Exercise as it relates to Disease/The effect of lumbar stabilization and walking exercises on chronic low back pain

This article is an original critical analysis of; "The effect of lumbar stabilisation and walking exercises on chronic low back pain - a randomised controlled trial" by JH Suh, H Kim, GP Jung, JY Ko, JS Ryu - Medicine, 2019 - ncbi.nlm.nih.gov.



What is the background to this research?

 * In modern society, lower back pain (LBP) is one of the most prevalent physical disorders that affects performance at work as well as general well-being across all ages.


 * Chronic pain is closely associated with structural and histomorphological changes in spinal muscles. These back muscles, become fatigued through over-exertion. Over time poor coordination of the spinal muscles leads to chronic LBP.


 * Exercise can be a proactive treatment for improving muscle strength, endurance and functional impairment amongst low back pain patients.
 * Many avenues of physical activity have been referred to and introduced in the study, but no superior exercise mode was suggested.


 * This study aims to compare the effectiveness of two exercises that can help reduce LBP, namely individualised graded lumbar stabilisation exercises (IGLSE) and walking exercises (WE).

Where is the research from?

 * This research highlights the comparison between two successful exercise modes that are integrated into the treatment of LBP.
 * This study can be found on PubMed(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616307/).
 * This research is supported by Research Resettlement Fund for the new faculty of Seoul National University, and basic science research program via the National research Foundation of Korea (NRF), which is funded by the Ministry of Education.
 * Commercial parties that have directly contributed to the research financially do not stand to profit from the results.
 * According to the authors, there were no identifiable conflicts of interest.
 * Authors
 * Ju Seok Ryu
 * Dr. Ryu belongs to the Seoul National University College of Medicine, and has been actively involved in research since 2004 to now. (895 of citations, 16 of h-index and 58 article, 1 letter, and 1 review).

What kind of research was this?

 * The study format was a RCT with a total of 48 participants who all experienced chronic LBP. Within the study there were 4 experimental groups: flexibility exercise, walking exercise, stabilisation exercise, and stabilisation with walking exercise. The study duration was 6 weeks.
 * Lower back pain is a widespread common chronic condition, exercise is one of the most effective treatment strategies and there is a pleather of available research on PubMed.
 * In comparison to similar studies this research involved a smaller testing population and was shorter in duration.

What did the research involve?

 * Summary
 * The participants were randomly sorted into 4 different groups, and performed the appropriate exercises.
 * Dosage: 30-60mins sessions, completed 5 times/week, for 6 weeks in total
 * Education: All participants received education surrounding correct and healthy posture for managing LBP as well as how to engage and brace their abdominal muscles.
 * Primary outcome measurement:
 * Visual analog scale(VAS) of their pain during physical activity and at rest.
 * Secondary outcome measurement:
 * VAS of radiating pain measured at rest and during physical activity
 * Individual medication dosage (number of times/day)
 * Oswestry disability index
 * Beck depression inventory
 * Endurances of patient in specific postural positions
 * Strength of lumbar extensors
 * Methodology
 * This research used a randomised control trial format and the subjects were recruited from the universities outpatient rehab clinic.
 * The RCT structure of this study makes for reliable and accurate comparisons between the exercise groups.


 * Limitation
 * The causes or severity of each patient's lower back pain was not disclosed during the study.
 * The duration of research could have been extended to assess the long term effects of the exercises.
 * The results from this study only reflect the short term benefits as opposed to positive changes overtime.
 * The types and effects of medications participants were using during study were not considered as a contributing factor to the results.

What were the basic results?

 * Results
 * LBP reduced during physical activity across all four experimental groups
 * LBP reduced at rest: FE group and SE group
 * Frequency of medication use decreased in the FE group
 * Exercise frequency increased: SE, WE
 * The highest compliance: SE group
 * Overall there were no clinically significant differences between the 4 experimental groups


 * Interpret
 * Clinicians from the study confidently recommended SE and WE as suitable treatments for patients experiencing chronic LBP. The exercises were found not only to relieve lower back pain but in addition, improved overall muscle endurance, core stability and prevented the progression of LBP.
 * The results from the WE group and the stabilisation training + WE group produced substantial improvements in the muscle endurance of the back muscles.
 * Researchers also identified the beneficial contribution posture related education and muscle bracing exercises produced within all experimental groups

What conclusions can we take from this research?

 * As a result of this study, there is no doubt that the exercise treatments were effective in the LBP patients.
 * As the research highlighted, the combination of targeted exercises, stabilisation and postural training as well as patient education are effective in reducing LBP related symptoms and altering the management of their pain through adjusting the patient's perspective of treatment options

Practical advice

 * Exercises including walking, lumbar stabilisation, postural training and stretching are low cost activities that do not require any additional equipment and can be completed in any setting at a time of convenience. In addition, these exercises are easy to self-pace and adapt to avoid high levels of fatigue and exhaustion, the sets and reps can be modified to increase the recovery period.
 * Maintaining compliance to the exercises outside of a clinical setting could be hard to continue due to barriers in patient motivation and the lack of persistent feedback.
 * According to additional research some strategies for increasing compliance and patient motivation include group sessions, involving a second person such as a a friend or family member and keeping an exercise log/diary.

Further information/resources

 * Causes of Lower Back Pain
 * Lower Back Pain Symptoms, Diagnosis, and Treatment
 * Lower Back Pain: Symptoms, Stretches, Exercise for Pain Relief
 * 11 Exercises for Lower Back Pain Relief