Comparative effectiveness of lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain: randomized clinical trial

Esha A Bhadauria, Peeyoosha Gurudut, Esha A Bhadauria, Peeyoosha Gurudut

Abstract

The aim of the present study was to compare three different forms of exercises namely lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain (LBP) in terms of pain, range of motion, core strength and function. In this study, 44 subjects suffering from non-specific LBP for more than 3 months were randomly allocated into the lumbar stabilization group, the dynamic strengthening group, and the Pilates group. Ten sessions of exercises for 3 weeks were prescribed along with interferential current and hot moist pack. Pain was assessed by visual analog scale, functional affection by modified Oswestry Disability Questionnaire, range of motion by assessing lumbar flexion and extension by modified Schober test and core strength was assessed by pressure biofeedback on day 1 and day 10 of the treatment. There was reduction of pain, improvement in range of motion, functional ability and core strength in all the 3 exercise groups. The improvement was significantly greater in the lumbar stabilization group for all the outcome measures, when compared the posttreatment after 10th session. Pairwise comparison showed that there was greater reduction of disability in the Pilates group than the dynamic strengthening group. It was concluded that the lumbar stabilization is more superior compared to the dynamic strengthening and Pilates in chronic nonspecific LBP. However, long-term benefits need to be assessed and compared with prospective follow-up studies.

Keywords: Chronic low back pain; Dynamic strengthening; Lumbar stabilization; Pilates.

Conflict of interest statement

CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Flow chart diagram.
Fig. 2
Fig. 2
Stabilization exercise.
Fig. 3
Fig. 3
Pilates.
Fig. 4
Fig. 4
Strengthening exercise.

References

    1. Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379:482–491.
    1. Biering-Sørensen F. A prospective study of low back pain in a general population. I. Occurrence, recurrence and aetiology. Scand J Rehabil Med. 1983;15:71–79.
    1. Bindra S, Sinha AK, Benjamin AI. Epidemiology of low back pain in Indian population: a review. Int J Appl Basic Med Res. 2015;5:166–179.
    1. Burton AK, Balagué F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, Leclerc A, Müller G, van der Beek AJ COST B13 Working Group on Guidelines for Prevention in Low Back Pain. Chapter 2. European guidelines for prevention in low back pain: November 2004. Eur Spine J. 2006;15(Suppl 2):S136–168.
    1. Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain. 1983;16:87–101.
    1. Comfort P, Pearson SJ, Mather D. An electromyographical comparison of trunk muscle activity during isometric trunk and dynamic strengthening exercises. J Strength Cond Res. 2011;25:149–154.
    1. de Paula Lima PO, de Oliveira RR, Costa LO, Laurentino GE. Measurement properties of the pressure biofeedback unit in the evaluation of transversus abdominis muscle activity: a systematic review. Physiotherapy. 2011;97:100–106.
    1. Deyo RA, Walsh NE, Martin DC, Schoenfeld LS, Ramamurthy S. A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain. N Engl J Med. 1990;322:1627–1634.
    1. Ferreira PH, Ferreira ML, Maher CG, Herbert RD, Refshauge K. Specific stabilisation exercise for spinal and pelvic pain: a systematic review. Aust J Physiother. 2006;52:79–88.
    1. Fritz JM, Irrgang JJ. A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther. 2001;81:776–788.
    1. Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low back pain. Orthop Clin North Am. 1991;22:263–271.
    1. Gladwell V, Head S, Haggar M, Beneke R. Does a program of Pilates improve chronic non-specific low back pain? J Sport Rehabil. 2006;15:338–350.
    1. Graven-Nielsen T, Svensson P, Arendt-Nielsen L. Effects of experimental muscle pain on muscle activity and co-ordination during static and dynamic motor function. Electroencephalogr Clin Neurophysiol. 1997;105:156–164.
    1. Han TS, Schouten JS, Lean ME, Seidell JC. The prevalence of low back pain and associations with body fatness, fat distribution and height. Int J Obes Relat Metab Disord. 1997;21:600–607.
    1. Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005;(3):CD000335.
    1. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332:1430–1434.
    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;85:209–225.
    1. Krismer M, van Tulder M Low Back Pain Group of the Bone and Joint Health Strategies for Europe Project. Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific) Best Pract Res Clin Rheumatol. 2007;21:77–91.
    1. Macedo LG, Maher CG, Latimer J, McAuley JH. Motor control exercise for persistent, nonspecific low back pain: a systematic review. Phys Ther. 2009;89:9–25.
    1. Manniche C, Lundberg E, Christensen I, Bentzen L, Hesselsøe G. Intensive dynamic back exercises for chronic low back pain: a clinical trial. Pain. 1991;47:53–63.
    1. Moon HJ, Choi KH, Kim DH, Kim HJ, Cho YK, Lee KH, Kim JH, Choi YJ. Effect of lumbar stabilization and dynamic lumbar strengthening exercises in patients with chronic low back pain. Ann Rehabil Med. 2013;37:110–117.
    1. Nadler SF, Steiner DJ, Erasala GN, Hengehold DA, Hinkle RT, Beth Goodale M, Abeln SB, Weingand KW. Continuous low-level heat wrap therapy provides more efficacy than Ibuprofen and acetaminophen for acute low back pain. Spine (Phila Pa 1976) 2002;27:1012–1017.
    1. Pereira LM, Obara K, Dias JM, Menacho MO, Guariglia DA, Schiavoni D, Pereira HM, Cardoso JR. Comparing the Pilates method with no exercise or lumbar stabilization for pain and functionality in patients with chronic low back pain: systematic review and meta-analysis. Clin Rehabil. 2012;26:10–20.
    1. Poitras S, Brosseau L. Evidence-informed management of chronic low back pain with transcutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy. Spine J. 2008;8:226–233.
    1. Rydeard R, Leger A, Smith D. Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. J Orthop Sports Phys Ther. 2006;36:472–484.
    1. Saal JA, Saal JS. Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study. Spine (Phila Pa 1976) 1989;14:431–437.
    1. Sculco AD, Paup DC, Fernhall B, Sculco MJ. Effects of aerobic exercise on low back pain patients in treatment. Spine J. 2001;1:95–101.
    1. Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2005;143:849–856.
    1. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2010;171:135–154.
    1. Storheim K, Bø K, Pederstad O, Jahnsen R. Intra-tester reproducibility of pressure biofeedback in measurement of transversus abdominis function. Physiother Res Int. 2002;7:239–249.
    1. Tousignant M, Poulin L, Marchand S, Viau A, Place C. The Modified-Modified Schober Test for range of motion assessment of lumbar flexion in patients with low back pain: a study of criterion validity, intra- and inter-rater reliability and minimum metrically detectable change. Disabil Rehabil. 2005;27:553–559.
    1. Zambito A, Bianchini D, Gatti D, Viapiana O, Rossini M, Adami S. Interferential and horizontal therapies in chronic low back pain: a randomized, double blind, clinical study. Clin Exp Rheumatol. 2006;24:534–539.
    1. Zanoli G, Strömqvist B, Jönsson B. Visual analog scales for interpretation of back and leg pain intensity in patients operated for degenerative lumbar spine disorders. Spine (Phila Pa 1976) 2001;26:2375–2380.

Source: PubMed

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