Comparison of Selected Methods for Strengthening Stabilization Muscles of Lumbar Spine in Vertebrogenic Patients
Authors:
M. Holinka 1,2; J. Gallo 2; I. Tozzi 3; M. Zvonař 4; M. Filip 5; J. Kristiníková 5; R. Pavličný 1
Authors‘ workplace:
Ortopedické oddělení, Karvinská hornická nemocnice, a. s., Karviná
primář MUDr. R. Pavličný
1; Ortopedická klinika, LF UP, Fakultní nemocnice Olomouc
přednosta prof. MUDr. J. Gallo, Ph. D.
2; Klinika tělovýchovného lékařství a kardiovaskulární rehabilitace, LF UP, Fakultní nemocnice Olomouc
přednostka prof. MUDr. E. Sovová, Ph. D., MBA
3; Katedra kineziologie, Fakulta sportovních studií, Masarykova univerzita v Brně
vedoucí doc. Mgr. M. Zvonař, Ph. D.
4; Ústav rehabilitace, Lékařská fakulta, Ostravská univerzita
vedoucí doc. MUDr. M. Filip, Ph. D.
5
Published in:
Rehabil. fyz. Lék., 24, 2017, No. 2, pp. 84-98.
Category:
Original Papers
Overview
Introduction:
Backache belongs to most frequent symptoms, which most of adult population encounter during life. Positive influence of strengthening stabilization muscles of spine on subsiding backache and improvement of common daily activities has been demonstrated in various studies. It has been abundantly used in sending patients to outpatient rehabilitation. On the other hand most patients are not sufficiently motivated for independent exercise after the outpatient rehabilitation ended. It resulted in frequent and ineffective repetition of rehabilitation several times a year. This work was intended to compare selected methods for strengthening stabilization of spine muscles in patients with chronic backache, which can be used in the home environment, to evaluate the real impact on the growth of muscular tissue by means of sonography examination, for improvement of daily activities, a decline of pains and to compare the results with outpatient rehabilitation and with each other. At the same time the authors intended to evaluate collaboration from the patient’s side and to evaluate the duration of tolerance and application of selected methods in individual groups of patients.
Methodic approach:
80 patients with chronic lumbar backache were included in the study, 29 men (36.3%) and 51 women (63.7 %) at the age of 31 to 83 years. The cohort encompassed two groups: patients treated by locomotor intervention (n=60) formed the first group, where the therapy of backache was made by strengthening of spine stabilization muscles (outpatient rehabilitation, gymnastic ball, dynamic directional pad). The control group was not subjected to aimed motion therapy (n=20) and was composed of patients, where the treatment was based on medication therapy. The pain intensity and limitation of daily activities were evaluated on the basis of visual analog scale and Oswestry questionnaire.
The strengthening of selected stabilization muscles of lumbar spine was evaluated by sonography examination. The study included observation of average analgesic consumption and duration of intervention with individual methods.
Results:
in this cohort of patients we recorded various degrees of declined backache, neurological symptomatology, analgesic consumption and improvement of common daily activities related to strengthening of stabilization muscles after 6 months of observation. However, with a decline of regular exercise after completed outpatient rehabilitation or diminished motivation for exercise on the gymnastic ball the original complaints reappeared as shown in the next control examination after 2 months of observation. It was accompanied by weakening of the already strengthened muscles to the original values. It became particularly manifest in m. multifidus. On the contrary the group of patients who strengthened the stabilization muscles of the spine by the dynamic directional pad revealed the longest period of intervention of the selected method. In agreement with this conclusion the authors recorded the highest increment of the extent of stabilization muscles together with decreased accompanying complaints in follow up examinations after 6 and 12 months. There was no marked change in the observed parameters in the control group.
Conclusion:
The observation that patients are very little willing to do exercise actively and independently in sufficient frequency or to continue the mastered exercise having completed outpatient rehabilitation may explain the frequent need of repetition. This long-term lack of collaboration from the side of some patients probably decreases its efficiency. In the long run this observation may explain increasing cost related to misuse of this kind of health care and the high consumption of analgesic preparations at the same time. The combined outpatient rehabilitation with long-term tolerated methods for strengthening of stabilization muscles of the spine in home conditions has proved useful as a possible solution in increased efficiency of this kind of care. Based on our results we may recommend the use of dynamic directional pad in routine practice.
Keywords:
stabilization muscles of the spine, sonography, muscular thickness, outpatient rehabilitation, gymnastic ball, dynamic directional pad, strengthening the stabilization muscles of the spine, health care cost
Sources
1. AKBARI, M., SARRAFZADEH, J., MAROUFI, N., HAGHANI, H.: Changes in postural and trunk muscles responses in patients with chronic nonspecific low back pain during sudden upper limb loading. Med. J. Islam Repub. Iran, 2015, 29, s. 265.
2. AMANO, S., LUDIN, A. F., CLIFT, R., NAKAZAWA, M., LAW, T. D., RUSH, L. J., MANINI, T. M., THOMAS, J. S., RUSS, D. W., CLARK, B. C.: Effectiveness of blood flow restricted exercise compared with standard exercise in patients with recurrent low back pain: study protocol for a randomized controlled trial. Trials, 17, 2016, 1, s. 81.
3. ARAB, A. M., RASOULI, O., AMIRI, M., TAHAN, N.: Reliability of ultrasound measurement of automatic activity of the abdominal muscle in participants with and without chronic low back pain. Chiropr. Man Therap., 21, 2013, 1, s. 37.
4. BACHMANN, S., OESCH, P.: Physiotherapy and rehabilitation for low back pain. Ther Umsch, 70, 2013, 9, s. 543-548.
5. BARKER, K. L., SHAMLEY, D. R., JACKSON, D.: Changes in the crosssectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability. Spine, 29, 2004, 22, s, 515-519.
6. BEACH, T. A., PARKINSON, R. J., STOTHART, J. P., CALLAGHAN, J. P.: Effects of prolonged sitting on the passive flexion stiffness of the in vivo lumbar spine. Spine J, 5, 2005, 2, s. 145-154.
7. COOPER, R. G., CLAIR FORBES, W. S., JAYSON, M. I.: Radiographic demonstration of paraspinal muscle wasting in patients with chronic low back pain. Br. J. Rheumatol., 31, 1992, 6, s. 389-394.
8. CORLETT, E. N.: Background to sitting at work: research-based requirements for the design of work seats. Ergonomics, 49, 2006, 14, s. 1538-1546.
9. COSTA, L. O., MAHER, C. G., LATIMER, J., HODGES, P. W., SHIRLEY, D.: An investigation of the reproducibility of ultrasound measures of abdominal muscle activation in patients with chronic non-specific low back pain. Eur. Spine J., 18, 2009, 7, s. 1059-1065.
10. DANNEELS, L. A., VANDERSTRAETEN, G. G., CAMBIER, D. C., WITVROUW, E. E., DE CUYPER, H. J.: CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J., 9, 2000, 4, s. 266-272.
11. GIBBONS, L. E., LATIKKA, P., VIDEMAN, T., MANNINEN, H., BATTIÉ, M. C.: The association of trunk muscle cross-sectional area and magnetic resonance image parameters with isokinetic and psychophysical lifting strength and static back muscle endurance in men. J. Spinal. Disord, 10, 1997, 5, s. 398-403.
12. GRENIER, S. G., MCGILL, S. M.: Quantification of lumbar stability by using 2 different abdominal activation strategies. Arch. Phys. Med. Rehabil., 88, 2007, 1, s. 54-62.
13. GUPTA, N., CHRISTIANSEN, C. S., HALLMAN, D. M., KORSHØJ, M., CARNEIRO, I. G., HOLTERMANN, A.: Is objectively measured sitting time associated with low back pain? A cross-sectional investigation in the NOMAD study. PLoS One, 10, 2015, 3, s. e0121159.
14. HIDES, J. A., RICHARDSON, C. A., JULL, G. A.: Magnetic resonance imaging and ultrasonography of the lumbar multifidus muscle: Comparison of two different modalities. Spine, 20, 1995, 1, s. 54-58.
15. HIDES, J., RICHARDSON, C., JULL, G.: Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine, 21, 1996, 23, s. 2763–2769.
16. HIDES, J. A., JULL, G. A., RICHARDSON, C. A.: Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine, 26, 2001, 11, s. 243-248.
17. HIDES, J. A., STOKES, M. J., SAIDE, M., JULL, G. A., COOPER, D. H.: Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine, 19, 1994, 2, s. 165-172.
18. HODGES, P. W., RICHARDSON, C. A.: Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Arch. Phys. Med. Rehabil., 80, 1999, 9, s. 1005-1012.
19. HODGES, P. W., RICHARDSON, C. A.: Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J. Spinal Disord., 11, 1998, 1, s. 46-56.
20. HODGES, P. W., RICHARDSON, C. A.: Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine, 21, 1996, 22, s. 2640–2650.
21. HOLINKA, M., GALLO, J., ZAPLETALOVÁ, J.: Sonografické posouzení stabilizačních svalů bederní páteře u vertebrogenních pacientů. Rehabil. fyz. lék., 23, 2016, 2, s. 64-73.
22. HOSSEINIFAR, M., AKBARI, M., BEHTASH, H., AMIRI, M., SARRAFZADEH, J.: 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 nack pain. J. Phys. Ther. Sci., 25, 2013, 12, s. 1541-1545.
23. HULTMAN, G., NORDIN, M., SARASTE, H., OHLSEN, H.: Body composition, endurance, strength, cross-sectional area, and density of mm erector spinae in men with and without low back pain. J. Spinal Disord., 6, 1993, 2, s. 114-123.
24. CHOLEWICKI, J., MCGILL, S. M.: Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Clin. Biomec.., 11, 1996, 1, s. 1-15.
25. JULL, G. A., RICHARDSON, C. A.: Motor control problems in patients with spinal pain: a new direction for therapeutic exercises. J. Manipulative Physiol. Ther., 23, 2000, 2, s. 115-117.
26. KAMAZ, M., KIREŞI, D., OĞUZ, H., EMLIK, D., LEVEN-DOĞLU, F.: CT measurement of trunk muscle areas in patients with chronic low back pain. Diagn Intervent Radiol., 13, 2007, 3, s. 144-148.
27. KATZ, J. N.: Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J. Bone Joint Surg. Am., 88, 2006, 2, s. 21-24.
28. KIESEL, K. B., UHL, T., UNDERWOOD, F. B., NITZ, A. J.: Rehabilitative ultrasound measurement of select trunk muscle activation during induced pain. Man. Ther., 13, 2008, 2, s.132-138.
29. KONG, Y. S., LEE, W. J., PARK, S., JANG, G. U.: The effects of prone bridge exercise on trunk muscle thickness in chronic low back pain patients. J. Phys. Ther. Sci., 27, 2015, 7, s. 2073-2076.
30. LEE, S. H., KIM, T. H., LEE, B. H.: The effect of abdominal bracing in combination with low extremity movements on changes in thickness of abdominal muscles and lumbar strength for low back pain. J. Phys. The.r Sci., 26, 2014, 1, s. 157-60.
31. LIEBENSON, C.: Spinal stabilization training: the therapeutic alternative to weight training. J. Body. Mov. Ther., 1, 1997, 2, s. 87-90.
32. LINZER, P., FILIP, M., ŠÁMAL, F., KREMR J., ŠÁLEK, T., GAJDOŠ, M., JARKOVSKÝ, J.: Comparison of biochemical markers of muscle damage and inflammatory response between the open discectomy, microsurgical discectomy, and microsurgical discectomy using tubular retractor. J. Neurol. Surg. A Cent. Eu.r Neurosurg., 76, 2015, 5, s. 384-391.
33. MASSÉ-ALARIE, H., FLAMAND, V. H., MOFFET, H., SCHNEIDER, C.: Corticomotor control of deep abdominal muscles in chronic low back pain and anticipatory postural adjustments. Exp. Brain. Res., 218, 2012, 1, s. 99-109.
34. MCGILL, S. M., HUGHSON, R. L., PARKS, K.: Lumbar erector spinae oxygenation during prolonged contractions: implications for prolonged work. Ergonomics, 43, 2000, 4, s. 486-493.
35. MCMEEKEN, J. M., BEITH, I. D., NEWHAM, D. J., MILLIGAN, P., CRITCHLEY, D. J.: The relationship between EMG and changes in thickness of transverses abdominis. Clin. Biomech., 19, 2004, 4, s. 337-342.
36. MENGIARDI, B., SCHMID, M. R., BOOS, N., PFIRRMANN, C. W., BRUNNER, F., ELFERING, A., HODLER, J.: Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology, 240, 2006, 3, s. 786-792.
37. MORK, P. J., WESTGAARD, R. H.: Back posture and low back muscle activity in female computer workers: a field study. Clin. Biomech., 24, 2009, 2, s. 169-175.
38. NACHEMSON, A. L.: Disc pressure measurements. Spine (Phila Pa 1976), 6, 1981, 1, s. 93-97.
39. O‘SULLIVAN, P. B.: Lumbar segmental ‘instability’: clinical presentation and specific stabilizing exercise management. Man. The., 5, 2000, 1, s. 2-12.
40. PARKKOLA, R., RYTOKOSKI, U., KORMANO, M.: Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine, 18, 1993, 7, s. 830-836.
41. PHOENIX, J., BETAL, D., ROBERTS, N., HELLIWELL, T. R., EDWARDS, R. H.: Objective quantification of muscle and fat in human dystrophic muscle by magnetic resonance image analysis. Muscle Nerve, 19, 1996, 3, s. 302-310.
42. PINHEIRO, J., FIGUEIREDO, P., BRANCO, J., RAMOS, S., FERREIRA, L.: Nonspecific chronic low back pain and function: a clinical study in a physical medicine and rehabilitation consultation. Acta Med. Port., 24, 2011, 2, s. 287-292.
43. POPE, M. H., GOH, K. L., MAGNUSSON, M. L.: Spine ergonomics. Annu Rev. Biomed. Eng., 2002, 4, s. 49-68.
44. RICHARDSON, C., HODGES, P. W. , HIDES, J., RICHARD-SON, C.: Therapeutic exercise for lumbopelvic stabilization: a motor control approach for the treatment and prevention of low back pain. 2nd ed. New York, Churchill Livingstone, 2004, 271 s.
45. RISSANEN, A., KALIMO, H., ALARANTA, H.: Effect of intensive training on the isokinetic strength and structure of lumbar muscles in patients with chronic low back pain. Spine (Phila Pa 1976), 20, 1995, 3, s. 333-340.
46. SALIBA, S. A., CROY, T., GUTHRIE, R., GROOMS, D., WELTMAN, A., GRINDSTAFF, T. L.: Differences in transverse abdominis activation with stable and unstable bridging exercises in individuals with low back pain. N. Am. J. Sports Phys. Ther., 5, 2010, 2, s. 63-73.
47. SCOTT, I. R., VAUGHAN, A. R., HALL, J.: Swiss ball enhances lumbar multifidus activity in chronic low back pain. Phys. Ther. Sports, 16, 2015, 1, s. 40-44.
48. SCHIPHORST PREUPER, H. R., GEERTZEN, J. H., VAN WIJHE, M., BOONSTRA, A. M., MOLMANS, B. H., DIJKSTRA, P. U., RENEMAN, M. F.: Do analgesics improve functioning in patients with chronic low back pain? An explorative triple-blinded RCT. Eur. Spine J., 23, 2014, 4, s. 800-806.
49. ŠPRINGROVÁ, I.: Funkce - diagnostika - terapie hlubokého stabilizačního systému. 2. vyd., Česko, REHASPRING centrum, s.r.o., s. 12-14.
50. TEYHEN, D. S., WILLIAMSON, J. N., CARLSON, N. H., SUTTLES, S. T., O‘LAUGHLIN, S. J., WHITTAKER, J. L., GOFFAR, S. L., CHILDS, J. D.: Ultrasound characteristics of the deep abdominal muscles during the active straight leg raise test. Arch. Phys. Med. Rehabil., 90, 2009, 5, s. 761-767.
51. Ústav zdravotnických informací a statistiky ČR: Zdravotnická ročenka České republiky 2012 [online]. Praha: ÚZIS ČR, 2013 [cit. 2017-9-1]. Dostupné z: http://www.uzis.cz/.
52. Ústav zdravotnických informací a statistiky ČR: Zdravotnická ročenka České republiky 2013 [online]. Praha: ÚZIS ČR, 2014 [cit. 2017-9-1]. Dostupné z: http://www.uzis.cz/.
53. Ústav zdravotnických informací a statistiky ČR: Činnost společných vyšetřovacích a léčebných složek 2012 [online]. Praha: ÚZIS ČR, 2013 [cit. 2017-9-1]. Dostupné z: http://www.uzis.cz/.
54. WILKE, H. J., WOLF, S., CLAES, L. E., ARAND, M., WIESEND, A.: Stability increase of the lumbar spine with different muscle groups. A biomechanical in vitro study. Spine, 20, 1995, 2, s. 192-198.
55. YANG, H. S., LEE, Y. S., JIN, S. A.: Effect of evidence-based trunk stability exercises on the thickness of the trunk muscles. J. Phys. Ther. Sci., 27, 2015, 2, s. 473-475.
56. YILDIRIM, Y., GUNAY, S., KARADIBAK, D.: Identifying factors associated with low back pain among employees working at a package producing industry. J. Back Musculoskeletal Rehabil., 27, 2014, 1, s. 25-32.
57. YOON, J. S., LEE, J. H., KIM, J. S.: The effect of swiss ball stabilization exercise on pain and bone mineral density of patients with chronic low back pain. J. Phys. Ther. Sci., 25, 2013, 8, s. 953-956.
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Physiotherapist, university degree Rehabilitation Sports medicineArticle was published in
Rehabilitation and Physical Medicine
2017 Issue 2
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