A pilot study on the short-term effects of myofascial release and core stability exercises on balance in chronic low back pain
,
Abstract
Background and Aim: Balance disorders are among common complications of chronic low back pain (LBP). Since the tissue and echogenicity of thoracolumbar fascia changes in chronic LBP, the independent motion of fascia layers would negatively alter, and it may affect the control of spine movements. It has been shown that myofascial release (MFR) improves the function of transversus abdominis as a core muscle in LBP. So, MFR may affect the balance and postural control in these patients. The aim of this study was to evaluate the immediate effects of MFR and core stability (CS) exercises on dynamic balance and pain in women with chronic non-specific LBP.
Methods: In this pilot study, with a pretest-posttest design, 10 females aged 30 ± 9.04 participated. The participants received one session of MFR on thoracolumbar fascia and CS exercises. The outcome measures were dynamic balance by Y balance test (YBT) and pain with visual analogue scale (VAS), which were assessed before and immediately after the intervention.
Results: Dynamic balance improved significantly (p < 0.02) after intervention. The VAS as an indicator of pain intensity showed significant improvement (p = 0.005).
Conclusion: The application of MFR plus CS exercises for a single session is effective in improving dynamic balance and pain in women with chronic non-specific LBP.
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2. Nachemson AL, Jonsson E. Neck and back pain: the scientific evidence of causes, diagnosis, and treatment. Philadelphia: Lippincott Williams & Wilkins; 2000.
3. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003;12(2):149-65. doi: 10.1007/s00586-002-0508-5
4. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028-37. doi: 10.1002/art.34347
5. Wilke J, Schleip R, Klingler W, Stecco C. The lumbodorsal fascia as a potential source of low back pain: a narrative review. Biomed Res Int. 2017;2017:5349620. doi: 10.1155/2017/5349620
6. Selkow NM, Eck MR, Rivas S. Transversus abdominis activation and timing improves following core stability training: a randomized trial. Int J Sports Phys Ther. 2017;12(7):1048-56. doi: 10.26603/ijspt20171048
7. Moghadam N, Ghaffari MS, Noormohammadpour P, Rostami M, Zarei M, Moosavi M, et al. Comparison of the recruitment of transverse abdominis through drawing-in and bracing in different core stability training positions. J Exerc Rehabil. 2019;15(6):819-25. doi: 10.12965/jer.1939064.352
8. Langevin HM, Fox JR, Koptiuch C, Badger GJ, Greenan-Naumann AC, Bouffard NA, et al. Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC Musculoskelet Disord. 2011;12:203. doi: 10.1186/1471-2474-12-203
9. della Volpe R, Popa T, Ginanneschi F, Spidalieri R, Mazzocchio R, Rossi A. Changes in coordination of postural control during dynamic stance in chronic low back pain patients. Gait Posture. 2006;24(3):349-55. doi: 10.1016/j.gaitpost.2005.10.009
10. Koch C, Hänsel F. Non-specific low back pain and postural control during quiet standing-A systematic review. Front Psychol. 2019;10:586. doi: 10.3389/fpsyg.2019.00586
11. Ghamkhar L, Kahlaee AH. Trunk muscles activation patterns during walking in subjects with and without chronic low back pain: a systematic review. PM R. 2015;7(5):519-26. doi: 10.1016/j.pmrj.2015.01.013.
12. Alexandrov AV, Frolov AA, Horak FB, Carlson-Kuhta P, Park S. Feedback equilibrium control during human standing. Biol Cybern. 2005;93(5):309-22. doi:10.1007/s00422-005-0004-1
13. Karimi N, Ebrahimi I, Kahrizi S, Torkaman G. Evaluation of postural balance using the biodex balance system in subjects with and without low back pain. Pak J Med Sci. 2008;24(3):372-7.
14. Clark MA, Fater D, Reuteman P. Core (trunk) stabi¬lization and its importance for closed kinetic chain rehabilitation. Orthop Phys Ther Clin N Am. 2000;9:119-35.
15. Hodges PW, Richardson CA. Contraction of the abdominal muscles associated with movement of the lower limb. Phys Ther. 1997;77(2):132-42. doi: 10.1093/ptj/77.2.132
16. Ferreira PH, Ferreira ML, Hodges PW. Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity. Spine (Phila Pa 1976). 2004;29(22):2560-6. doi: 10.1097/01.brs.0000144410.89182.f9
17. Ajimsha MS, Al-Mudahka NR, Al-Madzhar JA. Effectiveness of myofascial release systematic review of randomized controlled trials. J Bodyw Mov Ther. 2015;19(1):102-12. doi: 10.1016/j.jbmt.2014.06.001
18. Wong KK, Chai HM, Chen YJ, Wang CL, Shau YW, Wang SF. Mechanical deformation of posterior thoracolumbar fascia after myofascial release in healthy men: A study of dynamic ultrasound. Musculoskelet Sci Pract. 2017;27:124-30. doi: 10.1016/j.math.2016.10.011
19. Langevin HM, Stevens-Tuttle D, Fox JR, Badger GJ, Bouffard NA, Krag MH. Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain. BMC Musculoskelet Disord. 2009;10:151. doi: 10.1186/1471-2474-10-151
20. Spector M. Musculoskeletal connective tissue cells with muscle: expression of muscle actin in and contraction offibroblasts, chondrocytes, and osteoblasts. Wound Repair Regen. 2001;9(1):11-8. doi: 10.1046/j.1524-475x.2001.00011.x
21. Schleip R, Klingler W, Lehmann-Horn F. Active fascial contractility: Fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics. Med Hypotheses. 2005;65(2):273-7. doi: 10.1016/j.mehy.2005.03.005
22. Chen YH, Chai HM, Shau YW, Wang CL, Wang SF. Increased sliding of transverse abdominis during contraction after myofascial release in patients with chronic low back pain. Man Ther. 2016;23:69-75. doi: 10.1016/j.math.2015.10.004
23. Kim JJ, Park SY. Immediate effects of the trunk stabilizing exercise on static balance parameters in double-leg and one leg stance. J Phys Ther Sci. 2016;28(6):1673-5. doi: 10.1589/jpts.28.1673
24. Trampas A, Mpeneka A, Malliou V, Godolias G, Vlachakis P. Immediate effects of core-stability exercises and clinical massage on dynamic-balance performance of patients with chronic specific low back pain. J Sport Rehabil. 2015;24(4):373-83. doi: 10-1123/jsr.2014-0215
25. Okubo Y, Kaneoka K, Imai A, Shiina I, Tatsumura M, Izumi S, et al. Electromyographic analysis of transversus abdominis and lumbar multifidus using wire electrodes during lumbar stabilization exercises. J Orthop Sports Phys Ther. 2010;40(11):743-50. doi: 10.2519/jospt.2010.3192
26. Plisky PJ, Gorman PP, Butler RJ, Kiesel KB, Underwood FB, Elkins B. The reliability of an instrumented device for measuring components of the star excursion balance test. N Am J Sports Phys Ther. 2009;4(2):92-9.
27. Butowicz CM, Ebaugh DD, Noehren B, Silfies SP. Validation of two clinical measures of core stability. Int J Sports Phys Ther. 2016;11(1):15-23.
28. Hawker GA, Mian S, Kendzerska T, French M Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S240-52. doi: 10.1002/acr.20543
29. Smeets RJ, Vlaeyen JW, Kester AD, Knottnerus JA. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. J Pain. 2006;7(4):261-71. doi: 10.1016/j.jpain.2005.10.011
30. Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity the visual analogue scale. Pain. 1983;16(1):87-101. doi: 10.1016/0304-3959(83)90088-x
31. Manheim CJ, The myofascial release manual. 3rd ed. New Jersey: Slack Incorporated; 2001.
32. Duncan R. Myofascial release (hands-on guides for therapists). 1st ed. Champaign, IL: Human Kinetics, Inc.; 2014.
33. Middel B, van Sonderen E. Statistical significant change versus relevant or important change in (quasi) experimental design: some conceptual and methodological problems in estimating magnitude of intervention-related change in health services research. Int J Integr Care. 2002;2:e15. doi: 10.5334/ijic.65
34. Beardsley C, Škarabot J. Effects of self-myofascial release: A systematic review. J Bodyw Mov Ther. 2015;19(4):747-58. doi:10.1016/j.jbmt.2015.08.007
35. Tozzi P, Bongiorno D, Vitturini C. Fascial release effects on patients with non-specific cervical or lumbar pain. J Bodyw Mov Ther. 2011;15(4):405-16. doi: 10.1016/j.jbmt.2010.11.003
36. Jacobs JV, Henry SM, Nagle KJ. People with chronic low back pain exhibit decreased variability in the timing of their anticipatory postural adjustments. Behav Neurosci. 2009;123(2):455-8. doi: 10.1037/a0014479
37. Bednar DA, Orr FW, Simon GT. Observations on the pathomorphology of the thoracolumbar fascia in chronic mechanical back pain. A microscopic study. Spine (Phila Pa 1976). 1995;15;20(10):1161-4. doi: 10.1097/00007632-199505150-00010
38. Radebold A, Cholewicki J, Polzhofer GK, Greene HS. Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain. Spine (Phila Pa 1976). 2001;26(7):724-30. doi: 10.1097/00007632-200104010-00004
39. Staud R. Peripheral pain mechanisms in chronic widespread pain. Best Pract Res Clin Rheumatol. 2011;25(2):155-64. doi: 10.1016/j.berh.2010.01.010
40. Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain. 1987;30(1):115-26. doi: 10.1016/0304-3959(87)90089-3
41. Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord. 2014;9;15:416. doi: 10.1186/1471-2474-15-416
42. Standaert CJ, Weinstein SM, Rumpeltes J. Evidence-informed management of chronic low back pain with lumbar stabilization exercises. Spine J. 2008;8(1):114-20. doi: 10.1016/j.spinee.2007.10.015
43. May S, Johnson R. Stabilisation exercises for low back pain: a systematic review. Physiotherapy. 2008;94(3):179-89. doi: 10.1016/j.physio.2007.08.010
44. Staron RS, Karapondo DL, Kraemer WJ, Fry AC, Gordon SE, Falkel JE, et al. Skeletal muscle adaptations during early phase of heavy-resistance training in men and women. J Appl Physiol (1985). 1994;76(3):1247-55. doi: 10.1152/jappl.1994.76.3.1247
45. Granacher U, Lacroix A, Muehlbauer T, Roettger K, Gollhofer A. Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults. Gerontology. 2013;59(2):105-13. doi: 10.1159/000343152
2. Nachemson AL, Jonsson E. Neck and back pain: the scientific evidence of causes, diagnosis, and treatment. Philadelphia: Lippincott Williams & Wilkins; 2000.
3. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003;12(2):149-65. doi: 10.1007/s00586-002-0508-5
4. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028-37. doi: 10.1002/art.34347
5. Wilke J, Schleip R, Klingler W, Stecco C. The lumbodorsal fascia as a potential source of low back pain: a narrative review. Biomed Res Int. 2017;2017:5349620. doi: 10.1155/2017/5349620
6. Selkow NM, Eck MR, Rivas S. Transversus abdominis activation and timing improves following core stability training: a randomized trial. Int J Sports Phys Ther. 2017;12(7):1048-56. doi: 10.26603/ijspt20171048
7. Moghadam N, Ghaffari MS, Noormohammadpour P, Rostami M, Zarei M, Moosavi M, et al. Comparison of the recruitment of transverse abdominis through drawing-in and bracing in different core stability training positions. J Exerc Rehabil. 2019;15(6):819-25. doi: 10.12965/jer.1939064.352
8. Langevin HM, Fox JR, Koptiuch C, Badger GJ, Greenan-Naumann AC, Bouffard NA, et al. Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC Musculoskelet Disord. 2011;12:203. doi: 10.1186/1471-2474-12-203
9. della Volpe R, Popa T, Ginanneschi F, Spidalieri R, Mazzocchio R, Rossi A. Changes in coordination of postural control during dynamic stance in chronic low back pain patients. Gait Posture. 2006;24(3):349-55. doi: 10.1016/j.gaitpost.2005.10.009
10. Koch C, Hänsel F. Non-specific low back pain and postural control during quiet standing-A systematic review. Front Psychol. 2019;10:586. doi: 10.3389/fpsyg.2019.00586
11. Ghamkhar L, Kahlaee AH. Trunk muscles activation patterns during walking in subjects with and without chronic low back pain: a systematic review. PM R. 2015;7(5):519-26. doi: 10.1016/j.pmrj.2015.01.013.
12. Alexandrov AV, Frolov AA, Horak FB, Carlson-Kuhta P, Park S. Feedback equilibrium control during human standing. Biol Cybern. 2005;93(5):309-22. doi:10.1007/s00422-005-0004-1
13. Karimi N, Ebrahimi I, Kahrizi S, Torkaman G. Evaluation of postural balance using the biodex balance system in subjects with and without low back pain. Pak J Med Sci. 2008;24(3):372-7.
14. Clark MA, Fater D, Reuteman P. Core (trunk) stabi¬lization and its importance for closed kinetic chain rehabilitation. Orthop Phys Ther Clin N Am. 2000;9:119-35.
15. Hodges PW, Richardson CA. Contraction of the abdominal muscles associated with movement of the lower limb. Phys Ther. 1997;77(2):132-42. doi: 10.1093/ptj/77.2.132
16. Ferreira PH, Ferreira ML, Hodges PW. Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity. Spine (Phila Pa 1976). 2004;29(22):2560-6. doi: 10.1097/01.brs.0000144410.89182.f9
17. Ajimsha MS, Al-Mudahka NR, Al-Madzhar JA. Effectiveness of myofascial release systematic review of randomized controlled trials. J Bodyw Mov Ther. 2015;19(1):102-12. doi: 10.1016/j.jbmt.2014.06.001
18. Wong KK, Chai HM, Chen YJ, Wang CL, Shau YW, Wang SF. Mechanical deformation of posterior thoracolumbar fascia after myofascial release in healthy men: A study of dynamic ultrasound. Musculoskelet Sci Pract. 2017;27:124-30. doi: 10.1016/j.math.2016.10.011
19. Langevin HM, Stevens-Tuttle D, Fox JR, Badger GJ, Bouffard NA, Krag MH. Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain. BMC Musculoskelet Disord. 2009;10:151. doi: 10.1186/1471-2474-10-151
20. Spector M. Musculoskeletal connective tissue cells with muscle: expression of muscle actin in and contraction offibroblasts, chondrocytes, and osteoblasts. Wound Repair Regen. 2001;9(1):11-8. doi: 10.1046/j.1524-475x.2001.00011.x
21. Schleip R, Klingler W, Lehmann-Horn F. Active fascial contractility: Fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics. Med Hypotheses. 2005;65(2):273-7. doi: 10.1016/j.mehy.2005.03.005
22. Chen YH, Chai HM, Shau YW, Wang CL, Wang SF. Increased sliding of transverse abdominis during contraction after myofascial release in patients with chronic low back pain. Man Ther. 2016;23:69-75. doi: 10.1016/j.math.2015.10.004
23. Kim JJ, Park SY. Immediate effects of the trunk stabilizing exercise on static balance parameters in double-leg and one leg stance. J Phys Ther Sci. 2016;28(6):1673-5. doi: 10.1589/jpts.28.1673
24. Trampas A, Mpeneka A, Malliou V, Godolias G, Vlachakis P. Immediate effects of core-stability exercises and clinical massage on dynamic-balance performance of patients with chronic specific low back pain. J Sport Rehabil. 2015;24(4):373-83. doi: 10-1123/jsr.2014-0215
25. Okubo Y, Kaneoka K, Imai A, Shiina I, Tatsumura M, Izumi S, et al. Electromyographic analysis of transversus abdominis and lumbar multifidus using wire electrodes during lumbar stabilization exercises. J Orthop Sports Phys Ther. 2010;40(11):743-50. doi: 10.2519/jospt.2010.3192
26. Plisky PJ, Gorman PP, Butler RJ, Kiesel KB, Underwood FB, Elkins B. The reliability of an instrumented device for measuring components of the star excursion balance test. N Am J Sports Phys Ther. 2009;4(2):92-9.
27. Butowicz CM, Ebaugh DD, Noehren B, Silfies SP. Validation of two clinical measures of core stability. Int J Sports Phys Ther. 2016;11(1):15-23.
28. Hawker GA, Mian S, Kendzerska T, French M Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S240-52. doi: 10.1002/acr.20543
29. Smeets RJ, Vlaeyen JW, Kester AD, Knottnerus JA. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. J Pain. 2006;7(4):261-71. doi: 10.1016/j.jpain.2005.10.011
30. Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity the visual analogue scale. Pain. 1983;16(1):87-101. doi: 10.1016/0304-3959(83)90088-x
31. Manheim CJ, The myofascial release manual. 3rd ed. New Jersey: Slack Incorporated; 2001.
32. Duncan R. Myofascial release (hands-on guides for therapists). 1st ed. Champaign, IL: Human Kinetics, Inc.; 2014.
33. Middel B, van Sonderen E. Statistical significant change versus relevant or important change in (quasi) experimental design: some conceptual and methodological problems in estimating magnitude of intervention-related change in health services research. Int J Integr Care. 2002;2:e15. doi: 10.5334/ijic.65
34. Beardsley C, Škarabot J. Effects of self-myofascial release: A systematic review. J Bodyw Mov Ther. 2015;19(4):747-58. doi:10.1016/j.jbmt.2015.08.007
35. Tozzi P, Bongiorno D, Vitturini C. Fascial release effects on patients with non-specific cervical or lumbar pain. J Bodyw Mov Ther. 2011;15(4):405-16. doi: 10.1016/j.jbmt.2010.11.003
36. Jacobs JV, Henry SM, Nagle KJ. People with chronic low back pain exhibit decreased variability in the timing of their anticipatory postural adjustments. Behav Neurosci. 2009;123(2):455-8. doi: 10.1037/a0014479
37. Bednar DA, Orr FW, Simon GT. Observations on the pathomorphology of the thoracolumbar fascia in chronic mechanical back pain. A microscopic study. Spine (Phila Pa 1976). 1995;15;20(10):1161-4. doi: 10.1097/00007632-199505150-00010
38. Radebold A, Cholewicki J, Polzhofer GK, Greene HS. Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain. Spine (Phila Pa 1976). 2001;26(7):724-30. doi: 10.1097/00007632-200104010-00004
39. Staud R. Peripheral pain mechanisms in chronic widespread pain. Best Pract Res Clin Rheumatol. 2011;25(2):155-64. doi: 10.1016/j.berh.2010.01.010
40. Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain. 1987;30(1):115-26. doi: 10.1016/0304-3959(87)90089-3
41. Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord. 2014;9;15:416. doi: 10.1186/1471-2474-15-416
42. Standaert CJ, Weinstein SM, Rumpeltes J. Evidence-informed management of chronic low back pain with lumbar stabilization exercises. Spine J. 2008;8(1):114-20. doi: 10.1016/j.spinee.2007.10.015
43. May S, Johnson R. Stabilisation exercises for low back pain: a systematic review. Physiotherapy. 2008;94(3):179-89. doi: 10.1016/j.physio.2007.08.010
44. Staron RS, Karapondo DL, Kraemer WJ, Fry AC, Gordon SE, Falkel JE, et al. Skeletal muscle adaptations during early phase of heavy-resistance training in men and women. J Appl Physiol (1985). 1994;76(3):1247-55. doi: 10.1152/jappl.1994.76.3.1247
45. Granacher U, Lacroix A, Muehlbauer T, Roettger K, Gollhofer A. Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults. Gerontology. 2013;59(2):105-13. doi: 10.1159/000343152
| Files | ||
| Issue | Vol 29 No 2 (2020) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/avr.v29i2.2792 | |
| Keywords | ||
| Dynamic balance; core stability; low back pain; myofascial release | ||
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How to Cite
1.
Mavajian M, Fakhari Z, Naghdi S, Bagheri H, Jalaie S. A pilot study on the short-term effects of myofascial release and core stability exercises on balance in chronic low back pain. Aud Vestib Res. 2020;29(2):109-116.
