Sacroiliac joint movement and treatment of dysfunction using manual therapy

Delaney Harris

PTH 662 Manual Therapy II

Central Michigan University

 The sacroiliac joint (SIJ) is the area of the body where the spine connects to the ilium

bone of the pelvis. This joint is responsible for the transferring of loads back and forth between

the lower extremities and the spine.1 There are conflicting thoughts and research looking into if

this joint has any motion. This has been researched since 460 BC. Some researchers believe that

there is no movement at the SIJ. Others believe that it is only moveable in pregnant women. It is

also thought to be a diarthrodial joint with a synovial membrane, meaning that it is movable in

both men and women.1 This then leads to the question of; do manual techniques and muscle

energy techniques (MET) influence the SIJ. If there is no movement in the joint, then they would

not affect the joint but if there is movement in the joint then it could help with SIJ dysfunction or

pain. SIJ dysfunction is stated to be a painful condition that results from abnormal motion at this

joint, whether it is hypermobile or hypomobile. This pain can be felt at the SIJ, or it can refer to

the low back.2 This literature review looks at the effect of manual techniques and MET on the SIJ

to answer the question, do manual techniques, and MET help improve SIJ dysfunction in adults,

or is the joint immobile?

The article, Effectiveness of muscle energy technique as compared to Maitland

mobilization for the treatment of chronic sacroiliac joint dysfunction by Zaidi and Ahmed, looks

at the treatments of mobilizations and MET to compare if one is better than the other when

treating chronic SIJ dysfunction.3 They looked at 60 participants, both male and female, from the

ages of 25 to 55 years of age who had chronic SIJ dysfunction. These participants were put into

two randomized groups. Group-A was treated with MET and group-B was treated with Maitland

mobilizations. Each group was also given the same set of lumbopelvic stability exercises

alongside the other techniques. Group-A was treated with MET of the quadratus lumborum,

iliopsoas, and piriformis on the affected side. They performed 1 set of 5 repetitions with 10-

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second holds for each muscle at every treatment session. SIJ mobilizations were performed 3

times for 30 seconds of oscillations on group-B. The measures that they used were the Visual

Analogue Scale (VAS) and the Modified Oswesrty Disability Index (MODI). These measures

were taken on the first day before any treatment and then taken again after 4 weeks which

consisted of 12 total treatment sessions.3

The results show that there was a significant improvement in both group-A and group-B.

For group-A the VAS scored 7.67±1.34 and the MODI scored 28.33±4.68 for the pre-test before

any treatment. Both of these scores decreased after treatment. The VAS was 4.33±1.34 and the

MODI was 9.20±3.12 after the 4 weeks of treatment. Group-B's VAS scored 7.43±1.38 and the

MODI scored 30.27±5.39 for the pre-test. The post-test showed the VAS decreasing to

4.00±1.20 and the MODI decreasing to 8.30±3.69. Although both groups did show a decrease in

pain, they did not show a significant difference between each other. Both MET and Maitland

mobilizations can be used to improve chronic SIJ dysfunction and there is no difference between

the benefits of the techniques.3

In the article, Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint

Dysfunction: A Randomized Controlled Trial by Nejati, Safarcherati, and Karimi, they look at

using self-mobilizations, manipulations, and manipulations with an exercise program to treat SIJ

dysfunction.4 The first group was the ET group that performed self-mobilizations, SIJ stretching,

and lumbosacral exercises. The MT group had posterior innominate mobilizations and SIJ

manipulations performed on them. The EMT group received the manipulations as well as

exercise therapy. The 51 participants, both male and female, were randomly put into one of these

three groups. The outcome measures that were looked at for this study were the VAS, Oswesrty

Disability Index (ODI), and the Timed up and go (TUG). They looked at both subjective and

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objective measures. The outcome measures were taken at baseline, week 6, week 12, and week

24. The participants were treated for 12 weeks and then did not perform any exercises for the

next 12 weeks and then their outcome measures were taken again at 24 weeks.4

This study showed no significant difference between the ET, MT, and EMT groups but

they all had great improvement in each of the outcome measures. The baseline measurement for

the ET group for VAS was 5.52 and at 12 weeks it decreased to 0.35. The VAS then increased to

2.23 at 24 weeks. The ODI went from 28.52 to 11.17 at 12 weeks then to 19.64 at 24 weeks. The

TUG went from 12.58 to 10.35 at 12 weeks and 11.76 at 24 weeks. The MT group for VAS was

4 and at 12 weeks it decreased to 2.47. The VAS then increased to 2.82 at 24 weeks. The ODI

went from 23.58 to 20.17 to 22.17 at 24 weeks. The TUG went from 11.70 to 11.05 at 12 weeks

and then increased to 11.52 at 24 weeks. The EMT group for VAS was 4.70 and at 12 weeks it

decreased to 0.47. The VAS increased to 2.64 at 24 weeks. The ODI went from 28.52 to 12.17

then increased to 22.11 at 12 weeks. The TUG went from 11.88 to 9.58 at 12 weeks and then

increased to 11.70 at 24 weeks. Even though there was the least amount of change with the MT

group in 12 weeks they had the most carry-over to the 24-week check. There was the least

amount of increase after not performing the exercises for 12 weeks. All three of the groups had

an improvement in SIJ dysfunction symptoms but it can not be concluded that one of these

techniques is better than the others.4

In the article, Effects of mobilization treatment on sacroiliac joint dysfunction syndrome

by Dogan, Sahbaz, and Diracoglu, they looked at two groups to help improve SIJ dysfunction.5

The first group was given a home exercise program of SIJ strengthening and stretching exercises.

The second group was given manual mobilizations to the SIJ and the home exercise program that

was given to the first group. The 63 participants, ranging from the ages 18-60 years of age, were

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randomly placed into one of the two groups. The outcome measures that were used were the

VAS and the 36-Item Short Form Survey (SF-36). These were taken before the interventions,

one week, and 1 month of the study.5

This study also showed that there was no significant difference between the treatment

types but both treatments did have a significant effect on SIJ dysfunction. The VAS for the

exercise group started at 6.93±1.98 and then decreased to 3.63±2.01. The SF-36 started at

69.51±16.79 and increased to 81.12±20.84. The manual mobilization group started with the VAS

at 7.60±1.95 and then decreased to 4.03±2.15. The SF-36 went from 70.66±18.17 to 78.83±15.95

at the end of one month. Both groups showed improvement in pain and quality of life shown

from these outcome measures.5

The Physiotherapist Evidence Database, also known as PEDro, is used to determine if

randomized control trials are reliable to use with evidence-based practice. There are 11 items that

are rated for a total overall score of 0 to 10. The scores 0 to 3 are rated as poor, 4 to 5 as fair, 6 to

8 as good, and 9 to 10 would be excellent.6 The first article that was reviewed scored a 3/10. The

second article scored 4/10 and the third scored 5/10. In all the studies the participants were

assigned blindly to the treatment groups, but the therapist knew the treatment groups.

There is minimal research on this topic and there needs to be more to help with the actual

findings. In the first article, there was no adequate follow-up on the participants after the trial.

The second and third articles both showed a follow-up with the participants after the treatment

was complete. The third article was the only study that talked about the reliability of the outcome

measures that were used.

All three of the studies showed that there was a significant improvement in SIJ

dysfunction while using manual techniques and MET. If there was no difference in symptoms

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between the groups then that would have shown that there is no movement in the SIJ. Because

there was an alleviation of symptoms from these techniques it seems to provide some evidence

that there is a movement within the joint. Further research needs to be done to confirm this based

on the PEDro scores and the lack of research looking at these treatments and the movement of

the SIJ that are out there. With the research that is out there, it is safe to say that treating the SIJ

for dysfunction and pain with manual techniques, such as manipulations, mobilizations, and

MET, is an important tool to have. In the research, it could not be concluded that one of these

techniques is better than the others.

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Reference
1. Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The
sacroiliac joint: an overview of its anatomy, function and potential clinical
implications. J Anat. 2012;221(6):537-567. doi:10.1111/j.1469-7580.2012.01564.x

2. Sacroiliac (SI) joint dysfunction causes symptoms & treatments. Spine Connection. (n.d.).
Retrieved March 18, 2023, from
https://spineconnection.org/back-pain-conditions/sacroiliac-joint-dysfunction/.
3. Zaidi F, Ahmed I. Effectiveness of muscle energy technique as compared to Maitland
mobilization for the treatment of chronic sacroiliac joint dysfunction. J Pak Med Assoc.
2020;70(10):1693-1697. doi:10.5455/JPMA.43722
4. Nejati P, Safarcherati A, Karimi F. Effectiveness of Exercise Therapy and Manipulation
on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial. Pain Physician.
2019;22(1):53-61.
5. Dogan N, Sahbaz T, Diracoglu D. Effects of mobilization treatment on sacroiliac joint
dysfunction syndrome. Rev Assoc Med Bras (1992). 2021;67(7):1003-1009.
doi:10.1590/1806-9282.20210436
6. Moseley AM, Elkins MR, Van der Wees PJ, Pinheiro MB. Using research to guide
practice: The Physiotherapy Evidence Database (PEDro). Braz J Phys Ther.
2020;24(5):384-391. doi:10.1016/j.bjpt.2019.11.002