Clinical trial NCT06303388: Effects of Bruegger's Exercises Versus Egoscue Exercise on Lower Cross Syndrome
Official title: Effects of Bruegger's Exercises Versus Egoscue Exercise on Lower Cross Syndrome
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Lower Cross Syndrome
Keywords: Pain
Hyperlordosis
Anterior pelvic tilt
Lead sponsor: Riphah International University
Sponsor class: OTHER
First posted: 2024-03-12
Enrollment: 34
Sex: ALL
Minimum age (years): 16
Maximum age (years): 65
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This study aims to find effects of Bruegger's Exercise versus Egoscue exercise on pain and hyperlordosis on patient with lower cross syndrome. This is interventional study which recruits 34 participants ,14 in each group.

Detailed description: A randomized control trial will be conducted on patients with lower cross syndrome. A total number of 34 participants will be randomised into two groups with 17 participants in each group. Both groups will receive Hot Packs on the lumbar area for 10 minutes. Group A will receive Conventional Therapy and will follow protocol of Bruegger's Exercise. Group B will follow protocol of the Egoscue exercise. This study aims to decrease pain and hyperlordosis.

Each group will be assessed at baseline which will include pain through NPRS, hyperlordosis through flexicurve ruler and anterior pelvic tilt through pelvic inclinometer. Data from both groups will again be assessed after 4 weeks of intervention.

Protocol of Bruegger's Exercise: Pt. position: Upright sitting on a chair.

1. Sit with your buttocks at the edge of a chair.
2. Spread your legs apart slightly.
3. Turn your toes out slightly.
4. Rest your weight on your legs/feet \& relax your abdominal muscles.
5. Tilt your pelvis forward (i.e. arch your lower back) while lifting your chest up
6. Rotate your arms outward while turning your palms up.
7. Hold your head high in the air, with a slight arch in the neck.

The patient is to perform this exercise once or twice every 20-30 minutes of prolonged sitting and held in this position for 30-60 seconds. To avoid non-compliance patient will be asked to perform five repetitions of particular exercise with five second hold during their clinical session.

Protocol of Egoscue Exercise The Egoscue group received a total of 10 exercises which includes

1. Static back alone and with breathing
2. Abdominal contraction while in the static back position
3. abductor press
4. Overhead extension
5. elbow curls on a wall
6. Static wall
7. Upper spinal twist
8. pelvic tilts
9. supine groin progressive
10. Air bench exercises

Week 1: 3 times with 10 s hold time Week 2: 5 times with 10 s hold time Week 3: 15 times with 10 s hold time Week 4: 20 times with 10 s hold time

Eligibility criteria: Inclusion Criteria: • Females and males aged between 16 to 65 years

* Participants had to present with low back pain
* Participants had to meet the criteria for lower crossed syndrome indicating tight hip flexors (Modified Thomas test) and erector spinae (visual assessment through toe touching) together with weak glutei (Prone Hip Extension Co-ordination/Strength Test) and abdominals (Trunk Flexion Co-ordination and Strength Test)and thoracic kyphosis.
* Angle of anterior pelvic tilt \> 10 degrees

Exclusion Criteria: • Participants who would be undergoing other forms of treatment that may interfere with the study, for the duration of the study, including other manipulative and physical therapies specific to back pain.

* Presence of other conditions that may mimic low back pain, e.g. nerve entrapment.
* Participants taking any medication that may interfere with the results of this study including, pain medication, anti-inflammatory medication, and muscle relaxants.
* Surgery on the back, pelvis, or sacrum is indicated or has previously occurred
* LBP having localised or radiating pain.
* Practiced any kind of exercise or sports activity during the last 6 months.

Primary outcomes:
measure: Flexicurve Ruler
timeFrame: 12 day
measure: Pelvic Inclinometer
timeFrame: 12 day
measure: NPRS
timeFrame: 12 Day
Secondary outcomes:
measure: Modified Thomas Test
timeFrame: 12 day
measure: Visual Assessment through toe touching
timeFrame: 12 day
measure: Prone Hip Extension Co-ordination Test
timeFrame: 12 day
measure: Trunk Flexion Co-ordination and Strength Test
timeFrame: 12 day
Other outcomes:
Locations:
city: Rawalpindi
country: Pakistan
facility: Pakistan Railway General Hospital
state: Federal
Study officials:
affiliation: Riphah International University
name: Nadia Ishtiaq, MS
role: PRINCIPAL_INVESTIGATOR
References:
citation: Waters T. The effect of Bruegger's exercise on chronic low back pain in association with lower crossed syndrome: University of Johannesburg (South Africa); 2014.
citation: Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006 Jun 17;332(7555):1430-4. doi: 10.1136/bmj.332.7555.1430. No abstract available.
citation: May S, Johnson R. Stabilisation exercises for low back pain: a systematic review. Physiotherapy. 2008;94(3):179-89
citation: Nourbakhsh MR, Arabloo AM, Salavati M. The relationship between pelvic cross syndrome and chronic low back pain. Journal of back and musculoskeletal rehabilitation. 2006;19(4):119-28.
citation: Kudchadkar GS, Gurudut P, Welling A. Comparative effect of mat pilates and egoscue exercises in asymptomatic individuals with lumbar hyperlordosis: A randomized controlled trial. Indian Journal of Physical Therapy and Research. 2019;1(2):79-88.
citation: Sequeira S, Gurudut P, Kage V. Exploring effects of Egoscue versus lumbar stabilisation exercises for lower crossed syndrome on postural stability and hyperlordotic posture correction. Comparative Exercise Physiology. 2023:1-12.
citation: Vehrs Z. The Effect of Egoscue Corrective Exercises on Chronic Knee and Hip Pain: Brigham Young University; 2014.
citation: Laxmi V R, G N, V S, G M, Gopinath Y, G T. Efficacy of Janda's approach versus bruegger's exercise in pelvic cross syndrome and its impact on quality of life. International Journal of Research in Pharmaceutical Sciences. 2020;11:1701-6.
citation: Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976). 2005 Jun 1;30(11):1331-4. doi: 10.1097/01.brs.0000164099.92112.29.
citation: Kahl C, Cleland JA. Visual analogue scale, numeric pain rating scale and the McGill pain Questionnaire: an overview of psychometric properties. Physical therapy reviews. 2005;10(2):123-8.
citation: Macintyre NJ, Bennett L, Bonnyman AM, Stratford PW. Optimizing reliability of digital inclinometer and flexicurve ruler measures of spine curvatures in postmenopausal women with osteoporosis of the spine: an illustration of the use of generalizability theory. ISRN Rheumatol. 2011;2011:571698. doi: 10.5402/2011/571698. Epub 2011 Feb 7.
citation: Khan N, Nouman M, Iqbal MA, Anwar K, Sajjad AG, Hussain SA. Comparing the Effect of Stretching and Muscle Energy Technique in the Management of Lower Cross Syndrome. Pakistan Journal of Medical & Health Sciences. 2022;16(07):31-