Effects of mobilization treatment on sacroiliac joint dysfunction syndrome

Key points

1. 01Single-blind randomized trial of 63 patients with sacroiliac joint dysfunction, split into a home exercise group and a mobilization-plus-exercise group.
2. 02Pain at rest and on activity (VAS) dropped significantly in both groups by one month (p<0.001).
3. 03Quality of life (SF-36) improved in five subscales in both groups; social function and emotional role improved only in the mobilization group, while mental health improved only in the exercise group.
4. 04Positive sacroiliac provocation and motion tests decreased significantly within both groups.
5. 05No statistically significant difference between the two groups at one month for pain, quality of life, or specific tests (p>0.05).

How it was conducted

Design

Single-center randomized controlled trial, 1:1 randomization, two parallel groups

Participants

63 patients (analyzed) aged 18 to 60 diagnosed with sacroiliac joint dysfunction syndrome, VAS at least 3, at least three of six positive provocation tests

Groups

Home exercise program alone (n=31) vs combined manual therapy mobilization plus home exercise (n=32)

Interventions

Home stretching and strengthening exercises for both groups for 3 weeks; mobilization group also received SIJ manual therapy, one session per week for 3 weeks

Outcomes

Visual analog scale for pain, SF-36 quality of life, and SIJ physical examination tests at baseline, 24 h, 1 week, and 1 month

What they found

• VAS at rest in the exercise group fell from 3.50±2.74 at baseline to 1.73±1.83 at 1 month (p<0.001).
• VAS at rest in the mobilization group fell from 4.00±2.58 to 1.36±2.22 at 1 month (p<0.001).
• VAS on activity in the exercise group fell from 6.93±1.98 to 3.63±2.01 at 1 month (p<0.001); in the mobilization group from 7.60±1.95 to 4.03±2.15 (p<0.001).
• No significant between-group difference in VAS at rest (p=0.236) or VAS on activity (p=0.408) for the baseline-to-1-month change.
• SF-36 improved in physical function, physical role, body pain, vitality, and general health in both groups (p<0.05); social function and emotional role improved only in the mobilization group, and mental health only in the exercise group.
• All SIJ physical examination tests improved significantly within both groups (p<0.05) with no significant between-group difference (all p>0.05).
• Baseline test positivity rates: distraction and compression 85.7%, Gaenslen 88.9%, posterior friction 93.7%, sacral thrust 100%, FABER 52.4%, motion palpation 100%.

Limitations

• No control group was included due to ethical concerns, so improvement cannot be separated from natural course or placebo.
• Short follow-up of only one month limits conclusions about durable or longer-term effects.
• Single-center study with a small sample of about 31 to 32 patients per group.
• Sacroiliac dysfunction has no direct diagnostic test and relies on provocation and palpation tests of variable reliability.

Why it matters

For patients

A guided home exercise program may relieve sacroiliac pain and improve daily function, and adding hands-on mobilization is unlikely to add much beyond the exercises in the short term.

For clinicians

Both home exercise alone and exercise plus mobilization yield significant short-term improvement, so mobilization can be offered but did not show superiority over exercise for sacroiliac joint dysfunction at one month.

For readers

In a small one-month trial, manual mobilization added no clear benefit over a home exercise program alone, echoing prior literature that found no superiority between the approaches.