RANDOMIZED COMPARATIVE STUDY ON THE EFFICACY OF MULTI-MODAL INTERVENTION INCLUDING WILLIAM’S FLEXION EXERCISES, TENS AND MULLIGAN MOBILIZATION IN LUMBAR DEGENERATIVE DISORDERS

Abstract

Lumbar disc degenerative disease is the most common cause of Low back pain throughout the world (1) Intervertebral discs are among the largest avascular tissues in the body, relying on diffusion for nutrition, and consists of inner nucleus pulposus, outer annulus fibrosus and cartilage located superiorly and inferiorly. Intervertebral disc resists compression because of its osmotic properties of the proteoglycans, which help to maintain disc height (2)

Due to excessive loading, deformation of the endplate occurs which leads to decreased intradiscal pressure, loss of intervertebral disc height and increased stress to the surrounding annulus fibrosus and facet joints. Signs of lumbar degenerative disease includes one or all of the following: diminished disc height, narrowing of facet, spondylophytes and endplates degeneration, spinal canal stenosis, narrowing of lateral recess in the spinal canal, disc desiccation, diffuse annular bulging beyond the disc space, defects and sclerosis of the endplates, and bone spur at the vertebral apophyses(3). Lumbar degenerative disc disease can occur at any spinal level, but it most commonly affects the L3-L4 and L5-S1 segment of lumbar spine (4).

The lumbosacral complex is biomechanically vulnerable to segmental instability, contributing to the high prevalence of low back pain among affected individuals (5).

Lumbosacral junction is an important unit of the spine. The lumbar spine comprising 5 distinct vertebrae (L1-L5) articulate with the sacrum, a rigid, fused structure consisting of 5 sacral segments (S1-S5)

The lumbar vertebrae structurally larger and more robust compared to other vertebral segments, a morphological adaptation that facilitates the transmission and support of axial body weight.

Larger vertebral bodies increase surface area for weight distributions and thicker intervertebral discs absorb shock and facilitate weight transfer, stronger pedicles and laminae provide structural support (6)

The lumbar spinal canal demonstrates a relatively narrower and more triangular configuration in cross-section compared to the wider, more oval morphology observed in the cervical and thoracic regions.

The lumbosacral complex in the lumbar spine is susceptible to both mechanical injury such as herniation, or degeneration and non-mechanical injury like degenerative conditions, inflammation due to anatomical, biomechanical and physiological factors including spinal anatomy, ligament support etc. (7)