Effects of Six-Week Exercise Training Protocol On Pain Relief in Patients With Lumbar Disc Herniation
Effects of Six-Week Exercise Training Protocol On Pain Relief in Patients With Lumbar Disc Herniation
Effects of Six-Week Exercise Training Protocol On Pain Relief in Patients With Lumbar Disc Herniation
1
Certified Board of Physical Medicine and Rehabilitation, Comprehensive Rehabilitation Center, Hamadan, Hamadan, Iran
2
Department of Sport Biomechanics, School of Physical Education and Sport Sciences, Bu-Ali Sina University, Hamadan, Iran
3
Center of Physical Education and Sport Sciences, Applied Science and Technology University, Hamadan, Iran
4
Associate Professor, Department of Sport Biomechanics, School of Physical Education and Sport Sciences, Bu-Ali Sina University, Hamadan, Iran
5
Assistant Professor, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Citation: Yazdani AH, Hesari P, Eghbali-Khosro Sh, Anbarian M, Babaei-Ghazani A. Effects of six-week
exercise training protocol on pain relief in patients with lumbar disc herniation. J Anal Res Clin Med
2016; 4(1): 27-33. Doi: 10.15171/jarcm.2016.005
that the disk degeneration is a more prevalent disk herniation were recruited. The subjects
among men than women. It starts primarily in of this interventional prospective before-after
men from the second decade of life, whereas it study included 13 male and 51 female
occurs in women in the third decade.4 patients. All participants provided written
Meanwhile, the back pain complication of the informed consent and the study was
normal life and the kinetic activities affects both approved by regional ethics committee. They
genders seriously. At present, there are were selected by the random sampling
numerous strategies for the treatment of the method from the patients referred to the
lumbar pains caused by the disk herniation outpatient clinic. Inclusion criteria were men
which mostly emphasize the pain relief. and women suffering from the LBPs due to
Exercises and remedial sports have been the disk herniation for more than 5 months,
suggested as one of the non-aggressive aged 20-70 years old. Exclusion criteria were
strategies to relieve the chronic back pains a history of lumbar spine fracture, history of
caused by the disk herniation. In all of these cancer, systemic steroid use, systemically ill,
studies the effective role of remedial sports uncontrolled diabetes mellitus (DM), skeletal
has been emphasized to lessen the LBPs and deformity, history of rheumatologic
to restore the patient’s normal activities.5 disorders, progressive motor weakness,
Various researches have been carried out incontinency and awakening pain at night.
to cure the lumbar pains by means of the They were examined by the specialists, and
surgery method of lumbar disk. Statistically, lumbar disk herniation was proved by physical
different results have been reported. For examination and imaging studies. The physical
instance, some reports have asserted 60-90% examination included straight leg raise (SLR),
pain relief; however, other reports have reverse SLR, cross SLR, manual muscle tests,
stated that pain and kinetic deficits remained stretch tendon reflexes and sensory tests.
in 30-70% of patients after the surgery. The Magnetic resonance imaging (MRI) conducted
persistence of these problems after the for all the patients. All participants had
surgery could be the result of posterior or lateral disk herniation at L4-L5 or
musculoskeletal imbalance in core muscles L5-S1 level in MRI study.
and highlights the consideration of exercise For pain evaluation progress during the
training to remedy the LBP. Until now, study, we utilized a visual analog scale (VAS)
research projects have been conducted to which consists of the graduated line of 10 cm
examine the effects of stabilizing kinetic length ranging from 0 (no pain) to 10
exercises on the subjects suffering from the indicating an extreme amount of pain. The
chronic lumbar pains. They have pursued the evaluation of the pain was carried out before
stability and performance improvement of starting the first session, in session 6 after the
the lumbar spine musculature.6,7 beginning of the exercise protocol and after
Few comparative studies have taken place 12 training sessions. The participants ought
to reveal exercise effect on pain reduction in to specify their self-evaluation of the existent
different genders inflicted to the lumbar disk pain on VAS scoring system.
herniation. The exercise training protocol was as
Consequently, it behooves the researches follows: Intervention consisted of 6 weeks;
in the field to broaden and deepen their two sessions a week and each session lasted
studies. This study aims at comparing the for 25-30 minutes of training. After a slight
effect of an exercise protocol on the amount warm-up activity for 5 minutes, they
of pain improvement in both genders exercised with the leg press device, lateral
suffering from the disk herniation. thoracic flexion and extension for the first
three sessions (Figures 1 and 2). After the
fourth sessions, the lateral thoracic rotation
About 64 patients with LBP due to lumbar was added to the training program which
required the flexion as well as extension Chicago, IL, USA). To determine the training
exercises at the sixth session. All trainings effects on the pain scale, the correlated T was
were carried out with the implementation of used and to compare the research groups.
Documentation Based Care (DBC) device The independent test was administered. The
made in Finland. The patients who were significant level was considered as P = 0.050.
unable to do the lateral flexion and rotation
movements due the pain were exempted
from the activities. During the training Mean age, height, and weight of participants in
program, the participants were asked to this study were 56.9 ± 11.7 year, 163.03 ± 7.90
avoid taking any kind of painkillers. cm and 69.6 ± 10.3 kg, respectively. The age,
All the analyses were performed applying height, and weight of the two groups (female
SPSS software (version 13, SPSS Inc., and male) are given at table 1.
Figure 3 indicates the observed amount of noticed that the amount of pain reduction did
pain for the participants in pre DBC, 6 weeks not reveal a significant difference between
and 12 weeks after initiation of DBC. As it is the male and female subjects during the 1st
seen, the pain amount has decreased and 6th sessions (P = 0.074), whereas the pain
significantly during the 6 and 12th sessions decrease was significantly greater in men
compared to the first session (P = 0.001). than women between the 1 and 12th sessions
Table 2 display the amount of observed VAS (P = 0.047). Based on VAS there was 12 units
changes in the two groups between the 1st to greater in men than women during the 1 and
the 6th and the 1st to the 12th sessions. It can be 12th sessions.
Figure 3. The observed amount of pain for the total participants during intervention and follow-up
VAS: Visual analog scale
st th st th
Table 2. The amount of observed changes in the two groups between the 1 to the 6 and the 1 to the 12 sessions
Pain change between the sessions Female Male Significant
Amount of pain decrease between the 1st and 6th session 1.60 ± 1.17 2.00 ± 2.15 0.074
Amount of pain decrease between the 1st and 12th session 1.90 ± 2.41 1.90 ± 3.65 0.047*
*
Statistically significant
exercises and under surveillance trainings on permanently and leads to the further
decreasing the pain and improving the disability of the patient. Meanwhile as soon
patients’ abilities against the chronic LBPs. as core stabilizing muscles become stronger,
Standaert et al.10 have reported that the the pain will reduce, and the patient will
stabilizing exercises of the vertebras are exercise better and get the ability to move
effective in ameliorating the performance and correctly and save the normal posture, so the
the pains for the various groups with the pain cycle brakes.
LBP. According to the study done by As a result, the pain and disability will
Karimi,11 the researcher have suggested the gradually lessen, and the patient will get rid
exercises should aim to improve the vertebra of the defective cycle and the state of
stability instead of increasing the power or disability. His movements are restored, and
hypertrophy of the trunk in the cases of LBPs. the performances are ameliorated. The
Other studies showed a reduction of the findings of this project maintained that the
pain and failure of the patients’ with LBP amount of back pain has lessened and
through the resistance exercises. relieved significantly all participants of the
Furthermore, revealed that the training two groups in the 6 and 12th sessions than
simultaneous with the coordinating and that of the first.
resisting exercises would be more effective They were correlated with the findings of
than each in separation. Nutter12 in the USA, the other studies. Oliveira and Goncalves15
Ylinen et al.13 in Finland and Tritilanunt and assessed the effects of 8 weeks resistance
Wajanavisit14 in Thailand have shown that exercises on the electromyography (EMG)
the useful and curable effects of the sports on range (root mean square) and the frequent of
killing the muscular-skeletal pains. In the muscles based on the EMG fatigue
Canada, the researchers have demonstrated threshold (as the highest level of exercises
that daily and regular exercises of even 12 which is done without any change in the
minutes will raise the LBP endurance.1 Some EMG). The findings of their study pointed
investigations have reported the aerobic that the exercise plan based on EMGFT1
exercises will prevent the mechanical pains would influence EMG range more than the
more effectively and inexpensively than the MF frequency which is likely related to the
other clinical methods such as medicinal and recalling pattern of the muscles. Even
physical therapies.1 through the extensor muscles of the trunk
In this study, the target muscles including showed the variations in the frequency
the multifidus which are the profound parameter, they become the flexible sign
muscles of the spinal vertebrates. It is resulted from the training program. On the
difficult to access them through Williams and other hand, Cacchio et al.16 proved that the
McKenzie’s exercises. Yet, if different devices training program would decrease the EMG
are designed to improve the multifidus at activity of the antagonist muscles, the co-
various directions such as flexion, extension, contractile amount of the muscles and
lateral flexion and rotation, the muscles will increase the force output because of the
get stronger. They play crucial roles in improvement in the recalling pattern of the
controlling and stabilizing the spinal muscles and the enhancement of
vertebrates; however, they become weakened coordination in motor unit synchronism as
and atrophic in the patients who suffer from well as motor learning. It would lead to the
the protruding lumbar disk. Later on, it will decrease of pressure amount on the joints at
not be easy for them to how the access to the the final stage, and the perceived pain would
same muscles with the common routines. be relieved by the patient.
When the muscles get weaker, the back pain The amount of pain decrease did not
gets stronger, so the patient is compelled to reveal any significant discrepancy between
being still. The defective cycle repeats itself the male and female groups. However, it was
significantly greater in men than women are related to the fact that muscular mass and
between the 1st and the 12th sessions. The contractile cords are more outnumbered in
decrease rate of the pain based on the VAS men than in women. When the training time
scale was roughly 12 units greater in men is enhanced, the muscular power is more
than in women between the 1st and 12th resulted from the muscular hypertrophy.
sessions. The previous studies also reported Men are of more muscular mass, rapid
the increase in muscular powers of the contractile motor units and hypertrophy.
various age groups after a period of They lead to the increase of power in men;
increasingly resistant trainings. The power consequently, the pressure on the joints is
increase is due to the neural flexibility, in relieved, and the pain decreases even
particular, during the beginning weeks of through to prove the issue requires the
exercises. There are evidence that less action assessment of the muscular power.
individuals fail to recall all motor units This project is faced some limitations
during the maximum voluntary contractions. including, small sample number, lake of the
Consequently, the greatest amount of power control group, lack of the evaluation for the
increase pertains to the muscular-neural EMG activities and muscular power.
flexibilities during the beginning weeks of
the exercises.
They, in turn, cause the better recalling for This study revealed that 6 weeks exercise
perfect motor units available. After the training program could reduce the greater
beginning weeks, the greater increase of amount of pain in males with lumbar disc
power will be cause of the hypertrophy (the herniation compared to females. This 6 weeks
increase of the segmental and physiologic core stabilizing exercise protocol could be a
level of the muscles) and the increase in the good recommendation for all patients with
segmental level of the muscular cords. As a disk herniated LBP.
result, the decrease amount of pain in both
groups has been identical because the
amelioration resulted from the exercises has Authors have no conflict of interest.
neural reasons during the 1st weeks of the
program, whereas when the exercise period
is elongated, the pain decrease is greater in The authors would like to thank Dr. Yazdani
men than in women. Probably, the reasons Rehabilitation Center for cooperation in
for the pain decrease among the male group this research.