The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial

Abstract

Background: Various exercises have been proposed to mitigate chronic low back pain (LBP). However, to date, no one particular exercise has been shown to be superior. Hence, the aim of this study was to compare the efficiency between 2 exercises: the individualized graded lumbar stabilization exercise (IGLSE) and walking exercise (WE).

Methods: A randomized controlled trial was conducted in 48 participants with chronic LBP. After screening, participants were randomized to 1 of 4 groups: flexibility exercise, WE, stabilization exercise (SE), and stabilization with WE (SWE) groups. Participants underwent each exercise for 6 weeks. The primary outcome was visual analog scale (VAS) of LBP during rest and physical activity. Secondary outcomes were as follows: VAS of radiating pain measured during rest and physical activity; frequency of medication use (number of times/day); Oswestry disability index; Beck depression inventory; endurances of specific posture; and strength of lumbar extensor muscles.

Results: LBP during physical activity was significantly decreased in all 4 groups. Exercise frequency was significantly increased in the SE and WE groups; exercise time was significantly increased in the SE group. The endurance of supine, side lying, and prone posture were significantly improved in the WE and SWE groups.

Conclusions: Lumbar SE and WE can be recommended for patients with chronic LBP because they not only relieve back pain but also prevent chronic back pain through improving muscle endurance.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1

These figures show the exercise protocol for flexibility and lumbar stabilization exercises. Flexibility exercise consisted of stretching in the abdominal muscle, quadriceps, hamstring, tensor fascia lata, piriformis, and quadratus lumborum muscles (A). The stabilization exercise group was educated with individualized graded lumbar stabilization exercise (IGLSE). The IGLSE protocol consisted of 2 parts: the stretching exercises and stabilization exercises (B). After the stretching exercises of 5 minutes, patients were instructed to complete the stabilization exercises for 25 minutes. Each level had 7 basic positions: supine, dead bug, side-lying, prone, bird dog, bridge, and plank positions (5 levels). At the beginning, patients were placed into an exercise level with moderate difficulty, with gradual increase in difficulty with increased patient capacity. Squared figures show a specific posture used to measure the muscular endurance for the secondary outcome. Endurance was measured on 3 postures (supine, side-lying, and prone), respectively.

Figure 1 (Continued)

These figures show the exercise protocol for flexibility and lumbar stabilization exercises. Flexibility exercise consisted of stretching in the abdominal muscle, quadriceps, hamstring, tensor fascia lata, piriformis, and quadratus lumborum muscles (A). The stabilization exercise group was educated with individualized graded lumbar stabilization exercise (IGLSE). The IGLSE protocol consisted of 2 parts: the stretching exercises and stabilization exercises (B). After the stretching exercises of 5 minutes, patients were instructed to complete the stabilization exercises for 25 minutes. Each level had 7 basic positions: supine, dead bug, side-lying, prone, bird dog, bridge, and plank positions (5 levels). At the beginning, patients were placed into an exercise level with moderate difficulty, with gradual increase in difficulty with increased patient capacity. Squared figures show a specific posture used to measure the muscular endurance for the secondary outcome. Endurance was measured on 3 postures (supine, side-lying, and prone), respectively.

Figure 2

This figure shows the study flow diagram.

Figure 3

These figures show the changes of LBP and radiating pain during rest and physical activity, although statistically insignificant, the stabilization exercise group and walking exercise group showed more continuous improvement of LBP during rest and physical activity than the flexibility exercise group (A, B, D).

Figure 4

Figure (A) shows the pamphlet illustrating the correct postures. The correct lumbar posture emphasizes the significance of lumbar lordosis, which is effective in preventing lumbar disc protrusion (A). Figure (B) shows the rationale of why we adapted lumbar stabilization exercise that activates not only the deep muscles but also the superficial muscles simultaneously rather than motor control exercise. When lumbar 4-5 disc herniation develop, more loosening is developed at the multifidus muscle (eg, 20%) than the erector spinae muscle (eg, 10%). As a consequence, contraction of the deep multifidus muscles in these patients develops later than healthy population because of muscular loosening (B).