Browse > Article
http://dx.doi.org/10.20540/JIAPTR.2020.11.1.1981

Comparison of the Effects of Joint Mobilization, Gym Ball Exercises, and Breathing Exercises on Flexion Relaxation Phenomenon and Pain in Patients with Chronic Low Back Pain  

Lim, Chaegil (Department of Physical Therapy, Gachon University)
Publication Information
Journal of International Academy of Physical Therapy Research / v.11, no.1, 2020 , pp. 1981-1991 More about this Journal
Abstract
Background: Although various exercises have been performed for patients with chronic low back pain (CLBP), the effects of these exercises including joint mobilization, gym ball exercises, and breathing exercises on flexion relaxation ratio (FRR) have not been compared. Objective: To compare the effects of joint mobilization, gym ball exercises, and breathing exercises on the flexion relaxation phenomenon (FRP) and pain in patients with chronic low back pain. Design: Randomized pretest-posttest control group design. Methods: Thirty-six patients with chronic low back pain who were undergoing rehabilitation at a rehabilitation center were included. The patients were randomly divided into three groups: joint mobilization group (JMG; n=12), gym ball exercise group (GBG; n=12), and breathing exercise group (BEG; n=12). The exercises were performed for 40 minutes a day, twice a week, for a total of 12 weeks. Results: There were no significant differences in FRR between the three groups (P>.05). Significant decreases in the modified visual analog scale (MVAS) scores after intervention between the groups were found (P<.05). The GBG was significantly decreases from the JMG in the MVAS (P<.05). However, there were significant improvements between the pre- and post-interventional findings on FRR and MVAS in the three groups (P<.05). Conclusion: We demonstrated that intervention using joint mobilization, gym ball exercises, and breathing exercises improve FRP and pain in patients with CLBP.
Keywords
Breathing exercise; Flexion relaxation phenomenon; Joint mobilization; Gym ball; Chronic low back pain;
Citations & Related Records
Times Cited By KSCI : 2  (Citation Analysis)
연도 인용수 순위
1 Michael K. OXFORD DICTIONARY OF SPORTS SCIENCE AND MEDICINE. 3rd ed. Oxford, England: Oxford University Press; 2007.
2 Callaghan JP, Dunk NM. Examination of the flexion relaxation phenomenon in erector spinae muscles during short duration slumped sitting. Clin Biomech (Bristol, Avon). 2002;17(5):353-360.   DOI
3 Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine (Phila Pa 1976). 1996;21(22):2640-2650.   DOI
4 Lamoth CJ, Meijer OG, Daffertshofer A, Wuisman PI, Beek PJ. Effects of chronic low back pain on trunk coordination and back muscle activity during walking: changes in motor control. Eur Spine J. 2006;15(1):23-40.   DOI
5 Adams MA, Freeman BJ, Morrison HP, Nelson IW, Dolan P. Mechanical initiation of intervertebral disc degeneration. Spine (Phila Pa 1976). 2000;25(13):1625-1636.   DOI
6 Brinckmann P, Biggemann M, Hilweg D. Fatigue fracture of human lumbar vertebrae. Clin Biomech (Bristol, Avon). 1988;3 Suppl 1:i-S23.
7 Bogduk N. The anatomy of the lumbar intervertebral disc syndrome. Med J Aust. 1976;1(23):878-881.   DOI
8 Kavcic N, Grenier S, McGill SM. Determining the stabilizing role of individual torso muscles during rehabilitation exercises. Spine (Phila Pa 1976). 2004;29(11):1254-1265.   DOI
9 Hicks GE, Fritz JM, Delitto A, McGill SM. 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.   DOI
10 Gatchel RJ, Polatin PB, Mayer TG. The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine (Phila Pa 1976). 1995;20(24):2702-2709.   DOI
11 Cottingham JT, Maitland J. A three-paradigm treatment model using soft tissue mobilization and guided movement-awareness techniques for a patient with chronic low back pain: a case study. J Orthop Sports Phys Ther. 1997;26(3):155-167.   DOI
12 Johansson H, Sojka P. Pathophysiological mechanisms involved in genesis and spread of muscular tension in occupational muscle pain and in chronic musculoskeletal pain syndromes: a hypothesis. Med Hypotheses. 1991;35(3):196-203.   DOI
13 Cholewicki J, McGill SM. Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Clin Biomech (Bristol, Avon). 1996;11(1):1-15.   DOI
14 Cholewicki J, Panjabi MM, Khachatryan A. Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture. Spine (Phila Pa 1976). 1997;22(19):2207-2212.   DOI
15 Kisner C, Colby L. Therapeutic exercise. foundations and techniques. 4th ed. Philadelphia: FA Davis company; 2002.
16 Godges JJ, Mattson-Bell M, Thorpe D, Shah D. The immediate effects of soft tissue mobilization with proprioceptive neuromuscular facilitation on glenohumeral external rotation and overhead reach. J Orthop Sports Phys Ther. 2003;33(12):713-718.   DOI
17 Alaranta H, Luoto S, Heliovaara M, Hurri H. Static back endurance and the risk of low-back pain. Clin Biomech (Bristol, Avon). 1995;10(6):323-324.   DOI
18 Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006;6(2):131-137.   DOI
19 Paris SV. Mobilization of the spine. Phys Ther. 1979;59(8):988-995.   DOI
20 Hyman J, Liebenson C. Rehabilitation of the Spine: A Practioner's Manual. Philadelphia: Lippincott Williams and Wilkins; 1996.
21 Whitmore KE. Complementary and alternative therapies as treatment approaches for interstitial cystitis. Rev Urol. 2002;4 Suppl 1(Suppl 1):S28-S35.
22 Holloway EA, West RJ. Integrated breathing and relaxation training (the Papworth method) for adults with asthma in primary care: a randomised controlled trial. Thorax. 2007;62(12):1039-1042.   DOI
23 Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354(9178):581-585.   DOI
24 Macdonald DA, Dawson AP, Hodges PW. Behavior of the lumbar multifidus during lower extremity movements in people with recurrent low back pain during symptom remission. J Orthop Sports Phys Ther. 2011;41(3):155-164.   DOI
25 van Dieen JH, Selen LP, Cholewicki J. Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr Kinesiol. 2003;13(4):333-351.   DOI
26 Floyd WF, Silver PH. The function of the erectores spinae muscles in certain movements and postures in man. J Physiol. 1955;129(1):184-203.   DOI
27 Sluka KA. Pain mechanisms involved in musculoskeletal disorders. J Orthop Sports Phys Ther. 1996;24(4):240-254.   DOI
28 Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. J Clin Invest. 2010;120(11):3760-3772.   DOI
29 Basbaum AI, Bautista DM, Scherrer G, Julius D. Cellular and molecular mechanisms of pain. Cell. 2009;139(2):267-284.   DOI
30 Lee SH, Lee SG, Choi BR. Effect of trunk stabilization exercises on trunk muscle activation using different respiratory conditions. J Phys Ther Sci. 2018;30(4):567-569.   DOI
31 Bezzoli E, Andreotti D, Pianta L, et al. Motor control exercises of the lumbar-pelvic region improve respiratory function in obese men. A pilot study. Disabil Rehabil. 2018;40(2):152-158.   DOI
32 Park SS, Choi BR. Effects of lumbar stabilization exercises on the flexion-relaxation phenomenon of the erector spinae. J Phys Ther Sci. 2016;28(6):1709-1711.   DOI
33 McGill SM, Childs A, Liebenson C. Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database. Arch Phys Med Rehabil. 1999;80(8):941-944.   DOI
34 Park SS, Choi BR. Effects of lumbar stabilization exercises on the flexion-relaxation phenomenon of the erector spinae. J Phys Ther Sci. 2016;28(6):1709-1711.   DOI
35 Janssens L, McConnell AK, Pijnenburg M, et al. Inspiratory muscle training affects proprioceptive use and low back pain. Med Sci Sports Exerc. 2015;47(1):12-19.
36 Mehling WE, Hamel KA, Acree M, Byl N, Hecht FM. Randomized, controlled trial of breath therapy for patients with chronic low-back pain. Altern Ther Health Med. 2005;11(4):44-52.
37 Chung SH, Lee JS, Yoon JS. Effects of stabilization exercise using a ball on mutifidus cross-sectional area in patients with chronic low back pain. J Sports Sci Med. 2013;12(3):533-541.
38 Kim K, Park RJ, Bae S. Effect of diaphragmatic breathing exercise on Activation of trunk muscle of patients with low back pain. J Kor Phys Ther. 2005;17(3):311-327.
39 Balague F, Mannion AF, Pellise F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482-491.   DOI
40 Sremakaew M, Jull G, Treleaven J, Barbero M, Falla D, Uthaikhup S. Effects of local treatment with and without sensorimotor and balance exercise in individuals with neck pain: protocol for a randomized controlled trial. BMC Musculoskelet Disord. 2018;19(1):48.   DOI
41 Anderson RU, Wise D, Sawyer T, Chan C. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;174(1):155-160.   DOI
42 Masse-Alarie H, Beaulieu LD, Preuss R, Schneider C. Influence of chronic low back pain and fear of movement on the activation of the transversely oriented abdominal muscles during forward bending. J Electromyogr Kinesiol. 2016;27:87-94.   DOI
43 SENIAM (Sensor Location). http://seniam.org/sensor_location.htm. Accessed 2009.
44 Alschuler KN, Neblett R, Wiggert E, Haig AJ, Geisser ME. Flexion-relaxation and clinical features associated with chronic low back pain: A comparison of different methods of quantifying flexion-relaxation. Clin J Pain. 2009;25(9):760-766.   DOI
45 JM W, DJ K. Assessment of the Spinal Pain Using Visual Analogue Scale (VAS). J Kor Spine Sur. 1995;2(2):177-184.
46 Lee HY, Cheon SH, Yong MS. Effect of diaphragm breathing exercise applied on the basis of overload principle. J Phys Ther Sci. 2017;29(6):1054-1056.   DOI
47 Borenstein DG. Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Curr Opin Rheumatol. 2001;13(2):128-134.   DOI
48 Kaltenborn FM. The Spine: Basic Evaluation and Mobilization Techniques. 2nd ed. Oslo: Norli; 1993.
49 Valenza MC, Cabrera-Martos I, Torres-Sanchez I, Garces-Garcia A, Mateos-Toset S, ValenzaDemet G. The Effects of Doming of the Diaphragm in Subjects With Short-Hamstring Syndrome: A Randomized Controlled Trial. J Sport Rehabil. 2015;24(4):342-348.   DOI
50 Chaitow L, Bradley D, Gilbert C. Recognizing and treating breathing disorders a multidisciplinary approach. 2nd ed. London: Churchill Livingstone; 2014.
51 MacGregor AJ, Andrew T, Sambrook PN, Spector TD. Structural, psychological, and genetic influences on low back and neck pain: a study of adult female twins. Arthritis Rheum. 2004;51(2):160-167.   DOI
52 Deyo RA, Bass JE. Lifestyle and low-back pain. The influence of smoking and obesity. Spine (Phila Pa 1976). 1989;14(5):501-506.   DOI
53 Kerr MS, Frank JW, Shannon HS, et al. Biomechanical and psychosocial risk factors for low back pain at work. Am J Public Health. 2001;91(7):1069-1075.   DOI
54 Hoogendoorn WE, Bongers PM, de Vet HC, et al. Flexion and rotation of the trunk and lifting at work are risk factors for low back pain: results of a prospective cohort study. Spine (Phila Pa 1976). 2000;25(23):3087-3092.   DOI
55 Marras WS, Granata KP. The development of an EMG-assisted model to assess spine loading during whole-body free-dynamic lifting. J Electromyogr Kinesiol. 1997;7(4):259-268.   DOI
56 Marshall P, Murphy B. Changes in the flexion relaxation response following an exercise intervention. Spine (Phila Pa 1976). 2006;31(23):E877-883.   DOI
57 McLaughlin L. Breathing evaluation and retraining in manual therapy. J Bodyw Mov Ther. 2009;13(3):276-282.   DOI
58 Cho B, Yoon J. Effects of Breathing Exercise on Flexion Relaxation Phenomenon and Thoracic Excursion in Patients with Chronic Low Back Pain. KSIM. 2019;7(1):125-134.