Pelvic Stabilization Exercises & (PNF) on Pain, Disability & Functional Leg Length

Study Overview
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Brief Summary
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The aim of the study is to compare the effects of pelvic stabilization exercises and proprioceptive neuromuscular facilitation on pain, disability and functional leg length in patients with anterior innominate iliosacral dysfunction.

Detailed Description
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Illiosacral Dysfunction is accompanied by an abnormal movement of the ilium in relation to the sacrum, most commonly classified as either anterior or posterior innominate dysfunction. One of the unrecognized causes of low back and pelvic pain, as well as source of pain to proximal lower extremity is sacroiliac joint (SIJ) which arises from L5, S1 and in particular if there was an associated groin pain. There is a strong consensus on the effects of stabilization exercises in patients with chronic LBP, also some evidence for its benefits in patients with SJD. The aim of the study is to compare the effects of pelvic stabilization exercises and proprioceptive neuromuscular facilitation on pain, disability and functional leg length in patients with anterior innominate rotation dysfunction. A total of 26 patients with Anterior innominate iliosacral dysfunction will be included in the study. Ethical approval will be taken from ethical committee of Riphah Internatinal University Lahore. Non-probability convenience sampling technique will be used to divide participants into group. Sample size is twenty-six. After taking informed consent and maintaining the confidentiality of individual participant, both groups will be treated with baseline treatment via the application of Hot pack. Group A will be treated with Proprioceptive neuromuscular facilitation and Group B will be treated with Pelvic Stabilization Exercises for eight weeks. Outcome measuring tools for pain (Numeric Pain Rating Scale), Functional Disability (Modified Oswestry low back pain disability Questionnaire) and Functional Leg length (Tape Method) will be noted pre, 4th week and post treatment. Data will be Analyzed by SPSS version 29. Descriptive statistics will be used for demographics. The normality of the data will be assessed by Shapiro-Wilk test. If the data is normally distributed parametric test i.e., T-Test will be used for inter group difference while Paired Sample T-Test will be used for intra group pre and post treatment difference. If the data is not normally distributed a nonparametric test i.e., Mann-Whitney test will be used.

Official Title
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Comparison of Pelvic Stabilization Exercises and Proprioceptive Neuromuscular Facilitation on Pain, Disability and Functional Leg Length in Patients With Anterior Innominate Iliosacral Dysfunction.

Conditions
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Anterior Innominate Iliosacral Dysfunction

Intervention / Treatment
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* Other: Proprioceptive neuromuscular facilitation
* Other: Pelvic stabilization exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient within ages of 25 and 45 years. Both male and female participants will be included. Episode of Lumbopelvic pain within the previous 6 weeks with pain radiating till the knee and associated groin pain. Pain and tenderness at SIJ The diagnostic criteria for SJD were five clinical tests Compression, Distraction, sacral thrust, thigh thrust and Gaenslen test (patient with a minimum of 3 positive results among the 5 provocation tests) Positive Special test for Anterior Innominate Dysfunction (Standing flexion test, Seated flexion test, Supine to sit test and Gillet test) NPRS = 3 to 6 Exclusion Criteria: Any other medical/systemic illness relevant to lower back and lower extremity Previous major surgery for lower back and lower extremity SLR Less than 45° Pain radiating past the knee Pregnant and lactating females Had been diagnosed by physician with a diagnosis other than SIJD Receiving manual therapy for the sacroiliac joint in the past 3 month

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 45 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: Proprioceptive neuromuscular facilitation<br>The patients will be positioned in supine lying and then contract relax will be performed on affected side of pelvis first in D1 pattern (anterior elevation and posterior depression) 3 times with 10 sec contractions and 5 sec relaxations in 1 set. Then in D2 pattern (posterior elevation and anterior depression) 3 times with 10 sec contractions and 5 sec relaxations in 1 set. 3 set of each diagonal pattern to be performed in 1 treatment session alternatively. Treatment will be given for a period of 4 days a week for 8 weeks | Other: Proprioceptive neuromuscular facilitation<br>* Group A (Proprioceptive neuromuscular facilitation.) will be treated with Proprioceptive neuromuscular facilitation, before applying exercise, Hot pack will be applied for 15 minutes. (8 weeks, 4 sessions per week) The patients will be positioned in supine lying and then contract relax will be performed on affected side of pelvis first in D1 pattern (anterior elevation and posterior depression) 3 times with 10 sec contractions and 5 sec relaxations in 1 set. Then in D2 pattern (posterior elevation and anterior depression) 3 times with 10 sec contractions and 5 sec relaxations in 1 set. 3 set of each diagonal pattern to be performed in 1 treatment session alternatively. Treatment will be given for a period of 4 days a week for 8 weeks<br>|
| Experimental: Pelvic stabilization exercises<br>All participants will receive training programs for the eight levels of training from static to dynamic conditions. The practiced therapy method will first taught by a physical therapist with a verbal explanation and visual aids (such as photographs) in each group. The therapist will supervise all stages of the exercise therapy to ensure the patients correctly performed the exercises. The supervised exercise intervention will be conducted 3 days a week for 8 weeks. | Other: Pelvic stabilization exercises<br>* Group B (Pelvic stabilization exercises) will be treated with Pelvic Stabilization Exercise, before applying exercise we will apply Hot pack for 15minutes (8 weeks, 3 sessions per week). All participants will receive training programs for the eight levels of training from static to dynamic conditions. The practiced therapy method will first be taught by a physical therapist with a verbal explanation and visual aids (such as photographs) in each group. The therapist will supervise all stages of the exercise therapy to ensure the patients correctly performed the exercises. The supervised exercise intervention will be conducted 3 days a week for 8 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rating Scale NPRS | Change from baseline the NPRS is a self-reporting or clinician-administered measuring tool that has extreme values ranging from no pain to severe pain, on either horizontal or vertical line of scale. Numeric Rating Scale (NRS-11), which is an eleven-point scale in which the end points are the extremes of no pain at all (score of 0) and the worst pain the patient has ever experienced (score of 10). | 8 week | 
| Modified Oswestry low back pain disability Questionnaire | Change from baseline this questionnaire has been designed to give information as to how back pain has affected the ability to manage in everyday life. It consists of total of 10 questions which are scored as follow: This scale consists of 10 items in the form of activities of daily living with each item scoring from 0 to 5 where 0 is no difficulty in performing that activity and 5 inability to do that activity. | 8 week | 
| Measurement of Functional Leg length: (Tape Method): | Change from baseline the true leg length measurement or spinomalleolar distance (acceptable validity and reliability [intraclass correlation coefficient (ICC3,3) range 0.98 - 0.99] in measuring LLD) was used to assess the leg length of the subjects. A measuring tape will then use to measure from the apex of anterior superior iliac spine (ASIS) to the distal end of the medial malleolus in each leg and recorded in millimeter (mm). The following is the classification of the level of LLD: mild (< 30 mm), moderate (30 - 60 mm) and severe (> 60 mm). | 8 week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Anterior innominate Iliosacral Dysfunction, Functional leg length, Pelvic Stabilization Exercise, Proprioceptive Neuromuscular Facilitation, Disability