Recurrent Low Back Pain:Linking Mechanisms to Outcomes
The purpose of this study is to determine if trunk neuromuscular control strategies are changed by therapeutic exercises emphasizing core stabilization.
Hypothesis: subjects with low back pain who demonstrate clinically meaningful improvements in function and pain will have significantly improved trunk motor control strategies.
Hypothesis: measures of trunk control will demonstrate 'construct-validity'. This will be tested using a known group method demonstrating:
- no significant change in motor control measures within the untreated, healthy control group.
- significant changes within the low back subjects who demonstrate clinically meaningful improvements.
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||Recurrent Low Back Pain:Linking Mechanisms to Outcomes|
- Trunk Neuromuscular Control [ Time Frame: Baseline, 8 weeks ] [ Designated as safety issue: No ]Using surface EMG, trunk kinematics and force plate parameters. Trunk motor control is characterized and compared between groups and pre/post intervention in the low back pain group.
- Oswestry Disability Index [ Time Frame: Baseline, 8 weeks ] [ Designated as safety issue: No ]measure of functional limitations
|Study Start Date:||August 2009|
|Estimated Study Completion Date:||June 2014|
|Estimated Primary Completion Date:||April 2014 (Final data collection date for primary outcome measure)|
Low back pain
Individuals with current low back pain attributed to poor trunk neuromuscular control (clinical instability).
Other: Core Stabilization
The 8-week core stabilization program emphasizes use of specific local stabilizing muscles (transverse abdominis[TrA], lumbar multifidus[LM]) to restore active control and stability to the trunk. This program emphasizes training using isometric co-contractions and a progression (3 stages) based upon a motor learning paradigm.
Stage 1: emphasizes neutral position of the spine and activation of the TrA and LM. Performance feedback is emphasized and monitored through observation and palpation.
Stage 2: promotes maintenance the co-contraction while performing movements of the trunk and superimposing movements of the upper and lower extremities. Trunk conditioning is also emphasized (i.e., curl ups, quadruped leg/arm lifts and side support). Feedback is gradually reduced.
Stage 3: emphasis on maintenance of the co-contraction while performing exercises on an unstable surface or during perturbation of the activity. Random practice patterns are used to enhance motor learning.
A growing body of evidence suggests that poor neuromuscular control of the lumbopelvic region is an important finding in a large number of patients with recurrent and chronic low back pain and may play a role in recurrence of symptoms. Despite findings of altered trunk motor control in individuals with low back pain, the neuromuscular strategies underlying these alterations have not been satisfactorily characterized. The aims of this study are to(1) identify which neural control strategies are altered following a rehabilitation program that emphasizes trunk control and stability using a motor learning approach and (2) provide preliminary evidence of a link between hypothesized mechanism and effectiveness for programs designed to improve trunk control.
|United States, Pennsylvania|
|Philadelphia, Pennsylvania, United States, 19102|
|Optimum Physical Therapy Associates|
|West Chester, Pennsylvania, United States, 19380|
|Principal Investigator:||Sheri P. Silfies, PT, PhD||Drexel University|