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Research Article | DOI: https://doi.org/10.31579/2768-0487/068
*Corresponding Author: Delwar Hossain, Consultant Physiotherapist, Protibondi Seba O Sahajyo Kendra, Noakhali.
Citation: D Hossain. (2022). Chronic Low Back Pain and its Sustainable Management by Using Core Strengthening Exercise and Mechanical Traction. Journal of Clinical and Laboratory Research. 5(2); DOI:10.31579/2768-0487/068
Copyright: © 2022 Delwar Hossain. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 09 December 2021 | Accepted: 03 January 2022 | Published: 13 January 2022
Keywords: chronic low back pain; core strengthening exercise; mechanical traction
This experimental study was conducted to determine the effectiveness of neural mobilization and conventional physiotherapy technique in patients with chronic low back pain with a sample of 100. The study reveals that the mean age of the core muscle strengthening group was 33.88+(or)-10.77 years whereas mechanical traction group was 42.46+(or)-9.51 years of age. Study shows that mean BMI of core muscle strengthening group and mechanical traction group was 24.05+(or)-4.329 and 25.28+(or)-4.562. Study found that the mean severity of pain before treatment was 6.380+0.725 and after treatment was 2.74+(or)-0.921 of core muscle strengthening and the mean severity of pain before treatment was 7.100+(or)-0.839 and after treatment was 3.64+(or)-1.173. Study shows that mean score Oswestry low back pain disability index of core muscle strengthening before treatment was 20.54+3.7 and after treatment was 7.94+(or)-3.419, compare to mechanical traction before treatment was 22.88+(or)-3.127 and after treatment was 11.92+(or)-4.004. There was statistically highly significant findings of core muscle strengthening and mechanical traction where t-value was 35.665 and 26.938 which was measured by Universal pain Assessment Tool, another statistically highly significant finding of core muscle strengthening and mechanical traction where t-value were 21.995 and 19.039 which was measured by Oswestry low back pain disability index.
Low back pain that lasts at least one day and limits activity is a common complaint [1]. Globally, about 40% of people have LBP at some point in theirlives [1] , with estimates as high as 80% of people in the developed world [2]. Approximately 9 to 12% of people have LBP at any given point in time, and nearly one quarter report having it at some point over any one-month period [3]. Difficulty most often begins between 20 and 40 years of age [4] Low back pain is more common among people aged 40-80 years, with the overall number of individuals affected expected to increase as the population ages [1]. Bangladesh is a developing country and the industrialization process is also getting momentum. Now a day, various types of mechanical problems are increasing due to rapid industrialization and mechanization. Chronic low back pain is one of them and it causes a great economic burden on individuals, communities and governments. Chronic low back pain has high prevalence of other musculoskeletal disorders in many developed countries. For persistent chronic low back pain usually continue to have moderate pain and disability. People at higher risk of long-term disability include those with poor coping skills or with fear of activity those with a poor ability to cope with pain, functional impairments, poor general health, or a significant psychiatric or psychological component to the pain. Core muscle strengthening and mechanical traction play a key role in improving pain relief, range of motion as well as functional activities of chronic low back pain patient. This study- chronic low back pain and its sustainable management by using core muscle strengthening exercise and mechanical traction would offer the best hope for identification of the problems, develops new tools, take necessary steps to minimize suffering of this disorders.
Study design: It was an experimental study.
Outcome measure: Pain and disability index
Parameter: Universal Pain Assessment Tool and Oswestry Low Back Pain Disability Index
Sample population: The sample population was consisted of male and female who complain of chronic low back pain and consult to the physician in two selected hospitals in two different locations.
Study area: The study was conducted Protibondi Seba O Sahajyo Kendra, Noakhali and Prime Hospital Ltd, Noakhali.
Study site
A. Protibondi Seba O Sahajyo Kendra (PSOSK)
Location- Noakhali Sadar, Maijdee, Noakhali.
Type of hospital- Physiotherapy, Occupational and Speech therapy based rehabilitation centre, it is a district level government seba Kendra, under the Jatiyo Protibondhi Unnayan Foundation (JPUF), Ministry of Social Welfare, Bangladesh.
Facilities –outdoor facilities
B. Prime Hospital Ltd.
Location- Hospital Road, Maijdee, Noakhali.
Number of beds -100
Type of hospital - General hospital
Facilities – Indoor and outdoor facilities, especially well developed in neurology and orthopedic and Physiotherapy.
Study period
1st July, 2018 to 30th October, 2018.
Sample size: Researcher took 100 samples for time and fund limitation where 50 sample for core muscle strengthening exercise and rest 50 for mechanical traction.
Inclusion Criteria
Those who are willing to give consent and participate for interview, irrespective of sex.
Clinically diagnosed chronic low back pain patient.
Bone muscle nerve and disc related pain is included.
Duration of pain must be more than 12 weeks
Exclusion Criteria
Pathological disease like TB, Tumor and Osteoporotic patients are excluded
Those who are mentally and physically handicapped
Who refused to participate in interview
Immediate surgical intervention of lumber and lower limbs
Pregnant mother.
Sampling technique: Randomized sampling technique was applied.
Data collection tools: A pretested, modified, interviewer administrated, semi-structured questionnaire was used to collect the data.
Data management and analysis: After collection of data of the respondents were organized. Data were entered into the computer into a data base in the software package. Statistical package for the social science (SPSS) Version 16.0 (Polar engineering and consulting, Chicago) using descriptive statistics such as frequency, distribution, range, mean, and percentage. All scores and percentages was computed and presented in tabular form, charts, and graphs as appropriate. Further it was analyzed with the help of chi-square test and p-value. Finally the data were interpreted on the basis of study findings.
Ethical consideration: Prior to the commencement of this study, the research protocol was approved by the research committee of the academic institution. The aims and objectives of the study along with its procedure, risks and benefits were explained to the respondents in easily understandable local language and then informed consent was taken from each. Then it was assured that all information and records will be kept confidential and used only for research purpose.
The table1 reveals that the mean age of the respondents were 43.70+(or)-1.354 years with a range from 16 to 74 years. It is found from table 1 that 28% , 26%, 20%,12%,8%,6% of the respondents belonged to age group 36-45years, 46-55 years, 26-35 years, 66-65 years ,<25>66 years and above respectively of neural mobilization technique compare to conventional physiotherapy technique mean age of the respondents 43.10+(or)-1.404 years with a range from 17 to 73 years. That 30%, 22%, 20%,12%,10% and 6% of the respondents belonged to age group 36-45years, 46-55 years, 26-35 years, 66-65 years ,<25>66 years and above respectively.
Table 2 shows that, t-value was 15.646 which were greater than tabulated t-value 3.496 that was statistically highly significant findings of neural mobilization which was measured by Universal pain Assessment Tool, compare to conventional Physiotherapy technique, t-value was 13.802 which were greater than tabulated t-value 3.496 that was statistically highly significant findings which was measured by Universal pain Assessment Tool.
Table 3 shows that, t-value was 13.698 which were greater than tabulated t-value 3.496 that was statistically highly significant findings of neural mobilization which was measured by Osestry Low back pain disability index, compare to conventional Physiotherapy technique, t-value was 13.09 which were greater than tabulated t-value 3.496 that was statistically highly significant findings which was measured by Osestry Low back pain disability index.
p value obtained from Pearson Chi-square (χ2) test
The table no. 4 finds that p- value was 0.040 which was less than 0.05 that was statistically significant association between age sex and severity of pain of neural mobilization technique compare to conventional physiotherapy technique , p- value was 0.141 which was more than 0.05 that was no significant association between sex and severity of pain (before treatment).
p value obtained from Pearson Chi-square (χ2) test
The table no. 5 finds that p- value was 0.018 which was less than 0.05 that was statistically significant association between age sex and severity of pain (After treatment) of neural mobilization technique compare to conventional physiotherapy technique, p- value was 0.011 which was less than 0.05 that was significant association between sex and severity of pain (after treatment).
The study reveals that the mean age of the respondents were 43.70+(or)-1.354 years. It is found that 28% , 26%, 20%,12%,8%,6% of the respondents belonged to age group 36-45years, 46-55 years, 26-35 years, 66-65 years ,<25>66 years and above respectively of neural mobilization compare to conventional physiotherapy mean age of the respondents 43.10+(or)-1.404 years, 30%, 22%, 20%,12%,10 percentage belonged to age group 36-45years, 46-55 years, 26-35 years, 66-65 years ,<25>66 years and above respectively. These findings were similar to the study carried out by Beales DJ et.al .editors, Pahor S et.al .editors [5, 6]. It is found from that 38% of the respondents were service holder, 26% housewife, 12% student, 8 Percentage retried person and only 2% were workers respectively of neural mobilization technique compare to conventional physiotherapy technique, 38% of the respondents were service holder, 24 Percentage were housewife, 16% were business, 10 Percentage were student, 10 Percentage retried person and 2% were workers respectively. These findings were dissimilar to the study carried out by Olson PR et.al editors [7]. Study conclude that both chronic low back pain and its sustainable management by using core muscle strengthening exercise and mechanical traction brings significant improvement in patient with chronic low back pain. This study shows a relevant improvement in different functional level, decrease pain and lumbar disability by two therapeutic interventions. This preliminary study had a number of limitations. The experimental study was risk for the respondents. The sample size was comparatively small due to shortage of time and financial constraints of the research period and thus the result could not be generalized.
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