Chiropractic Procedures for the Sacroiliac Joint

For patients with lower back or buttock pain that stems from the sacroiliac joint, a variety of chiropractic procedures can be applied and are often considered the first line of treatment.

The chiropractic treatment goal for sacroiliac joint pain is to utilize a method that is best tolerated by the patient and yields the best outcome. Patients respond better to different approaches, so the chiropractor may adopt various manipulations to treat the patient's sacroiliac joint pain.

There are two general chiropractic manipulation approaches for sacroiliac joint dysfunction:

• Traditional chiropractic adjustment, also called spinal manipulation or high-velocity, low-amplitude (HVLA) thrust
• Gentle/less forceful adjustment, also called spinal mobilization; low-velocity, low-amplitude thrust

Chiropractors may also use adjunctive therapy to treat sacroiliac joint dysfunction.

Chiropractic Adjustment for Sacroiliac Joint Dysfunction

Chiropractic adjustment (spinal manipulation) of the sacroiliac joint is usually accomplished with the patient lying down on his or her side. Specifically:

1. The top knee is flexed (bent) and then raised toward the patient's chest.
2. The bottom shoulder is positioned forward, producing a stretch in the low back and pelvic region.
3. The chiropractor's contact hand is placed over the sacroiliac joint and pressure is applied while the patient's upper shoulder is tractioned (pushed to create tension) backward and the knee is tractioned towards the floor.
4. When the slack is removed from the lumbar spine, and the pre-manipulation position is determined to be comfortable, high-velocity, low-amplitude thrust is applied by the chiropractor. )

The thrust in this type of adjustment usually results in an audible release, called cavitation, which is created by oxygen, nitrogen, and carbon dioxide escaping from the joint when the joint is pushed past its passive range of motion but well within the tissue boundaries.

This chiropractic maneuver creates the typical "crack" often associated with joint manipulation and sounds similar to "cracking knuckles."

While this "cracking" description of a chiropractic manipulation may give an impression of something that is uncomfortable, the sensation is usually quite relieving, sometimes almost immediately. In fact, patients who have been treated with this approach in the past often request this procedure again when returning to a chiropractic clinic.

Some patients do not feel comfortable with or cannot tolerate the cracking sound or twisting involved with a traditional chiropractic adjustment. For these patients, a gentle or less forceful approach may be best.

While this article focuses on chiropractic treatment, osteopathic physicians (or other appropriately trained healthcare practitioners) may also use these or similar types of manipulation and adjunctive therapy to treat sacroiliac joint pain.