Effects of Manual Therapy And Flexibility Exercises For Low Back Pain

INTERVENTION: Intervention1: Manual Therapy Intervention Soft Tissue Mobilization such as effleurage and kneading and trigger point release of lumbar and gluteal muscles Central Posterior Anterior Mobilization Maitland Grade one and two progressing to three and four Unilateral Posterior Anterior Mobilization at restricted segments Transverse Mobilizations if segmental stiffness present Neural Mobilization if sciatic nerve glides is indicated) Active Re‐education such as pelvic tilts and core muscle activation and posture correction Home Advice such as ergonomical advicemand posture correction during daily activities : Flexibility Exercise Program Hamstring Stretch static progressed to PNF Hip Flexor Stretch (Iliopsoas) Piriformis Stretch in supine figure of four stretch Lumbar Extensor Stretch Quadriceps Stretch in standing or prone Progression from static to PNF after two weeks Home Exercise Program for daily stretching and posture awareness Intervention2: Manual Therapy Intervention: Soft Tissue Mobilization such as effleurage and trigger point release of lumbar and gluteal muscles, Central Posterior Anterior Mobilization Maitland Grade one and two progressing to three and four, Unilateral Posterior Anterior Mobilization at restricted segments ,Transverse Mobilizations if segmental stiffness present, Neural Mobilization if sciatic nerve glides is indicated), Active Re‐education such as pelvic tilts 10reps and core muscle activation 5sec hold 1o reps and posture correction, ergonomic advice and posture correction during daily activities Control Intervention1: Flexibility Exercise Program: Hamstring Stretch static progressed to PNF Hip Flexor Stretch (Iliopsoas)30 sec hold 3 reps, Piriformis Stretch in supine 30 sec hold 3 reps ,Lumbar Extensor Stretch 30sec hold 3 reps,Q CONDITION: Health Condition 1: M519‐ Unspecified thoracic, thoracolumbar and lumbosacral intervertebral disc disorder PRIMARY OUTCOME: 1.Numerical Pain Rating Scale ; 2.OSWESTRY LOW BACK PAIN DISABILITY QUESTIONNAIRE ; Timepoint: Baseline , 4weeks ; SECONDARY OUTCOME: 1.Manual Muscle Testing ; 2.Schobers testTimepoint: Baseline , 4 weeks INCLUSION CRITERIA: 1. Patients with lower back pain for more than 3 months. 2. Both Male and female Patients 3. Age above: more than 35 and less than 65 Years