Stabilization Exercises Versus Flexion Exercises in Degenerative Spondylolisthesis: A Randomized Controlled Trial

Abstract

Objective Exercise is the mainstay of treatment in patients with low back pain and the first-line option in degenerative spondylolisthesis; however, there is still no consensus surrounding the superiority of any specific exercise program. Thus, the primary aim was to compare the effectiveness of lumbar stabilization exercises and flexion exercises for pain control and improvements of disability in patients with chronic low back pain and degenerative spondylolisthesis. Methods A randomized controlled trial was conducted in a tertiary public hospital and included 92 patients over the age of 50 who were randomly allocate to lumbar stabilization exercises or flexion exercises. Participants received six session of physical therapy (monthly appointments) and were instructed to execute daily at home during the six months of the study. Primary outcome (measured at baseline, one month, three months, and six months) was pain intensity (visual analog scale, from 0 to 100 mm) and disability (Oswestry Disability Index, from 0% to 100%). Secondary outcomes were disability (Roland-Morris Disability Questionnaire, from 0 to 24 points), changes in body mass index, and flexibility (fingertip to floor, in centimeters) at baseline and six months, and also the total of days of analgesic use at six-month follow-up. Results Mean differences between groups were not significant (for lumbar pain: 0.56 [95% CI = −11.48 to 12.61]; for radicular pain: −1.23 [95% CI = −14.11 to 11.64]; for ODI: −0.61 [95% CI = −6.92 to 5.69]; for Roland-Morris Disability Questionnaire: 0.53 [95% CI = −1.69 to 2.76]). Conclusions The findings from the present study reveal that flexion exercises are not inferior to and offer a similar response to stabilization exercises for the control of pain and improvements of disability in patients with chronic low back pain and degenerative spondylolisthesis. Impact statement Exercise is the mainstay of treatment in patients with chronic low back pain and degenerative spondylolisthesis, however, there is still no consensus surrounding the superiority of any specific exercise program. This study finds that flexion exercises are not inferior to and offer a similar response to stabilization exercises. Lay summary Exercise is the mainstay of treatment in patients with chronic low back pain and degenerative spondylolisthesis, but there is no consensus on the superiority of any specific exercise program. If you have DS, flexion exercises may provide similar effects to stabilization exercises.

Trials and tribulations of transparency related to inconsistencies between plan and conduct in peer‐reviewed physiotherapy publications: A methodology review

“…Of the 40 RCTs reviewed, 7 were available via open access. Most RCTs ( n = 34, 85.0%) were registered, 25 prospectively 43–67 and 9 retrospectively 68–76 . All RCT registrations were accessible for review.…”

Los ejercicios de estabilización de la columna vertebral no son superiores a los ejercicios de flexión para los cambios de grosor muscular detectados por ecografía, en pacientes con lumbalgia crónica y espondilolistesis lumbar

“…The protocol was approved by the institute's Ethics and Research Committee prior to commencing the recruitment process in January 2017, and was conducted as a addstudy research in a randomized clinical trial already in the active recruitment phase evaluating the clinical response of the spine stabilization exercises vs flexion exercises (registration number 19/15 and clinicaltrials.gov database (ID NCT02664688). 7 All procedures performed on the participants were in accordance with the Committee's ethical standards and with the 1964 Helsinki Declaration and its later amendments. All participants provided written informed consent before study commencement and received a printed copy for their records.…”

“…1,6 In degenerative spondylolisthesis, a previous study demonstrated that lumbar stabilization exercises and flexion exercises offer a similar response for controlling pain and improving disability; however, trophic changes in response to the exercise program were not analyzed. 7 Ultrasound is an increasingly popular and affordable alternative for evaluating the musculoskeletal system, 8 and has proven to be a reliable and accurate tool for the measurement of muscle thickness of the lumbar segment. 9,10 The present study therefore aimed to evaluate-by ultrasound-the changes of the thickness of the main lumbar stabilizing muscles after twelve weeks of performing spine stabilization exercises and to compare these changes with another classical exercise routine (flexion exercises) in patients with CLBP and lumbar spondylolisthesis.…”

The McGill Approach to Core Stabilization in the Treatment of Chronic Low Back Pain: A Review

“…[5,35,36,37] This type of exercise therapy has evolved into a mainstay for treating chronic LBP with focus on core stabilization and muscle coordination. [3,38,39,40,41,42,43]…”