Document Type : RESEARCH PAPER
Department of physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, IRAN
Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
Department of Physiotherapy, school of Rehabilitation Sciences, Iran University of Medical Sciences.
Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
Recurrent low back pain (RLBP) affects different structures in the lumbar spine. Exercise therapy is highly recommended as one of the first lines of the treatment. One of the important variables that has been introduced to enhance it, is external focus. The aim of this study was to investigate the effects of external focus training on pain, thickness of transverse abdominis (TrA), internal oblique (IO), external oblique (EO) and lumbar multifidus (LM) muscles, kinesiophobia, fear-avoidance beliefs and disability of people with RLBP.
The randomized-controlled trial included a total of 38 RLBP patient. Patients were randomly divided into two groups as the treatment group (n=19) that received external focus training in addition to motor control training and control group (n=19) that received motor control training alone. The primary outcome was pain intensity and secondary outcomes were thickness of TrA, IO, EO and LM muscles, kinesiophobia, fear-avoidance beliefs and disability that were measured at the baseline and after 16 sessions of intervention. The interventions were performed three sessions weekly.
Improvement of pain intensity was obtained in the intervention group, significantly more than control group (P value< 0.001, Cohen’s d = -1.47). Thickness of TrA muscle in contraction condition of intervention group was significantly more on the left side (P value< 0.001, Cohen’s d = 1.05) and the right side (P value = 0.03, Cohen’s d = 0.44). Other outcomes didn't show significant difference. But the Cohen’s d effect size for the left IO (Cohen’s d = 0.57) and also TKS (Cohen’s d = -0.53) was moderate.
In RLBP patients, external focus training with motor control training could be effective to pain improvement. This intervention could increase the thickness of TrA muscle of RLBP, but has no significant effect on thickness of IO, EO and LM muscles. Results also indicated this intervention hasn’t significant effect on kinesiophobia, fear-avoidance beliefs and disability.
Level of evidence: Іb