Multidomain Geriatric Rehabilitation Management for Sacroiliac Joint–Related Low Back Pain in an Older Adult With Mild Frailty: A Case Report

Abstract

Low back pain (LBP) is highly prevalent in older adults and may arise from multiple degenerative and musculoskeletal problems. Sacroiliac joint (SIJ) pathology represents an important but potentially underrecognized contributor to pain in the lower back area, particularly when pain is localized around the posterior pelvic region and is reproduced by provocative maneuvers. In older adults, frailty, reduced physical capacity, and age-related comorbidities may further influence the clinical presentation. This case describes a multidisciplinary geriatric rehabilitation approach for an older woman with SIJ-related LBP, bilateral SIJ degenerative changes, and mild frailty.

Case Description: A 74-year-old retired nurse presented with a 6-month history of LBP localized predominantly to the lower lumbar and posterior pelvic dimple region, with intermittent radiation toward the right leg. Pain was initially rated 7–8 on the pain scale and was aggravated by bending and stair climbing. Neurological examination showed normal strength and sensation, without bowel or bladder dysfunction. Lumbar radiography demonstrated grade-I L4 spondylolisthesis, lumbar spondylosis, and bilateral SIJ degenerative changes. Clinically, pain localized to the SIJ and a positive bilateral Gaenslen test supported an SIJ-related component of her LBP. Comprehensive geriatric assessment identified mild frailty (Frailty Index 0.16), slight dependence in basic activities, reduced instrumental activity, and reduced functional endurance. The patient underwent a 12-week multidomain rehabilitation program including pain management, lumbopelvic stabilization, flexibility and posture training, strengthening, aerobic conditioning, breathing exercises, education on back and pelvic mechanics, home exercise, and environmental modification. Over the rehabilitation period, pain decreased from 7–8 to 2, the Oswestry Disability Index for LBP decreased from 14 to 4, and the 2-minute walk distance increased from 90 to 118 m. Timed Up and Go testing became feasible and was completed in 11.8 seconds. Patient remained independently ambulatory and was able to resume stair climbing and household activities without significant pain.

Conclusion: This case highlights the importance of considering SIJ-related pathology in older adults presenting with posterior pelvic LBP, particularly when pain is localized to the SIJ region and provocative testing is positive. A multidomain geriatric rehabilitation approach addressing pain, lumbopelvic stability, physical capacity, frailty, and environmental factors was associated with improvement in pain, disability, mobility, and participation. In older adults with multiple degenerative findings, clinical assessment of the SIJ may help identify a potentially relevant pain generator and guide individualized rehabilitation.