Postural Control and Trunk Neuromuscular Activation in Athletes With Chronic Low Back Pain
Condition: Athletic Injury; Low Back Pain
MeSH terms: Back Pain; Low Back Pain; Athletic Injuries
Study type: Interventional

Summary: 
      The relevance of this study is given by the feasibility to assess the effect of an
      intervention program based on the postural control and trunk neuromuscular activity,
      comparing two methods: stabilization exercises vs. back strengthening exercises, in athletes
      with low back pain. The main outcomes will be computed by electromyography measurement so
      that to assess the trunk neuromuscular activation pattern as well as by force platform
      parameters for determining of postural control. Clinical symptoms such as pain intensity,
      perception of disability and fear and avoidance will also be computed. This is the first
      study to compare two intervention methods using the main biological outcomes related to trunk
      neuromuscular function.
    

Detailed description: 
      For this study, a proposal of a 8-week intervention program will be carried out with lumbar
      stabilization exercises and back strengthening exercises, in 32 athletes with chronic low
      back, recruited by convenience and voluntaries from the community local and sports centers.
      Before intervention, all participantes will be evaluated by: electromoyography during back
      endurance and strength tests, balance performance, physical capacity, and by clinical
      outcomes such as pain, disability and psychological factors. All baseline testing and
      evaluation will be performed by a blinded evaluator to the study intervention. Afterwards,
      the participants will be randomized in two groups by a blinded evaluator (people not enroled
      to study): G1: exercises for lumbar stabilization; and G2: strengthening exercises. The
      intervention will follow 8 weeks, with 50 minutes of duration each session of therapy
      including measurement of blood pressure, heart rate and the Visual Analogue Scale (VAS)
      before and after each session, and the perception of exercise intensity monitored by Borg
      Scale. Within this proposal, the exercise sessions will performed twice a week. The
      intervention will follow the CONSORT recommendations for randomized controlled trials. The
      intervention will start in: G1 (n=16, motor control group), which will perform therapy with
      specific exercises for lumbar stabilization including the Swiss ball as therapeutic resource;
      while G2 (n=16, strength group) will perform back endurance progressive and resisted
      exercises on a Roman chair. The participants will not be blind to the study due to the
      characteristic of the exercises that often reflect to the improvement of the symptoms. In
      case of eventual losses, the intention-to-treat method will be used for the analyses. After
      the intervention, all groups will be invited to come back to the laboratory to proceed the
      same evaluation from baseline (trunk activation during exercises, balance, and clinical
      outcomes). For the analysis two-way ANOVA with repeated measures will be performed to compare
      the effects of the intervention (two groups) and times (baseline vs. end 8-weeks measurement)
      and the effects of interaction (Groups x Times). The size effect also will be computed to
      determine the rate of the changes observed.
    

Intervention name(s): G1: exercises for lumbar stabilization; G2: back strengthening exercises
Intervention type(s): Other; Other
Intervention description(s): Specific exercises for lumbar stabilization. The Group 1 (G1) will perform therapy with specific exercises for lumbar stabilization whith the Swiss ball as a therapeutic resource, including warming; stretching of hamstrings, paraspinals, trapezes; phasic perineal exercise; tonic perineal exercise; pelvic lumbar synergism; trunk mobility; mobility of the shoulder girdle; balance; and slow pelvic balance.; Specific back exercises. The Group 2 (G2) will perform therapy including back strengthing exercise on a Roman chair machine to perform flexion and extension of trunk with load progressive training.
Other intervention name(s): therapeutic exercises; Back resistive training
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Postural control; Physiotherapy; Sports injuries; Low back pain; training