Comparing Different Physiotherapy Interventions on APT in Non Specific Low Back Pain

NCT07098741 | Recruiting

• 1 other identifier: NOGH/MahtabAhmedPhD/0125/005
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

Anterior pelvic tilt (APT) is a prevalent postural deviation characterized by excessive forward rotation of the pelvis, often resulting in increased lumbar lordosis. This condition is frequently associated with non-specific low back pain (NSLBP), which affects a significant portion of the global population and poses substantial challenges for individuals' well-being and healthcare systems worldwide. NSLBP is a multifactorial condition with various etiological factors, including poor posture, muscle imbalances, sedentary lifestyle, and biomechanical abnormalities such as APT. Understanding and effectively managing APT in the context of NSLBP is crucial for reducing pain, improving functional capacity, and enhancing quality of life for affected individuals . Despite the prevalence and clinical significance of APT in NSLBP, there is a lack of comprehensive research comparing the effectiveness of different therapeutic interventions. Various approaches have been proposed, including core stability exercises, soft tissue release with manual therapy, stretching and flexibility exercises, and postural correction exercises . However, the relative efficacy of these interventions remains uncertain, hindering evidence-based decision-making in clinical practice. A variety of therapeutic interventions have been proposed for managing APT and NSLBP, aiming to address underlying biomechanical imbalances, improve musculoskeletal function, and alleviate pain. Core stability exercises, focused on strengthening the deep stabilizing muscles of the spine and pelvis, have shown promise in improving postural alignment and reducing NSLBP symptoms. Soft tissue release techniques, such as manual therapy and myofascial release, target tight and restricted muscles associated with APT, promoting relaxation and improved range of motion. Stretching and flexibility exercises aim to elongate tight musculature, particularly in the hip flexors and lumbar extensors, thereby reducing excessive pelvic tilt and alleviating NSLBP. Additionally, postural correction exercises focus on retraining optimal alignment and body mechanics, promoting a more neutral pelvic position and reducing strain on the lumbar spine.

Conditions

Anterior Pelvic Tilt; Low Back Pain

Keywords

physiotherapy interventions; Non specific low back pain; anterior pelvic tilt; low back pain treatment

Outcome Measures

Primary Outcomes (2)

• APT angle

  Anterior pelvic tilt angle will be assessed before, at mid and at end of interventions

  4 weeks

• Pain

  Pain severity will be assessed using Numeric Pain Rating Scale NPRS. NPRS measures the pain severity quantitatively having zero "0" as no pain at one end and "10" as the worst ever pain at the other end. Higher the score on NPRS, more severe the pain and vice versa.

  4weeks

Secondary Outcomes (1)

• Balance

  4 weeks

Study Arms (4)

Group A

EXPERIMENTAL

Core stability exercises with electrotherapy group.

Other: Core stability exercises with electrotherapy

Group B

EXPERIMENTAL

Soft tissue release with manual therapy and stretching group.

Other: Soft tissue release with manual therapy and stretching

Group C

EXPERIMENTAL

Postural correction exercises with contrast therapy group.

Other: Postural correction exercises with contrast therapy

Group D

EXPERIMENTAL

(Control group) combination of electrotherapy with stretching and flexibility exercises group.

Other: combination of electrotherapy with stretching and flexibility exercises

Interventions

Core stability exercises with electrotherapy OTHER

electrotherapy modalities for pain control will be used and exercises strengthening abdominal core muscles will be applied in two phases.

Group A

Soft tissue release with manual therapy and stretching OTHER

Manual soft tissue release will be performed and then stretching of back muscles and thigh muscles will be added to treatemnet.

Group B

Postural correction exercises with contrast therapy OTHER

Hot and cold packs will be used one after other for 10-15mins and specific exercises which are designed to improve posture will be taught and performed

Group C

combination of electrotherapy with stretching and flexibility exercises OTHER

some pain reducing electrotherapy modality like TENS will be used and general stretching and flexibility exercises will be performed

Group D

Eligibility Criteria

• Age: 20 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age: Participants must be between 20 and 40 years old.
• Gender: Both genders, Male and Female have equal chance of selection as participant in the study.
• Diagnosis: Participants must have a confirmed diagnosis of non-specific low back pain (NSLBP), altered lumbar posture, restricted range of motion of lumbar spine due to muscular spasm etc., altered anterior pelvic tilt angle by a qualified healthcare professional, based on standardized diagnostic criteria (e.g., clinical examination, imaging studies).
• Confirmation of Anterior Pelvic Tilt (APT): Participants exhibiting APT confirmed through physical assessment by a trained examiner. This confirmation will involve the use of standardized measures such as digital inclinometers or goniometers.
• Severity: Participants should have mild to moderate symptoms of non-specific low back pain (NSLBP) specially pain, as determined by the assessing healthcare provider.
• Physical Capability: Participants who are physically capable of performing the prescribed exercises and interventions without significant limitations.
• Consent: Participants who provide informed consent to participate in the study after receiving detailed information about the study objectives, procedures, potential risks, and benefits.
• Compliance: Participants who are willing and able to comply with the study procedures, including attending scheduled sessions, adhering to the intervention protocols, and completing required assessments.
• No Concurrent Treatment: Participants who have not undergone any concurrent treatments specifically targeting APT or low back pain during the study period to avoid confounding effects.

You may not qualify if:

• Trauma or Fracture: Individuals with a history of trauma or fracture around the pelvic and lumbar region, as this may significantly affect the participant's ability to perform the prescribed exercises and interventions and confound study outcomes.
• Orthopedic or Neurological Surgery: Participants with a history of orthopedic or neurological surgery related to the pelvic or lumbar region, as this may impact the participant's musculoskeletal function and response to the interventions.
• Malignancy: Individuals with a diagnosis of malignancy, as this may introduce confounding variables and complicate the interpretation of study outcomes.
• Autoimmune Disorders: Participants with autoimmune disorders affecting musculoskeletal function, as these conditions may influence the participant's response to interventions and introduce variability in study outcomes.
• Referred or Radiating Visceral Pains: Individuals experiencing referred or radiating visceral pains, as these symptoms may indicate underlying pathologies requiring specific treatment and may confound the assessment of APT and NSLBP.
• Gait Abnormalities and Neurological Disorders: Participants with gait abnormalities or neurological disorders affecting musculoskeletal function, as these conditions may influence the participant's ability to perform exercises and interventions and confound study outcomes.
• Congenital and Developmental Disorders: Individuals with congenital or developmental disorders affecting musculoskeletal function, as these conditions may introduce variability in study outcomes and complicate the interpretation of results.
• Pregnancy: Pregnant individuals will be excluded from the study due to the potential risks associated with certain physiotherapy modalities and the need for specialized considerations in this population.
• Contraindications: Participants with contraindications to specific physiotherapy modalities included in the study protocol (e.g., contraindications to electrotherapy) will be excluded to ensure participant safety.
• Inability to Attend Sessions: Participants who are unable to attend scheduled physiotherapy sessions due to logistical constraints (e.g., transportation issues, scheduling conflicts) will be excluded.
• Cognitive Impairment: Participants with significant cognitive impairment or communication difficulties that may impede their ability to understand and follow study instructions will be excluded.
• Participation in Other Research: Participants who are currently participating in other research studies involving treatment interventions for MPS and/or radiculopathy will be excluded to avoid potential confounding effects on outcomes and treatment adherence.

Sponsors & Collaborators

• National Orthopedic and General Hospital: lead

Study Sites (1)

National Orthopedic & General Hospital

Chak Four Hundred Fifty-four, Punjab Province, 63100, Pakistan

RECRUITING

Related Publications (13)

• Tan BT. A correlation study of the relationship between flat foot with anterior pelvic tilt and sacroiliac joints dysfunction among undergraduate students: UTAR; 2022.

  BACKGROUND

• Kahere M, Hlongwa M, Ginindza TG. A Scoping Review on the Epidemiology of Chronic Low Back Pain among Adults in Sub-Saharan Africa. Int J Environ Res Public Health. 2022 Mar 3;19(5):2964. doi: 10.3390/ijerph19052964.

  PMID: 35270657 BACKGROUND

• Algarni FS. Comparison of Abdominal and Hip Abductor Activation Between Chronic Low Back Pain and Asymptomatic Individuals During Walking. Masters Abstracts International; 2010.

  BACKGROUND

• Mavajian M, Fakhari Z, Naghdi S, Bagheri H, Jalaie S. A pilot study on the short-term effects of myofascial release and core stability exercises on balance in chronic low back pain. Auditory and Vestibular Research. 2020.

  BACKGROUND

• Shariat A, Anastasio AT, Soheili S, Rostad M. Home-based fundamental approach to alleviate low back pain using myofascial release, stretching, and spinal musculature strengthening during the COVID-19 pandemic. Work. 2020;67(1):11-19. doi: 10.3233/WOR-203248.

  PMID: 32955470 BACKGROUND

• Kim B, Yim J. Core Stability and Hip Exercises Improve Physical Function and Activity in Patients with Non-Specific Low Back Pain: A Randomized Controlled Trial. Tohoku J Exp Med. 2020 Jul;251(3):193-206. doi: 10.1620/tjem.251.193.

  PMID: 32669487 BACKGROUND

• Weng LM, Zheng YL, Peng MS, Chang TT, Wu B, Wang XQ. A Bibliometric Analysis of Nonspecific Low Back Pain Research. Pain Res Manag. 2020 Mar 9;2020:5396734. doi: 10.1155/2020/5396734. eCollection 2020.

  PMID: 32215136 BACKGROUND

• Morris P, Ali K, Merritt M, Pelletier J, Macedo LG. A systematic review of the role of inflammatory biomarkers in acute, subacute and chronic non-specific low back pain. BMC Musculoskelet Disord. 2020 Mar 3;21(1):142. doi: 10.1186/s12891-020-3154-3.

  PMID: 32126991 BACKGROUND

• Kahere M, Ginindza T. The burden of non-specific chronic low back pain among adults in KwaZulu-Natal, South Africa: a protocol for a mixed-methods study. BMJ Open. 2020 Sep 1;10(9):e039554. doi: 10.1136/bmjopen-2020-039554.

  PMID: 32873683 BACKGROUND

• Bramah C, Mendiguchia J, Dos'Santos T, Morin JB. Exploring the Role of Sprint Biomechanics in Hamstring Strain Injuries: A Current Opinion on Existing Concepts and Evidence. Sports Med. 2024 Apr;54(4):783-793. doi: 10.1007/s40279-023-01925-x. Epub 2023 Sep 19.

  PMID: 37725240 BACKGROUND

• Nagy P. The Biomechanical Demands of Ballet: Implications for Performance Profiling and Injury Aetiology: Edge Hill University; 2021

  BACKGROUND

• Shojaei I, Salt EG, Bazrgari B. A prospective study of lumbo-pelvic coordination in patients with non-chronic low back pain. J Biomech. 2020 Mar 26;102:109306. doi: 10.1016/j.jbiomech.2019.07.050. Epub 2019 Aug 7.

  PMID: 31427092 BACKGROUND

• Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord. 2014 Dec 9;15:416. doi: 10.1186/1471-2474-15-416.

  PMID: 25488399 BACKGROUND

MeSH Terms

Conditions

Low Back Pain

Interventions

Electric Stimulation Therapy; Musculoskeletal Manipulations

Condition Hierarchy (Ancestors)

Back Pain; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Therapeutics; Physical Therapy Modalities; Rehabilitation; Complementary Therapies

Study Officials

• Mazhar ALI, Phd

  National orhtopedic and general hospital

  STUDY CHAIR

Central Study Contacts

Mahtab AM Patafi, MPhil

CONTACT

+923017766019; mahtab.pataif1@gmail.com

Nasir Mehmood, MPhil

CONTACT

+923346165226; n.mehmood777@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: participants divided into four groups three interventional groups one control group

Study Record Dates

• First Submitted: July 19, 2025
• First Posted: August 1, 2025
• Study Start: March 20, 2025
• Primary Completion: August 10, 2025
• Study Completion: October 15, 2025
• Last Updated: August 1, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)