A randomized controlled trial to determine the effect of spinal stabilization exercise intervention based on pain level and standing balance differences in patients with low back pain

Abstract

Background: A number of studies have evaluated exercise interventions compared with other treatment strategies for subjects with recurrent low back pain (LBP); however, subject pain level and balance were not carefully considered. The purpose of this study was to investigate the effectiveness of spinal stabilization exercises (SSE) for managing pain and increasing balance strategy changes following unexpected perturbations in patients diagnosed with recurrent LBP.

Material/methods: Twenty-one age- and gender-matched patients participated in a supervised SSE or control exercise program 5 times a week over a 4-week period. The Million Visual Analogue Scale (MVAS) and Oswestry Disability Index (ODI) were used to measure each patient's level of pain and disability. Balance measurements were derived from recordings of the anterior-posterior (A/P) and medio-lateral (M/L) center of pressure (COP) displacements during 3 consecutive, unexpected random perturbations.

Results: The level of reported pain and disability significantly decreased following treatment for both groups. Although the M/L sway was not significantly different in either group (p=0.86), there was a significant difference between group and measurement time during A/P sway (p=0.04). The A/P displacement of the SSE group significantly decreased compared with the control group. The decreased A/P displacement can be linked to the SSE intervention, which helps prevent further injury by limiting an individual's response rate to external perturbations.

Conclusions: Clinicians might consider SSE for LBP patients as a possible rehabilitation strategy to reduce A/P displacement.

Figure 1

The set-up for the sudden load apparatus. A weighted tennis ball (6.4 N) is dropped onto a platform equipped with a load cell, which indicates the instant the ball hits the platform. (F: Force, BCOM: Body center of mass, GRF: Ground reaction force)

Figure 2

The level of pain changes based on MVAS following intervention (F=7.38, p<0.01).

Figure 3

The level of pain changes based on ODI following intervention (F=14.18, p<0.001).

Figure 4

The A/P displacement changes before and after intervention during repeated perturbations. The A/P sway changes in the group following SSE decreased compared to the control group over time, especially following the first perturbation. The pairwise comparison test indicated that the sway from the first perturbation significantly increased compared to the third perturbation.

Figure 5

The M/L displacement changes before and after intervention during repeated perturbations. The M/L sway changes in the group following SSE decreased compared to the control group over time, especially following the first perturbation.