Background: Various treatments are being tried for lumbar neuropathy. Among them, neural mobilization aims to reduce peripheral nerve sensitivity by stimulating them directly. Similarly, applying kinesiotape stimulates skin and joint receptors around the nerves, thereby affecting nerve function and movement. Objectives: To investigated the effect of low back pain on the neural mobilization and kinesiotaping. Design: Randomized controlled trial. Methods: Thirty patients with chronic low back pain were randomly allocated to three groups: the neural mobilization exercise with kinesiotaping group (NEKTG, n=10), the neural mobilization exercise group (NEG, n=10), and the kinesiotaping group (KTG, n=10). Each group performed six intervention sessions over two weeks. The results were analyzed by measuring the numeric pain rating scale (NPRS) and straight leg raise (SLR) before and after the intervention in each group. Results: NEKTG, NEG, and KTG all indicated a significant decrease in the back pain index before and after the intervention. However, there were no differences observed between the three groups. The SLR angles before the experiment were identical across the three groups. The SLR angles before and after the intervention were as follows: the SLR angle significantly increased in NEKTG. Furthermore, there was a significant increase in the SLR angle in NEKTG compared to both NEG and KTG. Conclusion: Neural mobilization combined with kinesiotaping provided better therapeutic effects regarding pain reduction and neurodynamic improvement compared to alone kinesiotaping and mobilization with chronic low back pain.

Background: Chronic back pain not only causes physical discomfort and decreased functionality but also affects emotional well-being, resulting in feelings of anxiety, depression, and other psychological issues. Studies have indicated that cognitive functional therapy and motor control exercises can alleviate chronic low back pain and associated psychological issues. Objectives: To investigated the effect of chronic low back pain on the cognitive functional therapy (CFT) and motor control exercises (MCE). Design: Quaxi-experimental study. Methods: Forty patients with chronic low back pain were randomly assigned and divided into 20 cognitive functional therapy group with motor control exercises group (CFTMG) and 20 patients in motor control exercises group (MCEG). After applying CFT with motor control exercises and motor control exercises for 8 weeks, changes in numeric pain rating scale (NPRS), Oswestry disability index (ODI) and Fear-avoidance beliefs questionnaire (FABQ) were observed. Results: In the CFTMG, statistically significant changes were observed in NPRS, ODI, and FABQ before and after the intervention. In the MCEG, statistically significant changes were observed in VAS and ODI before and after the intervention. Conclusion: The application of CFTM and MCE in patients suffering from chronic low back pain has demonstrated effectiveness in alleviating pain, enhancing back function, and reducing kinesiophobia associated with the condition.

Background: Pain neuroscience education (PNE) combined with exercise and mobilisation with cognitive goals presented decreases in pain and disability and an increase in spinal function compared to physiotherapy intervention in patients with chronic low back pain (CLBP). Objectives: To investigated the effect of forward head posture (FHP) with chronic neck pain on the PNE combined with cervical and thoracic mobilization. Design: A randomized controlled trial. Methods: The subjects were randomly allocated to the MDT with PNE group (MPNEG, n=15) and the PNE group (PNEG, n=15). Pain neuroscience education was provided to both groups, and MDT exercise was additionally performed in the experimental group. Training was conducted 3 times a week for 8 weeks, and the Oswestry Disability Index (ODI) and numeric rating scale (NRS) were used to measure the level of back pain dysfunction, and each was evaluated before and after the experiment. Results: Results from the study indicated that statistically significant decrease in NRS and ODI in MPNEG. In PNEG, there was statistically significant decrease in NRS. And in MPMES, there was a statistically significant decrease in ODI than in PNEG. Conclusion: The MDT combined with PNE is more effective than PNE alone as a treatment method for improving lumbar dysfunction and reducing pain in chronic low back pain.

Background: Technological developments have led to the creation of a mechanical device capable of providing a representative massage as a passive treatment. The use of mechanical massage offers the distinct advantage of being user-friendly and available for use at any given time. Objectives: To investigated present the outcomes of utilizing a massage bed on the range of motion (ROM) and pressure pain threshold (PPT) in patients diagnosed with chronic low back pain. Design: ABA design of a single case study. Methods: To measure the ROM of the subject's trunk flexion, extension, lateral flexion, and rotation, a tape measure and goniometer were utilized. Furthermore, PPT was measured using an electronic pressure pain meter. Baseline A and Baseline A’ periods were conducted for 5 consecutive days without intervention. Following the baseline periods, a massage bed intervention was administered for 1 hour daily for a total of 10 days during the Intervention B period. Daily assessments were performed, and the Intervention B period was conducted after the intervention. Results: The ROM effect was confirmed in trunk lateral flexion and rotation, while the PPT was effective in both L1, right L2, left L4, and left L5. Conclusion: The results of this study confirmed that the use of a massage bed improved the ROM and PPT in patients suffering from chronic back pain. Further randomized controlled trials involving a larger sample size are necessary to validate these findings.

본 연구에서는 만성요통을 가진 여성노인의 체형 및 요부안정화를 위해 12주간 필라테스 운동 프로그램을 적용한 후 체형에 미치는 영향을 알아보고, 통증의 변화를 규명함으로써 노화를 늦추고 신체활 동 영역을 높일 수 있는 노인에게 적합한 운동 프로그램 개발에 필요한 자료를 제공하고자 하였다. 이에 3~5cm 중증도 통증범위의 만성요통을 가진 16명여성노인을 대상으로 주관적 통증척도지를 통해 실험집단 8명, 통제집단 8명을 단순무선표집(Simple Random Sampling)으로 선정하였다. 요부안정화 필라테스 운동 프로그램은 주 2회씩 총 12주간 50~60분간 실시하였으며, 1세트 종료 시 1분 휴식을 주는 방식으로 실시 하였다. 그 결과 첫째, 체형 및 통증에서는 경추 기울기에서 요부안정화 운동그룹의 경우 운동 전에 비해 감소하였으나 통제집단은 증가하였다. 둘째, 요부 통증의 결과 운동집단의 경우 운동에 비해 감소하였으나 통제집단은 증가하였다. 결론적으로 요부안정화 필라테스 운동은 만성요통을 가진 여성노인에게 있어서 통 증을 감소시킬 수 있는 프로그램으로 적용될 수 있으며, 체형을 개선시키는데 도움을 줄 수 있는 것으로 확인되었다.

Background: Clinical practice guidelines for patients with chronic low back pain (CLBP) recommend therapeutic exercise, and recently, interventions for pain neuroscience education (PNE) are also recommended. Objectives: To investigate the effects of aquatic exercise combined with PNE on pain, disability, and fear-avoidance beliefs in patients with CLBP. Design: Randomized control trial. Methods: The 27 participants recruited in this study were randomly allocated as pain neuroscience education combined with aquatic exercise group (PAEG, n=14) and aquatic exercise group (AEG, n=13). Both groups performed aquatic exercise for 50 minutes, 3 times a week for 6 weeks, and only PAEG received additional PNE. Numeric pain rating scale (NPRS), modified oswestry disability questionnaire (MODQ), and fear-avoidance beliefs questionnaire (FABQ) were used as evaluation methods before and after intervention. Results: Statistically significant decrease in NPRS, MODQ and FABQ (physical activity and work score) before and after intervention in PAEG. However, there were statistically significant changes in NPRS, MODQ and FABQ (physical activity score) before and after intervention in AEG. PAEG and AEG before and after intervention indicated statistically significant differences in MODQ and FABQ (work score). Conclusion: Aquatic exercise combined with PNE improved disability (MODQ) and fear-avoidance beliefs (FABQ) has been shown to have additional benefits. Therefore, combining PNE as a clinical intervention for CLBP patients will enhance the therapeutic effect.

Background: Low back pain is a very common musculoskeletal disorder. Since low back pain can indicate physical and psychological problems, reducing the pain level of low back pain can be the primary goal of rehabilitation. Objectives: This study was performed to explain the personalized treatment protocol of Maitland orthopedic physiotherapy based on the brick wall concept for low back pain patients with hypomobility. Design: Randomized controlled study. Methods: A total of 14 chronic low back pain patients were divided into two groups. The experimental group received orthopedic manual physical therapy intervention. The control group received traditional physical therapy intervention. After the 3 days intervention, the joint range of motion and pain of the low back were measured. Results: The low back flexion, extension, lateral flexion, and rotation joint range of motion was significantly increased in the experimental group than in the control group (P<.05). Low back pain was significantly reduced in the experimental group than in the control group (P<.05). Conclusion: It was confirmed that Maitland orthopedic physical therapy was an effective method as an intervention method to improve the joint range of motion and pain of chronic low back pain patients.

Background: A recent study found that pain neuroscience education (PNE) alters pain intensity, knowledge of pain, disability, psychological function, and pain behavior in patients with musculoskeletal pain. However, they noted that PNE alone was not sufficient to affect chronic low back pain (CLBP) reduction. Objectives: To investigated the effect of CLBP on the PNE combined with lumbar mobilization. Design: Quasi-experiment study. Methods: A total of 33 patients aged 25 to less than 65, recruited from L-hospital for low back pain in Chungcheongnam-do. Out of 33 subjects, 17 were pain neuroscience education combined with lumbar mobilization group (PLMG) and 16 were lumbar mobilization group (LMG). The outcome was visual analogue scale (VAS), oswestry disability index (ODI) and the fear avoidance beliefs questionnaire (FABQ). The collected data was analyzed using the SPSS ver. 21.0 program by paired t-test and independent t-test. Results: PLMG was indicated statistically significant decrease in VAS, ODI and FABQ before and after intervention. However, there were statistically significant changes in VAS and ODI before and after intervention in LMG. PLMG and LMG before and after intervention indicated statistically significant differences in VAS, ODI and FABQ. Conclusion: The inclusion of PNE combined with lumbar mobilization in patients with CLBP is a promising and feasible approach to the management of CLBP.

Background: Bird dog exercise (BDE) is one of the lumbar stabilization exercises that rehabilitate low back pain by co-contraction of the local and global muscles. Previous studies have reported the effect of various type of BDEs (for example, practicing the exercises on various surfaces and changing the limb movement) for muscle co-contraction. Objects: This study aimed to investigate the effect of knee joint flexion position of the raised lower limb on abdominal and back muscle activity during BDE in patients with chronic low back pain (CLBP). Methods: Thirteen males participated in this study (age: 32.54 ± 4.48 years, height: 177.38 ± 7.17 cm). Surface electromyographic (SEMG) data of the internal abdominal oblique (IO), external abdominal oblique (EO), lumbar multifidus (MF), and thoracic part of the iliocostalis lumborum (ICLT) were collected in two knee joint flexion positions (90° flexion versus 0° flexion) during BDE. The SEMG data were expressed as a percentage of root mean square mean values obtained in the maximal voluntary isometric contraction. Results: Greater muscle activity of the IO (p = 0.001), MF (p = 0.009), and ICLT (p = 0.021) of the raised lower limb side and the EO (p = 0.001) and MF (p = 0.009) of the contralateral side were demonstrated in the knee joint flexion position compared to the knee joint extension position. Greater local/global activity ratios of the abdominal muscle (i.e., IO and EO) of the raised lower limb (p = 0.002) and the back muscle (i.e., MF and ICLT) of the contralateral side (p = 0.028) were also noted in the knee joint flexion position. Conclusion: BDE with a knee joint flexion position might be recommended as an alternative lumbar stabilization exercise to enhance muscle activity in both the raised lower limb and the contralateral sides of the trunk for individuals with CLBP

Treatment and management of chronic low back pain (CLBP) should be tailored to the patient’s individual context. However, there are limited resources available in which to find and manage the causes and mechanisms for each patient. In this study, we designed and developed a personalized context awareness system that uses machine learning techniques to understand the relationship between a patient’s lower back pain and the surrounding environment. A pilot study was conducted to verify the context awareness model. The performance of the lower back pain prediction model was successful enough to be practically usable. It was possible to use the information from the model to understand how the variables influence the occurrence of lower back pain.

Background: Back pain is associated with a high risk of recurrence. Various physical therapy techniques for back pain have been studied, including reprogramming the central nervous system by integrating sensation and motion with sensory exercise training. Objectives: To aimed verify the effectiveness of sensorimotor training in improving postural stability and pain levels. Design: A randomized controlled trial. Methods: The study population was randomized into a sensory exercise training group and trunk stabilization training group and treated three times a week for 4 weeks. Each group took part in sensorimotor training for 15 minutes or lumbar stabilization exercise for 15 minutes. Results: After the intervention both groups showed Improvements in the variables. There was a significant difference in the dynamic postural stability, limit of stability, and modified visual analog scale scores in the sensorimotor training group compared to the lumbar stabilization exercise group (P<.05). Conclusion: Sensorimotor training appears to be an effective physical therapy exercise program that can be applied in patients with low back pain to improve muscle control ability.

Background: Various treatments have been proposed for chronic low back pain (CLBP), but recent guidelines and reviews recommend regular physical exercise. However, some other studies have reported opposite results that sling exercise (SE) and other exercises (OE) did not differ in improving CLBP. Objectives: To systematically review and meta-analyze the effects of SE on CLBP in studies published in Korea. Design: A Systemic Review and Meta-analysis. Methods: Randomized controlled trials comparing SE with OE and modality therapy (MT), published up to June 2020, were identified by electronic searches. Primary outcomes were pain and disability. The weighted mean difference (WMD), stand mean difference (SMD) and 95% confidence interval (CI) were calculated using a random-effects model. Results: Based on the results of the meta-analysis, SE was effective for pain in the comparison of SE and MT [short-term: WMD=-1.64, 95% CI (-3.06, - 0.22); long-term: WMD=-0.34, 95% CI (-0.42, -0.26)]. It was effective for pain in the comparison of SE and OE [short-term: WMD=-1.18, 95% CI (-2.15, - 0.20); long-term: WMD=-0.66, 95% CI (-0.89, -0.43)]. It was also effective for disability in the comparison of SE and MT [short-term: SMD=-15.82, 95% CI (- 23.10, -8.54)]. We found no clinically relevant differences in disability between SE and OE. Heterogeneity was high in the comparison of SE and overall variables. Conclusion: If SE is applied to physical therapy to improve the main symptoms of CLBP patients, it may contribute to their recovery. More high-quality randomized studies on the topic are warranted.

Background: Although various exercises have been performed for patients with chronic low back pain (CLBP), the effects of these exercises including joint mobilization, gym ball exercises, and breathing exercises on flexion relaxation ratio (FRR) have not been compared. Objective: To compare the effects of joint mobilization, gym ball exercises, and breathing exercises on the flexion relaxation phenomenon (FRP) and pain in patients with chronic low back pain. Design: Randomized pretest-posttest control group design. Methods: Thirty-six patients with chronic low back pain who were undergoing rehabilitation at a rehabilitation center were included. The patients were randomly divided into three groups: joint mobilization group (JMG; n=12), gym ball exercise group (GBG; n=12), and breathing exercise group (BEG; n=12). The exercises were performed for 40 minutes a day, twice a week, for a total of 12 weeks. Results: There were no significant differences in FRR between the three groups (P>.05). Significant decreases in the modified visual analog scale (MVAS) scores after intervention between the groups were found (P<.05). The GBG was significantly decreases from the JMG in the MVAS (P<.05). However, there were significant improvements between the pre- and post-interventional findings on FRR and MVAS in the three groups (P<.05). Conclusion: We demonstrated that intervention using joint mobilization, gym ball exercises, and breathing exercises improve FRP and pain in patients with CLBP.

Background: Most of the previous researches on the abnormality of breathing pattern have focused on the silence of functional movements owing to such abnormality, however, have not been clearly identified the relationship between the abnormal breathing pattern on one hand and kinesiophobia and flexion relaxation phenomenon (FRP) on the other hand. Objective: To compare patients with chronic low back pain (CLBP) and healthy person in the abnormality of breathing pattern, kinesiophobia, and FRP during flexion and extension of the trunk. Design: Case-control study. Methods: The research subjects consisted of a group of 15 healthy adults and another group of 15 patients with CLBP. Capnography was used to measure the endtidal CO2 (EtCO2) and respiratory quotient (RQ). The muscle activity of multifidus and erector spinae of the subjects was measured during flexion and extension of the trunk to identify their FRP. The Nijmegen Questionnaire (NQ) and Tampa Scale of Kinesiophobia (TSK) were utilized to measure their breathing patterns and kinesiophobia, respectively. The Kolmogorov-Smirnov (K-S) test was conducted in order to analyze the normal distribution of the measured data. Their general characteristics were identified by the descriptive statistics and the independent t-test was performed to identify the differences between the two groups in terms of abnormality of breathing pattern, kinesiophobia, and FRP. The level of significance was set at α=.05. Results: The patients with CLBP had significantly less EtCO2 and shorter breathing hold time (BHT) than normal healthy person (p<.05). The patient with CLBP also had significantly greater kinesiophobia than healthy person (p<.05), and had less FRP than the healthy person (p<.01). Conclusions: These results suggest that the CLBP had greater abnormality of breathing pattern and kinesiophobia with less FRP than healthy person.

Background: Chronic low back pain (CLBP) causes morphological changes in muscles, reduces muscle strength, endurance and flexibility, negatively affects lumbar stability, and limits functional activity. Plank exercise strengthens core muscles, activates abdominal muscles, and improves intra-abdominal pressure to stabilize the trunk in patients with CLBP. Objects: We investigated the effect of plank exercise on abdominal muscle thickness and disability in patients with CLBP. Methods: We classified 33 subjects into 2 groups: An experimental (n1=17) and a control group (n2=16). Patients in the experimental group participated in plank exercise and those in the control group participated in stretching exercise. Patients in both groups attended 20-minute exercise sessions thrice a week for 4 weeks. Abdominal muscle thickness in each subject was evaluated ultrasonographically, and disabilities were assessed using the Oswestry disability index (ODI). Results: Four weeks later, abdominal muscle thickness showed a significant increase over baseline values in both groups (p<.05). Patients in the experimental group reported a more significant increase in the thickness of the external oblique muscle than that in the control group (p<.05). ODI scores in the experimental group were significantly lower after intervention than before intervention (p<.05). Conclusion: Plank exercise increases the thickness of the external oblique muscle and reduces disability secondary to mild CLBP. Therefore, plank exercise is needed to improve lumbar stability and functional activity in patients with mild CLBP.

Background: Compared to healthy people, patients with chronic lower back pain have reduced balance abilities which may cause proprioception problems, patients with chronic lower back pain avoid physical activities due to pain, and reduced activity levels lead to muscle weakening, which can further exacerbate pain. Recently, there have been many studies on the use of sensory stimulation; and among these studies, interventions that use vibrational stimulation have shown functional improvements in the patients. Objects: This study examined the effects of a stabilization exercise with vibration stimulation on the balance ability and disability in patients with chronic back pain. Methods: The subjects of the study were 30 persons who were randomly assigned to the experimental group and the control group, with 15 subjects in each. The subjects were evaluated before and after intervention via a balance ability test, the Korean Oswestry disability index (KODI) test, a pain test, and a proprioceptive sensory test. Both groups received general physical therapy. The experimental group performed the stabilization exercise with vibration stimulation, and the control group performed a general stabilization exercise, three times a week for six weeks. Results: After the intervention, both groups showed significant improvements in the balance ability test, the KODI test, the pain test, and the proprioceptive sensory test. The experimental group showed statistically significant, higher improvements than the control group in the balance ability test, the KODI test, and the proprioceptive sensory test. Conclusions: The stabilization exercise with vibration stimulation for patients with chronic back pain has been reported to provide greater functional improvements than the conventional intervention method. Therefore, the stabilization exercise in a vibration stimulation environment could be a useful intervention for patients with chronic back pain.

Background: Posterior-anterior (PA) vertebral mobilization, a manual therapy technique has been used for relieving pain or stiffness treating in spinal segment for in clinical practice, however evidence to gauge efficacy is yet to be synthesised. Objects: This study aimed to investigate the effect of PA mobilization of the thoracic spine on the respiratory function in patients with low back pain (LBP). Methods: The study participants included 30 patients with chronic LBP. They were randomly allocated to the experimental and control groups. The experimental and control groups received PA mobilization of the T1-T8 level of the thoracic spine and placebo mobilization, respectively. All patients received interventions for 35 minutes a day, five times a week, over 2-week period, respectively. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), forced expiratory flow 25∼75% (FEF25∼75%), and chest wall expansion were measured before and after the intervention. Statistical analysis was performed using independent t-test and two-way analysis of variance, and Pearson’s correlation analysis was used to compare the correlation between respiratory function and chest measurement. Results: The experimental group showed significant improvements in FVC, FEV1, PEF, FEF25∼75% (p<.05), and chest wall expansion (p<.05) compared with the control group. Conclusion: PA mobilization of the upper thoracic spine may be beneficial for improving respiratory function parameters including FVC, FEV1, PEF, FEF25∼75%, and chest wall expansion in patients with chronic LBP.

The purpose of this study was to investigate the effects of central posteroanterior mobilization on the pain, muscle tone, flexibility of trunk flexion, lumbar lordosis in patient with chronic back pain has been studied. The target subject was a 23 year old man, who had chronic back pain without surgical history within six months. The pain has been indicated by the pressure pain threshold, when the subject was pressed his spinous process of L3-L1 by the pressure of grade Ⅳ. The muscle tone, elasticity, and stiffness were measured by the MYOTONEⓇ PRO, and the flexibility of trunk flexion was evaluated by the distance from the figure tips to the floor, when subjects flexed their body. The lumbar lordosis was measured from the X-ray picture. The lumbar central posteroanterior mobilization of Maitland orthopedic physical therapy has been applied to the spinous process of L3-L1 in grade Ⅳ by five sets and 10 times for each set. According to the measurement result right after the intervention, the pain decreased from 2/10 to 1/10 based on the visual analogue scale. The flexibility of trunk flexion (distance from the finger tips to the floor) increased The muscle tone decreased from 15.3 to 14.65 and the muscle stiffness also decreased 53.5 from 310 to 256.5. However, the muscle elasticity increased from 0.89 to 1.04 and there was no changed on the lumbar lordosis as 25°. The results of the present study suggest that the central posteroanterior mobilization decrease the pain, muscle tone, and muscle stiffness of the lumbar area, however increase the muscle elasticity and flexibility of the trunk flexion.

The purpose of this study was to investigate the effects of lumbar stabilization and sling exercise on visual analogue scale (VAS), Korean Oswestry Disability Index (KODI), and stability index (ST) in patients with chronic lower back pain (CLBP). This study included participants with a VAS scale of 6 or higher and a KOD of 20-40%. They were randomly divided into a mat group (n=15) to perform lumbar stabilization exercises and a sling group (n=15) to perform sling exercises, and then they underwent a four-week experiment. The experimental results of this study were as follows: the VAS and KODI showed a statistically significant difference (P<.05) and a larger effect size within each group after the intervention, it exhibited no statistically significant difference between the two groups (P>.05). There were significant differences in ST before and after intervention in each group (P<.05), however there was no significant difference between the groups. The present study suggest that the effects of lumbar stabilization exercise and sling exercise are similar.

Background: Chronic back pain shows a high correlation with lumbar disability, physical disability for daily activities, and psychosocial factors, such as depression. Object: The purpose of this study was to examine the correlation of the level of pain and disability with psychosocial factors, which are potential disturbance variables, in patients with chronic lumbar pain. Method: The sample included 258 patients, who had complained of chronic lumbar pain for more than three months. The Quadruple Visual Analogue Scale was used to measure the level of pain, and a Korean version of Oswestry Disability Index was used to measure the level of disability. Psychosocial factors were measured using the Tampa scale for Kinesiophobia-11, Fear Avoidance Beliefs Questionnaire, and Pain Self-Efficacy Questionnaire. The collected data was analyzed using PASW 18.0, and an independent samples t-test was used to examine frequency, percentage, mean, and standard deviation of sociodemographic characteristics and major variables. Pearson’s correlation coefficient was used to investigate the correlation between the level of pain and disability and psychosocial factors. Stepwise multiple regression analysis was done to determine the level of pain and psychosocial factors of functional disorder. The significance level was set at α=.05. Result: There is a strong correlation between the level of pain and functional disorder and psychosocial factors in patients with chronic lumbar pain. The study also revealed that as the levels of pain and fear avoidance increase, pain self-efficacy decreases. Conclusion: The results suggest that negative perceptions towards pain, limitations of physical movement, and severe fear avoidance directly affect the decrease in pain self-efficacy. Therefore, it is recommended to test pain self-efficacy when measuring the level of pain and disability in patients with chronic low back pain.