@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2017;23(1):13-19

Background
The annual incidence of back pain in 50% of adults is in career age [1, 2].
Previous Studies
… [3-24]. Evidence of stabilization exercise in the treatment of chronic non-specific low back pain is plentiful but disputed because it is still no general agreement over their superiority over other treatments in the short and long term effects. It should be noted that most studies have been accompanied with other interventions (such as manual treatments especially massage). This suggests that combined therapy is more effective than treatment with stabilization exercise alone [25].
Aim(s)
The aim of this study was to compare the short-term effects of massage therapy, core stability exercise and combined method on limits of stability in patients with chronic non-specific low back pain.
Research type
This study is semi-experimental with pretest and posttest design.
Research society, place and time
This study was conducted in 2013 on 30 male patients with chronic non-specific low back pain referred to physiotherapy clinics of 1 and 3 districts of Tehran City.
Sampling method and number
30 male patients with chronic non-specific low back pain were selected randomly. Inclusion criteria included male gender, age range 20 to 50 years, suffering from chronic low back pain and enjoyment of general health. Also, numbness, decreased muscle strength or possibility of urinary incontinence that imply cauda equina syndrome, history of surgery of the spine and herniated disc, pain in the spine with fever and chills, morning stiffness, etc. that indicate infectious spondylopyosis, or inflammatory diseases, compression fracture due to osteoporosis, stenosis or spondylolisthesis, a fracture in the spine, pelvis and lower extremities which indicate the presence of osteoporosis or other diseases, a history of neuromuscular diseases and disorders of the vestibular system, a history of dizziness and the consumption of drugs with known effects on balance, spine and lower extremity malfunctions, malignancies, arthritis, and other infectious, systematic and metabolic diseases [24], and lack of physical activities were considered as exclusion criteria. Subjects were randomly assigned into three groups of massage therapy, core stability exercises, and combinational method.
Used devices&materials
In order to assess the optimal spatial and temporal dynamic postural control of each of the subjects, Limits-of-Stability Test on the force place device version 6.11. (Nerocom; United States) was used. In this test, the variables: 1) Reaction Time (RT): The time between the first command to move and the first movement of the patient in seconds, 2) Movement Velocity (MV): Average speed of movement of the center of gravity in degrees per second, 3) The Maximum Flow (MF): The maximum distance achieved during the test, and 4) Endpoint of Excursion (EPE): The distance of the first move toward the determined target that is considered as a percentage of the maximum distance, were evaluated in eight directions of anterior (1), right anterior (2), right lateral (3), right posterior (4), posterior (5), left posterior (6), left lateral (7), and left anterior (8)by the device. Subjects were randomly assigned into three groups of massage therapy, core stability exercises, and combined method. Massage therapy group received 12 15-minute sessions (4 weeks in form of every other day) of surface stroking, deep stroking, kneading and friction (each for 3 minutes) under the supervision of the researcher and a therapist [28]. All the techniques applied in the therapy group were in the lumbar region. Core stability exercise group received 12 sessions (4 weeks every other day) of the selective core exercises under the supervision of the therapist. The exercises have been designed into two parts (including warm-up and the main exercises). Before the main exercises, patients were doing warm-up exercises in order to prepare muscles for working out the other exercises. The total duration of training sessions were from 20 to 73 minutes. The total duration of training sessions was obtained from adding the duration of preservation of shrinkage or stretching to resting time. Combinational method group received 15-minute 12 sessions (4 weeks every other day) of massage therapy and core stability training protocols. The warm up exercises and the main exercises for both core stability exercises group and combinational method group were the same. During the study, the patients were asked to refrain from using drugs and other therapeutic interventions. Data were analyzed by SPSS 16 software. Shapiro-Wilk test was used to determine the normality distribution of the data. In order to evaluate the results before and after the test, and to compare the between groups comparison among the three groups, ANCOVA test was used.
Findings by Text
Subject had the mean age 33.44±9.02 years, mean weight 84.33±11.70 kg, mean height 177.00±4.40 cm, and mean body mass index of 26.58±2.75 kg per square meter. After applying any of the intervention, significant difference was observed between the groups in RT variable in the directions 3 (right lateral), and 8 (left anterior) (p<0.05; Figure 1). Also, after intervention, significant difference was obtained in amount of MV in direction 2 (right anterior) between only the two groups of core stability and combinational method exercises (p<0.05) i.e. the combined method had more improvement in MV compared with the core stability method (Figure 2). After intervention, only in Direction ME7 and between the two core stability exercises group and combined method group, there was a significant difference (p<0.05; Figure 3) that is core exercises caused more improvement in ME variable compared to the combined exercises. However, with respect to EPE variable in different directions, no significant difference was observed between the two groups (p<0.05; Figure 3).
Main comparison to the similar studies
The results of this study are in line with the results of systematic review of May and Johnson. They stated that in most studies, stabilization exercises were accompanied with other interventions such as manual intervention with or without recommendation, and only 4 studies used the stability exercises as the only therapy. Two of the studies clearly support core stability exercises and a study reported a significant difference between the two groups [25]. … [26-31].
Suggestions
It is suggested that a research be conducted in line with this study using other treatment methods in patients with acute and sub-acute back pain in different age of groups. On the other hand, since the assessment of balance parameters are considered as a criterion for the whole body operation, it is recommended that assessing the balance parameters of these patients be considered.
Limitations
lack of study on the effects of mental-psychological, economic and other factors on the variables of the study, and lack of control on the environmental factors such as nutrition pattern, rest and activity level of patient’s job were the limitations of this study.
Conclusions
Running each of the methods of massage therapy, core stability exercises and combined exercises in short-term (4 weeks) improve postural balance and improve the time and percentage of performance for the limit of stability in patients with chronic non-specific low back pain that the effect of combined therapy in improving the limit of stability in these patients is more than the other two methods.
Acknowledgments
All the participants of the study are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
The authors observed all ethical issues related to research on the human subjects.
Funding Sources
The study has been conducted without taking financial assistance from any organization and institutions.

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