Effects of Different Trunk Training Methods for Chronic Low Back Pain: A Meta-Analysis

Dhananjaya Sutanto, Robin S T Ho, Eric T C Poon, Yijian Yang, Stephen H S Wong, Dhananjaya Sutanto, Robin S T Ho, Eric T C Poon, Yijian Yang, Stephen H S Wong

Abstract

We conducted a systematic review and meta-analysis comparing motor control, isometric, and isotonic trunk training intervention for pain, disability, and re-injury risk reduction in chronic low back pain patients. The EMBASE, MEDLINE, CENTRAL, PsycINFO, SPORTDiscus, and CINAHL databases were searched from inception until 25 February 2021 for chronic low back pain intervention based on any trunk training. Outcomes include the Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ) for disability, the Numerical Pain Rating Scale (NPRS) for pain, and the Sorensen Test (ST) for future risk of re-injury. Isometric training was superior to the control with a mean difference (MD) = -1.66, 95% confidence interval (CI) [-2.30, -1.01] in pain reduction; MD = -7.94, 95% CI [-10.29, -5.59] in ODI; MD = -3.21, 95% CI [-4.83, -1.60] in RMDQ; and MD = 56.35 s, 95% CI [51.81 s, 60.90 s] in ST. Motor control was superior to the control with a MD = -2.44, 95% CI [-3.10, -1.79] in NPRS; MD = -8.32, 95% CI [-13.43, -3.22] in ODI; and MD = -3.58, 95% CI [-5.13, -2.03] in RMDQ. Isometric and motor control methods can effectively reduce pain and disability, with the isometric method reducing re-injury risk.

Keywords: exercise therapy; low back pain; rehabilitation.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of literature selection in the systematic reviews on trunk muscle training for chronic low back pain.
Figure 2
Figure 2
Pairwise meta-analyses on the effectiveness of isometric trunk muscle training compared to the control for chronic low back pain.
Figure 3
Figure 3
Pairwise meta-analyses on the effectiveness of motor control trunk muscle training compared to the control for chronic low back pain.
Figure 4
Figure 4
Pairwise meta-analyses on the comparative effectiveness of different trunk muscle training methods for chronic low back pain.
Figure 5
Figure 5
Pairwise meta-analyses with no significant results.
Figure 5
Figure 5
Pairwise meta-analyses with no significant results.
Figure 6
Figure 6
Risk of bias among the included randomised controlled trials.

References

    1. Deyo R.A., Rainville J., Kent D.L. What can the history and physical examination tell us about low back pain? JAMA. 1992;268:760–765. doi: 10.1001/jama.1992.03490060092030.
    1. Freburger J.K., Holmes G.M., Agans R.P., Jackman A.M., Darter J.D., Wallace A.S., Castel L.D., Kalsbeek W.D., Carey T.S. The rising prevalence of chronic low back pain. Arch. Intern. Med. 2009;169:251–258. doi: 10.1001/archinternmed.2008.543.
    1. Airaksinen O., Brox J.I., Cedraschi C., Hildebrandt J., Klaber-Moffett J., Kovacs F., Mannion A.F., Reis S.H.M.U.E.L., Staal J.B., Ursin H., et al. Chapter 4 European guidelines for the management of chronic nonspecific low back pain. Eur. Spine J. 2006;15:s192–s300. doi: 10.1007/s00586-006-1072-1.
    1. Deyo R.A., Mirza S.K., Martin B.I. Back pain prevalence and visit rates: Estimates from U.S. national surveys, 2002. Spine. 2006;31:2724–2727. doi: 10.1097/.
    1. Wong W.S., Fielding R. Prevalence and Characteristics of Chronic Pain in the General Population of Hong Kong. J. Pain. 2011;12:236–245. doi: 10.1016/j.jpain.2010.07.004.
    1. Cholewicki J., Juluru K., McGill S.M. Intra-abdominal pressure mechanism for stabilizing the lumbar spine. J. Biomech. 1999;32:13–17. doi: 10.1016/S0021-9290(98)00129-8.
    1. Gunning J., Callaghan J., McGill S. The role of prior loading history and spinal posture on the compressive tolerance and type of failure in the spine using a porcine trauma model. Clin. Biomech. 2001;16:471–480. doi: 10.1016/S0268-0033(01)00032-8.
    1. Veres S.P., Robertson P.A., Broom N.D. The morphology of acute disc herniation: A clinically relevant model defining the role of flexion. Spine. 2009;34:2288–2296. doi: 10.1097/BRS.0b013e3181a49d7e.
    1. Yingling V.R., McGill S.M. Anterior shear of spinal motion segments: Kinematics, kinetics, and resultant injuries observed in a porcine model. Spine. 1999;24:1882. doi: 10.1097/00007632-199909150-00004.
    1. Gore M., Sadosky A., Stacey B.R., Tai K.S., Leslie D. The burden of chronic low back pain: Clinical comorbidities, treatment patterns, and health care costs in usual care settings. Spine. 2012;37:E668–E677. doi: 10.1097/BRS.0b013e318241e5de.
    1. McGill S.M., Childs A., Liebenson C. Endurance times for low back stabilization exercises: Clinical targets for testing and training from a normal database. Arch. Phys. Med. Rehabil. 1999;80:941–944. doi: 10.1016/S0003-9993(99)90087-4.
    1. O’Sullivan P.B., Twomey L.T., Allison G.T. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis of spondylolisthesis. Spine. 1997;22:2959–2967. doi: 10.1097/00007632-199712150-00020.
    1. Zatsiorsky V.M. Science and Practice of Strength Training. 2nd ed. Human Kinetics; Champaign, IL, USA: 2006.
    1. Axler C.T., McGill S.M. Low back loads over a variety of abdominal exercises: Searching for the safest abdominal challenge. Med. Sci. Sports Exerc. 1997;29:804–811. doi: 10.1097/00005768-199706000-00011.
    1. Cohen I., Rainville J. Aggressive Exercise as Treatment for Chronic Low Back Pain. Sports Med. 2002;32:75–82. doi: 10.2165/00007256-200232010-00004.
    1. Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust. J. Physiother. 2002;48:297–302. doi: 10.1016/S0004-9514(14)60169-0.
    1. Maeo S., Takahashi T., Takai Y., Kanehisa H. Trunk muscle activities during abdominal bracing: Comparison among muscles and exercises. J. Sports Sci. Med. 2013;12:467–474.
    1. Tampier C., Drake J.D., Callaghan J.P., McGill S.M. Progressive disc herniation: An investigation of the mechanism using radiologic, histochemical, and microscopic dissection techniques on a porcine model. Spine. 2007;32:2869–2874. doi: 10.1097/BRS.0b013e31815b64f5.
    1. McGill S. Low Back Disorders: Evidence-Based Prevention and Rehabilitation. 3rd ed. Human Kinetics; Champaign, IL, USA: 2016.
    1. Rathod S., Shah N. The Effect of Training Core Stabilizers in Clerks with Low Back Pain. Indian J. Physiother. Occup. Ther. 2015;9:141–146. doi: 10.5958/0973-5674.2015.00029.5.
    1. Calatayud J., Guzman-Gonzalez B., Andersen L.L., Cruz-Montecinos C., Morell M.T., Roldán R., Ezzatvar Y., Casaña J. Effectiveness of a group-based progressive strength training in primary care to improve the recurrence of low back pain exacerbations and function: A randomised trial. Int. J. Environ. Res. Public Health. 2020;17:8326. doi: 10.3390/ijerph17228326.
    1. Akhtar M.W., Karimi H., Gilani S.A. Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic nonspecific low back pain: A randomized controlled clinical trial. Pak. J. Med. Sci. 2017;33:1002–1006. doi: 10.12669/pjms.334.12664.
    1. Bae C.R., Jin Y., Yoon B.C., Kim N.H., Park K.W., Lee S.H. Effects of assisted sit-up exercise compared to core stabilization exercise on patients with non-specific low back pain: A randomized controlled trial. J. Back Musculoskelet. Rehabil. 2018;31:871–880. doi: 10.3233/BMR-170997.
    1. Santaella da Fonseca Lopes de Sousa K., Orfale A.G., Meireles S.M., Roberto Leite J., Natour J. Assessment of a biofeedback program to treat chronic low back pain. J. Musculoskelet. Pain. 2009;17:369–377. doi: 10.3109/10582450903284828.
    1. Masharawi Y., Nadaf N. The effect of non-weight bearing group-exercising on females with non-specific chronic low back pain: A randomized single blind controlled pilot study. J. Back Musculoskelet. Rehabil. 2013;26:353–359. doi: 10.3233/BMR-130391.
    1. Hayden J., Van Tulder M.W., Malmivaara A., Koes B.W. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst. Rev. 2005 doi: 10.1002/14651858.CD000335.pub2.
    1. Smith B.E., Littlewood C., May S. An update of stabilisation exercises for low back pain: A systematic review with meta-analysis. BMC Musculoskelet. Disord. 2014;15:1–21. doi: 10.1186/1471-2474-15-416.
    1. Owen P.J., Miller C.T., Mundell N.L., Verswijveren S.J., Tagliaferri S.D., Brisby H., Bowe S.J., Belavy D.L. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br. J. Sports Med. 2020;54:1279–1287. doi: 10.1136/bjsports-2019-100886.
    1. Davies C.C., Nitz A.J. Psychometric properties of the Roland-Morris Disability Questionnaire compared to the Oswestry Disability Index: A systematic review. Phys. Ther. Rev. 2009;14:399–408. doi: 10.1179/108331909X12540993898134.
    1. Rethlefsen M.L., Kirtley S., Waffenschmidt S., Lakner Z., Popp J. PRISMA-S: An extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews. Syst. Rev. 2021;10:39. doi: 10.1186/s13643-020-01542-z.
    1. Parreira P., Heymans M.W., van Tulder M.W., Esmail R., Koes B.W., Poquet N., Lin C.W.C., Maher C.G. Back Schools for chronic non-specific low back pain. Cochrane Database Syst. Rev. 2017 doi: 10.1002/14651858.CD011674.pub2.
    1. Hildebrandt V.H. Back pain in the working population: Prevalence rates in Dutch trades and professions. Ergonomics. 1995;38:1283–1298. doi: 10.1080/00140139508925188.
    1. Kofotolis N., Kellis E. Effects of two 4-week proprioceptive neuromuscular facilitation programs on muscle endurance, flexibility, and functional performance in women with chronic low back pain. Phys. Ther. 2006;86:1001–1012. doi: 10.1093/ptj/86.7.1001.
    1. Aasa B., Berglund B., Aasa U. Potential predictors of activity and pain intensity twelve months after spinal motor control training in patients with low back pain. Physiotherapy. 2015;1:eS26–eS27. doi: 10.1016/j.physio.2015.03.135.
    1. Qaseem A., Wilt T.J., McLean R.M., Forciea M.A. Clinical Guidelines Committee of the American College of Physicians Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann. Intern. Med. 2017;166:514. doi: 10.7326/M16-2367.
    1. Nadeau M., Rosas-Arellano M.P., Gurr K.R., Bailey S.I., Taylor D.C., Grewal R., Lawlor D.K., Bailey C.S. The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation. Can. J. Surg. 2013;56:372. doi: 10.1503/cjs.016512.
    1. Ross M.D., Bayer E. Cancer as a cause of low back pain in a patient seen in a direct access physical therapy setting. J. Orthop. Sports Phys. Ther. 2005;35:651–658. doi: 10.2519/jospt.2005.35.10.651.
    1. Staud R. Evidence for shared pain mechanisms in osteoarthritis, low back pain, and fibromyalgia. Curr. Rheumatol. Rep. 2011;13:513. doi: 10.1007/s11926-011-0206-6.
    1. Hussain N.S., Perez-Cruet M.J. Complication management with minimally invasive spine procedures. Neurosurg. Focus. 2011;31:E2. doi: 10.3171/2011.8.FOCUS11165.
    1. Menon S.K., Onyia C.U. A short review on a complication of lumbar spine surgery: CSF leak. Clin. Neurol. Neurosurg. 2015;139:248–251. doi: 10.1016/j.clineuro.2015.10.013.
    1. Gladwell V., Head S., Haggar M., Beneke R. Does a program of Pilates improve chronic non-specific low back pain? 449. J. Sport Rehabil. 2006;15:338–350. doi: 10.1123/jsr.15.4.338.
    1. Abass A.O., Alli A.R., Olagbegi O.M., Christie C.J., Bolarinde S.O. Effects of an eight-week lumbar stabilization exercise programme on selected variables of patients with chronic low back pain. Bangladesh J. Med. Sci. 2020;19:467–474. doi: 10.3329/bjms.v19i3.45864.
    1. Wewege M.A., Booth J., Parmenter B.J. Aerobic vs. resistance exercise for chronic non-specific low back pain: A systematic review and meta-analysis. J. Back Musculoskelet. Rehabil. 2018;31:889–899. doi: 10.3233/BMR-170920.
    1. Khadilkar A., Odebiyi D.O., Brosseau, Wells G.A. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst. Rev. 2008 doi: 10.1002/14651858.CD003008.pub3.
    1. Ebadi S., Henschke N., Forogh B., Ansari N.N., van Tulder M.W., Babaei-Ghazani A., Fallah E. Therapeutic ultrasound for chronic low back pain. Cochrane Database Syst. Rev. 2020 doi: 10.1002/14651858.CD009169.pub3.
    1. Steffens D., Maher C.G., Pereira L.S., Stevens M.L., Oliveira V.C., Chapple M., Teixeira-Salmela L.F., Hancock M.J. Prevention of low back pain: A systematic review and meta-analysis. JAMA Intern. Med. 2016;176:199–208. doi: 10.1001/jamainternmed.2015.7431.
    1. Biering-Sørensen F. Physical measurements as risk indicators for low-back trouble over a one-year period. Spine. 1984;9:106–119. doi: 10.1097/00007632-198403000-00002.
    1. Denteneer L., Van Daele U., Truijen S., De Hertogh W., Meirte J., Stassijns G. Reliability of physical functioning tests in patients with low back pain: A systematic review. Spine J. 2018;18:190–207. doi: 10.1016/j.spinee.2017.08.257.
    1. Del Pozo-Cruz B., Mocholi M.H., del Pozo-Cruz J., Parraca J.A., Adsuar J.C., Gusi N. Reliability and validity of lumbar and abdominal trunk muscle endurance tests in office workers with nonspecific subacute low back pain. J. Back Musculoskelet. Rehabil. 2014;27:399–408. doi: 10.3233/BMR-140460.
    1. Pilz B., Vasconcelos R.A., Teixeira P.P., Mello W., Oliveira I.O., Ananias J., Timko M., Grossi D.B. Comparison of Hip and Lumbopelvic Performance Between Chronic Low Back Pain Patients Suited for the Functional Optimization Approach and Healthy Controls. Spine. 2020;45:E37–E44. doi: 10.1097/BRS.0000000000003198.
    1. Chiarotto A., Boers M., Deyo R.A., Buchbinder R., Corbin T.P., Costa L.O., Foster N.E., Grotle M., Koes B.W., Kovacs F.M., et al. Core outcome measurement instruments for clinical trials in nonspecific low back pain. Pain. 2018;159:481. doi: 10.1097/j.pain.0000000000001117.
    1. Smeets R., Köke A., Lin C.W., Ferreira M., Demoulin C. Measures of function in low back pain/disorders: Low back pain rating scale (LBPRS), oswestry disability index (ODI), progressive isoinertial lifting evaluation (PILE), quebec back pain disability scale (QBPDS), and roland-morris disability questionnaire (RDQ) Arthritis Care Res. 2011;63:S158–S173.
    1. Savigny P., Watson P., Underwood M. Early management of persistent non-specific low back pain: Summary of NICE guidance. BMJ. 2009;338 doi: 10.1136/bmj.b1805.
    1. Liguori G., American College of Sports Medicine . American College of Sports Medicine’s Guidelines for Exercise Testing and Prescription. 11th ed. Wolters Kluwer; Philadelphia, PA, USA: 2021. ACSM’s guidelines for exercise testing and prescription.
    1. Higgins J.P., Thompson S.G., Deeks J.J., Altman D.G. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560. doi: 10.1136/bmj.327.7414.557.
    1. Sterne J.A., Savović J., Page M.J., Page M.J., Hróbjartsson A., Boutron I., Reeves B., Eldridge S. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366 doi: 10.1136/bmj.l4898.
    1. Suni J., Rinne M., Natri A., Statistisian M.P., Parkkari J., Alaranta H. Control of the lumbar neutral zone decreases low back pain and improves self-evaluated work ability: A 12-month randomized controlled study. Spine. 2006;31:E611–E620. doi: 10.1097/01.brs.0000231701.76452.05.
    1. Hicks G.E., Fritz J.M., Delitto A., McGill S.M. Preliminary Development of a Clinical Prediction Rule for Determining Which Patients With Low Back Pain Will Respond to a Stabilization Exercise Program. Arch. Phys. Med. Rehabil. 2005;86:1753–1762. doi: 10.1016/j.apmr.2005.03.033.
    1. Fors M., Enthoven P., Abbott A., Öberg B. Effects of pre-surgery physiotherapy on walking ability and lower extremity strength in patients with degenerative lumbar spine disorder: Secondary outcomes of the PREPARE randomised controlled trial. BMC Musculoskelet. Disord. 2019;20:468. doi: 10.1186/s12891-019-2850-3.
    1. Puntumetakul R., Chalermsan R., Hlaing S.S., Tapanya W., Saiklang P., Boucaut R. The effect of core stabilization exercise on lumbar joint position sense in patients with subacute non-specific low back pain: A randomized controlled trial. J. Phys. Ther. Sci. 2018;30:1390–1395. doi: 10.1589/jpts.30.1390.
    1. Storheim K., Brox J.I., Holm I., Koller A.K., Bo K. Intensive group training versus cognitive intervention in sub-acute low back pain: Short-term results of a single-blind randomized controlled trial. J. Rehabil. Med. 2003;35:132–140. doi: 10.1080/16501970310010484.
    1. Wong E.Y., Deyo R.A. Acute low back pain. Prim. Care Update OB/GYNS. 2001;8:171–174. doi: 10.1016/S1068-607X(01)00077-4.
    1. Günay S., Yildirim Y., Karadibak D. The effect of the muscle endurance training on the chronic low back pain. Türk Fizyoterapi ve Rehabilitasyon Dergisi/Turkish. J. Physiother. Rehabil. 2014;25:4. doi: 10.7603/s40680-014-0004-y.
    1. Gonzalez-Medina G., Perez-Cabezas V., Ruiz-Molinero C., Chamorro-Moriana G., Jimenez-Rejano J.J., Galán-Mercant A. Effectiveness of Global Postural Re-Education in Chronic Non-Specific Low Back Pain: Systematic Review and Meta-Analysis. J. Clin. Med. 2021;10:5327. doi: 10.3390/jcm10225327.
    1. Ikeda D.M., McGill S.M. Can altering motions, postures, and loads provide immediate low back pain relief: A study of 4 cases investigating spine load, posture, and stability. Spine. 2012;37:E1469–E1475. doi: 10.1097/BRS.0b013e31826c97e5.
    1. Merinero D., Rodríguez-Aragón M., Álvarez-González J., López-Samanes Á., López-Pascual J. Acute Effects of Global Postural Re-Education on Non-Specific Low Back Pain. Does Time-of-Day Play a Role? Int. J. Environ. Res. Public Health. 2021;18:713. doi: 10.3390/ijerph18020713.
    1. Shamsi M., Mirzaei M., HamediRad M. Comparison of muscle activation imbalance following core stability or general exercises in nonspecific low back pain: A quasi-randomized controlled trial. BMC Sports Sci. Med. Rehabil. 2020;12:1–9. doi: 10.1186/s13102-020-00173-0.
    1. Shamsi M.B., Rezaei M., Zamanlou M., Sadeghi M., Pourahmadi M.R. Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial. Physiother. Theory Pract. 2016;32:171–178. doi: 10.3109/09593985.2015.1117550.
    1. Shamsi M.B., Sarrafzadeh J., Jamshidi A. Comparing core stability and traditional trunk exercise on chronic low back pain patients using three functional lumbopelvic stability tests. Physiother. Theory Pract. 2015;31:89–98. doi: 10.3109/09593985.2014.959144.
    1. Koumantakis G.A., Watson P.J., Oldham J.A. Trunk muscle stabilization training plus general exercise versus general exercise only: Randomized controlled trial of patients with recurrent low back pain. Phys. Ther. 2005;85:209–225. doi: 10.1093/ptj/85.3.209.
    1. Majiwala B.A., Warude T.A., Pawar A. Effect of isometric and isotonic exercise training on core muscle in patients with non-specific low back pain. Asian J. Pharm. Clin. Res. 2017;10:308–311. doi: 10.22159/ajpcr.2017.v10i6.17714.
    1. Bickel C.S., Cross J.M., Bamman M.M. Exercise dosing to retain resistance training adaptations in young and older adults. Med. Sci. Sports Exerc. 2011;43:1177–1187. doi: 10.1249/MSS.0b013e318207c15d.
    1. Moher D., Hopewell S., Schulz K.F., Montori V., Gøtzsche P.C., Devereaux P.J., Elbourne D., Egger M., Altman D.G. CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. J. Clin. Epidemiol. 2010;63:e1–e37. doi: 10.1016/j.jclinepi.2010.03.004.

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