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Frizziero A, Pellizzon G, Vittadini F, Bigliardi D, Costantino C. Efficacy of Core Stability in Non-Specific Chronic Low Back Pain. J Funct Morphol Kinesiol 2021; 6:jfmk6020037. [PMID: 33922389 PMCID: PMC8167732 DOI: 10.3390/jfmk6020037] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Management of chronic low back pain (cLBP) is often multidisciplinary, involving a combination of treatments, including therapeutic exercises. Core stability exercises aim to improve pain and disability in cLBP increasing spinal stability, neuromuscular control, and preventing shear force that causes injury to the lumbar spine. The purpose of this study was to review the available evidence about the effectiveness in reducing pain and improving disability of core stability exercises for non-specific cLBP. (2) Methods: We perform a systematic research on common Medline databases: PubMed, Pedro, and Cochrane Library. Search results were limited to articles written in English and published between January 2005 and November 2020.The search provided a total of 420 articles. Forty-nine articles met the inclusion criteria and 371 articles were excluded. (3) Results: Core stability provides great therapeutic effects in patients with non-specific chronic low back pain reducing pain intensity, functional disability, and improving quality of life, core muscle activation, and thickness. Evidences suggest that core stability is more effective than rest or no/minimal intervention and combination with other types of exercise for cLBP have shown grater efficacy. (4) Conclusion: Core stability could be proposed in a comprehensive approach in cLBP, the combination with other modalities of therapeutic exercise should be promoted. Patient compliance is crucial to determine the efficacy of the intervention.
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Affiliation(s)
- Antonio Frizziero
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.B.); (C.C.)
- Correspondence:
| | | | - Filippo Vittadini
- Department of Physical and Rehabilitation Medicine, Casa di Cura Policlinico S. Marco, 30100 Venice, Italy;
| | - Davide Bigliardi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.B.); (C.C.)
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.B.); (C.C.)
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Are neuromuscular adaptations present in people with recurrent spinal pain during a period of remission? a systematic review. PLoS One 2021; 16:e0249220. [PMID: 33793608 PMCID: PMC8016280 DOI: 10.1371/journal.pone.0249220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/14/2021] [Indexed: 12/11/2022] Open
Abstract
A plethora of evidence supports the existence of neuromuscular changes in people with chronic spinal pain (neck and low back pain), yet it is unclear whether neuromuscular adaptations persist for people with recurrent spinal pain when in a period of remission. This systematic review aimed to synthesise the evidence on neuromuscular adaptations in people with recurrent spinal pain during a period of remission. Electronic databases, grey literature, and key journals were searched from inception up to the 4th of September 2020. Eligibility criteria included observational studies investigating muscle activity, spine kinematics, muscle properties, sensorimotor control, and neuromuscular performance in adults (≥ 18 years) with recurrent spinal pain during a period of remission. Screening, data extraction, and quality assessment (Newcastle-Ottawa Scale) were conducted independently by two reviewers. Data synthesis was conducted per outcome domain. A meta-analysis with a random-effects model was performed where possible. The overall strength of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines (GRADE). From 8292 records, 27 and five studies were included in a qualitative and quantitative synthesis, respectively. Very low level of evidence supports muscle activity changes in people with recurrent low back pain, especially greater co-contraction, redistribution of muscle activity, and delayed postural control of deeper trunk muscles. Reduced range of motion of the lumbar spine was also found. Meaningful conclusions regarding other outcome domains or people with recurrent neck pain could not be drawn. In conclusion, people with recurrent low back pain during a period of remission show muscle activity and spine kinematics adaptations. Future research should investigate the long-term impact of these changes, as well as adaptations in people with recurrent neck pain.
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A Randomized Controlled Trial Investigating the Effects of Equine Simulator Riding on Low Back Pain, Morphological Changes, and Trunk Musculature in Elderly Women. ACTA ACUST UNITED AC 2020; 56:medicina56110610. [PMID: 33202928 PMCID: PMC7696898 DOI: 10.3390/medicina56110610] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 01/20/2023]
Abstract
Background and objectives: Studies on the effects of an equine riding simulator (ERS) program on back pain, spinal alignment, and isokinetic moments in subjects with chronic low back pain (CLBP) remain limited. The purpose of this study was to analyze changes in elderly women with CLBP who participate in an ERS program. Materials and Methods: The 80 participants were all women aged 61–84 years who were randomly assigned to either the control group (CON) or ERS group (ERSG). ERS exercise was performed for a duration of 12 weeks (three times each week). The degree of pain was measured using the Oswestry Disability Index and the visual analog scale. Body composition and spinal alignment were measured using bioelectrical impedance and raster stereography. The isokinetic moments of trunk extensor and flexor were measured before and after the training period. Results: The ERSG showed a significant decrease in back pain compared to the CON. There was a significant decrease in levels of fat in the ERSG, although no differences were shown in terms of muscle mass. However, there was an increased basal metabolic rate (BMR) in the ERSG. Spinal alignment in the ERSG significantly improved. The peak torques of the trunk extensor in the ERSG were also significantly increased. Conclusion: It can be inferred that the ERS exercise can decrease fat and improve the trunk extensor strength through increased BMR, leading to better spinal alignment and reducing back pain in elderly women with CLBP.
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Hubbard G, Beeken RJ, Taylor C, Oliphant R, Watson AJM, Munro J, Russell S, Goodman W. HALT (Hernia Active Living Trial): protocol for a feasibility study of a randomised controlled trial of a physical activity intervention to improve quality of life in people with bowel stoma with a bulge/parastomal hernia. Pilot Feasibility Stud 2020; 6:142. [PMID: 32983558 PMCID: PMC7517671 DOI: 10.1186/s40814-020-00674-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/01/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Parastomal hernia (PSH) can be repaired surgically, but results to date have been disappointing, with reported recurrence rates of 30 to 76%. Other types of intervention are therefore needed to improve the quality of life of people with PSH. One potential intervention is physical activity. We hypothesise that the intervention will increase core activation and control across the abdominal wall at a site of potential weakness and thus reduce the risk of PSH progression. Increases in physical activity will improve body image and quality of life (QoL). METHODS Subjects and sampleThere were approximately 20 adults with a bowel stoma and PSH. People with previous PSH repair will be excluded as well as people who already do core training.Study designThis is a feasibility study of a randomised controlled trial with 2 months follow-up, in 2 sites using mixed methods. Stage 1 involves intervention development and in stage 2, intervention and trial parameters will be assessed.InterventionA theoretically informed physical activity intervention was done, targeting people with PSH.Main outcome of feasibility studyThe main outcome is the decision by an independent Study Steering Committee whether to proceed to a full randomised controlled trial of the intervention.Other outcomesWe will evaluate 4 intervention parameters-fidelity, adherence, acceptability and safety and 3 trial parameters (eligible patients' consent rate, acceptability of study design and data availability rates for following endpoints): I.Diagnosis and classification of PSHII.Muscle activationIII.Body composition (BMI, waist circumference)IV.Patient reported outcomes: QoL, body image and physical functioningV.Physical activity;VI.Psychological determinants of physical activityOther dataIncluded are other data such as interviews with all participants about the intervention and trial procedures.Data analysis and statistical powerAs this is a feasibility study, the quantitative data will be analysed using descriptive statistics. Audio-recorded qualitative data from interviews will be transcribed verbatim and analysed thematically. DISCUSSION The feasibility and acceptability of key intervention and trial parameters will be used to decide whether to proceed to a full trial of the intervention, which aims to improve body image, quality of life and PSH progression. TRIAL REGISTRATION ISRCTN15207595.
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Affiliation(s)
- Gill Hubbard
- Department of Nursing and Midwifery, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH UK
| | - Rebecca J. Beeken
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL UK
| | - Claire Taylor
- St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, Middlesex, HA1 3UJ UK
| | - Raymond Oliphant
- Department of Surgery, Raigmore Hospital, NHS Highland, Old Perth Rd, Inverness, IV2 3UJ UK
| | - Angus J. M. Watson
- Department of Surgery, Raigmore Hospital, NHS Highland, Old Perth Rd, Inverness, IV2 3UJ UK
| | - Julie Munro
- Department of Nursing and Midwifery, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH UK
| | | | - William Goodman
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
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Effects of 3D Moving Platform Exercise on Physiological Parameters and Pain in Patients with Chronic Low Back Pain. ACTA ACUST UNITED AC 2020; 56:medicina56070351. [PMID: 32679755 PMCID: PMC7404725 DOI: 10.3390/medicina56070351] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 01/07/2023]
Abstract
Background and objectives: Patient-handling activities predispose women to chronic low back pain (CLBP), but sufficient evidence is not available on whether a 3D moving platform, made for core stability exercise, affects pain, trunk flexibility, and static/dynamic muscle contractions in CLBP patients. Materials and Methods: The participants were twenty-nine women who were randomly divided into a control group (CON) and a 3D exercise group (3DEG), which took part in 3D moving exercise three times a week for 8 weeks. Both groups measured a visual analog scale (VAS) about their CLBP. Body composition, forward and backward trunk flexibilities, static muscle contraction property in rectus abdominis, and erector spinae were measured by tensiomyography, which found contraction time (Tc) and maximal displacement (Dm). Dynamic muscle contraction property in the abdomen and back were measured with an isokinetic device, which could measure peak torque (Pt) and work per repetition (Wr), before and after the trial. Results: The 3DEG had a significantly decreased fat mass and waist/hip ratio, as well as improved static muscle contractions of the erector spinae. The Wr of trunk extensor of 3D exercise group were also significantly increased. In the VAS, although the scores showed a significant change in some variables, while others did not. The Δ% in feeling pain at rest or at night, during exercise, walking, sitting in a hard chair, sitting in a soft chair, and lying down in 3DEG were significantly changed after 8 weeks. This indicates that the platform exercise provided a greater reduction of pain for activities that are done on a daily basis. Conclusions: This study confirms that the 3D moving platform exercise can provide the similar effect of the core stability exercise used in previous studies. Moreover, this study suggests that 3D moving platform exercise is a suitable means to reduce fatness, to increase trunk extensor, and to increase trunk backward flexibility, which led to reduced back pain in the women with CLBP.
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Solana-Tramunt M, Ortegón A, Morales J, Nieto A, Nishishinya MB, Villafañe JH. Diagnostic accuracy of lumbopelvic motor control tests using pressure biofeedback unit in professional swimmers: A cross-sectional study. J Orthop 2019; 16:590-595. [PMID: 31686760 DOI: 10.1016/j.jor.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 03/11/2019] [Accepted: 06/02/2019] [Indexed: 11/18/2022] Open
Abstract
Hypothesis To determine the effect of receiving the visual feedback of the sphygmomanometer on lumbopelvic motor control (LPMC) tests in professional swimmers. Method 31 professional swimmers to participate in the study. The outcome was maximum absolute mmHg variation in the pressure biofeedback unit's manometer with and without visual feedback on four LPMC tests. Results Test scores were significantly affected by visual feedback F = 10.07, p = 0.002, η2 p = 0.117 and the type of test F = 32.53, p < 0.001, η2 p = 0.300. Conclusion Visual feedback has a positive effect on the Active Straight Leg Raise Test (ASLR), the Knee Lift Abdominal Test (KLAT) scores completed by professional swimmers.
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Affiliation(s)
- Mònica Solana-Tramunt
- Department of Sports Sciences, Ramon Llull University, FPCEE Blanquerna, Barcelona, Spain
- Royal Spanish Swimming Federation, Barcelona, Spain
| | - Alberto Ortegón
- Department of Sports Sciences, Ramon Llull University, FPCEE Blanquerna, Barcelona, Spain
- Lecturer on NSCA Certified Personal Trainer (NSCA-CPT®), Spain
| | - José Morales
- Department of Sports Sciences, Ramon Llull University, FPCEE Blanquerna, Barcelona, Spain
| | - Ainhoa Nieto
- Department of Sports Sciences, Ramon Llull University, FPCEE Blanquerna, Barcelona, Spain
| | - María Betina Nishishinya
- Department of Sports Sciences, Ramon Llull University, FPCEE Blanquerna, Barcelona, Spain
- Instituto Traumatológico Quirón, Spain
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The Role of a Multi-Step Core Stability Exercise Program in the Treatment of Nurses with Chronic Low Back Pain: A Single-Blinded Randomized Controlled Trial. Asian Spine J 2018; 12:490-502. [PMID: 29879777 PMCID: PMC6002169 DOI: 10.4184/asj.2018.12.3.490] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/03/2017] [Accepted: 10/10/2017] [Indexed: 12/02/2022] Open
Abstract
Study Design Single-blinded randomized controlled trial. Purpose To evaluate the effects of a multi-step core stability exercise program in nurses with chronic low back pain (CLBP). Overview of Literature CLBP is a common disorder among nurses. Considering that patient-handling activities predispose nurses to CLBP, core stability exercises suggested for managing CLBP in the general population may also be helpful in nurses. However, sufficient evidence is not available on whether a multi-step core stability exercise program affects pain, disability, quality of life, and the diameter of lateral abdominal muscles in nurses with CLBP. Methods In this single-blinded randomized controlled trial, 36 female nurses with CLBP were recruited. The sample was divided into two groups of 18 patients (intervention and control). Nurses in the intervention group performed core stability exercises for 8 weeks, based on a progressive pattern over time. Roland–Morris Disability Questionnaire (RDQ), quality of life (36-item Short Form Health Survey [SF-36]), ultrasound assessment of the diameter of lateral abdominal muscles, and Visual Analog Scale (VAS) score for pain were evaluated in the participants before and after the trial. Sixteen nurses (eight from each group) dropped out of the study, and analysis of covariance was used to compare outcomes for the remaining nurses in the intervention (10 nurses) and control (10 nurses) groups. Results The results after the trial showed significant improvements in RDQ, SF-36, and VAS score in the intervention group compared with that in the control group (p <0.005). Furthermore, the ultrasound data showed a significant increase in the left and right muscle diameter of all three abdominal muscles during the abdominal drawing-in maneuver in the intervention group compared with that in the control group (p <0.05). Conclusions This study showed that a multi-step core stability exercise program is a helpful treatment option for improving quality of life and reducing disability and pain in female nurses with CLBP.
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Comparison of Effects Between Core Stability Training and Sports Massage Therapy Among Elite Weightlifters with Chronic Non-Specific Low Back Pain: A Randomized Cross-Over Study. Asian J Sports Med 2018. [DOI: 10.5812/asjsm.58644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bagheri R, Takamjani IE, Dadgoo M, Sarrafzadeh J, Ahmadi A, Pourahmadi MR, Jafarpisheh AS. 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. Chiropr Man Therap 2017; 25:31. [PMID: 29177031 PMCID: PMC5688737 DOI: 10.1186/s12998-017-0162-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/23/2017] [Indexed: 11/10/2022] Open
Abstract
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 CVo and CVp 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.
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Affiliation(s)
- Rasool Bagheri
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences and Health Services, Tehran, Iran
| | - Ismail Ebrahimi Takamjani
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences and Health Services, Tehran, Iran.,School of Rehabilitation Sciences, Nezam St. Shah Nazari Ave. Madar Sq. Mirdamad Biv, P.O Box: 4391-15875, Tehran, Iran
| | - Mahdi Dadgoo
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences and Health Services, Tehran, Iran
| | - Javad Sarrafzadeh
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences and Health Services, Tehran, Iran
| | - Amir Ahmadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences and Health Services, Tehran, Iran
| | - Mohammad Reza Pourahmadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences and Health Services, Tehran, Iran
| | - Amir-Salar Jafarpisheh
- Department of Ergonomics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Lee JH. Effects of the centrifugal contraction exercise of the rectus abdominis accompanied with the isometric exercise of the transversus abdominis on pain and balance of lower back pain patients. J Phys Ther Sci 2017; 29:1405-1408. [PMID: 28878472 PMCID: PMC5574325 DOI: 10.1589/jpts.29.1405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/24/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The current study attempted to examine the effects of centrifugal contraction exercise of the rectus abdominis during the isometric contraction of the transversus abdominis on pain and balance of patients with chronic back pain. [Subjects and Methods] The subjects included thirty patients who were diagnosed with back pain due to causes other than neurological by a specialist after conducting a medical precision diagnosis. The experiment was performed after evenly dividing the subjects into two groups, namely, control and experimental, using a random method. This study measured pain by using the visual analog scale. To determine the patients' balancing ability using the Multifunktionale trainsgerate balance measurer. [Results] All groups showed a statistically significant within-group difference in visual analog scale and balance change. However, no significant between-group difference was observed in the comparison of therapy effects. [Conclusion] Strengthening the rectus abdominis can be an important factor for increasing the stability and reducing the pain of the lumbar area among patients with back pain.
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Affiliation(s)
- Jung-Ho Lee
- Department of Physical Therapy, Kyungdong University, Republic of Korea
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Paungmali A, Henry LJ, Sitilertpisan P, Pirunsan U, Uthaikhup S. Improvements in tissue blood flow and lumbopelvic stability after lumbopelvic core stabilization training in patients with chronic non-specific low back pain. J Phys Ther Sci 2016; 28:635-40. [PMID: 27064327 PMCID: PMC4793024 DOI: 10.1589/jpts.28.635] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/19/2015] [Indexed: 02/05/2023] Open
Abstract
[Purpose] This study investigated the effects of lumbopelvic stabilization training on
tissue blood flow changes in the lumbopelvic region and lumbopelvic stability compared to
placebo treatment and controlled intervention among patients with chronic non-specific low
back pain. [Subjects and Methods] A total of 25 participants (7 males, 18 females; mean
age, 33.3 ± 14.4 years) participated in this within-subject, repeated-measures,
double-blind, placebo-controlled comparison trial. The participants randomly underwent
three types of interventions that included lumbopelvic stabilization training, placebo
treatment, and controlled intervention with 48 hours between sessions. Lumbopelvic
stability and tissue blood flow were measured using a pressure biofeedback device and a
laser Doppler flow meter before and after the interventions. [Results] The
repeated-measures analysis of variance results demonstrated a significant increase in
tissue blood flow over the lumbopelvic region tissues for post- versus pre-lumbopelvic
stabilization training and compared to placebo and control interventions. A significant
increase in lumbopelvic stability before and after lumbopelvic stabilization training was
noted, as well as upon comparison to placebo and control interventions. [Conclusion] The
current study supports an increase in tissue blood flow in the lumbopelvic region and
improved lumbopelvic stability after core training among patients with chronic
non-specific low back pain.
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Affiliation(s)
- Aatit Paungmali
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Leonard Joseph Henry
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand; Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University Kebangsaan Malaysia, Malaysia
| | - Patraporn Sitilertpisan
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Ubon Pirunsan
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Sureeporn Uthaikhup
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
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