CMCT Versus CSE in Treatment of SIJ Pain
ConditionSacroiliac Joint Pain
Trial statusNot yet recruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18-45
SponsorCairo University
About this trial
This study aims to investigate the difference between integrating lumbopelvic cognitive movement control training versus core stabilization exercises to the conventional physiotherapy program on pain, function, lumbopelvic stability, functional load transfer, and postural control in patients suffering from SIJ pain. The main question it aims to answer is:
What are the effects of adding lumbopelvic movement control training versus core stabilization exercises to the conventional physiotherapy program in treating patients with SIJ pain?
Researchers will compare adding lumbopelvic movement control training versus core stabilization exercises to the conventional physiotherapy program to investigate its effectiveness in treatment of SIJ pain
Participants will:
1. receive the intervention as follows:
* Group (A) - Control Group: will receive conventional physiotherapy program (US and MET) * Group (B) - Core Stability Exercises Group: will receive conventional US, MET, and core stability ex's * Group (C) - Lumbopelvic cognitive movement control training Group: will receive conventional US, MET, and cognitive movement control training. 2. receive the training protocol 3 times a week for 8 weeks according to the set schedules. 3. perform a home exercise program in the same dose of repetitions and time as in the session. 4. be assessed before and after the intervention and training period to address the outcome measures.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Age of the subjects will range between 18 - 45 years for young middle-aged adults.
Unilateral SIJ pain lasting for at least 3 months, in lower back, buttock, groin, posterior superior iliac spine (PSIS) and with or without referral pain to the lower extremities.
SIJ pain below L5 region.
Non-centralized LBP i.e. has no directional preference.
Disqualifiers
Limb-length discrepancy,
Clear signs of nerve root compression (radiating pain, motor and/or sensory deficits,
Previous major back surgery or injury, fracture or arthritis of spine, pelvis, hip, knee or ankle joint,
Seronegative spondyloarthropathies,
Trial design
Design model
Parallel
Treatments tested in this trial
The conventional Physiotherpay Program (US & MET)
Other interventionThe conventional approach includes ultrasound (US) application combined with muscle energy technique (MET) for the lumbopelvic region. The subjects will receive therapeutic ultrasound (for 5 mins, intensity of 1W/cm2). In addition, MET will be applied in prone for anterior and posterior innominate rotation around the pelvis. The subject will then be asked to apply 20% force against that applied by the therapist and hold that contraction for 10 seconds over 5 to 10 repetitions.
Core Stability Exercises (CSE)
Other interventionIn addition to the conventional protocol including US and MET stretching, subjects in this group will perform core stabilization exercises (CSE) to improve the activation and coordination of deep core stabilizers: transversus abdominis, multifidus, and pelvic floor muscles, which are essential for maintaining lumbopelvic stability and neuromuscular control. The core stabilization exercises consist of 5 exercises: pelvic tilt, double knee to chest, bridging, bird-dog, and cat-camel, to be performed in the same order. Also, before each exercise, the physical therapist will give detailed verbal explanation and visual instructions (pictures) regarding the start and end positions. Each exercise will be done for two sets of 10 repetitions, 3 sessions per week (day after day), for 8 weeks.
Lumbopelvic cognitive movement control training (CMCT)
Other interventionIn addition to the traditional protocol including US and MET stretching, subjects in this group will undergo lumbopelvic cognitive movement control training (CMCT) that requires the lumbopelvic region to be positioned in a neutral alignment and the subject will be asked to consciously maintain the desired alignment and keep a pre-determined value of PBU whilst the lower limbs are actively moved to achieve a pre-determined benchmark. This training will be in multi-directions to address the lumbopelvic uncontrolled movements into flexion, extension and rotation as follows: * Into flexion, we will use double bent leg lift exercise * Into extension, we will use double leg lower exercise and also, double knee bend exercise * Into rotation, we will use single hip extension exercise and also, bent knee fallout exercise Each exercise will be done for 20-30 slow repetitions or up to two consecutive mins. of slow repetitions, with hold time (no pressure change) for at least 5 seconds inbetween.
Treatment groups
36 Participants
are divided into 3 treatment groupsGroup A: Group (A): Control GroupActive comparator 1 intervention
Group B: Group (B): Core Stability Exercises GroupExperimental treatment 2 interventions
Group C: Group (C): Lumbopelvic cognitive movement control training GroupExperimental treatment 2 interventions
Trial outcomes
Primary outcomes
1
Pain: using Numerical Pain Rating Scale (NPRS)
The Arabic Numeric Pain Rating Scale (ANPRS) measures pain intensity in Arabic-speaking patients. The patients will be asked to rate their pain on a 10-point pain scale with a 0 score means no pain and 10 score means maximum pain.
Time frame
Baseline (pre-treatment) and after 8 weeks (post-treatment)2
Functional disability: using Oswestry Disability Index (ODI)
The Arabic ODI is appropriate for use as a patient reported outcome measure with Arabic speaking individuals with low back pain and /or SIJ pain. The patients will be instructed to fill the ODI which is a self-report pencil and paper survey, where subjects indicate how their pain affects their abilities in 10 questions on domains such as pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, travel, and sexual life.
Time frame
Baseline (pre-treatment) and after 8 weeks (post-treatment)Secondary outcomes
1
Lumbopelvic motor control function: by Pressure Biofeedback Unit (PBU)
It will be used to indirectly monitor muscle activity by the change of pressure as a mean to estimate the muscle activation of the multifidus (MF) and transversus abdominis (TA) muscles that, in turn, helps patients undertake motor control exercise interventions. While the subjects will be trying to keep the PBU value constant as possible (40 mm Hg in supine and 70 mm Hg in prone), they will be instructed to breathe normally to avoid a Valsalva maneuver and to consciously do certain lower limb movements (double bent leg lift and lowering in crook-lying, double knee bend in prone).
Time frame
Baseline (pre-treatment) and after 8 weeks (post-treatment)2
Functional Load transfer: by Active straight leg raise test (ASLR)
The ASLR test will be performed to detect failed load transfer across the lumbopelvic region in supine position with straight legs and feet apart. Patients will be asked to raise his/her lower limb above the bench for 20 cm or 20° hip flexion without bending the knee and return it to back after a 1-2 second hold. The test then will be repeated while a manual compressive force is applied through the ilia, or with a belt tightened around the pelvis or SIJ. A positive test is denoted by improved ability to raise the leg.
Time frame
Baseline (pre-treatment) and after 8 weeks (post-treatment)3
Balance and Postural control: by Single leg stance balance test with eyes closed (SLSBT-EC)
This test will be used for detecting balance impairments and postural control deficits in SIJP patients. While standing bare-footed on the weightbearing lower extremity on the floor with the contralateral hip flexed to 45° and the knee flexed to 90° so that the knee is in front of the standing leg and the foot behind the standing leg, the patients will be asked to balance for up to 30 s with eyes closed (EC).
Time frame
Baseline (pre-treatment) and after 8 weeks (post-treatment)Sponsors and contacts
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Source ClinicalTrials.gov
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