 216 patients, 127 (58.8%) had sedentary work. Mean of pain intensity in VAS scale was found as 4.81 ±1.63. It was observed that sitting has been the most aggravating factor for LBP and it was relieved by rest, physiotherapy and medication. Association of frequency of LBP with gender and daily continuous sitting was found significant with p-value=0.03 and 0.00 respectively. Among LBP patients Faber’s test was used for diagnosis of Sacroiliitis. Faber’s test association with type of work was found significantly positive in those with sedentary work with p-value=0.031. Conclusion: The study showed that there was significant association of prolonged sitting with Sacroiliitis in patients with LBP. Key words: Low back pain, prolonged sitting, sacroiliitis. How to cite this article: Faruq NM, Israni P, Zehra N. Frequency of sacroiliitis in low back pain due to prolong sitting. J Dow Uni Health Sci 2014; 8(1): 26-30. INTRODUCTION accepted that about 13% (95% CI: 9-26%) of patients with persistent low back pain have the origin of pain Low back pain (LBP) refers to the pain felt in lower confirmed as the SIJ.5,15 Risk factors of Sacroiliitis back region. Such pain or discomfort affects the lower include poor posture, weak muscles, bending or twisting back as it supports most of our body's weight. Sitting the back, improper lifting, Ankylosing spondylitis, has been associated with risk of developing LBP.1 history of bone, joint or skin infections, Injury or Other risk factors of LBP may include old age, family trauma, Urinary tract infection, Pregnancy, obesity and history, pregnancy, compression fractures, back surgery, Illicit drug use.2 Treatment options may include various congenital deformity, sedentary lifestyle, poor posture ways of relieving inflammation. Non-steroidal Anti- and physical stress.2 inflammatory drugs can be useful in some cases. Sacroiliitis is an inflammatory arthritis of the sacroiliac Physiotherapy can be helpful in relieving pain in the joints that causes pain and stiffness of the lower back lower back and buttock region that can be associated frequently radiating into the buttocks. The relationship with Sacroiliitis. There may be some severe cases that between the sacroiliac joint (SIJ) and low back pain may require cortisone injection to block nerve pain. has been a subject of debate among some researchers The reason behind this research is to assess the regarding SIJ pain as a major contributor to the low association between sitting and presence of LBP and back pain problem3 with others regarding italso as frequency of Sacroiliitis in LBM. Research by unimportant or irrelevant.4,15 It is now generallyBlack KM was restricted to those occupations that require sitting for more than half of working time.1 Department of Physical Therapy1,2, Department of Community Health Sciences3, Ziauddin University, Karachi, Here “sitting” was discussed in the context of Western Pakistan. standards. Sitting was described as an erect posture in which the head and trunk are vertical, the lower legs Correspondence: Nabiha Mujahid Faruq, Department of Physical Therapy, Ziauddin University, Karachi, Pakistan. are bent at about 90 degrees at the hips and knees, and the feet are firmly placed on the floor.7 LBP has been Email: [email protected] 26 Journal of the Dow University of Health Sciences Karachi 2014, Vol. 8 (1): 26-30 Frequency of sacroiliitis in low back pain due to prolong sitting identified as one of the most costly disorders among Sample size was calculated with WHO sample size the worldwide working population.1,8,11,20 It can be estimation calculator. For sample size calculation caused by lifting a heavy object, sudden movements, prevalence of SIJ in LBP was taken as 13%, at 95% prolonged sitting in same position (especially in cars, confidence level and keeping 0.05 margin of error. The trucks and poorly designed chairs),9 or have an injury minimum number of participants required for inclusion or accident. Compared to standing posture, sitting in the sample was calculated as 174 but total 216 causes decrease in lumbar lordosis and at the same patients were included in the study. time increases low back muscle activity, disc pressure, and also the pressure on the Ischium, which are Data were collected through non probability convenience associated with Occupational LBP.8 Lower back sampling technique. For sample selection, those patients commonly reduces tolerance for the prolonged sitting of LBP were included in the study that had routine sitting required by many occupations and routine daily of more than 3-4 hours continuously every day. Patients activities.9 who had previous history of degeneration, post-operative, carcinoma and other diseases that might cause back pain Sacroiliac joint (SIJ) pain is a challenging condition were not included in the study. accounting for approximately 20% of cases of low back pain.1 Pain is present in the region of the SIJ.A pre tested and structured questionnaire was used to Stressing the SIJ by clinical tests reproduces the patient’s collect data. Patients were interviewed and detailed pain and selective infiltration of that joint relieves the history related to pain was asked and noted in the pain completely.10 In another study there were 70 questionnaire. (52%) patients with LBP of whom 31 (45%) had A diagnostic test was performed known as Faber’s test Computed Tomography (CT) evidence of Sacroiliitis. for the diagnosis of Sacroiliitis on patients with LBP. These were categorized by frequent episodes of morning spinal stiffness and positive sacroiliac compression The patient was in supine lying position, where the tests even in patients in which Sacroiliitis was not knee was flexed and the ankle was placed on the suspected.11 Schwarzer et al.12 have demonstrated that opposite knee. The hip was placed in flexion, abduction, the SIJ is a likely cause of low back pain in up to 30% and external rotation (from where the name FABER of patients presenting to a clinic. Daum13 stated that the comes from). The examiner applied a posteriorly SIJ is an underappreciated cause of LBP and pelvic pain, directed force against the medial knee of the bent leg towards the table top. A positive test occured when as well as a source of pain referred to the proximal lower 31 extremities. The incidence of sacroiliac joint disease in groin pain or buttock pain was produced. patients with LBP has been earlier evaluated by using Purpose of the study was explained to participants and CT scans of lumbosacral spine of the 64 patients, 48 informed consent was taken before including these cases (75%) had CT evidence of osteoarthritis at the patients in the study. Data were entered and analyzed sacroiliac joint. The authors concluded that there is a by using SPSS version 17. Frequencies and percentages high incidence of sacroiliac joint arthritis in patients 14 were calculated for qualitative variables while mean undergoing evaluation for LBP. and standard deviation for quantitative variables. Chi Purpose of this research is therefore to steer future square test was used to find association for qualitative research into areas with the greatest potential. Sacroiliac variables and p vale <0.05 was considered as significant. pain can be a cause of low back pain while prolonged sitting is a known risk factor of low back pain but the RESULTS association of prolonged sitting with Sacroiliitis has Total n= 216 patients were included in the study with not been discussed or researched in detail so far. Due mean age of 37 + 9 years. There were 120 (55.6%) to this, it is observed that quite frequently Sacroiliac males and 96 (44.4%) females. Out of the 216 patients, pain is missed out when assessing low back pain, 89 (41.2%) had active work stations while 127 (58.8%) focusing on other causes. There is an increasing demand had sedentary work. Of total, 144 (66.7%) patients had for evidence based health care. So the aim of this study a daily sitting of 3 hours while 72 (33.3) sat for 4 or was to assess the frequency of Sacroiliitis in patients more hours continuously every day. with Low Back Pain due to Prolonged Sitting. Among these patients 107 (49.5%) had frequent Low METHODOLOGY back pain, 45 (20.8%) had occasional, 39 (18.1%) had A cross sectional study was conducted in Physiotherapy constant and 25 (11.6%) had it once in a while. Intensity Department of Ziauddin Hospital, Karachi, Pakistan. of pain was measured by Visual Analogue Scale (VAS) Data were collected from patients who visited OPD which expresses pain numerically i.e. from 1-10, 1 being for management of LBP. Study was completed in 6 the mildest intensity of pain and 10 most severe. Mean months. of pain intensity in VAS scale was found as 4.81 ±1.63. Journal of the Dow University of Health Sciences Karachi 2014, Vol. 8 (1): 26-30 27 Nabiha Mujahid Faruq, Parkash Israni and Nosheen Zehra Table 1: Aggravating and Relieving factors of LBP in 17 (7.9%) pain radiated to both legs, in 18 (8.3%) to Percentage (%) Frequency right leg and in 13 (6%) to the left.