Rhythic stabilization versus combination of isotonics after 4-12 weeks physical exercise program in subjects with subacute and cronic low back pain

Introduction
Proprioceptive Neuromuscular facilitation (P.N.F.) exercises are designed to promote the neuromuscular response of the proprioceptors. P.N.F. patterns have a spiral, diagonal direction and are in line with the topographical arrangement of the muscles. P.N.F. therefore is commonly used, as an alternative form of progressive resistive exercise by physical therapist since its use should be more advantageous than the usual strength programs in athletic injury rehabilitation (Kofotolis et al. 2002, 2003). The purpose of this study was to asses, in subjects with low back pain, the changes and their permanence in muscular performance after a 4-12 weeks physical exercise program.

Methods

Sixty women with subacute and chronic low back pain (39.4±7.4yrs) participated on the experiment. The study design was carried out in five groups: 1) 4 weeks of rhythmic stabilization training (RS1) (6 days a week, n=13), 2) 4 weeks of combination of isotonics training (CI1) (6 days a week, n=13), 3) 12 weeks of rhythmic stabilization training (RS2) (2 days a week, n=12), 4) 12 weeks of combination of isotonics training (CI2) (2 days a week, n=13), and control (C) study, (n=9). RS training program consisted of alternating isometric contraction against resistance 5 sec, no motions intended and CI program consisted of alternating concentric, eccentric, static contraction of agonists without relaxation using the same principles used the rhythmic stabilization program. The intensity of the symptoms was evaluated with the Borg scale (0-11 maximal). The degree of functional impairment was assessed (%/100) with the Oswestry Low Back Pain Disability Questionnaire. Moreover, for the sample evaluation and the data collections were used: goniometer, hand stopwatches, a tape measure and platform of the steps. Flexibility, dynamic and static endurance of the trunk (flexion-extension) was measured, at the beginning of the study and after exercise program.

Results
Flexibility of the trunk flexion-extension of the exercise groups (RS1 & RS2) similarly increased significantly (p<0.000, p<0.000) at test occasion. The gains in flexibility of the exercise groups (CI1 & CI2) in the different measurements from 1.5% to 10.8% (p<0.032, p<0.001). Correlation was found between back pain intensity and the range of motion (CI1 extension p<0.031, CC2 flexion p<0.05). There was no significant change in the muscular performance of the control group. The muscular performance of the exercise groups (RS1, RS2, CI1 & CI2) similarly increased significantly (abdominal dynamic endurance, p<0.000, p<0.001, p<0.000 & p<0.007) at test occasion The gains in dynamic endurance increase in the different measurements from 11% to 50%. Extensor dynamic endurance, p<0.000, p<0.003, p<0.000 & p<0.000) at test occasion. The gains in dynamic endurance increase in the different measurements from 12.9% to 51.8%. The muscular performance of the exercise groups (RS1, RS2, CI1 & CI2) similarly increased significantly (abdominal static endurance, p<0.000, p<0.001, p<0.000 & p<0.000) at test occasion. The gains in dynamic endurance increase in the different measurements from 9.3% to 39.2%. Extensor static endurance, p<0.000, p<0.000, p<0.000 & p<0.000) at test occasion. The gains in static endurance increase in the different measurements from 16.8% to 69.5%. Back pain intensity was light or moderate among all the subjects and there were no differences between the study groups at the initial measurement session. Back pain intensity was found to decrease significantly (p<0.001, p<0.000, p<0.004 & p<0.002) of the exercises group. Functional disability (Oswestry Index) was also low (under 18.5%), and it decreased significantly (p<0.000, p<0.000, p<0.001 & p<0.001) for the RS1, RS2, CI1 and CI2 groups. No correlation was found between back pain intensity and the Oswestry Index. The muscle tests did not correlate with back pain intensity, test pain intensity, or with the Oswestry Index.

Conclusions

In conclusion, positive improvement of muscle performance was achieved with the 4-12 weeks rhythmic stabilisation and combination of isotonics, and these changes ranged from 10% to 70%. Back pain intensity and functional disability also decreased significantly. This study should especially help physiotherapeutic outpatient programs in planning the patient selection criteria, the content, and the outcomes and in realizing the feasibility of the activity based rehabilitation programs.

References

[1]. Kofotolis N. & et al. (2002). Journal of Human Movement Studies, 42, 155-165.
[2]. Kofotolis N. et al. (2003). Proceedings of the European Congress of