Skip to main content
SpringerLink
Log in

A random-perturbation therapy in chronic non-specific low-back pain patients: a randomised controlled trial

  • Original Article
  • Published:
European Journal of Applied Physiology Aims and scope Submit manuscript

Abstract

The purpose of the study was to assess the effectiveness of a specific rehabilitation therapy for chronic non-specific low-back pain patients, based on a random/irregular functional perturbation training induced by force disturbances to the spine. Forty patients (20 controls and 20 in the perturbation-based group) finished the whole experimental design. A random-perturbation exercise, which included variable and unpredictable disturbances, was implemented in the therapy of the perturbation-based group (13 weeks, two times per week and 1.5 h per session). The participants of the control group did not receive any specific training. Low-back pain, muscle strength, and neuromuscular control of spine stability were investigated before and after the therapy using the visual analog scale, maximal isometric and isokinetic contractions, nonlinear time series analysis, and by determining the stiffness and damping of the trunk after sudden perturbations. The perturbation-based therapy reduced patient’s low-back pain (35%), increased muscle strength (15–22%), and trunk stiffness (13%), while no significant changes were observed in the control group. It can be concluded that the proposed therapy has the potential to enhance trunk muscle capability as well as sensory information processing within the motor system during sudden loading and, as a consequence, improve the stabilization of the trunk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  • Anderson JS, Lampl I, Deda I, Gillespie DC, Ferster D (2000) The contribution of noise to contrast invariance of orientation tuning in cat visual cortex. Science 209:1968–1972

    Google Scholar 

  • Asgari M, Sanjari MA, Mokhtarinia HR, Moeini Sedeh S, Khalaf K, Parnianpour M (2015) The effects of movement speed on kinematic variability and dynamic stability of the trunk in healthy individuals and low back pain patients. Clin Biomech 30:682–688

    Google Scholar 

  • Beneck GJ, Kulig K (2012) Multifidus atrophy is localized and bilateral in active persons with chronic unilateral low back pain. Arch Phys Med Rehabil 93:300–306

    PubMed  Google Scholar 

  • Brown SHM, McGill SM (2009) The intrinsic stiffness of the in vivo lumbar spine in response to quick releases: implications for reflexive requirements. J Electromyogr Kinesiol 19:727–736

    PubMed  Google Scholar 

  • Cholewicki J, Simons AP, Radebold A (2000) Effects of external trunk loads on lumbar spine stability. J Biomech 33:1377–1385

    CAS  PubMed  Google Scholar 

  • Cholewicki J, Silfies SP, Shah RA, Greene HS, Reeves NP, Alvi K, Goldberg B (2005) Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine 30:2614–2620

    PubMed  Google Scholar 

  • Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Psychology Press, Hove, pp 20–27

    Google Scholar 

  • de Vlugt E, Schouten AC, van der Helm FCT, Teerhuis PC, Brouwn GG (2003) A force-controlled planar haptic device for movement control analysis of the human arm. J Neurosci Methods 129:151–168

    PubMed  Google Scholar 

  • Douglass JK, Wilkens L, Pantazelou E, Moss F (1993) Noise enhancement of information transfer in crayfish mechanoreceptors by stochastic resonance. Nature 365:337–340

    CAS  PubMed  Google Scholar 

  • Faisal AA, Selen LPJ, Wolpert DM (2008) Noise in the nervous system. Nat Rev Neurosci 9:292–303

    CAS  PubMed  PubMed Central  Google Scholar 

  • Fraser A, Swinney H (1986) Independent coordinates for strange attractors from mutual information. Phys Rev A Gen Phys 33:1134–1140

    CAS  PubMed  Google Scholar 

  • Freddolini M, Strike S, Lee RYW (2014) Stiffness properties of the trunk in people with low back pain. Hum Mov Sci 36:70–79

    PubMed  Google Scholar 

  • Frost DM, Beach TA, Callaghan JP, McGill SM (2015) Exercise-based performance enhancement and injury prevention for firefighters: contrasting the fitness- and movement-related adaptations to two training methodologies. J Strength Cond Res 29:2441–2459

    PubMed  Google Scholar 

  • Gildea JE, van den Hoorn W, Hides JA, Hodges PW (2015) Trunk dynamics are impaired in ballet dancers with back pain but improve with imagery. Med Sci Sport Exer 47:1665–1671

    Google Scholar 

  • Graham RB, Oikawa LY, Ross GB (2014) Comparing the local dynamic stability of trunk movements between varsity athletes with and without non-specific low back pain. J Biomech 47:1459–1464

    PubMed  Google Scholar 

  • Granacher U, Lacroix A, Muehlbauer T, Roettger K, Gollhofer A (2013) Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults. Gerontology 59:105–113

    PubMed  Google Scholar 

  • Granata KP, England SA (2006) Stability of dynamic trunk movement. Spine 31:E271–E276

    PubMed  PubMed Central  Google Scholar 

  • Hides JA, Jull GA, Richardson CA (2001) Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine 26:E243-248

    Google Scholar 

  • Hodges PW, Tucker K (2011) Moving differently in pain: a new theory to explain the adaptation to pain. Pain 152:S90-98

    Google Scholar 

  • Hodges P, van den Hoorn W, Dawson A, Cholewicki J (2009a) Changes in the mechanical properties of the trunk in low back pain may be associated with recurrence. J Biomech 42:61–66

    PubMed  Google Scholar 

  • Hodges PW, Galea MP, Holm S, Holm AK (2009b) Corticomotor excitability of back muscles is affected by intervertebral disc lesion in pigs. Eur J Neurosci 29:1490–1500

    PubMed  Google Scholar 

  • Ikeda DM, McGill SM (2012) Can altering motions, postures, and loads provide immediate low back pain relief: a study of 4 cases investigating spine load, posture, and stability. Spine 37:E1469-E1475

    Google Scholar 

  • Jeffries LJ, Milanese SF, Grimmer-Somers KA (2007) Epidemiology of adolescent spinal pain: a systematic overview of the research literature. Spine 32:2630–2637

    PubMed  Google Scholar 

  • Kantz HA (1994) Robust method to estimate the maximal Lyapunov exponent of a time series. Phys Lett A 185:77–87

    Google Scholar 

  • Kennel M, Brown R, Abarbanel H (1992) Determining embedding dimension for phase-space reconstruction using a geometrical construction. Phys Rev A 45:3403–3411

    CAS  PubMed  Google Scholar 

  • Kushner AM, Brent JL, Schoenfeld BJ, Hugentobler J, Lloyd RS, Vermeil A, Chu DA, Harbin J, McGill SM, Myer GD (2015) The back squat part 2: targeted training techniques to correct functional deficits and technical factors that limit performance. Strength Cond J 37:13–60

    PubMed  PubMed Central  Google Scholar 

  • Lin DC, Rymer WZ (2001) Damping actions of the neuromuscular system with inertial loads: human flexor pollicis longus muscle. J Neurophysiol 85:1059–1066

    CAS  PubMed  Google Scholar 

  • Liu W, Lipsitz LA, Montero-Odasso M, Bean J, Kerrigan DC, Collins JJ (2002) Noise-enhanced vibrotactile sensitivity in older adults, patients with stroke, and patients with diabetic neuropathy. Arch Phys Med Rehabil 83:171–176

    PubMed  Google Scholar 

  • McDonnell MD, Ward LM (2011) The benefits of noise in neural systems: bridging theory and experiment. Nat Rev Neurosci 12:415–426

    CAS  PubMed  Google Scholar 

  • Mirbagheri MM, Barbeau H, Kearney RE (2000) Intrinsic and reflex contributions to human ankle stiffness: variation with activation level and position. Exp Brain Res 135:423–436

    CAS  PubMed  Google Scholar 

  • Mori T, Kai S (2002) Noise-induced entrainment and stochastic resonance in human brain waves. Phys Rev Lett 88:218101

    PubMed  Google Scholar 

  • Priplata AA, Niemi JB, Harry JD, Lipsitz LA, Collins JJ (2003) Vibrating insoles and balance control in elderly people. Lancet 362:1123–1124

    PubMed  Google Scholar 

  • Radebold A, Cholewicki J, Panjabi MM, Patel TC (2000) Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain. Spine 25:947–954

    CAS  PubMed  Google Scholar 

  • Reeves NP, Cholewicki J, Lee AS, Mysliwiec LW (2009) The effects of stochastic resonance stimulation on spine proprioception and postural control in chronic low back pain patients. Spine 34:316–321

    PubMed  Google Scholar 

  • Ross GB, Mavor M, Brown SHM, Graham RB (2015) The effects of experimentally induced low back pain on spine rotational stiffness and local dynamic stability. Ann Biomed Eng 43:2120–2130

    PubMed  Google Scholar 

  • Shu Y, Hasenstaub A, Badoual M, Bal T, McCormick DA (2003) Barrages of synaptic activity control the gain and sensitivity of cortical neurons. J Neurosci 23:10388–10401

    CAS  PubMed  PubMed Central  Google Scholar 

  • Steele J, Bruce-Low S, Smith D (2015) A review of the specificity of exercises designed for conditioning the lumbar extensors. Br J Sports Med 49:291–297

    PubMed  Google Scholar 

  • Stuge B, Laerum E, Kirkesola G, Vøllestad N (2004) The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine 29:351–359

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  • Tsao H, Hodges PW (2008) Persistence of improvements in postural strategies following motor control training in people with recurrent low back pain. J Electromyogr Kinesiol 18:559–567

    PubMed  Google Scholar 

  • Tsao H, Tucker KJ, Hodges PW (2011) Changes in excitability of corticomotor inputs to the trunk muscles during experimentally-induced acute low back pain. Neuroscience 181:127–133

    CAS  PubMed  Google Scholar 

  • van Dieën JH, van Drunen P, Happee R (2017) Sensory contributions to stabilization of trunk posture in the sagittal plane. J Biomech. doi:10.1016/j.jbiomech.2017.07.016

    Article  PubMed  Google Scholar 

  • Willemink MJ, van Es HW, Helmhout PH, Diederik AL, Kelder JC, van Heesewijk JP (2012) The effects of dynamic isolated lumbar extensor training on lumbar multifidus functional cross-sectional area and functional status of patients with chronic nonspecific low back pain. Spine 37:E1651-E1658

    Google Scholar 

  • Willigenburg NW, Kingma I, Hoozemans MJM, van Dieen JH (2013) Precision control of trunk movement in low back pain patients. Hum Mov Sci 32:228–239

    PubMed  Google Scholar 

  • Winter DA (2009) Biomechanics and motor control of human movement. Wiley, Hoboken, p 86

    Google Scholar 

  • Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D’Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I (2002) ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine. J Biomech 35:543–548

    PubMed  Google Scholar 

Download references

Acknowledgements

The present study was funded by the German Federal Institute of Sport Science on behalf of the Federal Ministry of the Interior of Germany as the major funder. It is realized within MiSpEx—the National Research Network for Medicine in Spine Exercise (Grant Number 080102A/11-14). We declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.

Author information

Authors and Affiliations

  1. Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Philippstr. 13, Haus 11, 10115, Berlin, Germany

    Adamantios Arampatzis, Arno Schroll, Maria Moreno Catalá & Gunnar Laube

  2. Berlin School of Movement Science, Berlin, Germany

    Adamantios Arampatzis, Arno Schroll, Maria Moreno Catalá & Gunnar Laube

  3. Medical Park Berlin Humboldtmühle, Berlin, Germany

    Sabine Schüler & Karsten Dreinhofer

  4. Centrum für Muskuloskeletale Chirurgie (CMSC) Charité Universitätsmedizin Berlin, Berlin, Germany

    Karsten Dreinhofer

Authors
  1. Adamantios Arampatzis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arno Schroll
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Moreno Catalá
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gunnar Laube
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sabine Schüler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Karsten Dreinhofer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adamantios Arampatzis.

Ethics declarations

Conflict of interest

None to declare.

Additional information

Communicated by Benedicte Schepens.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arampatzis, A., Schroll, A., Catalá, M.M. et al. A random-perturbation therapy in chronic non-specific low-back pain patients: a randomised controlled trial. Eur J Appl Physiol 117, 2547–2560 (2017). https://doi.org/10.1007/s00421-017-3742-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00421-017-3742-6

Keywords

Search

Navigation