Activation of lumbar paraspinal and abdominal muscles during therapeutic exercises in chronic low back pain patients

Arokoski JP, Valta T, Kankaanpää M, Airaksinen O. Activation of lumbar paraspinal and abdominal muscles during therapeutic exercises in chronic low back pain patients. Arch Phys Med Rehabil 2004;85:823-32.

Objectives

To assess the activities of paraspinal and abdominal muscles during therapeutic exercises for the treatment of patients with nonspecific chronic low back pain (CLBP), and to study the effects of active physical rehabilitation on these activities.

Design

A cross-sectional study comparing muscle activities during 18 stabilization exercises, and a prospective follow-up of patients with CLBP during rehabilitation.

Setting

Rehabilitation clinic in university hospital in Finland.

Participants

Nine volunteers (5 men, 4 women) aged 27 to 58 years.

Intervention

Three months of active outpatient rehabilitation (4 to 6 times in a rehabilitation clinic, supplemented with self-motivated exercise at home) supervised by a physiotherapist.

Main outcome measures

Surface electromyography was recorded bilaterally from L5 level paraspinal, rectus abdominis, and obliquus externus abdominis muscles. The recorded signal was averaged and normalized to the maximal electromyographic amplitude obtained during the maximal voluntary contraction. The measurements were taken before and after the exercise treatment period.

Results

CLBP patients showed variable trunk muscle activity patterns during the different therapeutic exercises, similar to those that we reported earlier in healthy subjects. The maximal trunk isometric extension (pre, 147.3±75.9Nm; post, 170.1±72.3Nm) and flexion (pre, 72.0±37.9Nm; post, 93.5±42.5Nm) torques did not show a significant changes during the exercise period. However, trunk rotation-flexion torque (pre, 52.9±26.5Nm; post, 82.4±65.8Nm) increased significantly (35.8%) after the exercise period (P<.05). The corresponding maximal electromyographic amplitudes of back and abdominal muscles remained unchanged. Disability, as assessed by visual analog scale and Oswestry Disability Index, did not change.

Conclusions

The CLBP patients performed therapeutic exercises with similar abdominal and back extensor muscle activities in the same way as the healthy subjects in our earlier studies. In this study, active physical rehabilitation had no effect on the abdominal and back muscle activities or on pain and functional disability indices.     

Raised paraspinal muscle activity reduces rate of stature recovery after loaded exercise in individuals with chronic low back pain

OBJECTIVES: To further the understanding of stature recovery in subjects with and without chronic low back pain (CLBP) and to determine the relations among stature recovery, paraspinal muscle activity, and perceived pain and disability. DESIGN: A case-control study in which stature loss and recovery were assessed in subjects with and without CLBP after a 20-minute loaded walking task (10% of body mass). Group differences in pain, disability, and paraspinal muscle activity were also assessed. SETTING: A university laboratory. PARTICIPANTS: Twenty subjects with CLBP were matched (age, sex, body mass, physical activity level) with 20 controls who were recruited through notices in the university, general community, and local Primary Care Trust. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Stature changes and integrated electromyograms of the paraspinal muscles during a loading and unloading period were assessed. RESULTS: Stature changes after loading did not differ between groups ( P <.05). Subjects with CLBP recovered significantly less stature during unloading than did the controls ( P <.05). Paraspinal muscle activity correlated negatively with stature recovery ( P <.05). Relations among stature recovery, pain, and disability were shown ( P <.05). CONCLUSIONS: The elevated paraspinal muscle activity exhibited by the CLBP group increased compression on the intervertebral disks and diminished their ability to recover the height lost through loaded exercise. Further research is required to establish whether a change in paraspinal muscle activity is associated with corresponding changes in stature recovery, and if this has any clinical implications by reducing pain and disability.     

Effects of the abdominal drawing-in maneuver on muscle activity, pelvic motions, and knee flexion during active prone knee flexion in patients with lumbar extension rotation syndrome

Park K-N, Cynn H-S, Kwon O-Y, Lee W-H, Ha S-M, Kim S-J, Weon J-H. Effects of the abdominal drawing-in maneuver on muscle activity, pelvic motions, and knee flexion during active prone knee flexion in patients with lumbar extension rotation syndrome.

Objective

To investigate the effects of performing an abdominal drawing-in maneuver (ADIM) during active prone knee flexion on the hamstrings and erector spinae muscle activity, the amounts of pelvic motion and knee flexion, and onset of pelvic movements.

Design

Comparative, repeated-measures study.

Setting

University research laboratory.

Participants

Men patients (N=18) with lumbar extension rotation syndrome.

Intervention

Subjects performed prone knee flexion in 2 conditions.

Main Outcome Measures

To measure muscle activity, surface electromyogram (EMG) of both erector spinae and the medial and lateral hamstrings was performed. Kinematic data on the pelvic motion and knee flexion were measured using a 3-dimensional motion analysis system. Repeated 1-way analysis of variance was used for the statistical analysis.

Results

Significantly decreased electromyographic activity in the right and left erector spinae and significantly increased electromyographic activity in the medial and lateral hamstrings activity were shown during prone knee flexion in ADIM condition using the pressure biofeedback unit. In addition, the amounts of anterior pelvic tilt, pelvic rotation, knee flexion, and perceived pain decreased significantly during prone knee flexion in the ADIM condition compared with the same maneuver in the non-ADIM condition. The onset of anterior pelvic tilt and pelvic rotation occurred significantly earlier in the non-ADIM condition, compared with the ADIM condition.

Conclusions

ADIM effectively increased activation of knee flexors, decreased activation of back extensors, and reduced the pelvic motions and low back pain during prone knee flexion in patients with lumbar extension rotation syndrome.     

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.)     

The impact of increasing paraspinal muscle activity on stature recovery in asymptomatic people

Healey EL, Burden AM, McEwan IM, Fowler NE. The impact of increasing paraspinal muscle activity on stature recovery in asymptomatic people.

Objective

To determine whether changes in stature recovery could be exhibited in an asymptomatic group through the use of functional electric stimulation (FES).

Design

A repeated-measures cohort study considering the effects of FES on stature recovery after a loaded walking task in a group of asymptomatic subjects. Each participant performed the 20-minute loaded walking task (at 10% of body mass) on 2 separate occasions followed by a 20-minute recovery period, once with FES and once without. Measurements of stature using a stadiometer were recorded throughout.

Setting

A university laboratory.

Participants

Eight asymptomatic male volunteers (age, 29.0±5.1y; mass, 80.7±8.4kg; height, 1.81±0.06m) with no history of chronic low back pain (LBP) were recruited through notices in the university and local communities.

Interventions

Not applicable.

Main Outcome Measures

Recovery of stature was assessed via stadiometry during the postexercise unloading periods.

Results

Each participant experienced significantly better stature recovery (percentage of stature reduction) during the control session compared with the FES session, with mean stature recoveries of 104.6%±22.9% and 56.3%±27.4%, respectively (P=.01).

Conclusions

Use of FES correlated with significant reductions in stature recovery. Elevating paraspinal muscle activity may increase compression on the intervertebral disks and therefore diminish the ability to recover the reduction in height caused by the loaded walking task. This investigation offers further support to the theory that the raised paraspinal muscle activity exhibited by persons with chronic LBP leads to reduced stature recovery.     

Muscle activation changes after exercise rehabilitation for chronic low back pain

Marshall PW, Murphy BA. Muscle activation changes after exercise rehabilitation for chronic low back pain.

Objective

To investigate the changes in 2 electromyographic measures, flexion relaxation (FR) response and feed-forward activation of the deep abdominals, associated with low back pain (LBP) after different rehabilitation interventions.

Design

A 2×2 factorial design with subjects' self-selecting treatment with randomization after 4 weeks to either the specific exercise group or exercise advice group for a further 12-week period.

Setting

General community practitioners and university training center.

Participants

Subjects with chronic nonspecific LBP were recruited for this study. A total of 112 people were initially screened, and 60 were recruited for the study, with 50 being available for long-term follow-up.

Intervention

Four weeks of treatment (manipulative or nonmanipulation) and 12 weeks of subsequent exercise (supervised Swiss ball training or exercise advice).

Main Outcome Measures

The Oswestry Disability Index, FR response measured at T12-L1 and L4-5, and feed-forward activation of the deep abdominal muscles.

Results

More rapid improvements in disability were identified for subjects who received the supervised exercise program. The FR response at L4-5 also increased more for those who received directly supervised exercise. Long-term follow-up showed that there was still a between-group difference in the FR response, despite no difference in self-rated disability. Long-term changes were observed for the feed-forward activation of the deep abdominals; however, no exercise or treatment effects were identified.

Conclusions

Supervised exercise rehabilitation leads to more rapid improvements in self-rated disability, which were associated with greater improvement in the low back FR response.     

Changes in muscle activity and stature recovery after active rehabilitation for chronic low back pain

Patients with low back pain often demonstrate elevated paraspinal muscle activity compared to asymptomatic controls. This hyperactivity has been associated with a delayed rate of stature recovery following spinal loading tasks. The aim of this study was to investigate the changes in muscle activity and stature recovery in patients with chronic low back pain following an active rehabilitation programme. The body height recovery over a 40-min unloading period was assessed via stadiometry and surface electromyograms were recorded from the paraspinal muscles during standing. The measurements were repeated after patients had attended the rehabilitation programme and again at a six-month follow-up. Analysis was based on 17 patients who completed the post-treatment analysis and 12 of these who also participated in the follow-up. By the end of the six months, patients recovered significantly more height during the unloading session than at their initial visit (ES = 1.18; P < 0.01). Greater stature recovery immediately following the programme was associated with decreased pain (r = −0.55; P = 0.01). The increased height gain after six months suggests that delayed rates of recovery are not primarily caused by disc degeneration. Muscle activity did not decrease after treatment, perhaps reflecting a period of adaptation or altered patterns of motor control.     

A rehabilitation protocol for patients with lumbar degenerative disk disease treated with lumbar total disk replacement

Canbulat N, Sasani M, Ataker Y, Oktenoglu T, Berker N, Ercelen O, Cerezci O, Ozer AF, Berker E. A rehabilitation protocol for patients with lumbar degenerative disk disease treated with lumbar total disk replacement.

Objectives

To evaluate the efficacy of the rehabilitation protocol designed by the Physical Medicine and Rehabilitation Department on the patients with lumbar degenerative disk disease after lumbar disk replacement surgery.

Design

Open prospective auto-controlled trial.

Setting

Physical medicine and rehabilitation department, neurosurgery department, and anesthesiology and pain management department.

Participants

Patients (N=20) with single level lumbar degenerative disk disease were recruited for this study.

Interventions

Lumbar disk prosthesis surgery with metal on metal lumbar disk prosthesis; preoperative, provocative, diskography; and a postoperative rehabilitation program were used.

Main Outcome Measures

Change in the functional status and pain intensity in patients was evaluated by the Oswestry Disability Index (ODI) and visual analog scale (VAS) during rest and movement. The ODI and VAS during rest and movement were primary outcome criteria, while return to work and duration of hospital stay were secondary outcome criteria. The results for the various scoring systems were statistically analyzed using the t test.

Results

Preoperative mean VAS scores ± SD at rest and movement were initially in the range of 6.00±2.47 and 8.65±1.08, respectively. The scores decreased to 1.70±1.12 and 2.60±1.72 at 3 months postsurgery, respectively (P<0.01). The scores decreased to 1.20±0.69 and 1.90±1.07 at 12 months postsurgery, respectively (P<0.01). The mean preoperative ODI score was 73.3±15.5; the postoperative scores were 35.0±15.5 and 20.4±12.9 at 3 and 12 months, respectively (P<0.01). The mean duration of hospital stay ± SD was 3.5±1.6 days, and return to work was achieved after a mean ± SD period of 14.1± 4.3 days with no complications related to surgery or the rehabilitation protocol.

Conclusions

The protocol was designed for postoperative rehabilitation program after artificial lumbar disk replacement surgery for degenerative disk disease patients. The good outcomes are the result of a combination of very careful and restrictive patient selection, surgical technique, and presented rehabilitation program. These parameters provide early pain relief and return to activities of daily living after surgery.     

Ultrasound Characteristics of the Deep Abdominal Muscles During the Active Straight Leg Raise Test

Teyhen DS, Williamson JN, Carlson NH, Suttles ST, O'Laughlin SJ, Whittaker JL, Goffar SL, Childs JD. Ultrasound characteristics of the deep abdominal muscles during the active straight leg raise test.

Objective

To determine whether changes in the transversus abdominis (TrA) and internal oblique (IO) muscles, as seen on ultrasound imaging, during the active straight leg raise (ASLR) test differ between subjects with and without unilateral lumbopelvic pain.

Design

Cross-sectional, case-control study.

Setting

Clinical laboratory.

Participants

Subjects (n=15) with unilateral symptoms in the lumbopelvic region and age-matched and sex-matched control subjects (n=15).

Interventions

Bilateral measurements of the deep abdominal muscles (TrA and IO) were obtained simultaneously using ultrasound imaging to compare the percent change in muscle thickness from rest with (1) immediately on raising, (2) after a 10-second hold, and (3) within 5 seconds after returning the lower extremity to the plinth.

Main Outcome Measure

Percent change in muscle thickness of both muscles from rest to the other 3 time intervals during the ASLR test.

Results

The 3-way group × side measured × time and 2-way side measured × time interactions were not significant for either the TrA (P≥.34) or the IO (P≥.14) muscles. The 2-way interaction group × time was significant for both the TrA (P=.003) and the IO (P=.02) muscles. On lifting the lower extremity, the control group demonstrated a 23.7% and 11.2% increase in TrA and IO muscle thickness, respectively, while those with lumbopelvic pain demonstrated a 6.4% and 5.7% increase in TrA and IO muscle thickness, respectively.

Conclusions

Although subjects with unilateral lumbopelvic pain demonstrated a smaller increase in muscle thickness, during the ASLR test there appears to be a symmetrical response in both of the deep abdominal muscles regardless of which lower extremity is lifted during the ASLR test or the unilateral nature of the symptoms. This study attests to the potential construct validity of using the ASLR test to assess different motor control strategies of the TrA and IO muscles in subjects with unilateral lumbopelvic pain.     

Classifying subgroups of chronic low back pain patients based on lifting patterns

Slaboda JC, Boston JR, Rudy TE, Lieber SJ. Classifying subgroups of chronic low back pain patients based on lifting patterns.

Objective

To compare self-reported measures of chronic lower back pain (CLBP) patients who were assigned to 2 subgroups based on their lifting patterns performed during a repetitive lifting task.

Design

Cross-sectional study.

Setting

Research laboratory

Participants

CLBP subjects (n=81) and pain-free controls (n=53).

Interventions

Not applicable.

Main Outcome Measures

Measures of lifting patterns and self-reported disability, pain, and psychosocial aspects.

Results

Two CLBP subgroups were found: 1 group that lifts similarly to control subjects (n=35) and 1 group that lifts very differently from controls (n=46). The CLBP group that lifted differently than controls reported higher pain intensity (P=.005), higher pain severity (P=.025), and lower self-efficacy (P=.013) than the CLBP group that lifted similarly to controls.

Conclusions

A classification system based on lifting patterns identified 2 CLBP subgroups that were significantly different on lifting and self-reported measures, indicating the importance of physical functioning measures in classification systems.     

Piriformis syndrome: Correlation of muscle morphology with symptoms and signs

OBJECTIVE: To determine the relation of symptoms and pain provocation tests to abnormal piriformis morphology among people with chronic buttock pain. DESIGN: Each of 2 clinical symptoms and 2 clinical signs were compared with the abnormal morphology found on ultrasound. The pain-free side was used as an internal control. SETTING: A tertiary referral center. PARTICIPANTS: A series of 27 consecutive patients (26 women, 1 man; average age, 48 y) with chronic low lumbosacral or buttock pain, who presented to a musculoskeletal clinic over a 12-month period, underwent ultrasound assessment of piriformis muscle morphology. Four patients were excluded because their body mass index was in excess of 30 kg/m 2 . INTERVENTION: The symptomatic piriformis muscle was injected with bupivacaine after pain was assessed on a visual analog scale (VAS), using the resisted abduction test. MAIN OUTCOME MEASURE: A 70% reduction of pain on the VAS was considered positive for pain in the piriformis muscle. RESULTS: Odds ratios (ORs) and 95% confidence intervals were calculated comparing each of the signs and symptoms with normal morphology. The highest ORs were found for pain on walking up inclines (10.8), referred pain (5.3), and pain on needling the piriformis muscle (6.0). CONCLUSIONS: This study did not provide a criterion standard for the diagnosis of piriformis syndrome, but it did support the syndrome as a contributing factor in chronic buttock pain and very low back pain.     

Progressive hip rehabilitation: the effects of resistance band placement on gluteal activation during two common exercises

Background

A critical issue for constructing a progressive rehabilitation program is the knowledge of muscle activation levels across exercises and within exercise modifications. Many exercises are offered to enhance gluteal muscle activation during functional rehabilitation but little data exists to guide the progression of exercise intensity during rehabilitation. The objective of this paper was to examine the effects of altering resistance band placement during ‘Monster Walks’ and ‘Sumo Walks.’

Methods

Nine healthy male volunteers formed a convenience sample. Sixteen electromyography channels measured neural drive of selected muscles of the right hip and torso muscles. Three resistance band placements (around the knees, ankles and feet) during the two exercises were utilized to provide a progressive resistance to the gluteal muscles while repeated measures ANOVA with Bonferroni adjustment was used to assess differences in mean EMG. The presentation of exercises and band placement were randomized.

Findings

Examining muscle activation profiles in the three hip muscles of interest revealed the progressive nature of the neural drive when altering band placement. Tensor fascia latae (TFL) demonstrated a progressive activation moving the band from the knee to the distal band placement, but not between the ankle and foot placements. Gluteus medius demonstrated a progressive activation moving distally between band placements. Gluteus maximus was preferentially activated only during the foot placement.

Interpretation

The band placements offered a progressive increase in resistance for hip rehabilitation, specifically the gluteal muscles. The added benefit of placing the band around the forefoot was selective enhancement of the gluteal muscles versus TFL presumably by adding an external rotation effort to the hips. This information may assist those who address gluteal activation patterns for patients suffering hip and back conditions where gluteal activation has been affected.     

Surface electromyography of the paravertebral muscles in patients with chronic low back pain

OBJECTIVE: To investigate the differences in the electromyographic signals of patients with chronic low back pain (CLBP) and healthy subjects. DESIGN: Cross-sectional study with a matched-pair design. SETTING: University hospital. PARTICIPANTS: Thirty-one patients with CLBP and 31 healthy, matched-pair controls. INTERVENTIONS: The mean rectified surface electromyographic amplitude and muscle strength were measured during maximal voluntary contraction (MVC). During an endurance test at 60% of MVC, the electromyographic parameters of the 2 groups were compared.Main outcome measure Electromyographic measuring of local fatigue, which can be described with changes in the median frequency or by a different parameter of the power spectrum called frequency banding. RESULTS: The strength measurement revealed a deficiency of 40% in the patients and a deficit in the electromyographic amplitude of approximately 60%, compared with the control group. By pairwise comparison, the decrease in the median frequency during the endurance test was greater in the control group. In the frequency banding of the power spectrum, local fatigue was less pronounced in the CLBP patients in pairwise comparison. CONCLUSIONS: The back muscles of CLBP patients appear to be less fatigable than those of controls. The results can be explained by morphologic changes, but influences such as pain, avoidance of pain, and deconditioning, need to be considered when the results are assessed.     

A randomized clinical trial for the effect of static stretching and strengthening exercise on pelvic tilt angle in LBP patients

BackgroundStretching and strengthening exercises are commonly used to improve muscle shortness of the hamstring as any tension in this muscle can have an effect on the pelvic posture. Thus, the aim of this study was to evaluate the effects of two methods of improving short hamstring on the angle of pelvic tilt in LBP sufferers.MethodsForty-five low back pain patients aged 19–59 years with hamstring tightness participated in this clinical trial. The patients were categorized randomly into three groups: 1- static stretching, 2-strengthening exercise and 3-control group. The two intervention groups received physical therapy and special exercise program thrice a week in a total of 12 sessions, while the control group received only conventional physical therapy. Before and after the treatment implementation, the pelvic tilt and straight leg raising (SLR) degree were assessed for each group.ResultAfter 12 sessions of treatment, the ANCOVA models indicated non-significant differences in pelvic tilt angle and SLR score changes (p > 0.05), among the three groups. In addition, no statistically significant correlation was observed between the pelvic tilt and SLR test [except for the strengthening exercise group (Pearson correlation coefficient = −0.54, P < 0.05)].ConclusionsIn LBP sufferers, both static stretching and strengthening of hamstring muscle in its lengthened position caused elongation and extensibility in the hamstring muscle and increased SLR test score, but did not change pelvic tilt angle.     

Fear of injury and physical deconditioning in patients with chronic low back pain

OBJECTIVES: To test the assumption that fear of injury leads to disability and physical deconditioning in patients with chronic low back pain (CLBP) and to evaluate the relation between disability and physical deconditioning. DESIGN: Survey in a cross-sectional design. SETTING: A rehabilitation center in the Netherlands. PARTICIPANTS: Forty patients with nonspecific CLBP. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Fear of injury was measured with the Tampa Scale of Kinesiophobia. Physical fitness was expressed in aerobic fitness measured as predicted maximum oxygen consumption derived in a submaximal exercise test according the protocol of Siconolfi. Disability was measured with the Roland Disability Questionnaire. The association between fear of injury and physical fitness or disability was examined with correlational and multiple linear regression analyses. RESULTS: Fear of injury correlated significantly with disability (r=.44), but did not correlate significantly with aerobic fitness. There was no statistically significant association between disability and aerobic fitness. Multiple regression analysis revealed that aerobic fitness was predicted by gender only. CONCLUSIONS: Fear of injury appears to be more strongly associated with perceived disability than with aerobic fitness. The assumption that fear of injury leads to physical deconditioning was not confirmed in this sample of patients with CLBP.     

Continuous low-level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial

OBJECTIVE: To evaluate the effects of continuous low-level heat wrap therapy for the prevention and early phase treatment (ie, 0-48 h postexercise) of delayed-onset muscle soreness (DOMS) of the low back. DESIGN: Two prospective randomized controlled trials. SETTING: Outpatient medical facility. PARTICIPANTS: Sixty-seven subjects asymptomatic of back pain and in good general health (mean age, 23.5+/-6.6 y). INTERVENTIONS: Participants performed vigorous eccentric exercise to experimentally induce low back DOMS. Participants were assigned to 1 of 2 substudies (prevention and treatment) and randomized to 1 of 2 treatment groups within each substudy: prevention study (heat wrap, n=17; control [nontarget muscle stretch], n=18) and treatment study (heat wrap, n=16; cold pack, n=16). Interventions were administered 4 hours before and 4 hours after exercise in the prevention study and between hours 18 to 42 postexercise in the treatment study. MAIN OUTCOME MEASURES: To coincide with the expected occurrence of peak symptoms related to exercise-induced low back DOMS, hour 24 postexercise was considered primary. Pain intensity (prevention) and pain relief (treatment) were primary measures, and self-reported physical function and disability were secondary measures. RESULTS: In the prevention study, at hour 24 postexercise, pain intensity, disability, and deficits in self-reported physical function in subjects with the heat wrap were reduced by 47% (P<.001), 52.3% (P=.029), and 45% (P=.013), respectively, compared with the control group. At hour 24 in the treatment study, postexercise, pain relief with the heat wrap was 138% greater (P=.026) than with the cold pack; there were no differences between the groups in changes in self-reported physical function and disability. CONCLUSIONS: In this small study, continuous low-level heat wrap therapy was of significant benefit in the prevention and early phase treatment of low back DOMS.