Effects of an eight-week lumbar stabilization exercise programme on selected variables of patients with chronic low back pain

Bangladesh Journal of Medical Science Vol. 19 No. 03 July’20 Original article: Effects of an eight-week lumbar stabilization exercise programme on selected variables of patients with chronic low back pain Ademola O. Abass1, Abiola R. Alli2, Oladapo M. Olagbegi3, Candice J. Christie4and Samuel O. Bolarinde5 Abstract: Background: Lumbar stabilisation exercise has been shown to reduce pain and disability in patients with low back pain but information on its potential benefits in term of back muscle endurance is scarce. Objective: This study was aimed at investigating the effects of augmenting conventional physiotherapy with lumbar stabilization exercises on selected variables of patients with non-specific chronic low back pain (NSCLBP). Methods: Forty individuals with NSCLBP aged 20-60 years were assigned to one of experimental or control groups (20 in each). The experimental group had lumbar stabilisation exercises in addition to conventional therapy (transcutaneous electrical nerve stimulator and infrared) which was the only treatment for the control group. Both groups were treated thrice weekly. Participants’ pain intensity, disability index, kinesiophobia level and back muscle endurance were evaluated at baseline and after 8 weeks. Results: There was significant reduction in pain intensity (experimental: 6.74±1.37; 3.48±1.09; control: 6.57±1.40; 2.96±1.13) and disability index (experimental: 46.60±16.67; 26.55±14.78; control: 32.10±16.16; 24.60±15.27) and increase in back muscle endurance (experimental: 11.05±8.39; 14.30±19.24s; control: 10.85±9.79; 13.90±11.63s) for both groups. Experimental group had significantly greater reduction (p < 0.05) in disability index than the controls (p = 0.048). Conclusion: Augmenting conventional physiotherapy with lumbar stabilisation exercises achieved better reduction in disability than conventional therapy alone in patients with NSCLBP. Keywords: Endurance; low back pain; fear of movement; function; lumbar stabilization Bangladesh Journal of Medical Science Vol. 19 No. 03 July’20. Page : 467-474 DOI: https://doi.org/10.3329/bjms.v19i3.45864 Introduction Low back pain (LBP) is a common problem which affects the majority of adults at least once in their lifetime.1 It is a health challenge of global concern and is as common as a headache affecting all age groups and races.1,2 It is pain and discomfort localised below the costal margin and above the inferior gluteal folds with or without leg pain (sciatica).3,4 An acute episode of LBP usually resolves over a period of two to four weeks for 90% of patients, however, the recurrence rate of an acute episode is high, especially within the following 12 months.5 This recurrence leads to chronic low back pain (CLBP) which is associated with high economic and health care burden costs.5 The lifetime and one year prevalence of LBP is about 60-80% and 34% respectively.6,7 Men have a higher risk for recurrence than women and the highest recurrence has been reported among individuals between 25-44 years.7Low back pain is one of the most common musculoskeletal problems that bring 1. Ademola O. Abass, Department of Human Kinetics and Physical Education, Faculty of Education, University of Ibadan, Nigeria 2. Abiola R. Alli, Department of Physiotherapy, Federal Medical Centre, Owo, Ondo State, Nigeria. 3. Oladapo M. Olagbegi, Discipline of Physiotherapy, School of Health Sciences, University of Kwa ZuluNatal, Durban, South Africa. 4. Candice J. Christie, Department of Human Kinetics and Kinetics and Ergonomics, Rhodes University, Grahamstown, South Africa. 5. Samuel O. Bolarinde, Department of Physiotherapy, Federal Medical Centre, Owo, Ondo State, Nigeria. Correspondence to: Dr. Oladapo Michael Olagbegi, Discipline of Physiotherapy, School of Health Sciences, University of Kwa Zulu-Natal, Durban, South Africa. E-mail: 467 Effects of an eight-week lumbar stabilization exercise programme on selected variables of patients with chronic low back pain patients to the hospital8 and the third leading cause of disability and associated absenteeism from work.7 Low back pain is strongly associated with high level of disability which implies a significant inability to engage in meaningful and necessary activities of daily living.9 Clinical studies have also suggested that consideration of excessively negative orientation toward pain (pain catastrophizing) and kinesiophobia are important in managing chronic low back pain and associated disability.10,11,12 Kinesiophobia describes fear of movement and re-injury;11 it is an irrational and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re –injury.13 Individuals who catastrophize pain are likely to become fearful of pain, and this results in pain-related fear which is associated with avoidance behaviors, particularly, the avoidance of movement and physical activity.12 The individual may withdraw from activities of daily living and family.12 Moreover, pain-related fearis reportedly associated with increased bodily awareness and pain hypervigilance. Pain hypervigilance, in addition to depression and disuse, are associated with increased pain levels and experience.12 Studies have reported significant decrease in back extensor muscle endurance in patients with LBP; 14,15 these are postural muscles that aid in maintaining the upright standing posture and controlling lumbar forward bending. It is thought that decreased back muscle endurance causes muscular fatigue and consequently overloads soft tissue and the passive structures of the lumbar spine, resulting in low back pain.16 Reduced back extensor muscle endurance has been identified as an important risk factor for LBP 17 and there is an inverse relationship between pain intensity and static back extensors endurance among patients with long-term mechanical LBP.18Decreased back muscle endurance could be either a cause or consequence of LBP.19,20 Hence, assessment of back muscle endurance is crucial in the prediction, prevention and rehabilitation of LBP. Lumbar stabilisation exercises (LSE) and other exercise programs fall within a paradigm of therapeutic exercises used in treatment of LBP.21 They are exercises aimed at improving the activation patterns of trunk muscles, in order to relieve lumbar pain and limitation through trunk muscle contraction. 21,22 This exercise approach has become very popular as opposed to passive modalities such as; ultrasound, transcutaneous electrical nerve stimulation (TENS), short-wave diathermy, and massage that only aim 468 to reduce symptoms but do not in any way alleviate a patient’s predisposition to recurrent episode. The vulnerability of LBP recurrence is not completely understood23,24 however, instability of the lumbar motion is considered an important cause.25,26 Richardson and Jull 26 submitted that core stability exercises can be used to reactivate and improve the motor control of the multifidus (a (...truncated)