The effect of Bruegger’s exercise on chronic low back pain in association with lower crossed syndrome

M.Tech. (Chiropractic)Purpose: This study aims to determine the effect of Bruegger’s exercise on chronic low back pain in association with lower crossed syndrome and compare it to spinal manipulation alone or a combination of Bruegger’s exercise and spinal manipulation with regards to pain and disability, hip and lumbar range of motion as well as degree of lumbar lordosis. Method: Thirty participants who met the inclusion criteria were randomly allocated to one of three different groups of ten participants each. Group one was only instructed on how to perform Bruegger’s exercise. Group two only received a spinal manipulation/s over the restricted joint/s in the lumbar spine. Group three received a spinal manipulation/s over the restricted joint/s in the lumbar spine in conjunction to being instructed on how to perform Bruegger’s exercise. All participants were assessed over a four week period. All groups attended six treatment sessions over three weeks of which Bruegger’s exercise and/or spinal manipulation were performed. The participants who needed to perform Bruegger’s exercise were also advised to continue doing the exercise out of the treatment session where applicable. In the fourth week only measurements were taken and no treatment was administered. Procedure: Subjective data was collected at the first and fourth consultations prior to treatment, as well as on the seventh consultation by means of a Numerical Pain Rating Scale and Oswestry Low Back Pain Disability Questionnaire to assess pain and disability. Objective data was collected at the first and fourth consultations prior to treatment, as well as on the seventh consultation by means of a universal goniometer for assessing passive hip flexion and extension, a digital inclinometer for assessing active lumbar range of motion and a flexible ruler for measuring the degree of lumbar lordosis. Analysis of collected data was performed by a statician. Results: Clinically significant improvements in group 1, group 2 and group 3 were noted over the duration of the study with regards to pain, disability, hip and lumbar range of motion as well as degree of lumbar lordosis. Statistically significant changes were noted in group 1 and group 2 with regards to pain, disability, hip and lumbar range of motion as well as degree of lumbar lordosis, and in group 3 with regards to hip and lumbar range of motion as well as degree of lumbar lordosis. Conclusion: The results show that Bruegger’s exercise, spinal manipulation and the combination of Bruegger’s exercise and spinal manipulation are effective treatment protocols both clinically and significantly in decreasing pain and disability (not statistically for the combination of Bruegger’s exercise and spinal manipulation), increasing hip and lumbar range of motion as well as decreasing the degree of lumbar lordosis. However, there was no treatment protocol that proved to be preferential over the other. Because spinal manipulation alone showed the greatest overall clinical improvements, it may be suggested that spinal manipulation alone is the most effective in the treatment of chronic low back pain associated with lower crossed syndrome with regards to pain and disability, hip and lumbar range of motion as well as degree of lumbar lordosis. Also, the addition of Bruegger’s exercise may help in some instances to further assist in treatment once the full effects of the spinal manipulation has occurred and allowed for the muscles to be in their optimum state for exercise