The Effect of Sacroiliac and Lumbar Mobilizations Applied in Addition to Conventional Physical Therapy

NCT ID: NCT07285876

Last Updated: 2025-12-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-05-02

Study Completion Date

2023-03-31

Brief Summary

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Femoroacetabular impingement (FAI) is defined as impingement caused by abnormal morphology between the femoral head-neck junction and the acetabulum in the hip joint (Aoyama et al., 2017). As a result of morphological changes, abnormal contact between the proximal femur and acetabulum leads to chondrolabral lesions and secondary hip osteoarthritis (Casartelli, Maffiuletti, Leunig, 2019; Pierannunzii L., 2017). Femoroacetabular impingement syndrome (FAIS) is a clinical condition characterized by movement-related hip-groin pain that limits daily and athletic activities, accompanied by clinical findings, symptoms, and radiological findings associated with morphological changes (Brown-Taylor et al., 2022; Griffin et al., 2016). Symptoms typically appear suddenly and are associated with rotational and hip flexion movements that place stress on the joint (Nepple et al., 2013). The primary symptom is hip and/or groin pain related to movement or position. Typically, pain is related to activity during the acute phase, but in the chronic phase, it can occur with daily living activities or even at rest (Byrd, 2014; Nepple et al., 2013).

In patients with FAIS, reduced hip range of motion can be compensated by the pubic symphysis and sacroiliac joint (SIJ), and as a result of this compensation, hip dysfunction may develop due to increased stress on these structures. Studies describing the relationship between SIJ and FAIS are available in the literature. SIJ dysfunction causes asymmetry between the right and left innominate bones, altering the pelvic tilt angle. Excessive coverage of the femoral head by the acetabulum increases compression and creates a basis for labral tears. A study comparing postoperative pain and hip function in FAIS patients with and without SIJ anomalies showed that the group with SIJ anomalies had worse outcomes (Krishnamoorty et al., 2019).

In recent years, studies suggesting that pelvic posture and kinematics influence acetabular orientation have been increasing alongside the hip-spine concept (Krishnamoorty et al., 2019; Pierannunzii L., 2017). Although there are many similar studies in the literature examining the relationship between FAIS and the lumbopelvic junction, studies examining treatment options do not include a treatment approach targeting this relationship. While many researchers accept the value of conservative treatment methods for FAIS, there is insufficient published evidence on how this treatment should be applied.

This study was planned to investigate the effects of sacroiliac and lumbar mobilization as additional interventions to conventional physiotherapy on pain, balance, neuromuscular control, hip range of motion and hip function in patients with FAIS. The aim of our study was to include the surrounding joints that affect hip joint mechanics, as described in the literature, in the treatment program alongside physiotherapy applications, which are one of the conservative treatment methods. We also aimed to address the biomechanical limitations contributing to hip pain and dysfunction through a patient-centered approach and to evaluate their effect on the overall integrity and function of the hip and lumbopelvic joints and to evaluate its effect on the overall integrity and function of the hip and lumbopelvic joints. This study is the first to our knowledge and aims to shed light on whether patients with FAIS require more comprehensive manual therapy approaches based on the data obtained from the research.

Detailed Description

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Conditions

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Femoroacetabular Impingement Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Mobilization Group

Group Type EXPERIMENTAL

Lumbosacral Mobilization

Intervention Type OTHER

Sacroiliac joint: anterior ilium technique. The practitioner stabilized the sacrum. The fingers of the hand on the same side as the affected side were placed on the anterior iliac spine and the ilium was pulled upward over the sacrum.

Sacroiliac joint: posterior ilium technique. While the patient was lying prone, the affected side was determined using the spring test. The practitioner positioned the thenar eminence of the hand against the posterior protrusion of the ilium and applied a lateral push. While maintaining this push, the patient was asked to perform backward extension.

Lumbar region: Maitland postero-anterior technique. Grade II-III mobilization was applied to the lumbar region (L1-L5) in the postero-anterior direction. The practitioner placed the ulnar side of their hand, on the spinous process of the of the relevant segment with the wrist in extension. Using body weight, passive oscillations were performed directly on the relevant segment in the posteroanterior direction.

Conventional physical therapy

Intervention Type OTHER

The conventional physical therapy applied to the control group included pain-targeted electrotherapy methods (Conventional transcutaneous electrical nerve stimulation, ice therapy, ultrasound therapy), hip mobilization techniques, hip strengthening exercises, core and trunk stabilization exercises, posture exercises, activity modification, and patient education.

Conventional Physical Therapy Group

Group Type ACTIVE_COMPARATOR

Conventional physical therapy

Intervention Type OTHER

The conventional physical therapy applied to the control group included pain-targeted electrotherapy methods (Conventional transcutaneous electrical nerve stimulation, ice therapy, ultrasound therapy), hip mobilization techniques, hip strengthening exercises, core and trunk stabilization exercises, posture exercises, activity modification, and patient education.

Interventions

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Lumbosacral Mobilization

Sacroiliac joint: anterior ilium technique. The practitioner stabilized the sacrum. The fingers of the hand on the same side as the affected side were placed on the anterior iliac spine and the ilium was pulled upward over the sacrum.

Sacroiliac joint: posterior ilium technique. While the patient was lying prone, the affected side was determined using the spring test. The practitioner positioned the thenar eminence of the hand against the posterior protrusion of the ilium and applied a lateral push. While maintaining this push, the patient was asked to perform backward extension.

Lumbar region: Maitland postero-anterior technique. Grade II-III mobilization was applied to the lumbar region (L1-L5) in the postero-anterior direction. The practitioner placed the ulnar side of their hand, on the spinous process of the of the relevant segment with the wrist in extension. Using body weight, passive oscillations were performed directly on the relevant segment in the posteroanterior direction.

Intervention Type OTHER

Conventional physical therapy

The conventional physical therapy applied to the control group included pain-targeted electrotherapy methods (Conventional transcutaneous electrical nerve stimulation, ice therapy, ultrasound therapy), hip mobilization techniques, hip strengthening exercises, core and trunk stabilization exercises, posture exercises, activity modification, and patient education.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Having been diagnosed with femoroacetabular impingement syndrome by the same orthopedic surgeon
* Having hip pain associated with femoroacetabular impingement syndrome
* Having femoroacetabular impingement syndrome morphology in the imaging methods used for femoroacetabular impingement syndrome diagnosis (Radiography, Magnetic Resonance Imaging, Computed Tomography)
* Having improved cognitive function and be willing to participate in the study
* Having signed the informed consent form

Exclusion Criteria

* Having received physical therapy for hip pathology within the last 3 months
* Having a history of lower limb and lumbar region surgery
* Having advanced hip osteoarthritis
* Having neurological findings such as radiculopathy or myelopathy
* Having rheumatic diseases (ankylosing spondylitis, rheumatoid arthritis)
* Having infectious diseases (sacroiliitis)
* History of developmental and congenital hip dysplasia
* Fracture
* Pregnancy
Minimum Eligible Age

15 Years

Maximum Eligible Age

55 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fenerbahce University

OTHER

Sponsor Role lead

Responsible Party

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Baha Naci

Assist Prof.

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Dilber Karagözoğlu Coşkunsu, Dr.

Role: STUDY_CHAIR

Fenerbahce University

Locations

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Sportomed Sports Medicine and Orthopedic Rehabilitation Clinic

Istanbul, , Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

References

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Johansson AC, Karlsson H. The Star Excursion Balance Test: Criterion and divergent validity on patients with femoral acetabular impingement. Man Ther. 2016 Dec;26:104-109. doi: 10.1016/j.math.2016.07.015. Epub 2016 Aug 5.

Reference Type BACKGROUND
PMID: 27525357 (View on PubMed)

Martin RL, Enseki KR, Draovitch P, Trapuzzano T, Philippon MJ. Acetabular labral tears of the hip: examination and diagnostic challenges. J Orthop Sports Phys Ther. 2006 Jul;36(7):503-15. doi: 10.2519/jospt.2006.2135.

Reference Type BACKGROUND
PMID: 16881467 (View on PubMed)

Casartelli NC, Valenzuela PL, Maffiuletti NA, Leunig M. Effectiveness of Hip Arthroscopy on Treatment of Femoroacetabular Impingement Syndrome: A Meta-Analysis of Randomized Controlled Trials. Arthritis Care Res (Hoboken). 2021 Aug;73(8):1140-1145. doi: 10.1002/acr.24234. Epub 2021 Jul 5.

Reference Type BACKGROUND
PMID: 32339441 (View on PubMed)

Sharma A, Alahmari K, Ahmed I. Efficacy of Manual Therapy versus Conventional Physical Therapy in Chronic Low Back Pain Due to Lumbar Spondylosis. A Pilot Study. Med Sci (Basel). 2015 Jun 26;3(3):55-63. doi: 10.3390/medsci3030055.

Reference Type BACKGROUND
PMID: 29083391 (View on PubMed)

Ali MN, Sethi K, Noohu MM. Comparison of two mobilization techniques in management of chronic non-specific low back pain. J Bodyw Mov Ther. 2019 Oct;23(4):918-923. doi: 10.1016/j.jbmt.2019.02.020. Epub 2019 Feb 28.

Reference Type BACKGROUND
PMID: 31733783 (View on PubMed)

Byrd JW. Femoroacetabular impingement in athletes: current concepts. Am J Sports Med. 2014 Mar;42(3):737-51. doi: 10.1177/0363546513499136. Epub 2013 Aug 27.

Reference Type BACKGROUND
PMID: 23982400 (View on PubMed)

Krishnamoorthy VP, Beck EC, Kunze KN, Cancienne JM, Krivicich LM, Suppauksorn S, Ayeni OR, Nho SJ. Radiographic Prevalence of Sacroiliac Joint Abnormalities and Clinical Outcomes in Patients With Femoroacetabular Impingement Syndrome. Arthroscopy. 2019 Sep;35(9):2598-2605.e1. doi: 10.1016/j.arthro.2019.03.030.

Reference Type BACKGROUND
PMID: 31500745 (View on PubMed)

Brown-Taylor L, Bordner H, Glaws K, Vasileff WK, Walrod B, Di Stasi S. Prevalence of low back pain and related disability in patients with femoroacetabular impingement syndrome. PM R. 2022 Jan;14(1):8-18. doi: 10.1002/pmrj.12572. Epub 2021 May 1.

Reference Type BACKGROUND
PMID: 33583131 (View on PubMed)

Pierannunzii L. Pelvic posture and kinematics in femoroacetabular impingement: a systematic review. J Orthop Traumatol. 2017 Sep;18(3):187-196. doi: 10.1007/s10195-016-0439-2. Epub 2017 Feb 1.

Reference Type BACKGROUND
PMID: 28150180 (View on PubMed)

Aoyama M, Ohnishi Y, Utsunomiya H, Kanezaki S, Takeuchi H, Watanuki M, Matsuda DK, Uchida S. A Prospective, Randomized, Controlled Trial Comparing Conservative Treatment With Trunk Stabilization Exercise to Standard Hip Muscle Exercise for Treating Femoroacetabular Impingement: A Pilot Study. Clin J Sport Med. 2019 Jul;29(4):267-275. doi: 10.1097/JSM.0000000000000516.

Reference Type BACKGROUND
PMID: 31241527 (View on PubMed)

Related Links

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Other Identifiers

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2022-06/04

Identifier Type: -

Identifier Source: org_study_id