CORE STABILIZATION EXERCISE ON PAIN, DISABILITY AND SELECTED PULMONARY FUNCTION [FEV1 AND PEFR] IN PATIENTS WITH CHRONIC LOW BACK PAIN

L.R. Antony Soundararajan¹, A. Irani², B. NG³, S. Mannickal Thankappan⁴, T. J Palekar⁵

Background: Delayed muscle recruitment patterns, impaired local trunk muscle activation and reduced stability of the spine in LBP patients may cause motor control dysfunction and may affect forceful expiration. In our previous research we reported significant reduction of pulmonary function (FEV1 and PEFR) in chronic LBP (cLBP) patients. Research guidelines recommend core stabilization exercise (CSE) as a commonly used treatment strategy for cLBP. CSE involves activation and training of deep core muscles, namely transversus abdominis (TrA) and lumbar multifidus (LM), with minimal activity of the superficial muscles. TrA and LM plays a major role in stabilizing the lumbar region which in-turn improves the forceful expiration. However, to our knowledge, the role of CSE as an active treatment in increasing the reduced pulmonary function especially in cLBP patients has never been explored.

Purpose: This study aimed to examine the effect of CSE on selected pulmonary function parameters (FEV1 and PEFR), pain intensity, and functional disability in cLBP patients. We hypothesized that CSE might be an appropriate therapeutic exercise to improve the pulmonary function as well as to reduce pain and improve function.

Methods: Eighty-one patients aged between 20 to 60 with cLBP (LBP > 3 months duration) were selected. Participants were randomly allocated into CSE group (n=42) and a Routine Physiotherapy [RPT] group (n=39). RPT received electrotherapy [Ultrasound and TENS] and back exercises. Outcome measures included pain intensity [Visual Analogue Scale-VAS], Disability [Roland Morris Disability Questionnaire-RMDQ] and the pulmonary function [FEV1 and PEFR]. Pulmonary function was measured by Spirometer [Welch Allyn – Schiller (SP-1)]. Measures were taken at baseline and at the end 3rd, 6th and 9th weeks of intervention. Ultrasound and TENS were given to reduce pain before exercises in RPT. Both CSE and RPT patients did a different set of 12 exercises with 10 repetitions each, 3 sessions per week for 9 weeks duration was done.

Results: Mean age, weight and height of the patients were 36.61±7.2years, 63.11±8.3kg and 158.29±9.3cm respectively and both the groups were identical. CSE group in comparison to the RPT group had significant improvement in FEV1 at 3rd(p=0.052), 6th(p=0.041) and 9th(p<0.001) week of intervention with the effect size 0.742, 0.814 and 1.284 respectively. Similarly, PEFR also had significant improvement at 3rd(p=0.048), 6th(p=0.051) and 9th(p<0.001) week of intervention with the effect size 0.664, 0.786 and 1.118 respectively. In addition, CSE group had significantly reduced pain and disability also in the said interval than the control group.

Conclusion(s): We conclude that core stabilization exercise not only decreases the pain intensity and functional disability but also it helps to improve FEV1 and PEFR. This may be due to the active recruitment of the abdominal muscle and by dynamic stabilizing of the spine by multifidus during forced expiration. A limitation of this study was that muscle activity using electromyography (EMG) was not assessed directly.

Implications: The findings demonstrated that CSE are more suitable for patients with cLBP than RPT treatment in improving the impaired pulmonary function besides reducing the pain and improving the function and thus helps clinicians to decide better clinical practice.

Funding, acknowledgements: There is no funding agency for this research.

Keywords: Core stabilization exercises, Pulmonary function, Chronic Low back pain

Topic: Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: MIP College of Physiotherapy, Latur

Committee: Institutional Research Committee

Ethics number: MIP-543/239