DOI QR코드

DOI QR Code

Comparing the Immediate Effectiveness of Lumbar Flexion and Extension Exercise With Regards to Pain, Range of Motion, Pelvic Tilt, and Functional Gait Ability in Patients With Lumbar Spinal Stenosis

  • Do, Hyun-ho (Dept. of Rehabilitation Medicine, Konyang University Hospital) ;
  • Chon, Seung-chul (Dept. of Physical Therapy, College of Medical Science, Konyang University)
  • Received : 2019.09.18
  • Accepted : 2019.11.08
  • Published : 2019.11.19

Abstract

Background: In patients with lumbar spinal stenosis (LSS), lumbar flexion exercise (LFE) is considered a standard therapeutic exercise that widens the space between the spinal canal and intervertebral foramen. However, some researchers have reported that lumbar extension exercise (LEE) may improve lumbar pain and functional ability in patients with LSS. Although exercise intervention methods for patients with LSS have been widely applied in clinical settings, few studies have conducted comparative analysis of these exercise methods. Objects: This study aimed to compare the effects of LFE, LEE, and lumbar flexion combined with lumbar flexion-extension exercise (LFEE) on pain, range of motion (ROM), pelvic tilt angle, and functional gait ability in patients with LSS. Methods: A total of 30 patients with LSS, LFE (n1=10), LEE (n2=10), and LFEE (n3=10) were assigned to each of the three exercise groups. The numerical pain rating scale (NPRS), modified-modified schober test (MMST)-flexion, MMST-extension, pelvic tilt inclinometer, and 6-minute walking test (6MWT) were measured. Results: After the intervention, statistically significant differences were observed in the NPRS (p=.043), MMST-flexion (p<.001), MMST-extension (p<.001), and 6MWT (p=.005) between groups. According to the post hoc test, the NPRS was statistically significant difference between the LFEE and LEE groups (p=.034). The MMST-flexion was statistically significantly different between the LFE and LEE (p=.000), LFE and LFEE (p=.001), and LEE and LFEE (p=.001) groups. The MMST-extension was statistically significantly different between the LFE and LEE (p<.001), LFE and LFEE (p=.002), and LEE and LFEE (p=.008) groups. The 6MWT was statistically significantly different between the LFE and LFEE (p=.042) and the LEE and LFEE (p=.004) groups. Conclusion: This study suggested that LFEE was the most effective exercise for pain and functional gait ability in patients with LSS, LFE was the most effective exercise for lumbar flexion ROM, and LEE was the most effective exercise for lumbar extension ROM.

Keywords

References

  1. Alghadir AH, Anwer S, Iqbal A, et al. Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J Pain Res. 2018;(11):851-856. https://doi.org/10.2147/JPR.S158847
  2. Atlas SJ, Keller RB, Robson D, et al. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Spine (Phila Pa 1976). 2000;25(5):556-562. https://doi.org/10.1097/00007632-200003010-00005
  3. Battie MC, Bigos SJ, Sheehy A, et al. Spinal flexibility and individual factors that influence it. Phys Ther. 1987;67(5):653-658. https://doi.org/10.1093/ptj/67.5.653
  4. Binder DK, Schmidt MH, Weinstein PR. Lumbar spinal stenosis. Semin Neurol. 2002;22(2):157-166. https://doi.org/10.1055/s-2002-36539
  5. Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: A systematic review. J Eval Clin Pract. 2017;23(2):377-381. https://doi.org/10.1111/jep.12629
  6. Chen C, Lin Z, Zhang Y, et al. Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis? Pak J Med Sci. 2017;33(3):631-634. https://doi.org/10.12669/pjms.333.12123
  7. Clare HA, Adams R, Maher CG. A systematic review of efficacy of McKenzie therapy for spinal pain. Aust J Physiother. 2004;50(4):209-216. https://doi.org/10.1016/S0004-9514(14)60110-0
  8. Costandi S, Chopko B, Mekhail M, et al. Lumbar spinal stenosis: Therapeutic options review. Pain Pract. 2015;15(1):68-81. https://doi.org/10.1111/papr.12188
  9. Creighton D, Krass J, Marcoux B. Management of lumbar spinal stenosis through the use of translatoric manipulation and lumbar flexion exercises: A case series. J Manual Manip Ther. 2006;14(1):E1-E10. https://doi.org/10.1179/jmt.2006.14.1.1E
  10. Dobbs R, May S, Hope P. The validity of a clinical test for the diagnosis of lumbar spinal stenosis. Man Ther. 2016;25:27-34. https://doi.org/10.1016/j.math.2016.05.332
  11. Elnaggar IM, Nordin M, Sheikhzadeh A, et al. Effects of spinal flexion and extension exercises on low-back pain and spinal mobility in chronic mechanical low-back pain patients. Spine (Phila Pa 1976). 1991;16(8):967-972. https://doi.org/10.1097/00007632-199108000-00018
  12. Fast A. Low back disorders: conservative management. Arch Phys Med Rehabil. 1988;69(10):880-891.
  13. Fritz JM, Erhard RE, Delitto A, et al. Preliminary results of the use of a two-stage treadmill test as a clinical diagnostic tool in the differential diagnosis of lumbar spinal stenosis. J Spinal Disord. 1997;10(5):410-416. https://doi.org/10.1097/00002517-199710000-00009
  14. Goren A, Yildiz N, Topuz O, et al. Efficacy of exercise and ultrasound in patients with lumbar spinal stenosis: A prospective randomized controlled trial. Clin Rehabil. 2010;24(7):623-631. https://doi.org/10.1177/0269215510367539
  15. Hammerich AS. Lumbar spinal stenosis and exercise prescription. Top Geriatr Rehabil. 2014;30(2):108-116. https://doi.org/10.1097/TGR.0000000000000010
  16. Inoue G, Miyagi M, Takaso M. Surgical and nonsurgical treatments for lumbar spinal stenosis. Eur J Orthop Surg Traumatol. 2016;26(7):695-704. https://doi.org/10.1007/s00590-016-1818-3
  17. Jiang J, Wang H, Wang L, et al. Multifidus degeneration, a new risk factor for lumbar spinal stenosis: A case-control Study. World Neurosurg. 2017;99:226-231. https://doi.org/10.1016/j.wneu.2016.11.142
  18. Katz JN, Dalgas M, Stucki G, et al. Degenerative lumbar spinal stenosis: Diagnostic value of the history and physical examination. Arthritis Rheum. 1995;38(9):1236-1241. https://doi.org/10.1002/art.1780380910
  19. Krebs EE, Carey TS, Weinberger M. Accuracy of the pain numeric rating scale as a screening test in primary care. J Gen Intern Med. 2007;22(10):1453-1458. https://doi.org/10.1007/s11606-007-0321-2
  20. Kreiner DS, Shaffer WO, Baisden JL, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J. 2013;13(7):734-743. https://doi.org/10.1016/j.spinee.2012.11.059
  21. Lafian AM, Torralba KD. Lumbar spinal stenosis in older adults. Rheum Dis Clin North Am. 2018;44(3):501-512. https://doi.org/10.1016/j.rdc.2018.03.008
  22. Mu W, Shang Y, Mo Z, et al. Comparison of two types of exercises in the treatment of lumbar spinal stenosis. Pak J Med Sci. 2018;34(4):897-900. https://doi.org/10.12669/pjms.344.15296
  23. Nwuga G, Nwuga V. Relative therapeutic efficacy of the Williams and McKenzie protocols in back pain management. Physiother Pract. 1985;1(2):99-105. https://doi.org/10.3109/09593988509163857
  24. Onel D, Sari H, Donmez C. Lumbar spinal stenosis: Clinical/radiologic therapeutic evaluation in 145 patients. Conservative treatment or surgical intervention? Spine (Phila Pa 1976). 1993;18(2):291-298. https://doi.org/10.1097/00007632-199302000-00020
  25. Rikli RE, Jones CJ. The reliability and validity of a 6-minute walk test as a measure of physical endurance in older adults. J Aging Phys Act. 1998;6(4):363-375. https://doi.org/10.1123/japa.6.4.363
  26. Steele J, Bruce-Low S, Smith D, et al. A randomized controlled trial of limited range of motion lumbar extension exercise in chronic low back pain. Spine (Phila Pa 1976). 2013;38(15):1245-1252. https://doi.org/10.1097/BRS.0b013e318291b526
  27. Suzuki H, Endo K, Kobayashi H, et al. Total sagittal spinal alignment in patients with lumbar canal stenosis accompanied by intermittent claudication. Spine (Phila Pa 1976). 2010;35(9):E344-E346. https://doi.org/10.1097/BRS.0b013e3181c91121
  28. Tomkins-Lane CC, Battie MC, Macedo LG. Longitudinal construct validity and responsiveness of measures of walking capacity in individuals with lumbar spinal stenosis. Spine J. 2014;14(9):1936-1943. https://doi.org/10.1016/j.spinee.2013.11.030
  29. Tousignant M, Poulin L, Marchand S, et al. The modified-modified Schober test for range of motion assessment of lumbar flexion in patients with low back pain: a study of criterion validity, intra- and inter-rater reliability and minimum metrically detectable change. Disabil Rehabil. 2005;27(10):553-559. https://doi.org/10.1080/09638280400018411
  30. Turner JA, Ersek M, Herron L, et al. Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine (Phila Pa 1976). 1992;17(1):1-8. https://doi.org/10.1097/00007632-199201000-00001
  31. Whitman JM, Flynn TW, Childs JD, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: A randomized clinical trial. Spine (Phila Pa 1976). 2006;31(22):2541-2549. https://doi.org/10.1097/01.brs.0000241136.98159.8c
  32. Williams PC. Examination and conservative treatment for disc lesions of the lower spine. Clin Orthop. 1955;5:28-40.
  33. Williams R, Binkley J, Bloch R, et al. Reliability of the modified-modified Schöber and double inclinometer methods for measuring lumbar flexion and extension. Phys Ther. 1993;73(1):33-44.
  34. Youdas JW, Garrett TR, Egan KS, et al. Lumbar lordosis and pelvic inclination in adults with chronic low back pain. Phys Ther. 2000;80(3):261-275. https://doi.org/10.1093/ptj/80.3.261
  35. Zaina F, Tomkins-Lane C, Carragee E, et al. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016;29(1):CD010264. https://doi.org/10.1002/14651858.CD010264.pub2

Cited by

  1. 요추 척추관 협착증의 비수술적 치료에 대한 최근 국내·외 연구 동향 vol.31, pp.3, 2019, https://doi.org/10.18325/jkmr.2021.31.3.1