Comparison of Core Stability and Hip Strengthening Protocols in Sacroiliac Joint Dysfunction

Comparison of Core Stability and Hip Strengthening Protocols in Sacroiliac Joint Dysfunction.

The aim of this research is to compare the effects of core stability exercises and hip strengthening exercises on pain, posture, balance, proprioception, and functional status in patients with sacroiliac joint dysfunction. A randomized controlled trial will be conducted at Benazir Bhutto Hospital. The sample size will be 22 participants. The subjects will be divided into two groups, 11 subjects in the core stability exercise group and 11 subjects in the hip strengthening exercise group. The study duration will be 6 months. The sampling technique applied will be non-probability purposive sampling. Only 25-55 years individuals with unilateral sacroiliac joint dysfunction for more than 3 months and NPRS score ≥5 will be included. Tools used in the study are Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Pelvic Inclinometer, Flexicurve Ruler, Gait and Balance App, and Joint Repositioning Error test. Data will be analyzed through SPSS version 25.

Study Overview

• Status: Recruiting
• Conditions: Sacroiliac Joint Dysfunction
• Intervention / Treatment: Other: Core Stabilization; Other: Hip Strengthening Exercises

Detailed Description

Sacroiliac joint dysfunction is an important cause of low back pain and functional disability in many individuals. The sacroiliac joint is a synovial joint located between the sacrum and the ilium of the pelvis and plays a critical role in transferring loads between the upper body and lower extremities. When abnormal motion, inflammation, or misalignment occurs in this joint, it leads to pain and dysfunction. Patients with SIJ dysfunction commonly experience pain in the lower back, buttocks, posterior thigh, and sometimes radiating pain toward the lower limb.

The sacroiliac joint is supported by strong ligaments such as the interosseous sacroiliac ligament, anterior sacroiliac ligament, posterior sacroiliac ligament, sacrotuberous ligament, and sacrospinous ligament. These structures provide stability and restrict excessive motion of the joint. However, trauma, pregnancy, repetitive stress, degenerative changes, or previous lumbar fusion surgery can disturb the normal biomechanics of the joint and lead to sacroiliac joint dysfunction. Because symptoms of sacroiliac joint dysfunction often mimic other causes of low back pain such as facet joint syndrome or lumbar disc pathology, it can be difficult to diagnose clinically.

Patients with sacroiliac dysfunction often present with pain below the L5 level, difficulty in prolonged sitting, walking, climbing stairs, or lying on the affected side. Pain is usually localized around the posterior superior iliac spine. Diagnosis is typically based on clinical examination and provocation tests such as thigh thrust test, sacral thrust test, compression test, distraction test, Gaenslen's test, and flexion, abduction and external rotation test. A combination of these tests increases diagnostic accuracy.

Physiotherapy plays a major role in the management of sacroiliac joint dysfunction. Conservative treatment approaches focus on reducing pain, improving stability of the lumbopelvic region, and restoring normal functional movement patterns. Among these interventions, core stabilization exercises and hip strengthening exercises are commonly used. Core stabilization exercises focus on strengthening deep trunk muscles such as transversus abdominis, multifidus, pelvic floor muscles, and diaphragm, which improve spinal stability and control of the lumbopelvic region. Improved core stability reduces excessive shear forces across the sacroiliac joint and helps maintain proper pelvic alignment.

Hip strengthening exercises, on the other hand, primarily target muscles such as the gluteus medius, gluteus maximus, and hip external rotators. Weakness of these muscles can result in poor pelvic stability and altered load transfer during functional activities such as walking, standing, and lifting. Strengthening these muscles improves pelvic control, enhances force distribution across the lumbopelvic region, and reduces stress on the sacroiliac joint.

Previous studies have reported beneficial effects of both core stabilization and hip strengthening exercises in patients with low back pain and sacroiliac joint dysfunction. Research suggests that core stabilization exercises can improve proprioception, balance, neuromuscular control, and functional ability, while hip strengthening exercises improve gluteal activation, pelvic stability, and gait mechanics. However, limited research directly compares the effectiveness of these two exercise protocols in patients with unilateral sacroiliac joint dysfunction.

Therefore, the purpose of this study is to compare the effects of core stabilization exercises and hip strengthening exercises on pain, posture, balance, proprioception, and functional status in patients with sacroiliac joint dysfunction. It is hypothesized that there will be a significant difference between the effects of core stabilization exercises and hip strengthening exercises in improving clinical outcomes in patients with sacroiliac joint dysfunction.

• Study Type: Interventional
• Enrollment (Estimated): 22
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Imran Amjad, PhD; Phone Number: 03324390125; Email: imran.amjad@riphah.edu.pk

Study Locations

• Pakistan
  • Rawalpindi, Pakistan
    • Recruiting
    • National physiotherapy center
    • Contact: Muhammad Abdullah, PT; Phone Number: 03313134355; Email: npcr.pak@gmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Patients aged 25-55 years diagnosed with unilateral sacroiliac joint dysfunction.
• Patients having pain in the sacroiliac region for more than 3 months.
• Numeric Pain Rating Scale (NPRS) score ≥ 5.
• Patients with positive sacroiliac joint provocation tests (such as FABER test, compression test, distraction test, thigh thrust test, or sacral thrust test).
• Individuals able to participate in exercise therapy and follow treatment instructions.

Exclusion Criteria:

• History of lumbar spine surgery or pelvic surgery.
• Lumbar disc herniation or severe spinal pathology.
• Inflammatory joint diseases such as rheumatoid arthritis or ankylosing spondylitis.
• Neurological disorders affecting balance or proprioception.
• Recent fracture or trauma of the spine or pelvis.
• Pregnancy.

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: Core Stabilization Exercises; Participants in this group will receive core stabilization exercises	Other: Core Stabilization; Each session will begin with hot pack application over the sacroiliac region for 10 minutes followed by the exercise protocol and cool-down stretching. Treatment will be provided 3 sessions per week for 4 weeks, with each session lasting approximately 40-45 minutes.
Active Comparator: Hip Strengthening Exercises; Participants in this group will receive hip strengthening exercises	Other: Hip Strengthening Exercises; Exercises will be performed with resistance at approximately 75-80% repetition maximum for 2-3 sets of 8-12 repetitions. Each session will start with 10 minutes of hot pack application over the sacroiliac region followed by strengthening exercises and cool-down stretching including hamstring and piriformis stretches. Treatment will be provided 3 sessions per week for 4 weeks, with each session lasting approximately 40-45 minutes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Balance (Gait and Balance App)	Changes from baseline balance will be assessed using the Gait and Balance App, which evaluates postural stability and balance performance during functional activities in patients with sacroiliac joint dysfunction. This tool helps identify balance impairments related to lumbopelvic instability.	4 weeks
Proprioception (Joint Repositioning Error Test)	Changes from baseline proprioception will be measured using the Joint Repositioning Error Test, which evaluates the ability of patients to accurately reposition the lumbopelvic region. It helps assess sensorimotor control deficits associated with sacroiliac joint dysfunction.	4 weeks
Posture Assessment (Flexicurve Ruler)	Changes from baseline posture will be assessed using the Flexicurve ruler to measure lumbar curvature and spinal alignment associated with sacroiliac joint dysfunction.	4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Pain Rating Scale (NPRS)	Changes from baseline Numeric Pain Rating Scale will be used to assess pain intensity. The scale ranges from 0-10, where 0 indicates no pain and 10 indicates worst possible pain.	4 weeks
Oswestry Disability Index (ODI)	Changes from baseline Oswestry Disability Index will be used to measure functional disability in patients with sacroiliac joint dysfunction. The ODI consists of 10 sections assessing limitations in daily activities. Higher scores indicate greater disability.	4 weeks
Pelvic Alignment (Pelvic Inclinometer)	Changes from baseline pelvic alignment will be measured using a pelvic inclinometer to assess pelvic tilt and asymmetry related to sacroiliac joint dysfunction.	4 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Muhammad Affan Iqbal, PhD*, Riphah International University; Principal Investigator: Saba Naz, MSPT*, Riphah International University

Study record dates

Study Major Dates

• Study Start (Actual): June 30, 2026
• Primary Completion (Estimated): October 30, 2026
• Study Completion (Estimated): November 15, 2026

Study Registration Dates

• First Submitted: July 16, 2026
• First Submitted That Met QC Criteria: July 16, 2026
• First Posted (Actual): July 21, 2026

Study Record Updates

• Last Update Posted (Actual): July 21, 2026
• Last Update Submitted That Met QC Criteria: July 16, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Low Back Pain; Oswestry Disability Index; Numeric Pain Rating Scale; Sacroiliac Joint Dysfunction; Core Stability Exercises; Hip Strengthening Exercises
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Low Back Pain
• Other Study ID Numbers: RIPHAH/RCRAHS/REC/02287

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