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IRCT20220604055072N3 IRCT 2025-04-16 Rashid Latif Medical College Comparative effect of diaphragmatic training and myofascial release on pain, flexibility and disability in patients with chronic non-specific low back pain Comparative effect of diaphragmatic training and myofascial release on patients with chronic non-specific low back pain 2025-04-20 anticipated 44 Complete https://irct.ir/trial/82685 interventional Randomization: Randomized, Blinding: Single blinded, Placebo: Not used, Assignment: Parallel, Purpose: Treatment, Randomization description: Patients were allocated randomly to study groups using the lottery method. Each patient was asked to draw a closed slip marked with number 1 or 2 from a box. Group A include participants in box number one, while group B include participants of box number two. 48 patients were allocated based on randomization in two groups equally, i.e., 24 in each group, Blinding description: The interventions were based on outpatient rehabilitation program in both groups. The study participants were blind about groups a treatment protocol. N/A Chronic non-specific Low Back Pain. Intervention 1: Intervention group: Diaphragm Training. The diaphragm has a dual role of respiration and postural control. However, the role of the diaphragm is often overlooked in core stability exercise regime low back pain rehabilitation. Abdominal hollowing exercise, also known as the ‘tummy tuck’ exercise focusing on TrA and lumbar multifidus. Diaphragmatic breathing on activation of trunk muscles of patients with low back pain. Diaphragmatic breathing may affect activation of trunk muscles. Diaphragmatic breathing increases intra-abdominal pressure, and the increased intra-abdominal pressure may contribute to the lumbar stability. Experimental group performed diaphragmatic breathing exercise with six breathing positions. First week: Supine breathing + Crocodile breathing. Second week: Supine breathing with TheraBand + Crocodile breathing with TheraBand. Third week: Seated breathing + 90/90/90 breathing Fourth week: Seated breathing with TheraBand + TheraBand. Intervention 2: Comparative Intervention group: Myofascial Release technique. Myofascial release technique diaphragm performed as follow: The participant lay supine with relaxed limbs. Positioned at the head of the participant, the therapist made manual contact with the pisiform, hypothenar region and the last three fingers bilaterally to the underside of the seventh to tenth rib costal cartilages, with the therapist's forearms aligned toward the participant's shoulders. In the inspiratory phase, the therapist gently pulled the points of contact with both hands in the direction of the head and slightly laterally, accompanying the elevation of the ribs. During exhalation, the therapist deepened contact toward the inner costal margin, maintaining resistance. The manoeuvre was performed in two sets of 10 deep breaths, with a 1-minute interval between them. Undecided - It is not yet known if there will be a plan to make this available Justification or reason for indecision in sharing IPD is Undecided - It is not yet known if there will be a plan to make this available
public Sadia Ahmed
25-Km Ferozepur road Lahore
Lahore Pakistan 54600 +92 305 4501212 areejsaadia@gmail.com Rashid Latif Medical College scientific Sadia Ahmed
25-Km Ferozepur road Lahore
Lahore Pakistan 54900 +92 305 4501212 areejsaadia@gmail.com Rashid Latif Medical College Pakistan Participants were included if they had intermittent nonspecific CLBP for ≥12 weeks, with VAS between 3 to 7. All participants were active at a recreational level, for 2–4 times per week, since at least 3 years. Patients with low back pain without radiculopathy Individual willing to participate in study 20 years 45 years Both Upper abdominal surgery Lumbar surgery experience Inflammatory spinal disease Spinal deformities Neurologic radiating pain M54.5 Low back pain Treatment - Other Treatment - Other Intervention group: Diaphragm Training. The diaphragm has a dual role of respiration and postural control. However, the role of the diaphragm is often overlooked in core stability exercise regime low back pain rehabilitation. Abdominal hollowing exercise, also known as the ‘tummy tuck’ exercise focusing on TrA and lumbar multifidus. Diaphragmatic breathing on activation of trunk muscles of patients with low back pain. Diaphragmatic breathing may affect activation of trunk muscles. Diaphragmatic breathing increases intra-abdominal pressure, and the increased intra-abdominal pressure may contribute to the lumbar stability. Experimental group performed diaphragmatic breathing exercise with six breathing positions. First week: Supine breathing + Crocodile breathing. Second week: Supine breathing with TheraBand + Crocodile breathing with TheraBand. Third week: Seated breathing + 90/90/90 breathing Fourth week: Seated breathing with TheraBand + TheraBand. Comparative Intervention group: Myofascial Release technique. Myofascial release technique diaphragm performed as follow: The participant lay supine with relaxed limbs. Positioned at the head of the participant, the therapist made manual contact with the pisiform, hypothenar region and the last three fingers bilaterally to the underside of the seventh to tenth rib costal cartilages, with the therapist's forearms aligned toward the participant's shoulders. In the inspiratory phase, the therapist gently pulled the points of contact with both hands in the direction of the head and slightly laterally, accompanying the elevation of the ribs. During exhalation, the therapist deepened contact toward the inner costal margin, maintaining resistance. The manoeuvre was performed in two sets of 10 deep breaths, with a 1-minute interval between them. Pain. Timepoint: Pre-intervention and Post-4 week intervention. Method of measurement: Pain level was assessed by the Numerical Rating Scale (NRS). The participants rated their pain on a defined 0–10 scale, where 0 is no pain, and 10 is the worst pain imaginable. Disability. Timepoint: Pre-intervention and Post-4 week intervention. Method of measurement: The ODI is one of the most common scoring systems used for patients with LBP. The total score ranges from 0 to 100, where a higher score indicates a higher level of disability. Flexibility. Timepoint: Pre-intervention and Post-4 week intervention. Method of measurement: The examiner puts his thumbs on the inferior margin of the subject’s PSIS. An ink mark is drawn along the midline of the lumbar spine horizontal to the PSIS (lower landmark). While the examiner holds the tape firmly against the subject’s skin, he marks a second line 15 cm above the original one (higher landmark). Then the subject is asked to do an active anterior flexion of the trunk without increasing the pain. The new distance between the lower and higher landmarks is then measured. The subject returns to the neutral position. The difference in the initial distance between the skin markings in the neutral position and the new measurements made in the flexion position is used to indicate the amount of lumbar flexion. Rashid Latif Medical College Approved 2024-12-12 The Institutional Review Board of Rashid Latif Medical College 25-Km Ferozepur road Lahore Lahore Punjab Pakistan