Sacroiliac joint (SIJ) dysfunction remains a prevalent and often recalcitrant condition in orthopedic practice, frequently manifesting as low back and gluteal pain. For manual therapists, the standard of care has long involved various forms of SIJ mobilization to restore joint arthrokinematics. However, the complex myofascial relationships surrounding the pelvic girdle suggest that joint mobilization alone may not address all contributing factors. A recent Randomized Controlled Trial (RCT), published in the Journal of Bodywork and Movement Therapies in October 2025, investigates whether adding a specific piriformis stretch to standard mobilization protocols enhances clinical outcomes.
The Anatomical Interplay: Piriformis and the SIJ
The piriformis muscle is biomechanically distinct due to its origin on the anterior surface of the sacrum and its insertion on the greater trochanter. Because of this attachment, the muscle acts as a primary stabilizer of the SIJ. When the piriformis becomes hypertonic or shortened, it can restrict sacral motion, compress the sciatic nerve, and perpetuate dysfunction within the sacroiliac complex. Consequently, targeting this muscle specifically—rather than focusing solely on the joint interface—presents a logical avenue for therapeutic intervention.
Study Design: Mobilization vs. Combined Therapy
The study, conducted by Sadiq et al., utilized a non-blind randomized controlled trial design involving 36 participants diagnosed with SIJ dysfunction. The demographic was predominantly female (80.6%), with a mean age of approximately 33 years, reflecting the typical patient population seen in clinical settings for this condition.
Participants were divided into two groups:
- Control Group: Received thermo-electrotherapy followed by SIJ mobilization alone.
- Interventional Group: Received thermo-electrotherapy, SIJ mobilization, and an additional piriformis stretch.
The intervention was brief but intensive, consisting of three sessions administered on alternate days over a one-week period. Outcome measures included the Numeric Pain Rating Scale (NPRS) for pain intensity and the Oswestry Disability Index (ODI) for functional disability.
Key Findings: Function Over Pain
The results of this RCT offer a nuanced perspective on treatment efficacy. Interestingly, both groups demonstrated statistically significant improvements in pain and disability compared to their baseline scores. This reinforces the efficacy of SIJ mobilization as a core treatment modality.
However, the between-group analysis revealed a critical distinction. While there was no statistically significant difference in pain reduction between the two groups, the group receiving the piriformis stretch demonstrated significantly greater improvements in disability (ODI scores). This suggests that while mobilization effectively modulates nociception, the addition of soft tissue lengthening specifically targets the functional restrictions associated with SIJ dysfunction, allowing for better movement quality and daily activity performance.
Clinical Implications for Physiotherapists
For the clinician, these findings highlight the importance of a multimodal approach. Treating the articular component of SIJ dysfunction is necessary but perhaps insufficient for maximizing functional recovery. The data suggests that integrating piriformis stretching does not necessarily accelerate pain relief beyond what mobilization achieves, but it is superior for restoring physical function.
Given the low risk and time efficiency of adding a stretch to a treatment session, physiotherapists should consider routinely integrating piriformis elongation techniques alongside manual mobilization for patients presenting with SIJ dysfunction, particularly when functional limitation is a primary complaint.
References
Sadiq, A., Khalid, Z., Kiran, T., & Hassan, W. (2025). Additional effects of piriformis stretch in the management of sacroiliac joint dysfunction: A randomized control trial. Journal of Bodywork and Movement Therapies. https://pubmed.ncbi.nlm.nih.gov/40954575/
