Additional Gluteal Control Training for Low Back Pain With Functional Leg Length Inequality

Study Overview
=================
Brief Summary
-----------------
Low back pain (LBP) is a prevalent musculoskeletal disorder. A variety of exercise interventions which were designed as randomized control trails (RCTs) have been studied and shown effectiveness in improving pain and disability. These exercises typically focus on the abdominal and back musculature strength. However, many LBP patients did not show any improvement in their symptom after they carry out those exercise programs.

Detailed Description
-----------------
Low back pain (LBP) is a prevalent musculoskeletal disorder. A variety of exercise interventions which were designed as randomized control trails (RCTs) have been studied and shown effectiveness in improving pain and disability. These exercises typically focus on the abdominal and back musculature strength. However, many LBP patients did not show any improvement in their symptom after they carry out those exercise programs. Some authors consider that this type of low back pain may be caused by leg length inequality (LLI) in these patients, which resulted from poor gluteal neuromuscular control or muscles' imbalance. In consideration of few studies have been done for investigating the effects of gluteal muscles control training in LBP. Thus, the purpose of this study is to investigate the effect of additional gluteal muscles control training on improving functional LLI in patients with LBP. We hypothesized that gluteal muscle control training would be more effective in self-reported pain, and their functional disability would be improve after 6-week training program than control training group.

Official Title
-----------------
Additional Gluteal Control Training for Low Back Pain With Functional Leg Length Inequality: A Ramdomized Controlled Trail

Conditions
-----------------
Low Back Pain, Recurrent

Intervention / Treatment
-----------------
* Other: GC group
* Other: CG group


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: non-specific LBP (from inferior rib margin to the gluteal fold) more than 3 months Visual Analog Scale ≧5 (in past one month) pelvic innominate rotation (anterior rotation in dominant side) Exclusion Criteria: history of fracture or surgery congenital anomalies in the spine, pelvis, or lower limbs recent trauma, tumor, pregnancy or scoliosis lower extremity paresthesia, unknown weakness bowel and bladder dysfunction predominant lower extremity pain with standing presence of system illness, no reasoning weight loss, predominant night pain specific sacroiliac joint dysfunction

Ages Eligible for Study
-----------------
Minimum Age: 20 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: GC group<br>It mainly involve core stability exercise, stretching exercise and gluteal control training. All of above will be arranged 3 times a week for a total 6 weeks. | Other: GC group<br>* core stability training: hold 5s/rep, 20 reps/times supine, pelvic posterior tilt with TrA contraction. supine, pelvic posterior tilt and maintain bil. knee on 90 degrees. All four position with leg raise Stretching ex. : hold 15 s/reps, 5 reps/times Hamstring Quadriceps Additional gluteal muscle control training: hold 10 s/reps, 20 reps/times 1st to 2nd: clam ex. without resistance single leg bridge with maintain bil. ASIS even level 3rd to 4th: maintain 1st to 2nd ex. with resistance 5th: maintain 3rd to 4th ex. single leg standing on rock board to maintain balance 6th: maintain 5th ex. lunge ex. without hip internal rotation<br>* Other names: Additional gluteal muscle control training;|
| Experimental: CG group<br>It involve core stability exercise and stretching exercise. All of above will be arranged 3 times a week for a total 6 weeks. | Other: CG group<br>* core stability training: hold 5s/rep, 20 reps/times supine, pelvic posterior tilt with TrA contraction. supine, pelvic posterior tilt and maintain bil. knee on 90 degrees. All four position with leg raise Stretching ex. : hold 15 s/reps, 5 reps/times Hamstring Quadriceps<br>* Other names: General core strengthening;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Leg Length Inequality | functional leg length inequality | change from baseline at 6 weeks later | 
| Ilium Anterior Tilt Difference | bilateral ilium anterior tilt difference | change from baseline at 6 weeks later | 
| Pelvic Inclination | bilateral pelvic inclination | change from baseline at 6 weeks later | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Intensity | Visual Analog Scale (VAS) (0-10) Maximum: 10 Minimal: 0 higher scores mean a worse outcome | change from baseline at 6 weeks later | 
| Functional Disability | Oswestry disability index (ODI) Maximum: 100 Minimal: 0 higher scores mean a worse outcome | change from baseline at 6 weeks later | 
| Functional Ability | PSFS (0-10) Maximum: 10 Minimal: 0 higher scores mean a better outcome | change from baseline at 6 weeks later |