Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Article:
Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial
Introduction:
Sacroiliac joint dysfunction (SIJD) is a possible cause of lower back pain that can sometimes be overlooked by clinicians. This randomized control trial sought to help develop therapeutic guidelines for the treatment of SIJD by comparing the efficacy of Exercise therapy and manipulation therapy in the treatment of SID.
Methods:
In this study 51 participants were divided into three groups; exercise therapy, manipulation therapy or a combination of both. The exercise group received posterior innominate self-mobilization, sacroiliac joint stretching and spinal mobilization exercises. The manipulation therapy group underwent posterior innominate mobilizations as well as sacroiliac joint manipulations. The third group received mobilizations and manipulations followed by exercises. The three groups were assessed for pain and disability at 6, 12, and 24 weeks.
Results:
All three groups demonstrated significant improvements following interventions. The difference in effectiveness of each intervention was a function of time. At 6 weeks the manipulation intervention group experienced the most relief in symptoms, however at the 12-week mark, the exercise intervention group experienced the most relief. Interestingly, there was no significant difference between the groups at 24 weeks.
Discussion/Clinical Utility:
This is an interesting study as it demonstrates what approaches are likely to be effective at different stages of healing, but it does have some limitations. The follow up is short and there was no true control group, as at the time this was written, the authors state that there is currently no standard of treatment for SIJD. I would be curious to see what the difference would be for a group using only pharmacological or surgical interventions.
Despite its limitations, there are lessons to be learned from this study. The fact that all three groups had similar outcomes at 24 weeks demonstrates that multiple treatment approaches have efficacy. Clinically this is useful because if a patient is unable to receive manual intervention, there is evidence that they can still receive similar benefit from exercise interventions. Likewise, if a patient is in too much pain to perform exercises, they will likely still experience a benefit from manual intervention.
Based on the information presented, the best approach is to provide treatment that uses manual therapy as well as exercise therapy. The manual therapy helps to provide a quicker benefit in the early stages of healing and the exercise therapy helps to provide ongoing benefits as the episode of care progresses. Transitioning from a manual based approach to a more exercise-based approach is useful because manual therapy is effective in relieving symptoms early on but may lead to the patient being dependent on their therapist. Exercise interventions allow the patient to effectively treat their own symptoms and manage if they get symptoms in the future.
References
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. PMID: 30700068.