Investigation of Trunk Muscle Size and Function in Older Adults With Chronic Low Back Pain
Condition: Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      Rehabilitative Ultrasound Imaging (US) is a procedure used to evaluate skeletal muscle size
      and function to inform clinical practice. US has been shown to be a reliable and valid tool
      for measuring changes in trunk muscle (i.e. abdominal and back muscle) size and activity
      during sub-maximal contractions in younger populations. Younger adults with low back pain as
      compared with healthy adults without pain demonstrate smaller back muscle size, lower back
      muscle activity, and greater back muscle asymmetry (differences in right side compared with
      left side).

      No trials are published evaluating muscle adaptations using US in response to clinical
      treatments for low back pain in the older adult population. Increased muscle size and
      improved muscle symmetry have been reported in younger adults with low back pain who
      participate in low back stabilization exercises. These exercises use voluntary contractions
      of the back muscles with prolonged hold times and low loads. Neuromuscular Electrical
      Stimulation (NMES) is a treatment modality that increases muscle activity when voluntary
      activity is impaired and increases muscle size. Most studies assessing muscle size and
      activity in response to NMES have been conducted in the knee muscles (i.e. the quadriceps),
      while the impact of NMES on the back muscles remains relatively unexplored. Given the
      potential to evaluate back muscle size and activity with US, this assessment tool may be used
      to document muscle adaptations to a clinical intervention in older adults with low back pain.

      The purpose of this study is to conduct a 6-week clinical trial to determine if NMES plus
      lumbar stabilization exercises (i.e. NMES AND Stabilization Exercises) is superior to lumbar
      stabilization exercises (i.e. Moist Heat AND Stabilization Exercises) for improving back
      muscle size, activity, and side-to-side (i.e. right side versus left side) symmetry in older
      adults with chronic low back pain (i.e. low back pain of greater than 3 months). Muscle size,
      activity, and symmetry will be assessed using US before and after the treatments to determine
      if the treatments positively impact muscle. Secondary clinical measures of success will
      include improvements in physical, psychological, and social function pre- to post-treatment.
    


Intervention name(s): Neuromuscular Electrical Stimulation; Moist Heat
Intervention type(s): Other; Other
Intervention description(s): Neuromuscular Electrical Stimulation (NMES) to the low back muscles (i.e. spinal extensors) will be applied at the parameters previously used in the knee muscles at the maximal tolerable intensity, which results in a full, sustained isometric contraction of the back muscles. Pad placement will be just below the waist line, with 2, 2X2 inch pads, on either side of the spine. Participants will be positioned on their belly with 2 pillows under their stomach to level the spine and secured to a table using a belt that crosses the buttock.
The lumbar stabilization program will include exercises targeting the back muscles in three positions: standing, prone (belly), and quadruped (hands and knees).; For participants who do not receive NMES, moist heat will be applied for 15 minutes in a position of comfort for the participant.
The lumbar stabilization program will include exercises targeting the back muscles in three positions: standing, prone (belly), and quadruped (hands and knees).
Other intervention name(s): Lumbar Stabilization Exercises; Lumbar Stabilization Exercises
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment