Somatic Dysfunction of the SIJ is defined as hypo or hyper-mobility of the joint in addition to a malalignment or change of positioning of the sacrum and ilium bones (e.g. Forward sacral torsion, backward sacral torsion, bilateral anterior or posterior sacral nutation, Unilateral anterior and posterior sacral nutation). The classic physical signs for a dysfunction of the sacroiliac joint in which a unilateral anterior nutation of the sacrum or ilium has occurred in the sagittal plane about a transverse axis are: Sacral sulcus seen deeper, PSIS seen Caudad, Inferior lateral angle (ILA) seen Posterior, Pubic tubercle seen as Cephalad, ASIS as Cephalad, Sacroiliac joint seen upper pole and tender, Sacrospinous and Sacrotuberous ligament are under tension and gait abnormality seen due to leg length discrepancy.
A randomized control trial will be conducted to determine the effects of mulligan mobilization with movement in order to improve pain, lumbar range of motion and functional disability in patients with unilateral anterior sacral nutation. A sample size of 41 subjects will be taken, Data will be collected from Gosh-e-Shifa Medical Rehabilitation Centre and Al-Raheem Physiotherapy Centre of Lahore. Outcome measures will be taken using Numeric pain rating scale (NPRS) for pain, Lumbar flexion by Goniometer and Modified Oswestry Disability Index (MODI) for functional Disability. A written consent form will be taken from participants meeting inclusion criteria and will be randomly allocated in two groups (Group A and Group B) of equal members. Group A (Experimental group) will receive mulligan mobilization with movement along with standardized physiotherapy intervention. While Group B will receive only standardized physiotherapy intervention. Over the course of 6 weeks, all participants in the control group and the experimental group will attend a total of 18 intervention sessions (three times per week). All participants in both groups will be evaluated before and after the treatment programs.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
41
Participants receive Mulligan mobilization (10 Repetitions of 3 sets with 5 minutes rest period between each set) and baseline physical therapy intervention.Joint mobilization will be accomplished by using the posterior innominate (on affected side) and anterior innominate (on unaffected side) techniques (Mobilization with Movement).
* Hot pack for 10 minutes (32). (Electric Medicare Heating pad) * TENS with frequency of 120Hz at low intensity below the local painful sensory threshold with pulse of width 50-200 μs for 10 minutes (33). * SIJ Stretching Exercises (hamstring stretches, hip adductor stretch, piriformis stretch, quadriceps stretch, one knee to chest stretch, both knees to chest stretch, lower trunk rotation, and pelvic rotation stretch) (1). * Core Strengthening Exercises (Isometric hip abduction/adduction strengthening)
Gosh-e-Shifa Hospital and Al Raheem Physiotherapy Centre, Lahore.
Lahore, Pakistan
Mitchell Model for Unilateral Anterior Sacral Nutation
Osteopathic authors have adopted several models to assess and diagnose the presence of sacroiliac dysfunction. The Mitchell model recommends static bony palpatory findings combined with motion tests as a basis for determining the presence and nature of SIJD (25). Physiotherapists employed diagnostic techniques congruent with Mitchell's model, but they also frequently added additional motion tests, measured tenderness, and used pain provocation techniques
Time frame: 8 weeks
Numerical Pain Rating Scale (NPRS)
Patient level of pain will be assessed using this scale. This scale ranges from 0 to 10. 0 indicates "no pain" and 10 indicates "worst pain". Clinicians can be confident that a 2point change on the NPRS represents clinically meaningful change that exceeds the bounds of measurement error. NPRS shave shown high test-retest reliability(r=0.96)
Time frame: 8 weeks
Modified Oswestry Disability Index (MODI)
MODQ is a valid and reliable tool for the assessment of the disability following low back pain. The thorough questionnaire demonstrated good reliability, good internal consistency, and confirmed convergent validity. The physical component domain of the SF-36 (r=-0.55, p\<0.001) showing that MODI is measuring what it is supposed to measure in terms of disability and physical function.
Time frame: 8 weeks
Goniometer
It is recommended in clinical practice that the instruments for measuring spinal ROM should be valid and reliable, should have low cost and are easy to use. Study recommend the use of instruments with lower costs and easier handling, as the goniometer
Time frame: 8 weeks
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