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Research Article
EUROPEAN JOURNAL OF PHARMACEUTICAL
Nambi et al. European Journal of Pharmaceutical and Medical Research
ISSN 2394-3211
AND MEDICAL RESEARCH
www.ejpmr.com EJPMR
*1Asst. Professor, Dept of Physical Therapy and Rehabilitation, College of Applied Medical Sciences, Prince Sattam
Bin Abdul Aziz University, Al-Kharj, Saudi Arabia.
2
Asst. Professor, Dr. D.Y Patil College of Physiotherapy, D.y Patil Vidyapeeth, Pimpri, Pune, India.
ABSTRACT
Introduction: Low back pain affects approximately 80% of individuals, and represents the most common reason
of activity limitation in individuals less than 45 years of age. Objective: To determine the efficacy of a Lumbar
Strengthening Program in Lumbar Spine Derangement Syndrome 1. Methods: In a 2-week intervention study, 40
patients with lumbar spine derangement syndrome-1 were studied. Patients were randomly divided in two Groups:
Group-A (n=20) who were given McKenzie exercises; Group-B (n=20) performed the McKenzie exercises &
performed Resistance Training for the Lumbar Extensors. Both groups were submitted to two consecutive weeks of
treatment consisting of six times weekly. A Visual Analogue scale (VAS), Modified Oswestry Back Pain Disability
Questionnaire (MOQ) was administered at pretest and posttest. Wilcoxon signed ranks test was used for the
comparison between the pre and posttest values within Group A and Group B. Mann Whitney U test was used for
comparison between the posttest values of two groups. Results: A significant reduction in the pain intensity
(p<0.05), and increase in the functionality (p< 0.05) between pre & post treatment stages in both groups were
found. Both groups showed significant differences as to the pre & post treatment stages in the McKenzie therapy
and Resistance training for the Lumbar Extensor Muscle exercises, wherein Group B showed a more significant
improvement when compared to Group A. Conclusion: McKenzie therapy with resistance training for lumbar
extensors muscles produced a significantly greater decline in the pain intensity and improvement in function, when
compared to Mckenzie exercises alone.
KEYWORDS: Lumbar spine derangement syndrome 1, McKenzie therapy, Visual analog scale, Modified
oswestry low back pain disability questionnaire.
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Nambi et al. European Journal of Pharmaceutical and Medical Research
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Nambi et al. European Journal of Pharmaceutical and Medical Research
improvement occurred, progression 1 was repeated. If exercises at their own pace when they could hold a given
there was no improvement following 24 hours of position for 10 seconds. On reaching the fifth
application of progression1, progression 2 was applied. progression, they continued with the fifth progression
until the end of the exercise program.
Progression 2
Extension mobilization applied to each of the appropriate The five exercise progressions
segments. After 10 repetitions, continuous pressure was 1. Participant was instructed to lie in the prone position
maintained at the affected level, & the patient was asked with both arms by the sides of the body and lifted the
to perform EIL. The patients were instructed to continue head and trunk off the plinth from neutral to extension.
lying prone, lying prone in extension. If the progress was 2. Participant lay in prone position with the hands
satisfactory, the same program was continued. If there interlocked at the occiput so that shoulders were
was no improvement, progression 3 was applied. abducted to 90° and the elbows flexed, and lifted the
head and trunk off the plinth from neutral to extension.
Progression 3 3. Participant lay in prone position with both arms
Extension mobilization, Rotation mobilization in elevated forwards, and lifted the head, trunk and elevate
extension was applied to relax patient & to provide with arms off the plinth from neutral to extension.
pre-manipulative information. Once centralization 4. Participant lay in prone position and lifted the head,
occurred, self-treatment program as on day 1 was trunk and contralateral arm and leg off the plinth from
followed. Once pain free for three days, EIL was reduced neutral to extension.
to 3times/day and replaced by EIS whenever necessary 5. Participant lay in prone position with both shoulders
during the day. abducted and elbows flexed to 90°, and lifted the head,
trunk and both legs (with knees extended) off the
Since the function to be restored in patients with lumbar plinth44.
derangement syndrome 1 is flexion, flexion procedures
were begun. Once the patient’s condition proved stable, Dosage: 10 repetitions for static hold in each exercise
FIL was gradually increased. When no further gain was position for 10 seconds x 3sets/session.
obtained with FIL, progression to FIS day was done,
always followed by, EIL. Patients were instructed to Dynamic Back Extensors exercise.
discontinue FIS, when full flexion was recovered. &
continue, EIL, FIL, EIS, The patients were treated & Instead of the static posturing of the trunk in the prone
were not permitted to obtain any other forms of manual lying position the participant were asked to move the
therapy, electrotherapy, or other technique (e.g. trunk and the suspended limbs 10 times.
analgesics, acupuncture, injection therapy, or taping)
during the intervention period other than the designated RESULTS
protocol. All the patients were able to complete the 2 The mean age (mean ± SD) of the patients were 42.2 ±
weeks treatment program. 13.37 and 42.55 ± 13.17 in Group A & Group B
respectively. Group A comprised of 9 males (45%) and
Group- B (McKenzie therapy + Lumbar extensor 11 females (55%) & Group B comprised of 10 males
muscles strengthening program). (50%) and 10 females (50%).
Table-1: Pre and post values of VAS and MOQ in Group-A and Group-B.
Group-A Group-B
Variables p-value p-value
Pre Post Pre Post
VAS 7.2 ± 1.10 5.1 ± 0.96 0.000 7.2 ± 0.96 3.55 ± 0.94 0.000
OSW 29 ± 4.87 16.9 ± 4.56 0.000 29.25 ± 4.56 11.45 ± 2.68 0.000
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Nambi et al. European Journal of Pharmaceutical and Medical Research
The findings are in accordance with the results of Under this paradigm, muscle strength and endurance
Machado et al (2006) in their study to evaluate the training are believed to be important in the management
effectiveness of the McKenzie method for low back pain of LBP.
(LBP) had concluded that there is evidence that the
McKenzie method is more effective than passive therapy The inclusion of a lumbar extensor muscles
for acute LBP reducing pain and disability & the studies strengthening program along with the McKenzie
by, Brian E. Udermann et al (2004) on patients with protocol resulted in a significant reduction in the pain
lumbar posterior derangement that received therapeutic intensity, and improvement in the performance of
exercise as described by the McKenzie method whose functional activities.
results indicated that exercises based on repeated
movements is more beneficial in terms of pain reduction This study was conducted on forty patients with the
and recovery of function, significant improvements in mean age of 42.37±13.10 (mean ±SD) with derangement
range of motion, as well as in a variety of health-related syndrome 1. The patients were divided into two groups.
quality-of-life measures in LBP patients than joint Control Group A received Mckenzie therapy &
mobilization or the addition of resistance training for the experimental Group B received resistance training for
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Nambi et al. European Journal of Pharmaceutical and Medical Research
lumbar extensors (RTLE) along with Mckenzie therapy 8. Pollock, ML, Leggett, SH, Graves, JE, Jones, A,
for 6 days a week for 2 weeks and a re-evaluation taken Fultan, M and Cirulli, J. Effect of resistance training
after 2 weeks of treatment. on lumbar extension strength. The American Journal
of Sports Medicine, 1989; 17(5): 624-629.
The results showed a significant decline in the pain 9. Carolyn Kisner, lynn allen Colby (1996) therapeutic
intensity (p<0.05) & a significant improvement in exercise foundation and techniques, 3rd edition,
function (p<0.05) in the post treatment stage in jaypee brothers.
comparison to the pretreatment stage. 10. Sherry V. Risch et al, Lumbar strengthening in
chronic low back pain patients (1994).
By comparing the post treatment variables in both 11. Chidozie E. Mbada, Olusola et al, Effect of static
experimental groups, the results revealed that there was and dynamic back etensor muscles endurance
significant difference between the groups A & B. There exercise on pain intensity, activity limitation and
was a significant decline in intensity of pain (p=0.000) & participation restriction in patients with long term
improvement in function (p=0.00) in group B when mechanical low back pain, 2011.
compared to group A. 12. Brian E. Udermatnn et al, Combining Lumbar
Extension Training with Mckenzie therapy: Effect
In the experimental conditions used in this study, though on Pain, disability and psychological functioning in
both McKenzie therapy, & McKenzie therapy & chronic low back pain patients, 2004.
resistance training for lumbar extensors muscles, 13. Scrimshaw SV, Maher C, Responsiveness of Visual
produced a significant decline in the pain intensity and Analogue Scale and McGill pain scale Measures.
improvement in function, McKenzie therapy with Journal of manipulative physical therapy, 2001;
resistance training for lumbar extensors muscles 8(24): 501-504.
produced a significantly greater decline in the pain 14. Fairbank JC, pynsent PB. The Oswestry Disability
intensity and improvement in function, when compared Index. Spine (Phila Pa 1976), 2000; 25(22):
to Mckenzie exercises alone. 2940-52.
15. Mottola CA. Measurement strategies: the visual
Ethical Approval analogue scale, 1993; 6(5): 56-8.
The study received the ethical approval from Deanship 16. Williamson A, Hoggart B. Pain: A review of three
of scientific research and the study was conducted commonly used pain rating scales, J Clin Nurs,
according to the ethical guidelines and principles of the 2005; 14(7): 798-804.
Declaration of Helsinki. 17. Fritz JM, Irrgang JJ. A Comparison of a Modified
Oswestry Low Back Pain Disability Questionnaire
ACKNOWLEDGEMENT and the Quebec Back Pain Disability Scale. Phys
The author is thankful to all the participants and the Ther, 2001 Feb; 81(2): 776-88.
assistants who have participated in the study. 18. Garcia A, Costa L, Da Silva T, Gondo F, Cyrillo F,
Costa R, Costa L. Effectiveness of Back School
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