Effect of Lumbar Stabilization Exercises With and Without YTWL (Scapular Stabilization Exercises) on Reducing Chronic Low Back Pain and Related Disability by Numerical Pain Rating Scale and Modified Oswestry Disability Index Respectively. (A RCT)

Background:

Chronic low back pain is a common health problem that can affect a person's ability to work, exercise, sleep, and perform everyday activities. In many people, the exact cause of the pain cannot be identified. This is known as non-specific chronic low back pain (NSCLBP). Chronic low back pain is generally considered pain in the lower back that continues for more than three months without a specific disease or injury being identified as the cause.

People with chronic low back pain may experience pain, stiffness, difficulty moving, reduced muscle strength and endurance, and difficulty performing activities such as walking, sitting, standing, bending, or lifting. Factors such as prolonged sitting, poor posture, reduced muscle endurance, and poor control of body movements may contribute to the problem.

Purpose of the Study:

Exercise is an important part of physiotherapy treatment for chronic low back pain. Lumbar stabilization exercises (LSE) are commonly used to improve the strength and control of the muscles that support the spine. These exercises can help reduce pain and improve a person's ability to perform daily activities.

However, the muscles of the lower back do not work alone. The muscles around the abdomen, pelvis, upper back, and shoulder blades work together to control body movement. This connection is known as the kinetic chain. Weakness or poor endurance of the muscles around the shoulder blades may affect the way the trunk and pelvis move and may influence lower-back function.

This study will therefore investigate whether adding scapular stabilization exercises (SSE), specifically YTWL exercises, to conventional lumbar stabilization exercises can provide additional benefits for people with chronic non-specific low back pain.

What are YTWL exercises? YTWL exercises are simple exercises designed to strengthen and improve the control and endurance of muscles around the shoulder blades and upper back. The exercises involve moving the arms into positions that resemble the letters Y, T, W, and L. These movements target muscles such as the trapezius, rhomboids, and serratus anterior, which help keep the shoulder blades stable.

What will happen in the study? A total of 70 people with chronic non-specific low back pain will be included in the study. Participants will be recruited from the Physical Therapy Outpatient Department at Dow University Hospital, Ojha Campus.

Participants will be divided into two groups:

Group 1 (Control Group): Participants will receive conventional lumbar stabilization exercises along with a heating pad.

Group 2 (Experimental Group): Participants will receive conventional lumbar stabilization exercises, YTWL scapular stabilization exercises, and a heating pad.

Both groups will receive treatment for 4 weeks.

Before starting the treatment and after completing the 4-week treatment period, participants' outcomes will be assessed. The main areas being assessed are pain and disability.

Assessment of Pain:

Pain intensity will be measured using the Numerical Pain Rating Scale (NPRS). Participants will rate their pain on a scale from 0 to 10, where 0 means no pain and 10 represents the worst possible pain.

Assessment of Disability:

The effect of back pain on daily activities will be assessed using the Modified Oswestry Disability Index (MODI). This questionnaire evaluates how back pain affects activities such as walking, sitting, standing, lifting, personal care, and other daily activities.

The assessments will be performed before the treatment begins and after 4 weeks of treatment. The results from the two groups will then be compared using statistical analysis through SPSS software.

Why is this study important? The study may help determine whether adding exercises for the shoulder-blade muscles to conventional lower-back exercises provides additional benefits for people with chronic low back pain.

If the combined exercise program produces better results, it may provide physiotherapists with an additional exercise approach for managing patients with chronic non-specific low back pain. It may also help patients improve their physical function and reduce the effect of back pain on their daily lives.

For patients and families:

The study does not involve surgery or invasive procedures. It focuses on therapeutic exercises and a heating pad. Participants will be monitored during the treatment period, and their pain and ability to perform daily activities will be assessed before and after the intervention.

Overall aim:

The overall aim of this study is to determine whether adding YTWL scapular stabilization exercises to conventional lumbar stabilization exercises is more effective in reducing pain and disability than lumbar stabilization exercises alone in people with chronic non-specific low back pain.