Effects of External Focus and Motor Control Training in Comparison with Motor Control Training Alone on Pain, Thickness of Trunk Muscles and Function of Patients with Recurrent Low Back Pain: A Single Blinded, Randomized Controlled Trial | ||
| The Archives of Bone and Joint Surgery | ||
| مقاله 5، دوره 10، شماره 9، آذر 2022، صفحه 766-774 اصل مقاله (1.67 M) | ||
| نوع مقاله: RESEARCH PAPER | ||
| شناسه دیجیتال (DOI): 10.22038/abjs.2022.56938.2824 | ||
| نویسندگان | ||
| Hamid Zamani؛ Mahdi Dadgoo* ؛ Mohammad Akbari؛ Javad Sarrafzadeh؛ Mohammadreza Pourahmadi | ||
| Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran | ||
| چکیده | ||
| Background: Recurrent low back pain (RLBP) affects different structures in the lumbar spine. Exercise therapy is highly recommended as one of the first-line treatments. One crucial variable introduced to enhance RLBP is the external focus. The present study aimed to investigate the effects of external focus training on pain, the thickness of transverse abdominis (TrA), internal oblique (IO), external oblique (EO), and lumbar multifidus (LM) muscles, kinesiophobia, fearavoidance beliefs, and disability of people with RLBP. Methods: This randomized-controlled trial consisted of 38 RLBP patients. Patients were randomly divided into two groups the treatment group (n=19) that received external focus training in addition to motor control training and the control group (n=19) that received motor control training alone. The primary outcome was pain intensity, and secondary outcomes were the thickness of TrA, IO, EO, LM muscles, kinesiophobia, fear-avoidance beliefs, and disability that were measured at the baseline and after 16 sessions of interventions. The interventions were performed three sessions weekly. Results: Reduction in pain intensity was more significant in the intervention group than in the control group (P<0.001, Cohen’s d=-1.47). The thickness of TrA muscle in the contraction condition of the intervention group was significantly more on the left side (P<0.001, Cohen’s d=1.05) than on the right side (P=0.03, Cohen’s d=0.44). Other outcomes showed no significant differences. However, the Cohen’s d effect size for the left IO (Cohen’s d=0.57) and TKS (Cohen’s d=-0.53) were moderate. Conclusion: In RLBP patients, external focus and motor control training could effectively reduce the pain. Although this intervention could increase the thickness of the TrA muscle of RLBP, it has no significant effect on the thickness of IO, EO, and LM muscles. In addition, the obtained results indicated that this intervention has no significant effect on kinesiophobia, fear-avoidance beliefs, and disability.. Level of evidence: I | ||
| کلیدواژهها | ||
| Abdominal muscle؛ Disability؛ Exercise therapy؛ Lumbar region؛ Recurrent low back pain | ||
| مراجع | ||
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1. Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014;73(6):968- 74. doi: 10.1136/annrheumdis-2013-204428. 2. Balague F, Mannion AF, Pellise F, Cedraschi C. Nonspecific low back pain. Lancet 2012;379(9814):482- 91. doi: 10.1016/S0140-6736(11)60610-7. 3. Hoy DG, Smith E, Cross M, et al. Reflecting on the global burden of musculoskeletal conditions: lessons learnt from the global burden of disease 2010 study and the next steps forward. Ann Rheum Dis 2015;74(1):4-7. doi: 10.1136/annrheumdis-2014-205393. 4. Tulder MV, Koes B , eds. Evidence-Based Medicine for Low Back Pain. in:Spinal Imaging. MR: Springer, Berlin, Heidelberg ;2007. 5. Da Silva T, Mills K, Brown BT, Herbert RD, Maher CG, Hancock MJ. Risk of Recurrence of Low Back Pain: A Systematic Review. J Orthop Sports Phys Ther 2017;47(5):305-13. doi: 10.2519/jospt.2017.7415. 6. Fattahi AS, Maddah G, Motamedolshariati M, Ghiasi–Moghadam T. Chronic low back pain due to retroperitoneal cystic lymphangioma. Arch Bone Jt Surg 2014;2(1):72. 7. Soderberg GL, Barr JO. Muscular function in chronic low-back dysfunction. Spine 1983;8(1):79-85. doi: 10.1097/00007632-198301000-00014. 8. Seraj MS, Sarrafzadeh J, Maroufi N, Takamjani IE, Ahmadi A, Negahban H. The ratio of lumbar to hip motion during the trunk flexion in patients with mechanical chronic low back pain according to o’sullivan classification system: a cross-sectional study. Arch Bone Jt Surg 2018;6(6):560. 9. Bystrom MG, Rasmussen-Barr E, Grooten WJ. Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a metaanalysis. Spine 2013;38(6):E350-8. doi: 10.1097/ BRS.0b013e31828435fb. 10.Delitto A, George SZ, Van Dillen L, et al. Low back pain. J Orthop Sports Phys Ther 2012;42(4):A1-57. doi: 10.2519/jospt.2012.42.4.A1. 11.Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine 2001;26(11):E243-8. doi: 10.1097/00007632-200106010-00004. 12.Wulf G, Prinz W. Directing attention to movement effects enhances learning: a review. Psychon Bull Rev 2001;8(4):648-60. doi: 10.3758/bf03196201. 13.Wulf G, McNevin N, Shea CH. The automaticity of complex motor skill learning as a function of attentional focus. Q J Exp Psychol A 2001;54(4):1143- 54. doi: 10.1080/713756012. 14.Calatayud J, Casaña J, Martí�n F, Jakobsen MD, Andersen LL, Colado JC. Electromyographic Effect of Using Different Attentional Foci During the Front Plank Exercise. Am J Phys Med Rehabil 2019;98(1):26-9. doi: 10.1097/PHM.0000000000001008. 15.Hunt C, Paez A, Folmar E. The impact of attentional focus on the treatment of musculoskeletal and movement disorders. Int J Sports Phys Ther 2017;12(6):901-7. 16.Halliday MH, Pappas E, Hancock MJ, et al. A Randomized Controlled Trial Comparing the McKenzie Method to Motor Control Exercises in People With Chronic Low Back Pain and a Directional Preference. J Orthop Sports Phys Ther 2016;46(7):514-22. doi: 10.2519/ jospt.2016.6379. 17.Stanton TR, Latimer J, Maher CG, Hancock M. Definitions of recurrence of an episode of low back pain: a systematic review. Spine 2009;34(9):E316-22. doi: 10.1097/BRS.0b013e318198d073. 18.Critchley DJ, Coutts FJ. Abdominal muscle function in chronic low back pain patients: measurement with real-time ultrasound scanning. Physiotherapy 2002;88(6):322-32. https://doi.org/10.1016/S0031- 9406(05)60745-6 19.Koppenhaver SL, Hebert JJ, Fritz JM, Parent EC, Teyhen DS, Magel JS. Reliability of rehabilitative ultrasound imaging of the transversus abdominis and lumbar multifidus muscles. Arch Phys Med Rehabil 2009;90(1):87-94. doi: 10.1016/j.apmr.2008.06.022. 20.Hides J, Richardson C, Jull G, Davies S. Ultrasound imaging in rehabilitation. Aust J Physiother 1995;41(3):187-93. doi: 10.1016/S0004-9514(14) 60429-3. 21.Kiesel KB, Uhl TL, Underwood FB, Rodd DW, Nitz AJ. Measurement of lumbar multifidus muscle contraction with rehabilitative ultrasound imaging. Man Ther 2007;12(2):161-6. doi: 10.1016/j.math 2006.06.011. 22.Bourdon E, Ramos Jr W, Mavor MP, Beaudette SM, Graham RB. The effect of attentional focus on local dynamic stability during a repetitive spine flexion task. J Biomech 2018;80:196-9. doi: 10.1016/j. jbiomech.2018.09.015. 23.Hodges PW, Richardson CA. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Arch Phys Med Rehabil 1999;80(9):1005-12. doi: 10.1016/s0003- 9993(99)90052-7. 24.Cholewicki J, Silfies SP, Shah RA, et al. Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine 2005;30(23):2614-20. doi: 10.1097/01. brs.0000188273.27463.bc. 25.Rowley KM, Smith JA, Kulig K. Reduced trunk coupling in persons with recurrent low back pain is associated with greater deep-to-superficial trunk muscle activation ratios during the balance-dexterity task. J Orthop Sports Phys Ther 2019;49(12):887- 98. doi: 10.2519/jospt.2019.8756. doi: 10.2519/ jospt.2019.8756. 26.Hall L, Tsao H, MacDonald D, Coppieters M, Hodges PW. Immediate effects of co-contraction training on motor control of the trunk muscles in people with recurrent low back pain. J Electromyogr Kinesiol 2009;19(5):763- 73. doi: 10.1016/j.jelekin.2007.09.008. 27.Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine 1996;21(22):2640-50. doi: 10.1097/00007632-199611150-00014. 28.Crommert ME, Ekblom MM, Thorstensson A. Activation of transversus abdominis varies with postural demand in standing. Gait Posture 2011;33(3):473-7. doi: 10.1016/j.gaitpost.2010.12.028. 29.Foster NE, Bishop A, Thomas E, Main C, Horne R, Weinman J, et al. Illness perceptions of low back pain patients in primary care: what are they, do they change and are they associated with outcome? Pain 2008;136(1-2):177-87. doi: 10.1016/j.pain. 2007.12.007 | ||
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