The role of prism glass and postural restoration in managing a collegiate baseball player with bilateral sacroiliac joint dysfunction: a case report.

BACKGROUND AND
PURPOSE: Sacroiliac joint dysfunction (SIJD) is a condition affecting 15-30% of patients with low back pain seen in outpatient clinics. Currently there is no well-defined standard of care. The purpose of this case report is to discuss the multidisciplinary management between an athletic trainer and an optometrist for an athlete with bilateral SIJ dysfunction and a visual midline shift syndrome. CASE DESCRIPTION: A 21-year-old collegiate baseball player reported to the athletic training room, presenting with low back pain of three day duration, with tenderness over both posterior superior iliac spines (PSIS) (left > right). His pain at its worse was a 7/10 on the Numeric Pain Scale (NPS). The pain increased to the point that it limited his activities of daily living (ADLs) including getting dressed, putting on his shoes, sleeping, and getting in and out of a car.
INTERVENTIONS: The athlete was initially treated using traditional muscle energy techniques (MET) based intervention to correct SIJD, and lumbar stabilization exercises directed by a licensed athletic trainer, as well as manipulation by a chiropractor. Three weeks of treatment did not prove to be beneficial with only a minimal (1 point on the NPRS) decrease in pain. The athlete was then referred to the head athletic trainer for consultation who prescribed orthotics, for bilateral rear-foot valgus, and Postural Restoration (PR) therapeutic exercises. After two weeks of orthotic use and PR exercises the athlete's pain decreased one additional point on the NPRS. Due to lack of progress, an optometrist was then consulted. The neuro-optometrist prescribed 2 diopter base-down prisms to be worn two hours a day, for four weeks. After four weeks of prisms and new exercises, the athlete was asymptomatic and returned to full pain-free baseball participation without further complications. OUTCOMES: The Oswestry Disability Index Questionnaire (ODI) was 48% at initial (severe disability), 40% at five weeks and 0% at discharge. The Numeric Pain Scale (NPS) score went from 7/10 to 0/10. DISCUSSION: The athlete demonstrated only minimal relief of symptoms following MET, therapeutic exercises, and chiropractic manipulation. Intervention using prism glasses and PR exercises, designed to optimize posture and correct his visual midline shift syndrome, led to complete resolution of his symptoms. EVIDENCE LEVEL: 3a.