Effectiveness of specific stabilization exercise compared with traditional trunk exercise in women with non-specific low back pain: a pilot randomized controlled trial

Eduard Minobes-Molina, Maria Rosa Nogués, Montse Giralt, Carme Casajuana, Dyego Leandro Bezerra de Souza, Javier Jerez-Roig, Marta Romeu, Eduard Minobes-Molina, Maria Rosa Nogués, Montse Giralt, Carme Casajuana, Dyego Leandro Bezerra de Souza, Javier Jerez-Roig, Marta Romeu

Abstract

Background: Non-specific low back pain (LBP) is the leading cause of disability worldwide. The primary physiotherapeutic treatment for LBP is physical exercise, but evidence suggesting a specific exercise as most appropriate for any given case is limited.

Objective: To determine if specific stabilization exercise (SSE) is more effective than traditional trunk exercise (TTE) in reducing levels of pain, disability and inflammation in women with non-specific low back pain (LBP).

Design: A pilot randomized controlled trial was conducted in Rovira i Virgili University, Catalonia.

Methods: Thirty-nine females experiencing non-specific LBP were included in two groups: the TTE program and SSE program, both were conducted by a physiotherapist during twenty sessions. The primary outcome was pain intensity (10-cm Visual Analogue Scale). Secondary outcomes were disability (Roland Morris Disability Questionnaire), and inflammation (IL-6 and TNF-α plasma levels). Measurements were taken at baseline, at half intervention, at post-intervention, and a month later.

Results: Mean group differences in change from baseline to post-intervention for TTE were: -4.5 points (CI 3.3 to 5.6) for pain, -5.1 points (CI 3.0 to 7.3) for disability, 0.19 pg/mL (95% CI [-1.6-1.2]) for IL-6 levels, and 46.2 pg/mL (CI 13.0 to 85.3) for TNF-α levels. For SSE, differences were: -4.3 points (CI 3.1 to 5.6) for pain, -6.1 points (CI 3.7 to 8.6) for disability, 1.1 pg/mL (CI 0.0 to 2.1) for IL-6 levels , and 12.8 pg/mL (95% CI [-42.3-16.7]) for TNF-α levels. There were an insignificant effect size and no statistically significant overall mean differences between both groups.

Conclusion: This study suggests that both interventions (traditional trunk and specific stabilization exercises) are effective in reducing pain and disability in non-specific LBP patients, but the two programs produce different degrees of inflammation change.

Clinical trial registration number: NCT02103036.

Keywords: Exercise therapy; Inflammation; Low back pain; Pain; Physical therapist.

Conflict of interest statement

The authors declare there are no competing interests.

©2020 Minobes-Molina et al.

Figures

Figure 1. Design and flow of participants…
Figure 1. Design and flow of participants through the trial.
Figure 2. Progress of the exercise programs.
Figure 2. Progress of the exercise programs.
Figure 3. Mean (SD) TNF- α biomarker…
Figure 3. Mean (SD) TNF-α biomarker levels in TTEP group and SSEP group at baseline (session 0) and post-intervention (session 20).
TNF-α, tumour necrosis factor alpha; TTEP, traditional trunk exercise program; SSEP, specific stabilization exercise program; A, significant difference between baseline and post-intervention in TTEP group; a, significant difference between baseline groups; b, significant difference between post-intervention groups.
Figure 4. Mean (SD) IL-6 biomarker levels…
Figure 4. Mean (SD) IL-6 biomarker levels in TTEP group and SSEP group at baseline (session 0) and post-intervention (session 20).
IL-6, interleukin 6; TTEP, traditional trunk exercise program; SSEP, specific stabilization exercise program; B, significant difference between baseline and post-intervention in SSEP group.

References

    1. Al-Obaidi S, Mahmoud F. Immune responses following McKenzie lumbar spine exercise in individuals with acute low back pain: a preliminary study. Acta Medica Academica. 2014 doi: 10.5644/ama2006-124.96.
    1. Atlas SJ, Nardin RA. Evaluation and treatment of low back pain: an evidence-based approach to clinical care. Muscle & Nerve. 2003;27:265–284. doi: 10.1002/mus.10311.
    1. Bertalanffy A, Kober A, Bertalanffy P, Gustorff B, Gore O, Adel S, Hoerauf K. Transcutaneous electrical nerve stimulation reduces acute low back pain during emergency transport. Academic Emergency Medicine. 2005;12:607–611. doi: 10.1197/j.aem.2005.01.013.
    1. Bordas JM, Forcada J, Garcia JA, Joaniquet X, Pellisé F, Mazeres O, Prat N, Romera M. Generalitat de Catalunya. Institut Català de la Salut; 2004. Patologia de la columna lumbar en l’adult. Direcció clínica en l’atenció primària. Guies de pàctica clínica: material docent; pp. 1–49.
    1. Chang WD, Lin HY, Lai PT. Core strength training for patients with chronic low back pain. Journal of Physical Therapy Science. 2015;27:619–622. doi: 10.1589/jpts.27.619.
    1. Coulombe BJ, Games KE, Neil ER, Eberman LE. Core stability exercise versus general exercise for chronic low back pain. Journal of Athletic Training. 2017;52:71–72. doi: 10.4085/1062-6050-51.11.16.
    1. Cui JG, Holmin S, Mathiesen T, Meyerson BA, Linderoth B. Possible role of inflammatory mediators in tactile hypersensitivity in rat models of mononeuropathy. Pain. 2000;88:239–248. doi: 10.1016/S0304-3959(00)00331-6.
    1. De Queiroz BZ, Pereira DS, Lopes RA, Felício DC, Silva JP, De Britto Rosa NM, Dias JMD, Dias RC, Lustosa LP, Pereira LSM. Association between the plasma levels of mediators of inflammation with pain and disability in the elderly with acute low back pain: data from the Back Complaints in the Elders (BACE)-Brazil study. Spine. 2016;41:197–203. doi: 10.1097/BRS.0000000000001214.
    1. Field A. Discovering statistics using SPSS. 2nd edition. Sage Publications Ltd; London: 2005. Discovering statistics using SPSS.
    1. Garcia O, Medina A, Schiafinno A. In: Enquesta de Salut de Catalunya. Comportaments relacionats amb la salut, l’estat de salut i l’ús dels serveis sanitaris a Catalunya. Informe dels principals resultats 2015. 1a ed. Direcció General de Planificació en Salut, editor. Generalitat de Catalunya. Departament de Salut; 2016.
    1. Ghafourian M, Ashtary-Larky D, Chinipardaz R, Eskandary N, Mehavaran M. Inflammatory biomarkers’ response to two different intensities of a single bout exercise among soccer players. Iranian Red Crescent Medical Journal. 2016;18:e96005. doi: 10.5812/ircmj.21498.
    1. Gomes-Neto M, Lopes JM, Conceição CS, Araujo A, Brasileiro A, Sousa C, Carvalho VO, Arcanjo FL. Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: a systematic review and meta-analysis. Physical Therapy in Sport. 2017;23:136–142. doi: 10.1016/j.ptsp.2016.08.004.
    1. Haldeman S, Kopansky-Giles D, Hurwitz EL, Hoy D, Mark Erwin W, Dagenais S, Kawchuk G, Strömqvist B, Walsh N. Advancements in the management of spine disorders. Best Practice and Research: Clinical Rheumatology. 2012;26(2):263–280. doi: 10.1016/j.berh.2012.03.006.
    1. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF) Arthritis Care and Research. 2011;63(SUPPL. 11):S240–S252. doi: 10.1002/acr.20543.
    1. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R. A systematic review of the global prevalence of low back pain. Arthritis and Rheumatism. 2012;64:2028–2037. doi: 10.1002/art.34347.
    1. Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Practice and Research: Clinical Rheumatology. 2010;24:769–781. doi: 10.1016/j.berh.2010.10.002.
    1. Jauregui JJ, Cherian JJ, Gwam CU, Chughtai M, Mistry JB, Elmallah RK, Harwin SF, Bhave A, Mont MA. A meta-analysis of transcutaneous electrical nerve stimulation for chronic low back pain. Surgical Technology International. 2016;28:296–302.
    1. Koes BW, Van Tulder MW, Ostelo R, KimBurton A, Waddell G. Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine. 2001;26:2504–2513. doi: 10.1097/00007632-200111150-00022.
    1. Kofotolis ND, Vlachopoulos SP, Kellis E. Sequentially allocated clinical trial of rhythmic stabilization exercises and TENS in women with chronic low back pain. Clinical Rehabilitation. 2008;22:99–111. doi: 10.1177/0269215507080122.
    1. Koumantakis GA, Watson PJ, Jacqueline A. Research report trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with. Physical Therapy. 2005;85(3):209–225.
    1. Kovacs FM, Fernández C, Cordero A, Muriel A, González-Luján L, Gil Del Real MT. Non-specific low back pain in primary care in the Spanish National Health Service: a prospective study on clinical outcomes and determinants of management. BMC Health Services Research. 2006;6:57. doi: 10.1186/1472-6963-6-57.
    1. Kraychete DC, Sakata RK, Issy AM, Bacellar O, Santos-Jesus R, Carvalho EM. Serum cytokine levels in patients with chronic low back pain due to herniated disc: analytical cross-sectional study. Sao Paulo Medical Journal = Revista Paulista de Medicina. 2010;128(5):259–262. doi: 10.1590/S1516-31802010000500003.
    1. Lederman E. The myth of core stability. Journal of Bodywork and Movement Therapies. 2010;14(1):84–98. doi: 10.1016/j.jbmt.2009.08.001.
    1. Macedo LG, Latimer J, Maher CG, Hodges PW, Nicholas M, Tonkin L, McAuley JH, Stafford R. Motor control or graded activity exercises for chronic low back pain? A randomised controlled trial. BMC Musculoskeletal Disorders. 2008;9:65. doi: 10.1186/1471-2474-9-65.
    1. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Journal of Clinical Epidemiology. 2010;63:E1–E37. doi: 10.1016/j.jclinepi.2010.03.004.
    1. Niederer D, Mueller J. Sustainability effects of motor control stabilisation exercises on pain and function in chronic nonspecific low back pain patients: a systematic review with meta-analysis and meta-regression. PLOS ONE. 2020;15:e0227423. doi: 10.1371/journal.pone.0227423.
    1. Opal SM, Depalo VA. Impact of basic research on tomorrow’s medicine: anti-inflammatory cytokines. Chest. 2000;117:1162–1172. doi: 10.1378/chest.117.4.1162.
    1. Page SJ, Persch AC. Recruitment, retention, and blinding in clinical trials. American Journal of Occupational Therapy. 2013;67:154–161. doi: 10.5014/ajot.2013.006197.
    1. Parreira P, Heymans MW, Van Tulder MW, Esmail R, Koes BW, Poquet N, Lin CC, Maher CG. Back Schools for chronic non-specific low back pain. The Cochrane Database of Systematic Reviews. 2017;8(8):CD011674. doi: 10.1002/14651858.CD011674.pub2.
    1. Payares K, Lugo LH, Restrepo A. Validation of the roland morris questionnaire in colombia to evaluate disability in low back pain. Spine. 2015;40:1108–1114. doi: 10.1097/BRS.0000000000000963.
    1. Pereira DS, Mateo ECC, De Queiroz BZ, Assumpção AM, Miranda AS, Felício DC, Rocha NP, Da Cruz Dos Anjos DM, Pereira DAG, Teixeira AL, Pereira LSM. TNF-α, IL6, and IL10 polymorphisms and the effect of physical exercise on inflammatory parameters and physical performance in elderly women. Age. 2013;35:2455–2463. doi: 10.1007/s11357-013-9515-1.
    1. Petersen A, Pedersen B. The anti-inflammatory effect of exercise. Journal of Applied Physiology. 2005;98:1154–1162. doi: 10.1152/japplphysiol.00164.2004.
    1. Queiroz BZ, Pereira DS, De Britto Rosa NM, Lopes RA, Felício DC, Pereira DG, Dias JMD, Dias RC, Pereira LSM. Functional performance and plasma cytokine levels in elderly women with and without low back pain. Journal of Back and Musculoskeletal Rehabilitation. 2015 doi: 10.3233/BMR-140526.
    1. Saavedra Ramírez PG, Vásquez Duque GM, González Naranjo LA. Interleucina-6: ¿amiga o enemiga? Bases para comprender su utilidad como objetivo terapéutico. Iatreia. 2011;24(2):157–166.
    1. Sahin N, Albayrak I, Durmus B, Ugurlu H. Effectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trial. J Rehabil Med. 2011;43:224–229. doi: 10.2340/16501977-0650.
    1. Saner J, Kool J, De Bie RA, Sieben JM, Luomajoki H. Movement control exercise versus general exercise to reduce disability in patients with low back pain and movement control impairment. A randomised controlled trial. BMC Musculoskeletal Disorders. 2011;12:207. doi: 10.1186/1471-2474-12-207.
    1. Shamsi M, Sarrafzadeh J, Jamshidi A. Comparing core stability and traditional trunk exercise on chronic low back pain patients using three functional lumbopelvic stability tests. Physiotherapy Theory and Practice. 2015;31:89–98. doi: 10.3109/09593985.2014.959144.
    1. Takahashi H, Suguro T, Okazima Y, Motegi M, Okada Y, Kakiuchi T. Inflammatory cytokines in the herniated disc of the lumbar spine. Spine. 1996;21:218–224. doi: 10.1097/00007632-199601150-00011.
    1. Thong ISK, Jensen MP, Miró J, Tan G. The validity of pain intensity measures: what do the NRS, VAS, VRS, and FPS-R measure? Scandinavian Journal of Pain. 2018;18:99–107. doi: 10.1515/sjpain-2018-0012.
    1. Tomazoni SS, Costa LOP, Joensen J, Stausholm MB, Naterstad IF, Leal-Junior ECP, Bjordal JM. Effects of photobiomodulation therapy on inflammatory mediators in patients with chronic non-specific low back pain: protocol for a randomized placebo-controlled trial. Medicine. 2019;98:e15177. doi: 10.1097/MD.0000000000015177.
    1. Vallbona C, Roure E, Violan M, Alegre J. 2007. Guia de prescripció d’exercici físic per a la salut (PEFS)
    1. Van Den Hoogen HJM, Koes BW, Th J, Van Eijk M, Bouter LM, Devillé W. On the course of low back pain in general practice: a one year follow up study. Annals of the Rheumatic Diseases. 1998;57:13–19. doi: 10.1136/ard.57.1.13.
    1. Van Tubergen A, Debats I, Ryser L, Londoño J, Burgos-Vargas R, Cardiel MH, Landewé R, Stucki G, Van der Heijde D. Use of a numerical rating scale as an answer modality in ankylosing spondylitis-specific questionnaires. Arthritis Care & Research. 2002;47(3):242–248. doi: 10.1002/art.10397.
    1. Van Tulder MW, Assendelft WJJ, Koes BW, Bouter LM. Spinal radiographic findings and nonspecific low back pain: a systematic review of observational studies. Spine. 1997;22:427–434. doi: 10.1097/00007632-199702150-00015.
    1. Van Tulder M, Becker A, Bekkering T, Breen A, Del Real MTG, Hutchinson A, Koes B, Laerum E, Malmivaara A. Chapter 3: European guidelines for the management of acute nonspecific low back pain in primary care. European Spine Journal. 2006;15(SUPPL. 2):169–191. doi: 10.1007/s00586-006-1071-2.
    1. Van Tulder M, Malmivaara A, Esmail R, Koes B. Exercise therapy for low back pain: a systematic review within the framework of the cochrane collaboration back review group. Spine. 2000;25:2784–2796. doi: 10.1097/00007632-200011010-00011.
    1. Waddell G, Burton AK. Concepts of rehabilitation for the management of low back pain. Journal: Best Practice & Research Clinical Rheumatology. 2005;19:655–670. doi: 10.1016/j.berh.2005.03.008.
    1. Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. Journal of Spinal Disorders. 2000;13:205–217. doi: 10.1097/00002517-200006000-00003.
    1. Walker BF, Muller R, Grant WD. Low back pain in Australian adults. Health provider utilization and care seeking. Journal of Manipulative and Physiological Therapeutics. 2004;27:327–335. doi: 10.1016/j.jmpt.2004.04.006.
    1. Wang X, Zheng J, Yu Z, Bi X, Lou S, Liu J, Cai B, Hua Y, Wu M, Wei M, Shen H, Chen Y, Pan Y, Xu G, Chen P. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLOS ONE. 2012;7:e52082. doi: 10.1371/journal.pone.0052082.
    1. Wieser S, Horisberger B, Schmidhauser S, Eisenring C, Brügger U, Ruckstuhl A, Dietrich J, Mannion AF, Elfering A, Tamcan Ö, Müller U. Cost of low back pain in Switzerland in 2005. European Journal of Health Economics. 2011;12(5):455–467. doi: 10.1007/s10198-010-0258-y.
    1. Williams CM, Maher CG, Latimer J, McLachlan AJ, Hancock MJ, Day RO, Lin CWC. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. The Lancet. 2014;384(9954):1586–1596. doi: 10.1016/S0140-6736(14)60805-9.

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