Application of Pilates-based exercises in the treatment of chronic non-specific low back pain: state of the art

According to the current recommendations on the management of chronic non-specific low back pain (CNLBP), the intervention in this group of patients should include a programme of exercises. Pilates is a system of exercises widely used in patients with low back pain. The practices based on this method have promoted the restoration of the function of muscles involved in lumbopelvic stabilisation, that is, transversus abdominis, multifidus, diaphragm and pelvic floor muscles. During each exercise, specific principles of this method should be followed to restore or sustain the motor control of the lumbar spine and proper body posture. The aim of this study is to present the current state of knowledge concerning the application of Pilates method in the management of CNLBP as well as to define factors (eg, duration, frequency, exercises performed on a mat or specific equipment) influencing the effectiveness of Pilates in these individuals.

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Effect of a full pilates group exercise program on transversus abdominis thickness, daily function and pain in women with chronic low back pain

Kinesiology ◽

10.26582/k.53.2.15 ◽

2021 ◽

Vol 53 (2) ◽

pp. 318-325

Author(s):

Noelia Goldberg ◽

Asaf Weisman ◽

Snježana Schuster ◽

Gali Dar ◽

Youssef Masharawi

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Transversus Abdominis ◽

Group Differences ◽

Control Group ◽

Anatomical Location ◽

Low Back ◽

Healthy Group ◽

Healthy Women ◽

Pilates Method

The Pilates method is often used in the treatment of nonspecific low back pain (NSCLBP). The effect of Pilates group exercising (mat and apparatus combined) on women with NSCLBP is unknown. Studies on the Pilates method often use ultrasound (US) to measure transversus abdominis (TrA) thickness in one anatomical location. We recruited 40 women, 22 with NSCLBP and 18 healthy women (active control group), to join five weeks of biweekly Pilates group exercising (apparatus and mat). Measurements included TrA thickness (left and right) at rest, during active draw-in maneuver (ADIM), and its TrA% change in three anatomical areas; Roland-Morris disability questionnaire (RMDQ); and pain level (VAS). Before the study, no asymmetry in TrA thickness was noted as well as no between-group differences in TrA-thickness in three anatomic areas (in rest and ADIM). Following the intervention, TrA thickness increased during rest in the healthy group in two areas. No differences were noted between the two groups in ADIM in the anatomical locations. No between-group differences were found before the intervention in the TrA% change. Following the intervention, an increase in the TrA-% change was noticed in the NSCLBP group. A decrease in the healthy group was observed in area C. No effects were noted on the RMDQ and VAS. Five weeks of Pilates group exercising increased TrA thickness in healthy women and its percentage changed in women with NSCLBP. Measuring TrA thickness with US should be performed in three different anatomical locations on both sides. This measuring procedure has good inter- and intra-rater reliability and the potential to reveal physiological effects.

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Interactions between Musculoskeletal Dysfunction, Emotional Distress and Cytokines in Patients with Chronic Low Back Pain Syndrome

Reabilitacijos mokslai slauga kineziterapija ergoterapija ◽

10.33607/rmske.v1i6.865 ◽

2020 ◽

Vol 1 (6) ◽

Author(s):

Daina Šmite ◽

Gunta Ancāne ◽

Pēteris Tretjakovs

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Lumbar Spine ◽

Emotional Distress ◽

Chronic Low Back Pain ◽

Pain Syndrome ◽

Low Back

Despite different treatment methods, for approximately 30% of patients acute back pain turns into chronic pain syndrome which accompanied by disability creates remarkable material damage to patients themselves, to health care and to the society. The aim of the study was to analyse the interaction between musculoskeletal dysfunction, emotional distress and related disability, and their underlying neuroimonological pathophysiological mechanisms, in patients with chronic low back pain syndrome. The subjects were 43 patients, mean age 45 ± 1.3 years, with clinical diagnosis of lumbar spine disk pathology with chronic low back pain syndrome and present manifestation of emotional distress. All patients had complex assessment that included lumbar spine and pelvic motor control tests, muscle and ligaments palpation tests, Hospital Anxiety and Depression Scale, PF subscale of SF-36 survey, Visual Analogue Scale, immunological analysis of blood to detect the level of cytokines. The results approved interaction (p < 0.05) between motor control and palpation tests results, emotional distress features and pain intensity. Therefore musculoskeletal dysfunction in patients with chronic low back pain is connected both with physical and psycho-emotional factors, which has to be taken into account both when evaluating functional tests and during the treatment process. Clinically important finding is that limitation in physical activities in chronic low back pain patients are affected both by motor control impairment and depression symptoms, as well as pain intensity, which has to be remembered during rehabilitation planning process. Some of cytokines (TNF-a, IL-6, IL-8, IL-10, IL-2) correlated with emotional disturbances physical disturbances, pain syndrome characteristics and physical disability in patients with chronic low back pain. IL-10 and IL-8 appeared to be two of the most characteristic cytokines. It is interesting to note, that in literature studies have approved the role of IL-10 in the pathogenesis of chronic, widespread pain syndrome, but IL-8 has been shown in the role of the pathogenesis of radicular pain syndrome in patients with lumbar spine disk pathology [1, 2]. Studies of cytokines extend the understanding of bio-psycho-social aspects of chronic pain syndrome pathogenesis therefore improving process of assessment, clinical reasoning and therapy.Keywords: musculoskeletal dysfunction, emotional distress, chronic pain, cytokines.

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Rehabilitation of a Young Athlete With Extension-Based Low Back Pain Addressing Motor-Control Impairments and Central Sensitization

Journal of Athletic Training ◽

10.4085/1062-6050-238-16 ◽

2018 ◽

Vol 53 (2) ◽

pp. 168-173 ◽

Cited By ~ 5

Author(s):

John J. Winslow ◽

Mark Jackson ◽

Andrew Getzin ◽

Michael Costello

Keyword(s):

Nervous System ◽

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Lumbar Spine ◽

Central Sensitization ◽

Young Athlete ◽

Low Back ◽

Affective Factors ◽

Nociceptive Input

Objective: To describe the conservative management of a young athlete with extension-based (EB) low back pain (LBP). Background: We present the case of a 15-year-old female high school gymnast with a 4-year history of EB LBP. Magnetic resonance imaging revealed a healed spondylolysis and significant atrophy with fatty infiltrate of the lumbar multifidi muscles (LMM). She had several courses of outpatient orthopaedic rehabilitation that focused on core muscle strengthening (improving activation and strength of the LMM and transversus abdominus muscle in a neutral pelvic position) without long-lasting improvement. She was unable to tolerate higher levels of training or compete. Differential Diagnosis: The LMM are rich in muscle spindles and provide continuous feedback to the central nervous system about body position. Atrophy and fatty infiltrate of the LMM can compromise neuromuscular function and contribute to dysfunctional movement patterns that place a greater demand on lumbar spine structures. Ongoing motor-control impairments perpetuate nociceptive input, leading to central sensitization. Treatment: The athlete had difficulty controlling trunk extension during sport-specific activities; she moved early and to a greater extent in the lumbar spine. The aim of the treatment was to teach the athlete how to control her tendency to overload her lumbar spine when bending backward, thus reducing nociceptive input from lumbar spine structures and desensitizing the nervous system. Uniqueness: Treating EB LBP by addressing motor-control impairments and cognitive-affective factors as opposed to core strengthening. Conclusions: Activity modification, bracing, and traditional core-strengthening exercises may not be the most appropriate treatment for athletes experiencing EB LBP. Addressing cognitive-affective factors in addition to correcting maladaptive motor behavior and moving in a pain-free range reduces nociceptive input, desensitizes the nervous system, and allows athletes to gain control over their pain.

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Cortical changes in chronic low back pain: Current state of the art and implications for clinical practice

Manual Therapy ◽

10.1016/j.math.2010.06.008 ◽

2011 ◽

Vol 16 (1) ◽

pp. 15-20 ◽

Cited By ~ 189

Author(s):

Benedict Martin Wand ◽

Luke Parkitny ◽

Neil Edward O’Connell ◽

Hannu Luomajoki ◽

James Henry McAuley ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Chronic Low Back Pain ◽

State Of The Art ◽

Low Back ◽

Current State

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Changes in Morphometry of Trunk Muscles, Pain, and Disability Associated With Motor Control Training in People With Chronic Low Back Pain: a Systematic Review and Meta-analysis

10.21203/rs.3.rs-706368/v1 ◽

2021 ◽

Author(s):

Sanaz Shanbehzadeh ◽

Shabnam ShahAli ◽

Julie Hides ◽

Ismail Ebrahimi-Takamjani ◽

Omid Rasouli

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Chronic Low Back Pain ◽

Meta Analysis ◽

Mean Difference ◽

Transversus Abdominis ◽

Trunk Muscles ◽

Low Back

Abstract Background: This study aimed to review studies investigating the effects of motor control training (MCT) on the morphometry of trunk muscles (measured by ultrasound imaging; USI) and pain/or disability in individuals with chronic low back pain (CLBP).Method: PubMed, Web of Science, Scopus, and Cochrane Library databases were searched from inception until January 2020. Randomized control trials (RCTs) which included measurements of both muscle morphometry using USI and assessments of pain or disability in individuals with CLBP were included. Study selection, data extraction and quality assessment were done by two reviewers independently. Modified Downs and Black tool and grading of recommendations assessment, development, and evaluation tool were used to assess risk of bias and quality of evidence, respectively. A meta-analysis was performed using a random-effects model with mean difference (MD) or standardized mean difference (SMD). Results: Fifteen RCTs were included. The results revealed that there were no differences in the size (thickness) of the transversus abdominis (TrA), internal and external oblique, and lumbar multifidus muscles in studies which did and did not include MCT interventions. However, the contraction ratio for the TrA muscle was greater in response to MCT, with a high effect size (SMD= 0.93 CI: - 0.0 to 1.85). Pain (visual analogue scale, MD=1.00, 95%CI -1.77 to -0.24) and disability (SMD=-0.55, 95% CI: -0.94 to -0.16) scores were lower in the groups who underwent MCT compared with other interventions, with moderate and low effect sizes.Conclusions: MCT interventions were superior to other interventions for measures of TrA muscle function. Despite changes in pain and disability following MCT interventions, corresponding changes in trunk muscle morphometry (evaluated using thickness measures) were not evident. This could be due to the effect of other factors such as psychosocial factors that impact the clinical outcomes for those with CLBP.Systematic review registration: PROSPERO: CRD42019144768

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Effect of 2 Lumbar Spine Postures on Transversus Abdominis Muscle Thickness During a Voluntary Contraction in People With and Without Low Back Pain

Journal of Manipulative and Physiological Therapeutics ◽

10.1016/j.jmpt.2011.02.009 ◽

2011 ◽

Vol 34 (3) ◽

pp. 164-172 ◽

Cited By ~ 18

Author(s):

Rafael Z. Pinto ◽

Paulo H. Ferreira ◽

Marcia R. Franco ◽

Manuela L. Ferreira ◽

Mariana C. Ferreira ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Muscle Thickness ◽

Voluntary Contraction ◽

Transversus Abdominis ◽

Low Back ◽

Transversus Abdominis Muscle

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Body Mass, Nonspecific Low Back Pain, and Anatomical Changes in the Lumbar Spine in Judo Athletes

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2007.2508 ◽

2007 ◽

Author(s):

Takashi Okada

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Body Mass ◽

Low Back ◽

Anatomical Changes ◽

Judo Athletes

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Faculty Opinions recommendation of The anatomical basis for low back pain. Studies on the presence of sensory nerve endings in ligamentous, capsular and intervertebral disc structures in the human lumbar spine.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726427730.793519836 ◽

2016 ◽

Author(s):

Massimo Allegri

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Intervertebral Disc ◽

Sensory Nerve ◽

Nerve Endings ◽

Low Back ◽

Sensory Nerve Endings ◽

Anatomical Basis ◽

Human Lumbar Spine

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Correction of Posture Deviations in the Sagittal Plane Using the Pilates Method

SPORT AND SOCIETY ◽

10.36836/uaic/fefs/10.50 ◽

2019 ◽

pp. 3-13

Author(s):

Alexandru Cîtea ◽

George-Sebastian Iacob

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Postural Control ◽

Human Body ◽

Sagittal Plane ◽

The Body ◽

Lower Limbs ◽

Low Back ◽

Pilates Method ◽

The Relationship

Posture is commonly perceived as the relationship between the segments of the human body upright. Certain parts of the body such as the cephalic extremity, neck, torso, upper and lower limbs are involved in the final posture of the body. Musculoskeletal instabilities and reduced postural control lead to the installation of nonstructural posture deviations in all 3 anatomical planes. When we talk about the sagittal plane, it was concluded that there are 4 main types of posture deviation: hyperlordotic posture, kyphotic posture, rectitude and "sway-back" posture.Pilates method has become in the last decade a much more popular formof exercise used in rehabilitation. The Pilates method is frequently prescribed to people with low back pain due to their orientation on the stabilizing muscles of the pelvis. Pilates exercise is thus theorized to help reactivate the muscles and, by doingso, increases lumbar support, reduces pain, and improves body alignment.

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