Lower back pain is very common; this study reports it to affect 60-80% of people at some point in their life.
Weakening of the core muscles reduces trunk activity due to pain, structural damage and inhibition of the reflex muscle contraction mechanism, leading to disuse, muscle atrophy and more damage.
Adams (2004) reported that stabilisation muscles of the lumbar-pelvic region were first mobilised involuntarily during movement of the lower limbs in healthy people, while muscles of this region in low back pain patients with unstable lumbar vertebrae were mobilised later.
To increase stability to this area, lumbar stabilisation exercises are frequently used in physiotherapy practice, in addition to gluteus muscle work for further support around the hips and pelvis.
As a Pilates trained physiotherapist using these kinds of exercises every day, I came across this study on a Twitter post and hoped the results would support my clinical practice…
This study looked at 40 female subjects aged 30-50, randomly selected, with a visual analogue score (0= no pain, 10 = worst pain imaginable) of 5+ and low back pain disability score of 20% or more. They were randomly allocated into 2 groups: a lumbar segmental stabilisation plus gluteus muscle strengthening group, and a lumbar stabilisation group. The same lumbar stabilisation exercises were used in both groups and the exercises were performed 3x per week for 50 minutes per day, every other day. They measured a level of functional disability, muscle strength and balance before the intervention and 6 weeks after the intervention.
The results of the study were significant in both groups. The functional disability scores, muscle strength testing and balance outcome measures were dramatically improved in both groups, with the combination of lumbar stabilisation with gluteal strengthening taking the lead over lumbar stabilisation exercise alone.
The study supports lumbar stabilisation and gluteal strengthening for improving function, strength and balance for patients with chronic low back pain, which further supports my clinical practice. This is particularly relevant to me as it reflects the importance of deep core and hip muscle retraining in Pilates, rather than just global muscle exercise alone. However, I have to take note of this being a small sample and female-only study, and therefore it could be argued that it isn’t generalizable to the entire population. Nevertheless, I will continue to teach these exercises to my patients and ensure a combination of lumbar stabilisation and gluteal work to gain optimum results.
(Jeong et al, 2015)