Comparing the effects of motor control exercises and PNF exercises on postural control, strength, endurance, and proprioception in women with chronic nonspecific low back pain

Document Type : Research Paper

Authors

1 M.sc student. Sports Injury and corrective exercises, Raja University, Qazvin, Iran

2 Assistant Professor, Sports Injury and corrective exercises, Amir Kabir University, Tehran, Iran

3 Assistant Professor Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran

4 Assistant Professor of Corrective Exercises and Sports Injuries, Faculty of physical education and Sport Sciences, Shahrood University of Technology, Shahrood, Iran

Abstract

Background: Low back pain is a common debilitating condition and a major clinical and socio-economic problem in the most industrialized and non-industrialized countries.
Aim: The aim of this study was to compare the effect of motor control exercises and PNF exercises on postural control, strength, endurance and proprioception in women with chronic non-specific low back pain.
Materials and Methods: Forty-five women with non-specific chronic low back pain selected by convenience sampling and randomly divided into three groups of 15 (motor control exercises, PNF exercises, and control group). The pre-test included posture control, flexor and extensor muscle strength of the trunk, trunk muscle endurance, and proprioception using Y balance, dynamometer, McGill, and Goniometer tests, respectively. The subjects of the experimental groups performed the training program for 8 weeks under the supervision of the instructor and according to the training protocol. Then, the post-test was performed. Paired t-test and analysis of covariance at the significance level of 0.05 were used to collect data.
Results: The results showed that motor control and PNF exercises improved proprioception, postural control, endurance, and strength of trunk flexor and extensor muscles in women with non-specific chronic low back pain (α≤0.05). The results also showed that there was no significant difference between the effects of motor control and PNF exercises on proprioception, postural control, flexor muscle endurance, and extensor muscle strength (α≥0.05).
Discussion: Motor control and PNF exercises are effective in improving the proprioception, postural control, endurance, and strength of flexor and extensor muscles of the trunk with non-specific chronic low back pain, and both training methods are effective in treating chronic non-specific low back pain.

Keywords


[1] O’Sullivan K, O’Sullivan PB, O’Keeffe M. The Lancet Series on Low Back Pain: Reflections and Clinical Implications. BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine. 2019. doi: 10.1136/bjsports-2018-099671.

[2] Mertens P, Blond S, David R, Rigoard P. “Anatomy, physiology and neurobiology of the nociception: a focus on low back pain (part A)”. Neurochirurgie. 2015; 61: 22-34. doi: 10.1016/j.neuchi.2014.09.001.

[3] Bardin LD, King P, Maher CG. “Diagnostic triage for low back pain: a practical approach for primary care”. Medical Journal of Australia. 2017; 206(6): 268-273. doi: 10.5694/mja16.00828.

[4] Kamper SJ, Apeldoorn AT, Chiarotto A. “Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis”. Br Med J. 2015; 350: 1-15. doi: 10.1136/bmj.h444.

[5] Yaghoobi Z, Kahrizi S, Parnianpour M, Ebrahimi Takamjani E, FaghihZade S. “The short effects of two spinal stabilization exercise on balance tests and limit of stability in men with non-specific chronic low back pain: Randomized clinical trial study”. Journal of Tavanbakhshi. 2012; 1(51): 102-11.

[6] Sawant RS, Shinde SB. “Effect of hydrotherapy based exercises for chronic nonspecific low back pain”. Indian Journal of Physiotherapy and Occupational Therapy. 2019; 13(1): 133-8.

[7] Hirata RP, Salomoni SE, Christensen SW, Graven-Nielsen T. “Reorganized motor control strategies of trunk muscles due to acute low back pain”. Human Movement Science. 2015; 41: 282-294. doi: 10.1016/j.humov.2015.04.001.

[8] Waldhelm A, Li L. “Endurance tests are the most reliable core sta- bility related measurements”. Journal of Sport and Health Science. 2012; 1(2): 121-8. doi: 10.1016/j.jshs.2012.07.007. doi: 10.1016/j.jshs.2012.07.007.

[9] O’Sullivan PB. “Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism”. Manual Therapy. 2005; 10(4): 242-255. doi: 10.1016/j.math.2005.07.001. PMID: 16154380.

[10] Malla S, “Effect of motor control exercise on Swiss Ball and PNF technique on non- specific low back pain”. International Journal of Medical Research & Health Sciences. 2018; 7(4): 114-124.

[11] Mohamadi E, Rajabi R, Alizadeh MH. “The comparison of the lumbopelvic stabilizer muscle endurance in female athletes with and without patellofemoral pain syndrome”. Res Rehabil Sci. 2014; 9: 424-34.

[12] Pourtaghi F, Emami Moghadam Z, Ramezani M, Behnam Vashani H, Mohajer S. Effect of resistance training using thera-band on muscular strength and quality of life among the elderly. Evidence Based Care. 2017 Oct 1;7(3):7-16.

[13] 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”. North American Journal of Sports Physical Therapy. 2009; 4(2): 92-99. PMCID: PMC2953327. PMID: 21509114.

[14] Gorman PP, Butler RJ, Plisky PJ, Kiesel KB. “Upper quarter Y balance test: Reliability and performance comparison between genders in active adults”. Journal of Strength and Conditioning Research. 2012; 26(11): 3043-3048. doi: 10.1519/JSC.0b013e3182472fdb. PMID: 22228174.

[15] Plisky PJ, Rauh MJ, Kaminski TW, Underwood FB. “Star excursion balance test as a predictor of lower extremity injury in high school basketball players”. J Orthop Sports Phys Ther. 2006; 36(12): 911-919. doi: 10.2519/jospt.2006.2244. PMID: 17193868.

[16] Willson JD, Ireland ML, Davis I. "Core strength and lower extremity alignment during single leg squats". Med. Sci. Sports Exerc. 2006. 38(5): 945-952.

[17] McGill SM, Childs A, Liebenson C. “Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database”. Arch Phys Med Rehabil. 1999; 80(8): 941-4.  doi: 10.1016/s0003-9993(99)90087-4. PMID: 10453772.

[18] Letafatkar A, Nazarzadeh M, Hadadnezhad M, Farivar N. “The efficacy of a HUBER exercise system mediated sensorimotor training protocol on proprioceptive system, lumbar movement control and quality of life in patients with chronic non-specific low back pain”. Journal of Back and Musculoskeletal Rehabilitation. 2017; 30(4): 767-78. doi: 10.3233/BMR-150404. PMID: 28453452.

[19] Niederer D, Mueller J. “Sustainability effects of motor control stabilization exercises on pain and function in chronice nonspecific low back pain patients”. Plos One. 2020; 15(1): e0227423. doi: 10.1371/journal.pone.0227423. PMID: 31940397. PMCID: PMC6961919.

[20] Wang M, Pei ZW, Xiong BD, Meng XM, Chen XL, Liao WJ. Use of Kinesio taping in lower-extremity rehabilitation of post-stroke patients: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice. 2019 May 1; 35: 22-32. doi: 10.1016/j.ctcp.2019.01.008.

[21] Javadipour Z, Norasteh AA, Babagol Tabar Samakoush H. “Comparison of endurance and strength of trunk muscles and balance in female students with and without back pain”. Journal of Rehabilitation Medicine. 2020; Available Online: http://medrehab.sbmu.ac.ir/article_1101104_en.html. doi: 10.22037/JRM.2020.112686.2237.

[22] Kiani R, Fattahi H. Effects of Eight Weeks of TRX and CXWORX Exercises on Trunk Muscle Strength, Core Endurance, and Dynamic Balance of Female College Students. The Scientific Journal of Rehabilitation Medicine. 2021 May 22; 10(2): 186-201. doi: 10.22037/JRM.2020.111386.1954.

[23] Aly SM. “Trunk muscles response to core stabiliti exercises in patients with chronic low back pain: A randomized controlled trial”. International Journal of Physiotherapy and Research. 2017; 5(1): 1836-45.

[24] Letafatkar Kh, Bakhshi Harris M, Ghorbani S. Corrective and Therapeutic Movements. Bamdad Publications, 2009.

[25] Farahpour N, Moroori M. “The evaluation of importance of muscle resistance and anthropometric specialty in low back pain”. Harekat Journal. 2004; 18: 5-23. [in Persian]

[26] Burke_DG, Culligan_CJ, Holt LE. “Equipment designed to stimulate proprioceptive neuromuscular facilitation flexibility training”. Journal of Strength and Conditioning Research. 2000; 14(2): 135-39.

[27] Halliaday MH, Ferreira PH. “A randomized clinical trial comparing the McKenzie method and motor control exercises in people with chronice low back pain and a directional preference”, Science Direct Physiotherapy. 2019; 105(4): 442-445.

[28] Verbunt JA, Seelen HA, Vlaeyen JW, van de Heijden GJ, Heuts PH, Pons K, Knottnerus JA. Disuse and deconditioning in chronic low back pain: concepts and hypotheses on contributing mechanisms. European journal of pain. 2003 Feb 1;7(1):9-21. doi: 10.1016/S1090-3801(02)00071-X.

[29] Dundar U, Solak O, Yigit I, Evcik D, Kavuncu V. “Clinical effectiveness of aquatic exercise to treat chronic low back pain: a randomized controlled trial”. Semin Arthritis Rheum. 2015; 45: 229-23.

[30] Madigan ML, Davidson BS, Nussbaum MA. “Postural sway and joint kinematics during quiet standing are affected by lumbar extensor fatigue”. Hum Mov Sci. 2006; 25(6): 788-99.

[31] Hosseinabadi MR, Ghasemi Gholam A, Goharjoo MI, Faizi M. “Effects of core stability exercises and special suspension exercises on functional disability and pain in people with nonspecific chronic low back pain”. Journal of Rehabilitation Medicine. 2020; 9(2): 71-78.

[32] Asadi SY. “Effect of motor control exercise on proprioception and lumbar motor control in low back pain patients with motor control impairment”. Journal of Rehabilitation Medicine. 2021; 22; 10(2): 294-305. doi: 10.22037 / jrm.2020.113706.2430. [in Persian]

[33] Asadi SY, Letafatkar A, Shojauddin S, Eftekhari F. “Comparative effect of motor control and water exercise on proprioception, sensory acuity, and pain in patients with nonspecific chronic low back pain”. Journal of Rehabilitation Medicine. 2019; 7(1): 170-182.

[34] Hwang JA, Bae SH, Do Kim G, Kim KY. “The effects of sensorimotor training on anticipatory postural adjustment of the trunk in chronic low back pain patients”. Journal of Physical Therapy Science. 2013; 25(9): 1189-92.