Effect of the single-leg, lateral oblique, decline squat exercise on sacroiliac joint pain with knee pain.

[Purpose] This study investigated the effect of the single-leg, lateral oblique, decline squat exercise on sacroiliac joint pain with knee pain.
[Subjects and Methods] A 39-year-old female had severe pain in the right medial buttock and right anterior knee. This study assessed the anterior pelvic tilt angle and pain provocation tests before and after single-leg, lateral oblique, decline squat exercise for 4 weeks.
[Results] Following the course of exercise, the anterior pelvic tilt angles were increased, and the visual analog scale pain scores for both the right buttock and right knee were 2/10.
[Conclusion] Single-leg, lateral oblique, decline squat exercise may be effective for treating SI joint pain with knee pain in females.

INTRODUCTION

Imbalance of muscles around the knee can cause changes in the alignment of the knee joint1). Therefore, to prevent knee injuries in females, improved muscle balance around the knee during dynamic motions such as landing and balanced strengthening of lower limb muscles are necessary. Kim et al.1) found kinematic differences in landing motions between male and female college students and reported that the valgus angles of females were more increased than those of males during a vertical landing motion. The decline squat exercise moves the line of gravity backwards and increases external momentum during extension in knee joints2); thus, the squat exercise on a decline board has had great effectiveness in reducing knee pain due to the selective strengthening of lower extremity muscles3). This study investigated the effect of the single-leg, lateral oblique, decline squat exercise on sacroiliac (SI) joint pain with knee pain.

SUBJECTS AND METHODS

A 39-year-old female had severe pain in the right medial buttock and right anterior knee. She complained of continuous low back pain for 8 months, and examination revealed that her pelvis was tilted posteriorly. The patient was unable to sleep in the side-lying position due to the pain. The purpose and methods of the study were explained to the participant before her inclusion in the study, and she provided informed consent according to the principles of the Declaration of Helsinki. The pelvic inclination was measured with a palpation meter (PALM; Performance Attainment Associates, St. Paul, MN, USA) by one examiner. At the initial assessment, the anterior pelvic tilt angles were 3.5° and 6.5° on the right and left sides (normal range, 11 ± 4°), respectively. On palpation of the right medial buttock and right anterior patella, the visual analog scale (VAS) scores were 7/10 and 6/10, respectively. The SI joint pain provocation tests used in this study were the Gaenslen test and Patrick test. The single-leg, lateral oblique, decline squat exercise is performed with descent to 90° knee flexion, followed by ascent to the initial position at the individual’s natural speed. The exercise is performed on a 25° decline board with 30° lateral rotation. This study assessed the anterior pelvic tilt angle and the response to pain provocation tests before and after 4 weeks of performing the exercise.

RESULTS

Following the course of exercise, the anterior pelvic tilt angles were 8° and 10° on the right and left sides, respectively, and were higher than the initial values (3.5° and 6.5°). On palpation of the right medial buttock and right knee, the initial VAS scores of 7/10 and 6/10 decreased to 2/10 for both regions. No pain was experienced with the Gaenslen and Patrick tests.

DISCUSSION

The decline squat exercise induces anterior pelvic tilt as the trunk is pushed backward to compensate for the feeling of the trunk tilting forward2, 3). This serves as a good exercise for anterior pelvic tilt. The subject in the current study also experienced considerable reduction in lateral knee pain, due to decreased tension in the tensor fasciae latae or iliotibial band of the lateral knee. In particular, the pain in the SI joint also subsided after the course of exercise. The decline board used for the single-leg, lateral oblique, decline squat exercise induced foot supination, which promoted ideal alignment of the hip and pelvis, preventing knee valgus. In addition, the single-leg position can activate muscles that provide pelvic stability more effectively than the two-leg position4). Manual pelvic compression was demonstrated to be a compensatory strategy to enhance the force closure mechanism and thus normalize the altered motor responses5). The stability of the SI joint through form and/or force closure mechanisms was proposed to facilitate load transfer to the pelvis5). Therefore, the single-leg, lateral oblique, decline squat exercise can be effective for treating SI joint pain with knee pain caused by an abnormal quadriceps angle in females.