• Parisa Nejati, Afsaneh Safarcherati, and Farshid Karimi.
• Department of Sports medicine and Exercise Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
• Pain Physician. 2019 Jan 1; 22 (1): 53-61.

BackgroundThe 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.ObjectiveTo compare exercise therapy (ET), manipulation therapy (MT), and a combination of the 2 (EMT) in terms of their effectiveness in treating SIJD.Study DesignA comparative, prospective, single-blind randomized controlled trial .SettingSports Medicine Department of Rasoul Akram Hospital.MethodsA 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.ResultsAll 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.LimitationsA 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.ConclusionsExercise 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 WordsExercise therapy, manipulation therapy, sacroiliac joint dysfunction.

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