Non Pain Contingent Spine Rehabilitation Therapy in Chronic Low Back Pain
Condition: Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      The aim of study is to determine effects of non pain contingent spine rehabilitation in
      chronic low back pain.A Randomized controlled trial will be conducted at Railway general
      hospital.

      Sample size will be 32.Participants will be divided in two groups, 16 participants in group A
      will receive Non pain contingent spine rehabilitation (NCSR) therapy and 16 Group B will
      receive conventional physical therapy. The study duration will be six months. Purposive non
      probability sampling technique will be applied.
    

Detailed description: 
      Low back pain is defined as pain and discomfort below the costal margin and above the
      inferior gluteal folds. It has different characteristics such as aching, burning, stabbing,
      sharp or dull, well-defined, or vague. Low back pain may have intensity varying from mild to
      severe . Low back pain (LBP) causes more disability than any other medical condition
      worldwide Low Back Pain has a significant impact on functional capacity, as pain restricts
      occupational activities and is a major cause of absenteeism. Chronic low Back pain is defined
      as chronic when pain remains for more than three months it has different characteristics.
      Many authors define chronic pain as pain that lasts beyond the expected period of healing.
      Low back pain is classified and treated according to duration of symptoms, cause, absence or
      presence of radiculopathy and associated anatomical and radiographic changes. Symptoms
      persisting for less than 4 weeks is defined as acute low back pain and in sub-acute low back
      pain symptoms lasts for 4-12 weeks, chronic low back pain lasts for more than 12 weeks. Back
      pain can also be categorized into specific and nonspecific back pain, Specific back pain has
      a specific cause for example fracture and infection etc. and nonspecific is of unknown
      etiology. Non-specific pain is most common type of back pain. The prevalence of low back pain
      has been reported among many people especially when resulting from work related and
      occupational activities 75-84% of the general population suffer from low back pain and among
      them, it is estimated that 5-10% of the people experience LBP resulting in severe morbidity,
      increased health care costs, sick leaves and individual suffering. Men and women are equally
      reported to be affected by this condition. Core muscles maintain spinal stability, first
      group include deep core muscles also called local stabilizing muscles primarily include the
      transversus abdominis, lumbar multifidus, internal oblique muscle and quadratus lumborum.
      Second group include shallow core muscles, also known as global stabilizing muscles,
      including the rectus abdominis, internal and external oblique muscles, erector spinae,
      quadratus lumborum, and hip muscles. The causes of chronic low back pain are complex, several
      of which are unknown one major cause involves the weakening of the shallow trunk and
      abdominal muscle, another cause of chronic low back pain is the weakening of deep trunk
      muscles, such as the lumbar multifidus and transversus abdominis. Patients usually experience
      pain during lifting it leads to avoidance behavior and cause disability. Less intensive and
      cost effective non pain contingent rehabilitation therapy could target fear avoidance
      behavior toward lifting and in restoration of normal function.

      In female patients with chronic low back pain, Primary outcome measures were recorded by
      visual analogue scale (VAS) and oswestry disability index (ODI) .Patterns of improvement
      suggested that the Non pain Contingent Spinal Rehabilitation approach is more effective than
      Conventional Physical Therapy in female patients with chronic low back pain. It is feasible
      to adapt progressive Isoinertial lifting evaluation for determining the lifting capacity, it
      is a valid and reliable method. Lumbar dynamic strengthening exercises are beneficial in the
      treatment of chronic nonspecific LBP for reduction of pain, improvement in functional
      ability, increase range of motion and improve core strength. Exercise intervention programs
      involving either muscular strength, flexibility or aerobic fitness is beneficial for
      nonspecific chronic low back pain. Effects of lumbar stabilization exercise on functional
      disability and lumbar lordosis angle in patients with chronic low back pain in 2015 Lumbar
      stabilization exercise and conservative program were performed 3 times a week for 6 weeks and
      he reported that lumbar stabilization exercise is more effective than conservative treatment
      for improving functional disability and lumbar lordosis angle, and significant decrease in
      Oswestry disability index score. Comparative effect of core muscles strength training with
      supine bridging over prone bridging in patients with nonspecific low back pain and concluded
      that prone bridging exercise is more effective in improvement of functional activities and
      reducing pain than supine bridging exercise program in nonspecific low back pain.
      Effectiveness of core stabilization exercises and routine exercise therapy in management of
      pain in chronic non-specific low back pain" in which he reported that Core stabilization
      exercise is more effective than routine physical therapy exercise in terms of greater
      reduction in pain in patients with non-specific low back pain. In 2013 The purpose of the
      study was to determine the effect of core stabilization exercises in comparison with
      conventional exercises on pain, functional status in patients with non-specific LBP and they
      concluded Core stabilization exercises found to be more effective in reducing pain and
      improving functional status by decreasing disability of patients with non-specific low back
      pain in comparison with conventional exercises. Progressive Isoinertial Lift Evaluation
      (PILE) method was developed by Mayer et al.in PILE protocol describes it as lifting of weight
      in a box from floor to waist (lumbar test) or from floor to shoulder height (cervical test)
      at a rate of four lifts in a 20 second interval.
    

Intervention name(s): NCSR Program; conventional physical therapy
Intervention type(s): Other; Other
Intervention description(s): flexibility exercise,strengthening exercise,dynamic strengthening exercise,endurance training,counselling session; hot pack,flexibility training,strengthening exercise.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Low Back Pain; Non Pain Contingent Spine Rehabilitation