Effect of Quadratus Lumborum Muscle Energy Technique in Sacroilliac Joint Dysfunction.

Study Overview
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Brief Summary
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Sacroiliac joint as a potential source of low back pain is an overlooked problem. Yet, in the existing years there has been an increasing interest in sacroiliac joint as a pain originator and more attention is being paid into its assessment and treatment in the current literature. Muscle imbalance due to postural dysfunction involves mainly gluteus medius and hamstring; however the role of quadratus lumborum working on compensatory mechanism and its treatment effect in the management of sacroiliac joint dysfunction is yet not discovered.

Detailed Description
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Going through current literature, it is evident that sacroiliac joint dysfunction as a postural dysfunction is highly prevalent among adult population. This dysfunction due to major muscle imbalances if not treated timely can result in serious consequences later in life where it becomes the permanent dysfunction involving the major changes in the joint itself. Muscle imbalance due to postural dysfunction involves mainly gluteus medius and hamstring; however the role of quadratus lumborum working on compensatory mechanism and its treatment effect in the management of sacroiliac joint dysfunction is yet not discovered. All patients will be assessed and screened by consultants as indicated and will refer to physiotherapy with diagnosed non- specific chronic back pain.Patients will further be screened for SIJ dysfunction by physiotherapist.Only those patients who fulfill the criteria of Quadratus lumborum tightness & Gulteus medius weakness will randomly be selected and the sample of 70 will finally be selected for intervention.Written consent form will be taken from all study participants.Simple randomization technique will be used through Randomization Main software and randomization sheet will be generated. Patients will be further be assigned equally into two groups as per randomization sheet.Treatment will be performed three sessions per week for 4 weeks with postural advice and home exercise program with daily record of home diary. The selected outcome measures will be taken on initial visit (pre intervention), session 6 and final session 12 (post intervention).

Official Title
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Effect of Quadratus Lumborum Muscle Energy Technique Along With Gluteus Medius Strengthening Verus Gluteus Medius Strengthening Alone in the Management of Sacroilliac Joint Dysfunction.; A Randomized Controlled Trial.

Conditions
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Sacroiliac Disorder

Intervention / Treatment
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* Other: physiotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Subjects with unilateral non-specific LBP The Subjects having at least 3 pain provocative tests of SIJ positive out of 5. Age 30-50 years. Both male and female. Pain history greater than six weeks. SIJ diagnostic scoring cut off point 4. VAS cut off point mild to moderate. Exclusion Criteria: Radiating pain with sensory or motor deﬁcits. History of fracture or any spinal surgery Trauma Any dysfunction of hip or knee Any systemic disease. Pregnancy

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 50 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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental<br>Following physiotherapy treatment will be given to the participants in this group for 4 weeks and each session last for 30 minutes. i. MET Quadratus lumborum ii. Ultrasound iii. Gluteus medius exercises iv. Hamstring stretch Posture advice and home exercise program | Other: physiotherapy<br>* Treatment will be performed three sessions per week for 4 weeks with postural advice and home exercise program with daily record of home diary. The selected outcome measures will be taken on initial visit (pre intervention), session 6 and final session 12 (post intervention).<br>|
| Active Comparator: Comparator<br>Following physiotherapy treatment will be given to the participants in this group for 4 weeks and each session last for 30 minutes. i. Ultrasound ii.Gluteus medius exercises iii.Hamstring stretch | Other: physiotherapy<br>* Treatment will be performed three sessions per week for 4 weeks with postural advice and home exercise program with daily record of home diary. The selected outcome measures will be taken on initial visit (pre intervention), session 6 and final session 12 (post intervention).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| visual analog scale to measure the change in level of Pain intensity | A Visual Analogue ScalE is usually a horizontal line, 100 mm in length, anchored by word descriptors at each end ranging from no pain to severe pain. | Total duration of treatment is 4 weeks and 12 sessions, 3 sessions per week on alternate days. Patients will be assessed at baseline, at 6th session at the end of 2nd week and 12th session at the end of 4th week. | 
| Oswestry Disability Index to measure change in level of disability | Change in level of disability as evaluated by means of Oswestry Disability Index 2.0 (ODI) | Total duration of treatment is 4 weeks and 12 sessions, 3 sessions per week on alternate days. Patients will be assessed at baseline, at 6th session at the end of 2nd week and 12th session at the end of 4th week. | 
| SF-36 QUALITY OF LIFE to measure change in general health | SF-36 measure 8 different health concepts including general health, physical functioning, role functioning, bodily pain, mental health, emotional functioning, vitality, and social functioning. | Total duration of treatment is 4 weeks and 12 sessions, 3 sessions per week on alternate days. Patients will be assessed at baseline and 12th session at the end of 4th week. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hand Held Dynamometer to check gluteus medius muscle strength | The strength of the gluteus medius muscle was assessed on the dominant side using the Microfet2 hand-held dynamometer (MicroFET 2, Hoogan Health Industries, West Jordan, UT, USA). | Total duration of treatment is 4 weeks and 12 sessions, 3 sessions per week on alternate days. Patients will be assessed at baseline, at 6th session at the end of 2nd week and 12th session at the end of 4th week. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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MET, Quadratus lumborum, Sacroilliac joint