Combined Effects of Mulligan's Mobilization With Movement and Kinetic Control Training on Pain, Range of Motion, Gait and Functional Disability Among Patients With Sacroiliac Joint Dysfunction
Overview
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- Lahore University of Biological and Applied Sciences
- Enrollment
- 55
- Locations
- 2
- Primary Endpoint
- Numeric Pain Rating Scale (NPRS)
Overview
Brief Summary
Sacroiliac joint dysfunction (SIJD) is a frequent source of low back and pelvic pain and contributes significantly to movement restriction, altered gait patterns, and functional disability in adults. It is associated with impaired lumbopelvic motor control, weakness of key stabilizing muscles, and faulty load transfer across the pelvis. SIJD is prevalent in both physically active individuals and sedentary populations. In addition to its clinical impact, SIJD imposes a considerable socioeconomic burden due to reduced work productivity and long-term disability.
Contemporary management of SIJD emphasises on pain reduction, restoration of movement, functional independence, and participation in daily activities. Manual therapy techniques such as Mulligan's Mobilization with Movement (MWM) are widely used to correct positional faults and restore pain-free movement, while kinetic control training targets deficits in motor control of the lumbopelvic stabilizing muscles. Although both approaches are individually supported in the literature, evidence regarding their combined effectiveness on pain, range of motion, gait parameters, and functional disability remains limited. Therefore, this study aims to compare the effects of combined Mulligan's Mobilization with Movement and kinetic control training versus kinetic control training alone in patients with sacroiliac joint dysfunction using validated outcome measures.
Detailed Description
Sacroiliac joint dysfunction (SIJD) refers to altered biomechanics of the sacroiliac joint, characterized by either excessive or restricted movement, or the presence of abnormal motion patterns. It is a recognized source of pain originating from the sacroiliac joint and occurs due to abnormal or increased movement of the ilium relative to the sacrum, leading to irritation of the surrounding joint structures. The prevalence of SIJD among individuals with low back pain has been reported to range from 15% to 30% in Asian populations, including Pakistan. In the Pakistani context, SIJD is frequently observed among healthcare professionals and individuals whose occupations involve prolonged standing or repetitive postural activities. In recent years, the incidence of SIJD appears to be increasing, possibly due to sedentary lifestyles, cumulative mechanical stress, and improved clinical recognition of the sacroiliac joint as a distinct contributor to low back pain.
The clinical diagnosis of SIJD is primarily based on a detailed patient history and focused physical examination, while its management involves a combination of therapeutic approaches. Current management strategies are consistent with the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. Two therapeutic approaches of concern in this study are Mulligan's Mobilization with Movement (MWM) and KInetic Control (KC) training.
Mulligan's Mobilization with Movement (MWM) is a manual therapy technique that applies sustained accessory glides during active movement to correct positional faults and alleviate pain. This approach is intended to produce immediate functional improvement by combining pain-free accessory glides with physiological movement. Mobilization of the sacroiliac joint through physiotherapy aims to restore normal joint mechanics, enabling patients to maintain optimal sacroiliac joint function throughout daily activities.
Kinetic Control, as proposed by Comerford and Mottram, focuses on retraining faulty movement patterns to address uncontrolled movement and enhance joint stability. Movement is fundamental to functional performance and participation in daily life, and restoring controlled movement enables individuals to regain the functional choices that are often lost in the presence of pain and movement impairment. This study therefore seeks to compare the effects of Mulligan's MWM combined with kinetic control training targeting the gluteus maximus and multifidus muscles.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Outcomes Assessor)
Eligibility Criteria
- Ages
- 45 Years to 64 Years (Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Both male and female patients
- •Age between 45- 64 years
- •Unilateral non-radiating pain
- •Confirmed diagnosis through at least 3/5 provocative tests Faber test Distraction test Thigh thrust test Gaenslen test Sacral thrust test
- •Pain rating from 4-6 on Numeric Pain Rating Scale
- •Symptoms of SIJD for more than 2 months
Exclusion Criteria
- •Patients with history of any surgery at lumbo-sacral or pelvic region
- •Pregnancy, lactation
- •Congenital, postural deformities
- •Acute disc hernia and spinal stenosis that may cause pain in the lower back and hips, piriformis syndrome
- •Rheumatic diseases (fibromyalgia, ankylosing spondylitis, rheumatic arthritis)
- •Acute infections or malignancies
- •Having received manual therapy for the sacroiliac joint in the past 3 months
- •Injection of corticosteroids or anesthesia in the SIJ during the previous 1 month
- •Psychological disorders affecting the subject's ability to follow the instructions
Arms & Interventions
KC + MWM Group
Group A will receive routine physical therapy along with kinetic control training of multifidus and glutues maximus with mulliogan's mobilization with movement.
Intervention: Kinetic Control + Mobilization with Movement (Other)
MWMGroup
Group B will receive routine physical therapy along with Mulligan's mobilization with movement.
Intervention: Mobilization with Movement (Other)
Outcomes
Primary Outcomes
Numeric Pain Rating Scale (NPRS)
Time Frame: 8 weeks
The intensity of pain was measured by using the NPRS, a scale of 11 points starting from 0 to 10, where 0 represents no pain and 10 represents the worst possible pain. The NPRS has been found to possess good construct validity by showing strong correlation with other pain intensity measurement tools. This scale has also been found to possess consistent reliability (ICC: 0.58 to 0.88), especially in patients experiencing neck pain. The application of this scale has also been found to extend beyond patients experiencing musculoskeletal disorders.
Inclinometer
Time Frame: 8 weeks
ROM was measured by using an inclinometer to measure joint movement quantitatively. Inclinometer has been found to possess superior reliability over a goniometer for measuring ROM. High intrarater reliability values (ICC\>0.90) has been observed for inclinometers, indicating excellent consistency of measurement by a tester. High reliability has also been found for medical and digital types of inclinometers (ICC ≈ 0.91-0.95). For measuring ROM two inclinometers were fixed, with one placed over the T12 spinous process and the other over the S1 spinous process. This helped to measure the ROM of lumbar spine, keeping the effects of hip and sacral joints at a minimum. The ROM of lumbar spine was measured by using a dual inclinometer technique, keeping one over the superior aspect of T12 and the other over the inferior aspect of S1. The subjects were asked to perform various types of lumbar spine movements by keeping their knees straight.
Observational Gait Analysis (OGA)
Time Frame: 8 weeks
Gait assessment was carried out by using observational gait analysis (OGA), which is a structured assessment of gait using standardized gait assessment scales. It helps to assess and quantify abnormalities of gait through visual observation. The basic framework of OGA is a 5-point scale, where each gait parameter is scored during the stance and swing phases. The clinician first observes the gait cycle of the patient, focusing on the kinematic gait patterns including pelvic alignment during initial contact of the foot and knee flexion during the mid-swing phase. The OGA form provides a connection between qualitative and quantitative assessment of gait. This heps in the development of a rehabilitation program for each patient.
Modified Oswestry Disability Index (MODI)
Time Frame: 8 weeks
Functional disability was measured using MODI, a self reported questionnaire that was designed to measure disability related to low back and lumbopelvic disorders. MODI follows the same scoring system and disability interpretation criteria as the original ODI. It consists of 10 sections that include pain intensity, personal care (e.g., washing and dressing etc), lifting, walking, sitting, standing, sleeping, social life, travelling and eployment/home making. Each scored from 0 to 5, yielding a maximum total score of 50 points (or 45 points if 1 section is omitted). The final score is calculated by formula: Patient's total score / total possible score × 100 The percentage score is interpreted as follows: * 0-20% : minimal disbability * 21-40% : moderate disability * 41-60% : severe disability * 61-80% : crippling disability where pain impinges on all aspects of patient's life * 81-100%: patients are bed bound a minimum change of 10% is necessary to reflect reliable change in disability
Secondary Outcomes
No secondary outcomes reported
Investigators
Prof. Dr. Shoaib Waqas
Professor
Lahore University of Biological and Applied Sciences