EFFECTS OF EXTENSION BIASED EXTERNAL LIMB LOADING IN ADDITION TO MCKENZIE EXTENSION PROTOCOLS IN LUMBAR DERANGEMENT SYNDROME

A. Naeem¹, S. Kayani¹, F.A. Siddiqi¹, A. Iqbal²

Background: Stabilization & McKenzie training protocols have been widely accepted for the treatment of musculoskeletal disorders & various spine related issues of human body. However, the difference between limb loading & McKenzie extension exercise techniques in the management of Lumbar derangement syndrome is not well established. This study compared both treatment approaches in Lumbar Derangement Syndrome classified by Robin McKenzie with nearly 78% prevalence in general population.

Purpose: To determine the role of extension biased external limb loading & McKenzie extension exercises on Pain, Disability & lumbar Range of motion in patients with Lumbar derangement syndrome following McKenzie Method of Mechanical Diagnostic Therapy (MDT).

Methods: A randomized controlled trial was conducted at Foundation University Institute of Rehabilitation Sciences, Islamabad from July 2019 to January 2020, 30 patients were included and randomized into 2 groups, receiving 6 treatment sessions in total. Group A (n=15) received McKenzie extension training whereas Group B (n=15) received external limb loading exercises along with McKenzie extension exercises. Numeric pain rating scale (NPRS), Oswestry Disability Index (ODI) and Lumbar range of motion (ROM) were used as outcome measurement tools.

Results: A statistically significant difference was observed between Pre and Post NPRS, ODI and Lumbar ROM scores after 2 weeks of treatment for both groups (p< 0.05). Moreover, between group analysis by applying independent sample t-test on Group A & Group B revealed baseline mean values to be 7.00+0.926 & 7.00+0.75 (NPRS), 50.07+5.75 & 52.47+7.92 (ODI) respectively. Similarly, post-intervention analysis on Group A & Group B revealed mean scores to be 2.27+0.70 & 0.93+0.70 (NPRS), 21.93+3.61 & 16.20+4.34 (ODI) respectively with p value <0.05.

Conclusion(s): Both treatment techniques can effectively manage patients of lumbar derangement syndrome. However, patients treated with Extension Biased External Limb Loading along with McKenzie Extension Exercises together revealed greater reduction in Pain at NPRS, improved Functional disability status at ODI & better lumbar Range of motion using bubble inclinometer.

Implications: Current study might help to detect influence of progressive stabilization & McKenzie training over quality of life in terms of functional dependency & effects of spinal disc issues at overall postural stability index of an individual. There is also paucity of literature in establishing the effects of both treatment techniques in a developing country like Pakistan so the study will also fill this required gap. It is also important to mention that patients, once properly guided by an expert Physical therapist, can safely perform these exercises at home & can get rid of their lumbar spine issues to a greater extent which  highlights the importance of Physical therapy in society.

Funding, acknowledgements: None to report

Keywords: Lumbar derangement syndrome, Mechanical back pain, External limb loading

Topic: Musculoskeletal

Did this work require ethics approval? Yes

Institution: Riphah College of Rehabilitation Sciences, Riphah International University, Islamabad

Committee: Research Ethical Committee (REC) Riphah International University Islamabad, Pakistan

Ethics number: Riphah/RCRS/REC/00571