Sacroiliac joint dysfunction is a common source of low back and pelvic pain, often caused by improper load transfer through the pelvis. The sacrotuberous ligament stabilises the sacroiliac joint by limiting sacral nutation and supporting posterior pelvic structures. The sacroiliac joint connects the sacrum to the ischial tuberosity and integrates with muscles like the gluteus maximus and biceps femoris. Tightness, dysfunction, or pain in the sacrotuberous ligament can exacerbate sacroiliac joint dysfunction by altering mechanics. Dry needling is increasingly used for myofascial pain and muscle dysfunction. Applying dry needling to release ligamentous structures is novel and may improve the biomechanics of the sacroiliac joint by alleviating tension in the sacrotuberous ligament. The aim of the study is to investigate the efficacy of dry needling for releasing the sacrotuberous ligament in patients with sacroiliac joint dysfunctions on pain intensity, functional disability, and biomechanical changes, along with routine physical therapy compared to sham dry needling and routine physical therapy.
Diagnosed patients having symptoms of sacroiliac joint dysfunction
Both genders
Age 40-65 years
Standard clinical tests positive (Fortin finger test, Patrick's test)
Patients with a previous history of fracture
Prior SIJ surgery
Osteoporosis
Pregnancy or post-partum
Parallel
Group A: Dry Needling
Other interventionIn Group A, Dry needling of the STL will be performed with the patient in a prone position, supported with a pillow under the abdomen to minimize lumbar lordosis. After antiseptic skin preparation and adherence to infection-control protocols, sterile, single-use filiform needles (0.25-0.30 mm gauge, 50-75 mm length depending on patient body habitus) will be applied. Anatomical landmarks, including the posterior superior iliac spine, sacrum (S3-S5), and ischial tuberosity, will be palpated to identify the taut band of the ligament. Needle insertion will be carried out obliquely or slightly medially at a 30-45° angle, with a penetration depth of approximately 4-6 cm, adjusted according to individual anatomy and confirmed where possible by ultrasound guidance to enhance precision and safety. One to two needles will be inserted per symptomatic side, with bilateral treatment applied when indicated. Each needle will be retained for 30-60 seconds with light pistoning if required
Group B: Sham Dry Needling
Other interventionIdentify anatomical landmarks (PSIS, ischial tuberosity, S3-S5) and palpate the STL region exactly as in active DN. Place the introducer tube against the skin at the planned point(s); tap the top of the (blunt/retractable) needle as if inserting. For a fixed blunt-needle sham: insert the guide tube, then tap a blunt needle that is fixed inside the tube so it does not penetrate the skin (the subject feels pressure and tapping). For a retractable needle (Streitberger/Park): perform the same steps; the needle telescopes into handle on contact so skin is not pierced. Simulate identical manual manoeuvres (light pistoning or gentle manipulation of the introducer) for the same time as active DN (e.g., 30-60 sec). If the active protocol uses ultrasound guidance, simulate ultrasound probe contact and display but do not show images to the patient. Apply similar post-procedure care (pressure, dressing if used, reassurance).
Numeric Pain Rating Scale
The numeric pain rating scale (NPRS) is a validated subjective measure for acute or chronic pain assessment. Scores are based on self-reported measures of symptoms that are recorded by making a mark on a 10-cm line that represents a continuum between "no pain" and "worst pain."
Body Mass Index
Height in cm, weight in kg
Age
Age in years
Biomechanical Changes
SIJ range of motion (inclinometer)
Oswestry Disability Index
The Oswestry Disability Index (ODI) is a widely recognised and validated subjective tool for assessing functional disability in individuals with low back pain. This comprises 10 sections, each targeting a specific area of functional activity: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social life, and travelling. Each section contains 6 statements, scored from 0 to 5, representing increasing levels of disability.
Biomechanical Changes
STL elasticity (ultrasound elastography)
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