Effects and Mechanisms of Specific Trunk Exercises in Low Back Pain

NCT01611792 | Completed Results

• 1 other identifier: NIH/NCMRR/R01-HD040909
• Study Type: interventional
• Target: 58
• Locations: 1 country
• Sites: 1

Brief Summary

Low back pain affects 80% of Americans at some time during their lives. Although recovery usually occurs within 6 months, there is a 50% recurrence within one year's time. It has long been thought that poor control of trunk muscle may lead to abnormal forces across the spine, which then damage local spinal structures, thus, leading to low back pain. However, the investigators know little about the function of specific trunk muscles in healthy subjects during various activities of daily life. Furthermore, the precise muscle dysfunction associated with low back pain has not been well characterized at all. In addition, the investigators know little about which exercise protocol is most beneficial for particular subgroups of people with low back pain. Thus, the purposes of this study are to learn more about: 1) how trunk muscles are affected by low back pain; 2) which exercises might be most beneficial for people with certain kinds of low back pain; and 3) how these exercises influence trunk muscle function. By having a better understanding of which trunk muscles are affected by low back pain, rehabilitation specialists can design exercise programs and therapeutic interventions that are more specific and more effective.

Conditions

Low Back Pain

Keywords

Stabilization exercise; Strength and conditioning exercise; Physical therapy; Rehabilitation

Outcome Measures

Primary Outcomes (6)

• Change From Baseline to 11 Weeks in Oswestry Disability Scale (0-100%)

  Disability; Scale 0-100% Lower score is considered better/improved Negative value indicates improvement

  Baseline and 11 weeks

• Change From Baseline to 6 Months in Oswestry Disability Scale (0-100%)

  Disability; Sacle 0-100% Lower score is considered better/improved; Negative value indicates improvement

  Baseline and 6 Months

• Change From 11 Weeks to 6 Months in Oswestry Disability Scale (0-100%)

  Disability; Sacle 0-100% Lower score is considered better/improved; Negative value indicates improvement

  11 Weeks and 6 Months

• Change From Baseline to 11 Weeks in Numeric Pain Rating Scale (0-10 Points)

  Current Pain Scale 0-10 Lower score is better/improved; Negative value indicates improvement

  Baseline and 11 weeks

• Change From Baseline to 6 Months in Numeric Pain Rating Scale (0-10 Points)

  Current Pain Scale 0-10 Lower score is better/improved; Negative value indicates improvement

  Baseline and 6 months

• Change From 11 Weeks to 6 Months in Numeric Pain Rating Scale (0-10 Points)

  Current Pain Scale 0-10 Lower score is better/improved; Negative value indicates improvement

  11 weeks and 6 months

Study Arms (2)

Stabilization

EXPERIMENTAL

Other: Stabilization exercise protocol

Strengthening and Conditioning

ACTIVE COMPARATOR

Other: Strength and conditioning exercise protocol

Interventions

Stabilization exercise protocol OTHER

The stabilization exercise protocol consists of exercises focused on improving the ability of trunk muscles to stabilize the spine, beginning with training to isolate the deeper abdominal muscles as well as deep dorsal trunk muscles. Then patients were progressed to exercises that added leverage of the limbs while maintaining the co-contraction of the deeper abdominal muscles and deep dorsal trunk muscles while breathing normally. Various positions (e.g., supine and quadruped positions) were used to challenge the patients based on their tolerance. Finally, patients were progressed to exercises in more functional positions that included tasks/activities that were reported as challenging and/or painful; patients performed the tasks at the speed demanded by the particular task. Maintenance of the co-contraction of deep trunk muscles was emphasized during these functional activities.

Also known as: Trunk stabilization exercises, Segmental stabilization exercises

Stabilization

Strength and conditioning exercise protocol OTHER

This protocol contained trunk strengthening and endurance exercises. It consisted of 3 phases: 1) initial strengthening of trunk flexors/extensors in single plane movements, 2) trunk and lower-extremity stretching as well as progression of trunk-strengthening exercises to include multi-planar trunk movements. Aerobic exercises were progressed as tolerated and patient education about body biomechanics were reinforced, and 3) trunk-strengthening exercises under dynamic conditions (e.g., unstable support surface and in multi-planar trunk movements). During the 10 week protocol, exercises became more challenging, and each subject had to complete at least the first phase before moving onto the next phase in order to be included in post-testing analyses. There was no specific focus on the deep abdominal or deep dorsal trunk muscles during any of these exercises.

Also known as: General trunk exercise, General strength training

Strengthening and Conditioning

Eligibility Criteria

• Age: 21 Years - 55 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• a history of chronic LBP with or without recurrences for a minimum of 12 months
• between 21 - 55 years of age
• able to stand and walk without assistance
• have an Oswestry Disability Score of 19% or higher

You may not qualify if:

• any major structural spinal deformity including scoliosis, kyphosis, or stenosis
• spinal fracture or dislocation
• osteoporosis
• ankylosing spondylitis
• rheumatoid arthritis
• disc herniation with corroborating clinical signs and symptoms
• serious spinal complications such as tumor or infection
• previous spinal surgery
• frank neurological loss, i.e., weakness and sensory loss
• pain or paresthesia below the knee
• etiology of LBP other than the lumbar spine, e.g., hip joint
• history of neurological disease which required hospitalization
• active treatment for cancer
• history of unresolved cancer
• pregnancy or less than 6 months post-partum or less than 6 months post weaning

Sponsors & Collaborators

• University of Vermont: lead
• Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): collaborator

Study Sites (1)

Human Motion Analysis Laboratory

Burlington, Vermont, 05405, United States

Location

Related Publications (11)

• Jones SL, Henry SM, Raasch CC, Hitt JR, Bunn JY. Individuals with non-specific low back pain use a trunk stiffening strategy to maintain upright posture. J Electromyogr Kinesiol. 2012 Feb;22(1):13-20. doi: 10.1016/j.jelekin.2011.10.006. Epub 2011 Nov 18.

  PMID: 22100719 BACKGROUND

• Jacobs JV, Henry SM, Jones SL, Hitt JR, Bunn JY. A history of low back pain associates with altered electromyographic activation patterns in response to perturbations of standing balance. J Neurophysiol. 2011 Nov;106(5):2506-14. doi: 10.1152/jn.00296.2011. Epub 2011 Jul 27.

  PMID: 21795622 BACKGROUND

• Stokes IA, Gardner-Morse MG, Henry SM. Abdominal muscle activation increases lumbar spinal stability: analysis of contributions of different muscle groups. Clin Biomech (Bristol). 2011 Oct;26(8):797-803. doi: 10.1016/j.clinbiomech.2011.04.006. Epub 2011 May 14.

  PMID: 21571410 BACKGROUND

• Stokes IA, Gardner-Morse MG, Henry SM. Intra-abdominal pressure and abdominal wall muscular function: Spinal unloading mechanism. Clin Biomech (Bristol). 2010 Nov;25(9):859-66. doi: 10.1016/j.clinbiomech.2010.06.018. Epub 2010 Jul 23.

  PMID: 20655636 BACKGROUND

• Jones SL, Henry SM, Raasch CC, Hitt JR, Bunn JY. Responses to multi-directional surface translations involve redistribution of proximal versus distal strategies to maintain upright posture. Exp Brain Res. 2008 May;187(3):407-17. doi: 10.1007/s00221-008-1312-1. Epub 2008 Feb 26.

  PMID: 18299821 BACKGROUND

• Teyhen DS, Gill NW, Whittaker JL, Henry SM, Hides JA, Hodges P. Rehabilitative ultrasound imaging of the abdominal muscles. J Orthop Sports Phys Ther. 2007 Aug;37(8):450-66. doi: 10.2519/jospt.2007.2558.

  PMID: 17877281 BACKGROUND

• Henry SM, Teyhen DS. Ultrasound imaging as a feedback tool in the rehabilitation of trunk muscle dysfunction for people with low back pain. J Orthop Sports Phys Ther. 2007 Oct;37(10):627-34. doi: 10.2519/jospt.2007.2555.

  PMID: 17970410 BACKGROUND

• Anderson-Worth SG, Henry SM, Bunn JY. Use of real time ultrasound feedback enhances learning the abdominal hollowing exercise in patients with low back pain. New Zealand J Physiotherapy. 35(1):4-11, 2007.

  BACKGROUND

• Henry SM, Hitt JR, Jones SL, Bunn JY. Decreased limits of stability in response to postural perturbations in subjects with low back pain. Clin Biomech (Bristol). 2006 Nov;21(9):881-92. doi: 10.1016/j.clinbiomech.2006.04.016. Epub 2006 Jun 27.

  PMID: 16806618 BACKGROUND

• Henry SM, Westervelt KC. The use of real-time ultrasound feedback in teaching abdominal hollowing exercises to healthy subjects. J Orthop Sports Phys Ther. 2005 Jun;35(6):338-45. doi: 10.2519/jospt.2005.35.6.338.

  PMID: 16001905 BACKGROUND

• Lomond KV, Henry SM, Hitt JR, DeSarno MJ, Bunn JY. Altered postural responses persist following physical therapy of general versus specific trunk exercises in people with low back pain. Man Ther. 2014 Oct;19(5):425-32. doi: 10.1016/j.math.2014.04.007. Epub 2014 Apr 24.

  PMID: 24853255 BACKGROUND

MeSH Terms

Conditions

Low Back Pain

Condition Hierarchy (Ancestors)

Back Pain; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Results Point of Contact

• Title: Dr. Sharon M. Henry
• Organization: University of Vermont Medical Center, Burlington, VT

Sharon.Henry@uvm.edu

802 847-6733

Study Officials

• Sharon M Henry, PT, PhD

  University of Vermont

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, INVESTIGATOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: June 1, 2012
• First Posted: June 5, 2012
• Study Start: March 1, 2003
• Primary Completion: June 1, 2008
• Study Completion: June 1, 2008
• Last Updated: October 18, 2017
• Results First Posted: August 21, 2017

Record last verified: 2017-10

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)