Effects of Feldenkrais and Otago Exercise Protocols for Mechanical Low Back Pain

Low back pain (LBP) is a common health issue-affecting individual across diverse ages and socio- economic backgrounds, with approximately 80% of the population experiencing this musculoskeletal concern at some point in their lives. Despite its prevalence, the prognosis for LBP is generally favorable, emphasizing the importance of effective management strategies aimed at reducing pain and improving functional ability. The Feldenkrais Method and the Otago Exercise Programme (OEP) are two interdisciplinary approaches that have demonstrated promise in addressing mechanical non-specific low back pain. This study aims to evaluate the effectiveness of these two intervention protocols in alleviating chronic low back pain while concurrently enhancing functional abilities and reducing the risk of falls among older adults.

The study will be a randomized controlled trial conducted on participants. Data will be collected from Farooq hospital and Boston physiotherapy and wellness clinic. This study will be completed in time duration of 10 months after the approval of synopsis. Non-probability convenience sampling technique will be used and participant's age between 45-65, having mechanical low back pain for more than 3 months will be recruited in study after computer generated randomization. However, participants who have any chronic illness like recurrent spinal surgery, Malignancy, Spine Infection, Spinal fracture and congenital disturbance shall be excluded from this study. The subjects will be divided into two groups. Group A will receive awareness through movement sessions of trunk mobility, which will be guided verbally(such as rolling head left and right, bringing knees to chest, tilting to the sides, rolling pelvis.) and Group B will receive lower limb strength and balance exercises like knee extensions and hip abduction.

All these sessions will be of 30 minutes to for 2 sessions per week for 6 weeks. Pre and post assessments will be conducted and the tools that will be used are NPRS for pain, Universal goniometer for ROM, Functional disability (Oswestry Disability Index), Falls-related self-efficacy will be assessed by the Activities-Specific Balance Confidence (ABC) Scale. and Balance (Berg Balance Scale). Data will be analyzed by using SPSS version 26.0.

Study Overview

• Status: Recruiting
• Conditions: Low Back Pain
• Intervention / Treatment: Other: Feldenkrais method; Other: Otago exercise protocol.

• Study Type: Interventional
• Enrollment (Estimated): 36
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: iqbal Tariq, phd; Phone Number: 03338236752; Email: iqbal.tariq@riphah.edu.pk

Study Locations

• Pakistan
  • Lahore, Pakistan, 54000
    • Recruiting
    • Farooq Hospital
    • Contact: manahil zahra, msompt

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• • Age group 18 to 65 year (3)

  • Both gender male and female
  • LBP (duration ≥ 3 months) (3)
  • NPRS score ≥ 4/10 (indicating moderate pain)
  • ODI: Score ≥ 20/100 (indicating moderate disability)
  • BBS: Score ≤ 45/56 (indicating balance impairment)
  • BC Scale score: ≤ 60/100 (indicating moderate to low balance confidence)
  • Ability to walk independently
  • No severe cognitive impairment
  • Patient willing to perform in the study

Exclusion Criteria:

• • Recurrent spinal surgery(3)

  • Malignancy
  • Spine Infection
  • Spinal fracture
  • Congenital disturbance
  • Severe LBP (NPRS ≥ 9/10)
  • Significant balance impairment (BBS ≤ 20/56)
  • Severe disability (ODI ≥ 60/100)
  • ABC Scale score: ≥ 80/100 (indicating high balance confidence)
  • Older individuals with specific health conditions, such as cardiovascular disease and diabetes

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Feldenkrais method.; Group A will receive awareness through movement lessons, which are verbally, guided explorations of movement, conducted by a physiotherapist. The Feldenkrais method intervention consisted of 10 structured lessons, each 30 minutes in duration, delivered twice weekly. The program aimed to enhance trunk mobility and overall function without pain. Lessons progressed sequentially, building upon previous sessions. Segment 1 (Lesson 1-2) focused on breathing awareness and trunk perception in supine position, gaining control of the pelvis, and freeing hip joints. Segment 2 (Lesson 3-4) addressed flexion-extension and self-care in supine and prone positions. Segment 3 (Lesson 5-6) targeted flexion-extension, rotation, and shoulder control. Segment 4 (Lesson 7-8) emphasized balance and walking. The final lessons (9-10) integrated previous themes, reinforcing functional improvement	Other: Feldenkrais method; "Activating flexors" "The pelvic clock"twisting)."Side lying lesson for improving the integration of arms, shoulders and spine" (reaching motion of shoulders in different directions)."Transitioning from supine to side lying to sitting" (lying supine involving flexion, extension, and twisting)."Twisting on the side" "Twisting from supine with head fixed to the side" (by limiting the movement of the head, the rib cage is forced to participate in the twisting motion) "Lengthening the hamstrings" "Arm circles" (lying on side, circling arms in different directions). "Rolling from supine to prone via hip rotation
Active Comparator: Otago exercise protocol.; The study began by completing all 3-outcome measures by first asking about their pain intensity then by checking their balance through Berg Balance Scale and then checking the level of function through ODI questionere. The OEP included the following exercises: knee extension and knee flexion, hip abduction, calf raises, toe raises, sit to stand, semi squats from a standing position, tandem stand, tandem walk, sideways walking, backwards walking, heel walking, toe walking, one leg stand, and walking and turning around. All exercises will be performed with 10-20 repetitions, which will be progressed after 2 week	Other: Otago exercise protocol.; The study began by completing all 3-outcome measures by first asking about their pain intensity then by checking their balance through Berg Balance Scale and then checking the level of function through ODI questionere. The OEP included the following exercises: knee extension and knee flexion, hip abduction, calf raises, toe raises, sit to stand, semi squats from a standing position, tandem stand, tandem walk, sideways walking, backwards walking, heel walking, toe walking, one leg stand, and walking and turning around. All exercises will be performed with 10-20 repetitions, which will be progressed after 2 week.(12)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Berg Balance Scale ( BBS)	It is used to objectively determine a patient's ability (or inability) to safely balance during a series of predetermined tasks. Berg Balance Scale Sensitivity is 0.75-0.91 and Specificity is 0.67-0.85 (ability to identify those without balance impairment)It is a 14 item list with each item consisting of a five-point ordinal scale ranging from 0 to 4, with 0 indicating the lowest level of function and 4 the highest level of function and takes approximately 20 minutes to complete. It does not include the assessment of gait.	baseline and fourth week
Oswestry Disability Index (ODI)	It is a patient-completed questionnaire that gives a subjective percentage score of level of function (disability) in activities of daily living in those rehabilitating from low back pain. It was developed by Jeremy Fairbank and Graham Pynsent in Oswestry, England in 1980 and considered one of the best-accepted tools for assessment of low back pain. ODI Sensitivity (0.74-0.92) and Specificity is (0.63-0.85), The questionnaire examines the level of disability in 10 everyday activities of daily living. Each item consist of 6 statements which are scored from 0 to 5. With 0 indicating the least disability and 5 the greatest then the total score is calculated as a percentage, with 0% indicating no disability and 100% indicating the highest level of disability.	baseline and fourth week

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Rabiya Noor, PhD, Riphah International University

Publications and helpful links

General Publications

• Ahmadi H, Adib H, Selk-Ghaffari M, Shafizad M, Moradi S, Madani Z, Partovi G, Mahmoodi A. Comparison of the effects of the Feldenkrais method versus core stability exercise in the management of chronic low back pain: a randomised control trial. Clin Rehabil. 2020 Dec;34(12):1449-1457. doi: 10.1177/0269215520947069. Epub 2020 Jul 29.
• Gianola S, Bargeri S, Del Castillo G, Corbetta D, Turolla A, Andreano A, Moja L, Castellini G. Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis. Br J Sports Med. 2022 Jan;56(1):41-50. doi: 10.1136/bjsports-2020-103596. Epub 2021 Apr 13.
• Senbursa G, Pekyavas NO, Baltaci G. Comparison of Physiotherapy Approaches in Low Back Pain: A Randomized Controlled Trial. Korean J Fam Med. 2021 Mar;42(2):96-106. doi: 10.4082/kjfm.20.0025. Epub 2020 May 22.

Study record dates

Study Major Dates

• Study Start (Actual): December 15, 2024
• Primary Completion (Estimated): May 15, 2025
• Study Completion (Estimated): June 15, 2025

Study Registration Dates

• First Submitted: May 15, 2025
• First Submitted That Met QC Criteria: May 15, 2025
• First Posted (Actual): May 22, 2025

Study Record Updates

• Last Update Posted (Actual): May 22, 2025
• Last Update Submitted That Met QC Criteria: May 15, 2025
• Last Verified: May 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain; Low Back Pain
• Other Study ID Numbers: REC/RCR & AHS/24/0181

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No