The effect of manual techniques on maximum muscle activity electromyography, functional disability, and pain in women with non-specific chronic low back pain

Miri, Hadi; Haghighi, Mina; Mohammadi, Arezoo

doi:10.22059/sshr.2022.90197

The effect of manual techniques on maximum muscle activity electromyography, functional disability, and pain in women with non-specific chronic low back pain

Document Type : Research Paper

Authors

¹ Dr hadi miri, Assistant professor Department of Physical Education and Sport Sciences, Amirkabir University of Technology, Tehran, Iran

² Assistant Professor, Physical Education and Sport Sciences Department, shahrood University of Technology, shahrood, Iran

³ Master of Pathology and Corrective Movements، Department of Physical Education and Sport Sciences, Raja University، Qazvin، Iran

10.22059/sshr.2022.90197

Abstract

Background: Low back pain (LBP) can cause changes in muscle activity in affected individuals, making it difficult for them to contract their muscles effectively and engage in physical activities. Manual chiropractic techniques have been proposed as a potential solution to improve muscle orientation and function in individuals with LBP.
Aim: The purpose of this study was to investigate the effect of manual techniques on maximum muscle activity electromyography, functional disability, and pain in women with non-specific chronic low back pain.
Materials and Methods: Twenty women between the ages of 30 and 50, who had been experiencing NSCLBP for over three months with no history of spinal surgery or postural abnormalities, and were able to perform daily activities after providing consent, were recruited from a sports medicine clinic to participate in the study. In the pre-test, the Oswestry Disability Index (ODI) was used to assess functional disability, and the Visual Analogue Scale (VAS) was used to assess pain levels. Additionally, the maximum muscle activity of the multifidus and lumbar quadratus lumborum (QL) was measured using EMG. Chiropractic manipulation techniques were then implemented in the experimental group, with three sessions per week for six weeks, within the clinic. The same tests were repeated in the post-test. The ANOVA test was used to compare the chiropractic and control groups, with a significance level of α ≤ 0.05.
Results: The study results indicate that chiropractic manual techniques were effective in reducing lumbar EMG activity (P= 0.0001), reducing pain index (P= 0.002), and improving functional disability (P= 0.001) significantly.
Conclusion: The study findings suggest that six weeks of chiropractic manipulation techniques can induce a feeling of relaxation, reduce pain, and passively strengthen the lumbar muscles. These improvements in muscle condition and functional disability may lead to a reduction in pain experienced by individuals with NSCLBP.

Keywords

References

[1] Buchbinder TM, Öberg B, Costa LM, Woolf A, Schoene M, Croft P, Hartvigsen J, Cherkin D, Foster NE, et al. "Low back pain: A call for action". Lancet. 2018; 39(1): 2384-8. doi: 10.1016/S0140-6736(18)30488-4. PMID: 29573871.

[2] Assendelft SC, Emily IY, Suttorp MJ, Shekelle PG. Spinal Manipulative Therapy for Low Back Pain. Cochrane Database Syst. 2004.

[3] Oakley JM, Harrison DE. "X‐ray imaging is essential for contemporary chiropractic and manual therapy spinalrehabilitation: Radiography increases benefits and reduces risks". Dose‐Response. 2018; 1(6). doi: 10.1177/1559325818781437. PMID: 29977177 PMCID: PMC6024283.

[4] Arash Khaledi MB, Gheitasi M. "The effectiveness of exercise therapy on improving pain and functional disability in patients with non-specific chronic low back pain: A systematic review of english clinical trial". J Anesth Pain. 2021; 11(2): 89-107.

[5] Rezaei KTS. "The comparison of leg length discrepancy and quadratus lumborum muscle endurance between females with chronic low back pain and healthy females". J Res Rehabil Sci. 2014; 10(3): 459-66.

[6] Gordon R, Bloxham S. "A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain". In Healthcare Multidisciplinary Digital Publishing Institute. 2016; 4(2): 22. doi: 10.3390/healthcare4020022. PMCID: PMC4934575. PMID: 27417610.

[7] Asghar Akbari PJJ. "Comparison of lumbar specific stabilization exercises and general exercises in reducing pain and disability in patients with spondylolysis and spondylolisthesis". Journal of Birjand University of Medical Sciences. 2013; 20(1): 1-10.

[8] Aghamohamadi S. "Forecasting Death Trend of Endocrine, Nutritional, and Metabolic Diseases in Iran during 2006 to 2035". J Iranian Journal of Epidemiology. 2018; 14(1): 63-73.

[9] World Health Organization (WHO). "Noncommunicable diseases country profiles. Geneva: World Health Organization". 2011, Vol 94.

[10] Enoch FKP, Elkjaer A, Remvig L, Juul- Kristensen B. "Inter-examiner reproducibility of tests for lumbar motor control". BMC Musculoskeletal Disorders. 2011; 12(1). doi: 10.1186/1471-2474-12-114.

[11] Ferreira PHFM, Maher CG, Herbert RD, Refshauge K. "Specific stabilisation exercise for spinal and pelvic pain: a systematic review". Australian Journal of Physiotherapy. 2006; 52(2): 79-88. doi: 10.1016/s0004-9514(06)70043-5. PMID: 16764545.

[12] R VB. "The still technique manual, Indianapolis". American Academy of Osteopathy. 2006.

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[14] Cherkin DC, Deyo RA, Battié M, Street J, Barlow W. "A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain". New England Journal of Medicine. 1998; 339(15): 1021-9. doi: 10.1056/NEJM199810083391502.

[15] Herman PM, Edgington SE, Sorbero ME, Hurwitz EL, Goertz CM, Coulter ID. "Visit frequency and outcomes for patients using ongoing chiropractic care for chronic low-back and neck pain: an observational longitudinal study". Pain Physician. 2021; 24(1): E61-E74. PMID: 33400439; PMCID: PMC8667562.

[16] Herman PMES, Hurwitz EL, Coulter ID. "Predictors of visit frequency for patients using ongoing chiropractic care for chronic low back and chronic neck pain". BMC Musculoskel Disord. 2020; 21(298). doi: 10.1186/s12891-020-03330-1.

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[19] Bagheri Z, Ganji B. "Effect of eight weeks of core stability and acupuncture on pain and disability in middle age females with non-specific chronic low back pain". J Rehab Med. 2020; 8(4): 30-8.

[20] Taheri B, Barati A, Norasteh AA, Madadi-Shad M. "EMG analysis of tunk and lower limb muscles in three different squat exercises in athletes and non-athletes". Int J Sport Stud Hlth. 2018; 1(2): e79463. https://doi.org/10.5812/intjssh.79463.

[21] Price MP, Rafii A, Buckingham B. "The validation of visual analogue scales as ratio scale measures for chronic and experimental pain". Pain Physician. 1983; 17(1): 45-56. doi: 10.1016/0304-3959(83)90126-4. PMID: 6226917.

[22] Samadi HRR, Minoonejad H, Shahi Y, Samadi F. "Comparison of pain, disability and psychological effects of chronic low back pain in women before and after a period of stabilization exercise". Olympic. 2011; 18(2): 125-34.

[23] Farbod H, Abbasi A, Letafatkar A. "Comparison of electrical activity ratio in gluteus maximus and gluteus medius reletive to tensor fascia lata in participants with non-specific chronic low back pain and healthy participants during selected rehabilitation exercises". The Scientific Journal of Rehabilitation Medicine. 2018; 7(2): 158-68. doi: 10.22037/JRM.2018.110910.1616.

[24] Dorosti R, Khademi-Kalantari Kh, Akbarzadeh-Baghban A. "Comparison of the electrical activity of trunk core muscles and knee muscles in subjects with and without patellofemoral pain syndrome during gait". Tehran University Medical Journal. 2017; 75(7): 504-12.

[25] Kim Castello Branco MM. "Chiropractic manipulative therapy of the thoracic spine in combination with stretch and strengthening exercises, in improving postural kyphosis in woman". Science Direct. 2016; 2(1): 303-8. doi: 10.1016/j.hsag.2016.06.001.

[26] Clijsters M, Fronzoni F, Jenkins H. "Chiropractic treatment approaches for spinal musculoskeletal conditions: a cross-sectional survey". Chiropractic & Manual Therapies. 2014; 22(1): 1-0. doi: 10.1186/s12998-014-0033-8.

[27] Karolina Walewicz JT, Dobrzy´nski M, Sopel M, Kowal M, Ptaszkowski K, Dymarek R. "Effect of radial extracorporeal shock wave therapy on pain intensity, functional efficiency, and postural control parameters in patients with chronic low back pain: A randomized clinical trial". MPDI. 2020; 9(568). doi: 10.3390/jcm9020568. PMID: 32092987 PMCID: PMC7074373.

[28] Jian Chen M, Zhang F, Haizhu Chen NB, Pan H. "Rhabdomyolysis after the use of percussion massage gun: A case report". Physical Therapy & Rehabilitation Journal. 2020; 10(1): 1-5. doi: 10.1093/ptj/pzaa199. PMID: 33156927 PMCID: PMC7846179.

[29] Mirmoezzi M, Irandoust K, H’mida C, Taheri M, Trabelsi K, Ammar A, Paryab N, Nikolaidis PT, Knechtle B, Chtourou H. "Efficacy of hydrotherapy treatment for the management of chronic low back pain". Irish Journal of Medical Science. 2021; 1-9. doi: 10.1007/s11845-020-02447-5.

[30] Moon YE SH, Kim SH, Lee SY. "Extracorporeal shock wave therapy for sacroiliac joint pain: A prospective, randomized, sham-controlled short-term trial". J Back Musculoskelet Rehabil. 2017; 30(4): 779-84. doi: 10.3233/BMR-150405. PMID: 28372309.

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[34] Renkawitz T BD, Grifka J. "The association of low back pain, neuromuscular imbalance and trunk extension strength in athletes". The Spine Journal. 2006; 6(6): 73-83. doi: 10.1016/j.spinee.2006.03.012. PMID: 17088198.

[35] Akbari A, Jahanshahi Javaran P. "Comparison of lumbar specific stabilization exercises and general exercises in reducing pain and disability in patients with spondylolysis and spondylolisthesis". Journal of Birjand University of Medical Sciences. 2013; 20(1): 1-10.

[36] Mousavi SJ, Mehdian H, Mobini B, Montazeri A, Akbarnia B, et al. "Low back pain in Iran: a growing need to adapt and implement evidence-based practice in developing countries". Spine. 2011; 36(10): 638-46. doi: 10.1097/BRS.0b013e3181fa1da2. PMID: 21270691.

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The effect of manual techniques on maximum muscle activity electromyography, functional disability, and pain in women with non-specific chronic low back pain

References

[1] Buchbinder TM, Öberg B, Costa LM, Woolf A, Schoene M, Croft P, Hartvigsen J, Cherkin D, Foster NE, et al. "Low back pain: A call for action". Lancet. 2018; 39(1): 2384-8. doi: 10.1016/S0140-6736(18)30488-4. PMID: 29573871.

[2] Assendelft SC, Emily IY, Suttorp MJ, Shekelle PG. Spinal Manipulative Therapy for Low Back Pain. Cochrane Database Syst. 2004.

[3] Oakley JM, Harrison DE. "X‐ray imaging is essential for contemporary chiropractic and manual therapy spinalrehabilitation: Radiography increases benefits and reduces risks". Dose‐Response. 2018; 1(6). doi: 10.1177/1559325818781437. PMID: 29977177 PMCID: PMC6024283.

[4] Arash Khaledi MB, Gheitasi M. "The effectiveness of exercise therapy on improving pain and functional disability in patients with non-specific chronic low back pain: A systematic review of english clinical trial". J Anesth Pain. 2021; 11(2): 89-107.

[5] Rezaei KTS. "The comparison of leg length discrepancy and quadratus lumborum muscle endurance between females with chronic low back pain and healthy females". J Res Rehabil Sci. 2014; 10(3): 459-66.

[6] Gordon R, Bloxham S. "A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain". In Healthcare Multidisciplinary Digital Publishing Institute. 2016; 4(2): 22. doi: 10.3390/healthcare4020022. PMCID: PMC4934575. PMID: 27417610.

[7] Asghar Akbari PJJ. "Comparison of lumbar specific stabilization exercises and general exercises in reducing pain and disability in patients with spondylolysis and spondylolisthesis". Journal of Birjand University of Medical Sciences. 2013; 20(1): 1-10.

[8] Aghamohamadi S. "Forecasting Death Trend of Endocrine, Nutritional, and Metabolic Diseases in Iran during 2006 to 2035". J Iranian Journal of Epidemiology. 2018; 14(1): 63-73.

[9] World Health Organization (WHO). "Noncommunicable diseases country profiles. Geneva: World Health Organization". 2011, Vol 94.

[10] Enoch FKP, Elkjaer A, Remvig L, Juul- Kristensen B. "Inter-examiner reproducibility of tests for lumbar motor control". BMC Musculoskeletal Disorders. 2011; 12(1). doi: 10.1186/1471-2474-12-114.

[11] Ferreira PHFM, Maher CG, Herbert RD, Refshauge K. "Specific stabilisation exercise for spinal and pelvic pain: a systematic review". Australian Journal of Physiotherapy. 2006; 52(2): 79-88. doi: 10.1016/s0004-9514(06)70043-5. PMID: 16764545.

[12] R VB. "The still technique manual, Indianapolis". American Academy of Osteopathy. 2006.

[14] Cherkin DC, Deyo RA, Battié M, Street J, Barlow W. "A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain". New England Journal of Medicine. 1998; 339(15): 1021-9. doi: 10.1056/NEJM199810083391502.

[15] Herman PM, Edgington SE, Sorbero ME, Hurwitz EL, Goertz CM, Coulter ID. "Visit frequency and outcomes for patients using ongoing chiropractic care for chronic low-back and neck pain: an observational longitudinal study". Pain Physician. 2021; 24(1): E61-E74. PMID: 33400439; PMCID: PMC8667562.

[16] Herman PMES, Hurwitz EL, Coulter ID. "Predictors of visit frequency for patients using ongoing chiropractic care for chronic low back and chronic neck pain". BMC Musculoskel Disord. 2020; 21(298). doi: 10.1186/s12891-020-03330-1.

[18] Froud PS, Eldridge S, Seale C, Pincus T, Rajendran D, et al. "A systematic review and metasynthesis of the impact of low back pain on people’s lives". BMC Musculoskeletal Disorders. 2014; 15(1): 50. doi: 10.1186/1471-2474-15-50.

[19] Bagheri Z, Ganji B. "Effect of eight weeks of core stability and acupuncture on pain and disability in middle age females with non-specific chronic low back pain". J Rehab Med. 2020; 8(4): 30-8.

[20] Taheri B, Barati A, Norasteh AA, Madadi-Shad M. "EMG analysis of tunk and lower limb muscles in three different squat exercises in athletes and non-athletes". Int J Sport Stud Hlth. 2018; 1(2): e79463. https://doi.org/10.5812/intjssh.79463.

[21] Price MP, Rafii A, Buckingham B. "The validation of visual analogue scales as ratio scale measures for chronic and experimental pain". Pain Physician. 1983; 17(1): 45-56. doi: 10.1016/0304-3959(83)90126-4. PMID: 6226917.

[22] Samadi HRR, Minoonejad H, Shahi Y, Samadi F. "Comparison of pain, disability and psychological effects of chronic low back pain in women before and after a period of stabilization exercise". Olympic. 2011; 18(2): 125-34.

[24] Dorosti R, Khademi-Kalantari Kh, Akbarzadeh-Baghban A. "Comparison of the electrical activity of trunk core muscles and knee muscles in subjects with and without patellofemoral pain syndrome during gait". Tehran University Medical Journal. 2017; 75(7): 504-12.

[25] Kim Castello Branco MM. "Chiropractic manipulative therapy of the thoracic spine in combination with stretch and strengthening exercises, in improving postural kyphosis in woman". Science Direct. 2016; 2(1): 303-8. doi: 10.1016/j.hsag.2016.06.001.

[26] Clijsters M, Fronzoni F, Jenkins H. "Chiropractic treatment approaches for spinal musculoskeletal conditions: a cross-sectional survey". Chiropractic & Manual Therapies. 2014; 22(1): 1-0. doi: 10.1186/s12998-014-0033-8.

[28] Jian Chen M, Zhang F, Haizhu Chen NB, Pan H. "Rhabdomyolysis after the use of percussion massage gun: A case report". Physical Therapy & Rehabilitation Journal. 2020; 10(1): 1-5. doi: 10.1093/ptj/pzaa199. PMID: 33156927 PMCID: PMC7846179.

[29] Mirmoezzi M, Irandoust K, H’mida C, Taheri M, Trabelsi K, Ammar A, Paryab N, Nikolaidis PT, Knechtle B, Chtourou H. "Efficacy of hydrotherapy treatment for the management of chronic low back pain". Irish Journal of Medical Science. 2021; 1-9. doi: 10.1007/s11845-020-02447-5.

[30] Moon YE SH, Kim SH, Lee SY. "Extracorporeal shock wave therapy for sacroiliac joint pain: A prospective, randomized, sham-controlled short-term trial". J Back Musculoskelet Rehabil. 2017; 30(4): 779-84. doi: 10.3233/BMR-150405. PMID: 28372309.

[33] Lee SL, Park J. "Eects of extracorporeal shockwave therapy on patients with chronic low back pain and their dynamic balance ability". J Phys Ther Sci. 2014; 26: 7-10. doi: 10.1589/jpts.26.7. PMID: 24567665, PMCID: PMC3927045.

[34] Renkawitz T BD, Grifka J. "The association of low back pain, neuromuscular imbalance and trunk extension strength in athletes". The Spine Journal. 2006; 6(6): 73-83. doi: 10.1016/j.spinee.2006.03.012. PMID: 17088198.

[35] Akbari A, Jahanshahi Javaran P. "Comparison of lumbar specific stabilization exercises and general exercises in reducing pain and disability in patients with spondylolysis and spondylolisthesis". Journal of Birjand University of Medical Sciences. 2013; 20(1): 1-10.

[36] Mousavi SJ, Mehdian H, Mobini B, Montazeri A, Akbarnia B, et al. "Low back pain in Iran: a growing need to adapt and implement evidence-based practice in developing countries". Spine. 2011; 36(10): 638-46. doi: 10.1097/BRS.0b013e3181fa1da2. PMID: 21270691.

Volume 14, Issue 1
January 2022
Pages 97-107

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The effect of manual techniques on maximum muscle activity electromyography, functional disability, and pain in women with non-specific chronic low back pain

References

[1] Buchbinder TM, Öberg B, Costa LM, Woolf A, Schoene M, Croft P, Hartvigsen J, Cherkin D, Foster NE, et al. "Low back pain: A call for action". Lancet. 2018; 39(1): 2384-8. doi: 10.1016/S0140-6736(18)30488-4. PMID: 29573871.

[2] Assendelft SC, Emily IY, Suttorp MJ, Shekelle PG. Spinal Manipulative Therapy for Low Back Pain. Cochrane Database Syst. 2004.

[3] Oakley JM, Harrison DE. "X‐ray imaging is essential for contemporary chiropractic and manual therapy spinalrehabilitation: Radiography increases benefits and reduces risks". Dose‐Response. 2018; 1(6). doi: 10.1177/1559325818781437. PMID: 29977177 PMCID: PMC6024283.

[4] Arash Khaledi MB, Gheitasi M. "The effectiveness of exercise therapy on improving pain and functional disability in patients with non-specific chronic low back pain: A systematic review of english clinical trial". J Anesth Pain. 2021; 11(2): 89-107.

[5] Rezaei KTS. "The comparison of leg length discrepancy and quadratus lumborum muscle endurance between females with chronic low back pain and healthy females". J Res Rehabil Sci. 2014; 10(3): 459-66.

[6] Gordon R, Bloxham S. "A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain". In Healthcare Multidisciplinary Digital Publishing Institute. 2016; 4(2): 22. doi: 10.3390/healthcare4020022. PMCID: PMC4934575. PMID: 27417610.

[7] Asghar Akbari PJJ. "Comparison of lumbar specific stabilization exercises and general exercises in reducing pain and disability in patients with spondylolysis and spondylolisthesis". Journal of Birjand University of Medical Sciences. 2013; 20(1): 1-10.

[8] Aghamohamadi S. "Forecasting Death Trend of Endocrine, Nutritional, and Metabolic Diseases in Iran during 2006 to 2035". J Iranian Journal of Epidemiology. 2018; 14(1): 63-73.

[9] World Health Organization (WHO). "Noncommunicable diseases country profiles. Geneva: World Health Organization". 2011, Vol 94.

[10] Enoch FKP, Elkjaer A, Remvig L, Juul- Kristensen B. "Inter-examiner reproducibility of tests for lumbar motor control". BMC Musculoskeletal Disorders. 2011; 12(1). doi: 10.1186/1471-2474-12-114.

[11] Ferreira PHFM, Maher CG, Herbert RD, Refshauge K. "Specific stabilisation exercise for spinal and pelvic pain: a systematic review". Australian Journal of Physiotherapy. 2006; 52(2): 79-88. doi: 10.1016/s0004-9514(06)70043-5. PMID: 16764545.

[12] R VB. "The still technique manual, Indianapolis". American Academy of Osteopathy. 2006.

[14] Cherkin DC, Deyo RA, Battié M, Street J, Barlow W. "A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain". New England Journal of Medicine. 1998; 339(15): 1021-9. doi: 10.1056/NEJM199810083391502.

[15] Herman PM, Edgington SE, Sorbero ME, Hurwitz EL, Goertz CM, Coulter ID. "Visit frequency and outcomes for patients using ongoing chiropractic care for chronic low-back and neck pain: an observational longitudinal study". Pain Physician. 2021; 24(1): E61-E74. PMID: 33400439; PMCID: PMC8667562.

[16] Herman PMES, Hurwitz EL, Coulter ID. "Predictors of visit frequency for patients using ongoing chiropractic care for chronic low back and chronic neck pain". BMC Musculoskel Disord. 2020; 21(298). doi: 10.1186/s12891-020-03330-1.

[18] Froud PS, Eldridge S, Seale C, Pincus T, Rajendran D, et al. "A systematic review and metasynthesis of the impact of low back pain on people’s lives". BMC Musculoskeletal Disorders. 2014; 15(1): 50. doi: 10.1186/1471-2474-15-50.

[19] Bagheri Z, Ganji B. "Effect of eight weeks of core stability and acupuncture on pain and disability in middle age females with non-specific chronic low back pain". J Rehab Med. 2020; 8(4): 30-8.

[20] Taheri B, Barati A, Norasteh AA, Madadi-Shad M. "EMG analysis of tunk and lower limb muscles in three different squat exercises in athletes and non-athletes". Int J Sport Stud Hlth. 2018; 1(2): e79463. https://doi.org/10.5812/intjssh.79463.

[21] Price MP, Rafii A, Buckingham B. "The validation of visual analogue scales as ratio scale measures for chronic and experimental pain". Pain Physician. 1983; 17(1): 45-56. doi: 10.1016/0304-3959(83)90126-4. PMID: 6226917.

[22] Samadi HRR, Minoonejad H, Shahi Y, Samadi F. "Comparison of pain, disability and psychological effects of chronic low back pain in women before and after a period of stabilization exercise". Olympic. 2011; 18(2): 125-34.

[24] Dorosti R, Khademi-Kalantari Kh, Akbarzadeh-Baghban A. "Comparison of the electrical activity of trunk core muscles and knee muscles in subjects with and without patellofemoral pain syndrome during gait". Tehran University Medical Journal. 2017; 75(7): 504-12.

[25] Kim Castello Branco MM. "Chiropractic manipulative therapy of the thoracic spine in combination with stretch and strengthening exercises, in improving postural kyphosis in woman". Science Direct. 2016; 2(1): 303-8. doi: 10.1016/j.hsag.2016.06.001.

[26] Clijsters M, Fronzoni F, Jenkins H. "Chiropractic treatment approaches for spinal musculoskeletal conditions: a cross-sectional survey". Chiropractic & Manual Therapies. 2014; 22(1): 1-0. doi: 10.1186/s12998-014-0033-8.

[28] Jian Chen M, Zhang F, Haizhu Chen NB, Pan H. "Rhabdomyolysis after the use of percussion massage gun: A case report". Physical Therapy & Rehabilitation Journal. 2020; 10(1): 1-5. doi: 10.1093/ptj/pzaa199. PMID: 33156927 PMCID: PMC7846179.

[29] Mirmoezzi M, Irandoust K, H’mida C, Taheri M, Trabelsi K, Ammar A, Paryab N, Nikolaidis PT, Knechtle B, Chtourou H. "Efficacy of hydrotherapy treatment for the management of chronic low back pain". Irish Journal of Medical Science. 2021; 1-9. doi: 10.1007/s11845-020-02447-5.

[30] Moon YE SH, Kim SH, Lee SY. "Extracorporeal shock wave therapy for sacroiliac joint pain: A prospective, randomized, sham-controlled short-term trial". J Back Musculoskelet Rehabil. 2017; 30(4): 779-84. doi: 10.3233/BMR-150405. PMID: 28372309.

[33] Lee SL, Park J. "Eects of extracorporeal shockwave therapy on patients with chronic low back pain and their dynamic balance ability". J Phys Ther Sci. 2014; 26: 7-10. doi: 10.1589/jpts.26.7. PMID: 24567665, PMCID: PMC3927045.

[34] Renkawitz T BD, Grifka J. "The association of low back pain, neuromuscular imbalance and trunk extension strength in athletes". The Spine Journal. 2006; 6(6): 73-83. doi: 10.1016/j.spinee.2006.03.012. PMID: 17088198.

[35] Akbari A, Jahanshahi Javaran P. "Comparison of lumbar specific stabilization exercises and general exercises in reducing pain and disability in patients with spondylolysis and spondylolisthesis". Journal of Birjand University of Medical Sciences. 2013; 20(1): 1-10.

[36] Mousavi SJ, Mehdian H, Mobini B, Montazeri A, Akbarnia B, et al. "Low back pain in Iran: a growing need to adapt and implement evidence-based practice in developing countries". Spine. 2011; 36(10): 638-46. doi: 10.1097/BRS.0b013e3181fa1da2. PMID: 21270691.

Volume 14, Issue 1January 2022Pages 97-107

Files

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How to cite

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Volume 14, Issue 1
January 2022
Pages 97-107