Additional Effects of Mulligan Mobilization With Movement Along With Core Strengthening Exercises in Postpartum Females With Sacroiliac Joint Dysfunction

This study aims to evaluate the combined effectiveness of Mulligan mobilization and core strengthening exercises in managing postpartum sacroiliac joint dysfunction (SIJD). Postpartum SIJD is a common condition resulting from biomechanical and hormonal changes during pregnancy, often leading to pelvic instability and pain. Mulligan mobilization, a manual therapy technique, aims to correct joint alignment and restore pain-free movement. For the SIJ, Mulligan MWM aims to correct subtle positional faults or movement restrictions that may cause pain and dysfunction-especially common postpartum due to ligamentous laxity, hormonal changes, and altered biomechanics.The core muscles provide stability to the pelvis and lumbar spine. When these muscles are weak or imbalanced, it can lead to increased strain on the SIJ, contributing to pain and dysfunction. Strengthening the core improves load transfer through the pelvis and enhances neuromuscular control, thereby reducing SIJ stress and symptoms. Core strengthening exercises enhances outcomes by targeting both mechanical alignment and muscular stability. Core strengthening exercises target muscles that support pelvic stability, including the transverse abdominis and pelvic floor. The study hypothesizes that integrating Mulligan mobilization with core strengthening may provide superior outcomes in pain reduction, joint function, and overall quality of life compared to core exercises alone.

Study Overview

• Status: Recruiting
• Conditions: Post Partum; Sacro Iliac Joint Pain; Strength Training
• Intervention / Treatment: Procedure: Mulligan Mobilization with Movement along with core strengthening exercises; Procedure: Core & Pelvic Floor Exercises

Detailed Description

Sacroiliac joint dysfunction (SIJD) is a common musculoskeletal condition experienced by postpartum females, primarily due to the physiological and biomechanical changes that occur during pregnancy and childbirth. The sacroiliac joints, which connect the sacrum to the ilium on either side of the pelvis, play a critical role in transferring weight between the upper body and lower limbs. During pregnancy, hormonal changes-particularly increased levels of relaxin-cause ligamentous laxity, leading to reduced joint stability. Combined with the mechanical stress of a growing uterus, changes in posture, and altered gait, this laxity can cause misalignment, inflammation, and pain in the sacroiliac region. Postpartum, many women continue to experience discomfort due to persistent instability, muscular imbalances, or poor core control. Symptoms often include localized or radiating pain in the lower back, buttocks, or thighs, which may worsen with weight-bearing activities, prolonged standing, or transitions like standing from a seated position. Early recognition and targeted rehabilitation-including core strengthening, manual therapy, and postural retraining-are essential to restore stability, relieve pain, and support safe return to daily function and physical activity.

Mulligan Mobilization with Movement (MWM) is a manual therapy technique designed to restore normal joint mechanics and reduce pain by correcting subtle positional faults within a joint. For sacroiliac joint (SIJ) dysfunction, which commonly occurs postpartum due to ligament laxity, hormonal changes, and altered biomechanics, MWM offers a non-invasive and effective approach to improve joint alignment and function. The technique involves the therapist applying a sustained passive accessory glide to the affected innominate bone (ilium or sacrum), typically in an anterior or posterior direction, while the patient actively performs a specific movement such as hip flexion, lunging, or straight leg raise. This combined movement helps re-establish normal arthrokinematics and neuromuscular coordination, often resulting in immediate pain relief and improved mobility. A treatment belt may be used to assist with stabilization and provide the appropriate direction of force. MWM is typically performed in multiple repetitions within a session and is progressed based on patient tolerance and symptom response. It is considered highly beneficial in treating SIJ dysfunction when integrated with functional rehabilitation strategies, as it addresses both mechanical restrictions and movement impairments contributing to the dysfunction.Core strengthening exercises play a vital role in the rehabilitation of sacroiliac joint dysfunction (SIJD) in postpartum females by targeting the deep stabilizing muscles responsible for pelvic and lumbar support. During and after pregnancy, hormonal changes such as increased relaxin levels, along with biomechanical stress, can lead to ligamentous laxity and instability in the pelvic region, making the sacroiliac joints particularly vulnerable. Strengthening the core-especially the transversus abdominis, multifidus, pelvic floor muscles, and diaphragm-restores neuromuscular control and enhances the load transfer across the pelvis. The exercise program typically progresses through phases, beginning with gentle activation techniques like the abdominal draw-in maneuver, pelvic tilts, and pelvic floor contractions, which re-establish deep muscle engagement without overloading the joint. As stability improves, more dynamic exercises such as glute bridges, bird-dog, and side-lying clamshells are introduced to develop strength and coordination. Eventually, functional movements like modified planks, wall sits, and core-braced lunges help integrate stability into daily activities. These exercises, when performed consistently and under proper guidance, can significantly reduce pain, improve postural alignment, and enhance overall function in postpartum women with SIJD, making them a cornerstone of conservative management.

• Study Type: Interventional
• Enrollment (Estimated): 48
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Rida Zainab, DPT; Phone Number: 03045000297; Email: doczaini786@gmail.com
• Study Contact Backup: Name: Muhammad Furqan Hassan, MS-OMPT; Phone Number: 0333-4056768; Email: furqan.hassan@fui.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Islamabad, Punjab Province, Pakistan, 46000
      • Recruiting
      • Foundation University College of Physical Therapy
      • Contact: Rida Zainab, DPT; Phone Number: 03045000297; Email: doczaini786@gmail.com
      • Contact: Muhammad Furqan Hassan, MS-OMPT; Phone Number: 0333-4056768; Email: furqan.hassan@fuie.edu.pk

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Postpartum females(both normal delivery & C-section) aged 20-40 years
• Parity level: Multiparous
• Duration: 6 weeks to 6 months postpartum
• At least three Positive SIJ provocation tests (e.g., stork test, compression, distraction, thigh thrust, Ganslen's and sacral thrust)

Exclusion Criteria:

• Pelvic fractures or recent surgery
• Neurological or rheumatologic disorders
• Inability to participate in active exercise or manual therapy due to medical or psychological reasons

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Movement with mobilization with core strengthening exercise; movement with mobilization along with Core strengthening exercises Moist Heat (10 mins)TENS(10 mins) Movement with mobilization; SIJ belt-assisted MWM (supine/standing)- Therapist-applied posterior glide with pain-free hip flexion Core strengthening exercises (4 sets of 4 repetition per session) Clamshell pelvic tilt bridge side leg raises abdominal drawing in. Progression of exercises; Dead bug (with pelvic floor engagement)- Bridge with pelvic floor cue- Clamshells (side-lying, glute med targeting)- Modified side plank (knees down); Bird-dog- Full bridge (add band if ready)- Side plank (full or modified)- Functional pelvic floor: squat with exhale/lift; Single-leg bridge- (core + pelvic floor engaged)- Wall sits or squats	Procedure: Mulligan Mobilization with Movement along with core strengthening exercises; Week 1 Pain relief & gentle activation- SIJ belt-assisted MWM (supine/standing)- Therapist-applied posterior glide with pain-free hip flexion Week 2 Core re-engagement & stability- Standing hip flexion with MWM (with belt)- Low step-up + MWM Week 3 Functional integration- Sit-to-stand + MWM- Lateral step-down with therapist-assisted MWM Week 4 Load, endurance & return to function - Self-mobilization (belt or resistance band)- Light weighted lunges/step-ups (if cleared)
Active Comparator: Core strengthening exercises; Core strengthening exercises; Diaphragmatic breathing- Pelvic floor contraction + TA co-activation- Supine pelvic tilts-; Dead bug (with pelvic floor engagement)- Bridge with pelvic floor cue- Clamshells (side-lying, glute med targeting)- Modified side plank (knees down); Bird-dog- Full bridge (add band if ready)- Side plank (full or modified)- Functional pelvic floor: squat with exhale/lift; Single-leg bridge- (core + pelvic floor engaged)- Wall sits or squats	Procedure: Core & Pelvic Floor Exercises; Week 1- Diaphragmatic breathing- Pelvic floor contraction + TA co-activation- Supine pelvic tilts- Week 2- Dead bug (with pelvic floor engagement)- Bridge with pelvic floor cue- Clamshells (side-lying, glute med targeting)- Modified side plank (knees down) Week 3- Bird-dog- Full bridge (add band if ready)- Side plank (full or modified)- Functional pelvic floor: squat with exhale/lift Week 4- Single-leg bridge- (core + pelvic floor engaged)- Wall sits or squats

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity	It will be measured using numeric pain rating scale. '0' shows no pain whereas '10' represents worst pain.	Baseline, and 4th week
Sacroilaic Joint Disability	It will be measured using Denver SI Joint Questionnaire (DSIJQ). It is a 10 item questionnaire with 6 options to choose from.	Baseline, and 4th week
Lumbar Range of Motion	Lumbar ROM will be assessed using a dual inclinometer.	Baseline, and 4th week

Collaborators and Investigators

• Sponsor: Foundation University Islamabad
• Investigators: Principal Investigator: Rida Zainab, DPT, Foundation University Islamabad

Study record dates

Study Major Dates

• Study Start (Estimated): May 20, 2026
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): July 15, 2026

Study Registration Dates

• First Submitted: April 6, 2026
• First Submitted That Met QC Criteria: April 6, 2026
• First Posted (Actual): April 13, 2026

Study Record Updates

• Last Update Posted (Actual): May 20, 2026
• Last Update Submitted That Met QC Criteria: May 18, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: FUI/FUCP/CTR/05.26/RidaZainab

Drug and device information, study documents

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