Efficacy of Therapeutic Exercise for Recurrent Back Pain

点击翻译按钮获取中文摘要

DESCRIPTION (provided by applicant): Low back disorders are the leading cause of activity limitation and affect up to 47% of injured workers. While the majority (80% to 90%) of individuals with acute low back pain (LBP) recover by four weeks post injury, 60% to 86% of these patients will experience recurrent back pain during the year after the acute episode. Lumbar stabilization exercises are commonly used in rehabilitation programs for LBP, based on the theory that a source of pain and recurrent injury is inadequate neuromuscular control of the spine resulting from muscle damage, weakness, altered muscle coactivation patterns, and delayed responses. Therefore, it is necessary to determine whether stability can be improved by therapeutic exercise and determine whether neuromuscular control factors targeted by treatment contribute to stability. Specific Stabilization Exercise (SSE) involves a progression of training which initially emphasizes recruitment and coactivation of the deep muscles attached to the spine (multifidus and transverse abdominis) for local, lumbar segmental control. Later, exercises focus on recruitment of larger trunk muscles in neutral postures for trunk equilibrium control. Emerging evidence on a small cohort of patients indicates that SSE training reduces pain, improves function, and reduces the risk of low back pain recurrence up to 3 years post treatment. In the proposed investigation, 51 persons with acute, recurrent LBP who meet indications for stabilization exercise therapy will undergo 10-weeks of SSE training. Clinical outcomes (pain and function) and biomechanical measurements (local and global indices of motor control) will be evaluated at weeks 5 and 11. Statistical analyses will compare the change over time with SSE training and will compare the subjects with LBP to 51 subjects without LBP. The goal of this study is to identify local and global neuromuscular control factors that contribute to a state of potential instability in individuals with recurrent LBP. We will determine if and when SSE training improves these factors in persons with recurrent LBP. We will investigate the relationships between improvements in local and global factors of neuromuscular control and clinically important improvements in pain and functional status, The proposed study will initiate this research program and develop pilot statistics to facilitate the design of a large scale, prospective, randomized controlled trial.