Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial

Abstract

Background: The sacroiliac joint dysfunction (SIJD) has been found to be the primary culprit for lower back pain (LBP), but it is still overlooked and treated as LBP. There are no guidelines or appropriate therapeutic protocols for SIJD. Thus, there is a need for an effective treatment strategy for SIJD. Objective: To compare exercise therapy (ET), manipulation therapy (MT), and a combination of the 2 (EMT) in terms of their effectiveness in treating SIJD. Study Design: A comparative, prospective, single-blind randomized controlled trial . Setting: Sports Medicine Department of Rasoul Akram Hospital. Methods: A total of 51 patients with lower back or buttock pain resulting from SIJD were randomly assigned to 1 of 3 study groups: ET, MT, or EMT. The ET group received posterior innominate self-mobilization, sacroiliac joint stretching, and spinal stabilization exercises. The MT group underwent posterior innominate mobilization and SIJ manipulation. Lastly, the EMT group received manipulation maneuvers followed by exercise therapy. Pain and disability were assessed at 6, 12, and 24 weeks after the interventions. Results: All 3 groups demonstrated significant improvement in pain and disability scores compared to the baseline (P < 0.05). The difference among these therapeutic protocols was found to be a function of time. At week 6, MT showed notable results, but at week 12, the effect of ET was remarkable. Finally, at week 24, no significant difference was observed among the study groups. Limitations: A major limitation of the present study is lack of a control group receiving a type of intervention other than the experimental protocols. Another limitation is the short duration of follow-ups. Conclusions: Exercise and manipulation therapy appear to be effective in reducing pain and disability in patients with SIJD. However, the combination of these 2 therapies does not seem to bring about significantly better therapeutic results than either approach implemented separately. Key words: Exercise therapy, manipulation therapy, sacroiliac joint dysfunction

Pilot Study of Sacroiliac Joint Dysfunction Treated with a Single Session of Fascial Manipulation® Method: Clinical Implications for Effective Pain Reduction

“…The implication is that a systematic biomechanical assessment of the fascial system can lead to applications of myofascial treatments, such as Fascial Manipulation ® , that can restore the correct density of the hyaluronan between the layers of the thoracolumbar fascia and in adjacent fascial layers and, in this way, re-establish correct basal tension, receptor transmission and sacroiliac function, with a consequent reduction in perceived pain [ 13 ]. Furthermore, the possibility of rapidly decreasing pain around the SIJ can ostensibly improve patient management, allow for better tolerance of other treatments and permit the early application of pain-free exercise programs to establish more efficient movement patterns [ 1 , 9 , 25 ].…”

“…Sacroiliac joint dysfunction (SIJD) generally refers to pain in the lower back due to abnormal sacroiliac joint movement, either from hypomobility or hypermobility. It is considered to be the principal cause in up to 40% of low back pain cases [ 1 ]. The sacroiliac joint (SIJ) is an amphiarthrosis, 75% of which is formed by a synovial joint and the remaining part by fixed fibrocartilaginous elements.…”

Effectiveness of the Muscle Energy Technique versus Osteopathic Manipulation in the Treatment of Sacroiliac Joint Dysfunction in Athletes

“…Despite the high prevalence of sacroiliac dysfunction, there are no therapeutic protocols for this syndrome. It has been previously considered as a potential contributor to lower back pain but, according to scholars, there are few studies that have compared the effectiveness of the different therapeutic techniques [7].…”

A Finite Element Analysis of Sacroiliac Joint Displacements and Ligament Strains in Response to Three Manipulations

“…This condition is clinically referred to as SIJ subluxation [4]. Pathological bone destruction and traumatic fracture and dislocation require surgery [15][16][17][18], while SIJ pain without a speci c cause is usually treated with manipulations [19,20].…”

“…There are several common manipulations, including manipulation of hip and knee exion (MHKF), manipulation of oblique pulling (MOP), and manipulation of lower limb hyperextension (MLLH). A large number of studies have reported that manipulations have a good effect on the treatment of SIJ subluxation [19][20][21]. Different types of SIJ subluxation require different manipulations [22,23].…”