(646) 355-8777

Herman & Wallace Blog

Sacroiliac Dysfunction: Self Stabilization or Surgical Fixation

In this “quick fix” society, few people accept that musculoskeletal pain will require a commitment to following an exercise program for an extended period of time. If a hypomobile joint just needs to get moving and lubricated, one may get relief with a few manual therapy treatments and exercise sessions. However, if a joint is hypermobile (unstable) or degenerative and provokes a high level of pain, the rehab requires more time. The sacroiliac (SI) joint is one of those areas often requiring patients to work harder for the resolution of pain and dysfunction, but many seek surgical intervention instead.

Polly et al. (2016) performed a randomized controlled trial of minimally invasive sacroiliac joint fusion (SIJF) with placement of a system of triangular titanium implants using a lateral transiliac approach versus non-surgical management (NSM) for SI dysfunction. Of the 148 subjects, 102 underwent SIJF and 46 had NSM. The NSM group received medication, physical therapy per American Physical Therapy Association guidelines, steroid injections and radiofrequency ablation of sacral nerve root lateral branches. The surgical group showed superior outcomes at a 2 year follow up, as clinical improvement per VAS pain score was 83.1% and ODI was 68.2%. The NSM group showed <10% improvement.

Sachs et al. (2016) studied outcomes of patients ≥3 years after SIJF for chronic (>5 years) SIJ dysfunction secondary to degenerative sacroiliitis or SIJ disruption. One hundred and seven patients participated in the study, and minimally invasive transiliac SIJF was definitively correlated with decreased pain, low disability scores, and improvements in activities of daily living performance. Sadly, these authors stated, “there is no high-quality evidence that physical therapy is effective in chronic SIJ pain.”

Even radiofrequency neurotomy or neural ablation revealed positive results for patients according to Reddy et al. (2016). The authors explored 14 patients’ responses 1 year after Simplicity radiofrequency (RF) of the lateral branches of S1-S3 in a retrospective review. Improvements in global health per SF12 as well as pain reduction were statistically significant.

Jonely et al. (2015) presented a case study of a woman with a 14-year history of SIJ pain whose symptoms persisted after 2 months of physical therapy. A multi-modal approach was then pursued with success, even at the 1 year follow up. The patient received 4 prolotherapy injections, SIJ manipulation into nutation, a pelvic girdle belt, and specific stabilization exercises. Over a 12-month period, the patient had 20 physical therapy sessions. Her Oswestry Disability score improved from 34% to 14% at 6 months and was 0% at 1 year. Numeric pain scale rating improved to 4/10 at 6 months and 0/10 at 1 year. The authors concluded a multimodal approach can be successful to manage SIJ dysfunction.

Clearly, if quality of life is so poor a person cannot function because of SIJ pain and therapy has failed, surgery may be the only choice. I exhaust all conservative measures before I cry “uncle” for a surgical fix. Despite a paucity of literature on manual therapy and sacroiliac treatment, I know there are clinicians successfully treating patients with SI dysfunction. Taking the Sacroiliac Joint Evaluation and Treatment can broaden your scope of understanding the SI joint and how to provide the most effective treatment, possibly preventing more invasive techniques for patients.


Polly, D. W., Swofford, J., Whang, P. G., Frank, C. J., Glaser, J. A., Limoni, R. P., … and the INSITE Study Group. (2016). Two-Year Outcomes from a Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion vs. Non-Surgical Management for Sacroiliac Joint Dysfunction. International Journal of Spine Surgery, 10, 28. http://doi.org/10.14444/3028
Sachs, D., Kovalsky, D., Redmond, A., Limoni, R., Meyer, S. C., Harvey, C., & Kondrashov, D. (2016). Durable intermediate-to long-term outcomes after minimally invasive transiliac sacroiliac joint fusion using triangular titanium implants. Medical Devices (Auckland, N.Z.), 9, 213–222. http://doi.org/10.2147/MDER.S109276
Anjana Reddy, V. S., Sharma, C., Chang, K.-Y., & Mehta, V. (2016). “Simplicity” radiofrequency neurotomy of sacroiliac joint: a real life 1-year follow-up UK data. British Journal of Pain, 10(2), 90–99. http://doi.org/10.1177/2049463715627287
Jonely, H., Brismée, J.-M., Desai, M. J., & Reoli, R. (2015). Chronic sacroiliac joint and pelvic girdle dysfunction in a 35-year-old nulliparous woman successfully managed with multimodal and multidisciplinary approach. The Journal of Manual & Manipulative Therapy, 23(1), 20–26. http://doi.org/10.1179/2042618614Y.0000000086

Pediatric Enuresis: Neurogenic or Just Nervous?
Half Full or Empty: A Cup of Mindfulness for Heali...

Upcoming Continuing Education Courses

Pelvic Floor Level 2A - Atlanta, GA (Cancelled)

Mar 13, 2021 - Mar 14, 2021
Location: Emory Healthcare

Pelvic Floor Level 2A - Self-Hosted (SOLD OUT)

Mar 13, 2021 - Mar 14, 2021
Location: Self-Hosted Course

Postpartum Rehabilitation - Remote Course (SOLD OUT)

Mar 13, 2021 - Mar 14, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2A - Kenosha WI Satellite Location (SOLD OUT)

Mar 13, 2021 - Mar 14, 2021
Location: Aurora Health Care

Pelvic Floor Level 2A - West Hills, CA Satellite Location

Mar 13, 2021 - Mar 14, 2021
Location: Touch of Life PT

Pelvic Floor Level 2A - Torrance, CA Satellite Location (SOLD OUT)

Mar 13, 2021 - Mar 14, 2021
Location: Women's Advantage Inc

Sacral Nerve Manual Assessment and Treatment - Remote Course

Mar 13, 2021 - Mar 14, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2A - Brooklyn, NY Satellite Location (Sold Out)

Mar 13, 2021 - Mar 14, 2021
Location: PT of the City

Pelvic Floor Level 2A - San Diego, CA Satellite Location

Mar 13, 2021 - Mar 14, 2021
Location: Water and Sports Physical Therapy Clinics

Pelvic Floor Level 2A - Athens, GA Satellite Location

Mar 13, 2021 - Mar 14, 2021
Location: Thrive Integrated Medicine

Pelvic Floor Level 2A - Richmond, VA Satellite Location

Mar 13, 2021 - Mar 14, 2021
Location: Pivot Physical Therapy

Pelvic Floor Level 2A - Norfolk, VA Satellite Location

Mar 13, 2021 - Mar 14, 2021
Location: Riverside Physical Therapy

Pelvic Floor Level 2A - Sacramento, CA Satellite Location

Mar 13, 2021 - Mar 14, 2021
Location: East Sacramento Physical Therapy

Mobilization of Visceral Fascia: The Gastrointestinal System - Self-Hosted (SOLD OUT)

Mar 19, 2021 - Mar 21, 2021
Location: Self-Hosted Course

Mobilization of Visceral Fascia: The Gastrointestinal System - Worcester, MA Satellite Location

Mar 19, 2021 - Mar 21, 2021
Location: Central Mass PT & Wellness

Mobilization of Visceral Fascia: The Gastrointestinal System - Medford, OR Satellite Location

Mar 19, 2021 - Mar 21, 2021
Location: Asante Rogue Valley Medical Center

Athletes & Pelvic Rehabilitation - Remote Course

Mar 20, 2021 - Mar 21, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Satellite Lab Course

Mar 20, 2021 - Mar 21, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Self-Hosted (SOLD OUT)

Mar 20, 2021 - Mar 21, 2021
Location: Self-Hosted Course

Pelvic Floor Level 1 - Lisle, IL Satellite Location (SOLD OUT)

Mar 20, 2021 - Mar 21, 2021
Location: Ivy Rehab - Lisle, IL

Pelvic Floor Level 1 - Virginia Beach, VA Satellite Location (SOLD OUT)

Mar 20, 2021 - Mar 21, 2021
Location: Southeastern Physical Therapy

Pelvic Floor Level 1 - Jacksonville, FL Satellite Location (SOLD OUT)

Mar 20, 2021 - Mar 21, 2021
Location: Summit Physical Therapy

Pelvic Floor Level 1 - Fairfax, VA Satellite Location (SOLD OUT)

Mar 20, 2021 - Mar 21, 2021
Location: PT Solutions Physical Therapy

Pelvic Floor Level 1 - New York City, NY Satellite Location (SOLD OUT)

Mar 20, 2021 - Mar 21, 2021
Location: KNOSIS Center for Physiotherapy & Wellness

Pelvic Floor Level 1 - Missoula, MT Satellite Location (SOLD OUT)

Mar 20, 2021 - Mar 21, 2021
Location: University of Montana

Pelvic Floor Level 1 - Satellite Lab Course

Mar 27, 2021 - Mar 28, 2021