Effects of Core Strengthening on Mechanical Low Back Pain in Overweight Adults.
Condition: Low Back Pain, Mechanical; Overweight
MeSH terms: Overweight; Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      The goal of this clinical trial is to determine the effects of core strengthening on
      mechanical back pain in overweight adults.

      The main question is aims to answer:

      Is there an effect of core strengthening on mechanical back pain in overweight adults? The
      participants will be divided into two groups; group A and group B Group A will perform core
      strengthening after baseline treatment of therapeutic hot pack and Trans continuous mode for
      10 minutes.

      Group B will perform conventional exercises after baseline treatment of therapeutic hot pack
      and transcutaneous electrical nerve stimulation. continuous mode for 10 minutes. Each
      exercise will be repeated 10 times, with 10 second holds, followed by a five-minute rest
      interval.
    

Detailed description: 
      Low back pain (LBP) is defined as low back pain that keep on for more than 3 months, and it
      is the most commonly reported clinical symptom of orthopedic diseases. Low back pain has been
      the leading cause of disability globally for at least the past three decades and results in
      enormous direct healthcare and lost productivity costs. More than 50% of people in the United
      States are affected by LBP, and it is the primary cause of work nonappearance and everlasting
      disability. The core muscles, which are the primary muscle group for maintaining spinal
      strength, can be separated into two groups according to their functions and attributes.

      The origin of LBP is complex, several of which are unidentified. Management of chronic low
      back pain (CLBP) is often multidisciplinary, involving a combination of treatments, including
      therapeutic exercises. Core stability exercises aim to improve pain and disability in CLBP
      increasing spinal stability, neuromuscular control, and preventing shear force that causes
      injury to the lumbar spine. One major cause involves the weakening of the shallow trunk and
      abdominal muscles. Another cause of CLBP is the deteriorating of or insufficient motor
      control of the deep trunk muscles, such as the lumbar multifidus and transversus abdominis.
      Lumbar multifidus (LM), the main trunk stabilization muscle, may have reduced efficiency 24 h
      after the onset of acute LBP.

      During physical activities, the trunk muscle tissues ensure the mobility and stability of the
      lumbopelvic region; thus, changes in trunk muscle activity (particularly in the lumbar
      multifidus and transversus abdominis) are typically observed in patients with low back pain.
      Stabilization exercise programs have been widely applied for LBP treatment because they were
      effective in reducing LBP and disability. Core strength training is directed at working out
      the deep trunk muscles. However, autonomous training is challenging for LBP patients despite
      the existence of numerous core strength training strategies. Furthermore, no standardized
      system has been established for analyzing and comparing the results of core strength training
      and typical resistance training (6).

      Core strengthening impression have gained increased popularity in low back rehabilitation.
      Traditional low back pain rehabilitation is based on a stationary spine stability model and
      is composed mostly of modalities, stretching and strengthening exercises (7). More recent
      theories, however, include newer concepts of dynamic spinal stability, coordination and
      neuromuscular control. Core strengthening exercises incorporate these new concepts. Although
      more research is required, the best available evidence suggests that a core strengthening
      program may be advantageous in reducing pain scores, functional disability and recurrences of
      acute low back pain episodes. Strong clinical and emerging epidemiological evidence shows
      that muscle-strengthening exercises is independently associated with multiple health
      outcomes, including a reduced risk of all-cause mortality, incidence of diabetes and enhanced
      metabolic , musculoskeletal and mental health.

      Low back pain (LBP) is an economic burden to society, leading to functional disability
      resulting in loss of number of days at work. Literature review state that 75% or more
      patients with low back become temporarily disabled and around 5% people suffer from permanent
      disability .

      Diagnosis of mechanical low back pain is commonly made by physical examination, physical
      tests, palpation, imaging such as x-rays, MRI, and CT scan. Medication, physical therapy, and
      surgery are most commonly used managements of mechanical low back pain. The physical therapy
      management varies according to the patient condition, and includes modalities, exercise
      therapy, manual therapy and patient's education with a comprehensive home plan of care.

      The individual effectiveness of manual physical therapy and core stability exercises therapy
      are evident in the management of mechanical low back pain, but there is no single study
      available in the literature on the combined effects of physical therapy and core stability
      exercise therapy. The objective of the current study will be to determine the combined effect
      of physical therapy and core stability exercise therapy in the management of mechanical low
      back pain.

      The conventional physical therapy is a commonly used management of mechanical low back pain
      to improve the mobility of the lumbar spine. The core stabilization exercises for
      strengthening of spinal muscles to improve their ability to maintain neutral spine using the
      abdominal, back, neck and shoulder girdle muscles as stabilizers rather than movers. Trunk
      stability exercises that focus on either deep or superficial muscles might produce different
      effects on lumbar segmental motion .

      Obesity is a complex disease that accumulated excess body fat leads to negative effects on
      health.

      Obesity persists to accelerate resulting in an unprecedented epidemic that shows no
      significant signs of slowing down any time soon. Raised body mass index (BMI) is a risk
      factor for illness such as diabetes, cardiovascular diseases, and musculoskeletal disorders,
      resulting in dramatic decrease of life quality and expectancy. The main cause of obesity is
      long-term energy imbalance between consumed calories and expended calories. Here, The purpose
      of our study is to find out the effect of core strengthening on LBP and total body fat.
    

Intervention name(s): Core strengthening with conventional treatment; Conventional treatment
Intervention type(s): Other; Other
Intervention description(s): A detailed musculoskeletal examination of lumbar spine will be performed before the start of treatment. Oswestry Low Back Pain Disability Questionnaire for pain will be noted. An expert physical therapist with more than 7 years clinical experience will assist the patients in performing core stabilization exercise with conventional physical therapy protocol and routine physical therapy exercise. The session with the physical therapist will usually last for up to 40 minutes.
This group will perform planks, side planks and superman exercises along with knee to chest, pelvic rotation, back extension, and bridge exercises after baseline treatment of therapeutic hot pack and transcutaneous electrical nerve stimulation. continuous mode for 10 minutes.; A detailed musculoskeletal examination of lumbar spine will be performed before the start of treatment. Oswestry Low Back Pain Disability Questionnaire for pain will be noted. An expert physical therapist with more than 7 years clinical experience will assist the patients in performing core stabilization exercise with conventional physical therapy protocol and routine physical therapy exercise. The session with the physical therapist will usually last for up to 40 minutes.
This group will perform knee to chest, pelvic rotation, bridge and back extension exercises after baseline treatment of therapeutic hot pack and transcutaneous electrical nerve stimulation. continuous mode for 10 minutes. Each exercise will be repeated 10 times, with 10 second holds, followed by a five-minute rest interval
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: low back pain; overweight; exercise; core strengthening; numerical pain rating scale