Abstract
Objectives: To evaluate therapeutic exercise-induced hemodynamic changes in patients with flexion- and extension-provoked low back pain (LBP). Methods: Men with LBP (n=106) were divided into 2 groups: flexion-provoked LBP (n=61) and extensionprovoked LBP (n=45). The Japanese Orthopaedic Association (JOA) score, Visual Analogue Scale (VAS), SF-36 and intramuscular oxygenation measured by near-infrared spectroscopy on the paraspinal muscle during lumbar extension and flexion were evaluated at 2 and 4 weeks. Results: Deoxygenated hemoglobin during lumbar flexion was significantly lower in flexion-provoked LBP than in extension-provoked LBP. VAS and the SF-36 domains of physical functioning, role physical, bodily pain were significantly improved in the flexion-provoked LBP group. Oxygenated hemoglobin during lumbar extension was increased significantly in the flexion-provoked LBP group. Flexion-provoked LBP patients who exhibited favorable effects from therapeutic exercise also showed better lumbar muscle oxygenation after exercise. Conclusions: A stretching mechanism in the posterior lumbar elements appeared to have a promising therapeutic effect on extension-provoked LBP. Although LBP attributed to hypoperfusion and oxygenation is involved in flexionprovoked LBP, therapeutic exercise was effective in only 50% of these patients. Evaluating muscle blood flow in flexion-provoked LBP patients is critical for improving the therapeutic effect in these subjects.
Highlights
Low back pain (LBP) is a common malady that affects approximately 80-90% of people at some point in their lives. [1,2]
We previously suggested that muscular LBP involves paraspinal muscle blood flow because decreased oxygenated hemoglobin (Oxy-Hb) was detected by near-infrared spectroscopy (NIRS) in the trunk muscles of LBP patients [12]
Of the 106 patients selected for treatment, 61 (57.5%) in the flexionprovoked LBP group and 45 (42.5%) in the extension-provoked LBP group have participated in the study
Summary
Low back pain (LBP) is a common malady that affects approximately 80-90% of people at some point in their lives. [1,2]. Low back pain (LBP) is a common malady that affects approximately 80-90% of people at some point in their lives. The origin of LBP remains uncertain in most cases, and the precise cause of the pain is identified in only 15% of cases even after careful assessment and specific measurements [3]. LBP is typically classified as specific or non-specific, the latter of which is defined as symptoms without a specific cause and accounts for 85-90% of people with LBP [4,5]. From a clinical point of view, disc and/or facet joint-related disorders of the spine are estimated to occur in a high percentage of the LBP population. Patient-specific treatment based on assessment findings should be included in the management of LBP
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