“Effectiveness of Mulligan's Movement with Mobilization in the Rehabilitation of Sacro Iliac Joint Dysfunction”

Abstract

Background: Sacroiliac joint dysfunction (SIJD), allude to the pain in the sacroiliac joint caused by partial subluxation or dislocation in a non-anatomically correct position due to hypermobility or hypomobility within the joint. Mobilization with movement is the manual therapy technique introduced by Brian Mulligan for the management of various musculoskeletal dysfunctions. They address the problems of movement pain and restriction and bring about a change at the time of delivery. Sacroiliac joint dysfunction is due to a positional fault and  Brian Mulligan’s mobilization with the movement has been found  effective in correcting positional faults. Although there is evidence of Mulligan’s mobilization on improvement in ROM, there is lacuna of strong evidence to supports the hypothesis, that a reversal of  positional fault is the predominant mechanism for the action of  mulligan’s mobilization. As there is no evidence of the effect of Mulligan’s mobilization in sacroiliac joint dysfunction this study has been undertaken.

Methods: 52 subjects were screened having age group of 18-60 years, both males and females having pain over the SIJ with referral to buttock, groin, posterior aspect of the thigh with or without history of fall, having tenderness over sacroiliac joint on palpation and having 5 positive pain provocation tests out of seven were included. Subjects with Acute trauma to low back, Presence of neurological signs such as numbness & profound muscle weakness, Recent surgery on low back, Limb length discrepancies as it can affect the sacroiliac joint orientation, Inflammatory diseases like Ankylosing spondylitis, RA, Pregnancy, Fractures and other pathologies of unknown etiology and obese patients having indistinct osteal landmarks were excluded. 30 patients who fulfilled the screening criteria were included. Evaluation was done where chief complaints, HOPI, drug history was noted. The innominate bone inclination was measured with the help of pelvic inclinometer. Also baseline evaluation was done by Visual analogue scale (VAS) in SIJ pain and Oswestry low back ache disability index. These patients were then assigned to control group or in experimental group of 15 each, through random allocation sampling. Patients in Experimental Group were treated with mulligan’s mobilization with offending movement for correcting positional fault of SIJ along with hot packs (15 minutes) and core stability exercises and the Control Group received hot packs (15 minutes) and core stability exercises.

Results: Experimental Group  and Control Group were compared  statistically by using unpaired t test and the P value for pain  was found to be p=0.072 (innominate tilt), p=0.016 (VAS), p=0.047 (Oswestry). The P value for carryover effect was found to be p=0.064 (innominate tilt), p= 0.005 (VAS), p= 0.005 (oswestry) which is significant.

Conclusion: Mobilization with movement is effective in mitigating the positional fault at the SIJ, reducing the pain status of the patient thereby alleviating disability and return to activity.