Query: Posture corretion exercise for low back pain

title: Convergence and Divergence of Exercise Based Approaches That Incorporate Motor Control for the Management of Low Back Pain.
abstract: SYNOPSIS Many approaches for low back pain (LBP) management focus on modifying motor control, which refers to motor, sensory, and central processes for control of posture and movement. A common assumption across approaches is that the way an individual loads the spine by typical postures, movements, and muscle activation strategies contributes to LBP symptom onset, persistence, and recovery. However, there are also divergent features from one approach to another. This commentary presents key principles of 4 clinical physical therapy approaches, including how each incorporates motor control in LBP management, the convergence and divergence of these approaches, and how they interface with medical LBP management. The approaches considered are movement system impairment syndromes of the lumbar spine, Mechanical Diagnosis and Therapy, motor control training, and the integrated systems model. These were selected to represent the diversity of applications, including approaches using motor control as a central or an adjunct feature, and approaches that are evidence based or evidence informed. This identification of areas of convergence and divergence of approaches is designed to clarify the key aspects of each approach and thereby serve as a guide for the clinician and to provide a platform for considering a hybrid approach tailored to the individual patient.   May 2019.

title: Effectiveness of Education Program on Correct Posture and Daily Exercise in Reducing and Preventing Back Pain in Patients with Chronic Low Back Pain, Kuean Sub district, Kosumpisai District, Mahasarakam Province prasiththiphlkh`ngopraekrmkhwaamruueruue`ngthaathaangthiithuukt`ng ainchiiwitpracchamwanaelakaar``kkamlangkaayephuue
abstract: Chronic low back pain is one of the top five major health problems in Kuean Sub district, Kosumpisai District, Mahasarakam Province. This study aimed to assess the effects of an education program on correct posture in daily life together with therapeutic exercise to reduce and prevent low back pain as well as to study the effectiveness of physical therapy service in a primary care unit. Participants in this study were 36 patients with chronic low back pain in Kean subdistrict, Kosumpisai District, Mahasarakam province. Inclusion criteria comprised an average age of less than 60 years old and had low back pain in the past three months without signs of weakness or history of spinal surgery. The program activities included education on correct postures in everyday life and 3 sessions of group therapeutic exercises guided by a physical therapist. Assessment of pain and disability was conducted by using visual analogue scale pain and Roland Morris disability questionnaire before and after intervention. The results showed that there were significant reduction of pain score (83.33% and increase of functional work capacity (77.27% Moreover, within 2 years of the intervention only 13.88% of total participants had come to Kosumpisai Hospital for treatment. Therefore, we concluded that the program of education on correct posture and therapeutic exercise could prevent and reduce back pain, and improve functional work capacity. In addition, proactive physical therapy service in primary care unit could improve knowledge and reduce recurrence of low back pain in patients.  low back pain, correct posture, daily exercise

title: Postural cueing increases multifidus activation during stabilization exercise in participants with chronic and recurrent low back pain: An electromyographic study.
abstract: Persons with low back pain (LBP) have demonstrated altered morphology and function of the deep multifidus (DM) This study examined the effects of postural cueing for increased lumbar lordosis on DM and longissimus thoracis (LT) activation during lumbar stabilization exercises (LSE) performed by persons with LBP. Nine adults with a history of chronic or recurrent LBP were recruited. Fine wire EMG data was collected while participants performed 10 LSE's in neutral posture and with postural cueing. Percent maximum voluntary isometric contraction of L5 DM and T12 LT, and ratios of activation (DM/LT) were analyzed. There was a significant main effect for posture on DM activation (p 0.001) indicating greater activation levels during exercises performed with postural cueing vs. neutral posture. LT activation did not increase significantly with postural cueing. Following a significant 1 way repeated measures ANOVA (p 0.034) for the postural cueing condition, pairwise comparisons demonstrated significantly higher DM/LT activation ratios for prone leg lift, variable angle Roman chair at 15deg, bridging, and bilateral arm and leg lift. These results suggest postural cueing can be used across a range of LSE intensities to increase DM activation without a significant increase in LT activation in patients with chronic or recurrent LBP.

title: Effect of dynamic muscular stabilization training over conventional exercise program on mechanical low back pain in office workers to improve the quality of life: A randomized controlled study
abstract: Most jobs nowadays are sedentary in nature. Due to incorrect posture, strain on the spine, pelvis, muscles, tendons, joints, bones, and discs can lead to fatigue and deformation. Low back pain (LBP) is the most common one among all pains. It has a profound impact on the quality of life (QoL) Core training has emerged as a major trend in LBP management and prevention. In Dynamic Muscular Stabilization Training (DMST) adequate dynamic control of lumbar spine forces is achieved, which reduces the repetitive injury to the structures of the spinal segments and related tissues. Thus, the aim of the study is to assess the effectiveness of DMST on LBP in office workers.  The aim of this study was to determine the effect of DMST in mechanical LBP to improve the QoL in office workers.   One hundred and twenty four office workers (male and female, aged 30 50 years) were screened on Cornell musculoskeletal discomfort questionnaire (CMDQ) Fifty office workers were selected after screening, those who met the inclusion criteria (mechanical LBP and CMDQ for lower back more than 1.5) Office workers were equally divided into two groups, namely study group which received DMST and control group which received conventional exercises. Follow up assessments were conducted at the baseline, 4th week, and 8th week on Oswestry LBP disability questionnaire (OLBPDQ) and World Health Organization QoL BREF.  Both the study (n 25) and control (n 25) groups equally improved with their respective intervention. In the study group, LBP reduced more (P 0.001, 95% confidence interval [CI] 10.636 14.764) postintervention. Whereas, a significant improvement in physical (P 0.001, 95% CI: 86.099 91.301) and psychological (P 0.001, 95% CI: 60.725 69.475) domains of QoL was found in the study group compared to the control group. The correlation between OLBPDQ score and QoL domains was significant.  DMST improves QoL by a significant reduction in pain in office workers with mechanical LBP.

title: Trunk postural balance and low back pain: Reliability and relationship with clinical changes following a lumbar stabilization exercise program.
abstract: Lumbar stabilization programs reduce pain and disability, but the mechanisms of action underlying this treatment are unknown. Trunk postural control during unstable sitting represents a surrogate measure of motor control mechanisms involved to maintain the dynamic stability of the spine. This exploratory study aimed to determine the reliability of trunk postural control measures over an 8 week interval, their sensitivity to low back pain status and treatment and their relationship with clinical outcomes. Trunk postural control measures were determined in patients with low back pain before and after an 8 week lumbar stabilization exercise program. Healthy controls were assessed over the same interval, but without any treatment, to determine the reliability of the measures and act as a control group at baseline. The kinematics of a wobble chair during unstable sitting was summarized using different linear and nonlinear measures quantifying the quantity and quality of movement, respectively. The reliability of the measures was moderate to excellent. The results showed significant reduction in pain and disability following the intervention. While no impairment at baseline scores was found, some linear and nonlinear measures changed over the intervention period among the patient group. However, for nonlinear measures only, significant correlations were detected with the change scores of pain and disability. The change of measures over the intervention period was likely due to learning rather than the intervention as similar alteration was detected in the healthy subjects. The results suggest that only the quality (not the quantity) of movement may have relationship with pain and disability.

title: Sagittal lumbopelvic alignment in patients with low back pain and the effects of a high load lifting exercise and individualized low load motor control exercises a randomized controlled trial.
abstract: Assessment of posture and lumbopelvic alignment is often the main focus in the classification and treatment of patients with low back pain (LBP) However, little is known regarding the effects of motor control interventions on objective measures of lumbopelvic alignment.  The primary aim of this study was to describe the variation of sagittal lumbopelvic alignment in patients with nociceptive mechanical LBP. The secondary aim was to compare the effects of a high load lifting exercise (HLL) and low load motor control exercises (LMC) on the change in lumbopelvic alignment with a special emphasis on patients with high and low degrees of lumbar lordosis (lu) and sacral angle (sa) STUDY DESIGN This study is a secondary analysis of a randomized controlled trial evaluating the effects of HLL and LMC. PATIENT SAMPLE Patients from the primary study, that is, patients categorized with nociceptive mechanical LBP, who agreed to participate in the radiographic examination were included (n=66) OUTCOME MEASURES Lateral plain radiographic images were used to evaluate lumbopelvic alignment regarding the lumbar lordosis and the sacral angle as outcomes, with posterior bend as an explanatory variable.  The participants were recruited to the study from two occupational health care facilities. They were randomized to either the HLL or the LMC intervention group and offered 12 supervised exercise sessions. Outcome measures were collected at baseline and following the end of intervention period 2 months after baseline. Between and within group analyses of intervention groups and subgroups based on the distribution of the baseline values for the lumbar lordosis and the sacral angle, respectively (LOW, MID, and HIGH) were performed using both parametric and non parametric statistics.  The ranges of values for the present sample were 26.9 91.6deg (M=59.0deg, standard deviation [SD]=11.5deg) for the lumbar lordosis and 18.2 72.1deg (M=42.0deg, SD=9.6deg) for the sacral angle. There were no significant differences between the intervention groups in the percent change of eitheroutcome measure. Neither did any outcome change significantly over time within the intervention groups. In the subgroups, based on the distribution of respective baseline values, LOWlu showed a significantly increased lumbar lordosis, whereas HIGHsa showed a significantly decreased sacral angle following intervention.  This study describes the wide distribution of values for lumbopelvic alignment for patients with nociceptive mechanical LBP. Further research is needed to investigate subgroups of other types of LBP and contrast findings to those presented in this study. Our results also suggest that retraining of the lumbopelvic alignment could be possible for patients with LBP.

title: Effect of Modified Bridge Exercise on Muscle Activity of Erector Spinae, Gluteus Maximus and Biceps Femoris Muscle in Patients with Chronic Low Back Pain
abstract: The purpose of study was to investigate the effect of muscle activation of Erector spinae, Gluteus Maximus and Biceps femoris muscle during modified bridge exercise in patients with chronic low back pain.  The electromyogram was used to measure activation of Erector spinae, Gluteus Maximus and Biceps femoris muscle during five modified bridge exercise with electromyography electrodes in 21 patients (9 men, 12 women) who have suffered chronic low back pain.  The muscle activation of the erector spine to compare with NB, the posture of DB, TB, ABDB is statistically significant (p<0.05) In comparison with NB, the posture of TB and ABDB is statistically significant (p<0.05) for the gluteus maximus muscle activation. For biceps femoris muscle, all posture is statistically significant as compare with NB. In comparison with TB, the muscle activation of the erector spine is statistically significant in NB, and the gluteus maximus muscle activation is statistically significant (p<0.05) in NB, TMRB, DB.  These suggest that the 5 modified exercise for patients with chronic low back pain can induce compensation inhibition and selective muscle activation. It can be useful for providing a theoretical basis of back exercise program.

title: EFFECT OF STANDING EXERCISE USING PELVIS AND THORAX SYMMETRICAL DEVICE FOR CARE WORKERS WITH LOW BACK PAIN
abstract: Thirty six care workers have complaining LBP were randomized two groups. Exercises were supplied to subjects in the intervention group, performed exercises ten to thirty minutes a day while 8 month. In another group was no intervention. At the beginning of the study, two weeks, four weeks, and eight weeks were recorded two outcomes Roland Morris Disability Questionnaire (RMDQ) and Visual Analog Scale (VAS) on four postures (trunk extension/flexion/rotation and standing posture) In both groups, only Subjects of VAS 40mm on the beginning of this study were extracted to compare between groups at four terms. Statistical analyses were used the Mann Whitney U test after Bonferroni correction. Significance level before correction .05.

title: Identifying non specific low back pain clinical subgroups from sitting and standing repositioning posture tasks using a novel Cardiff Dempster Shafer Theory Classifier
abstract: Low back pain (LBP) classification systems are used to deliver targeted treatments matched to an individual profile, however, distinguishing between different subsets of LBP remains a clinical challenge.  A novel application of the Cardiff Dempster Shafer Theory Classifier was employed to identify clinical subgroups of LBP on the basis of repositioning accuracy for subjects performing a sitting and standing posture task. 87 LBP subjects, clinically subclassified into flexion (n 50) passive extension (n 14) and active extension (n 23) motor control impairment subgroups and 31 subjects with no LBP were recruited. Thoracic, lumbar and pelvic repositioning errors were quantified. The Classifier then transformed the error variables from each subject into a set of three belief values: (i) consistent with no LBP, (ii) consistent with LBP, (iii) indicating either LBP or no LBP.  In discriminating LBP from no LBP the Classifier accuracy was 96.61% From no LBP, subsets of flexion LBP, active extension and passive extension achieved 93.83, 98.15% and 97.62% accuracy, respectively. Classification accuracies of 96.8% 87.7% and 70.27% were found when discriminating flexion from passive extension, flexion from active extension and active from passive extension subsets, respectively. Sitting lumbar error magnitude best discriminated LBP from no LBP (92.4% accuracy) and the flexion subset from no LBP (90.1% accuracy) Standing lumbar error best discriminated active and passive extension from no LBP (94.4% and 95.2% accuracy, respectively)  Using repositioning accuracy, the Cardiff Dempster Shafer Theory Classifier distinguishes between subsets of LBP and could assist decision making for targeted exercise in LBP management.

title: Chronic low back pain and postural rehabilitation exercise: a literature review
abstract: Chronic low back represents one of the major causes of disability worldwide. Our narrative review has the purpose of highlighting the evidence supporting the different rehabilitative techniques described for its management. In total, 26 studies were found suitable to be included in the review (14 articles about pilates, six about McKenzie (MK) one article about Feldenkrais, three about Global Postural Rehabilitation (GPR) and two about Proprioceptive Neuromuscular Facilitation) The effect of exercise therapy was examined for each single study through changes in the main clinical outcomes (pain, disability, quality of life (QoL) and psychological aspects and the targeted aspects of physical function (muscle strength, mobility, muscular activity and flexibility) All the techniques are effective for the study groups with respect to the control groups in reducing pain and disability and improving the QoL and maintaining benefits at follow up; pilates, Back School, MK and Feldenkrais methods reduce pain and are more efficient than a pharmacological or instrumental approach in reducing disability and improving all psychological aspects also. GPR shows long lasting results for the last outcome. To date, it is difficult to affirm the superiority of one approach over another. Further high quality research is needed to confirm the effect of these techniques, together with the use of more appropriate evaluation measures.