1. Effects of Exercise Therapy with Trunk and Pelvic Fixation
on Acute Low Back Pain: A Randomized Controlled Trial
Makoto Nejishima1), Shigeki Yokoyama2), Takeshi Sugiura3), Yusuke Kubo3),
Shuhei Sugiyama3), Kaori Kobori3), Kazuyoshi Gamada4) , Shohei Ohgi 1)　
1) Seirei Christopher University, 2) Kyoto Tachibana University, 3) Kobori orthopedics clinic , 4) Hiroshima International University
Background
During acute-phase primary care for low back pain (LBP), patients should avoid resting and remain as active as possible. Development of an effective exercise therapy for acute-phase primary care is an important area of investigation to prevent chronic or recurrent LBP. Previously developed exercise therapies for acute LBP included specific stabilization exercise, stretching, and muscle strengthening. However, LBP arises from lumbar region movement. Therefore, methods in which lumbar region movement is avoided, thus causing no pain, are considered suitable forms of exercise therapy.
Purpose
This study aimed to verify the effects of exercise therapy with trunk and pelvic fixation, with consideration of pain arising during trunk movement and trunk mobility in patients with acute LBP.
Participants
24 patients with acute LBP (Table 1)
【Inclusion criteria】 20 and 60 years, pain experienced when flexing or extending the trunk scored at 30 mm or above on the visual analogue scale (VAS: 0 to 100 mm), and an LBP duration of less than 4 weeks. 【Exclusion criteria】 Known or suspected specific LBP, complain of pain during intervention, mental disease, pregnant woman, medication
Assignment
　Trunk flexion group 14 patients / extension pain group 10 patients.
From within each group, the patients were randomly assigned to
conventional physical therapy (C-PT group) /
exercise therapy with trunk and pelvic fixation after conventional
physical therapy (ATM2 group).
Intervention
The period of intervention was 2 weeks, with 1–2 sessions per week.
【 Conventional Physical Therapy: C-PT 】
thermotherapy and electrical stimulation therapy
each of 10 minutes, total 20 minutes
【 Exercise therapy using ATM®2: ATM2 】
capable of fixing the trunk and pelvis to a bed,
automatically exercising the trunk through flexion
or extension five times, maximum isometric
contraction 10 times for 3 seconds.
Measurement Index
【 Visual Analogue Scale : VAS 】
The degree of flexion or extension pain of the trunk
【 Trunk Mobility 】
Finger-Floor Distance（FFD): during trunk flexion
Trunk extension angular in standing using inclinometer
Data Analysis
two-way repeated-measures analysis of variance for the immediate effects at the initial intervention and the 2-week effects
Results
【VAS】
Results（continuation）
【Trunk Mobility】
Discussion and Conclusions
Exercise therapy with trunk and pelvic fixation, and isometric contraction that is performed within a range of mobility that does not cause pain may improve immediate pain during trunk movement in patients with acute low back pain.
Implications
In systematic reviews and medical guidelines for acute-phase low back pain treatment, exercise therapy is not presently recognized as effective. Nevertheless, exercise therapy with trunk and pelvic fixation could be used proactively for the treatment of acute low back pain.
Table 3
pre
immediate
2 weeks
FFD:
trunk flexion
(cm)
C-PT
-18.2
-12.7
-7.5
ATM2
-8.7
-6.8
-6.9
Inclinometer:
trunk extension
(degree)
26.2
31.0
41.2
27.8
36.4
37.2
Mobility of trunk showed improvement after 2 weeks of the therapy, however, no significant difference between the two groups was noted, respectively.
Fig1. ATM®2
(BackProject Corp.)
Table 2
pre
immediate
2 weeks
trunk flexion
(mm)
C-PT
40.8
32.8
16.0
ATM2
53.6
29.2
15.8
trunk extension
72.0
60.4
10.8
65.2
28.0
15.4
Acknowledgment
The study was approved by Seirei Christper University Ethics Committee（12-09）． *
Table 1
Flex. Pain
Ext. Pain
ATM2(7)
C-PT(7)
ATM2(5)
C-PT(5)
Age (yr) 38 48 39
Sex (male：female)
5 : 2
2 : 5
3 : 2
1 : 4
Body weight (kg)
63.3
62.3
67.6
59.6
Height (cm)
165.1
160.4
166.4
trunk flexion: Pain during trunk flexion showed improvement after 2 weeks of the therapy, however, no significant difference between the two groups was noted.
trunk extension: Pain during trunk extension showed improvement after 2 weeks of the therapy. Immediate effects, the ATM2 group improved significantly compared to the C-PT group( p = 0.02 ).
Contact details
MAKOTO NEJISHIMA
School of Rehabilitation Sciences, Seirei Christopher University
address: