Effects of lumbar extensor muscle strengthening and neuromuscular control retraining on disability in patients with chronic low back pain: a protocol for a randomised controlled trial

Abstract

IntroductionChronic low back pain (CLBP) is the leading cause of disability worldwide. However, there is no consensus in the literature regarding optimal management. Exercise intervention is the most widely used treatment as it likely influences contributing factors such as physical and psychological. Literature evaluating the effects of exercise on CLBP is often generalised, non-specific and employs inconsistent outcome measures. Moreover, the mechanisms behind exercise-related improvements are poorly understood. Recently, research has emerged identifying associations between neuromuscular-biomechanical impairments and CLBP-related disability. This information can be used as the basis for more specific and, potentially more efficacious exercise interventions for CLBP patients.Methods and analysisNinety-four participants (including both males and females) with CLBP aged 18–65 who present for treatment to a Melbourne-based private physiotherapy practice will be recruited and randomised into one of two treatment groups. Following baseline assessment, participants will be randomly allocated to receive either: (i) strengthening exercises in combination with lumbar force accuracy training exercises or (ii) strengthening exercises alone. Participants will attend exercise sessions twice a week for 12 weeks, with assessments conducted at baseline, midway (ie, 6 weeks into the trial) and at trial completion. All exercise interventions will be supervised by a qualified physiotherapist trained in the intervention protocol. The primary outcome will be functional disability measured using the Oswestry Disability Index. Other psychosocial and mechanistic parameters will also be measured.Ethics and disseminationThis study was given approval by the University of Melbourne Behavioural and Social Sciences Human Ethics Sub-Committee on 8 August 2017, reference number 1 749 845. Results of the randomised controlled trial will be published in peer-reviewed journals.Trial registration numberACTRN12618000894291.

Reliability of lumbar multifidus and iliocostalis lumborum thickness and echogenicity measurements using ultrasound imaging

“…Measurement of the IL muscle thickness was defined by the distance between the inside of the superior fascial border and the inferior fascial border (Figure 1c). LM and IL echogenicity was measured by (i) performing a circumferential trace of the inner fascial border of each muscle 30,31 and (ii) performing greyscale histogram analysis of the muscle area of interest. Echogenicity is a measure of acoustic reflectance 19 with ranges varying from 0 to 255: zero represents an inability to reflect ultrasound waves with the image appearing black whereas 255 represents complete reflection of ultrasound waves with the image appearing white 32 .…”

Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis

“…Exercise therapy has been demonstrated to be effective in decreasing pain compared with non-exercise-based treatments in adults [11], with such improvements thought to reflect some combination of the exercise-related physical and psychological adaptations. Exercise therapy is the most widely used non-pharmacological treatment, comparable to other conservative treatments for improving disability and pain intensity in CLBP [8,12,13]. Two recent systematic reviews reported that exercise training is an effective treatment for reducing pain in patients with CLBP; however, they both highlighted that it is still unclear exactly what forms of exercises are most effective or which mechanisms may most likely explain such improvements [8,13,14].…”

Thoracolumbar Slope Is Useful Parameter for Evaluating HealthRelated Quality of Life and Sagittal Imbalance Aggravation in Adult Spinal Deformity: A Prospective Observational Cohort Study

“…In addition, after the participants had provided written consent for participation, they were educated about the etiology, natural course, and surgical treatment of PDSI; they underwent brief training on the importance of core and lumbar extensor muscle strengthening exercises (lumbar extension, hip extension, trunk flexion, and leg press exercise) and rest. [13][14][15]…”