Comparison of the Effectiveness of Mobilization and Myofascial Release Techniques in Patients With Sacroiliac Joint Dysfunction

Kirsehir Ahi Evran Universitesi

Status: Not yet enrolling

Conditions: Sacroiliac Joint Dysfunction

Treatments: Other: Traditional treatment program; Other: myofascial relaxation; Other: Mobilization

Study type: Interventional

Funder types: Other

Identifiers

NCT07310368

52066301980*

Details and patient eligibility

About

Sacroiliac joint dysfunction (SIED) is one of the major causes of chronic mechanical low back pain and is associated with pain, postural control impairment, and functional limitations. While manual therapy approaches are commonly used in the treatment of sacroiliac joint pain, evidence regarding the clinical superiority of different manual techniques is limited.

This study was designed as a prospective, randomized controlled trial to compare the effects of myofascial release techniques and sacroiliac joint mobilizations, applied in addition to a traditional physical therapy program, on pain intensity, spinal mobility, postural control, and functional status in women diagnosed with sacroiliac joint dysfunction.

The study plans to include female individuals aged 18-65 years with a Visual Analog Scale (VAS) score ≥3 who have been diagnosed with sacroiliac joint dysfunction according to international diagnostic criteria. Participants will be randomly assigned to two groups: one group will receive traditional treatment combined with myofascial release techniques, while the other group will receive traditional treatment combined with sacroiliac joint mobilizations. Interventions will be performed three days per week for six weeks.

Primary and secondary outcome measures will include pain intensity (VAS), postural control (Biodex Balance System), spinal mobility, and postural endurance (Spinal Mouse) assessments. Participants will be randomly assigned to two groups: one group will receive traditional treatment combined with myofascial release techniques, while the other group will receive traditional treatment combined with sacroiliac joint mobilizations. Interventions will be performed three days a week for six weeks.

Primary and secondary outcome measures will include pain intensity (VAS), postural control (Biodex Balance System), spinal mobility, and postural endurance (Spinal Mouse) assessments. All assessments will be conducted before treatment and at the end of the six-week intervention period.

This study aims to provide clinical evidence regarding the comparative effectiveness of manual therapy approaches in the conservative treatment of sacroiliac joint dysfunction and to contribute to clinical decision-making processes.

Full description

This study is a clinical prospective, randomized controlled trial evaluating two different manual therapy approaches added to a traditional physical therapy program in women diagnosed with sacroiliac joint dysfunction (SIED). The primary objective of the study is to comparatively evaluate the effects of myofascial release techniques and sacroiliac joint mobilizations on pain, spinal mobility, postural control, and postural endurance.

Eligible participants included in the study will be randomly assigned to two intervention groups using a computer-based randomization method. Both groups will receive the same traditional physical therapy program three days a week for six weeks. This approach aims to ensure that any differences between the groups are solely attributable to the manual therapy technique applied.

The traditional physical therapy program will include stabilization and strengthening exercises targeting the abdominal and back muscles (bridge, back extension, and sit-up exercises) and therapeutic ultrasound application to the sacroiliac region. This program will be applied to all participants for the same duration and intensity.

Myofascial release techniques will be used in addition to the traditional physical therapy program. The myofascial release techniques applied in this group will be planned to target the erector spinae, quadratus lumborum, thoracolumbar fascia, piriformis, and gluteus medius muscles. The applications will be performed in accordance with the principles of soft tissue mobilization and fascial release.

Mobilization will be treated with sacroiliac joint mobilization techniques in addition to the traditional physical therapy program. In this group, posterior-anterior and inferior mobilization techniques will be applied to regulate the biomechanics of the sacroiliac joint and increase joint mobility. Mobilizations will be graded according to the patient's tolerance and performed within safe limits.

All interventions will be performed by physical therapists experienced in manual therapy. Participants will not be allowed to receive any other manual therapy or alternative treatment during the treatment period.

Outcome assessments will be conducted before the treatment program (baseline) and at the end of the six-week intervention period. Pain intensity will be assessed using the Visual Analog Scale (VAS) as the primary outcome measure. Secondary outcome measures will include postural control (Biodex Balance System), spinal mobility, and postural endurance (Spinal Mouse system). All measurements will be performed by the same evaluator under standardized conditions.

Enrollment: 42 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Being a female individual between the ages of 18 and 65.
• Having been diagnosed with sacroiliac joint dysfunction (according to the International Association for the Study of Pain criteria).
• Having localized pain in the sacroiliac joint region and pain that may radiate to the hip, groin, or lower extremities.
• Positivity in at least 3 out of 5 sacroiliac joint-specific provocation tests (Vorlauf, Gillet, irritation point positivity, posterior shear test, compression test).
• Pain intensity of ≥3 as assessed by the Visual Analog Scale (VAS).
• Volunteering to participate in the study and providing written informed consent.

Exclusion criteria

• History of surgery involving the spine, pelvis, or lower extremities.
• Presence of lumbar disc herniation, spinal stenosis, or acute pathologies of the hip joint.
• Diagnosis of piriformis syndrome or low back/hip pain originating from sources other than the sacroiliac joint.
• Known central or peripheral nervous system disease or progressive neurological deficit.
• History of rheumatological disease (rheumatoid arthritis, ankylosing spondylitis, etc.).
• Pregnancy or the presence of a serious systemic disease that could prevent participation in the study.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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42 participants in 2 patient groups

Myofascial Release

Experimental group

Description:

The myofascial release time for each muscle was 90 to 120 seconds, applied twice per session. 1. Myofascial release of the erector spinae muscles: the patient assumed a prone position; and the therapist stood at the patient's pelvis on the treatment side, applying the cross-hand technique. 2. Myofascial release of the quadratus lumborum muscle and thoracolumbar fascia: to increase the stretching force on the muscle, the patient lay on their side on the untreated side and placed a pillow under their lower back. The therapist stood behind the patient at the level of the patient's pelvis, applying the cross-hand technique. 3. Myofascial release of the piriformis muscle: The patient assumed a lateral recumbent position with the treated side on top. To increase muscle tension, the upper lower extremity was placed in hip flexion and adduction in front of the patient's lower extremity.

Treatment:

Other: myofascial relaxation

Other: Traditional treatment program

Mobilization

Experimental group

Description:

Patients lay on their side with the sacroiliac joint restricted at the top, and sacroiliac manipulation was performed. Then, the physiotherapist flexed the lumbar spine by moving toward the upper part of the thigh, applying an impulse using the intermittent stretching technique in the direction of the major thoracanthus from the iliac crest. In the prone position, caudal traction, traction of the sacrum relative to the ilium, and traction stretches from the iliac crests will be applied.

Treatment:

Other: Mobilization

Other: Traditional treatment program