Comparison of bilateral hip muscle strengthening with conventional therapy in students with non-specific chronic low back pain: A Randomized Controlled Trial

Nonspecific low back pain (NSLBP) is described as low back discomfort with no discernible, well-known pathophysiology, that is not caused by a specific condition. Many diagnoses by researchers have led to the conclusion that no important reason or disease is causing NSLBP. Pain in the lower back region might be caused by lifting large weights by age-related changes in the spine over time or by prolonged sitting in faulty posture in front of laptops or mobiles.

Students attend classroom sessions for theory input while also working in front of computers to search for materials, which requires prolonged sitting in most of their everyday activities. Prolonged sitting has become one of the factors causing musculoskeletal discomfort, particularly among university students who have LBP, which is often reported and highly connected with individual variables, work ergonomics, and incorrect posture and mobility. Postural pain is the pain caused by mechanical tension when a person maintains a bad posture for an extended period; the pain is usually eased by movement. There are no functional strength or flexibility limitations, but if the poor posture persists, strength and flexibility imbalances emerge. Chronic NSLBP patients experience pain, muscle atrophy, decrease in muscle strength, endurance, and flexibility these all occur as a result of the long-term reduction in trunk activity and disuse, which aggravates low back pain and causes secondary lumbar segment damage and physical disability. When compared to healthy people, those suffering from low back pain have less capacity to maintain balance. When the human body is subjected to an unexpected load, the muscles should respond quickly to maintain balance and posture against the load, but 3 patients with low back pain have a delayed response time, causing a problem with balance.

The prevalence of low back pain among university students is particularly significant due to their prolonged sitting with laptops and mobile phones in poor posture. Many factors influence low back pain in university students, including anthropometric data in individual’s twenties, physiological structure, genetic factors, age, gender, smoking, computer work duration, lumbar support usage, school furniture, sitting position, physical activity, and socioeconomic situations. Studies that have evaluated the hip muscles in chronic NSLBP patients found that there is a significant weakness in hip abductors, adductors, and extensors compared to healthy individuals, which increases the need for administrating the hip muscle strengthening protocol in the physical therapy protocols normally used. Some studies have used the hip strengthening protocol with other conventional therapies they have only targeted the hip abductors and extensors and concluded that the group with the hip strengthening protocols was having better and significant improvement in strength, pain disability, and balance but the population taken was of age 30-50 years of age. There is a clear gap in the literature to test the effectiveness of hip strengthening protocol for non-specific chronic low back pain in the student population.

This study aims to compare bilateral hip muscle strengthening with conventional treatment in students with chronic NSLBP. We hypothesized that the addition of hip strengthening exercises to a conventional exercise would result in an increase in strength, a reduction in pain and disability, and improved balance ability. The test components included will be hip muscle strength measurement using a dynamometer with a reliability of 0.98. The numeric pain Rating Scale (NPRS) consisted of 11 points; it exhibits moderate reliability ICC = 0.67; (0.27 – 0.84]. [4] To determine the level of disability caused by LBP, the Oswestry disability index (ODI) is utilized. The ICC value of ODI is 0.93. The single-leg standing test is used to assess LBP patients’ static balance skills. The suggested single-leg stance balancing test is a valid technique for evaluating balance.