Comparison Between Strain-counterstrain and Muscle Energy Technique in Sacroiliac Joint Dysfunction
Condition: Sacroiliac Joint Somatic Dysfunction
MeSH terms: Joint Diseases
Study type: Interventional

Summary: 
      Examine the effect of strain-counter strain (SCS) versus muscle energy technique (MET) on
      pain pressure threshold (PPT), functional disability, and the innominate angle tilt with SIJ
      dysfunction.
    

Detailed description: 
      Sacroiliac joint dysfunction (SIJD) can be cured with medical and physical therapy
      interventions. Standard physical therapy techniques include manual joint mobilization,
      manipulation, bracing, massage, patient education, aerobic training, general exercise, and
      electrotherapies such as heat, ultrasound, and transcutaneous electric nerve
      stimulation(TENS). In the physiotherapy context, an effective treatment strategy for
      unappreciated SIJD is needed. Currently, there are no guidelines or appropriate management
      plans for this dysfunction, physicians usually refer to it as low back pain alone, and
      physiotherapists treat the pain as low back pain (LBP). However, appropriate medical
      intervention or physical therapy may be carried out if the diagnosis is accurate.
      Furthermore, only a few studies tried to compare the effects of the various treatment
      approaches.

      Strain-counterstain (SCS) consider an excellent choice for building patient thrust as the
      patient is held passively in a pain-free position. SCS can facilitate treatment for the
      patient who has experienced pain during a treatment session by using other manual therapy
      techniques such as manipulation and MET or specific core stability exercises to enhance force
      closure of SIJ.

      SCS allows normalization of the tone of tight muscles involved in SIJ dysfunction which
      allows a significant improvement in recruitment of weak muscles, especially the gluteal
      group. SCS has shown its effectiveness in reducing pain or palpation tenderness over
      different musculoskeletal disorders such as acute/ chronic LBP, mechanical neck pain, and
      masseter trigger points.

      SCS affects local circulations which lead to more nutrient supply, metabolic waste removal,
      and reverse ischemia that can manifest as painful tender points (TPs) or sustain dysfunction.
      Current literature lacks consensus on mechanisms, contributing factors, and treatment of SIJ
      dysfunction.

      MET was advocated for the treatment of muscle imbalances in the lumbopelvic region, such as
      pelvic asymmetry. The theory behind MET assumes that the technique is used to correct
      asymmetry by targeting hamstring or hip flexor contractions on the painful side of the lower
      back and move the innominate in the proper direction. It is important to note, however, that
      evidence indicates that non-symptomatic individuals have also been shown to have pelvic
      asymmetries.

      While manual therapy is a helpful tool for LBP care, few studies have focused on the efficacy
      of SIJD. There is limited evidence concerning the efficacy of SCS and MET in SIJ dysfunction.
      According to investigators' knowledge, there is no study to investigate the effectiveness of
      SCS on SIJ dysfunction patients in comparison to muscle energy technique.
    

Intervention name(s): Strain-Counterstrain; Muscle Energy Technique
Intervention type(s): Procedure; Procedure
Intervention description(s): Strain-counterstrain will be applied to four muscle which are . Tender point of each muscle will be identified then the muscle will be positioned passively in the most relaxed position which will be held for 90 sec. This procedure will repeated 3 times for each muscle; Muscle energy technique will be applied to four muscles which are quadratus Lumborum, iliacus, piriform and erector spinae. Each muscle will be positioned passively in stretched position the patient asked to push against the therapist isometrically while holding breath for 5-10sec. After exhalation, the muscle will be moved into a new barrier. This procedure will repeated 3 times for each muscle
Other intervention name(s): Positional Release
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Strain-counterstrain; Muscle energy technique