RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1.NAME OF THE CANDIDATE

AND ADDRESS

ANKITA BOSE

HOUSE NO. 35-A/2, KRISHNA NAGAR,

KANPUR ROAD, LUCKNOW. (U.P.)

PIN – 226023

2.NAME OF THE INSTITUTION KRUPANIDHI COLLEGE OF

PHYSIOTHERAPY, BANGALORE

3.COURSE OF THE STUDY AND

SUBJECT

MASTER OF PHYSIOTHERAPY IN

MUSCULOSKELETAL DISORDERS

AND SPORTS PHYSIOTHERAPY

4.DATE OF ADMISSION TO THE

COURSE

22.06.2011

5.

TITLE OF THE TOPIC:

“A STUDY ON EFFICACY OF YOGA EXERCISES VERSUS PILATES ON

REDUCING PAIN AND DISABILITY IN SUBJECTS WITH CHRONIC

POSTURAL LOW BACK PAIN- COMPARATIVE STUDY”

1

6 BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Low-back pain is a very common condition, particularly in developed

countries. It can cause a great deal of pain and lost activity.1 It is an extremely common disorder in

our society, with lifetime prevalence rates placed as high as 80%.2 Low back pain is considered a

benign and self-limiting ’disease’(Waddell 1987).1Back pain is a common and costly health

problem, with more than 50% of adults bothered by it each year and 70% to 80% of adults

afflicted by it at some time in their lives. It is the most costly ailment of working age adults, with

an estimated $33 billion spent annually on medical costs and an estimated loss of $19.8 billion due

to loss of worker productivity..3

Low back pain in its initial stages can usually be explained neurophysiologically as

nociception generated by tissue insult or injury. Persistence of pain especially in a person in whom

adequate organic objective abnormalities cannot be found to explain the pain presents the problem

of chronic pain.4 It usually feels like an ache, tension or stiffness in your back. The pain can be

triggered by sitting badly, bending or sitting awkwardly, or lifting incorrectly. Backache is most

common in the lower back, although it can be felt anywhere along your spine, from your neck

down to your hips.5

Most back pain problems are secondary to poor posture, mechanical postural

changes, weak abdominal muscles, degenerative joint and disk problems. Muscle weakness and

lack of flexibility are the leading causes of chronic back pain.6Heavy manual work, sedentary

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work & driving, smoking, pregnancy can cause back pain.7

The goals of treating chronic low back pain often change over time, shifting

from the initial intent to cure to improving pain and function. Treatment should begin with

maximal recommended doses of nonsteroidal anti- inflammatory drugs (NSAIDs) and

acetaminophen, followed by adjunctive medications.8

Patients commonly use nonpharmacologic treatment options, with or

without consulting a physician including Acupuncture, Behaviour therapy which provides short-

term relief of chronic low back pain.8

Physical therapy provides modest short- and long-term relief

of back pain, improves psychological well-being, and increases functioning. Back schools, low-

level laser therapy, lumbar supports, prolotherapy, short wave diathermy, traction, transcutaneous

electrical nerve stimulation, and ultrasound have negative or conflicting evidence of effectiveness.

Exercise therapy, focusing on strengthening and stabilizing the core muscle groups of the

abdomen and back, appears to produce small improvements in pain and functioning in patients

with chronic low back pain.8

Yoga may offer an alternative approach to the treatment of low

back pain.9 Yoga is an increasingly popular "mind-body" complimentary and alternative medicine

therapy often used for relieving back pain and several small studies have found yoga effective for

this condition.3 An estimated 14 million Americans practiced yoga in 2002, including more than 1

million who used it as a treatment for back pain. Yoga and Pilates which have, both been gaining

in popularity over the last decade are two mind–body exercise interventions that address both the

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physical and mental aspects of pain with core strengthening, flexibility, and relaxation.10 The

practice of yoga in the Indian subcontinent has been documented as early as 3000 B.C. Yoga

involves disciplining the mind and body through exercises and meditation.The word yoga comes

from the same Sanskrit root as the word for yoke; it implies harnessing oneself to a discipline or a

way of life. There are several types of yoga; two are Hatha and Raja yoga, the most commonly

practiced in the West.Yoga includes meditation, relaxation, control of breathing, and various

physical postures (asanas).6 Regular practice of yoga establishes natural harmony and functional balance between

various organ systems, leading to better health and a feeling of well-being.6 The benefits of yoga

may be greater than those of exercise alone because yoga offers a combination of physical

exercise with mental focus, and patients are taught good posture, self-awareness, and self-care

along with relaxation.9 Yoga exercises strengthen and increase tone of weak muscles and help

with conscious control over autonomic functions of the body. Yoga postures, called asanas, help

with developing correct breathing patterns, bowel habits, and regular sleeping patterns. It teaches

the art of relaxation, relieving muscular and nervous tension and leads to increased energy.6

Hatha yoga, the yoga typically practiced in the United States, is only one part of the

non-sectarian philosophical system of yoga that emerged from the Indian culture approximately

4,000 years ago. Hatha yoga is comprised of three aspects which are integrated with one another

including (1) asanas or physical postures, (2) pranayama or breathing exercises and (3) meditation

or relaxation.The postures are designed to increase flexibility and strengthen the body in a

controlled fashion as well as improve balance.These poses are performed standing, sitting,

4

reclining, or inverted and may involve forward bends, backward bends, twists, or balancing.10

Pilates is another popular form of mind–body exercise where the focus

is on controlled movement, posture, and breathing. Joseph H. Pilates developed the

comprehensive program known as the Pilates method in the 1920’s.Over the last decade, the

popularity of this exercise has grown, and Pilates is now used as both a form of fitness and holistic

health. In addition, private Pilates studios are common and typically offer both group mat classes

as well as private sessions on specialized apparatus. Similar to yoga, the Pilates method

incorporates both physical and mental elements. The technique focuses on the ‘‘power house’’ or

what is known today as the core; in Pilates, this includes the abdominal, gluteal, and paraspinal

muscles in particular. Pilates exercises involve progressive multiplanar excursion of the trunk and

limbs. Each starts by stabilizing the core musculature and then proceeds through a controlled

range of motion.The goals are to increase muscle strength and endurance as well as flexibility and

to improve posture and balance. The mental element of Pilates is evident in the additional focus on

breathing and concentration during the execution of these exercises. Exercises are performed both

on the mat as well as on specialized equipment.10

The Pilates method has been increasingly applied for its

therapeutic benefits, however little scientific evidence supports or rebukes its use as a treatment

regimen for musculoskeletal diagnoses including LBP.10

Hence, this study aims to compare the effect of yoga exercises and

pilates in chronic postural low back pain on reducing pain and disability.

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6.1 NEED FOR THE STUDY

Low back pain or lumbago is a common musculoskeletal disorder

affecting 80% of people. Physical therapy can include heat, ice, massage, ultrasound & electric

stimulation. Active therapies consist of stretching, strengthening & aerobic exercises.11Yoga and

Pilates which have, both been gaining in popularity over the last decade are two mind–body

exercise interventions that address both the physical and mental aspects of pain with core

strengthening, flexibility, and relaxation.10

However, the previous studies had limitations, including small sample sizes, a single yoga

teacher delivering the program, and short-term follow-up. We therefore conducted a trial to

determine whether offering a 4-week yoga program to adults with chronic postural low

back pain led to greater improvements in back function than usual care.9

There has been a slow evolution of these non-traditional exercise regimens into treatment

paradigms for low back pain, although few studies examining their effects have been

published. The following study will focus on the scientific and theoretical basis of using

yoga and Pilates in the management of chronic postural low back pain.10

We found no published studies in western biomedical literature that evaluated yoga for

chronic low back pain; therefore, we designed a clinical trial to evaluate its effectiveness

and safety for this condition.12

6

6.2 OBJECTIVES OF THE STUDY

(A) OBJECTIVES

1. To find out the effectiveness of yoga exercises on reducing pain and disability in subjects

with chronic postural low back pain.

2. To find out the effectiveness of pilates on reducing pain and disability in subjects with

chronic postural low back pain.

3. To compare the effectiveness of yoga exercises and pilates on reducing pain and disability

in chronic postural low back pain.

(B) HYPOTHESIS

NULL HYPOTHESIS:

There is no significant difference exists between the efficacy of yoga and pilates in terms of pain and disability on subjects with chronic postural low back pain.

EXPERIMENTAL HYPOTHESIS:

There is a significant difference exists between the efficacy of yoga and pilates in terms of pain and disability on subjects with chronic postural low back pain.

6.2 REVIEW OF LITERATURE1. Bromagne S et. al Low back pain begin with an injury or commonly related to weak or poor posture. Improper posture has a direct effect on those suffering from lower back pain. The study (2007) demonstrated that lack of postural awareness can quite easily have an impact on the ability to know the exact placement of lower back while leaning forward, placing the lumbar spine in a

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poor posture for lifting or even maintaining the position to complete a task increasing a chance of damaging the lower back.13

2. Cox et. al

He conducted three small randomised controlled trials of yoga for low back pain, all of which showed effects on back pain that favoured the yoga group. Three studies showed effects on back pain that favoured the yoga group and this was statistically significant in two of the studies (yoga versus written material P < 0.001, yoga versus exercise P = 0.034; yoga versus educational control P = 0.003).14

3. Helen E. Tilbrook et. al A randomized trial conducted to compare the efficacy of yoga with

usual care in subjects with chronic low back pain, the yoga group had better back function at 3, 6,

and 12 months than the usual care group in mean Roland Morris Disability Questionnaire.Thus the

author concluded that after offering a 12-week yoga program to adults with chronic or recurrent

low back pain led to greater improvements in back function than did usual care.9

4. Robert B. Saper et. al The pilot randomized controlled trial conducted to assess the feasibility of studying yoga in a predominantly minority population with chronic low back pain

showed that yoga compared to usual care participants reported less analgesic use, less opiate use

and greater overall improvement at 12 weeks’ time. Thus the author concluded that a yoga study

intervention in a predominantly minority population with chronic low back pain was moderately

feasible and may be more effective than usual care for reducing pain and pain medication use.15

5. Williams K et.al The randomized controlled trial aim to evaluate the efficacy of Iyengar

yoga therapy in chronic low back pain,concluded that there were significantly greater reductions in

functional disability and pain intensity in the yoga group compared to the control group. A

significantly greater proportion of yoga subjects also reported clinical improvements. In addition,

depression also significantly lower in yoga subjects. Thus the author concluded that Yoga

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improves functional disability, pain intensity, and depression in adults with chronic low back pain.

There was also a clinically important trend for the yoga group to reduce their pain medication

usage compared to the control group.16

6. Tekur P et. al The study compared the effects of short term intensive yoga program on

pain, functional disability & spinal flexibility in subjects with chronic low back pain showed that

there was a significant reduction in Oswestry Disability Index scores in the yoga group compared

to the control group thus the author concluded that after Seven (7) days of a residential intensive

yoga-based lifestyle program reduced pain-related disability and improved spinal flexibility in

patients with chronic low back pain better than a physical exercise regimen.17

7. Sherman et. al A randomized controlled trial conducted to compare the effects of yoga

classes to conventional exercise classes and a self-care book in patients with low back pain. The

yoga group showed statistically and clinically important improvements in disability and pain at all

follow up points compared to conventional group. The authors concluded that yoga was more

effective, safe intervention for patients with non specific chronic low back pain.10

8. Williams et .al He evaluated the efficacy of an Iyengar yoga intervention compared to an

educational control group on pain-related outcomes in patients with chronic low back pain. Post

treatment, the yoga group had significantly lower pain disability index scores for functional

disability versus baseline compared to the control group with the yoga group’s mean scores

falling 76.9% and the control group 39.6%. The greater improvement in functional disability for

the yoga group was maintained at a 3-month follow-up. In addition, yoga participants had

statistically significant reductions in pain compared to the control group at a 3-month follow-up;

9

the yoga group reported a 70% decrease in pain compared to a 38% reduction in the control

group.The authors concluded that yoga therapy resulted in greater benefits for patients with

chronic low back pain compared to an educational program. 10

9. Jacobs et . al He conducted a feasibility study exploring an Iyengar yoga intervention for

chronic low back pain. They concluded, this study demonstrated the feasibility of developing a

yoga protocol based on consensus by an expert panel of senior yoga teachers with moderately

good adherence.10

10. Galantino et. al He published a randomized controlled pilot study in studying the effects of a

modified yoga protocol on patients with chronic low back pain. After 6 weeks, the authors

reported that both 46% of the yoga group and 40% of the control group were less disabled as

measured by the Oswestry Disability Index. In addition, the Sit and Reach and Functional Reach

tests improved in 64 and 90%, respectively, of the yoga group while only two participants (20%)

in the control group improved on these measures. This study appears to be potentially important

trends of decreased depression and improved flexibility and balance in patients with chronic low

back pain undergoing a yoga intervention.10

11. Galantino ML et. al He conducted a randomized pilot study to evaluate the impact of

modified Hatha Yoga in subjects with chronic low back pain. Potentially important trends in the

functional measurement scores showed improved balance and flexibility and decreased disability

and depression for the yoga group. In addition, analysis of the qualitative data revealed the

following frequency of responses (1) group intervention motivated the participants and (2) yoga

fostered relaxation and new awareness/learning. Thus the author concluded that a modified yoga-

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based intervention may benefit individuals with chronic low back pain, but a larger study is

necessary to provide definitive evidence.18

12. Donzelli et. al

He published a randomized controlled study to evaluate the efficacy of a

Pilates method called Pilates CovaTech compared to a Back School intervention for patients with

low back pain. In the Pilates group, average Oswestry Low Back Pain Disability Questionnaire

scores showed a sharper fall in the first month versus baseline values compared to the Back

School group. In addition, the participants in the Pilates method reported a better subjective

response to treatment as compared to those in the Back School method at all follow-up time

points. The authors concluded that good results obtained with the Pilates CovaTech method in

terms of both short- and long-term (6 month) outcomes. They also stated the Pilates intervention

had better compliance because of subjective responses such as improvement of symptoms and

satisfaction with treatment. In conclusion, the authors proposed the Pilates CovaTech method

was a valid alternative in the management of patients with non-specific chronic low back pain.10

13. Rydeard et. al He conducted a randomized controlled study on the effects of a Pilates-based

therapeutic exercise protocol on patients with chronic low back pain as compared to a control

group receiving usual care. There were significantly lower levels of disability and pain following

intervention in the Pilates group compared to the control group. The authors concluded that

treatment with a modified Pilates- based approach was more efficacious in reducing functional

disability and pain intensity than usual care in a population with chronic low back pain.10

14. Lim EC et. al

He conducted a randomized controlled trial to compare pain and disability

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individuals with persistent nonspecific low back pain who were treated with Pilates exercises

compared to minimal or other interventions. Thus the authors concluded that Pilates- based

exercises are superior to minimal intervention for pain relief.19

15. La Touche R et.al

He conducted a study to review and analyze where the Pilates Method was

used as treatment for non-specific chronic low back pain (CLBP). The authors analyzed all

demonstrate positive effects, such as improved general function and reduction in pain when

applying the Pilates Method in treating non-specific chronic low back pain in adults. However,

further research is required to determine which specific parameters are to be applied when

prescribing exercises based on the Pilates Method with patients suffering from non-specific

chronic low back pain.11

16. Smith D et. al He conducted a randomized controlled trial to investigate the efficacy of a

pilates based therapeutic exercise approach in a population with chronic low back pain (LBP). The authors concluded that the individuals in the specific- exercise-training group reported a

significant decrease in low back pain and disability, which was maintained over a 12 month

follow-up period. Treatment with a modified Pilates- based approach was more efficacious than

usual care in population with chronic, unresolved low back pain.20

17. Paul S. Myles et.al He conducted a trial to test the hypothesis that the Visual Analog Scale

score is a linear pain measurement. The Visual Analog Scale is a term widely used to measure

pain. Even very small change in Visual Analog Scale score repressants a relating change in

magnitude of pain sensation. Thus the use of Visual Analog Scale is now meaningfully quantify

the amount of pain.21

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18. Matthew O.B. Olaogun et. al

Pain rating scale such as Visual Analog Scale is an important tool

for assessing patients symptom status. The study determined to check the reliability and validity

of Visual Analog Scale and concluded that Visual Analog Scale is reliable and valid for clinical

rating of low back pain.22

19. Donald D. Price et. al

Visual Analog Scale with sensitive intensity responses to different

levels of chronic pain and direct temperature matches to 3 levels of chronic pain, thereby

demonstrating the valid using Visual Analog Scale for measurement of chronic pain.23

20. Fairbank, Jeremy et. al

He conducted a trial to review the versions of Oswestry Disablity

Index instrument, document methods by which it has been validated, collate data from scores

found in normal and back pain populations, provide curves for power calculations studies using

the Oswestry Disability Index, and maintain it as a gold standard outcome measure.Thus the

authors concluded that Oswestry Disability Index remains a valid and vigorous measure and has

been a worthwhile outcome measure.24

21. R.O. Niskanen

The Oswestry Disability Index can be used to monitor the response to

treatment and rehabilitation in spinal problems. It is based on patients subjective impression of

his own state of disability.25

22. Fairbank JCT et. al

The Oswestry Disability Index is an extremely important tool that

researchers and disability evaluators use to measure a patient’s permanent functional disability.

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This test has been around for more than 25 years and is considered the “gold standard” of low

back pain functional outcome tools.26

7. MATERIALS AND METHODOLOGY

7.1 SOURCES OF DATA

(A) POPULATION:

Chronic postural low back pain subjects from hospitals and clinics in and around Bangalore

(B) SAMPLE SIZE:

30 subjects with age group of 18-60 yrs satisfying the selection criteria will be selected from the population and to be divided into two groups with 15 subjects in each group.

7.2 METHOD OF COLLECTION OF DATA

7.2.1 (A) SAMPLING TECHNIQUE:

Convenient Sampling

(B) MEASUREMENT TOOLS:

Visual Analog Scale (VAS) Oswestry Disability index (ODI)

7.2.2 STUDY DESIGN:

Comparative study with pre-test and post-test design.

7.3 SELECTION CRITERIA:-

(A) INCLUSION CRITERIA:

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In order to participate in this study, subjects will have to fulfill following criteria:

Patients diagnosed with chronic postural low back pain and whose pain has persisted at

least three months will be eligible for the study.

Age groups:18- 60 years Both male and female subjects.

(B) EXCLUSION CRITERIA:

Subjects over 60 yrs of age.

Pregnant women.

Acute low back pain subjects.

Subjects with recent spinal surgery.

Subjects with history of psychosis, drugs or alcohol abuse.

Un-cooperative subjects.

Subjects with medical conditions like dementia, multiple sclerosis or diabetes with neurological symptoms.

Subjects with sciatica.

Subjects with low back pain other than postural origin.

Subjects with any progressive health problems.

7.4 DURATION

4weeks

7.5 MATERIALS USED FOR THE STUDY:

Assessment chart Pen

Paper

15

Stop Watch

Measuring tape

Exercise mat

7.6 PROCEDURE:

All the subjects diagnosed as chronic postural low back pain will be included in

the study based on selection criteria. The formal informed consent shall be obtained and signed by

the subject themselves or their guardian.

The subjects fulfilling the inclusion criteria will be randomly divided into two groups -

Experimental group-I : to be treated with Yoga exercises (15 subjects)

Experimental group-II : to be treated with Pilates (15 subjects)

Pre intervention measurements:

Outcome measures including the Oswestry Disability Index (ODI) for

disability and Visual Analog Scale (VAS) for pain were assessed at baseline and at 4 weeks in

both groups.

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Intervention for Experimental Group I:

YOGA:

Hatha yoga, the yoga typically practiced in the United States, is only one part of the non-sectarian

philosophical system of yoga that emerged from the Indian culture approximately 4,000 years ago.

Hatha yoga is comprised of three aspects which are integrated with one another including (1)

asanas or physical postures, (2) pranayama or breathing exercises and (3) meditation or relaxation.

The postures are designed to increase flexibility and strengthen the body in a controlled fashion as

well as improve balance. These poses are performed standing, sitting, reclining, or inverted and

may involve forward bends, backward bends, twists, or balancing. Breathing exercises link the

postures together and help the mind focus. A Hatha yoga class concludes with a short meditation

session during which the participant lies supine with eyes closed while shifting attention inwardly

to create a relaxed state of being. Instructor typically leads a group of practitioners through a class

lasting 60–90 min. Instructor administered the 1 hour protocol twice weekly for 4 weeks. In

addition, yoga participants were asked to practice yoga at home for 1 hr per day as frequently as

possible throughout the week. An certified Yoga expert can be called for assistance.10

Intervention for Experimental Group II:

PILATES:

Pilates is a "functional fitness" method. The basic fundamental exercises in pilates are:

Starting Position - Constructive Rest - Neutral Spine:- The exercise we do to find neutral spine

is a press of the lower back into the floor, then a release of the spine into a small arch. Between

these two points is a place where the 3 curves of the spine are in their natural position. The basic

move are-

Lie on back with arms by sides. Knees should be bent, legs and feet should be parallel to

each other, about hip distance apart.

Inhale.

Exhale and use abs to press lower spine into the floor.

Inhale to release.

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Exhale and pull lower spine up, creating a small arch of the low back.

Inhale to release.

Head Nod: Head nod is an extension of the lengthening of the spine that we go for in Pilates. It is

an integral part of the many Pilates exercises that articulate the spine in forward bends and rolling

exercises.

Begin in the start position.

Inhale to lengthen the spine and tilt the chin down toward the chest. Head stays on the mat.

Exhale to return to the neutral position.

Inhale to tip the head back a little bit.

Exhale to return to the neutral position.

Arms Over: Arms over is about keeping our alignment as the torso is challenged by the arms

moving overhead. It also helps us increase our range of motion in the shoulders.The Basic Move:

From the start position, inhale to bring the fingertips up to the ceiling.

Exhale to bring the arms down toward the floor.

Inhale to bring the arms up again.

Exhale to release to the floor.

Angel Arms: Though it engages some different muscles, angel arms, like arms over, helps

understanding of how to use the arms and shoulders without losing the alignment of back and

ribcage.

The Basic Move:

From the basic position, on an in-breath, the arms sweep out to the sides along the floor

and Exhale to return the arms by your sides.

Pelvic Clock: Pelvic clock increases awareness of pelvic position and strengthens the muscles we

need for pelvic stability. The Basic Move:

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Imagine there is a clock placed flat on lower abs. The 12 is at bellybutton, the 3 is on left

hip, the 6 is at pubic bone, and the 9 is on right hip and use abdominal muscles to initiate

and control the movement, sequentially move around the clock pulling first the 12

down, then rotate to the 3, the 6, and nine.

Knee Folds: Being able to move the leg in the hip socket without effecting the stability of the

pelvis is one of the most important goals of knee folds. This kind of activity is important in all

kinds of movements that we do in everyday life, such as sitting, walking and lifting.

From the start position, On an inhale, feel abdominal muscles to lift one leg off the floor.

Allow a deep fold at the hip.

Exhale and return foot to the floor. Be sure to use abdominal control. Don't let the thigh

take over.27

In Pilates, we use the dynamic of full breathing -big inhales and exhales- to initiate and

power our Pilates exercises, and most Pilates exercises are taught with breathing patterns. One of

the first steps in learning to breathe well is to learn diaphragmatic deep breathing. The diaphragms

a dome-shaped muscle that sits below the lungs, horizontally bisecting the trunk of the body.

When we breath in, the diaphragm contracts and flattens downward creating a vacuum that

drawsin air. When we exhale, the diaphragm returns to its dome shape, pushing air out of the

body.

The Set Up: We can do this exercise lying on back with knees bent or even now, sitting up reading.

Do it with one hand resting lightly on lower belly to feel the breath moving in body. Shoulders

relaxed and dropped away from ears. Spine is long we call neutral spine, a natural position of the

spine that allows the curves of the spine to be present. In sitting, feel that weight is falling directly

down through sit bones and head is floating up toward the sky. Throat is open and relaxed.

The Inhale: Breathe in slowly through nose. Let the air flow into upper chest and down spine

expanding the sides and lower ribs, filling the diaphragm, back and lower back, and dropping all

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the way down into the pelvis. Allow the deep inhale to push belly out a little bit.

The Exhale: Let go of breath in the reverse order. Drop lower abs, then belly. Let ribs pull in, and

last, let chest to drop as it fully expel all the air.28

Similar to yoga, the Pilates method incorporates both physical and mental elements.

The technique focuses on the ‘power house’’ or what is known today as the core; in Pilates, this

includes the abdominal, gluteal, and paraspinal muscles in particular. Pilates exercises involve

progressive multiplanar excursion of the trunk and limbs. Each starts by stabilizing the core

musculature and then proceeds through a controlled range of motion. The Pilates protocol

consisted of exercises performed on the mat. The physical therapists are trained in this protocol

taught the 1hr session 3 times weekly for 4 weeks. In addition, the Pilates participants were asked

to complete a 15-min home program 6 days per week which involved similar exercises performed

on the floor.10

Post- intervention measurement

Outcomes were evaluated at baseline and end of treatment in both groups; in addition, retention

of treatment effect for disability by Oswestry Disability Index and pain by Visual Analog Scale

was tested at 3, 6, and 12 months post-treatment in both groups.

STATISTICAL ANALYSIS

Independent “t”- test

Paired “t”- test

7.7 Does the study require any investigation or intervention to be conducted on patients or

other humans or animals? If so please describe.

Yes, the study will be carried out on subjects with age group of 18 – 65 years, diagnosed with

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chronic postural low back pain to be treated with yoga exercises and pilates.

7.8 Has ethical clearance been obtained from the subject and the institution?

Yes, Ethical clearance has been obtained from the institution.

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9. SIGNATURE OF CANDIDATE

10. REMARKS OF GUIDE PRESENTED TO THE RESEARCH COMMITTEE AND APPROVED

11. 11.1 NAME AND DESIGNATION OF GUIDE

Mr. D.MUTHU RAJ MPT (ORTHO), MIAP, DPHAsst. Professor

11.2 SIGNATURE

11.3 CO-GUIDE (if any)

11.4 SIGNATURE

11.5 HEAD OF THE DEPARTMENT

Mr. RAMESH KUMAR J.MPT (NEUROLOGY AND PSYCHOSOMATIC DISORDERS), PROFESSOR

11.6 SIGNATURE

12 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL

24

12.2 SIGNATURE

25