This study holds significant importance as it directly addresses the need for effective physiotherapy interventions in patients with sacroiliac joint dysfunction, a condition that contributes substantially to lower back pain and disability. By comparing the effects of Fascial Manipulation and Muscle Energy Technique on pain pressure threshold, disability, and range of motion, the study provides evidence-based guidance for clinicians in selecting the most appropriate treatment. The findings can help physiotherapists develop more targeted rehabilitation plans, improve patient outcomes, and reduce treatment time. Additionally, this research adds to the limited literature available on stecco fascial manipulation and muscle energy technique approaches for SI joint dysfunction and may encourage further studies to refine and expand conservative management strategies. Ultimately, the study benefits both healthcare professionals and patients by promoting more efficient, safe, and effective physiotherapy care.
Both male and female.
Participants with a medical diagnosis of SIJD (posterior innominate and anterior innominate), pain and tenderness at PSIS, Sacral Sulcus, Ilia.
Pain in the paraspinal muscles, gluteal or groin region, and radiating to either leg.
3 Positive special tests for SIJD (Faber test, Thigh thrust test, Distraction test, compression test, and Gaenslen test).
Subjects with leg length discrepancy.
Subjects with any pathology observed in the lower extremity.
Subjects with pre-diagnosed tumors of the hip and spine.
Pregnancy.
Parallel
Stecco fascial manipulation
Other interventionStecco myofascial manipulation on the retro-lumbi which are located over the muscle bellies of the erector spinae at the T12- L1 level, retro-talus which are located in the myotendinous passage of the gastrocnemius, retro-thorax, which are located over the muscle bellies of the erector spinae, at the level of T4-T5, extra-thorax, which are located medially to the scapula, at the level of the scapular spine, over the rhomboid and serratus posterior superior muscle, extra-lumbi which are situated below the 12th rib, over the insertion of the oblique muscle. Fascial manipulation was not performed directly over the painful area; instead, selected fascial points situated at least 20 cm away from the site of pain were treated to avoid local tissue irritation and to utilize the principle of fascial continuity. Manual manipulation was performed using sustained deep pressure applied with the therapist's knuckles or elbow, combined with friction over the identified points.
Muscle energy technique
Other interventionMET was applied in two forms: Anterior and posterior dysfunction of the SIJ. The MET technique for correction of anterior dysfunction of the sacroiliac joint was performed by placing the individual in a lateral position on the opposite side to that of the dysfunction. The blocked leg was taken by the examiner, while the unaffected leg remained extended on the stretcher. The leg was placed in hip flexion until the first point of tension that prevented the posterior rotation of the ilium was found.hold it for 10 second and apply four repitation.In order to correct the SIJ dysfunction due to a posteriorly rotated ilium, the individual was placed in a prone position with his or her unaffected side leg in extension, while the affected side leg was in knee flexion. The therapist held the leg in a 90◦ flexion and tried to help hip extension so as to get the ilium to rotate posteriorly in order to correct the dysfunction. Hold it for 10 second and apply for four repitation.
Goniometer
Lumbar range of motion (ROM) was assessed using a universal goniometer, a simple, handheld clinical instrument specifically designed to measure joint angles and the extent of movement in degrees. The goniometer consists of two arms and a central fulcrum, allowing accurate quantification of active lumbar movements, including flexion, extension, lateral flexion, and rotation. Standardized patient positioning and anatomical landmark identification were used to enhance measurement accuracy. Reduced lumbar ROM is commonly associated with pain and functional limitation in individuals with sacroiliac joint dysfunction.
Pain self-efficacy questionnaire (PSEQ)
Pain self-efficacy, defined as an individual's confidence in performing daily activities despite the presence of pain, was assessed using the Pain Self-Efficacy Questionnaire (PSEQ). The PSEQ is a widely used, condition-independent, self-reported outcome measure designed to evaluate how confidently individuals can function while experiencing pain. It consists of 10 items, each rated on a 7-point Likert scale (0-6), producing a total score ranging from 0 to 60, with higher scores indicating greater pain self-efficacy.
Algometer:
Pressure pain threshold (PPT) was assessed using a handheld pressure algometer, an objective instrument designed to quantify mechanical pain sensitivity by applying controlled, gradually increasing pressure to soft tissues. In this study, the algometer was applied over a standardized anatomical point in the sacroiliac joint region until the participant first perceived pain, at which point the corresponding value was recorded in kilograms or Newtons. Higher PPT values indicate greater pain tolerance, whereas lower values reflect increased pain sensitivity.
Oswestry disability index (ODI)
Functional disability related to sacroiliac joint dysfunction was assessed using the Oswestry Disability Index (ODI), which is one of the most widely used and validated questionnaires for measuring disability associated with low back and pelvic pain. The ODI is a condition-specific, self-reported outcome measure designed to assess the degree to which pain affects an individual's ability to perform activities of daily living, including personal care, lifting, walking, sitting, standing, sleeping, social life, and traveling. It consists of 10 items, each scored on a 6-point scale (0-5), yielding a total score ranging from 0 to 50, which is commonly converted into a percentage score, with higher scores indicating greater functional disability.
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