Comparing the Effects of the Postural Restoration Exercises with and without Core Stability Exercises in Patients with Non-Specific Chronic Low Back Pain
,
Abstract
Introduction: This study compares the effect of postural restoration (PR) exercises with and without core stability exercises on the pain, intensity, function, quality of life (QoL), and passive range of motion (PROM) at lumbo pelvic-femoral complex in patients with non-specific chronic low back pain.
Materials and Methods: This was an interventional type of randomized clinical trial study. The participants were 45 female patients (48.1±6.11 years, 161.4±5.06 cm height, 65.08±6.9 kg weight, and 24.9±2.8 body mass index). They were randomly divided into three equal groups: Group 1=PR exercises and core exercises, group 2=PR exercises, and group 3=control group. Pain intensity, function, QoL, and PROM were measured with the visual analog scale, Oswestry disability index, short form-36 questionnaire, and goniometer. The analysis of covariance was used to compare the means in the study groups before and after the intervention. The intervention groups performed the exercises for six weeks.
Results: The results showed a significant difference between the QoL, pain intensity, function, and PROM of left hip adduction in the group with PR exercises with and without core exercises and control (P=0.000). In the PR group with core exercises (P=0.001) and without core exercises (P=0.001), a significant increase was observed in the adduction of the left hip. There was no significant difference between the function (P=0.850), pain (P=0.120), QoL (P=0.328), and PROM (P=0.094) in the intervention groups.
Conclusion: PR exercises with and without core stability are equally effective in reducing pain and improving function, QoL, and hip adduction range of motion in women with left anterior interior chain patterns.
1. Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: Systematic review and meta-analysis of randomised controlled trials. BMJ. 2019; ;364:l689. [DOI:10.1136/bmj.l689] [PMID]
2. Andersson G. The epidemiology of spinal disorders. In: Frymoyer JB, Ducker TB, editors. The adult spine: Principles and practice. Lippincott-Raven; 1997. [Link]
3. Andersson GB. Epidemiological features of chronic low-back pain. The lancet. 1999; 354(9178):581-5. [DOI:10.1016/S0140-6736(99)01312-4] [PMID]
4. Maigne JY, Aivaliklis A, Pfefer F. Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine. 1996; 21(16):1889-92. [DOI:10.1097/00007632-199608150-00012] [PMID]
5. Kapron AL, Anderson AE, Aoki SK, Phillips LG, Petron DJ, Toth R, et al. Radiographic prevalence of femoroacetabular impingement in collegiate football players: AAOS Exhibit Selection. The Journal of Bone and Joint Surgery. American volume. 2011; 93(19):e111(1-10). [DOI:10.2106/JBJS.K.00544] [PMID]
6. Lievense A, Bierma-Zeinstra S, Schouten B, Bohnen A, Verhaar J, Koes B. Prognosis of trochanteric pain in primary care. British Journal of General Practice. 2005; 55(512):199-204. [PMID]
7. Boyle KL, Demske JR. Management of a female with chronic sciatica and low back pain: A case report. Physiotherapy Theory and Practice. 2009; 25(1):44-54. [DOI:10.1080/09593980802622677] [PMID]
8. Boyle KL. Ethnography of the postural restoration subculture: A posture based approach to patient/client management [PhD dissertation]. Florida: Nova Southeastern University; 2006. [Link]
9. Wolpert L. Development of the asymmetric human. European Review. 2005; 13(S2):97-103. [DOI:10.1017/S1062798705000682]
10. Hruska R. Myokinematic restoration: An integrated approach to treatment of patterned lumbo-pelvic-femoral pathomechanics [course manual]. Elon (NC): Postural Restoration Institute; 2005. [Link]
11. Tenney HR, Boyle KL, DeBord A. Influence of hamstring and abdominal muscle activation on a positive Ober’s test in people with lumbopelvic pain. Physiotherapy Canada. 2013; 65(1):4-11. [DOI:10.3138/ptc.2011-33] [PMID]
12. Kouwenhoven JW, Vincken KL, Bartels LW, Castelein RM. Analysis of preexistent vertebral rotation in the normal spine. Spine. 2006; 31(13):1467-72. [DOI:10.1097/01.brs.0000219938.14686.b3] [PMID]
13. Krabak B, Kennedy DJ. Functional rehabilitation of lumbar spine injuries in the athlete. Sports Medicine and Arthroscopy Review. 2008; 16(1):47-54. [DOI:10.1097/JSA.0b013e318164c431] [PMID]
14. Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Medicine. 2006; 36(3):189-98. [DOI:10.2165/00007256-200636030-00001] [PMID]
15. Nadler SF, Malanga GA, Bartoli LA, Feinberg JH, Prybicien M, Deprince M. Hip muscle imbalance and low back pain in athletes: Influence of core strengthening. Medicine & Science in Sports & Exercise. 2002; 34(1):9-16. [DOI:10.1097/00005768-200201000-00003] [PMID]
16. Hides J, Stanton W, Mendis MD, Sexton M. The relationship of transversus abdominis and lumbar multifidus clinical muscle tests in patients with chronic low back pain. Manual Therapy. 2011; 16(6):573-7. [DOI:10.1016/j.math.2011.05.007] [PMID]
17. Goldman MD, Mead J. Mechanical interaction between the diaphragm and rib cage. Journal of Applied Physiology. 1973; 35(2):197-204. [DOI:10.1152/jappl.1973.35.2.197] [PMID]
18. Henning S, Mangino LC, Massé J. Postural restoration: A Tri-planar asymmetrical framework for understanding, assessing, and treating scoliosis and other spinal dysfunctions. In: Bettany-Saltikov J, Schreiber S, editors. Innovations in spinal deformities and postural disorders. London: IntechOpen; 2017. [DOI:10.5772/intechopen.69037]
19. Boyle K, Jansa S, Lauseng C, Lewis C. Management of a woman diagnosed with trochanteric bursitis with the use of a Protonics® neuromuscular system. Journal of the Section on Women’s Health. 2003; 27(1):12-6. [Link]
20. Danieli E, Airò P, Bettoni L, Cinquini M, Antonioli CM, Cavazzana I, et al. Health-related quality of life measured by the Short Form 36 (SF-36) in systemic sclerosis: Correlations with indexes of disease activity and severity, disability, and depressive symptoms. Clinical Rheumatology. 2005; 24(1):48-54. [DOI:10.1007/s10067-004-0970-z] [PMID]
21. van Trijffel E, van de Pol RJ, Oostendorp RA, Lucas C. Inter-rater reliability for measurement of passive physiological movements in lower extremity joints is generally low: A systematic review. Journal of Physiotherapy. 2010; 56(4):223-35. [DOI:10.1016/S1836-9553(10)70005-9] [PMID]
22. Bayattork M, Khaledi A. Is online exercise at home more effective than hydrotherapy and physiotherapy in patients with non-specific chronic low back pain? A randomized clinical trial. Physical Treatments - Specific Physical Therapy Journal. 2022; 12(1):51-60. [DOI:10.32598/ptj.12.1.517.1]
23. Shah S, Shirodkar S, Deo M. Effectiveness of core stability and diaphragmatic breathing vs. core stability alone on pain and function in mechanical non-specific low back pain patients: A randomised control trial. International Journal of Health Sciences and Research. 2020; 10(2):232-41. [Link]
24. Vera-Garcia FJ, Elvira JL, Brown SH, McGill SM. Effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations. Journal of Electromyography and Kinesiology. 2007; 17(5):556-67. [DOI:10.1016/j.jelekin.2006.07.004] [PMID]
25. Motallebi L, Mohseni Bandpei MA, Rahmani N. [Effects of stabilization exercises on pain intensity, functional disability and cross sectional area of multifidus muscle in women with non-specific chronic low back pain (Persian)]. Journal of Mazandaran University of Medical Sciences. 2013; 23(100):11-9. [Link]
26. Gheitasi M, Khaledi A, Daneshjoo A. [The effect of combined core stability and sensory-motor exercises on pain, performance and movement fear in retired male athletes with non-specific chronic low back pain (Persian)]. Journal of Anesthesiology and Pain. 2020; 11(1):38-48. [Link]
27. Khaledi A, Bayattork M, Gheitasi M. [The effectiveness of exercise therapy on improving pain and functional disability in patients with non-specific chronic low back pain: A systematic review of english clinical trials (Persian)]. Anesthesiology and Pain. 2020; 11(2):89-107. [Link]
28. Cassart M, Pettiaux N, Gevenois PA, Paiva M, Estenne M. Effect of chronic hyperinflation on diaphragm length and surface area. American Journal of Respiratory and Critical Care Medicine. 1997; 156(2 Pt 1):504-8. [DOI:10.1164/ajrccm.156.2.9612089] [PMID]
29. Mead J. Functional significance of the area of apposition of diaphragm to rib cage [proceedings]. American Review of Respiratory Disease. 1979; 119(2P2):31-2. [PMID]
30. Boyle KL. Managing a female patient with left low back pain and sacroiliac joint pain with therapeutic exercise: A case report. Physiotherapy Canada. 2011; 63(2):154-63. [DOI:10.3138/ptc.2009-37] [PMID]
31. Waldron JL, McKenney MA, Samuel MN, Girouard TJ, Turner CL, Radzak KN. The use of postural restoration for treatment of chronic rotator cuff pathology: A case report. International Journal of Sports Physical Therapy. 2020; 15(5):832-9. [DOI:10.26603/ijspt20200832] [PMID]
32. Kasai R. Current trends in exercise management for chronic low back pain: Comparison between strengthening exercise and spinal segmental stabilization exercise. Journal of Physical Therapy Science. 2006; 18(1):97-105. [DOI:10.1589/jpts.18.97]
33. Richardson C, Jull G, Hides J, Hodges P. Therapeutic exercise for spinal segmental stabilization in low back pain. London: Churchill Livingstone; 1999. [Link]
34. Hesse S, Werner C, von Frankenberg S, Bardeleben A. Treadmill training with partial body weight support after stroke. Physical Medicine and Rehabilitation Clinics of North America. 2003; 14(1):S111-23. [DOI:10.1016/S1047-9651(02)00061-X] [PMID]
35. Fouladi N, Namin BG, Sokhangoei Y. Comparing the effect of core stability exercises and electrotherapy on nonspecific chronic low back pain in mother assistants working in mentally or physical retarded children wards. Journal of Modern Rehabilitation. 2017; 11(1):63-72. [DOI:10.18869/nirp.jmr.11.1.63]
36. Robertson J. FP Kendall and EK McCreary “muscles, testing and function”. British Journal of Sports Medicine. 1984; 18(1):25. [DOI:10.1136/bjsm.18.1.25]
37. Robey JH, Boyle K. The role of prism glass and postural restoration in managing a collegiate baseball player with bilateral sacroiliac joint dysfunction: A case report. International Journal of Sports Physical Therapy. 2013; 8(5):716-28. [PMID]
38. Finta R, Nagy E, Bender T. The effect of diaphragm training on lumbar stabilizer muscles: A new concept for improving segmental stability in the case of low back pain. Journal of Pain Research. 2018; 11:3031-45. [DOI:10.2147/JPR.S181610] [PMID]
39. Boyle KL. Clinical application of the right sidelying respiratory left adductor pull back exercise. International Journal of Sports Physical Therapy. 2013; 8(3):349-58. [PMID]
40. Nambi GS, Inbasekaran D, Khuman R, Devi S, Shanmugananth, Jagannathan K. Changes in pain intensity and health related quality of life with Iyengar yoga in nonspecific chronic low back pain: A randomized controlled study. International Journal of Yoga. 2014; 7(1):48-53. [DOI:10.4103/0973-6131.123481] [PMID]
41. Sengupta P. Health impacts of yoga and pranayama: A state-of-the-art review. International Journal of Preventive Medicine. 2012; 3(7):444-58. [PMID]
42. Rosenzweig S, Greeson JM, Reibel DK, Green JS, Jasser SA, Beasley D. Mindfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practice. Journal of Psychosomatic Research. 2010; 68(1):29-36. [DOI:10.1016/j.jpsychores.2009.03.010] [PMID]
2. Andersson G. The epidemiology of spinal disorders. In: Frymoyer JB, Ducker TB, editors. The adult spine: Principles and practice. Lippincott-Raven; 1997. [Link]
3. Andersson GB. Epidemiological features of chronic low-back pain. The lancet. 1999; 354(9178):581-5. [DOI:10.1016/S0140-6736(99)01312-4] [PMID]
4. Maigne JY, Aivaliklis A, Pfefer F. Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine. 1996; 21(16):1889-92. [DOI:10.1097/00007632-199608150-00012] [PMID]
5. Kapron AL, Anderson AE, Aoki SK, Phillips LG, Petron DJ, Toth R, et al. Radiographic prevalence of femoroacetabular impingement in collegiate football players: AAOS Exhibit Selection. The Journal of Bone and Joint Surgery. American volume. 2011; 93(19):e111(1-10). [DOI:10.2106/JBJS.K.00544] [PMID]
6. Lievense A, Bierma-Zeinstra S, Schouten B, Bohnen A, Verhaar J, Koes B. Prognosis of trochanteric pain in primary care. British Journal of General Practice. 2005; 55(512):199-204. [PMID]
7. Boyle KL, Demske JR. Management of a female with chronic sciatica and low back pain: A case report. Physiotherapy Theory and Practice. 2009; 25(1):44-54. [DOI:10.1080/09593980802622677] [PMID]
8. Boyle KL. Ethnography of the postural restoration subculture: A posture based approach to patient/client management [PhD dissertation]. Florida: Nova Southeastern University; 2006. [Link]
9. Wolpert L. Development of the asymmetric human. European Review. 2005; 13(S2):97-103. [DOI:10.1017/S1062798705000682]
10. Hruska R. Myokinematic restoration: An integrated approach to treatment of patterned lumbo-pelvic-femoral pathomechanics [course manual]. Elon (NC): Postural Restoration Institute; 2005. [Link]
11. Tenney HR, Boyle KL, DeBord A. Influence of hamstring and abdominal muscle activation on a positive Ober’s test in people with lumbopelvic pain. Physiotherapy Canada. 2013; 65(1):4-11. [DOI:10.3138/ptc.2011-33] [PMID]
12. Kouwenhoven JW, Vincken KL, Bartels LW, Castelein RM. Analysis of preexistent vertebral rotation in the normal spine. Spine. 2006; 31(13):1467-72. [DOI:10.1097/01.brs.0000219938.14686.b3] [PMID]
13. Krabak B, Kennedy DJ. Functional rehabilitation of lumbar spine injuries in the athlete. Sports Medicine and Arthroscopy Review. 2008; 16(1):47-54. [DOI:10.1097/JSA.0b013e318164c431] [PMID]
14. Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Medicine. 2006; 36(3):189-98. [DOI:10.2165/00007256-200636030-00001] [PMID]
15. Nadler SF, Malanga GA, Bartoli LA, Feinberg JH, Prybicien M, Deprince M. Hip muscle imbalance and low back pain in athletes: Influence of core strengthening. Medicine & Science in Sports & Exercise. 2002; 34(1):9-16. [DOI:10.1097/00005768-200201000-00003] [PMID]
16. Hides J, Stanton W, Mendis MD, Sexton M. The relationship of transversus abdominis and lumbar multifidus clinical muscle tests in patients with chronic low back pain. Manual Therapy. 2011; 16(6):573-7. [DOI:10.1016/j.math.2011.05.007] [PMID]
17. Goldman MD, Mead J. Mechanical interaction between the diaphragm and rib cage. Journal of Applied Physiology. 1973; 35(2):197-204. [DOI:10.1152/jappl.1973.35.2.197] [PMID]
18. Henning S, Mangino LC, Massé J. Postural restoration: A Tri-planar asymmetrical framework for understanding, assessing, and treating scoliosis and other spinal dysfunctions. In: Bettany-Saltikov J, Schreiber S, editors. Innovations in spinal deformities and postural disorders. London: IntechOpen; 2017. [DOI:10.5772/intechopen.69037]
19. Boyle K, Jansa S, Lauseng C, Lewis C. Management of a woman diagnosed with trochanteric bursitis with the use of a Protonics® neuromuscular system. Journal of the Section on Women’s Health. 2003; 27(1):12-6. [Link]
20. Danieli E, Airò P, Bettoni L, Cinquini M, Antonioli CM, Cavazzana I, et al. Health-related quality of life measured by the Short Form 36 (SF-36) in systemic sclerosis: Correlations with indexes of disease activity and severity, disability, and depressive symptoms. Clinical Rheumatology. 2005; 24(1):48-54. [DOI:10.1007/s10067-004-0970-z] [PMID]
21. van Trijffel E, van de Pol RJ, Oostendorp RA, Lucas C. Inter-rater reliability for measurement of passive physiological movements in lower extremity joints is generally low: A systematic review. Journal of Physiotherapy. 2010; 56(4):223-35. [DOI:10.1016/S1836-9553(10)70005-9] [PMID]
22. Bayattork M, Khaledi A. Is online exercise at home more effective than hydrotherapy and physiotherapy in patients with non-specific chronic low back pain? A randomized clinical trial. Physical Treatments - Specific Physical Therapy Journal. 2022; 12(1):51-60. [DOI:10.32598/ptj.12.1.517.1]
23. Shah S, Shirodkar S, Deo M. Effectiveness of core stability and diaphragmatic breathing vs. core stability alone on pain and function in mechanical non-specific low back pain patients: A randomised control trial. International Journal of Health Sciences and Research. 2020; 10(2):232-41. [Link]
24. Vera-Garcia FJ, Elvira JL, Brown SH, McGill SM. Effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations. Journal of Electromyography and Kinesiology. 2007; 17(5):556-67. [DOI:10.1016/j.jelekin.2006.07.004] [PMID]
25. Motallebi L, Mohseni Bandpei MA, Rahmani N. [Effects of stabilization exercises on pain intensity, functional disability and cross sectional area of multifidus muscle in women with non-specific chronic low back pain (Persian)]. Journal of Mazandaran University of Medical Sciences. 2013; 23(100):11-9. [Link]
26. Gheitasi M, Khaledi A, Daneshjoo A. [The effect of combined core stability and sensory-motor exercises on pain, performance and movement fear in retired male athletes with non-specific chronic low back pain (Persian)]. Journal of Anesthesiology and Pain. 2020; 11(1):38-48. [Link]
27. Khaledi A, Bayattork M, Gheitasi M. [The effectiveness of exercise therapy on improving pain and functional disability in patients with non-specific chronic low back pain: A systematic review of english clinical trials (Persian)]. Anesthesiology and Pain. 2020; 11(2):89-107. [Link]
28. Cassart M, Pettiaux N, Gevenois PA, Paiva M, Estenne M. Effect of chronic hyperinflation on diaphragm length and surface area. American Journal of Respiratory and Critical Care Medicine. 1997; 156(2 Pt 1):504-8. [DOI:10.1164/ajrccm.156.2.9612089] [PMID]
29. Mead J. Functional significance of the area of apposition of diaphragm to rib cage [proceedings]. American Review of Respiratory Disease. 1979; 119(2P2):31-2. [PMID]
30. Boyle KL. Managing a female patient with left low back pain and sacroiliac joint pain with therapeutic exercise: A case report. Physiotherapy Canada. 2011; 63(2):154-63. [DOI:10.3138/ptc.2009-37] [PMID]
31. Waldron JL, McKenney MA, Samuel MN, Girouard TJ, Turner CL, Radzak KN. The use of postural restoration for treatment of chronic rotator cuff pathology: A case report. International Journal of Sports Physical Therapy. 2020; 15(5):832-9. [DOI:10.26603/ijspt20200832] [PMID]
32. Kasai R. Current trends in exercise management for chronic low back pain: Comparison between strengthening exercise and spinal segmental stabilization exercise. Journal of Physical Therapy Science. 2006; 18(1):97-105. [DOI:10.1589/jpts.18.97]
33. Richardson C, Jull G, Hides J, Hodges P. Therapeutic exercise for spinal segmental stabilization in low back pain. London: Churchill Livingstone; 1999. [Link]
34. Hesse S, Werner C, von Frankenberg S, Bardeleben A. Treadmill training with partial body weight support after stroke. Physical Medicine and Rehabilitation Clinics of North America. 2003; 14(1):S111-23. [DOI:10.1016/S1047-9651(02)00061-X] [PMID]
35. Fouladi N, Namin BG, Sokhangoei Y. Comparing the effect of core stability exercises and electrotherapy on nonspecific chronic low back pain in mother assistants working in mentally or physical retarded children wards. Journal of Modern Rehabilitation. 2017; 11(1):63-72. [DOI:10.18869/nirp.jmr.11.1.63]
36. Robertson J. FP Kendall and EK McCreary “muscles, testing and function”. British Journal of Sports Medicine. 1984; 18(1):25. [DOI:10.1136/bjsm.18.1.25]
37. Robey JH, Boyle K. The role of prism glass and postural restoration in managing a collegiate baseball player with bilateral sacroiliac joint dysfunction: A case report. International Journal of Sports Physical Therapy. 2013; 8(5):716-28. [PMID]
38. Finta R, Nagy E, Bender T. The effect of diaphragm training on lumbar stabilizer muscles: A new concept for improving segmental stability in the case of low back pain. Journal of Pain Research. 2018; 11:3031-45. [DOI:10.2147/JPR.S181610] [PMID]
39. Boyle KL. Clinical application of the right sidelying respiratory left adductor pull back exercise. International Journal of Sports Physical Therapy. 2013; 8(3):349-58. [PMID]
40. Nambi GS, Inbasekaran D, Khuman R, Devi S, Shanmugananth, Jagannathan K. Changes in pain intensity and health related quality of life with Iyengar yoga in nonspecific chronic low back pain: A randomized controlled study. International Journal of Yoga. 2014; 7(1):48-53. [DOI:10.4103/0973-6131.123481] [PMID]
41. Sengupta P. Health impacts of yoga and pranayama: A state-of-the-art review. International Journal of Preventive Medicine. 2012; 3(7):444-58. [PMID]
42. Rosenzweig S, Greeson JM, Reibel DK, Green JS, Jasser SA, Beasley D. Mindfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practice. Journal of Psychosomatic Research. 2010; 68(1):29-36. [DOI:10.1016/j.jpsychores.2009.03.010] [PMID]
| Files | ||
| Issue | Vol 18 No 1 (2024) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v18i1.14728 | |
| Keywords | ||
| Core stability Exercise therapy Low back pain Postural restoration | ||
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How to Cite
1.
Fouladi N, Minoonejad H, Rajabi R. Comparing the Effects of the Postural Restoration Exercises with and without Core Stability Exercises in Patients with Non-Specific Chronic Low Back Pain. jmr. 2024;18(1):41-54.
