Effects of Weighted and Elastic Resistance Training of Gluteus Maximus in Sacroiliac Joint Dysfunction
Condition: Sacroiliac Disorder
MeSH terms: Joint Diseases; Body Weight
Study type: Interventional

Summary: 
      This research aims to compare the effect of weighted and elastic resistance training of
      gluteus maximus in subjects with sacroiliac joint dysfunction. Randomized clinical trials
      were done. The sample size was 54. The subjects were divided into two groups, 27 subjects in
      the weighted resistance training group and 27 in the elastic resisted training group. The
      study duration was of 1 year. The sampling technique applied was the non-probability
      connivance sampling technique. Only 20-40 years of symptomatic subjects with pain in the SI
      region for at least 12 weeks (chronic) and had no previous physical therapy treatment were
      included. Tools used in the study are numeric pain scale, dynamometer, and Oswestry
      disability index. Data was be analyzed through SPSS 21.
    

Detailed description: 
      Sacroiliac joint dysfunction or sacroiliitis are common terms used to describe the pain of
      the sacroiliac joint. It is usually caused by abnormal motion (i.e. hyper- or hypo-mobile) or
      mal-alignment of the sacroiliac joint. Sacroiliac joint (SI) dysfunction is a well-documented
      clinical entity that can cause pain and loss of function, The sacroiliac joint (SIJ) has been
      implicated as the primary pain source in 10% to 25% of the patients with low back pain.
      During pregnancy, 20% to 80% of the women experience low back or posterior pelvic pain
      frequently arising from the SIJ.

      The Gluteus maximus is inserted proximally into the sacrum, the dorsal sacral ligaments, the
      posterior portion of the crest of the ilium, and the sacrotuberous ligament. The muscle
      fibers run inferiorly and laterally to the distal insertion, where it splits into two
      components. The upper half of the muscle inserts into the iliotibial tract of the fascia and
      the lower half into the gluteal tuberosity of the femur. Due to its attachments, the gluteus
      maximus is primarily involved in hip extension and lateral rotation.

      Fischer & Houtz found in electromyography (EMG) study that the strongest contractions of
      gluteus maximus occurred with muscle setting by isometric contraction, external rotation,
      abduction with resistance, and vigorous hyperextension exercises of the thigh and trunk in an
      erect posture. Weakness of gluteal muscles causes decreased sacroiliac (SI) joint stability
      in patients with sacroiliac disorders. gluteus maximus muscle, due to its attachments to the
      sacrum, iliac bones, and sacrotuberous ligament, plays a significant role in the stability of
      the SI joint. The stabilizing forces applied to the SI joint, therefore, could be compromised
      with gluteal muscle weakness. In patients with gluteal weakness, shortening of the hamstring
      muscles, through their common attachments to the ischial tuberosity and sacrotuberous
      ligament, could compensate for gluteal muscle weakness and contribute to the SI joint
      stability.

      A relationship between the gluteus maximus and the SI joint has been investigated in
      particular. Anatomical studies suggest that the gluteus maximus, with muscle fibers
      perpendicular to the joint surfaces, can help to stabilize the SI joint. Furthermore, it was
      discovered that activating the gluteus maximus increased compressive force across the SI
      joint. Individuals with SI joint dysfunction have abnormal gluteus maximus recruitment during
      weight-bearing exercises. As a result, it is hypothesized that gluteus maximus weakness can
      be linked to incorrect loading of the SI joint and be a cause of the impairments associated
      with SI joint dysfunction.

      Hip extension exercise is the general clinical method for improving the weakened muscle
      strength of the hip extensors. These exercises are often used to strengthen the gluteus
      maximus and is also recommended for patients with pain in the lower back, pelvis, or hip. The
      gluteus maximus contributes to the postural alignments, core stability, and functional
      abilities that are important for normal gait. A weakness of the gluteus maximus can cause an
      abnormal gait cycle that can affect the gait mechanics at both hip and knee joints. In
      particular, gluteus maximus exercise is important for patients who have low back pain and
      lower extremity injuries. Patients with low back pain show reduced activity of the gluteus
      maximus. Early activation of the hamstring muscles and spinal erector, as well as delayed or
      decreased activation of the gluteal muscles, are considered indications of faulty muscle
      activation.

      Studies have assessed methods for selective strengthening of the gluteus maximus. Prone hip
      extension (PHE) exercise is generally used to activate and strengthen the gluteus maximus
      selectively. Active prone hip extension with knee flexion is a common exercise employed to
      optimize gluteus maximus activation because this position causes active insufficiency of the
      hamstring. A previous study reported that PHE exercise is the most effective method for
      activating the gluteal muscles when subjects extend their hip with 30° abduction. Other
      studies have suggested that an abdominal drawing-in maneuver (ADIM) with prone hip extension
      is useful for the selective activation of the gluteus maximus from the erector spinae and
      hamstring.

      A correction of the abnormal pattern is recommended to reduce the stress on the spine and hip
      joint. In a clinical setting, the ADIM is used during hip extension to prevent abnormal
      motion of the pelvis and lumbar., and the degree of knee extension affects the gluteus
      maximus activity. When the level of knee extension is increased, the activity of the gluteus
      maximus decreases, and the hamstring activity increases. Previous studies compared the muscle
      activities of the hamstring and gluteus maximus during prone hip extension with ADIM. The
      following were applied during active prone hip extension exercises: knee flexion, knee
      extension, hip external rotation with knee flexion, and hip external rotation with knee
      extension. In addition, eleven different exercises of the gluteus maximus used in therapeutic
      exercises were compared.

      Although a wide variety of different exercises are advocated train and condition gluteus
      maximus and surrounding musculature, there are no specific guidelines for gluteus maximus
      strengthening with SI joint dysfunction using best evidence-based practice. This study aims
      to find out whether the weighted and elastic resistance training of gluteus maximus provides
      better results in subjects with SIJ dysfunction.
    

Intervention name(s): Group A: Elastic resisted training for Gluteus Maximus strength; Group B: Weight resisted training for Gluteus Maximus strength
Intervention type(s): Other; Other
Intervention description(s): Subjects attended physical therapy two times per week for a total of 10 visits. In the first five sessions, subjects performed the following exercises to strengthen the gluteus maximus: bilateral bridge, unilateral bridge, and non-weight-bearing hip extension in prone with the knee flexed at 90 degrees. In the next five sessions, abduction and external rotation in a quadruped ("fire hydrant" exercise) and weight-bearing hip extension (known as "deadlift" exercise) are added. Each exercise was performed for 10 repetitions. Elastic resistance was Added to the fire hydrant, hip extension in prone and deadlift exercises to allow each subject to perform at a 10-repetition maximum. The resistance for each subject was adjusted weekly as needed. The exercise program was performed under direct supervision only during the physical therapy sessions.; Subjects attended p two times per week for a total of 10 visits. The participants performed PHEKF in 90° knee flexion with 30° hip abduction and 10° hip extension to increase the muscle activity of the gluteus maximus. In the prone position, the participant performed 10° hip extension until the posterior knee reached the horizontal bar. The participants maintained 90° knee flexion with 30° hip abduction and 10° hip extension in the prone position against the resistance. Sandbags (3 kg) will be used to provide resistance on the ankle through a rope and pulley. Each subject performed three sets with three repetitions of five seconds each. 1-minute break is allowed between each set.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: gluteus maximus; Elastic resistance training; weighted resistance training