The Utility of Sacroiliac Manual Therapy for Outcome Improvement in Patients with Sacroiliac Joint Pain and Dysfunction: A Systematic Review with Meta-Analysis

Objective(s): To investigate the impact of sacroiliac (SI) manual therapy on outcomes in patients with sacroiliac joint dysfunction (SIJD) to improve patient care.

Data Sources: A systematic review was performed using PubMed, CINAHL, and MEDLINE on January 24th, 2023 from database inception with search terms ("sacroiliac") AND ("manual therapy" OR "manipulation").

Study Selection: Inclusion criteria was SI joint involvement, use of manual therapy, randomized controlled trials only, and outcomes related to pain (0-10 scale) and function (Oswestry Disability Index). Exclusion criteria was low back pain without SI joint dysfunction, no manual interventions used, non-randomized trials, and follow-up less than one week. Multiple authors participated in article screening and final selection. A total of 10 randomized controlled trials met final inclusion criteria out of 851 articles.

Data Extraction: Multiple authors participated in data extraction. Articles were assessed for quality and bias via the Physiotherapy Evidence Database (PEDro) criteria.

Data Synthesis: Included patients (n=421) had an average age of 39.5 (7.5) years with an average follow-up of 7.3 (4.2) weeks. SI joint manual therapy with or without exercise had a significant improvement in pain (p=0.027) and function via the Oswestry score (p=0.021) as compared to controls (exercise, ultrasound, and electrotherapy). Patients receiving SI thrust manipulation with or without exercise had a significantly greater decrease in pain (p=0.035) but not function (p=0.11) compared to patients who received exercise without manual therapy. Patients receiving muscle energy techniques (MET) with or without other interventions did not result in a significant improvement in pain as compared to patients receiving exercise (p=0.308).

Conclusions: SI manual therapy with or without exercise is an effective short-term conservative treatment option for improving pain and disability in patients with SIJD. However, improvements in disability are small and may not be clinically significant. SI thrust manipulation, but not MET, can result in significant improvement in pain in patients with SIJD.

Author(s) Disclosures: The authors have no disclosures to report.