The effect of core stabilization exercise on lumbar joint position sense in patients with subacute non-specific low back pain: a randomized controlled trial

Efficacy of specific exercises in general population with non-specific low back pain: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Localized exercises are employed to activate, train, or restore the function of particular muscles and they are usually considered as part of treating individuals suffering low back pain. So, this systematic review and meta-analysis aimed to assess the efficacy of specific exercises in general population with non-specific low back pain (LBP).

METHODS

We conducted electronic searches in MEDLINE/PubMed, Scopus, Web of Science (WoS), and Google scholar from January 1990 to June 2021. Initially, 47,740 records were identified. Following the removal of duplicates, 32,138 records were left. After reviewing titles and abstracts, 262 papers were chosen for thorough assessment. Among these, 208 studies were excluded, resulting in 54 trials meeting the inclusion criteria for this study. Additionally, 46 of these trials were randomized controlled trials and were further evaluated for the meta-analysis. We included trials investigating the effectiveness of exercise therapy, including isometric activation of deep trunk muscles, strengthening exercises, stabilization exercises, stretching exercises, and proprioceptive neuromuscular facilitation exercises (PNF) in LBP patients. The primary outcome was pain intensity, measured using tools such as the visual analogue scale (VAS) and numeric pain rating scale (NPRS). The secondary outcome was disability, assessed through instruments such as the Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). The quality of the eligible studies was assessed using the Verhagen tool, and the level of evidence was evaluated using the GRADE approach.

RESULTS

Based on the Verhagen tool, 46 trials (85.2%) were categorized as having low methodological quality, while 8 studies (14.8%) were considered to have medium methodological quality. The meta-analysis indicated a small efficacy in favor of isometric activation of deep trunk muscles (-0.37, 95% CI: -0.88 to 0.13), a moderate efficacy in favor of stabilization exercises (-0.53, 95% CI: -1.13 to 0.08), and a large efficacy in favor of PNF exercises (-0.91, 95% CI: -1.62 to -0.2) for reducing pain intensity as assessed by VAS or NPRS tools. Moreover, the meta-analysis revealed a moderate efficacy for isometric activation of deep trunk muscles (-0.61, CI: -1.02 to -0.19), and a large efficacy for PNF exercises (-1.26, 95% CI: -1.81 to -0.72) in improving disability, assessed using RMDQ or ODI questionnaires. The level of certainty in the evidence, as determined by the GRADE approach, was very low to low.

CONCLUSION

These findings emphasize the importance of incorporating localized therapeutic exercises as a fundamental aspect of managing non-specific LBP. Clinicians should consider utilizing localized therapeutic exercise tailored to individual patient needs. Furthermore, further research investigating optimal exercise therapy, optimal dose of the exercises, durations, and long-term adherence is warranted to enhance the precision and efficacy of exercise-based interventions for non-specific LBP.

Physical therapy for acute and sub-acute low back pain: A systematic review and expert consensus

OBJECTIVE

To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions.

DATA SOURCES

A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years.

REVIEW METHODS

Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts.

RESULTS

Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain.

CONCLUSIONS

The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years.

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.

The preliminary results of physiotherapy scoliosis-specific exercises on spine joint position sense in adolescent idiopathic scoliosis: A randomized controlled trial

BACKGROUND

It has been observed that there are difficulties in maintaining spinal harmony in the absence of proprioceptive information, which has an important role in achieving postural control in scoliosis. One of the tests used to evaluate proprioceptive mechanisms is joint position reproduction.

OBJECTIVES

The main aim of our study was to investigate the effect of physiotherapy scoliosis-specific exercise (PSSE) on spine joint reposition (JR) sense. The second aim was to determine the effects of PSSE on the angle of trunk rotation (ATR), posture, and deformity perception in adolescent idiopathic scoliosis.

METHODS

Twenty-nine patients with adolescent idiopathic scoliosis (mean age 13.79 ± 1.82 years) were randomly allocated to two groups. "Schroth" exercises were applied to the PSSE group for 8 weeks (16 sessions). The control group was placed on the waiting list. Patients' JR error (dual inclinometer), ATR (scoliometer), posture parameters (PostureScreen Mobile, Posterior Trunk Asymmetry Index, and Anterior Trunk Asymmetry Index), and deformity perception (Walter Reed Visual Assessment Scale [WRVAS]) were assessed at the first session and at the end of 8 weeks.

RESULTS

The initial demographic characteristics, Cobb (thoracal: 19.41 ± 7.03 degrees; lumbar: 20.76 ± 7.24 degrees) and ATR (thoracal: 5.86 ± 3.98 degrees; lumbar: 5.66 ± 3.33 degrees) and clinical test parameters of the groups (JR, posture parameters, and WRVAS) were similar (P > .05). According to the findings, thoracal and lumbar JR error values (P < .05), ATR (P ≤ .001), posture parameters (P ≤ .001), and WRVAS (P = .048) were significantly improved in the PSSE group. Besides, when the groups were compared, a significant difference was found in favor of PSSE except for the deformity perception (P < .05).

CONCLUSIONS

Schroth exercises have a positive contribution for improving JR sense of the spine, vertebral rotation, and posture.

A Systematic Review of the Effectiveness of Core Stability Exercises in Patients with Non-Specific Low Back Pain

Background

Low back pain affects millions of people worldwide and can be a difficult condition to manage clinically. Many cases do not have a discernable etiology, further increasing the complexity of finding an effective intervention. Core stabilization exercises (CSE) strengthen the musculature that provides stability to the spine and show promising outcomes.

Purpose

To examine the efficacy of CSE exercises in the treatment of NSLBP in adult patients.

Study Selection

Studies were included if they had patients diagnosed with NSLBP, used CSE as a treatment for NSLBP, and were a clinical trial. Exclusion criteria were studies that did not utilize an objective pain scale, patients who had a specific diagnosed pathology contributing to the NSLBP or received treatment for their NSLBP within the prior six months.

Methods

The literature was systematically searched in the PubMed, Sports Medicine & Education Index, and CINHAL databases, using the search terms core stabilization, low back pain, and exercise. The initial search yielded 229 articles and was refined using search terms 'NOT analysis' in order to target randomized control trials and exclude meta-analyses to narrow the search. Full-text of the articles were assessed for eligibility by utilizing inclusion and exclusion criteria that were included in this review. Articles were assessed for quality using the PEDro scale and relevant data were extracted.

Results

Five moderate-quality studies (PEDRO range: 5-8) support CSE is an effective method to decrease pain, improve functionality, and increase core strength in patients with NSLBP. Although there are other commonly used methods to treating NSLBP, CSE have shown to be a beneficial method to treating NSLBP.

Conclusion

Grade B evidence suggests core stabilization exercises can be considered a favorable method for treating pain in patients with NSLBP.

Level of Evidence

1b.

Treatment of Degenerative Lumbar Spondylolisthesis by Tongdu Bushen Acupuncture, Intradermal Acupuncture, and Moxibustion Integrated Therapy Combined with Core Muscle Training Program: Study Protocol for a Randomized Controlled Clinical Trial

Background

Degenerative lumbar spondylolisthesis (DLS), one of the most common causes of low back pain, is defined as the displacement of a vertebral body over the lower vertebral body with degenerative changes and the absence of fracture or defect in the vertebral ring. This disease is a common and frequently occurring disease. Currently, there are many clinical treatment methods, but there is no specific method, and most of them have the characteristics of slow effect and easy recurrence.

Objective

The objective of this study is to summarize and analyze the effects of treatment of degenerative lumbar spondylolisthesis by Tongdu Bushen acupuncture, intradermal acupuncture, and moxibustion integrated therapy combined with core muscle training program (CMT) on the improvement of pain degree and dysfunction index, as well as the gait characteristics.

Methods

120 patients with DLS will be recruited and randomly divided into two groups using electroacupuncture combined with the CMT group as the control group. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association score (JOA) will be used for evaluation. The spatiotemporal and kinematics parameters in gait analysis, as well as the ability of lumbar muscle contraction, fatigue resistance, relaxation, and coordination of lumbar muscle in surface electromyography (sEMG), will be used as objective observation indexes to observe the effectiveness of Tongdu Bushen acupuncture, intradermal acupuncture, and moxibustion integrated therapy combined with CMT. Discussion. Tongdu Bushen acupuncture, intradermal acupuncture, and moxibustion integrated therapy is a traditional Chinese medicine treatment for DLS. Our results will provide evidence to determine whether the integrated therapy can effectively treat DLS, as well as its advantages and safety, and lay a foundation for further research. This trial is registered with ChiCTR2100050409.

Effects of Different Trunk Training Methods for Chronic Low Back Pain: A Meta-Analysis

We conducted a systematic review and meta-analysis comparing motor control, isometric, and isotonic trunk training intervention for pain, disability, and re-injury risk reduction in chronic low back pain patients. The EMBASE, MEDLINE, CENTRAL, PsycINFO, SPORTDiscus, and CINAHL databases were searched from inception until 25 February 2021 for chronic low back pain intervention based on any trunk training. Outcomes include the Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ) for disability, the Numerical Pain Rating Scale (NPRS) for pain, and the Sorensen Test (ST) for future risk of re-injury. Isometric training was superior to the control with a mean difference (MD) = −1.66, 95% confidence interval (CI) [−2.30, −1.01] in pain reduction; MD = −7.94, 95% CI [−10.29, −5.59] in ODI; MD = −3.21, 95% CI [−4.83, −1.60] in RMDQ; and MD = 56.35 s, 95% CI [51.81 s, 60.90 s] in ST. Motor control was superior to the control with a MD = −2.44, 95% CI [−3.10, −1.79] in NPRS; MD = −8.32, 95% CI [−13.43, −3.22] in ODI; and MD = −3.58, 95% CI [−5.13, −2.03] in RMDQ. Isometric and motor control methods can effectively reduce pain and disability, with the isometric method reducing re-injury risk.

Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial

Background

Therapeutic exercises are used in clinical practice for patients with low back pain (LBP). Core stabilization exercises can retrain the important function of local trunk muscles and increase the accuracy of the sensory integration process for stability of the spine in individuals with LBP. The aim of this study was to compare the effects of two different exercise regimes, Core stabilization exercises (CSE) and Strengthening exercise (STE), on proprioception, balance, muscle thickness and pain-related outcomes in patients with subacute non-specific low back pain (NSLBP).

Methods

Thirty-six subacute NSLBP patients, [mean age, 34.78 ± 9.07 years; BMI, 24.03 ± 3.20 Kg/m²; and duration of current pain, 8.22 ± 1.61 weeks], were included in this study. They were randomly allocated into either CSE (n = 18) or STE groups (n = 18). Exercise training was given for 30 min, three times per week, for up to 4 weeks. Proprioception, standing balance, muscle thickness of transversus abdominis (TrA) and lumbar multifidus (LM), and pain-related outcomes, comprising pain, functional disability and fear of movement, were assessed at baseline and after 4 weeks of intervention.

Results

The CSE group demonstrated significantly more improvement than the STE group after 4 weeks of intervention. Improvements were in: proprioception [mean difference (95% CI): − 0.295 (− 0.37 to − 0.2), effect size: 1.38, (p <  0.001)], balance: single leg standing with eyes open and eyes closed on both stable and unstable surfaces (p <  0.05), and percentage change of muscle thickness of TrA and LM (p <  0.01). Although both exercise groups gained relief from pain, the CSE group demonstrated greater reduction of functional disability [effect size: 0.61, (p <  0.05)] and fear of movement [effect size: 0.80, (p < 0.01)]. There were no significant adverse effects in either type of exercise program.

Conclusion

Despite both core stabilization and strengthening exercises reducing pain, core stabilization exercise is superior to strengthening exercise. It is effective in improving proprioception, balance, and percentage change of muscle thickness of TrA and LM, and reducing functional disability and fear of movement in patients with subacute NSLBP.

Trial registration

Thai Clinical Trial Registry (TCTR20180822001; August 21, 2018).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04858-6.

Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021

Low back pain (LBP) remains a musculoskeletal condition with an adverse societal impact. Globally, LBP is highly prevalent and a leading cause of disability. This is an update to the 2012 Academy of Orthopaedic Physical Therapy (AOPT), formerly the Orthopaedic Section of the American Physical Therapy Association (APTA), clinical practice guideline (CPG) for LBP. The overall objective of this update was to provide recommendations on interventions delivered by physical therapists or studied in care settings that included physical therapy providers. It also focused on synthesizing new evidence, with the purpose of making recommendations for specific nonpharmacologic treatments. J Orthop Sports Phys Ther 2021;51(11):CPG1-CPG60. doi:10.2519/jospt.2021.0304.

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.

Test-Retest Reliability of an iPhone® Inclinometer Application to Assess the Lumbar Joint Repositioning Error in Non-Specific Chronic Low Back Pain

Background: The joint position sense (JPS) has been used as an indirect marker of proprioception in subjects with non-specific chronic low back pain (NSCLBP), showing impairment in previous studies. It seems necessary to devise reliable tests to measure proprioceptive deficits in subjects with NSLBP. The objective of this study was to analyse the test-retest reliability and smallest real difference (SRD) of lumbar proprioception through the JPS indicator in a sample of patients with NSCLBP. Methods: Fifty participants with NSCLBP performed three repetitions of 30° lumbar flexion while standing and sitting using the iPhone^® inclinometer application to measure the lumbar joint repositioning error. For the reliability analysis, we performed an intra-session test-retest. Results: The total sample ICC values were excellent for standing (0.96) and sitting (0.93) 30° lumbar flexion. In addition, our results showed that, for the total sample, an SRD < 12% can be considered as a true change in proprioception concerning this procedure. On the other hand, men have better reliability than women in both standing and sitting positions. Additionally, the sitting position has better reliability than the standing position. The standard error of measurement (SEM) percentage was 4.2 for standing and 3.8 for sitting. The SRD percentage was 11.6 for standing and 10.4 for sitting. Conclusions: The iPhone^® inclinometer seems reliable for assessing proprioceptive ability through the lumbar joint repositioning error in subjects with NSCLBP in both standing (ICC = 0.96) and sitting (ICC = 0.93) positions. This technological device showed a lower measurement error for sitting position (SRD < 12%).

Effects of specific muscle activation for low back pain on activity limitation, pain, work participation, or recurrence: A systematic review

BACKGROUND

Specific muscle activation (SMA) is a commonly used treatment for people with low back pain (LBP) however there is variability in systematic reviews to date on effectiveness. This may be because of the use of eligibility criteria incongruent with original descriptions of the SMA approach.

PURPOSE

The purpose of this study was to determine the effectiveness of SMA on improving activity limitation, pain, work participation or recurrence for people with LBP.

STUDY DESIGN

Systematic review METHODS: Computer databases were searched for randomised controlled trials (RCTs) published in English up to September 6, 2019. Eligibility criteria were chosen to ensure all clinically relevant RCTs were included and trials of poorly defined or executed SMA excluded. Outcomes for activity limitation, pain, work participation or recurrence were extracted.

RESULTS

Twenty-eight RCTs were included in this review with 18 being considered high quality. GRADE quality assessment revealed low to high quality evidence that SMA was more effective than exercise, conservative medical management, multi-modal physiotherapy, placebo, advice and minimal intervention.

CONCLUSIONS

This systematic review is the first to evaluate the effectiveness of SMA in accordance with the original clinical descriptions. We found significant evidence supporting the effectiveness of SMA for the treatment of LBP. Where significant results were demonstrated, the between-group differences were in many comparisons clinically important based on contemporary definitions and an effect size of 0.5 or more. Practitioners should consider SMA as a treatment component in their patients with LBP.

Balance Control in Patients with Subacute Non-Specific Low Back Pain, with and without Lumbar Instability: A Cross-Sectional Study

BACKGROUND

Patients with low back pain (LBP) have poorly coordinated neuromuscular control, which may alter the normal postural stability of the spine. Altered movement control may occur at any stage of LBP.

PURPOSE

(1) To identify differences in balance control and proprioceptive sense between subacute non-specific LBP (NSLBP) patients with and without lumbar instability (LI) and healthy subjects and (2) to investigate the correlation between factors of motor control deficits and balance.

PATIENTS AND METHODS

Thirty-six participants matched by gender, age, and body mass index (BMI) were allocated into three groups of 12: subacute NSLBP patients with LI, subacute NSLBP patients without LI, and healthy subjects. Balance, proprioceptive sense, pain, functional disability, and fear of movement were evaluated.

RESULTS

Subacute NSLBP patients with LI exhibited greater impairments in balance control, proprioceptive sense, and functional ability than patients without LI (p<0.05). Subacute NSLBP patients showed more impairments in balance control, proprioceptive sense, and fear of movement than healthy subjects (p<0.001), with the following effect sizes (partial η2) for static balance on stable and unstable surface: 0.597 and 0.560, anticipatory balance: 0.417, and dynamic balance: 0.536; proprioceptive sense: 0.676; and fear of movement: 0.379. Significant fair correlations were found between (1) static balance and proprioceptive sense, functional disability, and fear of movement; (2) functional reach test (FRT) and pain; and (3) the five times sit to stand test (FTSTS) and functional disability.

CONCLUSION

Subacute NSLBP patients with LI showed greater impairment in balance control than patients without LI. Reduced proprioceptive sense, increased pain, functional disability, and fear of movement were fairly related to impaired balance.

The Effect of Stabilization Exercises Along With Self-care Training on Transverse Abdominal Activity, Pain, and Disability in Mothers With Low Back Pain Having Children With Cerebral Palsy: A Randomized Controlled Trial

OBJECTIVE

Many mothers of children with cerebral palsy experience low back pain, so the purpose of this study was to investigate the effect of stabilization exercises along with self-care training on transverse abdominal muscle activity, pain, disability, and depression in them.

DESIGN

In this single-blinded randomized clinical trial, 32 mothers with cerebral palsy children were selected were randomly divided into two groups. Both groups received self-care training individually. For the experimental group, in addition to the self-care training, 24 sessions of stabilization exercises were held. Outcome measures included visual analog scale, Roland-Morris Disability Questionnaire, Persian version of Beck Depression Inventory-II, and ultrasonography.

RESULTS

In the experimental group, the transverse abdominal muscle activity during abdominal hollowing exercises was significantly increased (P < 0.05). There was no significant difference between the two groups in pain, disability, and depression (P > 0.05).

CONCLUSIONS

Stabilization exercises could improve the voluntary activity of transverse abdominal muscle of mothers of children with cerebral palsy.