The Effects Of Myofascial Release Technique Combined With Core Stabilization Exercise In Elderly With Non-Specific Low Back Pain: A Randomized Controlled, Single-Blind Study

Gulsah Ozsoy, Nursen Ilcin, Ismail Ozsoy, Barış Gurpinar, Oznur Buyukturan, Buket Buyukturan, Caner Kararti, Senem Sas, Gulsah Ozsoy, Nursen Ilcin, Ismail Ozsoy, Barış Gurpinar, Oznur Buyukturan, Buket Buyukturan, Caner Kararti, Senem Sas

Abstract

Purpose: To evaluate the effects of Myofascial Release Technique (MRT) with a roller massager combined with core stabilization exercises (CSE) in elderly with non-specific low back pain (NSLBP).

Patients and methods: A total of forty-five participants were randomly divided into two groups (CSE and CSE+MRT). A core stabilization exercise program was applied for the participants in the CSE group for 3 days per week for a total of 6 weeks. In addition to the core stabilization exercises, myofascial relaxation technique with a roller massager was performed for 3 days per week for 6 weeks for the participants in the CSE+MRT group. Participants were assessed in terms of pain, low back disability, lower body flexibility, kinesiophobia, core stability endurance, spinal mobility, gait characteristics and quality of life both pre- and post-treatment.

Results: It was found that the improvement in core stability endurance (p=0.031) and spinal mobility (in the sagittal plane) (p=0.022) was greater in the CSE+MRT group compared to the CSE group. There was no significant difference between the two groups in terms of pain, low back disability, lower body flexibility, kinesiophobia, gait characteristics and quality of life (p>0.05).

Conclusion: The current study suggests that myofascial release technique with a roller massager combined with core stabilization exercises can be a better choice in the treatment of NSLBP in elderly.

Clinicaltrialsgov identifier: NCT03898089.

Keywords: core stabilization exercises; myofascial release technique; non-specific low back pain.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2019 Ozsoy et al.

Figures

Figure 1
Figure 1
Examples of core stabilization exercises: beginner (AC), intermediate (DF), advanced (GI).
Figure 2
Figure 2
Examples of the roller massage application: gastrocnemius/achilles tendon (A), sacrolumbar fascia/erector spinae (B).
Figure 3
Figure 3
Study flow diagram.

References

    1. Golob AL, Wipf JE. Low back pain. Med Clin North Am. 2014;98(3):405–428. doi:10.1016/j.mcna.2014.01.003
    1. Beyera GK, O’Brien J, Campbell S. Health-care utilisation for low back pain: a systematic review and meta-analysis of population-based observational studies. Rheumatol Int. 2019. doi:10.1007/s00296-019-04430-5
    1. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet (London, England). 2017;389(10070):736–747. doi:10.1016/S0140-6736(16)30970-9
    1. El-Sayed AM, Hadley C, Tessema F, Tegegn A, Cowan JA Jr., Galea S. Back and neck pain and psychopathology in rural sub-Saharan Africa: evidence from the Gilgel Gibe Growth and Development Study, Ethiopia. Spine. 2010;35(6):684–689. doi:10.1097/BRS.0b013e3181b4926e
    1. Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(6):968–974. doi:10.1136/annrheumdis-2013-204428
    1. Jones LD, Pandit H, Lavy C. Back pain in the elderly: a review. Maturitas. 2014;78(4):258–262. doi:10.1016/j.maturitas.2014.05.004
    1. Nascimento P, Costa LOP, Araujo AC, Poitras S, Bilodeau M. Effectiveness of interventions for non-specific low back pain in older adults. A systematic review and meta-analysis. Physiotherapy. 2019;105(2):147–162. doi:10.1016/j.physio.2018.11.004
    1. Gatton ML, Pearcy MJ, Pettet GJ, Evans JH. A three-dimensional mathematical model of the thoracolumbar fascia and an estimate of its biomechanical effect. J Biomech. 2010;43(14):2792–2797.
    1. Wilke J, Schleip R, Klingler W, Stecco C. The lumbodorsal fascia as a potential source of low back pain: a narrative review. Biomed Res Int. 2017;2017:5349620.
    1. Myers TW. Anatomy Trains E-Book: Myofascial Meridians for Manual and Movement Therapists. Elsevier Health Sciences; 2013.
    1. Barker PJ, Urquhart DM, Story IH, Fahrer M, Briggs CA. The middle layer of lumbar fascia and attachments to lumbar transverse processes: implications for segmental control and fracture. Eur Spine J. 2007;16(12):2232–2237. doi:10.1007/s00586-007-0502-z
    1. Barker PJ, Briggs CA. Attachments of the posterior layer of lumbar fascia. Spine. 1999;24(17):1757–1764. doi:10.1097/00007632-199909010-00002
    1. Wilke J, Macchi V, De Caro R, Stecco C. Fascia thickness, aging and flexibility: is there an association? J Anat. 2019;234(1):43–49. doi:10.1111/joa.12902
    1. Hides JA, Belavy DL, Cassar L, Williams M, Wilson SJ, Richardson CA. Altered response of the anterolateral abdominal muscles to simulated weight-bearing in subjects with low back pain. Eur Spine J. 2009;18(3):410–418. doi:10.1007/s00586-008-0827-2
    1. Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine. 1996;21(22):2640–2650. doi:10.1097/00007632-199611150-00014
    1. Chen YH, Chai HM, Shau YW, Wang CL, Wang SF. Increased sliding of transverse abdominis during contraction after myofascial release in patients with chronic low back pain. Man Ther. 2016;23:69–75. doi:10.1016/j.math.2015.10.004
    1. Jorgensen JE, Afzali T, Riis A. Effect of differentiating exercise guidance based on a patient’s level of low back pain in primary care: a mixed-methods systematic review protocol. BMJ Open. 2018;8(1):e019742. doi:10.1136/bmjopen-2017-019742
    1. O’Connell NE, Cook CE, Wand BM, Ward SP. Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines. Best Pract Res Clin Rheumatol. 2016;30(6):968–980. doi:10.1016/j.berh.2017.05.001
    1. Hodges PW. Core stability exercise in chronic low back pain. Orthop Clin North Am. 2003;34(2):245–254.
    1. 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. doi:10.1371/journal.pone.0052082
    1. Kim M, Kim M, Oh S, Yoon B. The effectiveness of hollowing and bracing strategies with lumbar stabilization exercise in older adult women with nonspecific low back pain: a quasi-experimental study on a community-based rehabilitation. J Manipulative Physiol Ther. 2018;41(1):1–9. doi:10.1016/j.jmpt.2017.06.012
    1. Laimi K, Makila A, Barlund E, et al. Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: a systematic review. Clin Rehabil. 2018;32(4):440–450. doi:10.1177/0269215517732820
    1. Arguisuelas MD, Lison JF, Sanchez-Zuriaga D, Martinez-Hurtado I, Domenech-Fernandez J. Effects of myofascial release in nonspecific chronic low back pain: a randomized clinical trial. Spine. 2017;42(9):627–634. doi:10.1097/BRS.0000000000001897
    1. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S240–S252.
    1. Farasyn A, Lassat B. Cross friction algometry (CFA): comparison of pressure pain thresholds between patients with chronic non-specific low back pain and healthy subjects. J Bodyw Mov Ther. 2016;20(2):224–234. doi:10.1016/j.jbmt.2015.09.005
    1. Fairbank JC, Pynsent PB. The oswestry disability index. Spine. 2000;25(22):2940–2952; discussion 2952. doi:10.1097/00007632-200011150-00017
    1. Jones CJ, Rikli RE, Max J, Noffal G. The reliability and validity of a chair sit-and-reach test as a measure of hamstring flexibility in older adults. Res Q Exerc Sport. 1998;69(4):338–343. doi:10.1080/02701367.1998.10607708
    1. Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363–372. doi:10.1016/0304-3959(94)00279-n
    1. Schellenberg KL, Lang JM, Chan KM, Burnham RS. A clinical tool for office assessment of lumbar spine stabilization endurance: prone and supine bridge maneuvers. Am J Phys Med Rehabil. 2007;86(5):380–386. doi:10.1097/PHM.0b013e318032156a
    1. Seichert N, Baumann M, Senn E, Zuckriegl HJPRKM. The “back mouse”–an analog-digital measuring device to record the sagittal outline of the back. Phys Rehab Kur Med. 1994;4(35–43):35–43.
    1. Newell D, Shead V, Sloane L. Changes in gait and balance parameters in elderly subjects attending an 8-week supervised Pilates programme. J Bodyw Mov Ther. 2012;16(4):549–554. doi:10.1016/j.jbmt.2012.02.002
    1. Gobbens RJ, Remmen R. The effects of sociodemographic factors on quality of life among people aged 50 years or older are not unequivocal: comparing SF-12, WHOQOL-BREF, and WHOQOL-OLD. Clin Interv Aging. 2019;14:231–239. doi:10.2147/CIA.S189560
    1. Akuthota V, Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. Curr Sports Med Rep. 2008;7(1):39–44. doi:10.1097/01.CSMR.0000308663.13278.69
    1. Baerga-Varela L, Abreu Ramos AM. Core strengthening exercises for low back pain. Bol Asoc Med P R. 2006;98(1):56–61.
    1. Cheatham SW, Stull KR. Roller massage: A commentary on clinical standards and survey of physical therapy professionals - Part 1. Int J Sports Phys Ther. 2018;13(4):763–772.
    1. Cavanaugh MT, Doweling A, Young JD, et al. An acute session of roller massage prolongs voluntary torque development and diminishes evoked pain. Eur J Appl Physiol. 2017;117(1):109–117. doi:10.1007/s00421-016-3503-y
    1. Halperin I, Aboodarda SJ, Button DC, Andersen LL, Behm DG. Roller massager improves range of motion of plantar flexor muscles without subsequent decreases in force parameters. Int J Sports Phys Ther. 2014;9(1):92–102.
    1. Aboodarda SJ, Spence AJ, Button DC. Pain pressure threshold of a muscle tender spot increases following local and non-local rolling massage. BMC Musculoskelet Disord. 2015;16:265.
    1. Henry Joseph L, Hancharoenkul B, Sitilertpisan P, Pirunsan U, Paungmalia A. 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;9:1. doi:10.5812/asjsm
    1. Maher JM, Markey JC, Ebert-May D. The other half of the story: effect size analysis in quantitative research. CBE Life Sci Educ. 2013;12(3):345–351. doi:10.1187/cbe.13-04-0082
    1. Akhtar MW, Karimi H, Gilani SA. Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial. Pak J Med Sci. 2017;33(4):1002–1006. doi:10.12669/pjms.334.12664
    1. Chang WD, Lin HY, Lai PT. Core strength training for patients with chronic low back pain. J Phys Ther Sci. 2015;27(3):619–622. doi:10.1589/jpts.27.619
    1. Clauw DJ, Williams D, Lauerman W, et al. Pain sensitivity as a correlate of clinical status in individuals with chronic low back pain. Spine. 1999;24(19):2035–2041. doi:10.1097/00007632-199910010-00013
    1. Farasyn A, Meeusen R. The influence of non-specific low back pain on pressure pain thresholds and disability. Eur J Pain. 2005;9(4):375–381. doi:10.1016/j.ejpain.2004.09.005
    1. Goubert D, Meeus M, Willems T, et al. The association between back muscle characteristics and pressure pain sensitivity in low back pain patients. Scand J Pain. 2018;18(2):281–293. doi:10.1515/sjpain-2017-0142
    1. Paungmali A, Joseph LH, Sitilertpisan P, Pirunsan U, Uthaikhup S. Lumbopelvic core stabilization exercise and pain modulation among individuals with chronic nonspecific low back pain. Pain Pract. 2017;17(8):1008–1014. doi:10.1111/papr.12552
    1. Rodriguez-Huguet M, Gil-Salu JL, Rodriguez-Huguet P, Cabrera-Afonso JR, Lomas-Vega R. Effects of myofascial release on pressure pain thresholds in patients with neck pain: a single-blind randomized controlled trial. Am J Phys Med Rehabil. 2018;97(1):16–22. doi:10.1097/PHM.0000000000000790
    1. Andrusaitis SF, Brech GC, Vitale GF, Greve JM. Trunk stabilization among women with chronic lower back pain: a randomized, controlled, and blinded pilot study. Clinics (Sao Paulo). 2011;66(9):1645–1650. doi:10.1590/s1807-59322011000900024
    1. Arguisuelas MD, Lison JF, Domenech-Fernandez J, Martinez-Hurtado I, Salvador Coloma P, Sanchez-Zuriaga D. Effects of myofascial release in erector spinae myoelectric activity and lumbar spine kinematics in non-specific chronic low back pain: randomized controlled trial. Clin Biomech (Bristol, Avon). 2019;63:27–33. doi:10.1016/j.clinbiomech.2019.02.009
    1. Frey M, Poynter A, Younge K, De Carvalho D. The relationship between lumbopelvic flexibility and sitting posture in adult women. J Biomech. 2019;84:204–210. doi:10.1016/j.jbiomech.2018.12.048
    1. Na’ima A, Sari G, Utomo D. Combination effect of core stability exercise and contract relax exercise on hamstring flexibility. Paper presented at:
    1. Williams W, Selkow NM. Self-myofascial release of the superficial back line improves sit-and-reach distance. J Sport Rehabil. Epub 2019, Mar 12.
    1. Antunes RS, de Macedo BG, Amaral Tda S, Gomes Hde A, Pereira LS, Rocha FL. Pain, kinesiophobia and quality of life in chronic low back pain and depression. Acta Ortop Bras. 2013;21(1):27–29. doi:10.1590/S1413-78522013000100005
    1. Bunzli S, Smith A, Watkins R, Schutze R, O’Sullivan P. What do people who score highly on the tampa scale of kinesiophobia really believe? A mixed methods investigation in people with chronic nonspecific low back pain. Clin J Pain. 2015;31(7):621–632. doi:10.1097/AJP.0000000000000143
    1. Norris C, Matthews M. The role of an integrated back stability program in patients with chronic low back pain. Complement Ther Clin Pract. 2008;14(4):255–263. doi:10.1016/j.ctcp.2008.06.001
    1. Hodges PW, Moseley GL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol. 2003;13(4):361–370.
    1. Russo M, Deckers K, Eldabe S, et al. Muscle control and non-specific chronic low back pain. Neuromodulation. 2018;21(1):1–9. doi:10.1111/ner.12738
    1. Bayraktar D, Guclu-Gunduz A, Lambeck J, Yazici G, Aykol S, Demirci H. A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: a pilot study. Disabil Rehabil. 2016;38(12):1163–1171. doi:10.3109/09638288.2015.1075608
    1. Junker D, Stoggl T. The training effects of foam rolling on core strength endurance, balance, muscle performance and range of motion: a randomized controlled trial. J Sports Sci Med. 2019;18(2):229–238.
    1. Bergstrom G, Aniansson A, Bjelle A, Grimby G, Lundgren-Lindquist B, Svanborg A. Functional consequences of joint impairment at age 79. Scand J Rehabil Med. 1985;17(4):183–190.
    1. Granacher U, Lacroix A, Muehlbauer T, Roettger K, Gollhofer A. Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults. Gerontology. 2013;59(2):105–113. doi:10.1159/000343152
    1. Balasubramaniam A, Ghandi VM, Sambandamoorthy A, Sciences B. Role of myofascial release therapy on pain and lumbar range of motion in mechanical back pain: an exploratory investigation of desk job workers. Ibnosina J Med Biomed Sci. 2014;6(2):75–80.
    1. Reid MC, Williams CS, Gill TM. Back pain and decline in lower extremity physical function among community-dwelling older persons. J Gerontol A Biol Sci Med Sci. 2005;60(6):793–797. doi:10.1093/gerona/60.6.793
    1. Rudy TE, Weiner DK, Lieber SJ, Slaboda J, Boston JR. The impact of chronic low back pain on older adults: a comparative study of patients and controls. Pain. 2007;131(3):293–301. doi:10.1016/j.pain.2007.01.012
    1. Hicks GE, Sions JM, Coyle PC, Pohlig RT. Altered spatiotemporal characteristics of gait in older adults with chronic low back pain. Gait Posture. 2017;55:172–176. doi:10.1016/j.gaitpost.2017.04.027
    1. Kim NJ, Kim JS, Wang JS, Park JH, Choi JH. The effects of isometric trunk exercises and dynamic trunk exercises on gait in elderly people. J Phys Ther Sci. 2015;27(6):1685–1689. doi:10.1589/jpts.27.1685
    1. Husky MM, Ferdous Farin F, Compagnone P, Fermanian C, Kovess-Masfety V. Chronic back pain and its association with quality of life in a large French population survey. Health Qual Life Outcomes. 2018;16(1):195. doi:10.1186/s12955-018-1018-4
    1. Deyo RA, Andersson G, Bombardier C, et al. Outcome measures for studying patients with low back pain. Spine. 1994;19(18 Suppl):2032s–2036s. doi:10.1097/00007632-199409151-00003
    1. Kovacs FM, Abraira V, Zamora J, et al. Correlation between pain, disability, and quality of life in patients with common low back pain. Spine. 2004;29(2):206–210. doi:10.1097/01.BRS.0000107235.47465.08
    1. Noormohammadpour P, Kordi M, Mansournia MA, Akbari-Fakhrabadi M, Kordi R. 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(3):490–502. doi:10.4184/asj.2018.12.3.490

Source: PubMed

3
Subscribe