Effect of retro-walking on pain, functional disability, quality of life and sleep problems in patients with chronic low back pain

Introduction
Chronic low back pain is an important clinical, social, economic, and public health problem, with low treatment success rates. Retro-walking works on multiple factors of the causative agents of low back pain. Therefore the aim of the current study was to investigate the effect of retro-walking on pain, functional disability, quality of life and sleep problems in patients with chronic low back pain.

Methods
It was a two parallel arm, single blinded, randomized, controlled clinical trial. Thirty-one patients both males and females with chronic low back pain were recruited from December 2016 till April 2017 out of which twenty-nine completed the study. The experimental group had 16 patients (aged 24.7 ± 5.56 with 22.7 ± 4.28 Body Mass Index) whereas the control group had 15 patients (aged 25.9 ± 5.61with and 22.1 ± 3.15 Body Mass Index). Pain, Functional Disability, Quality of Life and Sleep Problems were measured by Numerical pain rating scale, Oswestry Disability Index, Short Form Health Survey 36 and sleep diary Both the groups received same conventional treatment for three physiotherapy sessions per week for three weeks. Experimental group additionally participated in 15 minutes of retro-walking at the comfortable walking speed which was determined prior to the commencement of the intervention along with the conventional treatment.

Results
All variables of the sleep diary, i.e., sleeping hours/week [Time effect (p = 0.004), time × group interaction effect (p = 0.001)], sleep efficiency [Time effect (p = 0.024), time × group interaction effect (p = 0.004)] and restoration post sleep [Time effect (p = 0.014), time × group interaction effect (p = 0.034)] showed significant differences in the experimental group. The experimental group also demonstrated significant differences over time (p = 0.001) in all the other outcome measures such as pain, pain disability, quality of life and sleep patterns and habits.

Conclusions
Conventional physiotherapy is an effective means of treatment for Chronic Low back pain. However, there was a added advantage of retro-walking as the experimental group showed a faster recovery. Thus, making it an effective treatment adjunct.