Evidence Based Care

Evidence Based Care

The Effect of Combined Therapeutic Protocol (Therapeutic Exercises and Massage) on the Pain and Physical Performance in Men with Chronic Low Back Pain due to Lumbar Disc Herniation

Document Type : Original Quantitative and Qualitative Research Paper

Authors
Reza Khanzadeh 1
Ali akbar Hashemi 2
Farzad Omidi kashani 3
Majid Zandi 1
Mahmood Khodabakhshi 1
1 MSc in Physical Education and Sport Sciences, Ferdowsi University, Mashhad, Iran
2 Assistant Professor in Physical Education and Sport Sciences, Ferdowsi University, Mashhad, Iran
3 Assistant Professor, Department of Orthopedic, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
10.22038/ebcj.2012.397
Abstract
Background: Chronic low back pain due to disc herniation is one of the common diseases in the community. In addition to the pain caused by this problem, which is a major complication, decreased and defective physical performance in daily living are other major concerns.
Aim: To investigate the effect of combined therapeutic protocol (therapeutic exercises and massage) on the pain and physical performance in the patients with chronic low back pain due to the lumbar disc herniation.
Method: We conducted a quasi experimental study in two experimental and control groups, each composed of 15 male patients with chronic low back pain. Experimental group were undergone the combined protocol for eight weeks. Control group received no therapeutic protocol during the study period. Subjects’ physical performance was assessed through measuring the duration of five tests which have been modeled based on patients’ daily activities. Visual Analog Scale (VAS) was used to measure pain score. Wilcoxon and t student tests were used for data analysis.
Results: The mean score of age, weight, height and Body Mass Index of the subjects were 41.61±4.99 years, 78.55±11.3 kg, 175.81±5.98 cm and 25.36±2.97 kg/m2, respectively. The experimental group showed a significant difference in terms of physical performance (31/41 ± 3/14, p=0/002) and pain score (2/85 ± 1/83, p=0/003).
Conclusion: Based on the results, combined therapeutic protocol can be used to improve physical performance and to reduce pain in patients suffering from chronic low back pain due to disc herniation.
Keywords
Low back pain
Disc herniation
therapeutic exercise
Massage
physical performance
  1. Andersson GB. Epidemiological Features of Chronic Low Back Pain. Lancent 1999; 345(9178):581-5. Review
  2. Tsauo JY, Chen WH, Liang HW, Jang Y. The Effectiveness of a Functional Training Programme for Patients With Chronic Low Back Pain - a Pilot Study. Disabil Rehabil 2009; 31(13): 1100-6.  
  3. Plastanga N, Field D, Soames R. Anatomy & Human Movement: Stracture and Function. 3th ed. Oxford. Butterworth- Heinemann, 1998.p. 189-201.
  4. Bakhtiary AH, Safavi-FarokhiZ , Rezasoltani A. Lumbar Stabilizing Exercises Improve Activities of Daily Living in Patients with Lumbar Disc Herniation. J Back Musculoskelet Rehabil 2005; 55-60.
  5. Kemal G, Cigdem T, Ozlen P, and Goktay Y. A Comparison of Inverted Spinal Traction and Conventional Traction in the Treatment of Lumbar Disc Herniations. Physiotherap Theory Practice 2000; 16, 151-60.
  6. Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA. Lack of Effectiveness of Bed Rest for Sciatica. N Engl J Med. 1999 Feb 11; 340(6):418-23.
  7. Rejeski WJ, Mihalko SL. Physical Activity and Quality of Life in Older Adults. J Gerontol A Biol Sci Med Sci. 2001 Oct; 56 Spec No 2:23-35.
  8. Campbell WW, Vasconcelos O, Laine FJ. Focal Atrophy of the Multifidus Muscle in Lumbosacral Radiculopathy. Muscle Nerve. 1998 Oct; 21(10):1350-3.
  9. Hodges PW, Richardson CA. Inefficient Muscular Stabilization of the Lumbar Spine Associated with Low Back Pain. A Motor Control Evaluation of Transverses Abdominis. Spine (Phila Pa 1976). 1996 Nov 15; 21(22):2640-50.
  10. Mattila M, Hurme M, Alaranta H, Paljärvi L, Kalimo H, Falck B, et al. The Multifidus Muscle in Patients with Lumbar Disc Herniation. A Histochemical and Morphometric Analysis of Intraoperative Biopsies. Spine (Phila Pa 1976). 1986 Sep; 11(7):732-8.
  11. Cresswell AG, Grundström H, Thorstensson A. Observsation on Intra-Abdominal Pressure and Patterns of Abdominal  Intra-Muscular Activity in Men. Acta Physiol Scand. 1992 Apr; 144(4):409-18.
  12. Plastanga N, Field D, Soames R. Anatomy & Human Movement: Structure and Function. 3rd ed. Oxford. Butterworth-Heinemann, 1998:233-8.
  13. Wilke HJ, Wolf S, Claes LE, Arand M, Wiesend A. Stability Increase of the Lumbar Spine with Different Muscle Groups. A Biomechanical in Vitro Study. Spine (Phila Pa 1976). 1995 Jan 15;20(2):192-8.
  14. Postacchini F. Lumbar Disc Herniation: A new Equilibrium is Needed Between Nonoperative and Operative Treatment. Spine (Phila Pa 1976). 2001 Mar 15;26(6):601-3.
  15. Kong WZ, Goel VK, Gilbertson LG, Weinstein JN. Effects of Muscle Dysfunction on Lumbar Spine Mechanics. A Finite Element Study Based on a Two Motion Segments Model. Spine (Phila Pa 1976). 1996 Oct 1; 21(19):2197-206; discussion 2206-7.
  16. Niemistö L, Lahtinen-Suopanki T, Rissanen P, Lindgren KA, Sarna S, Hurri H. A Randomized Trial of Combined Manipulation, Stabilizing Exercises, and Physician Consultation Compared to Physician Consultation Alone for Chronic Low Back Pain. Spine (Phila Pa 1976). 2003 Oct 1; 28(19):2185-91.
  17. O'Sullivan PB, Phyty GD, Twomey LT, Allison GT.Evaluation of Specific Stabilizing Exercise in The Treatment of Chronic Low Back Pain with Radiologic Diagnosis of Spondyloysis or Spondylolisthesis. Spine (Phila Pa 1976). 1997 Dec 15;22(24):2959-67.
  18. Panjabi MM. The Stabilizing System of The Spine. Part I. Function, dysfunction, Adaptation, and Enhancement. J Spinal Disord. 1992 Dec;5(4):383-9.
  19. Pappas CT, Harrington T, Sonntag VK. Outcome Analysis in The 654 Surgically Treated Lumbar Disc Herniation. Neurosurgery. 1992 Jun;30(6):862-6.
  20. Cholewicki J, McGill SM. Mechanical Stability of The Lumbar Spine in Vivo: Implication for Injury and Chronic Low Back Pain. Clin Biomech (Bristol, Avon). 1996 Jan;11(1):1-15.
  21. Hides JA, Richardson CA, Jull GA. Multifidus Muscle Recovery is not Automatic After Resolution of Acute, First-Episode Low Back Pain. Spine (Phila Pa 1976). 1996 Dec 1;21(23):2763-9.
  22. Rissanen A, Kalimo H, Alaranta H. Effect of Intensive Training on The Isokinetic Strength and Structure of Lumbar Muscle in Patients with Chronic Low Back Pain. Spine (Phila Pa 1976). 1995 Feb 1;20(3):333-40.
  23. Tanaka TH, Leisman G, Mori H, Nishijo K. The Effect of Massage on  Localized Lumbar Muscle Fatigue. BMC Complement Altern Med. 2002 Oct 14;2-9.
  24. Goats GC. Massage – The Scientific Basis of an Ancient Art: Part 2. Physiological and Therapeutic Effects. Br J Sports Med. 1994 Sep;28(3):153-6.
  25. Frode O, Aure PT, Nilsen J. Manual Therapyand Exercise Therapy in Patients With Chronic Low Back Pain: A Randomized, Controlled Trial With 1-Year Follow-up. 2003;Spine 28(6):525-31.
  26. Whiteny w. Lowe.Orthopedic Massage ,Theory and Technique. Second Edition. Mosby Elsevier.2009; p: 156-63.
Evidence Based Care
Volume 2, Issue 2 - Serial Number 2
شماره پیاپی سوم
Summer 2012
Pages 29-36