McGill Stabilization Exercises VS Proprioceptive Neuromuscular Facilitation Technique in Chronic Non-specific LBP
Condition: Chronic Non-specific Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      Non-specific chronic low back pain (NS-CLBP) is defined as lumber pain persisting for longer
      than three months, in absence of a suspected pathology or any specific cause. A specific
      diagnosis of low back pain cannot be obtained in approximately 80% patients with low back
      pain, indicating that patients with low back pain are often diagnosed with non-specific low
      back pain and these are the majority of the individuals with low back pain that present to
      physiotherapy In other cases the cause may be a minor problem with a disc between two spinal
      bones (vertebrae), or a minor problem with a small facet joint between two vertebrae. There
      may be other minor problems in the structures and tissues of the lower back that result in
      pain. Objective of this study is to compare the effects McGill stabilization exercises and
      proprioceptive neuromuscular facilitation technique on pain, range of motion and functional
      disability in chronic non-specific Low back pain.
    

Detailed description: 
      Low back pain (LBP) is one of the commonest musculoskeletal disorders and one of the most
      demanding ones in cost of care and medical attention. It was stated earlier that 70% of
      adults would experience LBP at least once over their lifespan. Furthermore, over 80% of such
      patients report recurrent episodes. The worldwide point prevalence of low back pain (acute,
      subacute and chronic) was 7.83% in 2017, with 577 million people affected at any one time. In
      2017, low back pain was responsible for around 65 million years lived with disability,
      representing a deterioration of about 17.5% since 2007 mainly owing to population growth and
      ageing, with the greatest increase recorded for low-income and middle-income countries.
      People more often leave their job because of low back pain than diabetes, hypertension,
      neoplasm, asthma, heart and respiratory disease combined. A sedentary lifestyle with a lack
      of physical activity results in the loss of muscle power and strength and can be a predictor
      of LBP leading to recurrent LBP. Non-specific chronic low back pain (NS-CLBP) is defined as
      lumbar pain persisting for longer than three months, in absence of a suspected pathology (red
      flag conditions such as e.g. tumor, infection or fracture).Patients commonly have limited
      range of motion and dis-coordination in the function of various body parts due to pain.
      Nonspecific LBP is described as pain that has no specific pathology as infection, neoplasm,
      etc.; rather, it might develop for mechanical reasons. It is characterized by heavy pain
      worsening with exertion, especially in the afternoon, and reliving with rest. Moreover, the
      application of faulty ergonomic principles may be a cause of LBP or worsen its symptoms.
      Chronic LBP is associated with histomorphologic and structural changes in the paraspinalis
      muscles. These back muscles are smaller, contain fat, and show a degree of atrophic changes
      in select muscle fibers. Therefore, the lumbar paraspinalis muscles are weak with excessive
      fatigability. Furthermore, poor coordination of the paraspinalis muscles has been associated
      with chronic LBP. These contribute to a vicious cycle of LBP and deconditioning syndrome. One
      type of NSCLBP is continuing and recurrent primarily nociceptive CLBP due to vertebral joint
      overload subsequent to functional instability of the lumbar spine. This condition may occur
      due to disruption of the motor control system to the key stabilizing muscles in the lumbar
      spine, particularly the lumbar multifidus muscle (MF).Traditionally, treatment of CLBP has
      focused on analgesia and activity restriction. However, this treatment is ineffective and can
      even be harmful, generating distrust among patients and frustration towards PHCPs. Most
      guidelines agree on the first line of care in case of acute episode: advice, reassurance and
      encouragement to engage in light physical activity. When second-line treatment is needed, a
      range of therapeutic interventions (pharmacological and physiotherapy) for acute NSLBP are
      available. Patients with CLBP usually have more comorbidity and impose greater economic
      burdens to the society than those without CLBP. Recent research shows that the number of
      people with disabilities caused by chronic LBP has increased by 54% in the last 30
      years.Thus, LBP poses substantial challenges for the medical system, creates socioeconomic
      issues for working-age adults, and levies a severe medical burden on individuals and society.

      Nonspecific CLBP pain is associated with major depression, decreased productivity,
      disability, and reduced life quality. Therefore, there is an urgent need for research to
      better understand the underlying mechanisms that cause and sustain nonspecific CLBP and guide
      effective treatments. Exercise is an effective, non-pharmacologic treatment for chronic LBP,
      and most clinical practice guidelines recommend exercise as first-line treatment for chronic
      LBP. However, there is limited evidence about which exercise is best and the long-term
      effects of different exercise-based treatments.Proprioceptive neuromuscular facilitation
      (PNF) training has been recommended for sensorimotor control training as well as for
      stimulating lumbar muscle proprioception. Basic procedures, such as rotational patterns of
      movement and different techniques, including rhythmic stabilization, dynamic reversals,
      combination of isotonics, repeated contractions, and contract-relax, can be applied to
      improve flexibility, muscle strength, and movement. Thus, the concept of PNF is to enhance
      joint coordination, muscle strength, movement control, stability, and mobility. Its main
      objective is to reach the highest possible functional level. To achieve the highest
      functional level, therapists apply motor control and motor learning principles when using
      PNF. Exercises improve muscle strength, flexibility, endurance, and ability to perform life
      activities. Proprioceptive neuromuscular facilitation (PNF) involves stretching, resisted
      movements which improves muscle disharmony, atrophy, and joint movement limitation. Lumbar
      stabilization exercises (LSE) develop the awareness of muscle contraction and control from
      simple to complex patterns. Both exercises are effective individually in chronic low back
      pain patients. This study was conducted to find out which technique is better.
    

Intervention name(s): McGill stabilization exercise; Proprioceptive neuromuscular facilitation technique
Intervention type(s): Other; Other
Intervention description(s): McGill Curl Up Lie down on your back.
The Side Bridge Lie on your side.
The Bird Dog.; . The patient is in sitting position and faces the physical therapist. The RST program consisted of alternating (trunk flexion-extension) isometric contractions against resistance for 10 seconds, with no motion intended. Subjects performed 3 sets of 15 repetitions at maximal resistance provided by the same physical therapist. Rest intervals of 30 seconds and 60 seconds were provided after the completion of 15 repetitions for each pattern and between sets, respectively.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Non-specific Low back pain, McGill, Paraspinal muscles