The effect of individualized gradable stabilization exercises in patients with chronic low back pain: Case-control study

Disability reduction following a lumbar stabilization exercise program for low back pain: large vs. small improvement subgroup analyses of physical and psychological variables

BACKGROUND

Little is known about why patients with low back pain (LBP) respond differently to treatment, and more specifically, to a lumbar stabilization exercise program. As a first step toward answering this question, the present study evaluates how subgroups of patients who demonstrate large and small clinical improvements differ in terms of physical and psychological changes during treatment.

METHODS

Participants (n = 110) performed the exercise program (clinical sessions and home exercises) over eight weeks, with 100 retained at six-month follow-up. Physical measures (lumbar segmental instability, motor control impairments, range of motion, trunk muscle endurance and physical performance tests) were collected twice (baseline, end of treatment), while psychological measures (fear-avoidance beliefs, pain catastrophizing, psychological distress, illness perceptions, outcome expectations) were collected at four time points (baseline, mid-treatment, end of treatment, follow-up). The participants were divided into three subgroups (large, moderate and small clinical improvements) based on the change of perceived disability scores. ANOVA for repeated measure compared well-contrasted subgroups (large vs. small improvement) at different times to test for SUBGROUP × TIME interactions.

RESULTS

Statistically significant interactions were observed for several physical and psychological measures. In all these interactions, the large- and small-improvement subgroups were equivalent at baseline, but the large-improvement subgroup showed more improvements over time compared to the small-improvement subgroup. For psychological measures only (fear-avoidance beliefs, pain catastrophizing, illness perceptions), between-group differences reached moderate to strong effect sizes, at the end of treatment and follow-up.

CONCLUSIONS

The large-improvement subgroup showed more improvement than the small-improvement subgroup with regard to physical factors typically targeted by this specific exercise program as well as for psychological factors that are known to influence clinical outcomes.

Effect of adding abdominal bracing to spinal stabilization exercise on lumbar lordosis angle, extensor strength, pain, and function in patients with non-specific chronic low back pain: A prospective randomized pilot study

TRIAL DESIGN

This study investigated the effect of adding abdominal bracing to spinal stability exercise in patients with chronic low back pain (CLBP). This prospective, randomized pilot study included 67 patients and was conducted at the sports medicine center of a single hospital.

METHODS

The abdominal bracing group (ABBG) underwent spinal stability exercise with abdominal bracing (N = 33), comprising 50 minutes training twice a week for 24 weeks. The control group performed only spinal stability exercise (N = 34) for 50 minutes twice a week for 24 weeks. The ABBG received abdominal bracing training at each session and applied abdominal bracing during the spinal stability exercise. The lumbar lordosis angle (LLA) and spine extensor muscle strength were measured. Spinal flexion angles were measured every 12° from 0° to 72°. The visual analog scale score and Oswestry disability index were measured before treatment and at 12 and 24 weeks after treatment.

RESULTS

The LLA increased over time in both the groups but was not significantly different between the groups. Spine extensor strength was improved over time in both the groups, and an interactive effect was observed at a spinal flexion angle of 60° and 72°. Pain and function were also improved over time in both the groups, but the effect was stronger in the ABBG than in the control group. In patients with CLBP, spinal stability exercise changed the LLA.

CONCLUSIONS

Although adding abdominal bracing to spinal stability exercise did not affect the changes in the LLA, abdominal bracing improved the spinal extensor strength, pain, and function in patients with CLBP. Therefore, it is recommended to add abdominal bracing to spinal stability exercise to maintain the lordosis angle and to improve CLBP symptoms.

Post-COVID Patients With New-Onset Chronic Pain 2 Years After Infection: Cross-Sectional Study

BACKGROUND

Although pain is common in non-hospitalized post-COVID-19 syndrome, only a few studies have provided information on the pain experience of these patients.

AIM

To identify the clinical and psychosocial profile associated with pain in non-hospitalized patients with post-COVID-19 syndrome.

METHOD

In this study there were three groups: healthy control group, successfully recovered group, and post-COVID syndrome group. Pain-related clinical profile and pain-related psychosocial variables were collected. Pain-related clinical profile included: pain intensity and interference (Brief Pain Inventory), central sensitization (Central Sensitization Scale), insomnia severity (Insomnia Severity Index), and pain treatment. Pain-related psychosocial variables were: fear of movement and (re)injury (Tampa Scale for Kinesiophobia), catastrophizing (Pain Catastrophizing Scale), depression, anxiety and stress (Depression, Anxiety and Stress Scale), and fear-avoidance beliefs (Fear Avoidance Beliefs Questionnaire).

RESULTS

In all, 170 participants were included in the study (healthy control group n = 58, successfully recovered group n = 57, and post-COVID syndrome group n = 55). Post-COVID syndrome group obtained significantly worse punctuation in pain-related clinical profile and psychosocial variables than the other two groups (p < .05).

CONCLUSIONS

In conclusion, patients with post-COVID-19 syndrome have experienced high pain intensity and interference, central sensitization, increased insomnia severity, fear of movement, catastrophizing, fear-avoidance beliefs, depression, anxiety, and stress.

Adults with lower-limb amputation: Reduced multifidi muscle activity and extensor muscle endurance is associated with worse physical performance

Trunk muscles may be an overlooked region of deficits following lower-limb amputation (LLA). This study sought to determine the extent that trunk muscle deficits are associated with physical function following amputation. Sedentary adults with a unilateral transtibial- (n = 25) or transfemoral-level (n = 14) amputation were recruited for this cross-sectional research study. Participants underwent a clinical examination that included ultrasound imaging of the lumbar multifidi muscles, the modified Biering-Sorensen Endurance Test (mBSET), and performance-based measures, that is, the Timed Up and Go (TUG), Berg Balance Scale (BBS), and 10-m Walk Test (10mWT). Associations between trunk muscle metrics and performance were explored with regression modeling, while considering covariates known to impact performance postamputation (p ≤ 0.100). Average ultrasound-obtained, lumbar multifidi activity was 14% and 16% for transfemoral- and transtibial-level amputations, respectively, while extensor endurance was 37.34 and 12.61 s, respectively. For TUG, nonamputated-side multifidi activity and an interaction term (level x non-amputated-side multifidi activity) explained 9.4% and 6.2% of the total variance, respectively. For 10mWT, beyond covariates, non-amputated-side multifidi activity and the interaction term explained 6.1% and 5.8% of the total variance, respectively. For TUG, extensor endurance and an interaction term (level x mBSET) explained 11.9% and 8.3% of the total variance beyond covariates; for BBS and 10mWT, extensor endurance explained 11.2% and 17.2% of the total variance, respectively. Findings highlight deficits in lumbar multifidi activity and extensor muscle endurance among sedentary adults with a LLA; reduced muscle activity and endurance may be important factors to target during rehabilitation to enhance mobility-related outcomes.

The effects of Pilates on pain, functionality, quality of life, flexibility and endurance in lumbar disc herniation

Aim: To assess the effects of clinical Pilates exercises (CPE) on the level of pain, functional status, flexibility, static and dynamic endurance of the trunk muscles and quality of life (QoL) in patients with lumbar disc herniation. Materials & methods: Individuals were divided into two groups: the CPE (6 weeks, three-times a week) group (n = 27) and the control group (n = 27). The clinical outcome measures were the visual analog scale for the evaluation of the pain intensity, Oswestry disability index for functional disability, short form-36 for health related QoL, sit and reach and hand finger floor distance test for the flexibility, side-bridge and sit-ups test for the static and dynamic endurance. Results: At the end of the 6 weeks the amount of decrease in the level of pain and Oswestry disability index, amount of increase in sit-reach test and hand-finger-to-floor distance, duration of the lateral bridge and sits-ups test and most of the short form-36 sub parameters was significantly higher (p < 0.05) in the CPE group. Conclusion: CPE was an effective and safe method for symptomatic patients with lumbar disc herniation in reducing the pain level and functional disability and improving flexibility, static and dynamic endurance and partially their QoL. Clinical Trial Registration: NCT03198273 (ClinicalTrials.gov).

Effects of progressive neuromuscular stabilization exercise on the support surface on patients with high obesity with lumbar instability: A double-blinded randomized controlled trial

BACKGROUND

Intensive neuromuscular stabilization exercise on highly obese patients with low back pain results in positive effects of body fat decline and prevention of complications. The purpose of this study is to investigate the effects of progressive neuromuscular stabilization exercise on unstable surface on pain, motor function, psychosocial factors, balance, and abdominal contraction with highly obese patients with lumbar instability.

METHODS

This study is a double-blinded randomized controlled trial. A total of 46 highly obese patients (body mass index [BMI] ≥ 30 kg/m2) with lumbar instability were assigned randomly to experimental group (n = 23) and control group (n = 23). The control group performed the intensive progressive exercise on a stable surface and the experimental group on an unstable surface.

RESULT

Significant differences were shown for BMI, QVAS, K-ODI, FABQ, and balance ability for both groups before and after the intervention (P < .05), and only the experimental group showed significant difference for transverse abdominis muscle thickness in contraction and contraction rate (P < .05). Compared to the control group, the experimental group showed significant difference (P < .05) in the amount of changes for QVAS, K-ODI, balance ability, transverse abdominis muscle thickness in contraction, and contraction rate.

CONCLUSION

Progressive neuromuscular stabilization exercise program on unstable surfaces demonstrated to be an effective and clinically useful method to decrease pain level, increase motor function, balance, and transverse abdominis muscle thickness in contraction and contraction rate for highly obese patients with lumbar instability.

The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial

BACKGROUND

Various exercises have been proposed to mitigate chronic low back pain (LBP). However, to date, no one particular exercise has been shown to be superior. Hence, the aim of this study was to compare the efficiency between 2 exercises: the individualized graded lumbar stabilization exercise (IGLSE) and walking exercise (WE).

METHODS

A randomized controlled trial was conducted in 48 participants with chronic LBP. After screening, participants were randomized to 1 of 4 groups: flexibility exercise, WE, stabilization exercise (SE), and stabilization with WE (SWE) groups. Participants underwent each exercise for 6 weeks. The primary outcome was visual analog scale (VAS) of LBP during rest and physical activity. Secondary outcomes were as follows: VAS of radiating pain measured during rest and physical activity; frequency of medication use (number of times/day); Oswestry disability index; Beck depression inventory; endurances of specific posture; and strength of lumbar extensor muscles.

RESULTS

LBP during physical activity was significantly decreased in all 4 groups. Exercise frequency was significantly increased in the SE and WE groups; exercise time was significantly increased in the SE group. The endurance of supine, side lying, and prone posture were significantly improved in the WE and SWE groups.

CONCLUSIONS

Lumbar SE and WE can be recommended for patients with chronic LBP because they not only relieve back pain but also prevent chronic back pain through improving muscle endurance.

Effects of a Progressive Stabilization Exercise Program Using Respiratory Resistance for Patients with Lumbar Instability: A Randomized Controlled Trial

Background

This study investigated the effects of progressive stabilization exercise program carried out with respiratory resistance in patients with lumbar instability.

Material/Methods

Forty-three patients with lumbar instability were randomly assigned to experimental (n=20) and control groups (n=23). The experimental group performed progressive lumbar stabilization exercises along with respiratory resistance, and the control group only performed progressive lumbar stabilization exercises, for 40 min per session, 3 sessions a week, for 4 weeks. Numeric rating scale (NRS), Korean-Oswestry disability index (K-ODI), static balance ability, Fear-Avoidance Beliefs Questionnaire (FABQ), and pulmonary function test (PFT) were performed before and after the intervention program for comparison.

Results

The 2 groups showed significant differences in NRS, K-ODI, balance ability, and FABQ after the interventions (p<0.05), but greater improvements were shown by the experimental group in balance ability and FABQ values. PFT results in the experimental group showed a significant increase (p<0.05) in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and maximum voluntary ventilation (MVV). The experimental group showed a greater improvement (p<0.05) in FVC and MVV compared to the control group.

Conclusions

Progressive stabilization exercise program with respiratory resistance is an effective method with clinical significance in pain reduction, psychosocial stability, and enhancement of motor and respiratory functions.

Proposal of a new exercise protocol for idiopathic scoliosis: A preliminary study

In clinical practice, we found a unilateral instability in patients with right thoracic scoliosis during asymmetric spinal stabilization exercise (ASSE), which can be an important clue to identify the pathophysiology of idiopathic scoliosis (IS).We investigated the relationship between unilateral postural instability and weakness of paraspinal muscles according to curve pattern. And finally, we propose the new exercise method based on the curve pattern.Combined use of prospective and retrospective clinical trials.Fifteen participants without IS and 10 patients with IS in 1 tertiary referral hospital.In 15 participants without IS, surface electromyography (sEMG) was used to evaluate the muscular activation patterns in the bilateral erector spinae (ES), rectus abdominis (RA), and external oblique (EO) muscles during ASSE. In addition, to assess the clinical effect of ASSE, Cobb angle and rotation grade were measured from 10 patients with IS.The most significant findings from the sEMG data were the increased activities of ipsilateral 7th thoracic ES during hand-up motion, ipsilateral 3rd lumbar ES during leg-up motion, and 12th thoracic and 3rd lumbar ES during side-bridging. In a radiographic analysis, specific components of ASSE that activates the concave side muscles were found to be effective for IS.The paraspinal muscle strengthening of the concave side using ASSE can improve the severity of scoliosis. Based on this research, we could propose a new exercise protocol that can be personalized according to the curve pattern.