Effects of Mulligan’s Mobilization with and Without Clamshell Exercise on Pain, Disability, and Quality of Life in Patients with Sacroiliac Joint Dysfunction

Abstract

Background: Sacroiliac joint dysfunction (SIJD) is a prevalent yet underdiagnosed contributor to low back pain, especially among women. Despite the growing use of manual therapies like Mulligan Mobilization, the additive effect of targeted muscle strengthening such as clamshell exercises remains underexplored in anterior innominate dysfunction. Objective: To compare the effects of Mulligan Mobilization with and without clamshell exercises on pain, disability, and quality of life in patients with anterior innominate sacroiliac joint dysfunction, hypothesizing superior outcomes with the combined intervention. Methods: A single-blinded randomized controlled trial was conducted involving 38 participants aged 20–50 years diagnosed with hypomobile anterior innominate SIJD, recruited from Fatima Memorial Hospital and Boston Physiotherapy and Wellness Clinic. Inclusion required positive Leslett’s criteria and moderate NPRS and ODI scores. Participants were randomized into two equal groups (n = 19), receiving either Mulligan Mobilization alone or combined with clamshell exercises, for 18 sessions over six weeks. Outcomes were assessed at baseline and post-intervention using the Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), and EQ-5D for quality of life. Ethical approval was granted by Riphah International University, following the Declaration of Helsinki. Statistical analyses, including paired and independent t-tests, were conducted using SPSS v25. Results: Both groups showed statistically significant improvements (p < 0.001) across all outcomes, with Group B (Mulligan + clamshell) demonstrating greater reductions in NPRS (mean difference = 4.68 vs. 2.47), ODI (18.47 vs. 10.47), and superior improvement in EQ-5D scores (mean difference = 20.31 vs. 17.89). These results were both statistically and clinically meaningful. Conclusion: Mulligan Mobilization significantly reduces pain and disability in anterior innominate SIJD; however, the addition of clamshell exercises enhances these effects, offering a clinically relevant, cost-effective intervention for improving function and quality of life. These findings support integrating targeted gluteal strengthening with manual therapy in routine rehabilitation.