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