CHAUDHARY CHARAN SINGH UNIVERSITY MEERUT, UTTAR PRADESH PERFORMA FOR REGISTERATION OF MPT

NAME OF THE CANDIDATE

Kamakshi Gupta

NAME OF THE INSTITUTION AND ADDRESS

Institute of Applied Medicines and Research (IAMR) 9th Km. Stone, Delhi-Meerut Road, Duhai, Ghaziabad (U.P.)

COURSE OF STUDY AND SPECIALIZATION

MPT (Orthopaedics) Effect of general exercises versus general exercises alongwith hamstring stretching in non specific low back pain.

TOPIC OF THE SYNOPSIS

DATE OF SUBMISSION OF THE SYNOPSIS

30-12-2010

TITLE

Effect of general exercises versus general exercises alongwith hamstring stretching in non specific low back pain. INTRODUCTION About 8 in 10 people have one or more bouts of low back pain. In most cases, it is not due to a serious disease or serious back problem, and the exact cause of the pain is not clear. This is called non-specific lower back pain. The lower back is also called the 'lumbosacral area' of the back. It is the part of the back between the bottom of the ribs and the top of the legs. Low back pain (LBP) is defined as pain localised between the 12th rib and the inferior gluteal folds, with or without leg pain. Most of the lower back is made up from muscles that attach to, and surround, the spine. The spine is made up of many bones called vertebrae. The vertebrae are roughly circular and between each vertebra is a 'disc'. The discs between the vertebrae are a combination of a strong fibrous outer layer and a softer, gel like centre. The discs act as shock absorbers and allow the spine to be flexible. Strong ligaments also attach to adjacent vertebrae to give extra support and strength to the spine. The various muscles that are attached to the spine enable the spine to bend and move in various ways. Non-specific low back pain means that the pain is not due to any specific or underlying disease that can be found. It is thought that in some cases the cause may be a sprain (an over-stretch) of a ligament or muscle. In other cases the cause may be a minor problem with a disc between two vertebrae, or a minor problem with a small 'facet' joint between two vertebrae. There may be other minor problems in the structures and tissues of the lower back that result in pain. However, these causes of the pain are impossible to prove by tests. Therefore, it is usually impossible for a doctor to say exactly where the pain is coming from, or exactly what is causing the pain. To some people, not knowing the exact cause of the pain is unsettling. However, looked at another way, many people find it reassuring to know that the diagnosis is non-specific back pain which means there is no serious problem or disease of the back or spine. In addition our spines may have become stiff and inflexible over time because we havent stretched effectively for years. Sometimes our lifestyles are quite inactive and we don't move around or exercise as much as we should, with that we lose fitness and muscle tone. Usually it is a combination of these things that causes the problem. The following diagram helps to visualise the relationship between postural stresses and pain

Effect of hamstring stretch in non specific low back pain Tight hamstrings pressure the pelvis and spinal cord. Stretch hamstrings to improve range of motion, and help cells within spinal disc space to receive nutrients. This stretch is particularly effective for people complaining of low back pain with walking. The hamstring muscles attach on the lower pelvis. If these muscles are tight, they pull the spine into a flattened alignment and place the spinal discs in an unstable position. Keeping the proper length of your hamstrings means keeping the proper curve in your low back and protecting your spine. The action of pointing and flexing your foot while in the hamstring stretch position helps to ensure that the nerves coming from your back and running down your leg are gliding properly. Stretching out the hamstrings reduces the risk of injury, and can have a protective effect on the low back. Effect of general back extension exercises in non specific low back pain Strengthen glutes and loosen your hips, which will take pressure off your lower back. Exercise balls have been around for awhile, but are gaining in popularity with health practitioners due to the many benefits derived from its use. Just simply sitting on the ball requires use of postural muscles. Strengthening the spine. Simply bouncing up and down on the ball will help increase proprioceptive input to the spine. Proprioception is what helps keep your muscles coordinated and thereby promotes spinal stability. Improve impairments in back flexibility and strength. STATEMENT OF PROBLEM

Hamstring stretch alonwith general exercises has been proposed as an effective method in management of non specific low back pain in relieving pain and improving functional outcome. AIM OF THE STUDY To prove the effectiveness of hamstring stretch alongwith general exercises in the management of non specific low back pain. PURPOSE OF THE STUDY To compare the effect of hamstring stretch along with general exercises against general exercises in management of non specific low back pain. EXPERIMENTAL HYPOTHESIS It is hypothesized that hamstring stretch alongwith general exercises is more effective than general exercises only of non specific low back pain in relieving pain and improving functional outcome. NULL HYPOTHESIS Hamstring stretch alongwith general exercises is not an effective treatment tool for non specific low back pain against general exercises only. SIGNIFICANCE OF THE STUDY If proved effective hamstring stretch alongwith general exercises can be incorporated as an effective treatment tool for the management of non specific low back pain. REVIEW OF LITERATURE Ludwig etal concluded that hamstring stretching is effective in reducing low back pain. Watson PJ, etal concluded thata general exercise program reduced disability in short term to a greater extent than stabilization enhanced exercise approach in patients with recurrent low back pain. METHODOLOGY Study Design Randomized clinical trial Study Centre Sample size Experimental group (group A) Control group (group B) Sampling Random sampling Grouping of subjects Multiple block randomization. Inclusion criteria Age 18-35 years non specific low back pain> 1 month. a passive slr angle <800 neurological symptoms were absent . Exclusion criteria Systemic diseases Spondylosis. Spondylolisthesis.

 Signs and symptoms of instability are present. Instrumentation for data collection Short form Mc Gill questionnaire: consists of 15 descriptors of pain quality (11 sensory, 4 effective), each rated on an intensity scale from 0 to 3. Goniometer: for measuring active knee extension. PROCEDURE Subjects will have to undergo screening process to establish non specific low back pain. All procedure will be explained to subjects prior to any screening measurements and informed consent will be taken from all subjects involved in the study. Subjects will be randomly allocated to group A and B. Subjects in group A will be given hamstring stretch along with general exercises for 3 days per week. Subjects in group B will be given general exercises for 3 days per week. General exercises included were: Classic abdominal and back extensor training. Lifting trunk to neutral position from prone position with pillow under stomach and arms by the side. Coordination: pelvic tilting from lying, sitting and standing positions. Upper and oblique abdominals from lying position: with knee straight and bend. Abdominals from lying position: heel slides, lower abdominal crunches, leg slides, lower abdominal crunches, straight leg lifts, cycling exercise. Back extensors: bridging, lifting trunk to neutral position from prone position and arms in elevation, single leg extensors from prone and 4 point kneeling positions. Swiss ball coordination exercises: alternate arm leg lifts sitting on a ball, abdominal curls in prone position,pulling leg towards chest, single leg bridging. OUTCOME MEASURES Functional out come- Short form Mc Gill questionnaire. DATA COLLECTION Research student will collect data. -Pain: Pain score will be taken daily before and after treatment but for data analysis it will be collected at the baseline and after intervention on 3rd week. -Functional outcome: Functional outcome will be collected at the baseline and after intervention on 3rd week. DATA ANALYSIS The data collected from both groups will be analyzed statistically and outcomes will be analyzed in terms of change from baseline.

TIME OF STUDY 3 weeks duration REFERENCES Jan P.K. Halberstma, Phd, Ludwig N.H. Goeken, MD, Phd, At L. Hof, Phd, Johan W. Groothoff, Phd, Willem H. Esima, MD, Extensibility and stiffness of hamstrings in patient with non specific low back pain. Arch. Phys Med Rehabil 2001;82:232-8. GA Koumantakis, , trunk muscle stabilization training plus general exercises versus general exercises only: randomized control trail for patients with recurrent low back pain, physical therapy, 2005;85:209-225.

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SIGNATURE AND SEAL OF EXTERNAL GUIDE

PRINCIPAL IAMR