Sacroiliac joint manipulation for low back and radicular pain: outcomes in a 100-patient single-center cohort

Sacroiliac joint (SIJ) dysfunction is an underrecognized source of lumbosacral and leg pain. Manual therapy targeting SIJ hypomobility/blockage may rapidly reduce pain and disability, yet pragmatic outcome data remain limited.

We conducted a single-center observational cohort study of 100 consecutive adults (73% women; mean age 49.16 ± 14.28 years; BMI 25.99 ± 4.15 kg/m²) with lumbosacral and/or radicular leg pain attributed to SIJ dysfunction. Eligibility required cross-sectional imaging (CT/MRI) and ≥ 3 positive SIJ provocation tests (e.g., Patrick/FABER, Mennell, thigh thrust, Yeoman's, SIJ compression, hip rotation). All patients received a standardized SIJ manipulation protocol (up to three sessions, 7-day intervals) administered by the same physiotherapist. Pain intensity on the Numerical Rating Scale (NRS) was measured at baseline, after each session, and at 3 months; disability was assessed with the Oswestry Disability Index (ODI). Nonparametric statistics were prespecified (Shapiro-Wilk test for normality; Friedman test with Kendall's W and Holm-adjusted Wilcoxon post hoc test for repeated NRS; Wilcoxon signed-rank test for ODI; α < 0.05).

The most frequent abnormal finding was the Mennell sign (clinical finding, 100%); key provocation tests were commonly positive [thigh thrust 89%, Mennell (provocation) test 81%, Yeoman's test 52%]. Median NRS decreased from 8 (IQR: 7-9) at baseline to 1 (IQR: 0-3) after the first manipulation, 0 (IQR: 0-0) after the second and third, and 0 (IQR: 0-2) at 3 months (Friedman p < 0.001). ODI improved from 30 (IQR: 25-35) to 7 (IQR: 6-9; p < 0.001), with significant gains across all domains (all p < 0.001) at 3 months.

In carefully triaged patients with suspected SIJ-mediated pain, a short, standardized SIJ manipulation sequence was associated with large, rapid, and sustained improvements in pain and disability through 3 months. These pragmatic data complement prior trials and support considering SIJ manipulation as a low-cost, repeatable option within conservative care pathways. Randomized, assessor-blinded studies with longer follow-up are warranted to confirm causality and identify likely responders.