Effects of Retro-Walking Along With Core Stabilization in Non-specific Chronic Low Back Pain Patients

The aim of this study is to find the effects of retro walking along with core stabilization on pain, disability and balance in non-specific chronic low back pain patients. Randomized controlled trials will be done at Railway general hospital, Rawalpindi and Care plus medical center, Islamabad. The sample size was 42. The subjects were divided in two groups, 21 subjects in group A will undergo retro-walking along with core stabilization and 21 in group B will undergo only core stabilization exercises. Conventional physical therapy protocol will apply to both groups. Sampling technique applied was purposive nonprobability sampling technique. Only 25-40 years individual with chronic low back pain were included. Tools used in the study are visual analogue scale, Oswestry Disability Index and G\&B app. Data will be analyzed through Statistical Package for the Social Sciences version 21.

Low back pain is defined as the pain that typically originates above the inferior gluteal folds and below the costal margins. Low back pain is divided into specific low back pain that refer to the pain that originates due to any pathology and can be spinal or non-spinal in origin. Non-specific low back pain is refer to the pain that persist without any identifiable cause such as tumor, infection, osteoporosis, fracture, cauda- equina syndrome, radicular pain and inflammatory disorders. It is highly reported musculoskeletal condition and represents a considerable health concern world-wide and also the leading cause of disabilities and can be occur in any age group which imposes burden both economically and socially on individuals as well as health care system. Non-specific low back pain is further divided into: acute (\<3 months of duration) and chronic (\>3 months of pain duration). Low back pain is multifactorial in nature i.e. it can be biomechanical, neurological or psychological. Every individual once in life must encounters low back pain. Several risk factors are associated with low back pain such as genetic predisposition, superfluous dynamic or static loading, excessive bending and twisting movements, poor postural alignment, obesity, lack of physical activity, stress and anxiety. Several treatments are recommended for patients with low back pain including medication, short waves, infiltration, or blockade. Exercise therapy consists of a vast range of interventions such as aerobics, movements to improve flexibility and strength, stretching, stabilization, coordination and balance training. These treatment options are effective, but we want to explore techniques which are feasible and cost effective for patients of chronic low back pain. Retro-walking, which is also known as retro-pulsion, or backward walking is proving to be valuable therapeutic technique in rehabilitation. This method first practiced in ancient China to work on physical fitness and well-being of clients. Retro- walking is different in its gait pattern from forward walking, for example speed and stride length decreased and cadence increased. It is confirmed that flexibility of hamstring is increased by retro-walking in healthy individuals. The gait pattern in retro-walking involves the leg swings backward with the knee bent. The toe touches the ground initially and then the knee gradually straightens up as the foot makes full contact with the ground. Retro-walking also helps in improvement of spinal alignment which can be disturbed due to low back pain. In contrast, core stabilization has been widely used in treatment of chronic low back pain. Several studies have observed that weakness of lumbar multifidi and transverse abdominis muscle and delayed tonic activation of these muscles during gait and movement can be the cause of chronic low back pain. Decreased functioning of these muscles can be the cause of lumbar instability, increase in stress and loads of the surrounding structures in lumbar spine. Core stability exercises are used to regain normal muscles functioning which can help in lumbar stability, neuromuscular control within the lumbar region and it also prevents shear forces that can cause injury to the lumbar spine. According to the literature, Ansari et al. assess the effects of retro-walking and conventional physiotherapy treatment on students' with low back pain. After 1 month of the treatment flexion range of motion of lumbar spine showed no significant changes between two groups but pain and balance of the group introduced with retro-walking showed a significant improvement. Dr. RP Panday conducted a study aimed at investigating the effects of retro walking verses core stabilization exercises on pain and function in the patients with mechanical low back pain. Pain and disability reduction is seen in both groups, but better results are observed with retro walking. PR Parikh et al. conducted a study on effectiveness of forward walking versus retro walking on Balance, Gait speed and Lower body functional strength among the elderly population. The result of this study shows significant improvement in balance, gait and lower body functional strength both with forward and backward walking, but backward walking shows better results. Azeem et al. assessed the effects of retro walking on pain, functional disability, quality of life and sleep problems in patients with chronic low back pain. years. After 3 weeks of intervention there is a significant decrease in pain observed in both groups but the group introduced with retro walking showed a better improvement. SS et al. conducted a research on effect of retro walking on pain, functional disability and performance in knee osteoarthritis patients . After 6 weeks of intervention it showed that the group with retro walking showed significant improvement. Su Su Hlaing et al. conducted a study on effect of core stabilization and strengthening exercises on proprioception, balance, muscle thickness and pain related outcomes in with chronic low back pain. After interventions of 4 weeks the group which introduced core stabilization shows better result than strengthening exercises.