APPENDIX S3.
Studies are presented in time-ordered manner from most recent to oldest by year of publication
| # | Article, type of study | Participant characteristics | Treatment | Treatment details | Outcome measures | Conclusion |
|---|---|---|---|---|---|---|
| 1 | Malla et al. (2018), randomized clinical trial | 20 CNLBP participants Experimental group: n: 10 Mean age: 33.7 ± 6.66y Comparison group: n: 10 Mean age: 31.5 ± 4.83y |
Experimental group:
RS (alternating [trunk flexion-extension] isometric contractions against resistance) in a seated position Comparison group: Motor control exercises (including sit-up and back extensor exercises on a swiss ball) |
Treatment interventions were applied 5 times a week for 5 weeks, with each session lasting about 15 min; Experimental group: 3 sets of 15 repetitions at maximal resistance for 10 seconds, with rest intervals of 30 s for each trunk pattern, and 60 s after completing 15 repetitions for each set Reassessments were performed at the end of treatment sessions |
Pain intensity (VAS), functional disability (RMDQ), and lumbar flexion and extension ROM (baseline digital inclinometer) |
After intervention, the results indicated a significant improvement in pain, functional disability, and ROM in patients with NLBP employing RS technique as well as motor control exercise on the swiss ball. However, both interventions showed to be similarly effective in decreasing pain, disability and increasing ROM in patients with NLBP |
| 2 | Areeudomwong et al. (2017), randomized clinical trial | 42 CNLBP participants Experimental group: Sex: 6♂ 15♀ Mean age: 35.4 ± 10.3y Mean height: 162.5 ± 10.5cm Mean body mass: 55.6 ± 7.3kg Comparison group: Sex: 5♂ 16♀ Mean age: 36.2 ± 9.9y Mean height: 163.7 ± 9.4cm Mean body mass: 55.8 ± 8.5kg |
Experimental group:
Alternating isometric contractions of trunk flexor and extensor muscles against maximal resistance in a seated position + alternating concentric and eccentric contractions of trunk flexors (CI) in a seated position + trunk PNF pattern using bilateral diagonal upper limbs movements against maximal resistance in a seated position Comparison group: Educational booklet (including information about anatomy and LBP causes, an active self-management approach to LBP encouraging the patient to identify postures/movements that are painful, activity for enhancing recovery, and rehabilitative exercises) |
Treatment interventions were applied 5 times a week for 4 weeks, with each session lasting about 30 min; Experimental group: 3 sets of 15 repetitions for each PNF intervention, with rest intervals of 30 s between the sets, and 60 s after completing 15 repetitions for each trunk PNF pattern; Reassessments were performed at the end of 4th and 12th weeks |
Pain intensity (NPRS), functional disability (RMDQ), health-related quality of life (SF-36 V.2), patient satisfaction (Global Perceived Effect Scale), and lumbar erector spinae muscle activity (surface EMG) | After 4 weeks, participants in the experimental group showed a significant reduction in pain intensity and functional disability, and improved patient satisfaction and health-related quality of life compared to the comparison group. These effects were still significant at the 12-week follow-up assessment. Lumbar erector spinae muscle activity in the experimental group was significantly increased throughout the measurement periods compared to the comparison group |
| 3 | Kim and Lee (2017), randomized clinical trial | 30 CLBP participants Experimental group: Sex: 8♂ 7♀ Mean age: 39.8 ± 5.47y Mean height: 168.73 ± 7.27cm Mean body mass: 67.6 ± 9.51kg Comparison group: Sex: 9♂ 6♀ Mean age: 39.4 ± 5.69y Mean height: 168.73 ± 8.01cm Mean body mass: 67.07 ± 9.65kg |
Experimental group:
Warm-up (stretching, ROM exercises, RI, HR, or CR) + PNF patterns (bilateral asymmetrical lower extremity, flexion-adduction-external rotation lower extremity [D1 flexion], extension-adduction-internal rotation upper extremity [D2 extension], chopping, neck flexion, trunk flexion) + PNF techniques (RS, SR, RI, and CI) + cool-down (stretching, ROM exercises, RI, HR, or CR) Comparison group: Electrotherapy (hot pack [80°C] + interfacial current therapy [2,000–2,500 Hz] + ultrasound [0.8–1 MHz]) |
Treatment interventions were applied 5 times a week for 6 weeks; Experimental group: Warm-up for 10 min, main exercises for 30 min (3 sets of 8-15 repetitions), and cool-down for 10 min (a total of 50 min); Comparison group: Hot pack for 20 min, interfacial current therapy for 20 min, and ultrasound for 10 min (50 min total treatment time); Reassessments were performed at the end of 6th week |
Pain intensity (VAS), functional disability (ODI), and FEV1 (spirometer) | After a 6-week treatment, the improvements in FEV1, pain intensity, and functional disability were significantly greater in the experimental group than in the comparison group |
| 4 | Hosseinifar et al. (2016), randomized controlled trial | 30 CNLBP participants Experimental group: n: 15 Mean age: 40.53 ± 10.83y Mean height: 166.33 ± 4.7cm Mean body mass: 68.33 ± 0.6kg Comparison group: n: 15 Mean age: 40.33 ± 11.37y Mean height: 162.33 ± 4.11cm Mean body mass: 66.53 ± 7.02kg |
Experimental group:
Head, neck and upper (DFR, DFL, DEL, DER) trunk and lower trunk (DFR, DFL, DEL, DER) patterns + electrotherapy (burst-mode TENS [pulse width, 200 μs; frequency, 100 Hz; burst frequency, 2 Hz] + hot pack) Comparison group: Electrotherapy (burst-mode TENS [pulse width, 200 μs; frequency, 100 Hz; burst frequency, 2 Hz] + hot pack) |
Treatment interventions were applied 5 times a week for 4 weeks; Experimental group: 3 sets of 15 repetitions of each exercise, resting time between repetitions and sets was 30 s and 60 s, respectively; Comparison group: TENS for 20 min, and hot pack for 20 min; Reassessments were performed at the end of 4th week |
Pain intensity (McGill Pain questionnaire), functional disability (ODI), lumbar lordosis (flexible ruler), and lumbar flexion and extension ROM (modified-modified Schober test) | After a 4-week treatment, pain intensity, functional disability, and lumbar spine ROM were improved significantly in the experimental group. However, the degree of lumbar lordosis was not changed after treatment. Furthermore, there was a significant difference between the 2 groups regarding pain intensity, functional disability, and mobility of lumbar spine |
| 5 | Jadeja et al. (2015), randomized controlled trial |
40 (28♂ 12♀) postural CLBP participants, aged between 20 to 40 years |
Experimental group:
IFT (small sweep; frequency, 90-100HZ) + RS (alternating [trunk flexion-extension] isometric contractions against resistance) + CI (alternating concentric and eccentric contractions of agonists without relaxation, resisted active concentric contraction [trunk flexion], resisted eccentric contraction [trunk flexion], and resisted maintained contraction [trunk flexion-extension]) + conventional back exercises (abdominal contraction, single knee to chest stretch, abdominal curl ups, prone on elbows, prone on hands, bridging, straight leg raises, postural advice) Comparison group: IFT (small sweep; frequency, 90-100HZ) + conventional back exercises (abdominal contraction, single knee to chest stretch, abdominal curl ups, prone on elbows, prone on hands, bridging, straight leg raises, postural advice) |
Treatment interventions were applied 5 times a week for 4 weeks, IFT: 15 min; Experimental group: RS: 3 sets of 15 repetitions at maximal resistance, rest intervals of 30 s and 60 s were provided after the completion of 15 repetitions for each pattern and between sets, respectively; CI: 5 s contraction, 3 sets of 15 repetitions against maximal resistance were performed. Rest intervals were the same as those described above Comparison group: participants were asked to perform 10 repetitions of each exercise with 5 s hold Reassessments were performed at the end of 4th week |
Pain intensity (VAS), core muscles strength (Core Stability Gradation), health-related quality of life (SF-36) | There was a significant improvement in VAS score in both groups, but the experimental group showed more significant improvement than the comparison group. In addition, there was a significant improvement in core muscles strength and SF-36 score in the experimental group |
| 6 | Kumar and Moitra (2015), randomized clinical trial | 30 NLBP participants, aged between 20-40 years |
Experimental group:
Contract relax technique of the hamstrings Comparison group 1: Muscle energy technique (PIR) of the hamstrings Comparison group 2: Static stretching of the hamstrings |
Treatment interventions were applied 5 consecutive days a week for 4 weeks; Reassessments were performed at the end of 4th week |
Pain intensity (NPRS), AKE (universal goniometer) | There was significant improvement in pain intensity and active knee extension ROM in the muscle energy technique and contract relax technique groups compared to the static stretching group |
| 7 | Mavromoustakos et al. (2015), randomized clinical trial |
80 CLBP participants Experimental group: Sex: 23♂ 17♀ Mean age: 40.35 ± 9.62y Mean height: 171 ± 5cm Mean body mass: 74.38 ± 7.91kg Comparison group: Sex: 22♂ 18♀ Mean age: 40.88 ± 1.28y Mean height: 1.70 ± 0.08cm Mean body mass: 74.65 ± 8.36kg |
Experimental group:
PNF techniques in different starting positions: supine (RI, replication, exercise [keeping pelvic neutral position during hips movements in a hook lying position, keeping upper trunk neutral position during hips and pelvis movements, bridging, bridging with pelvis movements, gait stimulation, rolling from supine to side lying]) + sitting (SR, exercise [upper trunk flexion/extension with minimal lower trunk rotation, body transfers on the chair in different directions were performed with and without arms use, sit-to-stand movement]) + standing (RI, replication) All exercises were performed using CI, HR, and CR Comparison group: General exercise using a published protocol (Koumantakis et al., 2005) |
Treatment interventions were applied for 6 weeks and each session lasted about 60 min; Experimental group: RI and replication were initiated from week 1, while SR and CI gradually introduced from week 2 and fully implemented from week 3 onwards, the intensity of exercise started from 5 repetitions X 5 s contraction (weeks 1-2), it progressed to 7 repetitions X 7 s; contractions (weeks 3-4) and increased to 10 repetitions X 10 s contractions (weeks 5-6); Comparison group: The intensity was the same as the experimental group; Reassessments were performed at the end of 6th and 8th weeks |
Pain intensity (McGill pain questionnaire), functional disability (RMDQ), psychological status (Emotions Scale) | After a 6-week treatment, pain intensity decreased more in the experimental group than the comparison group. Functional disability decreased in the experimental group, while the comparison group showed an improvement only immediately after the program. Finally, positive emotions increased significantly only in the experimental group, while there was a reduction in negative emotions for both groups |
| 8 | Mistry et al. (2015), randomized clinical trial | 30 CLBP participants, aged between 20 to 60 years Experimental group: n: 15 Comparison group: n: 15 |
Experimental group:
Modified HR for the hamstrings in the supine position + conventional physical therapy (abdominal and extensor isometric exercise + hot pack) Comparison group: ART + conventional physical therapy (abdominal and extensor isometric exercise + hot pack) |
Treatment interventions were applied for 10 sessions over a period of 6 months; Experimental group: 7 counts hold time, 5 s relax time, 3 repetitions; Comparison group: 5 repetitions; Reassessments were performed at the end of treatment sessions |
Pain intensity (VAS), functional disability (MODI), AKE (unknown) | Both techniques improved hamstrings flexibility and reduce pain and disability in CLBP patients. However, the experimental group showed significant improvement compared to the comparison group |
| 9 | Young et al. (2015), randomized clinical trial | 48 elderly participants with CLBP Experimental group: n: 24 Comparison group: n: 24 |
Experimental group:
PNF patterns Comparison group: Swiss ball training |
Treatment interventions were applied for 50 min per day, 3 times a week for 6 weeks; Reassessments were performed at the end of treatment sessions |
Pain intensity (VAS), dynamic balance (FRT [cm]) and TUG [cm]), static balance (mean velocity of COP in X and Y directions during standing) | After intervention, both groups showed a significant improvement in pain intensity, dynamic balance, and static balance. However, there was no significant difference in the dynamic balance, and pain intensity results between the 2 groups |
| 10 | Lee et al. (2014), randomized clinical trial | 40 CLBP participants Experimental group: n: 20 Mean age: 34.75 ± 0.85y Mean height: 174.07 ± 1.05cm Mean body mass: 71.25 ± 4.59kg Comparison group: n: 20 Mean age: 34.2 ± 0.69y Mean height: 172.85 ± 1.24cm Mean body mass: 70.75 ± 3.81kg |
Experimental group:
PNF combination patterns (sprinter/skater posture in bridge, side-lying, sitting, standing positions) Comparison group: Ball exercises (pelvic tilts while sitting on the ball; lying back on the ball, hip lifts while lying back on the ball, and marching was performed while lying with the chest on the ball and crunching, followed by arching while holding the ball between the calves, moving the body right and left while lifting the legs on the ball, bridging, and right and left stretches while leaning on the ball), |
Treatment interventions were applied 4 times a week for 6 weeks Experimental group: 15 min; Comparison group: 15 s rest interval between sets, Pelvic tilt: 2 sets, 20 repetitions, Hip lift: 2 sets, 10 s hold time, Marching: 1 set, 10 s, Stretch: 10 s; Reassessments were performed at the end of 2nd, 4th and 6th weeks |
Pain intensity (VAS), muscle activity (surface EMG) | After 6 weeks intervention, the experimental group showed significant improvements in pain intensity and muscle activity compared to the comparison group |
| 11 | Kotteeswaran et al. (2014), randomized clinical trial | 103 LBP participants Experimental group: Sex: 32♂ 19♀ Mean age: 26.83 ± 6.24y Comparison group: Sex: 32♂ 19♀ Mean age: 27.42 ± 5.23y |
Experimental group:
IFT (beat frequency, 80-120HZ) + contract relax technique of the hamstrings in a supine position Comparison group: IFT (beat frequency, 80-120HZ) + dynamic soft tissue mobilization (deep longitudinal strokes were applied to the entire hamstrings in the prone and supine positions + active knee extension with 5 deep distal to proximal longitudinal strokes over the hamstrings) |
Treatment interventions were applied 3 times a week for 4 weeks; IFT: 10 min; Both groups were treated for 5 repetitions with a rest of 20 s between repetitions in 1 session Reassessments were performed at the end of treatment sessions |
Pain intensity (NPRS), AKE (universal goniometer) | The results indicated that both groups showed significant improvement after 4 weeks. However, the dynamic soft tissue mobilization was more effective than the contract relax technique in improving AKE and decreasing pain in LBP patients |
| 12 | Park and Seo (2014), randomized clinical trial | 30 obese participants with LBP Experimental group: Sex: 15♂ Mean age: 34.5 ± 9.1y Mean height: 174.1 ± 6.1cm Mean body mass: 76.1 ± 3.2kg BMI: 29.1 ± 2.8kg/m2 Comparison group: Sex: 15♂ Mean age: 33.5 ± 8.2y Mean height: 176.8 ± 3.3cm Mean body mass: 77.8 ± 6.2kg BMI: 28.4 ± 1.3kg/m2 |
Experimental group:
Scapular PNF patterns in a supine position (anterior depression – posterior elevation) and pelvic patterns (anterior elevation – posterior depression) + conventional physical therapy (hot pack, IFT, ultrasound, and rest) Comparison group: Strengthening exercise (warm-up [stretching], flexion exercise, extension exercise, and cool-down) + conventional physical therapy (hot pack, IFT, ultrasound, and rest) |
Treatment interventions were applied 3 times a week for 4 weeks, with each session lasting about 30 min, Rest: 5 min; Comparison group: Warm-up: 5 min, Flexion and extension exercises: 10 min, Cool-down: 5 min; Reassessments were performed at the end of treatment sessions |
Functional disability (ODI), lumbar flexion and extension ROM (cm; measurements were taken from the ground to the participants’ chins) | The experimental group showed significant differences in the disability index and lumbar flexibility from the comparison group. Lumbar flexion and extension ROM and functional disability improved significantly in the experimental group. However, there were no significant changes in the comparison group after intervention |
| 13 | Franklin et al. (2013), randomized clinical trial | 53 patients with LBP Experimental group: Sex: 15♂ 12♀ Mean age: 33.11 ± 8.10y Comparison group: Sex: 14♂ 12♀ Mean age: 33.73 ± 8.01y |
Experimental group:
SWD (continuous mode) + CI of trunk flexors with maximal resistance Comparison group: SWD (continuous mode) + core stability exercise (curl up, side bridges, bird dog) |
Treatment interventions were applied 4 weeks Experimental group: 45-60 min per day, 20-30 min SWD, resisted active concentric contraction for 5 s (trunk flexors), resisted eccentric contraction for 5 s (trunk flexors), 3 sets and 15 repetitions; Comparison group: In the first 2 weeks, the exercises were performed in clinic and in the second 2 weeks the exercises were performed at home (home exercise), 20 repetitions for each exercise, 20-30 min SWD; Reassessments were performed at the end of 4th weeks |
Pain intensity (VAS), functional disability (MODI), lumbar flexion and extension ROM (modified-modified Schober test) | After 4 weeks intervention, the PNF group shows highly significant improvement in all the outcomes measures as compared to core strengthening |
| 14 | George et al. (2013), randomized controlled trial | 40 men with mechanical LBP aged between 18-45 years |
Experimental group:
CI of trunk flexion and extension with maximal resistance in a high sitting position + conventional strengthening exercise (curl ups, trunk extension, leg lifts, exercise for transversus abdominis in the 4-point kneeling or prone lying, exercise for lumbar multifidus in the prone lying or sitting, co-contraction of the transversus abdominis and lumbar multifidus in the upright position) Comparison group: Conventional strengthening exercise (curl ups, trunk extension, leg lifts, exercise for transversus abdominis in the 4-point kneeling or prone lying, exercise for lumbar multifidus in the prone lying or sitting, co-contraction of the transversus abdominis and lumbar multifidus in the upright position) |
Treatment interventions were applied 3 weeks Experimental group: 5 s isometric contraction (trunk flexion and extension), 3 sets of 15 repetitions, 30 s rest interval between repetitions, 60 s rest interval between sets; Total treatment duration of trunk PNF training: 30-35, min; Comparison group: Each exercise consisted of 15 repetitions with 6 s hold time in the beginning and gradually progressed to 10 s; Total treatment duration of conventional exercises: 25- 30 min Reassessments were performed at the end of treatment sessions |
Pain intensity (VAS), functional disability (MODI), transversus abdominis activation capacity (stabilizer pressure biofeedback unit) | The results showed that trunk PNF training along with conventional strengthening exercises in subjects with mechanical LBP induces a greater improvement on pain and functional disability as compared to conventional strengthening exercises alone. However, no significant difference was found between 2 groups in transversus abdominis activation capacity |
| 15 | Tanvi et al. (2013), randomized clinical trial | 27 women with post-partum lumbo-pelvic pain Experimental group: n: 13 Mean age: 28.28 ± 3.79y Mean height: 156 ± 4cm Mean body mass: 59.78 ± 6.47kg BMI: 24.37 ± 2.39kg/m2 Comparison group: n: 14 Mean age: 27.23 ± 4.81y Mean height: 158 ± 12cm Mean body mass: 64.19 ± 7.06kg BMI: 25.64 ± 4.80kg/m2 |
Experimental group:
IR + PNF techniques in a seated position (alternating [trunk flexion-extension] isometric contractions against resistance with no motion intended; and CI [concentric, isometric and eccentric contraction of agonists without relaxation]) Comparison group: IR + lumbo-pelvic stabilization exercises (abdominal hollowing, quadruped abdominal hollowing, unilateral abduction, unilateral knee raise, bilateral knee raise, unilateral heel slide and bilateral heel slide) |
Treatment interventions were applied 3 weeks Experimental group: IR: 15 min, 10 s hold time, 2 sets with 15 repetitions and 10 min rest between 2 techniques; Comparison group: IR: 15 min, The exercise programme was performed every day for 1 month except on Sunday (24 sessions), 10-15 repetitions (10 times in first 12 sessions and 15 times at other 12 sessions); Reassessments were performed at the end of 2nd and 4th weeks |
Pain intensity (NPRS), functional disability (Quebec back pain disability score), trunk flexor and extensor static and dynamic endurance (curl-up and Sorenson tests) | The results indicated that both groups demonstrated improvements in static and dynamic muscle endurance, pain and functional disability. However, the comparison showed significantly greater improvements than the experimental group |
| 16 | Byuon and Son (2012), randomized clinical trial | 54 patients with NLBP Experimental group: n: 26 Mean age: 58 ± 6.3y Mean height: 159.6 ± 9cm Mean body mass: 56.3 ± 8.1kg Comparison group: n: 28 Mean age: 60.8 ± 5.7y Mean height: 155 ± 5.4cm Mean body mass: 55.8 ± 8.1kg |
Experimental group:
Hot compress + IFT + PNF pattern (lower extremities flexion, adduction, external rotation with knee flexion, sprinter, and lifting) Comparison group: Hot compress + IFT + lumbar stabilization exercise (supine, bridge, quadruped, standing) |
Treatment interventions were applied 4 times a week for 6 weeks Experimental group: Hot compress: 20 min, IFT: 20 min, 3 sets, 15 repetitions in each set, 10 s hold time, 10 s rest time; Comparison group: Hot compress: 20 min, IFT: 20 min, 3 sets, 15 repetitions in each set, 10 s hold time, 10 s rest time; Reassessments were performed at the end of treatment sessions |
Pain intensity (VAS), repositioning error (digital goniometer) | Although both groups showed significant reduction in pain intensity and repositioning error after 6 weeks, the experimental group demonstrated significantly greater improvements than the comparison group |
| 17 | Kumar et al. (2011), randomized controlled trial | 30 male patients with recurrent mechanical CLBP Experimental group: n: 15 Mean age: 24.07 ± 2.19y Mean height: 170.73 ± 5.46cm Mean body mass: 66.93 ± 9.02kg Comparison group: n: 15 Mean age: 22.53 ± 2.85y Mean height: 170 ± 3.57cm Mean body mass: 68.07 ± 6.48kg |
Experimental group:
CI (concentric, isometric and eccentric contraction of agonists without relaxation in a seated position) + conventional physical therapy (alternate knee to chest, pelvic bridging, pelvic rolling, alternate arm leg extension [for both sides]) Comparison group: conventional physical therapy (alternate knee to chest, pelvic bridging, pelvic rolling, alternate arm leg extension [for both sides]) |
Treatment interventions were applied 5 times a week for 4 weeks Experimental group: 3 sets of 15 repetitions, rest intervals of 30 s and 60 s were provided after the completion of 15 repetitions for each pattern and between sets, respectively; Comparison group: 3 sets of 15 repetitions, rest intervals of 30 s and 60 s were provided after the completion of 15 repetitions for each pattern and between sets, respectively; Reassessments were performed at the end of treatment sessions |
Pain intensity (VAS), functional disability (MODI), trunk flexion endurance (curl-up), trunk extension endurance (Sorenson tests), and lumbar flexion and extension ROM (fingertip-to-floor) | The experimental group demonstrated significant improvements in lumbar mobility, muscle endurance, pain intensity, and functional disability. However, the comparison group also showed improvement in pain intensity and functional disability. Moreover, the difference in functional disability between the 2 groups was significant after intervention |
| 18 | Kofotolis et al. (2008), randomized controlled trial |
92 women with CLBP Experimental group 1: n: 23 Mean age: 41 ± 5.5y Mean height: 166.2 ± 0.8cm Mean body mass: 69 ± 3.9kg BMI: 24.9 ± 1.2kg Experimental group 2: n: 21 Mean age: 37.5 ± 8.6y Mean height: 169 ± 0.5cm Mean body mass: 69.7 ± 3.9kg BMI: 24.3 ± 1.4kg Comparison group 1: n: 23 Mean age: 41.2 ± 5y Mean height: 168.5 ± 0.7cm Mean body mass: 70 ± 4.3kg BMI: 24.6 ± 1kg Comparison group 2: n: 21 Mean age: 42.2 ± 7.8y Mean height: 169.9 ± 0.5cm Mean body mass: 69.1 ± 6.9kg BMI: 23.8 ± 1.7kg |
Experimental group 1:
RS (alternating [trunk flexion-extension] isometric contractions against resistance, no motions intended) Experimental group 2: RS + TENS treatment in a prone position (4 electrodes were applied on the fascia thoracolumbalis and approximately 10 cm proximal to this, along the midline of the muscle) Comparison group 1: TENS treatment in a prone position (4 electrodes were applied on the fascia thoracolumbalis and approximately 10 cm proximal to this, along the midline of the muscle) Comparison group 2: Placebo stimulation at the same sites for the same duration and period as the comparison group 1, using placebo units identical to the real TENS units in appearance, with the indicator lamp lit up when being switched on |
Treatment interventions were applied 5 times a week for 4 weeks. Training sessions had a total duration of 30–45 min Experimental group 1: 10 s hold time, 3 sets of 15 repetitions, 30 s rest interval between repetitions, 60 s rest interval between sets; Experimental group 2: RS parameters were the same as the Experimental group 1, TENS parameters: Pulse duration of 200 μs and a frequency of 4 Hz using a ‘strong but comfortable’ level of stimulation; Comparison group 1: The programme consisted of 40–45 min of TENS treatment; Reassessments were performed immediately after, 4 weeks, and 8 weeks post intervention |
Pain intensity (Borg verbal rating pain scale), functional disability (ODI), total lumbar ROM (flexicurve technique), dynamic and static flexion endurance (curl-up test), dynamic and static extension endurance (modified Sorenson test) | The experimental group 1 and experimental group 2 displayed statistically significant improvements in pain intensity and functional disability, lumbar extension ROM, dynamic endurance of trunk flexion, and static endurance of trunk extension compared with the remaining groups. In addition, treatment with TENS (the comparison group 1) was more effective than treatment with a placebo (the comparison group 2), less effective than a combination of RS and TENS (the experimental group 2), and adds no apparent benefit to that of RS alone (the experimental group 1) |
| 19 | Olczak et al. (2008), randomized clinical trial | 60 acute and subacute patients with intervertebral disc injuries Experimental group: n: 30 Median age: 55.5 (33-69)y Median height: 170 (158-185)cm Median body mass: 66 (56-79)kg Comparison group: n: 30 Median age: 54 (28-68)y Median height: 170.5 (158-187)cm Median body mass: 67.5 (58-80)kg |
Experimental group:
Scapula, pelvis, and upper limb PNF patterns + PNF techniques (hold relax) + abdominal roll Comparison group: Hyperextension in a prone position, hyperextension with various types of additional pressure, and flexion in a supine position + abdominal roll |
Reassessments were performed immediately on completion of the treatment and during a long-term follow-up evaluation at 6 months after the end of treatment. | Pain intensity (diagram on the McKenzie examination chart, VAS), lumbar flexion and extension ROM (Saunder digital inclinometer), and abdominal and paraspinal muscle strength (Nicholas manual muscle tester) |
There was more rapid pain reduction, improvement of ROM, strength and fewer relapses in the experimental group. The positive effects of the treatment were sustained over the 6-month follow-up |
| 20 | Kofotolis and Kellis (2006), randomized clinical trial | 86 women with CLBP Experimental group 1: n: 28 Mean age: 40.6 ± 6.4y Mean height: 165.7 ± 8.4cm Mean body mass: 68.8 ± 3.8kg BMI: 25.2 ± 1kg Experimental group 2: n: 28 Mean age: 41.8 ± 7.7y Mean height: 168.6 ± 5.6cm Mean body mass: 70.1 ± 4.4kg BMI: 24.8 ± 1.7kg Comparison group: n: 30 Mean age: 42.1 ± 8.4y Mean height: 169.2 ± 4.2cm Mean body mass: 69.6 ± 6.1kg BMI: 24.3 ± 0.7kg |
Experimental group 1:
Warm-up (stationary bicycling, stretching exercises) + RS (alternating [trunk flexion extension] isometric contractions against resistance, no motions intended) + cool-down Experimental group 2: Warm-up (stationary bicycling, stretching exercises) + CI [concentric, isometric and eccentric contraction of agonists (trunk flexion) without relaxation]) + cool-down Comparison group: The comparison group was instructed to avoid structured exercise or activities other than those required for normal daily living |
Treatment interventions were applied 5 times a week for 4 weeks. Training sessions had a total duration of 30–45 min Experimental group 1: Stationary bicycling: 7-10 min, RS: 10 s hold time, 3 sets of 15 repetitions at maximal resistance, 30 s rest interval between repetitions, 60 s rest interval between sets; Experimental group 2: Stationary bicycling: 7-10 min, CI: 5 s hold time, 3 sets of 15 repetitions at maximal resistance, 30 s rest interval between repetitions, 60 s rest interval between sets; Reassessments were performed immediately after, 4 weeks, and 8 weeks post intervention |
Pain intensity (Borg verbal rating pain scale), functional disability (ODI), total lumbar ROM (flexicurve technique), dynamic and static flexion endurance (curl-up test), dynamic and static extension endurance (modified Sorenson test) | The application of 4-week RS and CI PNF programmes increased the muscle endurance of people with CLBP. Back pain intensity and functional disability also decreased significantly. The results suggested that short-term programmes with dynamic or static PNF exercises were particularly effective in improving trunk muscle endurance and mobility as well as in reducing back pain symptoms and improving functional performance in people with CLBP. Because the CI group showed greater improvements, the use of dynamic PNF exercises for the management of CLBP appears to be more effective |
Abbreviations: AKE: active knee extension; ART: active release technique; BMI: body mass index; CI: combination of isotonics; CLBP: chronic non-specific low back pain; CNLBP: chronic non-specific low back pain; CR: contract-relax; DEL: diagonal, extension with rotation to left; DER: diagonal, extension with rotation to right; DFL: diagonal, flexion with rotation to left; DFR: diagonal, flexion with rotation to right; EMG: electromyography; FEV1: forced expiratory volume at 1 s; HR: hold-relax; IFT: interferential therapy; IR: infra-red radiation; LBP: low back pain; MODI: modified Oswestry disability index; NLBP: non-specific low back pain; NPRS: numerical rating scale; PNF: proprioceptive neuromuscular facilitation; RI: rhythmic initiation; RMDQ: Roland–Morris disability questionnaire; ROM: range of motion; RS: rhythmic stabilization; SR: stabilizing reversals; SWD: short-wave diathermy; TENS: transcutaneous electrical nerve stimulation; VAS: visual analogue scale.