| INTERVENTIONS |
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Intervention type
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Intervention name
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Dose
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Duration
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Intervention description
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Group size
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Nature of control
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| Experimental Group |
Spinal manipulation with spinal stabilzation exercises |
Once per session, where patient will receive 3 sessions per week for 4 consecutive weeks |
3 sessions per week for 4 consecutive weeks |
Patient will be positioned side lying on non-affected side facing the therapist with the bottom leg in approximately 30 degrees of hip and knee flexion.
The therapist stands in front of the patient and presses the front of the hip into the patient’s knee to support the top leg. The single leg forward bending technique is used to forward bend the lumbar spine up to the segment to be manipulated and then the hip and spine are slightly extended to maintain the spinal segment inferior to the targeted segment in a forward bent position. Once this point is reached, the top leg is “hooked” onto the bottom leg.The position of the hands is now switched so that the pad of the third digit of the caudal hand now palpates the inter-spinous space of the targeted segment and the second digit palpates one segment above. The spine is rotated to include the segment superior to the segment to be manipulated, but the segment to be manipulated is maintained in neutral. This is accomplished by pulling the patient’s bottom arm (from proximal to the elbow) in a forward and upward rotary motion with the cranial hand. Next, fold the patient’s arms loosely across the patient’s chest.The cranial hand slides underneath the patient’s top arm, and the pad of the long finger contacts the top right lateral side of the spinous process of segment. The cranial leg leaves the ground and the knee on the patient’s upper leg slides down the thigh of the therapist’s caudal leg. Equal and opposite forces through the forearms (with contact with the patient’s right anterior shoulder and chest and the right posterior hip and pelvis) are used to take up the slack and induce right rotation of the specified segment. The manipulation is coordinated with the patient’s breathing, with progressive oscillation into more rotation each time. |
15 |
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| Experimental Group |
Mobilization with movement with spinal stabilzation exercises |
This technique will be repeated ten times/session |
3 sessions per week for 4 consecutive weeks |
The patient sits on a plinth with his legs over the side. The therapist stands behind him and place a belt around his lower abdomen keeping it below the anterior superior iliac spine for comfort. The belt should be below therapist hip joints. The ulner border of therapist's right hand is placed under the spinous process of the vertebra above at the suspected spinal segment. Therapist's other hand should be placed on the bed to the left of the patient. The therapist will apply a gliding force with his right hand up along the treatment plane as the patient flexes forward. The therapist maintains the facet glide until the patient is erect again. |
15 |
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| Control Group |
Spinal stabilzation exercises |
Each exercise was done ten times at each session with hold for six seconds at the end of the range, (Jari et al., 2004). |
three sessions/week for 4 consecutive weeks |
Strengthening exercises for back muscles by active back extension and bridging (Jari et al., 2004) and strengthening exercises for abdominal muscles by sit up exercise, and posterior pelvic tilt (El Naggar et al., 1991). |
15 |
Active-Treatment of Control Group |