The effects of selective Pilates versus extension-based exercises on rehabilitation of low back pain

Introduction

Chronic non-specific low back pain (LBP) may lead to functional impairment and physical disability. The aim of this study was to compare the effects of selective Pilates (SP) and extension-based (EB) exercises on pain, lumbar spine curvature, lumbar forward flexion range of motion (ROM), and physical disability in such individuals.

Predictive factors for progression through the difficulty levels of Pilates exercises in patients with low back pain: a secondary analysis of a randomized controlled trial

Background

The progression through the difficulty levels of Pilates exercises is a subjective criterion, that depends on the therapist's experience and ability to identify the best moment to progress to the next level.

Effectiveness of graded activity versus physiotherapy in patients with chronic nonspecific low back pain: midterm follow up results of a randomized controlled trial

Background

Low back pain (LBP) is a major health and economic problem worldwide. Graded activity and physiotherapy are commonly used interventions for nonspecific low back pain. However, there is currently little evidence to support the use of one intervention over the other in the medium-term.

Muscle Activation During Pilates Exercises in Participants With Chronic Nonspecific Low Back Pain: A Cross-Sectional Case-Control Study

Objective

To determine the amplitude of the electromyographic activity of trunk muscles during Pilates exercises in women with and without chronic low back pain (LBP).

Altered postural responses persist following physical therapy of general versus specific trunk exercises in people with low back pain

Interventions that target trunk muscle impairments in people with LBP have been promoted; however, the treatment effects on muscle activation impairments during postural tasks remain unclear. Thus, our objective was to evaluate the effects trunk stabilization vs. general strength and conditioning exercises on the automatic postural response in persons with chronic low back pain (LBP).Fifty-eight subjects with chronic, recurrent LBP (n = 58) (i.e., longer than six months) were recruited and randomly assigned to one of two, 10-week physical therapy programs: stabilization (n = 29) or strength and conditioning (n = 29). Pain and function were measured at 11 weeks and 6 months post-treatment initiation. To quantify postural following support surface perturbations, surface electrodes recorded electromyography (EMG) of trunk and leg muscles and force plates recorded forces under the feet, to calculate the center of pressure.Both groups demonstrated significant improvements in pain and function out to 6 months. There were also changes in muscle activation patterns immediately post-treatment, but not at 6 months. However, changes in center of pressure (COP) responses were treatment specific. Following treatment, the stabilization group demonstrated later onset of COP displacement, while the onset of COP displacement in the strengthening group was significantly earlier following treatment.Despite two different treatments, clinical improvements and muscle activation patterns were similar for both groups, indicating that the stabilization treatment protocol does not preferentially improve treatment outcomes or inter-muscle postural coordination patterns for persons with LBP.Clinical Trial Registration NumberNCT01611792.     

The effects of neck mobilization in patients with chronic neck pain: A randomized controlled trial

Objective

To determine the effect of mobilization and routine physiotherapy on pain, disability, neck range of motion (ROM) and neck muscle endurance (NME) in patients having chronic mechanical neck pain (NP).

Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial

Chan CW, Mok NW, Yeung EW. Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial.

Objective

To examine the effect of adding aerobic exercise to conventional physiotherapy treatment for patients with chronic low back pain (LBP) in reducing pain and disability.

Design

Randomized controlled trial.

Setting

A physiotherapy outpatient setting in Hong Kong.

Participants

Patients with chronic LBP (N=46) were recruited and randomly assigned to either a control (n=22) or an intervention (n=24) group.

Interventions

An 8-week intervention; both groups received conventional physiotherapy with additional individually tailored aerobic exercise prescribed only to the intervention group.

Main Outcome Measures

Visual analog pain scale, Aberdeen Low Back Pain Disability Scale, and physical fitness measurements were taken at baseline, 8 weeks, and 12 months from the commencement of the intervention. Multivariate analysis of variance was performed to examine between-group differences.

Results

Both groups demonstrated a significant reduction in pain (P<.001) and an improvement in disability (P<.001) at 8 weeks and 12 months; however, no differences were observed between groups. There was no significant difference in LBP relapse at 12 months between the 2 groups (χ²=2.30, P=.13).

Conclusions

The addition of aerobic training to conventional physiotherapy treatment did not enhance either short- or long-term improvement of pain and disability in patients with chronic LBP.     

Neurodynamic exercises provide no additional benefit to extension-oriented exercises in people with chronic low back-related leg pain and a directional preference: A randomized clinical trial

BackgroundChronic low back-related leg pain may involve mixed pain mechanisms. A strategy to address both neuropathic and nociceptive pain symptoms would be combining treatments.ObjectiveTo assess the effects of adding neurodynamic exercises to extension-oriented exercises in patients with chronic low back-related leg pain and a directional preference.DesignTwo arm, single blind, randomized clinical trial.MethodEligible participants were aged between 18 and 65 years, had low back pain radiating below gluteus for at least 3 months, pain intensity greater than 3 points in the numerical pain rating scale, positive SLR test and a directional preference for lumbar extension movements. Thirty-one participants were randomly allocated into one of two groups: extension-oriented exercises (EE) or extension exercises plus neurodynamic exercises (EEN). Primary outcomes were leg pain intensity and function at 3 weeks. Secondary outcomes were low back pain intensity, disability, global perceived effect and quality of life at 3 weeks and at 1 month.ResultsRetention rate was 100% (n = 14) in EE and 94% (n = 16) in EEN for primary outcome analysis. There was no between-group difference for the primary outcomes and for low back pain intensity, GPE and quality of life at 3 weeks. For some outcomes, EE was superior to EEN.ConclusionsWe found no benefits in adding neurodynamic exercises to extension-oriented exercises for patients with nerve-related leg pain and a directional preference. As this study has a small and very specific sample, results may be interpreted with caution.     

Evaluation of a randomized controlled trial in the management of chronic lower back pain in a French automotive industry: an observational study

Nassif H, Brosset N, Guillaume M, Delore-Milles E, Tafflet M, Buchholz F, Toussaint J-F. Evaluation of a randomized controlled trial in the management of chronic lower back pain in a French automotive industry: an observational study.

Objective

To evaluate a specific workplace intervention for the management of chronic lower back pain among employees working in assembly positions in the automotive industry.

Design

Randomized controlled trial.

Setting

On site at the workplace of a French automotive manufacturer.

Participants

Subjects (N=75 volunteers) were recruited on site and randomly assigned to either an experimental group (n=37) or a control group (n=38).

Intervention

The experimental group followed a supervised 60-minute session, 3 times per week, of muscle strengthening, flexibility, and endurance training during 2 months. The control group received no direct intervention. Evaluation took place at baseline, 2 months, and 6 months.

Main Outcome Measures

Pain related parameters were evaluated using validated questionnaires and scales translated into French (Quebec Back Pain Disability Scale, Rolan Morris Disability Questionnaire, Dallas Pain Questionnaire, and the Tampa Scale for Kinesiophobia). Perceived pain intensity was evaluated using the numerical rating scale, and physical outcome measures were evaluated using specific indicators (flexibility, Biering-Sorensen Test, Shirado test). The multivariate analysis of variance, t test, and Wilcoxon signed-rank test were used for statistical analysis.

Results

We observed a significant beneficial effect (P<.025) for the experimental group at 2 and 6 months in pain parameters, specific flexibility, and in back functions, and a significant improvement at 6 months in the control group for the perceived pain intensity, anterior flexion, flexibility of quadriceps, and Dallas Pain Questionnaire's work recreational score. An increase in the practice of physical activity outside the workplace was noted in both groups at 2 months but persisted at 6 months for the experimental group.

Conclusions

This study reinforces the multiple health benefits of physical activity and physical therapy modalities in the workplace by assisting individuals at risk who have chronic LBP.     

Immediate effects of Pilates based therapeutic exercise on postural control of young individuals with non-specific low back pain: A randomized controlled trial

ObjectivesLow back pain affects the person's ability to keep balance, especially in challenging conditions. The purpose of this study was to determine the immediate effects of Pilates exercises on postural sway and dynamic balance of young individuals with non-specific low back pain.DesignControlled laboratory design.Settings and main outcome measuresForty-six participants with non-specific low back pain were randomized to a Pilates (n = 23, 10 males; age: 21.8 ± 3.2 years) and a control group (n = 23, 9 males; age: 22.8 ± 3.6 years). Postural sway was assessed with a force platform and dynamic balance with the Star Excursion Balance Test, before and after the intervention or rest period. To assess postural sway, participants stood still on an unstable surface set on the force plate for 90s, with eyes closed.InterventionThe intervention lasted 20 min and consisted on four Pilates exercises: single leg stretch (level 1), pelvic press (level 1), swimming (level 1) and kneeling opposite arm and leg reach.ResultsAt baseline, no differences were found between groups. The Pilates group improved in all the postural sway values (area of CoP: 11.5 ± 3.4 to 9.7 ± 2.7 cm², p = 0.002 and CoP velocity: 2.8 ± 0.6 to 2.3 ± 0.5 cm/s, p < 0.001) and in the Star Excursion Balance Test. Control group only improved in CoP velocity, however, this improvement was significantly inferior compared to the Pilates group.ConclusionsPilates exercises immediately improved postural sway and dynamic balance in young adults with non-specific low back pain.     

Effect of Pilates Matwork exercises on posterior chain flexibility and trunk mobility in school children: A randomized clinical trial

ObjectiveTo investigate the effects of an exercise program, based on the Pilates Matwork method, on posterior chain flexibility and trunk mobility in healthy school age children.Design and settingThe study was a parallel-group randomized clinical trial. The participants were randomly assigned to groups: Pilates Group (PG) and Control Group (CG). The program was developed at the Early Childhood Education Institute, Londrina-PR.Participants43 children with age between eight to 12 years, no prior knowledge of the Pilates method, and no exercise training in the last six months.InterventionFour months of twice a week 50 min Pilates Matwork exercises were administered.Outcome measuresFlexibility and mobility, assessed using the sit-and-reach test, fingertip-to-floor test and photogrammetry. The assessors were blinded to the allocation of participants.ResultsThree children were excluded before randomization and 40 were randomized (PG n = 20; CG n = 20).12 children were excluded during the protocol (PG n = 7; CG n = 5) and included in the intention to treat analysis. No significant difference between groups was observed for flexibility measures. There was a significant difference in the following outcomes for the PG: distance reached in the sit-and-reach test between pre-test (median 14.25[11.25–28.38]) and post-test (median 20.25[12.00–29.63]) (ES = 0.29, SRM = 0.73); Posterior angle of the knee in the fingertip-to-floor test between pre-test (median 191.60[187.20–191.60]) and post-test (median 189.00[185.90–191.50]) (ES = 0.56, SRM = 0.54).ConclusionThere were no differences in posterior chain flexibility and trunk mobility between school age children who underwent Pilates Matwork exercises and the control. However, children who participated in the exercise program showed improvement in some results of flexibility.Clinical trial registration numberBrazilian Registry of Clinical Trials (REBEC) (N° RBR-8t5p7d).     

Isolated lumbar extensor strengthening versus regular physical therapy in an army working population with nonacute low back pain: a randomized controlled trial

Helmhout PH, Harts CC, Viechtbauer W, Staal JB, de Bie RA. Isolated lumbar extensor strengthening versus regular physical therapy in an army working population with nonacute low back pain: a randomized controlled trial.

Objective

To evaluate the effectiveness of specific lumbar extensor training compared with regular physical therapy (PT) in workers with nonspecific nonacute low back pain (LBP).

Design

A multicenter randomized controlled trial with 1-year follow-up.

Setting

PT department in (military primary care) health centers.

Participants

Predominantly male soldiers (N=129) with 4 weeks or more of low back complaints who were referred by the health center's general practitioner for PT (mean age, 35.9±10.8y; range, 20-56y), of whom 127 randomized participants were included in the analyses. One patient withdrew because of adverse effects during treatment.

Interventions

Participants were assigned to 1 of 2 treatment programs: (1) a 10-week device-supported isolated lumbar extension training, twice a week, or (2) regular PT, mainly consisting of exercise therapy and aerobic activities.

Main Outcome Measures

Functional status (Roland-Morris Disability Questionnaire, Patient-Specific Functional Scale) and global perceived effect were assessed in the short term (5wk, 10wk) and long term (6mo, 12mo).

Results

Both groups showed a favorable development in main outcomes over time: short-term improvements (after 10 weeks of treatment) remained stable or even slightly increased throughout the 12-month follow-up. No significant differences between the 2 groups were shown for any of the outcome measures, at any time.

Conclusions

Consistent with prior evidence, specific back strengthening does not seem to offer incremental benefits in LBP management compared with regular PT care that mainly consists of general exercise therapy. (ISRCTN identifier ISRCTN19334317.)     

Effects of static stretching and strengthening exercises on flexion relaxation ratio in patients with LBP: A randomized clinical trial

IntroductionStretching and strengthening exercises are commonly used to improve muscle shortness. Consequently, the aim of this trial was to compare the flexion-relaxation response (electromyography activities of shortened hamstring and back muscles) in chronic nonspecific LBP patients.MethodsIn this randomized controlled clinical trial, forty-five eligible patients were randomly categorized into three groups; static stretching (n = 15), strengthening exercise in lengthened hamstring position (n = 15) and control (n = 15). All groups received conventional physical therapy for LBP and the two intervention groups received special exercise programs as well. Each group performed three treatment sessions for a week, a total of 12 sessions. The flexion-relaxation ratio (FRR) for knee and back muscles were assessed as the primary outcome measure. Pain and functional disability for participants were also assessed.ResultsThe results indicated non-significant differences between the three groups regarding the changes of FRR (mean between-group differences ranged over 0.69 to 39.1; p > 0.05), pain and disability (mean between-group differences ranged over 0.15 to 5.96; p > 0.05). Within-group analysis for each group, revealed statistically significant improvement in the patients' score of either pain (mean within-group differences ranged over −27.20 to −35.76; p < 0.001) or disability (mean within-group differences ranged over −16.17 to 24.95; p < 0.001) as secondary outcomes. In other words, the scores of pain and disability decreased in all treatment groups as compared to the baseline.ConclusionNeither static stretching nor strengthening exercises in lengthened hamstring position affected FRR more than the control group.     

The addition of neurodynamic exercises to extension-oriented exercises among patients with chronic back-related leg pain: A study protocol

BackgroundPatients with back-related leg pain exhibit nociceptive and neuropathic characteristics. Few studies have investigated the combination of interventions considering these characteristics.ObjectivesTo investigate if the addition of neurodynamic exercises (EEN) to extension-oriented exercises (EE) promotes additional benefits in individuals with back-related leg pain and a directional preference.MethodsPatients will be randomized to either EE or EEN. Patients from both groups will receive 7 sessions over 3 weeks. Low back and leg pain, function, quality of life, disability, and global perceived effect will be evaluated at baseline, 3 weeks after randomization and 1-month follow-up. A linear mixed model will be used for outcomes analysis.     

Short- and long-term effects of a six-week clinical Pilates program in addition to physical therapy on postmenopausal women with chronic low back pain: a randomized controlled trial

Purpose: To determine the short- and long-term effectiveness of the application of Clinical Pilates in addition to physical therapy versus a physical therapy treatment alone in a population of postmenopausal women with chronic low back pain (CLBP). Methods: A single-blind randomized controlled trial with repeated measures and a follow-up period. One hundred and one patients were randomly allocated to a Pilates?+?physical therapy (PPT) group or to a physical therapy (PT) only group for six weeks. Pain and disability were measured by visual analog scale (VAS) and the Oswestry disability index respectively preintervention, after 6 weeks of treatment and after 1-year follow-up. Results: There were significant differences between groups in pain and disability after 6 weeks of treatment, with better results in the PPT group with an effect size of d?=?3.14 and d?=?2.33 for pain and disability. After 1-year follow-up, only PPT group showed better results compared with baseline with an effect size of d?=?2.49 and d?=?4.98 for pain and disability. Conclusion: The results suggest that using Clinical Pilates in addition to physical therapy provides improved results on pain management and functional status for postmenopausal woman with CLBP and that its benefits still linger after one year.

• Implications for Rehabilitation

• Chronic Low Back Pain could benefit from the Pilates practice in postmenopausal women.

• Improvement in pain and disability derived from CLBP seem to be maintained over time due to Pilates practice.

• Pilates constitutes a safe tool to be applied in older population with CLBP due to its ability to be adapted to every performance and physical level.

     

The efficacy of traction for back pain: a systematic review of randomized controlled trials

OBJECTIVE: To assess the efficacy of traction for patients with low back pain (LBP) with or without radiating pain, taking into account the clinical technique or parameters used. DATA SOURCES: A computer-aided search of MEDLINE, CINAHL, AMED, and the Cochrane Collaboration was conducted for randomized controlled trials (RCTs) in the English language, from 1966 to December 2001. STUDY SELECTION: RCTs were included if: participants were over the age of 18 years, with LBP with or without radiating pain; the intervention group received traction as the main or sole treatment; the comparison group received sham traction or another conservative treatment; and the study used 1 of 4 primary outcome measures. DATA EXTRACTION: The study was conducted in 2 strands. Strand 1 assessed methodologic quality using a specific criteria list recommended by the Cochrane Back Review Group. The strength of the evidence was then rated using the Agency for Health Care Policy and Research system. Strand 2 applied further inclusion criteria based on recommended clinical parameters. One reviewer conducted the selection and data extraction. DATA SYNTHESIS: Strand 1: 1 study scored 9 points (maximum score, 10 points); the other 12 scored between 0 and 3 points, indicating that most were of poor quality. Nine studies reported negative findings, but only 1 study was of a high quality. Three studies reported positive findings and 1 study was inconclusive. Strand 2: only 4 trials having low methodologic quality were included, 2 of which reported negative findings, and 2 positive findings. CONCLUSION: The evidence for the use of traction in LBP remains inconclusive because of the continued lack of methodologic rigor and the limited application of clinical parameters as used in clinical practice. Further trials, which give attention to these areas, are needed before any firm conclusions and recommendations may be made.     

Effects of Pilates training VS. Suspension training on quality of life in women with knee osteoarthritis: A randomized controlled trial

IntroductionOsteoarthritis is the most common synovial joint disease and is characterized by progressive destruction of the articular cartilage. This study aimed to compare the effect of Pilates and suspension training in patients with knee Osteoarthritis.MethodsThe participants in this randomized trial study were patients with knee Osteoarthritis. In this study, 30 females (61.40 ± 4.85 years) were divided into three groups of suspension training, Pilates, and control group. Participants were randomly assigned to 8-week (3x/week, 1 h/session) Pilates and suspension training program groups. The static and dynamic balance, range of motion, and knee function were respectively measured by The Stork stand balance test, Y balance test, Goniometers, and The WOMAC performance disability questionnaire. To analyze the findings, a dependent sample t-test, covariance test, and Bonferroni's post hoc test were used (P ≤ 0.05).ResultsDynamic and static balance in the suspension training and Pilates training caused a significant increase (P ≤ 0.05) compared to the control group. Also, the range of motion and motor performance in the suspension training and Pilates training showed a significant decrease (P ≤ 0.05) compared to the control group. The suspension training compared to the Pilates training was more effective on dynamic and static balance (P ≤ 0.05). Also, the suspension training compared to the Pilates training had more effect on Range of motion and Motor performance (P ≤ 0.05).ConclusionIt seems that Pilates and suspension training can be used in medical centers as a complementary rehabilitation method among female patients with knee Osteoarthritis to improve the dynamic and static balance, range of motion, and performance.     

Motivational enhancement therapy in addition to physical therapy improves motivational factors and treatment outcomes in people with low back pain: a randomized controlled trial

Vong SK, Cheing GL, Chan F, So EM, Chan CC. Motivational enhancement therapy in addition to physical therapy improves motivational factors and treatment outcomes in people with low back pain: a randomized controlled trial.

Objectives

To examine whether the addition of motivational enhancement treatment (MET) to conventional physical therapy (PT) produces better outcomes than PT alone in people with chronic low back pain (LBP).

Design

A double-blinded, prospective, randomized, controlled trial.

Setting

PT outpatient department.

Participants

Participants (N=76) with chronic LBP were randomly assigned to receive 10 sessions of either MET plus PT or PT alone.

Intervention

MET included motivational interviewing strategies and motivation-enhancing factors. The PT program consisted of interferential therapy and back exercises.

Main Outcome Measures

Motivational-enhancing factors, pain intensity, physical functions, and exercise compliance.

Results

The MET-plus-PT group produced significantly greater improvements than the PT group in 3 motivation-enhancing factors; proxy efficacy (P<.001), working alliance (P<.001), and treatment expectancy (P=.011). Furthermore, they performed significantly better in lifting capacity (P=.015), 36-Item Short Form Health Survey General Health subscale (P=.015), and exercise compliance (P=.002) than the PT group. A trend of a greater decrease in visual analog scale and Roland-Morris Disability Questionnaire scores also was found in the MET-plus-PT group than the PT group.

Conclusion

The addition of MET to PT treatment can effectively enhance motivation and exercise compliance and show better improvement in physical function in patients with chronic LBP compared with PT alone.     

Postero-anterior movements of the cervical spine: repeatability of force displacement curves

The repeatability of instrumented assessments of postero-anterior (PA) movements has been reported previously for lumbar and thoracic spines, but only in relation to limited parameters of the movement. This study describes a device for measuring PA movements of the cervical spine and reports on repeatability of the entire force/displacement (FD) curves. Repeatability was assessed using coefficients of multiple determination (CMDs) and adjusted CMDs (where the mean offset between the two curves are removed and the shape of the curve can be more directly assessed) for inter-rater intra-day (inter-rater), intra-rater inter-day (inter-day) and intra-rater intra-day (intra-rater) repeated measurements. The mean CMD and mean adjusted CMD for intra-rater measurements (0.90 and 0.99, respectively) were significantly higher than for the other measurement intervals. Inter-rater and inter-day mean CMDs were 0.76 and 0.73 and mean adjusted CMDs were 0.96 and 0.97. It is concluded that the maximum repeatability is achieved if the same operator reassesses the patient on the same day. It is hoped that the methodology described will form the basis for further research that will enable greater understanding of what characteristics of PA movements inform manual palpation and thereby enable improvement in both manual therapy treatment teaching efficiency of manual therapy skills.