Shareef
Shareef
Shareef
net/publication/356914816
CITATIONS READS
0 1,239
4 authors, including:
All content following this page was uploaded by Patchava Apparao on 10 December 2021.
Effectiveness Of William’s Flexion Exercises and Motor Control Exercises on Pain and
Function in Subjects with Non-Specific Low Back Pain Among Student Population
Dr.MD.Shareef1, Dr. A. Sai Rama Krishna2, Dr. PatchavaApparao3, Dr. R. Geetha Mounika4, Dr. P.
Pundarikaksha5
2,4,5
P.G, MPT Orthopedics Specialties, Department of Physiotherapy, P.G3,Principal ,MPT. PhD (Orthopedics),
Swatantra Institute of Physiotherapy and Rehabilitation,
Rajamahendravaram, Andhra Pradesh, India
*Corresponding Author:
Dr.MD.Shareef, (MPT Orthopedics specialties)
P.G, Department of Physiotherapy, Swatantra Institute of Physiotherapy and Rehabilitation,
Rajamahendravaram, Andhra Pradesh, India
Keywords: Non-Specific Low Back Pain (NSLBP), (VAS), (ODI), William’s Flexion Exercises (WFE), Motor
Control Exercises (MCE)
INTRODUCTION
Low Back Pain (LBP) is one of the most common Health Organization (WHO) LBP is the leading cause
musculoskeletal disorders and a leading cause of of disability3. The overall burden of LBP arising from
activity limitation that can eventually result in ergonomic exposures at work was estimated at 21.8
disability, decreased quality of life, and work million disability adjusted life years in 20104. LBP is
absenteeism1. LBP is estimated that 80% of the classified as Mechanical Non-Mechanical and
350
population will suffer atleast one episode of LBP at Psychogenic Mechanical Low Back Pain may be
some point during their lives2. According to World Specific or Nonspecific. About 90% of LBP is
International Journal of Medical Science and Current Research | July-August 2021 | Vol 4 | Issue 4
Dr. MD. Shareefat al International Journal of Medical Science and Current Research (IJMSCR)
considered as Non specific5. Non-Specific Low Back Motor control exercises has become the most popular
Pain (NSLBP) is defined as the pain, muscle tension treatment method in spinal rehabilitation
or stiffness localized below the costal margin and Physiological studies have demonstrated that patients
above the inferior gluteal fold of unknown with Low Back Pain exhibit a delayed onset of
etiology6.In Global Burden of Disease (GBD) 2010. activity of the deep trunk muscles (e.g., transverses
LBP ranked highest in terms of Global Disability7. In abdominis, multifidus) when the stability of the spine
the clinical practice as well as in literature is challenged in dynamic tasks. Moreover, it was
Nonspecific Low Back Pain is usually classified by found that patients with low back pain tend to
the duration of the complaints8. NSLBP is classified increase the spinal stiffness to compensate for the
on the basis of duration as Acute (pain lasting less lack of stability from the deep muscles by increasing
than 6 weeks) Sub Acute (6 to 12 weeks) and chronic the activity of the superficial muscles. Finally, the
(more than 12 weeks) 9. The etiology of Low Back patients who recovered from an episode of acute low
Pain is still unknown, but it is believed to be back pain are more susceptible to recurrence and
multifactorial. Non-Specific Low Back Pain does not chronicity if these changes were not treated with
have a pathoanatomical cause; treatment focuses on motor control exercise11. Motor control exercises are
reducing pain and its consequences. Many factors used in improving function of specific trunk muscles
effecting NSLBP such as physiological structure, that controls inter-segmental movement of the spine,
genetic factors, anthropometrics, psychological including transverses abdominis, multifidus, the
characteristics, age, gender, smoking status, the diaphragm and pelvic floor muscles12. Both
duration of watching Television (TV), using the William’s Flexion Exercises and Motor Control
computer, carrying backpacks, lumbar support usage, Exercises are effective in decreasing Pain and
sitting postures, obesity, physical activity and socio improving Function in Subjects with Non-Specific
economic situations12. The diagnosis of Non-Specific Low Back Pain. But there are very limited studies by
Low Back Pain (NSLBP) is dependent on the comparing these two exercises so the need of the
clinician being satisfied for not having any specific study arises.
cause. Physiotherapy is the main interventions used
MATERIALS AND METHODS
to maintain conservative treatment which uses
different modalities and Various Therapeutic are Study Design: Prospective Study
used to regain function and strengthen, stabilize the Ethical Clearance and Informed Consent: The
spine. Due to highly demanding curriculum during Study protocol was approved by the Ethical
the studies, medical students are exposed to stress, Committee of GSL Medical College
sedentary lifestyles, and long hours of hospital wards Rajamahendravaram (Annexure-I); the principal
and clinics which may lead to high prevalence of Low investigator explained the purpose of the study and
back pain in student population. Recent evidence given the patient information sheet. The participants
shows that the exercise therapy includes William’s were requested to provide their consent to
Flexion Exercises and Motor Control Exercises have participation in the study (Annexure-II). All the
been proved effectively in reducing symptoms of participants signed the informed consent and the rights
Non-Specific Low Back Pain. of the included participants have been secured.
William’s Flexion Exercises is also called Lumbar Study Population: Subjects clinically diagnosed with
Flexion Exercises. Williams explained, the patient to Non-Specific Low Back Pain (NSLBP) by
perform exercises and adhere to postural principles Orthopaedician.
which serve to decrease the lumbar lordosis to a
minimum thereby reducing the pressure on the Study Setting: The study was conducted at our
posterior elements on the lumbar spine. These Department of Physiotherapy, GSL Medical College,
exercises outlined to accomplish a proper balance Rajamahendravaram, Andhra Pradesh, India.
between the flexor and extensor groups of postural Study Duration: The study was conducted during the
351
muscles. These exercises used for lumbar flexion to period between June 2019 and June 2020.
avoid lumbar extension and strengthen the abdominal
and gluteus musculature to manage low back pain10. Sampling Method: Simple Random Sampling
Page
legs keeping knees extended arms over stretched over extend leg, then flex the leg, return the ankle While
the legs and eyes focus ahead. maintaining connection to multifidus, with included
pelvic floor contraction and this connection was held
6. HIP FLEXOR STRETCH: Place one foot in front of
the other with the left leg (front) knee flexed and right throughout themovement.
leg (back) knee extended hold rigidly straight. Flex EXERCISE 2: Position of the subject: Supine position.
forward through the trunk until the left knee contracts Subject in Supine with knees and hips flexed subjects
the axillary fold (arm pit region) repeat the right leg was instructed to lift the right foot off the floor and
forward and left legback. then the left foot off the floor and asked for the
Alternate leg extension which included pelvic floor
7. SQUAT: Stand with two feets parallel about
contraction and this connection was held throughout
shoulders width apart attempting to maintain the trunk
the movement along with a proper strategy for core
as perpendicular as possible to the floor, eyes focused
stabilization. Subjects were asked to exert with
ahead and feet flat on the floor, the subject slowly
exhalation and to breathe in to rest orhold.
lowers his body by flexing his knees.
GROUP B: MOTOR CONTROL EXERCISES15 STATISTICAL ANALYSIS
Subjects in Group-B received Motor Control All statistical analysis was done by using SPSS
Exercises. The subjects were asked to perform Motor software version 21.0 and Microsoft Excel 2007.
Control Exercises thrice a week for 8 weeks under Descriptive Statistical data were presented in the form
supervision by the physiotherapist. of mean +/- Standard deviation and Mean difference
Stage 1: 8 repetitions 5-10 second’s hold: It involves were calculated and presented.
exercises aimed at retraining transverse abdominus, BETWEEN THE GROUPS: Independent Student
and multifidus. These exercises were supplemented “t”- test was performed to assess the statistically
with exercises for the pelvic floor muscles, breathing significant difference in the mean values of between
control and control of spinal posture. the groups for (VAS for pain and ODI for function).
EXERCISE 1: Isolation of Transverse Abdominis WITH IN THE GROUPS: Paired Student “t”-test
Training: Position of the Subject: Supine position and was performed to assess the statistical significant
Subjects were instructed to lie on their back with spine difference in the mean values of between the groups
in neutral position (gentle anterior curve in the lumbar for Pain (VAS) and Function (ODI) score from Pretest
spine). and Posttest values.
EXERCISE 2: Isolation of Multifidus. Position of the For all statistical analysis P-Value < 0.05 was
subject: Side lying position. Subjects will be in a side considered as statistically significant.
lying position with the spine in neutral posture, Hips
RESULTS
are flexed. Therapist palpated the multifidus to isolate.
If multifidus deficit it will feel like a hole or soft spot The aim of the study was to find the effectiveness of
compare to the oppositeside. William’s Flexion Exercises and Motor Control
Exercises on Pain and Function in Subjects with Non-
Stage 2: 15reps with 5-10 sec hold: As the Subjects Specific Low Back Pain. The consort flow chart of the
has learned to isolate the Transverse abdominis and study showed the study organization in terms of
Multifidus muscle. They were instructed to practice subjects screening, Random allocation and analysis
isolation of these muscles in Sitting and Standing
following theIntervention.
position then progressed by targeting the coordination
of trunk and limb movement and maintenance of trunk A total of 150 subjects were screened for eligibility,
stability. Strengthen the co activated core Subject lies amongst 80 subjects were included in the study trail.
on the back or side or sit with the spine in a neutral All the 80 subjects who metinclusion criteria have
posture. undergone baseline assessment and included subjects
were randomized into two equal groups consisting
353
function.
Volume 4, Issue 4; July-August 2021; Page No 350-360
© 2021 IJMSCR. All Rights Reserved
Dr. MD. Shareefat al International Journal of Medical Science and Current Research (IJMSCR)
19. Tanna T, Thiyagarajan S, Gounder PC. 22. Arvind Kumar. Role of Motor Control Exercises
Comparing the Effectiveness of Motor Control in Non-Specific Low Back Pain Population: A
Exercises versus McKenzie Exercises for Work Randomised Placebo- Controlled Trail Int J
Related Back Pain. Open Journal of Therapy and Physiother Res 018; 6(4);2823-.
Rehabilitation. 2016 Jul 18;4(3):178-85. 23. Vikranth GR, Mathias L, Ghori MM.
20. Halliday MH, Ferreira PH, Hancock MJ, Clare Effectiveness of core stabilization exercises and
HA. A randomized controlled trial comparing motor control exercise in patients with low back
McKenzie therapy and motor control exercises on ache. International journal of physiotherapy. 2015
the recruitment of trunk muscles in people with Jun 1;2(3):544-51.
chronic low back pain: a trial protocol. 24. Richardson CA Jull ga Hodges pw and Hides
Physiotherapy. 2015 Jun 1; 101(2):232-8. Therapeutic Exercises for Spinal Segmental
21. Rabab MM Afifi, Lilian Z Albert, Ghada R Koura Stabilization in low back pain scientific basis and
Effect of Pilates mat Exercises versus Motor clinical approach Edinburach Churchill
Control Exercises on nonspecific acute low back Livingston JA(1999).
pain patients /International Journal of ChemTech
Research, 2017, 10(5):391-401
TABLES
Table-1: Analysis of Mean Scores of VAS from Pre test to Post test within Group-A
GROUP A MEAN S.D P VALUE INFERENCE
PRE VAS 6.95 1.060962
0.000 *1 SIGNIFICANT
POST VAS 2.825 0.873763
Table-2: Analysis of Mean Scores of VAS from Pre test to Post test within Group-B
GROUP B MEAN S.D P VALUE INFERENCE
PRE VAS 6.65 1.144664 0.000 *2 SIGNIFICANT
POST VAS 4.175 0.930605
Table-3: Comparison of Mean Score of VAS in between the Groups (Pre test) at Baseline Measurement
for Groups-A&B
GROUP A & B MEAN S.D P VALUE INFERENCE
PRE VAS 6.95 1.125641 0.227771 INSIGNIFICANT
PRE VAS 6.65 1.1310256
356
Page
Table-4: Analysis of Mean Scores of VAS in between the Groups at Post Test for Groups-A&B
GROUP A & B MEAN S.D P VALUE INFERENCE
POST VAS 2.825 0.763462 0.000 *3 SIGNIFICANT
POST VAS 4.175 0.866026
Table-5: Analysis of Mean Scores of ODI from Pre test to Post test within Group-A
GROUP A MEAN S.D P VALUE INFERENCE
PRE ODI 39.0825 6.558763 0.000 *9 SIGNIFICANT
POST ODI 20.78 3.401674
Table-6: Analysis of Mean Scores of ODI from Pre test to Post test within Group-B
GROUP B MEAN S.D P VALUE INFERENCE
PRE ODI 41.46 7. 849083 0.000 *8 SIGNIFICANT
POST ODI 36.9525 6.776581
Table-7: Comparison of Mean Score of ODI in between the Groups Pre test at baseline Measurement for
Groups-A&B
GROUP A & B MEAN S.D P VALUE INFERENCE
PRE ODI 39.0825 43.01738 0.145676 INSIGNIFICANT
PRE ODI 41.46 61.6081
Table-8: Analysis of Mean Score of ODI in between the Groups Post test for Groups-A&B
GROUP A & B MEAN S.D P VALUE INFERENCE
POST ODI 20.78 11.57138 0.000 *2 SIGNIFICANT
POST ODI 36.9525 45.92204
357
Page
FIGURES:
Figure-1: Analysis of Mean Scores of VAS from Pre test to Post test within Group-A
0
PRE VAS POST VAS
GROUP A
Figure-2: Analysis of Mean Scores of VAS from Pre test to Post test within Group-B
8.00 4.17
6.00
4.00 GROUP B PRE VAS
2.00 GROUP B POST VAS
0.00
PRE VAS POST VAS
GROUP B
Figure-3: Comparison of Mean Score of VAS in between the Groups (Pre test) at Baseline Measurement
for Groups-A&B
7.00
6.90
6.80 6.65
GROUP A & B PRE VAS
6.70
GROUP A & B PRE VAS
6.60
6.50
PRE VAS PRE VAS
GROUP A & B
358
Page
Figure-4: Analysis of Mean Scores of VAS in between the Groups at Post Test for Groups-A&B
Figure-5: Analysis of Mean Scores of ODI from Pre test to Post test within Group-A
40.00
20.78
30.00
GROUP A PRE ODI
20.00 GROUP A POST ODI
10.00
0.00
PRE ODI POST ODI
GROUP A
Figure-6: Analysis of Mean Scores of ODI from Pre test to Post test within Group-B
41.46
MEAN SCORES -ODI
42.00
40.00 36.95
GROUP B PRE ODI
38.00
GROUP B POST ODI
36.00
34.00
PRE ODI POST ODI
GROUP B
359
Page
Figure-7: Comparison of Mean Score of ODI in between the Groups Pre test at baseline Measurement for
Groups-A&B
41.46
MEAN SCORE -ODI
42.00
41.00 39.08
40.00 GROUP A & B PRE ODI
39.00 GROUP A & B PRE ODI
38.00
37.00
PRE ODI PRE ODI
GROUP A & B
Figure-8: Analysis of Mean Score of ODI in between the Groups Post test for Groups-A&B
36.95
MEAN SCORE-ODI
40.00 20.78
30.00 POST ODI
POST ODI
20.00
10.00
0.00
POST ODI POST ODI
360
Page