Effects of stabilisation exercise on subclinical chronic low back pain
This was a mixed method study incorporating a randomized controlled trial (RCf) and focus
group interviews to explore the effects of spinal stabilization exercises on sub-clinical chronic low
back disorders and participants' perceptions of this type of treatment programme. Eighty four
participants (34 males and 50 females) in the RCf were randomly allocated to control (no
exercise) or exercise treatment groups in which they carried out stabilization exercises at different
frequencies i.e. once weekly, twice weekly or three times weekly. Outcome measures used in the
RCT were plasma serotonin concentration measured using an enzyme linked immunoassay
technique, multifidus cross sectional area measured with diagnostic ultrasound imaging, pain
intensity measured with numeric rating scale, functional disability measured with the Roland-
Moris Disability Questionnaire and quality of life measured with Nottingham Health Profile. Data
were collected at baseline, after six weeks of intervention and at 18 weeks follow up assessments.
The results of the RCf showed that spinal stabilization exercises produced a significant increase
in plasma serotonin concentration by 17.8% at all stages of data collection in all the exercise
groups. All the participants in the treatment groups experienced significant reduction, by more
than SO %, in pain and functional disability and improvement by more than 50% in quality of life
scores after six weeks of treatment (P <0.05). The extent of reduction in pain and functional
disability scores and improvement in quality oflife showed a clear trend in favour of the three
times weekly exercise group at 18 weeks follow up assessments. Significant increase in the size of
multifidus cross sectional area was observed only in the three times weekly exercise group
(P <0.05). A linear regression analysis showed significant correlation between the changes in
plasma serotonin and each of pain, functional disability and quality of life scores. (r values
ranged from 0.42 to 0.67, P < 0.05).
Following the RCf, nine participants (3 males and 6 females) took part in two focus groups
interviews. Open ended questions were used to maximize discussion. Audio recording was used
to record participant's opinions during the interview process. Careful checking, reading, and
correction of the transcripts was carried out and a thematic analysis was conducted on the data.
The main themes that emerged from the data analysis from the focus group interviews were:
• Participants' perception of the causes and aggravating factors for their low back disorders.
• Physical dimensions of participants' experience of low back disorders.
• Emotional and psychological dimensions of participants' experience of low back
• Perceived treatment effects on pain intensity and functional limitation.
• Impact of the treatment programme on participants' empowerment and self efficacy.
• Impact of information on participants' attitude to treatment.
• Relationship with the therapist.
• Compliance with the home programme of stabilization exercises.
• Suggestion for improvement in future studies involving spinal stabilization exercises.
The results of this study have indicated that an increased plasma serotonin concentration
gained by the use of stabilization exercises could have a role to play in the outcome of
treatment in patients with subclinical chronic LBP. The results generally indicated a better
outcome of treatment in the three times weekly exercise group. Participants' explanations for
the perceived improvements included major increases in confidence levels and formulation of
self help strategies. They also reflected on their ability to exert better control over their own
back pain, due to increased empowerment and self efficacy based on better understanding of
the spine and how it works.