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The Effect of Straight Leg Raise with Lumbar Stabilization Exercises in Subjects of Low Back Pain with Adverse Neural Tension Between the Age Group 20-50 Years

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The Effect of Straight Leg Raise with Lumbar Stabilization Exercises in Subjects of Low Back Pain with Adverse Neural Tension Between the Age Group 20-50 Years DOI Number: 10.5958/0973-5674.2019.00020.0 The Effect of Straight Leg Raise with Lumbar Stabilization Exercises in Subjects of Low Back Pain with Adverse Neural Tension between the Age Group 20-50 Years Mahesh Mitra1, Niharika Gaikwad2 1Principal, 2MPT, NDMVP College of Physiotherapy, N.D.M.V.P college of physiotherapy, Vasantdada Nagar, Adgaon, Nasik ABSTRACT Low back pain is a common disorder which involves muscles, nerves, and bones of the back. About 70% to 85% of population has low back pain at some point in life. Adverse neural tension is defined as physiological or mechanical response produced when structures of the nervous system exceed their normal range of movement. Mechanically or chemically sensitized nerves show abnormal mechano sensitivity. Purpose: purpose of the study was to find the effect of Straight Leg Raise With lumbar stabilization exercises in reducing pain, improving ROM and physical functions in low back pain subjects with adverse neural tension. Aim: To find the effect of Straight Leg Raise with lumbar stabilization exercises in reducing pain, improving ROM, and physical functions in low back pain subjects with adverse neural tension. Objective: To study the effect of straight leg raise with lumbar stabilization exercises in reducing pain, improving ROM, and physical functions in low back pain subjects with adverse neural tension between the age group 20-50 years. Method: This study was conducted on 30 lower back pain patients, age 20-50 years were taken from NDMVP Hospital and research centre, physiotherapy opd . Convenience sampling method was used. ROM, Numerical pain rating scale- pain and Modified oswestry disability questionnaire- disability was assessed. Results: P value is less than 0.05 for NPRS, ROM and modified ODI .The NPRS, PSLR and Modified ODI Questionnaire scores improved significantly by SLR with lumbar stabilization exercises after 3 weeks in subjects of low back pain with adverse neural tension. Conclusion: SLR with lumbar stabilization exercises is effective in reducing pain improving ROM, and physical functions in low back pain subjects with adverse neural tension. Keywords: low back pain with adverse neural tension, SLR Stretching, lumbar stabilization exercises INTRODUCTION movement3-5. Mechanically or chemically sensitize nerves show abnormal mechanosensitivity6. In India incidence of low back pain (LBP) has been reported to be 23.9% and has a life time prevalence of 60- Radiating low back pain or Lumbar radiculopathy 85%. There are various causes of low back pain(LBP) refers to the phenomenon in which the pain produced in producing radicular and non-radicular symptoms. Low the lumbar region radiates or travels down in one or both back pain (LBP) is a common disorder involving the lower limbs with the presence of neural dysfunction. muscles, nerves, and bones of the back. Pain can vary Radiating low back pain could be attributed to various from a dull constant ache to a sudden sharp feeling1. causes such as compression of one or more nerve roots Chronic low back pain is defined by pain persisting for caused by a direct pressure from a herniated disc, more than 12 weeks2. Adverse neural tension is defined degenerative changes in the lumbar spine that cause as physiological or mechanical response produced when irritation of nerve roots, or sciatica due to compression structures of the nervous system increases their normal of sciatic nerve roots, facetal hypertrophy that may 102 Indian Journal of Physiotherapy and Occupational Therapy, January-March 2019, Vol.13, No. 1 compress the nerve root at the lateral foraminal exit, OBJECTIVE foraminal stenosis (narrowing of spinal canal through which the spinal nerve exits due to bone spurs or arthritis) To study the effect of straight leg raise with lumbar – more common in elderly adults, diabetes, nerve root stabilization exercises in reducing pain, improving injuries, scar tissue from previous spinal surgery that is ROM, and physical functions in low back pain subjects affecting the nerve root7-9. with adverse neural tension between the age group 20- 50 years. Neural mobilization has a great role in management of radiculopathy and low back pain . The Straight Leg MATERIAL AND METHOD Raise (SLR) test is frequently used in the assessment of patients presenting with LBP. Improving the range of This experimental study was conducted on 30 SLR has a beneficial effect in storing normal movement lower back pain patients, aged between 20-50 years were taken from NDMVP Hospital and research centre, and decreasing the degree of impairment due to low physiotherapy OPD. Convenient sampling method was back disease 10. used for study. There is no formal definition of lumbar stabilization Inclusion Criteria: exercises , the approach is aimed at improving the neuromuscular control, strength, and endurance of the 1. Age group of both sexes with 20-50 years. muscles that are central to maintaining the dynamic 2. Pain referred distal to buttocks. spinal and trunk stability. Group of muscles particularly 3. SLR testing between 45-70 degree (painfull range). the transversus abdominis and lumbar multifidius, also other paraspinal, abdominal, diaphragmatic, and pelvic 4. Mild to moderate pain (2 to 6 on NPRS). muscles, lumbar stabilization exercise has been accepted 5. Modified oswestry score greater than 10%. as a more empiric therapeutic exercise method than any other exercise method. To improve spinal segment Exclusion Criteria: instability, lumbar stabilization exercises that strengthen 1. Red flags for a serious spinal condition (e.g. the local muscle group located deep in the trunk around infection, tumors, osteoporosis, spinal fracture, etc.) the lumbar vertebrae, which play an important role in 2. Pregnancy. providing dynamic stability for spinal segments, are useful for relieving functional disability of the spine. 3. history of spinal surgery. Lumbar stabilization is important for maintaining the 4. Osteoporosis. spine and performing extremity movements and is applied to adjust the imbalance between the abdominal and trunk 5. straight leg raise (SLR) test of less than 45°. extensor muscles. Such imbalance causes diseases in the 6. Spondylosis, Disc herniation, Cervicogenic lumbar vertebral region of the musculoskeletal system, headache. which must be treated to prevent low back pain11. PROCEDURE Hence the rationale of the present study was to check the effectiveness straight leg raising with lumbar Subjects clinically diagnosed low back pain with stabilization exercise in the treatment of low back pain adverse neural tension were screened according to with adverse neural tension. inclusion and exclusion criteria. Ethical clearance was obtained and informed consent was taken from each AIM subject. Subjects were briefed about the study & the intervention.30 Patients were recruited and were given To find the effect of Straight Leg Raise with lumbar straight leg raise stretching and lumbar stabilization stabilization exercises in reducing pain, improving exercises. The effect of intervention was measured using ROM, and physical functions in low back pain subjects outcome measures comprising of NPRS, PSLR and with adverse neural tension. Modified ODI before and after 3 weeks. Indian Journal of Physiotherapy and Occupational Therapy, January-March 2019, Vol.13, No. 1 103 Straight leg raise stretching: The subject is in supine and • Patient position: hook-lying relaxed in the center of the bed, with one pillow under the draw in your lower abdomen, hold head. Therapist will stand at the affected side and raised Patient instruction: the contraction and breath. Slide your one leg along the side which is perpendicular to the bed in straight leg the mat to straighten the knee and return to the starting raise test with one hand placed under the ankle joint and position. Do not release your abdominal contraction the other hand placed on the knee joints until either pain during the exercise. Repeat with your other leg. Dosage: in the back or referred pain to the leg is seen. 10 repetitions on each leg. Week 2 z Patient position: hook-lying Patient instruction: draw in your lower abdomen, hold the contraction and breath. Squeeze your buttocks together and lift your pelvis up. Do not release your abdominal contraction. Hold this position for 5-10 seconds. Dosage: 5-10 seconds hold and 10 repetitions. z Patient position: hook-lying Patient instruction: draw in your lower abdomen. Lift one leg up without bending the knee upto approximately 45°. Hold the position for 5-10 seconds. Lower the leg. Figure 1: Straight leg raise stretching Repeat with other leg. Dosage: 5-10 seconds hold and 10 repetitions. Then the lower limb is taken down few degrees from this symptomatic point. The therapist will mobilize Week 3 the sciatic nerve by gentle oscillations alternatively z Patient position: four-point kneeling toward ankle dorsiflexion and plantar flexion . This sequences is repeated several times, in which the Patient instruction: slowly pull your navel up, hold amplitude is increased according to the patient response. the contraction and breath. Raise your one leg up The technique progressed to a point where symptoms with the knee straight followed by the opposite arm where resistance of the movement was encountered. As without bending the elbow. Hold this position for 5-10 seconds. Lower your arm and leg. Repeat with the other the pain is relieved, the therapist increase the range of diagonal leg and arm. Dosage: 5-10 seconds hold and 10 motion until reaching the maximum range of straight leg repetitions. raise with pain free. The position is held for 30seconds. Frequency: 2 times week for 3 weeks z Patient position: prone They were instructed to perform the stabilization Patient instruction: slowly pull your navel up hold the exercises at home twice a day on the days they did not contraction and breath. Slowly raise both your legs up come for their treatment sessions. Each exercises were straight without bending your knees. Hold this position carried forward each week.
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