Efficacy of manual therapy for sacroiliac joint pain syndrome: a systematic review and meta-analysis of randomized controlled trials

ABSTRACT

Introduction

This study examined the efficacy of manual therapy for pain and disability measures in adults with sacroiliac joint pain syndrome (SIJPS).

Methods

We searched six databases, including gray literature, on 24 October 2023, for randomized controlled trials (RCTs) examining sacroiliac joint (SIJ) manual therapy outcomes via pain or disability in adults with SIJPS. We evaluated quality via the Physiotherapy Evidence Database scale and certainty via Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Standardized mean differences (SMDs) in post-treatment pain and disability scores were pooled using random-effects models in meta-regressions.

Results

We included 16 RCTs (421 adults; mean age = 37.7 years), with 11 RCTs being meta-analyzed. Compared to non-manual physiotherapy (i.e. exercise ± passive modalities; 10 RCTs) or sham (1 RCT) interventions, SIJ manual therapy did not significantly reduce pain (SMD: −0.88; 95%-CI: −1.84; 0.08, p = 0.0686) yet had a statistically significant moderate effect in reducing disability (SMD: −0.67; 95% CI: −1.32; −0.03, p = 0.0418). The superiority of individual manual therapies was unclear due to low sample size, wide confidence intervals for effect estimates, and inability to meta-analyze five RCTs with a unique head-to-head design. RCTs were of ‘good’ (56%) or ‘fair’ (44%) quality, and heterogeneity was high. Certainty was very low for pain and low for disability outcomes.

Conclusion

SIJ manual therapy appears efficacious for improving disability in adults with SIJPS, while its efficacy for pain is uncertain. It is unclear which specific manual therapy techniques may be more efficacious. These findings should be interpreted cautiously until further high-quality RCTs are available examining manual therapy against control groups such as exercise.

Registration

PROSPERO (CRD42023394326).

KEYWORDS:

• Physical therapy
• musculoskeletal manipulations
• chiropractic manipulation
• osteopathic manipulation
• sacroiliac joint
• low back pain
• chiropractic
• meta-analysis
• Manual Therapy

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10669817.2024.2316420.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The authors reported that there is no funding associated with the work featured in this article.

Notes on contributors

Robert J. Trager

Robert J. Trager is a chiropractor and researcher at University Hospitals, and a student in Duke University’s Master of Health Sciences in Clinical Research program.

Anthony N. Baumann

Anthony N. Baumann is a physical therapist at University Hospitals and a medical student at Northeast Ohio Medical University, pursuing orthopedic surgery.

Hudson Rogers

Hudson Rogers is a medical student at Northeast Ohio Medical University, pursuing emergency medicine.

Joshua Tidd

Joshua Tidd is a medical student at Northeast Ohio Medical University, pursuing orthopedic surgery.

Kevin Orellana

Kevin Orellana is a research fellow with Children’s Hospital of Philadelphia, pursuing orthopedic surgery.

Gordon Preston

Gordon Preston is an orthopedic spine surgeon at Cleveland Clinic Akron General hospital.

Keith Baldwin

Keith Baldwin is an orthopedic surgeon at Children’s Hospital of Philadelphia, with training in physical therapy and statistics.