The most common musculoskeletal problem in both developed and developing countries is low back pain. Quadratus lumborum syndrome is a common source of low back pain, defined as a myofascial pain syndrome characterized by pain due to spasm and stiffness of the quadratus lumborum muscle. This condition often occurs when weak back muscles are compensated by the quadratus lumborum, leading to painful muscle spasms. This study aims to determine the effects of PIR on pain, muscle endurance, and disability in patients with Quadratus Lumborum Syndrome.
This randomized controlled trial will be conducted at Ittefaq Hospital Lahore over a 4-month period. A sample size of 32 participants, aged 20 to 45 will be selected using non-probability convenient sampling. Informed consent will be obtained from all participants. Participants will be divided into two groups: Group A will receive Post-Isometric Relaxation in addition to standard physical therapy, while Group B will receive only standard physical therapy which includes a hot pack, TENS, core stability exercises and Maitland's mobilization. Outcome measures including the Numeric pain rating scale (NPRS), McGill's torso muscular endurance test, Oswestry disability index (ODI) urdu version and Lateral flexion test for mobility will be assessed at baseline and after 4 weeks. Inclusion criteria include positive hip hike and lateral flexion tests, lumbar pain with an NPRS score of \>3 to ≤7, and an ODI score of ≥5 to ≤24. Exclusion criteria include chronic pain, spondylolisthesis and previous spinal surgeries. Data will be analyzed using IBM SPSS 25.0.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
32
Maitland MobilizationPosterior-Anterior Glide will be performed on the transverse processes of the L1 to L4 vertebrae. The amplitude will initially be grade 1 and 2 for pain relief, and grade 3 and 4 will be used to improve ROM, with slow speed, smooth rhythm, and 2 to 3 oscillations per second for 30 seconds. There will be 2 to 3 sets for each vertebra
The practitioner stands behind the side lying patient, at waist level. The patient has the uppermost arm extended over the head to firmly grasp the top end of the table and, on an inhalation, abducts the uppermost leg until the practitioner palpates strong quadratus activity (elevation of around 30° usually). The patient holds the leg isometrically in this manner, allowing gravity to provide resistance for 10-second, the patient allows the leg to hang slightly behind him over the back of the table. The practitioner straddles this and, cradling the pelvis with both hands (fingers interlocked over crest of pelvis), leans back to take out all slack and to ease the pelvis away from the lower ribs during an exhalation. The stretch should be held for between 10 and 30 seconds. Contraction followed by stretch is repeated with raised leg in front of, behind the trunk in order to activate different fibers and was given bilaterally
Ittefaq Hospital
Lahore, Punjab Province, Pakistan
low back Pain intensity
Numeric Pain Rating Scale (NPRS): Patient level of pain will be assessed using the NPRS. It is a tool commonly used to measure pain severity on a 0-10 scale with 0 means no pain, 1-3 means mild pain, 4-6 means moderate pain and 7-10 means severe pain . Patients rate their current level of pain and their worst and least amount of pain in the last 24 hours. The average of the 3 ratings or any single rating may be used to represent the patient's level of pain . The NPRS validity is 0.86 and reliability is 0.96
Time frame: upto 4 weeks
Muscle Endurance
McGill's Torso Muscular Endurance Test: Muscle endurance of the quadratus lumborum will be assessed using this test. McGill's test assesses core muscle endurance through trunk flexor, trunk extensor, and right and left lateral trunk musculature tests. Participants maintain isometric postures for as long as possible and the time held in each position is recorded. The scores from the subtests are summed for an overall score. The McGill test has shown excellent reliability (ICC = 0.97-0.99).
Time frame: upto 4 weeks
Functional Disability
Oswestry Disability Index (ODI) Urdu Version: The ODI is a questionnaire that scores pain-related disability in patients with LBP. It is a valid measure for disability in LBP. The ODI is made up of 10 items dealing with various functional aspects. Each item is scored from 0 to 5, with higher values representing greater disability . The ODI-U has excellent test-retest reliability for total score (ICC2,1 = 0.95).
Time frame: upto 4 weeks
Lateral Flexion
Lateral Flexion Test: To evaluate trunk lateral flexion ROM, patients stand with their backs against a wall and feet shoulder-width apart. An initial mark is made where the middle fingertip rests on the lateral thigh. Then, they flex laterally, keeping their back and shoulders against the wall. A second mark is made where the middle fingertip moves down to on the thigh. The distance between the two marks is measured in centimeters. An average is calculated using three readings per side. lateral flexion test shows strong reliability, with intraclass correlations over 0.84.
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Time frame: upto 4 weeks