The Effect of Diaphragm Muscle Training on Chronic Low Back Pain

Study Overview
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Brief Summary
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Brief Summary: Low back pain is very common problem in all the developed countries and affects children to elderly. Based on the etiology the low back pain is divided into two type: nonspecific and specific low back pain. If the pathological reason is known it is defined as specific and if the reason for the pain is unknown it is defined as nonspecific low back pain. The postulated reason for nonspecific low back pain is the segmental instability of the lumbar spine. Diaphragm muscle has a role in maintaining the segmental stability. The aim of this study to reduce the severity of the low back pain with improving the stability of the lumbar spine by using diaphragm training.

Detailed Description
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The study is a randomized controlled trial. The participants are divided randomly into two groups. One of the groups take part in a complex training which contains stretching, strengthening, mobilizing exercises and proprioceptive training and this training is completed by diaphragm strengthening exercises. This group is defined as diaphragm training group. The members of the diaphragm training group use the POWERbreathe Medic Plus device. Opposed to the diaphragm training group the members of the control group take part only in the complex training without strengthening the diaphragm muscle. The pain intensity is assessed by Visual Analogue Scale and the diameter of the stabilizer muscles' belly is measured by B-mode ultrasound examination, using Zonare Z.One Ultrasound System (Mountain View, CA, USA). The thickness of the transversus abdominis muscle, the lumbar multifidus muscle and the diaphragm muscle is assessed in two different positions: during lying and during sitting position with weightlifting. The muscles are measured in two different states: a relaxed and a contracted state. Functional tests and a balance platform (NeuroCom) are used to measure the stability, and the function of the diaphragm is assessed by using a POWERbreathe KH2 device.

Official Title
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The Effect of Diaphragm Muscle Training on Chronic Low Back Pain

Conditions
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Low Back Pain, Diaphragm

Intervention / Treatment
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* Other: Complex training
* Other: Diaphragm training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Chronic low back pain Do not take part in other treatment Be able to learn the usage of diaphragm trainer Exclusion Criteria: Balance problems with neurological cause Malignant tumor Serious organ disease Respiratory disease A previous surgical intervention which affected the trunk The patient is unable to cooperate
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Control group -complex training<br>complex training | Other: Complex training<br>* The training program contains stretching, mobilizing, strengthening exercises on the trunk and hip muscles and a proprioceptive training.<br>|
| Active Comparator: Experimental group -diaphragm training<br>diaphragm training | Other: Complex training<br>* The training program contains stretching, mobilizing, strengthening exercises on the trunk and hip muscles and a proprioceptive training.<br>Other: Diaphragm training<br>* The training program contains strengthening exercises on the diaphragm muscle.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain assessed by Visual Analogue Scale (followed by its scale information in the Description) | The severity of the pain is measured with Visual Analogue Scale (VAS) before and after the intervention. This is a semi-objective, self-report device that is used extensively to measure such complaints as pain. The sclale is a 10 cm line. The scale is anchored by 'no pain' (0 score) and 'worst imaginable pain' (score of 10). Therefore the higher values represent a worse outcome. When using the Visual Analogue Scale, the participants had to mark on a 10 cm long line the average severity of lumbar pain and we measured the distance of their mark from the zero point in cm-s. | 8 weeks | 
| Thickness of the stabilizer muscles' belly | The thickness of the stabilizer muscles's belly is measured with an ultrasound examination (Zonare Z.One Ultrasound System). The assessed muscles are transversus abdominis muscle, diaphragm muscle and lumbar multifidus muscle before and after the intervention. | 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Respiratory muscles' function | Respiratory muscles' function is measured with POWERbreathe KH2 device before and after the intervention. | 8 weeks | 
| Limits of stability in sitting | It is measured by modified Functional and Lateral Reach Test before and after the intervention. Modified means the sitting position. | 8 weeks | 
| Functional skills | The functional skills are measured by the standard Timed Up and Go Test, Four Square Step Test and Fingertip to Toe Test before and after the intervention. | 8 week | 
| Balance and stability | The balance and the stability of the participants is measured with a force platform (NeuroCom Basic Balance Master) using CTSIB and Unilateral Stance protocol before and after the intervention. | 8 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Low Back Pain, Diaphragm