Effectiveness of Physiotherapy Techniques in Sacroiliac Joint Dysfunction: A Systematic Review

Sacroiliac joint dysfunction (SIJD) is an under-recognized source of lumbopelvic pain and disability. Physiotherapy management commonly includes manipulation, mobilization, muscle energy technique (MET), exercise therapy, and adjuncts such as electrotherapy or shock wave therapy, but their relative effectiveness remains unclear. Here, we systematically searched PubMed, Scopus, and Web of Science (up to 19 July 2025) for randomized and pilot trials in adults with SIJD. Most included studies compared one active physiotherapy intervention with another and reported within-group reductions in pain and disability. Some individual trials reported greater improvements in selected outcomes with specific manual therapy approaches than with exercise-only or electrotherapy comparators. In an exploratory meta-analysis of three eligible trials (n = 125), the pooled effect for MET versus mobilization on disability was SMD = −0.11 (95% CI −2.49 to 2.27), with high heterogeneity (I2 ≈ 86%). Given the small evidence base, high risk of bias, and substantial imprecision and heterogeneity, this estimate should be considered hypothesis-generating and does not establish superiority, equivalence, or the absence of a clinically meaningful difference between the approaches. Because sham, placebo, no-treatment, or usual-care comparators were uncommon, the available evidence primarily informs the comparative effectiveness of physiotherapy approaches and does not establish the absolute effectiveness of manual therapy. No single technique demonstrated consistent superiority. Larger, well-reported randomized controlled trials using standardized SIJD criteria, appropriate control groups, and longer follow-up are required.