Effect of Upper-Extremity Strengthening Exercises on the Lumbar Strength, Disability and Pain of Patients with Chronic Low Back Pain: A Randomized Controlled Study

Abstract

The present study aimed to analyze the impacts of a low back rehabilitation program accompanied with neck, shoulder and upper back exercises on pain, disability, and physical characteristics of patients with chronic low back pain. Twenty sedentary male patients with chronic low back pain participated in the study on a voluntary basis. The patients were randomly allocated into two groups: a conventional low back exercise group (CE) and a supported exercise group (SE; CE plus upper back, neck, and shoulder exercises). The Modified Oswestry Disability Questionnaire (MODQ) was used to evaluate the disability status and the Visual Analog Scale (VAS) was used to identify the pain states of the patients. In addition, neck, lumbar and shoulder isokinetic and isometric strengths of the patients were evaluated. The CE group performed lumbar stretching, mobilization and stabilization exercises in addition to low-back and abdominal isometric and concentric strengthening exercises. The SE group performed static stretching and isotonic exercises for the neck, upper-back, and shoulder muscles, in addition to the exercises performed in CE group. The exercises were implemented 3 days a week for 6 weeks in both groups. Following the 6-week exercise periods in both groups, statistically significant (p < 0.01) improvements were observed in the patients' levels of pain and the scores of MODQ reflecting an easing of disability. With respect to the levels of pain and disability, the improvements observed in the SE group was significantly (p < 0.01) greater than the improvement observed in the CE group. Based on the findings of this study, we can conclude that a low back exercise program used in combination with neck, shoulder and upper back exercises reduces the level of pain and disability in patients with chronic low back pain more prominently than conventional low back exercises.

Keywords: Chronic back pain; back and neck exercises; disability; pain.

Figure 1.

Study Plan. VAS: Visual Analog Scale, MODQ: Modified Oswestry Disability Questionnaire

Figure 2.

Isokinetic neck strength test.

Figure 3.

Isometric neck strength test.

Figure 4.

Stretching, mobilization, and isometric exercises.

Figure 5.

Lumbar stabilization exercises, (a) abdominal and lumbar concentric exercises, and (b) isotonic neck, shoulder, and back exercises.

Figure 6.

Change in the VAS scores. VAS: Visual Analog Scale; SE: Supported exercise group; CE: Classical exercise group; BE: Before exercise; AE: After exercise; ** p < 0.01: statistical significance level within groups before and after exercise; †† p < 0.01: statistical significance level between groups.

Figure 7.

Percent change in the MODQ scores. MODQ: Modified Oswestry Disability Questionnaire; SE: Supported exercise group; CE: Conventional exercise group; BE: Before exercise; AE: After exercise; **p<0.01: statistical significance level within groups before and after exercise; ††p<0.001: statistical significance level between groups.