Ejercicios de Movilidad Torácica Frente a Ejercicios de Movilidad de Cadera para la Estabilización del Núcleo en la Espondilitis Lumbar (TME-HME)

In the Core stabilization exercises (control group)patients will receive Core stabilization exercises as Abdomen Curl ,Supine Bridging ,Bird Dog , Side Bridging , Plank , Curl Up and Sitting On Ball. In each session. The exercises will consist of 3 levels (from easy to difficult). In the advanced level exercises, resistance limb exercises will be added and the exercises will be completed gradually. Each exercise will be performed for 3 sets of 8-10 repetition.

Core stabilization exercises include Abdomen Curl ,Supine Bridging ,Bird Dog , Side Bridging , Plank , Curl Up and Sitting On Ball In each session. The exercises will consist of 3 levels (from easy to difficult). In the advanced level exercises, patients will be asked to maintain the neutral curvature of the lumbar spine, resistance limb exercises will be added and the exercises will be completed gradually. Each exercise will be performed for 3 sets of 8-10 repetition.

In the thoracic Mobility Exercises group ( experimental group B) will receive core stabilization Exercises program(as Abdomen Curl ,Supine Bridging ,Bird Dog , Side Bridging , Plank , Curl Up and Sitting On Ball. In each session) in addition to thoracic Mobility Exercises as (Thoracic extension with foam roller ,Thoracic extension with chair ,Thoracic flexion in quadruped , Right Thoracic rotation in side lying ,Left Thoracic rotation in side lying , Right kneeling Thoracic rotation , Left kneeling Thoracic rotation , Right Thoracic sitting lateral flexion and Left Thoracic sitting lateral flexion .Each exercise will be performed for 3 sets of 10 repetitions in addition to core stabilization program

receive thoracic Mobility Exercises as movements in all directions of thoracic spine as (Thoracic extension with foam roller ,Thoracic extension with chair ,Thoracic flexion in quadruped , Right Thoracic rotation in side lying ,Left Thoracic rotation in side lying , Right kneeling Thoracic rotation , Left kneeling Thoracic rotation , Right Thoracic sitting lateral flexion and Left Thoracic sitting lateral flexion) .Each exercise will be performed for 3 sets of 10 repetitions.

will receive core stabilization Exercises program(as Abdomen Curl ,Supine Bridging ,Bird Dog , Side Bridging , Plank , Curl Up and Sitting On Ball. In each session) The exercises will consist of 3 levels (from easy to difficult). In the advanced level exercises, resistance limb exercises will be added and the exercises will be completed gradually. Each exercise will be performed for 3 sets of 8-10 repetition.

will receive core stabilization Exercises program(as Abdomen Curl ,Supine Bridging ,Bird Dog , Side Bridging , Plank , Curl Up and Sitting On Ball. In each session) in addition to hip mobility exercises program The patients will perform 8 different hip mobility exercises; reverse v-ups, butterfly, frog, internal rotation with foot rise, pike, revolved crescent lunge, pigeon, lunge on the knee. Each exercise will be performed for 2 sets of 20 seconds.

will receive core stabilization Exercises program(as Abdomen Curl ,Supine Bridging ,Bird Dog , Side Bridging , Plank , Curl Up and Sitting On Ball. In each session) in addition to hip Mobility Exercises (The patients will perform 8 different hip mobility exercises; reverse v-ups, butterfly, frog, internal rotation with foot rise, pike, revolved crescent lunge, pigeon, lunge on the knee. Each exercise will be performed for 2 sets of 20 seconds).

will receive core stabilization Exercises program(as Abdomen Curl ,Supine Bridging ,Bird Dog , Side Bridging , Plank , Curl Up and Sitting On Ball. In each session) The exercises will consist of 3 levels (from easy to difficult). In the advanced level exercises, resistance limb exercises will be added and the exercises will be completed gradually. Each exercise will be performed for 3 sets of 8-10 repetition.

Functional disability caused by low back pain will be assessed using the Arabic version of the Modified Oswestry Disability Index (MODI-Ar).

Pain intensity will be assessed using the Arabic version of the 11-point Numerical Pain Rating Scale (NPRS-Ar), ranging from 0 (no pain) to 10 (worst possible pain).

Active lumbar range of motion will be measured using the Back Range of Motion (BROM) device, including flexion, extension, right and left lateral flexion, and right and left rotation. Each movement will be measured over three trials, and the average value will be used for analysis.

Lumbar flexion mobility will be assessed using the Modified Schober Test. Skin markings will be placed 15 cm above and 5 cm below the lumbosacral junction (L5-S1). The change in distance during forward trunk flexion will be recorded in centimeters.

Fear of movement and re-injury will be assessed using the Arabic version of the Tampa Scale for Kinesiophobia (TSK-Ar), which evaluates fear of movement and physical activity using a 4-point Likert scale.

Health-related quality of life will be assessed using the RAND 36-Item Health Survey, which evaluates physical functioning, emotional well-being, social functioning, and other health-related domains. Each domain is scored from 0 to 100, with higher scores indicating better health status.