Project Summary Low Back Pain is one of the most prevalent musculoskeletal conditions worldwide. More than 70% of the people experience low back pain at some time in their life. The sacroiliac joint has been found to be the source of pain in 30% of mechanical low back pain sufferers. Sacral torsion is one of the types of SIJ dysfunction. This randomized controlled trial, conducted at Fauji Foundation Hospital and Foundation University College of Physical Therapy will assess the effects of combining muscle energy technique with mobilization on pain, lumbar range of motion, disability and active straight leg raise. Participants will be randomly assigned to either mobilization alone or mobilization with muscle energy technique, performed three times per week for two weeks. Data will be collected at baseline and at end of study (week 2) using the Numeric pain rating scale, goniometer, inclinometer and oswestry disability index. This study addresses a research gap by exploring combined effects of muscle energy technique (PFS) and Maitland mobilization for sacral torsion in improving pain, lumbar mobility, disability and active straight leg raise.

Low back pain (LBP) is one of the most common musculoskeletal conditions globally, with over 70% of individuals experiencing it at some point in their lifetime. It is the leading cause of disability worldwide and remains the primary global contributor to years lived with disability. A significant source of mechanical low back pain is the sacroiliac joint (SIJ), which accounts for 15% to 30% of cases, making it a key area of interest in both diagnosis and treatment.

SIJ dysfunction typically presents with localized pain and stiffness and can be difficult to differentiate from other causes of LBP such as lumbar spine or hip pathology. The dysfunction usually results from abnormal joint motion or malalignment, often linked to repetitive stress or minor subluxation that damages the joint capsule or posterior ligamentous structures. SIJ dysfunction can be categorized into five main types: anterior rotation, posterior rotation, up slip, down slip, and sacral torsions.

Sacral torsions are a specific type of SIJ dysfunction involving asymmetrical movement of the sacrum along a physiologic oblique axis, leading to joint fixation. These torsions are commonly described in osteopathic literature and include four types: Left-on-Left, Right-on-Right (forward torsions), and Right-on-Left, Left-on-Right (backward torsions). Such dysfunctions are frequently associated with asymmetries in lumbo-pelvic rhythm, leg length discrepancies, scoliosis, and muscular imbalances, particularly involving the hamstrings, piriformis, and quadratus lumborum. These biomechanical and muscular irregularities contribute to pelvic asymmetry during functional movements like forward flexion.

Muscle imbalances play a crucial role in the development and persistence of SIJ dysfunction. These may arise from adaptive responses or underlying biomechanical issues, leading to altered motor control and impaired movement quality. Balance in muscle strength and length, especially between corresponding groups on the left and right sides, is essential for maintaining proper pelvic alignment. Studies such as Jacobs et al. (2005) have shown significant asymmetries in hip abductor strength, highlighting the importance of bilateral symmetry in functional movement.

Conservative management of chronic SIJ dysfunction commonly includes physical therapy, manual therapy, activity modification, and pharmacological interventions such as analgesics and anti-inflammatory medications. Among manual therapy techniques, Muscle Energy Technique (MET) is widely used to address muscle imbalances by utilizing voluntary isometric contractions to engage autogenic or reciprocal inhibition mechanisms. This process activates the Golgi tendon organs, reducing muscle tension and facilitating improved joint mobility. A variation of MET, known as Post-Facilitation Stretch (PFS), involves a maximal isometric contraction followed by a rapid stretch, and has been shown to effectively increase flexibility and range of motion.

Inclusion Criteria:

• Age between 22- 44 years (18)
• Both males and females
• Clinically diagnosed sacral torsion. (Annexure E)
• Patients with pain intensity of at least 5 on NPRS
• Positive standing flexion test
• Positive seated flexion test
• Positive Gillet test
• Uneven anatomical landmarks (Sacral Sulcus, Inferior Lateral Angle, Lumbar Lordosis, Lumbar scoliosis, L5 position)

Exclusion Criteria:

• 1. Neurological deficits (hemiparesis, paralysis) 2. Pregnancy 3. Spinal surgery of any kind 4. Antero-Retro Spondylolisthesis diagnosed through radiological findings 5. Degenerative disc disease diagnosed through radiological findings 6. Spinal stenosis 7. Infection, tumors, osteoporosis, spinal fracture