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Altered postural responses persist following physical therapy of general versus specific trunk exercises in people with low back pain.

Abstract

Interventions that target trunk muscle impairments in people with LBP have been promoted; however, the treatment effects on muscle activation impairments during postural tasks remain unclear. Thus, our objective was to evaluate the effects trunk stabilization vs. general strength and conditioning exercises on the automatic postural response in persons with chronic low back pain (LBP). Fifty-eight subjects with chronic, recurrent LBP (n = 58) (i.e., longer than six months) were recruited and randomly assigned to one of two, 10-week physical therapy programs: stabilization (n = 29) or strength and conditioning (n = 29). Pain and function were measured at 11 weeks and 6 months post-treatment initiation. To quantify postural following support surface perturbations, surface electrodes recorded electromyography (EMG) of trunk and leg muscles and force plates recorded forces under the feet, to calculate the center of pressure. Both groups demonstrated significant improvements in pain and function out to 6 months. There were also changes in muscle activation patterns immediately post-treatment, but not at 6 months. However, changes in center of pressure (COP) responses were treatment specific. Following treatment, the stabilization group demonstrated later onset of COP displacement, while the onset of COP displacement in the strengthening group was significantly earlier following treatment. Despite two different treatments, clinical improvements and muscle activation patterns were similar for both groups, indicating that the stabilization treatment protocol does not preferentially improve treatment outcomes or inter-muscle postural coordination patterns for persons with LBP.

CLINICAL TRIAL REGISTRATION NUMBER

NCT01611792.

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  • Authors+Show Affiliations

    ,

    Health and Exercise Sciences Divison, Central Michigan University, Mt. Pleasant, MI, USA. Electronic address: lomon2k@cmich.edu.

    ,

    Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA.

    ,

    Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA.

    ,

    Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA.

    Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA.

    Source

    Manual therapy 19:5 2014 Oct pg 425-32

    MeSH

    Adult
    Chronic Disease
    Disability Evaluation
    Electromyography
    Exercise Therapy
    Female
    Humans
    Low Back Pain
    Male
    Muscle Strength
    Pain Measurement
    Physical Therapy Modalities
    Posture
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial

    Language

    ENG

    PubMed ID

    24853255

    Citation

    TY - JOUR T1 - Altered postural responses persist following physical therapy of general versus specific trunk exercises in people with low back pain. AU - Lomond,Karen V, AU - Henry,Sharon M, AU - Hitt,Juvena R, AU - DeSarno,Michael J, AU - Bunn,Janice Y, Y1 - 2014/Apr/24/ PY - 2013/7/29/received PY - 2014/1/22/revised PY - 2014/4/6/accepted PY - 2014/5/24/entrez PY - 2014/5/24/pubmed PY - 2016/10/7/medline KW - Electromyography KW - Low back pain (LBP) KW - Physical therapy KW - Posture SP - 425 EP - 32 JF - Manual therapy JO - Man Ther VL - 19 IS - 5 N2 - UNLABELLED: Interventions that target trunk muscle impairments in people with LBP have been promoted; however, the treatment effects on muscle activation impairments during postural tasks remain unclear. Thus, our objective was to evaluate the effects trunk stabilization vs. general strength and conditioning exercises on the automatic postural response in persons with chronic low back pain (LBP). Fifty-eight subjects with chronic, recurrent LBP (n = 58) (i.e., longer than six months) were recruited and randomly assigned to one of two, 10-week physical therapy programs: stabilization (n = 29) or strength and conditioning (n = 29). Pain and function were measured at 11 weeks and 6 months post-treatment initiation. To quantify postural following support surface perturbations, surface electrodes recorded electromyography (EMG) of trunk and leg muscles and force plates recorded forces under the feet, to calculate the center of pressure. Both groups demonstrated significant improvements in pain and function out to 6 months. There were also changes in muscle activation patterns immediately post-treatment, but not at 6 months. However, changes in center of pressure (COP) responses were treatment specific. Following treatment, the stabilization group demonstrated later onset of COP displacement, while the onset of COP displacement in the strengthening group was significantly earlier following treatment. Despite two different treatments, clinical improvements and muscle activation patterns were similar for both groups, indicating that the stabilization treatment protocol does not preferentially improve treatment outcomes or inter-muscle postural coordination patterns for persons with LBP. CLINICAL TRIAL REGISTRATION NUMBER: NCT01611792. SN - 1532-2769 UR - https://www.unboundmedicine.com/medline/citation/24853255/Altered_postural_responses_persist_following_physical_therapy_of_general_versus_specific_trunk_exercises_in_people_with_low_back_pain_ L2 - http://linkinghub.elsevier.com/retrieve/pii/S1356-689X(14)00068-X ER -