KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. / Name of the Candidate and Address
( In block letters) / RAKHI SINHA
D/O MR. RAMSHANKAR PRASAD,
NEAR WOMENS COLLEGE, KASHIPUR,
SAMASTHIPUR, BIHAR-848 101.
2. / Name of the Institute / LAXMI MEMORIAL COLLEGE OF PHYSIOTHERAPY, MANGALORE
3. / Course of study and Subject / MASTER OF PHYSIOTHERAPY(MPT)
2 YEARS DEGREE COURSE
PHYSIOTHERAPY IN MUSCULOSKELETAL CONDITIONS AND SPORTS.
4. / Date of Admission to the Course / 18 JUNE 2009
5. / Title of the topic / EFFICACY OF SPECIFIC STABILIZATION EXERCISES AND CONVENTIONAL BACK EXTENSION EXERCISES IN THE MANAGEMENT OF CHRONIC DISC PROLAPSE. A COMPARATIVE STUDY
6. / Brief Resume of the intended work
6.1 NEED FOR THE STUDY
•Athletes are at high risk of sustaining a lower lumbar spine injury as they perform a demanding tasks and sometimes they damage the intervertebral disc because of excessive weight bearing.
•Athletes, although being fit and active are known to reduced risk of back pain, but this is negated by research showing that high volume training performed by elite athletes may increase the risk.1
•Because all movements happen and begins at core then progress out to arms and leg , core strength is very essential. It is seen that:-
•Core efficiency enables the structures to operate optimally in the distribution of weights, absorption of force and transfer of ground reaction forces.
•Muscle requires training of optimal functioning.The core stabilization training concepts involves spinal stabilization which must be adequate to effectively utilize strength, power,neuromuscular control and endurance of prime movers.
•A weak core means decreased force production and efficiency and this may result in injury.
•Core stability is essential for the maintenance of an upright posture and especially for the movements and lifts that required extra effort such as lifting a heavy weight from the ground to a table. Without core stability the lower back is not supported from inside and can be injured by a strain caused by the exercise.2
•Thus the purpose of study is to compare the effectiveness of conventional back exercises and stabilization exercises for athletes with disc prolapse.
HYPOTHESIS:
Null Hypothesis (H0):
There may not be a significant difference between the core muscle strengthening exercises and conventional back extension exercises in patients with chronic disc prolapse
Alternate Hypothesis ( H1):
There may be significant difference between the core muscle strengthening exercises and conventional back extension exercises in patients with chronic disc prolapse
6.2 REVIEW OF LITERATURE:
• In the study found that, lumbar extension training brought about reduction in low back pain, improvement in ROM and improvement of spinal conditions and lumbar extension strength.3
•It have stated that specific back extension exercises that focus on deep stabilizing muscles have proven to reverse motor control deficits that occur after back injury or degenerative change.The most significant finding thus for is that people who do not retrain the deep stablizing muscles are 12.4 times more likely to have reccurance of back pain within 3years.4
•In the study it has stated that the trunk muscles respond to exercise progression to improve dynamic spinal stability.5
•It has stated that core strengthening, is in essence, a description of muscular control required around the lumbar spine to maintain functional stability.6
•It has stated that core stability has an important role in injury prevention.7
•It has shown in the study that participation in sports appear to be a risk factor for the development of disc degeneration . Every sports places unique demand on the lumbar spine and inturn, intervertebral discs.The elite athletes have a greater prevalence and greater degree of disc generation than normal population.8
•It has stated that the co-contraction of Transverse Abdominis and Multifidus muscles occurred prior to any movements of the limbs. This suggested that these muscles anticipate dynamic forces which may acts on the lumbar spine and stablise the area prior to any movements.They also showed that timing of co-ordination of these muscles was very significant, and the back injury patients were unable to recruit their Transverse Abdominis and Multifidus muscles early enough to stablise the spine prior to movement.9 Furthermore, the Multifidus muscle show poor recruitment in back injury patients, again showing how the recruitment of these deep trunk muscle is very important.10
•It has stated that role of back treatment exercise program in diskoganic low back pain yield superior therapeutic results with significant reduction in pain.11
•It has concluded that lumbar extension exercises and whole vibration exercises yield a significant reduction in pain sensation and pain related disability in chronic low back pain.12
•It has concluded that Ronald Morris Questionnaire has been shown to yield reliable measurements which are valid for inferring the level of disability and to be sensitive to change over time for groups of patients with low back pain.13
•It has concluded in the study that Bulging / Herniated intervertebral disc, the treatment focus is on centralizing the bulging nucleus back into the disc. Initial management of any pain and spasm can be treated by modalities like heat, Ultra sound, Massage or other common methods as the pain subsides the treatment focus will shift to the core of the problem. This will include specific exercises to assist in centralizing the disc: Spinal extension exercises, Spinal flexion exercises, Postural management and core trunk strengthening and stabilization to improve endurance, strength and power.14
•It has stated in the study that "In the very acute phase (first 48 hours) of a disc prolapse, various anti-inflammatory procedures can be used to reduce inflammation and pain. Once the acute period has passed physiotherapy treatment aims to minimise joint stiffness. After the initial pain has subsided, remedial exercises to strengthen the spine are very important to restore normal spinal movements and muscle strength. The main aim of exercise is to encourage mobility, reduce muscle spasm, prevent further deterioration in the muscles and speed recovery.15
6.3OBJECTIVES OF THE STUDY
•To find out efficacy of core muscles strengthening in athletes with chronic disc prolapse.
•To find out efficacy of conventional back extension exercises in athletes with chronic disc prolapse.
•To compare the efficacy of core muscle strengthening and conventional back extension exercises with chronic disc prolapse.
7. / MATERIALS AND METHODS:
7.1 STUDY DESIGN: Experimental study
SOURCE OF DATA:
•A.J hospital,OPD of Laxmi memorial college of physiotherapy and patients will be included from the other orthopaedic clinics.
7.2 METHOD OF COLLECTION OF DATA
Sample Size:
Total number of subjects in the study are 30.
Subjects will be explained about the study and subjects demographic data will be collected by a self questionnaire to fulfill the inclusion and exclusion criteria and eligible subjects are taken asper theconvenience.
Subjects will be categorized into two groups.
Experimental group A perform specific stablisation exercises: 15 subjects.
Experimental groupB perform conventional back extension exercises: 15 subjects.
SAMPLING TECHNIQUE:
Cluster Sampling technique.
INCLUSION CRITERIA:
•Subjects are weight lifters, body builders between the age group of 20-40 years (at university level).
•Both sexes
•All subjects included will have prior clinical examination by the physician with prediagnosed case of disc protrusion.
•Subject with recurrent episodes of back pain with primary complaint of leg pain.
EXCLUSION CRITERIA:
•Subject with spinal surgery.
•Spondylosis / Spondylolisthesis
•Structural deformities like scoliosis
•Cardiovascular disorders (Atherosclerosis)
•Cauda Equina Compression
MATERIALS:
•Assessment form
•Treatment couch
•Visual analogue scale
•Ronald-Morris Disability Questionnaire.
TECHNIQUE OF APPLICATION
Method
•Experimental group A perform specific stabilization exercises and experimental group B perform conventional back extension exercises.
•In both groups exercises are given for 4 weeks at a frequency of 5 times/ week for 30-45 minutes.
•Each exercise consist of 3 sets and 10 repetitions (10 sec hold ) in each set.
•Progression is made when the patient are able to perform 3 sets of 10-15 repetitions of an exercise with ease.
•Pain and functional disability will be measured before intervention and after intervention at the end of 1st, 2nd, 3rd and 4th week.
Outcome measures
•Pain is measured with Visual analogue scale (VAS)
•Funtional disability is measured using the Ronald-Morris questionnaire (RMDQ).
STATISTICAL ANALYSIS
•Student “t”-test
7.3Does the study require any investigations or intervention to be conducted on patients or other humans or animals? If so, please describe briefly.
YES
Specific core stabilisation exercises and conventional back exercises will be given for the subjects belonging to different groups respectively.
Has Ethical clearance been obtained from your institutions?
In Case of 7.3
YES
8 / List of Reference
- Curr sports Med Rep; 2004;3(1):41-46
- Wikipedia, the free encyclopedia. Core stability. 16 October 2009
- Miltner O, Writz DC, Seibert CH.Z Orthop Ihre Grenzgeb.2001 jul- aug; 139(4): 287-93
- Richardson C, Jull G, Hodges P. Therapeutic exercise for spinal segmental stabilisation in low back pain. Scientific basis and clinical approach. Chruchill Livingstone 1999; pp. 61-96
- Davidson KL,Hubley- Kozey CL. Arch Phys Med rehabil .2005 Feb; 86(2):216-23.
- Akuthota V, Nadler SF, Arch Phys Med rehabil 2004 Mar ;85 (3 Suppl 1) :586-92
- Lectun DT, Ireland ML, Wilson JD, clantyne BT, Davis IM. Med Sci sports exerc 2004 Jun; 36(6):926-34
- Ong A, Anderson J Roche J. A pilot study for prevalence of lumbar disc degeneration in elite athletes with low back pain at the sydney 2000 Olympic games. Br J Sports Med 2003 ;37:263-266
- Hodges PW and Richardson CA. Inefficient muscle stabilization of lumbar spine associated with low back pain 1996;21(22): 2640-2650.
- Hides Julie A, Richardson CA Carolyn A, Jull Gwendolen A. Multifidus muscle recovery is not automatic after resolution of acute, first episode low back pain. Spine 1996 ;21(23): 2763-2769.
- V Vad, A Bhat Y Tarabichi. Physical Medicine and rehabilitation, Vol 88 ,Issue 5 , Pages 577-582.
- Jom Rittwegar MD, Karsten Just,MD ,Katja Kautzsch Spine Vol 27 ,Number 17 pp 1829-1834 2002, Lippincott William and Wilkins.
- Stratford PW,Binkley J,Solomon P. Defining the minimum level of detectable changes for Ronald-Morris questionnaire Phys Ther. 1996;76: 359-365.
- Doug Wallace PT ATC. Bulging/Herniated intervertebral discs. Common athletes injuries.The articles has been published in the year 2006
- T.J Salih. Conservative treatment of disc prolapse and back pain.The article published: 6th October 2003.