INTRODUCTION
q Low back pain is a highly prevalent issue with a
widespread distribution.
q It is an
omnipresent and often debilitating condition that affects a significant portion
of the global population.
q It is one of
the preeminent cause for disability and notably impacts productivity, affecting
individuals and healthcare systems worldwide.
q The majority of
low back pain cases are considered non-specific, indicating they lack a clear
identifiable pathological cause.
q Non-specific
low back pain includes various pain sensations that cannot be linked to obvious
structural issues like fractures, herniated discs, or infections.
q This wide
classification of non-specific low back pain encompasses pain from muscle
strain, sprains, bad posture, or overuse, often worsened by psychological
factors like stress and anxiety.
q A research in
2022 found that 66% of the population in India had experienced low back pain at
some point in their lifetime.
q In 1980, Caufriez et al. introduced Hypopressive
Abdominal Gymnastics (HAG) to prevent pelvic floor issues post-pregnancy, and
later to enhance postural stability.
q The focus is on
exercises for posture that help reduce pressure in the abdominal, perineal, and thoracic cavities.
q This technique,
combined with posture methods, targets activating type I tonic muscle fibers,
which should enhance the coordinated activation of all muscles involved in
posture, including the deep muscles in the trunk.
q These exercises
could directly engage the transversus abdominis muscle, potentially enhancing
the strength of the abdominal wall and better spine stabilization.
q In terms of
postural techniques, HAG involves moving through a series of positions,
starting with standing and finishing in a supine position, including kneeling,
quadruped, and sitting positions along the way. NEED OF STUDY
q Low back pain is the leading cause of disability in
terms of years lived with disability (YLDs).
q So it is
essential to integrate innovative methods to accomplish accelerated recovery in
individuals with LBP, thus enhancing patient outcomes.
q Up until now,
most studies have concentrated on evaluating the impacts of HAG on pelvic floor
dysfunctions. However, there have been few studies that have examined how core
muscle groups may assist in stabilizing the spine properly.
q Henceforth, training
the core muscles which generate trunk stability can be beneficial in
alleviating low back pain.
q There are lack
of studies assessing the effects of HAG on non-specific low back pain.
q Therefore,
gaining a deeper understanding of the impacts of HAG is essential in order to
begin enhancing and refining various intervention guidelines and protocols.
AIM
Ø
To
assess the effect of hypopressive abdominal gymnastics on pain, flexibility and
function in individuals with non-specific low back pain. OBJECTIVES
q To determine the effect of Hypopressive Abdominal
Gymnastics (HAG) on pain by VAS in individuals with non-specific low back pain.
q To determine
the effect of Hypopressive Abdominal Gymnastics (HAG) on flexibility by Sit and
Reach test in individuals with non-specific low back pain.
q To determine
the effect of Hypopressive Abdominal Gymnastics (HAG) on function by Modified
Oswestry Disability Index (MODI) in individuals with non-specific low back
pain. HYPOTHESIS
Null Hypothesis
q H01 : There is no significant
effect of Hypopressive Abdominal Gymnastics (HAG) on pain in individuals with
non-specific low back pain.
q H02
: There is no significant effect of Hypopressive Abdominal Gymnastics (HAG) on
flexibility in individuals with non-specific low back pain.
q H03
: There is no significant effect of Hypopressive Abdominal Gymnastics (HAG) on
function in individuals with non-specific low back pain.
q H04
: There is no significant effect of Conventional Therapy on pain in individuals
with non-specific low back pain.
q H05
: There is no significant effect of Conventional Therapy on flexibility in
individuals with non-specific low back pain.
q H06 : There is no significant
effect of Conventional Therapy on function in individuals with non-specific low
back pain.
q H07 : There is no significant
difference between Hypopressive Abdominal Gymnastics (HAG) and Conventional
Therapy on pain in individuals with non-specific low back pain.
q H08
: There is no significant difference between Hypopressive Abdominal Gymnastics
(HAG) and Conventional Therapy on flexibility in individuals with non-specific
low back pain.
q H09
: There is no significant difference between Hypopressive Abdominal Gymnastics
(HAG) and Conventional Therapy on function in individuals with non-specific low
back pain.
Alternate Hypothesis
q H11 : There is significant
effect of Hypopressive Abdominal Gymnastics (HAG) on pain in individuals with
non-specific low back pain.
q H12
: There is significant effect of Hypopressive Abdominal Gymnastics (HAG) on
flexibility in individuals with non-specific low back pain.
q H13
: There is significant effect of Hypopressive Abdominal Gymnastics (HAG) on
function in individuals with non-specific low back pain.
q H14
: There is significant effect of Conventional Therapy on pain in individuals
with non-specific low back pain.
q H15
: There is significant effect of Conventional Therapy on flexibility in
individuals with non-specific low back pain.
q H16
: There is significant effect of Conventional Therapy on function in
individuals with non-specific low back pain.
q H17 : There is significant
difference between Hypopressive Abdominal Gymnastics (HAG) and Conventional
Therapy on pain in individuals with non-specific low back pain.
q H18
: There is significant difference between Hypopressive Abdominal
Gymnastics (HAG) and Conventional Therapy on flexibility in individuals with non-specific
low back pain.
q H19
: There is significant difference between Hypopressive Abdominal
Gymnastics (HAG) and Conventional Therapy on function in individuals with
non-specific low back pain. METHODOLOGY
Ø Study Design :- An Experimental Study (NRCT)
Ø Study Duration :- 6 months
Ø Sample Size :- 36 (18 in each group)
Ø Sample Design :- Simple random sampling
Ø Group A :- Hypopressive Abdominal Gymnastics +
Conventional Therapy
Ø Group B :- Conventional Therapy
Ø Treatment Duration :- 2 weeks
OUTCOME MEASURES
q Pain using Visual Analog Scale (VAS).
q Flexibility
using Sit and Reach Test.
q Function using
Modified Oswestry Disability Index (MODI). CRITERIA INCLUSION
•
Individuals
between the age of 18-40 years (According to Newman’s Classification)
•
Males
and females both
•
Individuals
diagnosed with non-specific low back pain persistent for more than a week
•
Visual
Analog Scale (VAS) score ranging between 3-7
•
Individuals
diagnosed with non-specific low back pain willing to participate
EXCLUSION
•
Patients
with cardio-respiratory disease
•
Pregnancy
or suspected pregnancy
•
Patients
with disc lesion or stenosis
•
Patients
with spinal deformities
•
Patients
with spondylolysis or spondylolisthesis
•
Neuromuscular
conditions or rheumatisms
MATERIALS TO BE USED
Ø Consent form
Ø A box about 30
cms or a step
Ø Ruler
Ø Plinth or mat
Ø Hot pack
Ø Stopwatch
Ø Paper
Ø Pen
Ø Pencil
Ø Visual Analog
Scale (VAS)
Ø Modified
Oswestry Disability Index (MODI) PROCEDURE
q Ethical clearance from the Institutional Ethics and
Research Committee will be taken.
q After ethical
approval the subjects will be screened as per the eligibility of inclusion
criteria.
q Subjects will
be explained about the study.
q A written
consent form will be signed by the subjects.
q The subjects
will be divided in two groups.
q Pre assessment
will be taken for pain, flexibility and function.
q Group A
[Experimental group] will receive Hypopressive Abdominal Gymnastics along with Conventional
Therapy
q Group B [Control Group] will receive Conventional
Therapy.
q After 2 weeks
of treatment, post assessment will be taken. In group A (experimental group), administer
Hypopressive Abdominal Gymnastics along with Conventional Therapy
q Patient position :- Begin with standing
q Procedure :- Hypopressive Abdominal Gymnastics will be carried out based on the
principles established by Curifez, Rebullido and Pinsach.(4)
q They detailed the following steps :-
•
Neutral
pelvis as well as spine elongation
•
Dorsiflexion
of ankles
•
Flexion
of knees
•
Shoulder
girdle muscle activation
q Now, they will perform 3 normal breathing cycles with
slow deep exhalations (inspiration and maximum exhalation).
q
Followed
by “diaphragmatic aspiration” maneuver, i.e. breathing maintenance after
expansion of rib cage.
q Treatment duration :- 2 weeks, 8 sessions (4 sessions
per week)
q Every session includes 6 hypopressive abdominal
gymnastics with 2 minutes of rest between each, and each exercise will be done
3 times. q In group B (control group), Conventional Therapy will
be administered. q Patient position :- Supine lying q Procedure :- The following protocol is to be followed(19) :- •
Hot
pack application :- 10 minutes •
Pelvic
bridging •
Pelvic
tilt exercises •
Back
extension exercises •
Static
abdominal exercises •
Knee
to chest exercises •
Curl-ups •
Lion
exercises •
Cat-camel
stretch •
Static
Hamstring stretches :- 30 seconds hold, 3 repetitions(20) •
Treatment
duration :- 2 weeks, 8 sessions (4 sessions per week) •
Each
exercise will have 10 repetitions and one set will be performed. STATISTICAL ANALYSIS
Ø Suitable
statistical tests depending upon the distribution of data would be applied.
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