About
Scope & Aims
Editorial office
Editorial board
Ethical standards and procedures
Abstracting and indexing
Contact
Articles & Issues
Current issue
Articles in press
Archive
For Authors
General rules
Ethics in publishing
Guide for authors
Templates
Publication charge
For Reviewers
Our reviewers
Ethics in publishing
Guide for reviewers
Books and Events
Books
Events
ORIGINAL PAPER
Effect of core stabilization exercises on lumbar lordotic angle in patients with lumbar disc degeneration
1
Physical Therapy Department, Kasr Alainy Hospital, Cairo, Egypt
2
Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
3
Radiology Department, Faculty of Medicine, Cairo University, Giza, Egypt
Submission date: 2020-09-29
Acceptance date: 2020-12-02
Publication date: 2022-12-19
Physiother Quart. 2022;30(4):87-95
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Although core stabilization exercises (CSEs) prove to be effective in patients with various musculoskeletal disorders, their impact in lumbar disc degeneration (LDD) has not been fully investigated. This study aimed to examine the effects of CSEs on lumbar lordotic angle (LLA), pain intensity, and functional disability in patients with LDD.
Methods:
Overall, 97 adult patients of both genders with LDD were randomly assigned to the study or control group. The study group (n = 48) received CSEs in addition to traditional physical therapy; the control group (n = 49) received only traditional physical therapy, 3 sessions per week for 12 weeks. LLA, pain intensity, and functional disability were determined before and after the treatment program. LLA was measured with the Surgimap Spine software on marked lateral view X-ray films (OmniDiagnost Eleva); pain intensity was evaluated with visual analogue scale (VAS); functional disability was assessed with Oswestry Disability Index (ODI).
Results:
There was no significant pre-treatment difference between the groups in LLA (p = 0.84), VAS (p = 0.49), or ODI (p = 0.12). Significant post-treatment differences were observed in both groups in all variables (p = 0.001). However, there was a significant decrease in the mean post-treatment values of all variables (p = 0.001) in the study group compared with the control group.
Conclusions:
CSEs could provide an additional effect of improving LLA, pain intensity, and functional abilities in patients with LDD.
Although core stabilization exercises (CSEs) prove to be effective in patients with various musculoskeletal disorders, their impact in lumbar disc degeneration (LDD) has not been fully investigated. This study aimed to examine the effects of CSEs on lumbar lordotic angle (LLA), pain intensity, and functional disability in patients with LDD.
Methods:
Overall, 97 adult patients of both genders with LDD were randomly assigned to the study or control group. The study group (n = 48) received CSEs in addition to traditional physical therapy; the control group (n = 49) received only traditional physical therapy, 3 sessions per week for 12 weeks. LLA, pain intensity, and functional disability were determined before and after the treatment program. LLA was measured with the Surgimap Spine software on marked lateral view X-ray films (OmniDiagnost Eleva); pain intensity was evaluated with visual analogue scale (VAS); functional disability was assessed with Oswestry Disability Index (ODI).
Results:
There was no significant pre-treatment difference between the groups in LLA (p = 0.84), VAS (p = 0.49), or ODI (p = 0.12). Significant post-treatment differences were observed in both groups in all variables (p = 0.001). However, there was a significant decrease in the mean post-treatment values of all variables (p = 0.001) in the study group compared with the control group.
Conclusions:
CSEs could provide an additional effect of improving LLA, pain intensity, and functional abilities in patients with LDD.
REFERENCES (53)
1.
Cheung KMC, Karppinen J, Chan D, Ho DWH, Song Y-Q, Sham P, et al. Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine. 2009;34(9):934–940; doi: 10.1097/BRS.0b013e3181a01b3f.
2.
Inoue N, Espinoza Orías AA. Biomechanics of intervertebral disc degeneration. Orthop Clin North Am. 2011;42(4):487–499; doi: 10.1016/j.ocl.2011.07.001.
3.
Buckwalter JA. Aging and degeneration of the human intervertebral disc. Spine. 1995;20(11):1307–1314; doi: 10.1097/00007632-199506000-00022.
4.
Weiler C, Lopez-Ramos M, Mayer HM, Korge A, Siepe CJ, Wuertz K, et al. Histological analysis of surgical lumbar intervertebral disc tissue provides evidence for an association between disc degeneration and increased body mass index. BMC Res Notes. 2011;4:497; doi: 10.1186/1756-0500-4-497.
5.
Hughes SPF, Freemont AJ, Hukins DWL, McGregor AH, Roberts S. The pathogenesis of degeneration of the intervertebral disc and emerging therapies in the management of back pain. J Bone Joint Surg Br. 2012;94(10):1298–1304; doi: 10.1302/0301-620X.94B10.28986.
6.
Mardare M, Oprea M, Popa I, Zazgyva A, Niculescu M, Poenaru DV. Sagittal balance parameters correlate with spinal conformational type and MRI changes in lumbar degenerative disc disease: results of a retrospective study. Eur J Orthop Surg Traumatol. 2016;26(7):735–743; doi: 10.1007/s00590-016-1842-3.
7.
Rozenberg S. Chronic low back pain: definition and treatment [in French]. Rev Prat. 2008;58(3):265–272.
8.
Dąbek J, Piotrkowicz J, Korzeń D, Gąsior Z. Knowledge and use of ergonomic principles in physicians and nurses with low back pain. Health Prob Civil. 2019;13(3):217–224; doi: 10.5114/hpc.2019.81342.
9.
Kułagowska E, Kosińska M, Karolak I. Safety and ergonomics in the work of long-term care nurses [in Polish]. Zeszyty Naukowe Małopolskiej Wyższej Szkoły Ekonomicznej w Tarnowie. 2017;35(3):79–91.
10.
Murata Y, Utsumi T, Hanaoka E, Takahashi K, Yamagata M, Moriya H. Changes in lumbar lordosis in young patients with low back pain during a 10-year period. J Orthop Sci. 2002;7(6):618–622; doi: 10.1007/s007760200111.
11.
Karacan I, Aydin T, Sahin Z, Cidem M, Koyuncu H, Aktas I, et al. Facet angles in lumbar disc herniation: their relation to anthropometric features. Spine. 2004;29(10):1132–1136; doi: 10.1097/00007632-200405150-00016.
12.
Harrison DE, Harrison DD, Cailliet R, Janik TJ, Holland B. Radiographic analysis of lumbar lordosis: centroid, Cobb, TRALL, and Harrison posterior tangent methods. Spine. 2001;26(11):235–242; doi: 10.1097/00007632-200106010-00003.
13.
Jackson RP, Kanemura T, Kawakami N, Hales C. Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine. 2000;25(5):575–586; doi: 10.1097/00007632-200003010-00008.
14.
Berlemann U, Jeszenszky DJ, Bühler DW, Harms J. The role of lumbar lordosis, vertebral end-plate inclination, disk height, and facet orientation in degenerative spondylolisthesis. J Spinal Disord. 1999;12(1):68–73.
15.
Endamlı DB, Bayramlar K, Turhan B. Investigation of fascial treatment effectiveness on pain, flexibility, functional level, and kinesiophobia in patients with chronic low back pain. Physiother Quart. 2019;27(3):1–5; doi: 10.5114/pq.2019.86461.
16.
Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol. 2003;13(4):371–379; doi: 10.1016/s1050-6411(03)00044-0.
17.
Arokoski JP, Valta T, Kankaanpää M, Airaksinen O. Activation of lumbar paraspinal and abdominal muscles during therapeutic exercises in chronic low back pain patients. Arch Phys Med Rehabil. 2004;85(5):823–832; doi: 10.1016/j.apmr.2003.06.013.
18.
Rasmussen-Barr E, Nilsson-Wikmar I, Arvidsson I. Stabilizing training compared with manual treatment in sub-acute and chronic low-back pain. Man Ther. 2003;8(4):233–241; doi: 10.1016/s1356-689x(03)00053-5.
19.
George SZ, Childs JD, Teyhen DS, Wu SS, Wright AC, Dugan JL, et al. Rationale, design, and protocol for the prevention of low back pain in the military (POLM) trial (NCT00373009). BMC Musculoskelet Disord. 2007;8:92; doi: 10.1186/1471-2474-8-92.
20.
Panjabi MM. The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord. 1992;5(4):390–396; doi: 10.1097/00002517-199212000-00002.
21.
Hodges PW. Core stability exercise in chronic low back pain. Orthop Clin North Am. 2003;34(2):245–254; doi: 10.1016/s0030-5898(03)00003-8.
22.
Ferreira PH, Ferreira ML, Maher CG, Herbert RD, Refshauge K. Specific stabilisation exercise for spinal and pelvic pain: a systematic review. Aust J Physiother. 2006;52(2):79–88; doi: 10.1016/s0004-9514(06)70043-5.
23.
Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine. 2000;25(22):2940–2952; doi: 10.1097/00007632-200011150-00017.
24.
Johnsen LG, Hellum C, Nygaard OP, Storheim K, Brox JI, Rossvoll I, et al. Comparison of the SF6D, the EQ5D, and the Oswestry Disability Index in patients with chronic low back pain and degenerative disc disease. BMC Musculoskelet Disord. 2013;14:148; doi: 10.1186/1471-2474-14-148.
25.
Maillot C, Ferrero E, Fort D, Heyberger C, Le Huec J-C. Reproducibility and repeatability of a new computerized software for sagittal spinopelvic and scoliosis curvature radiologic measurements: Keops®. Eur Spine J. 2015;24(7):1574–1581; doi: 10.1007/s00586-015-3817-1.
26.
Lee JS, Goh TS, Park SH, Lee HS, Suh KT. Radiographic measurement reliability of lumbar lordosis in ankylosing spondylitis. Eur Spine J. 2013;22(4):813–818; doi: 10.1007/s00586-012-2575-6.
27.
Hicks GE, George SZ, Nevitt MA, Cauley JA, Vogt MT. Measurement of lumbar lordosis: inter-rater reliability, minimum detectable change and longitudinal variation. J Spinal Disord Tech. 2006;19(7):501–506; doi: 10.1097/01.bsd.0000210116.94273.ad.
28.
Alghadir AH, Anwer S, Iqbal A, Iqbal ZA. Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J Pain Res. 2018;11:851–856; doi: 10.2147/JPR.S158847.
29.
Koes BW, Bouter LM, Beckerman H, van der Heijden GJMG, Knipschild PG. Physiotherapy exercises and back pain: a blinded review. BMJ. 1991;302(6792):1572–1576; doi: 10.1136/bmj.302.6792.1572.
30.
Luque-Suárez A, Díaz-Mohedo E, Medina-Porqueres I, Ponce-García T. Stabilization exercise for the management of low back pain. In: Norasteh AA (ed.), Low back pain. Rijeka: InTech; 2012; 261–292. Available from: http://www.intechopen.com/book....
31.
Rivera CE. Core and lumbopelvic stabilization in runners. Phys Med Rehabil Clin N Am. 2016;27(1):319–337; doi: 10.1016/j.pmr.2015.09.003.
32.
Izzo R, Popolizio T, D’Aprile P, Muto M. Spinal pain. Eur J Radiol. 2015;84(5):746–756; doi: 10.1016/j.ejrad.2015.01.018.
33.
Meucci RD, Fassa AG, Faria NMX. Prevalence of chronic low back pain: systematic review. Rev Saude Publica. 2015;49:1; doi: 10.1590/S0034-8910.2015049005874.
34.
Nies N, Sinnott PL. Variations in balance and body sway in middle-aged adults. Subjects with healthy backs compared with subjects with low-back dysfunction. Spine. 1991;16(3):325–330; doi: 10.1097/00007632-199103000-00012.
35.
Cho I, Jeon C, Lee S, Lee D, Hwangbo G. Effects of lumbar stabilization exercise on functional disability and lumbar lordosis angle in patients with chronic low back pain. J Phys Ther Sci. 2015;27(6):1983–1985; doi: 10.1589/jpts.27.1983.
36.
Hosseinifar M, Ghiasi F, Akbari A, Ghorbani M. The effect of stabilization exercises on lumbar lordosis in patients with low back pain. Ann Trop Med Public Health. 2017;10(6):1779–1784; doi: 10.4103/ATMPH.ATMPH_654_17.
37.
Ko K-J, Ha G-C, Yook Y-S, Kang S-J. Effects of 12-week lumbar stabilization exercise and sling exercise on lumbosacral region angle, lumbar muscle strength, and pain scale of patients with chronic low back pain. J Phys Ther Sci. 2008;30(1):18–22; doi: 10.1589/jpts.30.18.
38.
Schenkman M, Shipp KM, Chandler J, Studenski SA, Kuchibhatla M. Relationships between mobility of axial structures and physical performance. Phys Ther. 1996;76(3):276–285; doi: 10.1093/ptj/76.3.276.
39.
Oh JS, Choi DG, Kim YS. The effect of lumbar stability exercise program on sedentary life female, lumbosacral region angle, muscular strength, physical fitness and pain scale. Korean J Sports Med. 2017;35(1):15–24; doi: 10.5763/kjsm.2017.35.1.15.
40.
Ehrlich GE. Low back pain. Bull World Health Organ. 2003;81(9):671–676; doi: 10.1590/S0042-96862003000900010.
41.
Shafizadeh M. Movement coordination during sit-to-stand in low back pain people. Hum Mov. 2016;17(2):107–111; doi: 10.1515/humo-2016-0012.
42.
Şahin N, Karahan AY, Albayrak İ. Effectiveness of physical therapy and exercise on pain and functional status in patients with chronic low back pain: a randomized-controlled trial. Turk J Phys Med Rehabil. 2018;64(1):52–58; doi: 10.5606/tftrd.2018.1238.
43.
Łozińska P, Wójtowicz D, Wdowiak P, Dziuba-Słonina A. Changes in kinematic parameters during walking in adults with low back pain subjected to Vojta therapy. A pilot study. Physiother Quart. 2019;27(2):22–28; doi: 10.5114/pq.2019.84273.
44.
Schilling JF, Murphy JC, Bonney JR, Thich JL. Effect of core strength and endurance training on performance in college students: randomized pilot study. J Bodyw Mov Ther. 2013;17(3):278–290; doi: 10.1016/j.jbmt.2012.08.008.
45.
Carneiro KA, Rittenberg JD. The role of exercise and alternative treatments for low back pain. Phys Med Rehabil Clin N Am. 2010;21(4);777–792; doi: 10.1016/j.pmr.2010.06.006.
46.
Areeudomwong P, Puntumetakul R, Jirarattanaphochai K, Wanpen S, Kanpittaya J, Chatchawan U, et al. Core stabilization exercise improves pain intensity, functional disability and trunk muscle activity of patients with clinical lumbar instability: a pilot randomized controlled study. J Phys Ther Sci. 2012;24(10):1007–1012; doi: 10.1589/jpts.24.1007.
47.
Chen C, Lin Z, Zhang Y, Chen Z, Tang S. Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis? Pak J Med Sci. 2017;33(3):631–634; doi: 10.12669/pjms.333.12123.
48.
Niemistö L, Lahtinen-Suopanki T, Rissanen P, Lindgren K-A, Sarna S, Hurri H. A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain. Spine. 2003;28(19):2185–2191; doi: 10.1097/01.BRS.0000085096.62603.61.
49.
Hicks GE, Fritz JM, Delitto A, McGill SM. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil. 2005;86(9):1753–1762; doi: 10.1016/j.apmr.2005.03.033.
50.
Sekendiz B, Cuğ M, Korkusuz F. Effects of Swiss-ball core strength training on strength, endurance, flexibility, and balance in sedentary women. J Strength Cond Res. 2010;24(11):3032–3040; doi: 10.1519/JSC.0b013e3181d82e70.
51.
Shamsi MB, Rezaei M, Zamanlou M, Sadeghi M, Pourahmadi MR. Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial. Physiother Theory Pract. 2016;32(3):171–178; doi: 10.3109/09593985.2015.1117550.
52.
Cairns MC, Foster NE, Wright C. Randomized controlled trial of specific spinal stabilization exercises and conventional physiotherapy for recurrent low back pain. Spine. 2006;31(19):670–681; doi: 10.1097/01.brs.0000232787.71938.5d.
53.
May S, Johnson R. Stabilisation exercises for low back pain: a systematic review. Physiotherapy. 2008;94(3):179–189; doi: 10.1016/j.physio.2007.08.010.
Share
RELATED ARTICLE
| eISSN: | 2544-4395 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
