Introduction
Spinal stabilization exercise has become a well-known therapeutic modality commonly used in clinical practice. Various studies assessing long-term outcomes showed that stabilization exercise as a single or combined modality could improve pain intensity and disability and prevent recurrent episodes of chronic low back pain (CLBP).
Physical exercise through vibration application was previously studied based on the reflex modification mechanism by improving neural adaptation. However, no studies have reported on clinical trials of the spinal stabilization with direct vibration application to the paraspinal muscles.
This study investigated the clinical effect of localized and direct vibration to the trunk muscles during spinal stabilization exercise in patients with non-specific CLBP.
Methods
Design: A pilot randomized controlled trial.
Setting: Outpatient clinic.
Participants: Sixty-two participants with non-specific CLBP were randomly assigned to two groups: conventional stabilization exercise (CSE) or vibration stabilization exercise (VSE).
Interventions: The groups performed 12 sessions of the spinal stability exercise program over 4 weeks.
Objective outcome measures: Trunk muscle thickness and activity were determined of the following muscles using ultrasonography and surface electromyography (sEMG), respectively: transverse abdominis (TrA), external oblique (EO), internal oblique (IO), rectus abdominis (RA), lumbar multifidus (LM), and lumbar erector spinae (LES). Each Ultrasound and sEMG were perfomed at T0 and T1.
Subjective outcome measures: Pain intensity was measured using a VAS. CLBP related functional disability was evaluated using the Oswestry Disability Index (ODI). Pain and disability were assessed at T0, T1, and T2.
Results
The ultrasonographic examination revealed the increased ratio of the muscle thickness to the muscle contraction and relaxation after the training of the TrA and LM muscles in the CSE group and the TrA, LM, and IO muscles in the VSE group.
The sEMG evaluation resulted in statistical increases in the post-treatment activities of the EO, IO, and LM muscles in the CSE and the TrA, IO, and LM muscles in the VSE group. The ratio of muscle activity also revealed statistical increases: the IO/RA ratio in the CSE group and the IO/RA, TrA/RA, and LM/LES ratios in the VSE group.
After the exercise, the VAS and ODI showed statistically significant clinical improvement in both groups that were maintained after 8 weeks. There were no significant intergroup differences
Conclusions
Simultaneously with the voluntary contraction of the trunk muscles, direct vibration can be used as an adjunct to enhance the effect 25 of core stabilization exercises in patients with non-specific CLBP. |
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Flow chart showing subject recruitment and randomization. CLBP: chronic low backpain; CSE: conventional stabilization exercise; VSE: vibration stabilization exercise; VAS:visual analog scale; ODI: Oswestry Disability Index; sEMG: surface electromyography.
Spinal stabilization exercise program consisted of five different exercises: upper-body extension (A), alternate arm and leg lift (B), alternate arm and leg extension (C), diagonal curl up (D), and curl-up (E).
The conceptual design (A) and actual picture (B) of the applied vibration device.
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