Journal of Paramedical Sciences & Rehabilitation

Journal of Paramedical Sciences & Rehabilitation

The Effect of Eight Weeks of Motor Control Exercises and Myofascial Release on Muscular Endurance of the Central Part of Body in People with Non-Specific Chronic Low Back Pain

Document Type : Original Article

Authors
S Jamali Brayjani 1
M.H Alizadeh 2
N Rahnama 3
1 Department of Sports Injuries and Corrective Exercises, Faculty of Sports and Health Sciences, University of Tehran, Kish International Campus, Iran
2 Department of Sports Injuries and Corrective Exercises, Faculty of Sports and Health Sciences, University of Tehran, Tehran, Iran
3 Department of Sports Injuries and Corrective Exercises, Faculty of Sports Sciences, University of Isfahan, Isfahan, Iran
10.22038/jpsr.2024.82342.2652
Abstract
Purpose:
low Back pain is a major health problem around the world that today's society is involved in, which worsens functional status, quality of life, and social life. The purpose of the present study is the effect of eight weeks of motor control exercises and myofascial release on Muscular Endurance of the Central Part of Body in people with non-specific chronic low back pain
Methods:
The current study is of quasi-experimental type. In this study, 16 men with non-specific chronic low back pain diagnosed by a neurosurgeon were selected in a purposeful and accessible way and were randomly and equally divided into two experimental groups (age 30.2±6.1years, body mass index 23.7±3.7 kg/m2) and control (age 26.2±4.8 years, body mass index 25.6±5.4 kg/m2) the experimental group performed motor control exercises and myofascial release three times a week for a period of eight weeks, and the control group performed motor control exercises similar to the experimental group during the same period of time. The endurance of trunk flexion muscles (McGill Test) and trunk extension muscles (Biering Sorensen Test) of participants was evaluated before and after eight weeks of training. Data analysis was done using repeated measures analysis of variance and Bonferroni's post hoc test at a five percent error level and using SPSS software version 26.
Results:
Movement control exercises with and without myofascial release have caused a significant increase in the amount of muscle endurance (McGill and Biering Sorensen test), after training compared to before training (p<0.001). Muscular endurance (McGill and Biering Sorensen test) was not significantly different between the control and experimental groups (p>0.05). Also, there was no significant difference between the control and experimental groups in muscle endurance changes before and after training (p>0.05).
Conclusion:
According to the findings of the present study, it can be concluded that motor control exercises with and without myofascial release can improve the muscular endurance of the central region of the body in people with non-specific chronic low back pain, although the effect of motor control exercises and myofascial release on the muscular endurance of the central region The body was more than motor control exercises alone, but the amount of this effect was not significant. Therefore, it is possible that both protocols can be suggested as a useful method for the rehabilitation of people with non-specific chronic low back pain.
Keywords
Chronic Low Back Pain
Motor Control
Myofascial Release
Muscular Endurance
  1. Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol 2010; 24(6): 769-781
  2. Anderson GB. Epidemiological features of chronic low back pain. Lancet 1999; 354(9178): 381-385.
  3. Fujii T, Matsudaira K. Prevalence of low back pain and factors associated with chronic disabling back pain in Japan. Eur Spine J 2013; 22(2):432-438
  4. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, et al. What low back pain is and why we need to pay attention. Lancet 2018; 391(10137): 2356-2367.
  5. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 2003; 12(2): 149-165
  6. Alhowimel A, AlOtaibi M, Radford K, Coulson N. Psychosocial factors associated with change in pain and disability outcomes in chronic low back pain patients treated by physiotherapist: A systematic review. SAGE Open Medicine 2018; 6:2050312118757387
  7. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ 2006, 332(7555):1430-1434.
  8. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, et al. Chapter 4 European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 2(2): s192-s300.
  9. Lall MP, Restrepo E. The biopsychosocial model of low back pain and patient-centered outcomes following lumbar fusion. Orthop Nursing 2017; 36(3): 213-221.
  10. Knezevic NN, Candido KD, Vlaeyen JWS, Zundert JV, Cohen SP. Low back pain. Lancet 2021; 398(10294): 78-92.
  11. Hultman G, Nordin M, Saraste H, Ohlsen H. Body composition, endurance, strength, cross-sectional area, and density of MM erector spinae in men with and without low back pain. J Spinal Disords 1993; 6(2): 114-123.
  12. Parkkola R, Ryto¨koski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine 1993; 18(7): 830-836.
  13. Roy SH, De Luca CJ, Casavant DA. Lumbar muscle fatigue and chronic lower back pain. Spine 1989; 14(9): 992-1001.
  14. Ghamkhar L, Kahlaee AH. Trunk muscles activation pattern during walking in subjects with and without chronic low back pain: a systematic review. PM R 2015; 7(5): 519-526.
  15. Van Dieën JH, Selen LPJ, Cholewicki J. Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr Kinesiol 2003; 13(4): 333-351.
  16. Kramer M, Ebert V, Kinzl L, Dehner C, et al. Surface electromyography of the paravertebral muscles in patients with chronic low back pain. Arch Phys Med Rehabi 2005; 86(1): 31-36.
  17. Demoulin C, Crielaard JM, Vanderthommen M. Spinal muscle evaluation in healthy individuals and low-back-pain patients: a literature review. Joint Bone Spine 2007; 74(1): 9-13.
  18. Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol 2003;13(4): 371-379.
  19. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J 2000; 9(4): 266-272.
  20. Lariviere C, Bilodeau M, Forget R, Vadeboncoeur R, Mecheri H. Poor back muscle endurance is related to pain catastrophizing in patients with chronic low back pain. Spine 2010; 35(22): E1178-1186.
  21. Casser HR, Seddigh S, Rauschmann M. Acute lumbar Back pain. Investigation, differential diagnosis, and treatment. Dtsch Arztebl Int 2016; 113(13): 223-234.
  22. Hides J, Gilmore C, Stanton W, Bohlscheid E. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther 2008; 13(1), 43-49
  23. Shen FH, Samartzis D, Andersson GB. Nonsurgical management of acute and chronic low back pain. J Am Acad Orthop Surg 2006; 14(8): 477-487.
  24. Middelkoop MV, Rubinstein SM, Kuijpers T, Verhagen AP, 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.
  25. Kikuchi S, Togo K, Ebata N, Fujii K, et al. Database analysis on the relationships between nonsteroidal anti-inflammatory drug treatment variables and incidence of acute myocardial infarction in Japanese patients with osteoarthritis and chronic low back pain. Adv Ther 2021; 38(3): 1601-1613.
  26. Bally M, Dendukuri N, Rich B, Nadeau L, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ 2017; 357: j1909.
  27. Yijian Z, Hao L, Huilin Y, Bin P. Comparison of posterolateral fusion and posterior lumbar interbody fusion for treatment of degenerative spondylolisthesis: analysis of spino-pelvic sagittal balance and postoperative chronic low back pain. Clin Neurol Neurosurg 2018; 171:1-5.
  28. Schaller B. Failed back surgery syndrome: the role of symptomatic segmental single-level instability after lumbar microdiscectomy. Eur Spine J 2004; 13(3): 193-198.
  29. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017; 166(7): 514-530.
  30. Oliveira C B, Maher CG, Pinto RZ, Traeger AC, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: An updated overview. Eur Spine J 2018; 27(11): 2791-2803.
  31. Chou R, Qaseem A, Snow V, Casey D, et al. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007; 147(7): 478-491.
  32. Manniche C, Bentzen L, Hesselsøe G, Christensen I, Lundberg E. Clinical trial of intensive muscle training for chronic low back pain. Lancet 1988; 2(8626-862): 1473-1476.
  33. Manniche C, Lundberg E, Christensen I, Bentzen L, Hesselsøe G. Intensive dynamic back exercises for chronic low back pain: a clinical trial. Pain 1991; 47(1): 53-63.
  34. Hayden JA, Ellis J, Ogilvie R, Stewart AS, et al. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. J Physiother 2021; 67(4): 252-262.
  35. Middelkoop M, Rubinstein SM, Verhagen AP, Ostelo RW, et al. Exercise therapy for chronic nonspecific low-back pain. Best Practic Res Clin Rheumatol 2010; 24(2): 193-204
  36. Chou R, Deyo R, Friedly J, Skelly A, et al. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline. Ann Int Med 2017; 166(7): 493-505.
  37. Andreas Grooten WJ, Boström C, Dedering A, Halvorsen M, et al. Summarizing the effects of different exercise types in chronic low back pain – a systematic review of systematic reviews. BMC Musculoskelet Disord 2022; 23(1): 801.
  38. Van Dieën JH, Peter Reeves N, Kawchuk G, Van Dillen LR, Hodges PW. Analysis of Motor Control in Patients With Low Back Pain: A Key to Personalized Care? J Orthop Sports Phys Ther2019; 49(6): 380-388.
  39. Zhang C, Li Y, Zhong Y, Feng C, et al Effectiveness of motor control exercise on non-specific chronic low back pain, disability and core muscle morphological characteristics: a meta-analysis of randomized controlled trials. Eur J Phys Rehabil Med 2021; 57(5): 793-806.
  40. Saragiotto BT, Maher CG, Yamato TP, Leonardo C, et al. Motor Control Exercise for Nonspecific Low Back Pain A Cochrane Review. Spine 2016; 41(16): 1284-1295.
  41. Byström MG, Rasmussen-Barr E, Grooten WJ. Motor Control Exercises Reduces Pain and Disability in Chronic and Recurrent Low Back Pain: A Meta-Analysis. Spine 2013; 38(6): E350-E358.
  42. Hansen AE, Marcus NJ. Is It Time to Consider Soft Tissue as a Pain Generator in Nonspecific Low Back Pain? Pain Med 2016; 17(11):1969-1970.
  43. Mense S, Hoheisel U. Evidence for the existence of nociceptors in rat thoracolumbar fascia. J Bodyw Mov Ther 2016; 20(3): 623-628
  44. Gatton ML, Pearcy MJ, Pettet GJ, Evans JH. A three-dimensional mathematical model of the thoracolumbar fascia and an estimate of its biomechanical effect. J Biomech 2010; 43(14): 2792-2797.
  45. Wilke J, Schleip R, Klingler W, Stecco C. The Lumbodorsal Fascia as a Potential Source of Low Back Pain: A Narrative Review. Biomed Res Int 2017; 2017: 5349620
  46. Barker PJ, Urquhart DM, Story IH, Fahrer M, Briggs CA. The middle layer of lumbar fascia and attachments to lumbar transverse processes: implications for segmental control and fracture. Eur Spine J 2007; 16(12): 2232-2237.
  47. Barnes MF. The basic science of myofascial release: morphologic change in connective tissue. J Bodyw an Mov Ther 1997; 1(4): 231-238
  48. Laimi K, Mäkilä A, Bärlund E, Katajapuu N, et al. Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: a systematic review. Clin Rehabil 2018; 32(4): 440-450.
  49. Ajimsha MS, Al-Mudahka NR, Al-Madzhar JA. Effectiveness of myofascial release: Systematic review of randomized controlled trials. J Bodyw an Mov Ther 2015; 19(1): 102-112
  50. Licciardone JC, Stoll ST, Fulda KG, Russo DP, et al. Osteopathic Manipulative Treatment for Chronic Low Back Pain. Spine 2003; 28(13): 1355-1362.
  51. 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): 273-281.
  52. Haldeman S, Dagenais S. A supermarket approach to the evidence-informed management of chronic low back pain. The Spine J 2008; 8(1): 1-7.
  53. 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. Archives of Physical Medicine and Rehabilitation 2005; 86(9): 1753-1762.
  54. Rabin A, Shashua A, Pizem K, Dickstein R, Dar G. A Clinical Prediction Rule to Identify Patients with Low Back Pain Who Are Likely to Experience Short-Term Success Following Lumbar Stabilization Exercises: A Randomized Controlled Validation Study. J Orthop Sports Phys Ther 2014; 44(1): 6-B13.
  55. Fuming Z, Weihu X, Jiajia Y, Shufeng L, et al. Effect of m-health-based core stability exercise combined with self-compassion training for patients with non-specific chronic low back pain: study protocol for a randomized controlled trial. Trials 2022; 23(1): 265.
  56. McGill SM, Childs A, Liebenson C. Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database. Arch Phys Med Rehabil 1999; 80(8): 941-944. 
  57. Evans K, Refshauge KM, Adams R. Trunk muscle endurance tests: Reliability, and gender differences in athletes. J Sci Med Sport 2007; 10(6): 447-455.
  58. Keller A, Hellesnes J, Brox JI. Reliability of the Isokinetic Trunk Extensor Test, Biering-Sørensen Test, and strand Bicycle Test. Assessment of Intraclass Correlation Coefficient and Critical Difference in Patients with Chronic Low Back Pain and Healthy Individuals. Spine 2001; 26(7): 771-777.
  59. Rodríguez RF, Bueno CA, Redondo IC, Costoso AT, et al. Best Exercise Options for Reducing Pain and Disability in Adults with Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis. J Orthop Sports Phys Ther 2022; 52(8): 505-521.
  60. Hou CR, Tsai LC, Cheng KF, Chung KC, Hong CZ. Immediate effects of various therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil 2002; 83(10): 1406-1414.
  61. Richardson C, Hodges PW, Hides J. Therapeutic Exercise for Lumbopelvic Stabilization: A Motor Control Approach for the Treatment and Prevention of Low Back Pain. Second edition. Churchill Livingstone; 2004.
  62. Ibrahim AA, Akindele MO, Ganiyu SO, Bello B. Effects of motor control exercise and patient education program in the management of chronic low back pain among community-dwelling adults in rural Nigeria: a study protocol for a randomized clinical trial. Integr Med Res 2019; 8(2): 71-81.
  63. Ajimsha M S, 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): 273-281.
  64. Owen PJ, Miller CT, Mundell NL, Verswijveren SJJM, et al. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br J Sports Med 2020; 54(21): 1279-1287
  65. Park KN, Kwon OY, Yi CH, Cynn HS, et al. Effects of Motor Control Exercise Vs Muscle Stretching Exercise on Reducing Compensatory Lumbopelvic Motions and Low Back Pain: A Randomized Trial. J Manipulative Physiol Ther 2016; 39(8): 576-585.
  66. Ünal M, Evcik E, Kocatürk M, Algun ZC. Investigating the effects of myofascial induction therapy techniques on pain, function and quality of life in patients with chronic low back pain. J Bodyw Mov Ther 2020; 24(4): 188-195.
  67. Arguisuelas MD, Lisón JF, Doménech-Fernández J, Martínez-Hurtado I, et al. Effects of myofascial release in erector spinae myoelectric activity and lumbar spine kinematics in non-specific chronic low back pain: Randomized controlled trial. J Clin Biomech 2019; 63: 27-33.
  68. Wu Z, Wang Y, Ye X, Chen Z, et al. Myofascial Release for Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Front Med 2021; 8: 697986.
  69. Halliday MH, Pappas E, Hancock MJ, Clare HA, et al. A randomized clinical trial comparing the McKenzie method and motor control exercises in people with chronic low back pain and a directional preference: 1-year follow-up. J Physiotherapy 2019; 105(4): 442-445.
  70. Tamartash H, Bahrpeyma F, Mokhtari Dizaji M. Effect of Remote Myofascial Release on Lumbar Elasticity and Pain in Patients with Chronic Nonspecific Low Back Pain: A Randomized Clinical Trial. J Chiropr Med 2022; 22(1): 52-59.
  71. Chen Y, Campbell P, Strauss V Y, Foster N E, Jorda, K P.  Dunn K M. Trajectories and predictors of the longterm course of low back pain: Cohort study with 5-year followup. Pain 2018; 159(2): 252-260.
  72. Linton S J, Flink I K, Vlaeyen J W S. Understanding the etiology of chronic pain from a psychological perspective. Phys Ther 2018; 98(5): 315-324.
  73. O'Sullivan P B, Caneiro J P, O'Keeffe M, Smith A, et al. Cognitive functional therapy: An integrated behavioral approach for the targeted management of disabling low back pain. Phys Ther 2018; 98(5): 408-423.
  74. Bozorgmehr A, Zahednejad S, Salehi R, Ansar N.N, et al., Relationships between muscular impairments, pain, and disability in patients with chronic nonspecific low back pain: a cross sectional study, J Exerc Rehabil 2018; 14(6): 1041-1047.
  75. Moseley GL, Hodges PW. Reduced variability of postural strategy prevents normalization of motor changes induced by back pain: a risk factor for chronic trouble? Behav Neurosci 2006; 120(2): 474-476.
  76. Jacobs JV, Henry SM, Nagle KJ. People with chronic low back pain exhibit decreased variability in the timing of their anticipatory postural adjustments. Behav Neurosci 2009; 123(2): 455-458.
  77. Panjabi MM. A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Eur Spine J 2006; 15(5): 668-676.
  78. Cho KH, Beom JW, Lee TS, Lim JH, et al. Trunk Muscles Strength as a Risk Factor for Nonspecific Low Back Pain: A Pilot Study. Ann Rehabil Med 2014; 38(2): 234-240.
  79. Radebold A, Cholewicki J, Polzhofer GK, Greene HS. Impaired Postural Control of the Lumbar Spine Is Associated with Delayed Muscle Response Times in Patients with Chronic Idiopathic Low Back Pain. J Spine 2001; 26(7): 724-730.
  80. Tong MH, Mousavi SJ, Kiers H, Ferreira P, et al. Is There a Relationship Between Lumbar Proprioception and Low Back Pain? A Systematic Review with Meta-Analysis. Archives of Physical Medicine and Rehabilitation 2017; 98(1): 120-136.e2.
  81. Da Silva RA, Vieira ER, Fernandes KBP, Andraus RA, et al. People with chronic low back pain have poorer balance than controls in challenging tasks. J Disabil Rehabil 2018; 40(11): 1294-1300.
  82. Vanti C, Conti C, Faresin F, Ferrari S, Piccarreta R. The Relationship Between Clinical Instability and Endurance Tests, Pain, and Disability in Nonspecific Low Back Pain. J Manipulative Physiol Ther 2016; 39(5): 359-368.
  83. Kim KH, Cho SH, Goo BO, Baek IH. Differences in transversus abdominis muscle function between chronic low back pain patients and healthy subjects at maximum expiration: measurement with real-time ultrasonography. J Phys Ther Sci 2013; 25(7): 861-863.
  84. Russo M, Deckers K, Eldabe S, Kiesel K, et al. Muscle control and non-specific chronic low back pain. Neuromodulation. 2018; 21(1): 1-9.
  85. Kalichman L, Carmeli E, Been E. The association between imaging parameters of the paraspinal muscles, spinal degeneration, and low back pain. Biomed Res Int 2017; 2017: 2562957
  86. Macedo LG, Maher CG, Hancock MJ, Kamper SJ, et al. Predicting response to motor control exercises and graded activity for patients with low back pain: preplanned secondary analysis of a randomized controlled trial. Phys Ther 2014; 94(11): 1543-1554.
  87. Lynders C. The Critical Role of Development of the Transversus Abdominis in the Prevention and Treatment of Low Back Pain. HSS J 2019; 15(3): 214-220
  88. Kuruma H, Takei H, Nitta O, Furukawa Y, et al. Effects of Myofascial Release and Stretching Technique on Range of Motion and Reaction Time. J Phys Ther Sci 2013; 25(2): 169-171.
Journal of Paramedical Sciences & Rehabilitation
Volume 13, Issue 3
Summer 2024
Pages 7-20