Comparing core stability and traditional trunk exercise on chronic low back pain patients using three functional lumbopelvic stability tests

Effect of a lumbopelvic stability training program on lower extremity kinematic parameters in low back pain developers during single-leg squat

OBJECTIVES

Objective Altered movement patterns and lower extremity misalignment are key features in low back pain developers (LBPDs), leading to significant changes in functional movements such as squats. These changes may result in clinical low back pain (LBP) based on the kinesiopathology model. Core muscles are crucial for creating a stable platform for limb movement, but LBPDs typically have weak and poorly activated deep muscles, contributing to inefficient movement patterns. This study aims to assess the effect of a lumbopelvic stability program on lower extremity kinematics in LBPDs during single-leg squats (SLS).

DESIGN

Pre-post study.

SETTING

University dormitory gym.

PARTICIPANTS

Thirty female participants identified as LBPDs, divided into two groups of experimental (n = 15) and control (n = 15).

MAIN OUTCOME MEASURES

Kinematic variables, including hip and knee flexion and abduction, and ankle dorsiflexion and abduction (eversion), were measured during SLS using two-dimensional video analysis before and after the intervention.

RESULTS

Significant differences were found in hip flexion (F = 13.36, p = 0.001), hip abduction (F = 73.42, p = 0.001), knee flexion (F = 23.65, p = 0.001), and knee abduction (F = 13.37, p = 0.001) post-intervention.

CONCLUSION

A 6-week lumbopelvic stability program improved hip and knee kinematics in LBPDs, highlighting the importance of core stability in optimizing movement and potentially preventing future LBP.

The effectiveness of pelvic floor muscle training on lumbar function and muscle performance in sedentary women with lower back pain: a randomized controlled trial

OBJECTIVE

This study aimed to investigate the impact of combined core and pelvic floor muscle (PFM) training on lumbar function in sedentary women with lower back pain (LBP).

METHODS

This randomized controlled study included 60 female patients divided into three groups: a control group (n = 20), a core training group (n = 20), and a combined PFM and core training group (n = 20). The participants underwent three weekly interventions over four weeks. Trunk muscle endurance, deep lumbar stabilizing muscle activity, and LBP severity were assessed before and after the intervention.

RESULTS

Following the 4-week intervention: 1. In the combined PFM and core training group, significant improvements in muscle endurance (p < 0.01) were observed, particularly in the flexor, extensor, and right abdominal muscles compared to the control group (p < 0.05). 2. In the core training group, significant increases in muscle endurance were seen in various directions (p < 0.05), with highly significant improvements in flexion and right flexion directions (p < 0.01). The flexor muscles exhibited greater endurance than the control group (p < 0.05). 3. In the control group, dorsal muscle endurance significantly decreased after four weeks (p < 0.01). 4. Pain scores after 2 h of sitting significantly decreased (p < 0.01), along with reduced LBP differences (p < 0.05). There was a decrease in pain scores (p < 0.05) and a significant reduction in LBP after 2 h of sitting (p < 0.01).

CONCLUSION

Core training, either independently or combined with PFM training, can enhance trunk muscle endurance and alleviate LBP in sedentary women with LBP. Core training alone appeared to have a more pronounced effect.

The effects of abdominal muscle contraction using real-time feedback on adults with chronic low back pain: A pilot study

BackgroundThis study aimed to examine the influence of real-time feedback on intentional abdominal muscle engagement in adults with chronic low back pain (CLBP) during daily activities. The research further sought to evaluate the outcomes of this training on neuromuscular control, pain perception, and functional capacity.ObjectiveWe compared a group of adults who received real-time feedback on changes in waist circumference with a group trained in abdominal contraction without real-time feedback.MethodsSurface electromyographic (sEMG) signals were measured in the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and erector spinae (ES) muscles. Pain intensity was assessed using the visual analog scale (VAS), and functional outcomes were assessed using the Oswestry Disability Index (ODI).ResultsAfter the intervention, sEMG signals of the RA, EO, and IO muscles were significantly higher in the experimental group. There were no significant differences in ES muscle activity between the groups. Both the experimental and control groups showed significant decreases in VAS and ODI scores after the intervention.ConclusionIntentional abdominal contraction aided by real-time feedback can improve functionality in patients with chronic low back pain.

Effect of exercise and manual therapy or kinesiotaping on sEMG and pain perception in chronic low back pain: a randomized trial

The importance of incorporating lumbo-pelvic stability core and controlling motor exercises in patients with chronic low back pain (CLBP) reinforces the use of strategies to improve biopsychosocial beliefs by reducing biomedical postulations. However, clinical practice guidelines recommend multimodal approaches incorporating exercise and manual therapy (MT), and instead reject the application of kinesiotape (KT) in isolation. Therefore, the objectives of this study were to analyze the effects of 12 weeks of exercises combined with MT or KT on perceived low back pain using the visual analog scale (VAS) and muscle electric activity measured with electromyography (EMG) of the rectus abdominis and multifidus in CLBP (mild disability) and to explore the relationship between the rectus abdominis and multifidus ratios and pain perception after intervention. A blinded, 12-week randomized controlled trial (RCT) was carried out, involving three parallel groups of patients with CLBP. The study was registered at Clinicaltrial.gov and assigned the identification number NCT05544890 (19/09/22). The trial underwent an intention-to-treat analysis. The primary outcome revealed a multimodal treatment program supplemented by additional therapies such as MT and KT, resulting in significant reductions in perceived low back pain. The subjective assessment of individuals with CLBP indicated no discernible distinction between exclusive core stability exercises and control-motor training when combined with MT or KT. Notably, our findings demonstrated positive alterations in both the mean and peak EMG values of the right rectus abdominis in the exercise group, suggesting a beneficial impact on muscle activation. This study focused on assessing the activation levels of the trunk musculature, specifically the rectus abdominis (RA) and multifidus (MF), in individuals with CLBP exhibiting mild disability according to the Oswestry Disability Index. Importantly, improvements in the VAS values were observed independently of changes in muscle electrical activity.

Clinical relevance of combined treatment with exercise in patients with chronic low back pain: a randomized controlled trial

Low back pain is a widespread public health concern owing to its high prevalence rates according to the Global Burden of Diseases. This study aimed to investigate the effect of exercise alone or in combination with manual therapy and kinesiotherapy on pain sensitivity, disability, kinesiophobia, self-efficacy, and catastrophizing in patients with chronic low back pain (CLBP). A total of 55 participants were enrolled and randomly allocated to one of three groups: (1) exercise alone group (ET; n = 19), (2) exercise + manual therapy group (ETManual therapy; n = 18), and (3) exercise + kinesio tape group (ETkinesiotape; n = 18). The interventions consisted of core stabilization exercises (ET group), prior spinal manipulation with core exercises (ETManual therapy group), and combined application of kinesiotape plus core stabilization exercises (ETkinesiotape group). The primary outcome was disability. The secondary outcomes were pain sensitization, kinesiophobia, catastrophizing, and self-efficacy. Assessments were performed at baseline and at weeks 3, 6, and 12. All therapies applied achieved significant improvements over time after 12 weeks in all parameters analyzed. ETmanualtherapy showed the greatest changes in all variables, with significant differences from the rest of the interventions in Oswestry (ODI) (3 and 6 weeks, respectively). A clinically significant cutoff point was achieved for the ETmanualtherapy group in the ODI parameter (-54.71%, -63.16% and -87.70% at 3, 6, and 12 weeks, respectively). Manual therapy prior to the core exercise technique was the most effective approach to improve health-related functionality compared with exercise alone or exercise combined with kinesiotape in patients with CLBP.Clinical Trial Registration Number: NCT05544890.

Efficacy of Core Muscle Exercise Combined with Interferential Therapy in Alleviating Chronic Low Back Pain in High-Performance Fighter Pilots: A Randomized Controlled Trial

BACKGROUND

Chronic low back pain (LBP) related to flight is a prevalent health issue in military aviation, impacting pilots. The objective of this investigation was to ascertain if the application of core muscle training in conjunction with interferential current (IFC) therapy results in a reduction in pain severity and associated disability, consequently enhancing core muscle functionality in Chinese Air Force high-performance fighter pilots experiencing chronic LBP.

METHODS

Fifty-three fighter pilots with chronic LBP were randomized into 3 groups: a core muscle exercise combined with IFC group (CG, n = 19), a core muscle exercise group (EG, n = 19), and an IFC group (IG, n = 15). The three groups underwent therapeutic intervention 5 times a week for 12 weeks. The primary outcomes were pain intensity, Oswestry Disability Index (ODI) score and SF-12 health-related quality of life (PCS and MCS) score. Secondary outcomes included evaluations of trunk muscle strength, endurance, and range of motion (ROM) during medial/lateral rotation to assess muscle functionality. Measurements were obtained both before and after the implementation of the intervention therapy.

RESULTS

After 12 weeks of intervention therapy, all the health condition parameters significantly improved among the three groups. However, the CG had a significant improvement in pain intensity compared to the EG (MD = - 0.84 scores; 95% CI = - 1.54 to - 0.15; p = 0.013) and the IG (MD = - 1.22 scores; 95% CI = - 1.96 to - 0.48; p = 0.000). Additionally, the CG led to greater conservation of ODI and improved SF-12 PCS scores than did the IG (p < 0.05). Finally, compared with those at baseline, the core muscle function parameters in the CG and EG improved significantly at the end of the study, but no statistically significant differences were observed between the two groups (p > 0.05).

CONCLUSION

Among participants with chronic LBP, three intervention therapies appear effective in reducing pain, diminishing disability, and enhancing quality of life. Also, combined therapy significantly improved pain and disability compared to the other two monotherapies; moreover, combined therapy and core muscle exercise provided similar benefits in terms of core muscle function after 12 weeks of intervention therapy.

Exercise intervention for patients with chronic low back pain: a systematic review and network meta-analysis

Purpose

Chronic low back pain (CLBP) is an aging and public health issue that is a leading cause of disability worldwide and has a significant economic impact on a global scale. Treatments for CLBP are varied, and there is currently no study with high-quality evidence to show which treatment works best. Exercise therapy has the characteristics of minor harm, low cost, and convenient implementation. It has become a mainstream treatment method in clinics for chronic low back pain. However, there is insufficient evidence on which specific exercise regimen is more effective for chronic non-specific low back pain. This network meta-analysis aimed to evaluate the effects of different exercise therapies on chronic low back pain and provide a reference for exercise regimens in CLBP patients.

Methods

We searched PubMed, EMBASE, Cochrane Library, and Web of Science from inception to 10 May 2022. Inclusion and exclusion criteria were used for selection. We collected information from studies to compare the effects of 20 exercise interventions on patients with chronic low back pain.

Results

This study included 75 randomized controlled trials (RCTs) with 5,254 participants. Network meta-analysis results showed that tai chi [standardized mean difference (SMD), -2.11; 95% CI, -3.62 to -0.61], yoga (SMD, -1.76; 95% CI -2.72 to -0.81), Pilates exercise (SMD, -1.52; 95% CI, -2.68, to -0.36), and sling exercise (SMD, -1.19; 95% CI, -2.07 to -0.30) showed a better pain improvement than conventional rehabilitation. Tai chi (SMD, -2.42; 95% CI, -3.81 to -1.03) and yoga (SMD, -2.07; 95% CI, -2.80 to -1.34) showed a better pain improvement than no intervention provided. Yoga (SMD, -1.72; 95% CI, -2.91 to -0.53) and core or stabilization exercises (SMD, -1.04; 95% CI, -1.80 to -0.28) showed a better physical function improvement than conventional rehabilitation. Yoga (SMD, -1.81; 95% CI, -2.78 to -0.83) and core or stabilization exercises (SMD, -1.13; 95% CI, -1.66 to -0.59) showed a better physical function improvement than no intervention provided.

Conclusion

Compared with conventional rehabilitation and no intervention provided, tai chi, toga, Pilates exercise, sling exercise, motor control exercise, and core or stabilization exercises significantly improved CLBP in patients. Compared with conventional rehabilitation and no intervention provided, yoga and core or stabilization exercises were statistically significant in improving physical function in patients with CLBP. Due to the limitations of the quality and quantity of the included studies, it is difficult to make a definitive recommendation before more large-scale and high-quality RCTs are conducted.

Effects of back exercises versus transcutaneous electric nerve stimulation on relief of pain and disability in operating room nurses with chronic non-specific LBP: a randomized clinical trial

Background

Low back pain (LBP) is one of the most common musculoskeletal disorders related to working. Due to the nature of nursing work, this problem is often seen in nurses, including those who work in the operating rooms. Depending on the cause, there are various surgical and non-surgical methods to treat LBP. The present study was aimed to compare the effect of two therapeutic methods of back exercises and transcutaneous electrical nerve stimulation (TENS) on the disability and pain of operating room nurses with LBP.

Methods

In this clinical trial forty-four eligible operating room nurses (30 women, 14 men, mean age: 37.86 ± 6.74) with chronic nonspecific LBP were randomly assigned to back exercises (including the strengthening and stretching exercise (n = 22)) or TENS (n = 22) groups by permuted block randomization method.

These interventions were performed in both groups three sessions of 15 min per week for 6 weeks. The McGill pain questionnaire for back pain and the Oswestry disability questionnaire for disability assessment were completed immediately before and after the interventions.

Results

After 6 weeks, the mean of pain and disability decreased significantly in both groups compared to the baseline. Based on the results, significant decreases in the pain score (mean difference (95% CI): − 8.95 (− 12.77 to − 5.14); P-value < 0.001) and disability score (mean difference (95% CI): − 8.73(− 12.42 to − 5.03); P-value < 0.001) were revealed in the back exercises group after the intervention compared to the baseline. In addition, after the intervention in TENS group, the mean pain intensity and disability showed significant decrease, respectively (mean difference (95% CI): − 16.18 (− 19.81 to − 12.55); P-value < 0.001; mean difference (95% CI): − 15.82 (− 19.24 to − 12.40); P-value < 0.001).

After adjusting for the baseline values, the TENS group had a significantly higher pain score reduction than the back exercises group (mean difference (95% CI): − 4.23 (− 8.03 to − 0.44); P-value =0.030; Cohen’s d = 0.81). In addition, TENS led to a significant more decrease in the disability scores compared to the back exercises (mean difference (95% CI): − 3.99 (− 7.35 to − 0.64); P-value =0.021; Cohen’s d = 0.73). Furthermore, a statistically significant time by group interaction effect on pain and disability score was found (interaction p < 0.001).

Conclusion

Pain and disability were improved in both groups following 18 intervention sessions. However, pain and disability were improved to a greater extent in the TENS group than in the back exercises group.

Trial registration

The trial was retrospectively registered in the Iranian Registry of Clinical Trials (www.irct.ir) on 03/02/2019 as IRCT20180408039227N1.

Effects of Different Trunk Training Methods for Chronic Low Back Pain: A Meta-Analysis

We conducted a systematic review and meta-analysis comparing motor control, isometric, and isotonic trunk training intervention for pain, disability, and re-injury risk reduction in chronic low back pain patients. The EMBASE, MEDLINE, CENTRAL, PsycINFO, SPORTDiscus, and CINAHL databases were searched from inception until 25 February 2021 for chronic low back pain intervention based on any trunk training. Outcomes include the Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ) for disability, the Numerical Pain Rating Scale (NPRS) for pain, and the Sorensen Test (ST) for future risk of re-injury. Isometric training was superior to the control with a mean difference (MD) = −1.66, 95% confidence interval (CI) [−2.30, −1.01] in pain reduction; MD = −7.94, 95% CI [−10.29, −5.59] in ODI; MD = −3.21, 95% CI [−4.83, −1.60] in RMDQ; and MD = 56.35 s, 95% CI [51.81 s, 60.90 s] in ST. Motor control was superior to the control with a MD = −2.44, 95% CI [−3.10, −1.79] in NPRS; MD = −8.32, 95% CI [−13.43, −3.22] in ODI; and MD = −3.58, 95% CI [−5.13, −2.03] in RMDQ. Isometric and motor control methods can effectively reduce pain and disability, with the isometric method reducing re-injury risk.

Efficacy of a multidimensional versus usual care physiotherapy on pain and electroencephalography (EEG) spectrum in chronic nonspecific low back pain: study protocol for a randomized controlled trial

BACKGROUND

Non-specific chronic low back pain (NSCLBP) is a major public health and global socioeconomic burden associated with a complex interplay of biopsychosocial factors. Despite scientific signs of progress, treatment of NSCLBP often tends to stick to a biomechanical model, without targeting psychological and social factors. To enhance the clinical efficacy of usual physiotherapy for NSCLBP, the development of clinical strategies is to be pursued. This study aims to assess the effectiveness of multidimensional physiotherapy based on a biopsychosocial approach compared to usual care physiotherapy, on clinical findings and electroencephalography spectrum in non-specific chronic low back pain.

METHODS

This study is a triple-blind, two-arm (1:1) randomized controlled trial with a 4 months follow-up. Seventy NSCLBP patients will be randomly allocated to either the experimental (multidimensional physiotherapy) or the active control group (usual physiotherapy); each group will receive 6 weeks of physiotherapy. The main outcome is pain and secondary outcomes are brain function, quality of life, disability, lumbar flexion range of motion, and psychosocial correlates. Assessment will be performed at baseline, post-treatment, and at 1 and 4 months follow-up.

DISCUSSION

Findings may provide evidence on the effectiveness of multidimensional physiotherapy on clinical findings and brain characteristics and might provide evidence towards showing the role of brain and biopsychosocial factors on chronic pain.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04270422 , Registered on 17 February 2020, IRCT Identifier: IRCT20140810018754N11.

Effects of stabilization exercises on disability, pain, and core stability in patients with non-specific low back pain: A randomized controlled trial

BACKGROUND

Many studies have emphasized the importance of stabilization exercises (SE) for the management of non-specific low back pain (NSLBP), yet there is no study assessing all aspects of core stability in comparing SE and other exercises.

OBJECTIVE

To investigate the effects of SE on pain and core stability by using core stability tests that focus on all aspects of core stability in patients with NSLBP.

METHODS

Thirty-seven individuals with chronic NSLBP were randomly divided into two groups as SE and conventional exercises (CE). Both groups underwent the progressive exercise program three days per week for six weeks. The assessments were conducted before and after the exercise programs. The outcome measures included pain, disability, trunk strength, trunk flexor, extensor and lateral flexor endurance, function, flexibility, and motor control during eyes open/closed.

RESULTS

All assessment parameters except motor control during eyes open improved after SE (p < 0.05). Also, all assessment parameters except motor control during eyes open/closed and lateral trunk endurance improved after CE (p < 0.05). When comparing groups for gain scores, there were more significant improvements in pain during activity, endurance and function after SE (p < 0.05).

CONCLUSIONS

SE is more effective than CE in reducing pain during activity and improving core stability regarding functionality and endurance.

Visual assessment of movement quality: a study on intra- and interrater reliability of a multi-segmental single leg squat test

Background

The Single Leg Squat test (SLS) is a common tool used in clinical examination to set and evaluate rehabilitation goals, but there is not one established SLS test used in the clinic. Based on previous scientific findings on the reliability of the SLS test and with a methodological rigorous setup, the aim of the present study was to investigate the intra- and interrater reliability of a standardised multi-segmental SLS test.

Methods

We performed a study of measurement properties to investigate the intra- and interrater reliability of a standardised multi-segmental SLS test including the assessment of the foot, knee, pelvis, and trunk. Novice and experienced physiotherapists rated 65 video recorded SLS tests from 34 test persons. We followed the Quality Appraisal for Reliability Studies checklist.

Results

Regardless of the raters experience, the interrater reliability varied between “moderate” for the knee variable (ĸ = 0.41, 95% CI 0.10–0.72) and “almost perfect” for the foot (ĸ = 1.00, 95% CI 1.00–1.00). The intrarater reliability varied between “slight” (pelvic variable; ĸ = 0.17, 95% CI -0.22-0.55) to “almost perfect” (foot variable; ĸ = 1.00, 95% CI 1.00–1.00; trunk variable; ĸ = 0.82, 95% CI 0.66–0.97). A generalised kappa coefficient including the values from all raters and segments reached “moderate” interrater reliability (ĸ = 0.52, 95% CI 0.43–0.61), the corresponding value for the intrarater reliability reached “almost perfect” (ĸ = 0.82, 95% CI 0.77–0.86).

Conclusions

The present study shows a “moderate” interrater reliability and an “almost perfect” intrarater reliability for the variable all segments regardless of the raters experience. Thus, we conclude that the proposed standardised multi-segmental SLS test is reliable enough to be used in an active population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-021-00289-x.

Effectiveness of specific stabilization exercise compared with traditional trunk exercise in women with non-specific low back pain: a pilot randomized controlled trial

Background

Non-specific low back pain (LBP) is the leading cause of disability worldwide. The primary physiotherapeutic treatment for LBP is physical exercise, but evidence suggesting a specific exercise as most appropriate for any given case is limited.

Objective

To determine if specific stabilization exercise (SSE) is more effective than traditional trunk exercise (TTE) in reducing levels of pain, disability and inflammation in women with non-specific low back pain (LBP).

Design

A pilot randomized controlled trial was conducted in Rovira i Virgili University, Catalonia.

Methods

Thirty-nine females experiencing non-specific LBP were included in two groups: the TTE program and SSE program, both were conducted by a physiotherapist during twenty sessions. The primary outcome was pain intensity (10-cm Visual Analogue Scale). Secondary outcomes were disability (Roland Morris Disability Questionnaire), and inflammation (IL-6 and TNF-α plasma levels). Measurements were taken at baseline, at half intervention, at post-intervention, and a month later.

Results

Mean group differences in change from baseline to post-intervention for TTE were: -4.5 points (CI 3.3 to 5.6) for pain, -5.1 points (CI 3.0 to 7.3) for disability, 0.19 pg/mL (95% CI [-1.6-1.2]) for IL-6 levels, and 46.2 pg/mL (CI 13.0 to 85.3) for TNF-α levels. For SSE, differences were: -4.3 points (CI 3.1 to 5.6) for pain, -6.1 points (CI 3.7 to 8.6) for disability, 1.1 pg/mL (CI 0.0 to 2.1) for IL-6 levels , and 12.8 pg/mL (95% CI [-42.3-16.7]) for TNF-α levels. There were an insignificant effect size and no statistically significant overall mean differences between both groups.

Conclusion

This study suggests that both interventions (traditional trunk and specific stabilization exercises) are effective in reducing pain and disability in non-specific LBP patients, but the two programs produce different degrees of inflammation change.

Clinical trial registration number

NCT02103036.

Comparison of muscle activation imbalance following core stability or general exercises in nonspecific low back pain: a quasi-randomized controlled trial

Background

Low back pain causes changes in muscle activation patterns. Knowing how different exercises may improve altered muscle activation is useful in the treatment of patients. The aim of the study was to investigate whether there was a difference in the pattern of muscle activation in chronic nonspecific low back pain sufferers following core stability exercise (CSE) and general exercise (GE).

Methods

Fifty-six non-specific chronic LBP subjects were randomly assigned to either groups (28 participants in CSE and 28 in GE group). Both groups performed 16 sessions of an exercise program for about 5 weeks. Pain, disability and trunk muscle activation patterns (using surface electromyography) were measured at baseline and post-training.

Results

After the intervention period, antagonist coactivation ratio did not change in either groups. Though all compensated imbalance ratios (residual unequal muscular activity after cancellation of directionality) decreased towards negative (imbalance to left side) only this change for total muscles ratio in GE was significant (mean difference in GE group, 0.15; 95% CI: 0.02 to 0.28; p-value of paired t-test: 0.022); (mean difference in CSE, 0.02; 95% CI: − 0.07 to 0.11; p-value of paired t-test: 0.614).. No overall significantly decrease in uncompensated imbalance ratio (absolute imbalance values without cancellation directionality) was observed. Pain and disability decreased significantly in both groups. However, there was no difference between two groups in either of the variables after the intervention.

Conclusions

Both exercise programs reduced pain and disability and made or kept trunk muscle activation imbalance to the left side. The effects of two exercises on pain, disability and antagonist coactivation or imbalance ratios were not different.

Trial registration

This study was registered in the Iranian Clinical Trial Center with the code IRCT201111098035N1, Registered Jan 21, 2013.

Comparison of Core Stabilisation Exercise and Proprioceptive Neuromuscular Facilitation Training on Pain-related and Neuromuscular Response Outcomes for Chronic Low Back Pain: A Randomised Controlled Trial

Background

Existing literature offers little guidance for therapists who provide core stabilisation exercise (CSE) and proprioceptive neuromuscular facilitation (PNF) training to treat chronic low back pain (CLBP). Studies conducting a head-to-head comparison of CSE and PNF training for CLBP are needed.

Objective

To compare the effects of CSE and PNF training on pain-related outcomes and trunk muscle activity in CLBP patients.

Methods

Forty-five CLBP patients, ranging from 18 to 50 years of age, were randomly divided and assigned to either a four-week CSE, four-week PNF training, or control group. Pain-related outcomes, including pain intensity, functional disability and patient satisfaction, as well as superficial and deep trunk muscle activity were assessed before and after the four-week intervention, and at a three-month follow-up.

Results

Compared to the control group, those in the CSE and PNF training groups showed significant improvements in all pain-related outcomes after the four-week intervention and at three-month follow-up (P < 0.01). Following the four-week intervention, both CSE and PNF training groups demonstrated significant improvement in deep trunk muscle activity, including the transversus abdominis (TrA) and superficial fibres of lumbar multifidus (LM), compared to the control group (P < 0.05).

Conclusion

Four-week CSE and PNF training provided short-term and long-term effects on pain-related outcomes, along with increased deep trunk muscle activity in CLBP patients.

The Effects of Stabilization Exercise on the Thickness of Lateral Abdominal Muscles During Standing Tasks in Women With Chronic Low Back Pain: A Randomized Triple-Blinded Clinical Trial Study

CONTEXT

Chronic low back pain (CLBP) often presents with a dysfunction in deep abdominal muscles activity during standing tasks. Although some studies indicated that deep abdominal muscle activity improved during some functional tasks following stabilization exercise (SE), there is no study to evaluate the effect of SE on lateral abdominal muscles thickness during standing postural tasks.

OBJECTIVE

The purpose of this study was (1) to evaluate the lateral abdominal muscles thickness in the participants with CLBP while standing on a balance board and (2) to compare the effects of SE and a general exercise (GE) program on the lateral muscles thickness changes.

METHODS

This was a between-groups, triple-blinded randomized controlled trial design. In total, 40 females with CLBP were randomly assigned into 2 groups:  GE (control group) and supervised progressive SE (experimental group). Diagnostic ultrasound imaging was used before and after the intervention to measure lateral abdominal muscles thickness during standing on 2 different levels of platform in the Biodex Balance System. Visual analog scale and Roland-Morris Disability Questionnaire were used to evaluate changes in pain intensity and disability.

RESULTS

The results indicated significant increases in transverse abdominis muscle thickness during all standing tasks (P = .02) and significant decreases in pain intensity and disability following SE intervention (P < .001). However, the lateral abdominal muscle thicknesses were not changed after GE intervention while standing postural tasks (P > .05). The GE group revealed only significant decreases in pain intensity after intervention (P = .03).

CONCLUSION

Supervised progressive SE improved the activity of deep abdominal muscles in standing postural tasks in the patients with CLBP.

Athletes with a clinical rating of good and poor lumbopelvic stability have different kinematic variables during single leg squat and dip test

OBJECTIVES

To examine the kinematics of athletes with good and poor lumbopelvic stability (LPS) based on clinical rating criteria of single leg squat (SLS) and dip test (DT) The aim was to establish if good and poor LPS categorization is supported by differences in kinematic variables.

METHODS

Sixty-two recreational athletes had their LPS categorized using clinical rating criteria for SLS and DT as good, poor or neither good nor poor. Kinematic measures were examined in those with good (N = 8) or poor (N = 14) LPS and results compared to the rating criteria.

RESULTS

Multiple clinical rating criteria for good and poor LPS groups were distinguished by kinematic measures. Smoothness of motion for both SLS and DT distinguished good and poor LPS. Minimal (good) or discernible movement (poor) out of the starting plane was confirmed with kinematic measures. For SLS these movements were: weight-bearing hip adduction, non-weightbearing hip abduction, pelvic rotation, and trunk sideflexion, and for DT: weightbearing hip adduction, non-weightbearing hip abduction and pelvic obliquity. Additionally, hip dissociation (SLS) distinguished good and poor LPS.

CONCLUSION

Athletes with good and poor LPS have different kinematic measures in single leg squat and dip test. Multiple clinical rating criteria of LPS that distinguish good and poor stability were confirmed by kinematic measures.

Training intensity quantification of core stability exercises based on a smartphone accelerometer

Although core stability (CS) training is largely used to enhance motor performance and prevent musculoskeletal injuries, the lack of methods to quantify CS training intensity hinders the design of CS programs and the comparison and generalization of their effects. The aim of this study was to analyze the reliability of accelerometers integrated into smartphones to quantify the intensity of several CS isometric exercises. Additionally, this study analyzed to what extent the pelvic acceleration data represent the local stability of the core structures or the whole-body postural control. Twenty-three male and female physically-active individuals performed two testing-sessions spaced one week apart, each consisting of two 6-second trials of five variations of frontal bridge, back bridge, lateral bridge and bird-dog exercises. In order to assess load intensity based on the postural control challenge of CS exercises, a smartphone accelerometer and two force platforms were used to measure the mean pelvic linear acceleration and the mean velocity of the centre of pressure displacement, respectively. Reliability was assessed through the intra-class correlation coefficient (ICC_3,1) and the standard error of measurement (SEM). In addition, Pearson coefficient was used to analyze the correlation between parameters. The reliability analysis showed that most CS exercise variations obtained moderate-to-high reliability scores for pelvic acceleration (0.71<ICC<0.88; 13.23%≤SEM≤22.99%) and low-to-moderate reliability scores for centre of pressure displacement (0.24<ICC<0.89; 9.88%≤SEM≤35.90%). Regarding the correlation analysis, correlations between pelvic acceleration and centre of pressure displacement were moderate-to-high (0.52≤r≤0.81). Based on these results, smartphone accelerometers seem reliable devices to quantify isometric CS exercise intensity, which is useful to identify the individuals’ CS status and to improve the dose-response characterization of CS programs.

Effects of McGill stabilization exercises and conventional physiotherapy on pain, functional disability and active back range of motion in patients with chronic non-specific low back pain

[Purpose] The aim of this study was to compare the effects of “McGill stabilization exercises” and “conventional physiotherapy” on pain, functional disability and active back flexion and extension range of motion in patients with chronic non-specific low back pain. [Subjects and Methods] Thirty four patients with chronic non-specific low back pain were randomly assigned to McGill stabilization exercises group (n=17) and conventional physiotherapy group (n=17). In both groups, patients performed the corresponding exercises for six weeks. The visual analog scale (VAS), Quebec Low Back Pain Disability Scale Questionnaire and inclinometer were used to measure pain, functional disability, and active back flexion and extension range of motion, respectively. [Results] Statistically significant improvements were observed in pain, functional disability, and active back extension range of motion in McGill stabilization exercises group. However, active back flexion range of motion was the only clinical symptom that statistically increased in patients who performed conventional physiotherapy. There was no significant difference between the clinical characteristics while compared these two groups of patients. [Conclusion] The results of this study indicated that McGill stabilization exercises and conventional physiotherapy provided approximately similar improvement in pain, functional disability, and active back range of motion in patients with chronic non-specific low back pain. However, it appears that McGill stabilization exercises provide an additional benefit to patients with chronic non-specific low back, especially in pain and functional disability improvement.

A protocol for clinical trial study of the effect of core stabilization exercises on spine kinematics during gait with and without load in patients with non-specific chronic low back pain

Background

Non-specific chronic low back pain (NCLBP) is a major public health and global socioeconomic burden with a variety of symptoms such as gait abnormality. Trunk stiffness and deep trunk muscles dysfunction known as guarding mechanism in gait are factors leading to abnormal movement pattern of the spine. Anterior load carriage task during gait is also challenged the trunk stability and its movement pattern. It will be therefore of interest to examine the effect of a Core Stabilization Training Program (CSTP) on the trunk and pelvis kinematics including variability and peak displacement during gait with and without load in NCLBP patients.

Methods

Patients with NCLBP will participate in a program containing 16 sessions of CSTP and perceived pain, disability and kinematic will be evaluated with 100 mm visual analog scale (VAS), Oswestry Disability Index (ODI) and motion analyzing system respectively before and after the intervention. Participants will be asked to walk with self-selected comfortable speed for 3 times without load and 3 times with caring a load with hands.

Discussions

We will quantify the effectiveness of CSTP on the kinematic of trunk, lumbar and pelvis during gait. Comparing the kinematic pattern and movement variability using CV_o and CV_p can contribute to better understand the motor control strategy and movement pattern of the spine during an anterior load carriage task between patients with NCLBP and healthy.

Trial registration

IRCT number: IRCT2016080829264N1; pre-result.

Comparison of spinal stability following motor control and general exercises in nonspecific chronic low back pain patients

BACKGROUND

Motor control exercise was claimed to improve spinal stability in patients with chronic non-specific back pain, but to investigate the effectiveness of this exercise, other outcome measures have been used rather than spinal stability itself. The aim of our study is to assess motor control exercise effects on spinal stability using a biomechanical model.

METHODS

Fifty-one patients were assigned to either motor control or general exercises. Before and after trainings, participants were tested for spinal stability at seven isometric tasks. Electromyography signals were recorded from ten superficial muscles, and a hybrid EMG-driven musculoskeletal model estimated spinal stability indices at each task.

FINDINGS

Pain and disability significantly decreased in both groups. After trainings, patients had both increase and decrease in stability depending on the task, and stability did not increase/decrease uniformly in all patients. In the motor control group, stability increased at all positions but reached to significance only at right lateral pulling. In the general exercise group, except for pulling the trunk backward, stability decreased at other positions and reached to statistical significance only at pulling the trunk forward. No significant difference between groups was found in changing stability after the intervention.

INTERPRETATION

Interventions yielded no significant difference in disability, pain and stability index between two groups. Significant increase of stability in the motor control group at right lateral pulling may be attributed to more activity of abdominal muscles, and significant decrease of stability in the general exercise group at forward pulling may be attributed to more optimal activity of back muscles.

The Effect of Core Stabilization Exercise on the Kinematics and Joint Coordination of the Lumbar Spine and Hip During Sit-to-Stand and Stand-to-Sit in Patients With Chronic Nonspecific Low Back Pain (COSCIOUS): Study Protocol for a Randomized Double-Blind Controlled Trial

Background

Chronic nonspecific low back pain (CNLBP) is among the most prevalent health problems. Lumbar spine and hips kinematics and coordination can be affected in CNLBP. The effects of exercises on the kinematics and coordination of lumbar spine and hips during sit-to-stand (STS) and its reverse have not been evaluated.

Objective

The aim of this study is to investigate the effect of core stabilization exercise on the kinematics and joint coordination of the lumbar spine and hip during STS and its reverse in CNLBP patients.

Methods

COSCIOUS is a parallel randomized double-blind controlled trial. A total of 30 CNLBP patients and 15 asymptomatic participants will be included. The kinematics and joint coordination of the lumbar spine and hips will be evaluated during STS and its reverse using a motion capture system. The participants will be asked to sit in their usual posture on a stool. Reflective markers will be placed over the T12, S2, anterior and posterior superior iliac spines, greater trochanters, and lateral femoral epicondyles of both legs. The participants will be instructed to stand up at natural speed, remain in the erect posture for 3 seconds, and then sit down. Kinematic variables of the lumbar spine and hip will be computed. Afterward, the CNLBP participants will be allocated at random to receive one of 2 interventions: core stabilization or general exercise. Treatment sessions will be held 3 times per week for 16 sessions. After intervention, CNLBP participants will be assessed again.

Results

Funding for the study was provided in 2016 by Iran University of Medical Sciences. The study is expected to last approximately 12 months, depending on recruitment. Findings on the study’s primary outcomes are expected to be finalized by December 2017. The results of the study will be published in a peer-reviewed journal.

Conclusions

This investigation will evaluate the effects of core stabilization exercise on the kinematics and joint coordination of the lumbar spine and hip during STS and its reverse in patients with CNLBP. In addition, the effects of CNLBP on STS and its reverse will be investigated in COSCIOUS.

Trial Registration

Iranian Registry of Clinical Trials IRCT2016080812953N2; http://en.search.irct.ir/view/32003?format=xml (Archived by WebCite at http://www.webcitation.org/6qjTWd4Az)

Core Stability Exercise Versus General Exercise for Chronic Low Back Pain

Reference: Wang XQ, Zheng JJ, Yu ZW, et al. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One. 2012;7(12):e52082. Clinical Questions: Is core stability exercise more effective than general exercise in the treatment of patients with nonspecific low back pain (LBP)?

DATA SOURCES

 The authors searched the following databases: China Biological Medicine disc, Cochrane Library, Embase, and PubMed from 1970 through 2011. The key medical subject headings searched were chronic pain, exercise, LBP, lumbosacral region, and sciatica.

STUDY SELECTION

 Randomized controlled trials comparing core stability exercise with general exercise in the treatment of chronic LBP were investigated. Participants were male and female adults with LBP for at least 3 months that was not caused by a specific known condition. A control group receiving general exercise and an experimental group receiving core stability exercise were required for inclusion in the meta-analysis. Core stability was defined as the ability to ensure a stable neutral spine position, but the type of exercise was not specified. Outcome measures of pain intensity, back-specific functional status, quality of life, and work absenteeism were recorded at 3-, 6-, and 12-month intervals.

DATA EXTRACTION

 The study design, participant information, description of interventions in the control and experimental groups, outcome measures, and follow-up period were extracted. The mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate statistical significance. Risk of bias was assessed using the Cochrane Collaboration Recommendations, and all articles were rated as high risk for other bias with no further explanation given.

MAIN RESULTS

 Five studies involving 414 patients were included. Four studies assessed pain intensity using the visual analog scale or numeric rating scale. In the core stability exercise group, the reduction in pain was significant at 3 months (MD = -1.29, 95% CI = -2.47, -0.11; P = .003) but not at 6 months (MD = -0.50, 95% CI = -1.36, 0.35; P = .26). Functional status was improved at 3 months (MD = -7.14, 95% CI = -11.64, -2.65; P = .002) but not at 6 months (MD = -0.50, 95% CI = 0.36, 0.35; P = .26) or 12 months (MD = -0.32, 95% CI = -0.87, 0.23; P = .25). All of the included studies assessed back-specific functional status: 4 used the Oswestry Disability Index and 1 used the Roland-Morris Disability Questionnaire. Patients in the core stability exercise groups experienced improved functional status versus the general exercise group at 3 months (MD = -7.14, 95% CI = -11.64, -2.65; P = .002); no results were recorded at 6 or 12 months.

CONCLUSIONS

 In the short term, core stability exercise was more effective than general exercise for decreasing pain and increasing back-specific functional status in patients with LBP.

Motor control exercise for symptomatic lumbar disc herniation: protocol for a systematic review and meta-analysis

INTRODUCTION

Lumbar disc herniation (LDH) is a common condition in adults and can impose a heavy burden on both the individual and society. It is defined as displacement of disc components beyond the intervertebral disc space. Various conservative treatments have been recommended for the treatment of LDH and physical therapy plays a major role in the management of patients. Therapeutic exercise is effective for relieving pain and improving function in individuals with symptomatic LDH. The aim of this systematic review is to evaluate the effectiveness of motor control exercise (MCE) for symptomatic LDH.

METHODS AND ANALYSIS

We will include all clinical trial studies with a concurrent control group which evaluated the effect of MCEs in patients with symptomatic LDH. We will search PubMed, SCOPUS, PEDro, SPORTDiscus, CINAHL, CENTRAL and EMBASE with no restriction of language. Primary outcomes of this systematic review are pain intensity and functional disability and secondary outcomes are functional tests, muscle thickness, quality of life, return to work, muscle endurance and adverse events. Study selection and data extraction will be performed by two independent reviewers. The assessment of risk of bias will be implemented using the PEDro scale. Publication bias will be assessed by funnel plots, Begg's and Egger's tests. Heterogeneity will be evaluated using the I2 statistic and the χ2 test. In addition, subgroup analyses will be conducted for population and the secondary outcomes. All meta-analyses will be performed using Stata V.12 software.

ETHICS AND DISSEMINATION

No ethical concerns are predicted. The systematic review findings will be published in a peer-reviewed journal and will also be presented at national/international academic and clinical conferences.

TRIAL REGISTRATION NUMBER

CRD42016038166.

Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial

INTRODUCTION

The aim was to compare core stability and general exercises (GEs) in chronic low back pain (LBP) patients based on lumbopelvic stability (LPS) assessment through three endurance core stability tests. There is a controversy about preference of core stability exercise (CSE) over other types of exercise for chronic LBP. Studies which have compared these exercises used other outcomes than those related to LPS. As it is claimed that CSE enhances back stability, endurance tests for LPS were used.

MATERIALS AND METHODS

A 16-session CSE program and a GE program with the same duration were conducted for two groups of participants. Frequency of interventions for both groups was three times a week. Forty-three people (aged 18-60 years) with chronic non-specific LBP were alternately allocated to core stability (n = 22) or GE group (n = 21) when admitted. The primary outcomes were three endurance core stability tests including: (1) trunk flexor; (2) trunk extensor; and (3) side bridge tests. Secondary outcomes were disability and pain. Measurements were taken at baseline and the end of the intervention.

RESULTS

After the intervention, test times increased and disability and pain decreased within groups. There was no significant difference between two groups in increasing test times (p = 0.23 to p = 0.36) or decreasing disability (p = 0.16) and pain (p = 0.73).

CONCLUSIONS

CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients.