The Study: The effect of lumbar stabilization and walking exercises on chronic low back pain

 The Facts:

a. There are many exercises that have been used in an attempt to improve chronic low back pain.

 b. The authors indicate that no particular exercise has been found to be superior.

 c. “Hence, the aim of this study was to compare the efficiency between 2 exercises: the

individualized graded lumbar stabilization exercise (IGLSE) and walking exercise (WE).”

 d. 60 subjects were divided into 4 groups. [48 completed the 6 weeks of exercise]

 e. One group (SE) did stabilization exercises only.

 f. One group (WE) did walking exercise only.

 g. One group (SWE) combined stabilization exercises with walking.

 h. And one group (FE) performed flexibility exercises only.

 i. The program consisted of doing their exercise for 30 to 60 minutes for 5 sessions per week for a period of 6 weeks.

j. The subjects performed their exercises at home after being educated in how to perform the exercise at the clinic by a physical therapist.

 k. “The FE (flexibility) group received stretching exercise for the abdominal muscle, quadriceps, hamstring, tensor fascia lata, piriformis muscle, and quadratus lumborum muscles for 30 minutes.”

 l. The WE (walking) group walked fast on a flat surface with abdominal bracing for 30 minutes.

 m. “The SE [stabilization] group was educated on IGLSE, focusing on the modifiable intensity level based on the exercise capacities of each participant. The IGLSE protocol consisted of 2 parts: stretching exercises and SEs.” They stretched for 5 minutes and then did the stabilization exercises for 25 minutes.”

 n. And finally the SWE (Stabilization + Walking) group exercised for a full 60 minutes consisting of 30 minutes of walking plus 30 minutes of stabilization exercise.

 n. To measure the primary outcome they used a visual analog scale to evaluate low back pain. [After 12 weeks the subjects were interviewed by phone.]

 o. The authors concluded” “This study suggests that lumbar SE [stabilization exercises] and WE [walking exercise] should be recommended to patients with chronic LBP [low back pain] because they help not only to relieve back pain but also to prevent chronic back pain through the improvement of muscle endurance.”

 Take Home:

Both walking and stabilization exercises helped subjects with chronic low back pain more than either flexibility activities or combined walking + stabilization (SWE).

 Reviewer's Comments:

Great so we know that in this study that stabilization exercises and walking both helped. But that isn’t really the question. The question should always be what works best. Now I know that you can’t test all exercises at once and that this is a way to compare a couple of them. But let’s use some logic. If machines tend to work better if all the parts are put together properly then perhaps one goal of exercise might be to push things in the direction of making them go together properly. So if your spine was misaligned then perhaps your exercise might want to push it toward alignment. And if you had too much kyphosis perhaps you might want to consider reducing kyphosis or if you had too little cervical lordosis you might want to consider improving lordosis. You see, if I’m trying to drive to Seattle then I’d rather not spend a lot of time driving toward New York. But then that’s just me.

 Reviewer:  Roger Coleman DC

 Editor’s Comments: I was surprised to see that the WSE (Walking + Stabilization Exercise) group didn’t do as well as those that only Walked (WE) or performed Stabilization Exercise (SE). A closer reading gives us a practical consideration when prescribing exercise activities. I thought the author’s comments were worth quoting here.

 “According to the study design, the exercise time of the SWE group should be twice as long as that of the other groups. However, the patients who have chronic LBP usually show atrophic changes in lumbar paraspinalis muscles.[2,4] So, it seemed that 60 minutes of exercise was difficult to do in chronic LBP patients. In fact, the frequency of exercise was significantly increased in the WE and SE groups after the study compared with before the study; however, this trend was not observed in the SWE group. It is assumed that compliance may fall with prolonged exercise time that exceeds patient ability. In future studies, it would be important to select an exercise program of around 30 minutes.” (Emphasis ours)

 Editor: Mark R. Payne DC

 Reference: Suh JH, Kim H, Jung GP, KoJY, Ryu JS. The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine (Baltimore) 2019 Jun;98(26):e16173. doi: 10.1097/MD.0000000000016173.

 Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/31261549