Mulligan Mobilization With Movement in Patients With Unilateral Anterior Sacral Nutation.

Effect of Mulligan Mobilization With Movement on Pain, Range of Motion and Disability in Patients With Unilateral Anterior Sacral Nutation.

Somatic Dysfunction of the SIJ is defined as hypo or hyper-mobility of the joint in addition to a malalignment or change of positioning of the sacrum and ilium bones (e.g. Forward sacral torsion, backward sacral torsion, bilateral anterior or posterior sacral nutation, Unilateral anterior and posterior sacral nutation). The classic physical signs for a dysfunction of the sacroiliac joint in which a unilateral anterior nutation of the sacrum or ilium has occurred in the sagittal plane about a transverse axis are: Sacral sulcus seen deeper, PSIS seen Caudad, Inferior lateral angle (ILA) seen Posterior, Pubic tubercle seen as Cephalad, ASIS as Cephalad, Sacroiliac joint seen upper pole and tender, Sacrospinous and Sacrotuberous ligament are under tension and gait abnormality seen due to leg length discrepancy.

A randomized control trial will be conducted to determine the effects of mulligan mobilization with movement in order to improve pain, lumbar range of motion and functional disability in patients with unilateral anterior sacral nutation. A sample size of 41 subjects will be taken, Data will be collected from Gosh-e-Shifa Medical Rehabilitation Centre and Al-Raheem Physiotherapy Centre of Lahore. Outcome measures will be taken using Numeric pain rating scale (NPRS) for pain, Lumbar flexion by Goniometer and Modified Oswestry Disability Index (MODI) for functional Disability. A written consent form will be taken from participants meeting inclusion criteria and will be randomly allocated in two groups (Group A and Group B) of equal members. Group A (Experimental group) will receive mulligan mobilization with movement along with standardized physiotherapy intervention. While Group B will receive only standardized physiotherapy intervention. Over the course of 6 weeks, all participants in the control group and the experimental group will attend a total of 18 intervention sessions (three times per week). All participants in both groups will be evaluated before and after the treatment programs.

Inclusion Criteria:

• Numeric pain rating score from 3 to 7 (Pain around or close to the sacral sulcus)
• Patients with a minimum of 3 positive results from among the 5 provocation tests that show sacroiliac joint dysfunction.
• Fuctional Leg length discrepancy.
• Using no other nonsteroidal anti-inflammatory drugs during the therapy.

Exclusion Criteria:

• Prolapsed intervertebral disc (PIVD)
• Lumbar canal stenosis
• Tumors or any traumatic condition to pelvis and lower limb.
• Lumbar surgery within a year prior to the study or reported vertebral fracture,
• Pregnancy
• Ankylosing spondylitis