Sequential Core Stability Corrective Exercise Approach in Lower Crossed Syndrome

Study Overview
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Brief Summary
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The objective of the study will be to determine the effects of Sequential Core Stability Corrective Exercise Approach for Alignment and Muscle Function in Lower Crossed Syndrome.

Detailed Description
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Lower Crossed Syndrome is one of common postural disorder which occurs due to the muscular imbalance. It refers to specific altered muscle activation and movement patterns along with some postural deviations. Alterations in muscle activation include overactivity of hip flexors and lower back muscles paired underactivity of abdominals and gluteus muscle. This pattern of imbalance creates dysfunction. Postural correction exercise with inner and outer core muscles are necessary. There are different traditional structural approach, functional approach and biomechanics and are presumed to lead to adjustments in the length and strength of local muscles while ignoring other related malalignments and core stability. The objective of the study will be to determine the effects of Sequential Core Stability Corrective Exercise Approach for Alignment and Muscle Function in Lower Crossed Syndrome. It will be a randomized controlled trial. Sample size will be collected after running the pilot study. The participants will be recruited through convenient sampling technique and then allocated randomly to Groups. Outcome measures will be alignment and muscle function. Pre and post reading and after one month follow-up will be recorded. Data will be analyzed using statistical package for social sciences software version 25. After assessing normality of data by Shapiro-Wilk test, it will be decided either parametric or nonparametric test will be use within a group or between two groups. Keywords: Alignment, Core Stability, Diaphragm, Muscular Imbalance, Muscle thickness Pelvic floor.

Official Title
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Sequential Core Stability Corrective Exercise Approach for Alignment And Muscle Function In Lower Crossed Syndrome

Conditions
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Low Back Pain

Intervention / Treatment
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* Other: Control
* Other: Sequential Core Stability Corrective Exercise Approach


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Age group between 18 to 28 years No current incidence of low back pain or past history of low back dysfunction Kendall double leg lowering test: Abdominal muscle weakness to the extent of not being able to maintain posterior pelvic tilt during a double leg lowering test in supine position. Diagnosed with lower cross syndrome through assessment criteria of Janda muscle testing and assessment Exclusion Criteria: • Having any history of low back pain, spinal trauma, Joint dysfunction in past 3 months Congenital deformities at hip or lumbar region, Recent fracture to related joints in past 6 months Any family history of cardiopulmonary disease Any disease or urogenital tract Participants having BMI above 30. Recent history of hepatitis or Fatty liver or Any athlete having high physical activity. History of abdominal, hip or lumbar surgeries in past 3 months

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 28 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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
Interventional Model Description: 2
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: A: Control<br>Corrective Exercises Hip Flexor Stretch 30 seconds hold 3 repetitions on each side Thoracolumbar extensors stretch 30 second holds 3 repetitions Abdominal Curl ups with hands at side 10 repetitions 2 sets Progression: • Abdominal curl up with arms crossed • Abdominal curl ups with hands behind head Pelvic bridging 10 seconds hold 10 repetitions 2 sets | Other: Control<br>* Hip Flexor Stretch 30 seconds hold 3 repetitions on each side Thoracolumbar extensors stretch 30 second holds 3 repetitions Abdominal Curl ups with hands at side 10 repetitions 2 sets Progression: • Abdominal curl up with arms crossed • Abdominal curl ups with hands behind head Pelvic bridging 10 seconds hold 10 repetitions 2 sets<br>|
| Experimental: B: Sequential Core Stability Corrective Exercise Approach<br>Corrective Exercises Diaphragm Training Program As per standardized pulmonary rehabilitation guidelines,. Participant will be advised to breathe in gently with an improved tidal volume for ten repetitions, then after a short interval of break 15 repetitions will be done again. 30 Repetitions in set of 15, 15 with the interval rest. 2 sets. Pelvic floor Muscle training Participants will be asked to do pelvic floor training with high intensity (close to maximum) contractions with holding each muscle contraction for 6-8 seconds with relaxation of 6 seconds. Total 8 to 12 contractions. Core Stability exercises Beginning Progressing Advanced | Other: Sequential Core Stability Corrective Exercise Approach<br>* Corrective Exercises Diaphragm Training Program As per standardized pulmonary rehabilitation guidelines,. Participant will be advised to breathe in gently with an improved tidal volume for ten repetitions, then after a short interval of break 15 repetitions will be done again. 30 Repetitions in set of 15, 15 with the interval rest. 2 sets. Pelvic floor Muscle training Participants will be asked to do pelvic floor training with high intensity (close to maximum) contractions with holding each muscle contraction for 6-8 seconds with relaxation of 6 seconds. Total 8 to 12 contractions. Core Stability exercises Beginning Progressing Advanced<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Photometry for Pelvic Tilt | Angle of Pelvic tilt will be measured Through a Reliable and validated camera. | 6th Week | 
| Photometry for Chest Expansion | Angle of Chest expansion will be measured at Nipple line, Xiphoid level and at waist level, Through a Reliable and validated camera. | 6th Week | 
| Photometry for Cervicothoracic level | Angle of C7-T1 will be measured Through a Reliable and validated camera. | 6th Week | 
| Photometry for Lumber flexion | Angle of Lumber curve will be measured Through a Reliable and validated camera. | 6th Week | 
| Diaphragmatic excursion | To assess the diaphragmatic motion by M-mode US a 2.5-5 megahertz (MHz) phase array will be used. | 6th Week | 
| Levator ani Excursion | To assess the pelvic floor motion by M-mode US a 2.5-5 megahertz (MHz) array will be used. | 6th Week | 
| Diaphragmatic thickness and thickening | diaphragmatic thicknesses and thickening will be assessed by B-mode ultrasonography during various respiratory maneuvers | 6th Week | 
| Levator ani thickness and thickening | Levator ani thicknesses and thickening will be assessed by B-mode ultrasonography during various respiratory maneuvers | 6th Week | 
| Core stability | It will be measured by Pressure biofeedback unit for the transverse abdomens. | 6th Week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Forced Vital Capacity (FVC) | Pulmonary function test through spirometer, It will be measured by digital spirometer. | 6th Week | 
| Forced Expiratory Volume per second FEV1 | Pulmonary function test through spirometer, It will be measured by digital spirometer. | 6th Week | 
| Ratio of FEV1/ FVC | Pulmonary function test through spirometer, It will be measured by digital spirometer. | 6th Week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Alignment, Core Stability, Diaphragm, Pelvic floor, Dysfunction