The differential effects of core stabilization exercise regime and conventional physiotherapy regime on postural control parameters during perturbation in patients with movement and control impairment chronic low back pain

Abstract

BackgroundThe purpose of the present study was to examine the differential effect of core stability exercise training and conventional physiotherapy regime on altered postural control parameters in patients with chronic low back pain (CLBP). As heterogeneity in CLBP population moderates the effect of intervention on outcomes, in this study, interventions approaches were used based on sub-groups of CLBP.MethodsThis was an allocation concealed, blinded, sequential and pragmatic control trial. Three groups of participants were investigated during postural perturbations: 1) CLBP patients with movement impairment (n = 15, MI group) randomized to conventional physiotherapy regime 2) fifteen CLBP patients with control impairment randomized to core stability group (CI group) and 3) fifteen healthy controls (HC).ResultsThe MI group did not show any significant changes in postural control parameters after the intervention period however they improved significantly in disability scores and fear avoidance belief questionnaire work score (P < 0.05). The CI group showed significant improvements in Fx, Fz, and My variables (p < 0.013, p < 0.006, and p < 0.002 respectively with larger effect sizes: Hedges's g > 0.8) after 8 weeks of core stability exercises for the adjusted p values. Postural control parameters of HC group were analyzed independently with pre and post postural control parameters of CI and MI group. This revealed the significant improvements in postural control parameters in CI group compared to MI group indicating the specific adaptation to the core stability exercises in CI group. Though the disability scores were reduced significantly in CI and MI groups (p < 0.001), the post intervention scores between groups were not found significant (p < 0.288). Twenty percentage absolute risk reduction in flare-up rates during intervention was found in CI group (95% CI: 0.69-0.98).ConclusionsIn this study core stability exercise group demonstrated significant improvements after intervention in ground reaction forces (Fz, Mz; g > 0.8) indicating changes in load transfer patterns during perturbation similar to HC group.Trial registrationUTRN095032158-06012009423714

Intensive Abdominal Drawing-In Maneuver After Unipedal Postural Stability in Nonathletes With Core Instability

“…The COP sway analysis showed that the COP AP and COP ML sway velocities, SDs, and areas were improved markedly after the ADIM training. This finding corroborates the observations of other recent authors 7,8 who investigated the effect of core-stabilization exercises on bipedal postural stability. Muthukrishnan et al 8 compared the long-term effects of core-stabilization exercise (progression from static to dynamic) and conventional physical therapy in patients with chronic LBP and found improvements in the dynamic postural-stability measures (force, moment, and COP) that were comparable with those of healthy controls.…”

“…5 Similarly, Kaji et al 7 evaluated the immediate effect of core-stabilization exercise on static bipedal postural sway in 17 healthy young adults and showed a reduction in the COP sway area and velocity in the mediolateral direction. Muthukrishnan et al 8 compared the differential effects of core-stabilization exercise (static and dynamic) and conventional physiotherapy (mobilization, manipulation, traction, interferential therapy, hyperextension exercise, isometric trunk lifts, pelvic tilts, and basic strengthening exercises) on bipedal postural stability in individuals with LBP and compared their stability measures with those of normal controls. Whereas the core-stabilization exercise resulted in improved postural stability, the conventional physiotherapy did not reveal any meaningful changes, suggesting the important role of the former.…”

Fall prevention among older adults: Case reports exemplifying the value of incorporating lumbar stabilization training during balance exercises

“…The timing between trunk and pelvic rotations and erector spinae activity varies systematically with walking velocity and any alteration is reflected in spinal stabilization during unexpec ted perturbations (Lamoth et al 2007). Lumbar stabilization exercises causes significant improvements in disability scores and ground reaction forces, due to improved changes in load transfer patterns during perturbation (Muthukrishnan et al 2010). Phasic superficial paraspinal activity is associated with foot strike which controls trunk motion in the frontal and sagittal planes during locomotion.…”

Stabilization Exercise for the Management of Low Back Pain

“…However, core stability exercise demonstrates significant improvements in: distribution of ground reaction forces, use of optimized postural adjustments in the direction of perturbation, 20% absolute risk reduction of flare-up during intervention and 40% absolute risk reduction for resolution of back pain after core instability exercises (Muthukrishnan et al, 2010).…”

“…These studies have addressed the need of homogenous chronic low back pain group for better clinical outcomes. Evaluating postural control parameters such as centre of pressure displacements, moments and forces following interventions, particularly stability exercises, may provide insight into how this surrogate outcomes are mediated by different subgroups or heterogeneous chronic low back pain patients and identifying subgroups of chronic low back pain patients who are most likely to benefit after particular intervention (Muthukrishnan et al, 2010).…”