Efficacy of Integrating Cervical Posture Correction With Lumbar Stabilization Exercises for Mechanical Low Back Pain: A Randomized Blinded Clinical Trial

in Journal of Applied Biomechanics
View More View Less
  • 1 Pharos University
  • 2 Cairo University
  • 3 Suez University
  • 4 Delta University for Science and Technology
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $88.00

1 year online subscription

USD  $118.00

Student 2 year online subscription

USD  $168.00

2 year online subscription

USD  $224.00

Although current lumbar stabilization exercises are beneficial for chronic mechanical low back pain, further research is recommended focusing on global spinal alignment normalization. This randomized, controlled, blinded trial was conducted to determine the effects of adding cervical posture correction to lumber stabilization on chronic mechanical low back pain. Fifty adult patients (24 males) with chronic mechanical low back pain and forward head posture received 12 weeks treatment of either both programs (group A) or lumbar stabilization (group B). The primary outcome was back pain. The secondary outcomes included the craniovertebral angle, Oswestry Disability Index, C7-S1 sagittal vertical axis, and sagittal intervertebral movements. The multivariate analysis of variance indicated a significant group-by-time interaction (P = .001, partial η2 = .609). Pain, disability, C7-S1 sagittal vertical axis, and l2-l3 intervertebral rotation were reduced in group A more than B (P = .008, .001, .025, and .001). Craniovertebral angle was increased in A when compared to B (P = .001). However, there were no significant group-by-time interactions for other intervertebral movements. Within-group comparisons were significant for all outcomes except for craniovertebral angle within patients in the control group. Adding cervical posture correction with lumber stabilization for management of chronic low back pain seemed to have better effects than the application of a stabilization program only.

A.M. Elabd is with the Basic Science Department, Faculty of Physical Therapy, Pharos University, Alexandria, Egypt. Rasslan, Elhafez, and Elerian are with the Basic Science Department, Faculty of Physical Therapy, Cairo University, Dokki, Egypt. Elhafez is also with the Faculty of Physical Therapy, Suez University, Suez, Egypt. O.M. Elabd and Behiry are with the Department of Physical Therapy for Musculoskeletal Disorders, Faculty of Physical Therapy, Delta University for Science and Technology, Gamassa, Egypt.

A.M. Elabd (aliaelabd88@gmail.com) is corresponding author.
  • 1.

    Meucci RD, Fassa AG, Faria NM. Prevalence of chronic low back pain: systematic review. Rev Saude Publica. 2015;49:1. doi:10.1590/S0034-8910.2015049005874

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Manchikanti L, Singh V, Falco FJ, Benyamin RM, Hirsch JA. Epidemiology of low back pain in adults. Neuromodulation. 2014;17(suppl):310. doi:10.1111/ner.12018

  • 3.

    Hodges PW. The role of the motor system in spinal pain: implications for rehabilitation of the athlete following lower back pain. J Sci Med Sport. 2000;3(3):243253. PubMed ID: 11101263 doi:10.1016/S1440-2440(00)80033-X

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Delitto A, George SZ, Van Dillen L, et al. Low back pain: clinical practice guidelines linked to the international classification of functioning, disability, and health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2012;42(4):A1A57. doi:10.2519/jospt.2012.42.4.A1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Lizier DT, Perez MV, Sakata RK. Exercises for treatment of nonspecific low back pain. Rev Bras Anestesiol. 2012;62(6):838846. PubMed ID: 23176991 doi:10.1016/S0034-7094(12)70183-6

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Gomes-Neto M, Lopes JM, Conceição CS, et al. Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: a systematic review and meta-analysis. Phys Ther Sport. 2017;23:136142. PubMed ID: 27707631 doi:10.1016/j.ptsp.2016.08.004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Park KN, Kwon OY, Yi CH, et al. Effects of motor control exercise vs muscle stretching exercise on reducing compensatory lumbopelvic motions and low back pain: a randomized trial. J Manipulative Physiol Ther. 2016;39(8):576585. PubMed ID: 27599622 doi:10.1016/j.jmpt.2016.07.006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Kumar SP. Efficacy of segmental stabilization exercise for lumbar segmental instability in patients with mechanical low back pain: a randomized placebo controlled crossover study. N Am J Med Sci. 2011;3(10):456461. PubMed ID: 22363083 doi:10.4297/najms.2011.3456

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Javadian Y, Akbari M, Talebi GA, Janmohammadi N. Influence of core stability exercise on lumbar vertebral instability in patients presented with chronic low back pain: a randomized clinical trial. Caspian J Intern Med. 2015;6(2):98102. PubMed ID: 26221508

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Ferreira PH, Ferreira ML, Maher CG, Herbert RD, Refshauge K. Specific stabilisation exercise for spinal and pelvic pain: a systematic review. Aust J Physiother. 2006;52(2):7988. PubMed ID: 16764545 doi:10.1016/S0004-9514(06)70043-5

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    May S, Johnson R. Stabilization exercises for low back pain: a systematic review. Physiotherapy. 2008;94(3):179189. doi:10.1016/j.physio.2007.08.010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Haladay DE, Miller SJ, Challis J, Denegar CR. Quality of systematic reviews on specific spinal stabilization exercise for chronic low back pain. J Orthop Sports Phys Ther. 2013;43(4):242250. PubMed ID: 23321935 doi:10.2519/jospt.2013.4346

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Ting LH, Chiel HJ, Trumbower RD, et al. Neuromechanical principles underlying movement modularity and their implications for rehabilitation. Neuron. 2015;86(1):3854. PubMed ID: 25856485 doi:10.1016/j.neuron.2015.02.042

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Naserkhaki S, Jaremko JL, El-Rich M. Effects of inter-individual lumbar spine geometry variation on load-sharing: geometrically personalized Finite Element study. J Biomech. 2016;49(13):29092917. PubMed ID: 27448498 doi:10.1016/j.jbiomech.2016.06.032

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Chaléat-Valayer E, Mac-Thiong JM, Paquet J, Berthonnaud E, Siani F, Roussouly P. Sagittal spino-pelvic alignment in chronic low back pain. Eur Spine J. 2011;20(suppl):634640. doi:10.1007/s00586-011-1931-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Habibia A, Sahebozamani M, Yekta YZ, Valizadeh R. Comparison powers of couple force of anterior & posterior rotator’s muscles in Hyperlordosis and healthy male. Procedia Soc Behav Sci. 2011(15):23422346

    • Search Google Scholar
    • Export Citation
  • 17.

    Berthonnaud E, Dimnet J, Roussouly P, Labelle H. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech. 2005;18(1):4047. PubMed ID: 15687851 doi:10.1097/01.bsd.0000117542.88865.77

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Morningstar MW, Pettibon BR, Schlappi H, Schlappi M, Ireland V. Reflex control of the spine and posture: a review of the literature from a chiropractic perspective. Chiropr Osteopat. 2005;13(1):16. PubMed ID: 16091134 doi:10.1186/1746-1340-13-16

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Grod JP, Diakow PR. Effect of neck pain on verticality perception: a cohort study. Arch Phys Med Rehabil. 2002;83(3):412415. PubMed ID: 11887124 doi:10.1053/apmr.2002.29660

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Diab AA. The role of forward head correction in management of adolescent idiopathic scoliotic patients: a randomized controlled trial. Clin Rehabil. 2012;26(12):11231132. PubMed ID: 22801470 doi:10.1177/0269215512447085

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Moustafa IM, Diab AA. The effect of adding forward head posture corrective exercises in the management of lumbosacral radiculopathy: a randomized controlled study. J Manipulative Physiol Ther. 2015;38(3):167178. PubMed ID: 25704221 doi:10.1016/j.jmpt.2014.11.009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Nelson RM. Standardized tests and measures for assessing low-back pain in the occupational setting a developmental model. Spine. 1991;16(6):679680. doi:10.1097/00007632-199106000-00025

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Yip CH, Chiu TT, Poon AT. The relationship between head posture and severity and disability of patients with neck pain. Man Ther. 2008;13(2):148154. PubMed ID: 17368075 doi:10.1016/j.math.2006.11.002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Johnsen LG, Hellum C, Nygaard O, Storheim K, Brox JI, Rossvoll I. Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease. BMC Musculoskelet Disord. 2013. 14(1):148. PubMed ID: 23622053 doi:10.1186/1471-2474-14-148

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Singla D, Veqar Z, Hussain ME. Photogrammetric assessment of upper body posture using postural angles: a literature review. J Chiropr Med. 2017;16(2):131138. PubMed ID: 28559753 doi:10.1016/j.jcm.2017.01.005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res. 2008;31(2):165169. PubMed ID: 18467932 doi:10.1097/MRR.0b013e3282fc0f93

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Van Roo JD, Lazio MP, Pesce C, Malik S, Courtney DM. Visual analog scale (VAS) for assessment of acute mountain sickness (AMS) on Aconcagua. Wilderness Environ Med. 2011;22(1):714. PubMed ID: 21377113 doi:10.1016/j.wem.2010.10.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Fairbank JC, Pynsent PB. The oswestry disability index. Spine (Phila Pa 1976). 2000;25(22):29402953. doi:10.1097/00007632-200011150-00017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Grönblad M, Hupli M, Wennerstrand P, et al. Intercorrelation and test-retest reliability of the pain disability index (PDI) and the Oswestry Disability Questionnaire (ODQ) and their correlation with pain intensity in low back pain patients. Clin J Pain. 1993;9(3):189195. PubMed ID: 8219519 doi:10.1097/00002508-199309000-00006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Kyrölä KK, Salme J, Tuija J, Tero I, Eero K, Arja H. Intra- and interrater reliability of sagittal spinopelvic parameters on full-spine radiographs in adults with symptomatic spinal disorders. Neurospine. 2018;15(2):175181. PubMed ID: 29991248 doi:10.14245/ns.1836054.027

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Rasanani M, Bagheri H, Talebian S, Olyaei G. Reliability and accuracy of joint position sense measurement in the laboratory and clinic: utilising a new system. Acta Med Iran. 2007;45(5):395404.

    • Search Google Scholar
    • Export Citation
  • 32.

    Eslam B. An innovative software method for measuring lumbar lordosis. Annals of Biological Research 2012;3:204213.

  • 33.

    Katzman W, Parimi N, Gladin A, et al. Reliability of sagittal vertical axis measurement and association with measures of age-related hyperkyphosis. J Phys Ther Sci. 2018;30(12):14171423. PubMed ID: 30568327 doi:10.1589/jpts.30.1417

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Gadotti IC, Armijo-Olivo S, Silveira A, Magee D. Reliability of the craniocervical posture assessment: visual and angular measurements using photographs and radiographs. J Manipulative Physiol Ther. 2013;36(9):619625. PubMed ID: 24144423 doi:10.1016/j.jmpt.2013.09.002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Pitkänen MT, Manninen HI, Lindgren KA, Sihvonen TA, Airaksinen O, Soimakallio S. Segmental lumbar spine instability at flexion-extension radiography can be predicted by conventional radiography. Clin Radiol. 2002;57(7):632639. PubMed ID: 12096864 doi:10.1053/crad.2001.0899

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Tallroth K, Ylikoski M, Landtman M, Santavirta S. Reliability of radiographical measurements of spondylolisthesis and extension-flexion radiographs of the lumbar spine. Eur J Radiol. 1994;18(3):227231. PubMed ID: 7957297 doi:10.1016/0720-048X(94)90341-7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Frobin W, Brinckmann P, Leivseth G, Biggemann M, Reikers O. Precision measurement of segmental motion from flexion-extension radiographs of the lumbar spine. Clinic Biomech. 1996;11(8):45165.

    • Search Google Scholar
    • Export Citation
  • 38.

    Frobin W, Leivseth G, Biggemann M, Brinckmann P. Sagittal plane segmental motion of the cervical spine. A new precision measurement protocol and normal motion data of healthy adults. Clinic Biomech. 2002;17(1):2131. doi:10.1016/S0268-0033(01)00105-X

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39.

    Luque-Suárez A, Díaz-Mohedo E, Medina-Porqueres I, Ponce-García T. Stabilization exercise for the management of low back pain. In: Norasteh A. ed. Low Back Pain. 1st ed. Ch. 12. Croatia: InTech; 2012:261290. ISBN: 978-953-51-0599-2

    • Search Google Scholar
    • Export Citation
  • 40.

    Cohen J. Statistical power analysis for the behavioral sciences. New York, NY: Routledge Academic; 1988.

  • 41.

    Okubo Y, Kaneoka K, Imai A, et al. Electromyographic analysis of transversus abdominis and lumbar multifidus using wire electrodes during lumbar stabilization exercises. J Orthop Sports Phys Ther. 2010;40(11):743750. PubMed ID: 21041966 doi:10.2519/jospt.2010.3192

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Rose AD, Breen A. Relationships between paraspinal muscle activity and lumbar inter-vertebral range of motion. Healthcare. 2016;4(1):4. doi:10.3390/healthcare4010004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Protopsaltis TS, Scheer JK, Terran JS, et al. How the neck affects the back: changes in regional cervical sagittal alignment correlate to HRQOL improvement in adult thoracolumbar deformity patients at 2-year follow-up. J Neurosurg Spine. 2015;23(2):153158. PubMed ID: 25978077 doi:10.3171/2014.11.SPINE1441

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Schroeder J, Schaar H, Mattes K. Spinal alignment in low back pain patients and age-related side effects: a multivariate cross-sectional analysis of video rasterstereography back shape reconstruction data. Eur Spine J. 2013;22(9):19791985. PubMed ID: 23616202 doi:10.1007/s00586-013-2787-4

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Seaman DR, Winterstein JF. Dysafferentation: a novel term to describe the neuropathophysiological effects of joint complex dysfunction. A look at likely mechanisms of symptom generation. J Manipulative Physiol Ther. 1998;21(4):267280. PubMed ID: 9608382

    • Search Google Scholar
    • Export Citation
  • 46.

    Christensen ST, Hartvigsen J. Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. J Manipulative Physiol Ther. 2008;31(9):690714. PubMed ID: 19028253 doi:10.1016/j.jmpt.2008.10.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47.

    Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A review of biomechanics of the central nervous system--part II: spinal cord strains from postural loads. J Manipulative Physiol Ther. 1999;22(5):322332. PubMed ID: 10395435 doi:10.1016/S0161-4754(99)70065-5

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 245 245 216
Full Text Views 6 6 5
PDF Downloads 5 5 4