DISSERTATION SYNOPSIS

SUBMITTED ON

EFFECT OF STRETCHING ON SHORTENED QUADRATUS

LUMBORUM MUSCLE IN NON SPECIFIC LOW BACK PAIN

Towards partial fulfillment of

MASTER OF PHYSIOTHERAPY

(In Ortho)
By

Km. Bhavna Kushvah

Under the guidance of
Dr Sumit Subharti
Ortho
COLLEGE OF MEDICAL SCIENCES (ALLIED HEALTH SCIENCES)

IIMT UNIVERSITY, MEERUT, UTTAR PRADESH

2022-2024
 REGISTRATION FOR DISSERTATION

1. Name of the Student Km. Bhavna Kushvah

2, Name of the Department Physiotherapy

3. Name of the College College of Medical Sciences

(Allied Health Sciences)

4. Course of study and Branch Master of Physiotherapy

(Ortho)

6. Title of the Topic EFFECT OF STRETCHING ON

SHORTENED QUADRATUS
LUMBORUM MUSCLE IN NON
SPECIFIC LOW BACK PAIN
 INTRODUCTION

Low back pain is an extremely common problem that most people experience at some point in
their life Low back pain is well documented to be an extremely common health problem
however, its burden is often considered trivial. Low back pain is the leading cause of activity
limitation and work absence throughout much of the world , and it causes an enormous economic
burden on individuals, families, communities, industry and governments. 6 The common form of
low backache is mechanical type and 80-90% patients will complain of dull, achy, diffuse pain
and stiffness that is confined to the low back area or may radiate to buttock and hip which results
from reflex muscle spasm from primary pain, where there may have trigger points within their
muscles.8
Most low back injuries are not the result of a single exposure to a high magnitude load, but
instead a cumulative trauma from sub-failure magnitude loads. For instance, repeated small loads
(e.g. bending) or a sustained load (e.g. sitting). In particular low back injury has been shown to
result from repetitive motion at end range. According to McGill, it is usually a result of `a history
of excessive loading which gradually, but progressively, reduces the tissue failure tolerance. 17
Localised, structural factors such as trunk/spinal asymmetries, have been reduced in their
importance as contributing factors to back pain. 16 Volinn suggested that there were lower rates
of prevalence in developing countries than in developed countries, but did not determine whether
differences reflect demographic, cultural or research method factors. 10 Prevalence of back pain
ranges from 15—45% with point prevalence of 30% reported by Andersson. 9 Specific causes of
back pain are some degenerative conditions, inflammatory conditions, infective and neoplastic
causes, metabolic bone disease, referred pain, psychogenic pain, trauma and congenital
disorders.7 Low back pain is usually defined as pain or other symptoms between the costal
margins and the inferior gluteal folds, which might or might not have associated pain radiating to
the leg(s). Low back pain is usually classified as ‘specific’ or ‘non-specific’. Specific low back
pain is defined as that caused by a specific pathophysiological mechanism, such as disc prolapse
or herniated nucleus pulposus, infection, inflammatory arthopathy, tumour, osteoporosis or
fracture.1 Non-specific low back pain is defined as low back pain not attributable to a
recognizable, known specific pathology (eg, infection, tumors, osteoporosis, fracture, structural
deformity, inflammatory disorder, radicular syndrome, or cauda equina syndrome).2
Chronic pain is revealed to be widespread by community epidemiological studies. Non-specific
chronic low back pain is a common variant of this problem, and presents both doctor and patient
with difficulties in explanation and treatment because of the frequently poor `fit' between
expressed symptoms (and consequent perceived disability) and observable spinal pathology.
Indeed, one authority has noted that about 80% of such cases resist definitive diagnosis. 5 The
prevalence of non-specific low back pain (LBP) among children and adolescents is higher than
formerly believed. Population-based studies have demonstrated that its lifetime prevalence in
children and adolescents varies between 7 and 63%. 3 The natural history of NSLBP is very
promising - about 75% of the patients recover within 4 weeks of onset of pain. 4. The quadratus
lumborum, or QL, is a common source of lower back pain. [1] Because the QL connects
the pelvis to the spine and is therefore capable of extending the lower back when contracting
bilaterally, the two QLs pick up the slack, as it were, when the lower fibers of the erector
spinae are weak or inhibited (as they often are in the case of habitual seated computer use and/or
the use of a lower back support in a chair). Given their comparable mechanical disadvantage,
constant contraction while seated can overuse the QLs, resulting in muscle fatigue.2 A constantly
contracted QL, like any other muscle, will experience decreased blood flow, and, in time,
adhesions in the muscle and fascia may develop, the end point of which is muscle spasm.

This chain of events can be and often is accelerated by kyphosis which is invariably
accompanied by rounded shoulders, both of which place greater stress on the QLs by shifting
body weight forward, forcing the erector spinae, QLs, multifidius, and especially the levator
scapulae to work harder in both seated and standing positions to maintain an erect torso and
neck. The experience of "productive pain" or pleasure by a patient upon palpation of the QL is
indicative of such a condition.

While stretching and strengthening the QL are indicated for unilateral lower back pain, heat/ice
applications as well as massage and other myofascial therapies should be considered as part of
any comprehensive rehabilitation regimen.

De Franca and Levine describe the successful resolution of two patients suffering from low back
pain, flank pain, buttock and lateral hip pain using myofascial therapy aimed at restoring QL
muscle length and function, coupled with spinal manipulative therapy as indicated. The other
article by Bryner describes five cases of unilateral flank pain and local tenderness attributed to
involvement of the quadrates lumborum muscle.15

The quadrates lumborum describe its attachments as running between the iliac crest and the
twelfth rib, the iliac crest and the L1 to L4 TVPs and between the twelfth rib and the L1 to L4
TVPs. The transversus abdominis, psoas, quadratus lumborum and lumbar multifidus have each
been described as contributing to the control of lumbar segmental motion via either the
maintenance of spinal equilibrium or the development of intersegmental stiffness. Individually,
the multifidus, quadrates lumborum, psoas and transversus abdominis have been described as
functioning to maintain spinal stability.14.
Quadratus lumborum muscle lies lateral to the lumbar spine and connects the ilium to the twelfth
rib and to the lumbar vertebrae. Because of its costal attachment, anatomists have accorded it a
role in respiration and, because of its vertebral attachments, they have accorded it a function in
moving the lumbar spine confidently they stated that quadratus lumborum causes lateral flexion,
but uncertainty applies to extension. Anatomy texts state that the quadratus lumborum ‘probably
helps to extend’ or ‘may extend’ the lumbar spine. Bioengineers have found the muscle to be
active during a variety of lumbar movements, including extension, and have concluded that it is
an important stabilizer of the lumbar spine. 13

The quadratus lumborum muscle does three things: the quadratus lumborum assists in rotating
your torse, the quadratus lumborum assists in lateral flexion of your torso (i.e., side-bending, as
when, for example, performing a side plank exercise or kettlebell windmill exercise), and when
your left and right quadratus lumborum muscles contract at the same time, they assist in back
extension (i.e., straightening your back, as when, for example, you stand up, or perform a good
morning lift)
 AIM OF THE STUDY

To find out the effect of stretching on quardatus lumborum muscle in non specific low back pain.

SIGNIFICANCE

In today scenario majority of people suffer from non-specific low back pain and quadrates
lumborum is the most overlooked cause for low back pain since these exists a positive
correlation between the tightness of quadrates lumborum in non-specific low back pain patient
therefore, its stretching as a treatment protocol if provide to give significant results would be a
good treatment in the patients with non-specific low back ache.
 REVIEW OF LITERATURE

Federico Balagué, Anne F Mannion, Ferran Pellisé, Christine Cedraschi 2012 in their study
Non-specific low back pain states that low back pain has greatly increased in the past few
decades and the trend continues with, for example, the development of studies oriented towards
genetics and molecular events. Some of the newest lines of scientific and clinical investigation
that are being undertaken in relation to low back pain are shown in panel 2. Unfortunately, these
investigations have not yet translated into practical solutions, particularly for people with chronic
low back pain. In all probability, the conclusion of a report by Pransky and colleagues best
describes the foreseeable future.

Eyal Lederman Et al 2010 in their study the myth of core stability states that Core stability
exercises are no better than other forms of exercise in reducing chronic lower back pain. Any
therapeutic influence is related to the exercise effects rather than stability issue.

Eyal Lederman Et Al 2010 In Study The Fall Of The Postural-Structural-Biomechanical

Model In Manual And Physical Therapies: Mexemplified By Lower Back Pain state that
LBP has also important implications for what we aim to achieve and for our choice of technique
and exercise used to manage the condition use of manual techniques to readjust correct or
balance out the misaligned structure.

Mathew O.B. Olaogum and Andreas Kopf 2010 in study chronic nonspecific back pain low
state that prevalence of LBP is not a dependent on genetic factor that could predispose person of
specific ethnicity or race to this disorder men and women are affected equally but lifestyle may
be one of the most important predisposing factor for LBP .therefore LBP is starting to become a
major health care problem in all countries in which economic and cultural changes are
transforming their societies

D. Hoya, P. Brooksb, F. Blythc, R. Buchbinderd 2010 in study The Epidemiology of low

back pain State that This includes pain, activity limitations, participation restrictions, career
burden, use of health-care resources and financial burden. Impacts and outcomes from low back
pain are likely to vary significantly between and within populations depending on socio-
economic status, general access to health services, occupational distribution, pain perception and
other factors that are associated with the onset and prognosis of low back pain.
Hossain MHMD1, Choudhury MRA2, Mojumder MMA32009 In Study A Comparative
Study Of Treatment Of Chronic Backache Between Conventional Method And trigger
Point Injections (TPI) State that Irritation of the nociceptive receptor in the lumbar muscles,
their fascial sheaths, tendinous insertions, the spinous ligaments and degenerative changes in the
spine is a common cause of chronic low backache, because the structure in the vicinity of the
spine has nociceptive reception
Martin Underwood et al 2009 in study Diagnosing Acute Nonspecific Low Back Pain: Time
to Lower the Red Flags? State that patients to investigate for specific causes of low back pain
in different populations. However, any study with sufficient statistical power to producrobust
estimates of the sensitivity and specificity of single and multiple variables, which can then be
used to produce positive and negative predictive values in different populations, is likely to be
many times larger than this current study.
David W. Gullick, RN, Post Grad Dip Rural Crit Care ∗2007 in study Acute non-specific
back pain management in the emergency set ting: A review of the literature State that non
specific back pain is the most common cause of low back pain comprising 95% of cases in
primary care.The preva- lence of fractures is estimated at 3—5% and these are usually associated
with trauma, the elderly or corticos- teroid users following minor trauma.4Infection, tumours,
Ankylosing Spondylitis and degenerative spinal conditions are all much more rare causes of
lower back pain.4Con- ditions such as osteoarthritis, lumbar spondylitis and spinal canal stenosis
may be commonly found on imaging studies in asymptomatic patients and therefore may not be
related to the cause of the patient’s pain.Despite these conditions being more uncommon than
non specific pain they present serious pathology which must be excluded in all patients who
present with lower back pain.
 METHODOLOGY

RESEARCH DESIGN

This is an experimental is design in which effect of stretching on shortened quadrates lumborum

muscle in non specific low back pain is seen.

RESEARCH SETTINGS

This study was done in the research laboratory of physiotherapy,___________ at, Dehradun.

POPULATION

50 individuals of ____________________having mechanical low back ache

DURATION

The duration of study 4 months.

SAMPLE SIZE

30 subjects participated in the study.

SAMPLING METHOD

Random Sampling was done. Subjects were randomly allocated to the two equal experimental
groups

ETHICAL APPROVAL AND CONSENT

The study was referred for ethical consideration. Prior to the study an informed consent was
taken from all the subjects.

SELECTION CRITERIA

INCLUSION CRITERIA

• Subject between age group (18-25year)

• Subject who expressed a chief complaint tighten of low back ache more than 12 weeks.

• Subject who had low back pain after maintaining a certain prolonged posture
 EXCLUSION CRITERIA

subjects with history of any orthopedic surgery or any other low back surgery .

example –

• PIVD

• Spinal tumor

• Tb of spine

• Fracture of vertebrae

• Any lower limb injury.

VARIABLES

• DEPENDENT VARIABLE

• Disability index scale

• Muscle length

• INDEPENDENT VARIABLES

• Stretching

• Lumbar extensor exercise

• Active warm up exercise

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treatment of chronic Backache between conventional method and Trigger point
injections.
3. C. Liebenson the quadratus lumborum And spinal stability journal and movement
therapies january 2000.
4. EYal Lederman the myth of core stability journal homepage may 2010.
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