Core Stability Exercise Versus Diaphragmatic Release on Respiratory Functions on Physical Therapists With Low Back Pain
- Conditions
- Respiratory FunctionsMechanical Low Back Pain
- Interventions
- Procedure: Diaphragmatic release techniqueDevice: Core stabilization exercise using pressure biofeedback unit
- Registration Number
- NCT05860283
- Lead Sponsor
- Cairo University
- Brief Summary
To compare between core stability exercise and diaphragmatic release on respiratory functions on physical therapists with low back pain.
- Detailed Description
Low back pain is the most frequent self-reported type of musculoskeletal pain. It is often recurrent and has important socioeconomic consequences. 99.5% of Egyptian physical therapists (PTs) suffer from work related musculoskeletal disorders (WMSDs), mainly in the lower back (69.1%) and it is more common in female than male therapists. Physical therapists are routinely exposed to work-related physically demanding tasks such as handling heavy patients, applying manual techniques and assuming sustained awkward positions, which are the most common predisposing factors for development of WMSDs.
Respiratory dysfunction is a major factor for the diagnosis and treatment of chronic LBP. This respiratory dysfunction may be related to the altered function of the diaphragm and poor coordination of deep stabilization muscles due to dysfunctional movement patterns. Respiratory dysfunction compromises the subject's ability to stabilize the spine during balancing and postural tasks. Besides diaphragmatic dysfunction, several studies have observed in chronic LBP delayed or decreased activation of lumbar multifidi and transversus abdominus during gait and extremity movement. Since it is difficult to isolate contraction of the transversus abdominis required for the core stability exercises, biofeedback strategies using pressure biofeedback unit (PBU) will be used. This instrument allows visual detection of pressure fluctuations inherent to movements in that region. Another clinical use for the PBU is to help train lumbopelvic stability in individuals with chronic LBP during open-chain segmental control exercises, through challenging the motor control by active movements of the upper or lower limbs, meanwhile the individuals should maintain lumbopelvic neutral position known by getting visual feedback of maintenance of a steady pressure.
People with LBP have an abnormal diaphragm position impacted by small diaphragmatic excursions (mobility) with respiration, in other words "the diaphragm is splinted". Diaphragm tightness can promote shallow breathing, resulting in decreased diaphragm contractile force that impacts the diaphragm strength. Diaphragmatic release has an immediate effect on the diaphragm strength. Increased diaphragm strength immediately follows the intervention, suggesting utility of these techniques for patients with diaphragmatic movement restrictions or breathing-related disorders.
By reviewing the literature it was found that both core stability exercises and diaphragmatic release techniques have positive effects on both respiratory variables \& low back pain. Thus, the present study will compare between these two interventions.
Recruitment & Eligibility
- Status
- ENROLLING_BY_INVITATION
- Sex
- Female
- Target Recruitment
- 90
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Diaphragmatic release group Diaphragmatic release technique The subjects will lay supine with relaxed limbs. Positioned at the head of the subjects, there will be manual contact with the pisiform, hypothenar region and the last three fingers bilaterally to the underside of the seventh to tenth rib costal cartilages, with the forearms aligned toward the subject's shoulders. In the inspiratory phase, a gentle pull will be given at the points of contact with both hands in the direction of the head and slightly laterally, accompanying the elevation of the ribs. During exhalation, a deepened contact will be given towards the inner costal margin, to resist the rebounding movement of the thoracic cage. In the subsequent respiratory cycles, there will be a progressive increase in the depth of contact inside the costal margin. Core stabilization exercise group Core stabilization exercise using pressure biofeedback unit Core muscle activation exercises will be done using the pressure biofeedback unit. The session will include visual, auditory \& tactile biofeedback. Visual monitoring of the pressure gauge by the subjects during the exercise will be allowed and breath holding or compensatory movements will be avoided.
- Primary Outcome Measures
Name Time Method Total Faulty Breathing Scale (TFBS) one year Total faulty breathing scale will be used to assess faulty breathing pattern during quiet and deep breathing in an upright standing position. The presence or absence of faulty breathing is the outcome variable, to be assessed by observation of lifting of the clavicle, lateral rib motion, and abdominal movement which will be categorized on a scale of normal (0), mild (1-4), moderate (5-8), and severe (9-12). Higher scores indicate a worse outcome.
Pulmonary Function tests one year Test will be performed with a spirometer device. Forced vital capacity (FVC) in litres, forced expiratory volume in 1st second (FEV1) in litres, the ratio between FEV1/FVC in litres, peak expiratory flow rate (PEFR) in litres/min and minute volume ventilation (MVV) in litres/min will be measured by spirometer
The diaphragm excursion and thickness one year They will be assessed with ultrasound M-mode and B-modes, respectively.Diaphragm excursion ( in cm) will be taken during both quiet breathing (QB) and deep breathing (DB). The diaphragm thickness (in mm) will be measured at the end of inspiration (Tins) and expiration (Texp) during DB. Diaphragm thickness change is calculated by this formula: (Tins _ Texp)/Texp \*100.
Chest expansion one year It will be measured (in cm) using a tape measure. The three positions for measurement will be: 1) the upper chest, under the armpit mid-sternal line; 2) the lower chest, the xiphoid process mid-sternal line; and 3) the abdomen, at the umbilical area.
- Secondary Outcome Measures
Name Time Method Numerical pain rating scale (NPRS) one year Numerical pain rating scale is for rating pain intensity. Subjects will be asked to score the pain intensity over the last 24 hours on the NPRS. The scale range between 0 and 10, with 0 being no pain and 10 being worst pain.
Oswestry Disability Index (ODI) one year Oswestry disability index is a clinical assessment tool that will provide an estimate of LBP disability expressed as a percentage score.It consists of ten sections or items to assess pain, personal care, lifting, walking, sitting, standing, sleeping, sex life (if applicable), social life and travelling. Each item is scaled from 0 to 5. The rating is: "Patient Score = (Patient's score/Possible maximum score) × 100". A score of 0% means minimal disability, and a score of 100% means bed addiction. High scores in this scale indicate worse outcomes.
Pressure biofeedback unit (PBU) one year A three-chamber air-filled pressure cell, a catheter and a sphygmomanometer gauge used to assess core stability (in mmHg). The subjects will perform the Sahrmann five level core stability test. The starting pressure during this test is 40 mmHg and the subjects should be able to maintain this pressure in all the 5 levels of the test while performing abdominal drawing in maneuver for 10 seconds. Compensatory postures (holding of breath, movement of the pelvis, visible, or evident contraction of the External oblique muscle, and pressing of the heels toward the floor) indicates weak core muscles.
Trial Locations
- Locations (1)
Faculty of physical therapy- Cairo University
🇪🇬Cairo, Egypt