Effect of Talocrural Joint Thrust Manipulation on Mechanical Low Back Pain

Among all disabling musculoskeletal condition, non specific low back pain is most prevalent and universal condition. Its prevalence has increased over years and affects almost all at some phase in their life. Though, there are many causes of low back pain such as, sedentary life style, depression, poor nutritionist diet and so on, yet faulty posture is also one of the noteworthy causes of low back pain which cannot be overlooked. Faulty posture can result from any out of order body component, such as atypical foot biomechanics. Since lower limb is connected in a closed chain, atypical foot biomechanics leads to disruption in the whole chain ascending up to the spine, stressing spine soft tissues, upsetting its normal anatomical position and causing low back pain.

The lower limb is made up of all the structures from feet to pelvic, forming a closed mechanical chain. In this chain if any one segment is out of its neutral position it affects the whole chain. Like, if a foot is out of its alignment can be flattened or highly pronated, it will results in ankle internal rotation i,e. during the early stance phase of gait When the foot pronates, the calcaneus everts while the talus adducts and the plantar flexes. This inferomedial translation of the talus, results in inward rotation of shin and knee. Knee internal rotation, then make femur to rotate medially (internally) and pelvic to tilt anteriorly. This increased tilting of pelvic increases the curvature of the lumbar spine. Excessive curve at lumbar spine places excessive strain on the muscles, tendons and ligaments of the lower back, causing them to inflame and resulting pain. This domino effect, explains how a misalignment in the foot end up negatively effecting the health of one's lower back and a source of non specific low back pain.Though the direct treatment of lumbar region is important for LBP,yet ankle strategy is needed in order to correct the spinal imbalance. This research proceeded with the thought of taking a whole approach i.e. treating the main cause, causing LBP rather than just applying specific approach i.e. giving only symptomatic treatment for pain alleviation. With this approch talocrural/ankle joint is being taken within physical therapy treatment sphere through manipulation technique along with conventional physical therapy protocol for LBP in the current study.

Eligibility Criteria:
Inclusion Criteria:

* Participants falling in this category would be recruited into the study.

  * Willingness of participant.
  * Age group between 21-45 years (both male and female).
  * Localized, Low back pain- Sub acute(6-12 weeks) and chronic low back pain(12 weeks and above)
  * Asymptomatic Ankle- Pronated foot, Flat foot, Healed ankle injuries.
  * Test for inclusion of foot: Feiss line test (Medial Longitudinal Arch Angle), Stress Test for Ankle ligaments (Anterior Drawer Test, Talar Tilt Test, Eversion Stress Test).

Exclusion Criteria:

* Participant failing to fall in this category would be excluded of the study.

  * Any recent injury of spine or lower limb.
  * Any unhealed ankle injuries.
  * Patients with neurological deficit such as paresthesia, numbness and weakness in lower limb.
  * Spondylolysis or any defect or stress fracture in the pars interarticularis of the vertebral arch.
  * Spondylolisthesis or any displacement of vertebra.
  * Spinal fracture or any trauma in spinal column.
  * Spinal tumors (both primary and metastatic tumor).
  * Spinal surgery such as lumbar decompression surgery, lumbar fusion surgery.
  * Artificial disc replacement surgery.
  * Pregnancy.
  * Disc prolapsed such as protrusion, prolapse, extrusion and sequestration.
  * Any spinal curvature defect.
  * Receiving steroid injection within previous 3 months.
  * History of systemic disorder and malignancy.
  * Diagnosed diabetic patients.
  * Diagnosed Osteoporotic patients