Mobilization Versus Myofascial Release in Sacroiliac Joint Dysfunction: Effects on Pain, Balance, and Spinal Mobility
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 47
- 试验地点
- 1
- 主要终点
- Postural control assessment
研究概览
简要总结
Sacroiliac joint dysfunction (SIJD) is a musculoskeletal condition associated with low back and pelvic pain, functional limitations, impaired postural control, and reduced spinal mobility. Although manual therapy techniques are commonly used in the conservative management of SIJD, evidence directly comparing joint-focused and fascial-focused approaches remains limited.
This assessor-blinded, parallel-group randomized controlled trial compared sacroiliac joint mobilization and posterior chain-focused myofascial release, each applied in addition to a standardized conventional physiotherapy program, in adults aged 18-65 years with SIJD. Participants were randomly allocated in a 1:1 ratio to the mobilization group or the myofascial release group. Both groups received three supervised treatment sessions per week for six weeks.
The primary outcomes were postural control assessed using the Biodex Balance System and spinal posture, mobility, postural endurance, and total Spine Check performance assessed using the Spinal Mouse system. Secondary outcomes were resting, activity-related, and night pain assessed using the Visual Analog Scale and functional disability assessed using the Oswestry Disability Index. Assessments were performed at baseline and immediately after the six-week intervention.
详细描述
This prospective, assessor-blinded, two-arm, parallel-group randomized controlled trial compared the effects of sacroiliac joint mobilization and posterior chain-focused myofascial release in individuals diagnosed with sacroiliac joint dysfunction.
Eligible participants were randomly allocated in a 1:1 ratio using a computer-generated randomization sequence. Allocation concealment was provided using sequentially numbered, opaque, sealed envelopes. Both groups received the same standardized conventional physiotherapy program three times per week for six weeks, for a total of 18 supervised sessions.
The conventional physiotherapy program included bridging, trunk extension, and abdominal curl exercises, together with therapeutic ultrasound applied to the sacroiliac joint region. Exercises were performed in three sets of 15 repetitions and progressed at two-week intervals according to the participant's tolerance, movement quality, and pain response.
The myofascial release group additionally received posterior chain-focused manual techniques targeting the erector spinae, thoracolumbar and lumbar fascial structures, lumbosacral region, gluteal fascia, and gluteus medius. The mobilization group additionally received sacroiliac joint mobilization techniques performed in side-lying and prone positions.
The primary outcomes were static and dynamic postural control and Spinal Mouse-derived posture, spinal mobility, postural endurance, and total Spine Check scores. Secondary outcomes included resting, activity-related, and night pain and functional disability. All outcomes were assessed before treatment and immediately after the six-week intervention.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
盲法说明
The outcome assessor was not involved in intervention delivery and remained blinded to group allocation throughout the study. Participants were instructed not to disclose their treatment allocation to the assessor. Because of the nature of the manual therapy interventions, the treating physiotherapist and participants could not be blinded. Statistical analyses were conducted using a coded dataset, and group identities were concealed from the statistician until the analyses were completed.
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Individuals aged between 18 and 65 years. Clinical diagnosis of sacroiliac joint dysfunction according to the criteria of the International Association for the Study of Pain.
- •Pain localized to the sacroiliac joint region, with or without radiation to the hip, groin, or lower extremities.
- •Positive findings in at least three of five sacroiliac joint provocation tests: Vorlauf test, Gillet test, irritation point tenderness, posterior shear test, and compression test.
- •Pain intensity of at least 3 on the Visual Analog Scale. Voluntary participation and provision of written informed consent.
排除标准
- •History of surgery involving the spine, pelvis, or lower extremities. Lumbar disc herniation, spinal stenosis, or acute hip joint pathology. Piriformis syndrome or low back or hip pain originating from a condition other than sacroiliac joint dysfunction.
- •Central or peripheral neurological disease or progressive neurological deficit. Rheumatological disease, including rheumatoid arthritis or ankylosing spondylitis.
- •Pregnancy or a severe systemic condition that could interfere with participation.
研究组 & 干预措施
Myofascial Release
Participants received posterior chain-focused myofascial release in addition to the standardized conventional physiotherapy program. Each technique was applied for approximately 90-120 seconds and repeated twice during each treatment session.
The intervention included manual techniques targeting the erector spinae muscles, lumbosacral region, thoracolumbar and lumbar fascial structures, diaphragm-related fascial restrictions, gluteal fascia, and gluteus medius. Sustained cross-hand pressure, transverse knuckle pressure, lumbosacral decompression, fascial release, and distal-to-proximal deep massage techniques were used according to the targeted tissue and participant tolerance.
干预措施: myofascial relaxation (Other)
Mobilization
Participants received sacroiliac joint mobilization in addition to the standardized conventional physiotherapy program. The mobilization techniques were performed with the participant in side-lying and prone positions.
The intervention included mobilization of the restricted sacroiliac joint in side-lying, controlled lumbar flexion, mobilization directed from the iliac crest toward the greater trochanter, caudal traction of the sacrum, mobilization of the sacrum relative to the ilium, and stretching techniques initiated from the iliac crests.
Each mobilization technique was applied for 2 minutes using low-amplitude rhythmic movements within the participant's pain-free range. The technique was discontinued if pain increased or the participant was unable to tolerate the application.
干预措施: Mobilization (Other)
Myofascial Release
Participants received posterior chain-focused myofascial release in addition to the standardized conventional physiotherapy program. Each technique was applied for approximately 90-120 seconds and repeated twice during each treatment session.
The intervention included manual techniques targeting the erector spinae muscles, lumbosacral region, thoracolumbar and lumbar fascial structures, diaphragm-related fascial restrictions, gluteal fascia, and gluteus medius. Sustained cross-hand pressure, transverse knuckle pressure, lumbosacral decompression, fascial release, and distal-to-proximal deep massage techniques were used according to the targeted tissue and participant tolerance.
干预措施: Traditional treatment program (Other)
Mobilization
Participants received sacroiliac joint mobilization in addition to the standardized conventional physiotherapy program. The mobilization techniques were performed with the participant in side-lying and prone positions.
The intervention included mobilization of the restricted sacroiliac joint in side-lying, controlled lumbar flexion, mobilization directed from the iliac crest toward the greater trochanter, caudal traction of the sacrum, mobilization of the sacrum relative to the ilium, and stretching techniques initiated from the iliac crests.
Each mobilization technique was applied for 2 minutes using low-amplitude rhythmic movements within the participant's pain-free range. The technique was discontinued if pain increased or the participant was unable to tolerate the application.
干预措施: Traditional treatment program (Other)
结局指标
主要结局
Postural control assessment
时间窗: 6 week
Postural control will be assessed statically and dynamically. The Biodex balance system (Biodex Medical System Inc., NY, USA, SW45 30D E6N Model, SD 950 304) will be used. This device creates stability indices by evaluating movements in the overall, anterior-posterior, and medial-lateral directions. For static balance assessment, the subject is asked to hold a small circle containing a black dot representing their center of gravity without moving it for 20 seconds, repeated 3 times. For dynamic assessment, the floor movement level is set to 12 at the start and gradually reduced to 9 throughout the test. At these levels, the subject attempts to keep their center of gravity balanced within the small circle. Total, anterior-posterior (A-P), and medial-lateral (M-L) values are recorded. Increased values indicate worsening balance activity
Posture and spinal mobility
时间窗: 6 week
It was measured using the computer-assisted wireless Spinal Mouse device (the Spinal Mouse System, Idiag, Fehraltorf, Switzerland). The Spinal Mouse device is moved over the spine using its wheel, measuring the length of the spine, posture, and joint movements, and transferring this sequence to a computer environment. It is a reliable method that can noninvasively measure the physical characteristics and movement of the spine in a practical way. Measurements are taken from the spinous process of the seventh cervical vertebra to the third sacral vertebra. For spinal mobility, the trunk flexion posture is recorded. For postural competence values, an upright posture measurement is performed, and then a weight equal to 5% of the person's body weight is held parallel between the shoulders for 30 seconds. After the weight is still in the person's hands, the upright posture is measured again
Change in Static and Dynamic Postural Control
时间窗: Baseline and immediately after the 6-week intervention.
Postural control will be assessed statically and dynamically. The Biodex balance system (Biodex Medical System Inc., NY, USA, SW45 30D E6N Model, SD 950 304) will be used. This device creates stability indices by evaluating movements in the overall, anterior-posterior, and medial-lateral directions. For static balance assessment, the subject is asked to hold a small circle containing a black dot representing their center of gravity without moving it for 20 seconds, repeated 3 times. For dynamic assessment, the floor movement level is set to 12 at the start and gradually reduced to 9 throughout the test. At these levels, the subject attempts to keep their center of gravity balanced within the small circle. Total, anterior-posterior (A-P), and medial-lateral (M-L) values are recorded. Increased values indicate worsening balance activity
Change in Posture, Spinal Mobility, Postural Endurance, and Total Spine Check Score
时间窗: Baseline and immediately after the 6-week intervention.
It was measured using the computer-assisted wireless Spinal Mouse device (the Spinal Mouse System, Idiag, Fehraltorf, Switzerland). The Spinal Mouse device is moved over the spine using its wheel, measuring the length of the spine, posture, and joint movements, and transferring this sequence to a computer environment. It is a reliable method that can noninvasively measure the physical characteristics and movement of the spine in a practical way. Measurements are taken from the spinous process of the seventh cervical vertebra to the third sacral vertebra. For spinal mobility, the trunk flexion posture is recorded. For postural competence values, an upright posture measurement is performed, and then a weight equal to 5% of the person's body weight is held parallel between the shoulders for 30 seconds. After the weight is still in the person's hands, the upright posture is measured again
Postural control assessment
时间窗: 6 week
Postural control will be assessed statically and dynamically. The Biodex balance system (Biodex Medical System Inc., NY, USA, SW45 30D E6N Model, SD 950 304) will be used. This device creates stability indices by evaluating movements in the overall, anterior-posterior, and medial-lateral directions. For static balance assessment, the subject is asked to hold a small circle containing a black dot representing their center of gravity without moving it for 20 seconds, repeated 3 times. For dynamic assessment, the floor movement level is set to 12 at the start and gradually reduced to 9 throughout the test. At these levels, the subject attempts to keep their center of gravity balanced within the small circle. Total, anterior-posterior (A-P), and medial-lateral (M-L) values are recorded. Increased values indicate worsening balance activity
Posture and spinal mobility
时间窗: 6 week
It was measured using the computer-assisted wireless Spinal Mouse device (the Spinal Mouse System, Idiag, Fehraltorf, Switzerland). The Spinal Mouse device is moved over the spine using its wheel, measuring the length of the spine, posture, and joint movements, and transferring this sequence to a computer environment. It is a reliable method that can noninvasively measure the physical characteristics and movement of the spine in a practical way. Measurements are taken from the spinous process of the seventh cervical vertebra to the third sacral vertebra. For spinal mobility, the trunk flexion posture is recorded. For postural competence values, an upright posture measurement is performed, and then a weight equal to 5% of the person's body weight is held parallel between the shoulders for 30 seconds. After the weight is still in the person's hands, the upright posture is measured again
次要结局
- Pain level(6 week)
- Disability(6 week)
- Change in Resting, Activity-Related, and Night Pain(Baseline and immediately after the 6-week intervention.)
- Pain level(6 week)
- Disability(6 week)
研究者
Safak Kuzu
Assist. Prof.
Kirsehir Ahi Evran Universitesi