Comparing the Effects of Lumbar Stability Exercises and Telerehabilitation on Reducing Lumbar Lordotic Angle, Pain, and Disability in Postpartum Women

Overview

Low back pain is the most common symptoms experienced by people throughout the world. Although lifetime prevalence of low back pain among women is more but it is particularly common during pregnancy, affecting approximately 50% of women. Pregnancy induces significant physiological changes, which lead to increased ligamentous laxity that may persist for 3 to 6 months postpartum. Additionally, the expanding uterus shifts the maternal center of gravity anteriorly, resulting in compensatory lumbar hyperlordosis and contributing to lower back discomfort. While these adaptations help accommodate pregnancy, they often do not fully resolve after birth, especially in the presence of abdominal muscle weakness. The result is altered posture characterized by an exaggerated lumbar lordotic curve that may predispose postpartum women to continued pain and lumbar instability. Without a structured postpartum rehabilitation program, these postural abnormalities may go uncorrected. Ensuring adherence and completion of such programs is critical for preventing long-term musculoskeletal complication. There are many efficient way to help in maintaining adherence and completion of program including the use of digital platforms. The increasing availability of low cost internet and communication technologies has enhanced the capacity to deliver healthcare services through internet, enabling broader access to physiotherapy services and follow-up care through telerehabilitation. Telerehabilitation is one of the emerging field of telemedicine, defined as set of tools, procedure, and protocols to deliver the rehabilitation process remotely. The objective of the study is to facilitate implementation of the telerehabilitation for home based program for postpartum female. The objectives of the study is to compare the effectiveness of telerehabilitation-based lumbar stability exercises versus on-site lumbar stability exercises in improving lumbar stability among postpartum female and to facilitate implementation of the telerehabilitation for home based program for postpartum female. It is a randomized controlled trial. Participants meeting the inclusion criteria will be recruited and consent form will be taken than participants will be allocated to group A (On-Site Lumbar Stability exercise) and B (Telerehabilitation) through 1:1 method. Pre-treatment assessment will be carried out on Day 1 using the outcome measures tool like NPRS, ODI and LLA. Participant will receive intervention for 6 weeks, 3 sessions per weeks. After the completion, on 6 week Post-treatment assessment will be carried out using the same outcome measures tool like NPRS, ODI and LLA.

Group A will undergo 6 weeks onsite lumbar stabilization protocols and Group B will undergo 6 weeks telerehab lumbar stabilization protocols, both groups will undergo 3 sessions per week on alternate day. Both groups will have educational session on the pre-assessment day. Then group a Group A will undergo onsite lumbar stabilization protocols in-front of therapist while Group B will receive exercise session video and group B will perform exercise during live call with the therapist. There will be 5 minutes warm up period before each session in which quick rhythmic movement of the body will be perform. A cool down period will be performed after each session in which adductor stretch, iliopsoas stretch will be performed. Week 1-2 Core awareness \& activation In week 1, diaphragmatic breathing, abdominal drawing-in maneuvers 30 seconds to 1 minute, and pelvic floor contraction. In week 2, pelvic tilting in supine, supine line heel slide, supine lying marching will be added. Perform it ten times per set, 1 sets a day. The set and repetition will be increase progressively according to individual stamina. Week 3-4 Core Stabilizing excercise Continue week 1-2 maneuvers but in addition with glutes bridges, quadrupled bird dog, clamshells. Perform it ten times per set, 1 sets a day. The set and repetition will be increase progressively according to individual stamina. Week 5-6 Functional Activity Modified side plank, modified front planks, modified squatting, lunges. Perform it 5 times per set, 1 sets a day. The set and repetition will be increase progressively according to individual stamina. Diaphragmatic breathing Patient will be hook lying in supine position. Therapist will give cue to patient to place one hand on the chest and other hand below the ribs and take slow breath in through your nose for 2-3 sec and let the ribs expand sideways and allow the belly to gently rise after that exhale slowly through the mouth, like blowing the candle. Abdominal bracing Patient will be hook lying in supine position. Patient will place her hand on the lateral side of the abdominal wall. Therapist will give cue take breath in and now breath out, as you breathe out gently draw your belly button in and up. Patient will feel firming under the fingers Pelvic floor contraction Patient will be hook lying in supine position. Therapist will give cue to patient that think of tightening the pelvic floor upward in order to stop the flow of urine 10midstream. As you breath squeeze and lift the pelvic floor muscle hold for 5 second and then relax for 5 seconds Pelvic tilting Patient will be hook lying in supine position. Patient will take breath in and patient will gently flatten the lower back on the floor. Therapist will give cues to patient that imagine, there is sheet place under your lower back and I'm pulling it so you will flatten your lower back and will not let it go. Supine lying heel slide Patient will be hook lying in supine position on her back, with knee bent and arms relaxed neutral spine. Patient will engage her core by abdominal bracing and then slide her one foot will keeping her heel on the mat, straightening her leg and then bend her knee. Same will be performed on her alternate leg. Supine lying marching Patient will be hook lying in supine position on her back, with knee bent and arms relaxed neutral spine. Patient will engage her core by abdominal bracing and then lift her one foot off the floor , bringing the knee toward the chest Same will be perform on her alternate leg. Glutes bridge Patient will be hook lying in supine position on her back, with knee bent and arms relaxed neutral spine. Patient will position her heels close to body squeeze her glutes and then drive her hip up from the floor, and will continue lifting until her body form a straight line from shoulder to knee and then slowly lower her hip back to starting position. Quadrupled bird dog Patient will be on hand and knee on floor. Hand will be directly under the shoulders and knee will directly under the hips. Patient will brace her abdominal and slowly lift her arm and alternate leg and extend it while maintain stability. She will hold this position for few second and then return to starting position. Same will be performed on alternate side. Clamshell Patient will be lying on her side with her knee bent while keeping her feet together, she will slowly lift her top knee toward the ceiling, rotating the hip and then slowing return to starting position. Same will be perform on alternate side Modified Side plank Patient will be lying on her side with her knee bent at 90 degree and place her elbow directly under the shoulder. While bracing her abdominal, patient will lift her body from the floor until her body is at straight alignment and hold it for 10 second and then return to start position. Modified plank Patient will lie prone on the mat while her knee bent and elbow directly under her shoulder and will lift her hips off the floor and will keep her body in the straight alignment. She will hold this position for 10 second while breathing steadily Modified squatting Patient will stand with their back against a wall. Feet will be placed few inches apart from the walls and will be directly under the hip level. Then patient will slowly slide her back down by bending her hips and knee at the angle of 45 degree knee bent. She will hold this position for the 10 second and then return to start position Modified lunges Patient will stand upright with the feet hip-width apart and she will place her one foot forward and the other foot back, keeping both feet pointing straight ahead and will be holding chair for the balance. She will slowly bend both her knees, while lowering her body straight down. Therapist will give cues that keep your front knee inline the ankle and don't move past your toes. She will hold this position for the 10 second and then return to start position.