Mobilization Versus Myofascial Release in Sacroiliac Joint Dysfunction: Effects on Pain, Balance, and Spinal Mobility
Mobilization Versus Myofascial Release in Sacroiliac Joint Dysfunction: Effects on Pain, Balance, and Spinal Mobility
Sacroiliac joint dysfunction (SIJD) is a musculoskeletal condition associated with low back and pelvic pain, functional limitations, impaired postural control, and reduced spinal mobility. Although manual therapy techniques are commonly used in the conservative management of SIJD, evidence directly comparing joint-focused and fascial-focused approaches remains limited.
This assessor-blinded, parallel-group randomized controlled trial compared sacroiliac joint mobilization and posterior chain-focused myofascial release, each applied in addition to a standardized conventional physiotherapy program, in adults aged 18-65 years with SIJD. Participants were randomly allocated in a 1:1 ratio to the mobilization group or the myofascial release group. Both groups received three supervised treatment sessions per week for six weeks.
The primary outcomes were postural control assessed using the Biodex Balance System and spinal posture, mobility, postural endurance, and total Spine Check performance assessed using the Spinal Mouse system. Secondary outcomes were resting, activity-related, and night pain assessed using the Visual Analog Scale and functional disability assessed using the Oswestry Disability Index. Assessments were performed at baseline and immediately after the six-week intervention.
This prospective, assessor-blinded, two-arm, parallel-group randomized controlled trial compared the effects of sacroiliac joint mobilization and posterior chain-focused myofascial release in individuals diagnosed with sacroiliac joint dysfunction.
Eligible participants were randomly allocated in a 1:1 ratio using a computer-generated randomization sequence. Allocation concealment was provided using sequentially numbered, opaque, sealed envelopes. Both groups received the same standardized conventional physiotherapy program three times per week for six weeks, for a total of 18 supervised sessions.
The conventional physiotherapy program included bridging, trunk extension, and abdominal curl exercises, together with therapeutic ultrasound applied to the sacroiliac joint region. Exercises were performed in three sets of 15 repetitions and progressed at two-week intervals according to the participant's tolerance, movement quality, and pain response.
The myofascial release group additionally received posterior chain-focused manual techniques targeting the erector spinae, thoracolumbar and lumbar fascial structures, lumbosacral region, gluteal fascia, and gluteus medius. The mobilization group additionally received sacroiliac joint mobilization techniques performed in side-lying and prone positions.
The primary outcomes were static and dynamic postural control and Spinal Mouse-derived posture, spinal mobility, postural endurance, and total Spine Check scores. Secondary outcomes included resting, activity-related, and night pain and functional disability. All outcomes were assessed before treatment and immediately after the six-week intervention.
Inclusion Criteria Individuals aged between 18 and 65 years. Clinical diagnosis of sacroiliac joint dysfunction according to the criteria of the International Association for the Study of Pain.
Pain localized to the sacroiliac joint region, with or without radiation to the hip, groin, or lower extremities.
Positive findings in at least three of five sacroiliac joint provocation tests: Vorlauf test, Gillet test, irritation point tenderness, posterior shear test, and compression test.
Pain intensity of at least 3 on the Visual Analog Scale. Voluntary participation and provision of written informed consent.
--Exclusion Criteria History of surgery involving the spine, pelvis, or lower extremities. Lumbar disc herniation, spinal stenosis, or acute hip joint pathology. Piriformis syndrome or low back or hip pain originating from a condition other than sacroiliac joint dysfunction.
Central or peripheral neurological disease or progressive neurological deficit. Rheumatological disease, including rheumatoid arthritis or ankylosing spondylitis.
Pregnancy or a severe systemic condition that could interfere with participation.