Chronic Low Back Pain Clinical Trial
Official title:
The Effects of Short Arc Banding: A Novel Exercise Intervention in Patients With Chronic Low Back Pain
The general purpose of this pilot study is to determine the effects of a novel exercise intervention (short arc banding (SAB)) on the cross sectional area of lumbar multifidus well as functional outcomes assessments in patients with chronic low back pain.
Multifidus muscle is well known and documented to be a segmental spinal stabilizer and
postural muscle. (Bajek, Bogduk) Previous studies have shown evidence that patients with low
back pain (LBP) present with multifidus muscle atrophy. It has been documented that patients
presenting with unilateral back pain demonstrate an ipsilateral state of reduced cross
sectional area of lumbar multifidus (LM) at the segmental level of injury or pain.(Barker,
Hides) Chronic LBP sufferers demonstrate a localized and segmentally specific decrease in
cross sectional area of multifidus.(Hides) It has been theorized that multifidus muscle
surrounding a chronically painful or degenerative segment is less able to stabilize the
spine at that segment, predisposing chronic LBP patients to exacerbation due to the
inability to cope with demands of day to day life. (Bajek)
Rehabilitative Ultrasound Imaging (RUSI) has been verified as accurate and reliable in
determining cross sectional area of lumbar multifidus (Hides). The interrater and intrarater
reliability of RUSI has been shown high utilizing a standardized protocol. (Hides)
Measurement of LM contraction using RUSI has been shown a valid and useful measure to
determine activation of LM as correlated with EMG. (Kiesel) RUSI has been correlated with
MRI which is the gold standard for measuring CSA of LM. (Hides)
Type I muscle fibers are the predominant muscle fiber type in lumbar multifidus which has
led researchers to pursue spinal stabilization exercises which focus on isometric
contractions. These interventions stimulate mainly Type I muscle fibers because they do not
use speed or loading parameters theorized necessary to stimulate Type II fibers. (Rissanen,
Ng) Previous studies by Rantanen examined LM fiber type in post surgery low backs. Patients
with good recovery (minimal to no symptoms 5 years after surgery) showed increased Type II
muscle fiber type in relation to those with a poor recovery and Type I fibers increased.
(Rantanen) Limited mobility might account for decrease in diameter in Type II fibers in
patients undergoing lumbar surgeries.
Notably, Type I muscle fibers appear to increase in size in the presence of chronic LBP.
This is probably due to chronic pain induced low tension muscle spasm. (Mattila, Rantanen)
Stokes suggested that LM takes on an increasing role in spinal stability due to atrophy of
other muscles, thus the increase in size of Type I fibers versus Type II.
To date, the effects of a short arc fast tapping exercise with band resistance or short arc
banding (SAB) on the cross sectional area of multifidus has not been documented in the
literature. Short arc banding is a novel exercise treatment and to our knowledge is the
first study of this mode of exercise. Using a fast motion against band resistance we hope to
reach threshold necessary to stimulate not only type I muscle fibers which predominate the
LM, but also type II muscle fibers. From the literature, type II muscle fibers decrease in
cross sectional area in the presence of a segmental spinal lesion such as lumbar disc
herniation. Type II muscle fibers of multifidus aid the spine to respond to and stabilize a
ballistic load. Since modern man is much more sedentary, lumbar spines are not loaded
adequately to produce stimulation and maintain size of Type II muscle fibers
;
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
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