Strain Counter-Strain vs Maitland Mobilization for Sacroiliac Joint Pain (SCS-MAITLAND-S)

This is a double-blind, parallel-group, randomized clinical trial to be conducted at three hospitals in Faisalabad, Pakistan: National Hospital Faisalabad, Health 360 Faisalabad, and Madinah Teaching Hospital Faisalabad. The study duration is six months following synopsis approval. A total of 34 participants will be enrolled using simple random sampling. Inclusion criteria include: age 20 to 40 years, both males and females, pain at the sacroiliac joint region below L5 radiating to buttocks or back of thigh for at least 8 weeks, baseline pain intensity of 3 or more on the Numeric Pain Rating Scale, Modified Oswestry Disability Index score of at least 30 percent, and at least three positive provocation tests out of five (Gaenslen test, distraction test, compression test, thigh thrust test, and sacral thrust test). Exclusion criteria include: recent lumbar or hip surgery, lumbar or pelvic fracture, infectious conditions such as bone tumors or tuberculosis, inflammatory joint diseases such as rheumatoid arthritis or ankylosing spondylitis, and refusal to provide informed consent. Participants will be randomly assigned to two groups of 17 each. Group A will receive strain counter-strain technique targeting the quadratus lumborum, piriformis, and erector spinae muscles. The therapist will position the patient comfortably for 90 seconds per muscle, repeated three times per muscle, for three sets per session. Group B will receive Maitland mobilization grades II and III applied to the sacrum. Grade II will be used in week one and early week two for pain reduction, using 3 to 4 sets of 30-second oscillations. Grade III will be introduced by the end of week two and used primarily in weeks three and four for 40-second sets to improve mobility. Both groups will receive a 10-minute moist hot pack to the gluteal area before each treatment. Treatments will be delivered three times per week for four weeks. Outcome measures will be assessed at baseline and after completion of the fourth week. The Numeric Pain Rating Scale is an 11-point scale from 0 (no pain) to 10 (worst possible pain). The Modified Oswestry Disability Index contains ten sections each scored 0 to 5, converted to a percentage where higher scores indicate greater disability. Data will be analyzed using SPSS version 20. Between-group comparisons will be conducted using independent t-tests for normally distributed data or Mann-Whitney U tests for non-normal data. Within-group comparisons will use paired t-tests or Wilcoxon signed-rank tests. Statistical significance will be set at p less than 0.05.