BACKGROUND: Low back pain (LBP) is common, costly, and disabling. This study assesses a novel and simple LBP evaluation method and its merit in guiding the direction of a self-treatment exercise. METHODS: Randomized open-label intention is used to treat the study. Consecutive patients with LBP >= three months and pain >= 5/10 were evaluated in a Vancouver clinic with the Sacroiliac Forward Flexion Test (SIFFT) by comparing the height of posterior superior iliac spines using a level. Those with asymmetry >= 5 mm were offered participation. The assistant, who generated and encrypted the randomization, assigned participants: group 1 learned a two-minute, SIFFT-derived, sacroiliac-leveling exercise (SIFFT-E) as needed for LBP relief; group 2 used a pelvic stabilization belt as needed to prevent LBP, and group 3 continued the usual care. After one month, all participants used SIFFT-E and belt as needed for one month. The identifier number of this article in ClinicalTrials.gov is #NCT03888235. The trial is closed. Our primary outcome measure was the Oswestry Disability Index (ODI) (decrease) from baseline to one and two months. We also followed SIFFT improvement (decrease). FINDINGS: Of 72 LBP patients, 62 (86%) had >= 5 mm asymmetry. From zero to one month, the 21 (one dropout) SIFFT-E participants outperformed the 20 usual care participants for ODI improvement (12.5 +/- 14.8 versus -3.4 +/- 14.9 points; mean difference 15.9 (CI 6.7 to 25.0); p = 0.002 with number needed to treat (NNT) of 3.0 for ODI improvement >= 11). Belt use results were intermediate. At two months, after all the 62 participants used the exercise and belt as needed, combined ODI improvements were clinically significant (12.0 +/- 18.4 points), and SIFFT asymmetry was reduced by 8.6 +/- 8.6 mm. Five (8%) exercise and 12 (19%) belt wearers experienced mild side effects. INTERPRETATION: Sacroiliac asymmetry appears to be frequent. SIFFT may be clinically useful as an evaluation tool for prescribing a simple self-directed corrective exercise as seen by clinically significant improvements in function and asymmetry.

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