Compare the Effects of Decompression on Lumber Disc Protrusion Patient
Condition: Lumbar Disc Herniation
MeSH terms: Intervertebral Disc Displacement; Hernia
Study type: Interventional

Summary: 
      This is an RCT study in which 60 participant are included and half of the participant are
      randomized via lottery method in control and experimental group after fulfilling the
      inclusion criteria. The sampling technique is convenient sampling . The study compare the
      effects of conventional Physical Therapy and Decompression Therapy and determine the
      effectiveness of Decompression as treatment procedure for patients with Lumbar disc
      protrusion. The data collection procedure included the NPRS, ODI, structural questionnaire
      and assesment on the 1st, 4th and 8th visit. Data will be analyzed on IBM SPSS-21
      {Statistical Procedure of Social Sciences} software. The assessment will be done on 1st, 4th
      and 8th visits. after checking the normality of the date the Parametric/Non Parametric test
      will be apply to compare the means of the these groups. The 95% confidence interval will be
      used in term OD p value 0.05
    

Detailed description: 
      Low back pain is the common problem of our society, 80% people experience back pain at some
      stage of their life. Low Back pain life time prevalence is 65% to 80% and It is estimated
      that 28% experience disabling low back pain sometime during their lives.Point prevalence
      ranged from 12% to 33%, 1-year prevalence ranged from 22% to 65%, and lifetime prevalence
      ranged from 11% to 84%.Back pain peak prevalence age is 40-50, First episode of start in the
      20's and recurrence rates between 39-71%. Women tend to be affected more in cervical spine
      problem then men and Men tend to more affected in lumbar spine problem than women. Majority
      (80-90%) of low back disorders occur at the L4/5 and/or L5/S1. The occupational risk factor
      include driving (P<0.001), lifting, carrying, pulling, pushing, and twisting (P<0.001 for all
      variables) as well as nondriving vibrational exposure (P<0.001).

      Maitland divides lumber spine problems into two groups, in first group the L4/5 and L5/S1
      intervertebral discs are frequently a source of symptoms and second group have postural,
      muscles balance, muscles weakness, muscles spasm degenerative changes and mechanical movement
      disorders problems. The L5-S1 Segment is the most common site of problem in the spine because
      this level bears more weight, Center of gravity passes directly through this vertebra,
      transition L5 Mobile and S1 Stable, Large angle B/w L5 & S1 and great amount of movement.

      The intervertebral disk makes up 1/3 of the total length of vertebral column. The disc
      contains 85% to 90% of water, but the amount decrease up to 65% with age. The water binding
      capacity of the disc decrease with age and degenerative changes begin to occur after 2nd
      decade of the life. The Facet joint carry 20-25% axial body load but this may reach 70% with
      degeneration of the Disc. The most significant biochemical change to occur in disc
      degeneration is loss of proteoglycan. This loss is responsible for a fall in the osmotic
      pressure of the disc matrix and therefore a loss of hydration. Loading may thus lead to
      inappropriate stress concentrations along the endplate or in the annulus.

      Decompression therapy is a result oriented approach but it expensive and minimum availability
      in Pakistan. In physical therapy we use different exercise to solve the multiple spine
      problems. Some exercise used to treat orthopedic component such as mobilization,
      manipulation, SNAGS, and traction. Some exercise used to treat myogenic component such as
      Muscle energy technique, neuromuscular reeducation, active isolated stretch etc. Some
      exercise used to treat neurogenic component such as Neurodynamics, Active release technique
      etc. As we know the fascia is important component in our body most of the time the fascia
      restriction make the patient condition verse. Guy Voyer introduce the systems of exercise
      more the 35 years ago which works specially on spine at every intervertebral level including
      costal and pelvic articulation. These exercises are called Elongation Longitudinaux avec
      Decoaption Osteo-Articulaire (ELDOA) or simply Longitudinal Osteo-Articular De-coaptation
      Stretching (LOADS). It can be describe as fascial stretch that's localizes tension at the
      level of a specific spinal segment and create decompression. In which he combined improving
      the tone of the intrinsic muscles of the spine along with reinforcing the extrinsic muscles
      related to the spine aim the back and stretching the interlinking paraspinal muscles. ELDOA
      exercise is design for every level of the spine from base of the skull to sacro iliac joint.
      In each ELDOA exercise we create fascial tension above and below the joint or disc that one
      is trying to "open up" or decompress. The outcomes include; Release vertebral compression,
      improved blood circulation, Disc re-hydration, improve muscle tone and awareness. One of my
      study also proved that ELDOA Exercises improve the pain and functional level in the spinal
      disc protrusion patients.
    

Intervention name(s): Conventional Physiotherapy; Lumber Spinal Decompression
Intervention type(s): Other; Other
Intervention description(s): The treatment will be given in the following way.
Tens
Infrared/Moist Heat heat for 10 minutes at low back region.
Lumbar Mobilization (Maitland) CPA 3 sets of 10 reps
Stretching Exercises (Calf, Hams, Back Extensors) 3 sets of 8-10 reps
Strengthening Exercises (Back Extensors) 3 sets of 8-10 reps
Postural Education
Home Plan
Bed Rest with lumbar Sacral Support
Home plan:
Exercises Posture Correction Precautions Contra indication; The treatment will be given in the following way.
Tens
Infrared/Moist Heat heat for 10 minutes at low back region.
Lumbar Mobilization (Maitland) CPA 3 sets of 10 reps
Stretching Exercises (Calf, Hams, Back Extensors) 3 sets of 8-10 reps
Strengthening Exercises (Back Extensors) 3 sets of 8-10 reps
Postural Education
Home Plan
Decompression therapy session lumbar spinal decompression therapy for 30 minutes.
Home plan:
Exercises Posture Correction Precautions Contra indication
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: control group will recevie conventional physiotherapy sessions while the experimental group receive conventional along with decompression
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Decompression; Disc herniation; ODI; LBP