ChapterPDF Available

Abstract and Figures

Chronic low-back pain (CLBP) affects most adults at some point in their lives. The purpose of the review was to search and analyze contemporary studies on muscular stretching and core stability (CS) exercise in rehabilitation of CLBP. Science Direct, Springer, and Google Scholar database were searched for related articles published from 2008–2013. A total of 57 articles were identified; however, only 10 papers fulfilled the criteria for this review. The results showed that both CS exercise and muscular stretching improve pain level and functional disability among CLBP patients. However, there is modest evidence from the relevant reviews that CS exercise is superior to muscular stretching in CLBP rehabilitation since CS exercise improves the deep core muscles, whereas muscular stretching has no effect on the deep core muscles. The effects of specific types of stretching techniques (e.g., effect of dynamic stretching and PNF stretching) are unclear because most studies reviewed utilize only basic stretching techniques. Hence, there is a need for further studies to examine the effects of specific stretching techniques on CLBP.
Content may be subject to copyright.
Proceedings of the International Colloquium on Sports Science, Exercise, Engineering and Technology 2014 (ICoSSEET 2014)
Efficacy of core stability exercise and muscular
stretching on chronic lower back pain
Ebby Waqqash, Rahmat Adnan, Sarina Md Yusof, Shariman Ismadi Ismail
Faculty of Sports Science and Recreation
Universiti Teknologi MARA (UiTM)
Selangor, Malaysia
ebbywaqqash@hotmail.com
AbstractChronic low back pain (CLBP) affects most adults
at some point in their lives. The purpose of the review was to
search and analyze contemporary studies on muscular stretching
and core stability (CS) exercise in rehabilitation of CLBP. The
ScienceDirect, Springer and Google Scholar database was
searched for related articles published from 2008-2013. A total of
57 articles were identified however only 10 papers fulfilled the
criteria for this review. The results shows that both CS exercise
and muscular stretching improves pain level and functional
disability among CLBP patients. However, there is modest
evidence from the relevant reviews that CS exercise is superior to
muscular stretching in CLBP rehabilitation since CS exercise
improves the deep core muscles whereas muscular stretching has
no effect on the deep core muscles. The effects of specific types of
stretching techniques (e.g: Dynamic stretching and PNF
stretching) is unclear because most studies reviewed utilize only
basic stretching technique in their study. Hence, there is a need
for further studies to determine the effects of specific stretching
techniques on CLBP.
Keywordslow back pain, core exercise, stretching, and
rehabilitation.
I. INTRODUCTION
Chronic lower back pain (CLBP) is one of the most
prevalent causes of disability and morbidity in our society [1,
2].
According to [3], one of the primary causes of CLBP is
weakness and/or tightness in the core muscles. A weak core
is the fundamental that leads to many inefficient movements
that leads to injury. The tightness of core muscles also leads
to CLBP because it may influence the entire muscle kinetic
chain of body movement. [4] states that the core also known
as lumbo-pelvic-hip complex is attached to local (postural,
tonic) muscles i.e. transverse abdominis, multifidi, quadratus
lumborum. These local muscles are responsible for providing
segmental stability and directly controlling the lumbar
segments during movement.
Rehabilitation therapy for CLBP has emerged over the
time. Core stabilization (CS) exercise is the basic and
fundamental component of all comprehensive functional
rehabilitation programs [3]. CS exercise program is designed
to help an individual to gain functional strength,
neuromuscular control and muscle endurance of the core
muscles [3, 5]. Muscular stretching is another physical
therapy increasingly used in rehabilitation technique program
in CLBP [6]. Muscular Stretching for CLBP patient are
designed progressively stretch the muscle groups which are
assumed to be too short [3].
Commonly, lower back ache is only due to muscle
tightness rather than caused by injuries. The combine
treatment of stretching and CS exercise is time consuming &
may not be necessary as muscle tightness can be alleviated
with stretching alone. Thus it is still unclear which
appropriate physical rehabilitation treatment in managing
people with chronic back pain. The purpose of this article
was to review the empiric studies of muscular stretching and
core stability exercise in rehabilitation of CLBP.
II. METHODOLOGY
Search strategy:
The database used to search related articles was Springer,
Science Direct and Google Scholar database. Keywords: low
back pain, core exercise, stretching, and rehabilitation.
Inclusion criteria:
A study was included if it met the following criteria:
1. Written in English
2. The target population was people with CLBP.
3. Stretching or Core stability exercise as intervention.
4. Date of publication: 2008-2013
Exclusion Criteria:
A study was excluded if:
1. It was a systematic review or meta-analysis.
2. Other interventions aside from stretching and core
stability exercise (examples include massage, strength
training, locomotion training).
Figure 1:
Data collection process
III. RESULTS
57 papers were identified but only 10 papers were
identified to fulfill the inclusion and exclusion criteria for
this review. The papers was extracted from 3 different
databases; Science direct (46%), Springer (34%) and Google
Scholar (20%). In the 10 published papers (2008-2013), it
was discovered that the primary intervention for CLBP core
strengthening was core stability exercise. Muscular
stretching was identified as the secondary approach for
rehabilitation of CLBP. Most of the studies performed
combined interventions while only few compared the
interventions. The outcome measures most frequently used
by the studies were thoracolumbar ROM, functional
disability, pain, and trunk muscle strength and endurance.
Core stability exercise:
Five studies on core stability exercise were identified.
The reviewed studies showed that core stability exercise
helps to improve pain level, functional disability, and
activation of tonic core muscle groups.
In the first CS exercise study reviewed, [7] studied on the
effects of integrated back stability (IBS) program in CLBP
population. The IBS program helps improves level of pain
and functional impairment in 89% patients suffering from
CLBP. In the second CS exercise study reviewed, [8]
evaluated the efficacy of supervised core exercise, spinal
manipulation, and home exercise for the treatment of CLBP.
The researchers conclude that supervised core exercise was
significantly better than chiropractic spinal manipulation and
home exercise in terms of satisfaction with treatment and
trunk muscle endurance. In the third CS exercise study
reviewed, [9] investigated the effects of CLBP on the trunk
muscle activity, body balance, and lumbar range of motion
during performing core stability exercises. Their finding
shows that CLBP patients inhibit greater muscle activity
levels than control participants CLBP participants. In the
fourth CS exercise study reviewed, [2] studied on the effects
of pelvic floor muscle exercise on women with chronic back
pain. The overall finding shows that the pelvic floor muscle
exercise combined with routine treatment was not more
superior than routine treatment alone in terms of improving
pain and functional disability, but is more efficient in
improving core muscles strength and endurance. Finally in
the last CS exercise study reviewed, [10] compared the
effects of lumbar stabilization exercises on unstable surface
vs. on stable surface. The researchers conclude that both
lumbar stabilization exercises on stable and unstable surface
will improve cross sectional areas of the multifidus segment,
weight bearing, pain relief and functional disability. They
further mentioned that the lumbar stabilization exercise on
unstable surface is superior to stable surface.
Muscular Stretching:
Four studies on muscular stretching were identified. The
reviewed studies show that muscular stretching helps to
improve pain level, functional disability, and joint range of
motions (ROM).
Table 1:
Reviews on the efficacy of core stability exercise in
rehabilitation of CLBP
Authors
Intervention
Outcomes
Norris &
Matthews
[7]
6 week treatment
- Intervention group:
Integrated back
stability (IBS)
- Control group:
Back care advice
leaflet.
Pain & functional
impairment improve
following IBS.
Bronfort,
et al. [8]
6 weeks treatment :
- Supervised trunk exercise
(group 1)
- chiropractic spinal
manipulative therapy (group
2)
- home exercise (group 3)
Group 1 was
significantly better
treatment satisfaction &
trunk muscle endurance
than Group 2 and
Group3
Desai &
Marshall
[9]
2 sessions :
- 5 different exercise on
Labile (unstable) surface
CLBP patients > muscle
activity levels than
control participants.
Mohseni-
Bandpei, et
al. [2]
Control group:
- Routine therapy
Experimental group:
- Routine therapy
- Pelvic Floor Muscle
(PFM) exercise
Chung, et
al. [10]
Stabilization program (SP) +
balls:
- 8 week stabilization
program (3x/ week)
Stabilization program (SP) only:
- 8 week stabilization
program (3x/ week)
Both SP with or w/o ball
improve:
In the first muscular stretching study reviewed, [11]
conducted a biomechanical study on the effects of
performing stretching during prolong sitting. The researchers
discovered that stretching exercise in between prolong sitting
does not have any significant effect on the postural
alignment (spinal posture). Nevertheless, the stretches were
efficient in reducing the participants’ level of discomfort. In
the second muscular stretching study reviewed [12]
conducted an randomized controlled trial (RCT) comparing
yoga, stretching and self-care book for CLBP. The overall
finding was yoga sessions and conventional stretching were
equally efficient than self-care book in improving function
and pain level. In the third muscular stretching study
reviewed [13] examined the effectiveness of stretching
exercise program on low back pain (LBP) and exercise self-
efficacy among nurses in Taiwan. The researchers reported
that after 6 months of undergoing stretching program, 81%
of participants reported a moderate to high level of LBP
relief. Furthermore, they also improved on their exercise
self-efficacy. Finally In the last muscular stretching study
reviewed [14] discovered that active-static stretching (jack-
knife technique) is efficient to increase flexibility of tight
hamstrings which was reported to be one of the main causes
of CLBP.
Core stability exercise vs. Muscular Stretching:
[15] compared muscular stretching vs. segmental
stabilization in patients with CLBP. They discovered both
interventions improved pain and functional disability
although they found out that segmental stabilization was
superior to muscular stretching for improving Transverse
Abdominis (TA) muscle activation capacity among CLBP
patients.
IV. DISCUSSION
The purpose of this review was to evaluate the
effectiveness of core stabilization (CS) exercises versus
muscular stretching as a therapeutic exercise intervention on
patients with backache. 10 related studies were identified and
evaluated.
Core stability exercise rationales
Core stability exercise has become an integral component
in the management of patients with lower back pain for the
past decade [5]. The authors’ review of the existing evidence
suggests that core stability exercise is effective in improving
pain, function and activation of tonic core muscle groups
among heterogeneous group of patients with CLBP [2, 7-10].
Core stability exercise is defined as exercises which activates
deep core muscles such as the transverse abdominis (TA)
and multifidi [16].
The hypothetical rationale for the CLBP improvements
after CS exercise includes the following; A core stabilization
exercise program is designed to help an individual to gain
functional strength, neuromuscular control and muscle
endurance of the lumbo-pelvic-hip complex [3, 5]. This
approach will offer a more biomechanical efficient for the
entire kinetic chain of the lumbo-pelvic-hip complex thus
allowing the body to decelerate gravity, ground reaction
forces and momentum at the right joint, in the right plane and
at the right time [3]. [3] further mention that the increased
stability of the trunk will enable the individual to maintain
the spine and pelvis in the most comfortable and acceptable
mechanical position that control the forces of repetitive
micro trauma and protect the structures of the back from
further damage.
Muscular stretching rationales
Stretching is another physical therapy increasingly used
in rehabilitation technique program in CLBP [6]. Any
motion of body parts that causes movement of a joint can be
called stretching [17]. After extensive searching and reading
on studies of muscular stretching on CLBP, the authors
concluded that there are very few studies on the effects of
muscular stretching for CLBP rehabilitation. Furthermore,
the stretching protocols used in previous studies were very
general and not specific to recognized stretching protocols
(for example: Dynamic and PNF stretching). Despite the
limited studies of stretching on CLBP, the authors managed
to identify 4 studies related to the field. The authors’
discovered that muscular stretching is effective in improving
pain and function but does no improve muscular strength and
endurance of tonic core muscle groups [10-12, 14]. What is
the relationship between flexibility and lower back pain?
According to [4], specific muscle tightness or shortening
is commonly found in association with lower back pain.
Commonly shortened muscles include erector spinae, psoas,
iliotibial band, hip external rotators, hamstrings, rectus
femoris, and gastrocnemius. Tightness of these muscles
affects the biomechanical of the lumbar spine. Alter [18]
explains an example of a theoretical model based on
decrease lumbar flexion in those with lower back pain; tight
hip extensors decrease the lordotic curve that naturally exist
in the lumbar spine which can exaggerate the posterior tilt of
Table 2:
Reviews on the efficacy of muscular stretching in
rehabilitation of CLBP
Authors
Intervention
Outcomes
Rajaratnam
et al. [11]
2 hours to watch a movie
1. Control: sat continuously
2. Experiment: performed
stretch exe. when sited
Prolong sitting no effect on
postural alignment.
Stretches efficient reduce
discomfort.
Sherman,
et al. [12]
12 weeks, 1x a week
1. Yoga group
2. Stretching group
3. Self-book care group
Yoga & stretching equally
efficient than self-care book
in improving function and
pain level.
Chen, et al.
[13]
6 months; 3x a week
1. Control: Perform usual
activities: 50 min. per
session
2. Experiment: Stretching
exercise program
81% of experimental:
moderate to high level of
LBP relief; improved on
exercise self-efficacy
Sairyo, et
al. [14]
4 weeks , every day, 2 sets of
jackknife stretch
Jackknife stretch efficient to
increase flexibility of tight
hamstrings which was
reported to be one of the
main causes of CLBP
the pelvis. This condition will diminishes the shock
absorbing capacity of the lumbar segments and increases
compression forces on the lumbar spine. According to [19],
the thoracolumbar often maintain chronic muscular tension,
which can be greatly alleviated through effective stretching.
Stretching for lower back pain patient are designed
progressively stretch the muscle groups which are assumed
to be too short, especially the lumbar spinal muscle and the
hip flexors and extensors [3].
Core stability exercise vs. Muscular stretching
In the beginning, it appears that core stabilization
exercise and muscular stretching has equal effects in
rehabilitation of CLBP. Nonetheless, there is modest
evidence that core stability exercise is more beneficial than
muscular stretching in CLBP rehabilitation. It is discovered
that core stability exercise promotes improvement in tonic
core muscle strength and endurance whereas muscular
stretching does not [15].
This review has several limitations. First, the literature
searching scope is small as only 3 databases (Springer,
Science direct and Google Scholar) were used to search the
related articles, hence the authors may have overlook other
recent findings. Second, despite after thorough and extensive
searching using the common keywords, the search may have
not identified all articles. This is because some of the articles
may have been termed differently thus it was hard to find
these articles.
V. CONCLUSION
In summary, CLBP has been one of the most common
complaints in the modern society. The core also known as
lumbo-pelvic-hip complex is attached to local (postural,
tonic) muscles which are responsible for providing
segmental stability and directly controlling of the lumbar
segments during movement. Weakness and/or tightness of
these groups of muscles will cause many disorganized
movements that leads to lower back injury. Core stability
exercise has become a fundamental component in the
management of patients with CLBP as it helps individual to
regain functional strength, neuromuscular control and muscle
endurance of the lumbo-pelvic-hip complex. Stretching is
another intervention widely used in physical therapy which
helps alleviates CLBP by progressively stretching the muscle
groups which are assumed to be too short, especially the
lumbar spinal muscle and the hip flexors and extensor. Core
stability exercise is more beneficial than muscular stretching
in CLBP rehabilitation as CS exercise develops strong deep
core muscles to provide segmental stability and directly
controlling the lumbar segments during movement.
VI. REFERENCES
1. Ferreira, M.L., et al., Comparison of general
exercise, motor control exercise and spinal
manipulative therapy for chronic low back pain: A
randomized trial. Pain, 2007. 131(12): p. 31-37.
2. Mohseni-Bandpei, M.A., et al., The effect of pelvic
floor muscle exercise on women with chronic non-
specific low back pain. Journal of Bodywork and
Movement Therapies, 2011. 15(1): p. 75-81.
3. Prentice, E.W., Rehabilitation Techniques for
Sports Medicine and Athletic Training. Fifth ed.
2011: McGraw-Hill 707.
4. Brukner, P. and K. Khan, Clinical Sports Medicine.
Third ed. 2007, Sydney: McGraw-Hill.
5. Standaert, C.J., S.M. Weinstein, and J. Rumpeltes,
Evidence-informed management of chronic low
back pain with lumbar stabilization exercises. The
Spine Journal, 2008. 8(1): p. 114-120.
6. Poiraudeau, S. and M. Revel, Rehabilitation
therapy in chronic low back pain. Joint Bone
Spine, 2000. 67(6): p. 582-587.
7. Norris, C. and M. Matthews, The role of an
integrated back stability program in patients with
chronic low back pain. Complementary Therapies
in Clinical Practice, 2008. 14(4): p. 255-263.
8. Bronfort, G., et al., Supervised exercise, spinal
manipulation, and home exercise for chronic low
back pain: a randomized clinical trial. The Spine
Journal, 2011. 11(7): p. 585-598.
9. Desai, I. and M.W.P. Marshall, Acute effect of
labile surfaces during core stability exercises in
people with and without low back pain. Journal of
Electromyography and Kinesiology, 2010. 20: p.
1155-1162.
10. Chung, S., J. Lee, and J. Yoon, Effects of
Stabilization Exercise Using a Ball on Mutifidus
Cross-Sectional Area in Patients with Chronic Low
Back Pain. Journal of Sports Science and Medicine
2013. 12: p. 1-9.
11. Rajaratnam, B.S., et al., Can Stretching Exercises
Reduce Your Risks of Experiencing Low Back
Pain?, in 13th International Conference on
Biomedical Engineering, C. Lim and J.H. Goh,
Editors. 2009, Springer Berlin Heidelberg. p. 2114-
2117.
12. Sherman, K.J., et al., A randomized trial
comparing yoga, stretching, and a self-care book
for chronic low back pain. Archives of Internal
Medicine, 2011. 171(22): p. 2019-2026.
13. Chen, H.-M., et al., Effectiveness of a Stretching
Exercise Program on Low Back Pain and Exercise
Self-Efficacy Among Nurses in Taiwan: A
Randomized Clinical Trial. Pain Management
Nursing, 2012(0).
14. Sairyo, K., et al., Jack-knife stretching promotes
flexibility of tight hamstrings after 4 weeks: a pilot
study. European Journal of Orthopaedic Surgery &
Traumatology, 2013. 23(6): p. 657-663.
15. França, F.R., et al., Effects of Muscular Stretching
and Segmental Stabilization on Functional
Disability and Pain in Patients with Chronic Low
Back Pain: A Randomized, Controlled Trial.
Journal of Manipulative and Physiological
Therapeutics, 2012. 35(4): p. 279-285.
16. May, S. and R. Johnson, Stabilisation exercises for
low back pain: a systematic review. Physiotherapy,
2008. 94(3): p. 179-189.
17. Nelson, G.A. and J. Kokkonen, Stretching
Anatomy. 2007, United States of America: Human
Kinetics. 147.
18. Alter, J.M., Science of Flexibility. 3rd ed. 2004:
Human Kinetics.
19. McAtee, E.R. and J. Charland, Facilitated
Stretching. Third ed. 2007: Human kinetics. 183.
... Non-specific back pain is due to mechanical stress related to the wrong posture and over strain of back muscles in response to excess work. The vertebral column is designed with strong bones, ligaments, and musculature, supplied by the good blood supply and nerve supply to regulate the joints' movements and stability [6,7]. Lower limb movements are associated with lower back and pelvic stability. ...
Article
Full-text available
Background: Trunk muscle coordination can be improved by motor control exercise using Swiss ball exercises, trunk muscles that support the spine's stability and mobility. In this study effect of motor control exercise using Swiss ball is compared with stretching exercise on low back pain. This study is also aimed to find the effect of motor control exercise using Swiss ball and stretching exercise within the group on mechanical low back pain. Methods: A Comparative study was done at ACS Medical College and Hospital, Chennai, with 30 samples. The duration of the treatment was four weeks. Male and female genders were selected for the study with the age of 18-25 yrs. The outcome measures were Low Back Index Scale, Quebec Disability Scale, and Schober Test. Total 30 subjects were randomly allocated, 15 in each group A and B by fulfilling inclusion criteria. Intervention for Group A trained with motor control exercise using Swiss ball and Group B with stretching exercise. Both groups receive treatment for three sessions /week of a total of 12 sessions of treatment. Results: Motor Control Exercises using Swiss Ball found more effective than stretching on reduction of pain with mean difference 2.60 and 2.533 respectively, and stretching found more effective than motor control exercise on disability and improve spinal mobility with a mean difference of 19.00, 19.67, and 22.00, 23.00 respectively among patients mechanical low back pain. Conclusion: Motor Control Exercises using Swiss Ball was found more effective than stretching to reduce pain, disability and improve spinal mobility among patients with mechanical low back pain.
Article
Full-text available
Background and Aim: Stretching exercises are recommended for treat and prevention of symptoms of low back pain. Its effectiveness to improve postural alignment that contributes to low back pain has not been evaluated during prolonged sitting. The aim of this biomechanical study was to evaluate if performing stretching exercises during prolong sitting improved postural alignment. Method: 14 healthy subjects were randomly assigned to a control (C) and experimental (E) groups. Subjects in the (C) sat continuously for 2 hours to watch a movie while subjects in (E) were instructed to perform stretching exercises during the sitting period. Kinematic of changes in spinal posture throughout the sitting period was identified by retro-reflective markers placed on the trunk and pelvis. Subjects also expressed their Body Perceived Discomfort (BPD) they experience at the end of the prolonged sitting period. Results: Trunk inclination (t=-0.737, P=0.489), thoracic kyphosis (t= 1.685, P =0.143) and lumbar lordosis (t=-0.236, P =0.821) did not change significantly between the first hour and second hours of sitting within (C). There was also no significant differences in kinematics of the various spinal measures among (E) which performed stretching exercises during the prolonged sitting period (trunk inclination: t=-1.560, P=0.170, thoracic kyphosis: t=-0.907, P=0.399 & lumbar lordosis: t=-0.015, P =0.988). However, BPD scores between groups at the neck (P=0.005), upper back (P=0.003), mid and low back (P=0.005) and buttocks (P=0.016) were significantly lower among (E) compared to (C). Conclusion: This novel biomechanical study recommends the performance of stretching exercises to reduce the discomforts along the spine during periods of prolong sitting. The reduction of discomfort was not due to change in spinal alignment. Hence, ergonomic chairs that maintain static proper alignment are not effective as a treatment or prevention of low back pain.
Article
Full-text available
The purpose of this study was to compare the effects of 2 exercise programs, segmental stabilization exercises (SSEs) and stretching of trunk and hamstrings muscles, on functional disability, pain, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain. A total of 30 participants were enrolled in this study and randomly assigned to 1 of 2 groups as a function of intervention. In the segmental stabilization group (SS), exercises focused on the TrA and lumbar multifidus muscles, whereas in the stretching group (ST), exercises focused on stretching the erector spinae, hamstrings, and triceps surae. Severity of pain (visual analog scale and McGill pain questionnaire) and functional disability (Oswestry disability questionnaire) and TrA muscle activation capacity (Pressure Biofeedback Unit, or PBU) were compared as a function of intervention. Interventions lasted 6 weeks, and sessions happened twice a week (30 minutes each). Analysis of variance was used for intergroup and intragroup comparisons. As compared with baseline, both treatments were effective in relieving pain and improving disability (P < .001). Those in the SS group had significantly higher gains for all variables. The stretching group did not effectively activate the TrA (P = .94). Both techniques improved pain and reduced disability. In this study, SS was superior to muscular stretching for the measured variables associated with chronic low back pain.
Article
Full-text available
Chronic low back pain is a common problem lacking highly effective treatment options. Small trials suggest that yoga may have benefits for this condition. This trial was designed to determine whether yoga is more effective than conventional stretching exercises or a self-care book for primary care patients with chronic low back pain. A total of 228 adults with chronic low back pain were randomized to 12 weekly classes of yoga (92 patients) or conventional stretching exercises (91 patients) or a self-care book (45 patients). Back-related functional status (modified Roland Disability Questionnaire, a 23-point scale) and bothersomeness of pain (an 11-point numerical scale) at 12 weeks were the primary outcomes. Outcomes were assessed at baseline, 6, 12, and 26 weeks by interviewers unaware of treatment group. After adjustment for baseline values, 12-week outcomes for the yoga group were superior to those for the self-care group (mean difference for function, -2.5 [95% CI, -3.7 to -1.3]; P < .001; mean difference for symptoms, -1.1 [95% CI, -1.7 to -0.4]; P < .001). At 26 weeks, function for the yoga group remained superior (mean difference, -1.8 [95% CI, -3.1 to -0.5]; P < .001). Yoga was not superior to conventional stretching exercises at any time point. Yoga classes were more effective than a self-care book, but not more effective than stretching classes, in improving function and reducing symptoms due to chronic low back pain, with benefits lasting at least several months. clinicaltrials.gov Identifier: NCT00447668.
Article
The purpose of this study was to compare the effects of lumbar stabilization exercises using balls to the effects of general lumbar stabilization exercises with respect to changes in the cross section of the multifidus (MF), weight bearing, pain, and functional disorders in patients with non-specific chronic low back pain. Twelve patients participated in either a 8 week (3 days per week) stabilization exercise program using balls and control group (n = 12). The computer tomography (CT) was used to analyze MF cross-sectional areas (CSA) and Tetrax balancing scale was used to analyze left and right weight bearing differences. Both groups had significant changes in the CSA of the MF by segment after training (p < 0.05) and the experimental group showed greater increases at the L4 (F = 9.854, p = 0.005) and L5 (F = 39. 266, p = 0.000). Both groups showed significant decreases in weight bearing, from 9.25% to 5.83% in the experimental group and from 9.33% to 4.25% in the control group (p < 0.05), but did not differ significantly between the two groups. These results suggests that stabilization exercises using ball can increases in the CSA of the MF segments, improvement in weight bearing, pain relief, and recovery from functional disorders, and the increases in the CSA of the MF of the L4 and L5 segments for patients with low back pain. Key PointsCompared with the stabilization exercise using a ball and general stabilization exercise increased the CSA of the MF, weight bearing, pain, and functional ability in patients with low back pain.We verified that increases in the CSA of the MF of the L4 and L5 segments and functional ability during the stabilization exercise using a ball.The stabilization exercise using a ball was shown to be an effective exercise method for patients with low back pain in a rehabilitation program by increasing functional ability and the CSA of the MF.
Article
This article offers a brief look at facilitated stretching, an active-assisted form of stretching based on proprioceptive neuromuscular facilitation. It describes the method, the rationale for its development and use, and gives detailed instructions for performing several stretches, both with a facilitator and alone.
Article
Tight hamstrings are reported to be one of the causes of low back pain. However, there have been few reports on effective stretching procedures for the tight hamstrings. The so-called jack-knife stretch, an active-static type of stretching, can efficiently increase the flexibility of tight hamstrings. To evaluate hamstring tightness before and after the 4-week stretching protocol in healthy volunteer adults and patients aged under 18 years with low back pain. For understanding the hamstrings tightness, we measured two parameters including (1) finger to floor distance (FFD) and (2) pelvis forward inclination angle (PFIA). Eight healthy adult volunteers who had no lumbar or hip problems participated in this study (mean age: 26.8 years). All lacked flexibility and their FFD were positive before the experiment. Subjects performed 2 sets of the jack-knife stretch every day for 4 weeks. One set consisted of 5 repetitions, each held for 5 s. Before and during the 4-week experiment, the FFD and PFIA of toe-touching tests were measured weekly. For 17 of the sports players aged under 18, only FFD was measured. In adult volunteers, FFD was 14.1 ± 6.1 cm before the experiment and decreased to -8.1 ± 3.7 cm by the end of week 4, indicating a gain in flexibility of 22.2 cm. PFIA was 50.6 ± 8.2 before the experiment and 83.8 ± 5.8 degrees after. Before and after the experiment, the differences were significant (p < 0.05). For those aged under 18, FFD was 8.1 ± 8.0 and -9.6 ± 6.8, before and after the stretching, respectively. This difference was significant (p < 0.05). The jack-knife stretch is a useful active-static stretching technique to efficiently increase flexibility of tight hamstrings.
Article
The purpose of this study was to examine the effectiveness of a stretching exercise program (SEP) on low back pain (LBP) and exercise self-efficacy among nurses in Taiwan. A total of 127 nurses, who had been experiencing LBP for longer than 6 months and had LBP with pain scores greater than 4 on the Visual Analogue Scale for Pain (VASP), were randomly assigned to an experimental group and a control group. The experimental group (n = 64) followed an SEP, whereas the control group (n = 63) was directed to perform usual activities for 50 minutes per time, three times a week. Data were collected at four time points: at baseline, and 2, 4, and 6 months after the intervention. During the 6-month follow-up, the experimental group had significantly lower VASP scores than did the control group at the second, fourth, and sixth months. In addition, the experimental group showed significantly higher exercise self-efficacy than did the control group at the fourth and sixth months. A total of 81% of the participants in the experimental group reported a moderate to high level of LBP relief. The findings can be used to enhance self-care capabilities with SEP for nurses that experience LBP or are vulnerable to such work-related pain. SEP is an effective and safe nonpharmacological intervention for the management of LBP.
Article
ObjectivesTo examine the literature to determine if stabilisation exercises are effective for the treatment of pain and dysfunction in patients with low back pain.Data sourcesPubMed (MEDLINE), CINAHL, AMED, PEDro and the Cochrane Library were searched up to October 2006.Review methodsInclusion criteria were: randomised clinical trials; in English; full publications; subjects were adults with low back pain; one group received specific stabilisation exercises as the primary intervention; and outcome measures included some measure of pain and/or function. Following a systematic search of major databases, articles were scored according to the PEDro criteria for quality. Due to heterogeneity of specific interventions, control groups, duration of follow-up, outcome measures and study population, a meta-analysis was not conducted. A qualitative review was undertaken that focused on study quality, study population and type of control group.ResultsIn total, 18 trials were included in the review; a large number of trials were excluded. There was little evidence to support the use of stabilisation exercises for acute low back pain. There was some evidence to support the use of stabilisation exercises in chronic back pain, with the majority of high-quality trials showing a significant difference in favour of stabilisation exercises. Overall, however, the evidence was conflicting, and significant differences favouring stabilisation exercises were less likely when they were compared with active treatment control groups rather than inactive control groups.ConclusionsThere may be a role for specific stabilisation exercises in some patients with chronic low back pain, but these are no more effective than other active interventions.
Article
Several conservative therapies have been shown to be beneficial in the treatment of chronic low back pain (CLBP), including different forms of exercise and spinal manipulative therapy (SMT). The efficacy of less time-consuming and less costly self-care interventions, for example, home exercise, remains inconclusive in CLBP populations. The purpose of this study was to assess the relative efficacy of supervised exercise, spinal manipulation, and home exercise for the treatment of CLBP. An observer-blinded and mixed-method randomized clinical trial conducted in a university research clinic in Bloomington, MN, USA. Individuals, 18 to 65 years of age, who had a primary complaint of mechanical LBP of at least 6-week duration with or without radiating pain to the lower extremity were included in this trial. Patient-rated outcomes were pain, disability, general health status, medication use, global improvement, and satisfaction. Trunk muscle endurance and strength were assessed by blinded examiners, and qualitative interviews were performed at the end of the 12-week treatment phase. This prospective randomized clinical trial examined the short- (12 weeks) and long-term (52 weeks) relative efficacy of high-dose, supervised low-tech trunk exercise, chiropractic SMT, and a short course of home exercise and self-care advice for the treatment of LBP of at least 6-week duration. The study was approved by local institutional review boards. A total of 301 individuals were included in this trial. For all three treatment groups, outcomes improved during the 12 weeks of treatment. Those who received supervised trunk exercise were most satisfied with care and experienced the greatest gains in trunk muscle endurance and strength, but they did not significantly differ from those receiving chiropractic spinal manipulation or home exercise in terms of pain and other patient-rated individual outcomes, in both the short- and long-term. For CLBP, supervised exercise was significantly better than chiropractic spinal manipulation and home exercise in terms of satisfaction with treatment and trunk muscle endurance and strength. Although the short- and long-term differences between groups in patient-rated pain, disability, improvement, general health status, and medication use consistently favored the supervised exercise group, the differences were relatively small and not statistically significant for these individual outcomes.
Article
Dysfunction of spinal stability seems to be one of the causes of low back pain (LBP). It is thought that a large number of muscles have a role in spinal stability including the pelvic floor muscle (PFM). The purpose of this study was to investigate the effect of PFM exercise in the treatment of chronic LBP. After ethical approval, a randomized controlled clinical trial was carried out on 20 women with chronic LBP. Patients were randomly allocated into two groups: an experimental and a control group. The control group was given routine treatment including electrotherapy and general exercises; and the experimental group received routine treatment and additional PFM exercise. Pain intensity, functional disability and PFM strength and endurance were measured before, immediately after intervention and at 3 months follow-up. In both groups pain and functional disability were significantly reduced following treatment (p<0.01), but no significant difference was found between the two groups (p>0.05). All measurements were improved in both groups (p<0.01) although patients in the experimental group showed greater improvement in PFM strength and endurance (p<0.01). It seems that the PFM exercise combined with routine treatment was not superior to routine treatment alone in patients with chronic LBP.