Table 1. Demographic Variables of Samples
Back pain is common, with about nine out of ten adults experiencing it at some point in their life, and five out of ten working adults having it every year. The occurrence of low back pain in India is also alarming with nearly 60% of the people in India have suffered from low back pain at some point of time during their lifespan. It is the most common cause of chronic pain, and is a major contributor of missed work and disability. Low back pain can interfere with daily activities, but Back Strengthening Exercises may reduce low back pain and increase in physical activities. The objective of this study was to determine the effectiveness of back strengthening exercises on low back pain among school teachers in Kanyakumari District, Tamil Nadu. A quantitative approach with quasi experimental; one group of pretestposttest design was used. Thirty school teachers were selected by using purposive sampling technique. Pre-test was conducted and then taught about Back Strengthening Exercises with the help of pamphlet. Post-test assessment was done in one month after intervention. The findings showed that the pre-test mean pain score of Back Strengthening Exercises was 3±0.8 and after post-test was 1.4±0.5. The mean reduction of pain was 1.6±0.8. It was statistically highly significant at P<0.001 level. The present study also supports the necessity for doing exercises regularly that helps to reduce low back pain among school teachers.
Musculoskeletal disorders are an important public health problem. It is a complex problem for certain occupational groups, such as nursing personnel, teachers, bus conductors, traffic police, etc. Risk factors for back pain can be either individual origin or related to the workplace ( Ahmadi et al., 2014). The main occupational risk factors for back pain are uncomfortable and immobile postures, improper workplace design, heavy physical work, inadequate work organization, improper lifting techniques, and prolonged standing. Other factors, such as muscular weakness, smoking, obesity psychological factors, etc. ( Alexandre et al., 2001).
Low back pain has been declared to be an escalating health issue among individuals worldwide, with a lifetime prevalence ranging between 60% and 90% ( Lela and Josee, 2012; Burdorf and Jansen, 2006). The World Health Organization also recommends regular participation in physical activity for the prevention of various diseases, as well as to enhance muscle strength and bone density ( Crow and Willis, 2009). Low back pain is said to be a major health threat which leads to disability in high and lowincome countries ( Lela and Josee, 2012). Low back pain is the most common musculoskeletal problem worldwide with upto 85% of all people experiencing low back pain during their lifetimes. It has a substantial impact on lifestyle, quality of life, and work related disability ( Yip, 2004).
The magnitude of the burden from low back pain has grown worse in recent years. In 1990, a study ranking the most burdensome conditions in the U.S in terms of mortality or poor health as a result of disease put low back pain in sixth place. About 80% of adults experience low back pain at some point in their lifetimes. It is the most common cause of job-related disability and a leading contributor to missed working days ( Low Back Pain Fact Sheet, 2017; Nahin et al., 2016).
Medical evidence suggests that more than 80% of all low back pain cases are caused by weak trunk muscles. Many studies have supported the use of endurance exercises that incorporate the abdominal muscles to prevent low back pain ( Beim et al., 1997 Petrofsky et al. (2008) supported the fact that exercise therapy is effective in reducing back pain and improving the functional performance of adults.
According to the low back pain survey, 61% of Americans said they have experienced low back pain, and of those, 69% felt it has affected their daily lives. The good news is that most cases of low back pain are not serious and will respond well to conservative, proven treatments, such as physical therapy. The physical therapist helps to stay healthy, in shape, free of pain and in many cases, avoidance of painful surgeries, and the side effects of medication prescription ( American Physical Therapy Association, 2012).
Low back pain is the fifth most common reason for physician visits, which affects nearly 60 – 80% of people throughout their life time. Low back pain that has been present for longer than 3 months is considered as chronic low back pain. More than 80% of all health care costs can be attributed to chronic low back pain ( Khan et al., 2014). The occurrence of low back pain in India is also alarming with nearly 60% of the people have suffered from low back pain at some time during their life span ( Ahdhi et al., 2016).
Today, low back pain is a major problem in our country. There are a lot of literatures regarding the treatment of low back pain with non-pharmacological measures. Most of the people used non-pharmacological simple measures to treat illness. Back strengthening exercise is a simple technique for reducing low back pain which is practiced widely. The investigator from her clinical experience and review of literatures found that most of them never bother about doing low back exercises and the benefits of doing it. Hence, the investigators were motivated to assess the effectiveness of back strengthening exercises among school teachers with chronic low back pain.
“A study to assess the effectiveness of back strengthening exercises among school teachers with low back pain in selected schools in Kanyakumari District, Tamilnadu”.
The present study was adopted a quantitative approach with pre-experimental; one group pretest-posttest design. The sample consisted of 30 school teachers in Kanyakumari District selected by using purposive sampling technique. The researcher used two data collection instruments.
Demographic proforma - to collect the baseline socio demographic information about the school teachers.
A numerical pain rating scale - to assess the level of low back pain among school teachers. Total obtainable score was 0-10. The obtained score is interpreted as, no pain (0); mild pain (1-3); moderate pain (4-6), and severe pain (7- 10).
The content validity of the tool was obtained by submitting it to 10 experts. According to their opinion the tool got its final form. Split half method was used to test the reliability of the tool and the value of r=0.85, which revealed that the tool is reliable.
A pilot study was conducted on six school teachers to assess the feasibility and practicability and it was feasible. Prior permission to conduct the study was obtained from the concerned institutions and concerned authorities. Data were collected only after obtaining the informed consent from the samples. The inclusion criteria for the study were school teachers who were in the age group of 30-58 years and willing to participate in the study. The exclusion criteria for the study were school teachers who had undergone any back surgeries, using walking aids, pregnancy, any pathological low back pain, and spinal and orthopedic disorders.
On the first day of data collection, pre-test was conducted with a questionnaire, then taught about Back Strengthening Exercises like one leg balance exercise, wall slide exercise, and hip bridge exercise with the help of pamphlet and encouraged them to do exercises daily for 20 minutes in evening. Weekly follow up was done. Post-test assessment was done for one month after intervention.
Data presented in Table 1 showed that the majority of 15 (50%) samples were in the age group of 39-48 years, 27 (90%) got married, 24 (80%) belongs to a nuclear family, 17 (56.67%) of samples were resided in rural area, 10 (33.33%) were worked in middle school, 21 (70%) of samples were took 4-6 hours class/day, 26 (86.67%) had irregular exercise habit, 17 (56.67%) maintained normal weight and 15 (50%) of samples took rest and sleep as a home remedy for low back pain.
Table 1. Demographic Variables of Samples
Figure 1 represents the assessment of samples before and after undergoing Back Strengthening exercises. About 80% and 20% of samples had moderate and mild pain respectively in pre-test. 80% and 20% of samples had mild and moderate pain, respectively in post-test.
Figure 1. Assessment of Low Back Pain before and after Back Strengthening Exercises
Table 2 shows the pre-test mean pain score of Back Strengthening Exercises was 3 ± 0.8 and the post-test was 1.4 ± 0.5. The mean reduction of pain was 1.6 ± 0.8 and it was statistically highly significant at P<0.001 level.
Table 2. Effectiveness of Back Strengthening Exercises in Reduction of Low Back Pain
Ghosh et al. (2014) conducted a study on “Comparative study of muscle strengthening exercises for treatment of chronic low backache”, the outcomes of different muscle strengthening exercises in treatment of low back pain. One hundred and twenty patients in the age group of 20-40 years with mechanical low back pain were randomly divided into two groups and instructed to perform two different types of exercises for three months (McKenzie exercise and Swiss ball exercise). Patients were assessed by Visual Analogue Scale (VAS), Modified Schober Test (MST) for extension and Oswestry Disability Index (ODI) based on pain intensity levels, range of motion, functional disability before starting the exercise programmes and after 3 months of intervention ( Ghosh et al., 2014). They revealed that McKenzie exercise and Swiss ball exercise in patients with low back pain have reduced pain intensity, increased range of movement and decreased functional disability. McKenzie exercise seems to have higher efficacy as compared to Swiss ball exercise.
The findings of the study showed that the mean change between pre-test and post-test pain score was found to be highly significant and there was a significant association between the pre-test pain level and selected demographic variables like age, exercise habit, BMI and home remedy for low back pain at 0.05 level. Hence, the administration of Back Strengthening Exercises was effective in reduction of low back pain among school teachers.
The findings of the study have considerable implications on Nursing Practice, Nursing Education, Nursing Administration, and Nursing Research.
The results of present study showed that the administration of Back Strengthening exercises was effective in terms of reduction of low back pain and improvement of physical activities among school teachers. This study supports the need of exercises for women in improving their functional performance.