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Effect of stabilization exercises on balance parameters in chronic low back pain: a systematic review

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Abstract

Study design

Systematic literature review.

Background

Low back pain (LBP) is the leading cause of disability and absence from work these days. Poor balance and increased postural sway have been found to be frequently reported in individuals with chronic low back pain (CLBP). The spinal stabilization exercise is a comprehensive conservative approach used for the management of CLBP; however, its effect on managing balance impairment in this population is less clear.

Objectives

The present systematic review aimed to summarize the effect of stabilization exercise on balance outcomes in individuals with CLBP.

Methods

An electronic search of PubMed, Web of Science, PEDro, DOAJ and Scopus databases was performed to identify relevant randomized controlled trials (RCTs) from database inception till August 2021. Included studies had to have participants experiencing CLBP who were over 18 years old, utilize spinal stabilization exercise intervention, and report outcomes for at least one balance parameter. The methodological quality of RCTs was evaluated using the PEDro scale.

Results

The initial search resulted in 1150 articles to review. After screening abstracts, then full articles, a total of ten studies were included, of which scores ranged from 4–8/10 on the PEDro scale. A qualitative review was performed on the final selected ten RCTs. A meta-analysis was not possible due to high heterogeneity in the methodological parts of the study.

Conclusions

Low certainty of evidence suggests that an intervention of stabilization exercise tends to improve balance in the CLBP population. These results should be interpreted with caution as further high-quality RCTs are essentially needed due to the variations in methodological and statistical parts of the included studies.

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References

  1. Hartvigsen J, Hancock MJ, Kongsted A et al (2018) What low back pain is and why we need to pay attention. Lancet 391:2356–2367

    Article  Google Scholar 

  2. Dionne CE, Dunn KM, Croft PR et al (2008) A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine 33:95–103

    Article  Google Scholar 

  3. Maher C, Underwood M, Buchbinder R (2017) Non-specific low back pain. Lancet 389:736–747

    Article  Google Scholar 

  4. Bardin LD, King P, Maher CG (2017) Diagnostic triage for low back pain: a practical approach for primary care. Med J Aust 206:268–273

    Article  Google Scholar 

  5. Traeger AC, Lee H, Hübscher M et al (2019) Effect of intensive patient education vs placebo patient education on outcomes in patients with acute low back pain: a randomized clinical trial. JAMA Neurol 76:161–169

    Article  Google Scholar 

  6. Cho Y-K, Kim D-Y, Jung S-Y, Seong J-H (2015) Synergistic effect of a rehabilitation program and treadmill exercise on pain and dysfunction in patients with chronic low back pain. J Phys Ther Sci 27:1187–1190

    Article  Google Scholar 

  7. Actis JA, Honegger JD, Gates DH et al (2018) Validation of lumbar spine loading from a musculoskeletal model including the lower limbs and lumbar spine. J Biomech 68:107–114

    Article  Google Scholar 

  8. Costa LdCM, Maher CG, Hancock MJ et al (2012) The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ 184:E613–E624

    Article  Google Scholar 

  9. Schelldorfer S, Ernst MJ, Rast FM et al (2015) Low back pain and postural control, effects of task difficulty on centre of pressure and spinal kinematics. Gait Posture 41:112–118

    Article  Google Scholar 

  10. Ruhe A, Fejer R, Walker B (2011) Center of pressure excursion as a measure of balance performance in patients with non-specific low back pain compared to healthy controls: a systematic review of the literature. Eur Spine J 20:358–368. https://doi.org/10.1007/s00586-010-1543-2

    Article  PubMed  Google Scholar 

  11. Ganesh GS, Chhabra D, Mrityunjay K (2015) Efficacy of the star excursion balance test in detecting reach deficits in subjects with chronic low back pain. Physiother Res Int 20:9–15. https://doi.org/10.1002/pri.1589

    Article  PubMed  Google Scholar 

  12. Djordjevic O, Konstantinovic L, Miljkovic N, Bijelic G (2015) Relationship between electromyographic signal amplitude and thickness change of the trunk muscles in patients with and without low back pain. Clin J Pain 31:893–902. https://doi.org/10.1097/AJP.0000000000000179

    Article  PubMed  Google Scholar 

  13. Ruhe A, Fejer R, Walker B (2010) The test–retest reliability of centre of pressure measures in bipedal static task conditions—a systematic review of the literature. Gait Posture 32:436–445

    Article  Google Scholar 

  14. Leitner C, Mair P, Paul B et al (2009) Reliability of posturographic measurements in the assessment of impaired sensorimotor function in chronic low back pain. J Electromyogr Kinesiol 19:380–390

    Article  CAS  Google Scholar 

  15. Morrisette DC, Cholewicki J, Patenge WF et al (2014) A randomized clinical trial comparing extensible and inextensible lumbosacral orthoses and standard care alone in the management of lower back pain. Spine 39:1733

    Article  Google Scholar 

  16. Luomajoki H, Moseley GL (2011) Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls. Br J Sports Med 45:437–440

    Article  CAS  Google Scholar 

  17. Richardson C, Jull G, Hides J, Hodges P (1999) Therapeutic exercise for spinal segmental stabilization in low back pain. Churchill Livingstone, London

    Google Scholar 

  18. Hodges PW, Richardson CA (1996) Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine 21:2640–2650

    Article  CAS  Google Scholar 

  19. Mazaheri M, Coenen P, Parnianpour M et al (2013) Low back pain and postural sway during quiet standing with and without sensory manipulation: a systematic review. Gait Posture 37:12–22

    Article  Google Scholar 

  20. Berenshteyn Y, Gibson K, Hackett GC et al (2019) Is standing balance altered in individuals with chronic low back pain? A systematic review. Disabil Rehabil 41:1514–1523

    Article  Google Scholar 

  21. de Morton NA (2009) The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother 55:129–133

    Article  Google Scholar 

  22. Foley NC, Bhogal SK, Teasell RW et al (2006) Estimates of quality and reliability with the physiotherapy evidence-based database scale to assess the methodology of randomized controlled trials of pharmacological and nonpharmacological interventions. Phys Ther 86:817–824

    Article  Google Scholar 

  23. Maher CG, Sherrington C, Herbert RD et al (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83:713–721

    Article  Google Scholar 

  24. Verhagen AP, De Vet HCW, De Bie RA et al (1998) The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 51:1235–1241

    Article  CAS  Google Scholar 

  25. McCrary JM, Ackermann BJ, Halaki M (2015) A systematic review of the effects of upper body warm-up on performance and injury. Br J Sports Med 49:935–942

    Article  Google Scholar 

  26. Sullivan GM, Feinn R (2012) Using effect size—or why the p value is not enough. J Grad Med Educ 4:279–282. https://doi.org/10.4300/jgme-d-12-00156.1

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lakens D (2013) Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t tests and ANOVAs. Front Psychol 4:863

    Article  Google Scholar 

  28. Chung S, Lee J, Yoon J (2013) Effects of stabilization exercise using a ball on mutifidus cross-sectional area in patients with chronic low back pain. J Sports Sci Med 12:533

    PubMed  PubMed Central  Google Scholar 

  29. Heo M-Y, Kim K, Hur B-Y, Nam C-W (2015) The effect of lumbar stabilization exercises and thoracic mobilization and exercises on chronic low back pain patients. J Phys Ther Sci 27:3843–3846

    Article  Google Scholar 

  30. Hosseinifar M, Akbari A, Mahdavi M, Rahmati M (2018) Comparison of balance and stabilizing trainings on balance indices in patients suffering from nonspecific chronic low back pain. J Adv Pharm Technol Res 9:44

    Article  Google Scholar 

  31. Hwangbo G, Lee C-W, Kim S-G, Kim H-S (2015) The effects of trunk stability exercise and a combined exercise program on pain, flexibility, and static balance in chronic low back pain patients. J Phys Ther Sci 27:1153–1155

    Article  Google Scholar 

  32. Jeong U-C, Sim J-H, Kim C-Y et al (2015) The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients. J Phys Ther Sci 27:3813–3816

    Article  Google Scholar 

  33. Karimi N, Ebrahimi I, Ezzati K et al (2009) The effects of consecutive supervised stability training on postural balance in patients with chronic low back pain. Pak J Med Sci 25:177–181

    Google Scholar 

  34. Salavati M, Akhbari B, Takamjani IE et al (2016) Effect of spinal stabilization exercise on dynamic postural control and visual dependency in subjects with chronic non-specific low back pain. J Bodyw Mov Ther 20:441–448. https://doi.org/10.1016/j.jbmt.2015.10.003

    Article  PubMed  Google Scholar 

  35. Yu SH, Sim YH, Kim MH et al (2016) The effect of abdominal drawing-in exercise and myofascial release on pain, flexibility, and balance of elderly females. J Phys Ther Sci 28:2812–2815

    Article  Google Scholar 

  36. Yang J, Seo D (2015) The effects of whole body vibration on static balance, spinal curvature, pain, and disability of patients with low back pain. J Phys Ther Sci 27:805–808. https://doi.org/10.1589/jpts.27.805

    Article  PubMed  PubMed Central  Google Scholar 

  37. Sarker KK, Sethi J, Mohanty U (2020) Comparative clinical effects of spinal manipulation, core stability exercise, and supervised exercise on pain intensity, segmental instability, and health-related quality of life among patients with chronic nonspecific low back pain: a randomized control. J Nat Sci Biol Med 11:27

    Article  Google Scholar 

  38. Farajzadeh F, Ghaderi F, Asghari Jafarabadi M et al (2017) Effects of McGill stabilization exercise on pain and disability, range of motion and dynamic balance indices in patients with chronic nonspecific low back pain. J Babol Univ Med Sci 21–27

  39. Waqqash E, Chan M, Nadzalan AM et al (2020) The short-term effects of progressive vs conventional core stability exercise in rehabilitation of nonspecific chronic low back pain. Sains Malaysiana 49:2527–2537. https://doi.org/10.17576/jsm-2020-4910-18

    Article  Google Scholar 

  40. Örgün E, Kurt C, Özsu İ (2020) The effect of static and dynamic core exercises on dynamic balance, spinal stability, and hip mobility in female office workers. Turk J Phys Med Rehabil 66:271

    Article  Google Scholar 

  41. Kim B, Yim J (2020) Core stability and hip exercises improve physical function and activity in patients with non-specific low back pain: a randomized controlled trial. Tohoku J Exp Med 251:193–206

    Article  Google Scholar 

  42. Lee JB, Brown SHM (2018) Time course of the acute effects of core stabilisation exercise on seated postural control. Sport Biomech 17:494–501

    Google Scholar 

  43. da Silva RA, Vieira ER, Fernandes KBP et al (2018) People with chronic low back pain have poorer balance than controls in challenging tasks. Disabil Rehabil 40:1294–1300. https://doi.org/10.1080/09638288.2017.1294627

    Article  PubMed  Google Scholar 

  44. Ferreira PH, Ferreira ML, Maher CG et al (2006) Specific stabilisation exercise for spinal and pelvic pain: a systematic review. Aust J Physiother 52:79–88

    Article  Google Scholar 

  45. Tsao H, Hodges PW (2007) Immediate changes in feedforward postural adjustments following voluntary motor training. Exp Brain Res 181:537–546

    Article  Google Scholar 

  46. Tsao H, Galea MP, Hodges PW (2010) Driving plasticity in the motor cortex in recurrent low back pain. Eur J Pain 14:832–839

    Article  Google Scholar 

  47. Lewis JS, Hewitt JS, Billington L et al (2005) A randomized clinical trial comparing two physiotherapy interventions for chronic low back pain. Spine 30:711–721

    Article  Google Scholar 

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Funding

This study was not funded by any agency.

Author information

Authors and Affiliations

  1. Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025, India

    Sumbul Ansari & Saurabh Sharma

  2. Max Hospital, New Delhi, India

    Shailly Kumar

  3. Enrich Physio Clinics, Melbourne, VIC, Australia

    Shalini Sharma

Authors
  1. Sumbul Ansari
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  2. Saurabh Sharma
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  3. Shailly Kumar
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  4. Shalini Sharma
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Contributions

SA (Sumbul Ansari) developed the study idea and design. SA and SaS (Saurabh Sharma) performed the systematic search. SA, SaS, SK (Shailly Kumar) and ShS (Shalini Sharma) were involved in the quality rating of the included articles and revising and drafting the manuscript.

Corresponding author

Correspondence to Saurabh Sharma.

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Ansari, S., Sharma, S., Kumar, S. et al. Effect of stabilization exercises on balance parameters in chronic low back pain: a systematic review. Sport Sci Health 18, 603–619 (2022). https://doi.org/10.1007/s11332-021-00864-2

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  • DOI: https://doi.org/10.1007/s11332-021-00864-2

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