Olaoye Mistura Iyabo, Okonji Raphael, Ademoyegun Adekola, Gebrye Tadesse, Yeowell Gillian, Fatoye Francis, Mbada Chidozie
Department of Physiotherapy, Osun State University Teaching Hospital, Osogbo - Nigeria.
Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife - Nigeria.
Arch Physiother. 2025 Sep 17;15:229-249. doi: 10.33393/aop.2025.3331. eCollection 2025 Jan-Dec.
Apart from mechanical dysfunction, low back pain (LBP) is also associated with underlying inflammatory and muscle-related biochemical changes. An increase in certain biomarkers, such as IL-10, a key anti-inflammatory cytokine, provides a positive objective indicator of underlying physiological responses to interventions in LBP beyond subjective clinical measures. This study assessed the effects of McKenzie Extension Protocol (MEP), Static Back Extension Endurance (SBEE), and Dynamic Back Extension Endurance (DBEE) on selected clinical outcomes and biomarkers of muscle status [creatine kinase (CK)] and inflammation (IL-4 and IL-10) in LBP.
A randomized controlled trial involving 76 patients with chronic LBP who were randomly assigned to MEP, SBEE, or DBEE groups was conducted. MEP involved a specific sequence of lumbosacral repeated movements in extension. SBEE involved five different back extensor muscle endurance protocols of increasing difficulty level. DBEE was a dynamic replica of the SBEE. Pain, CK, IL-4, and IL-10 were the primary outcomes. Functional disability and health-related quality of life were the secondary outcomes. Assessments were conducted at baseline, 3rd, and 6th week of the study.
MEP and SBEE caused significant effects in all clinical and biochemical variables (p < 0.05) except IL-4 and IL-10 (p > 0.05). DBEE yielded no significant effects on IL-4 and IL-10 (p > 0.05). MEP had a significantly higher effect on pain (p < 0.05). SBEE had a greater impact on IL-4 (p < 0.05) and IL-10 (p < 0.05) at week 3. SBEE led to a higher impact on IL-4 (p < 0.05) and IL-10 (p < 0.05) at week 6. All interventions had comparable effects on other clinical parameters at week 6 (p > 0.05).
MEP reduced pain more, while SBEE led to higher changes in IL-4 and IL-10 inflammatory biomarker levels. Serum CK levels rose in all groups without indicating muscle damage. The results suggest that these exercises show potential benefits in modulating inflammation and enhancing muscle status, potentially supporting tissue repair and reducing chronic LBP, and therefore should be incorporated as part of strategies targeting underlying inflammatory processes in the management of chronic LBP.
除了机械功能障碍外，腰痛（LBP）还与潜在的炎症和肌肉相关的生化变化有关。某些生物标志物的增加，如关键的抗炎细胞因子白细胞介素-10（IL-10），为腰痛干预的潜在生理反应提供了一个积极的客观指标，超越了主观临床测量。本研究评估了麦肯齐伸展方案（MEP）、静态背部伸展耐力（SBEE）和动态背部伸展耐力（DBEE）对腰痛患者选定的临床结局以及肌肉状态[肌酸激酶（CK）]和炎症（IL-4和IL-10）生物标志物的影响。
进行了一项随机对照试验，纳入76例慢性腰痛患者，他们被随机分配到MEP、SBEE或DBEE组。MEP包括腰骶部重复伸展运动的特定序列。SBEE包括五个难度逐渐增加的不同背部伸肌耐力方案。DBEE是SBEE的动态模拟。疼痛、CK、IL-4和IL-10是主要结局。功能障碍和与健康相关的生活质量是次要结局。在研究的基线、第3周和第6周进行评估。
除IL-4和IL-10外（p>0.05），MEP和SBEE对所有临床和生化变量均有显著影响（p<0.05）。DBEE对IL-4和IL-10没有显著影响（p>0.05）。MEP对疼痛有显著更高的影响（p<0.05）。SBEE在第3周对IL-4（p<0.05）和IL-10（p<0.05）有更大影响。SBEE在第6周对IL-4（p<0.05）和IL-10（p<0.05）有更高影响。在第6周，所有干预对其他临床参数的影响相当（p>0.05）。
MEP能更有效地减轻疼痛，而SBEE能使IL-4和IL-10炎症生物标志物水平有更大变化。所有组的血清CK水平均升高，但未表明存在肌肉损伤。结果表明，这些运动在调节炎症和改善肌肉状态方面显示出潜在益处，可能有助于组织修复并减轻慢性腰痛，因此应作为针对慢性腰痛管理中潜在炎症过程的策略的一部分。
