alexa Effects of High Power Pain Threshold Static Ultrasound (HPPTSU) on Subjects with SI Joint Pathology | Open Access Journals
Journal of Traditional Medicine & Clinical Naturopathy
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Effects of High Power Pain Threshold Static Ultrasound (HPPTSU) on Subjects with SI Joint Pathology

Amit Dhawan*

Sardar Bhagwan Singh PG Institute of Institute of Biomedical Sciences and Research, Dehradun, India

*Corresponding Author:
Amit Dhawan
Sardar Bhagwan Singh PG Institute of Biomedical Sciences and Research, Dehradun, India
Tel: +918126098007

Received date: June 23, 2017; Accepted date: June 27, 2017; Published date: July 03, 2017

Citation: Dhawan A (2017) Effects of High Power Pain Threshold Static Ultrasound (HPPTSU) on Subjects with SI Joint Pathology. J Tradit Med Clin Natur 6:227. doi: 10.4172/2167-1206.1000227

Copyright: © 2017 Dhawan A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Traditional Medicine & Clinical Naturopathy


Each patient who suffers with low back pain with or without radiating symptoms should be checked for comprehensive examination of SI joint before making any conclusion.

The patients suffering with low back pain often complains of radiating pain down the buttocks, back side of the leg, and sometimes continuing below the knee to the leg. When they approach a physician/ surgeon they are directed for MRI or CT scan and in maximum cases it is revealed that they are suffering with degenerative effects of spine, disc prolapse, stenosis etc. After that the treatment starts with medicines (steroids, pain killers, multivitamins etc.), physiotherapy (TENS, IFT, SWD, Traction etc.) and lastly we have various surgical options. The agony of the patient still continues. Usually ignored but very frequent and important causes like the involvement of Long Posterior Sacroiliac Ligament, Trigger points over the Quadratus Lumborum Muscle, Iliolumbar Syndrome, Posterior Superior Iliac Bursa Syndrome, Iliac Apophysitis, and Superior Gluteal Nerve Entrapment between iliac crest and thoracolumbar fascia are often missed during the comprehensive assessment & examination of Sacro-Iliac Joint pathology.

High Power Pain Threshold Static Ultrasound (HPPTSU)

Sacroiliac joint pathology is a complex term which may involve the inflammation of bursa, ligament [1-3], trigger points in the muscles or entrapment of the surrounding nerves but it follows a systematic hierarchy from mild to severe involvement:

With the advancing age, the core musculature surrounding the lumbosacral spine weakens.


Sacroiliac arthritis: Inflammatory condition of the joint (severe form of dysfunction) (Stage IV)

Usually, the patient approaches the physician/physiotherapist in Stage III when there is a dysfunction in the working mechanism of the joint either in the form of a trigger point in the muscle, inflammation of the ligament and bursa, or entrapment of the nerve due to changes in the mechanical interface. In this stage the reversal of symptoms and correction of underlying pathology is still possible.

A multiple case trial was conducted in which the patients with sacroiliac dysfunction (Stage III) who had low back ache with and without radiating pain to the buttocks or to the knee were included in the study.

The subjects were divided into the following subdivisions:

1. Sacroiliac Dysfunction due to trigger points in Quadratus Lumborum muscle.

2. Sacroiliac Dysfunction due to inflammation of long posterior sacroiliac ligament and Iliolumbar ligament.

3. Sacroiliac Dysfunction due to posterior superior iliac spine bursitis.

Criteria for subject inclusion:

• Increased discomfort with sustained positions such as standing, sitting and lying, with the inability to attain a position of comfort.

• Radiating buttock pain which can be reported as a generalized distribution of “achiness” which can radiate upto the thigh.

• Increased discomfort with stair or hill climbing.

• Tenderness is found near the lumbo-sacral promontory and PSIS area.

After meeting the inclusion criteria, subjects were assessed for trigger points in the Quadratus lumborum in the region where paraspinal muscles meet the iliac crest, bursitis in which tenderness is palpated just over Posterior superior iliac spine and ligament dysfunction in which there is tenderness along the line of L5 vertebrae and iliac crest, and just inferior to the PSIS for long posterior sacroiliac ligament [4,5].

The subjects were treated with High Power Pain Threshold Static Ultrasound (HPPTSU) which was different than the conventional ultrasound therapy. In conventional ultrasound the applicator is moved in smooth overlapping sweeps or circles at rates of a few centimeters per second over areas of 25-100 cm2.

HPPTSU was applied in (W/cm2) in continuous modes, with the probe placed directly on the trigger point and held motionless on subjects with SI Joint Dysfunction due to Quadratus Lumborum Trigger Points. To elicit threshold pain, the ultrasound probe must be kept static on the trigger point. Intensity was gradually increased to the level of maximum pain the patient could bear. Intensity can vary from patient to patient according to the threshold of their skin resistance. It was kept at that level for 4 to 5 seconds and then reduced to the half-intensity level for another 15 seconds conventional ultrasound the applicator is moved in smooth overlapping sweeps or circles at rates of a few centimeters per second over areas of 25-100 cm2.

Location of the Probe for Quadratus Lumborum

Mostly the Quadratus lumborum develops trigger points deep in the muscle just above the posterior superior iliac spine [6,7].


The ultrasound probe was placed just above the posterior superior iliac spine as marked by the arrow.

In cases of SI Joint Dysfunction due to inflamed ligament or Bursitis, the HPPTSU was modified. The Ultrasound probe was placed directly over the ligament or bursa with the intensity of 2.5-3.0 w/cm2 till the moderate warmth was felt over the surface of the skin and then the probe was moved to the adjoining area of the ligament or bursa. The total treatment time was 10 min.

Location of the Probe for Long Posterior (Dorsal) Sacroiliac Ligament, Iliolumbar Ligament and Iliac Crest Bursa

The probe was placed just inferior and medial to the lower part of Posterior Superior Iliac Spine (PSIS) for dorsal sacroiliac ligament (1), just at the line of attachment from L5 vertebra to the PSIS for Iliolumbar ligament (2), and just superior to PSIS for bursa (3) as marked by the arrows.


The subjects reported immediate pain relief which were satisfactorily maintained till the next treatment session. The average number of sessions was 5 to 7 for the complete pain relief.

The technique was non-invasive and free of adverse effects if applied after accurate diagnosis with knowledge of regional anatomy.

This technique was applied in cases of SI Joint Dysfunction, but it was seen that it is equally effective in treating patients in Stages I and II.

Stages I and II subjects also respond very well to other electrotherapeutic agents but for patients in Stage III this was the highly effective strategy. Reversal of symptoms had been seen in Stage III patients with HPPTSU.

The results of the study indicate that low back ache patients’ needs to be diagnosed for SI joint pathology before treating them as per the results of the investigation which are more likely to show degenerative changes in the subjects of higher age groups and if the cause of SI Joint dysfunction is soft tissue (ligament or muscle injury) due to which low back pain arises, the best available treatment is HPPTSU.


Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Relevant Topics

Recommended Conferences

Article Usage

  • Total views: 52
  • [From(publication date):
    August-2017 - Jul 25, 2017]
  • Breakdown by view type
  • HTML page views : 36
  • PDF downloads :16

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

1-702-714-7001Extn: 9037

Business & Management Journals


1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

1-702-714-7001 Extn: 9042

© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version