Effects of Bruegger's Exercises Versus Egoscue Exercise on Lower Cross Syndrome

Not Applicable

Recruiting

• Conditions: Lower Cross Syndrome
• Interventions: Other: Bruegger,s Exercise; Other: Egoscue Exercise

• Registration Number: NCT06303388
• Lead Sponsor: Riphah International University

Brief Summary

This study aims to find effects of Bruegger's Exercise versus Egoscue exercise on pain and hyperlordosis on patient with lower cross syndrome. This is interventional study which recruits 34 participants ,14 in each group.

Detailed Description

A randomized control trial will be conducted on patients with lower cross syndrome. A total number of 34 participants will be randomised into two groups with 17 participants in each group. Both groups will receive Hot Packs on the lumbar area for 10 minutes. Group A will receive Conventional Therapy and will follow protocol of Bruegger's Exercise. Group B will follow protocol of the Egoscue exercise. This study aims to decrease pain and hyperlordosis.

Each group will be assessed at baseline which will include pain through NPRS, hyperlordosis through flexicurve ruler and anterior pelvic tilt through pelvic inclinometer. Data from both groups will again be assessed after 4 weeks of intervention.

Protocol of Bruegger's Exercise: Pt. position: Upright sitting on a chair.

1. Sit with your buttocks at the edge of a chair.

2. Spread your legs apart slightly.

3. Turn your toes out slightly.

4. Rest your weight on your legs/feet \& relax your abdominal muscles.

5. Tilt your pelvis forward (i.e. arch your lower back) while lifting your chest up

6. Rotate your arms outward while turning your palms up.

7. Hold your head high in the air, with a slight arch in the neck.

The patient is to perform this exercise once or twice every 20-30 minutes of prolonged sitting and held in this position for 30-60 seconds. To avoid non-compliance patient will be asked to perform five repetitions of particular exercise with five second hold during their clinical session.

Protocol of Egoscue Exercise The Egoscue group received a total of 10 exercises which includes

1. Static back alone and with breathing

2. Abdominal contraction while in the static back position

3. abductor press

4. Overhead extension

5. elbow curls on a wall

6. Static wall

7. Upper spinal twist

8. pelvic tilts

9. supine groin progressive

10. Air bench exercises

Week 1: 3 times with 10 s hold time Week 2: 5 times with 10 s hold time Week 3: 15 times with 10 s hold time Week 4: 20 times with 10 s hold time

Study Timeline

• Study Start: 2024-02-26
• Status Verified: 2024-03
• Study First Submitted: 2024-03-04
• Study First Submitted QC: 2024-03-04
• Last Update Submitted: 2024-03-04
• Study First Posted: 2024-03-12
• Last Update Posted: 2024-03-12
• Primary Completion: 2024-05-30
• Study Completion: 2024-06-15

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 34

Inclusion Criteria

• Females and males aged between 16 to 65 years

• Participants had to present with low back pain
• Participants had to meet the criteria for lower crossed syndrome indicating tight hip flexors (Modified Thomas test) and erector spinae (visual assessment through toe touching) together with weak glutei (Prone Hip Extension Co-ordination/Strength Test) and abdominals (Trunk Flexion Co-ordination and Strength Test)and thoracic kyphosis.
• Angle of anterior pelvic tilt > 10 degrees

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Exclusion Criteria

• Participants who would be undergoing other forms of treatment that may interfere with the study, for the duration of the study, including other manipulative and physical therapies specific to back pain.

• Presence of other conditions that may mimic low back pain, e.g. nerve entrapment.
• Participants taking any medication that may interfere with the results of this study including, pain medication, anti-inflammatory medication, and muscle relaxants.
• Surgery on the back, pelvis, or sacrum is indicated or has previously occurred
• LBP having localised or radiating pain.
• Practiced any kind of exercise or sports activity during the last 6 months.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Bruegger's Exercise	Bruegger,s Exercise	steps include in Breugger's Exercise 1. Sit with your buttocks at the edge of a chair. 2. Spread your legs apart slightly. 3. Turn your toes out slightly. 4. Rest your weight on your legs/feet \& relax your abdominal muscles. 5. Tilt your pelvis forward (i.e. arch your lower back) while lifting your chest up 6. Rotate your arms outward while turning your palms up. 7. Hold your head high in the air, with a slight arch in the neck. The patient is to slowly exhale by breathing out through their lips while actively externally rotating their arms and spreading their fingers. The patient is to perform this exercise once or twice every 20-30 minutes of prolonged sitting and held in this position for 30-60 seconds
Egoscue Exercise	Egoscue Exercise	• The Egoscue exercise comprise of 10 exercises which Included 1. Static back alone and with breathing. 2. Abdominal contraction while in the static back position. 3. abductor press 4. overhead extension 5. elbow curls on a wall 6. static wall 7. upper spinal twist 8 pelvic tilts 9.supine groin progressive 10.air bench exercises.

Primary Outcome Measures

Name	Time	Method
Flexicurve Ruler	12 day	The flexicurve ruler (flexible) is commonly used to measure the degree of spinal curvature of the lumbar lordosis in the sagittal plane. The flexible ruler was placed according to the Youdas method, over spinous processes from T12 to S2 vertebrae. The ruler was then cautiously removed from the spine and traced onto a plain piece of white paper. A vertical line was drawn to connect the T12 and S2 landmarks (L line) and together with the maximum width of the lumbar curvature (H line
Pelvic Inclinometer	12 day	A pelvic inclinometer was used to measure the anterior/posterior inclination of the pelvis of the subjects. An inclinometer has a 23 Cm length base and two 15 Cm arms in each side that freely move 360 degrees in horizontal plane. The ends of the arms are placed on the bony landmarks.The subject was asked to stand with the feet shoulder width apart. Even pressure was applied to both the arms of the inclinometer at anterior superior iliac spine and posterior superior iliac spine, with a bubble in the center the reading was then measured in degrees.
NPRS	12 Day	Several pain scales are used clinically to evaluate the severity of musculoskeletal pain, one of which is the Numeric Pain Rating Scale (NPRS-11), which is an eleven-point scale in which the endpoints are the extremes of no pain at all (score of 0) and the worst pain the patient has ever experienced (score of 10).

Secondary Outcome Measures

Name	Time	Method
Visual Assessment through toe touching	12 day	The patient was seated on the examining table with the pelvis in a vertical position and the legs extended. The patient was asked to actively flex foreword in order to bring the forehead to the knees. The normal functioning of the erector spinae should display an even 'C' shaped curve and a distance of 10cm from the knees to the forehead. There should be also no knee flexion and involve no pelvic tilting. Any deviation from these norms indicates shortness of the erector spinae muscles.
Modified Thomas Test	12 day	This test was performed with the patient supine and the thighs positioned over the edge of the examining table. The patient was told to grasp the thigh of the untested limb and pull it toward the chest to flatten the back and stabilise the pelvis, preventing an increase in lumbar lordosis. A standard stretch position for the iliopsoas muscle is demonstrated with the hip extended and the leg hanging freely with normal knee flexion. A positive test was indicated if the hip remained flexed against gravity on tested limb. Additionally, if there was also knee extension on the tested limb then further testing was needed to decide between a tight iliopsoas or rectus femoris muscle. This was done by passively extending the knee of the tested limb to neutralize the effect of the rectus femoris and find if there was still no change in hip flexion.
Prone Hip Extension Co-ordination Test	12 day	The patient lay prone and raised the tested thigh into extension with the knee held in an extended position. The researcher then palpated the lumbar erector spinae and gluteus maximus muscles. A normal activation sequence was then observed and palpated which involved first the hamstring and gluteus maximus muscles, then the contralateral lumbar erector spinae muscles and lastly the ipsilateral lumbar erector spinae muscles. A positive test result occurred if the lumbar erector spinae contracted before the gluteus maximus muscles did.
Trunk Flexion Co-ordination and Strength Test	12 day	The patient lay supine with the arms either behind the neck or forward across the body and knees bent. The researcher then contacted the patient's heels or positioned a hand under the patient's lumbar spine. The patient was then asked to complete a posterior pelvic tilt and raise the trunk up until the scapulae cleared the table. This position was maintained for 2 seconds. The patient then held the pelvic tilt while lowering their back to the table. The patient was then instructed to perform 10 repetitions while holding the last repetition for 30 seconds. A positive test result occurred if the patient could not perform 10 repetitions without the lumbar spine or heels rising off the table.

Trial Locations

Locations (1)

Pakistan Railway General Hospital; 🇵🇰 Rawalpindi, Federal, Pakistan