Modified Oswestry Disability Questionnaire Research Articles

Revolutionizing Back Pain Management: Is Epidural Platelet-Rich Plasma the Superior Choice Over Steroids?

Background and objective Low back discomfort is one of the main factors that restrict physical activity, and it is becoming more and more common. Surgery is the best option when all other conservative treatment methods have failed, but it is not a panacea. While local anesthetic-free and combined epidural steroid injections have been used for many years, their usefulness is limited to shorter periods. In the field of orthopedics, platelet-rich plasma (PRP) has gained widespread recognition as an adjuvant component. PRPhas been applied to improve tissue repair, both soft and hard.This comparative study aimed to evaluate the potential of PRP as atherapy for low back pain (LBP). Methods We included 64 adult individuals with complaints ofLBP. They were classified into two groups: group A underwent a single injection in the afflicted lumbar intervertebral disc (IVD) level with 1.5 ml of methylprednisolone, 1.5 ml 2% lidocaine, and 0.5 ml of saline under rigorous aseptic precautions; in contrast, group B was administered a single injection of 3 milliliters of autologous PRP. Patients' scores on the visual analog scale (VAS), the Modified Oswestry Disability Questionnaire (MODQ), and the Straight Leg Raising Test (SLRT) were assessed before and during therapy. Results The datagathered were subjected to statistical analysis. Statistically significant differences were found in the VAS scores between group A (methylprednisolone group) and group B (PRP group) post-one hour (6.0 ±0.74 vs. 6.92 ±0.57) and after three months (5.2 ±0.65 vs. 3.26 ±0.79). Conclusions Our study revealed gradual progressive improvement in the symptoms of patients in the PRP group as indicated by scores onSLRT, VAS, and MODQ. The results were comparable to those who received methylprednisolone injections. There was a statistically significant difference in VAS scores between the two groups, with the PRP group reporting a higher degree of pain reduction, showing that PRP is an effective alternative to epidural steroid infiltration in managing chronic LBP.

Spinal magnetic stimulation to treat chronic back pain: a feasibility study in veterans.

Aim: Chronic low back pain represents a significant societal problem leading to increased healthcare costs and quality of life. This study was designed to evaluate the feasibility and effectiveness of non-invasive spinal electromagnetic simulation (SEMS) to treat nonspecific chronic low back pain (CLBP). Methods: A single-site prospective study was conducted to evaluate SEMS in reducing pain and improving disability. A total of 17 patients received SEMS two to threesessions a week. The Numeric Rating Scale and the Modified Oswestry Disability Questionnaire were used to assess pain and disability. Results: Participants receiving SEMS exhibited statistically significant reductions in pain and disability. Conclusion: Current results suggest that non-invasive SEMS can be an effective treatment in reducing pain and improving disability associated with CLBP.

Ultrasound-guided transforaminal epidural injection with fluoroscopy confirmation for the treatment of unilateral lumbar radiculopathy: A randomized controlled non-inferiority study

BackgroundUltrasound (US)-guided injections for chronic pain has multiple advantages over traditional radiologic method. The study was performed to exam the clinical outcomes of lumbar transforaminal epidural injection (LTFEI) between US and fluoroscopy (FL) guidance for lumbar radiculopathy (LRP). MethodsA total of 164 patients with LRP were randomly assigned into US and FL group to receive LTFEI in a 1:1 ratio. Pain relief and functional disability were assessed by numeric rating scale (NRS) and Modified Oswestry Disability Questionnaire (MODQ) scores before treatment, 1 month and 3 months post-intervention. Contrast spread pattern, fluoroscopic image number and complications were also recorded. The primary outcome was accurate rate of contrast dispersing into lumbar epidural space, and non-inferiority margin was predefined at −15 %. ResultsThe accuracy of LTFEI was 90.2 % and 91.5 % in US and FL group, and the lower limit of the 95 %CI of mean difference between two modalities (−4.9 % (95 %CI: −12.8 %, 3.1 %)) was above the non-inferiority margin. Procedure time in US group (531.90 ± 67.12 s) was shorter than FL group (904.20 ± 120.20 s) (p < 0.05), while radiation dosage in the US group was lower than in the FL group (3047.20 ± 569.53 vs. 8807.50 ± 1039.10 μGy m2, p < 0.001). Both groups didn’t differ in pain reduction (F = 1.050, p = 0.306) and functional improvement (F = 0.103, p = 0.749) during follow-up period. No severe complications occurred in both groups. ConclusionsUS-guided LTFEI confirmed by FL was not inferior to conventional FL method in terms of accurate rate of lumbar epidural contrast dispersion. Effective pain relief and functional ability improvement were comparable between two modalities, and US technique had advantages of less radiation exposure and possible facilitation of avoiding critical vessels around intervertebral foramen.

Surface electromyography analysis of core stabilizing muscles during isometric shoulder contractions in athletes with low back pain

BackgroundThe study was carried out in the athletes with and without Low Back Pain (LBP) to determine the surface electromyography activity of core stabilizing muscles while performing isometric shoulder and trunk contractions. Study designCross-sectional study. MethodsThis study enlisted the participation of 40 athletes. Group A included 20 athletes (18 males and 2 females) without LBP, and Group B included 20 athletes (12 males and 8 females) with LBP. Athletes with LBP were assessed using the Modified Oswestry Disability Questionnaire (MODQ) and Visual Analog Scale (VAS) to determine their level of disability and pain severity, respectively. EMG activity of the rectus abdominis, external oblique, longissimus, and multifidus was recorded in both groups as they performed bilateral isometric shoulder and trunk contractions. ResultsIn the LBP group, EMG activity of the rectus abdominis and external oblique muscles was significantly lower (P < 0.05). The LBP group had significantly more multifidus activity (P = 0.03) than the NLBP group. Among all the exercises, bilateral isometric shoulder extension contraction activated the rectus abdominis, right external oblique, and longissimus group of muscles significantly more (P < 0.05) in both groups. In both groups, bilateral isometric shoulder flexion contraction resulted in significantly higher multifidus muscle activation (P = 0.002). ConclusionThe activation of core stabilizing muscles was altered in athletes with LBP. When athletes are unable to contract and activate trunk muscles owing to pain, upper extremity exercises can be used to activate these muscles.

EFFECT OF VITAMIN D SUPPLEMENTATION IN ADULTS PRESENTING WITH CHRONIC LOWER BACK PAIN

To determine the clinical efficacy of vitamin-D supplementation on pain intensity and functional disability in patients with chronic lower back pain.This prospective cohort study was conducted from 20th March 2017 to 19th March 2019. The inclusion criteria were patients of CLBP aged between 15 to 55 years. Exclusion criteria included all the patients with Disc prolapse, Spinal stenosis, Any signs of neurological involvement, Metabolic bone disease (Hypo- or Hyperparathyroidism) and Chronic kidney disease/Chronic liver disease. Patients were supplemented with 50,000 IU of oral vitamin-D3 every week for 8 weeks (induction phase) and 50,000 IU of oral vitamin-D3 once monthly for 6 months (maintenance phase). Efficacy parameters included pain intensity and functional disability measured by VAS and modified Oswestry disability questionnaire (MODQ) scores at baseline, 2, 3 and 6 months post-supplementation. Vitamin-D3 levels were measured at baseline,2,3 and 6 months.A total of 600 patients were included in the study. The mean age of patients was 44.2 ± 11.92 years. There were 337 (56.2%) male patients while 263 (43.8%) female patients. Baseline mean vitamin-D levels were 13.32 ± 6.10 ng/mL and increased to 37.18 ± 11.72 post supplementation (P &lt; 0.0001). There was a significant decrease in the pain score after 2nd, 3rd&amp; 6th months (61.7 ± 4.8, 45.2 ± 4.6 &amp; 36.9 ± 7.9, respectively) than 81.2 ± 2.4 before supplementation (P &lt; 0.001). The modified Oswestry disability score also showed significant improvement after 2nd, 3rd &amp; 6th months (35.5, 30.2 &amp; 25.8, respectively) as compared to baseline 46.4 (P &lt; 0.001). About 418 (69.7%) patients attained normal levels after 6 months.Vitamin-D supplementation in chronic lower back pain patients may lead to improvement in pain intensity and functional ability.

“CHRONIC LOW BACK PAIN AND ITS ASSOCIATION WITH SERUM VITAMIN D LEVEL IN AN INDIAN TERTIARY CARE CENTRE”

Vitamin D has a significant role to play in bone metabolism and neuromuscular function. Several researchers have indicated that Vitamin D deficiency may be possibly related to musculoskeletal pain including chronic low back pain.Aim: We aimed to examine the relationship between the levels of vitamin D and patients with chronic low back pain and to investigate its effects on pain and functional capacity.Materials and Methods: Two hundred and sixty patients (Female/Male:110/150) with complains of low back pain for more than three months, aged between 18 to 60 years and both genders, participated in the study. Visual Analog Pain Scale (VAS) was used to measure the state of pain. Pain-related functional capacity was evaluated using Modified Oswestry Disability Questionnaire (MODQ). Patients were classified into three groups based on their serum vitamin D levels: Sufficient ( 30 ng/mL), insufficient (20.1-29.9 ng/mL) and deficient ( 20 ng/mL).

Radiographic Investigation of Lumbar Vertebrae in Patients with Flexion and Extension Movement Disorder Syndrome.

The kinesiopathology model is a new rehabilitation model classifying, evaluating, and treating patients with non-specific back pain. Sahrmann proposed this model based on movement disorder syndromes. The present cross-sectional study aimed to evaluate the radiograph of the linear and angular displacement of the lumbar spine in patients with lumbar flexion impairment syndrome (LFIS) and lumbar extension impairment syndrome (LEIS). In this study, 50 adults aged 18-46 years were enrolled, including 25 patients with LFIS and 25 with LEIS. The eligible participants were referred to the radiology department for radiography in the common position of neutral, full extension, and full flexion position while standing. The White and Panjabi's method was used to measure the linear and angular displacements. Moreover, pain intensity was assessed using the visual analogue scale, and functional disability was investigated using a modified Oswestry Disability Questionnaire. The parameter of the linear displacement at the L3-L4 level was significantly different between the two groups (P=0.02). The mean duration of low back pain was longer in the LEIS, compared to the LFIS group (P=0.01). In patients with LEIS, compensatory responses occur that cause less linear displacement at the L3-L4 level, compared to the patients with LFIS. Therefore, it is important to design appropriate exercises to better control the linear displacement at the L3-L4 level during the full range of motion in patients with LFIS.

Cupping Therapy versus Myofascial Release for Mechanical Low Back Pain: A Report of Two Cases

Inherent abnormalities with the spine, the intervertebral disks, or the surrounding soft tissues are the source of mechanical Low Back Pain (LBP). The present case report presented two cases of mechanical LBP in a 27-year-old and a 26-year-old female, as they complained of LBP that typically began due to prolonged sitting and has lasted for atleast two months. The Numerical Pain Rating Scale (NPRS) indicated a pain intensity of seven out of 10 for LBP for both the patients and Modified Oswestry Disability Questionnaire (MODQ) indicated that disability was 54%; consequently. The 27-year-old female patient was provided with a twoweek supervised static cupping therapy protocol and 26-year-old female patient was provided with a Myofascial Release (MFR) protocol. After treatment, the NPRS revealed a remarkable reduction in pain intensity to two out of 10 for LBP for cupping therapy intervention and for MFR intervention reduction in pain intensity was marked four out of 10 for LBP. Disability was reduced to 14% for cupping therapy intervention and for MFR intervention disability was reduced to 22%. As static cupping therapy is used to target the deeper musculature of the lower back and MFR treatment used for overall release of fascia, the purpose of this case report was to illustrate the comparison in the effects of cupping therapy and MFR on mechanical LBP in reducing pain intensity and disability.

Assessing the outcomes of Prp and corticosteroid injections for sacroiliac joint pain

Sacroiliac joint pain is a symptom that can affect the life activities of patients in daily life. Invasive methods also occupy an important place in the treatment of this symptom. Our study evaluated the follow-up results of patients injected with Platelet-rich plasma and steroids due to sacroiliac joint pain. Patient files between the years 2018-2022 were evaluated retrospectively. Patients who underwent ultrasound-guided sacroiliac joint injection of platelet-rich plasma and steroids were divided into 2 groups. VAS and The Modified Oswestry Disability Questionnaire scores were evaluated at 1, 3, and 6 months. Eighty-seven patients were included in the study. It was understood that patients in both groups benefited after injection (p&lt;0.001). In the 1st month follow-up, it was concluded that the VAS and the Modified Oswestry Disability Questionnaire scores of the patient group who received steroids were significantly better (p&lt;0.001). In the 3rd month, the VAS (p=0.695) and the Modified Oswestry Disability Questionnaire (p=0.215) scores of both groups were similar in both groups. In the 6th month, the platelet-rich plasma group's results were significantly better (p&lt;0.001). Platelet-rich plasma and steroid injections are safe treatment methods for sacroiliac joint pain. Steroid injections in the short term and platelet-rich plasma injections in the long term are more effective.

Outcomes of the butler neural mobilization technique and manual therapy for chronic low back pain in patients with lumbar radiculopathy: A cross-sectional comparative study

Surgeries were considered the only effective treatment method for patients suffering from chronic low back pain with lumbar radiculopathy for a while. However, in the contemporary world, it is not regarded as the primary treatment method until other conventional pharmacological and physical therapy interventions have not proven effective. Therefore, this study compares the outcomes in terms of pain relief and perceived level of mobility in patients with chronic low back pain with lumbar radiculopathy, regardless of whether the butler neural mobilization technique or manual therapy is used. This comparative cross-sectional study was conducted in Lahore, recruiting 100 patients by rendering a purposive sampling technique undergoing any treatment method mentioned above. Observations were recorded pre- and postintervention with a follow-up of 7 days to assess the response to both techniques using a questionnaire. Face-to-face interviews were conducted to assess pain levels using the Numeric Pain Rating Scale (NPRS) and Modified Oswestry Disability Questionnaire (MODQ). Descriptive statistics, chi-square test, Mann‒Whitney U test, independent t test, and the Wilcoxon signed-rank test were used to analyze the data. The medical characteristics of patients who had opted for manual therapy and butler neural mobilization were not different (p &gt; 0.05), except for the quality of pain (p &lt; 0.05). However, pre- and postintervention NPRS scores, pain intensity during the last 24 hours using NPRS scores, and MODQ scores were significantly different among the groups, indicating postintervention pain reduction for both groups comprising patients who had opted for manual therapy (p = 0.001) and butler neural mobilization technique (p = 0.001). Moreover, patients who had opted for either technique had improved their disability levels compared with the preintervention disability levels (p = 0.001). The study concluded that both techniques significantly reduce pain and disability levels, including butler neural mobilization and manual therapy, among patients suffering from chronic low back pain with lumbar radiculopathy.

Effectiveness of Mulligan's Two-Leg Rotation Versus Muscle Energy Technique in Subjects With Hamstring Tightness.

BackgroundHamstring stiffness has been growing more common, but is often neglected. The hamstring muscle complex is the key and most commonly involved muscle group for stiffness, and the younger generation is particularly susceptible. The tightness causes a limited range of motion and associated consequences. The purpose of this study is to look for the efficacy of Mulligan’s two-leg rotation (TLR) and muscle energy technique (MET).MethodsTo evaluate TLR against MET, an intervention with a duration of six days per week was planned. Modified Oswestry disability questionnaire (MODQ), active knee extension (AKE), lumbar range of motion (LROM), and numerical pain rating scale (NPRS) were used as outcome measures. The duration of the study was six months. It is a pre and post-interventional type of study.ResultStatistical analysis was done by using descriptive and inferential statistics using Student’s paired and unpaired t-tests. The Statistical Package for Social Sciences (SPSS) version 27 (IBM Corp., Armonk, NY, USA) was used. A p-value <0.05 was considered significant. Both the treatment protocol were beneficial for the patients but TLR yields a more significant reduction in tightness and pain than MET.ConclusionThe results after the data analysis show that TLR should be utilized for individuals with hamstring tightness because it exhibited a significant reduction in tightness and pain when compared to MET.

Lumbopelvic stabilization versus Pilates exercises on spatiotemporal gait parameters in chronic nonspecific low back pain

Aim of the work: The purpose of the current study is to trace and investigate how lumbopelvic stabilization and Pilates exercises affect the spatiotemporal aspects of gait in persistent nonspecific low back pain cases (NS-CLBP). Methods: Patients with NS-CLBP (N=90) were randomly assigned to one of three groups: group A (stabilization + traditional therapy), group B (Pilates plus traditional therapy), and group C (conventional therapy) in a single-blinded randomized clinical trial with 12 treatments over six weeks. A Walkway pressure measurement system was used to determine both spatial and temporal parameters. The Visual Analog Scale, Modified Oswestry Disability Questionnaire, Biering–Sorensen test, and trunk flexion endurance test were adopted successfully to assess pain, function, and isometric endurance of trunk extensor and flexor. Results: According to a cross-group analysis, a statistically significant effect was found when p = 0.001 and f-value = 3.12. Also, a statistically clear interaction was figured out between treatment and time when p = 0.0001 and f-value = 3.44. Following therapy, the Pilates group showed a decrease in temporal parameters, pain, and functional impairment, as well as an increase in cadence and velocity (p 0.05).

Effects of Transcutaneous Electrical Nerve Stimulation along With Home Based Care Program on Low Back Pain and Disability in Post-Partum Patients

Aim: To determine the Effects of Transcutaneous Electrical Nerve Stimulation Along with home based care program in postpartum patient with low back pain for improving pain and disability Study design: Quasi-Experimental study Place and duration: Kanaan Physiotherapy and spine Clinic Lahore, Pakistan from 2 March 2021-3 September 2021. Methodology: A total of 70 postpartum patients age range between 18years-40years were randomly allocated in 2 groups. Inclusion criteria was patients having low back pain during delivery and any other syndrome or anatomical abnormality were excluded. Group A received TENS plus supervised conventional home physical therapy program while Group B received Conventional home physical therapy program. Both groups took 5 sessions in a week treatment. Generalized the low back pain was measured by numeric pain scale, Modified Oswestry disability questionnaire was used to assess disability. Data analysis was done by using SPSS Version 21. Results: The experimental group showed significant improvement low back pain postpartum in numeric rating pain scale (p&lt;0.00) (Pain) and Oswestry disability index (p&lt;0.00) (Disability) Conclusion: It was concluded that Transcutaneous Electrical Nerve Stimulation along with home based exercise was significantly in reducing low back pain in postpartum. Comparison between both groups showed significant improvement in decreasing disability and pain after treatment. Keywords: Low back pain, postpartum period, Transcutaneous Electrical Nerve Stimulation

Stratification of spine patients based on self-reported clinical symptom classes

Improving prognostic stratification for patients with low back pain (LBP) outside of a primary care setting has been identified as an important area for further research. Our study aimed to identify clinical symptom classes of patients presenting to a spine clinic based on 4 Patient Reported Outcome Measurement Information System (PROMIS) domains and evaluate demographic and clinical differences across classes. An observational cross-sectional study of patients seen in spine centers at a large health system. Adult patients with LBP seen in a spine center between November 14, 2018 and May 14, 2019 who completed patient-reported outcomes as part of routine care. PROMIS physical function, pain interference, satisfaction with social roles and activities, and fatigue. Latent class analysis identified symptom classes based on PROMIS domain scores ≥1 standard deviation worse (meaningfully worse) than the general population. A multivariable multinomial logistic regression model was constructed to evaluate differences in symptom classes based on demographics and socioeconomic characteristics. Lastly, the ability of the profiles to discriminate across levels of disability, based on the modified Oswestry Disability Questionnaire (ODI), was evaluated. There were 7,144 adult patients included in the study who visited spine clinics for a primary complaint of LBP and completed all 4 PROMIS domains (age 58.7±15.9, 54% female). Three distinct classes were identified. Class 1 ("Significant Symptoms," n=3238) had PROMIS scores that were meaningfully worse than the population average for all domains. Class 2 ("Mixed Symptoms," n=1366) had meaningfully worse scores on physical function and pain interference but average scores on other domains. Class 3 ("Mild Symptoms," n=2540) had average scores across all domains. Compared to patients in Class 3, those in Class 2 were more likely older, and those in Classes 1 and 2 were more likely to be divorced, have lower household income, and no employment. Level of disability was significantly different across each class (average (SD) ODI for Classes 1-3: 53.4 (14.3), 39.9 (12.5), 22.9 (12.1), p<.01). Patients presenting to specialty clinics for LBP demonstrate distinct clinical symptom classes which could be utilized to inform specific symptom-based treatment. Future research should evaluate the ability of these classes to predict long-term disability.

Six Weeks Effects of Dynamic Neuromuscular Stabilization (DNS) Training in Obese Postpartum Women With Low Back Pain: A Randomized Controlled Trial.

The worldwide prevalence of obesity and low back pain (LBP) has recently dramatically increased and is mainly indicated among postpartum women, leading to a range of adverse health consequences. This study aimed to investigate the effects of 6 weeks of Dynamic Neuromuscular Stabilization training (DNS) in obese postpartum women with LBP. This was a pretest-posttest study design. The study was conducted with 40 obese postpartum women with LBP randomized to receive DNS (n = 20) or General Exercise (GE, n = 20) 6 times a week for 6 weeks. The data were gathered before and after the 6-week intervention. Forty participants completed the study (mean ± SD, age 29.30 ± 3.77 years; weight 88.10 ± 6.09 kg; height 165.40 ± 6.31 cm; and BMI, 32.19 ± 1.07 kg/m2). The overall group-by-time interaction was significant for Numeric Pain-Rating Scale, Modified Oswestry Disability Questionnaire, Fear-Avoidance Beliefs Questionnaire, Inspiration and Expiration Breath Hold Time, and Respiratory Rate outcomes. The global rating of change was significantly different between groups (p < .05). The rate of improvement was higher in the DNS group compared to the GE group in all 6 tests. The present study confirms that DNS is applicable in obese postpartum women with LBP and effectively improved NPRS, MODQ, FABQ, BHT, and RR. It is clinically suggested that DNS is imperative based on ideal ontogenetic patterns to attain optimal results for obese postpartum women with LBP.

Effectiveness of Muscle Energy Technique Versus Strain Counter Strain Technique on Trigger Points of Quadratus Lumborum among Low Back Pain Patients

Objective: To determine the effectivness of muscle energy technique versus strain counter strain techniques on trigger points of quadratus lumborum among patients with low back pain. Methodology: A quasi-experimental trial was conducted on 40 patients who had low back pain due to trigger points in Sialkot medical complex hospital, Sialkot. The participants were divided into group A (MET) and group B (SCS). Group A was treated with muscle energy techniques and moist heat therapy, while Group B was treated with strain counter strain technique and moist heat therapy for two weeks. Numeric pain rating scale and Modified Oswestry Disability Questionnaire were used. Data was analyzed on SPSS 21. Results: The mean score of the Oswestry Disability Index (ODI) was 53.10±7.35 and 56.60 ± 7.89 at the start of treatment in group A (MET) and group B (SCS), respectively. The final ODI score for group A (MET) and group B (SCS) was 22.25± 5.87 and 37.70± 7.87, respectively. The mean value of pain intensity on the Numerical Pain Rating Scale (NPRS) was 7.30±1.25 vs. 7.85±1.26 at the start of treatment in Group A (MET) and Group B (SCS), respectively. The post-treatment NPRS score was 3.20 ±1.16 vs. 4.55±1.20 for Group A (MET) and Group B (SCS), respectively. Conclusion: According to the findings of this study, both METS and SCS significantly improved pain and functional disability in patients with low back pain caused by trigger points in the quadratus lumborum. However, in terms of mean difference, METS are more effective than SCS. Keywords: Strain counter strain, METS, Trigger points, Quadratus lumborum, Low back pain

Manual therapy and canal enlargement exercises versus conventional physiotherapy in lumbar stenosis – a study protocol

INTRODUCTION: Lumbar Canal Stenosis (LCS) is known as the well-established reason for pain and depleted walking capacity in patients with manifestations of paresthesia and pain in the lower back, gluteal region, posterior thigh, and legs which are termed as ‘Neurogenic Claudication’ (NC). Manual therapy combined with canal enlargement exercises and conventional physiotherapy may be considered in eradicating pain and NC symptoms, hence improving the quality of life. METHODS AND MATERIALS: Patients with LCS with canal diameter 8-12 mm at the level of L4 and below will be recruited for this study. Through the Block randomization method, they will be randomized into two interventional groups: Manual Therapy &amp; Canal Enlargement (MTCE) (n=16) and Conventional Physiotherapy (Cp) (n=16) groups. MTCE group will receive manual therapy and canal enlargement exercises, while the Cp group will receive only conventional physiotherapy. Both interventional groups will receive 3 days of treatment per week for 4 weeks. Modified Oswestry Disability questionnaire (MODI), Antero-Posterior (AP) canal diameter, Numeric Pain Rating Scale (NPRS), and Claudication Distance (CD) will be used for the evaluation. In addition, modified Oswestry Disability Index, AP canal Diameter, NPRS, Claudication distance, an SLR will be measured at baseline and post-intervention. DISCUSSION: The results of this research will dictate the applicability of manual therapy with an exercise protocol of canal enlargement exercises on pain and functional disability in patients with LCS.

Effectiveness of Lumbar Motor Control Exercises in Improving Lumbar Stability among Bharatanatyam Dancers

Background and purpose: Low back injuries among Bharatanatyam dancers are said to be over use relatedand secondary to biomechanical alignment defects. This causes weakness of the deep core muscles resultingin lumbar instability and low back pain. Motor control exercises aim to retrain the optimal control of thedeep spinal muscle and maintain normal control during physical and functional tasks. The study is designedto assess the effectiveness of motor control exercises in improving lumbar stability among Bharatanatyamdancers.Objectives: To find out the strength of the deep abdominal muscle function pre and post intervention. Tofind out the correlation between lumbar spine curvature in standing and the deep abdominal muscle strength.To assess the effectiveness of lumbar motor control exercises in improving lumbar stability.Design: Quasi experimental one group pre and post-test designMethods: A total of 85 subjects (females) aged between 18 to 30 years with Quebec score &gt;20 were recruitedusing purposive sampling method. Subjects were examined for core muscle activity using Stabilizer pressurebiofeedback and were assessed for Lumbar spine curvature using Flexible curve ruler. Pain and disabilitywere scored using Modified Oswestry disability questionnaire (MODQ). The intervention consisted of motorcontrol exercises for 6 weeks. Pre and post-test intervention scores were recorded and analysed. Results:The core muscle activity and Modified Oswestry disability score significantly (p&lt;0.001) improved after theintervention and showed strong significance. The correlation between lumbar lordosis angle and core muscleactivity showed positive relation (r = 0.859) and statistically significant (p&lt;0.001). Conclusion: The resultssuggest that, motor control exercises may be significantly effective in improving lumbar stability amongBharatanatyam dancers.

Effectiveness of Mulligan mobilization and Kinesio-taping technique on the anterior innominate dysfunction in females.

To determine the effects of Mulligan mobilisation with Kinesio Tex tape on pain and disability in anterior innominate dysfunction in females. The quasi-experimental study was conducted from March to August 2018 at the Allied Hospital and Javeed Medical Complex, Faisalabad, Pakistan, and comprised women with anterior innominate dysfunction. The subjects were divided into group A, which was treated with therapeutic ultrasound, Mulligan mobilisation and Kinesio taping, and group B, which was treated with therapeutic ultrasound and Mulligan mobilisation. Data was taken at baseline and after 10 days to measure pain and disability using visual analogue scale and Modified Oswestry Disability Questionnaire. Data was analysed using SPSS 20. Of the 30 women, there were 15(50%) in group A with a mean age of 32.80±6.02 years and 15(50%) in group B with a mean age of 34.20±6.51 years. Both groups showed significant improvement in pain and disability post-treatment (p<0.05), with group A showing more improvement than group B in terms of disability (p=0.001), but not in terms of pain (p=0.20). Both Mulligan mobilisation along with Kineso Tex tape and Mulligan mobilisation alone were found to be effective in reducing pain and disability, with the tape showing better improvement in pain and disability compared to those receiving mobilisation alone.

Efficacy of transforaminal epidural magnesium administration when combined with a local anaesthetic and steroid in the management of lower limb radicular pain.

Lower limb radicular pain resulting from a herniated intervertebral disc is a cause of functional disability and could lead to increased consumption of opioids. We evaluated the efficacy of epidural magnesium combined with a local anaesthetic and steroid in the management of this pain. This was a prospective, case-control, randomized, double-blind study. Fifty patients each received 2ml bupivacaine, 1ml (40mg) methylprednisolone and 1ml saline (0.9%) (group C) or magnesium (200mg) instead of saline (group M). The primary outcome measure was the improvement in the pain score (assessed using a visual analogue scale (VAS)), and the secondary outcome was the improvement in the functional ability (assessed using the Modified Oswestry Disability Questionnaire (MODQ)). The VAS and MODQ scores were assessed before and at 1day, 1week, 1month and 3months post-intervention. The VAS and MODQ scores were significantly better in group M compared to those in group C at all times post-injection (p-value<0.001). Comparisons within the same group showed that the VAS and MODQ scores were significantly better at all post-injection time points compared to the pre-injection scores in both group C and group M (p-values<0.0001). Adding magnesium to a local anaesthetic and steroid to be injected in the transforaminal epidural space could improve the pain and the quality of life in patients suffering from lower limb radicular pain due to lumbo-sacral disc herniation, and this improvement could last for up to 3months. Magnesium is efficient when added to local anaesthetics and steroids for management of lower limb radicular pain.