Additional Effects of Mulligan Mobilization With Movement Along With Core Strengthening Exercises in Postpartum Females With Sacroiliac Joint Dysfunction

Overview

This study aims to evaluate the combined effectiveness of Mulligan mobilization and core strengthening exercises in managing postpartum sacroiliac joint dysfunction (SIJD). Postpartum SIJD is a common condition resulting from biomechanical and hormonal changes during pregnancy, often leading to pelvic instability and pain. Mulligan mobilization, a manual therapy technique, aims to correct joint alignment and restore pain-free movement. For the SIJ, Mulligan MWM aims to correct subtle positional faults or movement restrictions that may cause pain and dysfunction-especially common postpartum due to ligamentous laxity, hormonal changes, and altered biomechanics.The core muscles provide stability to the pelvis and lumbar spine. When these muscles are weak or imbalanced, it can lead to increased strain on the SIJ, contributing to pain and dysfunction. Strengthening the core improves load transfer through the pelvis and enhances neuromuscular control, thereby reducing SIJ stress and symptoms. Core strengthening exercises enhances outcomes by targeting both mechanical alignment and muscular stability. Core strengthening exercises target muscles that support pelvic stability, including the transverse abdominis and pelvic floor. The study hypothesizes that integrating Mulligan mobilization with core strengthening may provide superior outcomes in pain reduction, joint function, and overall quality of life compared to core exercises alone.

Sacroiliac joint dysfunction (SIJD) is a common musculoskeletal condition experienced by postpartum females, primarily due to the physiological and biomechanical changes that occur during pregnancy and childbirth. The sacroiliac joints, which connect the sacrum to the ilium on either side of the pelvis, play a critical role in transferring weight between the upper body and lower limbs. During pregnancy, hormonal changes-particularly increased levels of relaxin-cause ligamentous laxity, leading to reduced joint stability. Combined with the mechanical stress of a growing uterus, changes in posture, and altered gait, this laxity can cause misalignment, inflammation, and pain in the sacroiliac region. Postpartum, many women continue to experience discomfort due to persistent instability, muscular imbalances, or poor core control. Symptoms often include localized or radiating pain in the lower back, buttocks, or thighs, which may worsen with weight-bearing activities, prolonged standing, or transitions like standing from a seated position. Early recognition and targeted rehabilitation-including core strengthening, manual therapy, and postural retraining-are essential to restore stability, relieve pain, and support safe return to daily function and physical activity. Mulligan Mobilization with Movement (MWM) is a manual therapy technique designed to restore normal joint mechanics and reduce pain by correcting subtle positional faults within a joint. For sacroiliac joint (SIJ) dysfunction, which commonly occurs postpartum due to ligament laxity, hormonal changes, and altered biomechanics, MWM offers a non-invasive and effective approach to improve joint alignment and function. The technique involves the therapist applying a sustained passive accessory glide to the affected innominate bone (ilium or sacrum), typically in an anterior or posterior direction, while the patient actively performs a specific movement such as hip flexion, lunging, or straight leg raise. This combined movement helps re-establish normal arthrokinematics and neuromuscular coordination, often resulting in immediate pain relief and improved mobility. A treatment belt may be used to assist with stabilization and provide the appropriate direction of force. MWM is typically performed in multiple repetitions within a session and is progressed based on patient tolerance and symptom response. It is considered highly beneficial in treating SIJ dysfunction when integrated with functional rehabilitation strategies, as it addresses both mechanical restrictions and movement impairments contributing to the dysfunction.Core strengthening exercises play a vital role in the rehabilitation of sacroiliac joint dysfunction (SIJD) in postpartum females by targeting the deep stabilizing muscles responsible for pelvic and lumbar support. During and after pregnancy, hormonal changes such as increased relaxin levels, along with biomechanical stress, can lead to ligamentous laxity and instability in the pelvic region, making the sacroiliac joints particularly vulnerable. Strengthening the core-especially the transversus abdominis, multifidus, pelvic floor muscles, and diaphragm-restores neuromuscular control and enhances the load transfer across the pelvis. The exercise program typically progresses through phases, beginning with gentle activation techniques like the abdominal draw-in maneuver, pelvic tilts, and pelvic floor contractions, which re-establish deep muscle engagement without overloading the joint. As stability improves, more dynamic exercises such as glute bridges, bird-dog, and side-lying clamshells are introduced to develop strength and coordination. Eventually, functional movements like modified planks, wall sits, and core-braced lunges help integrate stability into daily activities. These exercises, when performed consistently and under proper guidance, can significantly reduce pain, improve postural alignment, and enhance overall function in postpartum women with SIJD, making them a cornerstone of conservative management.