EFFECTIVENESS OF DIFFERENT PHYSICAL THERAPY EXERCISE TECHNIQUES IN CHRONIC LOW BACK PAIN: A RANDOMIZED CONTROLLED STUDY

Abstract

Purpose: Exercise therapy is the most common conservative treatment for low back pain. Exercise has generally been associated pain and kinesiophobia. In this context, especially paraspinal muscles need to be focused on. For this reason, the aim of our study is to evaluate different types of exercises that will help increase neuromuscular facilitation and core stability in paraspinal muscles by considering patient satisfaction. Methods: A total of thirty-seven female patients with chronic low back pain were included in the study. The Oswestry Low Back Pain Questionnaire was used to assess functionality. Core stability was evaluated with a stabilizer. Pain intensity and satisfaction were measured with Visual Analog Scale. Patients' kinesiophobia levels were assessed by using Tampa Kinesiophobia Scale. Patients were randomized into three groups according to the interventions as: Proprioceptive Neuromuscular Facilitation exercise group (n = 9), core stability exercise group (n = 14) and control (n = 14) group. The duration of applications was 3 days per week with a total of 6 weeks. Results: There were group differences for core muscle strength (p = .045), Oswestry scores (p = .001), pain intensity score (p = .003) and Tampa score (p = .001). There were significant gains for Core muscle strength and Oswestry scores for Proprioceptive Neuromuscular Facilitation and Core stability groups (p < .05). Conclusion. Core stabilization exercises have additional effects to improve rehabilitation outcomes for patients. Besides that, the level of patient satisfaction was importantly different between all groups in favor to Core stability in chronic low back pain.

Keywords

• Core stability
• exercise
• low back pain
• patient satisfaction
• proprioceptive neuromuscular facilitation

KRONİK BEL AĞRISINDA FARKLI FİZYOTERAPİ EGZERSİZ TEKNİKLERİNİN ETKİNLİĞİ: RANDOMİZE KONTROLLÜ BİR ÇALIŞMA

Öz

Amaç: Bel ağrısı için en yaygın konservatif tedavi egzersizdir. Egzersiz genellikle ağrı ve kinezyofobi ile ilişkilendirilmiştir. Bu bağlamda özellikle paraspinal kaslara da odaklanılması da gerekmektedir. Bu nedenle çalışmamızın amacı, paraspinal kaslarda nöromüsküler fasilitasyon ve core stabilitesini artırmaya yardımcı olacak farklı egzersiz türlerini hasta memnuniyetini göz önünde bulundurarak değerlendirmek idi. Yöntem: Kronik bel ağrısı olan otuz yedi kadın hasta çalışmaya dahil edildi. Fonksiyonellik değerlendirilmesi için Oswestry Bel Ağrısı Ölçeği kullanıldı. Core stabilizasyon stabilizatör ile değerlendirildi. Ağrı şiddeti ve memnuniyet Vizüel Analog Skala ile ölçüldü. Hastaların kinezyofobi düzeyleri Tampa Kinezyofobi Ölçeği ile değerlendirildi. Hastalar rastgele üç gruba ayrıldı; Proprioseptif Nöromuskuler Fasilitasyon egzersiz grubu (n=9), Core stabilizasyon grubu (n=14) ve kontrol grubu. Uygulama süresi haftada 3 gün toplam 6 hafta idi. Sonuçlar: Core kas kuvveti (p = 0,045), Oswestry skoru (p = 0,001), ağrı şiddet skoru (p = .003) ve Tampa skoru (p = 0,001) gruplar arasında farklılık gösterdi. Proprioseptif Nöromuskuler Fasilitasyon ve Core stabilizasyon egzersiz grubunda Core kas kuvveti ve Oswestry skorlarında anlamlı kazanımlar elde edildi (p <0,05). Sonuçlar: Kronik bel ağrısında Core stabilizasyon egzersizlerinin hastaların rehabilitasyon sonuçlarını geliştirmek için ek etkileri vardır. Bunun yanı sıra Core stabilizasyon lehine hasta memnuniyet düzeyi tüm gruplar arasında önemli ölçüde farklı idi.

Anahtar Kelimeler

• core stabilizasyon
• egzersiz
• bel ağrısı
• hasta memnuniyeti
• Proprioseptif Nöromuskuler Fasilitasyon

Kaynakça

1. 1. Hoy D, Brooks P, Blyth F, Buchbinder R, The epidemiology of low back pain. Best Pract & Res Clin Rheu, 2010, 24:769–81.
2. 2. Maher C, Underwood M, Buchbinder R, Non-specific low back pain. Lancet, 2017, 389: 736-47.
3. 3. Paige NM, Miake-Lye IM, Booth MS, Beroes JM, Mardian AS et al, Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA, 2017, 317(14): 1451-60.
4. 4. Shamsi MB, Sarrafzadeh J, Jamshidi A, Comparing core stability and traditional trunk exercise on chronic low back pain patients using three functional lumbopelvic stability tests. Physiother Theory Prac, 2015, 31(2):89-98.
5. 5. Ferreira ML, Smeets RJ, Kamper SJ, Ferreira PH, Machado LA, Can we explain heterogeneity among randomized clinical trials of exercise for chronic back pain? A meta-regression analysis of randomized controlled trials, Phy Ther, 2010, 90:1383-1403.
6. 6. Hayden JA, van Tulder MW, Malmivaara AV, Koes BW. Meta-analysis: exercise therapy for nonspecific low back pain, Ann InternMed, 2005, 142: 765-75.
7. 7. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R et al, Nonpharmacologic therapies for low back pain: a systematic review for an american college of physicians clinical practice guideline, Ann Intern Med, 2017, 166(7):493-505.
8. 8. Portney LG, Watkins MP. Foundations of clinical research: applications to practice. Upper saddle river, NJ, USA: Pearson Education Inc; 2009.

9. 9. Cohen J. Statistical power analysis for the behavioral sciences. New York: Academic Press; 1997.
10. 10. Kofotolis N, Vrabas IS, Vamvakoudis E, Papanikolaou A, Mandroukas K, Proprioceptive neuromuscular facilitation training induced alterations in muscle fibre type and crosssectional area, Br J Sports Med, 2005, 39(3): e11.
11. 11. Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 2012; Fa Davis.
12. 12. Yakut E, Düger T, Oksüz C, Yörükan S, Ureten K et al, Validation of the Turkish version of the oswestry disability index for patients with low back, Spine, 2004, 29: 581-5.
13. 13. Critchley D. Instructing pelvic floor contraction facilitates transvers abdominis thickness increase during low-abdominal hollowing, Physiother Res Int, 2002, 7:65–75.
14. 14. Jung D, Kim K, Lee S, Comparison of muscle activities using a pressure biofeedback unit during abdominal muscle training performed by normal adults in the standing and supine positions, J Phys Ther Sci, 2014, 26:191–3.
15. 15. Grooms DR, Grindstaff TL, Croy T, Hart JM, Saliba SA, Clinimetric analysis of pressure biofeedback and transversus abdominis function in individuals with stabilization classification low back pain, J Orthop Sports Phys Ther, 2013, 43:184-93.
16. 16. 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‐36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP), Arthritis Care Res, 2011, 63: 240-52.
17. 17. Tunca Yılmaz Ö, Yakut Y, Uygur F, Uluğ N, Turkish version of the Tampa scale for kinesiophobia and its test-retest reliability, Turk J Physiother Rehabil, 2011, 22(1):44-9.
18. 18. Coulombe BJ, Games KE, Neil ER, Eberman LE, Core stability exercise versus general exercise for chronic low back pain. J Athl Train, 2017, 52(1):71-2.
19. 19. Wang XQ, Zheng JJ, Yu ZW, Bi X, Lou SJ et al, A meta-analysis of core stability exercise versus general exercise for chronic low back pain, PLoS One 2012, 7(12):e52082.
20. 20. Kim GY, Ahn CS, Kim SS, The effects of 3-dimensional lumbar stabilization exercise have an effect on the improvement of pain and static or dynamic balance ability in 20’s age group with low back pain, Korean Soc Phys Med, 2011,6:235–46.
21. 21. Mohammad Bagher S, Mandana R, Mehdi Z, Mehdi S, Mohammad Reza P, Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? a quasi-randomized controlled trial, Physiother Theory Pract, 2016, 32(3):171-8.
22. 22. Areeudomwong P, Buttagat V, Comparison of Core Stabilisation Exercise and Proprioceptive Neuromuscular Facilitation Training on Pain-related and Neuromuscular Response Outcomes for Chronic Low Back Pain: A Randomised Controlled Trial, Malays J Med Sci, 2019, 26(6):77–89.
23. 23. Lee BK, Effects of the combined PNF and deep breathing exercises on the ROM and the VAS score of a frozen shoulder patient: Single case study, J Exerc Rehabil, 2015, 11(5):276-81.
24. 24. Kim JJ, Lee SY, Ha K. The effects of exercise using PNF in patients with a supraspinatus muscle tear. The Journal of Physical Therapy Science 2015;27(8): 2443-2446.
25. 25. Lempke L, Wilkinson R, Murray C, Stanek J, The effectiveness of PNF versus static stretching on increasing hip-flexion range of motion, J Sport Rehabil, 2018, 27(3):289-94.
26. 26. Park K, Seo K, The effects on the pain index and lumbar flexibility of obese patients with low back pain after PNF scapular and PNF pelvic patterns, J of Phys Ther Sci, 2014, 26(10): 1571-4.
27. 27. Kim BR, Lee HJ. Effects of proprioceptive neuromuscular facilitation-based abdominal muscle strengthening training on pulmonary function, pain, and functional disability index in chronic low back pain patients. J Exerc Rehabil, 2017, 13(4):486–90.