Effects of Spinal Flexion and Extension Exercises on Low-Back Pain and Spinal Mobility in Chronic Mechanical Low-Back Pain Patients

Elnaggar, Ibrahim Magdy; Nordin, Margareta; Sheikhzadeh, Ali; Parnianpour, Mohamad; Kahanovitz, Neil

doi:10.1097/00007632-199108000-00018

Cited by 136 publications

(48 citation statements)

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“…Therefore, it appears logical to train the coordination/propriocep tion of patients with LBP in as many different movements as possible with limited and controlled load. Thereby, coordinated reflexes will develop and the movements will become smooth, which might decrease the risk of I* cally harmful stress forces.When unfamiliar and complicated movements are performed, they are executed clumsily and with difficulty.Many studies have focused on training of muscle strength/endurance and/or mobility (9,11,12,22,23, 28,37,38), but we have found no studies evaluating the effect of coordination training. Therefore, we compared coordination training with intensive muscle endurance training, which is a recommended treatment for low back pain today (28.37).…”

mentioning

confidence: 85%

Exercises for Chronic Low Back Pain: A Clinical Trial

Johannsen¹,

Remvig²,

Kryger³

et al. 1995

J Orthop Sports Phys Ther

107

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Optimal muscle function does not depend upon muscle strength/ endurance and muscle flexibility only. The coordination of movement? is also of great importance. When unfamiliar and complicated movement? are performed, they are executed clumsily and with difficulty.With proper practice/training, they become smooth and easy (2). Specific coordinated reflexes p d u a l l y develop through training of specific movements. This is called coordination training and does not necessarily increase muscle cross-sectional area (muscle strength) (2). Coordination training is essential to increase performance in many sports and is also used with success in the prevention of injuries (43 R E S E A R C H S T U D Yance training alone will primarily improve the specific movements trained. However, everyday life consists of a wide spectrum of different movements of the back, including rotation and sidebending in different degrees of back flexion and extension. Therefore, it appears logical to train the coordination/propriocep tion of patients with LBP in as many different movements as possible with limited and controlled load. Thereby, coordinated reflexes will develop and the movements will become smooth, which might decrease the risk of I* cally harmful stress forces.When unfamiliar and complicated movements are performed, they are executed clumsily and with difficulty.Many studies have focused on training of muscle strength/endurance and/or mobility (9,11,12,22,23, 28,37,38), but we have found no studies evaluating the effect of coordination training. Therefore, we compared coordination training with intensive muscle endurance training, which is a recommended treatment for low back pain today (28.37). MATERIALS AND METHODS SubjectsForty consecutive patients were included in this study after informed consent. All patients were admitted to the Department of Rheumatology, Bispebjerg Hospital, Copenhagen, Denmark under the diagnosis of chronic low back pain. Eligibility was confined to patients aged 18-65 years with low back pain for more than 1 year. The patients had back pain for at 1ea.t 3 months in the last year, but were still employed. Those with signs of nerve root compression or evidence of spondylolisthesis, osteoporosis, painful osteoarthritis in the lower extremities, inflammatory rheumatic diseases, and neoplastic disorders were excluded. X-rays of the lumbar spine were performed before inclusion. The X-rays were evaluated by a trained radiologist. with special attention to the exclusion criteria, disc degeneration, facet joint arthrosis, spondylarthrosis, and Morbus Scheuermann. ProcedureAll included patients were randomized by stratification for sex, age (older/younger than 40 years), duration of symptoms (greater/less than 2 years), and normal/abnormal X-ray into two training models: endurance training and coordination training. The patient. were trained in groups of up to 10 patients for 1 hour twice a week during a Smonth period. Patients with more than 30% absence from training were excluded from the study. After ...

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mentioning

confidence: 85%

Exercises for Chronic Low Back Pain: A Clinical Trial

Johannsen¹,

Remvig²,

Kryger³

et al. 1995

J Orthop Sports Phys Ther

107

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“…One study [49] found weak significant negative correlations between changes in pain and in rotational and lateral mobility (r = -0.35 and r = -0.35, respectively). The second study [51] found a weak significant correlation between pain and rotational total mobility (r = -0.22) and pain and total mobility in lateral flexion (r = -0.12).…”

Section: Correlation Between Changes In Pain and Changes In Sagittal mentioning

confidence: 99%

“…Ten studies were found (of which 3 gave the actual correlation coefficient data [49][50][51] and 7 did not [52][53][54][55][56][57][58]) that focused on the correlation between changes in pain and changes in sagittal mobility (flexion or flexion and extension). Nine studies reported that there was no correlation while one reported a low, but significant correlation [49].…”

Section: Correlation Between Changes In Pain and Changes In Sagittal mentioning

confidence: 99%

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Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review

et al. 2011

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Introduction The effect size for exercise therapy in the treatment of chronic non-specific low back pain (cLBP) is only modest. This review aims to analyse the specificity of the effect by examining the relationship between the changes in clinical outcome (pain, disability) and the changes in the targeted aspects of physical function (muscle strength, mobility, muscular endurance) after exercise therapy. Methods We searched for exercise therapy trials for cLBP published up to 15 April 2010 in Medline, Embase, Cochrane Library, Cinahl, and PEDro. Two independent reviewers selected studies according to the inclusion criteria. Data extraction: one author extracted the data of the articles. Results Data synthesis: 16 studies with a total of 1,476 participants met the inclusion criteria. There was little evidence supporting a relationship between the changes in pain or physical function and the changes in performance for the following measures: mobility (no correlation in 9 studies, weak correlation in 1 study), trunk extension strength (7 and 2, respectively), trunk flexion strength (4 and 1, respectively) and back muscle endurance (7 and 0, respectively). Changes in disability showed no correlation with changes in mobility in three studies and a weak correlation in two; for strength, the numbers were four (no correlation) and two (weak correlation), respectively. ConclusionsThe findings do not support the notion that the treatment effects of exercise therapy in cLBP are directly attributable to changes in the musculoskeletal system. Future research aimed at increasing the effectiveness of exercise therapy in cLBP should explore the coincidental factors influencing symptom improvement.

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“…Flexion exercises, which are assumed to decrease lumbar lordosis, have been found to have the same effect on reducing LBP as extension exercises, which are expected to increase the lumbar curve. 16,29,32,40,78,127 This issue has been further investigated, and no relationship has been found between the size of lumbar lordosis and development of LBP. 27,30,37,41,87,96,124 These findings have led to questions regarding the rationale behind these two major theories and the subsequent treatment programs.…”

Section: Lumbar Lordosismentioning

confidence: 99%

Relationship Between Mechanical Factors and Incidence of Low Back Pain

Nourbakhsh¹,

Arab²

2002

J Orthop Sports Phys Ther

253

199

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Study Design: A multifactorial cross-sectional nonexperimental design. Objectives: To collectively investigate the association among 17 mechanical factors and occurrence of low back pain (LBP). Background: Several physical characteristics, based on assumptions, clinical findings, and scientific experiments, have been associated with the development of LBP. Controversy exists regarding the degree of association between some of these physical characteristics and LBP. Information regarding the degree of association of each factor to LBP is needed for effective prevention and appropriate treatment strategies. Methods and Measures:A total of 600 subjects participated in this study. Subjects were categorized into 4 groups: asymptomatic men (n = 150, age [mean ± SD] = 43 ± 15 years), asymptomatic women (n = 150, age [mean ± SD] = 43 ± 13 years), men with LBP (n = 150, age [mean ± SD] = 43 ± 14 years), and women with LBP (n = 150, age [mean ± SD] = 43 ± 13 years). Seventeen physical characteristics were measured in each group and the relative association of each characteristic with LBP was assessed. Results: Among all the factors tested, endurance of the back extensor muscles had the highest association with LBP. Other factors such as the length of the back extensor muscles, and the strength of the hip flexor, hip adductor, and abdominal muscles also had a significant association with LBP. Conclusion: It appears that muscle endurance and weakness are associated with LBP and that structural factors such as the size of the lumbar lordosis, pelvic tilt, leg length discrepancy, and the length of abdominal, hamstring, and iliopsoas muscles are not associated with the occurrence of LBP. J Orthop Sports Phys Ther 2002;32:447-460. Key Words: back extensor endurance, low back pain, lumbar lordosis, muscle length, muscle strength L ow back pain (LBP) is one of the most frequent healthrelated complaints in western societies. 110 Previous studies have indicated that 70% to 80% of the western population have had at least 1 episode of LBP in their lifetime. 110,120 Despite its detrimental association with social and workrelated activities, the exact cause of mechanical LBP has not yet been determined. Several factors, based on assumptions, clinical findings, and scientific experiments, have been associated with the development of LBP. However, with the use of different designs and testing procedures, controversial results have been reported in the literature.

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Effects of Spinal Flexion and Extension Exercises on Low-Back Pain and Spinal Mobility in Chronic Mechanical Low-Back Pain Patients

Cited by 136 publications

References 0 publications

Exercises for Chronic Low Back Pain: A Clinical Trial

Exercises for Chronic Low Back Pain: A Clinical Trial

Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review

Relationship Between Mechanical Factors and Incidence of Low Back Pain

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