PLoS One. 2013 Jun 27;8(6):e67779. Print 2013.
sexta-feira, 23 de agosto de 2013
quarta-feira, 14 de agosto de 2013
Evidências apontam para efetividade da abordagem fisioterapêutica na neuropatia diabética
M.R. Ebrahimpoor Mashhadi *,a, Z. Liaghat b
a Anatomy and Physiotherapy Ward School of Medicine, Kazeroun, Iran
b Physiotherapy Ward Shahid Chamran Hospital, Shiraz, Iran
Background. Diabetes mellitus is a common endo- crine disease which causes several problems in different part of the body. Peripheral diabetic neuropathy is a most noticeable one, leading to bilateral pain in some diabetic patient especially in distal parts of the upper and lower limbs.
Aims. To determine the effect of a new physical ther- apy method in relieving the neuropathic pains in dia- betic patients.
Methods. Six diabetic patients who had bilateral pain in their limbs were selected (4 men, 2 women)and received special physical therapy method for 15 days continuously as follow:
(a) Ultrasound (5 min continuous type 1 w/cm2), for forearms and hands in upper limbs and legs and foots in lower limbs.
(b) TENS (trans cutaneous electrical nerve stimulation, 20 min, Burst type), for forearms and hands in upper limbs and legs and foots in lower limbs.
(c) Neodynator (5 min LP wave, and 5 min DF wave immediately) for forearms and hands in upper limbs and legs and foots in lower limbs.
Results. Statistical analysis of the results proved the significant pain relief in diabetic patient after 15 days. (p 6 0.05). The cases who received the above treatment
were also followed up for 2 month period,while in none, the pain were again observable.
Conclusion. So this study showed that above physical therapy treatment method are effective for relieving the neuropathic pains in diabetic patients.
segunda-feira, 12 de agosto de 2013
Trabalho mostra que Crioterapia é eficiente nas dores dos tecidos moles, mas precisa de melhor definição de parâmetros para aplicabilidade !
J Athl Train. 2004 Sep;39(3):278-279.
Does Cryotherapy Improve Outcomes With Soft Tissue Injury?
Source
Pennsylvania State University, University Park, PA.Abstract
REFERENCE:
Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251-261.CLINICAL QUESTION:
What is the clinical evidence base for cryotherapy use?DATA SOURCES:
Studies were identified by using a computer-based literature search on a total of 8 databases: MEDLINE, Proquest, ISI Web of Science, Cumulative Index to Nursing and Allied Health (CINAHL) on Ovid, Allied and Complementary Medicine Database (AMED) on Ovid, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effectiveness, and Cochrane Controlled Trials Register (Central). This was supplemented with citation tracking of relevant primary and review articles. Search terms included surgery,orthopaedics,sports injury,soft tissue injury,sprains and strains,contusions,athletic injury,acute,compression, cryotherapy,ice,RICE, andcold.STUDY SELECTION:
To be included in the review, each study had to fulfill the following conditions: be a randomized, controlled trial of human subjects; be published in English as a full paper; include patients recovering from acute soft tissue or orthopaedic surgical interventions who received cryotherapy in inpatient, outpatient, or home-based treatment, in isolation or in combination with placebo or other therapies; provide comparisons with no treatment, placebo, a different mode or protocol of cryotherapy, or other physiotherapeutic interventions; and have outcome measures that included function (subjective or objective), pain, swelling, or range of motion.DATA EXTRACTION:
The study population, interventions, outcomes, follow-up, and reported results of the assessed trials were extracted and tabulated. The primary outcome measures were pain, swelling, and range of motion. Only 2 groups reported adequate data for return to normal function. All eligible articles were rated for methodologic quality using the PEDro scale. The PEDro scale is a checklist that examines the believability (internal validity) and the interpretability of trial quality. The 11-item checklist yields a maximum score of 10 if all criteria are satisfied. The intraclass correlation coefficient and kappa values are similar to those reported for 3 other frequently used quality scales (Chalmers Scale, Jadad Scale, and Maastricht List). Two reviewers graded the articles, a method that has been reported to be more reliable than one evaluator.MAIN RESULTS:
Specific search criteria identified 55 articles for review, of which 22 were eligible randomized, controlled clinical trials. The articles' scores on the PEDro scale were low, ranging from 1 to 5, with an average score of 3.4. Five studies provided adequate information on the subjects' baseline data, and only 3 studies concealed allocation during subject recruitment. No studies blinded their therapist's administration of therapy, and just 1 study blinded subjects. Only 1 study included an intention-to-treat analysis. The average number of subjects in the studies was 66.7; however, only 1 group undertook a power analysis. The types of injuries varied widely (eg, acute or surgical). No authors investigated subjects with muscle contusions or strains, and only 5 groups studied subjects with acute ligament sprains. The remaining 17 groups examined patients recovering from operative procedures (anterior cruciate ligament repair, knee arthroscopy, lateral retinacular release, total knee and hip arthroplasties, and carpal tunnel release). Additionally, the mode of cryotherapy varied widely, as did the duration and frequency of cryotherapy application. The time period when cryotherapy was applied after injury ranged from immediately after injury to 1 to 3 days postinjury. Adequate information on the actual surface temperature of the cooling device was not provided in the selected studies. Most authors recorded outcome variables over short periods (1 week), with the longest reporting follow-ups of pain, swelling, and range of motion recorded at 4 weeks postinjury. Data in that study were insufficient to calculate effect size. Nine studies did not provide data of the key outcome measures, so individual study effect estimates could not be calculated. A total of 12 treatment comparisons were made. Ice submersion with simultaneous exercises was significantly more effective than heat and contrast therapy plus simultaneous exercises at reducing swelling. Ice was reported to be no different from ice and low-frequency or high-frequency electric stimulation in effect on swelling, pain, and range of motion. Ice alone seemed to be more effective than applying no form of cryotherapy after minor knee surgery in terms of pain, but no differences were reported for range of motion and girth. Continuous cryotherapy was associated with a significantly greater decrease in pain and wrist circumference after surgery than intermittent cryotherapy. Evidence was marginal that a single simultaneous treatment with ice and compression is no more effective than no cryotherapy after an ankle sprain. The authors reported ice to be no more effective than rehabilitation only with regard to pain, swelling, and range of motion. Ice and compression seemed to be significantly more effective than ice alone in terms of decreasing pain. Additionally, ice, compression, and a placebo injection reduced pain more than a placebo injection alone. Lastly, in 8 studies, there seemed to be little difference in the effectiveness of ice and compression compared with compression alone. Only 2 of the 8 groups reported significant differences in favor of ice and compression.CONCLUSIONS:
Based on the available evidence, cryotherapy seems to be effective in decreasing pain. In comparison with other rehabilitation techniques, the efficacy of cryotherapy has been questioned. The exact effect of cryotherapy on more frequently treated acute injuries (eg, muscle strains and contusions) has not been fully elucidated. Additionally, the low methodologic quality of the available evidence is of concern. Many more high-quality studies are required to create evidence-based guidelines on the use of cryotherapy. These must focus on developing modes, durations, and frequencies of ice application that will optimize outcomes after injury.segunda-feira, 5 de agosto de 2013
Trabalho mostra evidências de que trtamento cirúrgico é inferior à abordagem conservadora intensiva nas enfermidades da coluna vertebral.
Spine (Phila Pa 1976). 2009 May 1;34(10):1094-109. doi: 10.1097/BRS.0b013e3181a105fc.
Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline.
Source
Department of Medicine, Oregon Evidence-based Practice Center, OR Health and Science University, Portland, OR, USA. chour@ohsu.eduAbstract
STUDY DESIGN:
Systematic review.OBJECTIVE:
To systematically assess benefits and harms of surgery for nonradicular back pain with common degenerative changes, radiculopathy with herniated lumbar disc, and symptomatic spinal stenosis.SUMMARY OF BACKGROUND DATA:
Although back surgery rates continue to increase, there is uncertainty or controversy about utility of back surgery for various conditions.METHODS:
Electronic database searches on Ovid MEDLINE and the Cochrane databases were conducted through July 2008 to identify randomized controlled trials and systematic reviews of the above therapies. All relevant studies were methodologically assessed by 2 independent reviewers using criteria developed by the Cochrane Back Review Group (for trials) and Oxman (for systematic reviews). A qualitative synthesis of results was performed using methods adapted from the US Preventive Services Task Force.RESULTS:
For nonradicular low back pain with common degenerative changes, we found fair evidence that fusion is no better than intensive rehabilitation with a cognitive-behavioral emphasis for improvement in pain or function, but slightly to moderately superior to standard (nonintensive) nonsurgical therapy. Less than half of patients experience optimal outcomes (defined as no more than sporadic pain, slight restriction of function, and occasional analgesics) following fusion. Clinical benefits of instrumented versus noninstrumented fusion are unclear. For radiculopathy with herniated lumbar disc, we found good evidence that standard open discectomy and microdiscectomy are moderately superior to nonsurgical therapy for improvement in pain and function through 2 to 3 months. For symptomatic spinal stenosis with or without degenerative spondylolisthesis, we found good evidence that decompressive surgery is moderately superior to nonsurgical therapy through 1 to 2 years. For both conditions, patients on average experience improvement either with or without surgery, and benefits associated with surgery decrease with long-term follow-up in some trials. Although there is fair evidence that artificial disc replacement is similarly effective compared to fusion for single level degenerative disc disease and that an interspinous spacer device is superior to nonsurgical therapy for 1- or 2-level spinal stenosis with symptoms relieved with forward flexion, insufficient evidence exists to judge long-term benefits or harms.CONCLUSION:
Surgery for radiculopathy with herniated lumbar disc and symptomatic spinal stenosis is associated with short-term benefits compared to nonsurgical therapy, though benefits diminish with long-term follow-up in some trials. For nonradicular back pain with common degenerative changes, fusion is no more effective than intensive rehabilitation, but associated with small to moderate benefits compared to standard nonsurgical therapy.Comment in
sexta-feira, 2 de agosto de 2013
Cinesioterapia Postural é efetiva na redução de disfunções em pacientes com dor lombar
Spine (Phila Pa 1976). 1995 Nov 1;20(21):2303-12.
The effects of spinal flexion and extension exercises and their associated postures in patients with acute low back pain.
Source
United States Army Medical Command, Europe HQ, 7th Medical Command, Heidelberg, Germany.Abstract
STUDY DESIGN:
A prospective randomized clinical trial compared the effects of flexion and extension back exercises and postures among soldiers with acute low back pain.OBJECTIVE:
To compare the immediate effects of back exercise on functional status, spinal mobility, straight leg raising, pain severity, and treatment satisfaction, and to determine whether spinal exercise during the acute stage of low back pain reduces recurrent episodes of low back pain.SUMMARY OF BACKGROUND DATA:
Conflicting reports exist concerning the efficacy of spinal flexion and extension exercises in patients with low back pain of varying duration. Poor study design and lack of functional outcomes characterize many of these studies.METHODS:
One-hundred-forty-nine subjects with acute low back pain received flexion exercise and posture (n = 57), extension exercise and posture (n = 62), or no exercise or posture (n = 30) for 8 weeks. Outcomes were assessed 1, 2, 4 and 8 weeks after treatment onset. A questionnaire assessed the recurrence of low back pain 6-12 months after study entry.RESULTS:
Flexion and extension exercise groups did not differ in any outcome over 8 weeks. After 1 week, both exercise groups had reduced disability scores, a higher proportion returning to work, and fewer subjects with a positive straight-leg raise compared with the control group. There was no difference among groups regarding recurrence of low back pain after 6-12 months.CONCLUSIONS:
There was no difference for any outcomes between the flexion or extension exercise groups. However, either exercise was slightly more effective than no exercise when patients with acute low back pain were treated.quinta-feira, 1 de agosto de 2013
Estudo revela que limitações funcionias dos pacientes com dor lombar crônica são melhor conduzidas com exercícios de estabilização.
Ann Rehabil Med. 2013 February; 37(1): 110–117.
Published online 2013 February 28. doi: 10.5535/arm.2013.37.1.110
PMCID: PMC3604220
Effect of Lumbar Stabilization and Dynamic Lumbar Strengthening Exercises in Patients With Chronic Low Back Pain
Hye Jin Moon, MD, Kyoung Hyo Choi, MD,
Dae Ha Kim, MD, Ha Jeong Kim, MD, Young Ki Cho, Kwang Hee Lee, Jung Hoo Kim, and Yoo Jung Choi
Dae Ha Kim, MD, Ha Jeong Kim, MD, Young Ki Cho, Kwang Hee Lee, Jung Hoo Kim, and Yoo Jung ChoiAbstract
Objective
To compare the effects of lumbar stabilization exercises and lumbar dynamic strengthening exercises on the maximal isometric strength of the lumbar extensors, pain severity and functional disability in patients with chronic low back pain (LBP).
Methods
Patients suffering nonspecific LBP for more than 3 months were included prospectively and randomized into lumbar stabilization exercise group (n=11) or lumbar dynamic strengthening exercise group (n=10). Exercises were performed for 1 hour, twice weekly, for 8 weeks. The strength of the lumbar extensors was measured at various angles ranging from 0° to 72° at intervals of 12°, using a MedX. The visual analog scale (VAS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ) were used to measure the severity of LBP and functional disability before and after the exercise.
Results
Compared with the baseline, lumbar extension strength at all angles improved significantly in both groups after 8 weeks. The improvements were significantly greater in the lumbar stabilization exercise group at 0° and 12° of lumbar flexion. VAS decreased significantly after treatment; however, the changes were not significantly different between the groups. ODQ scores improved significantly in the stabilization exercise group only.
Conclusion
Both lumbar stabilization and dynamic strengthening exercise strengthened the lumbar extensors and reduced LBP. However, the lumbar stabilization exercise was more effective in lumbar extensor strengthening and functional improvement in patients with nonspecific chronic LBP.
Keywords: Exercise, Low back pain, Muscle strength, Abdominal muscle, Rehabilitation
INTRODUCTION
Chronic low back pain (LBP) defined as back pain lasting more than 12 weeks, affects over 50% of the general population [1]. It is estimated that over 70% of the adults have at least one episode of LBP in their lifetime [2]. Because the causes of LBP are variable, different exercise regimens have been used to treat patients, including lumbar flexion, extension, isometric flexion, passive extension, and intensive dynamic back exercise regimens [3-6]. Many of these exercise regimes have not yielded satisfactory results [7,8], although it is accepted that some form of exercise is better than none [9,10].
Recently, there has been a focus on exercises that aim to maintain/improve lumbar spine stability [11]. Although no formal definition of lumbar stabilization exercises exists, the approach is aimed at improving the neuromuscular control, strength, and endurance of the muscles that are central to maintaining the dynamic spinal and trunk stability. Several groups of muscles particularly targeted the transversus abdominis and lumbar multifidi, but also other paraspinal, abdominal, diaphragmatic, and pelvic muscles [12].
Unsubstantiated suggestions that stabilization training may be useful in reducing pain and disability for all patients with nonspecific LBP, have appeared in the literature [13], but these assertions have not been definitively demonstrated. The overwhelming majority of studies on lumbar stabilization exercises use mixed groups (including patients with disc lesions, osteoarthritis, or leg pain) of subjects with nonspecific chronic LBP [12]. These studies cannot determine whether a specific subgroup of patients may be more responsive to lumbar stabilization exercises. Also, no randomized controlled trials have measured the maximal isometric contraction strength of lumbar extensors at different angles of lumbar flexion. Therefore, the aim of this study was to compare the effects of lumbar stabilization exercises and lumbar dynamic strengthening exercises on the maximal isometric contraction strength of the lumbar extensors, pain severity, and functional disability in patients with nonspecific chronic LBP.
MATERIALS AND METHODS
Patients complaining of nonspecific LBP without any structural or neuropsychological cause, for more than 3 months, were recruited from the rehabilitation outpatient-clinic. Exclusion criteria included a history of neurological, infectious, and systemic diseases, including cerebrovascular disease, spinal cord disease, spondylitis, cancer, rheumatologic disorders, and other chronic diseases that cause long-term immobilization. Patients who had undergone prior surgery for back pain, patients who were prescribed exercise therapy in the past, patients who seemed to have radicular pain due to nerve root involvement on physical examination, and patients with structural lesions, such as spondylolisthesis, vertebral bone fracture, scoliosis, and kyphosis on X-ray, were also excluded.
A total of 24 patients were enrolled in the study and randomly assigned to one of the two groups, a lumbar stabilization exercise group (n=12) and a conventional lumbar dynamic exercise group (n=12) by a computer-generated random number sequence. Two patients in the lumbar dynamic strengthening exercise group and one patient in the lumbar stabilization exercise group dropped out for personal reasons. The remaining 21 subjects completed the 8-week exercise program without incident.
Each exercise session lasted 60 minutes and was performed 2 days per week, for 8 weeks. All patients in both groups performed warm-up stretching exercises for 15 minutes before the main exercises and cool down exercises for 10 minutes after each session. All exercises were performed in the treatment room under the supervision of a physical therapist with technical knowledge. The therapist put each patient into the appropriate position to achieve the correct posture and muscle contraction.
Lumbar stabilization exercises consisted of 16 exercises, which were aimed to strengthen the deep lumbar stabilizing muscles: the transversus abdominis, lumbar multifidi, and internal obliques. All 16 stabilization exercises were performed once, consecutively, and in the same order (Fig. 1). Before each exercise, the physical therapist gave detailed verbal explanation and visual instructions (pictures), regarding the start and end positions. All exercises were conducted according to the following specific principles: breathe in and out, gently and slowly draw in your lower abdomen below your umbilicus without moving your upper stomach, back or pelvis" [14]; resulting in a situation referred to as hollowing [15]. Subjects practiced "hollowing" with a therapist providing verbal instruction and tactile feedback until they were able to perform the maneuver in a satisfactory manner. In addition, a "bulging" of the multifidus muscle should have been felt by the therapist when the fingers were placed on either side of the spinous processes of the L4 and L5 vertebrae, directly over the belly of this muscle [14]. These feedback techniques provided by precise palpitation of the appropriate muscles, ensure effective muscle activation [11].
Conventional lumbar dynamic strengthening exercises consisted of 14 exercises (Fig. 2), which activated the extensor (erector spinae) and flexor (rectus abdominis) muscle groups.
For all exercises in both groups, the final static position was held for 10 seconds, and each exercise was performed for 10 repetitions. There was a pause of 3 seconds between repetitions and a 60-second rest between each exercise. Exercise intensity (holding time and number of repetitions) was increased gradually, based on the tolerance of each patient.
Lumbar extension strength was assessed using a MedX (MedX Holdings Inc., Ocara, FL, USA) lumbar extension machine, which fixes the pelvis, thigh, and knee, to ensure complete stabilization allowing measurements of lumbar extension strength at flexion angles from 0° to 72° at intervals of 12° (0°, 12°, 24°, 36°, 48°, 60°, and 72°) [16]. Strength tests were conducted at each angle with an approximately 10 seconds rest between tests. Differences in the maximal isometric strength at a given angle of flexion were compared between the groups, before and after the exercise. The percentage change in muscle strength (strength after exercise-strength before exercise/strength before exercise×100; Δ%) after the dynamic strengthening exercises and lumbar stabilization exercises was also compared.
All evaluations were conducted by an examiner who was not the treating therapist. The examiner was aware of the study design, but was blinded to the group assignments. The examiner and a clinical physical therapist with 10 years of experience in musculoskeletal rehabilitation, who had attended specialized stabilization exercise seminars and was very familiar with the application of these exercise interventions (about 2 years direct experience) before the initiation of the trial, were responsible for supervising all the exercise sessions.
The severity of LBP was evaluated using a visual analog scale (VAS), which ranged from 0 to 100 [17]. The VAS consists of line (10 cm in length) with the left extremity indicating "no pain" and the right extremity indicating "unbearable pain." Participants were asked to mark the line to indicate their level of pain. Higher values suggest more intense pain. This instrument shows good reproducibility for assessing pain levels [18]. The patients indicated the average severity of their LBP over the previous 3 days.
The modified Oswestry Low Back Pain Disability Questionnaire (ODQ; also known as the Oswestry Disability Index) was used to evaluate the functional disability and quality of life [19]. This questionnaire was filled out before and after the 8-week exercise program.
This study was approved by the ethics committee of our institute and all subjects provided written informed consent.
Statistical analysis
Differences in general characteristics (e.g., male/female) between the two groups were analyzed using the Fisher's exact test. Differences in the baseline mean VAS, ODQ scores, and in the strength of the lumbar extensors between the two groups were analyzed using the Mann-Whitney U-test.
The baseline mean values were compared with the mean values after the treatment within groups using the Wilcoxon's test. The Mann-Whitney U-test was used to compare maximal isometric strength, VAS, and ODQ score between the two groups. Statistical significance was defined as a p-value <0.05. All statistical analysis were performed using SPSS ver. 18 (SPSS Inc., Chicago, IL, USA).
RESULTS
All 21 subjects (mean age, 28.5±4.9 years) who visited the Department of Rehabilitation outpatient clinic for chronic LBP were enrolled prospectively. There were no significant differences in the general characteristics or the baseline VAS and ODQ scores between the lumbar stabilization exercise and the dynamic lumbar strengthening exercise groups (Table 1).
The baseline maximal isometric contraction strength of the lumbar extensors at all angles of lumbar flexion did not differ significantly between the exercise groups, although the data was not shown.
Compared with that of the baseline, lumbar extension strength at all angles of lumbar flexion improved significantly in both groups after 8 weeks (Table 2). Table 3 shows the difference in maximal isometric contraction strength at a given angle of lumbar flexion before and after the exercise. Improvements were significantly larger in the lumbar stabilization exercise group at 0° and 12° of lumbar flexion than in the dynamic strengthening exercise group (Table 3). When the percentage change in maximal isometric strength at each angle (Δ%) was examined, the improvements were significantly greater in the lumbar stabilization exercise group, at 0° and 12° of lumbar flexion, than in the dynamic strengthening exercise group (Fig. 3).
The percentage change in maximal isometric muscle strength at each angle (Δ%) in the lumbar dynamic strengthening exercise and the stabilization exercise groups. The lumbar stabilization exercise group showed significantly greater improvement ...
Comparison of the improvements in lumbar extensor strength at different angles of lumbar flexion in two groups (unit, ft-lb)
The VAS reported by all subjects decreased significantly after the treatment, although the difference between the two groups was not significant. However, the ODQ scores significantly improved in the stabilization exercise group (but not in the dynamic strengthening exercise group) compared with the baseline scores. In stabilization exercise group showed better outcome in ODQ score than dynamic lumbar strengthening exercise group, although the difference between these two groups was not significant (Table 4).
DISCUSSION
The aim of this study was to compare the effects of lumbar stabilization exercises and lumbar dynamic strengthening exercises on the maximal isometric strength of the lumbar extensor muscles, pain severity, and functional disability in patients with chronic LBP. We found that both exercises improved the maximal isometric strength of lumbar extensors and pain severity. However, the functional improvements and lumbar extensor strength at low lumbar flexion angles were both better in the stabilization exercise group than that of the dynamic strengthening exercise group.
Among the abdominal muscles, the transverse abdominal, multifidus, and internal oblique muscles help to increase the intra-abdominal pressure, thereby contributing to the spinal and pelvic stability [18,20,21]. Our lumbar stabilization exercise group included some lumbar dynamic exercises, which may have strengthened the lumbar extensors at the large lumbar flexion angle in this group of patients. However, functional improvements and lumbar extensor strength at low lumbar flexion angles were both better in the stabilization exercise group, suggesting that these improvements were due to the stabilization exercises. In terms of length-tension relationships, the lumbar extensors are at their shortest at the flexion angles of 0° and 12°, thereby minimizing the isometric strength [22].
In our study, the improvement of ODQ score did not differ significantly between the lumbar stabilization exercise and dynamic strengthening exercise groups. Generally, ODQ scores of less than 20 indicate that functional disability is not regarded as significant in daily life [23]. Subjects in both of our groups had low ODQ scores and reported no significant difficulties in daily life, despite having chronic LBP. Thus, the degree of improvement after an 8-week program may not be reflected in this outcome. However, the improvement of ODQ scores tended to be higher in the lumbar stabilization exercise group than the dynamic lumbar strengthening exercise group. Moreover, the ODQ scores improved significantly after lumbar stabilization exercise, whereas there was no difference in ODQ scores before and after the dynamic lumbar strengthening exercise. These findings are supported by other studies [11] in which stabilization exercises translated into pain and functional capacity improvements.
A multicenter randomized controlled trial by Ferreira et al. [24], compared general exercises and lumbar stabilization exercises in patients with chronic LBP. The lumbar stabilization exercises groups showed marginally better outcomes than the general exercise group after 8 weeks in VAS and score of the Roland Morris Disability Questionnaire [25], but there was no significant difference between the two groups. These results were consistent with our results. This was a high-quality study and clinically relevant, however, the study enrolled a mixed group of subjects (including patients with disc lesions, osteoarthritis, and leg pain), which makes comparison difficult.
The present study has several limitations, including the small number of patients and their relatively young age; therefore, the results cannot be generalized to all patients with nonspecific chronic LBP. Also, the long-term effects of these exercise protocols cannot be predicted; further studies are needed with larger sample sizes and longer follow-up periods. The strength of the deep lumbar muscles was not monitored directly, using a needle electromyography, ultrasound measurements of deep muscle thickening, or muscle activation using pressure biofeedback [26]. Because we measured only the maximal isometric strength of the lumbar extensors, the results may not reflect the overall strength of the deep lumbar stabilization muscles.
In conclusion, both lumbar stabilization and conventional lumbar dynamic strengthening exercises increased the strength of the lumbar extensor muscles and reduced LBP. However, compared to that of lumbar dynamic strengthening exercises, lumbar stabilization exercises were more effective for strengthening lumbar extensors at small lumbar flexion angle and for improving the functional disability in patients with nonspecific chronic LBP.
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Articles from Annals of Rehabilitation Medicine are provided here courtesy of Korean Academy of Rehabilitation Medicine
Abordagem fisioterapêutica no assoalho pélvico pode melhorar condições dolorosa mecânica lombar.
J Int Med Res. 2013 Feb;41(1):146-52. doi: 10.1177/0300060513475383. Epub 2013 Jan 23.
Pelvic floor muscle exercise for chronic low back pain.
Source
Department of Rehabilitation Medicine, Pudong New District Gongli Hospital, Shanghai, China.Abstract
OBJECTIVE:
To assess the effect of pelvic floor muscle exercise in patients with chronic low back pain.METHODS:
Adults (aged ≥ 18 years) with chronic low back pain (with or without radiculopathy) were randomized to undergo either routine treatment (ultrasonography, short wave diathermy and lumbar strengthening exercises; control group) or routine treatment with pelvic floor exercises (intervention group) for 24 weeks. Pain, disability (Oswestry Disability Index [ODI] score) and trunk muscle function were assessed at baseline and after completion of treatment.RESULTS:
The study included 47 patients (control group n = 24; intervention group n = 23). Pain severity and ODI scores were significantly lower in the intervention group than in the control group after 24 weeks. There were no significant between-group differences in trunk muscle function.CONCLUSION:
Pelvic floor exercise in combination with routine treatment provides significant benefits in terms of pain relief and disability over routine treatment alone.
Assinar:
Postagens (Atom)