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Comparison of the Effects of Lumbar Stabilization Exercise According to the Presence or Absence of Gluteus Medius Muscle Weakness in Chronic Lower Back Pain Patients with Lumbar Instability

허리 불안정성이 있는 만성 허리통증 환자의 중간볼기근 약화 유무에 따른 허리 안정화 운동의 효과 비교

  • Dae-ho Kim (Department of Physical Therapy, Graduate School of Health and Medicine, Daejeon University) ;
  • Suhn-yeop Kim (Department of Physical Therapy, College of Health and Medical Science, Daejeon University)
  • 김대호 (대전대학교 보건의료대학원 물리치료학과) ;
  • 김선엽 (대전대학교 보건의료과학대학 물리치료학과)
  • Received : 2023.11.21
  • Accepted : 2023.12.08
  • Published : 2024.05.31

Abstract

PURPOSE: This study aimed to compare the effects of pain level, lower back pain dysfunction level, psychosocial level, hip abductor strength (HAS), number of positive lumbar instability tests, and dynamic balance (DB) by applying lumbar stabilization exercises according to the presence or absence of gluteus medius muscle weakness in chronic lower back pain (CLBP) patients with lumbar instability. METHODS: Thirty-five CLBP patients with lumbar instability were divided into the gluteus medius weakness (n = 18) and gluteus medius non-weakened (n = 17) groups using the gluteus medius manual muscle test. Intervention applied conservative physical therapy and lumbar stabilization exercises to both groups that lasted three times a week for four weeks. To compare the intervention effects, the quadruple visual analog scale (QVAS), the Korean version of the Oswestry disability index (K-ODI), fear-avoidance beliefs questionnaire (FABQ), HAS, lumbar instability tests positive response counter (LIC), and DB were measured. RESULTS: Significant differences were shown for QVAS, K-ODI, FABQ, HAS, LIC, and DB for both groups pre- and post-intervention (p < .05). Compared to the gluteus medius weakness group, the gluteus medius non-weakened group showed a significant difference (p < .05) in the changes in QVAS, K-ODI, FABQ-W, FABQ-total, and HAS. CONCLUSION: In CLBP patients with lumbar instability, having gluteus medius weakness was less effective in improving lumbar stabilization exercise than gluteus medius non-weakness regarding pain level, lower back pain dysfunction level, psychosocial level excluding physical activity, and hip abductor strength. Therefore, additional gluteus medius strengthening exercises are necessary for patients with lumbar instability and gluteus medius muscle weakness.

Keywords

References

  1. Vanti C, Andreatta S, Borghi S, et al. The effectiveness of walking versus exercise on pain and function in chronic low back pain: A systematic review and meta-analysis of randomized trials. Disabil Rehabil. 2019;41(6):622-32.
  2. Nahas EM, Ahmed DS, Magda SM, et al. Effect of shock wave therapy on postpartum low back pain. Med J Cairo Univ. 2018;86:893-901.
  3. Alqarni AM, Schneiders AG, Hendrick PA. Clinical tests to diagnose lumbar segmental instability: A systematic review. J Orthop Sports Phys Ther. 2011;41(3):130-40.
  4. Park JH, Son GH, Kim KG, et al. Therapeutic Exercise for Musculoskeletal Conditions. In: Seoul, Panmun Education. 2017. p. 541.
  5. Panjabi MM. The Stabilizing System of the Spine. Part I. Function, Dysfunction, Adaptation, and Enhancement. J Spinal Disord. 1992;5(4):383-9.
  6. Lee SJ, Kim YM. The effects of gluteal muscle exercises combined lumbar stabilization on lumbar stability in chronic low back pain patients with lumbar instability. J Korean Soc Phys Med. 2013;8(1):29-39.
  7. Joo MK, Kim JT, Kim SY. Reliability and validity of the Korean version of the fear-avoidance beliefs questionnaire. Phys Ther Korea. 2009;16(2):24-30.
  8. Solana-Tramunt M, Ortegon A, Morales J, et al. Diagnostic accuracy of lumbopelvic motor control tests using pressure biofeedback unit in professional swimmers: A cross-sectional study. J Orthop. 2019;16(6):590-5.
  9. Borghuis AJ, Lemmink KAPM, Hof AL. Core muscle response times and postural reactions in soccer players and nonplayers. Med Sci Sport Exerc. 2011;43(1):108-14.
  10. Adams MA. Biomechanics of back pain. Acupunct Med. 2004;22(4):178-88.
  11. Kim SY. Comparison of the difference of weight-bearing distribution between subjects with low back pain and healthy subjects. Phys Ther Korea. 2001;8(1):1-8.
  12. McGill SM, Grenier S, Kavcic N, et al. Coordination of muscle activity to assure stability of the lumbar spine. J Electromyogr Kinesiol. 2003;13:353-9.
  13. Rasmussen-Barr E, Nilsson-Wikmar L, Arvidsson I. Stabilizing training compared with manual treatment in sub-acute and chronic low-back pain. Man Ther. 2003;8(4):233-41.
  14. Macedo LG, Maher CG, Latimer J, et al. Motor control exercise for persistent, nonspecific low back pain: A systematic review. Phys Ther. 2009;89(1):9-25.
  15. Oh YJ, Park SH, Lee MM. Comparison of effects of abdominal draw-in lumbar stabilization exercises with and without respiratory resistance on women with low back pain: A randomized controlled trial. Med Sci Monit. 2020;26:1-9.
  16. Lee H, Kim S. Comparison of the effects of abdominal draw-in and expansion maneuvers on trunk stabilization in patients with low back pain and lumbar spine instability. Phys Ther korea. 2015;22(1):37-48.
  17. Seo J. Effect of exercise for strengthening hip abductor on patients with chronic low back pain showing lumbar instability. The Graduate School of Health and Sports Daejeon University; 2012.
  18. Park SH, Lee MM. Effects of a progressive stabilization exercise program using respiratory resistance for patients with lumbar instability: A randomized controlled trial. Med Sci Monit. 2019;25:1740-8.
  19. Hanada EY, Hubley-Kozey CL, McKeon MD, et al. The feasibility of measuring the activation of the trunk muscles in healthy older adults during trunk stability exercises. BMC Geriatr. 2008;8(1):33.
  20. Barr KP, Griggs M, Cadby T. Lumbar stabilization: A review of core concepts and current literature, Part 2. Am J Phys Med Rehabil. 2007;86(1):72-80.
  21. Beattie P. Current understanding of lumbar intervertebral disc degeneration: A review with emphasis upon etiology, pathophysiology, and lumbar magnetic resonance imaging findings. J Orthop Sport Phys Ther. 2008;38(6):329-40.
  22. Bewyer KJ, Bewyer DC, Messenger D, et al. Pilot data: Association between gluteus medius weakness and low back pain during pregnancy. Iowa Orthop J. 2009;29:97-9.
  23. Barbee Ellison J, Rose SJ, Sahrmann SA. Patterns of hip rotation range of motion: A comparison between healthy subjects and patients with low back pain. Phys Ther. 1990;70(9):537-41.
  24. Kankaanpaa M, Taimela S, Laaksonen D, et al. Back and hip extensor fatigability in chronic low back pain patients and controls. Arch Phys Med Rehabil. 1998;79(4):412-7.
  25. Kendall KD. Lumbopelvic stability in non-specific low back pain: Exploring the relationships between hip strengthening, lumbopelvic mechanics, and pain. J Sport Med. 2013;23:45-51.
  26. Lee S. The Effects of modified hip abductor strengthening exercise on back pain level and hip joint function for chronic low back pain patients with gluteus medius weakness. Graduate School, Daejeon University; 2015.
  27. Mukherjee S. Comparative analysis of gluteal strengthening exercise and core stabilization exercises program for gluteus dysfunction in chronic low back pain among residence of ziro, arunachal pradesh. Int J Innov Sci Res Technol. 2022;7(9):813-76.
  28. Jacobs C, Uhl TL, Seeley M, et al. Strength and fatigability of the dominant and nondominant hip abductors. J Athl Train. 2005;40(3):203-6.
  29. Boonstra M, De Waal Malefijt M, Verdonschot N. How to quantify knee function after total knee arthroplasty? Knee. 2008;15(5):390-5.
  30. Hicks GE, Fritz JM, Delitto A, et al. Interrater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil. 2003;84(12):1858-64.
  31. Kisner C, Colby LA. Therapeutic exercise: Foundations and techniques. 4th ed. In: Philadelphia, PA, FA Davis Co. 2002. p. 657-9.
  32. Richardson C, Jull G, Hodges P. Therapeutic exercise for spinal segmental stabilization in low back pain. In: Churchill Livingstone. 1999.
  33. Park DJ. Altered respiratory pattern of individuals with LBP and effects of abdominal exhalation maneuver. Graduate School, Catholic University of Pusan; 2013.
  34. Kasai Y, Morishita K, Kawakita E, et al. A new evaluation method for lumbar spinal instability: Passive lumbar extension test. Phys Ther. 2006;86(12):1661-7.
  35. Wiltse L. Spondylolisthesis: Classification, diagnosis and natural history. Semin Spine Surg. 1989;1:78-94.
  36. Kendall FP, McCreary EK, Provance PG, et al. Muscles: testing and function with posture and pain(5th ed). Baltimore. Williams & Wilkins. 2005.
  37. Lee K, Baik S, Yi C, et al. Electromyographic analysis of hip and trunk muscle activity during side bridge exercises in subjects with gluteus medius weakness. J Sport Rehabil. 2021;30(5):754-9.
  38. 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):E123-7.
  39. Click Fenter P, Bellew JW, Al PTA, et al. Reliability of stabilised commercial dynamometers for measuring hip abduction strength: A pilot study. Br J Sport Med. 2003;37(4):331-4.
  40. Plisky PJ, Gorman PP, Butler RJ, et al. The reliability of an instrumented device for measuring components of the star excursion balance test. N Am J Sport Phys Ther. 2009;4(2):92-9.
  41. Vuillerme N, Nougier V, Prieur JM. Can vision compensate for a lower limbs muscular fatigue for controlling posture in humans? Neurosci Lett. 2001;308(2):103-6.
  42. Wikstrom EA, Tillman MD , Smith AN, et al. A new force-plate technology measure of dynamic postural stability: The dynamic postural stability index. J Athl Train. 2005;40(4):305-9.
  43. Munro AG, Herrington LC. Between-session reliability of the star excursion balance test. Phys Ther Sport. 2010;11(4):128-32.
  44. Behm D G, D rinkwater EJ, Willardson JM, et al. The use of instability to train the core musculature. Appl Physiol Nutr Metab. 2010;35(1):91-108.
  45. Nelson-Wong E, Gregory DE, Winter DA, et al. Gluteus medius muscle activation patterns as a predictor of low back pain during standing. Clin Biomech. 2008;23(5):545-53.
  46. Jung OY. Comparison of the effect of abdominal draw-in lumbar stabilization exercises with respiratory resistance on women with low back pain. Graduate School of Health and Medicine, Daejeon University; 2020.
  47. Pincus T, McCracken LM. Psychological factors and treatment opportunities in low back pain. Best Pr Res Clin Rheumatol. 2013;27(5):625-35.
  48. Cha HG. Comparison of hip joint strength between young woman patient with chronic low back pain with lumbar instability and normal subjects. Phys Ther Rehabil Sci. 2022;11(3):370-5.
  49. Hodges PW. Core stability exercise in chronic low back pain. Orthop Clin North Am. 2003;34(2):245-54.
  50. O'Sullivan PB, Burnett A, Floyd AN, et al. Lumbar repositioning deficit in a specific low back pain population. Spine (Phila Pa 1976). 2003;28(10):1074-9.