CMCT Versus CSE in Treatment of SIJ Pain

Condition(s) studied

Investigational drug(s) / intervention(s)

The conventional Physiotherpay Program (US & MET): The conventional approach includes ultrasound (US) application combined with muscle energy technique (MET) for the lumbopelvic region. The subjects will receive therapeutic ultrasound (for 5 mins, intensity of 1W/cm2). In addition, MET will be applied in prone for anterior and posterior innominate rotation around the pelvis. The subject will then be asked to apply 20% force against that applied by the therapist and hold that contraction for 10 seconds over 5 to 10 repetitions.

Core Stability Exercises (CSE): In addition to the conventional protocol including US and MET stretching, subjects in this group will perform core stabilization exercises (CSE) to improve the activation and coordination of deep core stabilizers: transversus abdominis, multifidus, and pelvic floor muscles, which are essential for maintaining lumbopelvic stability and neuromuscular control. The core stabilization exercises consist of 5 exercises: pelvic tilt, double knee to chest, bridging, bird-dog, and cat-camel, to be performed in the same order. Also, before each exercise, the physical therapist will give detailed verbal explanation and visual instructions (pictures) regarding the start and end positions. Each exercise will be done for two sets of 10 repetitions, 3 sessions per week (day after day), for 8 weeks.

Lumbopelvic cognitive movement control training (CMCT): In addition to the traditional protocol including US and MET stretching, subjects in this group will undergo lumbopelvic cognitive movement control training (CMCT) that requires the lumbopelvic region to be positioned in a neutral alignment and the subject will be asked to consciously maintain the desired alignment and keep a pre-determined value of PBU whilst the lower limbs are actively moved to achieve a pre-determined benchmark. This training will be in multi-directions to address the lumbopelvic uncontrolled movements into flexion, extension and rotation as follows: * Into flexion, we will use double bent leg lift exercise * Into extension, we will use double leg lower exercise and also, double knee bend exercise * Into rotation, we will use single hip extension exercise and also, bent knee fallout exercise Each exercise will be done for 20-30 slow repetitions or up to two consecutive mins. of slow repetitions, with hold time (no pressure change) for at least 5 seconds inbetween.

Study summary

This study aims to investigate the difference between integrating lumbopelvic cognitive movement control training versus core stabilization exercises to the conventional physiotherapy program on pain, function, lumbopelvic stability, functional load transfer, and postural control in patients suffering from SIJ pain. The main question it aims to answer is:

What are the effects of adding lumbopelvic movement control training versus core stabilization exercises to the conventional physiotherapy program in treating patients with SIJ pain?

Researchers will compare adding lumbopelvic movement control training versus core stabilization exercises to the conventional physiotherapy program to investigate its effectiveness in treatment of SIJ pain

Participants will:

1. receive the intervention as follows:

* Group (A) - Control Group: will receive conventional physiotherapy program (US and MET)
* Group (B) - Core Stability Exercises Group: will receive conventional US, MET, and core stability ex's
* Group (C) - Lumbopelvic cognitive movement control training Group: will receive conventional US, MET, and cognitive movement control training.
2. receive the training protocol 3 times a week for 8 weeks according to the set schedules.
3. perform a home exercise program in the same dose of repetitions and time as in the session.
4. be assessed before and after the intervention and training period to address the outcome measures.

Eligibility

Primary outcome measure(s)

• Pain: using Numerical Pain Rating Scale (NPRS) — Baseline (pre-treatment) and after 8 weeks (post-treatment)
  The Arabic Numeric Pain Rating Scale (ANPRS) measures pain intensity in Arabic-speaking patients. The patients will be asked to rate their pain on a 10-point pain scale with a 0 score means no pain and 10 score means maximum pain.
• Functional disability: using Oswestry Disability Index (ODI) — Baseline (pre-treatment) and after 8 weeks (post-treatment)
  The Arabic ODI is appropriate for use as a patient reported outcome measure with Arabic speaking individuals with low back pain and /or SIJ pain. The patients will be instructed to fill the ODI which is a self-report pencil and paper survey, where subjects indicate how their pain affects their abilities in 10 questions on domains such as pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, travel, and sexual life.

Trial sites (1)

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