Effects and underlying mechanisms of unstable shoes on chronic low back pain: a randomized controlled trial

The effect of combining vibratory platform and unstable footwear on static balance in active young people

Vibratory platforms (VPs) and unstable footwear (UF) have both shown benefits on balance in some populations. However, there is no evidence about the combined effects of using UF while training on an VP in healthy and physically active young people. We aimed to evaluate the effects of wearing unstable footwear (UF) while training on a whole-body VP on balance in healthy, physically active young people. 23 participants were randomized into groups assigned UF (n = 11) or stable footwear (SF; n = 12). Both groups followed the same training program on an VP with the assigned footwear type twice a week for 12 weeks. The training consisted of performing 8 isometric exercises for progressively longer periods and higher oscillation amplitudes (15-60 s, 1-3 mm), at a fixed vibration frequency (20 Hz). The main outcomes were the antero-posterior and medio-lateral velocities of the center of pressure (COP) recorded using a plantar pressure corridor at baseline, post-treatment and 1-month follow-up. We found a statistically significant difference in the antero-posterior velocity during the monopodal test in the UF group between the different time-points (χ²(2) = 13.282, p = 0.001). Mediolateral COP velocity ranking during the bipodal test was lower for UF than for SF group (U = 19.50, z = - 2.86, p = 0.003) at follow-up. The traditional vibratory platform training does not seem to be effective to improve static balance in physically active young people, however, adding UF provided slightly greater effect.

The effects of shoes and insoles for low back pain: a systematic review and meta-analysis of randomized controlled trials

The aim of this review was to examine the effects of shoes and insoles on low back pain (LBP). Seven electronic databases were searched from their inception to May 2020. The methodological quality of the 14 included studies was assessed by PEDro scale. Quality of evidence was assessed using GRADE. Moderate evidence on the disability questionnaire score (SMD, 0.52; 95% CI, 0.28 to 0.77; P < 0.001) and pain score (SMD, 0.61; 95% CI, 0.36 to 0.85; P < 0.001) of the custom-made orthotics for chronic LBP compared with no orthotics/insoles intervention was found. Meta-analysis results also showed moderate evidence on the disability questionnaire score (SMD, 0.44; 95% CI, 0.05 to 0.82; P =0.03) in patients who wore unstable shoes compared with regular shoes. Pain and life quality scores showed low-quality evidence of unstable shoes for chronic LBP. Custom-made orthotics and unstable shoes can be recommended to patients as a management option of chronic LBP.

Unstable shoes for the treatment of lower back pain: a meta-analysis of randomized controlled trials

OBJECTIVE

We aimed to perform a systematic review and meta-analysis to compare the treatment effects of unstable shoes and flat shoes on lower back pain patients.

DATA SOURCES

Literature databases, including PubMed, Web of Science, and EMBASE (up to June 2019), were searched systematically.

REVIEW METHODS

Two authors independently screened the retrieved records and identified the randomized controlled trials where patients with lower back pain who wore unstable shoes as intervention and wore flat shoes as a control. Relevant data were extracted for meta-analysis using Review Manager 5.3 software. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the pooled outcome evidence levels.

RESULTS

Five randomized controlled trials and 251 patients were included in the analysis. The meta-analysis results showed that there was a tendency toward a reduction in the Roland-Morris disability questionnaire score (mean difference (MD) -2.16, 95% confidence interval (CI) -4.28 to -0.03, I² = 53%) and pain score (MD -0.84, 95% CI -1.66 to -0.02, I² = 84%) in patients wearing unstable shoes compared to those wearing flat shoes. There was no significant difference in the life quality scores between the unstable shoe and flat shoe groups (MD -0.59, 95% CI -6.18 to 5.01, I² = 0%). Functional disability and pain scores were determined to have very low-quality evidence, and life quality scores were determined to have low-quality evidence according to the Grading of Recommendations Assessment, Development and Evaluation analysis.

CONCLUSION

Unstable shoes may be effective in treating lower back pain in the clinic, but the conclusion was limited by the current low-quality studies.