Laurie's Blogs.


Jan 2023

SIJ Dysfunctions – Mobilize, Exercise, or Both? What does the Literature Say?

Laurie Edge-Hughes, BScPT, MAnimSt, CAFCI, CCRT

I subscribe to a few different email lists in order to gain more information about topics I care about.  One such list alerted me to a paper about mobilization for sacroiliac joint dysfunction.  Since that is a topic near and dear to me, I went down the rabbit hole to see what else I could find on the topic.  Yes, it’s human… but there is so much more human research out there… why not let the two-legged serve as the guinea pigs for the four-legged?  So, here’s a short compilation of what I found.  Enjoy!


Dogan N, Sahbaz T, Diracoglu D. Effects of mobilization treatment on sacroiliac joint dysfunction syndrome. Rev Assoc Med Bras (1992). 2021 Jul;67(7):1003-1009. 


This study randomized 64 patients with SIJD into an Exercise group or an Exercise group with Mobilization.  The researchers then followed them and reassessed at 24 h, at 1-week, and 1-month following the treatment.  


Upon diving into the paper, it actually appeared that the treatment techniques (the exercises, stretches, and mobilization techniques) were appropriate and given in sufficient frequency.  


Their conclusion?  As a result, we found that the exercise program and the manual therapy plus exercise program significantly improved pain intensity, quality of life, and the findings of specific tests in patients with SIJDS. In addition, superiority between the two groups in terms of pain intensity, quality of life, and specific tests was not determined.


Javadov A, Ketenci A, Aksoy C. The Efficiency of Manual Therapy and Sacroiliac and Lumbar Exercises in Patients with Sacroiliac Joint Dysfunction Syndrome. Pain Physician. 2021 May;24(3):223-233. 


This paper randomized 69 women with SIJD into 3 groups: SIJ-directed manual therapy plus SIJ home-exercises; SIJ-directed manual therapy plus lumbar spine home-exercises; or Only lumbar spine home-exercises.  The researchers reassessed the patients at 9-days and 28-days.


Here, the manual therapy technique was a high velocity low amplitude manipulation technique conducted once a week for 3 weeks.  Exercises also seemed to be appropriate in selection and advised performance of such.


Their conclusion?  Significant improvement in patients with sacroiliac joint dysfunction syndrome in all 3 groups was identified after the treatment. Specific exercise programs for SIJ with manual therapy especially yield even more efficient results.


Mapinduzi J, Ndacayisaba G, Mahaudens P, Hidalgo B. Effectiveness of motor control exercises versus other musculoskeletal therapies in patients with pelvic girdle pain of sacroiliac joint origin: A systematic review with meta-analysis of randomized controlled trials. J Back Musculoskelet Rehabil. 2022;35(4):713-728. 


This was a meta-analysis that looked at 12 randomized controlled trials of moderate to high quality that comprised of a total of 1407 patients in all.  Follow up durations were from 1-week to 2-years.  The review sought to determine the effectiveness of motor control exercises for two clinically relevant measures; i.e., pain and disability, on patients with pelvic girdle pain of sacroiliac joint origin.


Their conclusion?  Motor control exercises alone were not found to be effective in reducing pain at short-term. However, their combination with other musculoskeletal therapies revealed a significant and clinically-relevant decrease in pain and disability at short-term, especially in peripartum period.



My thoughts:  To me, it makes sense to always incorporate exercise along with manual therapy.  It also makes sense to incorporate manual therapy to exercise interventions as well!  Our bodies (as well as those of our non-human patients) are multi-structured with many elements that can cause pain, dysfunction, or disability.  To neglect one structure over another doesn’t necessarily make sense.  This is why so many forms of treatment exist!  Some target muscles, some target joints, some target inflammation, some target the nervous system, some target blood flow, some target fascia… and so on!  It’s also why we cannot ‘cook-book’ our patients to recovery.  We need to think about the patient as a whole and assess and identify what structures need interventions.  


On that note!  Have a great week ahead folks!

Cheers, Laurie