PIR of Quadratus Lumborum With and Without Gluteus Maximus Activation in Innominate Upslip Suprapubic Dysfunction

Study Overview
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Brief Summary
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The innominate up slip dysfunction is the most common in athletes and non-athletes, who present with low back pain and sacroiliac dysfunction. The main muscular structure that forms the force closure of the joint involves the bicep femoris and gluteus maximus that are involved in the stability of the of the pelvis through immense attachments through the Sacro-tuberous ligament. The objective of this study is to determine the effectiveness of Post Isometric Relaxation (PIR) of Quadratus lumborum with and without Gluteus maximus activation on pain, disability and pelvic tilt angle in patients with innominate upslip suprapubic dysfunction. The study will be a randomized controlled trial involving 34 patients both males and females aged 20 to 40 years with history of unilateral pelvic pain not radiating to L5 or above, Positive finding of sitting flexion test, standing flexion tests, stork test and Positive active straight leg raise test will be randomly recruited by consecutive sampling technique. The subjects having ankylosing spondylitis, lumbar radiculopathy, spinal pathologies, or any lumbar fracture will be excluded. All the patients in the study will be randomly assigned into two groups where Group A will be given muscle energy technique of quadratus lumborum along with gluteus maximus activation and Group B will be a control group treated with muscle energy technique only. Both groups will be given buttock squeezing and drawing in maneuver as common treatment along with muscle energy technique. Each session will be repeated for 20 minutes thrice a week. The treatment duration will be 4 weeks. Outcomes will be measured at the first day and then at the end of the 4th week by numeric pain rating scale, modified Oswestry disability index and iHandy inclinometer application. .

Official Title
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Effects of Post Isometric Relaxation of Quadratus Lumborum With and Without Gluteus Maximus Activation on Pain, Disability and Pelvic Tilt Angle in Patients With Innominate Upslip Suprapubic Dysfunction

Conditions
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Innominate Upslip Suprapubic Dysfunction

Intervention / Treatment
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* Other: Post isometric relaxation of quadratus lumborum and gluteus Gluteus maximus activation exercises
* Other: post isometric relaxation of the Quadratus lumborum


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients aged 20 to 40 years Both males & females History of unilateral pelvic pain not radiating to L5 or above Positive finding of sitting flexion test, standing flexion tests, stork test. Positive active straight leg raise test Exclusion Criteria: Subjects diagnosed with ankylosing spondylitis. Lumbar radiculopathy Spinal pathologies including spondylosis and spondylolisthesis. Subjects immediately post pregnancy. Disc herniation Lumbar fractures or spinal surgeries

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Post isometric relaxation of quadratus lumborum and gluteus Gluteus maximus activation exercises<br> | Other: Post isometric relaxation of quadratus lumborum and gluteus Gluteus maximus activation exercises<br>* Post Isometric Relaxation: The patient will be in a left recumbent position with his leg in a fully flexed position close to his chest and fixed by his left hand. The patient is asked to hold the treatment table with a right hand in an overhead position to support the body in applying the technique. The patient fully extended left will be taken away from the treatment table. At this point, the patient will be asked to press the leg down until the range where the patient feels discomfort to the point of torsion of Quadratus lumborum. This is the point that is the barrier range. Smaller than this range the patient will be asked to lift his left against the counterforce by the therapist and hold it for five to seven seconds which will be followed by five to seven seconds of relaxation. The technique will be repeated by five times in the pain-free range.<br>Other: post isometric relaxation of the Quadratus lumborum<br>* Post Isometric Relaxation: The patient will be in a left recumbent position with his leg in a fully flexed position close to his chest and fixed by his left hand. The patient is asked to hold the treatment table with a right hand in an overhead position to support the body in applying the technique. The patient fully extended left will be taken away from the treatment table. At this point, the patient will be asked to press the leg down until the range where the patient feels discomfort to the point of torsion of Quadratus lumborum. This is the point that is the barrier range. Smaller than this range the patient will be asked to lift his left against the counterforce by the therapist and hold it for five to seven seconds which will be followed by five to seven seconds of relaxation. The technique will be repeated by five times in the pain-free range<br>|
| Active Comparator: post isometric relaxation of the Quadratus lumborum<br> | Other: post isometric relaxation of the Quadratus lumborum<br>* Post Isometric Relaxation: The patient will be in a left recumbent position with his leg in a fully flexed position close to his chest and fixed by his left hand. The patient is asked to hold the treatment table with a right hand in an overhead position to support the body in applying the technique. The patient fully extended left will be taken away from the treatment table. At this point, the patient will be asked to press the leg down until the range where the patient feels discomfort to the point of torsion of Quadratus lumborum. This is the point that is the barrier range. Smaller than this range the patient will be asked to lift his left against the counterforce by the therapist and hold it for five to seven seconds which will be followed by five to seven seconds of relaxation. The technique will be repeated by five times in the pain-free range<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rating Scale (NPRS) | The numeric pain rating scale is a measurement of pain intensity in adults. The NPRS is a segmented numeric version of visual analogue scale (VAS) in which respondent select a whole number (0 to 10) that best reflects the intensity of pain. Scores range from 0 to 10 | 4 weeks | 
| Modified Oswestry disability index (MODI) | The disability will be measured by using the modified Oswestry Disability Index in individuals with innominate up slip suprapubic dysfunction. This is an extremely important tool used to measure a patient's permanent functional disability. The total score ranges from 0 to 50, with each section having a total possible score of 5. The patient can be further subcategorized into five groups according to their total score: 0%-20% (minimal disability), 20%-41% (moderate disability), 41%-60% (severe disability), 61%-80% (crippled), and 81%-100% (bedridden). The modified Oswestry Disability Index has a minimum charge of 15.5%. This measure has been proven to have good validity for detecting changes in the SIJ, with a minimum difference of 13-15 indicating clinical significance | 4 weeks | 
| I-Handy level inclinometer mobile app | The iPhone 12 (Apple Inc, Cupertino, CA, USA) will be used as a measuring instrument with level application (iHandy level). The iHandy level application is integrated into the iPhone and is a free application with a visual display similar to that of a digital inclinometer in regard to numeric size. The application uses the iPhones built-in accelerometer and a digital display to display the angle measured.. The unit of measurement will be degrees | 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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sacroiliac joint, suprapubic dysfunction, Muscle pain, Innominate upslip, pelvis