For therapy and research

Back pain is a common problem in the modern world, with one in every two people suffering from it in developed countries. And this number continues to rise. In 2010, Bauerfeind unveiled an answer to the differential diagnosis of SI joint syndrome in the form of its pelvic orthosis SacroLoc. This narrow orthosis stabilizes the pelvic girdle and relieves pain. Furthermore, it delivers convincing results in scientific study time and again. The SacroLoc gets right to the bottom of the sacroiliac joint’s complex structure and all the problems this entails. This alone is reason enough for Bauerfeind to once again turn its focus to the lower back, with a second generation of the orthosis. The new SacroLoc, with its highly elastic mesh material and patented strap, builds on the innovations of the first generation. The unusual case of one SI joint patient is a perfect illustration of how this orthosis can often produce an immediate effect. There could be only one answer for her indication.

If you were to meet Ingeborg Lepke today, you wouldn’t notice anything unusual about her. She walks briskly with her upper body upright , setting her feet down confidently on the ground. But it’s only been a few months since she was able to walk just like everyone else again. A small step for the world of healthcare represented a giant leap toward a pain-free life for the 56-year-old from Berlin. It’s difficult to imagine what happened to Ingeborg Lepke eighteen years ago – paradoxically, at a time that should have been one of great joy, not prolonged suffering. Eighteen years ago, Ingeborg Lepke’s son was born. That’s when it began. “I could barely take a single step after the birth,” she recalls. The young mother felt a severe pain in her legs, radiating down from her pelvis. Even small steps triggered the pain. And it didn’t get better. Just going about everyday life was a huge challenge. Pain medication wasn’t an option, which meant that this once sporty individual had to give up table tennis and badminton. “The physicians just couldn’t help me,” she says. “Nobody knew what was wrong.”

A relieving grip around the pelvis

How could someone endure constant pain while walking for so long? Ingeborg Lepke resigned herself to her fate… until late 2016. Then, something changed. Ingeborg was at her wits’ end and couldn’t take any more. She visited the Outpatient Rehabilitation Center in Berlin for psychotherapeutic treatment. There, in a facility run by the Helmut Nanz Stiftung, she was sent to Chief Orthopedic Physician Dr. med. Thomas Lang for a consultation. The physician remembers his first impression clearly: “I asked the patient to walk a few steps. Her gait was dragging and unsteady. Essentially, she was incapable of walking.” The orthopedist had a suspicion, which was backed up by the next test he performed: Dr. Lang asked the patient to stand on one leg while facing him. Her face contorted in pain. Then, the physician grasped her around the pelvic girdle. He exerted a compressive action with both hands. Ingeborg Lepke had no idea what had just happened: Her pain was gone!

SI joint dysfunction

For Dr. Lang, the one-legged pose was the final link in a chain of clues: “The prior history and the findings clearly pointed toward dysfunction,” explains the physician. “There was no indication of wear to the joint. The symptoms appeared virtually overnight.” Intervertebral disk prolapse and the classic “non-specific back pain” were also ruled out due to the patient’s symptoms. Dr. Lang was sure from a very early stage of the diagnosis that was later confirmed: The source of all Ingeborg Lepke’s problems could only be the SI joint region. “Problems with the SI joint are not unusual during pregnancy and childbirth,” says the physician. “The hormonal changes and increase in weight can lead to loosening of the ligaments at the joints, which then triggers pain (see also the interview on p. 20).”

Hotspot in the back

The sacroiliac joint has a special significance in the load distribution of the body. Located at the interface between the spine and the pelvis, it takes on the role of a mediator, distributing the loads from the torso toward the feet and vice versa, with forces from the lower extremities also being directed upwards via the SI joint. A high degree of local ligament stability is required in order for these loads to be transmitted correctly – and in order to keep the jagged structure of this mediator, the SI joint itself, intact. “The complexity of the SI joint is further increased by the flow of information from top to bottom and vice versa,” explains Dr. Lang. “The joints’ environment also carries sensory information for proprioception, which is essential for our sense of balance, among other things,” the physician says. The SI joint – a hotspot in the back that often needs a bit of help.

SacroLoc stabilizes like the orthopedist’s hands

The physician’s grip shed light on the solution: External stabilization around the pelvic girdle, which enabled the SI joint to do its job properly, had been shown to work for Ingeborg Lepke. Based on the patient’s unambiguous reaction when standing on one leg and her medical history, there was no need to use imaging techniques to confirm the differential diagnosis of SI joint syndrome. Pain provocation tests for confirming SI joint syndrome (see box on page 21), which Dr. Lang used on the patient , gave him complete certainty that the correct diagnosis was pelvic girdle instability due to loosening of the ligaments at the sacroiliac joints. But what can provide the same effect as the orthopedist’s grip? SacroLoc and SacroLoc. First of all , Dr. Lang prescribed the tried-and-tested pelvic orthosis to relieve the strain on the patient’s sacroiliac joints, then let her try out the new model in a wearing test , before it had even been launched on the market. The result was just as striking as what happened during the one-legged test: “It was simply unbelievable,” says Ingeborg Lepke. “Suddenly, I was able to walk in a whole different way. The pain disappeared almost completely.”

Even better targeted action with the new SacroLoc

Ingeborg Lepke’s constant companion, the SacroLoc, is once again scrutinized on Dr. Lang’s desk during a checkup appointment. “This is where the pads are incorporated,” he demonstrates, “with their cutouts that are positioned in exactly the right spot over the sacroiliac joints.” He picks up the orthosis to check it over. “A lot of smart ideas have gone into this.” Ingeborg Lepke now benefits from the SacroLoc on a constant basis. Once her pelvis had been stabilized and the pain eliminated, her pelvic and leg muscles could operate freely once more. “Luckily for her,” says the orthopedist , “she has a sporting background. If that weren’t the case, it probably would have been very difficult for her to get her old life back.”
You can really sense that , after years of suffering, Ingeborg has the courage to face life again. Finally, she knows what the problem is. And she has what she needs to combat it: “With the new SacroLoc, I can ride my bike again – especially in the summer, when I get to enjoy the lovely fresh air,” she says. “And I sit better with this one than I did with the first.” Perhaps she will soon be back playing table tennis or hitting the badminton courts. And how about multimodal therapy – is that necessary now? Dr. Lang looks surprised. “Why? She has the orthosis, which is perfect for her indication and leaves her pain-free.”

Images: Anika Büssemeier, istockphoto.com/Eraxion