Strain Counter-Strain vs Maitland Mobilization for Sacroiliac Joint Pain (SCS-MAITLAND-S)

August 17, 2026 updated by: Dr Waqar Younas, University of Faisalabad

Comparative Effects of Strain Counter-Strain Versus Maitland Mobilization Technique (Grade II and III) for Reducing Pain and Functional Limitation in Patients With Sacroiliac Joint Dysfunction

This randomized clinical trial compares two manual therapy techniques for treating sacroiliac joint dysfunction, a condition that causes lower back and buttock pain. The two techniques are strain counter-strain, an indirect positional release method, and Maitland mobilization grades II and III, a direct joint oscillation technique. Thirty-four participants aged 20 to 40 years with confirmed sacroiliac joint dysfunction will be randomly assigned to receive either strain counter-strain or Maitland mobilization three times per week for four weeks. Both groups will also receive a 10-minute moist hot pack before each treatment. Pain will be measured using the Numeric Pain Rating Scale and functional limitation using the Modified Oswestry Disability Index at baseline and after four weeks. The study aims to determine which technique is more effective for reducing pain and improving function in this patient population.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Active, not recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

This is a double-blind, parallel-group, randomized clinical trial to be conducted at three hospitals in Faisalabad, Pakistan: National Hospital Faisalabad, Health 360 Faisalabad, and Madinah Teaching Hospital Faisalabad. The study duration is six months following synopsis approval. A total of 34 participants will be enrolled using simple random sampling. Inclusion criteria include: age 20 to 40 years, both males and females, pain at the sacroiliac joint region below L5 radiating to buttocks or back of thigh for at least 8 weeks, baseline pain intensity of 3 or more on the Numeric Pain Rating Scale, Modified Oswestry Disability Index score of at least 30 percent, and at least three positive provocation tests out of five (Gaenslen test, distraction test, compression test, thigh thrust test, and sacral thrust test). Exclusion criteria include: recent lumbar or hip surgery, lumbar or pelvic fracture, infectious conditions such as bone tumors or tuberculosis, inflammatory joint diseases such as rheumatoid arthritis or ankylosing spondylitis, and refusal to provide informed consent. Participants will be randomly assigned to two groups of 17 each. Group A will receive strain counter-strain technique targeting the quadratus lumborum, piriformis, and erector spinae muscles. The therapist will position the patient comfortably for 90 seconds per muscle, repeated three times per muscle, for three sets per session. Group B will receive Maitland mobilization grades II and III applied to the sacrum. Grade II will be used in week one and early week two for pain reduction, using 3 to 4 sets of 30-second oscillations. Grade III will be introduced by the end of week two and used primarily in weeks three and four for 40-second sets to improve mobility. Both groups will receive a 10-minute moist hot pack to the gluteal area before each treatment. Treatments will be delivered three times per week for four weeks. Outcome measures will be assessed at baseline and after completion of the fourth week. The Numeric Pain Rating Scale is an 11-point scale from 0 (no pain) to 10 (worst possible pain). The Modified Oswestry Disability Index contains ten sections each scored 0 to 5, converted to a percentage where higher scores indicate greater disability. Data will be analyzed using SPSS version 20. Between-group comparisons will be conducted using independent t-tests for normally distributed data or Mann-Whitney U tests for non-normal data. Within-group comparisons will use paired t-tests or Wilcoxon signed-rank tests. Statistical significance will be set at p less than 0.05.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
34

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • Punjab Province
      • Faisalābad, Punjab Province, Pakistan, 3800
        • The University of Faisalabad

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Age 20 to 40 years, including both males and females
  • Pain at the level of the sacroiliac joint region below L5 and radiating to the buttocks or back of thigh
  • Pain duration of 8 weeks or longer
  • Baseline pain intensity of 3 or greater on the Numeric Pain Rating Scale
  • Modified Oswestry Disability Index score of at least 30 percent
  • At least 3 positive provocation tests out of 5: Gaenslen test, distraction test, compression test, thigh thrust test, and sacral thrust test
  • Willing and able to provide written informed consent

Exclusion Criteria:

  • Age below 19 years or above 40 years
  • Recent lumbar or hip surgery within the past 6 months
  • Lumbar or pelvic fracture
  • Infectious conditions including bone tumors, nerve root irritation, and tuberculosis of the spine or hip
  • Pre-diagnosed inflammatory joint diseases including rheumatoid arthritis and ankylosing spondylitis
  • Any condition that contraindicates manual therapy
  • Pregnancy (if applicable - you may want to add this, as SIJ pain is common in pregnancy but manual therapy protocols may differ)
  • Unable or unwilling to provide informed consent

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Strain Counter-Strain Group
Participants in this arm receive strain counter-strain technique applied to the quadratus lumborum, piriformis, and erector spinae muscles. The therapist places the patient in a comfortable position for each corresponding muscle for 90 seconds, repeated three times per muscle, for three sets per session. Treatment is delivered three times per week for four weeks. Each session begins with a 10-minute moist hot pack to the gluteal area.
Procedure: Strain Counter-Strain Technique
Strain counter-strain is an indirect manual therapy technique based on the proprioceptive hypothesis of somatic dysfunction. The therapist identifies tender points in the quadratus lumborum, piriformis, and erector spinae muscles. The patient is then placed in a comfortable position that reduces tension in the targeted muscle. This position is maintained for 90 seconds, after which the therapist passively returns the patient to the starting position. The procedure is repeated three times per muscle, with three sets per session. Treatment is provided three times per week for four weeks. A 10-minute moist hot pack is applied to the gluteal area before the technique begins.
Active Comparator: Maitland Mobilization Group
Participants in this arm receive Maitland mobilization grades II and III applied to the sacrum in prone lying. Grade II is used in week one and early week two using 3 to 4 sets of 30-second oscillations. Grade III is introduced by the end of week two and used primarily in weeks three and four for 40-second sets to improve mobility. Treatment is delivered three times per week for four weeks. Each session begins with a 10-minute moist hot pack to the gluteal area.
Procedure: Maitland Mobilization
Maitland mobilization is a manual therapy technique using passive oscillatory motions to treat joint pain and stiffness. The patient is positioned in prone lying. The therapist places hands centrally on the upper sacrum and applies pressure in a postero-anterior direction. Grade II (large amplitude, low intensity) is used for pain reduction in week one and early week two, with 3 to 4 sets of 30-second oscillations at 2 to 3 Hz. Grade III (large amplitude, high intensity) is introduced by the end of week two to improve stiffness and function, using 40-second sets at 2 to 3 Hz through weeks three and four. One Grade II session is added in week four to maintain pain relief. Treatment is provided three times per week for four weeks. A 10-minute moist hot pack is applied to the gluteal area before mobilization begins.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Change in Pain Intensity
Time Frame: Baseline and after 4 weeks of treatment (week 4)
Pain intensity is measured using the Numeric Pain Rating Scale (NPRS), an 11-point scale from 0 (no pain) to 10 (worst possible pain). Participants rate their current pain level at the sacroiliac joint region. The scale is administered by a blinded outcome assessor.
Baseline and after 4 weeks of treatment (week 4)

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Change in Functional Limitation
Time Frame: Baseline and after 4 weeks of treatment (week 4)
Functional limitation is measured using the Modified Oswestry Disability Index (MODI) questionnaire. The MODI contains ten sections covering activities of daily living: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, traveling, and employment/homemaking. Each section is scored from 0 to 5, with total score converted to a percentage. Higher percentages indicate greater disability. Scores are classified as: minimal disability (0 to 20 percent), moderate disability (21 to 40 percent), severe disability (41 to 60 percent), crippled (61 to 80 percent), and bed-bound or exaggerated symptoms (81 to 100 percent). The questionnaire is administered by a blinded outcome assessor.
Baseline and after 4 weeks of treatment (week 4)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University of Faisalabad

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
February 1, 2026

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
July 24, 2026

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
August 15, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
June 8, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 8, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
June 12, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
August 19, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 17, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
June 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • TUF/EIRB/ 208 /26

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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