TJPRC: International Journal of Physiotherapy & Occupational Therapy (TJPRC: IJPOT) ISSN(P): Applied; ISSN(E): 2455-1996 Vol. 2, Issue 2, Dec 2016, 9-16 TJPRC Pvt. Ltd. EFFECT OF COMBINING SLUMP STRETCHING WITH CONVENTIONAL PHYSIOTHERAPY IN THE TREATMENT OF SUBACUTE NON- RADICULAR LOW BACK PAIN ABSTRACT Objective of the Study S. VEENA @ KIRTHIKA, V. RAJALAXMI, S. SUDHAKAR, T. BHUVANESHWARAN & K. FOUSIYA THASLIM Faculty of Physiotherapy, Dr. M.G.R Educational & Research Institute University, Velappanchavadi, Chennai, Tamil Nadu, India To find the effectiveness of combining slump stretching with conventional physiotherapy as a comprehensive physiotherapy treatment approach in improving pain and disability in subjects with sub acute non- radicular low back pain. Study Design Experimental study design Sampling Simple Random sampling Setting Original Article Outpatient Physiotherapy department, A.C.S Medical college and Hospital Methodology Method 30 subjects with subactue non- radicular low back pain were divided into Group A (conventional group) and Group B (Experimental group) Result alone. Slump stretching combined with conventional physiotherapy is more effective than conventional physiotherapy Conclusion The present study concluded that 6weeks duration of exercise programme combining slump stretching with conventional physiotherapy is more effective than conventional physiotherapy alone in reduction of pain and disability in subjects with sub acute non- radicular low back pain. KEYWORDS: Sub Acute Non- Radicular Low Back Pain (NRLBP), Slump Stretching, Conventional Physiotherapy Received: Apr 20, 2016; Accepted: Jul 08, 2016; Published: Jul 26, 2016; Paper Id.: TJPRC:IJPOTDEC20162
10 S. Veena @ Kirthika, V. Rajalaxmi, S. Sudhakar, T. Bhuvaneshwaran & K. Fousiya Thaslim INTRODUCTION Low back pain or lumbago is common disorder involving the muscles and bones of the back. It affects about 40% of people at some point in their lives 1. The occurrence of low back pain in worldwide people is a fairly common condition. Typically, the source of pain experienced by these individual is due to injuries to the soft tissue structure that include the muscles, fascia and ligaments. Most of these cases resolve within 2-4 weeks 2. According to Len karats Low back pain is the pain in the low back area related to problems with lumbar spine, the disc between the vertebra, the ligaments around the spine, the spinal cord, the nerve root, muscles of the low back, internal organs of pelvis and abdomen or skin covering the lumbar area 3. The low back Pain can be classified into acute low back pain, sub acute low back pain and chronic low back pain 4. Radicular LBA is pain radiating along the dermatome of nerve root at its connections to the spinal column 5. A common form of radiculitis is sciatica or radicular pain radiating along the sciatic nerve. Non radicular LBA is not associated with neurologic symptoms or signs and not associated with spinal nerve root compression. 6 Pain is localized to the spine and par spinal region and does not radiate into leg 7. Physical therapist utilize a wide range of intervention in the management of low back pain, however the effectiveness for these intervention is limited. The conservative physiotherapy treatment for low back pain includes techniques like stretching exercises for both lower limbs, education about posture and body mechanics, core stabilization exercises, spinal extension exercise and neural stretching techniques 8. This study is an attempt to prove the efficacy of combining slump stretching with conventional exercise program in treating subjects with sub acute NRLBP. Need for the Study The need has been raised for further explorations in this regard and to find out whether the slump stretching combined with conventional physiotherapy is effective in the management of subactue low back pain. METHODOLOGY The study design is experimental type with randomized sampling. The study was done in the Department of Physiotherapy, ACS Medical College and hospital. 30 subjects with sub acute non radicular low back pain between 18 to 60 years of age both male and female with positive slump test were included. Subjects with Red flags, yellow flags pregnant women, history of spinal surgery and positive neurological signs were not included in study. The outcomes measures were the VAS and the Modified Oswestry Low Back Pain Disability Index (MODI) 9. Procedure During initial session, postural advices such as avoiding lifting, adapting correct sitting posture, squat lifting, and use of hard mattress were given to both the conventional group and experimental group subject. Both the groups also performed 3-5 repetition of stretching exercises for each leg for a period of 6 weeks 10. The stretch of each exercise was held for 20-30 seconds 11. The Group A (conventional Group) received progressive core stabilization exercise protocol for a duration 6 weeks and each exercise performed 10 times and 10 repetition for at least 10 seconds. Pelvic bridging, single leg abdominal press, double leg abdominal press, segmental rotation and quadruped were also performed 12.
Effect of Combining Slump Stretching with Conventional Physiotherapy 11 in the Treatment of Subacute Non- Radicular low Back Pain The conventional group subjects also received the endurance exercise protocol and trunk extensor muscles for duration of 6 weeks. Each exercise were performed 10 repetition with holding time for each repetition of at least 10 seconds. Group B (Experimental Group) received Slump stretching in addition to the conventional exercise program 13,14. Slump stretching was performed with the patient sitting on a high couch and asked to slump or slag with an overpressure applied by the physiotherapist to the lumbar and thoracic flexion. The subject is then asked to bend the neck chin to chest and an over pressure is applied. Then the patient performed knee extension and ankle dorsi flexion in sequence and the neck flexion is slowly relieved 15, 16, 17. Figure 1: Stretching Figure 2: Slump Stretching Figure 3: Core Stabilization Exercise Figure 4: Quadruped, Bridge,Single Leg Abdominal Press, Double Leg Abdominal Press, Segmental Rotation Data Analysis
12 S. Veena @ Kirthika, V. Rajalaxmi, S. Sudhakar, T. Bhuvaneshwaran & K. Fousiya Thaslim Table 1: Comparison of Visual Analouge Scale Score between Group- a and Group B in Pre and Post Test Vas Scale Group-A Group-B T-Test Significance MEAN S.D MEAN S.D PRE TEST 6.09.431 6.22.654.625.537** POST TEST 3.98.370 1.49.766 11.30.000*** This table shows that statistically significant difference in post test value of the visual analogue scale score between group A. and group B (***-p<0.001). Figure 5 Table 2: Comparison of Modified Oswestry Disability Index between Group A and Group- B in Pre and Post Test Modified Oswestry Disablity Index Group-A Group-B Mean S.D Mean S.D T-Test Significance PRE TEST 35.73 3.76 36.26 3.45.404.689 POST TEST 17.60 3.86 8.93 4.52 5.63.000*** This tables shows that statistically significant difference in post test values of the modified oswestry disability index score between group A and group B (***-p<0.001) Figure 6 Table 3: Comparison of Visual Analogue Scale Score, Modified Oswestry Disability Index Score with in Group-A between Pre and Post Test Group-B Pre Test Post Test MEAN S.D MEAN S.D T-Test Significance VAS 6.09.431 3.98.370 27.31.000*** MODI 35.73 3.76 17.60 3.86 39.73.000*** This table shows statistically significant difference in visual analogue scale score and modified oswestry disability index score between pre- test and post test (***-p<0.001)
Effect of Combining Slump Stretching with Conventional Physiotherapy 13 in the Treatment of Subacute Non- Radicular low Back Pain Figure 7 Table 4: Comparison of Visual Analogue Scale Score, Modified Oswestry Disability Index Score with in Group-B between Pre and Post Test Group-B Pre Test Post Test MEAN S.D MEAN S.D T-Test Significance VAS 6.22.654 1.49.766 48.81.000*** MODI 36.26 3.45 8.93 4.52 58.82.000*** This stable shows statistically significant difference in visual analogue scale score and modified oswestry disability index score (***-p<0.001) Figure 8 RESULTS Group B showing (1.49) lower mean value is more effective than Group A (3.98) at p-<0.001 in the VAS score. As far as the reduction of the Disability is concerned, Group B (8.93) with a lower mean value is more effective than Group A (17.60) in the MODI score. DISCUSSIONS The results of this study confirm the hypothesis that slump stretching may be beneficial in the management of patient with non- radicular low back pain. Slump stretching in addition to conventional physiotherapy exercises was beneficial in reducing short term disability and improving pain and promoting centralization of symptoms in tis experimental group of patients 18. The results are similar to those of George (2002) who reported that a subgroup of patients with low back pain might exist who have distal symptoms but whose symptoms do not improve with flexion or extension oriented exercises 19, 20. Table 1 and 2 shows significant decrease in the post test mean value for visual analogue scale score and Modified oswestry disability index score of Group B which is more effective than Group A. Table 3 and 4 shows statistically highly significant difference in VAS score and MODI score between pre test and post test week within Group A
14 S. Veena @ Kirthika, V. Rajalaxmi, S. Sudhakar, T. Bhuvaneshwaran & K. Fousiya Thaslim and group B (p<0.001). From the above statistical mean value it shows that group B shows significant reduction of pain and improvement in functional abilities. Hence slump stretching combined with conventional physiotherapy can be an effective exercise protocol in the treatment of patients with Non- radicular low back pain in terms of pain relief and reduction of disability which helps in the improvement of functional activities. CONCLUSIONS The result suggest that an exercise programme of combining slump stretching with conventional physiotherapy is more effective than conventional physiotherapy alone in reduction of pain and disability in subjects with sub actue non- radicular low back pain. RECOMMENDATIONS This study can be done in larger sample size. Further studies can be performed in females alone with older age group with longer follow up.chronic low back pain and Manipulation therapy can be included in further studies. REFERENCES 1. Van tilde MW, koss B, boater LM. A cost of illness study of back pain in the Netherlands. Pain. 1995; 62: 233-240 2. Mortimer M, presold G, wintering C. Low back pain in general population. Natural course and influence of physical exercise A 5- year follow up of the musculoskeletal intervention centre- norrtalje study spine.2006: 3045-3051 3. Hayden Va van toddler MW, M almivara AV, koes BW. Meta analysis: exercise therapy for non specific low back pain. Ann intern med. 2005; 142: 765-775. 4. Herrington L. Effects of different mobilization techniques on knee extension ROM in the slump position. The J manual and manipulative therapy 2006; 14(2): 101-107 5. Shack locks MO. Aerodynamics. Physiotherapy. 1995; 81(1):9-16 6. Butler DS. The sensitive nervous system. Adelaide, Australia: no group publications, 2000. 7. Shack lock MO clinical aerodynamics: A new system of Neuro musculoskeletal treatment. Oxford UK: Butterworth Heinemann; 2005 8. Steven GZ. Characteristics of patients with lower extremity symptoms treated with slump stretching: A cases series. J north up sports phys there. 2002; 32:391-398 9. George S Z. Differential diagnosis and treatment for treatment for patients with lower extremity symptoms. JOSPT. 2000; 30(8): 468-487. 10. James A. Porterfield, carl depose (1998), mechanical low back pain: perspectives in functional anatomy. 2 nd ed. Saunders 11. Delete A, Erhrd RE, bowling RW. A treatment based classification approach to low back syndrome; identifying and staging patients for conservative management phys. There 1995; 75: 470-489 12. Julie M. Fritz and james j irking; journal of the American physical therapy association; a compettion of a modified oswestry low back pain disability questionnaire and the quebec bck pain disability scale;2001;81:776-778 13. Deco RA, Rainsville J, Kent DL. What can the history and physical examination tell us about low back pain. Jamal 1992;268: 760-5 14. Papageorgiou AC et al. (1995) estimating the prevalence of low back pain in the general population. Evidence from the south
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