The sacroiliac joint (SIJ) can become dysfunctional through trauma and/ or pregnancy. The mechanism involves direct or repetitive microtrauma to the buttocks/ lower back. Treatment with specialised physiotherapy alleviates the problems in ~ 80% of cases. The remainder may respond to prolotherapy (hypertonic glucose injections into the dorsal intra-osseous ligament (DIOL) after multiple injections. We hypothesised that the response may be more rapid with injection of platelet enriched plasma (PRP) into the DIOL under ultrasound guidance.
Impingement of the medial branch of the superior cluneal (MBSC) nerves are thought to be an overlooked cause of low back pain, with this impingement occurring where the branches of these nerves pass over the superior rim of the iliac crest in osseofibrous tunnels formed by the thoracolumbar fascia.