Effects and Mechanisms of Specific Trunk Exercises in Low Back Pain
16 octobre 2017 mis à jour par: Sharon M. Henry, University of Vermont
Low back pain affects 80% of Americans at some time during their lives.
Although recovery usually occurs within 6 months, there is a 50% recurrence within one year's time.
It has long been thought that poor control of trunk muscle may lead to abnormal forces across the spine, which then damage local spinal structures, thus, leading to low back pain.
However, the investigators know little about the function of specific trunk muscles in healthy subjects during various activities of daily life.
Furthermore, the precise muscle dysfunction associated with low back pain has not been well characterized at all.
In addition, the investigators know little about which exercise protocol is most beneficial for particular subgroups of people with low back pain.
Thus, the purposes of this study are to learn more about: 1) how trunk muscles are affected by low back pain; 2) which exercises might be most beneficial for people with certain kinds of low back pain; and 3) how these exercises influence trunk muscle function.
By having a better understanding of which trunk muscles are affected by low back pain, rehabilitation specialists can design exercise programs and therapeutic interventions that are more specific and more effective.
Aperçu de l'étude
Statut
Complété
Les conditions
Intervention / Traitement
Type d'étude
Interventionnel
Inscription (Réel)
58
Phase
- N'est pas applicable
Contacts et emplacements
Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.
Lieux d'étude
-
-
Vermont
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Burlington, Vermont, États-Unis, 05405
- Human Motion Analysis Laboratory
-
-
Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
21 ans à 55 ans (Adulte)
Accepte les volontaires sains
Oui
Sexes éligibles pour l'étude
Tout
La description
Inclusion Criteria:
- a history of chronic LBP with or without recurrences for a minimum of 12 months
- between 21 - 55 years of age
- able to stand and walk without assistance
- have an Oswestry Disability Score of 19% or higher
Exclusion Criteria:
- any major structural spinal deformity including scoliosis, kyphosis, or stenosis
- spinal fracture or dislocation
- osteoporosis
- ankylosing spondylitis
- rheumatoid arthritis
- disc herniation with corroborating clinical signs and symptoms
- serious spinal complications such as tumor or infection
- previous spinal surgery
- frank neurological loss, i.e., weakness and sensory loss
- pain or paresthesia below the knee
- etiology of LBP other than the lumbar spine, e.g., hip joint
- history of neurological disease which required hospitalization
- active treatment for cancer
- history of unresolved cancer
- pregnancy or less than 6 months post-partum or less than 6 months post weaning
- magnified symptom-behavior
- worker's compensation or disability case
- in litigation for the LBP problem
- have a BMI ≥ 30
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Double
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Expérimental: Stabilization
|
The stabilization exercise protocol consists of exercises focused on improving the ability of trunk muscles to stabilize the spine, beginning with training to isolate the deeper abdominal muscles as well as deep dorsal trunk muscles.
Then patients were progressed to exercises that added leverage of the limbs while maintaining the co-contraction of the deeper abdominal muscles and deep dorsal trunk muscles while breathing normally.
Various positions (e.g., supine and quadruped positions) were used to challenge the patients based on their tolerance.
Finally, patients were progressed to exercises in more functional positions that included tasks/activities that were reported as challenging and/or painful; patients performed the tasks at the speed demanded by the particular task.
Maintenance of the co-contraction of deep trunk muscles was emphasized during these functional activities.
Autres noms:
|
|
Comparateur actif: Strengthening and Conditioning
|
This protocol contained trunk strengthening and endurance exercises.
It consisted of 3 phases: 1) initial strengthening of trunk flexors/extensors in single plane movements, 2) trunk and lower-extremity stretching as well as progression of trunk-strengthening exercises to include multi-planar trunk movements.
Aerobic exercises were progressed as tolerated and patient education about body biomechanics were reinforced, and 3) trunk-strengthening exercises under dynamic conditions (e.g., unstable support surface and in multi-planar trunk movements).
During the 10 week protocol, exercises became more challenging, and each subject had to complete at least the first phase before moving onto the next phase in order to be included in post-testing analyses.
There was no specific focus on the deep abdominal or deep dorsal trunk muscles during any of these exercises.
Autres noms:
|
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Change From Baseline to 11 Weeks in Oswestry Disability Scale (0-100%)
Délai: Baseline and 11 weeks
|
Disability; Scale 0-100% Lower score is considered better/improved Negative value indicates improvement
|
Baseline and 11 weeks
|
|
Change From Baseline to 6 Months in Oswestry Disability Scale (0-100%)
Délai: Baseline and 6 Months
|
Disability; Sacle 0-100% Lower score is considered better/improved; Negative value indicates improvement
|
Baseline and 6 Months
|
|
Change From 11 Weeks to 6 Months in Oswestry Disability Scale (0-100%)
Délai: 11 Weeks and 6 Months
|
Disability; Sacle 0-100% Lower score is considered better/improved; Negative value indicates improvement
|
11 Weeks and 6 Months
|
|
Change From Baseline to 11 Weeks in Numeric Pain Rating Scale (0-10 Points)
Délai: Baseline and 11 weeks
|
Current Pain Scale 0-10 Lower score is better/improved; Negative value indicates improvement
|
Baseline and 11 weeks
|
|
Change From Baseline to 6 Months in Numeric Pain Rating Scale (0-10 Points)
Délai: Baseline and 6 months
|
Current Pain Scale 0-10 Lower score is better/improved; Negative value indicates improvement
|
Baseline and 6 months
|
|
Change From 11 Weeks to 6 Months in Numeric Pain Rating Scale (0-10 Points)
Délai: 11 weeks and 6 months
|
Current Pain Scale 0-10 Lower score is better/improved; Negative value indicates improvement
|
11 weeks and 6 months
|
Collaborateurs et enquêteurs
C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.
Parrainer
Collaborateurs
Les enquêteurs
- Chercheur principal: Sharon M Henry, PT, PhD, University of Vermont
Publications et liens utiles
La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.
Publications générales
- Jacobs JV, Henry SM, Jones SL, Hitt JR, Bunn JY. A history of low back pain associates with altered electromyographic activation patterns in response to perturbations of standing balance. J Neurophysiol. 2011 Nov;106(5):2506-14. doi: 10.1152/jn.00296.2011. Epub 2011 Jul 27.
- Jones SL, Henry SM, Raasch CC, Hitt JR, Bunn JY. Individuals with non-specific low back pain use a trunk stiffening strategy to maintain upright posture. J Electromyogr Kinesiol. 2012 Feb;22(1):13-20. doi: 10.1016/j.jelekin.2011.10.006. Epub 2011 Nov 18.
- Stokes IA, Gardner-Morse MG, Henry SM. Abdominal muscle activation increases lumbar spinal stability: analysis of contributions of different muscle groups. Clin Biomech (Bristol, Avon). 2011 Oct;26(8):797-803. doi: 10.1016/j.clinbiomech.2011.04.006. Epub 2011 May 14.
- Stokes IA, Gardner-Morse MG, Henry SM. Intra-abdominal pressure and abdominal wall muscular function: Spinal unloading mechanism. Clin Biomech (Bristol, Avon). 2010 Nov;25(9):859-66. doi: 10.1016/j.clinbiomech.2010.06.018. Epub 2010 Jul 23.
- Jones SL, Henry SM, Raasch CC, Hitt JR, Bunn JY. Responses to multi-directional surface translations involve redistribution of proximal versus distal strategies to maintain upright posture. Exp Brain Res. 2008 May;187(3):407-17. doi: 10.1007/s00221-008-1312-1. Epub 2008 Feb 26.
- Teyhen DS, Gill NW, Whittaker JL, Henry SM, Hides JA, Hodges P. Rehabilitative ultrasound imaging of the abdominal muscles. J Orthop Sports Phys Ther. 2007 Aug;37(8):450-66. doi: 10.2519/jospt.2007.2558.
- Henry SM, Teyhen DS. Ultrasound imaging as a feedback tool in the rehabilitation of trunk muscle dysfunction for people with low back pain. J Orthop Sports Phys Ther. 2007 Oct;37(10):627-34. doi: 10.2519/jospt.2007.2555.
- Anderson-Worth SG, Henry SM, Bunn JY. Use of real time ultrasound feedback enhances learning the abdominal hollowing exercise in patients with low back pain. New Zealand J Physiotherapy. 35(1):4-11, 2007.
- Henry SM, Hitt JR, Jones SL, Bunn JY. Decreased limits of stability in response to postural perturbations in subjects with low back pain. Clin Biomech (Bristol, Avon). 2006 Nov;21(9):881-92. doi: 10.1016/j.clinbiomech.2006.04.016. Epub 2006 Jun 27.
- Henry SM, Westervelt KC. The use of real-time ultrasound feedback in teaching abdominal hollowing exercises to healthy subjects. J Orthop Sports Phys Ther. 2005 Jun;35(6):338-45. doi: 10.2519/jospt.2005.35.6.338.
- Lomond KV, Henry SM, Hitt JR, DeSarno MJ, Bunn JY. Altered postural responses persist following physical therapy of general versus specific trunk exercises in people with low back pain. Man Ther. 2014 Oct;19(5):425-32. doi: 10.1016/j.math.2014.04.007. Epub 2014 Apr 24.
Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude
1 mars 2003
Achèvement primaire (Réel)
1 juin 2008
Achèvement de l'étude (Réel)
1 juin 2008
Dates d'inscription aux études
Première soumission
1 juin 2012
Première soumission répondant aux critères de contrôle qualité
4 juin 2012
Première publication (Estimation)
5 juin 2012
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
18 octobre 2017
Dernière mise à jour soumise répondant aux critères de contrôle qualité
16 octobre 2017
Dernière vérification
1 octobre 2017
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- NIH/NCMRR/R01-HD040909
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
NON
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