Combined Effects of Mulligan's Mobilization With Movement and Kinetic Control Training on Pain, Range of Motion, Gait and Functional Disability Among Patients With Sacroiliac Joint Dysfunction

Combined Effects of Mulligan's Mobilization With Movement and Kinetic Control Training on Pain, Range of Motion, Gait and Functional Disability Among Patients With Sacroiliac Joint Dysfunction

Sacroiliac joint dysfunction (SIJD) is a frequent source of low back and pelvic pain and contributes significantly to movement restriction, altered gait patterns, and functional disability in adults. It is associated with impaired lumbopelvic motor control, weakness of key stabilizing muscles, and faulty load transfer across the pelvis. SIJD is prevalent in both physically active individuals and sedentary populations. In addition to its clinical impact, SIJD imposes a considerable socioeconomic burden due to reduced work productivity and long-term disability.

Contemporary management of SIJD emphasises on pain reduction, restoration of movement, functional independence, and participation in daily activities. Manual therapy techniques such as Mulligan's Mobilization with Movement (MWM) are widely used to correct positional faults and restore pain-free movement, while kinetic control training targets deficits in motor control of the lumbopelvic stabilizing muscles. Although both approaches are individually supported in the literature, evidence regarding their combined effectiveness on pain, range of motion, gait parameters, and functional disability remains limited. Therefore, this study aims to compare the effects of combined Mulligan's Mobilization with Movement and kinetic control training versus kinetic control training alone in patients with sacroiliac joint dysfunction using validated outcome measures.

Sacroiliac joint dysfunction (SIJD) refers to altered biomechanics of the sacroiliac joint, characterized by either excessive or restricted movement, or the presence of abnormal motion patterns. It is a recognized source of pain originating from the sacroiliac joint and occurs due to abnormal or increased movement of the ilium relative to the sacrum, leading to irritation of the surrounding joint structures. The prevalence of SIJD among individuals with low back pain has been reported to range from 15% to 30% in Asian populations, including Pakistan. In the Pakistani context, SIJD is frequently observed among healthcare professionals and individuals whose occupations involve prolonged standing or repetitive postural activities. In recent years, the incidence of SIJD appears to be increasing, possibly due to sedentary lifestyles, cumulative mechanical stress, and improved clinical recognition of the sacroiliac joint as a distinct contributor to low back pain.

The clinical diagnosis of SIJD is primarily based on a detailed patient history and focused physical examination, while its management involves a combination of therapeutic approaches. Current management strategies are consistent with the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. Two therapeutic approaches of concern in this study are Mulligan's Mobilization with Movement (MWM) and KInetic Control (KC) training.

Mulligan's Mobilization with Movement (MWM) is a manual therapy technique that applies sustained accessory glides during active movement to correct positional faults and alleviate pain. This approach is intended to produce immediate functional improvement by combining pain-free accessory glides with physiological movement. Mobilization of the sacroiliac joint through physiotherapy aims to restore normal joint mechanics, enabling patients to maintain optimal sacroiliac joint function throughout daily activities.

Kinetic Control, as proposed by Comerford and Mottram, focuses on retraining faulty movement patterns to address uncontrolled movement and enhance joint stability. Movement is fundamental to functional performance and participation in daily life, and restoring controlled movement enables individuals to regain the functional choices that are often lost in the presence of pain and movement impairment. This study therefore seeks to compare the effects of Mulligan's MWM combined with kinetic control training targeting the gluteus maximus and multifidus muscles.

Inclusion Criteria:

• Both male and female patients
• Age between 45- 64 years
• Unilateral non-radiating pain
• Confirmed diagnosis through at least 3/5 provocative tests Faber test Distraction test Thigh thrust test Gaenslen test Sacral thrust test
• Pain rating from 4-6 on Numeric Pain Rating Scale
• Symptoms of SIJD for more than 2 months

Exclusion Criteria:

• Patients with history of any surgery at lumbo-sacral or pelvic region
• Pregnancy, lactation
• Congenital, postural deformities
• Acute disc hernia and spinal stenosis that may cause pain in the lower back and hips, piriformis syndrome
• Rheumatic diseases (fibromyalgia, ankylosing spondylitis, rheumatic arthritis)
• Acute infections or malignancies
• Having received manual therapy for the sacroiliac joint in the past 3 months
• Injection of corticosteroids or anesthesia in the SIJ during the previous 1 month
• Psychological disorders affecting the subject's ability to follow the instructions