Comparing the Effectiveness of Chiropractic Manipulation and Muscle Energy Technique in Sacroiliac Joint Dysfunction Treatment

Abstract

Aim: The effects of chiropractic manipulation, muscle energy technique and home exercise program on pain, depression and functional level were compared in patients diagnosed with sacroiliac joint dysfunction (SIJD) in this study. Materials and Methods: Forty-five volunteer patients aged 20-65 years who were diagnosed with SIJD participated in this study. The patients were tested through chiropractic and orthopedic examination methods, and aspects of dysfunction were detected. Patients were randomized into 3 groups: Chiropractic Manipulation Group (CM), Muscle Energy Technique Group (MET), Control Group. All groups were assigned a home exercise program. All treatment groups were evaluated with numerical pain scale (NPS), Oswestry low back pain disability questionnaire (OLBPDQ), Beck depression inventory (BDI) and algometer before and after treatment. Descriptive statistics were used in data analysis, Kruskal-Wallis tests in intergroup comparisons, Mann-Whitney U tests in pairwise comparisons, and Friedman, post-hoc Wilcoxon Rank tests were used for intragroup comparisons. The statistical significance value was set at p<0.05 in the study. Findings: Of the 45 volunteers who continued the study, 27 were female and 18 were male, and their mean age was 39.47±9.92 years. According to the results of intragroup analyses, a significant difference was found in all examination methods, and as a result of the intergroup analyses, there was a significant difference in all examination parameters except BDI. In the paired comparisons, positive results were obtained in all examinations in the CM and MET groups compared to the control group, in all parameters except for BDI in the analyses between CM and MET, and in examinations performed after the 4-week implementation in favor of CM (p<0.05). Conclusion: In patients with SIJD, CM performed in addition to exercises was found to be more effective than MET and exercise alone.

Keywords

• Chiropractic
• Muscle Energy Technique
• Exercise
• Sacroiliac
• Dysfunction

References

1. 1. Bashir F. Diagnosis and manipulative therapy of sacroiliac joint disorder. International Musculoskeletal Medicine 2011; 33(3):115–119.
2. 2. Keklicek H, Demirel A, Yalcin A ve ark. Investigating the effects of sacroiliac joint dysfunction on gait in individuals with lumbar herniation nucleus pulposus. Gait & posture 2018; 65:467.
3. 3. Cho BY,Yoon JG. The effect of gait training with shoe inserts on the improvement of pain and gait in sacroiliac joint patients. Journal of physical therapy science 2015; 27(8): 2469-2471.
4. 4. Sarı H, Mısıroğlu TÖ. Sakroiliak Eklem Disfonksiyonu. Turkiye Klinikleri Physical Medicine Rehabilitation-Special Topics 2011; 4(1):53-59.
5. 5. Yıldız S, Ağaoğlu M. Dünya Sağlık Örgütü kılavuzları ışığı altında kayropraktik. Integratif Tıp Dergisi 2013; 1(2):73-76.
6. 6. Zelle BA, Gruen GS, Brown S, George S. Sacroiliac joint dysfunction: evaluation and management. The Clinical journal of pain 2005; 21(5):446-455.
7. 7. Mitchell FL. An Evaluation and Treatment Manual of Osteopathic Muscle Energy Procedures. First Edition, Valley Park: Mitchell; Moran and Pruzzo Associates, 1979:126-129.
8. 8. DeStefano L. Greenman’s Principles of Manual Medicine. Fourth Edition, Philadelphia: Wolters Kluwer, 2011:103-108.

9. 9. Chaitow L. Mucle Energy Techniques. Second Edition, Edinburgh:Churchill Livingstone, 2001:9-122.
10. 10. Kanchan R, Nitesh BS. Comparative analysis on the efficacy of the G.D Maitland’s concept of mobilization & muscle energy technique in treating sacroiliac joint dysfunction Journal of Physiotherapy and Occupational Therapy 2009; 3:18-22 . 11. Boyle KL. Managing a female patient with left low back pain and sacroiliac joint pain with therapeutic exercise: a case report. Physiother Can 2011; 63:154-163.
11. 12. Jeong-Hyun S, Gi DP, Hoo SP. The Effect of Sacroiliac Joint Mobilization on Pelvic Deformation and the Static Balance Ability of Female University Students with SI Joint Dysfunction Journal of Physical Therapy Science 2014; 26(6):845–848.
12. 13. Walker BF, French SD, Grant W, Green, S. A Cochrane review of combined chiropractic interventions for low-back pain. Spine 2011; 36: 230-242.
13. 14. Childs JD, Piva SR, Erhard RE. Immediate improvements in side-to-side weight bearing and iliac crest symmetry after manipulation in patients with low back pain. J Manipulative Physiol Ther 2004; 27:06–313.
14. 15. Suter E, McMorland G, Herzog W, Bray R. Decrease in quadriceps inhibition after sacroiliac joint manipulation in patients with anterior knee pain. J Manipulative Physiol Ther 1999; 22:l49-53. 16. Heinzman KJ. ‘Muscle Energy Technique’ presented at 2006 MN APTA spring conference, April 7-9,2006- Early Brown Heritage Center, Brooklyn Center,MN.
15. 17. Kumar SN, Akalwadi A, Babu VK, Wani ZR. Efficacy of adductor pull back exercise on pain and functional disability for sacroiliac joint dysfunction. Internatıonal Journal Of Physıotherapy 2015; 2(4):667-675
16. 18. Added MAN, de Freitas DG, Kasawara KT et all. Strengthenıng the gluteus maxımus ın subjects wıth sacroılıac dysfunctıon.. International journal of sports physical therapy 2018; 13(1):114.
17. 19. Michel F, Decavel P, Toussirot E, et all. Piriformis muscle syndrome: Diagnostic criteria and treatment of a monocentric series of 250 patients. Ann Phys Rehabil Med 2013; 56:371-383.
18. 20. Al-Subahi M, Alayat M, Alshehri MA, et all. The effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: a systematic review. Journal of physical therapy science 2017; 29(9):1689-1694.
19. 21. Barbosa AC, Martins FL, Barbosa MC. Manipulation and selective exercises decrease pelvic anteversion and low-back pain: a pilot study. J Back Musculoskeletal Rehabil 2013; 26:33–36.
20. 22. Fernández-Carnero J, Cleland JA, Arbizu RLT. Examination of motor and hypoalgesic effects of cervical vs thoracic spine manipulation in patients with lateral epicondylalgia: a clinical trial. Journal of manipulative and physiological therapeutics 2011; 34(7):432-440.
21. 23. Giles LG, Taylor JR. Low back pain associated with leg length inequality. Spine 1981; 6:510-521.
22. 24. Mathew R, Srivastava N, Joshi SA. Study to Compare the effectiveness of MET and Joint Mobilization along with Conventional Physiotherapy in the Management of SI Joint Dysfunction in Young Adults. Indian Journal of Physiotherapy & Occupational Therapy 2015; 9(3):203–208.
23. 25. Robertson D, Kumbhare D, Nolet P, Srbely J, Newton G. Associations between low back pain and depression and somatization in a Canadian emerging adult population. The Journal of the Canadian Chiropractic Association 2017; 61(2):96.
24. 26. Kennedy C, Kassab O, Gilkey D, Linnel S, Morris D. Psychosocial factors and low back pain among college students. Journal of American College Health 2008; 57(2): 191-196.
25. 27. Unalan D, Celikten M, Mazicioğlu M. Depressive symptom profile of Turkish students experiencing back pain. Social Behavior and Personality: an international journal 2009; 37(2):155-162.
26. 28. Mitchell T, O'Sullivan PB, Smith A, Burnett AF, Straker L, Thornton J, Rudd CJ. Biopsychosocial factors are associated with low back pain in female nursing students: a cross-sectional study. International journal of nursing studies 2009; 46(5):678-688.
27. 29. Kamali F, Shokri E. The effect of two manipulative therapy techniques and their outcome in patients with sacroiliac joint syndrome. Journal of bodywork and movement therapies 2012;16(1):29-35.
28. 30. 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;24:223-233.
29. 31. Shearar KA, Colloca CJ,White, HL. A randomized clinical trial of manual versus mechanical force manipulation in the treatment of sacroiliac joint syndrome. Journal of manipulative and physiological therapeutics 2005;28(7):493-501.
30. 32. Dhinkaran M, Sareen A, Arora T. Comparative analysis of muscle energy technique and conventional physiotherapy in treatment of sacroiliac joint dysfunction. Indian Journal of Physiotherapy and Occupational Therapy 2011;5(4): 127-130.
31. 33. Nejati P, Sartaj E, Imani F, Moeineddin R, Nejati L, Safavi M. Accuracy of the diagnostic tests of sacroiliac joint dysfunction. Journal of Chiropractic Medicine 2020;19(1):28-37.
32. 34. Choi JH, Oh JS, Kim MH. The Effect of Pelvic Compression Belt on the Strength of Hip Muscle and EMG Activity in Individuals with Sacroiliac Joint Pain during Prone Hip Extension. Journal of Musculoskeletal Science and Technology 2019;3(1):14-21.
33. 35. Kokmeyer DJ, Van der Wurff P, Aufdemkampe G, Fickenscher TC. The reliability of multitest regimens with sacroiliac pain provocation tests. Journal of Manipulative and Physiological Therapeutics 2002;25(1):42-48.
34. 36. Cooperstein R. Heuristic exploration of how leg checking procedures may lead to inappropriate sacroiliac clinical interventions. Journal of chiropractic medicine 2010;9(3):146-153.
35. 37. Childs JD, Piva SR,Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 2005;30(11):1331-1334.
36. 38. Srivastava S, KU DK, Mittal H, Dixit S, Nair A. Short-term effect of muscle energy technique and mechanical diagnosis and therapy in sacroiliac joint dysfunction: A pilot randomized clinical trial. Journal of Bodywork and Movement Therapies 2020;24(3):63-70.
37. 39. Jackson-Koku G. Beck depression inventory. Occupational Medicine 2016;66(2):174-175.
38. 40. Fairbank JC, Pynsent PB. The Oswestry disability index. Spine 2000;25(22):2940-2953.
39. 41. Mehra A, Baker D, Disney S, Pynsent PB. Oswestry Disability Index scoring made easy. The Annals of The Royal College of Surgeons of England 2008;90(6):497-499.