The relative effectiveness of manual manipulation versus manipulation using the activator adjusting instrument in the management of acute on chronic sacroiliac syndrome

Abstract

Low back pain is a significant health problem that has had a major impact on quality of life and on health care costs (Weiner, et al. 2000:450). Schwarzer, et al. (1995) established the sacroiliac joint to be a significant source of pain in patients with chronic low back pain. Bernard and Kirkaldy-Willis (1987:2107-2130) established the sacroiliac joint to be the primary source of low back pain in 22.5% of 1293 patients presenting with back pain. According to a review article by Hendler, et al. (1995:169), “manipulation provides dramatic relief” in cases of sacroiliac syndrome. Little research, however, has been done regarding instrument manipulation and it’s effect on acute, chronic or acute on chronic sacroiliac syndrome. Osterbauer and De Boer, et al. (1993) found a significant decrease in Visual Analogue Scale and Oswestry scores following treatment using instrument manipulation for sacroiliac joint syndrome. They also noted a reduction in the number of pain provocation tests applied to the research subjects. “Unless reliability and validity of assessments and effectiveness of treatment procedures can be demonstrated, clinicians should temper their claims of measurement of, and direct effects on, the sacroiliac joint” (Walker 1992:914). The study design was a randomised, omparative clinical trial. Sixty voluntary subjects were accepted onto the trial; each diagnosed as having acute on chronic sacroiliac joint syndrome, and divided into two groups of thirty subjects. Each subject received five treatments within a three-week period. The subjects in group one received manipulation using the Diversified Technique of manipulation and those in group two received instrument manipulation using the “Activator Adjusting Instrument”.