Non-specific Low Back Pain (NSLBP)
Conditions
Keywords
non-specific low back pain, pain management, Disability Evaluation, Exercise Therapy, Rehabilitation, sahrmann' exercise, McGill exercise
Brief summary
The goal of this clinical trial is to learn whether Sahrmann exercises or McGill exercises are more effective for reducing pain and improving function in adults with non-specific low back pain. It will also evaluate which exercise program is more effective in improving spinal range of motion. The main questions it aims to answer are: Do Sahrmann exercises reduce pain more effectively than McGill exercises? Do Sahrmann exercises improve disability more effectively than McGill exercises? Do Sahrmann exercises improve lumbar range of motion more effectively than McGill exercises? Researchers will compare a Sahrmann exercise program with a McGill exercise program to determine which approach produces better outcomes in patients with non-specific low back pain. Participants will: Be randomly assigned to either a Sahrmann exercise group or a McGill exercise group. Receive standard physical therapy treatment, including heat therapy and transcutaneous electrical nerve stimulation (TENS). Perform the assigned exercise program under the supervision of a physiotherapist. Attend exercise sessions 3-5 times per week during the study period. Complete assessments of pain, disability, and lumbar range of motion before and after the intervention. Have pain measured using the Numeric Pain Rating Scale (NPRS), disability measured using the Oswestry Disability Index (ODI), and lumbar range of motion measured using a Baseline Bubble Inclinometer.
Detailed description
Non-specific low back pain (NSLBP) is one of the most prevalent musculoskeletal disorders and a major cause of disability worldwide. It is characterized by pain localized between the lower rib margins and the gluteal folds without a specific identifiable pathology. Individuals with NSLBP often experience pain, reduced spinal mobility, impaired motor control, and functional limitations that negatively affect daily activities and quality of life. Exercise-based rehabilitation is widely recommended as a first-line treatment for NSLBP. Core stabilization exercises have gained considerable attention because deficits in trunk muscle function and lumbopelvic stability are believed to contribute to the persistence and recurrence of low back pain. Among the commonly used approaches, Sahrmann exercises and McGill exercises are designed to improve spinal stability through different mechanisms. The Sahrmann approach emphasizes motor control training and the correction of movement impairments through progressive lumbopelvic stabilization exercises. The McGill approach focuses on enhancing spinal stability and muscular endurance while minimizing spinal loading through a series of stabilization exercises commonly referred to as the McGill Big Three. Although both approaches are frequently used in rehabilitation practice, evidence directly comparing their effectiveness in individuals with NSLBP remains limited. This randomized controlled trial aims to compare the effects of Sahrmann exercises and McGill exercises on clinical outcomes in adults with non-specific low back pain. Participants will be randomly allocated to one of two treatment groups and will receive a supervised exercise program in addition to standard physical therapy care. Clinical assessments will be conducted before and after the intervention period to evaluate changes in pain, functional disability, and lumbar mobility. The findings of this study may help identify the more effective exercise-based rehabilitation approach for individuals with non-specific low back pain and provide evidence to support clinical decision-making in physical therapy practice.
Interventions
OTHERSahrmann's Exercises
Group A will receive sahrmann's exercises after the baseline treatment. It will be including 5 levels: Level 1 The participant slowly raised one leg to a position of approximately 90° hip flexion with 90° knee flexion. Level 2 From the final position of the previous level, the participant slowly lowered one leg such that the heel contacted the ground/plinth. Level 3 From the end position of level 1, the participant slowly lowered one leg such that the heel reached approximate 12cm above the ground. Then the leg slid out to fully extend the knee. Level 4 From the final position of level 1, the participant slowly lowered both legs together such that the heels contacted the plinth. Then the legs slid out to fully extend the knees. Level 5 From the final position of level 1, the participant slowly lowered both legs simultaneously such that the heels reached 12 cm above the ground. The legs then slid out to fully extend the knees.
OTHERMcGill Exercises
Patients will receive three exercises for rehabilitating lower back pain, termed the McGill Big Three (MGB3). Mcgill begins with motion exercise (cat-camel motion exercise. It consists of six to eight cycle of spinal flexion and extension in quadruped position. 1. Curl-up In which patient flexes one knee while keeping the other straight to minimize loss neutral posture. Then, the patient gently raises just the head and shoulders a short distance off the floor. 2. Side plank The patient lying on the side supported on his elbow and hip, knees bent to 90 degrees, free hand place on the opposite shoulder. The patient then raises his trunk until the body supported on elbows and knees. If patient not able to perform side support exercise, the patient would assume the side lying position and initiate the contraction of quadratus lumborum by trying to lift both lower limbs up toward the ceiling. 3. Bird-dog The bird dog exercise (opposite arm and leg extension in the quadruped position) carri
Sponsors
Riphah International University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 35 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosed patients of non-specific low back pain Adults between 18-35 years. Both male and female included Low back pain for minimum of three months NPRS score 3-7 will be recruited in this study.
Exclusion criteria
History of any trauma and spinal injury History of previous lumbar surgery History of cancer, spinal infection, rheumatologic diseases, spine fracture, red flag signs. Congenital anomly (scoliosis, kyphosis) Systemic diseases affecting bones \& joints such as rheumatoid arthritis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Numerical Pain Rating Scale (NPRS) | upto 6 weeks | In the current study, patients with NPRS score 3-7 will be recruited. Patient level of pain will be assessed using this scale. NRS is 11-points (NRS-11) which counts the pain and is wildly used in clinical settings because it is easy to administer and score. The patient is asked to indicate the value of his pain on the scale. A 11-point scale was used, with "0" representing "no pain" and "10" representing the "most severe pain imaginable" at the time of assessment (10). The Numeric Pain Rating Scale (NPRS) demonstrates moderate to excellent test-retest reliability with ICC values ranging from 0.58 to 0.93, and good construct validity with correlation coefficients of 0.48 to 0.54 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Oswestry Disability Index (ODI) | upto 6 weeks | The ODI was the primary outcomes used to assess self-reports of disability caused by LBP. The ODI is made up of 10 sections scored from 0 to 5 points, each section contain 6 statements with the total score ranging from 0 to 50 points. A higher score on questionnaires indicates a higher level of disability. The ODI (ICC \> 0.84) has been recognized as valid and reliable tools for patients suffering from chronic LBP. |
| Baseline Bubble Inclinometer | upto 6 weeks | A Baseline Bubble Inclinometer (Model 10602 built by Fabrication Enterprise Inc., USA) was used to measure the active back flexion and extension range of motion without thoraco-lumbar pain. To evaluate the active thoraco-lumbar flexion and extension range of motion, the inclinometer was used at the T12-L1 spinous process. |
Contacts
CONTACTSumrod Akram
PRINCIPAL_INVESTIGATORFatima Khan, MSPT*
Riphah International University
Outcome results
None listed