The Effects of Lumbar Stabilization Exercises With and Without Jaw Movements in Non-specific Low Back Pain.
Condition: Chronic Nonspecific Low Back Pain; Core Stability; Jaw Movements; Temporomandibular Joint
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      Core stability strength & coordination is necessary to perform smooth & coordinated upper &
      lower extremity movements & function. Altered core stability muscle strength, coordination &
      poor motor control can cause low back pain (LBP). Physical therapists especially those
      working with children having neurodevelopmental problems or adults with neurological
      disorders such as stroke are aware of the concepts of global movements. In this concept,
      alterations in one body segment may bring changes in other body segments. In neurological
      rehabilitation, the concept of Neuro-Developmental Technique (NDT) introduced by Bobath got
      worldwide recognition. This concept states that there are specific key points in the neck, &
      shoulders that can facilitate normal movements by enhancing the activity of core musculature
      in functional movements for instance, sit to stand & walking. This concept was further
      explored by Burnstein and suggested that biomechanically body joints and motor control works
      together as functional unit and not as single limb movement. Bobath and proprioceptive
      neuromuscular facilitation (PNF) concepts further explained that movements of the eye, head
      and neck facilitate trunk movements. Electromyography studies have shown that both single and
      rhythmical jaw opening and closing movements not only produced well-coordinated jaw and
      head-neck movements but also produced atlanto-occipital and cervical spine joints movements.
      The author further concluded that mouth opening and closing in fetal yawning is associated
      with head extension-flexion movements indicating that functional connections between the jaw
      and head-neck is innate. A human jaw or masticatory system is connected to the motor system
      through cranial nerves unlike central motor system which is connected to the body through
      spinal motor system. Brainstem central pattern generator (CPG) control masticatory system
      through descending pathways and are involved in voluntary movements of the jaw such as mouth
      opening and closing. The higher brain centers cortical masticatory area and primary motor
      cortex control these movements. In the current back pain literature core stability exercises
      have been used in the management of chronic low back pain. The jaw is connected to the
      head-neck and neck is connected to the trunk. Therefore there is to study the effects of core
      stability exercises performed with and without jaw movements in the management of chronic low
      back pain.
    

Detailed description: 
      A randomized experimental controlled trial will be carried out to compare the effectiveness
      of core stabilization exercises performed with and without jaw movements in the management of
      nonspecific chronic low back pain. A total of 80 male and female volunteers having subjects
      with chronic nonspecific low back pain will be recruited in this study. All subjects will be
      assessed for transverse abdominal muscle strength contraction, pain and disability using
      Pressure Biofeedback Unit (BPU), Numeric Pain Rating Scale (NPRS 0-10cm) and Ronald Morris
      Disability Questionnaire (RMDQ 0-24) respectively. The scores on the mentioned scales will be
      documented as per guidelines. After baseline assessment, all subjects will be allocated to
      two groups through computer-generated random sampling. Group 1 will perform core stability
      exercises alone; Group 2 will perform core stability exercises with teeth clenching This
      study will be conducted at the Physiotherapy Department of Sindh Institute of Physical
      Medicine and Rehabilitation (SIPM&R). The computer-generated random sampling technique will
      be used to allocate the participants into the study groups. Data will be analyzed using SPSS
      22 and one-way repeated measure ANOVA will be applied to see the mean difference in the 2
      groups. For pair-wise comparison, the Tukey test will be applied. For pain and disability
      scales Friedman's test will be applied to see the two scales' median differences.
    

Intervention name(s): core stability exercises with teeth clenching; core stability exercises
Intervention type(s): Other; Other
Intervention description(s): The intervention frequency will be 2 sessions per week for the duration of 6 weeks, comprising of 45 minutes session. Both groups will receive heat pack on lumbar spine for 12 minutes and both interventions will be held under the supervision of qualified Musculoskeletal Physiotherapists. During intervention and after 6 weeks of intervention.; The intervention frequency will be 2 sessions per week for the duration of 6 weeks, comprising of 45 minutes session. Both groups will receive heat pack on lumbar spine for 12 minutes and both interventions will be held under the supervision of qualified Musculoskeletal Physiotherapists. During intervention and after 6 weeks of intervention.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment