Disability and back muscle fatigability changes following two therapeutic exercise interventions in participants with recurrent low back pain

Paul S Sung, Paul S Sung

Abstract

Background: The level of disability and endurance of back muscles have been investigated, but there is conflicting evidence following specific exercise interventions for participants with recurrent low back pain (LBP). The purpose of this study was to compare the level of disability and slope of median frequency (MF) of thoracic and lumbar erector spinae (ES) muscles following core stabilization exercise (CSE) and spinal flexibility exercise (SFE).

Material/methods: In total, 46 individuals participated in this study. There were 25 participants in the CSE intervention group (average age of 47.7 ± 8.9 years) and 21 participants in the SFE group (average age of 53.1 ± 9.0 years). Each group participated in the specific exercise intervention program for 4 weeks while maintaining their current activity and/or exercise levels. The Oswestry Disability Index (ODI) was used to measure the level of disability changes. The fatigability of the ES back muscles was measured by the slope of MF, using a modified Sorensen test.

Results: The disability level decreased significantly following CSE intervention (t=2.23, p<0.05). However, there was no significant difference in muscle fatigability changes in the 4-week intervention period for either group.

Conclusions: The CSE intervention reduced disability level following the 4-week intervention period. Further studies are needed to investigate the effectiveness of specific back muscle exercises in longer intervention periods for back muscle fatigability.

Figures

Figure 1
Figure 1
The core stabilization exercise program.
Figure 2
Figure 2
The spinal flexibility exercise program.
Figure 3
Figure 3
Flow diagram depicting how the treatment group was formed as well as group membership and number of drop-outs throughout the course of the study.
Figure 4
Figure 4
The Oswestry Disability Index (ODI) scale following two interventions. The ODI decreased significantly from 24.89±11.89 to 17.73±11.75 for the core stabilization exercise group (t=2.23, p=0.03). However, the ODI of the spinal flexibility exercise group changed from 26.69±8.65 to 24.46±8.87 following the intervention (t=–0.86, p=0.40).

References

    1. Bono CM. Low-back pain in athletes. J Bone Joint Surg Am. 2004;86-A(2):382–96.
    1. Carlson C. Axial back pain in the athlete: pathophysiology and approach to rehabilitation. Curr Rev Musculoskelet Med. 2009;2(2):88–93.
    1. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8(1):8–20.
    1. Ivanova JI, et al. Real-world practice patterns, health-care utilization, and costs in patients with low back pain: the long road to guideline-concordant care. Spine J. 2011;11(7):622–32.
    1. Granata KP, Slota GP, Wilson SE. Influence of fatigue in neuromuscular control of spinal stability. Hum Factors. 2004;46(1):81–91.
    1. Coorevits PL, et al. Statistical modelling of fatigue-related electromyographic median frequency characteristics of back and hip muscles during a standardized isometric back extension test. J Electromyogr Kinesiol. 2005;15(5):444–51.
    1. Vuillerme N, Anziani B, Rougier P. Trunk extensor muscles fatigue affects undisturbed postural control in young healthy adults. Clin Biomech (Bristol, Avon) 2007;22(5):489–94.
    1. Sung PS, Zurcher U, Kaufman M. Gender differences in spectral and entropic measures of erector spinae muscle fatigue. J Rehabil Res Dev. 2008;45(9):1431–39.
    1. Johanson E, et al. The effect of acute back muscle fatigue on postural control strategy in people with and without recurrent low back pain. Eur Spine J. 2011;20(12):2152–59.
    1. Tsao H, et al. Motor training of the lumbar paraspinal muscles induces immediate changes in motor coordination in patients with recurrent low back pain. J Pain. 2010;11(11):1120–28.
    1. Hodges PW. Core stability exercise in chronic low back pain. Orthop Clin North Am. 2003;34(2):245–54.
    1. Hodges PW, Moseley GL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol. 2003;13(4):361–70.
    1. Abenhaim L, et al. The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain. Spine (Phila Pa 1976) 2000;25(4 Suppl):1–33S.
    1. van Tulder MW, et al. Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group. Spine. 2001;26(3):270–81.
    1. Rhee HS, Kim YH, Sung PS. A randomized controlled trial to determine the effect of spinal stabilization exercise intervention based on pain level and standing balance differences in patients with low back pain. Med Sci Monit. 2012;18(3):CR174–89.
    1. Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. Phys Ther. 2001;81(10):1641–74.
    1. Nadler SF, et al. Hip muscle imbalance and low back pain in athletes: influence of core strengthening. Med Sci Sports Exerc. 2002;34(1):9–16.
    1. Richardson CA, et al. Therapeutic exercise for spinal segmental stabilization in low back pain. London: Harcourt Publishers; 1999.
    1. Rainville J, et al. Exercise as a treatment for chronic low back pain. Spine J. 2004;4(1):106–15.
    1. Jenkins J, Beazell J. Flexibility for runners. Clin Sports Med. 2010;29(3):365–77.
    1. McGill SM. Low back exercises: evidence for improving exercise regimens. Phys Ther. 1998;78(7):754–65.
    1. Mayer TG, et al. Lumbar myoelectric spectral analysis for endurance assessment. A comparison of normals with deconditioned patients. Spine. 1989;14(9):986–91.
    1. Klein AB, et al. Comparison of spinal mobility and isometric trunk extensor forces with electromyographic spectral analysis in identifying low back pain. Physical Therapy. 1991;71(6):445–54.
    1. Lee T, Kim YH, Sung PS. A comparison of pain level and entropy changes following core stability exercise intervention. Med Sci Monit. 2011;17(7):CR362–68.
    1. Jackson CP, Brown MD. Is there a role for exercise in the treatment of patients with low back pain? Clin Orthop. 1983;(179):39–45.
    1. Lee TR, Kim YH, Sung PS. Spectral and entropy changes for back muscle fatigability following spinal stabilization exercises. J Rehabil Res Dev. 2010;47(2):133–42.
    1. Stanton TR, et al. How do we define the condition ‘recurrent low back pain’? A systematic review. Eur Spine J. 2010;19(4):533–39.
    1. O’Sullivan K, Murray E, Sainsbury D. The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects. BMC Musculoskelet Disord. 2009;10:37.
    1. Elnaggar IM, et al. Effects of spinal flexion and extension exercises on low-back pain and spinal mobility in chronic mechanical low-back pain patients. Spine. 1991;16(8):967–72.
    1. Hatzikotoulas K, et al. Muscle fatigue and electromyographic changes are not different in women and men matched for strength. Eur J Appl Physiol. 2004;92(3):298–304.
    1. Sung PS. Multifidi muscles median frequency before and after spinal stabilization exercises. Arch Phys Med Rehabil. 2003;84(9):1313–18.
    1. Elfving B, Dedering A, Nemeth G. Lumbar muscle fatigue and recovery in patients with long-term low-back trouble – electromyography and health-related factors. Clin Biomech (Bristol, Avon) 2003;18(7):619–30.
    1. Roy SH, et al. Classification of back muscle impairment based on the surface electromyographic signal. J Rehabil Res Dev. 1997;34(4):405–14.
    1. Mannion AF, et al. The use of surface EMG power spectral analysis in the evaluation of back muscle function. J Rehabil Res Dev. 1997;34(4):427–39.
    1. Klenerman L, et al. The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting. Spine. 1995;20(4):478–84.
    1. Begg C, et al. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. Jama. 1996;276(8):637–39.
    1. Sung PS, Spratt KF, Wilder DG. A possible methodological flaw in comparing dominant and nondominant sided lumbar spine muscle responses without simultaneously considering hand dominance. Spine. 2004;29(17):1914–22.
    1. Brophy R, et al. Gender influences: the role of leg dominance in ACL injury among soccer players. Br J Sports Med. 2010;44(10):694–97.
    1. Andersen TE, et al. Video analysis of the mechanisms for ankle injuries in football. Am J Sports Med. 2004;32(1 Suppl):69–79S.
    1. Fairbank JC, et al. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66(8):271–73.
    1. Sung PS, Zurcher U, Kaufman M. Reliability difference between spectral and entropic measures of erector spinae muscle fatigability. J Electromyogr Kinesiol. 2010;20(1):25–30.
    1. Lariviere C, et al. Evaluation of measurement strategies to increase the reliability of EMG indices to assess back muscle fatigue and recovery. J Electromyogr Kinesiol. 2002;12(2):91–102.
    1. Zipp P. Recommendations for the standardization of lead positions in surface electromyography. Eur J Appl Physiol. 1982;50:41–54.
    1. Wilder DG, Pope MH, Frymoyer JW. The biomechanics of lumbar disc herniation and the effect of overload and instability. J Spinal Disord. 1988;1(1):16–32.
    1. Sung PS, Lammers AR, Danial P. Different parts of erector spinae muscle fatigability in subjects with and without low back pain. Spine J. 2009;9(2):115–20.
    1. O’Sullivan P, et al. Altered patterns of abdominal muscle activation in patients with chronic low back pain. Aust J Physiother. 1997;43(2):91–98.
    1. Wu CY, et al. Responsiveness, minimal detectable change, and minimal clinically important difference of the Nottingham Extended Activities of Daily Living Scale in patients with improved performance after stroke rehabilitation. Arch Phys Med Rehabil. 2011;92(8):1281–87.
    1. Ostelo RW, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 2008;33(1):90–94.
    1. Clark BC, Manini TM, Ploutz-Snyder LL. Derecruitment of the lumbar musculature with fatiguing trunk extension exercise. Spine (Phila Pa 1976) 2003;28(3):282–87.
    1. Janda V. Muscles, central nervous motor regulation and back problems. In: Korr IM, editor. The Neurologic Mechanisms in Manulative Therapy. New York: Plenum Press; 1978.

Source: PubMed

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