Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study

Fábio Renovato França, Thomaz Nogueira Burke, Erica Sato Hanada, Amélia Pasqual Marques, Fábio Renovato França, Thomaz Nogueira Burke, Erica Sato Hanada, Amélia Pasqual Marques

Abstract

Objective: To contrast the efficacy of two exercise programs, segmental stabilization and strengthening of abdominal and trunk muscles, on pain, functional disability, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain.

Design: Our sample consisted of 30 individuals, randomly assigned to one of two treatment groups: segmental stabilization, where exercises focused on the TrA and lumbar multifidus muscles, and superficial strengthening, where exercises focused on the rectus abdominis, abdominus obliquus internus, abdominus obliquus externus, and erector spinae. Groups were examined to discovere whether the exercises created contrasts regarding pain (visual analogical scale and McGill pain questionnaire), functional disability (Oswestry disability questionnaire), and TrA muscle activation capacity (Pressure Biofeedback Unit = PBU). The program lasted 6 weeks, and 30-minute sessions occurred twice a week. Analysis of variance was used for inter- and intra-group comparisons. The significance level was established at 5%.

Results: As compared to baseline, both treatments were effective in relieving pain and improving disability (p < 0.001). Those in the segmental stabilization group had significant gains for all variables when compared to the ST group (p < 0.001), including TrA activation, where relative gains were 48.3% and -5.1%, respectively.

Conclusion: Both techniques lessened pain and reduced disability. Segmental stabilization is superior to superficial strengthening for all variables. Superficial strengthening does not improve TrA activation capacity.

Trial registration: ClinicalTrials.gov NCT01124201.

Figures

Figure 1
Figure 1
The test of the abdominal drawing in action in a prone position, monitoring the contraction of TrA with pressure biofeedback unit.

References

    1. Rozemberg S. Chronic low back pain: Definition and treatment. Rev Prat. 2008;15;58:265–72.
    1. Lawrence JP, Greene HS, Grauner JN. Back pain in athletes. J Am Acad Orthop Surg. 2006;14:726–35.
    1. De Vitta A. A lombalgia e suas relações com o tipo de ocupação com a idade e o sexo. Rev Bras Fisioter. 1996;1:67–72.
    1. Ebenbichler GR, Oddsson LIE, Kollmitzer J, Erim Z. Sensory‐motor control of the lower back: Implications for rehabilitation. Med Sci Sports Exerc. 2001;33:1889–98.
    1. Bayramoglu M, Akman MN, Kilinç S, Çetin N, Yavuz N, Özker R. Isokinetic measurement of trunk muscle strength in women with chronic low back pain. Am J Phys Med Rehabil. 2001;80:650–5.
    1. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, Cuyper HJ. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J. 2000;9:266–72.
    1. Hodges PW, Moseley GL, Gabrielsson A, Gandevia SC. Experimental muscle pain changes feed forward postural responses of the trunk muscles. Exp Brain Res. 2003;151:262–71.
    1. Barr KP, Griggs M, Cadby T. Lumbar stabilization: A review of core concepts and current literature, part 2. Am J Phys Med Rehabil. 2007;86:72–80.
    1. Shirado O, Kaneda K, Ito T. Trunk muscle strength during concentric and eccentric contraction: A comparison between healthy subjects and patients with low back pain. J Spinal Disord. 1992;5:175–82.
    1. Liddle SD, Baxter GD, Gracey JH. Exercice and chronic low back pain: What works? Pain. 2004;107:176–90.
    1. Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Meta‐analysis: Exercice therapy for nonspecific low back pain. Ann Intern Med. 2005;142:765–75.
    1. Carpenter DM, Nelson BW. Low back strengthening for the prevention and treatment of low back pain. Med Sci Sports Exerc. 1999;31:18–24.
    1. Leggett S, Mooney V, Matheson LN, Nelson B, Dreisinger T, Zytveld JV, Vie L. Restorative exercise for clinical back pain. A prospective two‐center study with one year follow‐up. Spine. 1999;24:889–98.
    1. Takemasa R, Yamamoto H, Tani T. Trunk muscle strength and effect of trunk muscle exercises for patients with chronic low back pain. The differences in patients with and without organic lumbar lesions. Spine. 1995;20:2522–30.
    1. Calmels P, Jacob JF, Fayolle‐Minon I, Charles C, Bouchet JP, Rimaud D, et al. Étude comparative entre technique isocinétique et kinésithérapie classique chez le lombalgique chronique. Résultats préliminaires. Ann Readapt Med Phys. 2004;47:20–7.
    1. Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic following resolution of acute first‐episode low back pain. Spine. 1996;21:2763–9.
    1. Richardson C, Hodges P, Hides J. Therapeutic exercise for lumbopelvic stabilization: a motor control approach for the treatment and prevention of low back pain. 2nd ed. London: Churchill Livingstone; 2004.
    1. Ferreira PH, Ferreira ML, Maher CG, Refshauge K, Herbert R, Hodges PW. Changes in recruitment of transversus abdominis correlate with disability in people with chronic low back pain. Br J Sports Med. published online 26 May 2009;doi:10.1136/bjsm.2009.061515.
    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;21:2640–50.
    1. Richardson C, Jull G, Hodges PW, Hides JA. Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain: Scientific Basis and Clinical Approach. 1a ed. Sydney: Churchill Livingstone; 1999.
    1. O'Sullivan PB, 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;22:2959–67.
    1. Hides JA, Jull GA, Richardson CA. Long‐term effects of specific stabilizing exercises for first‐episode low back pain. Spine. 2001;26:E243–8.
    1. Varoli FK, Pedrazzi V. Adapted version of the McGill pain questionnaire to Brazilian Portuguese. Braz Dent J. 2006;17:328–35.
    1. Vigatto R, Alexandre NM, Filho HR. Development of a Brazilian Portuguese version of the Oswestry Disability Index. Spine. 2007;32:481–6.
    1. Maciel SC, Jennings F, Jones A, Natour J. The development and validation of a Low Back Pain Knowledge Questionnaire ‐ LKQ. Clinics. 2009;64:1167–75.
    1. Furtado R, Jones A, Furtado RN, Jennings F, Natour J. Validation of the Brazilian‐Portuguese version of the Gesture Behavior Test for patients with non‐specific chronic low back pain. Clinics. 2009;64:83–90.
    1. Anonymous. Stabilizer pressure biofeedback. Operating Instructions. Brisbane: Chattanooga Pacific; 2002.
    1. Richardson C, Jull G. Muscle control‐pain control. What exercises would you prescribe? Manual Therapy. 1995;1:2–10.
    1. Kisner C, Colby L. Exercícios terapêuticos: Fundamentos etécnicas. 3a ed. São Paulo: Manole; 2000.
    1. Hides J, Wilson S, Stanton W, McMahon S, Keto H, McMahon K, et al. An MRI investigation into the function of the transversus abdominis muscle during “drawing‐in” of the abdominal wall. Spine. 2006;31:175–8.
    1. Cairms MC, Harrison K, Wright C. Pressure biofeedback: A useful tool in the quantification of abdominal muscular dysfunction? Physiother. 2000;86:127–38.
    1. Teyhen DS, Miltenberger CE, Deiters HM, Del Toro YM, Pulliam JN, Childs JD, et al. The use of ultrasound imaging of the abdominal drawing‐in maneuver in subjects with low back pain. J Orthop Sports Phys Ther. 2005;35:346–55.
    1. Rodacki CLN, Rodacki ALF, Ugrinowitsch C, Zielinski D, Costa RB. Spinal unloading after abdominal exercises. Clin Biomech. 2008;23:8–14.
    1. Bergmark A. Stability of lumbar spine: A study in mechanical engineering. Acta Orthop Scand. 1989;230:1–54.
    1. Snijders CJ, Ribbers MT, de Bakker HV, Stoeckart R, Stam HJ. EMG recordings of abdominal and back muscles in various standing postures: Validation of a biomechanical model on sacroiliac joint stability. J Eletromyogr Kinesiol. 1998;8:205–14.
    1. Norris CM. Abdominal muscle training in sport. Br J Sports Med. 1993;27:19–27.
    1. Mirka G, Kelaher D, Baker A, Harrison A, Davis J. Selective activation of the external oblique musculature during axial torque production. Clin Biomech. 1997;12:172–80.

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