Aleksiev Assen Romanov
From the Clinic of Physical Medicine and Rehabilitation, University Hospital Aleksandrovska, Medical University, Sofia, Bulgaria.
Spine (Phila Pa 1976). 2014 Jun 1;39(13):997-1003. doi: 10.1097/BRS.0000000000000338.
Randomized prevention trial.
To compare the long-term effect of strengthening versus flexibility exercises and to evaluate the additional effect of abdominal bracing in recurrent low back pain (LBP).
No conclusions could be made regarding appropriate exercise types or parameters in recurrent LBP. Abdominal bracing increases trunk stiffness; however, its long-term effect has not been evaluated in recurrent LBP yet.
Six hundred patients with recurrent LBP participated. They were randomized into 4 groups-150 patients (age: 42.5 ± 12.7) performed strengthening exercises; 150 patients (age: 41.3 ± 11.5) performed flexibility exercises; 150 patients (age: 41.0 ± 13.2) performed strengthening exercises and used abdominal bracing in daily activities/exercises; and 150 patients (age: 40.6 ± 12.3) performed flexibility exercises and used abdominal bracing in daily activities/exercises. At the beginning of the study and at the end of 10 consecutive years were recorded 6 outcomes-frequency, intensity, and duration of pain, as well as frequency, intensity, and duration of exercises.
Regarding the first 4 outcomes-all groups showed improvement from the beginning to the second year, but worsening from the second to the 10th year; there was no difference between strengthening and flexibility groups; bracing groups showed better results versus nonbracing groups. Intensity, frequency, and duration of the pain correlated with each other and with frequency of the exercises, but not with exercise duration or intensity.
The exercise frequency is more important than the type, duration, or intensity of the exercise. Abdominal bracing adds to the exercise effect. It could be considered as a "preliminary muscle back belt on demand" increasing the trunk stiffness and the frequency of the trunk muscle contractions/cocontractions without interruption of daily activities, which may remind/convince the patients to exercise more frequently. Frequent exercising and bracing seems effective long-term prevention advices in recurrent LBP.
随机预防试验。
比较强化锻炼与柔韧性锻炼的长期效果，并评估腹横肌激活训练对复发性下腰痛（LBP）的额外效果。
关于复发性LBP的适当运动类型或参数尚无定论。腹横肌激活训练可增加躯干僵硬度；然而，其在复发性LBP中的长期效果尚未得到评估。
600例复发性LBP患者参与研究。他们被随机分为4组——150例患者（年龄：42.5±12.7）进行强化锻炼；150例患者（年龄：41.3±11.5）进行柔韧性锻炼；150例患者（年龄：41.0±13.2）进行强化锻炼并在日常活动/锻炼中使用腹横肌激活训练；150例患者（年龄：40.6±12.3）进行柔韧性锻炼并在日常活动/锻炼中使用腹横肌激活训练。在研究开始时和连续10年结束时记录6项结果——疼痛的频率、强度和持续时间，以及锻炼的频率、强度和持续时间。
关于前4项结果——所有组从开始到第2年都有改善，但从第2年到第10年恶化；强化锻炼组和柔韧性锻炼组之间没有差异；使用腹横肌激活训练组比未使用组效果更好。疼痛的强度、频率和持续时间相互关联，且与锻炼频率相关，但与锻炼持续时间或强度无关。
锻炼频率比锻炼类型、持续时间或强度更重要。腹横肌激活训练可增强锻炼效果。它可被视为一种“按需使用的初步肌肉背带”，可增加躯干僵硬度和躯干肌肉收缩/协同收缩的频率，且不影响日常活动，这可能会提醒/促使患者更频繁地锻炼。频繁锻炼和使用腹横肌激活训练似乎是复发性LBP长期预防的有效建议。
2级。
