Long-term effects of a stabilization exercise therapy for chronic low back pain

Abstract

Low back pain is a common problem which affects the majority of adults at least once in a life time. The majority of them feel relief of symptoms spontaneously. However, a significant minority has recurrences and a small number suffer with persistent symptoms (Dunn and Croft, 2004). According to the experimental model from Hodges and Richardson (1996), individuals with a history of low back pain show a delay in contraction of the transversus abdominis muscle during a trunk disturbance leading to an inappropriate stabilization pattern which causes recurrences. Within 24 hours after the first low back pain episode the lumbar multifidus muscle shows an ipsilateral pain related decrease in muscle bulk and this loss of bulk is not recovered even after the symptoms have resolved (Hides et al., 1994,1996). Spinal segmental stabilization exercises were developed (Richardson and Jull, 1995) with the aim of correcting the transversus abdominis contraction delay and also to recover the activation of lumbar multifidus muscle. This motor control approach focuses on an isolated cocontraction of such muscles while keeping the lumbar spine in a neutral position (Richardson et al., 2004). Using ultra-sound and magnetic resonance imaging (Ferreira et al., 2004; Hides et al., 2006) it was possible to observe the appropriate pattern of transversus abdominis muscle contraction during the draw-in movement of the lower abdominal wall. In order to test the efficacy of this specific approach some authors undertook randomized controlled trials. Hides et al. (2001) conducted research which demonstrated a long-term