Comparison of Core Stability and Hip Strengthening Protocols in Sacroiliac Joint Dysfunction

Sacroiliac joint dysfunction is an important cause of low back pain and functional disability in many individuals. The sacroiliac joint is a synovial joint located between the sacrum and the ilium of the pelvis and plays a critical role in transferring loads between the upper body and lower extremities. When abnormal motion, inflammation, or misalignment occurs in this joint, it leads to pain and dysfunction. Patients with SIJ dysfunction commonly experience pain in the lower back, buttocks, posterior thigh, and sometimes radiating pain toward the lower limb.

The sacroiliac joint is supported by strong ligaments such as the interosseous sacroiliac ligament, anterior sacroiliac ligament, posterior sacroiliac ligament, sacrotuberous ligament, and sacrospinous ligament. These structures provide stability and restrict excessive motion of the joint. However, trauma, pregnancy, repetitive stress, degenerative changes, or previous lumbar fusion surgery can disturb the normal biomechanics of the joint and lead to sacroiliac joint dysfunction. Because symptoms of sacroiliac joint dysfunction often mimic other causes of low back pain such as facet joint syndrome or lumbar disc pathology, it can be difficult to diagnose clinically.

Patients with sacroiliac dysfunction often present with pain below the L5 level, difficulty in prolonged sitting, walking, climbing stairs, or lying on the affected side. Pain is usually localized around the posterior superior iliac spine. Diagnosis is typically based on clinical examination and provocation tests such as thigh thrust test, sacral thrust test, compression test, distraction test, Gaenslen's test, and flexion, abduction and external rotation test. A combination of these tests increases diagnostic accuracy.

Physiotherapy plays a major role in the management of sacroiliac joint dysfunction. Conservative treatment approaches focus on reducing pain, improving stability of the lumbopelvic region, and restoring normal functional movement patterns. Among these interventions, core stabilization exercises and hip strengthening exercises are commonly used. Core stabilization exercises focus on strengthening deep trunk muscles such as transversus abdominis, multifidus, pelvic floor muscles, and diaphragm, which improve spinal stability and control of the lumbopelvic region. Improved core stability reduces excessive shear forces across the sacroiliac joint and helps maintain proper pelvic alignment.

Hip strengthening exercises, on the other hand, primarily target muscles such as the gluteus medius, gluteus maximus, and hip external rotators. Weakness of these muscles can result in poor pelvic stability and altered load transfer during functional activities such as walking, standing, and lifting. Strengthening these muscles improves pelvic control, enhances force distribution across the lumbopelvic region, and reduces stress on the sacroiliac joint.

Previous studies have reported beneficial effects of both core stabilization and hip strengthening exercises in patients with low back pain and sacroiliac joint dysfunction. Research suggests that core stabilization exercises can improve proprioception, balance, neuromuscular control, and functional ability, while hip strengthening exercises improve gluteal activation, pelvic stability, and gait mechanics. However, limited research directly compares the effectiveness of these two exercise protocols in patients with unilateral sacroiliac joint dysfunction.

Therefore, the purpose of this study is to compare the effects of core stabilization exercises and hip strengthening exercises on pain, posture, balance, proprioception, and functional status in patients with sacroiliac joint dysfunction. It is hypothesized that there will be a significant difference between the effects of core stabilization exercises and hip strengthening exercises in improving clinical outcomes in patients with sacroiliac joint dysfunction.

Inclusion criteria

• Patients aged 25-55 years diagnosed with unilateral sacroiliac joint dysfunction.
• Patients having pain in the sacroiliac region for more than 3 months.
• Numeric Pain Rating Scale (NPRS) score ≥ 5.
• Patients with positive sacroiliac joint provocation tests (such as FABER test, compression test, distraction test, thigh thrust test, or sacral thrust test).
• Individuals able to participate in exercise therapy and follow treatment instructions.

Exclusion criteria

• History of lumbar spine surgery or pelvic surgery.
• Lumbar disc herniation or severe spinal pathology.
• Inflammatory joint diseases such as rheumatoid arthritis or ankylosing spondylitis.
• Neurological disorders affecting balance or proprioception.
• Recent fracture or trauma of the spine or pelvis.
• Pregnancy.