Efficacy of segmental stabilization exercise for lumbar segmental instability in patients with mechanical low back pain: A randomized placebo controlled crossover study

Abstract

Background: Lumbar segmental stability is an important biomechanical component that influences symptoms amongst patients with Mechanical low back pain.

Aims: To compare the efficacy of segmental stabilization exercises utilizing multifidus and transversus abdominis muscles versus a placebo treatment in patients with lumbar segmental instability.

Materials and methods: The study was an observer-blinded randomized placebo-controlled cross-over study of 18 adults (12 men, 6 women), of mean age 22.5 ± 1.09 yrs who scored 7/13 in subjective aspects and 8/14 in objective aspects of Delphi criteria for lumbar segmental instability. The selected subjects were then randomized to receive either placebo-control (prone lying) or experimental (lumbar segmental stabilization) as a first treatment. Each treatment was followed by a wash-out period of 24 hours. Outcomes were measured four times- pre- and post- first intervention, pre- and post- second intervention. The outcome measures used were pain on Visual analogue scale, Pressure pain threshold and Joint play grading scale (0-6 scale) on that level.

Results: Two-way analysis of variance and post-hoc analysis using Bonferonni test were used with level of significance set at p<.05 using Statistical package for social sciences version 12.0.1 for Windows. Visual analogue scale changed significantly in both the periods of intervention- in control (P =.016) and experimental (P =.000) periods. However this improvement was more significant in the experimental period. The Joint play grading scale scores improved only in the experimental condition compared to the control condition significantly. The Pressure pain threshold also improved significantly in the experimental condition (P =.000) while the changes in control condition was not statistically significant (P=.816).

Conclusion: Segmental stabilization exercise was more effective than placebo intervention in symptomatic lumbar segmental instability.

Keywords: Lumbar instability; crossover study; segmental stabilization exercise.

Appendix I

Fig. 1

(a): Identification of L4 level from highest point of iliac crest; (b): Identification of L2 level from lowest margin of thoracic cage.

Fig. 2

Assessment of spinal pressure-pain thresholds of the lumbar spine using the pressure algometer.

Fig. 3

(a): Application of central postero-anterior pressure and assessment of joint play (without spinal muscle contraction); (b): Application of central postero-anterior pressure and assessment of joint play (with spinal muscle contraction- note the lifted knees indicated by an arrow).

Fig. 4

(a): Flexion of lumbar spine; (b): Extension of lumbar spine; (c): Neutral position of the lumbar spine; (d): Tucking in the chin to activate the deep cervical short flexors; (e): Hollowing the abdomen with tucked in chin to activate transversus abdominis; (f): Lifting one arm up with maintaining the neutral position; (g): Therapist's hand placement for palpating the contraction of multifidi; and (h): Application of quick stretch to facilitate the contraction of multifidi.