Original Article
A Randomized Clinical Trial of Manual Versus Mechanical Force Manipulation in the Treatment of Sacroiliac Joint Syndrome

https://doi.org/10.1016/j.jmpt.2005.07.006Get rights and content

Abstract

Objective

To investigate the effect of instrument-delivered compared with traditional manual-delivered thrust chiropractic adjustments in the treatment of sacroiliac joint syndrome.

Methods

Prospective, randomized, comparative clinical trial. Sixty patients with sacroiliac syndrome were randomized into two groups of 30 subjects. Each subject received 4 chiropractic adjustments over a 2-week period and was evaluated at 1-week follow-up. One group received side-posture, high-velocity, low-amplitude chiropractic adjustments; the other group received mechanical-force, manually-assisted chiropractic adjustments using an Activator Adjusting Instrument (Activator Methods International, Ltd, Phoenix, Ariz).

Results

No significant differences between groups were noted at the initial consultation for any of the outcome variables. Statistically significant improvements were observed in both groups from the first to third, third to fifth, and first to fifth consultations for improvements (P < .001) in mean numerical pain rating scale 101 (group 1, 49.1-23.4; group 2, 48.9-22.5), revised Oswestry Low Back Pain Disability Questionnaire (group 1, 37.4-18.5; group 2, 36.6-15.1), orthopedic rating score (group 1, 7.6-0.6; group 2, 7.5-0.8), and algometry measures (group 1, 4.8-6.5; group 2, 5.0-6.8) for first to last visit for both groups.

Conclusions

The results indicate that a short regimen of either mechanical-force, manually-assisted or high-velocity, low-amplitude chiropractic adjustments were associated with a beneficial effect of a reduction in pain and disability in patients diagnosed with sacroiliac joint syndrome. Neither mechanical-force, manually-assisted nor high-velocity, low-amplitude adjustments were found to be more effective than the other in the treatment of this patient population.

Section snippets

Subject Recruitment and Inclusion Criteria

Subjects were recruited from the greater Durban area (outpatient chiropractic clinic, Durban Institute of Technology, Durban, South Africa) by means of advertisements placed in local newspapers; pamphlets placed in local sports clubs, gyms, and shopping centers; and advertising by word of mouth. All respondents were screened telephonically and subsequently scheduled for an initial consultation provided they met the initial criteria of having LBP. No stratification of subjects took place, and

Results

Of the 60 participating subjects 51.7% were men and 48.3% were women, with 16 men and 14 women randomized to group 1 and 15 men and 15 women randomized to group 2. The age distribution of the study participants is shown in Table 2. The number of patients in each age grouping was evenly spread across both groups with the highest proportion of subjects in the 18 to 30–year age range (33% and 37%, respectively, for groups 1 and 2). The 50 to 59–year-old grouping was the second largest (23% and

Discussion

The results of this study showed that chiropractic care including both HVLA and MFMA-type chiropractic adjustments were associated with a positive effect in the treatment of SIJ syndrome in this patient population. Because group 1 did not exhibit a greater effect over group 2 in either subjective (self-perceived pain and disability) or objective (ORS, pain pressure threshold) findings as hypothesized, this study found that both chiropractic adjustment regimens had an equal effect in the

Conclusions

The results of this trial indicate that a relatively short regimen (4 visits) of MFMA or HVLA chiropractic adjustments were associated with beneficial effects of reduction in 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. Acknowledging and overcoming the limitations of this study will allow for designing further research contributing to a greater

Acknowledgments

The authors thank the academic staff at Durban Institute of Technology Chiropractic Department and the clinical and administrative staff at the Department Day Clinic for their assistance and support throughout the completion of this study.

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      In this connection it should be noted that most previous studies used longer durations of treatment (Aure et al., 2003; Ferreira et al., 2007; Goldby et al., 2006; Stuge et al., 2004a, 2004b) or additional treatments (Flynn et al., 2002). Our results were in favor of short-term manual therapy for patients with SJD, in agreement with the conclusions of Kamali et al. (a single session) and Shearar et al. (2-week intervention period) (Kamali and Shokri, 2012; Shearar et al., 2005). In contrast, Castro-Sanchez et al. found no clinical benefits after three sessions of spinal manual therapy in patients with chronic non-specific LBP (Castro-Sanchez et al., 2016).

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    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. Presented at the Association of Chiropractic Colleges/Research Agenda IX Conference, Las Vegas, NV, March 11-14, 2004.

    Sources of support: None declared.

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    Copyright © 2005 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.