Scar Mobilization Techniques vs Core Stability Exercises on Scar Tissue and Lumbopelvic Pain

Study Overview
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Brief Summary
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The study will be a Randomized clinical trial to check the effects of scar mobilization techniques with and without core stabilization exercises on scar tissue mobility and lumbopelvic pain in females after a cesarean section suffering from back pain and restricted scar mobility. Duration of study will 6 months, convenient sampling technique used, subject following eligibility criteria from Rafiqa Medical Centre, Sargodha and Fatima Hospital, Sargodha, will randomly be allocated in two groups via lottery method, baseline assessment will be done, Group A participants will be given baseline treatment along with scar mobilization and core stabilization exercises, Group B participants will be given baseline treatment along with scar mobilization for 3 weeks. On the 5th and 9th day, the post-intervention assessment will be done via, Manual Scar mobility testing, Vancouver Scar Scale, Numeric Pain Rating Scale, and Oswestry Disability Index. 3 sessions per week will be given.

Detailed Description
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The study will be a Randomized clinical trial to check the effects of scar mobilization techniques with and without core stabilization exercises on scar tissue mobility and lumbopelvic pain in females after a cesarean section suffering from back pain and restricted scar mobility. Duration of study will 6 months, convenient sampling technique used, subject following eligibility criteria from Rafiqa Medical Centre, Sargodha and Fatima Hospital, Sargodha, will randomly be allocated in two groups via lottery method, baseline assessment will be done, Group A participants will be given baseline treatment along with scar mobilization and core stabilization exercises, Group B participants will be given baseline treatment along with scar mobilization for 3 weeks. On the 5th and 9th day, the post-intervention assessment will be done via, Manual Scar mobility testing, Vancouver Scar Scale, Numeric Pain Rating Scale, and Oswestry Disability Index. 3 sessions per week will be given. Scar mobilization techniques include the gentle stroking and lifting of the scar as well as moving the scar tissue in different directions. It also includes rolling, C- grip, S-grip, and ram horn mobilization of the scar tissue. These techniques are helpful to the physiotherapists to effectively remove the negative effects of poor wound healing, restore the aesthetics of visible tissues and hence improve the functioning of the fascial network, and thus also other parts of the body. Core stabilization exercises administered to the patients after cesarean section include the posture corrective exercises, abdominal draw-in, squatting, pelvis tilting, knee to chest, flexibility, and stretching exercises and bridges. Breathing exercises, isometric, and general mobility exercises were incorporated as baseline exercises in both groups.

Official Title
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Effects of Scar Mobilization Techniques With and Without Core Stability Exercises on Scar Tissue Mobility and Lumbopelvic Pain Following Cesarean Section

Conditions
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Back Pain, Scar Tissue

Intervention / Treatment
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* Other: Scar mobilization techniques
* Other: Core stabilization exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 20 -40 years. Lower segment transverse incision technique used. Minimum 6 weeks postnatal. Completely healed Scar. Limited scar mobilization in any direction or lifting. No complications after the surgery. Exclusion Criteria: Women with an abdominal hernia. Multiple births. Skin irritation or infection at the scar site. Diastasis Recti Abdominis History of abdominal surgery other than cesarean section.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group A: scar mobilization and core stabilization exercises group<br>Group A will perform exercises for 3 weeks. Participants will perform core stabilization exercises as well as scar mobility exercises. All exercises will be performed in 3 sessions per week for a period of 3 weeks. | Other: Scar mobilization techniques<br>* Scar mobilization techniques include the gentle stroking and lifting of the scar as well as moving the scar tissue in different directions. It also includes rolling, C- grip, S-grip, and ram horn mobilization of the scar tissue. Core stabilization exercises administered after cesarean section include the posture corrective exercises, abdominal draw-in, squatting, pelvis tilting, knee to chest, flexibility and stretching exercises, and bridges.<br>Other: Core stabilization exercises<br>* Core stabilization exercises<br>|
| Active Comparator: Group B: scar mobilization techniques group<br>Group B will perform scar mobilization exercises for 3 weeks along with baseline treatment. All exercises will be performed in 3 sessions per week for a period of 3 weeks. | Other: Scar mobilization techniques<br>* Scar mobilization techniques include the gentle stroking and lifting of the scar as well as moving the scar tissue in different directions. It also includes rolling, C- grip, S-grip, and ram horn mobilization of the scar tissue. Core stabilization exercises administered after cesarean section include the posture corrective exercises, abdominal draw-in, squatting, pelvis tilting, knee to chest, flexibility and stretching exercises, and bridges.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Manual Scar mobility testing | The physiotherapist evaluates the appearance and mobility of a healed scar. Mobility is checked by placing the hand or fingertips on or around it. By moving the scar in different directions, the skin's displacement in relation to the fascia is checked. Apart from the free movement of the scar in all directions in the frontal plane, lifting should also be possible. | up to 3 weeks | 
| Vancouver Scar Scale | The VSS evaluates only 4 physical scar features-pigmentation, vascularity, pliability, and height-and the rater assigns an ordinal value for each feature Each feature has word descriptions for all possible options to help the rater assign a proper value. The values translate into numeric scores, which are then summed into an overall score ranging from 0 to 13 points. | up to 3 weeks | 
| Numeric Pain Rating Scale | The NPRS is a segmented numeric scale in which the respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain. The common format is a horizontal bar or line. NPRS is anchored by terms describing pain severity extremes | up to 3 weeks | 
| Oswestry Disability Index | The Oswestry Disability Index is considered the 'gold standard' of low back functional outcome tools. It has 10 different sections. For each section the total possible score is 5. If all 10 sections are completed the score is calculated and interpreted in percentage measures. | up to 3 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cicatrix, Pelvic Girdle Pain, Postpartum Period, scar, back pain