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

March 17, 2015

JANUARY 11, 2004

Subject: Sacroiliac Joint Related Studies


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.

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