Commentary on "Spinal Stabilization Exercise Effectiveness for Low Back Pain in Adolescent Idiopathic Scoliosis: A Randomized Trial".

Abstract

“How should I apply this information?” In this study, a weekly physical therapy (PT) intervention group experienced significantly greater reduction of pain and an improvement in patient-selected functional outcomes than an unsupervised group. Although the use of technology, such as a DVD, is common for adolescents, using technology to provide intervention may not be an adequate substitute for weekly contact with PT. This study provides support for weekly PT intervention and for the role that spinal stabilization training may play in reducing low back pain in adolescents with adolescent idiopathic scoliosis. A prevention-oriented health care system could use the results of this study to support the development and implementation of PT programs for this patient population. The study provides a beginning point for future research to explore spinal stabilization training for adolescents with low back pain and the use of the Global Rating of Change, Patient Specific Functional Scale, and Revised Oswestry in studies with adolescent subjects. “What should I be mindful about when applying this information?” The majority of the prescribed exercises focused on neuromuscular activation and/or hold of transverse abdominis and lumbar multifidus, but change was not directly assessed for these muscle groups. The Prone Double-leg Test is more specific to multijoint spinal extensors. From a clinical perspective, using the Prone Double-leg Test as a test of muscular endurance should be considered with caution. Lack of improvement may be due to factors other than endurance of the spinal extensors. Structures that may be adversely affected during this test include spinal nerve roots due to compression during closure of the intervertebral foramen; facet joints due to irritation from compression or hypomobility; and the disc due to compression. Selecting an outcome measure for muscle performance requires consideration of several factors, including (1) what one wishes to measure, for example, activation, strength, or endurance; (2) whether the outcome measure is appropriate to assess the focus of training such as strength or endurance; and (3) how the test may affect regional structures. Each factor has the potential to affect outcomes in a positive or negative direction. Melodie Kondratek, PT, DScPT, OMPT Physical Therapy Program Oakland University Rochester, Michigan Dhana Ponners, PT, DPT, OMPT The Training Room Troy, Michigan