Comparative Effects of Two Rehabilitation Approaches on Lumbopelvic Function in Sacroiliac Joint Dysfunction (DNS CSE SIJD)

Effects of Dynamic Neuromuscular Stabilization Verses Core Stability Exercises on Pain and Lumbopelvic Stability Among Patients With Sacroiliac Joint Dysfunction

This research compares two rehabilitation strategies for people with sacroiliac joint dysfunction (SIJD): Dynamic Neuromuscular Stabilization (DNS) and Core Stability Exercises (CSE). SIJD is presented as a biomechanical source of low-back, buttock and leg pain caused by altered joint mechanics, muscle control problems, or asymmetric pelvic alignment; diagnosis relies on clinical provocation tests and exclusion of other causes. The study aims to determine which of the two exercise-based approaches better reduces pain and improves lumbopelvic control. The trial is a single-blinded, parallel randomized controlled trial conducted in an outpatient physiotherapy setting with supervised sessions over four weeks. Adults aged 20-50 with at least three positive SIJ provocation tests and moderate, chronic pain were included; important exclusions were prior spinal/pelvic surgery, systemic inflammatory disease, pregnancy, cardiopulmonary limitation or poor session attendance. Each participant received a baseline conventional physiotherapy package; one arm received a DNS program (breathing-based and developmental movement patterns) and the other performed progressive core-stability training emphasizing transversus abdominis and multifidus activation. Primary outcomes are pain (Numeric Pain Rating Scale) and lumbopelvic stability measured with a pressure biofeedback unit (PBU). Data were collected at baseline and after four weeks; the analysis plan uses SPSS with paired and independent t-tests, ANCOVA to adjust for baseline differences, and effect sizes/confidence intervals to interpret clinical relevance. Safety, informed consent, assessor blinding and standard ethical safeguards are described. The synopsis notes a gap in direct RCT evidence comparing DNS and CSE for SIJD and positions this trial to address that gap with clinical and mechanistic outcomes.

Study Overview

• Status: Not yet recruiting
• Conditions: Sacroiliac Joint Dysfunction
• Intervention / Treatment: Other: Dynamic Neuromuscular Stabilization; Other: Core stabilization Exercise Program

Detailed Description

Sacroiliac joint dysfunction (SIJD) is an increasingly recognized source of chronic low back and lumbopelvic pain, with significant implications for functional mobility and quality of life. The sacroiliac joint functions as a key biomechanical link between the spine and lower limbs, transmitting forces and maintaining postural stability during movement. Dysfunction in this joint can lead to abnormal motion, impaired neuromuscular coordination, asymmetrical pelvic alignment, and altered load transfer, which together contribute to persistent pain and disability. Individuals with SIJD commonly experience localized pain in the lower back, buttocks, groin, or posterior thigh, often exacerbated by prolonged standing, walking, transitional movements, or activities requiring unilateral weight-bearing. The condition is frequently misdiagnosed or overlooked due to symptom overlap with lumbar spine disorders. Consequently, clinical diagnosis relies on a combination of a cluster of sacroiliac joint provocation tests and the careful exclusion of other musculoskeletal or neurological causes.

Exercise-based rehabilitation is widely recommended as a primary conservative strategy for managing SIJD. Core Stability Exercises (CSE) are a conventional physiotherapy approach that emphasizes the activation, coordination, and strengthening of deep trunk stabilizers, particularly the transversus abdominis and lumbar multifidus. These exercises aim to restore segmental spinal control, improve lumbopelvic stability, and enhance the efficiency of force transmission across the pelvis and lower back during dynamic tasks. Dynamic Neuromuscular Stabilization (DNS), in contrast, is a motor control-oriented rehabilitation approach derived from developmental kinesiology principles. DNS focuses on restoring optimal breathing patterns, regulating intra-abdominal pressure, and facilitating coordinated activation of the diaphragm, pelvic floor, abdominal wall, and spinal stabilizers. Exercises are based on developmental movement patterns observed in early infancy and progress gradually from supported to more challenging functional postures. Both interventions are widely applied clinically; however, direct comparative evidence for their effectiveness in SIJD remains limited, particularly in structured, supervised outpatient settings.

This single-blinded, parallel-group randomized controlled trial was conducted to evaluate and compare the effects of DNS and CSE on pain intensity and lumbopelvic stability in adults with chronic SIJD. Participants aged 20-50 years with sacroiliac region pain persisting for at least three months were recruited. Inclusion required a clinical diagnosis confirmed by at least three positive provocation tests and the ability to participate in structured exercise sessions. Exclusion criteria included previous spinal or pelvic surgery, inflammatory joint disorders, pregnancy, neurological conditions, cardiopulmonary limitations, or other serious musculoskeletal pathologies. Participants with poor attendance or inability to complete the prescribed sessions were also excluded.

Eligible participants were randomly allocated to either the DNS group (Group 1) or the CSE group (Group 2) using a computer-generated randomization sequence, with allocation concealment maintained to reduce selection bias. Outcome assessment was conducted by a physiotherapist blinded to group assignment. Ethical approval was obtained prior to commencement, and all participants provided written informed consent. Participant confidentiality and standard ethical safeguards were strictly maintained throughout the study.

All participants received a standardized baseline physiotherapy program during each session to ensure uniform adjunct care. This included the application of superficial heat, transcutaneous electrical nerve stimulation, and stretching exercises targeting relevant muscle groups. After baseline treatment, participants received their respective exercise interventions. The DNS group engaged in a structured program three times per week over four weeks, focusing on diaphragmatic breathing, postural stabilization, and coordinated activation of deep trunk and pelvic muscles. Exercises progressed according to motor control proficiency, from supported positions to functional postures, with continuous verbal and tactile feedback to ensure proper execution. The CSE group performed a progressive core stabilization program with the same frequency and duration, emphasizing controlled activation of the transversus abdominis and lumbar multifidus, progressing to incorporate limb movements, balance challenges, and functional tasks. Biofeedback and therapist guidance were provided to promote correct recruitment patterns and postural alignment.

Primary outcomes included pain intensity, measured with the Numeric Pain Rating Scale, and lumbopelvic stability, assessed using a pressure biofeedback unit. Baseline measurements were obtained prior to intervention, and follow-up assessments were performed at the end of the four-week program.

All data were systematically entered, coded, and analyzed using the Statistical Package for the Social Sciences (SPSS). The dataset was screened for completeness, missing values, and entry errors. Descriptive statistics summarized demographic characteristics and baseline variables. Inferential analyses examined within-group and between-group changes using paired and independent statistical tests. Analysis of covariance was applied where baseline differences required adjustment. A significance threshold of p ≤ 0.05 was applied, and effect sizes with confidence intervals were calculated to assess clinical relevance alongside statistical significance.

A total of 40 participants completed the study, with 57.5% female and 42.5% male. Pain distribution was bilateral in 37.5%, predominantly right-sided in 37.5%, and left-sided in 25%. The mean age was 32.95 ± 7.57 years, and mean BMI was 26.83 ± 4.93 kg/m². Baseline comparison confirmed no significant differences between groups in pain intensity (p = 0.745) or lumbopelvic stability (p = 0.991), ensuring comparability for evaluating treatment effects.

Within-group analysis demonstrated substantial reductions in pain and improvements in lumbopelvic stability. Mean pain decreased from 6.58 ± 1.35 to 3.03 ± 1.29 (t = 13.375, p < 0.001), and lumbopelvic stability scores improved from 13.33 ± 3.72 to 6.35 ± 2.85 (t = 13.395, p < 0.001). Between-group comparison revealed a trend toward greater pain reduction in the DNS group (p = 0.052) and a statistically significant improvement in lumbopelvic stability compared to the CSE group (p = 0.011), indicating enhanced postural control outcomes with DNS.

Overall, both DNS and CSE were effective in reducing pain and improving lumbopelvic stability in individuals with chronic SIJD. DNS showed superior enhancement of neuromuscular control, suggesting it may provide additional benefits for improving coordinated trunk and pelvic muscle function. These findings contribute to the evidence base for physiotherapy interventions in SIJD and support the integration of motor control-based strategies alongside conventional core stabilization exercises in clinical practice

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Dr. Muhammad Zohaib, DPT; Phone Number: 03204417377; Email: muhammad.zohaib@ubas.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Ghurki Trust Teaching Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion criteria

1. Age between 30 and 45 years

2. Confirmed diagnosis by at least three positive provocation tests

   • FABER
   • Gaenslen's, Thigh Thrust
   • Compression
   • Distraction
3. Pain lasting three months or longer
4. NPRS score between 4 and 7

Exclusion criteria:

1. Other spinal conditions such as, spinal stenosis or tumors
2. Prior history of spinal or pelvic surgery
3. Patients with neurological disorders or systemic diseases such as rheumatoid arthritis
4. Pregnant women
5. Patients with cardiopulmonary conditions

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Dynamic Neuromuscular Stabilization; The intervention focuses on restoring motor control through developmental movement patterns, emphasizing coordinated activation of the diaphragm, pelvic floor, deep trunk, and spinal stabilizers. Exercises progress from supported positions, such as supine or quadruped, to more functional postures like sitting, standing, and weight-shifting tasks. Verbal and tactile feedback is provided throughout to ensure correct breathing, intra-abdominal pressure, and postural alignment, aiming to improve lumbopelvic stability, neuromuscular coordination, and reduce sacroiliac joint pain.	Other: Dynamic Neuromuscular Stabilization; Dynamic Neuromuscular Stabilization (DNS) is a motor control-based rehabilitation approach using human developmental movement patterns to restore optimal motor programs and improve lumbopelvic stability. In this study, participants receive supervised DNS sessions three times per week for four weeks, 45 minutes per session, including conventional physiotherapy followed by DNS exercises. Exercises progress from supine diaphragmatic breathing, abdominal bracing, quadruped rocking, and side-lying reaches to half-kneel, standing weight shifts, step-ups, split-squats and get-ups. Emphasis is on coordinated activation of diaphragm, pelvic floor, deep trunk, and spinal stabilizers, intra-abdominal pressure regulation, postural alignment, and sensorimotor control, with continuous verbal and tactile feedback. Unlike conventional core programs, DNS targets motor control, functional integration, and neuromuscular coordination rather than only strength or endurance.
Active Comparator: Core stability Exercise; The intervention targets activation and strengthening of deep trunk muscles, mainly the transversus abdominis and lumbar multifidus, to enhance segmental spinal stability. Exercises begin with low-load, isolated contractions of these muscles in supine or prone positions and progress to include limb movements, balance challenges, and functional tasks. Biofeedback and therapist guidance are used to ensure proper recruitment, postural control, and trunk endurance, aiming to reduce pain and improve lumbopelvic stability without integrating developmental movement patterns or specialized breathing techniques.	Other: Core stabilization Exercise Program; Core Stability Exercises (CSE) focus on improving segmental spinal and lumbopelvic stability by targeting the transversus abdominis (TrA) and lumbar multifidus (LM). In this study, participants receive supervised CSE sessions three times per week for four weeks, 45 minutes per session, beginning with low-load activation in supine, prone, and seated positions using abdominal drawing-in maneuver (ADIM), LM activation with contralateral arm raise, and TrA-LM co-contraction with bridging. Progression includes endurance training with controlled extremity movements, quadruped bird-dog, bridge marching, mini-squats, step-ups, wall push-ups, and self-palpation for awareness. Exercises emphasize isolated muscle activation, segmental control, and functional strength, guided by therapist supervision and biofeedback

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Lumbopelvic stability	Lumbopelvic Stability was measured with two validated instruments: Pressure Biofeedback Unit (PBU). The PBU is an inflatable pressure cuff that is attached to a pressure gauge that was positioned under the lumbar spine. Test was performed in hook lying abdominal drawing-in test by inflating the cuff approximately 40 mmHg. The patient was instructed to contract the TrA by draw-in maneuver. Normal functioning involves sustaining pressure within ±5-10 mmHg of the baseline value. A decrease or rise above this level signifies compromised stability	4 weeks
Pain Intensity	Pain Intensity was measured with the Numeric Pain Rating Scale (NPRS), an 11-point self-report scale from 0 (no pain) to 10 (worst pain possible). Participants were asked to indicate their average pain during the past 24 hours. The NPRS is a reliable and valid instrument to quantify musculoskeletal pain and can detect clinically significant change in pain.	4 weeks

Collaborators and Investigators

• Sponsor: Lahore University of Biological and Applied Sciences
• Investigators: Study Chair: Dr. Muhammad Zohaib, Lahore University of Biological and Applied Sciences; Principal Investigator: Saffa Shahid, DPT, Lahore College of Physical therapy; Principal Investigator: Seher Mushtaq, DPT, Lahore College of Physical therapy; Principal Investigator: Syed Muhammad Moiz, DPT, Lahore College of Physical therapy

Study record dates

Study Major Dates

• Study Start (Estimated): March 18, 2026
• Primary Completion (Estimated): March 18, 2026
• Study Completion (Estimated): September 27, 2026

Study Registration Dates

• First Submitted: February 16, 2026
• First Submitted That Met QC Criteria: February 16, 2026
• First Posted (Actual): February 20, 2026

Study Record Updates

• Last Update Posted (Actual): March 19, 2026
• Last Update Submitted That Met QC Criteria: March 16, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Core stability; lumbopelvic stability; DNS; SIJD
• Other Study ID Numbers: DPT/ERB/43; U1111-1334-7752 (Registry Identifier: WHO- Universal Trial number)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: After the publication
• IPD Sharing Time Frame: June 2026- October 2026
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No