Comparative Effects of Two Rehabilitation Approaches on Lumbopelvic Function in Sacroiliac Joint Dysfunction

NCT07425197 | Not Yet Recruiting

• 2 other identifiers: DPT/ERB/43U1111-1334-7752
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

This research compares two rehabilitation strategies for people with sacroiliac joint dysfunction (SIJD): Dynamic Neuromuscular Stabilization (DNS) and Core Stability Exercises (CSE). SIJD is presented as a biomechanical source of low-back, buttock and leg pain caused by altered joint mechanics, muscle control problems, or asymmetric pelvic alignment; diagnosis relies on clinical provocation tests and exclusion of other causes. The study aims to determine which of the two exercise-based approaches better reduces pain and improves lumbopelvic control. The trial is a single-blinded, parallel randomized controlled trial conducted in an outpatient physiotherapy setting with supervised sessions over four weeks. Adults aged 20-50 with at least three positive SIJ provocation tests and moderate, chronic pain were included; important exclusions were prior spinal/pelvic surgery, systemic inflammatory disease, pregnancy, cardiopulmonary limitation or poor session attendance. Each participant received a baseline conventional physiotherapy package; one arm received a DNS program (breathing-based and developmental movement patterns) and the other performed progressive core-stability training emphasizing transversus abdominis and multifidus activation. Primary outcomes are pain (Numeric Pain Rating Scale) and lumbopelvic stability measured with a pressure biofeedback unit (PBU). Data were collected at baseline and after four weeks; the analysis plan uses SPSS with paired and independent t-tests, ANCOVA to adjust for baseline differences, and effect sizes/confidence intervals to interpret clinical relevance. Safety, informed consent, assessor blinding and standard ethical safeguards are described. The synopsis notes a gap in direct RCT evidence comparing DNS and CSE for SIJD and positions this trial to address that gap with clinical and mechanistic outcomes.

Conditions

Sacroiliac Joint Dysfunction

Keywords

SIJD; DNS; Core stability; lumbopelvic stability

Outcome Measures

Primary Outcomes (2)

• Lumbopelvic stability

  Lumbopelvic Stability was measured with two validated instruments: Pressure Biofeedback Unit (PBU). The PBU is an inflatable pressure cuff that is attached to a pressure gauge that was positioned under the lumbar spine. Test was performed in hook lying abdominal drawing-in test by inflating the cuff approximately 40 mmHg. The patient was instructed to contract the TrA by draw-in maneuver. Normal functioning involves sustaining pressure within ±5-10 mmHg of the baseline value. A decrease or rise above this level signifies compromised stability

  4 weeks

• Pain Intensity

  Pain Intensity was measured with the Numeric Pain Rating Scale (NPRS), an 11-point self-report scale from 0 (no pain) to 10 (worst pain possible). Participants were asked to indicate their average pain during the past 24 hours. The NPRS is a reliable and valid instrument to quantify musculoskeletal pain and can detect clinically significant change in pain.

  4 weeks

Study Arms (2)

Dynamic Neuromuscular Stabilization

EXPERIMENTAL

The intervention focuses on restoring motor control through developmental movement patterns, emphasizing coordinated activation of the diaphragm, pelvic floor, deep trunk, and spinal stabilizers. Exercises progress from supported positions, such as supine or quadruped, to more functional postures like sitting, standing, and weight-shifting tasks. Verbal and tactile feedback is provided throughout to ensure correct breathing, intra-abdominal pressure, and postural alignment, aiming to improve lumbopelvic stability, neuromuscular coordination, and reduce sacroiliac joint pain.

Other: Dynamic Neuromuscular Stabilization

Core stability Exercise

ACTIVE COMPARATOR

The intervention targets activation and strengthening of deep trunk muscles, mainly the transversus abdominis and lumbar multifidus, to enhance segmental spinal stability. Exercises begin with low-load, isolated contractions of these muscles in supine or prone positions and progress to include limb movements, balance challenges, and functional tasks. Biofeedback and therapist guidance are used to ensure proper recruitment, postural control, and trunk endurance, aiming to reduce pain and improve lumbopelvic stability without integrating developmental movement patterns or specialized breathing techniques.

Other: Core stabilization Exercise Program

Interventions

Dynamic Neuromuscular Stabilization OTHER

Dynamic Neuromuscular Stabilization (DNS) is a motor control-based rehabilitation approach using human developmental movement patterns to restore optimal motor programs and improve lumbopelvic stability. In this study, participants receive supervised DNS sessions three times per week for four weeks, 45 minutes per session, including conventional physiotherapy followed by DNS exercises. Exercises progress from supine diaphragmatic breathing, abdominal bracing, quadruped rocking, and side-lying reaches to half-kneel, standing weight shifts, step-ups, split-squats and get-ups. Emphasis is on coordinated activation of diaphragm, pelvic floor, deep trunk, and spinal stabilizers, intra-abdominal pressure regulation, postural alignment, and sensorimotor control, with continuous verbal and tactile feedback. Unlike conventional core programs, DNS targets motor control, functional integration, and neuromuscular coordination rather than only strength or endurance.

Dynamic Neuromuscular Stabilization

Core stabilization Exercise Program OTHER

Core Stability Exercises (CSE) focus on improving segmental spinal and lumbopelvic stability by targeting the transversus abdominis (TrA) and lumbar multifidus (LM). In this study, participants receive supervised CSE sessions three times per week for four weeks, 45 minutes per session, beginning with low-load activation in supine, prone, and seated positions using abdominal drawing-in maneuver (ADIM), LM activation with contralateral arm raise, and TrA-LM co-contraction with bridging. Progression includes endurance training with controlled extremity movements, quadruped bird-dog, bridge marching, mini-squats, step-ups, wall push-ups, and self-palpation for awareness. Exercises emphasize isolated muscle activation, segmental control, and functional strength, guided by therapist supervision and biofeedback

Core stability Exercise

Eligibility Criteria

• Age: 30 Years - 45 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age between 30 and 45 years
• Confirmed diagnosis by at least three positive provocation tests
• FABER
• Gaenslen's, Thigh Thrust
• Compression
• Distraction
• Pain lasting three months or longer
• NPRS score between 4 and 7

You may not qualify if:

• Other spinal conditions such as, spinal stenosis or tumors
• Prior history of spinal or pelvic surgery
• Patients with neurological disorders or systemic diseases such as rheumatoid arthritis
• Pregnant women
• Patients with cardiopulmonary conditions

Sponsors & Collaborators

• Lahore University of Biological and Applied Sciences: lead

Study Sites (1)

Ghurki Trust Teaching Hospital

Lahore, Punjab Province, 54000, Pakistan

Location

Study Officials

• Dr. Muhammad Zohaib

  Lahore University of Biological and Applied Sciences

  STUDY CHAIR

• Saffa Shahid, DPT

  Lahore College of Physical therapy

  PRINCIPAL INVESTIGATOR

• Seher Mushtaq, DPT

  Lahore College of Physical therapy

  PRINCIPAL INVESTIGATOR

• Syed Muhammad Moiz, DPT

  Lahore College of Physical therapy

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Dr. Muhammad Zohaib, DPT

CONTACT

03204417377; muhammad.zohaib@ubas.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Demonstrator

Model Details: Not needed

Study Record Dates

• First Submitted: February 16, 2026
• First Posted: February 20, 2026
• Study Start: March 18, 2026
• Primary Completion: March 18, 2026
• Study Completion (Estimated): September 27, 2026
• Last Updated: March 19, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP
• Time Frame: June 2026- October 2026

Locations

PA (1)