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Core Stabilization With the Lumbar Extension Exercise in Low Back Pain

  • Noh, Dong-koog (Department of Physical Medicine and Rehabilitation, Seoul Hyu Hospital) ;
  • Cha, Young-joo (Sports.Movement.Artificial Robotics.Techology (SMART) Institute, Department of Physical Therapy, Yonsei University) ;
  • Kim, Dae-hun (Department of Physical Therapy, School of Medical & Public Health, Kyungdong University) ;
  • You, Joshua (Sung) H. (Sports.Movement.Artificial Robotics.Techology (SMART) Institute, Department of Physical Therapy, Yonsei University)
  • Received : 2018.10.07
  • Accepted : 2018.11.08
  • Published : 2018.11.19

Abstract

Background: We developed a novel integrative lumbar stabilization technique that combines lumbar extension (LE) exercise with abdominal drawing-in maneuver (ADIM) to ameliorate low back pain (LBP) associated with neuromuscular imbalance and instability, based on the collective evidence of contemporary spinal rehabilitation. Objects: The specific aim of the present study was to investigate the effects of LE exercise with and without ADIM on core muscle strength, lumbar spinal instability, and pain, as well as functional characteristics in individuals with LBP using advanced radiographic imaging techniques. Methods: patients with mechanical LBP (N = 40, 6 males; $35.1{\pm}7.6years$) were recruited and randomly assigned either to the combined LE and ADIM (experimental group) or the LE alone (control group). Outcome measures included the visual analog scale, the modified Oswestry Disability Index, muscle strength imbalance (MSI), and radiographic imaging. The lumbar intervertebral displacement (LID), intervertebral (IV) and total lumbar extension (TLE) angles were calculated to evaluate the lumbar segmental instability. Results: The experimental group showed significant differences in the L3-L4, L5-S1 LIDs, L4-L5 and L5-S1 IV angles, and TLE angle as compared to the controls (p<.05). Immediate pain reduction and muscle strength imbalance ratio were significantly different between the groups (p<.05). Conclusion: These results suggest that the addition of ADIM significantly increased lumbar spinal stabilization in individuals with LBP, thereby reducing pain associated with functional lumbar flexion during daily activities.

Keywords

References

  1. Abizanda P, Navarro JL, Garcia-Tomas MI, et al. Validity and usefulness of hand-held dynamometry for measuring muscle strength in community-dwelling older persons. Arch Gerontol Geriatr. 2012;54(1):21-27. http://doi.org/10.1016/j.archger.2011.02.006
  2. Akuthota V, Nadler SF. Core strengthening. Arch Phys Med Rehabil 2004;85:86-92. http://doi.org/10.1053/j.apmr.2003.12.005
  3. Berlemann U, Jeszenszky DJ, Buhler DW, et al. The role of lumbar lordosis, vertebral end-plate inclination, disc height, and facet orientation in degenerative spondylolisthesis. J Spinal Disord. 1999;12(1):68-73. https://doi.org/10.1097/00002517-199902000-00011
  4. Boonstra AM, Schiphorst Preuper HR, Reneman MF, et al. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabili Res. 2008;31(2):165-169. http://doi.org/10.1097/MRR.0b013e3282fc0f93
  5. Browder DA, Childs JD, Cleland JA, et al. Effectiveness of an extension-oriented treatment approach in a subgroup of subjects with low back pain: a randomized clinical trial. Phys Ther. 2007;87(12):1608-1618. http://doi.org/10.2522/ptj.20060297
  6. Clare HA, Adams R, Maher CG. Construct validity of lumbar extension measures in McKenzie's derangement syndrome. Man Ther. 2007;12(4):328-334. http://doi.org/10.1016/j.math.2006.07.006
  7. Cresswell AG, Grundstrom H, Thorstensson A. Observations on intra-abdominal pressure and patterns of abdominal intra-muscular activity in man. Acta Physiol Scand. 1992;144(4):409-418. http://doi.org/10.1111/j.1748-1716.1992.tb09314.x
  8. Donelson R, Aprill C, Medcalf R, et al. A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and anular competence. Spine (phila Pa 1976). 1997;22(10):1115-1122. https://doi.org/10.1097/00007632-199705150-00011
  9. Dupuis PR, Yong-Hing K, Cassidy JD, et al. Radiologic diagnosis of degenerative lumbar spinal instability. Spine (Phila Pa 1976). 1985;10(3):262-276. https://doi.org/10.1097/00007632-198504000-00015
  10. França FR, Burke TN, Hanada ES, et al. Segmental stabilization and muscular strengthening in chronic low back pain: A comparative study. Clinics (Sao Paulo). 2010;65(10):1013-1017. https://doi.org/10.1590/S1807-59322010001000015
  11. Frank C, Kobesova A, Kolar P. Dynamic neuromuscular stabilization & sports rehabilitation. Int J Sports Phys Ther. 2013;8(1):62-73.
  12. Fredericson M, Lee SU, Welsh J, et al. Changes in posterior disc bulging and intervertebral foraminal size associated with flexion-extension movement: a comparison between L4-5 and L5-S1 levels in normal subjects. Spine J. 2001;1(1):10-17. https://doi.org/10.1016/S1529-9430(01)00014-6
  13. Harris-Hayes M, Van Dillen LR, Sahrmann SA. Classification, treatment and outcomes of a patient with lumbar extension syndrome. Physiother Theory Pract. 2005;21(3):181-196. https://doi.org/10.1080/09593980500212987
  14. Hibbs AE, Thompson KG, French D, et al. Optimizing performance by improving core stability and core strength. Sports Med. 2008;38(12):995-1008. http://doi.org/10.2165/00007256-200838120-00004
  15. Hicks GE, Fritz JM, Delitto A, et al. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil. 2005;86(9):1753-1762. http://doi.org/10.1016/j.apmr.2005.03.033
  16. Hodges PW, Richardson CA. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Arch Phys Med Rehabil. 1999;80(9):1005-1012. https://doi.org/10.1016/S0003-9993(99)90052-7
  17. Hodges PW, Richardson CA. Transversus abdominis and the superficial abdominal muscles are controlled independently in a postural task. Neurosci Lett. 1999;265(2):91-94. https://doi.org/10.1016/S0304-3940(99)00216-5
  18. Hosseinifar M, Akbari M, Behtash H, et al. The effects of stabilization and mckenzie exercises on transverse abdominis and multifidus muscle thickness, pain, and disability: A randomized controlled trial in nonspecific chronic low back pain. J Phys Ther Sci. 2013;25(12):1541-1545. http://doi.org/10.1589/jpts.25.1541
  19. Janda V, Frack C, Lebenson C. Evaluation of muscular imbalance. Rehabilitation of the spine: A practitioner's manual, 1996:97-112.
  20. Kendall HO, Kendall FP, Wadsworth GE. Muscle testing and function. Am J Phys Med Rehabil 1973;52(1):43
  21. Kim DY, Lee SH, Lee HY, et al. Validation of the Korean version of the Oswestry disability index. Spine (Phila Pa 1976). 2005;30(5):E123-127. https://doi.org/10.1097/01.brs.0000157172.00635.3a
  22. Kong MH, Hymanson HJ, Song KY, et al. Kinetic magnetic resonance imaging analysis of abdominal segmental motion of the functional spine unit. J Neurosurg Spine. 2009;10(4);357-365. https://doi.org/10.3171/2008.12.SPINE08321
  23. Kumar SP. Efficacy of segmental stabilization exercise for lumbar segmental instability in patients with mechanical low back pain: A randomized placebo controlled crossover study. N Am J Med Sci. 2011;3(10):456-461. http://doi.org/10.4297/najms.2011.3456
  24. Marshall P, Murphy B. Delayed abdominal muscle onsets and self-report measures of pain and disability in chronic low back pain. J Electromyogr Kinesiol. 2010;20(5):833-839. http://doi.org/10.1016/j.jelekin.2009.09.005
  25. McKenzie RA, May S. Mechanical diagnosis and therapy: The lumbar spine. Waikanae, New Zealand: Spinal Publications. 2003.
  26. Miller ER, Schenk RJ, Karnes JL, et al. A comparison of the McKenzie approach to a specific spine stabilization program for chronic low back pain. J Man Manip Ther. 2005;13(2):103-112. http://doi.org/10.1179/106698105790824996
  27. O'Sullivan PB, Phyty GD, Twomey LT, et al. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. 1997;22(24):2959-2967. https://doi.org/10.1097/00007632-199712150-00020
  28. Powers CM, Beneck GJ, Kulig K, et al. Effects of a single session of posterior-to-anterior spinal mobilization and press-up exercise on pain response and lumbar spine extension in people with nonspecific low back pain. Phys Ther. 2008;88(4):485-493. http://doi.org/10.2522/ptj.20070069
  29. Richardson CA, Snijders CJ, Hides JA, et al. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine (Phila Pa 1976). 2002;27(4):399-405. https://doi.org/10.1097/00007632-200202150-00015
  30. Shaffer WO1, Spratt KF, Weinstein J, et al. 1990 Volvo Award in clinical sciences. The consistency and accuracy of roentgenograms for measuring sagittal translation in the lumbar vertebral motion segment. An experimental model. Spine (Phila Pa 1976). 1990;15(8):741-750.
  31. Shirazi-Adl A, El-Rich M, Pop DG, et al. Spinal muscle forces, internal loads and stability in standing under various postures and loads application of kinematics-based algorithm. Eur Spine J. 2005;14(4)381-392. http://doi.org/10.1007/s00586-004-0779-0
  32. Smith D, Bissell G, Bruce-Low S, et al. The effect of lumbar extension training with and without pelvic stabilization on lumbar strength and low back pain. J Back Musculoskelet Rehabil. 2011;24(4):241-249. http://doi.org/10.3233/BMR-2011-0301
  33. Stanton T, Kawchuk G. The effect of abdominal stabilization contractions on posteroanterior spinal stiffness. Spine (Phila Pa 1976). 2008;33(6):694-701. http://doi.org/10.1097/BRS.0b013e318166e034
  34. Teyhen DS, Rieger JL, Westrick RB, et al. Changes in deep abdominal muscle thickness during common trunk-strengthening exercises using ultrasound imaging. J Orthop Sports Phys Ther. 2008;38(10):596-605. http://doi.org/10.2519/jospt.2008.2897
  35. Van Dieen JH, Cholewicki J, Radebold A. Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine. Spine (Phila Pa 1976). 2003;28(8):834-841. https://doi.org/10.1097/01.BRS.0000058939.51147.55
  36. Van Dillen LR, Sahrmann SA, Norton BJ, et al. The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: A preliminary report. Arch Phys Med Rehabil. 2003;84(3):313-322. https://doi.org/10.1053/apmr.2003.50010
  37. Vasseljen O, Unsgaard-Tondel M, Westad C, et al. Effect of core stability exercises on feed-forward activation of deep abdominal muscles in chronic low back pain: A randomized controlled trial. Spine (Phila Pa 1976). 2012;37(13):1101-1108. http://doi.org/10.1097/BRS.0b013e318241377c
  38. Whittaker JL. Ultrasound imaging of the lateral abdominal wall muscles in individuals with lumbopelvic pain and signs of concurrent hypocapnia. Man Ther. 2008;13(5):404-410. http://doi.org/10.1016/j.math.2007.03.008

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