Effects of proprioceptive exercises on pain and function in chronic neck- and low back pain rehabilitation: a systematic literature review (original) (raw)
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Journal of NeuroEngineering and Rehabilitation, 2008
Background: Chronic neck pain is a common problem and is often associated with changes in sensorimotor functions, such as reduced proprioceptive acuity of the neck, altered coordination of the cervical muscles, and increased postural sway. In line with these findings there are studies supporting the efficacy of exercises targeting different aspects of sensorimotor function, for example training aimed at improving proprioception and muscle coordination. To further develop this type of exercises we have designed a novel device and method for neck coordination training. The aim of the study was to investigate the clinical applicability of the method and to obtain indications of preliminary effects on sensorimotor functions, symptoms and self-rated characteristics in non-specific chronic neck pain Methods: The study was designed as an uncontrolled clinical trial including fourteen subjects with chronic non-specific neck pain. A new device was designed to allow for an open skills task with adjustable difficulty. With visual feedback, subjects had to control the movement of a metal ball on a flat surface with a rim strapped on the subjects' head. Eight training sessions were performed over a four week period. Skill acquisition was measured throughout the intervention period. After intervention subjects were interviewed about their experience of the exercise and pain and sensorimotor functions, including the fast and slow components of postural sway and jerkiness-, range-, position sense-, movement time-and velocity of cervical rotation, were measured. At sixmonth follow up, self-rated pain, health and functioning was collected.
BMC Musculoskeletal Disorders
Background: Impaired cervical joint position sense and balance are associated with neck pain. Specific therapeutic exercise and manual therapy are effective for improving neck pain and functional ability but their effects on joint position sense and balance impairments remain uncertain. Changes in the joint position sense and balance may need to be addressed specifically. The primary objective is to investigate the most effective interventions to improve impaired cervical joint position sense and balance in individuals with neck pain. The secondary objective is to assess the effectiveness of the interventions on pain intensity and disability, pain location, dizziness symptoms, cervical range of motion, gait speed, functional ability, treatment satisfaction and quality of life. Methods: A 2 × 2 factorial, single blind RCT with immediate, short-and long-term follow-ups. One hundred and sixty eight participants with neck pain with impaired joint position sense and balance will be recruited into the trial. Participants will be randomly allocated to one of four intervention groups: i) local neck treatment, ii) local treatment plus tailored sensorimotor exercises, iii) local treatment plus balance exercises, and iv) local treatment plus sensorimotor and balance exercises. Participants receive two treatments for 6 weeks. Primary outcomes are postural sway and cervical joint position error. Secondary outcomes include gait speed, dizziness intensity, neck pain intensity, neck disability, pain extent and location, cervical range of motion, functional ability, perceived benefit, and quality of life. Assessment will be measured at baseline, immediately after treatment and at 3, 6, 12 month-follow ups. Discussion: Neck pain is one of the major causes of disability. Effective treatment must address not only the symptoms but the dysfunctions associated with neck pain. This trial will evaluate the effectiveness of interventions for individuals with neck pain with impaired cervical joint position sense and balance. This trial will impact on clinical practice by providing evidence towards optimal and efficient management. Trial registration: ClinicalTrials.gov (NCT03149302). May 10, 2017.
International Journal of Physiotherapy, 2015
Background: Back pain is a prevalent and expensive problem in society. 60-80% of people will suffer at least one episode of low back pain sometime in their lives and 30-40% of these will experience low back pain each year. Therefore the need of the following study is to see the effect of proprioceptive neuromuscular facilitation on back muscle strength, pain and QOL in subjects with Chronic Low Back Pain. Methods: Ethical approval was taken before study. Forty patients with chronic low back pain (28 male, 12 female) were included in the study and divided into two groups each containing 20 subjects. All the participants were signed written consent after being informed in detail about the study. Group A has been given the proprioceptive neuromuscular facilitation exercises including Rhythmic Stabilization (RST) and Combination of Isotonics (COI) and Conventional back exercises. Group B was given conventional back exercises only. Outcome measures were taken at the end of one month i.e. after the treatment protocol. VAS, SF-36Questionnaire and Core stability gradation were taken in both groups. Results: There is significant improvement in VAS score in both groups but Group A was having more significant improvement than Group B. Also there is significant improvement in core stability grading and SF 36 score in Group A. Conclusion: It is concluded that proprioceptive neuromuscular facilitation exercises on back is effective in reducing pain and improving core muscle strength in subjects with Chronic Low Back Pain.
2021
Introduction. As one of the highly prevalent musculoskeletal disorders, low back pain incurs high medical care costs. Proprioceptive neuromuscular facilitation has been used in treating chronic low back pain. This study aimed to investigate the effects of multiple proprioceptive neuromuscular facilitation techniques on endurance of the trunk musculature, spinal mobility, and impairment of function in cases of chronic low back pain. Methods. Patients in this study were randomly assigned into 3 groups. Group A received rhythmic stabilization training, group B received a combination of isotonic exercises, while group C received a combination of both rhythmic stabilization training and combination of isotonic exercises. Trunk endurance was evaluated with trunk flexion and trunk extension endurance tests, spinal mobility was assessed with a modified Schober test, and functional impairment was measured with oswestry disability index. Results. ANoVA showed significant differences (p < 0.05) among the groups after treatment in the measured outcomes. Tukey's honest significant difference post-hoc test revealed a highly statistically significant improvement in the measured outcomes of group C in comparison with the other groups in the post-intervention conditions. Conclusions. The application of the rhythmic stabilization training technique of proprioceptive neuromuscular facilitation followed by a combination of isotonic exercises was more effective than implementing either technique alone in the treatment of patients with chronic low back pain.
Jurnal Keterapian Fisik, 2021
Background: Non-specific low back pain is a type of pain that is located in spine area and does not radiate to the legs. Non-specific low back pain can limit daily activities and cause inability to do work. The aim of this study is to compare the effectiveness of proprioceptive neuromuscular facilitation (PNF) versus sensory motor training (SMT) in the treatment of ultrasound therapy (UST) and kinesio tape (KT) insertion in non-specific low back pain. Methods: This research is an experimental with a randomized pre-test and post-test control group design, in which the study participants were divided into two groups randomly. The control group (n = 10) is given UST+PNF+KT combination, while the treatment group (n = 10) is given UST+SMT+KT combination. Therapeutic evaluation measures include: pain scale with a numeric rating scale, range of motion with a goniometer, and lower back disability with the Indonesian Version of Oswestry Disability Index. The intervention is given 3 times per...
Objective assessments and a novel method for neck coordination exercise
2009
Chronic neck pain is a widespread problem that causes individual suffering as well as large costs for the society. The knowledge about the pathophysiology is poor and therefore specific diagnosis and causal treatment are rare. Important knowledge for characterization of the disorders has been gained from research on sensorimotor functions in people with neck pain. Moreover, rehabilitation regimes including sensorimotor exercises indicate promising results. The main objectives of this thesis were to extend the knowledge on sensorimotor dysfunctions in chronic neck pain, and to develop a new exercise method for improving sensorimotor functions of the neck. The studies focused on aspects of postural control and movements of the arm and neck. These are vital functions for many activities of daily living. People with chronic (>3 months) neck pain were compared to healthy controls (CON). Neck pain related to trauma was referred to as whiplash associated disorders (WAD), while neck pain without association to trauma was referred to as non-specific (NS). Arm-functioning was assessed in a pointing task. WAD and NS had reduced pointing precision compared to CON. The reduced precision was associated with self-rated difficulties performing neck movements, physical functioning, and in WAD, also pain and balance disturbances. Postural control was assessed in quite standing on a force platform without vision. The center of pressure signal was decomposed into it's slow and fast components. WAD and NS were compared to CON. The results revealed an effect of age on the magnitude of the fast sway component, but no effect of group. The magnitude of the slow component was elevated in both WAD and NS. This increase was associated with self-rated balance disturbance, arm-functioning, difficulties to run and sensory alterations in WAD, while in NS, the increase in the slow sway component was associated with concurrent low back pain. Neck movements were assessed in a cervical axial rotation test with maximal speed. In total 8 variables representing basic kinematics, including variables reflecting movement smoothness and conjunct motions were calculated. NS were compared to CON. Linear discriminant modelling indicated Peak Speed and conjunct motions as significant classification variables that together had a sensitivity of 76.3% and specificity of 77.6%. Retest reliability was good for Peak Speed but poor for the measure of conjunct motions. Peak Speed was slower in NS compared to CON, and even slower in a subgroup of NS with concurrent low back pain. Reduced Peak Speed was associated with self-rated difficulties performing neck movements, car driving, running, sleeping disturbances and pain. The clinical applicability of a novel method for neck coordination exercise was assessed in a pilot study on persons with NS. The results supported the applicability and indicated positive effects of the exercise: reduced postural sway in quite standing and increased smoothness in cervical rotations. Indications on improvement in self-rated disability and fear of movement were seen at six months follow up. In conclusion, sensorimotor functions can be altered in chronic neck pain, particularly in neck disorders with concurrent low back pain and WAD. The discriminative ability and clinical validity displayed in pointing precision, postural sway and cervical axial rotation speed imply that such tests can be valuable tools in the assessment of chronic neck pain patients, and for selecting and evaluating treatment interventions. Indications of improvements seen in the pilot-study support a future RCT.