Manual Therapy Followed by Dynamic Strengthening Exercise Along With Conventional Physiotherapy Versus Manual Therapy Along With Conventional Physiotherapy on The Improvement of Pain and Functional Disability In Patients With Chronic Non-Specific Low Back Pain: A Randomized-Controlled Pilot Study

Author(s): Md Nazmul Hassan, Parvin Akter, Mohammad Anwar Hossain, Koushik Ahmed, Farjana Sharmin, Md Shahoriar Ahmed, Kumar Amitav, Md Ashif Ikbal khan, Shazal Kumar Das, Lori M. Walton, Mohammad Habibur Rahman

Chronic low back pain (LBP), defined as back pain persisting for more than 12 weeks, affects over 50% of the general population.[1] It is the second most common factor for patients in search of primary care services.[2]According to the US National Center for Health Statistics, 14% of new patients admitted to a hospital for treatment had low back pain, representing 13 million people.[3] Also, it is estimated that over 70% of adults have had at least one episode of LBP in their lifetime.[4]In 2007, another study revealed that lower back region pain is caused by disc degeneration, spondylolisthesis, lumbar stenosis, epidural hematoma, and other causes, and 3% of all patients discharged from hospitals have symptomatic low back pain.[5] Because the causes of LBP are variable, different exercise regimens have been used to treat patients, including lumbar flexion, extension, isometric flexion, passive extension, and intensive dynamic back exercise regimens, and many of these exercise regimens have not yielded satisfactory results.[6]Recently, some studies have focused on exercises that aim to maintain or improve lumbar spine stability, such as lumbar stabilization exercises, which are aimed at improving the neuromuscular control, strength, and endurance of the muscles that are fundamental to maintaining spinal and trunk stability through several groups of muscles, particularly transverse abdominis and lumbar multifidi, but also other paraspinal, abdominal, diaphragmatic, and pelvic muscles.[7] Unsubstantiated suggestions that stabilization training may be useful in reducing pain and disability for all patients with nonspecific LBP, have appeared in the literature,[8] but these assertions have not been definitively demonstrated. Weakness of the abdominal muscles among the trunk muscles of low back pain patients is generally prevalent, and the strengthening of the abdominal muscles is essential in the recovery of the spinal neutral position.[9] When imbalance between the

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