Rguhs.ac.in
|RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, |
|KARNATAKA, BANGALORE |
|ANNEXURE II |
| |
|PROFORMA FOR REGISTRATION OF SUBJECT FOR |
|DISSERTATION |
|1. |Name of the Candidate and Address |RAKHI SINHA |
| |( In block letters) |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 |
| | |
| |6.3 OBJECTIVES 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 as per the convenience. |
| |Subjects will be categorized into two groups. |
| |Experimental group A perform specific stablisation exercises: 15 subjects. |
| |Experimental group B 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 |
| | |
| |Does 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. |
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