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

The Effect of Walking on Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis

Background

Previous literature lacks summative information on the mental health benefits achieved from different forms of walking.

Objective

The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety.

Methods

This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool.

Results

This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD -0.591, 95% CI -0.778 to -0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD -0.446, 95% CI -0.628 to -0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD -1.863, 95% CI -2.764 to -0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD -0.442, 95% CI -0.604 to -0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD -0.126, 95% CI -0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD -0.053, 95% CI -0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69).

Conclusions

Various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future.

Physical activity as mediator between back pain and disability

The objective was to explore the mediating role of leisure-time physical activity on the correlation between back pain and disability. A mediation analysis was conducted among the cross-sectional sample of 1330 patients in outpatient clinic. The average age was 47.6 years and 64% were women. For the entire sample, the mediating effect of physical activity remained below 10% of the total effect. The mediating effect was significantly greater among women comparing to men - up to 19.0% [95% confidence interval (CI) 10.4-27.6%] versus 2.3% (95% CI 0.0-6.1%). The effect did not significantly differ based on age, BMI, or educational or professional status. Some insignificant trends, however, could be seen - the effect was possibly stronger among patients with higher educational level and those with higher BMI. The results suggested that while physical activity seems to be a weak mediator, its mediating role might vary across different groups of patients with back pain. This variation should be taken into account when planning rehabilitation measures for people with back pain.

Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis

Chronic low back pain (cLBP) is a major cause of disability and healthcare expenditure worldwide. Its prevalence is increasing globally from somatic and psychosocial factors. While non-pharmacological management, and in particular physiotherapy, has been recommended as a first-line treatment for cLBP, it is not clear what type of physiotherapeutic approach is the most effective in terms of pain reduction and function improvement. This analysis is rendered more difficult by the vast number of available therapies and a lack of a widely accepted classification that can effectively highlight the differences in the outcomes of different management options. This study was conducted according to the PRISMA guidelines. In January 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which compared the efficacy of physiotherapy programs in patients with cLBP were accessed. Studies reporting on non-specific or mechanical cLPB were included. Data concerning the Visual Analogic Scale (VAS) or numeric rating scale (NRS), Roland Morris Disability Questionnaire (RMQ) and Oswestry Disability Index (ODI). Data from 12,773 patients were collected. The mean symptom duration was 61.2 ± 51.0 months and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years. The mean BMI was 25.8 ± 2.9 kg/m2. The Adapted Physical Exercise group evidenced the lowest pain score, followed by Multidisciplinary and Adapted Training Exercise/Complementary Medicine. The Adapted Physical Exercise group evidenced the lowest RMQ score followed by Therapeutic Exercises and Multidisciplinary. The Multidisciplinary group evidenced the lowest ODI score, followed by Adapted Physical Exercise and Physical Agent modalities. Within the considered physiotherapeutic and non-conventional approaches to manage nonspecific and/or mechanic cLBP, adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and disability.

Biofeedback-Based Proprioceptive Training to Improve Functional Prerequisites of Dragon Boating in Breast Cancer Survivors

Breast cancer (BC)-related sequelae drastically impact the psychophysical functioning and quality of life of affected women. Adapted physical activity (APA) has proved to effectively counteract these impairments in a non-medicalized framework. In particular, dragon boats are able to promote body functionality, social interaction, and quality of life in BC survivors, but the literature on specific motor gestures is scarce and practice is still based more on a re-educative perspective than a performative one. In this context, the present longitudinal study investigated the benefits of an adapted biofeedback-based sensorimotor training intervention on upper body functionality in a team of dragon ladies. The 8-week intervention was conceived as integrated dry workout sessions led by an APA kinesiologist and applied a novel sensorized proprioceptive device, such as a Libra board. Post-protocol evaluation revealed a significant improvement in bilateral upper limb mobility, core endurance, and trunk stability along with a distress decrease and quality of life enhancement through validated assessment tools. Our findings suggest that integrating biofeedback-based workout sessions can effectively promote upper body functionality in BC survivors practicing dragon boating. Furthermore, our innovative approach could help spread methodological hints able to boost exercise adherence in this target population, thus counteracting cancer recurrence while promoting overall well-being.

Comparative efficacy of acupuncture, venesection, and physical therapy on chronic low back pain outcomes: a randomized clinical trial

Objective

Chronic low back pain (CLBP) imposes considerable financial and social burden with poor response to medical and surgical treatments. Alternatively, acupuncture and venesection(Fasd) are traditionally used to alleviate nociceptive and musculoskeletal pains. This study aimed to evaluate the effectiveness and the safety of acupuncture and venesection on CLBP and patient functionality.

Methods

The current study was a single-blinded, randomized clinical trial with balanced allocation, conducted in the Department of Physical Medicine & Rehabilitation Medicine, in 2022. One hundred five CLBP patients who had no back pain-attributable structural or major diseases were randomly allocated into three parallel arms and received either physical therapy (PTG), acupuncture (APG), or venesection (VSG). Pain severity and functional aspects were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) during the study. VAS and ODI scores were defined as the primary outcomes.

Results

Ninety-five patients were reviewed in the final analysis (PTG=33, APG=30, VSG=31). Demographic data showed equal group distribution. Statistical analysis showed all procedures had reduced VAS score immediately after the first session, after the last session, and after follow-up; however, APG and VSG values were significantly lower (P<0.05). Pain reduction results in follow-up period were more sustainable in APG and VSG as compared to PTG (P<0.01). ODI results revealed global improvement after the last session of the treatment in all groups, while APG had more significant results (P<0.05). During the follow-up period, ODI still tended to decrease in VSG, non-significantly increased in APG, and significantly increased in PTG. Only two patients reported fainting after receiving venesection.

Conclusion

Considering the pain and functional scores, both acupuncture and venesection can reproduce reliable results. Acupuncture and venesection both have sustained effects on pain and daily function of the patients even after treatment termination, while physical therapy had more relapse in pain and functional limitations.

Management of Low Back Pain With Concurrent Hamstring Tightness: A Case Report Highlighting the Efficacy of Proprioceptive Neuromuscular Facilitation, Mulligan's Two-Leg Rotation Technique, and Exercise Regimen

Low back pain (LBP) is a prevalent musculoskeletal issue characterized by discomfort in the lumbosacral region. LBP localized between the 12th thoracic vertebra and inferior gluteal folds is common and often lacks a clear etiology. Various factors contribute to LBP, including increased lumbar lordosis, diminished abdominal muscle strength, reduced back extensor muscle endurance, and flexibility limitations in the back extensors, iliopsoas, and hamstrings. Treatment modalities for LBP encompass surgical intervention, pharmacotherapy, lumbar injections, psychotherapy, chiropractic care, and physiotherapy, with manual therapy being a prominent approach. Physiotherapists employ a spectrum of manual techniques, including mobilization, manipulation, and massage, to address LBP. Hamstring flexibility plays a pivotal role in spinal mechanics, and tight or shortened hamstrings can exacerbate LBP. Mulligan's techniques, notably the two-leg rotation (TLR) technique, are valuable interventions for addressing hamstring tightness in cases of LBP. Proprioceptive neuromuscular facilitation (PNF) was also used to manage pain and improve strength. This case report outlines the management of a 32-year-old male presenting with LBP and hamstring tightness coupled with core muscle weakness. Through comprehensive assessment and physiotherapeutic interventions, significant improvements were observed in pain intensity, lumbar range of motion, disability, straight leg raise (SLR), and core muscle strength following a three-week physiotherapy intervention.

Classification of the Pathological Range of Motion in Low Back Pain Using Wearable Sensors and Machine Learning

Low back pain (LBP) is a highly common musculoskeletal condition and the leading cause of work absenteeism. This project aims to develop a medical test to help healthcare professionals decide on and assign physical treatment for patients with nonspecific LBP. The design uses machine learning (ML) models based on the classification of motion capture (MoCap) data obtained from the range of motion (ROM) exercises among healthy and clinically diagnosed patients with LBP from Imbabura-Ecuador. The following seven ML algorithms were tested for evaluation and comparison: logistic regression, decision tree, random forest, support vector machine (SVM), k-nearest neighbor (KNN), multilayer perceptron (MLP), and gradient boosting algorithms. All ML techniques obtained an accuracy above 80%, and three models (SVM, random forest, and MLP) obtained an accuracy of >90%. SVM was found to be the best-performing algorithm. This article aims to improve the applicability of inertial MoCap in healthcare by making use of precise spatiotemporal measurements with a data-driven treatment approach to improve the quality of life of people with chronic LBP.

Mediation of the Association Between Physical Exercise and Depressive/Anxiety Symptoms by Pain and Sleep Problems Among Older Adults

In this study, based on the 2022 National Health and Aging Trend Study (N = 5,593, age 65+), we examined direct associations between moderate and vigorous physical exercise (PE) and depressive/anxiety symptoms as well as bothersome pain and sleep problems. We then examined if the association between PE and depressive/anxiety symptoms would be partially mediated by the effects of PE on bothersome pain and sleep problems. Results from a path model showed that controlling for sociodemographic and health statuses, PE was negatively associated with depressive/anxiety symptoms and bothersome pain, but it was not significantly associated with sleep problems. The mediation analysis showed that 10% of the total effects of PE on depressive/anxiety symptoms was indirect effects of PE on bothersome pain. This study is important as it examined the associations among PE, pain, sleep, and depression/anxiety in community-dwelling older adults in their natural environments. Healthcare and social service providers for older adults need to emphasize the importance and benefits of PE for older adults' physical and mental health. Easy access to venues for PE is also important.

Comparative effectiveness of nonpharmacological interventions in reducing psychological symptoms among patients with chronic low back pain

OBJECTIVES

Chronic low back pain (CLBP) can seriously impair the quality of life of patients and has a remarkable comorbidity with psychological symptoms, which, in turn, can further exacerbate the symptoms of CLBP. Psychological treatments are critical and nonnegligent for the management of CLBP, and thus, should attract sufficient attention. However, current evidence does not suggest the superiority and effectiveness of nonpharmacological interventions in reducing psychological symptoms among patients with CLBP.Thus, this study was designed to compare the effectiveness of nonpharmacological interventions for depression, anxiety, and mental health among patients with CLBP and to recommend preferred strategies for attenuating psychological symptoms in clinical practice.

METHODS

In this systematic review and network meta-analysis (NMA), PubMed, Embase Database, Web of Science, and Cochrane Library were searched from database inception until March 2022. Randomized clinical trials (RCTs) that compare different nonpharmacological interventions for depression, anxiety, and mental health among patients with CLBP were eligible. The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was used. Four reviewers in pairs and divided into two groups independently performed literature selection, data extraction, and risk of bias, and certainty of evidence assessments. This NMA was conducted with a random effects model under a frequentist framework. The major outcomes were depression, anxiety, and mental health presented as the standardized mean difference (SMD) with the corresponding 95% CI.

RESULTS

A total of 66 RCTs that randomized 4806 patients with CLBP met the inclusion criteria. The quality of evidence was typically low or some risks of bias (47 out of 66 trials, 71.3%), and the precision of summary estimates for effectiveness varied substantially. In addition, 7 categories of interventions with 26 specific treatments were evaluated. For depression, mind body therapy (pooled SMD = -1.20, 95% CI: -1.63 to -0.78), biopsychosocial approach (pooled SMD = -0.41, 95% CI: -0.70 to -0.12), and physical therapy (pooled SMD = -0.26, 95% CI: -0.50 to -0.02) exhibited remarkable effectiveness in reducing depression compared with the control group. For managing anxiety, mind body therapy (pooled SMD = -1.35, 95% CI: -1.90 to -0.80), multicomponent intervention (pooled SMD = -0.47, 95% CI: -0.88 to -0.06), and a biopsychosocial approach (pooled SMD = -0.46, 95% CI: -0.79 to -0.14) were substantially superior to the control group. For improving mental health, multicomponent intervention (pooled SMD = 0.77, 95% CI: 0.14 to 1.39), exercise (pooled SMD = 0.60, 95% CI: 0.08 to 1.11), and physical therapy (pooled SMD = 0.47, 95% CI: 0.02-0.92) demonstrated statistically substantial effectiveness compared with the control group. The rank probability indicated that mind body therapy achieved the highest effectiveness in reducing depression and anxiety among patients with CLBP. Besides, the combined results should be interpreted cautiously based on the results of analyses evaluating the inconsistency and certainty of the evidence.

CONCLUSION

This systemic review and NMA suggested that nonpharmacological interventions show promise for reducing psychological symptoms among patients with CLBP. In particular, mind body therapy and a biopsychosocial approach show considerable promise, and mind body therapy can be considered a priority choice in reducing depression and anxiety. These findings can aid clinicians in assessing the potential risks and benefits of available treatments for CLBP comorbidity with psychological symptoms and provide evidence for selecting interventions in clinical practice. More RCTs involving different interventions with rigorous methodology and an adequate sample size should be conducted in future research.

Perturbation-based Balance Training in Adults Aged Above 55 Years with Chronic Low Back Pain: A Comparison of Effects of Water versus Land Medium - A Preliminary Randomized Trial

BACKGROUND

'Rapid balance reaction' or 'perturbation' training is an emerging paradigm in elderly back pain rehabilitation due to its connection to postural stability.

OBJECTIVE

This study aimed to inform the feasibility and practicality of perturbation-based balance training (PBT) using a stratification approach and to determine the effectiveness of land versus water-based PBT in elderly individuals with chronic low back pain (CLBP).

METHODS

Elderly CLBP participants (n=24) received exercise interventions as per treatmentbased classification (TBC) and were randomly allotted into water-based perturbation exercises (WBPE, Mean age=63.0±2.6years, n=12) and land-based perturbation exercise group (LBPE, 62.3±2.6 years, n=12). Pain intensity, disability, scores of fear-avoidance beliefs, fall efficacy, and rate of perceived exertion (RPE) were assessed before and at the end of 6 weeks.

RESULTS

WBPE group reported a significant reduction in pain score (median difference(MD)):2, p<0.03), fear avoidance behaviour for work (MD:9, p<0.01) and fear avoidance behaviour for physical activity (MD:10, p< 0.05), improved straight leg raise right (SLR) (MD:37.5°, p<0.05), and improved modified fall efficacy scores (MFES, MD:25, p<0.05) compared to the LBPE group at post-intervention. Within-group analysis in both groups revealed significant improvement in clinical outcomes except for fear-avoidance beliefs related to physical activity in the LBPE group. Subgroup analysis revealed that the high BMI elderly CLBP group of LBPE had significant improvements similar to the WBPE group except for scores of FABQ physical activity scores and SLR.

CONCLUSION

Possible key factors for future research are discussed in the realms of perturbation exercise in the elderly with CLBP.

Determinants of outcomes for patients with chronic low back pain and fear-avoidance beliefs following treatment with specific stabilisation exercises

BACKGROUND

Specific stabilisation exercises (SSE) can combat the debilitating effects of chronic non-specific low back pain (CLBP), improve disability, pain and fear-avoidance beliefs (FAB).

OBJECTIVE

To elicit the determinants of outcome in patients with CLBP with associated FABs after treatment with SSE.

METHOD

Twenty-nine patients (20 females) with CLBP were classified using FAB questionnaire into high or low Work and Physical Activity (PA) subscales. After 4-week treatment, evaluations were done for pain, disability and lumbar spine active range of motion (AROM). Data was analysed exploratory-descriptively with a significance level set at p< 0.05.

RESULTS

Participants were aged 55.24 ± 11.91 years. They scored 19 (65.5%) and 5 (17.2%) respectively on Work and PA subscales. The post-intervention evaluation showed significant differences in all outcomes, but no significant difference between patients with high or low FAB scores for both subscales. PA scores correlated significantly with pain while work scores correlated significantly with disability. Participants' gender predicted disability, pain and AROM with moderate to large effect sizes.

CONCLUSION

SSE can potentially improve disability, pain and range of motion for patients with chronic low back pain regardless of FABQ status. Gender and baseline patient status are potential determinants of outcome of treatment using SSE.

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured Exercise Programs for Chronic Primary Low Back Pain in Adults

PURPOSE

Evaluate benefits and harms of structured exercise programs for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline.

METHODS

We searched for randomized controlled trials (RCTs) in electronic databases (inception to 17 May 2022). Eligible RCTs targeted structured exercise programs compared to placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of exercise could be isolated). We extracted outcomes, appraised risk of bias, conducted meta-analyses where appropriate, and assessed certainty of evidence using GRADE.

RESULTS

We screened 2503 records (after initial screening through Cochrane RCT Classifier and Cochrane Crowd) and 398 full text RCTs. Thirteen RCTs rated with overall low or unclear risk of bias were synthesized. Assessing individual exercise types (predominantly very low certainty evidence), pain reduction was associated with aerobic exercise and Pilates vs. no intervention, and motor control exercise vs. sham. Improved function was associated with mixed exercise vs. usual care, and Pilates vs. no intervention. Temporary increased minor pain was associated with mixed exercise vs. no intervention, and yoga vs. usual care. Little to no difference was found for other comparisons and outcomes. When pooling exercise types, exercise vs. no intervention probably reduces pain in adults (8 RCTs, SMD = - 0.33, 95% CI - 0.58 to - 0.08) and functional limitations in adults and older adults (8 RCTs, SMD = - 0.31, 95% CI - 0.57 to - 0.05) (moderate certainty evidence).

CONCLUSIONS

With moderate certainty, structured exercise programs probably reduce pain and functional limitations in adults and older people with CPLBP.

Complex Compression Fracture in the Thoracolumbar Junction: A Case Report

Compression fractures in the thoracolumbar junction are one of the most frequent types of spine injuries. They can be the result of trauma or underlying conditions of the vertebrae. We present a case report of a 68-year-old patient with pain and loss of mobility in the lumbar spine after sustaining a trauma via falling from a significant height. Lumbar spondylography and a following CT scan revealed a complex compression fracture of L1 with degenerative osteoporotic changes of lumbar vertebrae and several pathologies of the lumbosacral junction. A surgical intervention was performed in the form of posterior transpedicular vertebral stabilization with titanium rods and screws. Postoperatively, relief from the lumbar region pain was reported. No neurological deficit was observed. The patient was mobilized, rehabilitated, and discharged from the hospital. This case report emphasizes the use of reliable imaging methods for the diagnosis of thoracolumbar compression fracture and highlights the reliability of surgical treatment of the condition via posterior transpedicular vertebral stabilization.

Exercise intervention for patients with chronic low back pain: a systematic review and network meta-analysis

Purpose

Chronic low back pain (CLBP) is an aging and public health issue that is a leading cause of disability worldwide and has a significant economic impact on a global scale. Treatments for CLBP are varied, and there is currently no study with high-quality evidence to show which treatment works best. Exercise therapy has the characteristics of minor harm, low cost, and convenient implementation. It has become a mainstream treatment method in clinics for chronic low back pain. However, there is insufficient evidence on which specific exercise regimen is more effective for chronic non-specific low back pain. This network meta-analysis aimed to evaluate the effects of different exercise therapies on chronic low back pain and provide a reference for exercise regimens in CLBP patients.

Methods

We searched PubMed, EMBASE, Cochrane Library, and Web of Science from inception to 10 May 2022. Inclusion and exclusion criteria were used for selection. We collected information from studies to compare the effects of 20 exercise interventions on patients with chronic low back pain.

Results

This study included 75 randomized controlled trials (RCTs) with 5,254 participants. Network meta-analysis results showed that tai chi [standardized mean difference (SMD), -2.11; 95% CI, -3.62 to -0.61], yoga (SMD, -1.76; 95% CI -2.72 to -0.81), Pilates exercise (SMD, -1.52; 95% CI, -2.68, to -0.36), and sling exercise (SMD, -1.19; 95% CI, -2.07 to -0.30) showed a better pain improvement than conventional rehabilitation. Tai chi (SMD, -2.42; 95% CI, -3.81 to -1.03) and yoga (SMD, -2.07; 95% CI, -2.80 to -1.34) showed a better pain improvement than no intervention provided. Yoga (SMD, -1.72; 95% CI, -2.91 to -0.53) and core or stabilization exercises (SMD, -1.04; 95% CI, -1.80 to -0.28) showed a better physical function improvement than conventional rehabilitation. Yoga (SMD, -1.81; 95% CI, -2.78 to -0.83) and core or stabilization exercises (SMD, -1.13; 95% CI, -1.66 to -0.59) showed a better physical function improvement than no intervention provided.

Conclusion

Compared with conventional rehabilitation and no intervention provided, tai chi, toga, Pilates exercise, sling exercise, motor control exercise, and core or stabilization exercises significantly improved CLBP in patients. Compared with conventional rehabilitation and no intervention provided, yoga and core or stabilization exercises were statistically significant in improving physical function in patients with CLBP. Due to the limitations of the quality and quantity of the included studies, it is difficult to make a definitive recommendation before more large-scale and high-quality RCTs are conducted.

Exploring the Interplay of Muscular Endurance, Functional Balance, and Limits of Stability: A Comparative Study in Individuals with Lumbar Spondylosis Using a Computerized Stabilometric Force Platform

Lumbar spondylosis, characterized by degenerative changes in the lumbar spine, often leads to pain, reduced spinal stability, and musculoskeletal dysfunction. Understanding the impact of lumbar spondylosis on musculoskeletal function, particularly lumbar extensor endurance, functional balance, and limits of stability, is crucial for improving the management and well-being of affected individuals. This study aimed to assess lumbar extensor endurance, functional balance, and limits of stability in individuals with lumbar spondylosis compared to age-matched healthy individuals and explore the correlations among these parameters within the lumbar spondylosis group. The lumbar spondylosis group consisted of 60 individuals initially screened by an orthopedician and referred to physical therapy. Age-matched healthy controls (n = 60) were recruited. Inclusion criteria encompassed adults aged 45-70 years for both groups. Lumbar extensor endurance was assessed using the Sorensen test, functional balance with the Berg Balance Scale, and limits of stability using a computerized stabilometric force platform. Lumbar extensor endurance was significantly lower in individuals with lumbar spondylosis compared to healthy controls (23.06 s vs. 52.45 s, p < 0.001). Functional balance, as assessed by the Berg Balance Scale, demonstrated a significant decrement in the lumbar spondylosis group (48.36 vs. 53.34, p < 0.001). Additionally, limits of stability variables, under both eyes-open and eyes-closed conditions, exhibited marked impairments in the lumbar spondylosis group (p < 0.001 for all variables). Within the lumbar spondylosis group, lumbar extensor endurance exhibited significant positive correlations with functional balance (0.46, p < 0.001) and negative correlations with limits of stability variables (r ranging from -0.38 to -0.49, p < 0.01 for all variables). This study underscores the significance of addressing lumbar extensor endurance, functional balance, and stability impairments in the comprehensive management of lumbar spondylosis.

Effect of adding abdominal bracing to spinal stabilization exercise on lumbar lordosis angle, extensor strength, pain, and function in patients with non-specific chronic low back pain: A prospective randomized pilot study

TRIAL DESIGN

This study investigated the effect of adding abdominal bracing to spinal stability exercise in patients with chronic low back pain (CLBP). This prospective, randomized pilot study included 67 patients and was conducted at the sports medicine center of a single hospital.

METHODS

The abdominal bracing group (ABBG) underwent spinal stability exercise with abdominal bracing (N = 33), comprising 50 minutes training twice a week for 24 weeks. The control group performed only spinal stability exercise (N = 34) for 50 minutes twice a week for 24 weeks. The ABBG received abdominal bracing training at each session and applied abdominal bracing during the spinal stability exercise. The lumbar lordosis angle (LLA) and spine extensor muscle strength were measured. Spinal flexion angles were measured every 12° from 0° to 72°. The visual analog scale score and Oswestry disability index were measured before treatment and at 12 and 24 weeks after treatment.

RESULTS

The LLA increased over time in both the groups but was not significantly different between the groups. Spine extensor strength was improved over time in both the groups, and an interactive effect was observed at a spinal flexion angle of 60° and 72°. Pain and function were also improved over time in both the groups, but the effect was stronger in the ABBG than in the control group. In patients with CLBP, spinal stability exercise changed the LLA.

CONCLUSIONS

Although adding abdominal bracing to spinal stability exercise did not affect the changes in the LLA, abdominal bracing improved the spinal extensor strength, pain, and function in patients with CLBP. Therefore, it is recommended to add abdominal bracing to spinal stability exercise to maintain the lordosis angle and to improve CLBP symptoms.

Do Improved Trunk Mobility and Isometric Strength Correlate with Improved Pain and Disability after Multimodal Rehabilitation for Low Back Pain?

Objective  To determine the correlation between posttreatment trunk range of motion (ROM) and isometric strength (TIS) and pain and disability in patients who underwent multimodal rehabilitation for low back pain (LBP). Methods  In this prospective cohort study, 122 patients undergoing multimodal rehabilitation for LBP were analyzed. The pre- and posttreatment numerical pain rating scale (NPRS) and the Oswestry disability index (ODI) scores, as well as trunk ROM and TIS were compared. The Pearson correlation was used to determine correlation between posttreatment clinical outcomes and ROM and TIS. Results  At the end of treatment, the mean NPRS ( p  < 0.0001) and ODI ( p  < 0.0001) scores, mean trunk extension ( p  < 0.0001), and flexion ( p  < 0.0001) ROMs improved significantly. Similarly, posttreatment, the mean extension ( p  < 0.0001) and flexion ( p  < 0.0001) TISs improved significantly. There was a weak correlation between the NPRS score and ROM extension (r = -0.24, p  = 0.006) and flexion strength (r = -0.28, p  = 0.001), as well as between the ODI score and TIS extension (r = -0.30, p  = 0.0007) and flexion (r = -0.28, p  = 0.001). Conclusion  Despite significant improvement in pain, disability, trunk ROM, and TIS with multimodal treatment, there was a weak correlation between posttreatment pain and function and trunk ROM and TIS. Improvement in pain and function with physical rehabilitation treatment for LBP is a complex phenomenon and needs further investigation.

The effects of in-person-supervised, tele-supervised, and unsupervised stabilization exercises on pain, functionality, and kinesiophobia in patients with chronic low back pain: a randomized, single-blind trial

BACKGROUND

The efficacy of various supervision methods for stabilization exercises in patients with chronic low back pain (CLBP) remains uncertain.

OBJECTIVE

To evaluate the impact of supervised and unsupervised stabilization exercises in patients with CLBP.

METHODS

Sixty-six participants were assigned to the in-person-supervised, tele-supervised, or unsupervised groups. All participants received a 20-30-minute exercise program three times a week for 4 weeks. We assessed functionality (Oswestry Disability Index), pain intensity (Numeric Rating Scale), and kinesiophobia (Tampa Scale of Kinesiophobia) before and after the 4 weeks. The outcomes were analyzed using effect size, minimum clinically important difference (MCID), minimal detectable change (MDC), Wilcoxon test, and post hoc analyses.

RESULTS

While the unsupervised group improved in all measures (p < .05) both the tele-supervised (p = .001) and in-person-supervised (p < .001) groups achieved superior functionality exceeding MDC. The in-person-supervised group demonstrated greater functionality (p < .001) than the tele-supervised group, exceeding MCID. Pain intensity decreased in the tele-supervised (p = .011) and in-person-supervised groups (p < .001) compared to the unsupervised group, exceeding MCID and MDC. No significant difference was found in post-treatment NRS score changes between the supervised groups (p = .071). The in-person-supervised group displayed a greater reduction in kinesiophobia than the tele-supervised (p < .001) and unsupervised groups (p < .001) but not exceeding MCID or MDC. Effect sizes were large within and between groups except for a small effect size between the tele-supervised and unsupervised groups in kinesiophobia.

CONCLUSION

While tele-supervised stabilization exercises alleviate pain and enhance functionality, in-person-supervised exercises may be more effective in improving functionality and reducing kinesiophobia in patients with CLBP.

The effects of dynamic neuromuscular stabilization approach on clinical outcomes in older patients with chronic nonspecific low back pain: a randomized, controlled clinical trial

OBJECTIVE

We aimed to examine the effects of Dynamic Neuromuscular Stabilization (DNS) approach in older patients with chronic non-specific low back pain (CNSLBP).

METHODS

A total of 72 participants with CNSLBP were assigned to either the experimental group (n = 36) or control group (n = 36) in this randomized study. A conventional physiotherapy program was administered to the participants in the control group for 3 days per week for a total of 6 weeks. In addition to the conventional program, DNS exercise protocol was performed for 3 days per week for 6 weeks for the participants in the experimental group. While quality of movements and exercise capacity were our primary outcomes, functional balance and quality of life constituted our secondary outcomes. The participants were assessed both at baseline and post-treatment.

RESULTS

The improvement in a deep squat, in-line lunge, hurdle step, shoulder flexibility, rotary trunk stability, total Functional Movement Screening score, and Timed-up and Go Test score was greater in the experimental group (p<.05). The improvement was similar in both groups in terms of the rest of outcome measures.

DISCUSSION

This study demonstrated the effectiveness of the DNS approach on some functional movement patterns and functional balance performance in older patients with CNSLBP.

Erector Spinae Muscle Activation During Forward Movement in Individuals With or Without Chronic Lower Back Pain: A Systematic Review and Meta-analysis

Objective

To investigate the differences between erector spinae muscle activation in healthy individuals and patients with Chronic Lower Back Pain (CLBP) by conducting (a) systematic review and (b) meta-analysis.

Data Sources

PubMed, ScienceDirect, SPORTDiscus, and Google Scholar were used to conduct the searches, which included studies up to the 31st of March 2023 with no start date specified.

Study Selection

Any study otherwise meeting eligibility criteria was included if it reported either (1) a standard mean difference effect size; or (2) the means, SDs, and sample sizes for both the patient group and the comparator group.

Data Extraction

A total of 7 case control trials were used for the systematic review and meta-analysis.

Data Synthesis

The systematic review and meta-analysis revealed that total standardized mean difference in erector spinae muscle activation between healthy individuals vs patients with CLBP expressed in % maximum voluntary isometric contraction was 0.48 (95% confidence interval=0.21-0.74; P<.001) with the heterogeneity being I2=0% (P=.890). The electromyography (EMG) outputs showed significant differences in activation levels between the healthy and CLBP cohorts (P<.001).

Conclusions

A small effect size was found in the meta-analysis. The muscle activation levels of the erector spinae during forward propulsion were higher in CLBP individuals compared with healthy cohorts. The findings provide more clarity about the muscles that were the focus of previous research, what procedures were used to evaluate muscular contributions and what speeds the participants were moving at during the test sessions. Given the limited methodological quality of the included studies, the findings should be interpreted with caution. Future research should evaluate the effect of other factors such as walking distance and any changes in walking surfaces and gradients (ie, non-flat surfaces).

Enhancing Functional Ability in Chronic Nonspecific Lower Back Pain: The Impact of EMG-Guided Trunk Stabilization Exercises

BACKGROUND

Nonspecific lower back pain (NSLBP) is described as pain that is not caused by an identifiable, well-known disease, such as infection, tumor, osteoporosis, fracture, structural deformity, inflammatory condition, radicular syndrome, or cauda equina syndrome.

AIM

The aim of this study was to determine the effect of EMG-guided trunk stabilization exercises on functional disability associated with LBP.

MATERIALS AND METHODS

A single-blinded pre- and post-test experimental comparative design was used for this study. Fifty individuals with chronic NSLBP were screened for inclusion criteria. Of these, forty were randomly grouped into the EMG group receiving trunk-stability exercises with electromyography biofeedback and non-EMG group receiving trunk-stabilization exercises without EMG biofeedback. Participants performed five trunk-stability exercises 3 days a week for 4 weeks. The intensity of pain, range of motion, functional disability, and balance were measured at baseline and after 4 weeks.

RESULTS

Both techniques indicated a significant effect on chronic NSLBP; however, trunk-stability exercises combined with EMG biofeedback produced better results in alleviating the intensity of pain, increasing the range of motion, and improving functional disabilities and static balance.

CONCLUSION

The present study confirms that trunk-stability exercises with EMG biofeedback can be practiced safely, contributes to a greater boost in neuromuscular efficiency in the lumbar flexors and extensors, and is effective in modifying functional disability for patients with NSLBP.

The effectiveness of different aerobic exercises to improve pain intensity and disability in chronic low back pain patients: a systematic review

Background: Physical activity, including aerobic exercise, is highly recommended for chronic low back pain (CLBP) patients to improve pain intensity and functional disability. Objectives: To assess the effectiveness of different aerobic exercises to reduce pain intensity and functional disability in patients with CLBP. Methods: A computer-aided search was performed to find Randomised Controlled Trials (RCTs) that evaluated the effectiveness of different aerobic exercises in CLBP. Articles published between January 2007 to December 2020 were included in the review. Quality assessment using the PEDro scale, extraction of relevant information, and evaluation of outcomes were done by two reviewers independently. Results: A total of 17 studies were included that involved 1146 participants. Outcomes suggested that aerobic exercise combined with other interventions was more effective than aerobic exercise alone. Aerobic exercise with higher frequency (≥ 5 days/week) and longer duration (≥ 12 weeks) were effective to gain clinically significant (≥ 30%) improvements. Environment and using pedometer did not seem to influence the outcomes. Conclusions: Pain intensity and functional disability in CLBP patients can be minimized by prescribing aerobic exercise. However, to get better improvements, aerobic exercise should be done in combination with other interventions and at optimum frequency and duration. Further studies should emphasize examining the optimal doses and duration of different aerobic exercises.

Effects of Whole-Body Stretching Exercise during Lunch Break for Reducing Musculoskeletal Pain and Physical Exertion among Healthcare Professionals

Background and Objectives: To investigate the effect of whole-body stretching (WBS) exercise during lunch break for reducing musculoskeletal pain and physical exertion among healthcare professionals. Methods: Full-time healthcare professionals working in hospitals with more than one year of experience were invited to participate. Sixty healthcare professionals (age 37.15  ±  3.9 Years, height 1.61  ±  0.04 m, body mass 67.8  ±  6.3 kg, and BMI 26.5 ± 2.1 kg/m²) participated in this single-blinded, two-arm randomized controlled trial (RCT). Participants were divided into WBS (n = 30) and control (n = 30) groups. The WBS group performed a range of stretching exercises targeting the entire body during a lunch break period for 3 times a week for 6 weeks. The control group received an education program. Musculoskeletal pain and physical exertion were assessed using the Nordic musculoskeletal questionnaire and Borg rating of perceived exertion scale, respectively. Results: The 12-month prevalence of musculoskeletal discomfort among all healthcare professionals was highest in the low back region (46.7%), followed by the neck (43.3%), and then the knee (28.3%). About 22% of participants said that their neck discomfort impacted their job, while about 18% reported that their low back pain impacted their job. Results indicate that the WBS and education program had a beneficial impact on pain and physical exertion (p < 0.001). When comparing the two groups, the WBS group experienced a significantly greater decrease in pain intensity (mean difference 3.6 vs. 2.5) and physical exertion (mean difference 5.6 vs. 4.0) compared to an education program only. Conclusions: This study suggests that doing WBS exercises during lunchtime can help lessen musculoskeletal pain and fatigue, making it easier to get through the workday.

Effect of two suspension training programs on pain and musculoskeletal function in chronic low back pain: study protocol

The aim of this study is to compare the effects of two suspension training (ST) protocols on pain and musculoskeletal function in women with chronic low back pain (CLBP). The study will be randomized, controlled, blinded clinical trial. Women aged 18-60 years who present CLBP will be selected. They will be randomized into three groups: STG1, which will carry out the program with difficulty progression in the exercises; STG2, in which the progression will be made by increasing the number of sets; and control group. STG1 and STG2 will perform the training two-times a week for 60 min for 12 weeks. It is expected that ST will effectively reduce pain and improve functionality in CLBP and that the best protocol will be verified. Clinical Trial Registration: RBR-10rv3fqt.

Supervised exercise with or without laser-guided feedback for people with non-specific chronic low back pain. A randomized controlled clinical trial

BACKGROUND

Among the most effective therapeutic interventions in non-specific chronic low back pain (NSCLBP), clinical practice guidelines highlight exercise therapy and patient education; However, regarding the combined intervention of exercise and Pain Neuroscience Education (PNE), there is no consensus on the most effective form of exercise.

OBJETIVE

To find out what changes occurred after the application of two exercise modalities [Supervised Exercise (SE) and Laser-Guided Exercise (LGE)] and PNE on pain, pain pressure thresholds, disability, catastrophizing, kinesiophobia and lumbar proprioception in subjects with NSCLBP.

METHODS

Single-blind randomized clinical controlled trial. 60 subjects with NSCLBP. Both groups performed a a total of 16 therapeutic exercise sessions and 8 Pain Neuroscience Education sessions. With the Laser-Guided Exercise Therapy group performing laser-guided exercises.

RESULTS

A significant decrease was observed for pain intensity for both groups between baseline and post-intervention and the 3 month follow-up (p < 0.001). There was a significant between-group difference between baseline and post-intervention scores in terms of pain intensity and kinesiophobia in favour of the LGE group.

CONCLUSION

Supervised exercise with or without laser feedback, when combined with PNE, reduces pain intensity, disability, pain catastrophizing, kinesiophobia and improves proprioception and PPTs in patients with NSCLBP. At a 3-month follow-up, the combination of LGE plus PNE is most effective for reducing pain intensity.

Characteristics of the paravertebral muscle in adult degenerative scoliosis with PI-LL match or mismatch and risk factors for PI-LL mismatch

Objective

Pelvic incidence (PI) minus the lumbar lordosis (LL) angle (PI-LL) correlates with function and disability. It is associated with paravertebral muscle (PVM) degeneration and is a valuable tool for surgical planning of adult degenerative scoliosis (ADS). This study aims to explore the characteristics of PVM in ADS with PI-LL match or mismatch and to identify the risk factors for PI-LL mismatch.

Methods

A total of 67 patients with ADS were divided into PI-LL match and mismatch groups. The visual analog scale (VAS), symptom duration, and Oswestry disability index (ODI) were used to assess patients’ clinical symptoms and quality of life. The percentage of fat infiltration area (FIA%) of the multifidus muscle at the L1-S1 disc level was measured by using MRI with Image-J software. Sagittal vertical axis, LL, pelvic tilt (PT), PI, sacral slope, and the asymmetric and average degeneration degree of the multifidus were recorded. Logistic regression analysis was done to identify the risk factors for PI-LL mismatch.

Results

In the PI-LL match and mismatch groups, the average FIA% of the multifidus on the convex side was less than that on the concave side (P &lt; 0.05). There was no statistical difference of asymmetric degeneration degree of the multifidus between the two groups (P &gt; 0.05). In the PI-LL mismatch group, the average degeneration degree of the multifidus, VAS, symptom duration, and ODI were significantly higher than that in the PI-LL match group, respectively (32.22 ± 6.98 vs. 26.28 ± 6.23 (%), 4.33 ± 1.60 vs. 3.52 ± 1.46, 10.81 ± 4.83 vs. 6.58 ± 4.23 (month), 21.06 ± 12.58 vs. 12.97 ± 6.49, P &lt; 0.05). The average degeneration degree of the multifidus muscle was positively correlated with the VAS, symptom duration, and ODI, respectively (r = 0.515, 0.614, and 0.548, P &lt; 0.05). Sagittal plane balance, LL, PT, and the average degeneration degree of the multifidus were the risk factors for PI-LL mismatch (OR: 15.447, 95% CI: 1.274–187.269; OR: 0.001, 95% CI: 0.000–0.099; OR: 107.540, 95% CI: 5.195–2,225.975; OR: 52.531, 95% CI: 1.797–1,535.551, P &lt; 0.05).

Conclusion

The PVM on the concave side was larger than that on the convex side in ADS irrespective of whether PI-LL matched or not. PI-LL mismatch could aggravate this abnormal change, which is an important cause of pain and disability in ADS. Sagittal plane imbalance, decreased LL, higher PT, and larger average degeneration degree of the multifidus were independent risk factors for PI-LL mismatch.

Home Exercise Programs Are Infrequently Prescribed in Trials of Supervised Exercise for Individuals With Low Back Pain: A Scoping Review of 292 Randomized Controlled Trials

OBJECTIVES: To (1) determine how often home exercise programs (HEPs) are prescribed in supervised exercise trials for low back pain (LBP) and (2) describe characteristics of the HEP programs (design, purpose, dose, and adherence). DESIGN: Scoping review. LITERATURE SEARCH: PubMed, CINAHL, and Ovid MEDLINE were searched from January 1, 2010, to August 17, 2021. STUDY SELECTION CRITERIA: Randomized controlled trials that included adults with LBP who received exercise interventions. DATA SYNTHESIS: The presence or absence of a prescribed HEP and any details of the HEP including design, dose, and adherence were extracted and summarized. RESULTS: Of 2689 potentially relevant trials, 292 were eligible for inclusion. Ninety-four trials (32%) included a HEP. The most commonly prescribed home exercises were core stability, trunk strengthening, and motor control exercises. There was great variation in the frequency and duration with which HEPs were prescribed. Adherence to HEPs was measured in fewer than half of the trials, and the methods for measuring adherence were inconsistent. Adherence to HEPs ranged from 29% to 82% in the 21 trials that reported adherence. CONCLUSION: Home exercise programs are not regularly prescribed in supervised exercise trials for LBP. There was considerable variation in prescribing HEPs and monitoring exercise adherence in trials of exercise-based treatments for adults with LBP. There is no consistent method used to measure participants' adherence to HEPs, and adherence percentages vary widely. J Orthop Sports Phys Ther 2023;53(3):120-142. Epub: 16 January 2023. doi:10.2519/jospt.2023.11448.

Efficacy of Transcutaneous Electrical Nerve Stimulation and Interferential Current on Tactile Acuity of Individuals With Nonspecific Chronic Low Back Pain

OBJECTIVES

Transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) are pain electrotherapies with questioned efficacy. Studies of their effects on tactile acuity of individuals with nonspecific chronic low back pain (NSCLBP) are limited, hence, this study.

MATERIALS AND METHODS

Thirty-three individuals with NSCLBP randomly allocated into three groups completed this study. Data collected from participants included age, gender, and anthropometric characteristics of height, weight, body mass index, and percentage body fat measured with standard instruments. Also, participants' tactile acuity, pain intensity, and disability were assessed before and after interventions with digital caliper, numerical pain rating scale, and Roland-Morris Disability Questionnaire, respectively. Interventions consisted of stretching, strengthening, and stabilization exercises to all three groups in addition of TENS to group 1 and IFC to group 2, respectively, for five weeks. Descriptive statistics of mean and standard deviation summarized the data. Inferential statistics of paired t-test, independent t-test, and analysis of variance tested the level of significance among variables at p ≤ 0.05.

RESULTS

Tactile acuity was significantly (p < 0.05) increased after TENS intervention only, while pain intensity was significantly (p < 0.05) reduced after the three interventions. The result showed no gender difference in tactile acuity values among the participants.

CONCLUSIONS

TENS increases the tactile acuity of individuals with NSCLBP, whereas IFC demonstrated no significant change in tactile acuity.

Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis

OBJECTIVE

To determine which type of exercise is best for reducing pain and disability in adults with chronic low back pain (LBP).

DESIGN

Systematic review with a network meta-analysis (NMA) of randomized controlled trials (RCTs).

LITERATURE SEARCH

Six electronic databases were systematically searched from inception to July 2021.

STUDY SELECTION CRITERIA

RCTs testing the effects of exercise on reducing self-perceived pain or disability in adults (aged 18-65 years) with chronic LBP.

DATA SYNTHESIS

We followed the PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, incorporating NMAs of health care interventions) statement when reporting our NMA. A frequentist NMA was conducted. The probability of each intervention being the most effective was conducted according to surface under the cumulative ranking curve (SUCRA) values.

RESULTS

We included 118 trials (9710 participants). There were 28 head-to-head comparisons, 7 indirect comparisons for pain, and 8 indirect comparisons for disability. Compared with control, all types of physical exercises were effective for improving pain and disability, except for stretching exercises (for reducing pain) and the McKenzie method (for reducing disability). The most effective interventions for reducing pain were Pilates, mind-body, and core-based exercises. The most effective interventions for reducing disability were Pilates, strength, and core-based exercises. On SUCRA analysis, Pilates had the highest likelihood for reducing pain (93%) and disability (98%).

CONCLUSION

Although most exercise interventions had benefits for managing pain and disability in chronic LBP, the most beneficial programs were those that included (1) at least 1 to 2 sessions per week of Pilates or strength exercises; (2) sessions of less than 60 minutes of core-based, strength, or mind-body exercises; and (3) training programs from 3 to 9 weeks of Pilates and core-based exercises. J Orthop Sports Phys Ther 2022;52(8):505-521. Epub: 19 June 2022. doi:10.2519/jospt.2022.10671.

The Role of Exercise in Treating Low Back Pain

ABSTRACT

The purpose of this review is to highlight the role of exercise in preventing and managing acute and chronic axial low back pain (LBP). LBP is one of the leading contributors to years lived with disability as well as health care expenditures in the United States. With an expected increase in prevalence due to an aging population, sports medicine providers have a unique opportunity to provide effective treatment strategies incorporating exercise advice and prescription. Although the majority of individuals with acute LBP will have their symptoms resolve spontaneously, almost 40% will have recurrence or develop chronic LBP within 1 year. No single exercise method has been shown to be more effective than another. The evidence for walking programs, aerobic exercise, yoga, Pilates, and tai chi for LBP is discussed. Our review summarizes the beneficial role of a personalized exercise program and related counseling strategies in the prevention and management of LBP.

Relationship between the number of steps taken during lockdown caused by the COVID-19 pandemic and low back pain

Introduction: In 2020, the whole world was overwhelmed by the SARS-CoV-2 coronavirus threat. In order to prevent the spread of the virus, national governments introduced restrictions of movement in public space, closing schools, universities, many companies switched to remote working. In addition to the obvious benefits of the above changes, numerous side effects can be observed. One of them is pain in the locomotive organs caused by the sedentary lifestyle. Objective: The main objective of the study was to assess the relationship between physical activity during quarantine, caused by the COVID-19 pandemic, and the occurrence of spinal pain. Material and methods: The study was attended by 55 people (29 women and 26 men) who attended physiotherapeutic consultations due to low back pain. For comparison purposes, they were divided into two groups: Group 1 (n=24) includes active persons, Group 2 (n=31) includes inactive persons. The survey was conducted in June 2020. The study used the reading of pedometers from mobile phones and the Rolland-Morris Questionnaire, Laitinen’s Pain Scale and author’s own questionnaire. The respondents were asked to share the pedometer results from given weeks before, during and after restriction causes by the COVID-19. Results: Physically active persons (those performing health training) performed more steps before introducing restrictions (p<0.001). After the introduction of restrictions, all-day activity decreased significantly in both groups. The evaluation of pain characteristics revealed significant differences (between groups) in two categories – pain intensity and physical activity limitation. Group 2 individuals also reported greater functional limitations. Conclusion: In physically inactive people, the intensity of low back pain was much higher. This proves the relationship between activity levels and pain.

[Psychosomatics in Pain Therapy - Challenges of Chronic Pain]

Although there is growing awareness among physicians regarding chronic pain, the patient with chronic pain is often considered a complex, if not "difficult" patient in practice. Patients with chronic pain are thus at increased risk of being hastily dismissed and sent on their way. At the same time, therapeutic options are often limited and therapeutic successes not satisfying.

Non randomised trial of GRAVITY system therapy effectiveness in chronic, low intensity low back disc disease

Study aim: Chronic low back pain (CLBP) is a therapeutically challenging pain syndrome. Physical exercises are the most common therapy used in CLBP treatment. The aim of the study was to verify if GRAVITY system exercise can be effective in the therapy of chronic discogenic low back pain. The GRAVITY system exercise aims at strengthening full body muscles using the trainee’s own body weight only.

Material and methods: The study was registered at ClinicalTrials.gov Identifier: NCT04765293. We used TREND statement. The study populations were 50 patients with CLBP. The study population (group I) consisted of 25 patients who had GRAVITY system exercise. The clinical control group were 25 patients who received standard treatment in an outpatient clinic of National Health Fund. Before the start of the training, the patients’ had their muscle strength responsible for stabilizing the lumbar segment measured. We also measured patients’ Oswestry Disability Index (ODI) prior to and after the therapy cycle. The therapy was conducted twice a week for 40 minutes over the period of 4 weeks. The clinical control group were 25 patients who received treatment from the National Health Fund and had only standardised physical therapy (laser, ultrasound, cryotherapy and magnetic therapy) sessions for two weeks.

Results. We found statistically significant reduction in pain and disability in the study population after the treatment, but muscle strength did not increase significantly.

Conclusions: 1. GRAVITY system exercise might efficient in pain and disability reduction. Muscle strength did not increase after therapy. 2. Pain and disability had positive correlation with female sex, decreased physical activity and sedentary work.

Vibrating Exercise Equipment in Middle-Age and Older Women with Chronic Low Back Pain and Effects on Bioelectrical Activity, Range of Motion and Pain Intensity: A Randomized, Single-Blinded Sham Intervention Study

Simple Summary

Physical activity is often recommended as part of the management of chronic low back pain, which is one of the most common musculoskeletal disorders. Vibrating exercise equipment is used despite little scientific evidence to support its effectiveness in the prevention and treatment of musculoskeletal problems. The aim of this study was to evaluate the efficiency of using vibrating exercise equipment in women with chronic low back pain. Here, 92 women aged 49–80 years were assigned to one of two groups: the experimental and the control group. The intervention consisted of aerobic exercises with specific handheld equipment. Both groups performed physical activity twice weekly for 10 weeks. The erector spinae muscles’ bioelectrical activity, the lumbar range of motion and pain intensity were measured in all participants at baseline and after 10 weeks. Compared with baseline measures, there was a significant decrease in the bioelectrical activity of the erector spinae muscles during flexion movement, rest at maximum flexion, extension movement and rest in a prone position; an increase in the lumbar range of motion and a decrease in pain intensity following a program of physical activity with vibrating exercise equipment. No significant changes were found in intergroup comparisons; however, physical activity with vibrating exercise equipment could be a prospective strategy for increasing lumbar range of motion and decreasing pain and erector spinae muscle activity in people with chronic low back pain.

Abstract

Background: Chronic low back pain (CLBP) is one of the most common musculoskeletal disorders. Physical activity (PA) is often recommended as part of the management of CLBP, but to date, no one particular exercise has been shown to be superior. Vibrating exercise equipment (VEE) is widely available and used despite little scientific evidence to support its effectiveness in the prevention and treatment of musculoskeletal problems. The aim of this study was to evaluate the efficiency of using VEE compared with sham-VEE in women with CLBP. Methods: A randomized (1:1 randomization scheme) single-blinded sham-controlled intervention study was conducted. Through simple randomization, 92 women aged 49–80 years were assigned to one of two groups: VEE (the experimental group) and sham-VEE (the control group). The VEE and sham-VEE intervention consisted of aerobic exercises with specific handheld equipment. Both groups performed physical activity twice weekly for 10 weeks. The erector spinae muscles’ bioelectrical activity (using an eight-channel electromyograph MyoSystem 1400L), lumbar range of motion (Schober’s test) and pain intensity (visual analog scale) were measured in all participants at baseline and after 10 weeks. Results: There was a significant decrease in the bioelectrical activity of the erector spinae muscles during flexion movement (left: Me = 18.2 before; Me = 14.1 after; p = 0.045; right: Me = 15.4 before; Me = 12.6 after; p = 0.010), rest at maximum flexion (left: Me = 18.1 before; Me = 12.5 after; p = 0.038), extension movement (right: Me = 21.8 before; Me = 20.2 after; p = 0.031) and rest in a prone position (right: Me = 3.5 before; Me = 3.2 after; 0.049); an increase in lumbar range of motion (Me = 17.0 before; Me = 18.0 after; p = 0.0017) and a decrease in pain intensity (Me = 4.0 before; Me = 1.0 after; p = 0.001) following a program of PA in the VEE group. Conclusions: No significant changes were found in intergroup comparisons. The beneficial changes regarding decreased subjective pain sensation in the VEE and sham-VEE groups may be due to participation in systematic physical activity. However, PA with vibrating exercise equipment could be a prospective strategy for increasing lumbar range of motion and for decreasing pain and erector spinae muscle activity in people with CLBP.

Walking, Cycling, and Swimming for Nonspecific Low Back Pain: A Systematic Review With Meta-analysis

OBJECTIVE

To investigate the effectiveness of walking/running, cycling, or swimming for treating or preventing nonspecific low back pain (LBP).

DESIGN

Intervention systematic review.

LITERATURE SEARCH

Five databases were searched to April 2021.

STUDY SELECTION CRITERIA

Randomized controlled trials evaluating walking/running, cycling, or swimming to treat or prevent LBP were included.

DATA SYNTHESIS

We calculated standardized mean differences (SMDs) and 95% confidence intervals (CIs). Certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

No trials assessed LBP prevention or addressed acute LBP. Nineteen trials (2362 participants) assessed treatment of chronic/recurrent LBP. Low-certainty evidence suggests that walking/running was less effective than alternate interventions in reducing pain in the short term (8 trials; SMD, 0.81; 95% CI: 0.28, 1.34) and medium term (5 trials; SMD, 0.80; 95% CI: 0.10, 1.49). High-certainty evidence suggests that walking/running was less effective than alternate interventions at reducing disability in the short term (8 trials; SMD, 0.22; 95% CI: 0.06, 0.38) and medium term (4 trials; SMD, 0.28; 95% CI: 0.05, 0.51). There was high-certainty evidence of a small effect in favor of walking/running compared to minimal/no intervention for reducing pain in the short term (10 trials; SMD, -0.23; 95% CI: -0.35, -0.10) and medium term (6 trials; SMD, -0.26; 95% CI: -0.40, -0.13) and disability in the short term (7 trials; SMD, -0.19; 95% CI: -0.33, -0.06). Scarcity of trials meant few conclusions could be drawn regarding cycling and swimming.

CONCLUSION

Although less effective than alternate interventions, walking/running was slightly more effective than minimal/no intervention for treating chronic/recurrent LBP. J Orthop Sports Phys Ther 2022;52(2):85-99. Epub 16 Nov 2021. doi:10.2519/jospt.2022.10612.

Regular Aerobic Exercise Attenuates Pain and Anxiety in Mice by Restoring Serotonin-modulated Synaptic Plasticity in the ACC

PURPOSE

Clinical studies found that regular aerobic exercise has analgesic and anti-anxiety effects; however, the underlying neural mechanisms remain unclear. Multiple studies have suggested that regular aerobic exercise may exert brain-protective effects by promoting the release of serotonin, which may be a pain modulator. The anterior cingulate cortex (ACC) is a key brain area for pain information processing, receiving dense serotonergic innervation. As a result, we hypothesized that exercise may increase the release of serotonin in the ACC, thus improving pain and anxiety behaviours.

METHODS

Integrative methods were used, including behavioural, electrophysiological, pharmacological, biochemical, and genetic approaches, to explore the effects of regular aerobic exercise and the underlying neural mechanisms.

RESULTS

Regular aerobic exercise in the form of voluntary wheel running for 30 minutes daily for 15 days showed significant effectiveness in relieving pain and concomitant anxiety in complete Freund's adjuvant (CFA)-induced chronic inflammation pain models. c-Fos staining and multielectrode array recordings revealed alterations in neuronal activities and synaptic plasticity in the ACC. Moreover, systemic pharmacological treatment with 4-chloro-DL-phenylalanine (PCPA) to deplete endogenous serotonin and local delivery of serotonin to the ACC revealed that exercise-related serotonin release in the ACC bidirectionally modulates pain sensitization and anxiety behaviours by modulating synaptic plasticity in the ACC. Furthermore, we found that 5-HT1A and 5-HT7 receptors mediated the serotonin modulation effects under conditions of regular aerobic exercise through local infusion of a selective antagonist and shRNA in the ACC.

CONCLUSIONS

Our results reveal that regular aerobic exercise can increase serotonin release and modulate synaptic plasticity in the ACC, ultimately improving pain and concomitant anxiety behaviours through the functions of the 5-HT1A and 5-HT7 receptors.

[Results of the study of functional recovery of professional athletes after minimally invasive lumbar fusion]

OBJECTIVE

To conduct a comprehensive clinical-neurological assessment and to study the results of functional recovery of professional athletes after minimally invasive lumbar interbody fusion.

MATERIALS AND METHODS

The retrospective study included 27 patients-professional athletes who were operated on using minimally invasive decompression and stabilization techniques in the period 2010 to 2019. Clinical-neurological effectiveness was assessed when returning to previous sports activity was 14 (9; 17) weeks and 4 (3; 5) years after surgery.

RESULTS

The follow-up showed a significant improvement in clinical and neurological parameters: persistent elimination of radicular and muscular-skeletal symptoms, a decrease in the level of pain according to a visual analogue scale in the lumbar spine from 68 (61; 85) mm to 3 (2; 11) mm (p=0.002) and in the lower extremities from 84 (78; 91) mm to 1 (0; 3) mm (p=0.001), change in the physical component of health from 26.18 (23.58; 28.37) to 49.82 (49.03; 53.04) (p=0.002) and the psychological component of health from 27.87 (26.22; 29.29) to 52.18 (49.12; 55.66) (p=0.001), significant improvement in the perception of physical activity according to the Borg RPE Scale from 17 (16; 18) points to 9 (8; 9) (p<0.001). In one case (3.7%), the patient did not return to his previous sports career.

CONCLUSION

The use of minimally invasive rigid stabilization in the overwhelming majority of professional athletes made it possible in the shortest possible time to achieve regression of neurological symptoms, reduce pain, improve the quality of life, restore the functional state and return to previous sports activities.

The efficacy of kinesio taping as an adjunct to physical therapy for chronic low back pain for at least two weeks: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND:

Kinesio taping (KT) is a relatively new treatment method for chronic low back pain (CLBP). The effectiveness of KT as an adjunct to physical therapy (PT) for CLBP remains controversial.

OBJECTIVE:

The aim of this updated meta-analysis was to critically examine and evaluate the evidence of recent randomized controlled trials regarding the effectiveness of KT as an adjunct to PT for CLBP for at least 2 weeks.

METHODS:

This systematic review and meta-analysis was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, Cochrane Library were searched in September 2020 by two independent reviewers. The risk of bias was assessed using the Cochrane Collaboration's tool. Data analysis was performed with Review Manager Software.

RESULTS:

Twelve randomized controlled trials with a total of 676 patients were included in our study. Mean improvements were significantly higher in the KT+PT group than the PT group for pain score (SMD, 0.73 [95% CI, 0.37–1.08], P < .00001) and disability (SMD, 1.01 [95% CI, 0.42–1.59], P = .0007). Of 12 studies based on the pain score, 7 reported KT+PT patients to have significantly less pain at latest follow-up when compared with PA patients (P < .05). Of 11 studies based on the disability, 8 reported KT+PT patients to have significantly better improvements at latest follow-up when compared with PA patients (P < .05).

CONCLUSION:

Kinesio taping combined with physical therapy provided better therapeutic effects regarding pain reduction and disability improvement compared with physical therapy alone in individuals with chronic low back pain. Limitation: 1. Included studies and sample sizes were small and most studies were with moderate evidence level; 2. several important outcomes such as range of motion and distance walked were lack; 3. heterogeneity among the included studies was unavoidable.

Effect of Different Exercise Types on the Cross-Sectional Area and Lumbar Lordosis Angle in Patients with Flat Back Syndrome

Flat back syndrome (FBS) is a sagittal imbalance wherein the normal spinal curvature is reduced. This study aimed to compare the effects of different exercise programs on the cross-sectional area (CSA) of the lumbar muscles, lumbar lordosis angle (LLA), lumbar disability, and flexibility in patients with FBS. Thirty-six females with flexible FBS were randomly allocated to the corrective exercise group (CEG, n = 12), resistance exercise group (REG, n = 12), and physical therapy group (PTG, n = 12). CEG and REG patients participated in a 12-week exercise intervention for 60 min three times per week. The CSA, LLA, Oswestry disability index (ODI), and sit-and-reach test were measured before and after intervention. CSA showed a significant difference between groups (p < 0.01), with CEG and REG demonstrating a significant increase (p < 0.05 and p < 0.05, respectively). LLA showed a significant difference between groups (p < 0.001); CEG showed a higher increase than did REG (p < 0.01) and PTG (p < 0.001). ODI also showed a significant difference between groups (p < 0.001), being lower in CEG than in REG (p < 0.001) and PTG (p < 0.001). Lumbar flexibility significantly improved in all groups, albeit with a significant difference (p < 0.001). Although corrective and resistance exercise programs effectively improve these parameters, corrective exercise is superior to other interventions for patients with FBS.

Exercise therapy for chronic low back pain

BACKGROUND

Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs.

OBJECTIVES

The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments.

SEARCH METHODS

We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update.

SELECTION CRITERIA

We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration.

DATA COLLECTION AND ANALYSIS

Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo.

MAIN RESULTS

We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias.  Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups.

AUTHORS' CONCLUSIONS

We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.

Effects of transcutaneous electrical nerve stimulation and instrument-assisted soft tissue mobilization combined treatment on chronic low back pain: A randomized controlled trial

BACKGROUND

Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain (CLBP) requires a treatment period of ⩾ 6 weeks to decrease pain and disability and is ineffective as sole treatment. Instrument-assisted soft tissue mobilization (IASTM) has rapid effects in musculoskeletal disorders.

OBJECTIVE

This study aimed to investigate the effects of a 3-week combined TENS and IASTM treatment (TICT) on CLBP.

METHODS

Thirty-two young men with CLBP were randomly divided into the TICT and control groups (n= 16 each). Patients were evaluated with the visual analog (VAS) and face pain-rating scales (FPRS) for pain, the Oswestry Disability Index (ODI) and passive straight leg raise (PSLR) test for flexibility, and the supine bridge test (SBT) for endurance before and after the treatment course. The TICT group received TICT on the lower back, glutes, and hamstrings, six times in 3 weeks.

RESULTS

Group, time, and group × time interaction effects on pain were significant (VAS and FPRS, all p< 0.001). Group × time interaction (ODI, p< 0.001; PSLR, p< 0.05; SBT, p< 0.01) and group (ODI, p< 0.05) and time main effects (ODI, p< 0.001; PSLR, p< 0.01; SBT, p< 0.001) on motor function were significant.

CONCLUSION

Thus, short-term TICT decreased pain level and increased motor function in CLBP patients, yet further investigation is needed on different age and gender groups.

[Results of minimally invasive lumbar fusion in professional athletes: a single-center retrospective study]

Professional athletes have a high basic level of physical fitness and significant motivation for returning to previous rhythm of functional activity within the shortest period after trauma without deterioration of baseline level of sportsmanship. Despite the well-presented results of lumbar spine fusion in general population, these data among professional athletes are not well understood.

OBJECTIVE

To analyze the results of minimally invasive lumbar fusion in professional athletes.

MATERIAL AND METHODS

A retrospective study included 27 athletes (19 men and 8 women) aged 29 (26; 34) years after minimally invasive lumbar spine decompression and fusion via anterior, lateral and posterior approaches. Total lumbar lordosis, degenerative changes in adjacent segment, area of multifidus muscle, perioperative complications and timing of sports rehabilitation were analyzed within 3-5 (mean 4) years after surgery.

RESULTS

We found an increase of total lumbar lordosis from 35.2° to 44.1° (p=0.02), no significant muscle atrophy (<30%) and degeneration of adjacent segment (p>0.05). There were 5 perioperative complications (18.5%). Mean period of sports rehabilitation was 14 (9; 17) weeks. One (3.7%) patient did not return to his previous sports career.

CONCLUSION

Minimally invasive short-segment lumbar interbody fusion in professional athletes is characterized by low risk of fixation element failure, no significant degeneration of adjacent level and postoperative muscle atrophy. This procedure ensures early rehabilitation and returning to sports.

Aerobic Physical Exercise for Pain Intensity, Aerobic Capacity, and Quality of Life in Patients With Chronic Pain: A Systematic Review and Meta-Analysis

BACKGROUND

Currently, chronic pain is a disabling condition that is difficult to manage, which generates a high burden on health systems. The objective is to determine the effects of aerobic physical exercise in adults with chronic pain.

METHODS

A systematic review of searches in databases including MEDLINE, LILACS, ScienceDirect, PEDro, OTseeker, The Cochrane Library, EBSCO, and Google Scholar was conducted. The search process was carried out until July 31, 2020, and the study selection process was independently carried out through a criteria analysis for each phase. Outcome measures were chosen: aerobic capacity, physical function, quality of life, and pain.

RESULTS

Twenty-seven studies were included in which aerobic exercise was considered as an option to treat chronic pain. These studies showed significant results compared with other treatment options in terms of pain measurements (-0.22 [-0.42 to -0.03]) and aerobic capacity. For quality of life, there were significant improvements in the physical function component over the mental health component evaluated with the short form health survey-36/12.

CONCLUSION

Aerobic exercise is a nonpharmacological therapeutic option for treatment. Also, aerobic capacity and endurance improved when this type of exercise was prescribed, thus resulting in a substantial improvement in the quality of life of people suffering from chronic pain.

Neuromuscular exercises on pain intensity, functional disability, proprioception, and balance of military personnel with chronic low back pain

BACKGROUND

Due to their occupational status, military personnel are a high-risk group for low back pain (LBP).

PURPOSE

The aim of this study was to investigate the effect of neuromuscular exercises on the severity of pain, functional disability, proprioception, and balance in military personnel with LBP.

METHODS

Military personnel with LBP were randomly assigned into two groups: intervention (n=15) and control (n=15). The intervention group performed 60 minutes of neuromuscular exercises three times per week for eight weeks while the control group continued their routine physical activities.

RESULTS

The mean post-intervention pain intensity, disability, and proprioception error significantly decreased in the intervention group. Whereas their mean post-interventions static and dynamic balance scores significantly increased.

CONCLUSIONS

The results indicate eight weeks of neuromuscular exercise decreased pain intensity and improved functional ability, static and dynamic balance, and proprioception among military staff suffering chronic low back pain.

Lifestyle Medicine for Chronic Lower Back Pain: An Evidence-Based Approach

Lower back pain is a leading cause of work absence and activity limitations globally, with a 60% to 85% lifetime chance of occurrence. This article highlights the role that lifestyle medicine plays in managing lower back pain as a cost-effective intervention strategy. It is suggested that lifestyle medicine strategies, such as incorporating whole foods and a plant-based diet, sustainable physical activity and mind-body exercises, restorative sleep, stress resiliency, awareness and mitigation of substance abuse and addiction, and establishing meaningful social networks and self-care strategies, be a part of managing chronic lower back pain.

Clinical-Instrumental Results and Analysis of Functional Activity Restoration in Professional Athletes After Lumbar Total Disk Replacement

OBJECTIVE

To analyze the clinical and biomechanical outcome of professional athletes after lumbar total disk replacement, with a focus on restoration of the functional activity.

METHODS

This nonrandomized retrospective single-center study included 11 professional athletes who underwent lumbar disc replacement surgery using the prosthesis M6-L (Spinal Kinetics, Schaffhausen, Switzerland). The average postoperative follow-up was 3.18 ± 1.14 years. The following outcomes were evaluated: intensity of pain in the lumbar spine and lower limbs, Oswestry Disability Index, Short-Form 36, complications, time of return to previous sports activity, range of movement, degree of lumbar lordosis, degenerative changes of the adjacent levels, and degree of heterotopic ossification.

RESULTS

The operated patients reported significant decrease of pain on visual analog scale (P < 0.001) as well as significant improvement of Oswestry Disability Index (P = 0.001) and Short-Form 36 (P < 0.001). For the duration of follow-up, the patients maintained segmental range of motion at L4-L5 (P = 0.04) and L5-S1 (P = 0.03) levels. There was also some statistically insignificant increase of global lumbar lordosis (P = 0.84). We did not identify any significant degeneration of the adjacent intervertebral disks (P > 0.05) or progression of the facet joint degenerative changes at the implantation level and in the adjacent segments (P > 0.05). One patient (9.1%) developed grade I heterotopic ossification 5 years after surgery and in 1 patient (9.1%), a lesion of superior hypogastric plexus was recorded. The average time of return to previous sports activity was 9.72 ± 3.03 weeks.

CONCLUSIONS

Total lumbar disc replacement using M6-L prosthesis in professional athletes made it possible to achieve statistically significant reduction of pain and facilitated early return to normal sports activities. In our opinion, preservation of movement of the operated lumbar segment can help to reduce the mechanical stress with beneficial impact on the rate of degeneration of the adjacent level.

Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis

BACKGROUND

While chronic exercise training has been demonstrated to be an effective non-pharmacological treatment for chronic low back pain (CLBP), there has been a relative lack of evidence or clinical guidelines for whether a posterior chain resistance training programme provides any benefits over general exercise (GE).

OBJECTIVES

To determine if chronic posterior chain resistance training (PCRT), defined as exercise programmes of ≥6 weeks duration focused on the thoracic, lumbar and hip extensor musculature, is more effective than GE in improving pain, level of disability, muscular strength and the number of adverse events in recreationally active and sedentary individuals with CLBP.

METHODS

Four electronic databases were systematically searched from 25 September 2019 until 30 August 2020. Using the Joanna Briggs Institute (JBI) Critical Appraisal Tools checklist for randomized controlled trials (RCTs), articles were critically appraised and compared against the inclusion/exclusion criteria. Standardized mean difference (SMD), risk difference (RD) and confidence interval (CI) were calculated using Review Manager 5.3.

RESULTS

Eight articles were included, with a total of 408 participants (203 PCRT, 205 GE). Both PCRT and GE were effective in improving a number of CLBP-related outcomes, but these effects were often significantly greater in PCRT than GE, especially with greater training durations (i.e. 12-16 weeks compared to 6-8 weeks). Specifically, when compared to GE, PCRT demonstrated a greater reduction in pain (SMD = - 0.61 (95% CI - 1.21 to 0.00), p = 0.05; I2 = 74%) and level of disability (SMD = - 0.53 (95% CI - 0.97 to - 0.09), p = 0.02; I2 = 52%), as well as a greater increase in muscle strength (SMD = 0.67 (95% CI 0.21 to 1.13), p = 0.004; I2 = 0%). No differences in the number of adverse events were reported between PCRT and GE (RD = - 0.02 (95% CI - 0.10 to 0.05), p = 0.57; I2 = 72%).

CONCLUSION

Results of the meta-analysis indicated that 12-16 weeks of PCRT had a statistically significantly greater effect than GE on pain, level of disability and muscular strength, with no significant difference in the number of adverse events for recreationally active and sedentary patients with CLBP. Clinicians should strongly consider utilizing PCRT interventions for 12-16 weeks with patients with CLBP to maximize their improvements in pain, disability and muscle strength. Future research should focus on comparing the efficacy and adverse events associated with specific PCRT exercise training and movement patterns (i.e. deadlift, hip lift) in treating this population.

TRIAL REGISTRATION

PROSPERO CRD42020155700 .

A qualitative systematic review of the views, experiences and perceptions of Pilates-trained physiotherapists and their patients

OBJECTIVES

A review of qualitative studies exploring Pilates-trained physiotherapists and their patients' perspectives and experiences of Pilates, aiming to improve practice and provide a deeper insight into the way this method is being utilized along with its effects on participants.

DESIGN

Qualitative evidence synthesis using meta-ethnography.

DATA SOURCES

A comprehensive search strategy, limited to English language articles, was conducted to MEDLINE (PubMed), EMBASE, CINAHL, PEDro and Cochrane Central for the period of January 2000 (inception) to June 2020. This was supplemented by identification of Grey literature through Google Scholar, website searching and reference lists.

STUDY SELECTION

Qualitative studies reporting experiences and perceptions of patients' or Pilates-trained physiotherapists' regarding the efficacy of Pilates for the management of chronic musculoskeletal conditions. After a process of exclusion, eight studies were included in the synthesis.

DATA EXTRACTION

The textual data were analysed by a qualitative software program. Studies were critically appraised independently by two reviewers.

DATA SYNTHESIS

Articles were synthesized using a technique of meta-ethnography. Three themes emerged from the process of reciprocal translation: (1) Benefits of the Pilates approach; (2) most effective ways to utilize and most beneficial parameters and (3) risks, precautions, contraindications and indications.

CONCLUSION

This is the first qualitative evidence synthesis of practitioners' and patients' perspectives of Pilates. Findings support evidence for the various benefits of this approach and provide fresh insight into the way this method can be practiced to maximize efficiency and focus on the patients' needs.

KEY RECOMMENDATIONS

Pilates-trained physiotherapists identified that Pilates can be tailored to individual requirements, preferences and needs, to promote self-management to facilitate clinical and cost-effective care.