Immediate effect of hip joint mobilization versus sacroiliac joint mobilization on gluteus maximus muscle strength- A randomized clinical trial

The gluteus maximus, the largest and most superficial muscle, plays a crucial role in adapting to the postural changes from quadrupedal to bipedal locomotion. Its proximal insertion includes the sacrum, dorsal sacral ligaments, posterior crest section, and sacrotuberous ligament, with fibers extending to insert into the iliotibial tract and gluteal tuberosity of the femur. This muscle is vital for generating the force necessary to maintain an upright bipedal posture. Weakness or delayed activation of the gluteus maximus can lead to injuries and chronic pain, impacting performance and strength, and potentially causing ankle injuries, hamstring strains, lower back pain, and increased stress on the anterior hip joint.

Muscle strength assessment is essential in clinical examinations and can be done using various methods such as manual muscle testing, hand-held dynamometers, and digital dynamometers. Strengthening exercises involve applying external loads through different techniques like isometric contraction, weight cuffs, Therabands, plyometrics, mobilization, and manipulation techniques. Joint immobilization can lead to restrictions and adhesions, reducing tissue load-bearing capacity, which can be reversed by joint mobilization to improve muscle function.

The arthrokinetic reflex (AKR) refers to reflexes regulating neuromuscular activity through articular receptors. These receptors can inhibit or facilitate muscle tone, with stretching of the joint capsule triggering mechanoreceptors to influence muscle tone and reflexes. AKR protects the body from overstressing structures related to fixated joints, and mobilization can improve muscle strength by enhancing the extensibility of capsuloligamentous structures, affecting mechanoreceptor activation. Mobilization stretches these tissues to their ideal length, removing the AKR’s inhibitory effect and potentially improving motor activity and muscle strength.

This study aimed to assess the immediate impact of hip joint versus sacroiliac joint mobilization on gluteus maximus muscle strength, given its crucial role in hip extension and importance in rehabilitation. The application of Maitland mobilization techniques on these joints and their effects on gluteus maximus strength were explored.