Effects of combining diaphragm training with electrical stimulation on pain, function, and balance in athletes with chronic low back pain: a randomized clinical trial

Abstract

Background It is unknown how diaphragm training combined with electrical stimulation affects pain, function, static stability, and balance in athletes with chronic low back pain (CLBP). This study aimed to explore the effects of combining diaphragm training with electrical stimulation on pain, function, static stability, and dynamic balance in athletes with nonspecific CLBP. Methods The design was a randomized clinical trial. A total of 24 amateur athletes (12 women, 12 men, mean age: 35.2 ± 9.8) with nonspecific CLBP were randomly allocated into two groups. The experimental group (n = 12) received diaphragm training plus Transcutaneous Electrical Nerve Stimulation (TENS), while the control group (n = 12) received TENS alone. Both groups underwent 12 sessions over a four-week period. Static stability, dynamic balance, pain, and function were measured pre- and post-intervention. Results Analysis of variance 2 × 2 revealed greater improvements in pain (p < 0.001), static stability (p < 0.001), and dynamic balance (p < 0.01) in the experimental group compared to the control group. Function was improved in both groups following the interventions (p < 0.001), and there was a trend of a larger improvement in the experimental group than the control group (p = 0.09). Fisher’s exact test showed that the experimental group reported ≥50% improvement only in the pain score, not function, compared to the group that received TENS alone (p = 0.005). Conclusions Pain, function, static stability, and dynamic balance were improved in both groups following 12 intervention sessions. However, pain, static stability, and dynamic balance were improved to a greater extent in diaphragm training plus TENS than TENS alone in amateur athletes with CLBP. Therefore, it seems beneficial to add diaphragm training to the rehabilitation program for athletes with nonspecific CLBP. Trial registration The trial was retrospectively registered in the Iranian Registry of Clinical Trials (www.irct.ir) on September 10, 2020 as IRCT20090228001719N8.

Effects of exercise on balance in patients with non-specific low back pain: a systematic review and meta-analysis

“…All the trials assessed static balance, whereas in two studies 27,29 dynamic balance was considered.…”

“…The static balance performances were explored through different modalities: six studies [29][30][31][32][33]36 measured postural sway by using posturography, four trials [25][26][27]34 adopted different motor-task tests such as stork stand test 25 , blind flamingo test 26 , unilateral hip bridge endurance test 27 and single limb stance test 34 ; finally, two RCTs 28,35 considered stability indices through the "Biodex Balance System". In both the studies 27,29 assessing dynamic balance, the "star excursion balance test" was used.…”

“…All the included studies (n=12) [25][26][27][28][29][30][31][32][33][34][35][36] were RCTs. Interventions presented differences across studies, since four trials 25,29,30,34 investigated the effects of a Pilates training, two studies 32,35 focused on stability training and two others 28,36 on whole vibration therapy; functional resistance exercises, diaphragmatic training, therapeutic exercise and sensorimotor training were investigated by the other included studies 26,27,31,33 .…”

“…All the included studies (n=12) [25][26][27][28][29][30][31][32][33][34][35][36] were RCTs. Interventions presented differences across studies, since four trials 25,29,30,34 investigated the effects of a Pilates training, two studies 32,35 focused on stability training and two others 28,36 on whole vibration therapy; functional resistance exercises, diaphragmatic training, therapeutic exercise and sensorimotor training were investigated by the other included studies 26,27,31,33 . Regarding control groups, most of the studies 25,26,[28][29][30][31][32]34,36 opted for "no intervention", only suggesting daily normal activities; two trials 27,35 compared exercise to instrumental therapies such as TENS, ultrasounds and laser-therapy.…”

“…Since the trials dealt with physical therapy modalities, a high RoB was attributed to "blinding of personnel" criterion; furthermore, none of the studies declared that the subjects were masked, so blinding of participants was also considered to be at high risk of bias. In addition, some issues were detected for selection bias: seven RCTs [25][26][27][28]31,33,35 were judged at high risk for allocation concealment, and one of these 31 did not perform a proper random sequence generation. Other six studies 25,27,32,33,35,36 did not detail the randomization procedure sufficiently, so the risk was judged as unclear.…”