Effects of Spinal Manipulation and Muscle Energy Technique on Pain, Function, Thickness of muscles for Patients with Sacroiliac Joint Dysfunction

The purpose of study is to examine the effect of spinal manipulation therapy and muscle energy technique on pain, function and thickness(at rest, contracted and percent change thickness of the deep abdominals(Internal oblique ,Transverse abdominal) Global muscles Latissimus dorsi and Gluteus maximus)

In this research, 44 eligible patients of Sacroiliac Joint Dysfunction referring to Life Line Hospital,Gulab daivi hospital and Ganj Baksh Spinal Research Hospital were chosen purposefully and a code was allocated to each one of them. Then, patients were randomly divided into Four Groups.(Three Intervention Groups and One Control Group)

After approval of proposal from institutional review committee a randomized clinical trial study of 7 months duration will be conducted at Ganj Baksh spinal research and rehabilitation hospital-trust, Life Line hospital and Gulab devi hospital ,department of Physical therapy ferozpur road Lahore Pakistan. Baseline pre-treatment measurements will be compared with post-treatment measurement that will be taken after one month and three months follow up interval. It is double blinded study, assessor and patients will be blinded by following procedure. Assessors will be blinded by assigning specific identity numbers and all consent, readings forms will be placed in locker to bind assessors (Arif, Raham) and to ensure data safety.. Patients will be blinded from group treatments and hypothesis by informing partial information regarding treatment groups.

Inclusion criteria: Male patients between 18 to 45 years old with unilateral low back pain up to knee will be included. At least three out of six sacroiliac joint provocation tests with standing flexion test and seating flexion test must be positive. No strengthening exercise of muscles in last three months. No surgical history. No disc pathology confirmed by MRI. No facet joint hypo mobility. No ankylosing spondylitis. Exclusion criteria: Abnormal recording of thickness by ultrasound. fatigability of subjects Over time Unwillingness of subjects to continue testing due to fear.

There are four groups ,Three Experimental Groups and one Control Group respectively , 1. Muscle Energy Group, 2. Spinal Manipulation Therapy group, 3. Muscle Energy with Spinal Manipulation Therapy Group. 4.Control Group(Conventional Group) Treatment session for each group will be twice a week for four weeks.

Outcomes will be measured using modified oswestry disability index score for function, numeric pain rating scale for pain and ultrasonography for muscle thickness.

Tehran University of Medical Sciences-International Campus

Four groups will be divided by simple random sampling by using Four alphabetic chance: A) First group, B) second group and C) third group. D) Fourth Group Patients will be assigned randomly in Four groups by Physical Therapist (Rabiya) by using concealed opaque envelope mentioning Specific Identity Numbers generated through Random Number Generator to avoid biasness.

Double Blind: Assessor Blind: Data safety will be ensured by assigning Specific Identity numbers and all consent, readings forms will be placed in locker to bind Assessors (Arif, Amir). Patients Blind: Patients will be blinded from group treatments and Hypothesis by informing partial information regarding treatment.