Effects of Retro Walking in Chronic Non-specific Low Back Pain
Condition: Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      Chronic low back pain (CLBP) is a clinical entity that can be defined as back pain with
      duration of more than 12 weeks. Chronic low back pain is associated with restriction in daily
      physical activities that ultimately leads to disuse atrophy of muscles. Moreover, weak and
      atrophied muscles around the lumbar spine cause immense immobility and recurring low back
      pain in these patients. The objective of this study will be to determine the effect of retro
      walking on pain, physical function and flexibility in chronic non-specific low back pain.

      This study will be a randomized controlled trial and will be conducted in physiotherapy
      department in DHQ hospital Nankana Sahib. The study will be completed in time duration of six
      months after the approval of synopsis and consecutive sampling technique will be used. 40
      subjects will be divided in two groups. Group A will follow retro walking and conventional
      treatment while group B will follow only conventional treatment. Data will be collected by
      all participants before 1st session after 6th session and at the end of 12th session by using
      NPRS, MODI, sit and reach test and Modified schobber's test. Data will be analyzed by
      SPSS-25.
    

Detailed description: 
      Chronic low back pain (CLBP) is a clinical entity that can be defined as back pain with
      duration of more than 12 weeks. Epidemiologic evidence suggests that 50% of the general
      population experiences CLBP and around 70% have encountered at least one occurrence of it
      during their lifetime.Chronic low back pain is associated with restriction in daily physical
      activities that ultimately leads to disuse atrophy of muscles.Moreover, weak and atrophied
      muscles around the lumbar spine cause immense immobility and recurring low back pain in these
      patients The prevalence of low back pain increases peak between 35-55 years of age.Low back
      pain is caused by a degenerated or damaged facet joint or sacroiliac joint with soft tissue
      injury on the trunk or by lumbar instability from weakened muscle strength.Lumbar instability
      restricts muscle strength, endurance, flexibility, and active range of motion (AROM). In
      particular, patients with Chronic low back pain (CLBP) persisting for more than 6 months
      restrict trunk movement to minimize pain in the lumbosacral area or leg, which aggravates the
      level of lumbar muscle weakness in paraspinal muscles and the multifidus.These changes
      increase lumbar instability and raise the recurrence of low back pain. Patients with CLBP
      suffer from deteriorated physical functions and production activities due to weakened muscle
      strength in the lumbar region.

      In 2015 Yun Ha Park et al, conducted a study to confirm the effect of various forms of
      walking on health related physical fitness, lumbar muscle strength, range of motion and the
      pain index. Forty females were divided into 4 groups: walking forward (n=10), walking
      backward (n=10), walking forward & backward (n=10), and control group (n=10). All
      participants in walking groups walked 50 min/day and 3 days/week during 10 weeks. The results
      of study concluded that walking forward, walking backward, and walking forward & backward
      caused significant changes in health related physical fitness, lumbar muscle strength, ROM
      and pain. Especially the group of walking backward showed low figures in pain.

      In a study conducted by Kim SH et al, in 2016 twenty five unilateral exercise athlete were
      included. The purpose of this study was to investigate the effect of backward walking on
      isokinetic muscular function, low back pain index and lumbo sacral angle in unilateral
      exercise athletes. Backward walking was performed with a frequency of three times a week by
      60 minutes at a time for 10 weeks. Comparison of related variables before and after backward
      walking was verified. This study concluded that backward walking improves muscle strength of
      the lumbar vertebra and reduces the lumbosacral angle and appeared to reduce the pain of the
      lumbar vertebra.

      In an experimental study conducted by Manisha Rathi et al in 2017, 30 women having mechanical
      low back pain were divided in 2 groups Group A and Group B. Group A underwent core
      strengthening exercises and hot pack for 10 min, and Group B underwent same protocol along
      with Retro-walking for 10 min, the protocol was given for 4 weeks, outcome measures were NPRS
      at rest and activity and core strength. Results showed that there was significant reduction
      in NPRS at rest and activity in both the groups but group B showed more reduction.

      In 2018 Ansari B et al, conducted an experimental study to investigate the electromyographic
      activity of lumbar multifidus (MF) and erector spinae (ES) muscle during forward walking (FW)
      and backward walking (BW) in participants with and without chronic low back pain (CLBP). 25
      health and 25 chronic low back pain patients was included. Study concluded that BW leads to
      greater activation of the paraspinal muscles. Along with global extensor (ES), activity of
      core extensor (MF) is also higher during BW than FW in both healthy participants and CLBP
      patients. BW is a more favorable aerobic activity to enhance lumbar para spinal recruitment.
      These findings may have important clinical implications in the rehabilitation of CLBP.

      In a study conducted by Ansari S et al, in 2020 thirty athletes with low back pain were
      randomly assigned in two groups. One group was given conventional treatment and other was
      given retro walking and conventional treatment. . Pain, flexion range of motion, balance, and
      muscle fatigability were examined before and after 4 weeks of the intervention. Study
      concluded that retro walking when added to conventional exercises may be helpful in reducing
      chronic mechanical LBP and improving dynamic balance but has no additional effect in
      improving the flexion range of motion and reducing muscle fatigability.

      The literature has proved the significant effects of retro walking on pain, balance, and
      range of motion in athletes, but its effects on physical function, pain and flexibility of
      hamstrings and flexibility of lumbar spine in chronic non- specific low back pain in general
      population are still needed to be investigated further. The objective of current study will
      be to determine the effects of retro walking on pain, physical function and flexibility in
      chronic non-specific low back pain.
    

Intervention name(s): Retro walking; conventional physical therapy
Intervention type(s): Other; Other
Intervention description(s): Retro walking will be performed on treadmill for 15 min per day for 3 days per week for 4 weeks at self-paced speed.; hot pack for 10 mints and conventional exercise program Conventional physiotherapeutic exercise program which consist of exercises such as
prone leg extension
prone lying chest elevation
prone extension with alternate arm and leg lift
supine bridging, bridging with one leg lift Each exercise will be performed as 2 sets of 12 repetitions of each exercise, each exercise position maintained for 10 s, and a rest of 1 min between the sets will be perform. No external load/resistance will be provided for the exercises, and the participants will be perform the exercise within their available range of motion
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment