Effect of Physiotherapy Treatment in the Autonomic Activation and Pain Perception in Male Patients with Non-Specific Subacute Low Back Pain.

Helios Pareja-Galeano,Gonzalo Jaén-Crespo,Vanesa Abuín-Porras,Carlos Romero-Morales,Vicente Javier Clemente-Suárez,Emmanuel Navarro-Flores

doi:10.3390/jcm10081793

Abstract

Introduction: Physiotherapy treatment is a common intervention for low back pain (LBP) patients. These interventions have been related to physiological effects in the central nervous system. Thus, the aim of this study was to analyze the effect of physiotherapy treatment in patients with LBP in the autonomic nervous system activation and subjective pain perception of patients. Methods: A total of 30 male subjects diagnosed with non-specific subacute LBP received a 50 min session consisting of (a) a manual therapy based on joint mobilization and soft tissues techniques in the lumbo-pelvic area, (b) a stretching program, and (c) motor control exercises of the core muscles. The autonomic modification of participants was assessed prior to and after the physiotherapy treatment. Results: Heart rate variability (HRV) analysis reported a significant increase in average RR (p = 0.001), RMSSD (p = 0.008), LRMSSD (p = 0.001), SDNN (p = 0.005), and PNN50 (p = 0.024) after the session. Frequency-domain measures showed a significant increase in LF (p = 0.030) and HF (p = 0.014), and a decrease in LF/HF ratio (p = 0.046). A significant decrease was found in minimum HR values (p = 0.001) and average HR (p = 0.001). Moreover, maximal HR decreased its value from 116.7 ± 26.1 to 113.7 ± 40.8 after intervention. In addition, subjective pain perception (VAS scores) was significantly lower (p = 0.001) in the post-session assessment. Conclusions: Physiotherapy treatment produced an increase in parasympathetic nervous system activation and a decrease in subjective pain perception in non-specific subacute LBP patients.

Highlights

Physiotherapy treatment is a common intervention for low back pain (LBP) patients
RR abbreviation corresponds to the interval between successive “R” points, root mean square of successive differences (RMSSD) corresponds to the square root of the mean of the squares of the successive differences between adjacent beat to beat intervals, LRMSSD stands for the logarithm of the square root of the mean value of the sum of squared differences of all successive R-R intervals, SDNN stands for the standard deviation of all normal RR intervals, RMSSD corresponds to the square root of the mean of the sum of the squared differences between adjacent normal R-R intervals, PNN50 stands for the percentage of differences between adjacent normal R-R intervals more than 50 ms, LF stands for low frequency, and HF stands for high frequency
The Heart rate variability (HRV) analysis showed a significant increase in average RR (p = 0.001), RMSSD (p = 0.008), LRMSSD (p = 0.001), SDNN (p = 0.005), and PNN50 (p = 0.024) after the treatment

Summary

Introduction

Physiotherapy treatment is a common intervention for low back pain (LBP) patients These interventions have been related to physiological effects in the central nervous system. The aim of this study was to analyze the effect of physiotherapy treatment in patients with LBP in the autonomic nervous system activation and subjective pain perception of patients. Conclusions: Physiotherapy treatment produced an increase in parasympathetic nervous system activation and a decrease in subjective pain perception in non-specific subacute LBP patients. Physiotherapy treatment for LBP generally includes a combination of mobilization, massage, and different manual therapy techniques [4,5], combined with active therapies such as motor control exercise [6,7,8], Pilates exercise [9], and others [10]. Despite the high prevalence of back pain, few treatment methods have a critical evidence [14]

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