Combined Effects of Mulligan's Mobilization With Movement and Kinetic Control Training on Pain, Range of Motion, Gait and Functional Disability Among Patients With Sacroiliac Joint Dysfunction (MWM KCT SIJD)

Sacroiliac joint dysfunction (SIJD) is a frequent source of low back and pelvic pain and contributes significantly to movement restriction, altered gait patterns, and functional disability in adults. It is associated with impaired lumbopelvic motor control, weakness of key stabilizing muscles, and faulty load transfer across the pelvis. SIJD is prevalent in both physically active individuals and sedentary populations. In addition to its clinical impact, SIJD imposes a considerable socioeconomic burden due to reduced work productivity and long-term disability.

Contemporary management of SIJD emphasises on pain reduction, restoration of movement, functional independence, and participation in daily activities. Manual therapy techniques such as Mulligan's Mobilization with Movement (MWM) are widely used to correct positional faults and restore pain-free movement, while kinetic control training targets deficits in motor control of the lumbopelvic stabilizing muscles. Although both approaches are individually supported in the literature, evidence regarding their combined effectiveness on pain, range of motion, gait parameters, and functional disability remains limited. Therefore, this study aims to compare the effects of combined Mulligan's Mobilization with Movement and kinetic control training versus kinetic control training alone in patients with sacroiliac joint dysfunction using validated outcome measures.

Study Overview

• Status: Recruiting
• Conditions: Sacroiliac Joint Dysfunction
• Intervention / Treatment: Other: Kinetic Control + Mobilization with Movement; Other: Mobilization with Movement

Detailed Description

Sacroiliac joint dysfunction (SIJD) refers to altered biomechanics of the sacroiliac joint, characterized by either excessive or restricted movement, or the presence of abnormal motion patterns. It is a recognized source of pain originating from the sacroiliac joint and occurs due to abnormal or increased movement of the ilium relative to the sacrum, leading to irritation of the surrounding joint structures. The prevalence of SIJD among individuals with low back pain has been reported to range from 15% to 30% in Asian populations, including Pakistan. In the Pakistani context, SIJD is frequently observed among healthcare professionals and individuals whose occupations involve prolonged standing or repetitive postural activities. In recent years, the incidence of SIJD appears to be increasing, possibly due to sedentary lifestyles, cumulative mechanical stress, and improved clinical recognition of the sacroiliac joint as a distinct contributor to low back pain.

The clinical diagnosis of SIJD is primarily based on a detailed patient history and focused physical examination, while its management involves a combination of therapeutic approaches. Current management strategies are consistent with the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. Two therapeutic approaches of concern in this study are Mulligan's Mobilization with Movement (MWM) and KInetic Control (KC) training.

Mulligan's Mobilization with Movement (MWM) is a manual therapy technique that applies sustained accessory glides during active movement to correct positional faults and alleviate pain. This approach is intended to produce immediate functional improvement by combining pain-free accessory glides with physiological movement. Mobilization of the sacroiliac joint through physiotherapy aims to restore normal joint mechanics, enabling patients to maintain optimal sacroiliac joint function throughout daily activities.

Kinetic Control, as proposed by Comerford and Mottram, focuses on retraining faulty movement patterns to address uncontrolled movement and enhance joint stability. Movement is fundamental to functional performance and participation in daily life, and restoring controlled movement enables individuals to regain the functional choices that are often lost in the presence of pain and movement impairment. This study therefore seeks to compare the effects of Mulligan's MWM combined with kinetic control training targeting the gluteus maximus and multifidus muscles.

• Study Type: Interventional
• Enrollment (Estimated): 55
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Misha Zahid; Phone Number: +923277866777; Email: misha15zahid@gmail.com

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan
      • Not yet recruiting
      • Ali Hospital
    • Lahore, Punjab Province, Pakistan
      • Recruiting
      • Physiotherapy Center

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Both male and female patients
• Age between 45- 64 years
• Unilateral non-radiating pain
• Confirmed diagnosis through at least 3/5 provocative tests Faber test Distraction test Thigh thrust test Gaenslen test Sacral thrust test
• Pain rating from 4-6 on Numeric Pain Rating Scale
• Symptoms of SIJD for more than 2 months

Exclusion Criteria:

• Patients with history of any surgery at lumbo-sacral or pelvic region
• Pregnancy, lactation
• Congenital, postural deformities
• Acute disc hernia and spinal stenosis that may cause pain in the lower back and hips, piriformis syndrome
• Rheumatic diseases (fibromyalgia, ankylosing spondylitis, rheumatic arthritis)
• Acute infections or malignancies
• Having received manual therapy for the sacroiliac joint in the past 3 months
• Injection of corticosteroids or anesthesia in the SIJ during the previous 1 month
• Psychological disorders affecting the subject's ability to follow the instructions

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: KC + MWM Group; Group A will receive routine physical therapy along with kinetic control training of multifidus and glutues maximus with mulliogan's mobilization with movement.	Other: Kinetic Control + Mobilization with Movement; Participants will receive baseline therapy consisting of superficial heating therapy followed by structured stretching and strengthening exercises for the sacroiliac joint and lumbar region on mat. Then Mulligan's MWM will be applied to the sacroiliac joint using sustained accessory glides combined with pain-free active movement. This will be followed by kinetic control training targeting the gluteus maximus and multifidus muscles. Gluteus maximus retraining will be performed in supported positions emphasising controlled hip extension with the knee flexed while maintaining lumbo-pelvic neutrality. Multifidus retraining will target the deep segmental lumbar extensors with contribution from the deep thoracic extensors. Training will begin in crook lying with a pillow or thick folded towel under the sacrum to elevate the pelvis and allow the lumbar spine to relax while thoracic spine remians neutral. Each session lasts 45 minutes. The intervention will be delivered for 8 weeks.
Active Comparator: MWMGroup; Group B will receive routine physical therapy along with Mulligan's mobilization with movement.	Other: Mobilization with Movement; Participants will receive baseline therapy consisting of superficial heating therapy followed by structured stretching and strengthening exercises for the sacroiliac joint and lumbar region on mat. Mulligan's MWM will be applied according to standard Mulligan principles. Participants will be classified as having anterior or posterior ilial rotation based on physical examination findings. For anterior rotation, a sustained posterior glide to the affected ilium with sacral stabilization will be applied during prone press-up. For posterior rotation, an anterolateral glide will be delivered over the posterior superior iliac spine with counter-pressure to the opposite ilium. Mobilization will be performed in non-weight-bearing for 3 sets of 10 repetitions per session, within a pain-free range, over 8 weeks (3 sessions/week).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Pain Rating Scale (NPRS)	The intensity of pain was measured by using the NPRS, a scale of 11 points starting from 0 to 10, where 0 represents no pain and 10 represents the worst possible pain. The NPRS has been found to possess good construct validity by showing strong correlation with other pain intensity measurement tools. This scale has also been found to possess consistent reliability (ICC: 0.58 to 0.88), especially in patients experiencing neck pain. The application of this scale has also been found to extend beyond patients experiencing musculoskeletal disorders.	8 weeks
Inclinometer	ROM was measured by using an inclinometer to measure joint movement quantitatively. Inclinometer has been found to possess superior reliability over a goniometer for measuring ROM. High intrarater reliability values (ICC>0.90) has been observed for inclinometers, indicating excellent consistency of measurement by a tester. High reliability has also been found for medical and digital types of inclinometers (ICC ≈ 0.91-0.95). For measuring ROM two inclinometers were fixed, with one placed over the T12 spinous process and the other over the S1 spinous process. This helped to measure the ROM of lumbar spine, keeping the effects of hip and sacral joints at a minimum. The ROM of lumbar spine was measured by using a dual inclinometer technique, keeping one over the superior aspect of T12 and the other over the inferior aspect of S1. The subjects were asked to perform various types of lumbar spine movements by keeping their knees straight.	8 weeks
Observational Gait Analysis (OGA)	Gait assessment was carried out by using observational gait analysis (OGA), which is a structured assessment of gait using standardized gait assessment scales. It helps to assess and quantify abnormalities of gait through visual observation. The basic framework of OGA is a 5-point scale, where each gait parameter is scored during the stance and swing phases. The clinician first observes the gait cycle of the patient, focusing on the kinematic gait patterns including pelvic alignment during initial contact of the foot and knee flexion during the mid-swing phase. The OGA form provides a connection between qualitative and quantitative assessment of gait. This heps in the development of a rehabilitation program for each patient.	8 weeks
Modified Oswestry Disability Index (MODI)	Functional disability was measured using MODI, a self reported questionnaire that was designed to measure disability related to low back and lumbopelvic disorders. MODI follows the same scoring system and disability interpretation criteria as the original ODI. It consists of 10 sections that include pain intensity, personal care (e.g., washing and dressing etc), lifting, walking, sitting, standing, sleeping, social life, travelling and eployment/home making. Each scored from 0 to 5, yielding a maximum total score of 50 points (or 45 points if 1 section is omitted). The final score is calculated by formula: Patient's total score / total possible score × 100 The percentage score is interpreted as follows: 0-20% : minimal disbability; 21-40% : moderate disability; 41-60% : severe disability; 61-80% : crippling disability where pain impinges on all aspects of patient's life; 81-100%: patients are bed bound a minimum change of 10% is necessary to reflect reliable change in disability	8 weeks

Collaborators and Investigators

• Sponsor: Lahore University of Biological and Applied Sciences

Study record dates

Study Major Dates

• Study Start (Actual): April 15, 2026
• Primary Completion (Estimated): October 15, 2026
• Study Completion (Estimated): October 15, 2026

Study Registration Dates

• First Submitted: January 13, 2026
• First Submitted That Met QC Criteria: April 7, 2026
• First Posted (Actual): April 14, 2026

Study Record Updates

• Last Update Posted (Actual): May 26, 2026
• Last Update Submitted That Met QC Criteria: May 21, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Sacroiliac Joint Dysfunction; Mulligan's Mobilization with Movement; Kinetic Control Training; Uncontrolled Movement
• Additional Relevant MeSH Terms: Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Physiological Phenomena; Movement
• Other Study ID Numbers: UBAS/ERB/FoRS/25/019

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