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This randomized controlled trial aims to compare the effectiveness of elastic resistance training and free weight training in strengthening the gluteus medius muscle among patients with chronic non-specific low back pain. Weakness in the gluteus medius can contribute to pelvic instability and altered gait patterns, which may exacerbate low back pain. While both elastic resistance and free weight exercises are commonly used in rehabilitation, there is limited evidence comparing their relative benefits in this population. This study evaluates improvements in pain, muscle strength, and overall gait speed following each intervention. The findings will help guide clinicians in choosing the most effective and accessible strengthening method for patients with chronic non-specific low back pain.
The gluteus medius plays a vital role in pelvic stabilization and maintaining proper gait mechanics. Dysfunction or weakness in this muscle is frequently associated with chronic non-specific low back pain, a condition affecting a significant proportion of the population. Rehabilitation strategies that target the gluteus medius are crucial for restoring lumbar-pelvic stability, optimizing functional movement, and reducing pain.
Free weight training, using equipment like dumbbells and barbells, is a traditional method to enhance muscle strength and improve neuromuscular coordination. However, it often requires proper supervision to avoid injury due to the need for controlled movements and joint stability. On the other hand, elastic resistance training, which employs tools like resistance bands or tubes, offers a safer, cost-effective, and portable alternative. It allows progressive resistance throughout the range of motion, matching the user's strength curve and facilitating home-based exercise programs.
This randomized controlled trial is designed to compare these two training modalities, which are elastic resistance versus free weights in terms of their effectiveness at improving gluteus medius strength, reducing low back pain, and enhancing gait speed in patients with chronic non-specific low back pain. The trial includes baseline and post-intervention assessments using validated clinical tools for measuring pain, strength, and gait speed.
The goal is to determine which intervention yields greater clinical benefit and offers a more practical approach for implementation in therapeutic settings, especially for populations with limited access to conventional gym equipment. The findings could contribute valuable evidence to inform clinical decision-making in physical therapy and rehabilitation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Elastic Resistance Training with Conventional Training | Experimental | The participants in this group will receive elastic resistance training with conventional training. The intervention would be given 5 times per week on alternate days for 4 weeks. Each exercise session will be given in 2sets of 8 repetitions each set. |
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| Free Weight Training along with Conventional Training | Active Comparator | The participants in this group will receive free weight training along with conventional training. The intervention frequency will be the same as group A (5 times/week for 4 weeks). Each exercise session will be given in 2 sets of 8 repetitions each set. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Elastic Resistance Training | Procedure | The type of resistance exercises in which the participants use the Thera Band of yellow and red colours (weight about 2-2.5 kg with full elongation) for resistance training |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Pain Intensity | Pain will be assessed using the Numeric Pain Rating Scale (NPRS), a self-reported 11-point scale ranging from 0 (no pain) to 10 (worst imaginable pain). | Baseline and at 4 weeks post-intervention |
| Change in Gluteus Medius Muscle Strength | Muscle strength will be measured using a manual muscle testing to assess isometric strength of the gluteus medius. A system of manually testing weakness of muscles by assuming different positions and performing movements against gravity or gravity eliminated depending on the strength of the and 5 indicates the muscle can hold anti-gravity position against maximum resistance. | Baseline and at 4 weeks post-intervention |
| Change in Overall Gait Speed | Gait speed will be measured using the 10-Meter Walk Test (10MWT), recorded in meters per second (m/s). | Baseline and at 4 weeks post-intervention |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Gulab Noor, MSPT | Institute of Physical Medicine and Rehabilitation, Khyber Medical University Peshawar | Principal Investigator |
| Dr Hazrat Bilal, PhD* | Institute of Physical Medicine and Rehabilitation, Khyber Medical University Peshawar | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Rehman Medical Institute | Peshawar | Khyber Pakhtunkhwa | 25000 | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31451199 | Background | Roelker SA, Kautz SA, Neptune RR. Muscle contributions to mediolateral and anteroposterior foot placement during walking. J Biomech. 2019 Oct 11;95:109310. doi: 10.1016/j.jbiomech.2019.08.004. Epub 2019 Aug 9. | |
| 25700608 | Background | Ventura JD, Klute GK, Neptune RR. Individual muscle contributions to circular turning mechanics. J Biomech. 2015 Apr 13;48(6):1067-74. doi: 10.1016/j.jbiomech.2015.01.026. Epub 2015 Feb 2. |
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Data obtained through this study may be provided to qualified researchers with academic interested in the stated study area after its proper monitoring. Data or samples shared will be coded, with no PHI included. Prior permission of the investigators, participants and concerned departments will be obtained.
Data requests can be submitted starting 12 months after article publication.
Access can be requested by qualified researchers through proper approval of the investigators.
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Participants will be randomly assigned to either an elastic resistance training group or a free weight training group to compare outcomes related to pain, strength, and gait speed.
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Participants and assessors performing pre- and post-intervention evaluations will be blinded to group allocation to reduce bias.
|
| Free Weight Exercises | Procedure | The type of resistance exercises in which the participants use weight cuffs (weight 2-2.5 kg) tied to their lower leg for resistance training |
|
| Conventional Training | Procedure | The conventional training includes side-lying hip abductions, standing weighted abductions, and lateral step-ups exercises. |
|
| 34713383 | Background | Kasitinon D, Li WX, Wang EXS, Fredericson M. Physical Examination and Patellofemoral Pain Syndrome: an Updated Review. Curr Rev Musculoskelet Med. 2021 Dec;14(6):406-412. doi: 10.1007/s12178-021-09730-7. Epub 2021 Oct 29. |
| 28226298 | Background | Bauer CM, Rast FM, Ernst MJ, Meichtry A, Kool J, Rissanen SM, Suni JH, Kankaanpaa M. The effect of muscle fatigue and low back pain on lumbar movement variability and complexity. J Electromyogr Kinesiol. 2017 Apr;33:94-102. doi: 10.1016/j.jelekin.2017.02.003. Epub 2017 Feb 13. |
| 34721067 | Background | Lanza MB, Rock K, Marchese V, Addison O, Gray VL. Hip Abductor and Adductor Rate of Torque Development and Muscle Activation, but Not Muscle Size, Are Associated With Functional Performance. Front Physiol. 2021 Oct 14;12:744153. doi: 10.3389/fphys.2021.744153. eCollection 2021. |
| 26674405 | Background | Sheahan PJ, Diesbourg TL, Fischer SL. The effect of rest break schedule on acute low back pain development in pain and non-pain developers during seated work. Appl Ergon. 2016 Mar;53 Pt A:64-70. doi: 10.1016/j.apergo.2015.08.013. Epub 2015 Sep 10. |
| 26646514 | Background | Khayambashi K, Ghoddosi N, Straub RK, Powers CM. Hip Muscle Strength Predicts Noncontact Anterior Cruciate Ligament Injury in Male and Female Athletes: A Prospective Study. Am J Sports Med. 2016 Feb;44(2):355-61. doi: 10.1177/0363546515616237. Epub 2015 Dec 8. |
| 26900496 | Background | Butowicz CM, Ebaugh DD, Noehren B, Silfies SP. VALIDATION OF TWO CLINICAL MEASURES OF CORE STABILITY. Int J Sports Phys Ther. 2016 Feb;11(1):15-23. |
| 37996958 | Background | Qiu J, Zhou T, Jin H, Pan Y, Qian T, Xue C, Xia W, Shi H, An B. Effect of adding hip exercises to general rehabilitation treatment of knee osteoarthritis on patients' physical functions: a randomized clinical trial. BMC Sports Sci Med Rehabil. 2023 Nov 23;15(1):158. doi: 10.1186/s13102-023-00772-7. |
| 30026952 | Background | Lorenzetti S, Ostermann M, Zeidler F, Zimmer P, Jentsch L, List R, Taylor WR, Schellenberg F. How to squat? Effects of various stance widths, foot placement angles and level of experience on knee, hip and trunk motion and loading. BMC Sports Sci Med Rehabil. 2018 Jul 17;10:14. doi: 10.1186/s13102-018-0103-7. eCollection 2018. |
| 30991013 | Background | Psilander N, Eftestol E, Cumming KT, Juvkam I, Ekblom MM, Sunding K, Wernbom M, Holmberg HC, Ekblom B, Bruusgaard JC, Raastad T, Gundersen K. Effects of training, detraining, and retraining on strength, hypertrophy, and myonuclear number in human skeletal muscle. J Appl Physiol (1985). 2019 Jun 1;126(6):1636-1645. doi: 10.1152/japplphysiol.00917.2018. Epub 2019 Apr 11. |
| ID | Term |
|---|---|
| D017116 | Low Back Pain |
| ID | Term |
|---|---|
| D001416 | Back Pain |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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