CMCT Versus CSE in Treatment of SIJ Pain

January 19, 2026 updated by: Mina Maher Morkos, Cairo University

Lumbopelvic Cognitive Movement Control Training Versus Core Stability Exercises in Treatment of Sacroiliac Joint Pain

This study aims to investigate the difference between integrating lumbopelvic cognitive movement control training versus core stabilization exercises to the conventional physiotherapy program on pain, function, lumbopelvic stability, functional load transfer, and postural control in patients suffering from SIJ pain. The main question it aims to answer is:

What are the effects of adding lumbopelvic movement control training versus core stabilization exercises to the conventional physiotherapy program in treating patients with SIJ pain?

Researchers will compare adding lumbopelvic movement control training versus core stabilization exercises to the conventional physiotherapy program to investigate its effectiveness in treatment of SIJ pain

Participants will:

  1. receive the intervention as follows:

    • Group (A) - Control Group: will receive conventional physiotherapy program (US and MET)
    • Group (B) - Core Stability Exercises Group: will receive conventional US, MET, and core stability ex's
    • Group (C) - Lumbopelvic cognitive movement control training Group: will receive conventional US, MET, and cognitive movement control training.
  2. receive the training protocol 3 times a week for 8 weeks according to the set schedules.
  3. perform a home exercise program in the same dose of repetitions and time as in the session.
  4. be assessed before and after the intervention and training period to address the outcome measures.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

The sacroiliac joint (SIJ) pain is a significant contributor to LBP at any age, but it affects the elderly and young active people more frequently. Based on estimates from several studies, the SIJ causes pain in 10-38% of LBP patients. Altered lumbopelvic stability causes faulty movement of the spine during limb movement, and the faulty movement may cause mechanical irritation to the adjacent joint which when repeated and accumulated may cause LBP or SIJP. Additionally, it was revealed that patients with LBP have altered movement strategies in the form of uncontrolled movements which cause symptoms. This uncontrolled movement can be defined as 'an inability to cognitively control movement at a specific site and direction, while moving elsewhere to benchmark standards'.

Despite the need to identify the most effective treatment options for SIJ pain, controversy still remains with unclear definite conclusion regarding the use of physiotherapy interventions in those patients. Clinically, the diagnosis pathway has become more definite, but the treatment algorithm is less well-defined with conflicting evidence of the standard treatment either invasively or conservatively. For the management of SIJP, the conventional approach which includes ultrasound (US) application combined with muscle energy technique (MET) for the lumbopelvic region can be successfully used. Moreover, core stabilization exercises are considered a fundamental component of physiotherapy with the goal to improve the strength and coordination of deep core stabilizers such as the transversus abdominis, multifidus, and pelvic floor muscles, which are critical for maintaining lumbopelvic stability, reducing pain and disability and also, lowing the risk of recurrent injury. Among the conservative interventions, cognitive movement control training has begun to emerge as a promising management approach and garnered attention in recent years because it involves active cognitive participation and focuses on improving stability and neuromuscular control of the lumbosacral region.

Despite that stabilization and motor control exercises, in the context of the physiotherapy literature, are a well-established management method for LBP and SIJ region pain, there is still limited evidence on which stabilization or motor control training approach is more effective and leads to better outcomes in patients with LBP of sacroiliac origin. Unfortunately, within the available literature, various treatment plans for SIJ pain have been described but there are few published studies regarding postural lumbopelvic stability and SIJ and as a result, the assessment and management of SIJP subjects with potential balance or postural control deficits are valuable and needed.

Although the effectiveness of motor control training in reducing pain in the lumbar spine was confirmed, the need for the selection of exercises due to the occurrence of various forms of movement pattern disorders is still critical. This underlies the need to recognize individual differences in clinical presentation and/or which activities and functions are painful and difficult to do. Therefore, here is the importance of cognitive movement control training in targeting the patient's own complaint and also tailoring interventions based on assessment.

So, CMCT can be an effective form of treatment for lumbopelvic pain because this type of exercises restores normal muscle activation, proprioceptive reeducation, and retraining of movement patterns with a positive effect of on disability and pain severity in the short-term and long-term.

Despite it has been shown to have great clinical utility at the hip and groin and also, on the non-specific low back pain with positive effects on disability and pain severity in the short and long terms, there are no clear results about the effect of cognitive movement control retraining on patients with SIJP. Therefore, here is the significance of this study.

Study Type

Interventional

Enrollment (Estimated)

36

Phase

  • 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 Contact

Study Locations

  • Egypt
      • Giza, Egypt
        • Faculty of physical therapy, Cairo University
        • Contact:
        • Principal Investigator:
          • Mina M Morkos, Assistant Lecturer, PT. MSc

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

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. Age of the subjects will range between 18 - 45 years for young middle-aged adults.
  2. Unilateral SIJ pain lasting for at least 3 months, in lower back, buttock, groin, posterior superior iliac spine (PSIS) and with or without referral pain to the lower extremities.
  3. SIJ pain below L5 region.
  4. Non-centralized LBP i.e. has no directional preference.
  5. Score positive on 3 out of 5 SIJP provocation tests: compression, distraction, sacral thrust, thigh thrust, Gaenslen's.

Exclusion Criteria:

  1. Limb-length discrepancy,
  2. Clear signs of nerve root compression (radiating pain, motor and/or sensory deficits,
  3. Previous major back surgery or injury, fracture or arthritis of spine, pelvis, hip, knee or ankle joint,
  4. Seronegative spondyloarthropathies,
  5. Visual or vestibular deficit,
  6. Unable to follow command/ cognitive deficits,
  7. Postpartum women less than six months,

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: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Group (A): Control Group
The subjects will receive therapeutic ultrasound (for 5 mins, intensity of 1W/cm2). In addition, MET will be applied in prone position for anterior and posterior innominate rotation around the pelvis.
Other: The conventional Physiotherpay Program (US & MET)
The conventional approach includes ultrasound (US) application combined with muscle energy technique (MET) for the lumbopelvic region. The subjects will receive therapeutic ultrasound (for 5 mins, intensity of 1W/cm2). In addition, MET will be applied in prone for anterior and posterior innominate rotation around the pelvis. The subject will then be asked to apply 20% force against that applied by the therapist and hold that contraction for 10 seconds over 5 to 10 repetitions.
Other Names:
  • control group
  • traditional program
Experimental: Group (B): Core Stability Exercises Group

In addition to the traditional protocol delivered in group (A) including US and stretching by MET, subjects in this group will perform core stabilization exercises (CSE) to improve the activation and coordination of deep core stabilizers: transversus abdominis, multifidus, and pelvic floor muscles.

The core stabilization exercises consist of 5 exercises: pelvic tilt, double knee to chest, bridging, bird-dog, and cat-camel to be performed in the same order.
Other: The conventional Physiotherpay Program (US & MET)
The conventional approach includes ultrasound (US) application combined with muscle energy technique (MET) for the lumbopelvic region. The subjects will receive therapeutic ultrasound (for 5 mins, intensity of 1W/cm2). In addition, MET will be applied in prone for anterior and posterior innominate rotation around the pelvis. The subject will then be asked to apply 20% force against that applied by the therapist and hold that contraction for 10 seconds over 5 to 10 repetitions.
Other Names:
  • control group
  • traditional program
Other: Core Stability Exercises (CSE)

In addition to the conventional protocol including US and MET stretching, subjects in this group will perform core stabilization exercises (CSE) to improve the activation and coordination of deep core stabilizers: transversus abdominis, multifidus, and pelvic floor muscles, which are essential for maintaining lumbopelvic stability and neuromuscular control.

The core stabilization exercises consist of 5 exercises: pelvic tilt, double knee to chest, bridging, bird-dog, and cat-camel, to be performed in the same order. Also, before each exercise, the physical therapist will give detailed verbal explanation and visual instructions (pictures) regarding the start and end positions. Each exercise will be done for two sets of 10 repetitions, 3 sessions per week (day after day), for 8 weeks.
Experimental: Group (C): Lumbopelvic cognitive movement control training Group

In addition to the traditional protocol delivered in group (A) including US and stretching by MET, subjects in this group will undergo lumbopelvic cognitive movement control training (CMCT) that requires the lumbopelvic region to be positioned neutrally and the subject will be asked to consciously maintain the desired alignment and keep a pre-determined value of PBU whilst the lower limbs are actively moved to achieve a pre-determined benchmark.

This training will be in multi-directions to address the lumbopelvic uncontrolled movements into flexion, extension and rotation as follows:

  • Into flexion, we will use double bent leg lift exercise.
  • Into extension, we will use double leg lower exercise and also, double knee bend exercise
  • Into rotation, we will use single hip extension exercise and also, bent knee fallout exercise
Other: The conventional Physiotherpay Program (US & MET)
The conventional approach includes ultrasound (US) application combined with muscle energy technique (MET) for the lumbopelvic region. The subjects will receive therapeutic ultrasound (for 5 mins, intensity of 1W/cm2). In addition, MET will be applied in prone for anterior and posterior innominate rotation around the pelvis. The subject will then be asked to apply 20% force against that applied by the therapist and hold that contraction for 10 seconds over 5 to 10 repetitions.
Other Names:
  • control group
  • traditional program
Other: Lumbopelvic cognitive movement control training (CMCT)

In addition to the traditional protocol including US and MET stretching, subjects in this group will undergo lumbopelvic cognitive movement control training (CMCT) that requires the lumbopelvic region to be positioned in a neutral alignment and the subject will be asked to consciously maintain the desired alignment and keep a pre-determined value of PBU whilst the lower limbs are actively moved to achieve a pre-determined benchmark.

This training will be in multi-directions to address the lumbopelvic uncontrolled movements into flexion, extension and rotation as follows:

  • Into flexion, we will use double bent leg lift exercise
  • Into extension, we will use double leg lower exercise and also, double knee bend exercise
  • Into rotation, we will use single hip extension exercise and also, bent knee fallout exercise Each exercise will be done for 20-30 slow repetitions or up to two consecutive mins. of slow repetitions, with hold time (no pressure change) for at least 5 seconds inbetween.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Pain: using Numerical Pain Rating Scale (NPRS)
Time Frame: Baseline (pre-treatment) and after 8 weeks (post-treatment)
The Arabic Numeric Pain Rating Scale (ANPRS) measures pain intensity in Arabic-speaking patients. The patients will be asked to rate their pain on a 10-point pain scale with a 0 score means no pain and 10 score means maximum pain.
Baseline (pre-treatment) and after 8 weeks (post-treatment)
Functional disability: using Oswestry Disability Index (ODI)
Time Frame: Baseline (pre-treatment) and after 8 weeks (post-treatment)
The Arabic ODI is appropriate for use as a patient reported outcome measure with Arabic speaking individuals with low back pain and /or SIJ pain. The patients will be instructed to fill the ODI which is a self-report pencil and paper survey, where subjects indicate how their pain affects their abilities in 10 questions on domains such as pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, travel, and sexual life.
Baseline (pre-treatment) and after 8 weeks (post-treatment)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Lumbopelvic motor control function: by Pressure Biofeedback Unit (PBU)
Time Frame: Baseline (pre-treatment) and after 8 weeks (post-treatment)

It will be used to indirectly monitor muscle activity by the change of pressure as a mean to estimate the muscle activation of the multifidus (MF) and transversus abdominis (TA) muscles that, in turn, helps patients undertake motor control exercise interventions.

While the subjects will be trying to keep the PBU value constant as possible (40 mm Hg in supine and 70 mm Hg in prone), they will be instructed to breathe normally to avoid a Valsalva maneuver and to consciously do certain lower limb movements (double bent leg lift and lowering in crook-lying, double knee bend in prone).
Baseline (pre-treatment) and after 8 weeks (post-treatment)
Functional Load transfer: by Active straight leg raise test (ASLR)
Time Frame: Baseline (pre-treatment) and after 8 weeks (post-treatment)
The ASLR test will be performed to detect failed load transfer across the lumbopelvic region in supine position with straight legs and feet apart. Patients will be asked to raise his/her lower limb above the bench for 20 cm or 20° hip flexion without bending the knee and return it to back after a 1-2 second hold. The test then will be repeated while a manual compressive force is applied through the ilia, or with a belt tightened around the pelvis or SIJ. A positive test is denoted by improved ability to raise the leg.
Baseline (pre-treatment) and after 8 weeks (post-treatment)
Balance and Postural control: by Single leg stance balance test with eyes closed (SLSBT-EC)
Time Frame: Baseline (pre-treatment) and after 8 weeks (post-treatment)
This test will be used for detecting balance impairments and postural control deficits in SIJP patients. While standing bare-footed on the weightbearing lower extremity on the floor with the contralateral hip flexed to 45° and the knee flexed to 90° so that the knee is in front of the standing leg and the foot behind the standing leg, the patients will be asked to balance for up to 30 s with eyes closed (EC).
Baseline (pre-treatment) and after 8 weeks (post-treatment)

Collaborators and Investigators

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

Sponsor

Cairo University

Investigators

  • Study Chair: Salwa F Abdelmajeed, Professor, PT. PhD., Cairo University
  • Study Director: Marihan Z Aziz, Lecturer, PT. PhD, Cairo University
  • Study Chair: Ihab M Emran, Assistant Professor, MD. PhD, Faculty of Medicine (Kasr Al-Aini), Cairo University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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 (Estimated)

February 1, 2026

Primary Completion (Estimated)

July 1, 2026

Study Completion (Estimated)

August 1, 2026

Study Registration Dates

First Submitted

January 19, 2026

First Submitted That Met QC Criteria

January 19, 2026

First Posted (Actual)

January 27, 2026

Study Record Updates

Last Update Posted (Actual)

January 27, 2026

Last Update Submitted That Met QC Criteria

January 19, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CMCT in SIJ Pain

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

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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