to compare between Global Postural Reeducation and Pilates mat on pelvic angles, pain intensity, hip flexibility and Functional disability in patients with chronic non-specific low back pain
Chronic low back pain is a common health problem in many developed and developing countries. Individuals suffering from chronic low back pain experience major physical, social, mental, and occupational disruptions. It is not only one of the leading causes of pain but also of a costly burden on the health care budget as chronic low back pain leads to a frequent demand for medical services. The majority of patients (up to 90%) are categorized as having nonspecific low back pain.Global postural reeducation (GPR) is a conservative treatment that we can consider as a global postural exercise method, and widely used in physical therapy clinical practice in many countries. Pilates is a concept of body and mind exercise and a system of repetitive exercises including whole-body movements, breathing, centering, rhythm, and concentration. Pilates is a mindful approach exercise that promote strength, stability and is used for health enhancement and in several diseases.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
60
The global postural reeducation exercise involves a sequence of active, moderate postures as well as exercises that are designed to realign joints, stretch shortened muscles, in addition, strengthen the contraction of the antagonist's muscles to prevent postural asymmetry. There are eight different therapeutic postures in the GPR approach that should be held for 15 to 20 min while lying, sitting, or standing. Only two or three postures have been proposed to encourage treatment standardization+ conventional therapy
the patients will receive pilates in the form of single leg stretch + Pelvic press + Swimming + Opposite arm and leg reach + Side to side), 3 sets of 10 repetitions
pain intensity
VAS is employed as a quantitative tool to assess the subjective intensity of pain experienced by an individual. The VAS is a reliable and valid method for assessing low back pain clinically. It consists of a single handwritten mark down the length of a 10-cm line, with "no pain" at one end of the scale (0 cm) and "worst pain" at the other (10 cm)
Time frame: up to six weeks
disability
The Arabic version of the Oswestry Disability Index (ODI) has been applied to evaluate the disability brought reliability. The questionnaire was filled out by the patient in about 5 min, and the doctor scored it in around 1 min. Each component is given a score between 0 and 5, with 5 being the most severe disability. The index is determined through the division of the total score by the range of scores, and then its numerical representation as a percentage is derived by multiplying the result by 100. As a result, the denominator drops by 5 for each query that is unanswered
Time frame: up to six weeks
anterior pelvic tilt
Using the iHandy Level app on a smartphone will be used to assess anterior pelvic tilt. The anterior and posterior iliac spines were felt. The iHandy's angle was set to 0 while the patient was lying prone, and a semi-permanent pen was used to mark the skin at levels L5-S1.The patient was lying in a long sitting position with his or her feet flat against a wall. The examiner instructed the patient to move their ischial tuberosities into a more posterior position and to raise their chest towards the wall. Try to stay at the same height while you move forward from the hips. Proceed as far as you are able to. Stop when you feel you can no longer go or when your knees start to lift under your hands. Instead of bouncing, hold as tightly as you can. There were only 10 s in this pose.
Time frame: up to six weeks
lumbar lordosis
flexible ruler will be used to assess lumbar lordosis. To get an accurate reading of lumbar lordosis, a flexible ruler is employed. The flexible ruler demonstrates high reliability and validity as a portable and non-invasive tool for measuring lumbar lordosis. Specifically, the validity of lumbar lordosis measures obtained using the flexible ruler, when compared to those obtained using X-ray imaging, is reported to be 0.91. An angel's theta can be calculated using the formula \[theta\]=4×\[arctan(2H/L)\], where theta stands for the magnitude of the lordotic curve. The lumbar lordotic angle typically ranges from 6.50 to 17.80°.
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the patients will receive conventional physiotherapy treatment which consists of routine physical therapy eg. (Back, hamstring, calf and hip flexors stretches, Abdominal curl up exercises etc along with ultrasound and Transcutaneous electrical nerve stimulation (TENS).
Time frame: up to six weeks
hip flexor flexibility
hip flexor flexibility will be used to assess hip flexor flexibility. The modified Thomas test has been used to evaluate hip flexor flexibility. The patient was lying on their back during this test, and their thigh was hanging over the side of the examination table. The patient firmly held the thigh of the unexamined limb and brought it closer to their chest. The pelvis was rotated posteriorly, and the lumbar spine was flat on the plinth. Using a goniometer to measure the angle of hip flexion, the length of the iliopsoas muscle was determined. The femur's greater trochanter and fulcrum were in line. Using the pelvis as a reference point, the measurement was performed by positioning the goniometer's fixed arm along the lateral midline of the abdomen and its moving arm along the lateral midline of the femur.
Time frame: up to six weeks