PNF vs Pilates Exercises in Patients With CLBP

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-12-11

Study Completion Date

2022-12-01

Brief Summary

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Low back pain (LBP) is a common health problem that affects people all over the world and is a leading cause of disability, affecting work performance and overall health. In patients with low back pain, spinal movements are restricted, endurance decreases, flexor, and extensor muscle strength weaken, and aerobic capacity is impaired. Exercise is an essential component in the therapy of many musculoskeletal issues and chronic disorders. In the literature, studies using Pilates exercises and PNF exercises in patients with CLBP have demonstrated that both treatments have some beneficial effects in terms of reducing pain and disability, as well as improving the functional level and quality of life. Studies in the literature showed that both methods are among the treatment methods frequently used in the clinic, but it is difficult to provide sufficient information about which method is more effective. Therefore, the aim of this study is to examine the effects of PNF and Pilates exercises on pain, body image, fear-avoidance beliefs, core stability, disability, and balance functions in individuals with CLBP.

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Detailed Description

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Low back pain (LBP) is a common health problem that affects people all over the world and is a leading cause of disability, affecting work performance and overall health. Chronic LBP (CLBP) is defined as a problem that develops due to mechanical or non-mechanical causes and is characterized by pain, movement, and antalgic posture in the gluteal region and spine, limiting physical activity. In patients with low back pain, spinal movements are restricted, endurance decreases, flexor, and extensor muscle strength weaken, and aerobic capacity is impaired. It has been found that in patients with CLBP, pain creates fear of movement and avoidance belief, leading to inadequacy in physical functionality and a decrease in quality of life. Exercise is an essential component in the therapy of many musculoskeletal issues and chronic disorders. Exercise therapy addresses aims such as pain relief, relaxing, strengthening weak muscles, extending shortened muscles, minimizing mechanical stress on spinal structures, correcting posture, enhancing endurance, and quickly returning to work.

The Pilates Method is a mind-body approach to therapeutic exercises that promotes movement stability and control. Pilates focuses on body posture alignment, which includes proper head, shoulder, and pelvic girdle adjustment in a neutral position while preserving spine curvatures, as well as the axial position of the lower limbs and symmetrical weight-bearing of the feet in standing position. Back pain inhibits various motions of the lumbar spine and pelvis, and this condition weakens the stabilizer muscles, which can lead to CLBP. In the rehabilitation of patients with back pain, the stabilizer muscles are emphasized in order to decrease pain and improve muscular endurance and strength. The Pilates method utilizes principles of various accepted rehabilitation methods that have scientific support for LBP, including core strengthening. This is important since core weakness has been increasingly recognized as a biomechanical deficit in patients with LBP. The systematic review study by Wells et al (2014) indicates that Pilates exercise results in statistically significant improvements in pain and functional ability in the short term compared to usual care and physical activity in people with CLBP. Another recent systematic review by Barros et al. (2020), on the other hand, shows that the Pilates exercise program in moderate-to-high quality RCTs for the treatment of lower back pain is still insufficient.

Proprioceptive neuromuscular facilitation (PNF) is based on facilitating the responses of neuromuscular mechanisms by stimulating proprioceptors which aim to increase muscle strength, improve active movement ability, increase muscle endurance, and improve stabilization at the point where the technique is applied within the movement pattern. A systematic review and meta-analysis by Tong et al. (2014), identified that compared to controls, patients with low back pain have poorer lumbar proprioception. Furthermore, Meier et al. (2019) stated that back pain-induced disturbed or diminished proprioceptive signaling likely plays a key role in causing long-term alterations in the top-down regulation of the motor system via motor and sensory cortex remodeling. Individuals with chronic LBP showed lower acuity for detecting changes in trunk position and demonstrated significantly higher trunk repositioning errors during flexion of the back compared with pain-free individuals. Nijs et al. (2012), suggested that the presence of increased proprioceptive prediction errors might originate from reduced/disrupted proprioceptive input, probably triggered by nociceptive input. Therefore, the underlying physiological mechanisms of the PNF techniques such as autogenic inhibition, reciprocal inhibition, stress relaxation, and the gate control theory may influence the competition between the proprioceptive and nociceptive inputs, resulting in pain reduction and improved joint control. Furthermore, it has been found that PNF training can increase trunk muscular flexibility, strength, and endurance, providing support for the application of PNF training in functional improvement. Pourahmadi et al. (2020) stated in their systematic review and meta-analysis study that there was a low quality of evidence and a weak level of recommendation that PNF training had good benefits on back pain and disability in LBP patients and suggested further high-quality randomized clinical trials regarding long-term effects of PNF training.

In the literature, studies using Pilates exercises and PNF exercises in patients with CLBP have demonstrated that both treatments have some beneficial effects in terms of reducing pain and disability, as well as improving the functional level and quality of life. Studies in the literature showed that both methods are among the treatment methods frequently used in the clinic, but it is difficult to provide sufficient information about which method is more effective. Therefore, the aim of this study is to examine the effects of PNF and Pilates exercises on pain, body image, fear-avoidance beliefs, core stability, disability, and balance functions in individuals with CLBP.

Conditions

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Low Back Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized controlled study

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Pilates exercise group

Pilates exercise group will receive a total of 20 sessions of 30 minute Pilates exercises 5 days a week which will be performed under the supervision of a physiotherapist.

Group Type EXPERIMENTAL

Pilates exercise

Intervention Type OTHER

All participants will be given a basic introduction to the Pilates-based exercises and will be taught how to activate the core muscles, which entails isometric contraction of the transverses abdominis, pelvic floor, and multifidus muscles while exhaling during diaphragmatic breathing, before beginning the exercise program. The Pilates exercise program will consist of floor exercises on a mat, including the following exercises: one-leg kick, single leg stretch, shoulder bridge, the hundred, one leg circle, and swimming. All exercises progressed at three degrees of difficulty: basic, intermediate, and advanced. Depending on the patient's tolerance, each exercise will be done for 8-10 repetitions. The treatment plan included a five-minute warm-up, twenty minutes of exercise, and a five-minute cool-down.

PNF exercise group

A total of 20 sessions of PNF exercises for 30 minutes, 5 days a week, will be performed individually with a physiotherapist.

Group Type EXPERIMENTAL

PNF exercise

Intervention Type OTHER

The PNF techniques utilized in the PNF exercise group will include a combination of isotonics, rhythmic stabilization, and repeated stretch. The exercises which will be performed are; (1) Trunk rotation in sitting position (1a) Chopping to the left and right and (1b) Lifting to the left and right, (2) Rolling activity (2a) Resistance to pelvic anterior patterns 2(b) Resistance to posterior patterns, 2(c) Combination of scapula and pelvis, 2(d) Combination of scapula and pelvis (i.e. asymmetrical exercise for trunk extension: the scapula moves in posterior elevation, the pelvis in posterior depression) and (3) Bridging activity (3a) Stabilize the pelvis in its neutral position, 3(b) Bridging lower trunk rotation and, 3(c) Bridging on two legs in the supine position.

Interventions

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Pilates exercise

All participants will be given a basic introduction to the Pilates-based exercises and will be taught how to activate the core muscles, which entails isometric contraction of the transverses abdominis, pelvic floor, and multifidus muscles while exhaling during diaphragmatic breathing, before beginning the exercise program. The Pilates exercise program will consist of floor exercises on a mat, including the following exercises: one-leg kick, single leg stretch, shoulder bridge, the hundred, one leg circle, and swimming. All exercises progressed at three degrees of difficulty: basic, intermediate, and advanced. Depending on the patient's tolerance, each exercise will be done for 8-10 repetitions. The treatment plan included a five-minute warm-up, twenty minutes of exercise, and a five-minute cool-down.

Intervention Type OTHER

PNF exercise

The PNF techniques utilized in the PNF exercise group will include a combination of isotonics, rhythmic stabilization, and repeated stretch. The exercises which will be performed are; (1) Trunk rotation in sitting position (1a) Chopping to the left and right and (1b) Lifting to the left and right, (2) Rolling activity (2a) Resistance to pelvic anterior patterns 2(b) Resistance to posterior patterns, 2(c) Combination of scapula and pelvis, 2(d) Combination of scapula and pelvis (i.e. asymmetrical exercise for trunk extension: the scapula moves in posterior elevation, the pelvis in posterior depression) and (3) Bridging activity (3a) Stabilize the pelvis in its neutral position, 3(b) Bridging lower trunk rotation and, 3(c) Bridging on two legs in the supine position.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients between the ages of 30-65
* Complained of CLBP for more than 3 months without any neurological impairment
* Characterize their pain as \>3 on the Visual Analogue Scale (VAS)
* Non-obese (BMI 30 kg/m2)

Exclusion Criteria

* Different areas of back pain (for example, neck pain and upper back pain)
* Previous spinal surgery, structural deformities, spinal cord compression, pregnancy, severe cardiovascular or metabolic disease, and acute infection
* Who received any physiotherapy approach or exercise therapy in the previous three months

Minimum Eligible Age

30 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No