Physical Therapists

A Peer Reviewed Publication of the College of Allied Health & Nursing at Nova Southeastern University Dedicated to allied health professional practice and education http://ijahsp.nova.edu Vol. 2 No. 2 ISSN 1540-580X Physical Therapists’ Evaluation of the Trunk Flexors in Patients with Low Back Pain Shari A. Rone-Adams, DBA, MHSA, PT, GCS1 Eric Shamus, PhD, PT, CSCS2 Melissa Hileman, MPT3 1. 2. 3. Associate Professor, College of Allied Health and Nursing, Department of Physical Therapy, Nova Southeastern University Assistant Professor, College of Osteopathic Medicine, Nova Southeastern University Graduate, Nova Southeastern University, Physical Therapy Program Citation: Rone-Adams, S., Shamus, E., Hileman, M. Physical therapists evaluation of the trunk flexors in patients with low back pain. The Internet Journal of Allied Health Sciences and Practice. April 2004. Volume 2 Number 2. ABSTRACT Study Design: This study utilized a single blind design in the observation of 20 initial low back evaluations performed by physical therapists. The physical therapists were blinded to what the researchers were observing. Objective: The objective of this study was to determine whether or not physical therapists were quantifying the strength of trunk flexors when the patient’s chief complaint was low back pain. Background: The literature has shown that there is a relationship between back pain and decreased strength in the abdominal muscles. Therefore, it appears important for physical therapists to evaluate the abdominal muscles in patients with low back pain. Methods and Measures: Twenty physical therapists participated in the study. The researchers observed if trunk flexor strength was quantified during the initial evaluation of 20 patients with low back pain. Following the observation, each physical therapist was given a questionnaire and asked to comment on their evaluation of the trunk flexors. Results: Of the evaluations that were observed, 15% of the physical therapists evaluated the trunk flexors and 85% did not. Conclusion: This study demonstrated that therapists did not consistently quantify abdominal strength when treating patients with low back pain. INTRODUCTION Studies indicate that 70-80% of the population experience at least one episode of back pain during their lifetime.1,2 Several factors have been associated with the incidence of low back pain. The literature has identified clinical factors to include changes in lumbar lordosis and pelvic tilt, leg length discrepancy, foot pronation, and the length, strength and endurance of various muscles of the trunk and lower extremity.3 One of the factors that has been highly associated with low back pain has been abdominal muscle weakness. Studies have investigated abdominal muscle weakness and its mechanical effect on the back. Some studies have speculated that weak abdominal muscles result in an increased anterior pelvic tilt and lumbar lordosis, while other studies have negated the relationship between pelvic tilt, lumbar lordosis and abdominal muscle weakness.4-7 But the fact remains that many studies have shown that patients with low back pain have weaker abdominal muscle strength than healthy controls.3, 8-15 In 2002, Nourbakhsh and Arab3 performed a study with 600 men and women that showed that one of the factors associated with low back pain was decreased strength in the abdominal muscles. Other factors also associated with low back pain included muscle length and endurance of the back extensors, and strength of the hip flexors and hip adductors.3 Lee et al.14 investigated various factors associated with low back pain in an industrial setting. A cross sectional study was carried out among 1,562 employees of a large utilities corporation. The results indicated that abdominal muscle weakness was associated with chronic low back pain. Bayramoglu et al.15 found that in a sample of 25 female patients who had been experiencing low back pain for at © The Internet Journal of Allied Health Sciences and Practice, 2004 Physical Therapists’ Evaluation of the Trunk Flexors in Patients with Low Back Pain 2 least 3 months, that decreased trunk muscle strength (extensors and abdominals) and increased body mass index was directly associated with chronic low back pain. Helewa et al.8 compared four different measures of abdominal muscle strength in 24 male subjects (12 with low back pain and 12 without low back pain). The results showed that the subjects with low back pain had significantly weaker abdominal muscles in three of the four measures.8 In 1993, Helewa et al. 16 continued their research on the relationship between abdominal muscle strength, lumbar stabilization, and low back pain. In this study, three instruments were used to test the strength of the abdominal muscles: a sphygmomanometer, a vigormeter, and a myometer. Each of these methods required the subject to perform a sit-up from supine. The test position was a half sit-up at 45 degrees of hip flexion, knees at 90 degrees, and feet secured. The results of the study showed that with all three instruments, the subjects who proclaimed to have low back pain, also had abdominal weakness and decreased lumbar stabilization when compared to the controls.16 This study verified the results Helewa et al.8 found in their 1990 study. Suzuki et al.13 investigated the differences in trunk flexion strength, between 90 males with low back pain and 50 control subjects. The subjects performed the sit-up from supine while both isometric and isokinetic measurements were taken. Suzuki et al.13 discovered that the subjects with low back pain had significantly greater weakness in the abdominal muscles than the controls, when the abdominal muscles were tested with the legs extended. The researchers also calculated the percentage of strength decrements and found that there was a significant amount of fatigue in the subjects with low back pain as compared to the controls.13 In addition to the research indicating that abdominal muscle weakness is associated with low back pain, there is also considerable literature documenting the efficacy of low back exercises in the conservative treatment of chronic low back pain. In 1998, O’Sullivan et al.17 determined that conscious and automatic patterns of abdominal activity could be altered by specific exercise interventions. Helewa et al.18 compared back exercises and back education programs for patient with low back pain and found that the incidence of low back pain episodes were same when comparing the group receiving exercise and back education to the group receiving exercise only. In 2000, Taimela et al.19 showed that exercises are beneficial after guided treatment in the maintenance of the results of a physical therapy program for low back pain. Takemasa et al.20 performed a study with the purpose of examining the differences in trunk muscle strength characteristics and the effect of trunk muscle exercises on individuals with and without detectabl (...truncated)