EFFICACY OF SLUMP STRETCHING IN COMBINATION WITH CONVENTIONAL THERAPY IN NON-RADICULAR LOW BACK PAIN

Background: Low back pain (LBP) is a common problem which experienced by all in anyone stage in their lifetime. Mostly it is due to the altered neural tension which can be tested by slump test and this slump stretching can be also used as intervention tool and moreover studies showed that slump stretching is beneficial in treating the patients. If the effectiveness of the slump stretching and its combined effectiveness along with the conventional therapy are determined it will add evidence for their effectiveness in treating the patients with low back pain. Objective: 1. To study whether the application of slump stretching with conventional therapy can reduce the disability due to pain andincrease the range of motion in patients with non radicular low back pain 2. To evaluate the treatment efficacy of slump stretching in comparing with conventional therapy in patients with non radicular low back pain. Methods and measures: 45 patients with non radicular low back pain satisfying the inclusion and exclusion criteria were randomly assigned to three groups. Group A received the slump with conventional therapy, Group B received slump stretching and group C received conventional therapy. Outcome measures: NPRS Scores, Disability Questionnaire, Active Lumbar Flexion Range Statistical analysis: paired t test is used to compare baseline and post intervention within the group and ANOVA with post hoc analysis is used to compare between the groups. Results: Group A showed significant difference when compared with Group B and Group C. significant difference was found between Group B and C by comparing the mean difference between the groups. Conclusion: from the study we can draw a conclusion that slump stretching is beneficial than the conventional therapy and can be added to conventional therapy protocols in improving the disability status due to low back pain. Slump stretching can be added with other treatment protocols based upon the patient requirements. INTRODUCTION Back pain is an extremely common phenomenon; a price mankind has to pay for their upright posture. Low back pain is a major public health problem all over the world and by definition it is defined as pain, aching, or discomfort localized in the area between the costal margin and the gluteal folds.It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations(1). The prevalence of low back pain varies from country to country but uniformly high in industrialised nations(2). Though the Peak prevalence is in the group between 45 and 60 years of age but most of the people suffer incapacitating low back pain at some stages in their lives. Especially, the prevalence of low back pain in children and adolescents are higher in rates and shown by age of 20 as life time prevalence(3)(4). Most of the patients will have chronic non-specific low back pain which is due to physiological and structural fragility in the lumbar region, and it is often caused by improper posture, which can be called a living functioning impairment. Basically, the structural integrity of the body segment depends upon on joint axis, muscles and nervous structure. Any alteration from normal structural &functional alignment of muscle and it results in alteration of extensibility of nervous system(5). When mechanical stresses applied to nerves evoke physiological responses such as shift in intraneural blood flow, impulse traffic and axonal transport and the joint angulation alter the length of the nerve bed on the opened side of the axis of rotation. This causes the nerve on the expanded side to slide and elongate in counter to that joint movement(6). [VOLUME 6 I ISSUE 2 I APRIL – JUNE 2019] e ISSN 2348 –1269, Print ISSN 2349-5138 http://ijrar.com/ Cosmos Impact Factor 4.236 Research Paper IJRARInternational Journal of Research and Analytical Reviews 357i The lumbar spine consists of both static and dynamic components that are responsible for stability of the spine. Vertebral bodies, intervertebral disc, ligaments, facet joints and joint capsule constitute the static component whereas muscles and tendons of the trunk comprise the dynamic component. Without the assistance of the dynamic component, the lumbar spine buckles under compressive loads less than approximately 90N, whereas the vivo spine can with stands loads of up to 18000N. The important specific muscles needed for the stability of the spine are Transverse abdominis, Erector spinae, multifidus, Quadratus lumborum and Oblique abdominals(7). Slump Stretching: Stretching is one of the techniques or strategies to improve the motor function which involves the application of manual and mechanical force to elongate (lengthen) structures that have adaptively shortened. The term static stretching refers to the method of stretching in which the muscle is slowly elongated to the tolerance and the end position (greatest tolerated length) is held at least 20 to 30 seconds or longer depending upon the patient’s tolerance (8). In recent years, neurodynamic tests have been used as an intervention to potentially to resolve the abnormal physiology within the nervous system. Slump test is one of the neurodynamic tests to rule out whether a herniated disc, neural tension, or altered neurodynamics are contributing to the patient’s symptoms but it can be used as the interventional tool. Several studies have examined the effectiveness of slump stretching for subjects with LBP. Physiologically Slump stretching was effective in reducing the patient’s pain by dispersing intraneural edema, thus pressure gradients, hypoxia and associated symptoms are improved(9). Slump stretching also reduces antidromic impulses generated in C– fibers at the dysfunctional site which results in the release of Neuro peptides and subsequent inflammation in the tissues supplied by the nerve (6). Hence, if the normal neurodynamics are restored by alleviating any sites of neural compression, dissipated friction, anti dormically evoked impulses may perhaps be eliminated. Slump stretching may have outcome in scar tissue reduction, which had gripped to neural tissue and its associated connective tissue structures(10) . Shortwave Diathermy: Shortwave diathermy is the use of high frequency electromagnetic waves of frequency at 27.12MHz and 11m therapeutically (commonly). Physiologically, The thermal heating effects of SWD is vasodilatation, exaggerated rate of nerve conduction and rise in collagen extensibility, acceleration of enzymatic activity, alteration in skeletal muscle strength, and possibly towering of nociceptive threshold (11). When the tissue temperature raised up to 42°C ,it is found to cause a decline in firing rate of type II muscle spindles efferent and γ – efferent and elevates firing rate of type Ib fibers from the Golgi tendon organs. These alteration in nerve fibers lowers the firing rate of α – motor neurons and hence reduction in the muscle spasm is found and non-thermal effects includes superficial wound local oxygen perfusion, enhance nutrient availability, and assist phagocytosis(11).