Effects of Stecco Fascial Manipulation Versus Muscle Energy Technique on Pain Pressure Threshold, Range of Motion and Disability Among Patients With Sacroiliac Joint Dysfunction

NCT07723014 | Recruiting DMC

• 1 other identifier: UBAS/ERB/26/04/024
• Study Type: interventional
• Target: 52
• Locations: 1 country
• Sites: 1

Brief Summary

This study holds significant importance as it directly addresses the need for effective physiotherapy interventions in patients with sacroiliac joint dysfunction, a condition that contributes substantially to lower back pain and disability. By comparing the effects of Fascial Manipulation and Muscle Energy Technique on pain pressure threshold, disability, and range of motion, the study provides evidence-based guidance for clinicians in selecting the most appropriate treatment. The findings can help physiotherapists develop more targeted rehabilitation plans, improve patient outcomes, and reduce treatment time. Additionally, this research adds to the limited literature available on stecco fascial manipulation and muscle energy technique approaches for SI joint dysfunction and may encourage further studies to refine and expand conservative management strategies. Ultimately, the study benefits both healthcare professionals and patients by promoting more efficient, safe, and effective physiotherapy care.

Conditions

Sacroiliac Joint Dysfunction

Keywords

Stecco fascial manipulation; Muscle enrgy technique (MET); Functional disability

Outcome Measures

Primary Outcomes (4)

• Goniometer

  Lumbar range of motion (ROM) was assessed using a universal goniometer, a simple, handheld clinical instrument specifically designed to measure joint angles and the extent of movement in degrees. The goniometer consists of two arms and a central fulcrum, allowing accurate quantification of active lumbar movements, including flexion, extension, lateral flexion, and rotation. Standardized patient positioning and anatomical landmark identification were used to enhance measurement accuracy. Reduced lumbar ROM is commonly associated with pain and functional limitation in individuals with sacroiliac joint dysfunction.

  [ baseline, 4 weeks( followup)]

• Pain self-efficacy questionnaire (PSEQ)

  Pain self-efficacy, defined as an individual's confidence in performing daily activities despite the presence of pain, was assessed using the Pain Self-Efficacy Questionnaire (PSEQ). The PSEQ is a widely used, condition-independent, self-reported outcome measure designed to evaluate how confidently individuals can function while experiencing pain. It consists of 10 items, each rated on a 7-point Likert scale (0-6), producing a total score ranging from 0 to 60, with higher scores indicating greater pain self-efficacy.

  baseline, 4 weeks (follow up)

• Algometer:

  Pressure pain threshold (PPT) was assessed using a handheld pressure algometer, an objective instrument designed to quantify mechanical pain sensitivity by applying controlled, gradually increasing pressure to soft tissues. In this study, the algometer was applied over a standardized anatomical point in the sacroiliac joint region until the participant first perceived pain, at which point the corresponding value was recorded in kilograms or Newtons. Higher PPT values indicate greater pain tolerance, whereas lower values reflect increased pain sensitivity.

  baseline, 4 weeks(followup)

• Oswestry disability index (ODI)

  Functional disability related to sacroiliac joint dysfunction was assessed using the Oswestry Disability Index (ODI), which is one of the most widely used and validated questionnaires for measuring disability associated with low back and pelvic pain. The ODI is a condition-specific, self-reported outcome measure designed to assess the degree to which pain affects an individual's ability to perform activities of daily living, including personal care, lifting, walking, sitting, standing, sleeping, social life, and traveling. It consists of 10 items, each scored on a 6-point scale (0-5), yielding a total score ranging from 0 to 50, which is commonly converted into a percentage score, with higher scores indicating greater functional disability.

  baseline, 4 weeks ( followup)]

Study Arms (2)

Stecco fascial manipulation

EXPERIMENTAL

26 patient were given the Stecco myofascial manipulation on the retro-lumbi which are located over the muscle bellies of the erector spinae at the T12- L1 level, retro-talus which are located in the myotendinous passage of the gastrocnemius, retro-thorax, which are located over the muscle bellies of the erector spinae, at the level of T4-T5, extra-thorax, which are located medially to the scapula, at the level of the scapular spine, over the rhomboid and serratus posterior superior muscle, extra-lumbi which are situated below the 12th rib, over the insertion of the oblique muscle. Fascial manipulation was not performed directly over the painful area; instead, selected fascial points situated at least 20 cm away from the site of pain were treated to avoid local tissue irritation and to utilize the principle of fascial continuity

Other: Stecco fascial manipulation

Muscle Energy Technique

OTHER

26 patients were given the muscle energy technique MET was applied in two forms: Anterior and posterior dysfunction of the SIJ. The MET technique for correction of anterior dysfunction of the sacroiliac joint was performed by placing the individual in a lateral position on the opposite side to that of the dysfunction. The blocked leg was taken by the examiner, while the unaffected leg remained extended on the stretcher. The leg was placed in hip flexion until the first point of tension that prevented the posterior rotation of the ilium was found. While this technique was being used, the patient was asked to push his leg into hip extension while the examiner held it and prevented movement. Four contractions were performed, resisted by the therapist, and held for 7-10 s. The individual was then asked to relax the leg, and the examiner continued to perform the hip flexion until a new point of tension was found

Other: Muscle energy technique

Interventions

Muscle energy technique OTHER

MET was applied in two forms: Anterior and posterior dysfunction of the SIJ. The MET technique for correction of anterior dysfunction of the sacroiliac joint was performed by placing the individual in a lateral position on the opposite side to that of the dysfunction. The blocked leg was taken by the examiner, while the unaffected leg remained extended on the stretcher. The leg was placed in hip flexion until the first point of tension that prevented the posterior rotation of the ilium was found.hold it for 10 second and apply four repitation.In order to correct the SIJ dysfunction due to a posteriorly rotated ilium, the individual was placed in a prone position with his or her unaffected side leg in extension, while the affected side leg was in knee flexion. The therapist held the leg in a 90◦ flexion and tried to help hip extension so as to get the ilium to rotate posteriorly in order to correct the dysfunction. Hold it for 10 second and apply for four repitation.

Muscle Energy Technique

Stecco fascial manipulation OTHER

Stecco myofascial manipulation on the retro-lumbi which are located over the muscle bellies of the erector spinae at the T12- L1 level, retro-talus which are located in the myotendinous passage of the gastrocnemius, retro-thorax, which are located over the muscle bellies of the erector spinae, at the level of T4-T5, extra-thorax, which are located medially to the scapula, at the level of the scapular spine, over the rhomboid and serratus posterior superior muscle, extra-lumbi which are situated below the 12th rib, over the insertion of the oblique muscle. Fascial manipulation was not performed directly over the painful area; instead, selected fascial points situated at least 20 cm away from the site of pain were treated to avoid local tissue irritation and to utilize the principle of fascial continuity. Manual manipulation was performed using sustained deep pressure applied with the therapist's knuckles or elbow, combined with friction over the identified points.

Stecco fascial manipulation

Eligibility Criteria

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

You may qualify if:

• Both male and female.
• Participants with a medical diagnosis of SIJD (posterior innominate and anterior innominate), pain and tenderness at PSIS, Sacral Sulcus, Ilia.
• Pain in the paraspinal muscles, gluteal or groin region, and radiating to either leg.
• Positive special tests for SIJD (Faber test, Thigh thrust test, Distraction test, compression test, and Gaenslen test).
• Pain lasting for less than 3 months.

You may not qualify if:

• Subjects with leg length discrepancy.
• Subjects with any pathology observed in the lower extremity.
• Subjects with pre-diagnosed tumors of the hip and spine.
• Pregnancy.
• Subjects with any history of recent trauma involving the lower limb.

Sponsors & Collaborators

• Lahore University of Biological and Applied Sciences: lead

Study Sites (1)

Lahore General Hospital

Lahore, Punjab Province, 54000, Pakistan

RECRUITING

Related Publications (5)

• Hughes L, Paton B, Rosenblatt B, Gissane C, Patterson SD. Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med. 2017 Jul;51(13):1003-1011. doi: 10.1136/bjsports-2016-097071. Epub 2017 Mar 4.

  PMID: 28259850 BACKGROUND

• Centner C, Wiegel P, Gollhofer A, Konig D. Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis. Sports Med. 2019 Jan;49(1):95-108. doi: 10.1007/s40279-018-0994-1.

  PMID: 30306467 BACKGROUND

• Sorensen B, Aagaard P, Hjortshoj MH, Hansen SK, Suetta C, Couppe C, Magnusson SP, Johannsen FE. Physiological and clinical effects of low-intensity blood-flow restricted resistance exercise compared to standard rehabilitation in adults with knee osteoarthritis-Protocol for a randomized controlled trial. PLoS One. 2023 Dec 14;18(12):e0295666. doi: 10.1371/journal.pone.0295666. eCollection 2023.

  PMID: 38096198 BACKGROUND

• Harper SA, Roberts LM, Layne AS, Jaeger BC, Gardner AK, Sibille KT, Wu SS, Vincent KR, Fillingim RB, Manini TM, Buford TW. Blood-Flow Restriction Resistance Exercise for Older Adults with Knee Osteoarthritis: A Pilot Randomized Clinical Trial. J Clin Med. 2019 Feb 21;8(2):265. doi: 10.3390/jcm8020265.

  PMID: 30795545 BACKGROUND

• Freitas EDS, Miller RM, Heishman AD, Aniceto RR, Silva JGC, Bemben MG. Perceptual responses to continuous versus intermittent blood flow restriction exercise: A randomized controlled trial. Physiol Behav. 2019 Dec 1;212:112717. doi: 10.1016/j.physbeh.2019.112717. Epub 2019 Oct 17.

  PMID: 31629764 BACKGROUND

Central Study Contacts

Shahzaib Salik

CONTACT

+923241479454; shahzaibsalik322@gmail.com

Yamna Mazher

CONTACT

+923327965489; yamna.mazhar@ubas.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: outcome assessor will be blind about participants allocation; this will ensure that their evaluations are objective and not influenced by knowledge of which treatment group participants belong to. Participants in both groups will be masked to the treatment of the other group by scheduling their sessions at different times
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This study will use a parallel-group randomized controlled design, with participants randomly allocated into two intervention groups. Group A (Stecco fascial manipulation): Participentwere given the Stecco myofascial manipulation was not performed directly over the painful area; instead, selected fascial points situated at least 20 cm away from the site of pain with the help of therapist knuckels and elbow.The principleGroup B Muscle enrgy technique for given to the correction of anterior and posterior dysfunction of sacroiliac joint dysfunction.Both groups received standardized conventional physiotherapy, which included the application of moist heat therapy using a hydrocollator hot pack. The hot pack was applied over the affected area with adequate towel layers for 10-15 minutes. Sessions will be conducted 1 times per week for 4 weeks. Participants will be randomly assigned into two parallel groups without crossover to ensure unbiased comparison of outcomes.

Study Record Dates

• First Submitted: July 20, 2026
• First Posted: July 23, 2026
• Study Start: May 1, 2026
• Primary Completion: July 30, 2026
• Study Completion (Estimated): October 10, 2026
• Last Updated: July 23, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)