Christopher James McCarthy

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.

Background Spinal manipulation is commonly used to treat back pain. The application of spinal manipulation has traditionally involved an element of targeting the technique to a level of the spine where the proposed movement dysfunction is sited. We evaluated the effects of a targeted manipulative thrust versus a thrust applied generally to the lumbar region. Methods A randomised controlled clinical trial in patients with low back pain following CONSORT (Consolidated Standards of Reporting Trials) guidelines. Sixty subjects were randomly allocated to two groups: one group received a targeted manipulative thrust (n=29) and the other a general manipulation thrust (GT) (n=31) to the lumbar spine. Thrust was either localised to a clinician-defined symptomatic spinal level or an equal force was applied through the whole lumbosacral region. We measured pressure-pain thresholds (PPTs) using algometry and muscle activity (magnitude of stretch reflex) via surface electromyography. Numerical ratings of pain and Oswestry Disability Index scores were collected. Results Repeated measures of analysis of covariance revealed no between-group differences in self-reported pain or PPT for any of the muscles studied. Summary A GT procedure—applied without any specific targeting—was as effective in reducing participants’ pain scores as targeted approaches. Trial registration number ISRCTN11994230.

Introduction: Knee and hip osteoarthritis (OA) is a leading cause of disability worldwide. Therapeutic exercise is a recommended core treatment for people with knee and hip OA, however, the observed effect sizes for reducing pain and improving physical function are small to moderate. This may be due to insufficient targeting of exercise to subgroups of people who are most likely to respond and/or suboptimal content of exercise programmes. This study aims to identify: (1) subgroups of people with knee and hip OA that do/do not respond to therapeutic exercise and to different types of exercise and (2) mediators of the effect of therapeutic exercise for reducing pain and improving physical function. This will enable optimal targeting and refining the content of future exercise interventions. Methods and analysis: Systematic review and individual participant data meta-analyses. A previous comprehensive systematic review will be updated to identify randomised controlled trials that compare the effects of therapeutic exercise for people with knee and hip OA on pain and physical function to a non-exercise control. Lead authors of eligible trials will be invited to share individual participant data. Trial-level and participant-level characteristics (for baseline variables and outcomes) of included studies will be summarised. Meta-analyses will use a two-stage approach, where effect estimates are obtained for each trial and then synthesised using a random effects model (to account for heterogeneity). All analyses will be on an intention-to-treat principle and all summary meta-analysis estimates will be reported as standardised mean differences with 95% CI. Ethics and dissemination: Research ethical or governance approval is exempt as no new data are being collected and no identifiable participant information will be shared. Findings will be disseminated via national and international conferences, publication in peer-reviewed journals and summaries posted on websites accessed by the public and clinicians. PROSPERO registration number: CRD 42017054049.

Following on from recent newspaper articles,1 BJSM podcasts2 and the Chartered Society of Physiotherapy's recent Back Pain Myth buster campaign,3 a short article was published in the Daily Mail Online 4 in August of this year. The article summarised the messages of the back pain myth buster campaign and advocated basic evidence-based approaches to exercise and management. The article was accessed over 29 000 times with 125 reader comments being posted in the following 2 weeks. Having reviewed the comments, it became apparent that there were a number of themes within the data and thus a colleague and I undertook a thematic analysis of the comments …

To explore current diagnostic practice and attitudes of Greek and United Kingdom physiotherapists (PTs) on assessing low back pain (LBP) patients. Three focus groups were undertaken, followed by a structured questionnaire-type survey comprising 23 health professionals and a random stratified sample of 150 PTs, respectively. Twenty-nine themes relating to LBP diagnostic practice emerged. These were then given to 30 British PTs assessing their level of agreement with their Greek counterparts. Analysis was performed by percentage agreements and χ² tests. The survey was divided into three subsections; PTs’ attitudes on LBP assessment, patients’ attitudes and diagnostic/healthcare issues, each constituting 14, 7 and 8 statements, respectively. Over half of the statements fell within the 30%-80% agreement between Greece and United Kingdom whereas, 5 statements reported low (< 10%) and 8 statements demonstrated high (> 90%) PT percentage agreement. Similarities across British and Greek PTs were detected in history taking methods and in the way PTs feel patients perceive physiotherapy practice whereas, re-assessment was undertaken less frequently in Greece. Diagnosis according to 91% of the Greek PTs is considered a “privilege” which is exclusive for doctors in Greece (only 17% British PTs agreed) and is accompanied with a great overuse of medical investigations. Forty percent of Greek PTs (compared to 0% of British) consider themselves as “executers”, being unable to interfere with treatment plan, possibly implying lack of autonomy. Although similarities on history taking methods and on patients’ attitudes were detected across both groups, gross differences were found in re-assessment procedures and diagnostic issues between Greek and British physiotherapists, highlighting differences in service delivery and professional autonomy.

Journal of Rehabilitation Medicine is an international peer-review journal published in English, with at least 10 issues published per year.

Journal of Rehabilitation Medicine is an international peer-review journal published in English, with at least 10 issues published per year.