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.
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
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
Parallel
Kinetic Control + Mobilization with Movement
Other interventionParticipants will receive baseline therapy consisting of superficial heating therapy followed by structured stretching and strengthening exercises for the sacroiliac joint and lumbar region on mat. Then Mulligan's MWM will be applied to the sacroiliac joint using sustained accessory glides combined with pain-free active movement. This will be followed by kinetic control training targeting the gluteus maximus and multifidus muscles. Gluteus maximus retraining will be performed in supported positions emphasising controlled hip extension with the knee flexed while maintaining lumbo-pelvic neutrality. Multifidus retraining will target the deep segmental lumbar extensors with contribution from the deep thoracic extensors. Training will begin in crook lying with a pillow or thick folded towel under the sacrum to elevate the pelvis and allow the lumbar spine to relax while thoracic spine remians neutral. Each session lasts 45 minutes. The intervention will be delivered for 8 weeks.
Mobilization with Movement
Other interventionParticipants will receive baseline therapy consisting of superficial heating therapy followed by structured stretching and strengthening exercises for the sacroiliac joint and lumbar region on mat. Mulligan's MWM will be applied according to standard Mulligan principles. Participants will be classified as having anterior or posterior ilial rotation based on physical examination findings. For anterior rotation, a sustained posterior glide to the affected ilium with sacral stabilization will be applied during prone press-up. For posterior rotation, an anterolateral glide will be delivered over the posterior superior iliac spine with counter-pressure to the opposite ilium. Mobilization will be performed in non-weight-bearing for 3 sets of 10 repetitions per session, within a pain-free range, over 8 weeks (3 sessions/week).
Numeric Pain Rating Scale (NPRS)
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
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)
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)
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
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