Rheumatology International

, Volume 30, Issue 7, pp 901–910 | Cite as

Effects of therapeutic ultrasound and electrical stimulation program on pain, trunk muscle strength, disability, walking performance, quality of life, and depression in patients with low back pain: a randomized-controlled trial

  • Dilek DurmusEmail author
  • Yunus Durmaz
  • Ferhan Canturk
Original Article


The aim of this trial is to investigate and compare the effects of electrical stimulation (ES) program and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 59 patients with definite CLBP were enrolled in this study. These patients were randomized into three groups. Group 1 (n = 20) was given an ES program and exercises. Group 2 (n = 19) was given an US treatment and exercises. Group 3 (n = 20) was accepted as the control group and was given only exercises. All of the programs were performed 3 days a week, for 6 weeks. The patients were evaluated according to pain, disability, walking performance, endurance, mobility, QOL, depression. The trunk muscle strength was measured with a hand-held dynamometer. All of the groups showed stastically significant improvements in pain, disability, muscle strength, endurance, walking performance, mobility, sub-scores of SF 36, and depression when compared with their initial status. The intergroup comparison showed significant difference in physical function, energy and social function sub-groups of SF-36, VAS pain, extensor muscle strength, between three groups. This difference was statistically significant in the groups 1 and 2 compared to the control group. There was also no significant difference between the groups 1 and 2. We observed that US treatment and ES treatment were effective in improving pain, isometric extensor muscle strength, and QOL in patients with CLBP.


Electrical stimulation Ultrasound Trunk muscle strength Pain Disability Endurance Quality of life Depression 


Conflict of interest



  1. 1.
    Frank AO, Souza LD (2001) Conservative management of low back pain. Int J Clin Pract 55:21–31PubMedGoogle Scholar
  2. 2.
    Uden A, Aström M, Bergenudd H (1988) Pain drawings in chronic back pain. Spine 13:389–392CrossRefPubMedGoogle Scholar
  3. 3.
    Nicolaisen T, Jorgensen K (1985) Trunk strength, back muscle endurance, and low-back trouble. Scand J Rehab Med 17:121–127Google Scholar
  4. 4.
    Mayer TG, Smith SS, Keeley J et al (1985) Quantification of lumbar function. Part 2. Sagittal plane trunk strength in chronic low-back pain patients. Spine 10:765–772CrossRefPubMedGoogle Scholar
  5. 5.
    Liddle SD, Baxter GD, Gracey JH (2004) Exercise and chronic low back pain: what works? Pain 107:176–190CrossRefPubMedGoogle Scholar
  6. 6.
    Rainville J, Hartigan C, Martinez E et al (2004) Exercise as a treatment for chronic low back pain. Spine J 4:106–115CrossRefPubMedGoogle Scholar
  7. 7.
    Liberson WT (1984) Electrotherapy. In: Ruskin AP (ed) Current therapy in physiatry. W.B. Sounders Company, Philadelphia, pp 161–191Google Scholar
  8. 8.
    Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation ınterventions for low back pain (2001) Phys Ther 81:1641–1674Google Scholar
  9. 9.
    Harris GR, Susman JL (2002) Managing musculoskeletal complaints with rehabilitation therapy: summary of the Philadelphia Panel evidence-based clinical practice guidelines on musculoskeletal rehabilitation interventions. J Fam Pract 51:1042–1046PubMedGoogle Scholar
  10. 10.
    Grubisic F, Grazio S, Jajic Z et al (2006) Therapeutic ultrasound in chronic low back pain treatment. Reumatizam 53:18–21PubMedGoogle Scholar
  11. 11.
    Melzack R, Vetere P, Finch L (1983) Transcutaneous electrical nerve stimulation for low back pain: A comparison of TENS and massage for pain and range of motion. Phys Ther 63:489–493PubMedGoogle Scholar
  12. 12.
    Rutkowski B, Neidzialkowska T, Otto J (1977) Electrical stimulation in chronic low back pain. Br J Anaesth 49:629–632CrossRefPubMedGoogle Scholar
  13. 13.
    Durmus D, Akyol Y, Alayli G et al (2008) Effects of electrical stimulation program on trunk muscle strength, functional capacity, quality of life, and depression in the patients with low back pain: a randomized controlled trial. Rheumatol Int Dec 20 (Epub ehead of print)Google Scholar
  14. 14.
    Durmus D, Alayli G, Canturk F (2007) Effects of quadriceps electrical stimulation program on clinical parameters in the patients with knee osteoarthritis. Clin Rheumatol 26:674–678CrossRefPubMedGoogle Scholar
  15. 15.
    Kahanovitz N, Nordin M, Verderame R et al (1987) Normal trunk muscle strength and endurance in women and the effects of exercises and electrical stimulation. Spine 12:112–118CrossRefPubMedGoogle Scholar
  16. 16.
    Koldaş Doğan S, Sonel Tur B et al (2008) Comparison of three different approaches in the treatment of chronic low back pain. Clin Rheumatol 27:873–881CrossRefPubMedGoogle Scholar
  17. 17.
    Kääpä E, Frantsi K, Sarna S et al (2006) Multidisciplinary group rehabilitation versus ındividual physiotherapy for chronic nonspecific low back pain: a randomized trial. Spine 31:371–376CrossRefPubMedGoogle Scholar
  18. 18.
    Duruöz MT, Ozcan E, Ketenci A et al (1999) Cross cultural validation of the revised Oswestry pain questionnaire (ROPQ) in a Turkish population. Arthritis Rheum 42(9). (Annual Scientific Meeting. Boston, Massachusetts, P1200)Google Scholar
  19. 19.
    Grönblad M, Hupli M, Wennerstrand P et al (1993) 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 9:189–195PubMedCrossRefGoogle Scholar
  20. 20.
    Macrael IF, Wright V (1969) Measurement of back movement. Ann Rheum Dis 28:584CrossRefGoogle Scholar
  21. 21.
    Ito T, Shirado O, Suzuki H et al (1996) Lumbar trunk muscle endurance testing: an inexpensive alternative to a machine for evaluation. Arch Phys Med Rehabil 77:75–79CrossRefPubMedGoogle Scholar
  22. 22.
    McGill SM, Childs A, Liebenson C (1999) Endurance times for low back stabilization exercises clinical targets for testing and training from a normal database. Arch Phys Med Rehabil 80:941–944CrossRefPubMedGoogle Scholar
  23. 23.
    Kvien TK, Kaasa S, Smedstad LM (1998) Performance of the Norwegian SF-36 Health Survey in patients with rheumatoid arthritis. II. A comparison of the SF-36 with disease-specific measures. J Clin Epidemiol 51:1077–1086CrossRefPubMedGoogle Scholar
  24. 24.
    Beck AT, Ward CH, Mendelson M et al (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571PubMedGoogle Scholar
  25. 25.
    Wheeler AH (1995) Diagnosis and management of low back pain and sciatica. Am Fam Physician 52:1333–1341PubMedGoogle Scholar
  26. 26.
    Cailliet R (1981) Low back pain syndrome. FA Davis, Philadelphia, pp 206–225Google Scholar
  27. 27.
    Mannion AF, Müntener M, Taimela S et al (2001) Comparison of three active therapies for chronic low back pain: results of a randomized clinical trial with one-year follow-up. Rheumatol 40:772–778CrossRefGoogle Scholar
  28. 28.
    Taimela S, Diederich C, Hubsch M et al (2000) The role of physical exercise and inactivity in pain recurrence and absenteeism from work after active outpatient rehabilitation for recurrent or chronic low back pain. Spine 25:1809–1816CrossRefPubMedGoogle Scholar
  29. 29.
    Bayramoglu M, Akman MN, Kilinç S et al (2001) Isokinetic measurement of trunk muscle strength in women with chronic low-back pain. Am J Phys Med Rehabil 80:650–655CrossRefPubMedGoogle Scholar
  30. 30.
    Robertson VJ, Baker KG (2001) A review of therapeutic ultrasound: effectiveness studies. Phys Ther 81:1339–1350PubMedGoogle Scholar
  31. 31.
    Unlu Z, Tasci S, Tarhan S et al (2008) Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. J Manipulative Physiol Ther 31:191–198CrossRefPubMedGoogle Scholar
  32. 32.
    Lehmann JF, De Lateur BJ (1990) Therapeutic heat. In: Lehmann JF (ed) Therapeutic heat and cold. Wiliams and Wilkins, Baldimore, pp 417–562Google Scholar
  33. 33.
    Lehmann JF, Bunner GD, Stow RW (1958) Pain threshold measurements after therapeutic application of ultrasound, microwaves and infrared. Arch Phys Med Rehabil 39:560–565PubMedGoogle Scholar
  34. 34.
    Québec Task Force on Spinal Disorders (1987) Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Spine 12:51–59Google Scholar
  35. 35.
    Gaines JM, Metter EJ, Talbot LA (2004) The effect of neuromuscular electrical stimulation on arthritis knee pain in older adults with osteoarthritis of the knee. Appl Nurs Res 17:201–206CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of Physical Medicine and Rehabilitation, Medical FacultyOndokuz Mayis UniversitySamsunTurkey

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