High and low volume core stabilization training in chronic low back pain: randomized crossover study

Authors

DOI:

https://doi.org/10.33233/rbfex.v21i2.5102

Keywords:

chronic pain; low back pain; exercise; analgesia; women

Abstract

Introduction: Core stabilization training is pointed as an effective option for pain relief chronic non-specific low back pain (CNLBP), however, the adequate training volume to induce analgesia is still unknown. Objective: To evaluate the effect of one session of high and low volume core stabilization training protocols on endogenous pain modulation in women with CNLBP. Methods: This is an evaluator-blinded randomized crossover trial. Eighteen volunteers participated of the study, whom performed two core stabilization training sessions: high and low training volume. The variables evaluated were the pressure pain thresholds (PPT) and temporal summation (TS) by digital pressure algometer, in addition to the conditioned pain modulation (CPM) using a pressure algometer and ischemic compression with sphygmomanometer as conditioned stimulus. A 2x2 repeated measures ANOVA was performed to compare training and time, Bonferroni's post hoc test for pairwise comparison from interactions (time and training). Data were expressed as mean ± standard deviation and the significance level established in 5%. Results: When comparing pre and post intragroup, low volume core stabilization training showed significant increase at the PPT in L5 (p < 0.05) and tibialis anterior (p < 0.01). High volume training not showed a significant increase in none of the PPT measures. However, none of the investigated protocols changed TS and CPM in women with CNLBP. Conclusion: Low volume core stabilization training produces local analgesia and remote hypoalgesia, demonstrated by increased PPT in L5 and tibialis anterior. However, none of the investigated protocols were effective to reduce the central sensitization assessed by CPM and TS.

Author Biographies

Poliana de Jesus Santos, UFS

Programa de Pós-Graduação em Ciências Fisiológicas, Universidade Federal de Sergipe, Aracajú, SE, Brasil

Marta Silva Santos, UFS

Programa de Pós-Graduação em Ciências Fisiológicas, Universidade Federal de Sergipe, Aracajú, SE, Brasil

Alan Bruno Silva Vasconcelos, Centro Universitários Ages

Departamento de Educação Física, Centro Universitário Ages, Paripiranga, BA, Brasil

Marzo Edir Da Silva Grigoletto, UFS

Departamento de Educação Física, Universidade Federal de Sergipe, Aracajú, SE, Brasil

References

Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet 2012;379(9814):482-91. doi: 10.1016/S0140-6736(11)60610-7

Giesbrecht RJ, Battié MC. A comparison of pressure pain detection thresholds in people with chronic low back pain and volunteers without pain. Phys Ther 2005 [Internet];85(10):1085-92. [cited 4 June 2022] Available from: https://pubmed.ncbi.nlm.nih.gov/16180957/

Curatolo M, Arendt-Nielsen L. Central hypersensitivity in chronic musculoskeletal pain. Phys Med Rehabil Clin N Am 2015;26(2):175-84. doi: 10.1016/j.pmr.2014.12.002

Arribas-Romano A, Fernández-Carnero J, Molina-Rueda F, Angulo-Diaz-Parreño S, Navarro-Santana MJ. Efficacy of physical therapy on nociceptive pain processing alterations in patients with chronic musculoskeletal pain: a systematic review and meta-analysis. Pain Med 2020;21(10):2502-17. doi: 10.1093/pm/pnz366

Hayden JA, Wilson MN, Stewarts S, Cartwright JL, Smith AO, Riley RD, et al. Exercise treatment effect modifiers in persistent low back pain: an individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials. Br J Sports Med 2020;54(21):1277-78. doi: 10.1136/bjsports-2019-101205

Nijs J, Kosek E, Van Oosterwijck J, Meeus M. Dysfunctional endogenous analgesia during exercise in patients with chronic pain: to exercise or not to exercise? Pain Physician 2012 [Internet] ;15(3 Suppl):Es205-13. [cited June 4, 2022]. Available from: https://pubmed.ncbi.nlm.nih.gov/22786458/

van Middelkoop M, Rubinstein SM, Verhagen AP, Ostelo RW, Koes BW, van Tulder MW. Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol 2010;24(2):193-204. doi: 10.1016/j.berh.2010.01.002

Koltyn KF. Analgesia following exercise: a review. Sports Med 2000;29(2):85-98. doi: 10.2165/00007256-200029020-00002

Grimby-Ekman A, Ahlstrand C, Gerdle B, Larsson B, Sandén H. Pain intensity and pressure pain thresholds after a light dynamic physical load in patients with chronic neck-shoulder pain. BMC Musculoskelet Disord 2020;21(1):266. doi: 10.1186/s12891-020-03298-y

Rice D, Nijs J, Kosek E, Wideman T, Hasenbring MI, Koltyn K, et al. Exercise-induced hypoalgesia in pain-free and chronic pain populations: state of the art and future directions. J Pain 2019;20(11):1249-66. doi: 10.1016/j.jpain.2019.03.005

Burrows NJ, Booth J, Sturnieks DL, Barry BK. Acute resistance exercise and pressure pain sensitivity in knee osteoarthritis: a randomised crossover trial. Osteoarthritis Cartilage 2014;22(3):407-14. doi: 10.1016/j.joca.2013.12.023

Kuithan P, Heneghan NR, Rushton A, Sanderson A, Falla D. Lack of exercise-induced hypoalgesia to repetitive back movement in people with chronic low back pain. Pain Pract 2019;19(7):740-50. doi: 10.1111/papr.12804

Lima LV, Abner TSS, Sluka KA. Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena. J Physiol 2017;595(13):4141-50. doi: 10.1113/JP273355

Navratilova E, Nation K, Remeniuk B, Neugebauer V, Bannister K, Dickenson AH, et al. Selective modulation of tonic aversive qualities of neuropathic pain by morphine in the central nucleus of the amygdala requires endogenous opioid signaling in the anterior cingulate cortex. Pain 2020;161(3):609-18. doi: 10.1097/j.pain.0000000000001748

Rhudy JL, Lannon EW, Kuhn BL, Palit S, Payne MF, Sturycz CA, et al. Assessing peripheral fibers, pain sensitivity, central sensitization, and descending inhibition in Native Americans: main findings from the Oklahoma Study of Native American Pain Risk. Pain 2020;161(2):388-404. doi: 10.1097/j.pain.0000000000001715

Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil 2015;29(12):1155-67. doi: 10.1177/0269215515570379

Bhadauria EA, Gurudut P. Comparative effectiveness of lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain: randomized clinical trial. J Exerc Rehabil 2017;13(4):477-85. doi: 10.12965/jer.1734972.486

Niederer D, Mueller J. Sustainability effects of motor control stabilisation exercises on pain and function in chronic nonspecific low back pain patients: A systematic review with meta-analysis and meta-regression. PLoS One 2020;15(1):e0227423. doi: 10.1371/journal.pone.0227423

Mueller J, Niederer D. Dose-response-relationship of stabilisation exercises in patients with chronic non-specific low back pain: a systematic review with meta-regression. Sci Rep 2020;10(1):16921. doi: 10.1038/s41598-020-73954-9

Paungmali A, Joseph LH, Punturee K, Sitilertpisan P, Pirunsan U, Uthaikhup S. Immediate effects of core stabilization exercise on β-endorphin and cortisol levels among patients with chronic nonspecific low back pain: a randomized crossover design. J Manipulative Physiol Ther 2018;41(3):181-8. doi: 10.1016/j.jmpt.2018.01.002

Waseem M, Karimi H, Gilani SA, Hassan D. Treatment of disability associated with chronic non-specific low back pain using core stabilization exercises in Pakistani population. J Back Musculoskelet Rehabil 2019;32(1):149-54. doi: 10.3233/BMR-171114

Paungmali A, Joseph LH, Sitilertpisan P, Pirunsan U, Uthaikhup S. Lumbopelvic core stabilization exercise and pain modulation among individuals with chronic nonspecific low back pain. Pain Pract 2017;17(8):1008-14. doi: 10.1111/papr.12552

Corrêa JB, Costa LO, de Oliveira NT, Sluka KA, Liebano RE. Effects of the carrier frequency of interferential current on pain modulation in patients with chronic nonspecific low back pain: a protocol of a randomised controlled trial. BMC Musculoskelet Disord 2013;14:195. doi: 10.1002/ejp.889

Corrêa JB, Costa LO, de Oliveira NT, Sluka KA, Liebano RE. Central sensitization and changes in conditioned pain modulation in people with chronic nonspecific low back pain: a case-control study. Exp Brain Res 2015;233(8):2391-9. doi: 10.1007/s00221-015-4309-6

Dailey DL, Rakel BA, Vance CG, Liebano RE, Amrit AS, Bush HM, et al. Transcutaneous electrical nerve stimulation reduces pain, fatigue and hyperalgesia while restoring central inhibition in primary fibromyalgia. Pain 2013;154(11):2554-62. doi: 10.1016/j.pain.2013.07.043

O'Neill S, Kjær P, Graven-Nielsen T, Manniche C, Arendt-Nielsen L. Low pressure pain thresholds are associated with, but does not predispose for, low back pain. Eur Spine J 2011;20(12):2120-5. doi: 10.1007/s00586-011-1796-4

Leite PMS, Mendonça ARC, Maciel LYS, Poderoso-Neto ML, Araujo CCA, Góis HCJ, et al. Does electroacupuncture treatment reduce pain and change quantitative sensory testing responses in patients with chronic nonspecific low back pain? a randomized controlled clinical trial. Evid Based Complement Alternat Med 2018:8586746. doi: 10.1155/2018/8586746

Karcioglu O, Topacoglu H, Dikme O. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med 2018;36(4):707-14. doi: 10.1016/j.ajem.2018.01.008

Nogueira CSN, Corrente EC, Piedade SMS. Quadrados latinos obtidos por meio de técnicas de confundimento em ensaios fatoriais. Sci Agr 2020;57:421-4. doi: 10.1590/S0103-90162000000300008

Koltyn KF, Brellenthin AG, Cook DB, Sehgal N, Hillard C. Mechanisms of exercise-induced hypoalgesia. J Pain 2014;15(12):1294-304. doi: 10.1016/j.jpain.2014.09.006

Dailey DL, Keffala VJ, Sluka KA. Do cognitive and physical fatigue tasks enhance pain, cognitive fatigue, and physical fatigue in people with fibromyalgia? Arthritis Care Res (Hoboken) 2015;67(2):288-96. doi: 10.1002/acr.22417

Imamura M, Chen J, Matsubayashi SR, Targino RA, Alfieri FM, Bueno DK, et al. Changes in pressure pain threshold in patients with chronic nonspecific low back pain. Spine (Phila Pa 1976) 2013;38(24):2098-107. doi: 10.1097/01.brs.0000435027.50317.d7

Meeus M, Roussel NA, Truijen S, Nijs J. Reduced pressure pain thresholds in response to exercise in chronic fatigue syndrome but not in chronic low back pain: an experimental study. J Rehabil Med 2010;42(9):884-90. doi: 10.2340/16501977-0595

Ray CA, Carter JR. Central modulation of exercise-induced muscle pain in humans. J Physiol 2007;585(Pt 1):287-94. doi: 10.1113/jphysiol.2007.140509

Kapandji AI. Fisiologia articular. 5 ed. Rio de Janeiro: Guanabara Koogan; 2000.

Lannersten L, Kosek E. Dysfunction of endogenous pain inhibition during exercise with painful muscles in patients with shoulder myalgia and fibromyalgia. Pain 2010;151(1):77-86. doi: 10.1016/j.pain.2010.06.021

Lewis GN, Rice DA, McNair PJ. Conditioned pain modulation in populations with chronic pain: a systematic review and meta-analysis. J Pain 2012;13(10):936-44. doi: 10.1016/j.jpain.2012.07.005

Arendt-Nielsen L, Fernández-de-Las-Peñas C, Graven-Nielsen T. Basic aspects of musculoskeletal pain: from acute to chronic pain. J Man Manip Ther 2011;19(4):186-93. doi: 10.1179/106698111X13129729551903

Roussel NA, Nijs J, Meeus M, Mylius V, Fayt C, Oostendorp R. Central sensitization and altered central pain processing in chronic low back pain: fact or myth? Clin J Pain 2013;29(7):625-38. doi: 10.1097/AJP.0b013e31826f9a71

Published

2022-08-06