The objective was to investigate the electromyographic activity of the lumbar multifidus (MF) muscle and longissimus thoracis muscle, along with their activity ratio (MF longissimus thoracis ratio), during quadruped stabilization exercise performed with neutral posture and with increased lumbar lordosis in patients with chronic low back pain (CLBP). A total of 23 patients with CLBP (12 females and 11 males) were recruited based on inclusion and exclusion criterion. Each patient performed 4 exercises in random order, with surface electromyography electrodes and an electrogoniometer attached. A cross-sectional study design was used to measure the amplitude of muscle activation (as a percentage of maximum voluntary contraction) in each patient across the 2 muscles (MF and longissimus thoracis) during quadruped stabilization exercise with neutral posture and with increased lumbar lordosis. A 2-way analysis of variance was conducted, which demonstrated a statistically significant increase in the recruitment of MF with increased lumbar lordosis in patients with CLBP during quadruped exercise. An increase of 9.7% and 16.9% maximum voluntary contraction in MF electromyographic activity was observed in lumbar lordosis posture during the quadruped leg raise and quadruped leg-arm raise exercise, respectively (P < .01), when compared to the neutral posture. The increased recruitment of MF with lumbar lordosis in the quadruped position has strong implications in the assessment and management of patients with CLBP.

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Introduction: Neck Pain (NP) is a major public health problem. Social and economic participation of many individuals gets negatively impacted due to NP. Fatigue and pain are common complaints in patients with this condition. Both can interfere with the daily life of patients by affecting the quality of sleep which can lead to psychological issues. But, the prevalence of fatigue and its association with pain, sleep quality and psychological factors have not been examined properly in patients complaining of NP. Aim: To examine the prevalence of fatigue and its association with pain intensity, depression, anxiety, and sleep disturbance in patients with NP. Materials and Methods: A cross-sectional study on 296 NP patients with a mean age of 30±7.2 years (181 males and 115 females) was conducted between March 2019 till November 2019. It was conducted at the Physiotherapy Department of the University and Amarjyoti College of Physiotherapy. The Multidimensional Fatigue Inventory (MFI), Hospital Anxiety and Depression, Pittsburgh Sleep Quality Index (PSQI) and Numeric Pain Rating Scale were used to evaluate fatigue, depression and anxiety, sleep quality and pain intensity, respectively. Spearman’s rank correlation coefficient and Mann-Whitney U test were used for analysis. Results: The point prevalence rate of severe fatigue in participants was 39.86%. Fatigue was significantly related with pain intensity, psychological factors, and sleep quality (p<0.05). We also observed a significant association between sleep quality and psychological factors in this sample (p<0.05). Conclusion: Fatigue was a prominent factor in patients with NP and it was associated with pain intensity, depression, anxiety, and sleep disturbance. Prevalence of fatigue was higher in chronic stage of NP than in the acute sage. Identifying these factors may help in prevention and management of NP and its co-morbidities.

IntroductionChronic low back pain is an important clinical, social, economic, and public health problem, with low treatment success rates. Retro-walking works on multiple factors of the causative agents of low back pain. Therefore the aim of the current study was to investigate the effect of retro-walking on pain, functional disability, quality of life and sleep problems in patients with chronic low back pain.MethodsIt was a two parallel arm, single blinded, randomized, controlled clinical trial. Thirty-one patients both males and females with chronic low back pain were recruited from December 2016 till April 2017 out of which twenty-nine completed the study. The experimental group had 16 patients (aged 24.7 ± 5.56 with 22.7 ± 4.28 Body Mass Index) whereas the control group had 15 patients (aged 25.9 ± 5.61with and 22.1 ± 3.15 Body Mass Index). Pain, Functional Disability, Quality of Life and Sleep Problems were measured by Numerical pain rating scale, Oswestry Disability Index, Short Form Health Survey 36 and sleep diary Both the groups received same conventional treatment for three physiotherapy sessions per week for three weeks. Experimental group additionally participated in 15 minutes of retro-walking at the comfortable walking speed which was determined prior to the commencement of the intervention along with the conventional treatment.ResultsAll variables of the sleep diary, i.e., sleeping hours/week [Time effect (<i>p</i> = 0.004), time × group interaction effect (<i>p</i> = 0.001)], sleep efficiency [Time effect (<i>p</i> = 0.024), time × group interaction effect (<i>p</i> = 0.004)] and restoration post sleep [Time effect (<i>p</i> = 0.014), time × group interaction effect (<i>p</i> = 0.034)] showed significant differences in the experimental group. The experimental group also demonstrated significant differences over time (<i>p</i> = 0.001) in all the other outcome measures such as pain, pain disability, quality of life and sleep patterns and habits.ConclusionsConventional physiotherapy is an effective means of treatment for Chronic Low back pain. However, there was a added advantage of retro-walking as the experimental group showed a faster recovery. Thus, making it an effective treatment adjunct.

Various lines of evidence suggest that a bidirectional relationship exists between poor sleep quality and chronic pain, with each condition tending to promote and exacerbate the other. This has led to the hypothesis that the two conditions may be linked by common underlying mechanisms. It has thus been suggested that inadequate sleep and