Effects Of Posterior Oblique Sling Strengthening on Temporo-Spatial Gait Parameters in Young Adults

The aim of this study is to determine the effects of posterior oblique sling strengthening on gait parameters (speed, stride length, and cadence), gluteus maximus strength, latissimus dorsi flexibility, and trunk rotation in young adults. A randomized clinical trial will be conducted at Riphah Internal university, Rawal General \& Dental Hospital and Rawal Institute of Rehabilitation \& Health Sciences. Recruiting 48 participants aged 18-30 years with unilateral or bilateral posterior oblique sling tightness. Participants will be randomly assigned into two groups through the sealed envelope method. The intervention will be performed four times per week for three weeks, followed by a home-based program from weeks 4 to 6. Assessments will be conducted at baseline, post-1st session, weekly during intervention, and at week 6. Tools used include Inclinometer (for lumbar range of motion), Goniometer (to assess latissimus dorsi length), Waistband Pedometer (to measure gait parameters such as cadence, walking speed, and stride length), Hand-held Dynamometer (to assess gluteus maximus strength), Inches Tape (for Pectoralis Minor Length Test to evaluate muscle flexibility and scapular positioning) and demographic measures..

The posterior oblique sling, consisting of the latissimus dorsi, gluteus maximus, and thoracolumbar fascia, is vital for lumbar-pelvic stability and efficient force transmission during movement. The gluteus maximus plays a key role in transferring force from the lower limb to the pelvis, stabilizing the lumbar region. Tightness in the POS can restrict hip extension by limiting the flexibility of the gluteus maximus and hamstrings, affecting gait efficiency and coordination. Increased gait speed improves arm swing, coordination, and trunk rotation, while limited arm swing reduces gait efficiency. Prolonged sitting in younger adults (ages 20-30) can tighten the POS, weakening the posterior chain and raising back pain risk. Targeted stability exercises are key to prevention.

Disruptions in the posterior oblique sling, such as gluteus maximus weakness or thoracolumbar fascia tightness, can lead to compensatory latissimus dorsi overactivation, reduced lumbar mobility, and altered scapular motion, worsening chronic low back pain. Enhanced arm swing improves coordination, gait speed, and stride length, highlighting upper body influence on lower body movement.

Intervention for posterior oblique sling tightness focuses on improving mobility and lumbar-pelvic control through a combination of techniques. Muscle Energy Techniques are applied to the latissimus dorsi and gluteus maximus to release tension and enhance flexibility. Dynamic stretching and myofascial release are incorporated to further improve muscle mobility and fascia flexibility. Functional exercises, such as resisted trunk rotation, engage the POS to enhance stability and coordination. Additionally, exercises like the abdominal drawing-in maneuver combined with prone hip extension target core strength and lumbar control, while the Prone Hip Extension with 125° of left shoulder abduction supports improved trunk and gait stability, addressing the interconnectedness of the posterior chain.

Collectively, these findings underscore the importance of addressing muscle imbalances in the POS through targeted strengthening exercises and gait training, which are essential for improving dynamic stability, alleviating CLBP symptoms, and restoring functional movement. Sedentary behaviors in young adults contribute significantly to posterior oblique sling (POS) dysfunction, manifesting as tightness and weakness in key muscle groups, which adversely affects gait mechanics, musculoskeletal health, and overall quality of life. The POS, comprising the gluteus maximus, latissimus dorsi, and thoracolumbar fascia, plays a critical role in trunk rotation, dynamic stability, and efficient gait patterns. Despite its importance, there is a noticeable gap in specialized interventions targeting POS dysfunction, leaving many young adults at risk of poor mobility, musculoskeletal injuries, and long-term health complications

Eligibility Criteria:
Inclusion Criteria:

* Age 18-30 years.
* Both Genders: Male and Female.
* Participants either unilateral or bilateral POS tightness.
* Participants had latissimus dorsi tightness indicates:
* Modified rotation test (10-degree rotation difference than contralateral side)
* Participants had gluteal maximus weakness indicates:
* Prone hip extension test (unable to lift leg more than 15 degrees or do compensatory mechanism)

Exclusion Criteria:

* Participants who have pectoralis minor tightness indicates:
* Pectoralis Minor Length Test (assessing the ability to flatten the posterior shoulder with posterior force applied in a supine position distance greater than 2.6 cm (1 inch) by inches tape indicate Pectoralis Minor tightness).
* Diagnosed Lumbar spondylosis.
* Diagnosed disc prolapse.
* Diagnosed neurological deficits.
* Diagnosed cerebellar or vestibular lesions impacting balance and gait.
* The presence of knee, ankle, or hip pathologies that impair lower limb function.
* Spine surgery within the past 12 months
* Unable to understand and follow the commands