Mobilization Versus Myofascial Release in Sacroiliac Joint Dysfunction
Mobilization Versus Myofascial Release in Sacroiliac Joint Dysfunction: Effects on Pain, Balance, and Spinal Mobility
Sacroiliac joint dysfunction (SIJD) is a musculoskeletal condition associated with low back and pelvic pain, functional limitations, impaired postural control, and reduced spinal mobility. Although manual therapy techniques are commonly used in the conservative management of SIJD, evidence directly comparing joint-focused and fascial-focused approaches remains limited.
This assessor-blinded, parallel-group randomized controlled trial compared sacroiliac joint mobilization and posterior chain-focused myofascial release, each applied in addition to a standardized conventional physiotherapy program, in adults aged 18-65 years with SIJD. Participants were randomly allocated in a 1:1 ratio to the mobilization group or the myofascial release group. Both groups received three supervised treatment sessions per week for six weeks.
The primary outcomes were postural control assessed using the Biodex Balance System and spinal posture, mobility, postural endurance, and total Spine Check performance assessed using the Spinal Mouse system. Secondary outcomes were resting, activity-related, and night pain assessed using the Visual Analog Scale and functional disability assessed using the Oswestry Disability Index. Assessments were performed at baseline and immediately after the six-week intervention.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This prospective, assessor-blinded, two-arm, parallel-group randomized controlled trial compared the effects of sacroiliac joint mobilization and posterior chain-focused myofascial release in individuals diagnosed with sacroiliac joint dysfunction.
Eligible participants were randomly allocated in a 1:1 ratio using a computer-generated randomization sequence. Allocation concealment was provided using sequentially numbered, opaque, sealed envelopes. Both groups received the same standardized conventional physiotherapy program three times per week for six weeks, for a total of 18 supervised sessions.
The conventional physiotherapy program included bridging, trunk extension, and abdominal curl exercises, together with therapeutic ultrasound applied to the sacroiliac joint region. Exercises were performed in three sets of 15 repetitions and progressed at two-week intervals according to the participant's tolerance, movement quality, and pain response.
The myofascial release group additionally received posterior chain-focused manual techniques targeting the erector spinae, thoracolumbar and lumbar fascial structures, lumbosacral region, gluteal fascia, and gluteus medius. The mobilization group additionally received sacroiliac joint mobilization techniques performed in side-lying and prone positions.
The primary outcomes were static and dynamic postural control and Spinal Mouse-derived posture, spinal mobility, postural endurance, and total Spine Check scores. Secondary outcomes included resting, activity-related, and night pain and functional disability. All outcomes were assessed before treatment and immediately after the six-week intervention.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Kirşehi̇r
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Center, Kirşehi̇r, Turkey (Türkiye)
- Kirşehir Ahi Evran University
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria Individuals aged between 18 and 65 years. Clinical diagnosis of sacroiliac joint dysfunction according to the criteria of the International Association for the Study of Pain.
Pain localized to the sacroiliac joint region, with or without radiation to the hip, groin, or lower extremities.
Positive findings in at least three of five sacroiliac joint provocation tests: Vorlauf test, Gillet test, irritation point tenderness, posterior shear test, and compression test.
Pain intensity of at least 3 on the Visual Analog Scale. Voluntary participation and provision of written informed consent.
--Exclusion Criteria History of surgery involving the spine, pelvis, or lower extremities. Lumbar disc herniation, spinal stenosis, or acute hip joint pathology. Piriformis syndrome or low back or hip pain originating from a condition other than sacroiliac joint dysfunction.
Central or peripheral neurological disease or progressive neurological deficit. Rheumatological disease, including rheumatoid arthritis or ankylosing spondylitis.
Pregnancy or a severe systemic condition that could interfere with participation.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Myofascial Release
Participants received posterior chain-focused myofascial release in addition to the standardized conventional physiotherapy program. Each technique was applied for approximately 90-120 seconds and repeated twice during each treatment session. The intervention included manual techniques targeting the erector spinae muscles, lumbosacral region, thoracolumbar and lumbar fascial structures, diaphragm-related fascial restrictions, gluteal fascia, and gluteus medius. Sustained cross-hand pressure, transverse knuckle pressure, lumbosacral decompression, fascial release, and distal-to-proximal deep massage techniques were used according to the targeted tissue and participant tolerance. |
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 level on the treatment side, applying the cross-hand technique.
2. To increase muscle tension, the patient's lower extremity was placed in hip flexion and adduction at the highest point.
The therapist stood behind the patient, at the level of the patient's pelvis, and applied the transverse tapping technique using the knuckles.
4. Myofascial release of the gluteus medius muscle: The patient assumed a lateral recumbent position on the untreated side.
The therapist stood behind the patient, at the level of the patient's pelvis, and applied the vertical tapping technique using the knuckles.
Both groups received a standardized conventional physiotherapy program consisting of therapeutic exercise and therapeutic ultrasound. The exercises included bridging, trunk extension, and abdominal curl exercises and were performed in three sets of 15 repetitions. The exercises were progressed from initial to intermediate and advanced levels at two-week intervals when participants completed the prescribed sets with appropriate technique and without increased pain. Therapeutic ultrasound was applied over the right and left sacroiliac joint regions with the participant in the prone position. Continuous ultrasound was delivered at a frequency of 1 MHz and an intensity of 1.5 W/cm² using a 4-cm-diameter probe for a total duration of 6 minutes. Treatment was delivered three times per week for six weeks, for a total of 18 supervised sessions. |
|
Experimental: Mobilization
Participants received sacroiliac joint mobilization in addition to the standardized conventional physiotherapy program. The mobilization techniques were performed with the participant in side-lying and prone positions. The intervention included mobilization of the restricted sacroiliac joint in side-lying, controlled lumbar flexion, mobilization directed from the iliac crest toward the greater trochanter, caudal traction of the sacrum, mobilization of the sacrum relative to the ilium, and stretching techniques initiated from the iliac crests. Each mobilization technique was applied for 2 minutes using low-amplitude rhythmic movements within the participant's pain-free range. The technique was discontinued if pain increased or the participant was unable to tolerate the application. |
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.
Both groups received a standardized conventional physiotherapy program consisting of therapeutic exercise and therapeutic ultrasound. The exercises included bridging, trunk extension, and abdominal curl exercises and were performed in three sets of 15 repetitions. The exercises were progressed from initial to intermediate and advanced levels at two-week intervals when participants completed the prescribed sets with appropriate technique and without increased pain. Therapeutic ultrasound was applied over the right and left sacroiliac joint regions with the participant in the prone position. Continuous ultrasound was delivered at a frequency of 1 MHz and an intensity of 1.5 W/cm² using a 4-cm-diameter probe for a total duration of 6 minutes. Treatment was delivered three times per week for six weeks, for a total of 18 supervised sessions. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Change in Static and Dynamic Postural Control
Time Frame: Baseline and immediately after the 6-week intervention.
|
Postural control will be assessed statically and dynamically.
The Biodex balance system (Biodex Medical System Inc., NY, USA, SW45 30D E6N Model, SD 950 304) will be used.
This device creates stability indices by evaluating movements in the overall, anterior-posterior, and medial-lateral directions.
For static balance assessment, the subject is asked to hold a small circle containing a black dot representing their center of gravity without moving it for 20 seconds, repeated 3 times.
For dynamic assessment, the floor movement level is set to 12 at the start and gradually reduced to 9 throughout the test.
At these levels, the subject attempts to keep their center of gravity balanced within the small circle.
Total, anterior-posterior (A-P), and medial-lateral (M-L) values are recorded.
Increased values indicate worsening balance activity
|
Baseline and immediately after the 6-week intervention.
|
|
Change in Posture, Spinal Mobility, Postural Endurance, and Total Spine Check Score
Time Frame: Baseline and immediately after the 6-week intervention.
|
It was measured using the computer-assisted wireless Spinal Mouse device (the Spinal Mouse System, Idiag, Fehraltorf, Switzerland).
The Spinal Mouse device is moved over the spine using its wheel, measuring the length of the spine, posture, and joint movements, and transferring this sequence to a computer environment.
It is a reliable method that can noninvasively measure the physical characteristics and movement of the spine in a practical way.
Measurements are taken from the spinous process of the seventh cervical vertebra to the third sacral vertebra.
For spinal mobility, the trunk flexion posture is recorded.
For postural competence values, an upright posture measurement is performed, and then a weight equal to 5% of the person's body weight is held parallel between the shoulders for 30 seconds.
After the weight is still in the person's hands, the upright posture is measured again
|
Baseline and immediately after the 6-week intervention.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Disability
Time Frame: 6 week
|
OSWESTRY LOW BACK PAIN DISABILITY QUESTIONNAIRE The Oswestry Back Pain Disability Questionnaire will be used to obtain information about how much back (or leg) pain affects a person's daily activities.
The questionnaire consists of 10 sections.
The patient is asked to mark the most appropriate answer for themselves.
The score is calculated, and the resulting percentage values are interpreted according to the values given below 0% - 20% - minimal disability 20% - 40% - moderate disability 40% - 60% - severe disability 60% - 80% - disabled 80% - 100% - bedridden
|
6 week
|
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Change in Resting, Activity-Related, and Night Pain
Time Frame: Baseline and immediately after the 6-week intervention.
|
Resting, activity-related, and night pain were assessed separately using a 10-cm Visual Analog Scale.
A score of 0 indicated no pain, and a score of 10 indicated the worst imaginable pain.
Higher scores indicated greater pain intensity.
|
Baseline and immediately after the 6-week intervention.
|
Collaborators and Investigators
Sponsor
Investigators
- Study Director: Şafak KUZU, Kirsehir Ahi Evran Universitesi
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- 52066301980*
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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