Subject: Sacroiliac Joint Related Studies

Title: A Randomized Clinical Trial of the Relative Effectiveness of Manual Versus Mechanical Force Chiropractic Adjustments in the Management of Sacroiliac Joint Syndrome

Reference: Kirstin A. Shearar, et. al Journal of Chiropractic Education Jan. 2004: 18(1) 29

Abstract: This study was submitted as a dissertation to the Faculty of Health, in compliance with the requirements for the Master’s Degree in Technology from the Chiropractic Department, Durban Institute of Technology, Durban, South Africa.

Sacroiliac joint (SIJ) syndrome is a common presenting disorder among patients with back pain. Previous research has demonstrated a benefit of spinal manipulation in patients with SIJ syndrome. However, no study has compared the relative effectiveness of different forms of spinal manipulation or chiropractic adjustments in its management. The purpose of this study was to determine the relative effect of instrument-delivered as compared to traditional manual- delivered thrust chiropractic adjustments in the treatment of SIJ syndrome.

METHODS: A prospective, randomized, comparative clinical trial was conducted at the outpatient chiropractic clinic, Durban Institute of Technology, Durban, South Africa. Sixty patients (31 male, 29 female, ages 18—59) diagnosed with SIJ syndrome were randomized into two groups of 30 subjects. Each subject received four chiropractic adjustments over a 2-week period and was subsequently evaluated at 1-week follow-up. The subjects in one group (group 1) received side posture, high- velocity, low-amplitude (HYLA) chiropractic adjustments of the symptomatic SIJ using the National-Diversified technique. The subjects in the other group (group 2) received mechanical force, manually assisted (MFMA) chiropractic adjustments of the symptomatic SIJ using an Activator Adjusting Instrument. Both groups received only chiropractic adjustment as treatment intervention with no other treatment modalities or interventions utilized, including medication use. Outcomes included the Numerical Pain Rating Scale- 101 (NRS), Revised Oswestry Low Back Pain Disability Questionnaire (Oswestry), algometry, and Orthopedic Rating Scale (ORS). Outcomes were statistically analyzed using the Mann-Whitney U test (for intergroup analysis), and Friedman’s T test (for intragroup analysis) to assess differences from the first, third, and final consultations within and between groups.

RESULTS: No significant differences between groups were noted at the initial consultation for any of the subjective and objective variables. Statistically significant improvements in subjective and objective outcomes were observed in both groups from the first to third, third to fifth, and first to fifth consultations for all measures except pain pressure threshold. Specifically, statistically significant improvements (p < .001) in mean NRS (group 1 = 49.1 to 23.4; group 2 = 48.9 to 22.5), Oswestry (group 1 = 37.4 to 18.5; group 2 = 36.6 to 15.1), ORS (group 1 = 7.6 to 0.6; group 2 = 7.5 to 0.8), and algometry measures (group 1 = 4.8 to 6.5; group 2 = 5.0 to 6.8) were observed from the first to last visit for both groups. Statistical analysis of the subjective and objective data showed equal improvement for both groups. Intergroup analysis showed that there was a slight difference between the two groups, favoring MFMA (group 2). However, these observations were not statistically significant for all the outcome measures.

CONCLUSION: The results of this clinical trial indicate that a relatively short regimen of both MFMA and HVLA chiropractic adjustments provides a beneficial effect associated with reducing pain and disability in patients diagnosed with SIJ syndrome. Neither MFMA nor HVLA adjustments were found to be more effective than the other in the treatment of this patient population.