Effect of PNF and Lumbar Stabilization Exercises on Muscle Strength and Endurance in Lumbar Disc Hernia
Condition: Lumbar Disc Herniation
MeSH terms: Intervertebral Disc Displacement; Hernia
Study type: Interventional

Summary: 
      Background/Objective: This study investigates the effect of lumbar stabilization and
      proprioceptive neuromuscular facilitation (PNF) training on muscle strength and muscle
      endurance.

      Methods: Sixty-four participants between the ages of 15 and 69 years, graded "protrusion and
      bulging lumbar herniation" according to the Macnab Classification, were divided into four
      groups of 16: lumbar stabilization training (strength training, 5 days/week for 4 weeks); PNF
      training (5 days/week for 4 weeks); physical therapy (hot pack, TENS, ultrasound, 5 days/week
      for 4 weeks); and control (without any application). Sociodemographic features were recorded
      and muscle strength tested. Before and after exercise, a visual analog scale (VAS) and
      Oswestry Disability Index (ODI) were measured by a physical therapist. After 4 weeks, the
      evaluations were repeated.

      Results: There were significant increases in muscle strength and muscle endurance in the
      lumbar stabilization group, who also showed significant improvement in pain intensity at rest
      and during activity, and in ODI (p<0.05). Similar results were observed in the PNF group
      (p<0.05), although not to the same extent. Patients undergoing physical therapy showed
      significant differences only in pain intensity at rest, at activity, and in ODI (p<0.05).

      Conclusion: Undertaking an appropriate physiotherapy and rehabilitation program aiming to
      reduce waist circumference of patients with low muscle strength and low muscle endurance will
      help to increase muscle strength and endurance and reduce pain, and contribute toward the
      correction of functional disabilities.
    

Detailed description: 
      Lumbar disc herniation (LDH) is a clinical entity characterized by compression of the spinal
      nerve roots and resultant back and leg pain. Though uncommon, LDH has been reported as a
      cause of recurrent low back pain.

      Although more than 100 risk factors have been identified for LDH, it is difficult to
      determine a specific etiology. The most important risk factors are intense sporting activity,
      heavy lifting, frequent rotation of the body, exposure to vibrations, age, tall stature,
      obesity, smoking, and psychological and genetic factors.

      It has been shown that in LDH patients; the strength and endurance of the back and abdominal
      muscles are reduced, and this aspect has been reported as a major predisposing factor for low
      back pain. Hence, an exercise program as part of conservative treatment of low back pain and
      after surgery would be of potential benefit for patients. Twomey and Taylor have shown that
      behavioral and cognitive principles combined with exercise programs can be effective in
      reducing disability in patients with chronic low back pain.

      The severity of symptoms in disc herniation depends not only on the amount of herniated disc
      pressure but also on nervous irritability. To reduce the sensitivity of nerve fibers to pain,
      symptomatic initiatives that include drugs, physical therapy, and psychological methods can
      be successful. The primary purpose of physical therapy is control of pain and inflammation,
      and secondarily to improve symptoms such as stiffness in the joints and muscle spasms.
      Physical therapy also delivers psychological effects. Agents used in physical therapy are
      generally administered in a combined regimen. We undertook this study to investigate the
      effect of lumbar stabilization training and proprioceptive neuromuscular facilitation (PNF)
      training on muscle strength and muscle endurance.

      Results The groups showed no difference in demographic and clinical characteristics( p>0.05).

      When groups' evaluations before and after treatment were compared, statistically significant
      differences were found in VAS after treatment (at rest), VAS (at activity), Oswestry
      Disability Index (ODI), abdominal strength, endurance of back extensor, left hip flexion
      flexibility, sit and reach flexibility, 60°/sec trunk flexion, 90°/sec trunk extension,
      90°/sec trunk flexion, 120°/sec trunk flexion, and 120°/sec trunk extension.

      When pairwise comparisons of groups were conducted, there were significant differences in the
      stabilization group's ODI, left hip flexion flexibility, sit and reach flexibility, 90°/sec
      trunk extension, and 90°/sec trunk flexion muscle strength values when compared with values
      in the PNF group.
    

Intervention name(s): PNF; lumbar stabilization training; Physical Therapy; Control
Intervention type(s): Other; Other; Other; Other
Intervention description(s): PNF; lumbar stabilization training; Physical Therapy; Control group
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Disc herniation; Endurance; Lumbar stabilization exercise; PNF; Strength