@2024 Afarand., IRAN
ISSN: 2008-2630 Iranian Journal of War & Public Health 2019;11(2):85-91
ISSN: 2008-2630 Iranian Journal of War & Public Health 2019;11(2):85-91
Effect of Selective Home-Based Exercises on Chronic Low Back Pain in Unilateral Below Knee Amputees
ARTICLE INFO
Article Type
Original ResearchAuthors
Faraji E (1)Barati A.H (2)
Sadeghi H (1)
Allami M (*3)
Fateh H.R (4)
(*3) Medical Device Department, Janbazan Medical & Engineering Research Center (JMERC), Tehran, Iran
(1) Sport Injuries & Corrective Exercise Department, Physical Education & Sport Sciences Faculty, Kharazmi University, Tehran, Iran
(1) Sport Injuries & Corrective Exercise Department, Physical Education & Sport Sciences Faculty, Kharazmi University, Tehran, Iran
(2) Sport Injuries & Corrective Exercise Department, Physical Education & Sport Sciences Faculty, Shahid Beheshti University, Tehran, Iran
(4) Physical Medicine & Rehabilitation Department, Tehran University of Medical Sciences, Tehran, Iran
Correspondence
Article History
Received: November 5, 2017Accepted: December 25, 2017
ePublished: May 15, 2019
ABSTRACT
Aims
Different studies have shown different effects of exercise on low back pain. The aim of the present study was to assess the effect of selective home-based exercises on chronic low back pain in unilateral below knee amputees.
Materials & Methods In this randomized controlled clinical trial with pretest-posttest design conducted in 2016, 53 unilateral below knee amputees with chronic low back pain referred to Kowsar orthotic and prosthetic center to assess their health status were selected by random sampling method. They were randomly assigned to intervention group (n=29) and control group (n=24). An interventional exercise program for myofascial release, stretching, activation, and integration (5 days a week) was performed for the intervention group, but the intervention group did not receive any intervention. A numeric rating scale and an Oswestry Disability Index, abdominal endurance test, Modified Biering-Sørensen Test, and electromyography (EMG) signals were used to measure the effect of exercise on low back pain. The data were analyzed by SPSS software 20, using paired- samples and independent t-test.
Findings At the end of the training program in the intervention group, there was a significant decrease in pain score and disability index and a significant increase in extensor muscle endurance and flexor muscle endurance (p<0.05). The electrical activity of lumbar multifidus and elector spinae muscles activity improved in the intervention group in comparison with control group (p<0.05).
Conclusion A comprehensive program with parts of myofacial release, stretching, activation, and integration affects the low back pain in lower limb amputees.
Materials & Methods In this randomized controlled clinical trial with pretest-posttest design conducted in 2016, 53 unilateral below knee amputees with chronic low back pain referred to Kowsar orthotic and prosthetic center to assess their health status were selected by random sampling method. They were randomly assigned to intervention group (n=29) and control group (n=24). An interventional exercise program for myofascial release, stretching, activation, and integration (5 days a week) was performed for the intervention group, but the intervention group did not receive any intervention. A numeric rating scale and an Oswestry Disability Index, abdominal endurance test, Modified Biering-Sørensen Test, and electromyography (EMG) signals were used to measure the effect of exercise on low back pain. The data were analyzed by SPSS software 20, using paired- samples and independent t-test.
Findings At the end of the training program in the intervention group, there was a significant decrease in pain score and disability index and a significant increase in extensor muscle endurance and flexor muscle endurance (p<0.05). The electrical activity of lumbar multifidus and elector spinae muscles activity improved in the intervention group in comparison with control group (p<0.05).
Conclusion A comprehensive program with parts of myofacial release, stretching, activation, and integration affects the low back pain in lower limb amputees.
CITATION LINKS
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[6]Jensen MP, Smith DG, Ehde DM, Robinsin LR. Pain site and the effects of amputation pain: further clarification of the meaning of mild, moderate, and severe pain. Pain. 2001;91(3):317-22.
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[8]Friel K, Domholdt E, Smith DG. Physical and functional measures related to low back pain in individuals with lower-limb amputation: an exploratory pilot study. J Rehabil Res Dev. 2005;42(2):155-66.
[9]Schmalz T, Blumentritt S, Reimers C. Selective thigh muscle atrophy in trans-tibial amputees: an ultrasonographic study. Arch Orthop Trauma Surg. 2001;121(6):307-12.
[10]Childers WL, Kistenberg RS, Gregor RJ. The biomechanics of cycling with a transtibial amputation: Recommendations for prosthetic design and direction for future research. Prosthet Orthot Int. 2009;33(3):256-71.
[11]Silverman AK, Neptune RR. Differences in whole-body angular momentum between below-knee amputees and non-amputees across walking speeds. J Biomech. 2011;44(3):379-85.
[12]Sagawa Y, Turcot K, Armand S, Thevenon A, Vuillerme N, Watelain E. Biomechanics and physiological parameters during gait in lower-limb amputees: a systematic review. Gait Posture. 2011;33(4):511-26.
[13]Van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J. 2011;20(1):19-39.
[14]Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015;29(12):1155-67.
[15]Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord. 2014;15(1):416.
[16]Haladay DE, Miller SJ, Challis J, Denegar CR. Quality of systematic reviews on specific spinal stabilization exercise for chronic low back pain. J Orthop Sports Phys Ther. 2013;43(4):242-50.
[17]Hayden JA, Van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005;142(9):776-85.
[18]Savigny P, Kuntze S, Watson P, Underwood M, Ritchie G, Cotterell M, et al. Low back pain: early management of persistent non-specific low back pain. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners; 2009.
[19]Wong CK, Ehrlich JE, Ersing JC, Maroldi NJ, Stevenson CE, Varca MJ. Exercise programs to improve gait performance in people with lower limb amputation: a systematic review. Prosthet Orthot Int. 2016;40(1):8-17.
[20]Clark M, Lucett S. NASM essentials of corrective exercise training. Philadelphia: Lippincott Williams & Wilkins; 2010.
[21]Simpson AK, Cholewicki J, Grauer J. Chronic low back pain. Curr Pain Headache Rep. 2006;10(6):431-6.
[22]American College of Sport Medicine. ACSM’s Guidelines for exercise testing and prescription. Thompson WR, Gordon NF, Pescatello LS, editors. 8th Edition. Philadelphia: Lippincott Williams & Wilkins; 2010.
[23]Scrimshaw SV, Maher C. Responsiveness of visual analogue and McGill pain scale measures. J Manipulative Physiol Ther. 2001;24(8):501-4.
[24]Fairbank JC, Pynsent PB. The Oswestry disability index. Spine. 2000;25(22):2940-53.
[25]Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003;4(7):407-14.
[26]Fairbank J, Couper J, Davies J, O’brien J. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66(8):271-3.
[27]Moffroid MT. Endurance of trunk muscles in persons with chronic low back pain: assessment, performance, training. J Rehabil Res Dev. 1997;34(4):440-7.
[28]Claus AP, Hides JA, Moseley GL, Hodges PW. Different ways to balance the spine: subtle changes in sagittal spinal curves affect regional muscle activity. Spine. 2009;34(6):E208-14.
[29]Tsao H, Druitt TR, Schollum TM, Hodges PW. Motor training of the lumbar paraspinal muscles induces immediate changes in motor coordination in patients with recurrent low back pain. J Pain. 2010;11(11):1120-8.
[30]Johnson J. Functional rehabilitation of low back pain with core stabilizations exercises: suggestions for exercises and progressions in athletes. Utah State University. 2012.
[31]Moon HJ, Choi KH, Kim DH, Kim HJ, Cho YK, Lee KH, et al. Effect of lumbar stabilization and dynamic lumbar strengthening exercises in patients with chronic low back pain. Ann Rehabil Med. 2013;37(1):110-7.
[32]Hosseinifar M, Akbari A, Shahrakinasab A. The effects of McKenzie and lumbar stabilization exercises on the improvement of function and pain in patients with chronic low back pain: a randomized controlled trial. J Shahrekord Univ Med Sci. 2009;11(1):1-9. [Persian]
[33]Lim ECW, Poh RL, Low AY, Wong WP. Effects of Pilates-based exercises on pain and disability in individuals with persistent nonspecific low back pain: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2011;41(2):70-80.
[34]Anaforoğlu B, Erbahceci F, Aksekili MA. The effectiveness of a back school program in lower limb amputees: a randomized controlled study. Turk J Med Sci. 2016;46(4):1122-9.
[35]Nezhad Roomezi S, Rahnama N, Habibi A, Negahban H. The effect of core stability training on pain and performance in women patients with non-specific chronic low back pain. J Res Rehabil Sci. 2012;8(1):57-64. [Persian]
[36]Yaghoubi Z, Kahrizi S, Parnianpour M, Ebrahimi Takmajani E, Faghihzadeh S. The short effects of two spinal stabilization exercise on balance tests and limit of stability in men with non–specific chronic low back pain: randomized clinical trial study. J Rehabil. 2012;13(1):102-13. [Persian]
[37]Rhee HS, Kim YH, Sung PS. A randomized controlled trial to determine the effect of spinal stabilization exercise intervention based on pain level and standing balance differences in patients with low back pain. Med Sci Monit. 2012;18(3):CR174-81.
[38]Keller TS, Colloca CJ. Mechanical force spinal manipulation increases trunk muscle strength assessed by electromyography: a comparative clinical trial. J Manipulative Physiol Ther. 2000;23(9):585-95.
[39]Lewis SE, Holmes PS, Woby SR, Hindle J, Fowler NE. Short-term effect of superficial heat treatment on paraspinal muscle activity, stature recovery, and psychological factors in patients with chronic low back pain. Arch Phys Med Rehabil. 2012;93(2):367-72.
[40]Oh S, Kim M, Lee M, Lee D, Kim T, Yoon B. Self-management of myofascial trigger point release by using an inflatable ball among elderly patients with chronic low back pain: a case series. Ann Yoga Phys Ther. 2016;1(2):1013-21.
[41]Ajimsha MS, Daniel B, Chithra S. Effectiveness of myofascial release in the management of chronic low back pain in nursing professionals. J Bodyw Mov Ther. 2014;18(2):273-81.
[42]Casale R, Ceccherelli F, Labeeb AA, Biella GE. Phantom limb pain relief by contralateral myofascial injection with local anaesthetic in a placebo-controlled study: preliminary results. J Rehabil Med. 2009;41(6):418-22.
[43]Yoo S. Complications following an amputation. Phys Med Rehabil Clin N Am. 2014;25(1):169-78.
[44]Sherman KJ, Cherkin DC, Wellman RD, Cook AJ, Hawkes RJ, Delaney K, et al. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Arch Intern Med. 2011;171(22):2019-26.
[45]Tonosu J, Matsudaira K, Oka H, Okazaki H, Oshio T, Hanaoka I, et al. A population approach to analyze the effectiveness of a back extension exercise “One Stretch” in patients with low back pain: a replication study. J Orthop Sci. 2016;21(4):414-8.
[46]Gaffney BM, Murray AM, Christiansen CL, Davidson BS. Identification of trunk and pelvis movement compensations in patients with transtibial amputation using angular momentum separation. Gait posture. 2016;45:151-6.
[47]Hendershot BD, Wolf EJ. Mediolateral joint powers at the low back among persons with unilateral transfemoral amputation. Arch Phys Med Rehabil. 2015;96(1):154-7.
[48]Miyake Y, Nakamura S, Nakajima M. The effect of trunk coordination exercise on dynamic postural control using a Core Noodle. J Bodyw Mov Ther. 2014;18(4):519-25.
[49]Imai A, Kaneoka K, Okubo Y, Shiraki H. Effects of two types of trunk exercises on balance and athletic performance in youth soccer players. Int J Sports Phys Ther. 2014;9(1)47-57.
[50]Rueda FM, Diego IMA, Sánchez AM, Tejada MC, Montero FMR, Page JCM. Knee and hip internal moments and upper-body kinematics in the frontal plane in unilateral transtibial amputees. Gait Posture. 2013;37(3):436-9.
[2]Gailey R, Allen K, Castles J, Kucharik J, Roeder M. Review of secondary physical conditions associated with lower-limb amputation and long-term prosthesis use. J Rehabil Res Dev. 2008;45(1):15-29.
[3]Vonk J, Shackelford TK. The Oxford handbook of comparative evolutionary psychology. New York: Oxford University Press; 2012.
[4]Ephraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin LE. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Arch Phys Med Rehabil. 2005;86(10):1910-9.
[5]Ehde DM, Smith DG, Czerniecki JM, Campbell KM, Malchow DM, Robinson LR. Back pain as a secondary disability in persons with lower limb amputations. Arch Phys Med Rehabil. 2001;82(6):731-4.
[6]Jensen MP, Smith DG, Ehde DM, Robinsin LR. Pain site and the effects of amputation pain: further clarification of the meaning of mild, moderate, and severe pain. Pain. 2001;91(3):317-22.
[7]Morgenroth DC, Orendurff MS, Shakir A, Segal A, Shofer J, Czerniecki JM. The relationship between lumbar spine kinematics during gait and low-back pain in transfemoral amputees. Am J Phys Med Rehabil. 2010;89(8):635-43.
[8]Friel K, Domholdt E, Smith DG. Physical and functional measures related to low back pain in individuals with lower-limb amputation: an exploratory pilot study. J Rehabil Res Dev. 2005;42(2):155-66.
[9]Schmalz T, Blumentritt S, Reimers C. Selective thigh muscle atrophy in trans-tibial amputees: an ultrasonographic study. Arch Orthop Trauma Surg. 2001;121(6):307-12.
[10]Childers WL, Kistenberg RS, Gregor RJ. The biomechanics of cycling with a transtibial amputation: Recommendations for prosthetic design and direction for future research. Prosthet Orthot Int. 2009;33(3):256-71.
[11]Silverman AK, Neptune RR. Differences in whole-body angular momentum between below-knee amputees and non-amputees across walking speeds. J Biomech. 2011;44(3):379-85.
[12]Sagawa Y, Turcot K, Armand S, Thevenon A, Vuillerme N, Watelain E. Biomechanics and physiological parameters during gait in lower-limb amputees: a systematic review. Gait Posture. 2011;33(4):511-26.
[13]Van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J. 2011;20(1):19-39.
[14]Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015;29(12):1155-67.
[15]Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord. 2014;15(1):416.
[16]Haladay DE, Miller SJ, Challis J, Denegar CR. Quality of systematic reviews on specific spinal stabilization exercise for chronic low back pain. J Orthop Sports Phys Ther. 2013;43(4):242-50.
[17]Hayden JA, Van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005;142(9):776-85.
[18]Savigny P, Kuntze S, Watson P, Underwood M, Ritchie G, Cotterell M, et al. Low back pain: early management of persistent non-specific low back pain. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners; 2009.
[19]Wong CK, Ehrlich JE, Ersing JC, Maroldi NJ, Stevenson CE, Varca MJ. Exercise programs to improve gait performance in people with lower limb amputation: a systematic review. Prosthet Orthot Int. 2016;40(1):8-17.
[20]Clark M, Lucett S. NASM essentials of corrective exercise training. Philadelphia: Lippincott Williams & Wilkins; 2010.
[21]Simpson AK, Cholewicki J, Grauer J. Chronic low back pain. Curr Pain Headache Rep. 2006;10(6):431-6.
[22]American College of Sport Medicine. ACSM’s Guidelines for exercise testing and prescription. Thompson WR, Gordon NF, Pescatello LS, editors. 8th Edition. Philadelphia: Lippincott Williams & Wilkins; 2010.
[23]Scrimshaw SV, Maher C. Responsiveness of visual analogue and McGill pain scale measures. J Manipulative Physiol Ther. 2001;24(8):501-4.
[24]Fairbank JC, Pynsent PB. The Oswestry disability index. Spine. 2000;25(22):2940-53.
[25]Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003;4(7):407-14.
[26]Fairbank J, Couper J, Davies J, O’brien J. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66(8):271-3.
[27]Moffroid MT. Endurance of trunk muscles in persons with chronic low back pain: assessment, performance, training. J Rehabil Res Dev. 1997;34(4):440-7.
[28]Claus AP, Hides JA, Moseley GL, Hodges PW. Different ways to balance the spine: subtle changes in sagittal spinal curves affect regional muscle activity. Spine. 2009;34(6):E208-14.
[29]Tsao H, Druitt TR, Schollum TM, Hodges PW. Motor training of the lumbar paraspinal muscles induces immediate changes in motor coordination in patients with recurrent low back pain. J Pain. 2010;11(11):1120-8.
[30]Johnson J. Functional rehabilitation of low back pain with core stabilizations exercises: suggestions for exercises and progressions in athletes. Utah State University. 2012.
[31]Moon HJ, Choi KH, Kim DH, Kim HJ, Cho YK, Lee KH, et al. Effect of lumbar stabilization and dynamic lumbar strengthening exercises in patients with chronic low back pain. Ann Rehabil Med. 2013;37(1):110-7.
[32]Hosseinifar M, Akbari A, Shahrakinasab A. The effects of McKenzie and lumbar stabilization exercises on the improvement of function and pain in patients with chronic low back pain: a randomized controlled trial. J Shahrekord Univ Med Sci. 2009;11(1):1-9. [Persian]
[33]Lim ECW, Poh RL, Low AY, Wong WP. Effects of Pilates-based exercises on pain and disability in individuals with persistent nonspecific low back pain: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2011;41(2):70-80.
[34]Anaforoğlu B, Erbahceci F, Aksekili MA. The effectiveness of a back school program in lower limb amputees: a randomized controlled study. Turk J Med Sci. 2016;46(4):1122-9.
[35]Nezhad Roomezi S, Rahnama N, Habibi A, Negahban H. The effect of core stability training on pain and performance in women patients with non-specific chronic low back pain. J Res Rehabil Sci. 2012;8(1):57-64. [Persian]
[36]Yaghoubi Z, Kahrizi S, Parnianpour M, Ebrahimi Takmajani E, Faghihzadeh S. The short effects of two spinal stabilization exercise on balance tests and limit of stability in men with non–specific chronic low back pain: randomized clinical trial study. J Rehabil. 2012;13(1):102-13. [Persian]
[37]Rhee HS, Kim YH, Sung PS. A randomized controlled trial to determine the effect of spinal stabilization exercise intervention based on pain level and standing balance differences in patients with low back pain. Med Sci Monit. 2012;18(3):CR174-81.
[38]Keller TS, Colloca CJ. Mechanical force spinal manipulation increases trunk muscle strength assessed by electromyography: a comparative clinical trial. J Manipulative Physiol Ther. 2000;23(9):585-95.
[39]Lewis SE, Holmes PS, Woby SR, Hindle J, Fowler NE. Short-term effect of superficial heat treatment on paraspinal muscle activity, stature recovery, and psychological factors in patients with chronic low back pain. Arch Phys Med Rehabil. 2012;93(2):367-72.
[40]Oh S, Kim M, Lee M, Lee D, Kim T, Yoon B. Self-management of myofascial trigger point release by using an inflatable ball among elderly patients with chronic low back pain: a case series. Ann Yoga Phys Ther. 2016;1(2):1013-21.
[41]Ajimsha MS, Daniel B, Chithra S. Effectiveness of myofascial release in the management of chronic low back pain in nursing professionals. J Bodyw Mov Ther. 2014;18(2):273-81.
[42]Casale R, Ceccherelli F, Labeeb AA, Biella GE. Phantom limb pain relief by contralateral myofascial injection with local anaesthetic in a placebo-controlled study: preliminary results. J Rehabil Med. 2009;41(6):418-22.
[43]Yoo S. Complications following an amputation. Phys Med Rehabil Clin N Am. 2014;25(1):169-78.
[44]Sherman KJ, Cherkin DC, Wellman RD, Cook AJ, Hawkes RJ, Delaney K, et al. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Arch Intern Med. 2011;171(22):2019-26.
[45]Tonosu J, Matsudaira K, Oka H, Okazaki H, Oshio T, Hanaoka I, et al. A population approach to analyze the effectiveness of a back extension exercise “One Stretch” in patients with low back pain: a replication study. J Orthop Sci. 2016;21(4):414-8.
[46]Gaffney BM, Murray AM, Christiansen CL, Davidson BS. Identification of trunk and pelvis movement compensations in patients with transtibial amputation using angular momentum separation. Gait posture. 2016;45:151-6.
[47]Hendershot BD, Wolf EJ. Mediolateral joint powers at the low back among persons with unilateral transfemoral amputation. Arch Phys Med Rehabil. 2015;96(1):154-7.
[48]Miyake Y, Nakamura S, Nakajima M. The effect of trunk coordination exercise on dynamic postural control using a Core Noodle. J Bodyw Mov Ther. 2014;18(4):519-25.
[49]Imai A, Kaneoka K, Okubo Y, Shiraki H. Effects of two types of trunk exercises on balance and athletic performance in youth soccer players. Int J Sports Phys Ther. 2014;9(1)47-57.
[50]Rueda FM, Diego IMA, Sánchez AM, Tejada MC, Montero FMR, Page JCM. Knee and hip internal moments and upper-body kinematics in the frontal plane in unilateral transtibial amputees. Gait Posture. 2013;37(3):436-9.