Treatment of the sacroiliac joint in patients with leg pain

The authors conducted this study in order to assess which treatment is successful for SIJ-related back and leg pain as the sacroiliac joint (SIJ) may be a cause of sciatica. The study used a single-blinded randomised trial to assess the short-term therapeutic efficacy of physiotherapy, manual therapy, and intra-articular injection with local corticosteroids in the SIJ in 51 patients with SIJ-related leg pain. The effect of the treatment was evaluated after 6 and 12 weeks. Of the 51 patients, 25 (56 %) were successfully treated. Physiotherapy was successful in 3 out of 15 patients (20 %), manual therapy in 13 of the 18 (72 %), and intra-articular injection in 9 of 18 (50 %) patients (p = 0.01). Manual therapy had a considerably higher success rate than physiotherapy (p = 0.003).

The authors’ concluded that in their small single-blinded prospective study, manual therapy appeared to be the choice of treatment for patients with SIJ-related leg pain. They also said that a another therapeutic option to be considered is an intra-articular injection.

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Jerry Hesch

Please post the reference. There is a lot of marketing going on for sacroiliac injection and fusion and one physical therapist charges a high sum for “adjusting the pelvis” in the operating room in order to “assure an effective surgery”. You can easily find that online. There is a tremendous amount of marketing for sacroiliac joint fusions, just click opn that conservative journal Spine and up pops an ad for minimally invasive SIJ fusion, the new answer for failed back syndrome, including an ongoing study for its application for degenerated SI joints! It is nice to see studies on conservative care. The intraarticular injections get a large marketing push and are described as the “gold standard.” There is no gold standard. There are a few injection studies that demonstrate much better response to extra-articular injections. However, intrarticular requires fluroscopy and reiumburses much more, so economics, not quality of care dictates care. See references below.

I blog, write and teach on the topic of SIJD at The approach I use is the most significant departure from the traditional model and is research and evidence-based.

Thank you.
Jerry Hesch
Berthelot JM, Labat JJ, Le Goff B, Gouin F, Maugars Y.Provocative sacroiliac joint maneuvers and sacroiliac joint block are unreliable for diagnosing sacroiliac joint pain. Joint Bone Spine. 2006 Jan;73(1):17-23.

Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S.Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: prospective comparative study. J Orthop Sci. 2007 May;12(3):274-80. Epub 2007 May 31.

Borowsky CD, et al. Sources of sacroiliac region pain: Insights gained from a study comparing standard intra-articular injection with a technique combining intra- and peri-articular injection. Arch Phys Med. 2008;89:2048-2056.

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