Low back pain is the most common symptoms experienced by people throughout the world. Although lifetime prevalence of low back pain among women is more but it is particularly common during pregnancy, affecting approximately 50% of women. Pregnancy induces significant physiological changes, which lead to increased ligamentous laxity that may persist for 3 to 6 months postpartum. Additionally, the expanding uterus shifts the maternal center of gravity anteriorly, resulting in compensatory lumbar hyperlordosis and contributing to lower back discomfort. While these adaptations help accommodate pregnancy, they often do not fully resolve after birth, especially in the presence of abdominal muscle weakness. The result is altered posture characterized by an exaggerated lumbar lordotic curve that may predispose postpartum women to continued pain and lumbar instability. Without a structured postpartum rehabilitation program, these postural abnormalities may go uncorrected. Ensuring adherence and completion of such programs is critical for preventing long-term musculoskeletal complication. There are many efficient way to help in maintaining adherence and completion of program including the use of digital platforms. The increasing availability of low cost internet and communication technologies has enhanced the capacity to deliver healthcare services through internet, enabling broader access to physiotherapy services and follow-up care through telerehabilitation. Telerehabilitation is one of the emerging field of telemedicine, defined as set of tools, procedure, and protocols to deliver the rehabilitation process remotely. The objective of the study is to facilitate implementation of the telerehabilitation for home based program for postpartum female. The objectives of the study is to compare the effectiveness of telerehabilitation-based lumbar stability exercises versus on-site lumbar stability exercises in improving lumbar stability among postpartum female and to facilitate implementation of the telerehabilitation for home based program for postpartum female. It is a randomized controlled trial. Participants meeting the inclusion criteria will be recruited and consent form will be taken than participants will be allocated to group A (On-Site Lumbar Stability exercise) and B (Telerehabilitation) through 1:1 method. Pre-treatment assessment will be carried out on Day 1 using the outcome measures tool like NPRS, ODI and LLA. Participant will receive intervention for 6 weeks, 3 sessions per weeks. After the completion, on 6 week Post-treatment assessment will be carried out using the same outcome measures tool like NPRS, ODI and LLA.
Female participants 6 weeks up to 12 month post-partum women.
Participants who has access to internet services and technologies
Participants with mild-to-moderate self-reported low back pain for at least 2 weeks.
Objectively measured lumbar lordotic angle beyond normative range of 40 Degree
Congenital spine deformities like scoliosis
Pelvic prolapsed
Parallel
Lumbar stabilization
Procedure/SurgeryGroup A will undergo 6 weeks onsite lumbar stabilization protocols in front of the therapist and will undergo 3 sessions per week on alternate day. It will have educational session on the pre-assessment day. There will be 5 minutes warm up period before each session in which quick rhythmic movement of the body will be perform. A cool down period will be performed after each session in which adductor stretch, iliopsoas stretch will be performed. Week 1-2 Core awareness \& activation In week 1, diaphragmatic breathing, abdominal drawing-in maneuvers 30 seconds to 1 minute, and pelvic floor contraction. In week 2, pelvic tilting in supine, supine line heel slide, supine lying marching will be added. Perform it ten times per set, 1 sets a day. The set and repetition will be increase progressively according to individual stamina. Week 3-4 Core Stabilizing exercise Continue week 1-2 maneuvers but in addition with glutes bridges, quadrupled bird dog, clamshells.
Telerehabilitation
Procedure/SurgeryGroup B will undergo 6 weeks telerehab lumbar stabilization protocols, will undergo 3 sessions per week on alternate day. It will have educational session on the pre-assessment day. Then group B will receive exercise session video and group B will perform exercise during live call with the therapist. There will be 5 minutes warm up period before each session in which quick rhythmic movement of the body will be perform. A cool down period will be performed after each session in which adductor stretch, iliopsoas stretch will be performed. Week 1-2 Core awareness \& activation In week 1, diaphragmatic breathing, abdominal drawing-in maneuvers 30 seconds to 1 minute, and pelvic floor contraction. In week 2, pelvic tilting in supine, supine line heel slide, supine lying marching will be added. Perform it ten times per set, 1 sets a day. The set and repetition will be increase progressively according to individual stamina. Week 3-4 Core Stabilizing exercise. Week 5-6 Functional Activity
Lumbar Pain Intensity
It will be measured by numeric pain rating scale in which patients rate their pain from 0 (no pain) to 10 (worst pain imaginable).
Lumbar Disability
It will be measured by Oswestry Disability Index(ODI) which reliable and valid self-administered questionnaire consisting of 10 sections to assess level of disability in patients.
Lumbar Lordotic Angle
Lumbar Lordotic Angle is measured through Flexicurve method. The spinous processes of T12 (as the starting point) and S2 (as the endpoint) were identified through palpation by an evaluator during the assessment of spinal curvature. While contouring the flexicurve along the spine, the locations of the T12 and S1 spinous processes were marked using the instrument's integrated metric scale. Once the flexicurve was molded to match the spinal curvature, it was carefully removed, and its internal edge previously in contact with the skin was traced onto graph paper. This tracing represented the lumbar curvature in the sagittal plane, with the relevant spinous processes clearly marked. A vertical line was drawn between T12 and S2, and the deepest point of the curve was used to draw a perpendicular line to calculate the depth. These measurements were used to assess lumbar curvature. Formula θ=4Arctan 2H/L Whereas 'L' is the length of the spine segment and 'H' is the maximum depth of the curve.
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