Download - Training Program Design for Low Back Pain
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CONTENTS
Introduction......................................................................................................................1
Background of the Study.................................................................................................. 2
Subjects Background.......................................................................................................3
Type of Injury................................................................................................................... 4
Treatment......................................................................................................................... 4
Fitness Evaluation............................................................................................................ 5
Study Design....................................................................................................................6
Data collection..................................................................................................................6
Designing Training Program............................................................................................. 6
Training Goals..............................................................................................................6Type of Exercise ..........................................................................................................7Intensity........................................................................................................................ 7
Frequency....................................................................................................................7Training Program..........................................................................................................7
Result.............................................................................................................................25
Discussion......................................................................................................................26
Summary........................................................................................................................27
References..................................................................................................................... 28
TRAINING PROGRAM DESIGN FOR LOW BACK PAIN
Introduction
Nearly all adults experience back pain at some point in their working lives. This common
problem is one of the leading causes of lost work days and individual suffering. If steps
are not taken to maintain a healthy back, the pain can become long-term and
disabling(Occupational Safety and Health Administration., 2007). Back pain is one of the
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most common medical problems in America. Eight out of ten people will experience back
pain at some point in their life. Back pain is ranked second only to headaches as the
most frequent location of pain (Rice & Pollard, 2002). Normally back injuries tend to
peak between the ages of 35 and 45 in people who are still active but less fit
(Occupational Safety and Health Administration., 2007). However, it can experience by
anyone who undergo injury on spine structure. Chronic low-back pain afflicts millions of
persons each year and is associated with significant impairment in physical and
psychosocial functioning. The chronic pain experience is recognized to be a
multidimensional syndrome with many different causes, which is influenced by varying
socio-environmental factors, predispositions, and personalities (Risch et al., 1993). A
back problem can present as a dull ache or an excruciating stab, shooting pain or
tenderness to the touch. There may be stiffness and pain in the lower back, or a person
may experience pain and/or numbness radiating from the back, down into the legs
(Shaari & Rahman, 2003). Exercise is one of the most frequently used modalities in the
rehabilitation of subjects with chronic low back pain. The primary goals of physical
exercise in the management of chronic low back pain are to gain muscle strength,
flexibility and endurance, to restored injured tissues and to contribute to the ability to
sustain normal life activities such as those at work (Kofotolis & Kellis, 2006).
However, many of us still do not know causes, symptom and proper treatment for
low back pain. Therefore, the purpose of this case study is to design proper training
program for patient who suffer low back pain and examine its effect in more detail.
Background of the Study
The study was implemented at Kolej Matrikulasi Londang, Melaka. Initially this case
study has selected subject with obese problem. The objective of this subject is to reduce
fat and increase calorie expenditure. Thus, the researcher designs a training program for
obese person with stated objective. Training program has been sustained for only four
weeks before he has posting to Kolej Matrikulasi Gopeng, Perak. Although the
appointment of posting date on 19 April 2009, the subject has refused to continue theprogram with reason can not commit with program. The letter of appointment to a job is
attached in appendix A.
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Picture 1: Gymnasium which is training program conducted.
Therefore, in order to replace the subject the researcher takes one week to find a new
subject. In one week time, the researcher was introduced with a new subject who
suffered low back pain injury. Based on the discussion with the subject, he has agreed to
follow the training program. At the same time, the subject is under supervision of
physiotherapy treatment from Hospital Tentera Kem Terendak Melaka. Therefore, in
order to cope with the treatment, the researcher has meeting with specialist doctor who
supervise the subject. The objective of the meeting is to explain the training program and
discuss the subjects condition and his level of injury in more depth. Based on the
discussion, the doctor has agreed the subject to follow the program providing that the
program does not worsen subjects condition.
Subjects Background.
The subject has suffered low back pain for eight months ago. Before he undergone low
back pain, his lifestyle is quite active playing volleyball. It was started when he plays
volleyball on August last year. Based on the discussion, he told that improper landing
when he jumps for spike the ball is the causes of he suffers low back pain. Since then,
his movement, range of motion and flexibility become limited. Besides that, since the
Body Mass Index of the subject is classified as overweight (28.1), I do believe that
overweight problem is one of the factors contributed to worse the injury. Consequently,
the subject gets a treatment in Hospital Tentera Kem Terendak Melaka for five days in
ward for the past seven months. Treatment in the hospital is based on traction for three
times per day and followed by heat therapy three times per weeks. Here is the subjects
personal biodata:
Name : Sazuaranie b. Hanapiah
Job : Lecturer
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Age : 33 years old
H/P : 019-6653441
Gender: Male
Height : 179 cm
Weight : 90 kg
BMI : 28.1 (Over weight)
Experience in weight training: Never
Medical history: Appendicitis (long time ago)
According to the subject, he also takes calcium magnesium as his medication in order to
cure his low back pain. The medication is provided by the hospital as part of a treatment.
Type of Injury
The subject has suffered chronic low back pain which the pain persists more than three
months. According to the record of diagnosis by specialist doctor at 94 Hospital
Angkatan Tentera, Kem Terendak Melaka, his low back pain injury is classified as
prolapsed intervertebral disk which is known as herniated disk or slipped disk. The L4/5
and L5/S1 was slipped out of original structure which pressing on the nerve roots.
Therefore, it causes back pain and sciatic pain cause severe pain spreading
down on his left leg and often into the foot. The symptoms of the pain are limited
in range of motion, pain on L4/5 and L5/S1 disk, hip muscle numbness, hard to stand inlonger duration and limited in movement. This is supported by University of Missouri
(2001), which stated that pinching and inflammation of these nerve roots (the long
arms of the nerve that stretch out from the nerve body) are just likely to cause
numbness, pain, or motor problem in the leg or arms to which they connect than to
cause back pain at the side of the pinching. Based on the discussion with the subject, he
claimed that the pain has affected his sleep and his life style.
Treatment
In order to treat the injury, the subject was referred to The 94 Hospital Angkatan
Tentera, Kem Terendak Melaka on February and was investigated where Magnetic
Resonance Imaging (MRI) done on 23 February 2009. Based on the investigation, his
injury is classified as the impression of diffuse L4/5 and L5/S1 prolapsed intervertebral
disk (PID). He was then referred to the Physical Rehabilitation and Physiotherapy
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Department and was assessed using Oswestry Disability Index (ODI) with score 18%
minimal disability. The treatments that were applied to the subject are traction,
analgesic, electrotherapy (Short Wave Diathermy-SWD), medication, and exercise
without supervision and proper training program. However, at the same time the subject
also tries alternative treatment which traditional massage was chosen. Among all of
these treatments, only Short Wave Diathermy (SWD) is still continues for once a week at
the hospital. Based on the discussion with the doctor, the subject is in the phase of
physiotherapy which SWD as a treatment to cure the injury. SWD has been applied on
the site of injury for 20 minutes every session of treatment.
Picture 2: The subject is treating using Short Wave Diathermy (SWD).
Fitness Evaluation
The subject has been evaluated in order to examine the level of fitness and condition of
pain. Screening tests to detect the level of seriousness in herniated disk include asking
about the presence of sciatica, the straight leg raise, and the crossed straight leg raise
(i.e., raising the contralateral, unaffected leg). The evaluation is based on the
observation of flexibility and range of motion of hip and several basic movements. Based
on the evaluation, the researcher found that, range of motion of hip joint is very limited.
The range of motion is limited due to pain on back hip and sciatic pain on his left leg.
Besides that, his average resting heart rate is about 80 beats per minute (bpm) which
shows that his fitness is above normal heart rate. Oswestry Questionnaire also was usedas an instrument to evaluate level of fitness of the subject. Based on the interview, since
he suffer low back pain, his daily life become passive compared to before undergo low
back pain.
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The subject is also rare in applying physical exercise after he suffers low back
pain. Although he was informed by physiotherapist to exercise, the subject seldom
exercises or stretches his muscle. This is due to lack of knowledge and no proper
training program to be followed. Therefore, based on the evaluation, I do believe that
fitness level of the subject is very poor in term of fitness components and need to be
trained in order to strengthen the core muscles and hip muscle to be functional.
Study Design
The case study design was utilized experimental pre and post test design. The design
include pre-test measured before training program followed by the treatment (training
program) for six weeks. Then, when the training program was completed, post-test
measured to examine the effect of training program on the subject. The reason why theduration of training program only planned for six weeks has been explained by the
researcher in the background of the study.
Data collection
The data is collected by using Oswestry Low Back Pain Disability Questionnaire (r =.99)
a self-assessment score for chronic back pain patients. The Oswestry index is based on
a patients subjective impression on his or her own state of disability. Though the
questionnaire is rather old, it has been validated and its reliability and sensitivity to
changes in functional status have been proved (Niskanen, 2002). As discuss before, the
data was gathered before training program (pre-test) and after training program (post-
test).
Designing Training Program
The training program was designed based on the fitness evaluation and subjects
background, medical history and depth discussion with the doctor who supervise the
subject for the whole treatment. Therefore the researcher has design the training
program and these variables are expected to influence the effect of training program.
Training Goals
The goal of this training program is to reduce pain which suffered by the subject
for almost eight months. Meanwhile, other goals are to improve strength,
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mobility, coordination, endurance, increase range of motion (ROM), increase
blood flow and increase flexibility gradually.
Type of Exercise
Type of exercise in this training program is based on two strategies. Theresearcher has planned to design the program basically base on isometric and
isotonic exercise. Unfortunately, isometric strengthening is joint-angle specific;
that is, strength gains occur only at the angle used. Therefore, the training was
performed isometric exercise at multiple angles. While isotonic exercise involves
training with constant external resistances, the amount of force to move the
resistance varies, depending primarily on joint angle and the length of each
agonist muscle. Basically, the type of exercise that has been chosen is based on
special consideration of low back pain injury. The exercises were identified by thejournal and specialist as a specific exercise special for treat low back pain
population.
Intensity
Based on the type of injury and medical history of the subject, the researcher has
planned the training program with low intensity and then increase gradually. This
is because of to allow strength gain to occur with an intensity low enough that the
newly formed collagen fibers are not disrupted.
Frequency
Since the program is designed with low intensity, the frequency of training is
three days per week. The training was conducted on evening from 5.30 pm to
6.30 pm for the first four week and extended from 5.00 to 6.30 pm for the
following weeks.
Training Program
Training 1
The program for week 1 is designed to give the subject chances of adaptation.
However, the subject is not forced if pain stressful. The objective of this week is
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to develop foundation of training since the subject does not get use with
resistance training.
Week: 1
Day: Monday
Warming Up: Cycling 10 minutes
Stretching: Passive static stretching
Time: 5.30-6.30 pm.
Intensity: Very Low
Cool Down: Static stretch (low intensity).
Training 2
Week: 1
Day: Wednesday
Warming Up: Cycling 10 minutes
Stretching: Static stretching
Time: 5.30-6.30
Intensity: Very Low
Target Muscle Exercise Set 1 Set 2
Rep Time Rep TimeHamstring Hip flexor stretch 1 5 sec
Abdominal muscle Partial curl 1 5 sec
Lower back muscle Superman 1 5 sec
Hamstring Gluteal stretch 1 5 secQuadriceps Seated leg raise 1 5 sec
Lower back muscle Pelvic tilt 1 5 sec
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Cool Down: Passive static stretch (low intensity)
Training 3
Week: 1
Day: Friday
Warming Up: Cycling 10 minutes
Stretching: Passive static stretching
Time: 5.30-6.30
Intensity: Very Low
Target Muscle Exercise Set 1 Set 2
Rep Time Rep TimeLower back muscle Hip flexor stretch 1 5 sec
Abdominal muscle Partial curl 1 5 sec
Lower back muscle Superman 1 5 sec
Hamstring Gluteal stretch 1 5 secQuadriceps Leg raise 1 5 sec
Lower back muscle Pelvic tilt 1 5 sec
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Cool Down: Passive static stretching (low intensity).
Training 4
Based on the observation and verbal communication with the subject, the subject
has adapted to the initial program. Therefore, the intensity of the training is
increased and variation has been added on for current training in relation to the
principles of progression and individuality. PNF stretching also has been applied
in order to generate isometric contraction.
Week: 2
Day: Monday
Warming Up: Cycling 15 minutes
Target Muscle Exercise Set 1 Set 2
Rep Time Rep TimeLower back muscle Hip flexor stretch 1 5 sec
Abdominal muscle Partial curl 1 5 sec
Lower back muscle Superman 1 5 sec
Hamstring Gluteal stretch 1 5 secQuadriceps Leg raise 1 5 sec
Lower back muscle Pelvic tilt 1 5 sec
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Stretching: Static stretching
Time: 5.30-6.30 pm.
Intensity: Very Low
Cool Down: Passive static stretching (low intensity)
Training 5
Week: 2
Day: Wednesday
Warming Up: Cycling 15 minutes
Stretching: Static stretching
Time: 5.30-6.30 pm.
Intensity: Low
Target Muscle Exercise Set 1 Set 2Rep Time Rep Time
Lower back muscle Cat and camel 1 8 sec
Abdominal muscle Partial curl 1 8 sec
Lower back muscle Leg raise 1 8 sec
Hamstring Gluteal stretch 1 8 sec
Quadriceps Leg raise 1 8 sec
Lower back muscle Pelvic tilt 1 8 sec
PNF stretching
Lower back muscle Trunk flexion 1 8 sec
Lower back muscle Trunk extension 1 8 sec
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Cool Down: Static stretch (low intensity)
Training 6
Week: 2
Day: Friday
Warming Up: Cycling 15 minutes
Stretching: Static stretching
Time: 5.30-6.30 pm.
Intensity: Low
Target Muscle Exercise Set 1 Set 2
Rep Time Rep TimeLower back muscle Cat and camel 2 10 sec
Abdominal muscle Partial curl 2 10 sec
Lower back muscle Superman 2 10 sec
Hamstring Gluteal stretch 2 10 secQuadriceps Seated Leg raise 2 10 sec
Lower back muscle Pelvic tilt 2 10 sec
PNF stretching
Lower back muscle Trunk flexion 2 10 sec
Lower back muscle Trunk extension 2 10 sec
Hamstring Hip extensor 2 10 sec
Quadriceps Hip flexor 2 10 sec
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Cool down: Passive stretch (low intensity)
Training 7
The researcher found that the subject has been adapted with the previous
program. Therefore, the variables (intensity and repetition) have been
manipulated in this week in order to be more effective.
Week: 3
Day: Monday
Warming Up: Cycling 20 minutes
Stretching: Static stretching
Time: 5.30-6.30 pm.
Intensity: Low
Target Muscle Exercise Set 1 Set 2
Rep Time Rep TimeLower back muscle Cat and camel 2 10 sec
Quadriceps Seated Leg raise 2 10 sec
Lower back muscle Superman 2 10 sec
Hamstring Gluteal stretch 2 10 secAbdominal muscle Partial curl 2 10 sec
Lower back muscle Pelvic tilt 2 10 sec
PNF stretching
Lower back muscle Trunk flexion 2 10 sec
Lower back muscle Trunk extension 2 10 sec
Hamstring Hip extensor 2 10 sec
Quadriceps Hip flexor 2 10 sec
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Cool down: Passive stretch
Training 8
Week: 3
Day: Wednesday
Warming Up: Cycling 20 minutes
Stretching: Static stretching
Time: 5.30-6.30 pm.
Intensity: Low
Target Muscle Exercise Set 1 Set 2
Rep Time Rep TimeLower back muscle Superman 5 5 sec
Quadriceps Swiss ball squat 6 -
Abdominal muscle Swiss ball partial curl 5 5 sec
Soleus, Gastrocnemius Standing calf raise 5 5 sec
Lower back muscle Swiss ball single leg bridge
and curl
6 -
PNF stretching
Lower back muscle Trunk flexion 3 10 sec
Lower back muscle Trunk extension 3 10 sec
Hamstring Hip extensor 3 10 sec
Quadriceps Hip flexor 3 10 sec
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Cool down: Passive stretch
Training 9
Week: 3
Day: Friday
Warming Up: Cycling 20 minutes
Stretching: Static stretching
Time: 5.30-6.30 pm.
Intensity: Low
Target Muscle Exercise Set 1 Set 2
Rep Time Rep TimeLower back muscle Superman with plate (1kg) 4 8 sec
Quadriceps Swiss ball squat 8 -
Abdominal muscle Swiss ball partial curl 4 8 sec
Soleus, Gastrocnemius Standing calf raise 8 -Lower back muscle Swiss ball single leg bridge
and curl
4 8 sec
PNF stretching
Lower back muscle Trunk flexion 4 7 sec
Lower back muscle Trunk extension 4 7 sec
Hamstring Hip extensor 4 7 sec
Quadriceps Hip flexor 4 7 sec
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Cool down: Passive stretch
Training 10
Since the program has entered week 4, the researcher has designed to add on
set of training. Based on the observation, the subject has improved in term of
pain (reduced) and core strength (increased). Therefore, a little adjustment on
training program has been made to cope with principle of variety and fun which
swimming has been chosen as a part of training program. The chosen of
exercise also mostly based on dynamic exercise.
Week: 4
Day: Monday
Warming Up: Cycling 25 minutes
Target Muscle Exercise Set 1 Set 2
Rep Time Rep TimeLower back muscle Superman 5 5 sec
Quadriceps Swiss ball squat 10 -
Abdominal muscle Swiss ball partial curl 5 5 sec
Soleus, Gastrocnemius Standing calf raise 10 -Lower back muscle Swiss ball single leg bridge
and curl
5 5sec
PNF stretching
Lower back muscle Trunk flexion 3 10 sec
Lower back muscle Trunk extension 3 10 sec
Hamstring Hip extensor 3 10 sec
Quadriceps Hip flexor 3 10 sec
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Stretching: Static stretching
Time: 5.00-6.30 pm.
Intensity: Low-moderate
Cool down: Passive stretch
Training 11
Week: 4
Day: Wednesday
Warming Up: Active movement.
Stretching: Static stretching
Time: 5.00-6.30 pm.
Intensity: Low-moderate
Target Muscle Exercise Set 1 Set 2Rep Time Rep Time
Tricep Standing Triceps Extension 8 2kg 8 2kg
External abdominal oblique,
Lattisimus dorsi, erector
spinae
Swiss ball oblique 8 - 8 -
QuadricepsSwiss ball squat with
dumbbell (1 kg)8 2kg 8 2kg
Abdominal muscle Swiss ball partial curl 5 5 sec 5 5 sec
Soleus, Gastrocnemius Standing calf raise 5 5 sec 5 5 sec
Lower back muscleSwiss ball single leg bridge
and curl5 5sec 5 5sec
PNF stretching
Lower back muscle Trunk flexion 3 10 sec 3 10 sec
Lower back muscle Trunk extension 3 10 sec 3 10 sec
Hamstring Hip extensor 3 10 sec 3 10 sec
Quadriceps Hip flexor 3 10 sec 3 10 sec
Target Muscle Exercise Set 1 Set 2Rep Time Rep Time
Whole muscleSwimming Tg. Bidara
Resort1 10 min 1 10 min
PNF stretching
Lower back muscle Trunk flexion 3 10 sec 3 10 sec
Lower back muscle Trunk extension 3 10 sec 3 10 sec
Hamstring Hip extensor 3 10 sec 3 10 sec
Quadriceps Hip flexor 3 10 sec 3 10 sec
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Cool down: Passive stretch
Training 12
Week: 4
Day: Friday
Warming Up: Cycling 25 minutes
Stretching: Static stretching
Time: 5.00-6.30 pm.
Intensity: Low-moderate
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Cool down: Passive stretch
Training 13
The researcher still continues with manipulating the variables of training. The
intensity and volume of the training has been reduced while repetition increases
in order to increase subjects adaptation.
Week: 5
Day: Monday
Warming Up: Cycling 25 minutes
Stretching: Static stretching
Time: 5.00-6.30 pm.
Intensity: Low-moderate
Target Muscle Exercise Set 1 Set 2
Rep Time Rep TimeTricep Standing Triceps Extension 8 2kg 8 2kg
External abdominal oblique,
Lattisimus dorsi, erector
spinae
Swiss ball oblique 8 - 8 -
Quadriceps Swiss ball squat with
dumbbell (1 kg)
8 2kg 8 2kg
Abdominal muscle Swiss ball partial curl 5 5 sec 5 5 sec
Soleus, Gastrocnemius Standing calf raise 5 5 sec 5 5 sec
Lower back muscle Swiss ball single leg bridge
and curl
5 5sec 5 5sec
PNF stretching
Lower back muscle Trunk flexion 3 10 sec 3 10 sec
Lower back muscle Trunk extension 3 10 sec 3 10 sec
Hamstring Hip extensor 3 10 sec 3 10 sec
Quadriceps Hip flexor 3 10 sec 3 10 sec
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Cool down: Passive stretch
Training 14
Week: 4
Day: Wednesday
Warming Up: Active movement.
Stretching: Static stretching
Time: 5.00-6.30 pm.
Intensity: Low-moderate
Target Muscle Exercise Set 1 Set 2
Rep Time Rep TimePectoralis major Standing Bench Press 10 1.5kg 10 1.5kg
External abdominal oblique,
Lattisimus dorsi, erector
spinae
Swiss ball oblique 10 - 10 -
QuadricepsSwiss ball squat with
dumbbell (1 kg)10 1.5kg 10 1.5kg
Abdominal muscle Swiss ball oblique exercise 10 5 sec 10 5 sec
Soleus, Gastrocnemius Standing calf raise 10 5 sec 10 5 sec
Lower back muscleSwiss ball single leg bridge
and curl10 5sec 10 5sec
Hamstring Leg curl 10 1.5kg 10 1.5kg
PNF stretching
Lower back muscle Trunk flexion 4 8 sec 4 8 sec
Lower back muscle Trunk extension 4 8 sec 4 8 sec
Hamstring Hip extensor 4 8 sec 4 8 secQuadriceps Hip flexor 4 8 sec 4 8 sec
Target Muscle Exercise Set 1 Set 2
Rep Time Rep Time
Whole muscleSwimming Tg. Bidara
Resort1 12 min 1 12 min
PNF stretching
Lower back muscle Trunk flexion 3 10 sec 3 10 sec
Lower back muscle Trunk extension 3 10 sec 3 10 sec
Hamstring Hip extensor 3 10 sec 3 10 sec
Quadriceps Hip flexor 3 10 sec 3 10 sec
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Cool down: Passive stretch
Training 15
Week: 5
Day: Friday
Warming Up: Cycling 25 minutes
Stretching: Static stretching
Time: 5.00-6.30 pm.
Intensity: Low-moderate
Target Muscle Exercise Set 1 Set 2Rep Time Rep Time
Tricep Standing Triceps Extension 8 2kg 8 2kg
External abdominal oblique,
Lattisimus dorsi, erector
spinae
Swiss ball oblique 8 - 8 -
QuadricepsSwiss ball squat with
dumbbell (1 kg)8 2kg 8 2kg
Abdominal muscle Swiss ball partial curl 5 5 sec 5 5 sec
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Soleus, Gastrocnemius Standing calf raise 5 5 sec 5 5 sec
Lower back muscleSwiss ball single leg bridge
and curl5 5sec 5 5sec
PNF stretching
Lower back muscle Trunk flexion 3 10 sec 3 10 sec
Lower back muscle Trunk extension 3 10 sec 3 10 sec
Hamstring Hip extensor 3 10 sec 3 10 secQuadriceps Hip flexor 3 10 sec 3 10 sec
Cool down: Passive stretch
Training 16
The subject has shown adaptability to resistance training program. Although, this
is the last session of training program for the case study, training program will be
continued soon in order to cope the subject needs. Oswestry Lower Back Pain
Disability Questionnaire was conducted at the last training session in order to
measure the effect of training program on low back pains impact on the activities
of daily living.
Week: 6
Day: Monday
Warming Up: Cycling 25 minutes
Stretching: Static stretching
Time: 5.00-6.30 pm.
Intensity: Low-moderate
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Cool down: Passive stretch
Training 17
Week: 4
Day: Wednesday
Warming Up: Active movement.
Stretching: Static stretching
Time: 5.00-6.30 pm.
Intensity: Low-moderate
Cool down: Passive stretch
Target Muscle Exercise Set 1 Set 2
Rep Time Rep Time
GluteusStanding Hip abduction &
adduction12 - 12 -
External abdominal oblique,
Lattisimus dorsi, erector
spinae
Swiss ball oblique 12 - 12 -
HamstringHamstring curl with Swiss
ball12 2kg 12 2kg
Abdominal muscle Prone straight leg raised 12 5 sec 12 5 sec
Soleus, Gastrocnemius Seated calf raise on Swiss
ball with 2kg weight
12 5 sec 12 5 sec
Lower back muscle Superman with weigh plate 12 5sec 12 5sec
Quadricep Swiss ball squat with
dumbbell
12 2kg 12 2kg
PNF stretchingLower back muscle Trunk flexion 4 10 sec 4 10 sec
Lower back muscle Trunk extension 4 10 sec 4 10 sec
Hamstring Hip extensor 4 10 sec 4 10 sec
Quadriceps Hip flexor 4 10 sec 4 10 sec
Target Muscle Exercise Set 1 Set 2Rep Time Rep Time
Whole muscleSwimming Tg. Bidara
Resort1 15 min 1 15 min
PNF stretching
Lower back muscle Trunk flexion 3 15 sec 3 15 sec
Lower back muscle Trunk extension 3 15 sec 3 15 sec
Hamstring Hip extensor 3 15 sec 3 15 sec
Quadriceps Hip flexor 3 15 sec 3 15 sec
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Cool down: Passive stretch
Result
Of the 18 session in six weeks training program, the subject has completed all training
session with successful. Based on the data collection for pre-test using the Oswestry
Low Back Pain Disability Questionnaire (r=0.99), subject scored 24% of its impact on the
activities of daily living. However, after doing the training program post-test indicates that
the scored is 12%.
Target Muscle Exercise Set 1 Set 2
Rep Time Rep Time
GluteusStanding Hip abduction &
adduction12 - 12 -
External abdominal oblique,
Lattisimus dorsi, erector
spinae
Swiss ball oblique 12 - 12 -
HamstringHamstring curl with Swiss
ball12 2kg 12 2kg
Abdominal muscle Prone straight leg raised 12 5 sec 12 5 sec
Soleus, GastrocnemiusSeated calf raise on Swiss
ball with 2kg weight12 5 sec 12 5 sec
Lower back muscle Superman with weigh plate 12 5sec 12 5sec
QuadricepSwiss ball squat with
dumbbell12 2kg 12 2kg
PNF stretchingLower back muscle Trunk flexion 4 10 sec 4 10 sec
Lower back muscle Trunk extension 4 10 sec 4 10 sec
Hamstring Hip extensor 4 10 sec 4 10 sec
Quadriceps Hip flexor 4 10 sec 4 10 sec
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0
5
10
15
20
25
Pre-
Test
Post-
Test
Test
Figure 1: Comparison of pre and post test data.
Therefore, it is shows that the pain has significantly decreased to 12% of its impact on
the activities of daily living after doing training program. Based on the interview with the
subject, the researcher found that the feeling of comfortable and relaxation has
increased compared to before training program.
Discussion
The main finding in this case study is that, by doing proper training program for person
who undergone low back pain, its impact on the activities of daily living can be reduced.
Through observation, for the first week of training program, the subject claimed that the
pain being main constrain of doing exercise. However, when he has adapted to the
program, the pain gradually reduced. However, the intensity of the program was
designed from very low intensity and gradually increased to moderate. Since, the subject
know his level of pain, thus the researcher does not force him to perform precisely to the
training program. Another factor that influences reducing pain is a treatment at The 94
Hospital Angkatan Tentera, Kem Terendak Melaka.
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Picture 3: Lt. Kol. Dr. Zainal b. Othman
Based on the interview and discussion with the doctor who supervise the subject, he
claimed that the subject show improvement. The doctor has evaluated the subject by
using the same questionnaire and comparing the pre-test (administered on the day
referred to rehabilitation department) and post-test (administered on the day of
discussion) and found 10% improvement in disability. However, since the researcher
also used the same questionnaire, and measured on different period, the researcher
found 12% of improvement. The reason why both result is different because of after
post-test measured by the doctor the subject still continue doing training program and
measured again by the researcher a week after. Therefore, this may contribute to
differentiation of the result.
Summary
The current study showed that specific exercise of the low-back in chronic low-back pain
patients is important for increasing strength and reducing pain and psychosocial
dysfunction. This treatment did not ameliorate psychological distress or socio-
environmental influences. This implies that physical rehabilitation is an important
component of rehabilitation for chronic low-back pain patients and should be included
with psychological rehabilitation for maximizing return to work and improved daily
functioning. In conclusion, this study demonstrated that lumbar extension exercisestrengthened the low-back extensor muscles in a population of chronic low-back pain
patients. Associated improvements were also found in the experience of pain and
perceived physical dysfunction as measured by the Oswestry Disability Index.
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References
Kofotolis, N., & Kellis, E. (2006). Effects of two 4-week proprioceptive neuromuscular
facilitation programs on muscle endurance, flexibility and functional performance
in women with chronic low back pain.Physical Therapy, 86,(7).Niskanen, R. O. (2002). The oswestry low back pain disability questionnaire. A two-year
follow-up of spine surgery patients. Scandinavian Journal of Surgery, 91.Occupational Safety and Health Administration. (2007). Back injury prevention for the
landscaping and horticultural services industry. Kansas State UniversityAgricultural Experiment Station and Cooperative Extension Service, 7(56).
Rice, C. A., & Pollard, J. M. (2002). Back pain. Health Education Rural Outreach
(HERO), 6(3).Risch, S. V., Norvell, N. K., Pollock, M. L., Risch, E. D., Langer, H., Fulton, M., et al.
(1993). Lumbar strengthening in chronic low back pain patients physiologic and
psychological benefits. SPINE 18( 2).Shaari, A. H., & Rahman, H. A. (2003). Sakit belakang dan faktor yang
mempengaruhinya di kalangan penoreh getah di Pahang. Malaysian Journal of
Public Health Medicine, 3(1).University of Missouri. (2001). Handbook of disabilities: Chronic low back pain:
University of Missouri.
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APPENDIX A
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APPENDIX B
Medical Assessment Letter
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APPENDIX CTraining Session
Picture 4: Subject doing Alternate Arm/ Leg Raises
Picture 5: PNF exercise
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APPENDIX DThe Oswestry Disability Index (Pre and Post Test)