Lumbar
Conditions
Keywords
Diaphragm, Core, lumbar instability
Brief summary
The purpose of this study is to compare the effect of combining diaphragmatic strengthening with core stability exercises versus core stability exercises alone on recovery time, pain, and stability in lumbar instability individuals.
Detailed description
Lumbar instability is a common medical problem. There is a 50-70% chance of a person suffering from LBP during his or her lifetime having lumbar instability. It is often referred to as clinical spinal instability. Clinical spinal instability is controversial and poorly understood. Properly conducted clinical studies of patients with spinal pain and documented clinical instability would be good to explore this concept. However, pursuing such a course is difficult. The diaphragm has a dual role in respiration and postural control. Evidence suggests that current core stability exercises for low back pain are superior to minimal or no treatment, however, no more beneficial than general exercises and/or manual therapy. There appears to be a higher focus on the transverses abdominis and multifidi muscles and minimal attention to the diaphragm. We propose that any form of core stabilization exercises for low back pain rehabilitation should consider the diaphragm. Core stabilization program could commence with facilitation of normal breathing patterns and progressive systematic restoration of the postural control role of the diaphragm muscle. So, the aim of this trial is to determine whether combining diaphragmatic strengthening exercises with core stability training leads to faster improvements in pain and instability in individuals with lumbar instability, compared to traditional core exercises alone.
Interventions
Participants will receive supervised diaphragm strengthening exercises combined with core stability training, three sessions per week for 8 weeks (45 minutes/session). Diaphragm strengthening will be performed using an elastic TheraBand wrapped around the thoracolumbar junction to provide progressive inspiratory resistance, with intensity progressed according to the Borg Rating of Perceived Exertion (RPE: 11 during weeks 1-2, 13 during weeks 3-5, and 15 during weeks 6-8).
OTHERCore stability exercises
Participants will receive supervised core stability exercises only, three sessions per week for 8 weeks (45 minutes/session). The exercise program includes the abdominal drawing-in maneuver (ADIM), side-bridge, and quadruped exercises, with progressive increases in exercise difficulty every two weeks. Participants will perform the same exercise progression as the intervention group but without diaphragm strengthening or TheraBand resistance.
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
25 Years to 35 Years
Healthy volunteers
No
Inclusion criteria
* Age between 25 and 35 years. * Positive prone instability test. * Straight leg raising \>90 degrees. * Pain assessment on VAS \>5/10. * All patients will suffer from clinical lumber instability (characterized by excessive movement in specific segments during active movement and posterior-anterior spring test causing large movements and pain)
Exclusion criteria
* Patients with cardiovascular diseases. * Patients with cerebrovascular diseases. * Patients with neurological diseases. * Patients with any attention disorders or physical disability. * Patients with any diseases/conditions preventing physical activity participation. * Patients with history of back surgery, inflammatory spinal disorder, deformed vertebrae, fracture, or neurological radiating pain. * Patients with central obesity (A waist to hip ratio \>0.90 in males or \> 0.85 in females).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity assessed using the Visual Analogue Scale (VAS) | 8 weeks | Pain intensity will be evaluated using a 10-cm Visual Analogue Scale (VAS), with scores ranging from 0 (no pain) to 10 (worst imaginable pain). Higher scores indicate greater pain intensity. |
| Pressure pain threshold assessed by pressure algometry | 8 weeks | Pressure pain threshold will be measured over the lumbar paraspinal muscles using a handheld pressure algometer. Higher values indicate reduced pain sensitivity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Core muscle stability assessed using a Pressure Biofeedback Unit (PBU) | 8 weeks | Core muscle stability will be assessed using a Pressure Biofeedback Unit during abdominal drawing-in tasks. Improved pressure control indicates better activation of the local stabilizing muscles. |
| Functional disability assessed using the Oswestry Disability Index (ODI) | 8 weeks | Functional disability related to low back pain will be evaluated using the Oswestry Disability Index (ODI). Scores range from 0 to 100%, with higher scores indicating greater disability. |
Countries
Egypt
Contacts
CONTACTAhmed Hesham Abd El-Mawgoud, B.Sc
CONTACTMona AbdelRaouf Moursy, PhD
STUDY_CHAIRAhmad Mahdi Ahmad, PhD
Professor, Cairo University
STUDY_DIRECTORMaged Mohamed Samy Abouelsoud, PhD
Professor, Ain Shams University
STUDY_DIRECTORMona AbdelRaouf Moursy
Assist. Professor, Cairo University
Outcome results
None listed