CHAPTER-1

1
 INTRODUCTION

Low back pain (LBA) is a common symptom of musculoskeletal disorders or of

disorders involving the lumbar vertebrae. It can be either acute, subacute or
chronic in its clinical presentation. Pain felt in the lower back may come from the
spine, muscles, nerves, or other structures in that region. It may feel a variety of
symptoms if hurt the back. There may have a tingling or burning sensation, a dull
aching, or sharp pain. There may experience weakness in the legs or feet.It won't
necessarily be one event that actually causes the pain.[1]
Many things can cause low back pain –Muscle strain or spasm, sprains of
ligaments (which attach bone to bone ),joint problems or a slipped disk. The most
common cause is using back muscles in activities not used to like lifting heavy
furniture or doing and heavy work. A slipped disk (also called a herniated disk)
happens when a disk between the bones of the spine bulges and pressure on
nerves. This is often cause by twisting while lifting . [3]
Here are some detailed causes of LBA

1. Postural Stress
Poor posture stresses your spine. Ligaments are overstretched, muscles tire and
joints and nerves are put under pressure.

2
2. Muscle Strains
Minor back muscle strains quickly improve on their own, but more severe strains
will need physiotherapy treatment to relieve pain and promote healing.

3. Ligament Sprains
Stretching ligaments too far or too quickly makes them tear and bleed into
surrounding tissues, causing swelling and pain. Motor vehicle and sporting
accidents are common causes.

4. Disc Problems
Discs are anchored to the vertebrae, above and below, so they cannot 'slip' out
of place. They can wear down with age, but most disc problems arise from injury.
Discs can bulge (prolapse), herniate or even rupture.

5. Sciatica
The sciatic nerves run from the lower back, through the buttocks and down the
back of your legs. Irritation anywhere along this pathway will cause pain in the
back and legs.

6. Arthritis
Vertebral and facet joints can be affected by arthritis, causing degeneration and
inflammation within the joint and the growth of bony spurs on the edges of the
vertebrae. [4]

SYMPTOMS
The type, location, and severity of low back pain depends upon what is causing
it.
1. SYMPTOMS OF BACK SPRAIN OR STRAIN
2. SYMPTOMS OF NERVE ROOT PRESSURE
3. SYMPTOMS OF ARTHRITIS

3
SYMPTOMS OF BACK SPRAIN OR STRAIN
Muscle spasms, Cramping, Stiffness and Pain mostly in the back and buttocks,
Pain may develop quickly or over a longer period of time, Pain generally occurs
in episodes. It is aggravated by weight-bearing or specific movements and is
relieved by rest. The most severe pain usually lasts 48 to 72 hours and may be
followed by days or weeks of less severe pain.

SYMPTOMS OF NERVE ROOT PRESSURE INCLUDES

Leg pain: If pain extends below the knee, it is more likely to be due to pressure
on a nerve than to a muscle problem. If a nerve in the back is pinched, or
irritated, the pain can spread to your buttocks and thighs. This is known as
sciatica. Pain can also be made worse by activities that cause you to forcefully
contract the core muscles of your trunk such as a cough, sneeze, or a difficult
bowel movement, or if you hold your breath during an activity Valsalva maneuver
Nerve-related problems, such as tingling, numbness, or weakness in one leg or
in the foot, lower leg, or both legs.

SYMPTOMS OF ARTHRITIS OF SPINE INCLUDES

Pain and stiffness that is worse in the back and hip region. Arthritis pain starts
gradually, gets worse over time, and lasts longer than 3 to 6 months.
It is generally worse in the morning or after prolonged periods of inactivity.
Arthritis pain gets better when you move around. Symptoms caused by arthritis
and symptoms due to back injury are often similar and commonly occur together.

Causes of low back pain in physiotherapists while doing assessment by

performing special tests for the confirmation of the diagnosis or treatment by
exercises, mobilization, manipulation and other different techniques in the
course. Causes can be doing many things improperly while doing that mentioning
like - Prolonged standing, sitting or lifting. Then suddenly one simple movement
like reaching for something to the floor or turning for something leads to back
pain in physiotherapists.

4
STATEMENT OF STUDY
Prevalence of low back pain in PHYSIOTHERAPISTS in Ludhiana

PURPOSE OF STUDY
To spread the awareness of low back pain among PHYSIOTHERAPISTS. So
that the back pain while doing treatment can be avoided & early interventions can
be done.

OBJECTIVES OF STUDY
1. To study the prevalence of low back pain in PHYSIOTHERAPISTS with age
group between 20 – 35 years both males and females.
2. To find which category has highest percentage from oswestry low back pain
questionnaire.

5
CHAPTER-2

6
 REVIEW OF LITERATURE

There are many research studies on the prevalence of low back pain in medical
professionals – Physicians, Surgeons, Dentists, Nurses, etc but till now there is
no research study and published articles of the prevalence of low back pain
among physiotherapists.

7
CHAPTER – 3

8
RESEARCH DESIGN AND METHODOLOGY
Research methodology deals with the methods and materials used for this study
with Survey design and Type of sampling is Stratified Random sampling using
the Instrumental Tool of Low back pain questionnaire with total sample size of
100 physiotherapists .
Inclusion criteria
Age – 20 – 35 years
Both sexes are included
Exclusion criteria
Pregnancy
Sciatica
Vertebral fractures
PROCEDURE OF STUDY
Each participant is given verbal introduction for the questionnaire & assigned
consent form prior to the participation in the study. After this they were made to
fill the explained questionnaire and are given the Instruction to tick the box which
most closely described their problems and then score is given to each participant
out of 50.

9
CHAPTER-4

10
TOTAL PARTICIPANTS MALES FEMALES

100 23 77

MEAN AGE (FEMALES ) 22.22%

MEAN AGE ( MALES ) 23.56%

TOTAL MEAN AGE 22.66%

11
12
Sr. TOTAL TOTAL
NO. SECTIONS PARTICIPANTS PROBLEM SCORE RESULT Yes No

1 SECTION 1 100 PAIN INTENSITY 500 116 23.2 76.8

2 SECTION 2 100 PERSONAL CARE 500 79 15.8 84.2

3 SECTION 3 100 LIFTING 500 85 17 83

4 SECTION 4 100 WALKING 500 88 17.6 82.4

5 SECTION 5 100 SITTING 500 91 18.2 81.8

6 SECTION 6 100 STANDING 500 117 23.4 76.6

7 SECTION 7 100 SLEEPING 500 52 10.4 89.6

8 SECTION 8 100 SOCIAL LIFE 500 57 11.4 88.6

9 SECTION 9 100 TRAVELLING 500 96 19.2 80.8

SMPLOYMENT / HOME
10 SECTION 10 100 MAKING 500 76 15.2 84.8

Total 5000 857 17.14 82.86

13
 Individual Score out 50 (100 Subjects)

30

28
27

25

23

21 21
20
19
18 18
17 17 17 17
Score

16 16 16 16
15 15 15
14 14
13
12
11 1111 11 11 11 11
10 10 10 10 10 10
9 9 9 9 9
8 8 8 8 88 8 8888 8 8
7 7 7 7 7 7 7
66 6 6 6 6
5 5 5 5 5 55 5 5 5
4 4 444 4 44 4 4
3 33
2 2 2
11 1 1 1 1
0 0 0 0 0

Subjects

SCORE

14
 Scores in Percentage

100%

90%

80%

70%

60%

50%
No
Yes
40%

30%

20%

10%

0%
PAIN PERSONAL LIFTING WALKING SITTING STANDING SLEEPING SOCIAL LIFE TRAVELLING SMPLOYMENT / Total
INTENSITY CARE HOME MAKING

Problem

15
 Diagrammatic representation of Questionnaire Score in
PHYSIOTHERAPISTS IN LUDHIANA

QUESTIONNAIRE FOR PHYSIOTHERAPIST

PAIN
INTENSITY
No
76.8%

Prevalence rate in this

case is 23.2 % only

Yes
23.2%

PERSONAL
CARE No
84.2%
Prevalence rate in this
case is 15.8 % only

Yes
15.8%

16
 LIFTING
No
Prevalence rate in this 83.0%
case is 17 % only

Yes
17.0%

WALKING
No
Prevalence rate in this 82.4%
case is 17.6 % only

Yes
17.6%

17
 SITTING
No
Prevalence rate in this 81.8%
case is 18.2 % only

Yes
18.2%

STANDING
No
Prevalence rate in this 76.6%
case is 23.4 % only

Yes
23.4%

18
 SLEEPING
No
Prevalence rate in this 89.6%
case is 10.4 % only

Yes
10.4%

SOCIAL LIFE
No
88.6%
Prevalence rate in this
case is 11.4 % only

Yes
11.4%

TRAVELLING

19
Prevalence rate in this
case is 19.2 % only

EMPLOYMEN
T / HOME No
84.8%
MAKING

Prevalence rate in this

case is 15.2 % only

Yes
15.2%

20
Overall Score
No
Prevalence rate is 82.9%
17.1 %

Yes
17.1%

CHAPTER-5

21
 Discussion

The participants were made to fill the explained questionnaire and are given the
instructions to tick the box which most closely described their problems.
Figure 1 pie shows: about 23.2% of physiotherapists had pain intensity and
76.8% were normal
Figure 2 pie shows: about 15.8% of physiotherapists had pain during personal
care and 84.2% were normal
Figure 3 pie shows: about 17.0% of physiotherapists had pain while lifting and
83.0% were normal
Figure 4 pie shows: about 17.6% of physiotherapists had pain while walking and
82.4% were normal
Figure 5 pie shows: about 18.2% of physiotherapists had pain while sitting and
81.8% were normal
Figure 6 pie shows: about 23.4% of physiotherapists had pain while standing
and 76.6% were normal

22
Figure 7 pie shows: about 10.4% of physiotherapists had pain while sleeping
and 89.6% were normal
Figure 8 pie shows: about 11.4% of physiotherapists had pain in its social life
and 88.6% were normal
Figure 9 pie shows: about 19.2% of physiotherapists had pain while travelling
and 80.8% were normal
Figure 10 pie shows : about 15.2% of physiotherapists had pain in its
employment/home – making and 84.8% were normal
Overall score is that 17.1% of physiotherapists had low back pain in Ludhiana
and 82.9% were normal.
This study has shown that standing has the highest percentage of cause of low
back pain in physiotherapist in Ludhiana, this is because the occupation of
therapist required prolonged standing and frequent change in different postures
while doing treatment by doing mobilization, stretching, resistance exercises,
passive movements, etc. With prolonged standing, there may occur postural low
back pain due to these different reasons. While giving any stretching or lifting any
heavy weight for example if the patient is obese, mechanical low back pain may
occur, With these different frequent changes in posture and by not adopting
proper ergonomics of back, there may occur symptoms of back pain like
increased lumbar lordosis, paraspinal muscle spasm or any nerve related
problems like weakness, numbness and tingling or If the nerve is pinched then
pain can radiate to the leg or foot then symptoms of sciatica may also occur.

23
CHAPTER - 6

24
Limitations
1. This study was localized to particular geographical area.
2. There is no proper ratio of males & females.
3. Daily activities are not included.
4. BMI is not considered.
Further scope
1. The study can be done on larger sample size.
2. This study should include the proper ratio of males & females.
3. This study should be carried out in wider area.
4. The study can be on the basis of BMI (body mass index) .
Conclusion
This Survey has concluded that there is prevalence of Low back pain related to
the mean age of 22.6 years of 100 subjects with the 77 females and 23 males.
This study has also shown that prevalence rate in low back pain is higher in
standing and lower in sleeping.

25
Summary
Various factors are responsible for the low back pain. This survey was done to
know that at what position physiotherapists having a low back pain while doing
treatment to the patients and to create awareness of low back pain in
physiotherapists so that back pain while doing treatment can avoid that position
and early interventions can be done. In this survey questionnaire was distributed
among different age groups of both the sexes total sample size 100 each subject
is given verbal introduction for the questionnaire & Assigned consent form prior
to the participation in the study. After this subjects were made to fill the explained
quest are given the instruction to tick the box which most closely described their
problems and then data was collected, analyzed and results were obtained.
This study has shown that prevalence rate of low back pain in physiotherapists in
Ludhiana is very low that is 17.1% only

REFERENCES

1. By Jonathan Cluett, M.D. About.com Updated: October 29, 2007

2. Modified oswestry low back pain questionnaire
3. Carol & Richard Eustice About.com Updated: May 27, 2006
4. US Preventative Services Task Force. Primary Care Interventions to Prevent
Low Back Pain: Brief Evidence Update. Rockville, MD: Agency for Healthcare
Research and Quality; February 2004.
5. Anema JR, Steenstra IA, Bongers PM, de Vet HC, Knol DL, Loisel P, van
Mechelen W. Multidisciplinary rehabilitation for subacute low back pain:
graded activity or workplace intervention or both? A randomized controlled
trial. Spine 2007; 32:291-298.
6. Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, et al.: a joint
clinical practice guideline from the

26
APPENDICES

27
 Ethical Consideration

1. The identity of the subject will be protected throughout the study and also in
the publication so made.
2. Each subject randomly, will be allocated a secret code throughout and after
the study.
3. A decoding note will be made on subjects first appearance and will be
retained by me maintaining all secrecy.
4. All subjects would be briefed about my legal condition to observe any act of
data protection.
5. After briefing only about their rights, I will make them sign the consent form
6. Subjects will be free in any state of the project to walk out of it, if they fell the
need.
All the information to be collected shall pertain to the study only.

28
 Consent Form

TITLE OF PROJECT:

Find The Prevelance Of Low Back Pain In Physiotherapist In Ludhiana

I , being asked to participate in the above study

because it satisfies their eligibility criteria which are:
Age between 20 to 35 years
I confirm that I understand the information dated (__/__/____) for this study.
I understand that my participation is voluntary
I agree to take part in the above research study

Signature of participant
Signature of researcher

29
 Modified Oswestry Low Back Pain Questionnaire
This questionnaire is designed to enable us to understand how much you low
back pain has affected your ability to manage your everyday activities. Please
answer each section by marking in each section one circle that most applies to
you. We realize that you may feel that more than one statement may relate to
you, but please just mark the circle that most closely describes your
problem.

Section 1 - Pain Intensity

 The pain comes and goes and is very mild.
 The pain is mild and does not vary much.
 The pain comes and goes and is moderate.
 The pain is moderate and does not vary much.
 The pain comes and goes and is severe.
 The pain is severe and does not vary much.

Section 2 - Personal Care

 I do not have to change my way of washing or dressing to avoid pain.

30
 I do not normally change my way of washing or dressing even though it
causes me pain.
 Washing and dressing increase the pain, but I manage not to change my way
of doing it.
 Washing and dressing increases the pain and I find it necessary to change
my way of doing it.
 Because of the pain I am unable to do some washing and dressing without
help.
 Because of the pain I am unable to do any washing and dressing without
help.

31
Section 3 - Lifting (skip if you have not attempted lifting since the onset of
your low back pain)
 I can lift heavy weights without extra low back pain.
 I can lift heavy weights but it causes extra pain.
 Pain prevents me lifting heavy weights off the floor.
 Pain prevents me lifting heavy weights off the floor, but I can manage if they
are conveniently positioned, e.g. on a table.
 Pain prevents me lifting heavy weights but I can manage light to medium
weights if they are conveniently positioned.
 I can only lift light weights at the most.

Section 4 - Walking
 I have no pain walking.
 I have some pain on walking, but I can still walk my required to normal
distances.
 Pain prevents me from walking long distances.
 Pain prevents me from walking intermediate distances.
 Pain prevents me from walking even short distances.
 Pain prevents me from walking at all.

Section 5 - Sitting
 Sitting does not cause me any pain.
 I can sit as long as I need provided I have my choice of sitting surfaces.
 Pain prevents me from sitting more than 1 hour.
 Pain prevents me from sitting more than 1/2 hour.
 Pain prevents me from sitting more than 10 minutes.
 Pain prevents me from sitting at all.

Section 6 - Standing
 I can stand as long as I want without pain.

32
 I have some pain while standing, but it does not increase with time.
 I cannot stand for longer than 1 hour without increasing pain.
 I cannot stand for longer than 1/2 hour without increasing pain.
 I cannot stand for longer than 10 minutes without increasing pain.
 I avoid standing because it increases the pain immediately.

Section 7 - Sleeping
 I have no pain while in bed.
 I have pain in bed, but it does not prevent me from sleeping well.
 Because of pain I sleep only 3/4 of normal time.
 Because of pain I sleep only 1/2 of normal time.
 Because of pain I sleep only 1/4 of normal time.
 Pain prevents me from sleeping at all.

Section 8 - Social Life

 My social life is normal and gives me no pain.
 My social life in normal, but increases the degree of pain.
 Pain prevents me from participating in more energetic activities e.g. sports,
dancing.
 Pain prevents me from going out very often.
 Pain has restricted my social life to my home.
 I hardly have any social life because of pain.

Section 9 - Traveling
 I get no pain while traveling.
 I get some pain while traveling, but none of my usual forms of travel make it
any worse.
 I get some pain while traveling, but it does not compel me to seek alternative
forms of travel.

33
 I get extra pain while traveling that requires me to seek alternative forms of
travel.
 Pain restricts all forms of travel.
 Pain prevents all forms of travel except that done lying down.

Section 10 - Employment/Homemaking
 My normal job/homemaking duties do not cause pain.
 My normal job/homemaking duties cause me extra pain, but I can still perform
all that is required of me.
 I can perform most of my job/homemaking duties, but pain prevents me from
performing more physically stressful activities e.g. lifting, vacuuming, etc.
 Pain prevents me from doing anything but light duties.
 Pain prevents me from doing even light duties.
 Pain prevents me from performing any job or homemaking chore.

SCORE_________________________

34
 MASTER CHART

PERCENTAGE
S NO. CODE AGE SEX SCORE
(%)
1 NK 24 F 4 8
2 SK 22 F 6 12
3 NC 22 M 6 12
4 SU 21 F 2 4
5 RK 22 F 8 16
6 CM 23 F 7 14
7 RS 22 F 0 0
8 AS 22 F 28 56
9 JK 22 F 14 28
10 PK 22 F 7 14
11 AB 23 F 9 18
12 MK 22 F 16 32
13 NL 22 F 2 4
14 PY 22 F 18 36
15 DL 23 M 8 16
16 VK 22 F 13 26
17 MK 22 F 11 22
18 PK 22 F 1 2
19 SS 22 F 1 2
20 PB 23 F 16 32
21 SM 22 F 4 8
22 TK 25 F 9 18
23 ZB 23 F 5 10
24 DA 30 F 12 24
25 SW 22 F 0 0
26 RN 22 F 4 8
27 RC 22 F 4 8
28 RH 22 F 4 8
29 MS 22 F 6 12
30 BN 22 F 1 2
31 JK 22 F 3 6
32 MN 22 F 4 8
33 HS 22 F 1 2
34 SR 25 F 9 18
35 AA 22 F 0 0
36 SH 25 F 1 2
37 LD 22 M 10 20
38 PM 22 M 4 8
39 HD 22 F 4 8
40 MU 23 M 7 14
41 SY 22 F 15 30
42 RD 23 F 7 14
43 VM 22 M 8 16

35
44 RM 22 F 5 10
45 RT 23 F 7 14
46 DH 31 M 5 10
47 DG 24 F 11 22
48 DP 23 F 11 22
49 DA 39 M 5 10
50 DD 22 F 8 16
51 SN 21 F 4 8
52 SL 22 F 8 16
53 LT 25 M 8 16
54 NM 21 M 7 14
55 RA 22 F 8 16
56 AD 21 M 7 14
57 SK 22 F 11 22
58 AT 21 F 10 20
59 KN 23 F 5 10
60 RV 22 M 5 10
61 CH 24 F 10 20
62 AK 23 F 9 18
63 NH 23 F 8 16
64 PH 22 F 8 16
65 GH 22 F 8 16
66 MP 22 F 8 16
67 SH 22 F 16 32
68 MV 22 F 11 22
69 PN 22 F 17 34
70 MN 22 F 11 22
71 RZ 22 F 4 8
72 RL 22 F 3 6
73 GS 22 M 3 6
74 MH 21 M 6 12
75 SI 22 F 0 0
76 PI 22 F 17 34
77 PA 22 F 2 4
78 SH 22 M 9 18
79 HH 22 M 5 10
80 MJ 23 F 1 2
81 IT 23 M 23 46
82 DS 22 M 18 36
83 KB 22 F 6 12
84 HN 22 F 27 54
85 MT 22 M 10 20
86 GJ 22 F 15 30
87 SA 22 F 6 12
88 PP 22 M 11 22
89 PR 22 F 5 10
90 KN 22 F 8 16
91 DN 25 F 21 42

36
 92 DJ 24 F 14 28
93 DV 22 M 17 34
94 DY 24 F 10 20
95 PN 21 F 19 38
96 RI 21 F 8 16
97 HN 22 F 5 10
98 PE 22 M 16 32
99 AL 23 F 21 42
100 AA 22 M 17 34

37