Study on the effect of dynamic neuromuscular stabilization technique for chronic low back pain_West China Medical Journal

Authors：

YANG Kuannü , LI Jianhua , WU Fangchao , ZHANG Kai , HU Jinna ,  LI Yangzheng

Department of Rehabilitation Medcine, Sir Run Run Shaw Hospital, the Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, P. R. China;

Corresponding author：

LI Yangzheng, Email: yangzheng.li@zju.edu.cn

Keywords：

Chronic non-specific low back pain; Dynamic neuromuscular stabilization technique; Breath control training

DOI：

10.7507/1002-0179.202103299

Video：

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Objective To explore the effect of dynamic neuromuscular stabilization technique for chronic non-specific low back pain. Methods From July 2019 to June 2020, 60 patients with chronic non-specific low back pain who underwent rehabilitation at the outpatient clinic of Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine were prospectively selected. All patients were divided into trial group and control group by random number table method. There were 30 cases in each group. The control group used rehabilitation education and core muscle strength training. The trial group used dynamic neuromuscular stabilization of chest and abdomen combined with breathing control training on the basis of the treatment plan of the control group. The Visual Analogue Scale (VAS) score, Oswestry Dability Index (ODI), abdominal pressure stability, xiphoid level thoracic mobility and axillary level thoracic mobility were compared between the two groups of patients. Results All the 60 patients in this study completed the trial, and there was no recurrent case during treatment, after treatment or during follow-up. There was no statistically significant difference in age, gender, height, weight, body mass index, or course of disease between the two groups (P>0.05). Taking VAS score as the dependent variable, the result of generalized estimating equations showed that the difference in VAS score between the trial group and the control group was statistically significant (χ²=4.132, P=0.042), and the VAS scores at 12 weeks of follow-up and at 8 weeks of treatment differed significantly from that before treatment (χ²=1618.814, P<0.001; χ²=1573.419, P<0.001); the between-group comparisons at different time points showed that the difference in VAS score between the two groups at 12 weeks of follow-up was statistically significant (P<0.001), and the remaining between-group differences were not statistically significant (P>0.05). Taking ODI score as the dependent variable, the result of generalized estimating equations showed that the difference in total ODI score between the two groups was statistically significant (χ²=11.063, P=0.001), and the ODI scores at 12 weeks of follow-up and at 8 weeks of treatment differed significantly from that before treatment (χ²=524.694, P<0.001; χ²=717.236, P<0.001); the between-group comparisons at different time points showed that there were statistically significant differences between the two groups at 8 weeks of treatment and at 12 weeks of follow-up (P<0.001). After treatment, the improvement of stability value of abdominal pressure [(−4.93±8.14) vs. (−1.33±4.78) mm Hg (1 mm Hg=0.133 kPa)], the improvement of xiphoid level thoracic mobility [(1.87±0.62) vs. (1.52±0.70) cm] and the improvement of axillary level thoracic mobility [(1.78±0.62) vs. (0.92±0.45) cm] in the trial group were better than those in the control group (P<0.05).Conclusion The dynamic neuromuscular stabilization technique can improve the dysfunction and relieve the symptoms of patients with chronic non-specific low back pain, and it is worthy of promotion.

Citation： YANG Kuannü, LI Jianhua, WU Fangchao, ZHANG Kai, HU Jinna, LI Yangzheng. Study on the effect of dynamic neuromuscular stabilization technique for chronic low back pain. West China Medical Journal, 2021, 36(8): 1062-1067. doi: 10.7507/1002-0179.202103299 Copy

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2.	中国康复医学会脊柱脊髓专业委员会专家组. 中国急/慢性非特异性腰背痛诊疗专家共识. 中国脊柱脊髓杂志, 2016, 26(12): 1134-1138.
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4.	Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J, 2018, 27(11): 2791-2803.
5.	Key J. “The core”: understanding it, and retraining its dysfunction. J Bodyw Mov Ther, 2013, 17(4): 541-559.
6.	Saragiotto BT, Maher CG, Yamato TP, et al. Motor control exercise for nonspecific low back pain: a cochrane review. Spine (Phila Pa 1976), 2016, 41(16): 1284-1295.
7.	Bordoni B, Zanier E. Anatomic connections of the diaphragm: influence of respiration on the body system. J Multidiscip Healthc, 2013, 6: 281-91.
8.	Unger M, Jelsma J, Stark C. Effect of a trunk-targeted intervention using vibration on posture and gait in children with spastic type cerebral palsy: a randomized control trial. Dev Neurorehabil, 2013, 16(2): 79-88.
9.	Frank C, Kobesova A, Kolar P. Dynamic neuromuscular stabilization & sports rehabilitation. Int J Sports Phys Ther, 2013, 8(1): 62-73.
10.	Kolar P, Sulc J, Kyncl M, et al. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther, 2012, 42(4): 352-362.
11.	Deyo RA, Dworkin SF, Amtmann D, et al. Report of the NIH task force on research standards for chronic low back pain. Pain Med, 2014, 15(8): 1249-1267.
12.	中华医学会. 临床技术操作规范物理医学与康复学分册. 北京: 人民军医出版社, 2004: 89.
13.	David JM. Orthopedic physical assessment. Canada: Elsevier,2013: 588.
14.	Stanton TR, Latimer J, Maher CG, et al. How do we define the condition ‘recurrent low back pain’? A systematic review. Eur Spine J, 2010, 19(4): 533-539.
15.	Stanton TR, Latimer J, Maher CG, et al. Definitions of recurrence of an episode of low back pain: a systematic review. Spine (Phila Pa 1976), 2009, 34(9): E316-E322.
16.	de Vet HC, Heymans MW, Dunn KM, et al. Episodes of low back pain: a proposal for uniform definitions to be used in research. Spine (Phila Pa 1976), 2002, 27(21): 2409-2416.
17.	Sheikhhoseini R, O’Sullivan K, Alizadeh MH, et al. Altered motor control in athletes with low back pain: a literature review. Ann Appl Sport Sci, 2016, 4(4): 43-50.
18.	Mohan V, Paungmali A, Sitilerpisan P, et al. Respiratory characteristics of individuals with non-specific low back pain: a cross-sectional study. Nurs Health Sci, 2018, 20(2): 224-230.
19.	Shah SG, Choezom T, Prabu Raja G. Comparison of respiratory parameters in participants with and without chronic low back pain. J Bodyw Mov Ther, 2019, 23(4): 894-900.
20.	Kim KH, Cho SH, Goo BO, et al. Differences in transversus abdominis muscle function between chronic low back pain patients and healthy subjects at maximum expiration: measurement with real-time ultrasonography. J Phys Ther Sci, 2013, 25(7): 861-863.
21.	Miura T, Yamanaka M, Ukishiro K, et al. Individuals with chronic low back pain do not modulate the level of transversus abdominis muscle contraction across different postures. Man Ther, 2014, 19(6): 534-540.
22.	Arab AM, Shanbehzadeh S, Rasouli O, et al. Automatic activity of deep and superficial abdominal muscles during stable and unstable sitting positions in individuals with chronic low back pain. J Bodyw Mov Ther, 2018, 22(3): 627-631.
23.	Son MS, Jung DH, You JSH, et al. Effects of dynamic neuromuscular stabilization on diaphragm movement, postural control, balance and gait performance in cerebral palsy. NeuroRehabilitation, 2017, 41(4): 739-746.
24.	Haddas R, Sawyer SF, Sizer PS Jr, et al. Effects of volitional spine stabilization and lower extremity fatigue on trunk control during landing in individuals with recurrent low back pain. J Orthop Sports Phys Ther, 2016, 46(2): 71-78.
25.	Delitto A, George SZ, Van Dillen L, et al. Low back pain. J Orthop Sports Phys Ther, 2012, 42(4): A1-A57.
26.	Richardson CA, Snijders CJ, Hides JA, et al. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine (Phila Pa 1976), 2002, 27(4): 399-405.
27.	埃文·奥萨尔. 腰肌功能解剖与评估: 康复、纠正性和功能性训练. 张志杰, 刘春龙, 朱毅, 译. 北京: 北京科学技术出版社, 2020: 23.
28.	Cavaggioni L, Ongaro L, Zannin E, et al. Effects of different core exercises on respiratory parameters and abdominal strength. J Phys Ther Sci, 2015, 27(10): 3249-3253.
29.	Lephart SM, Henry TJ. The physiological basis for open and closed kinctic chain rehabilitation for the upper extremity. J Sport Rehabil, 1996, 5: 71-87.

1. Gordon R, Bloxham S. A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain. Healthcare (Basel), 2016, 4(2): 22.
2. 中国康复医学会脊柱脊髓专业委员会专家组. 中国急/慢性非特异性腰背痛诊疗专家共识. 中国脊柱脊髓杂志, 2016, 26(12): 1134-1138.
3. Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin, 2007, 25(2): 353-371.
4. Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J, 2018, 27(11): 2791-2803.
5. Key J. “The core”: understanding it, and retraining its dysfunction. J Bodyw Mov Ther, 2013, 17(4): 541-559.
6. Saragiotto BT, Maher CG, Yamato TP, et al. Motor control exercise for nonspecific low back pain: a cochrane review. Spine (Phila Pa 1976), 2016, 41(16): 1284-1295.
7. Bordoni B, Zanier E. Anatomic connections of the diaphragm: influence of respiration on the body system. J Multidiscip Healthc, 2013, 6: 281-91.
8. Unger M, Jelsma J, Stark C. Effect of a trunk-targeted intervention using vibration on posture and gait in children with spastic type cerebral palsy: a randomized control trial. Dev Neurorehabil, 2013, 16(2): 79-88.
9. Frank C, Kobesova A, Kolar P. Dynamic neuromuscular stabilization & sports rehabilitation. Int J Sports Phys Ther, 2013, 8(1): 62-73.
10. Kolar P, Sulc J, Kyncl M, et al. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther, 2012, 42(4): 352-362.
11. Deyo RA, Dworkin SF, Amtmann D, et al. Report of the NIH task force on research standards for chronic low back pain. Pain Med, 2014, 15(8): 1249-1267.
12. 中华医学会. 临床技术操作规范物理医学与康复学分册. 北京: 人民军医出版社, 2004: 89.
13. David JM. Orthopedic physical assessment. Canada: Elsevier,2013: 588.
14. Stanton TR, Latimer J, Maher CG, et al. How do we define the condition ‘recurrent low back pain’? A systematic review. Eur Spine J, 2010, 19(4): 533-539.
15. Stanton TR, Latimer J, Maher CG, et al. Definitions of recurrence of an episode of low back pain: a systematic review. Spine (Phila Pa 1976), 2009, 34(9): E316-E322.
16. de Vet HC, Heymans MW, Dunn KM, et al. Episodes of low back pain: a proposal for uniform definitions to be used in research. Spine (Phila Pa 1976), 2002, 27(21): 2409-2416.
17. Sheikhhoseini R, O’Sullivan K, Alizadeh MH, et al. Altered motor control in athletes with low back pain: a literature review. Ann Appl Sport Sci, 2016, 4(4): 43-50.
18. Mohan V, Paungmali A, Sitilerpisan P, et al. Respiratory characteristics of individuals with non-specific low back pain: a cross-sectional study. Nurs Health Sci, 2018, 20(2): 224-230.
19. Shah SG, Choezom T, Prabu Raja G. Comparison of respiratory parameters in participants with and without chronic low back pain. J Bodyw Mov Ther, 2019, 23(4): 894-900.
20. Kim KH, Cho SH, Goo BO, et al. Differences in transversus abdominis muscle function between chronic low back pain patients and healthy subjects at maximum expiration: measurement with real-time ultrasonography. J Phys Ther Sci, 2013, 25(7): 861-863.
21. Miura T, Yamanaka M, Ukishiro K, et al. Individuals with chronic low back pain do not modulate the level of transversus abdominis muscle contraction across different postures. Man Ther, 2014, 19(6): 534-540.
22. Arab AM, Shanbehzadeh S, Rasouli O, et al. Automatic activity of deep and superficial abdominal muscles during stable and unstable sitting positions in individuals with chronic low back pain. J Bodyw Mov Ther, 2018, 22(3): 627-631.
23. Son MS, Jung DH, You JSH, et al. Effects of dynamic neuromuscular stabilization on diaphragm movement, postural control, balance and gait performance in cerebral palsy. NeuroRehabilitation, 2017, 41(4): 739-746.
24. Haddas R, Sawyer SF, Sizer PS Jr, et al. Effects of volitional spine stabilization and lower extremity fatigue on trunk control during landing in individuals with recurrent low back pain. J Orthop Sports Phys Ther, 2016, 46(2): 71-78.
25. Delitto A, George SZ, Van Dillen L, et al. Low back pain. J Orthop Sports Phys Ther, 2012, 42(4): A1-A57.
26. Richardson CA, Snijders CJ, Hides JA, et al. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine (Phila Pa 1976), 2002, 27(4): 399-405.
27. 埃文·奥萨尔. 腰肌功能解剖与评估: 康复、纠正性和功能性训练. 张志杰, 刘春龙, 朱毅, 译. 北京: 北京科学技术出版社, 2020: 23.
28. Cavaggioni L, Ongaro L, Zannin E, et al. Effects of different core exercises on respiratory parameters and abdominal strength. J Phys Ther Sci, 2015, 27(10): 3249-3253.
29. Lephart SM, Henry TJ. The physiological basis for open and closed kinctic chain rehabilitation for the upper extremity. J Sport Rehabil, 1996, 5: 71-87.

West China Medical Journal

Study on the effect of dynamic neuromuscular stabilization technique for chronic low back pain

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