Sports Medicine Research: In the Lab & In the Field: Are Individualized Exercise Programs for Chronic Low Back Pain Overrated? (Sports Med Res)
Friday, August 24, 2012

Are Individualized Exercise Programs for Chronic Low Back Pain Overrated?

Clinical Pilates versus General Exercise for Chronic Low Back Pain: Randomized Trial.

Wajswelner H, Metcalf B, Bennell K. Med Sci Sports Exerc. 2012 Jul;44(7):1197-205

In a recent post, SMR discussed the utilization of vertical traction to restore lumbar curvature as an effective way to reduce low back pain (LBP).  Traction was compared to conservative generalized exercise measures, but was a generalized plan of exercise more appropriate than a clinically prescribed exercise regimen?   Wajswelner et al. hypothesized that LBP will be significantly reduced in a patient population that undergoes a clinically prescribed and individualized Pilates exercise regimen when compared to individuals that complete a generalized exercise plan. Eighty-seven individuals (age 18-70 years) were recruited for this study all of which presented with chronic LBP, defined as >3 months.  The participants were then randomly divided into either a Pilates intervention group (n=44) or a general exercise (GE) intervention group (n=43). The GE group performed the following exercises: stationary bike, leg stretches, upper-body weights, theraband, Swiss ball, and multi-directional, non-specific floor exercises.  Each group underwent 1-hr of training with physiotherapists to familiarize them with their exercises, initially.  Over the next 6 weeks, the GE group attended group exercise sessions (no more than 4 participants/group) 2x's/week for 6 weeks, with each session lasting 1 hour.  Each participant was instructed to perform a minimal amount of home exercises daily during the 6-week timeframe and to continue doing them throughout the 12 and 24-week follow up periods. The Pilates group received an individually catered exercise routine created by a trained physiotherapist, which was based upon the participant's history, aggravating factors and physical exam.  All exercises were performed on the reformer and trapeze equipment to help guide and support the subjects throughout their exercises.  The most common exercise aspects focused on for this group included: breath control, finding and maintaining spinal comfort range, exercise movement precision, correct posture, central trunk stability, smoothness of motion as well as complete range of motion. Each member conducted 6 to 12 exercises on the equipment and 1 to 4 floor exercises or chair/wall exercises as a part of their home exercise program.  The primary outcome measure for both groups was pain/disability as measured by the Quebec scale at baseline, 6, 12, and 24 weeks.  At 6 weeks pain/disability was shown to significantly improve in both groups when compared to baseline.  However the improvement difference between both groups was not statistically significant, but the Pilates group did see a trend towards higher improvement scores.  Both groups maintained their improved Quebec scores at the 12 and 24-week follow-up points, but the difference between the 2 was not statistically significant.

The results of this study are interesting for a few reasons. First, it demonstrates that any form of exercise (individual or general) will have a positive impact on LBP. The authors stated that a few variables may have contributed to the lack of group differences. One major factor that may have affected the outcome measure was that subjects were still able to utilize analgesic medication throughout the testing.  While the authors tried to keep its utilization to a minimum, the subjects had the ultimate say as to whether they would take medication or not outside of the structured exercise time.  Another item that might have contributed to the lack of group differences was the relatively short study period.  As it stands, both groups underwent roughly 12 to 14 hours of structured, hands-on training with their respective therapist.  With the Pilates group there was a trend for a higher Quebec scores.  The authors feel that 20+ hours of total Pilates training might have elicited a higher, and possibly a significant response.  Conversely, 20+ total hours of GE might have elicited the same response.  What are your thoughts on this study?  Do you currently utilize any form of Pilates training with your athletes for LBP or do you find that general exercise is the way to go?  What type of results do you typically see in contrast to more generalized exercise? 

Written by: Mark Rice
Reviewed by Stephen Thomas

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Wajswelner H, Metcalf B, & Bennell K (2012). Clinical Pilates versus general exercise for chronic low back pain: randomized trial. Medicine and Science in Sports and Exercise, 44 (7), 1197-205 PMID: 22246216

4 comments:

Jessica Staheli said...

I've had Spondylolysis my entire life and nothing seems to help it :( my back still hurts 24/7

Alistair Taylor said...

i like your blog post. thnks for the above information. your site is very much informative.

Kyle Kosik said...

I think this is an interesting article. As mentioned above it appears that just performing any time of general exercise appears to be an effective treatment for individuals with chronic LBP. Based off of this study, as a clinician I would prescribe my patients with a general exercise program. This is because having personally tried performing Pilates, educating a patient on a general exercise program would be easier and more user friendly than Pilates. There are many steps and positions within Pilates and it takes months of practice and proper technique to be able to perform all of the Pilates correctly. Where as a general exercise program can be something very general, and easy to for the patient to perform at home while watching TV.

Personally though, when treating an individual with low back pain I like to perform a pelvic evaluation to figure out what is causing the pain. Once you find the underlying problem, you can make a rehabilitation program more tailored to what is causing the pain. Whether that is a pelvic rotation or something more muscular.

Mark A. Rice said...

Kyle, thanks for taking the time to read and comment. You make a bunch of great points regarding general exercise vs pilates utility. I believe that both can be used effectively to help with low back pain. Pilates used in conjunction with a generalized exercise program might have a place in our therapeutic tool chest. Especially if we're looking to keep a patient/client engaged and challenged and to keep the treatment sessions from getting stale. Great points. Thanks again.

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