Managing SIJ Pain With Exercise, Manual Therapy and Stratified Care

Management must match the clinical findings and target the cause, whether tissue sensitivity, fear of movement or a mix of factors. The MINT study from 2017 found a standardized exercise program reduced chronic SIJ pain as much as radiofrequency denervation. Manual therapy can help some patients, mostly in acute stages, but it does not move bones back into place. Its effects come from changes in the local neurochemical environment, the dorsal horn and supraspinal pain inhibition, including placebo analgesia, as outlined by Bialosky in 2009. Thorvaldur describes a 2020 paper led by Darren Beales that stratifies patients into low, medium and high risk using questionnaires and clinical findings, then addresses contributing factors through goal setting, shared decision making and active engagement. Patients should get a plain explanation of their pain, reassurance that the pelvic girdle is strong and stable, and regular reevaluation. The part closes with Marcus Aurelius: if it is not true, do not say it.