Archive for category Sacroiliac Joint



The objective of this case series was to investigate the feasibility and safety of a novel method for the management of chronic lower back pain. Injections of recombinant human growth hormone and testosterone to the painful and dysfunctional areas in individuals with chronic lower back pain were used. In addition, the participants received manual therapies and exercise addressing physical impairments such as motor control, strength, endurance, pain, and loss of movement. Pain ratings and self-rated functional outcomes were assessed.


This is a case series involving consecutive patients with chronic lower back pain who received the intervention of injections of recombinant human growth hormone and testosterone, and attended chiropractic and/or physical therapy. Outcomes were measured at 12 months from the time of injection.


A community based hospital affiliated office, and a private practice block suite.


A total of 60 consecutive patients attending a pain management practice for chronic lower back pain were recruited for the experimental treatment. Most participants were private pay.


Participants who provided informed consent and were determined not to have radicular pain received diagnostic blocks. Those who responded favorably to the diagnostic blocks received injections of recombinant human growth hormone and testosterone in the areas treated with the blocks. Participants also received manipulation- and impairment-based exercises.


Outcomes were assessed at 12 months through pain ratings with the Mankowski Pain Scale and the Oswestry Disability Index.


Of the 60 patients recruited, 49 provided informed consent, and 39 completed all aspects of the study. Those patients receiving the intervention reported a significant decrease in pain ratings (P<0.01) and a significant improvement in self-rated Oswestry Disability Index scores (P<0.01). In addition, in the Oswestry Disability Index results, 41% of the patients demonstrated a 50% or greater change in their disability score. Of the subjects who withdrew from the study, one was due to the pain created by the injections and nine were for nonstudy factors.


The intervention appeared to be safe and the results provide a reasonable expectation that the intervention would be beneficial for a population of individuals with chronic nonradicular lower back pain. Due to the design of the study, causality cannot be inferred, but the results do indicate that further study of the intervention may be warranted.

J Pain Res. 2015 Jun 23;8:295-302. [PMID:26203272]

Author information: Dubick MN, Ravin TH, Michel Y, Morrisette DC;  Charleston, SC, USA.

Full Text Article 

Read More



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


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).


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.


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.

J Manipulative Physiol Ther. 2005 Sep;28(7):493-501. [PMID:16182023]

Author information: Shearar KA, Colloca CJ, White HL. Chiropractic Department, Durban Institute of Technology, Durban, South Africa.

Read More


The purpose of this study was to determine the neuromuscular  reflex responses of the erector spinae musculature to spinal  manipulative thrusts (SMTs) in patients with LBP. 20 (10 male/10 female,  mean age = 43 yrs.) consecutive LBP patients received MFMA SMTs  delivered to the transverse and spinous processes of T8, T12, L2, L4,  L5, and the sacral base and PSIS by means of an Activator Adjusting  Instrument (AAI) equipped with an impedance head. Surface, linear  enveloped, electromyographic (sEMG) recordings were obtained from  electrodes located bilaterally over the L5 and L3 erector spinae muscles  during each of the thrusts. Repeated pre. post isometric extension  strength tests were performed to normalize reflex data. 1600 sEMG  recordings were analyzed from 20 SMT treatments and comparisons were  made between segmental level, segmental contact point (spinous vs.  tranverse processes), and magnitude of the sEMG reflex response. SEMG  threshold was further assessed for correlation of patient self. reported  pain and disability, Consistent, but relatively localized sEMG reflex  responses occurred in response to the MFMA SMTs. 95 % of patients showed  a positive sEMG response to MFMA SMT, Patients with frequent to  constant LBP symptoms tended to have a more marked sEMG response in  comparison to patients with occasional to intermittent LBP. This is the  first study demonstrating neuromuscular reflex responses associated with  MFMA SMT in patients with LBP.

Reference: Christopher J. Colloca, D.C.1, Tony S. Keller, Ph.D. 2, Daryn E. Seltzer, D.C.3, Arlan W. Fuhr, D.C.1;  Lumbar Erector Spinae Reflex Responses to Mechanical Force, Manually-  Assisted Thoracolumbar and Sacroiliac Joint Manipulation in Patients  with Low Back Pain; Proceedings of the 2000 International Conference on Spinal  Manipulation, Bloomington, MN September 21-23,2000.

1 Postdoctoral & Related Professional Education  Department Faculty, Logan College of Chiropractic, St, Louis, MO, USA;  National Institute of Chiropractic Research, Phoenix, AZ, USA; Private  Practice of Chiropractic, Phoenix, AZ, USA. 2 Professor, Department of Mechanical Engineering  & Department of Orthopedics and Rehabilitation, The University of  Vermont, Burlington, VT, USA. 3 National Institute of Chiropractic Research, Phoenix, AZ, USA; Private Practice of Chiropractic, Phoenix, AZ, USA.

Read More



To evaluate diagnostic and biomechanical correlates and treatment outcomes of manipulative/adjustive care in patients highly selected for sacroiliac joint syndrome (SIJS).


Descriptive case series, 1 wk baseline, 1 yr follow-up.


Private chiropractic practice.


Ten out of 153 consecutive new patients (4 male and 6 female) with “primary,” chronic, uncomplicated SIJS were selected over an 11-mo period on the basis of painful SIJ and provocation tests.


Back pain (visual analogue scale), Oswestry disability index, lumbar provocation tests and biomechanical measures of gait and postural sway.


Six-wk regimen of mechanical force, manually assisted, short lever adjustments (MFMA) with an Activator instrument.


Pain decreased significantly from a mean baseline value of 25 to 12 (t = 2.28; p < .05). Likewise, the average disability scores diminished from 28 to 13% (t = 2.3; p < .05), and a reduction in the number of positive provocation tests was noted (Fisher Exact Probability range Z = 0.025-0.045). Gait and sway parameters were indistinguishable from normals, before or after treatment. Response to the 1-yr follow-up questionnaire (6/10) revealed stability of symptoms at a low level.


While the majority of subjects recorded some degree of positive outcome, we conclude that: a) discrete SIJS remains difficult to diagnose, but may be possible by judicious choice of screening tests; b) MFMA may benefit some patients with chronic SIJ pain; and c) gait and sway measurement yielded no correlation with clinical conditions.

J Manipulative Physiol Ther. 1993 Feb;16(2):82-90. [PMID:8445358]

Author information: Osterbauer PJ, De Boer KF, Widmaier R, Petermann E, Fuhr AW. National Institute of Chiropractic Research, Phoenix, AZ 85018.


Read More