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

Muhammad Waseem Akhtar, Hossein Karimi, Syed Amir Gilani, Muhammad Waseem Akhtar, Hossein Karimi, Syed Amir Gilani

Abstract

Background & objective: Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain. However, there is lack of consensus on the best exercise treatment and numerous studies are underway. Conclusive studies are lacking especially in this part of the world. Thisstudy was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exerciseprovided in patients with nonspecific chronic mechanical low back pain.

Methods: This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine Institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A & B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale (VAS) pretreatment, at 2nd, 4th and 6th week post treatment.

Results: The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2nd, 4th and 6th week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively.

Conclusion: Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with non-specific low back pain.

Keywords: Core Stability; Exercise Therapy; Low Back Pain; Manual Therapy.

Figures

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Fig. 1
Flow Sheet Diagram of the Research Process.

References

    1. Orrock PJ, Myers SP. Osteopathic intervention in chronic non-specific low back pain: a systematic review. BMC Musculoskelet Disord. 2013;14(1):129. doi:10.1186/1471-2474-14-129.
    1. Savigny P, Kuntze S, Watson P, Underwood M, Ritchie G, Cotterell M, et al. Low back pain: early management of persistent non-specific low back pain. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners. 2009:14.
    1. Rosario-MEDERI B, do Maranhão SL, de Oncologia M, Garcia JB. Prevalence of low back pain in Latin America: a systematic literature review. Pain Physician. 2014;17:379–391.
    1. Airaksinen O, Brox J, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4 European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15:s192–s300.
    1. Faas A. Exercises: which ones are worth trying, for which patients, and when? Spine. 1996;21(24):2874–2478.
    1. Koes BW, Bouter LM, Beckerman H, Van Der Heijden G, Knipschild PG. Physiotherapy exercises and back pain: a blinded review. BMJ. 1991;302(6792):1572–1576.
    1. Long A, Donelson R, Fung T. Does it matter which exercise?: A randomized control trial of exercise for low back pain. Spine. 2004;29(23):2593–2602.
    1. Cherkin DC, Deyo RA, Battié M, Street J, Barlow W. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. New Eng J Med. 1998;339(15):1021–1029.
    1. Van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain: a systematic review of randomized controlled trials of the most common interventions. Spine. 1997;22(18):2128–2156.
    1. Abenhaim L, Rossignol M, Valat JP, Nordin M, Avouac B, Blotman F, et al. The role of activity in the therapeutic management of back pain: Report of the International Paris Task Force on Back Pain. Spine. 2000;25(4S):1S–33S.
    1. Foster NE, Thompson KA, Baxter GD, Allen JM. Management of nonspecific low back pain by physiotherapists in Britain and Ireland: a descriptive questionnaire of current clinical practice. Spine. 1999;24(13):1332.
    1. Richardson C, Jull G. Muscle control–pain control. What exercises would you prescribe? Man Ther. 1995;1(1):2–10.
    1. Akuthota V, Nadler SF. Core strengthening. Arch Phys Med Rehabil. 2004;85:86–92.
    1. Wang XQ, Zheng JJ, Yu ZW, Bi X, Lou SJ, Liu J, et al. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PloS one. 2012;7(12):e52082.
    1. Hibbs AE, Thompson KG, French D, Wrigley A, Spears I. Optimizing performance by improving core stability and core strength. Sports Med. 2008;38(12):995–1008.
    1. Sakpal T. Sample size estimation in clinical trial. Perspect Clin Res. 2010;1(2):67–69.
    1. Boonstra AM, Preuper HRS, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res. 2008;31(2):165–169.
    1. Kelly A. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001;18(3):205–207.
    1. Kisner C, Colby LA. Therapeutic exercise: foundations and techniques: Fa Davis. 2012
    1. Areeudomwong P, Puntumetakul R, Jirarattanaphochai K, Wanpen S, Kanpittaya J, Chatchawan U, et al. Core stabilization exercise improves pain intensity, functional disability and trunk muscle activity of patients with clinical lumbar instability: a pilot randomized controlled study. J Phys Ther Sci. 2012;24(10):1007–1012.
    1. Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Phys Ther. 2005;85(3):209–25.
    1. O'Sullivan PB, Phyty GDM, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine. 1997;22(24):2959–2967.
    1. Cholewicki J, Juluru K, Radebold A, Panjabi MM, McGill SM. Lumbar spine stability can be augmented with an abdominal belt and/or increased intra-abdominal pressure. Eur Spine J. 1999;8(5):388–395.
    1. Costa LO, Maher CG, Latimer J, Hodges PW, Herbert RD, Refshauge KM, et al. Motor control exercise for chronic low back pain: a randomized placebo-controlled trial. Phys Ther. 2009;89(12):1275–1286.

Source: PubMed

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