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Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study.

ABSTRACT: OBJECTIVE:To contrast the efficacy of two exercise programs, segmental stabilization and strengthening of abdominal and trunk muscles, on pain, functional disability, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain. DESIGN:Our sample consisted of 30 individuals, randomly assigned to one of two treatment groups: segmental stabilization, where exercises focused on the TrA and lumbar multifidus muscles, and superficial strengthening, where exercises focused on the rectus abdominis, abdominus obliquus internus, abdominus obliquus externus, and erector spinae. Groups were examined to discovere whether the exercises created contrasts regarding pain (visual analogical scale and McGill pain questionnaire), functional disability (Oswestry disability questionnaire), and TrA muscle activation capacity (Pressure Biofeedback Unit = PBU). The program lasted 6 weeks, and 30-minute sessions occurred twice a week. Analysis of variance was used for inter- and intra-group comparisons. The significance level was established at 5%. RESULTS:As compared to baseline, both treatments were effective in relieving pain and improving disability (p < 0.001). Those in the segmental stabilization group had significant gains for all variables when compared to the ST group (p < 0.001), including TrA activation, where relative gains were 48.3% and -5.1%, respectively. CONCLUSION:Both techniques lessened pain and reduced disability. Segmental stabilization is superior to superficial strengthening for all variables. Superficial strengthening does not improve TrA activation capacity.

SUBMITTER: Franca FR

PROVIDER: S-EPMC2972594 | biostudies-literature | 2010

REPOSITORIES: biostudies-literature

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Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study.

França Fábio Renovato FR Burke Thomaz Nogueira TN Hanada Erica Sato ES Marques Amélia Pasqual AP

Clinics (Sao Paulo, Brazil) 20100101 10

<h4>Objective</h4>To contrast the efficacy of two exercise programs, segmental stabilization and strengthening of abdominal and trunk muscles, on pain, functional disability, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain.<h4>Design</h4>Our sample consisted of 30 individuals, randomly assigned to one of two treatment groups: segmental stabilization, where exercises focused on the TrA and lumbar multifidus muscles, and superficial strengthening ...[more]

PMID: 21120303

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Project description:BackgroundChronic back pains are progressively disabling working individuals, including 60-80% of the general population, for which their diagnosis is challenging to healthcare workers worldwide, thereby becoming a burden to nations.PurposeThe study aimed to investigate the efficacy of core strengthening exercise (CSE) and intensive dynamic back exercise (IDBE) on pain, core muscle endurance, and functional disability in patients with chronic non-specific low back pain (LBP).MethodsThe study was based on a three-arm parallel-group randomized control design. Forty-five participants with chronic non-specific LBP were recruited and randomly divided into the CSE, IDBE, and Control groups. The CSE and IDBE groups received CSE and IDBE, respectively. However, the Control group received no intervention. Numeric pain rating scale, Oswestry Disability Index, core flexors, extensors, and side bridge tests assessed pain intensity, functional disability, and endurance of core muscles. Outcome scores for the dependent variables were collected at baseline (pre-intervention) and six-week post-intervention. There were no follow-up measurements in this study. A one-way multivariate analysis of covariance (MANCOVA) was used to analyze the intervention effects on the outcomes within groups and between groups, respectively; keeping the significance-level alpha at 95%, i.e., p < 0.05. A univariate F-test was performed to observe the superiority of one treatment over another. Pearson's correlation coefficient test was conducted to determine a relation between the dependent variables. In all statistical analyses, the level of significance α was kept at 0.05.ResultsAll forty-five out of sixty-three participants with chronic non-specific low back pain (male, 32 and female, 23; average age, 20.24 ± 1.46 years; average pain duration, 19.6 ± 5.42 weeks) completed the study and their data were analyzed. The MANCOVA test showed a significant difference between the treatment groups on the combined multiple endurance tests for the core muscles (flexors, extensors, side bridge tests to the right and left), Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) scores after controlling for baseline scores of all the dependent variables: F (6, 12) = 23.381; p < 0.05; Wilks' Λ = 0.033; partial η2 = 0.819. A post hoc pair-wise comparison followed by a univariate F-test indicated that a significant improvement was found between the CSE vs. IDBE vs. Control groups on the post-test scores of all the dependent variables except VAS and EET (CSE vs. IDBE only). A Pearson's correlation coefficient test revealed a notable relation between the dependent variables.ConclusionsThe experimental group CSE was found to be more effective than IDBE on improving functional disability, cores' flexors, and side bridges' endurance tests than IDBE. The magnitude of this improvement exceeded the minimal clinically important difference (MCID), suggesting a clinically relevant enhancement in functional disability, core flexors, and side bridge endurance for participants engaged in CSE. However, CSE vs. IDBE revealed non-significant differences on reducing pain and core extensors' endurance. The absence of statistically significant differences suggests that the observed changes did not exceed the established MCID for pain intensity and core extensors' endurance. In addition, partial eta-squared value revealed the superiority of CSE over IDBE and Control groups. This suggests that the observed differences between the two interventions are not only statistically significant, but also clinically relevant, surpassing the established MCID.

Project description:Reduced postural control is thought to contribute to the development and persistence of chronic non-specific low back pain (CNLBP). It is therefore frequently assessed in affected patients and commonly reported as the average amount of postural sway while standing upright under a variety of sensory conditions. These averaged linear outcomes, such as mean centre of pressure (CP) displacement or mean CP surface areas, may not reflect the true postural status. Adding nonlinear outcomes and multi-segmental kinematic analysis has been reported to better reflect the complexity of postural control and may detect subtler postural differences. In this cross-sectional study, a combination of linear and nonlinear postural parameters were assessed in patients with CNLBP (n = 24, 24-75 years, 9 females) and compared to symptom-free controls (CG, n = 34, 22-67 years, 11 females). Primary outcome was postural control measured by variance of joint configurations (uncontrolled manifold index, UI), confidence ellipse surface areas (CEA) and approximate entropy (ApEn) of CP dispersion during the response phase of a perturbed postural control task on a swaying platform. Secondary outcomes were segment excursions and clinical outcome correlates for pain and function. Non-parametric tests for group comparison with P-adjustment for multiple comparisons were conducted. Principal component analysis was applied to identify patterns of segmental contribution in both groups. CNLBP and CG performed similarly with respect to the primary outcomes. Comparison of joint kinematics revealed significant differences of hip (P < .001) and neck (P < .025) angular excursion, representing medium to large group effects (r's = .36 - .51). Significant (P's < .05), but moderate correlations of ApEn (r = -.42) and UI (r = -.46) with the health-related outcomes were observed. These findings lend further support to the notion that averaged linear outcomes do not suffice to describe subtle postural differences in CNLBP patients with low to moderate pain status.

Project description:BackgroundLow back pain that lasts longer than three months is called chronic low back pain. Chronic low back pain is among the most common problems in the world, causing severe disability and loss of employment in patients.ObjectiveTo investigate the effect of pulse electromagnetic field therapy (PEMFT) added to routine physical therapy on pain and functional status in patients with chronic low back pain.MethodsThis retrospective comparative study included 69 patients with chronic low back pain. The patients were divided into two groups: those who received lumbar transcutaneous electrical nerve stimulation, infrared, and ultrasound treatments, and those who additionally received PEMFT. The files of patients with chronic low back pain were reviewed, and those who had been evaluated using the Quebec Back Pain Disability Scale (QBPDS) in terms of functional capacity and effects of low back pain and the Visual Analogue Scale (VAS) for pain both before and after treatment were included in the study.ResultsNo significant difference was detected between the two groups' pretreatment VAS and QBPDS scores (p > 0.05). The second-and-third measurement scores of both groups were significantly lower than their first-measurement VAS and QBPDS scores (p ˂ 0.001), but there was no significant difference between their second- and third-measurement scores (p > 0.05). According to the inter-group comparison of the VAS and QBPDS scores, the second and third-measurement scores of the PEMFT group were significantly lower than those of the control group (p ˂ 0.001).ConclusionsPEMFT seems to be able to alleviate pain intensity and ameliorate disability in patients with chronic low back pain. PEMFT can be considered an effective and safe option that can be added to routine physical therapy modalities for relieving chronic low back pain frequently encountered in clinical practice. Further studies validating the effectiveness of PEMFT could strengthen its position in the management of chronic low back pain.

Project description:ObjectiveThe aim of this study was to assess the feasibility and potential effectiveness of an 8-week virtual EMG biofeedback intervention for patients with CLBP.MethodsPatients with CLBP completed validated baseline and post-intervention assessments of pain intensity and interference (Brief Pain Inventory), back pain-related disability (Oswestry Disability Index), anxiety and depression (Hospital Anxiety and Depression Scale). Participants underwent a series of Quantitative Sensory Testing (QST) procedures assessing responses to mechanical stimuli during two separate visits (baseline and post-intervention). In addition, we assessed, using surface EMG, the muscle tension in the trapezius, latissimus, and low back muscles at each session. Patients were randomized into the EMG biofeedback intervention or usual care group. Factorial analysis of variance including the interaction between treatment group and time was used to analyze the changes in pain intensity (primary outcome), pain interference, disability (secondary outcomes), anxiety, and depression (secondary outcomes).ResultsCompared to the treatment as usual comparison group, patients in the EMG biofeedback group reported lower pain intensity after completing the intervention (mean group difference 0.9, 95% CI -1.07, -0.32; p≤0.01). Compared to baseline, participants in the EMG biofeedback group demonstrated statistically significant reductions in pain interference (mean difference 1.3, 95% CI 0.42, 2.1; p≤0.01), disability (mean difference 4.32, 95% CI 1.2, 7.3; p≤0.01), and significant increases in low back pain thresholds (mean difference 0.5, 95% CI -0.87, -0.05; p≤0.01), assessed by QST. However, no significant group by time effects were observed for secondary outcomes: pain interference, disability, and low back pain thresholds. In addition, significant changes were observed in muscle tension for the trapezius, latissimus, and low back muscles in the EMG biofeedback group (p<0.001).ConclusionsVirtual EMG biofeedback shows promise as a potential therapy for reducing pain and disability in individuals with chronic nonspecific low back pain.

Dataset Information

Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study.

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Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study.

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