A systematic review of current evidence on clinical outcomes of lumbar roll and modified SIMS manipulation techniques in sacroiliac joint dysfunction

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Abstract
Introduction: The lumbar roll and modified SIMS are two manipulation techniques commonly used to treat sacroiliac joint dysfunction (SIJD), a frequent cause of low back and pelvic pain. However, recent evidence comparing their relative clinical efficacy remains limited.Methods: This systematic review was registered in PROSPERO (Reg. No. CRD420251253094) and conducted according to PRISMA 2020 guidelines. Studies published between January 2021 and December 2025 were identified through searches of PubMed, Scopus, Web of Science, CINAHL, PEDro, the Cochrane Library, and Google Scholar (first 200 results). Eligible studies included randomized controlled trials, quasi-experimental trials, and controlled clinical studies evaluating lumbar roll or modified SIMS manipulation in adults with SIJD diagnosed using imaging-assisted criteria or validated provocation tests. Screening, data extraction, and risk-of-bias assessment (RoB-2 and ROBINS-I) were independently performed by two reviewers.Results: Of 1,264 identified records, nine studies met the inclusion criteria, with sample sizes ranging from 30 to 90 participants. Most studies reported significant short-term improvements in pain (VAS/NPRS) and disability (ODI/functional measures) following manipulation, with lumbar roll and modified SIMS showing comparable clinical benefits. Several studies also reported improvements in pelvic alignment and mobility. Adverse events were infrequent, transient, and no serious complications were reported.Conclusion: Lumbar roll and modified SIMS manipulation provide consistent short-term clinical benefits for SIJD, particularly in reducing pain and disability. However, evidence remains limited by the lack of direct head-to-head comparisons, methodological heterogeneity, and short follow-up periods. Further high-quality studies are needed to establish long-term efficacy and optimal treatment protocols.

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