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Lendraitienė E, Styraitė B, Šakalienė R, Misytė G, Bileviciute-Ljungar I. Effects of Pain Neuroscience Education and Physiotherapy on Chronic Low Back Pain, Fear of Movement and Functional Status: A Randomised Pilot Study. J Clin Med 2024; 13:2081. [PMID: 38610845 PMCID: PMC11012892 DOI: 10.3390/jcm13072081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/04/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Chronic non-specific low back pain is a non-harmous condition often found in the general population. It is one of the most significant disabilities and needs different treatment modalities. This study investigates the effects of pain neuroscience education and physiotherapy on pain intensity, fear of movement and functional status in a Lithuanian cohort with non-specific low back pain. Methods: The study was performed at the primary health care unit in Kaunas, Lithuania. The key inclusion criterion was persistent non-specific low back pain longer than three months and which affects daily life functions. Thirty participants (mean 33.47, SD 4.38 years age, 70% women) were randomised into two training groups with and without pain neuroscience education (for a total of 60 min of teaching). Physiotherapy was performed twice per week during 45 min/session for a period of 10 weeks with exercises which strengthen, stabilize, and stretch the spinal cord muscles. Outcomes included pain intensity, kinesiophobia and disability and these were measured by self-scored questionnaires (numeric rating scale, Tampa scale for kinesiophobia-11, Oswestry disability index and the Roland-Morris questionnaire, respectively). Results: The results indicate that both groups improved in the measured outcomes, with the only difference between them being a better improvement in kinesiophobia in the group receiving physiotherapy and pain neuroscience education. Conclusions: The results of this study confirm that a relatively short intervention of pain neuroscience education enhances the effects of physiotherapy and should be implemented in clinical practice.
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Affiliation(s)
- Eglė Lendraitienė
- Department of Rehabilitation, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (E.L.); (B.S.); (G.M.)
| | - Barbora Styraitė
- Department of Rehabilitation, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (E.L.); (B.S.); (G.M.)
| | - Rasa Šakalienė
- Department of Rehabilitation, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (E.L.); (B.S.); (G.M.)
| | - Gabija Misytė
- Department of Rehabilitation, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (E.L.); (B.S.); (G.M.)
| | - Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, 18288 Stockholm, Sweden
- Multidisciplinary Pain Clinic, Capio St. Göran Hospital, 11219 Stockholm, Sweden
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Khaledi A, Gheitasi M. Isometric vs Isotonic Core Stabilization Exercises to Improve Pain and Disability in Patients with Non-specific Chronic Low Back Pain: A Randomized Controlled Trial. Anesth Pain Med 2024; 14:e144046. [PMID: 38725921 PMCID: PMC11078224 DOI: 10.5812/aapm-144046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 05/12/2024] Open
Abstract
Background Non-specific chronic low back pain (NSCLBP) is a prevalent condition that affects 90% of individuals experiencing low back pain. Core stabilization exercises (CSE) stand out as the most commonly employed therapeutic approach for managing NSCLBP. Nevertheless, there remains uncertainty regarding the superior effectiveness between isometric (ISOM) and isotonic (ISOT) types of CSE in the treatment of NSCLBP. Objectives The primary objective of this study was to compare the efficacy of ISOM and ISOT exercises concerning pain and disability in patients with NSCLBP. Additionally, the study aimed to assess the effectiveness of both ISOM and ISOT in comparison to no intervention concerning these variables in these patients. Methods This study was a randomized controlled trial that involved 41 men and women experiencing NSCLBP. Participants were randomly allocated to three groups: ISOM CSE (n = 13), ISOT CSE (n = 14), and a waitlist control (n = 14). The exercise training was administered for 40 - 60 minutes three times a week over a period of up to 8 weeks. Pain (assessed using the Visual Analog Scale or VAS) and disability (evaluated through the Oswestry Disability Index or ODI) variables were measured before and after the interventions. Results Based on the results, there was no significant difference between the 2 exercise groups (ISOM and ISOT) regarding pain and disability. However, the ISOM group demonstrated numerically better results than the ISOT group. Both the ISOM and ISOT groups exhibited a significant decrease in pain levels, with the VAS score decreasing from 5.5 to 2.7 for ISOM and from 5.8 to 3.7 for ISOT, as compared to the control group (P < 0.001 and P = 0.001, respectively). Additionally, the average disability showed a significant improvement in both the ISOM (ODI score from 17 to 11) and ISOT (ODI score from 15.4 to 11) groups compared to the control group (P < 0.001). Conclusions Both ISOM and ISOT methods are effective in alleviating pain and disability in patients with NSCLBP. However, there is no significant difference in the benefits between them. Numerically, ISOM exercises were found to be superior. Further studies are needed to obtain a more accurate answer regarding their superiority.
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Affiliation(s)
- Arash Khaledi
- Department of Sports Science, Kish International Campus, University of Tehran, Kish, Iran
| | - Mehdi Gheitasi
- Department of Health & Sport Rehabilitation, Faculty of Sport Science & Health, University of Shahid Beheshti, Tehran, Iran
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Mudda S, Janardhan SK, Santenna C, Mooventhan A, Shetty P. Efficacy of Integrated Yoga and Naturopathy With Physiotherapy or Acupuncture for Low Back Pain: A Parallel, Two-Arm, Randomized Trial. Cureus 2024; 16:e55198. [PMID: 38558622 PMCID: PMC10980909 DOI: 10.7759/cureus.55198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Low back pain (LBP) is a musculoskeletal condition that affects many individuals. While physiotherapy and acupuncture are frequently used treatments, determining their specific contributions when used alongside integrated yoga and naturopathy (IYN) therapy for relieving chronic LBP symptoms and enhancing quality of life is important. METHODOLOGY In the present prospective randomized comparative trial, a total of 60 participants were divided into the following two groups: physiotherapy with IYN and acupuncture with IYN. The treatment duration was 10 days, and assessments were conducted both before (baseline) and after the intervention. Various assessment tools, such as the visual analog scale (VAS), Oswestry Disability Index (ODI), fingertip-to-floor test (FTF), State-Trait Anxiety Inventory (STAI), and Short Form 36 (SF-36), were utilized. The statistical analysis was performed using SPSS version 21.0 (Armonk, NY: IBM Corp). RESULTS The results revealed significant differences in VAS score, ODI, FTF score, STAI score, and SF-36 score between the physiotherapy and acupuncture groups (p<0.001). A t-test for the equality of means and a Mann-Whitney U test were used to compare the two groups; these tests revealed a significant difference in disability levels, range of motion, and state of anxiety. The acupuncture group showed a significant difference in the ODI (15.9 {12.6, 19.3}; p <0.001) and state anxiety (23.0 {20.0, 26.0}; p<0.001) compared to the physiotherapy ODI (22.4 {18.5, 26.4}) and state anxiety (27.5 {25.0, 30.0}). The physiotherapy group showed a significant difference in range of motion (7.7 {5.7, 9.7}; p<0.001) compared to the acupuncture group (11.6 {9.8, 13.5}). CONCLUSION The present study findings revealed that both physiotherapy and acupuncture, as interventions along with integrated yoga and naturopathy may be considered an effective treatment strategy for chronic LBP.
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Affiliation(s)
- Sofia Mudda
- Yoga and Naturopathy, Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa, and Homoeopathy (AYUSH) All India Institute of Medical Sciences, Bhopal, IND
| | - Sujatha K Janardhan
- Natural Therapeutics, Sri Dharmasthala Manjunatheshwara (SDM) College of Naturopathy and Yogic Sciences, Mangalore, IND
| | | | - Aruchunan Mooventhan
- Research, Government Yoga and Naturopathy Medical College and Hospital, Chennai, IND
| | - Prashanth Shetty
- Yoga, Sri Dharmasthala Manjunatheshwara (SDM) College of Naturopathy and Yogic Sciences, Mangalore, IND
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Cho M, Lee M, Jeong T, Chung Y. Effect of lower limb resistance exercise with abdominal draw-in on stroke survivors: A pilot study. NeuroRehabilitation 2024; 55:29-39. [PMID: 39213099 DOI: 10.3233/nre-240117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Evidence-based guidelines are needed to inform rehabilitation practice including the effect of non-paralytic lower limb resistance exercise with abdominal drawing-in technique (ADIM) on recovery of trunk control, balance and daily living after stroke survivors. OBJECTIVE The purpose of this study was to compare the effects of trunk control strengthening performed in non-paralytic lower limb resistance exercise with ADIM on trunk control, balance, daily living in stroke survivors. METHODS The 24 participants with stroke were randomly divided into three groups: lower limb resistance exercise group (LRAG; n = 8), lower limb exercise group (LAG; n = 8), and control group (CG; n = 8). The training sessions were conducted three times a week for four weeks. Outcome measures included the Korean version Trunk Impairment Scale (K-TIS), Postural Assessment Scale of Stroke (PASS), Modified Functional Reach Test (mFRT), Berg Balance Scale (BBS), Foot print and Modified Barthel's Index (MBI). RESULTS The results showed that the LRAG had a significant effect on the K-TIS, PASS, mFRT, Foot print and MBI than the LAG and CG (p < 0.05). The BBS results showed a significant difference the CG (p < 0.05). CONCLUSION This study showed that repeated non-paralytic lower limb resistance exercises with ADIM can be used clinically as a training method for general physiotherapy in patients with reduced postural control, balance and daily living.
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Affiliation(s)
- Myunggi Cho
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, Korea
| | - Miyoung Lee
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, Korea
| | - Taewoong Jeong
- Soonchynhyang University Bucheon Hospital, Bucheon, Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, Korea
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Ikwuanusi S, Tella A, Akinbo S, Nwaedozie O, Adje M. Determinants of outcomes for patients with chronic low back pain and fear-avoidance beliefs following treatment with specific stabilisation exercises. J Back Musculoskelet Rehabil 2024; 37:1059-1069. [PMID: 38217583 PMCID: PMC11307052 DOI: 10.3233/bmr-230312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/11/2023] [Indexed: 01/15/2024]
Abstract
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.
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Affiliation(s)
- Stephanie Ikwuanusi
- Department of Physiotherapy, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Abidemi Tella
- Department of Physiotherapy, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Sunday Akinbo
- Department of Physiotherapy, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Obianuju Nwaedozie
- Department of Physiotherapy, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Mishael Adje
- LUNEX International University of Health, Exercise & Sports, Differdange, Luxembourg
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Zhou T, Salman D, McGregor AH. What do we mean by 'self-management' for chronic low back pain? A narrative review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4377-4389. [PMID: 37640886 DOI: 10.1007/s00586-023-07900-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 03/29/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Chronic low back pain (CLBP) is a highly prevalent musculoskeletal condition affecting 60-80% of the general population within their lifetime. Given the large numbers of people affected, self-management approaches have been introduced as a way to manage this condition with endorsement by the national institute for health and care excellence. Interventions are often termed self-management without defining either content or goals. Our study sought to determine the content, characteristics, and evidence for self-management of CLBP. METHODS This narrative review was conducted using a systematic approach to search journal articles in English that focused on CLBP self-management. MEDLINE, EMBASE, CINAHL, and PsycINFO databases were used to identify publications with terms relating to back pain and self-management from January 2016 until January 2022. RESULTS In total, 15 studies were found suitable for inclusion in the review. Core components of self-management strategies include exercise, education, and psychological interventions, but there was a lack of consistency with respect to content. Intervention characteristics were either under-reported or varied. Furthermore, outcome measures used to assess these self-management programmes were diverse, mainly focusing on functional disability and pain intensity. CONCLUSIONS Inconsistencies in the content of self-management interventions, intervention characteristics, and outcome measures used for assessing self-management programmes were found across the literature. Current self-management approaches do not consider the complex biopsychosocial nature of CLBP. A consensus on the key components of self-management interventions, and how they should be evaluated, will pave the way for research to determine whether self-management can effectively manage CLBP.
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Affiliation(s)
- Tianyu Zhou
- MSk Lab, Department of Surgery & Cancer, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK
| | - David Salman
- MSk Lab, Department of Surgery & Cancer, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - Alison H McGregor
- MSk Lab, Department of Surgery & Cancer, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK.
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Sannasi R, Dakshinamurthy A, Dommerholt J, Desai V, Kumar A, Sugavanam T. Diaphragm and core stabilization exercises in low back pain: A narrative review. J Bodyw Mov Ther 2023; 36:221-227. [PMID: 37949564 DOI: 10.1016/j.jbmt.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/03/2023] [Accepted: 07/04/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Core stabilization is a vital concept in clinical rehabilitation (including low back pain rehabilitation) and competitive athletic training. The core comprises of a complex network of hip, trunk and neck muscles including the diaphragm. AIMS The paper aims to discuss the role of the diaphragm in core stability, summarize current evidence and put forth ideal core training strategies involving the diaphragm. METHOD Narrative review RESULTS: The diaphragm has a dual role of respiration and postural control. Evidence suggests that current core stability exercises for low back pain are superior than minimal or no treatment, however, no more beneficial than general exercises and/or manual therapy. There appears to be a higher focus on the transversus abdominis and multifidi muscles and minimal attention to the diaphragm. We propose that any form of core stabilization exercises for low back pain rehabilitation should consider the diaphragm. Core stabilization program could commence with facilitation of normal breathing patterns and progressive systematic restoration of the postural control role of the diaphragm muscle. CONCLUSION The role of the diaphragm is often overlooked in both research and practice. Attention to the diaphragm may improve the effectiveness of core stability exercise in low back pain rehabilitation.
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Affiliation(s)
- Rajasekar Sannasi
- Institute of Physiotherapy, Srinivas University, Mangalore, Karnataka, India.
| | - Anandhi Dakshinamurthy
- SRM College of Physiotherapy, Faculty of Medical and Health Sciences, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, 603203, Kanchipuram, Chennai, Tamil Nadu, India.
| | - Jan Dommerholt
- Myopain Seminars, Bethesda, MD 20814, USA; Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
| | - Vidhi Desai
- Institute of Physiotherapy, Srinivas University, Mangalore, Karnataka, India.
| | - Ajay Kumar
- Institute of Physiotherapy, Srinivas University, Mangalore, Karnataka, India.
| | - Thavapriya Sugavanam
- Health Services Research Unit, Oxford Population Health, University of Oxford, Oxford, United Kingdom.
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An Exercise Prescription To Improve Posture, Minimize Injury, and Improve Career Longevity in Surgeons. Eur Urol Focus 2023:S2405-4569(23)00041-X. [PMID: 36804719 DOI: 10.1016/j.euf.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/13/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023]
Abstract
A contemporary exercise and strength regimen can improve posture, minimize injury, and improve career longevity in surgeons. By targeting core stability, neck posture, and thoracoscapular strength, surgeons and operating room teams can minimize neck and lower back pain.
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