Shih Y-F1, Huang W-H1
1National Yang-Ming University, Physical Therapy and Assistive Technology, Taipei, Taiwan
Background: Low back pain (LBP) is a prevalent musculoskeletal disorder, and many LBP patients are accompanied by functional leg length inequality (FLLI). Some authors suggested that poor gluteal control ability might contribute to pelvis malalignment and lead to FLLI related LBP. But no study has examined the effects of hip control training in LBP patients with FLLI.
Purpose: This study aimed to investigate the effect of additional gluteal control training on FLLI, the symmetry of pelvic alignment, hip control ability, pain, and disability in the LBP patients with FLLI.
Methods: We recruited 48 LBP patients with FLLI and randomized them into the additional gluteal control training group (GT) (experimental group, 10 males and 14 females, 47.58±9.42 years, n=24) or the regular training group (RT) (control group, 11 males and 13 females, 47.38±11.31 years, n=24). Both groups received general physical therapy for 6 weeks, and GT group received additional gluteal control training. The primary outcomes were pelvic inclination (PI) (degree), ilium anterior tilt difference (IATD) (degree), and functional leg length inequality (FLLI) (centimeter). And the secondary outcome measures were visual analogue scale (VAS), patient specific-functional scale (PSFS), Oswestry disability index (ODI), hip control ability, global rating of change scale (GRoC), lower extremity strength (kilogram) and lower extremity flexibility (degree). Comparisons of all continuous variables were performed using the two-way repeated measures analysis of variance (ANOVA). The significance level was set at 0.05. This study was approved by the Institutional Review Board of National Yang-Ming University (YM106055F).
Results: The GT group showed bigger improvement in PI (1.03±0.37 v.s 1.56±0.51, time by group effect: p 0.001) (degree), IATD (0.67±0.65 vs. 2.27±0.65, time by group effect: p=0.002) (degree), FLLI (0.3±0.21 vs. 0.58±0.13, time by group effect: p 0.001) (centimeter), VAS (1.30±1.21 vs. 3.44±1.06, time by group effect: p 0.001), hip control ability (0.85±0.67 vs. 2.14±0.64, time by group effect: p 0.001), GRoC (3-week: p=0.005; 6-week: 0.02) as compare to the RT group. The GT group also had greater improvement in lower extremity strength (hip extensors (11.57±2.25 vs. 10.12±3.12, time by group effect: p=0.036), hip abductors (10.26±2.20 vs. 8.72±2.08, time by group effect: p 0.001), and hip adductors (9.36±2.12 vs. 8.21±2.19, time by group effect: p=0.76) and flexibilities (hamstring (46.64±4.64 vs. 47.49±6.00, time by group effect: p=0.035), iliotibial band (16.66±2.59 vs. 12.71±2.66, time by group effect: p=0.004) and rectus femoris (45.30±7.20 vs. 39.22±6.57, time by group effect: p=0.029) as compared to the RT group after 6-week intervention.
Conclusion(s): Additional gluteal control training was effective in improving pelvic alignment, pain intensity, functional disability, lower extremity strength (hip extensors, hip abductors, and hip adductors) and lower extremity flexibility in the LBP patients with FLLI.
Implications: Clinicians should consider integrating gluteal control training into the intervention program for patients with LBP combined with FLLI.
Keywords: Functional leg length, back pain, pelvis malaignmet
Funding acknowledgements: This study was in part supported by Ministry of Science and Technology, Taiwan (MOST 106-2410-H-010-012-MY2).
Purpose: This study aimed to investigate the effect of additional gluteal control training on FLLI, the symmetry of pelvic alignment, hip control ability, pain, and disability in the LBP patients with FLLI.
Methods: We recruited 48 LBP patients with FLLI and randomized them into the additional gluteal control training group (GT) (experimental group, 10 males and 14 females, 47.58±9.42 years, n=24) or the regular training group (RT) (control group, 11 males and 13 females, 47.38±11.31 years, n=24). Both groups received general physical therapy for 6 weeks, and GT group received additional gluteal control training. The primary outcomes were pelvic inclination (PI) (degree), ilium anterior tilt difference (IATD) (degree), and functional leg length inequality (FLLI) (centimeter). And the secondary outcome measures were visual analogue scale (VAS), patient specific-functional scale (PSFS), Oswestry disability index (ODI), hip control ability, global rating of change scale (GRoC), lower extremity strength (kilogram) and lower extremity flexibility (degree). Comparisons of all continuous variables were performed using the two-way repeated measures analysis of variance (ANOVA). The significance level was set at 0.05. This study was approved by the Institutional Review Board of National Yang-Ming University (YM106055F).
Results: The GT group showed bigger improvement in PI (1.03±0.37 v.s 1.56±0.51, time by group effect: p 0.001) (degree), IATD (0.67±0.65 vs. 2.27±0.65, time by group effect: p=0.002) (degree), FLLI (0.3±0.21 vs. 0.58±0.13, time by group effect: p 0.001) (centimeter), VAS (1.30±1.21 vs. 3.44±1.06, time by group effect: p 0.001), hip control ability (0.85±0.67 vs. 2.14±0.64, time by group effect: p 0.001), GRoC (3-week: p=0.005; 6-week: 0.02) as compare to the RT group. The GT group also had greater improvement in lower extremity strength (hip extensors (11.57±2.25 vs. 10.12±3.12, time by group effect: p=0.036), hip abductors (10.26±2.20 vs. 8.72±2.08, time by group effect: p 0.001), and hip adductors (9.36±2.12 vs. 8.21±2.19, time by group effect: p=0.76) and flexibilities (hamstring (46.64±4.64 vs. 47.49±6.00, time by group effect: p=0.035), iliotibial band (16.66±2.59 vs. 12.71±2.66, time by group effect: p=0.004) and rectus femoris (45.30±7.20 vs. 39.22±6.57, time by group effect: p=0.029) as compared to the RT group after 6-week intervention.
Conclusion(s): Additional gluteal control training was effective in improving pelvic alignment, pain intensity, functional disability, lower extremity strength (hip extensors, hip abductors, and hip adductors) and lower extremity flexibility in the LBP patients with FLLI.
Implications: Clinicians should consider integrating gluteal control training into the intervention program for patients with LBP combined with FLLI.
Keywords: Functional leg length, back pain, pelvis malaignmet
Funding acknowledgements: This study was in part supported by Ministry of Science and Technology, Taiwan (MOST 106-2410-H-010-012-MY2).
Topic: Musculoskeletal: spine
Ethics approval required: Yes
Institution: National Yang-Ming University, Taipei, Taiwan
Ethics committee: Institutional Review Board
Ethics number: YM106055F
All authors, affiliations and abstracts have been published as submitted.
