Pilates in Women With Chronic Low Back Pain

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the effect of a Pilates exercise program (PEP) on the flexo-relaxation ratio (FRR) of the erector spinae (ES) muscle during standing maximal trunk flexion/extension in women with chronic low-back pain (LBP). A secondary goal is to investigate the effect of PEP on full trunk flexion ROM (TFRoM), pain intensity and functional capacity and analyse their relationship with the FRR.

Detailed Description
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Purpose: To evaluate the effect of a Pilates exercise program (PEP) on the flexo-relaxation ratio (FRR) of the erector spinae (ES) muscle during standing maximal trunk flexion/extension in women with chronic low-back pain (LBP). A secondary goal was to investigate the effect of PEP on full trunk flexion ROM (TFRoM), pain intensity and functional capacity and analyse their relationship with the FRR. Material and methods: Thirty women with chronic LPB were randomly assigned to either PEP (EG, n=15) or control group (CG=15). EG followed an 8-week PEP while no specific intervention was carried out on the controls. Before and after this period all variables were recorded.

Official Title
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Effect of a Pilates Exercise Program on the Flexion-relaxation Rate in Women With Chronic

Conditions
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Back Pain, Low

Intervention / Treatment
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* Other: Pilates exercise program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: lumbar or lumbosacral pain (with or without radicular pain) for at least six months; a score higher than 6/50 on the Oswestry Disability Index (ODI) absence of any back treatment for the last three months. Exclusion Criteria: body mass index > 30 kg/m2 prior surgery of the pelvis, spinal column or lower extremity scoliosis; systemic or degenerative disease history of neurological diseases or deficits not related to back pain pregnancy or hypertension.

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: EG: Exercise Group<br>Pilates exercise program (1 h x 2 sessions per week x 2 months) | Other: Pilates exercise program<br>* The Pilates Exercise Program (PEP) (1 h x 2 sessions per week x 2 months) was delivered by one Pilates professional (with a mean of 6.5 years of experience in Pilates). The PEP carried out by Pilates instructor has been published in a previous study [31]. The exercises focused on core stability, posture, breathing, flexibility, strength, and muscle control, being the active awareness of the use of trunk muscles to stabilize the pelvic-lumbar region the main approach. The exercises performed were: the hundred, the rolled up, single leg circles with bent leg, spine stretch, rolling like a ball and single leg stretch. Each exercise was performed as follows: 4 repetitions of 30 seconds with 2 minutes of recovery between repetitions. In order to complete the 60 minutes session two exercises: the superman and the double leg bridge were added to the mentioned PEP.<br>* Other names: Core strength exercise program;|
| No Intervention: CG: Control Group<br>Usual lifestyle | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| FRR was calculated by dividing the maximal EMG amplitude during flexion by the minimum EMG amplitude at full flexion. The mean of the 3 trials performed was used to determine the FRR for each muscle for each subject. | A lower FRR indicated a greater state of muscle relaxation. Asymmetry in muscle activity between both (right and left) ES muscles was calculated as their mean difference in RMS in the three flexion-extension tasks. Asymmetry in the FRR was calculated as the absolute difference between FRR of the right and left ES muscles. | 2 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Full TFRoM was calculated as the average TFRoM from the three flexion-extension tasks. | To obtain the full trunk flexion ROM (TFRoM), the angular position of the inertial EMG sensor (attached with a kinesio-tape at T3 vertebrae) was measured from the start to the end of the flexion movement. | 2 months | 
| The version adapted to the Spanish population of the Low Back Outcome Score (LBOS) questionnaire was used to measure self-reported functional capacity. | LBOS was measured at pre-intervention (T0) and pos-intervention (T8). | 2 months | 
| A 10-cm Visual Analog Scale (VAS) was used to evaluate pain intensity | VAS was measured at pre-intervention (T0) and pos-intervention (T8). | 2 months |