Low Back Pain in Computer Professionals A Comparison Between Yogasanas And Mckenzie Treatment Approaches

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1 Index Copernicus Value Volume 5 Issue 06 June-2017 Pages ISSN(e): Website: DOI: Low Back Pain in Computer Professionals A Comparison Between Yogasanas And Mckenzie Treatment Approaches Authors Tushar J. Palekar 1, Pallavi Ganesh Harkal 2* Manisha A Rathi 3, Gaurang D Baxi 4, 1 Principal and Professor, Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, India. 2* PG Resident, Dr. D. Y. Patil College of Physiotherapy, Dr.D.Y.Patil Vidyapeeth, Pune, India. 3 Professor, Dr. D. Y. Patil College of Physiotherapy, Dr. D.Y.Patil Vidyapeeth, Pune, India. 4 Associate Professor, Dr.D. Y. Patil College of Physiotherapy, Dr. D. Y.Patil Vidyapeeth, Pune, India. Corresponding author Pallavi Ganesh Harkal 2 ABSTRACT: An estimated 70% of people will experience low back pain at some point in their lives, and recurrence rates can be as high as 85%. Recent studies suggest that yoga-a widely practiced physical/mental discipline may relieve back pain and reduce functional disability. The objective of this study to find out effect of Yoga and Mckenzie exercises in computer workers having low back pain. This was an experimental study conducted at Dr. D. Y. Patil College of Physiotherapy Pimpri Pune. 60 individuals by occupation computer workers were included according to inclusion criteria by random sampling technique. They were divided into 2 groups: Group A-30 (Yoga Exercises) and -30 (Mckenzie Exercises). Subjects were randomly assigned to either of the two groups. 10 treatment sessions over 2 weeks were given. Outcome Measures used were Visual analogue scale at rest & activity and the Rolland Morris Disability Questionnaire. A statistically significant improvement in pre & post measures of VAS at rest (4.88) & (3.9) and at activity (5.63) & (4.3) (p<0.001) & RMDQ score reduced to (7.3) & (4.03) (p<0.001) of the Mckenzie group compared to the Yoga group. This results of study shows that Mckenzie exercises better to alleviate pain and improve functional measures compared to Yogasana. Keywords: LBP, Yoga, McKenzie, RMDQ. INTRODUCTION: Low back pain is an extremely common symptom in a general population. Back pain affects up to 85% of the population. Low back pain is the most common disability in those under the age of 45 and the most expressive health problem in those between age of 20 to The patients with chronic low back pain have adaptive changes related to long term dysfunction. Therefore, when systematically reviewing treatments for low back pain, chronic low back pain should be considered separately from acute and sub acute low back pain. Low back pain which affects nearly everyone of us at some stage of our active adult life is one of the most common ailments afflicting mankind. It interferes with simple activities of daily living like moving about and getting a comfortable night s sleep. It is often the unexpected and unguarded movements that causes a sudden episode of low back pain. From poor postural habits a person gradually loses the ability to perform certain movements. 2,3 Tushar J. Palekar et al IJSRE Volume 05 Issue 06 June 2017 Page 6507

2 The risk of incurring low back pain are greater when the weight of the load to be lifted increases, and when lifting is performed by unfit people. The intradiscal pressure increases when the weight is lifted with the back bent and knees straight when compared to lifting weight with back straight and knees bent. 3,5 R. McKenzie states that with an intact annular wall, a bulge appearing in the posterior annulus on extension is normal. And it is unlikely that the annular tearing will occur as a result of stress. A bulge in the posterior wall on flexion when annular wall is damaged may be harmful, it indicates a weakening posterior annulus. There are three syndromes depicted by R. McKenzie; (1) the postural syndrome, (2) the dysfunction syndrome and (3) the derangement syndrome. The major goal of exercise therapy in chronic low back pain is to gain muscle strength, endurance and treatment should focus on improvement of disability. 10,6 Yoga is about creating balance in the body through developing both strength and flexibility. Yoga strengthens muscle groups. Many postures in yoga strengthen the back and abdominal muscles and help the body maintain a proper upright posture and movement. Stretching and relaxation reduces tension in stress carrying muscles. when these muscles are well conditioned, it helps to offset back pain. Importance of McKenzie exercises and Yoga exercises is not only used to strengthen the back muscles, but also to promote rapid symptom relief. MATERIALS AND METHODS : Patients satisfying inclusion and exclusion criteria were included in the study. Patients were divided randomly into two groups. Each group was containing 30 Participants. The assessment of Low back pain was done pre and post intervention and consist of a detailed history with the duration of symptoms and VAS was administered for pain intensity. Roland Morris disability Questionnaire 12-Item version was taken. Group A was given Yoga and was given Mckenzie exercises for 10 sessions, 5 sessions/week. Inclusion criteria: Computer workers suffering from mechanical Low back pain of Age years both Males and Females Working on computer for 8 hours daily having pain in forward flexion also. Exclusion criteria: Patient undergone spinal surgery, spinal fracture & Patient having pain in spinal extension. Table 1 Pre and Post treatment values of Visual Analogue Scale at Rest between Group A and Group Pre Post t value p value Mean SD Mean SD A < B < Graph PRE POST 1 0 Group A Tushar J. Palekar et al IJSRE Volume 05 Issue 06 June 2017 Page 6508

3 Table 2 Pre and Post treatment values of Visual Analogue Scale on Activity between Group A and Group Pre Post t value p value Mean SD Mean SD A < B < Graph Group A pre post Table 3 Pre and Post treatment values of Rolland Morris Disability Questionnaire within Group A and Group Pre Post t value p value Mean SD Mean SD A < B < Graph pre post 0 Group A RESULT: Dependent variables included Visual Analogue Scale (VAS), Rolland Morris Disability Questionnaire; Straight Leg Raise Test. Data was obtained for each subject on 1 st day before treatment and on 10 th day of the protocol. Data was collected for each subject by calculating the average value of the variables of all the 60 subjects and then the statistics were conducted. Unpaired t test were used to compare data between two groups. Table 1 shows pre and post treatment values of Visual Analogue Scale at Rest between Group A and Group B(4.88) & (3.9). The p values for both groups are < which interprets that the result for Group A and B is highly significant since the value is < Table 2 shows pre and post treatment values of Visual Analogue Scale on Activity between Group A and (5.63) & (4.3). The p values for both groups are < which interprets that the result for Group A and B is highly significant since the value is < Tushar J. Palekar et al IJSRE Volume 05 Issue 06 June 2017 Page 6509

4 Table 3 shows pre and post treatment values of Straight Leg Raise Test between Group A and (47.67 & 54.67). The p values for both groups are < which interprets that the result for Group A and B is highly significant since the value is < Table 4 shows pre and post treatment values of Rolland Morris Disability Questionnaire between Group A and (7.3) & (4.03). The p values for both groups are < which interprets that the result for Group A and B is highly significant since the value is < DISCUSSION: The present study was aimed to evaluate the effect of Yoga and McKenzie exercises in computer workers having low back pain. In this study, results showed that statistical significant difference exists between pre treatments and post treatments values in both the groups in reduction of pain and improvement in range of motion of lumbar spine. In Computer related work, person has to work in sitting for long time. Therefore, when we compare the other work in standing with computer workers in sitting level of intradiscal pressure increases by almost 50% during sitting with hips and knees flexed. Lordotic or kyphotic posture, slouch or sway back posture, flat back posture are most likely due to sustained faulty posture, prolonged standing, continue slouching or flexing in sitting or standing respectively. After the analysis of data, it was found that there was significant improvement in the values of VAS and RMDQ score within group that is pre and post treatment. There was change of outcome measures between the groups. showed significant reduction in pain and functional disability and increase in range of motion as compared to group A. In this study Group A(30) participants was given yoga therapy for 2 weeks of protocol showed statistically significant result in reducing pain(p< 0.001) and improving functional measures among subjects with low back pain. Amy M. Sawyer et al. (2012) in their study found that Yoga Therapy when applied considered an effective treatment for individuals with chronic low back pain that are seeking non-surgical intervention. In addition to stretching and strengthening the muscles of the back and lower extremities through physical postures, yoga may have the additional benefit of reducing stress through meditation and breathing exercises, contributing to an overall reduction in symptoms for individuals with low back pain 8. However, Jhon M.D. et. Al. August (2004) in their study found that Patients who practice Hatha yoga say it is valuable for preventing and managing stress-related chronic health problems, including low back pain. In a survey of 3000 people receiving yoga for health ailments (1142 [38%] with back pain), 98% claimed that yoga benefited them. 5 Likewise, Christopher Hill et.al.(2013) in their study compared Yoga with other care modalities in patients with chronic low back pain, there was a greater relief in pain, spasm, tenderness in affected muscles. 5 Helen E. Tillbrook et. Al.(2011) has provided 12-week Yoga program to adults with chronic or recurrent low back pain and conclude that yoga led to greater improvement in back function than usual care. 4 Dhanesh kumar et. Al. (2014) they compared Yoga versus Exercise therapy in the management of mechanical low back pain. This study has shown reduction in functional disability and improvement in flexibility in subjects having low back pain. 7 Similarly, (30) participants which received McKenzie exercises also showed significant reduction in pain intensity, lumbar ranges improved performance and decrease in Roland Morris Disability score from Pre to Post readings (P< 0.001). This was supported by a study done by Luciana Machado (2010) A major clinical observation in this study is that anticipated pain prior to any physical task was always higher than the actual reported pain while performing the task at intake and all follow ups. After the McKenzie intervention and on the 1st follow-up, there was a marked decrease in both anticipated and actual reported pain scores. This, however was associated with improved performance time regardless of decrease in Rolland Morris Disability Score observed on the Pre and Post treatment 3. Another research to support this Tushar J. Palekar et al IJSRE Volume 05 Issue 06 June 2017 Page 6510

5 study Brian M. Musanich (2006) Clinical evidence suggests that McKenzie therapy is an effective method for managing back pain in the short term (3 months) compared with other therapies 16. As regards to Pain Intensity level (VAS), both Yoga therapy and Mckenzie exercise group revealed a statistical significant reduction in pain intensity level (P< 0.001) after the intervention period in individuals with chronic low back pain. The RMDQ 12-item version has also shown significant improvement within the groups (P<0.001). Group-B showed significant reduction in functional disability than Group-A. Results of the present study demonstrate that (McKenzie Exercises) showed statistically and clinically significant improvement in pain threshold when compared to Group A (Yoga Exercises). Reduction in low back pain intensity after the application of McKenzie Exercises could be due to the proper positioning, body alignment, posture, intradiscal pressure manual in the treatment. This mechanism could be the reason for better result yielded in Mckenzie Group Exercises. Hence the alternative hypothesis is proved. This study provides justification for future research. Future research studies would benefit from clearly described allocation concealment and blinding procedures, as well as larger sample sizes and higher completion rates. It may also be helpful to identify a clear set of yoga postures, including specific variations and modifications, to form the basis of a replicable low back care protocol. Future researchers should also include the effectiveness of McKenzie therapy when radicular symptoms are present. CONCLUSION: This study demonstrates that both the techniques are effective in improving the pain threshold in subjects with Low Back Pain in computer workers. However, on comparison, Mckenzie exercises showed better results to alleviate pain and improve functional measures. Hence, the Mckenzie exercises are the better choice of treatment in improving pain threshold in computer workers having low back pain. REFERENCES: 1. AK Sharma, S khera, J Khandekae (2006) computer related health problems among IT professionals in Delhi.vol 31:1; R.A. Mckenzie, The lumbar spine mechanical diagnosis and therapy. Spinal publications, New Zealand Pp-4-13, 19-24, Robin Mckenzie, Treat Your back, 4 th edition, spinal publications Ltd. New Zealand, pp1,7-12, 21-45, Cox H, Tilbrook H, Aplin J, Semlyen A, Torgerson D, et al. (2010) A randomised controlled trial of yoga for the treatment of chronic low back pain: results of a pilot study. Complement Ther Clin Pract 16: Bungum, T., Satterwhite, M., Jackson, A. W., & Morrow, J. R., Jr. (2003). The relationship of body mass index, medical costs, and job absenteeism. American Journal of Health Behavior, 27, Margreeta Noerdin, Federico Balague, Christine cedraschi Nonspecific lower back pain surgical versus nonsurgical treatment, clinical Orthopaedic and related research 2006, February, No.443: David J. Magee, Orthopaedic Physical Assessment, 4 th edition, published by Harcourt (India) private Limited, New Delhi, Pp475, Amy M. Sawyer, Martinez SK, Warren GL (2012) Impact of Yoga on Low Back Pain and Function: A Systematic Review and Meta-Analysis. J Yoga Phys Ther 2:120. Vol 2; Issue Tushar J. Palekar et al IJSRE Volume 05 Issue 06 June 2017 Page 6511

6 9. Jasobanta sethi, Jaspal sing, Vijay Imbanathan(2011) effect of body mass index on work related musculoskeletal discomfort in computer workers. 3: Carolyn Kisner, Lynn allen Colby, Therapeutic Exercises, 4 th edition, Jaypee Brothers, New Delhi, Pp Margreeta Noerdin, Federico Balague, Christine Cedraschi Nonspecific Lower Back pain surgical versus non-surgical treatment, clinical Orthopaedic and related research 2006, February, No.443: Mckenzie RA (2003) The lumbar spine; Mechanical Diagnosis and Therapy. (2 nd edn), Spinal Publications, Waikanae, New Zealand. 13. Anthony H Wheeler, Paathophysiology of chronic low back pain, pain and orthopaedic neurology, June 30, Skai Yoshihito, Matsuyama Yukihiro,Okumoto Akira,Ishiguro Naoki, A randomized controlled trial of mckenzie therapy for chronic low back pain, journal of japnese Society of Lumbar spine disorders.2006, vol12; no-1: Helen Razmjou,John F.Kramel, Intertester reliability of the Mckenzie evaluation in assessing patients with mechanical low back pain,journal of orthopaedic nd sports physical therapy, 2000 vol 30(7: ). 16. Brian M Busanich and Susan D vercheure, Does mckenzie therapy improves outcomes for back pain, 2006,vol 41;(1): Tushar J. Palekar et al IJSRE Volume 05 Issue 06 June 2017 Page 6512