WHEN THE SACROILIAC JOINT IS NO LONGER IGNORED: SUPERIOR OUTCOMES WITH COMBINED SIJ AND LUMBAR REHABILITATION

Abstract

Background: Chronic low back pain (CLBP) is a leading cause of disability worldwide. While most rehabilitation focuses on the lumbar spine, the sacroiliac joint (SIJ) is frequently overlooked as a potential pain generator. Failure to address SIJ dysfunction may result in suboptimal outcomes. Methodology: A single-blind randomized controlled trial was conducted at Health & Wellness Physio Rehab Center from October 2024 to January 2025. Sixty adults with CLBP and positive SIJ provocation tests were randomized into an experimental group (n = 30) receiving conventional lumbar physiotherapy plus SIJ-specific manual therapy and stabilization, or a control group (n = 30) receiving conventional lumbar physiotherapy alone. Both groups were treated three times weekly for 12 weeks. Pain (VAS), disability (Oswestry Disability Index, ODI) and functional measures (SLR, trunk flexion) were assessed at baseline, 6 weeks and 12 weeks. Data were analyzed in SPSS 26 using repeated-measures ANOVA with post-hoc tests. Results: Fifty-six participants completed the study. Significant group × time interactions were found for VAS (F = 6.78, p = 0.002) and ODI (F = 8.45, p = 0.001). At 12 weeks, mean pain reduction was 3.2 (SD 1.0) in the experimental group versus 1.8 (SD 0.9) in controls (p = 0.003), and disability reduction was 14.5% (SD 5.2) versus 7.2% (SD 4.8) respectively (p = 0.001). Functional tests improved significantly more in the experimental group. No serious adverse events occurred. Conclusion: Including SIJ-specific manual therapy and stabilization with conventional lumbar rehabilitation produced significantly greater improvements in pain, disability and function over 3 months than lumbar therapy alone. Clinicians should routinely assess and address SIJ dysfunction in patients with chronic low back pain.