Skip to main content

Comparison of three different approaches in the treatment of chronic low back pain

Clinical Rheumatology volume 27, pages 873–881 (2008)Cite this article

Abstract

Our aim is to investigate the effects of three therapeutic approaches in the chronic low back pain on pain, spinal mobility, disability, psychological state, and aerobic capacity. Sixty patients with chronic low back pain were randomized to three groups: group 1, aerobic exercise + home exercise; group 2, physical therapy (hot pack, ultrasound, TENS) + home exercise; group 3, home exercise only. Spinal mobility, pain severity, disability, and psychological disturbance of the patients were assessed before and after the treatment and at 1-month follow-up. Aerobic capacities of the patients were measured before and after treatment. All of the groups showed similar decrease in pain after the treatment and at 1-month follow-up, and there was no significant difference between the groups. In group 2, a significant decrease in Beck Depression Inventory scores was observed with treatment. At 1-month follow-up, group 1 and 2 showed significant decreases in General Health Assessment Questionnaire scores. In group 2, there was also a significant improvement in Roland Morris Disability scores. There were similar improvements in exercise test duration and the MET levels in all the three groups. All of the three therapeutic approaches were found to be effective in diminishing pain and thus increasing aerobic capacity in patients with chronic low back pain. On the other hand, physical therapy + home exercise was found to be more effective regarding disability and psychological disturbance.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Fig. 1

References

  1. Sinaki M, Mokri B (2000) Low back pain and disorders of the lumbar spine. In: Braddom RL (ed) Physical Medicine and Rehabilitation. WB Saunders Comp, Philadelphia, pp 853–893

  2. Weinstein SM, Herring SA (1993) Rehabilitation of the patient with low back pain. In: Delisa JA, Gans BM (eds) Rehabilitation Medicine Principles and Practice. J.B. Lippincott Company, Philadelphia, pp 996–1017.

  3. Descarreaux M, Normand MC, Laurencelle L et al (2002) Evaluation of a specific home exercise program for low back pain. J Manipulative Physiol Ther 25:497–503

    Article  PubMed  Google Scholar 

  4. Wheeler AH (1995) Diagnosis and management of low back pain and sciatica. Am. fam. phys 52(5):1333–1341

    CAS  Google Scholar 

  5. Phillips K, Ch’ien APY, Norwood BR et al (2003) Chronic low back pain management in primary care. The Nurse Practitioner 28(8):26–31

    Article  PubMed  Google Scholar 

  6. Lahad A, Malter AD, Berg AO et al (1994) The effectiveness of four interventions for the prevention of low back pain. JAMA 272(16):1286–1291

    Article  PubMed  CAS  Google Scholar 

  7. Helewa A, Goldsmith CH, Lee P et al (1999) Does strengthening the abdominal muscles prevent low back pain – a randomized controlled trial. J Rheumatol 26:1808–1815

    PubMed  CAS  Google Scholar 

  8. Frank AO, Souza LD (2001) Conservative management of low back pain. Int J Clin Pract 55(1):21–31

    PubMed  CAS  Google Scholar 

  9. Liddle SD, Baxter GD, Gracey JH (2004) Exercise and chronic low back pain: what works? Pain 107:176–190

    Article  PubMed  Google Scholar 

  10. Bayramoğlu M, Akman MN, Kılınç Ş et al (2001) Isokinetic measurement of trunk muscle strength in women with chronic low back pain. Am J Phys Med Rehabil 80:650–655

    Article  PubMed  Google Scholar 

  11. 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 40:772–778

    Article  CAS  Google Scholar 

  12. Taimela S, Diederich C, Hubsch M (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 25:1809–1816

    Article  PubMed  CAS  Google Scholar 

  13. Tulder MV, Malmivaara A, Esmail R et al (2000) Exercise therapy for low back pain. Spine 25:2784–2796

    Article  PubMed  Google Scholar 

  14. Saridoğan ME (2000) Bel ağrısı nedenleri ve epidemiyolojisi. In: Kutsal YG (ed) Modern Tıp Seminerleri. Ankara pp 19–29

  15. Özcan E (2002) Bel ağrılı hastaların konservatif tedavisi. In: Özcan E, Ketenci A (eds) Bel Ağrısı Tanı ve Tedavi. Nobel Kitabevi, İstanbul, pp 187–219

  16. Rainville J, Hartigan C, Martinez E et al (2004) Exercise as a treatment for chronic low back pain. Spine J 4:106–115

    Article  PubMed  Google Scholar 

  17. Kankaanpaa M, Taimela S, Airaksinen O et al (1999) The efficacy of active rehabilitation in chronic low back pain. Spine 24:1034–1042

    Article  PubMed  CAS  Google Scholar 

  18. Van der Velde G, Mierau D (2000) The effect of exercise on percentile rank aerobic capacity, pain, and self-rated disability in patients with chronic low-back pain: a retrospective chart review. Arch Phys Med Rehabil 81:1457–1463

    Article  PubMed  Google Scholar 

  19. Chatzitheodorou D, Kabitsis C, Malliou P et al (2007) A pilot study of the effects of high-intensity aerobic exercise versus passive interventions on pain, disability, psycgological strain, and serum cortisol concentrations in people with chronic low back pain. Phys Ther 87(3):304–312

    Article  PubMed  Google Scholar 

  20. Bensten H, Lindgarde F, Manthorpe R (1997) The effect of dynamic strength back exercise and/or a home training program in 57 year old women with chronic low back pain. Spine 22:1494–1500

    Article  Google Scholar 

  21. Ross MD (2002) Physical therapy and changes in disability for patients with low back pain. Military Medicine 167:662–665

    PubMed  Google Scholar 

  22. Brosseau L, Milne S, Robinson V et al (2002) Efficacy of the transcutaneous electrical nerve stimulation for the treatment of chronic low back pain. Spine 27:596–603

    Article  PubMed  Google Scholar 

  23. Oldervoll LM, Ro M, Zwart JA (2001) Comparison of two physical exercise programs for the early intervention of pain in the neck, shoulders and lower back in female hospital staff. J Rehabil Med 33:156–161

    Article  PubMed  CAS  Google Scholar 

  24. Carpenter DM, Nelson BW (1999) Low back strengthening for the prevention and treatment of low back pain. Medicine and science in sports and exercise 31(1):18–24

    Article  PubMed  CAS  Google Scholar 

  25. Macrael IF, Wright V (1969) Measurement of back movement. Ann Rheum Dis 28:584

    Article  Google Scholar 

  26. Gatchel RJ, Mayer TG, Capra P et al (1986) Quantification of lumbar function. Part 6: the use of psychological measures in guiding physical functional restoration. Spine 11:36–42

    Article  PubMed  CAS  Google Scholar 

  27. Roland M, Morris R (1983) A study of the natural history of back pain. Spine 8:141

    Article  PubMed  CAS  Google Scholar 

  28. Kucukdeveci AA, Tennant A, Elhan AH et al (2001) Validation of the Turkish version of the Roland Morris Disability Questionnaire for use in low back pain. Spine 26(24):2738–2743

    Article  PubMed  CAS  Google Scholar 

  29. Goldberg DP, Williams P (1988) A user’s guide to the General Health Questionnaire. NFER/Nelson, Windsor, CA

    Google Scholar 

  30. Kılıc C (1996) Genel Sağlık Anketi; güvenirlik ve geçerlik çalışması. Türk Psikiyatri Dergisi 7:3–9

    Google Scholar 

  31. Beck AT (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571

    PubMed  CAS  Google Scholar 

  32. Hisli N (1989) Beck Depresyon Envanterinin üniversite öğrencileri içi geçerliği, güvenirliği. Psikoloji Dergisi 7:3–13

    Google Scholar 

  33. Siegel S, Castellan NJ (1988) The case of k related samples, section 7,2: The Friedman two-way analysis of variance by Ranks. In: Siegel S, Castellan NJ (eds) Nonparametric Statistics for the Behavioral Sciences. Mc Graw Hill Inc, New York, pp 174–183

  34. Conover WJ (1980) Some methods based on Ranks, section 5,2 several independent samples. In: Conover WJ (ed) Practical Non-parametric İstatistics. John Wiley and sons, pp 229–239

  35. Jacobsson L, Lindgarde F, Monthorpe R (1989) The commonest rheumatic complaints of over six weeks’ duration in a twelve month period in a defined Swedish population: prevalences and relationships. Scand J Rheumatol 18:353–360

    Article  PubMed  CAS  Google Scholar 

  36. Hartigan C, Rainville J, Sobel JB et al (2000) Long term exercise adherence after intensive rehabilitation for chronic low back pain. Medicine and science in sports and exercise 32(3):551–557

    Article  PubMed  CAS  Google Scholar 

  37. Rainville J, Jouve CA, Hartigan C et al (2002) Comparison of short and long term outcomes for aggressive spine rehabilitation delivered two versus three times per week. The Spine Journal 2:402–407

    Article  PubMed  Google Scholar 

  38. Handa N, Yamamoto H, Tani T et al (2000) The effect of trunk muscle exercises in patients over 40 years of age with chronic low back pain. J Orthop Sci 5:210–216

    Article  PubMed  CAS  Google Scholar 

  39. Goldstein MS, Morgenstern H, Hurwitz EL et al (2002) The impact of treatment confidence on pain and related disability among patients with low back pain: results from the University of California, Los Angeles, low back pain study. The Spine Journal 2:391–401

    Article  PubMed  Google Scholar 

  40. Wittink H, Michel TH, Wagner A et al (2000) Deconditioning in patients with chronic low back pain. Spine 25:2221–2228

    Article  PubMed  CAS  Google Scholar 

  41. Hoch AZ, Young J, Press J (2006) Aerobic fitness in women with chronic discogenic nonradicular low back pain. Am J Phys Med Rehabil 85(7):607–613

    Article  PubMed  Google Scholar 

  42. Smeets RJ, Wittink H, Hidding A et al (2006) Do patients with chronic low back pain have a lower level of aerobic fitness than healthy controls?: are pain, disability, fear of injury, working status, or level of leisure time activity associated with the difference in aerobic fitness level. Spine 31(1):90–97

    Article  PubMed  Google Scholar 

  43. Cunha IT, Simmonds MJ, Protas EJ et al (2002) Back pain, physical function and estimates of aerobic capacity. Am J Phys Med Rehabil 81:913–920

    Article  Google Scholar 

  44. Sculco AD, Paup DC, Fernhall B et al (2001) Effects of aerobic exercise on low back pain patients in treatment. The Spine Journal 1:95–101

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Author notes

  1. Şebnem Koldaş Doğan

    Present address: , 100.yıl mah. 399.sok. Ozpetek sitesi. 33/43, Ankara, Turkey

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Ufuk University School of Medicine, Ankara, Turkey

    Şebnem Koldaş Doğan

  2. Department of Physical Medicine and Rehabilitation, Ankara University School of Medicine, Ankara, Turkey

    Birkan Sonel Tur, Yeşim Kurtaiş & Mesut Birol Atay

Authors
  1. Şebnem Koldaş Doğan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Birkan Sonel Tur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yeşim Kurtaiş
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mesut Birol Atay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Şebnem Koldaş Doğan.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Koldaş Doğan, Ş., Sonel Tur, B., Kurtaiş, Y. et al. Comparison of three different approaches in the treatment of chronic low back pain. Clin Rheumatol 27, 873–881 (2008). https://doi.org/10.1007/s10067-007-0815-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-007-0815-7

Keywords

  • Aerobic exercise
  • Chronic low back pain
  • Disability
  • Home exercise and physiotherapy treatment