Restricted accessResearch articleFirst published online 2020-11
Efficacy of the lumbar stabilization and thoracic mobilization exercise program on pain intensity and functional disability reduction in chronic low back pain patients with lumbar radiculopathy: A randomized controlled trial
Exercise programs in the treatment of chronic lumbar pain are quite diverse, but it has been proven that stabilization exercises are the most effective.
OBJECTIVE:
We compared the lumbar stabilization exercise program in a closed and open kinetic chain (LSCO) and lumbar stabilization exercises and thoracic mobilization program in a closed kinetic chain (LSTMC), and evaluated the clinical effectiveness of each program.
METHODS:
Prospective, randomized, controlled trial in 80 chronic low back pain (CLBP) patients with lumbar radiculopathy of both sexes (35 male, 45 female), average age (48.45 10.22 years), divided in two groups that performed different sets of exercises. Participants were given laser therapy, transcutaneous electro-nerve stimulation and an eight-week kinesiotherapy that included exercises to strengthen the deep lumbar spine stabilizers. Retesting was done after four and eight weeks.
RESULTS:
Statistically significant ( 0.05) superior recovery of the LSTMC group subjects compared to the LSCO group was achieved at all measurement intervals in the pain intensity and functional disability parameters.
CONCLUSION:
Patients who performed the lumbar stabilization and thoracic mobilization exercise program in a closed kinetic chain had the most effective reduction of pain intensity and functional disability.
LoeserJDTreedeR-D. The kyoto protocol of IASP basic pain terminology. Pain. 2008; 137(3): 473-7.
2.
TreedeR-DJensenTSCampbellJCruccuGDostrovskyJGriffinJ, et al. Neuropathic pain redefinition and a grading system for clinical and research purposes. Neurology. 2008; 70(18): 1630-5.
3.
StaalJBHlobilHTwiskJWSmidTKöke ArJvan MechelenW. Graded activity for low back pain in occupational health CareA randomized, controlled trial. Ann Intern Med. 2004; 140(2): 77-84.
4.
WaddellG. The clinical course of low back pain. The back pain revolution. 1998.
5.
RozenbergS. Chronic low back pain: Definition and treatment. La Revue du Praticien. 2008; 58(3): 265-72.
6.
TsaoHGaleaMHodgesP. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain. 2008; 131(8): 2161-71.
7.
TsaoHHodgesPW. Immediate changes in feedforward postural adjustments following voluntary motor training. Exp Brain Res. 2007; 181(4): 537-46.
8.
TsaoHHodgesPW. Persistence of improvements in postural strategies following motor control training in people with recurrent low back pain. J Electromyogr Kinesiol. 2008; 18(4): 559-67.
9.
FerreiraPHFerreiraMLMaherCGHerbertRDRefshaugeK. Specific stabilisation exercise for spinal and pelvic pain: A systematic review. Aust J Physiother. 2006; 52(2): 79-88.
10.
HeoM-YKimKHurB-YNamC-W. The effect of lumbar stabilization exercises and thoracic mobilization and exercises on chronic low back pain patients. J Phys Ther Sci. 2015; 27(12): 3843-6.
11.
WooS-DKimT-H. The effects of lumbar stabilization exercise with thoracic extension exercise on lumbosacral alignment and the low back pain disability index in patients with chronic low back pain. J Phys Ther Sci. 2016; 28(2): 680-4.
12.
YangS-RKimKParkS-J. The effect of thoracic spine mobilization and stabilization exercise on the muscular strength and flexibility of the trunk of chronic low back pain patients. J Phys Ther Sci. 2015; 27(12): 3851-4.
13.
KumarSP. Efficacy of segmental stabilization exercise for lumbar segmental instability in patients with mechanical low back pain: A randomized placebo controlled crossover study. N Am J Med Sci. 2011; 3(10): 456.
14.
FredericsonMMooreT. Muscular balance, core stability, and injury prevention for middle-and long-distance runners. Phys Med Rehabil Clin. 2005; 16(3): 669-89.
15.
RohlmannAClaesLBergmannGGraichenFNeefPWilkeH-J. Comparison of intradiscal pressures and spinal fixator loads for different body positions and exercises. Ergonomics. 2001; 44(8): 781-94.
16.
BeimGMGiraldoJLPinciveroDMBorrorMJFuFH. Abdominal strengthening exercises: A comparative EMG study. J Sport Rehabil. 1997; 6(1): 11-20.
17.
MiddleditchAOliverJ. Functional anatomy of the spine: Elsevier Health Sciences; 2005.
18.
MayerFSchlumbergerAVan CingelRHenrotinYLaubeWSchmidtbleicherD. Training and testing in open versus closed kinetic chain. Isokinet Exerc Sci. 2003; 11(4): 181-7.
19.
OsteloRWde VetHC. Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol. 2005; 19(4): 593-607.
20.
Von KorffMJensenMPKarolyP. Assessing global pain severity by self-report in clinical and health services research. Spine (Phila Pa 1976). 2000; 25(24): 3140-51.
21.
OsteloRWDeyoRAStratfordPWaddellGCroftPVon KorffM, et al. Interpreting change scores for pain and functional status in low back pain: Towards international consensus regarding minimal important change. Spine (Phila Pa 1976). 2008; 33(1): 90-4.
22.
BouhassiraDAttalNAlchaarHBoureauFBrochetBBruxelleJ, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005; 114(1): 29-36.
23.
HicksGEFritzJMDelittoAMcGillSM. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil. 2005; 86(9): 1753-62.
24.
FrankJWKerrMSBrookerA-SDeMaioSEMaetzelAShannonHS, et al. Disability resulting from occupational low back pain: Part I: What do we know about primary prevention? A review of the scientific evidence on prevention before disability begins. Spine (Phila Pa 1976). 1996; 21(24): 2908-17.
25.
MannionACaporasoFPulkovskiNSprottH. Spine stabilisation exercises in the treatment of chronic low back pain: A good clinical outcome is not associated with improved abdominal muscle function. Eur Spine J. 2012; 21(7): 1301-10.
26.
Unsgaard-TøndelMNilsenTILMagnussenJVasseljenO. Is activation of transversus abdominis and obliquus internus abdominis associated with long-term changes in chronic low back pain? A prospective study with 1-year follow-up. Br J Sports Med. 2012; 46(10): 729-34.
27.
ThomasESilmanAJCroftPRPapageorgiouACJaysonMIMacfarlaneGJ. Predicting who develops chronic low back pain in primary care: A prospective study. BMJ. 1999; 318(7199): 1662-7.
28.
BenerAVerjeeMDafeeahEEFalahOAl-JuhaishiTSchloglJ, et al. Psychological factors: Anxiety, depression, and somatization symptoms in low back pain patients. J Pain Res. 2013; 6: 95.
29.
KamperSJApeldoornAChiarottoASmeetsROsteloRGuzmanJ, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015; 350: h444.
30.
DunnlKMJordanKPCroftPR. Contributions of prognostic factors for poor outcome in primary care low back pain patients. Eur J Pain. 2011; 15(3): 313-9.
31.
CooperNAScavoKMStricklandKJTipayamongkolNNicholsonJDBewyerDC, et al. Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. Eur Spine J. 2016; 25(4): 1258-65.
32.
ChouLBradySRUrquhartDMTeichtahlAJCicuttiniFMPascoJA, et al. The association between obesity and low back pain and disability is affected by mood disorders: A population-based, cross-sectional study of men. Medicine. 2016; 95(15).
33.
ChoIJeonCLeeSLeeDHwangboG. Effects of lumbar stabilization exercise on functional disability and lumbar lordosis angle in patients with chronic low back pain. J Phys Ther Sci. 2015; 27(6): 1983-5.
34.
ChangW-DLinH-YLaiP-T. Core strength training for patients with chronic low back pain. J Phys Ther Sci. 2015; 27(3): 619-22.
35.
FrançaFRBurkeTNHanadaESMarquesAP. Segmental stabilization and muscular strengthening in chronic low back pain: A comparative study. Clinics. 2010; 65(10): 1013-7.
36.
GattiRFaccendiniSTettamantiABarberoMBalestriACaloriG. Efficacy of trunk balance exercises for individuals with chronic low back pain: A randomized clinical trial. J Orthop Sports Phys Ther. 2011; 41(8): 542-52.
37.
LeeSKimSY. Effects of hip exercises for chronic low-back pain patients with lumbar instability. J Phys Ther Sci. 2015; 27(2): 345-8.
38.
Unsgaard-TøndelMFladmarkAMSalvesenØVasseljenO. Motor control exercises, sling exercises, and general exercises for patients with chronic low back pain: A randomized controlled trial with 1-year follow-up. Phys Ther. 2010; 90(10): 1426-40.
39.
ChitraR. Effect of lumbar stabilization exercise and lumbar extension exercise in the treatment of chronic low back pain. ESJ. 2014; 10(21).
