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Core stability exercise

An interesting meta-analysis 1, published in PLoS One, decided to review the effects of core stability exercise and general exercise when dealing with people with chronic LBP or low back pain. The results showed that core stability exercise was beneficial for decreasing chronic LBP in the short term.

What Was the Context?

Along with mental illness, LBP happens to be one of the most common disabilities affecting people in Western countries. Chronic LBP is known to psychologically, physically, and financially affect global populations in an adverse manner.

Exercise therapy has been deemed to help with relieving pain as well as improve the overall functionality of people with chronic LBP. Sports medicine and rehabilitation centers have begun to use core stability training. Studies have shown that such exercises are a vital component of LBP rehabilitation.

However, it’s been a bit unclear about whether or not core stability exercise is more beneficial compared to general exercise for patients managing chronic LBP.

With a better understanding of the possible benefits, core stability exercise can be optimized for improved results and to prevent wastage of time and resources during the rehabilitation process.

What Was the Objective?

The current meta-analysis was conducted to observe the effects of administrating core stability exercise as a treatment for chronic LBP while comparing it to general exercise.

What Was the Methodology?

Randomized controlled trials or RCTs were identified from electronic databases such as China Biology Medicine disc, PubMed, Embase, and the Cochrane Library. Duplicates were removed. Also, only the RCTs which examined the effects of core stability exercise compared to general exercise for treating chronic LBP were selected.

The date range for the search was 1970 to October 2011. The selected data featured male and female subjects (all over 18 years) who had chronic LBP that was longer than three months.

Meta-analysis was done through the Review Manager Software (RevMan 5.2). The I2 statistic and the chi-squared test was used to evaluate heterogeneity among the studies.

What Were the Results?

While 229 records were identified, only 28 were potentially eligible, with the final selected articles being only 5. Data shared that for short-term relief from pain, core stability exercise was better compared to general exercise. Take note; no significant changes between the two were observed at 6 months.

Furthermore, in short-term, core stability exercise showed significant improvement in a person’s functional status when compared to general exercise.

What Was Concluded?

The overall results suggested that compared to general exercise, pain relief can be decreased and the back-specific functional status of a patient can be improved through core stability exercise. But the said difference was only observed for the short-term, with no significant differences in relief from pain in intermediate as well as long-term follow-ups.

However, the current results are supported by low-quality data. Further research can help us better understand possible intermediate and long-term benefits.

Also, with yoga, Pilates, and Tai chi being core stability exercises, more research should be conducted to see which exercise would be more beneficial for subjects with chronic LBP.

Assessing the Relationship Between Biomechanical Instability and Degenerative Changes in the Lumbar Spine in CLBP Patients

There still seems to be some controversy when it comes to addressing the relationship between biomechanical instability and the degenerative changes in the lumbar spine in CLBP (chronic lower back pain) patients. A study 1 decided to gather more data about it.

Why such a focus?

Chronic low back pain or CLBP may be caused by the biomechanical instability following degenerative changes in the lumbar spine. Low back pain is experienced by millions of people around the globe. The course of clinical treatment for such an issue can be guided through radiographical assessment. Such an assessment would be of the bending motions of the lumbar spine as it might aid with the identification of the absence or presence of biomechanical instability in patients with CLBP.

Lumbar spine

Due to the said controversy, this study decided to look into the relationship between biomechanical instability and degree of degenerative changes in the lumbar spine in CLBP patients. Being a retrospective radiographical study, it focused on evaluating the changes in kinematics at various lumbar levels (the L5-S1 level, in particular) with progressive grades of disc degeneration as well as facet joint osteoarthritis in CLBP patients.

The Study

The current study involved 72 (51 males and 21 females) consecutive CLBP patients. The age range of the participants was kept 18 to 70 years.

It used standing neutral and dynamic flexion/extension (Fx/Ex) radiographs of the lumbar spine to evaluate the in vivo segmental kinematics at the L1-L2 through L5-L1. Changes in signal intensity and central disc height on mid-sagittal T2-weight MR (magnetic resonance) scans were used to quantify disc degeneration.

What were the Results?

The study shared that disc degeneration and facet joint osteoarthritis was able to occur independently of each other at the L5-L1 level. However, an association was observed at the L4-L5 as well as the L3-L4 levels. A greater range of motion in Ex and a smaller range of motion in Fx was observed in the absence of facet joint osteoarthritis (when compared to the upper lumbar levels). No change in the L5-L1 kinematics was observed with progressive disc degeneration in the absence of facet joint osteoarthritis. However, in the presence of such osteoarthritis, re-stabilization of the L5-L1 segment was observed between the severe and mild disc degeneration states.

 

Assessing the Relationship Between Biomechanical Instability and Degenerative Changes

The Conclusion

The study concluded that unique degenerative and kinematic characteristics were exhibited by the L5-S1 motion segment compared with the upper lumbar motion segments. Furthermore, at the L5-S1 level, facet joint osteoarthritis and disc degeneration occurred independently of each other. The L5-S1 motion segment was biomechanically re-stabilized by severe disc degeneration if facet joint osteoarthritis was present.

What does it mean?

The study shared that the L5-S1 level, due to having unique anatomical features, may play a significant role in re-stabilizing the level with severe degeneration of the disc and facet joints. The data will prove beneficial in understanding more about CLBP and its clinical treatments.