Effects of Manual Therapy and Inclined Board Standing on Low Back Pain
Condition: Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      To date, there have been limited clinical trials conducted to determine the effects of manual
      therapy combined with passive stretching and inclined board standing for treating low-back
      pain. This will be the first randomized controlled trial to evaluate the effects of these
      integrated interventions. The study aims to develop a new approach towards the cost-effective
      management of low-back pain, in line with the World Health Organization's (WHO) vision of
      maximizing health outcomes, preventing disability, and reducing the cost of care.
    

Detailed description: 
      Manual therapy is a sub-type of physical therapy that uses hands-on maneuver to diagnose and
      treat musculoskeletal pain and dysfunction. Mobilization and manipulation are widely used for
      the management of low-back-pain (LBP), a common and debilitating condition that affects
      millions of people worldwide. The goal of manual therapy is to improve mobility, reduce pain
      and discomfort, and enhance functional capacity. Evidence is growing now a days that is in
      the direction of usage of manual therapy for the treatment of the lower back pain. Many
      studies have demonstrated the effectiveness of manual-therapy procedures such as spinal high
      velocity low amplitude thrust, low velocity and high intensity joint passive movement, and
      massage in alleviating pain and dysfunction and enhancing physical and mental functions in
      clinical cases with lower backache.

      The prime purpose of this research aimed to investigate the relationship between the length
      of the tensor fasciae lata (TFL) and pelvic rotation during one-leg stance in healthy adults.
      41 participants were assessed using a 3-dimensional motion analyzer, and their TFL length and
      hip rotation range of motion were measured. The results divided participants into two groups
      based on their pelvic rotation during one-leg stance. Although there was no significant
      difference in TFL length between the two groups, the study suggests that pelvic instability
      may cause trunk instability during one-leg stance.

      Another study looked at static balance in three different standing positions with and without
      a foam surface. It found that standing over slanted surfaces increased postural unsteadiness,
      and that dorsiflexed ankles over a foam surface created more postural instability.

      To create a human-like biped posture, a study created a Neural Controllable (NC) model to
      represent a human-like biped posture. The model generated physiologically reasonable muscle
      activations and captured the idea that individuals choose a low active stiffness level while
      standing to use less energy.

      Another researcher reviewed the involvement of the "kinetic chain" in overhead athletes and
      applied it to clinical workout adjustments for the prevention and treatment of shoulder
      injuries. The study found that lower extremities, trunk, and scapular area all play a role in
      the formation of adequate terminal segment acceleration during overhead throwing and serving
      actions. The study suggests that traditional shoulder exercises should include scapular
      stabilizer and core musculature activation in addition to rotator cuff activation.

      Research Gap:

      Low-back-pain (LBP) is a Musculo-skeletal ailment that has a negative societal impact and is
      extremely common around the world, causing disability. LBP is one of the most common reasons
      people seek medical attention in the United States, along with neck pain, which is connected
      with the greatest healthcare expenses. Surgical patients are the most expensive per care
      episode, however the vast majority of lower backache management spending can be attributable
      to the substantially higher number of non-operative care episodes.

      In 2021, Academy of Orthopedic Physical Therapy (AOPT) has published updated Clinical
      Practice Guidelines (CPG) for acute and chronic low-back-pain linked to the ICF model for
      physical therapists The updated Clinical Practice Guidelines (CPGs) for the treatment of
      lower back pain (LBP) recommend four interventional categories: exercise, manual and
      other-directed therapies, classification systems, and patient education. The guidelines were
      developed to be applicable globally and acknowledge that differences in factors such as
      healthcare systems, cultural norms, and social health determinants may impact the
      implementation of these recommendations. Physical therapists are the primary audience, but
      other stakeholders may also find the guidelines useful. The CPG update has identified
      knowledge gaps in the treatment of LBP and recommended further research using Single Level I
      RCT or Small-Sample Level II RCTs With Short Follow-up Times to develop better and
      cost-effective management approaches.
    

Intervention name(s): Manual Therapy; Inclined Board Standing
Intervention type(s): Other; Other
Intervention description(s): After the baseline assessment, each intervention group will be given physical therapy treatment. The group A will receive Manual Mobilization of the Lumbosacral Spine followed by passive stretching of the hip abductors of both sides of the body. The patient then will be asked to stand on the inclined board for 01 minute with feet 3 to 4 inches apart hands placed on the wall at the level of shoulder joints. After 01-minute patient will be asked to leave the inclined board. The patient will be advised to do this 01-minute inclined board standing for three times a day at home. All the patients in Group A will receive this treatment regime for two weeks.; The patients in Group B will be asked to stick to their medications if advised and stand on the inclined board for 01 minute. Inclined boards will be provided to all patients and will be advised to follow the inclined standing for 01 minute for three times a day at home for two weeks. After two weeks at the completion of intervention, they will be assessed through self-reporting questionnaires of the study.
Other intervention name(s): Passive Stretching; Inclined Board Standing; Routine medications(if any)
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two arm parallel research involves two groups randomized into Interventional Group-A and Interventional Group-B. The unit of randomization will be Agile Institute of Rehabilitation Sciences. This study will use 2 (between groups: Effects of mobilization with passive stretching of lateral rotators along with inclined board standing vs Inclined board standing) ×3 (time: before vs. after vs. 4 weeks after follow-up) mixed design to measure the effects of mobilization, passive stretching of hip abductors and inclined board standing on low back patient.
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Low Back Pain; Manual Therapy; Passive Stretching; Inclined Board Standing