NCT07529093

Combined Effects of Mulligan's Mobilization With Movement and Kinetic Control Training on Pain, Range of Motion, Gait and Functional Disability Among Patients With Sacroiliac Joint Dysfunction

• Status: Not Yet Recruiting
• Phase: N/A
• Study type: Interventional
• Enrollment: 55 (estimated)
• Sponsor: Lahore University of Biological and Applied Sciences · Academic / Other
• Sex: All
• Age: 45 Years – 64 Years
• Healthy volunteers: Not accepted

Summary

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.

Detailed description

Sacroiliac joint dysfunction (SIJD) refers to altered biomechanics of the sacroiliac joint, characterized by either excessive or restricted movement, or the presence of abnormal motion patterns. It is a recognized source of pain originating from the sacroiliac joint and occurs due to abnormal or increased movement of the ilium relative to the sacrum, leading to irritation of the surrounding joint structures. The prevalence of SIJD among individuals with low back pain has been reported to range from 15% to 30% in Asian populations, including Pakistan. In the Pakistani context, SIJD is frequently observed among healthcare professionals and individuals whose occupations involve prolonged standing or repetitive postural activities. In recent years, the incidence of SIJD appears to be increasing, possibly due to sedentary lifestyles, cumulative mechanical stress, and improved clinical recognition of the sacroiliac joint as a distinct contributor to low back pain. The clinical diagnosis of SIJD is primarily based on a detailed patient history and focused physical examination, while its management involves a combination of therapeutic approaches. Current management strategies are consistent with the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. Two therapeutic approaches of concern in this study are Mulligan's Mobilization with Movement (MWM) and KInetic Control (KC) training. Mulligan's Mobilization with Movement (MWM) is a manual therapy technique that applies sustained accessory glides during active movement to correct positional faults and alleviate pain. This approach is intended to produce immediate functional improvement by combining pain-free accessory glides with physiological movement. Mobilization of the sacroiliac joint through physiotherapy aims to restore normal joint mechanics, enabling patients to maintain optimal sacroiliac joint function throughout daily activities. Kinetic Control, as proposed by Comerford and Mottram, focuses on retraining faulty movement patterns to address uncontrolled movement and enhance joint stability. Movement is fundamental to functional performance and participation in daily life, and restoring controlled movement enables individuals to regain the functional choices that are often lost in the presence of pain and movement impairment. This study therefore seeks to compare the effects of Mulligan's MWM combined with kinetic control training targeting the gluteus maximus and multifidus muscles.

Conditions

• Sacroiliac Joint Dysfunction

Interventions

Type	Name	Description
OTHER	Kinetic Control + Mobilization with Movement	Participants 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.
OTHER	Mobilization with Movement	Participants 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).

Timeline

• Start date: 2026-04-15
• Primary completion: 2026-10-15
• Completion: 2026-10-15
• First posted: 2026-04-14
• Last updated: 2026-04-14

Locations

2 sites across 1 country: Pakistan