Nejati P, Safarcherati A, Karimi F Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial. Pain Physician. 2019 Jan;22(1):53-61. (Original study)

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.

Discipline Area Score
Rehab Clinician (OT/PT) 5 / 7
Physician 5 / 7
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Comments from MORE raters

Physician rater

This randomised trial looked at the role of exercise therapy, manipulation and a combination of both in the management of low back pain thought to be due to sacroiliac joint dysfunction. Manipulation gave a better outcome in the short term but long term outcomes were no different for exercise versus manipulation versus the combination. The lack of a control group and the short duration of treatment are a problem with this study.

Physician rater

I have enjoyed supporting patients with SI joint pain over the years using a similar approach to this. I would like to see evidence to support or refute my subjective experience. Although not conclusive, this at least suggests I'm probably not doing harm. In my practice, a large proportion of "back pain" is SI and the more people rest, the worse it seems to get.

Rehab Clinician (OT/PT) rater

The interventions is well described. There is no control group, so the results of intervention versus none is not known.
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