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Introduction:

The human body is driven through physical and functional activity. Activity has an impact on lifestyle. Technological advances are increasing the number of three physically inactive lifestyles. Lack of exercise is considered a health risk factor and is often associated with the development of degenerative diseases such as hypertension, obesity, and spinal disease.

The present scenario on lifestyle is persons are doing fewer activities and using more gadgets its call sedentary lifestyle and sedentary lifestyle has an impact on person’s postural health of the body and its give impact on the structure of the body like bones and muscles due to faulty adaptation of postures it gives more impact on the spinal health of the human body.

The spine is an integral part of human mechanics because it has natural curvature that provides the body stability and mobility. Kyphosis is a condition in which the natural curves of the spine are unnaturally high. it can occur as a result of poor posture, while lordosis might develop as a result of an enlarged lumbar curve. A subject with enhanced lumbar lordosis has weak and stretched abdominal muscles, whereas the spine's erector muscles and hip flexor muscles should be shortened. During relaxed standing, these lumbopelvic imbalances should cause an increased lumbar lordosis and an enhanced anterior tilt of the pelvis.1-3

Malalignment of the spinal structure affects posture and causes a variety of spinal disorders such as back pain, neck pain, scoliosis, and kyphosis. Back pain and disability are associated with lack of exercise and affect about 80% of the adult population at some point in life. In some cases, this painful condition can be severe and chronic, so an exercise program as a non-pharmacological treatment to improve spinal stability and mobility, thereby reducing back pain and disability. 4-6

Physical treatments aim to enhance function and stop disability from getting worse, Active strategies like exercise are associated with decreased disability. Passive methods (rest, medications) are related to worsening disability and aren't recommended. Public health programs should educate the general public on the prevention of low back pain and neck pain. The goal of this research is to help the community stay healthy and understand the value of back-related health and awareness activities. 14-23

A spinal wellness program is a program to assess and maintain the physical and functional alignment of the spine among people without any pain, which incorporates stretching and strengthening to make sure normal structural stability and functional mobility. Wellness is a concept at the forefront of health promotion. The structure of this program is aimed at promoting health and identifying and correcting spinal problems.

Need of the study

physical changes like tightness, stiffness, or weakness as well as functional limitations are not recognized until pain and discomfort overcome the ADLs. Spinal wellness should be taken into consideration from early aging with prediction, prevention, and personalization. Thus we would like to develop a comprehensive program for assessing and managing the normality of spinal structure under the spinal wellness program

Materials and Methodology

Materials to be used

(a)bubble inclinometer, (b) goniometer (c) measure tape

Methodology

study design: an interventional study

study setting: community-dwelling,

study population: healthy individual

study sample: purposive sampling

Study duration:3 months

sample size: 30

venue for data collection: Rajkot city

CRITERIA FOR SELECTION

 Inclusive criteria: age between 20 to 55 years, SF 36 health questionnaire Exclusion criteria: history of hospitalization in the last six months, history of the spinal implant, Presence of history of having severe pain

Intervention:

Mode: Stretching and Strengthening       

Frequency:1 session/day, 6 days/week, 2 weeks.

Intensity: Stretching 30 sec hold, strengthening 40- 60% of 10RM

Type: Flexibility and mobility

Time   : Each session 30-35 min.

Sessions  : Total 12 sessions, 6 Supervised and 6 Non supervised

Repetition: For stretching 3 reps/day, strengthening 10 reps/day

Procedure:

 

Intervention program

CERVICAL

CERVICAL

MOTION

SHORTENING

LENGTHENING

INTERVENTION

STRENGTHENING EXERCISE

STRETCHING EXERCISE

ROM RESTRICTED

extension

Neck flexors

Neck extensors

Strengthening followed by stretching

Prone kneeling head bending forward and backward, isometric neck exercise

Scalene muscle stretch

ROM RESTRICTED

flexors

Neck extensors

Neck flexors

Strengthening followed by stretching

High lying position head unsupported flexion, isometric neck exercise

Trapezius stretch, scalene and SCM stretch

ROM RESTRICTED

Side flexion

Contralateral

Scalene and SCM

Ipsilateral Scalene and SCM

Strengthening followed by stretching

High side-lying head  unsupported side flexion, isometric neck exercise

Scalene muscle stretch, trapezius muscle stretch

ROM RESTRICTED

rotation

Contralateral

SCM

Ipsilateral

SCM

Strengthening followed by stretching

High side-lying head  unsupported head rotation, isometric neck exercise

SCM stretch, scalene stretch

CERVICAL

MOTION

LENGTHENING

SHORTENING

INTERVENTION

STRENGTHENING EXERCISE

STRETCHING EXERCISE

DECREASE STRENGTH

extension

Neck extensors

Neck flexors

Strengthening followed by stretching

Prone kneeling head bending forward and backward, isometric neck exercise

Scalene muscle stretch

DECREASE STRENGTH

flexors

Neck flexors

Neck extensors

Strengthening followed by stretching

High lying position head unsupported flexion, isometric neck exercise

Trapezius stretch, scalene and SCM stretch

DECREASE STRENGTH

Side flexion

Ipsilateral Scalene and SCM

Contralateral

Scalene and SCM

Strengthening followed by stretching

High side-lying head  unsupported side flexion, isometric neck exercise

Scalene muscle stretch, trapezius muscle stretch

DECREASE STRENGTH

rotation

Ipsilateral

SCM

Contralateral

SCM

Strengthening followed by stretching

High side-lying head  unsupported head rotation, isometric neck exercise

SCM stretch, scalene stretch

 

 THORACOLUMBAR

 

MOTION

SHORTENING

LENGTHENING

INTERVENTION

STRENGTHENING EXERCISE

STRETCHING EXERCISE

ROM restricted

Flexion

extensors

flexors

Strengthening followed by stretching

Curl ups, bilateral leg raise

Erector spine stretch, child pose stretching

ROM restricted

Extension

flexors

extensor

Strengthening followed by stretching

Superman,

Burd dog

Cobra stretch

ROM restricted

Side bending

Contralateral side flexors

Unilateral side flexors

Strengthening followed by stretching

Side plank hip lift exercise

Quadratus lumborum stretch

ROM restricted

rotation

Contralateral rotators

Unilateral rotators

Strengthening followed by stretching

Russian twist,

Supine bicycling crunches, trunk rotation exercise

Oblique muscle stretch

 

    

MOTION

LENGTHENING

SHORTENING

INTERVENTION

STRENGTHENING EXERCISE

STRETCHING EXERCISE

DECREASE STRENGTH

Flexion

flexors

extensors

Strengthening followed by stretching

Curl ups, bilateral leg raise

Erector spine stretch, child pose stretching

DECREASE STRENGTH

Extension

extensor

flexors

Strengthening followed by stretching

Superman,

Burd dog

Cobra stretch

DECREASE STRENGTH

Side bending

Unilateral side flexors

Contralateral side flexors

Strengthening followed by stretching

Side plank hip lift exercise

Quadratus lumborum stretch

DECREASE STRENGTH

rotation

Unilateral rotators

Contralateral rotators

Strengthening followed by stretching

Russian twist,

Supine bicycling crunches, trunk rotation exercise

Oblique muscle stretch

 

 

shortening

lengthening

intervention

Strengthening exercise

Stretching exercise

Excessive lumbar lordosis

lumbar extensors

Hip flexors, abdominal muscles

Strengthening followed by stretching

Curl ups, bilateral leg raise,

Russian twist

Erector spine stretch, child pose stretching

Decreased lumbar lordosis

Hamstrings,

Abdominal muscles

iliopsoas muscle, lumbar extensor

Strengthening followed by stretching

Superman,

Burd dog, SLR

Hamstring stretch, cobra stretch

 

 

SHORTENING

LENGTHENING

INTERVENTION

STRENGTHENING EXERCISE

STRETCHING EXERCISE

EXCESSIVE

KYPHOSIS

pectoralis major, subclavius, and pectoralis minor

trapezius, rhomboids, and rotator cuff muscles

Strengthening followed by stretching

Blackburn exercise

Corner pec stretch

PELVIC

  

SHORTENING

LENGTHENING

INTERVENTION

STRENGTHENING EXERCISE

STRETCHING EXERCISE

  

iliopsoas, lumbar extensors

Abdominal muscles

strengthening, followed by stretching

Curl ups, bilateral leg raise,

Russian twist

Erector spine stretch, child pose stretching

POSTERIOR PELVIC TILT

Hamstring, glutes, and lower abdominal muscles

Quadriceps, lower back muscles

strengthening, followed by stretching

Superman, squat, high sitting knee extension 

Cobra pose, hamstring stretch

LATERAL PELVIC TILT

Opposite side abductors and erector spine

Same side erectors spine and abductors

Strengthening followed by stretching

Superman,

Burd dog, side SLR

Erector spine stretch, child pose stretching, piriformis stretch

 

HIP

 

MOTION

LENGTHENING

SHORTENING

INTERVENTION

STRENGTHENING EXERCISE

STRETCHING EXERCISE

ROM RESTRICTED

Flexion

Iliopsoas, rectus femoris

Hamstring, gluteus Maximus

Strengthening followed by stretching

Supine SLR, squatting

Hamstring stretch, unilateral knee to chest

ROM RESTRICTED

Extension

Hamstring, gluteus Maximus

Iliopsoas, rectus femoris

Strengthening followed by stretching

Squatting, standing hamstring curl 

Iliopsoas and quadriceps stretch

ROM RESTRICTED

abduction

Piriformis, gluteus medias, gluteus-minimus

Adductors longus, brevis

Strengthening followed by stretching

Side SLR, squat to hip abduction

Butterfly stretch, sumo squat

ROM RESTRICTED

adduction

Adductors longus, brevis

Piriformis, gluteus medias, gluteus-minimus

Strengthening followed by stretching

Side lying hip adduction

 

Piriformis stretch, sumo squat

ROM RESTRICTED

Medial rotation

anterior fibres of gluteus medius and minimus, tensor fascia latae

biceps femoris, gluteus maximus, piriformis

Strengthening followed by stretching

Squat to hip abduction, side lying abdction

Unilateral knee to chest, piriformis stretch, hamstring strech

ROM RESTRICTED

Lateral rotation

biceps femoris, gluteus maximus, piriformis

anterior fibres of gluteus medius and minimus, tensor fascia latae

Strengthening followed by stretching

Hamstring curl,

Squat to hip abduction, side SLR

TFL stretch, sumo squat

 

 

MOTION

SHORTENING

LENGTHENING

INTERVENTION

STRENGTHENING EXERCISE

STRETCHING EXERCISE

DECREASE STRENGTH

Flexion

Hamstring, gluteus Maximus

Iliopsoas, rectus femoris

Strengthening followed by stretching

Supine SLR, squatting

Hamstring stretch, unilateral knee to chest

DECREASE STRENGTH

Extension

Iliopsoas, rectus femoris

Hamstring, gluteus Maximus

Strengthening followed by stretching

Squatting, standing hamstring curl 

Iliopsoas and quadriceps stretch

DECREASE STRENGTH

abduction

Adductors longus, brevis

Piriformis, gluteus medias, gluteus-minimus

Strengthening followed by stretching

Side SLR, squat to hip abduction

Butterfly stretch, sumo squat

DECREASE STRENGTH

adduction

Piriformis, gluteus medias, gluteus-minimus

Adductors longus, brevis

Strengthening followed by stretching

Side-lying hip adduction

 

Piriformis stretch, sumo squat

DECREASE STRENGTH

Medial rotation

biceps femoris, gluteus maximus, piriformis

anterior fibers of gluteus medius and minimus, tensor fascia lata

Strengthening followed by stretching

Squat to hip abduction, side-lying abduction

Unilateral knee to chest, piriformis stretch, hamstring strech

DECREASE STRENGTH

Lateral rotation

anterior fibres of gluteus medius and minimus, tensor fascia latae

biceps femoris, gluteus maximus, piriformis

Strengthening followed by stretching

Hamstring curl,

Squat to hip abduction, side SLR

TFL stretch, sumo squat

 

SCAPULA AND SHOULDER

 

Present

lengthening

shortening

intervention

Strengthening exercise

Stretching exercise

protraction

Yes or no

trapezius, rhomboids, and latissimus dorsi muscles

serratus anterior, pectoralis major, and pectoralis minor muscles

Strengthening followed by stretching

Black burn ex’s

Corner pec stretch

retraction

Yes or no

serratus anterior, pectoralis major, and pectoralis minor muscles

trapezius, rhomboids, and latissimus dorsi muscles

Strengthening followed by stretching

Wall pushups

Trapezius stretch,

Lats stretch

Elevation

Yes or no

Upper trapezius, serratus anterior,levator scapulae

trapezius, rhomboid muscles

Strengthening followed by stretching

Shoulder shrug,

Prone on elbow

Rhomboid stretch, treps stretch

depression

Yes or no

Trapezius,  rhomboid muscles

Upper trapezius, serratus anterior,levator scapulae

Strengthening followed by stretching

Black burn ex’s

Trapezius stretch, lats stretch, levator scaplae stretch

Statistical analysis

Statistical analysis was done using SPSS version 25 was used to generate graphs and tables.

Variable was assessed for normality. For that value of skewness, kurtosis, histogram, and Shapiro-Wilk test was used.

For the normal distribution, the value of skewness and kurtosis should be between  -1.96 to +1.96 and the value for the Shapiro-Wilk test should be greater than 0.05.

Data were normally distributed so the paired T-test (parametric) was used.

The level of significance was considered less than 0.05, the confidence interval was kept at 95%.

Result:

Table 1: Range of Motion of Cervical Spine Test Analysis

 

 

Mean

SD

T value

P-value

Left side rotation

Pre

14.57

1.524

4.894

0.000

Post

13.17

0.699

Right side rotation

pre

14.70

1.442

6.073

0.000

Post

13.17

0.699

Left side flexion

Pre

14.87

1.408

7.549

0.000

Post

13.13

0.681

Right side flexion

Pre

14.83

1.416

7.369

0.000

Post

13.13

0.681

Interpretation:  Paired T-Test of Range of Motion was done. As per the data analyzed, the p-value (probability value) of all ROM is 0.000 which is less than 0.05 (standard value). This shows there is a significant difference between Pre ROM score and Post ROM score. Moreover, there is also improvement seen in the mean Post ROM value

Table 2: Analysis of The Range of Motion Thoracolumbar Spine

 

 

Mean

SD

T value

P value

Flexion

Pre

8.13

1.456

-6.326

0.000

Post

9.70

0.535

Extension

pre

8.17

1.440

-5.049

0.000

Post

9.50

0.861

 Lt lateral flexion

Pre

35.17

7.159

8.732

0.000

Post

27.33

4.088

 

 

Rt lateral flexion

Pre

35.53

7.286

8.733

0.000

Post

27.53

4.208

 

 

Interpretation: Paired T-Test of Range of Motion of thoracolumbar spine was done. As per the data analyzed, the p-value (probability value) of all ROM is 0.000 which is less than 0.05 (standard value). This shows there is a significant difference between Pre ROM score and Post ROM score. Moreover, there is also improvement seen in the mean Post ROM value.

Table 3: Analysis of The Range of Motion Lumbar Spine

 

 

Mean

SD

T value

P-value

Flexion

pre

7.00

1.414

-7.047

0.000

post

7.77

0.935

extension

Pre

3.07

1.461

-7.449

0.000

post

3.80

1.064

Interpretation: Paired T-Test of Range of Motion of the lumbar spine was done. As per the data analyzed, the p-value (probability value) of all ROM is 0.000 which is less than 0.05 (standard value). This shows there is a significant difference between Pre ROM score and Post ROM score. Moreover, there is also improvement seen in the mean Post ROM value.

Table 4: V Sit and Reach Test

 

 

Mean

SD

T value

P-value

V sit and reach test

pre

21.43

2.254

-5.215

0.000

post

22.37

2.008

Interpretation: Paired T-Test of v sit and reach test was done. As per the data analysed, the p-value (probability value) of all v sit and reach tests is 0.000 which is less than 0.05 (standard value). This shows there is a significant difference between Pre v sit and reach test score and Post v sit and reach test score. Moreover, there is also improvement seen in the mean Post v sit and reach test value.

Table 5: Spine Functional Index

 

 

Mean

SD

 T value

P-value

Spine functional index

Pre

94.13

3.636

8.363

0.000

Post

99.47

1.383

Interpretation: Paired T-Test of spine functional index was done. As per the data analysed, the p-value (probability value) of all ROM is 0.000 which is less than 0.05 (standard value). This shows there is a significant difference between the Pre SPI score and the Post SPI score. Moreover, there is also improvement seen in the mean Post SPI value.

Table 6: Manual Muscle Testing of the Spine

 

 

Mean

SD

t value

P value

Flexion

Pre

4.07

0.740

-7.047

0.000

Post

4.90

0.305

Extension

Pre

3.87

0.730

-7.449

0.000

Post

4.77

0.504

rotation

Pre

4.07

0.740

-7.047

0.000

Post

4.90

0.305

t/extension

Pre

3.87

0.730

-7.449

0.000

Post

4.77

0.504

Interpretation: Paired T-Test manual muscle test was done. As per the data analyzed, the p-value (probability value) of all MMT is 0.000 which is less than 0.05 (standard value). This shows there is a significant difference between the Pre MMT score and Post MMT score. Moreover, there is also improvement seen in the mean Post MMT value.

Table 7: Curvature of The Spine

 

 

Mean

SD

T value

P value

T1-T2

Pre

21.67

7.112

5.693

0.012

Post

20.67

5.979

T11-T12

pre

21.83

6.884

2.971

0.006

Post

20.67

5.683

L1-L2

Pre

11.00

5.931

-2.971

0.006

Post

12.17

5.032

L4-L5

Pre

11.17

6.254

-2.971

0.006

Post

12.33

5.371

Interpretation: Paired T-Test of curvature of the spine was done. As per the data analyzed, the p-value (probability value) of all curvatures of the spine is 0.000 which is less than 0.05 (standard value). This shows there is a significant difference between Pre curvature of the spine score and Post curvature of the spine score. Moreover, there is also improvement seen in the mean Post curvature of the spine value.

Discussion :

Above study demonstrated that stretching exercises targeting the neck muscles trapezius, scalene, sternocleidomastoid significantly improve neck range of motion and increase neck functions among healthy individuals. When you stretch a muscle, your body responds by increasing blood flow to that area. The blood vessels around the targeted muscle widen to allow more blood to flow through, and your heart starts pumping more blood. Our results were in line with previous studies showing the benefit of stretching exercise for the neck condition.the current study was to evaluate the effectiveness of stretching on thoracolumbar range of motion (ROM), functional limitation in a healthy individual. Erector spine stretch, child pose stretching, cobra stretch, quadratus lumborum stretch, oblique muscle stretch one can demonstrate improvement on thoracolumbar ROM.

The current study was to evaluate the effectiveness of stretching on lumbar range of motion (ROM), functional limitation in a healthy individual. Erector spine stretch, child pose stretching, cobra stretch, quadratus lumborum stretch, oblique muscle stretch one can demonstrate improvement on lumbar ROM. When you stretch a muscle, your body responds by increasing blood flow to that area. The blood vessels around the targeted muscle widen to allow more blood to flow through, and your heart starts pumping more blood. Our results were in line with previous studies showing the benefit of stretching exercise for the back condition.  v sit and reach test is one of the linear flexibility tests which helps to measure the extensibility of the hamstrings and lower back. In the post mean we can find the improvement in the flexibility in the hamstring and lower back. Because we did the back flexibility and strengthening exercise which helps in the back flexibility and mobility.

we find out to increase spine functional index score after this program, because our program is target the whole spine, and our program includes stretching and strengthening exercises which help in the improvement in spinal stability and mobility.above study demonstrated that strengthening exercise targeting the back and core muscles and exercise we done curl-ups, bilateral leg raise, superman, burd dog, side plank leg lift, Russian twist significantly improve back range of motion and increased back functions among healthy individuals. In the pre mean we find out lumbar flexion strength is more than lumbar extension, which causes muscle imbalance. And this is one of the reasons for back pain, so in this wellness program, we fix it.in the measurement of the curvature of the spine we find the subject is affected by poor posture that’s why they have kyphosis, increase lumbar lordosis, and some have a flat back syndrome. When the person’s lumbar lordosis is increase so they have tightness in the back and weakness the abdominal muscle, the body’s posture affects by the kinetic chain, and time our comprehensive program helps in the improvement in the spinal stability and mobility, after the program, we have seen a significant change in the curvature of the spine.

Conclusion:

In context to result and discussion spinal wellness program must be taken into consideration in the early age of life within the lifestyle modification to prevent spine-related disease and disorder such comprehensive spinal wellness program can be prescribed to the community for health and wellness.However, further study is needed to evaluate the efficacy of the present spinal wellness program with available therapeutic plans for understanding changes between the groups.

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The Journal publishes original papers, current concepts, reviews and other articles relevant to physiotherapy with the aim to promote advances in research in the field of Physiotherapy. It also provides an opportunity for the expression of individual opinions on healthcare." with "The journal aims to promote research advances in the field of physiotherapy by publishing original papers, current concepts, reviews, and other relevant articles. In addition, it provides a platform for individuals to express their opinions on healthcare.

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