Neuromuscular control of walking with chronic low-back pain. Efficacy of graded activity versus supervised exercises in patients with chronic non-specific low back pain: protocol of a randomised controlled trial
The reported association of low-back pain and musculoskeletal disorders contributed to the examination of the lumbar spine and hip extensor activation patterns in back pain sufferers during walking . Seventeen idiopathic low-back pain male subjects and 16 healthy volunteers participated in the study .  Hip joint ROMs in the sagittal plane and neuromuscular activities of erector spinae [ L3 , T12 ] , gluteus maximus and biceps femoris were recorded on one r and omly selected body side in each group . Analysis using the Student 's t-test revealed significant differences for hip joint range of motion , stride time and significantly earlier onsets of the lumbar spine and hip extensors of the back pain sufferers compared with the healthy controls . It is assumed , that low-back disorders are related to changes of the lumbar spine and hip extensor recruitment pattern Background Low back pain is a relevant public health problem , being an important cause of work absenteeism worldwide , as well as affecting the quality of life of sufferers and their individual functional performances . Supervised active physical routines and of cognitive-behavioral therapies are recommended for the treatment of chronic Low back pain , although evidence to support the effectiveness of different techniques is missing . Accordingly , the aim of this study is to contrast the effectiveness of two types of exercises , grade d activity or supervised , in decreasing symptoms of chronic low back pain . Methods / design Sample will consist of 66 patients , blindly allocated into one of two groups : 1 ) Grade d activity which , based on an operant approach , will use time-contingent methods aim ing to increase participants ’ activity levels ; 2 ) Supervised exercise , where participants will be trained for strengthening , stretching , and motor control targeting different muscle groups . Interventions will last one hour , and will happen twice a week for 6 weeks . Outcomes ( pain , disability , quality of life , global perceived effect , return to work , physical activity , physical capacity , and kinesiophobia ) will be assessed at baseline , at treatment end , and three and six months after treatment end . Data collection will be conducted by an investigator blinded to treatment allocation . Discussion This project describes the r and omisation method that will be used to compare the effectiveness of two different treatments for chronic low back pain : grade d activity and supervised exercises . Since optimal approach for patients with chronic back pain have yet not been defined based on evidence , good quality studies on the subject are necessary . Trial registration
Pooled data revealed no significant difference in the overall activity level of adults or adolescents with CLBP , however there is evidence that older adults with chronic low back pain are less active than controls .
The results suggest that patients exhibit an altered pattern of physical activity over the course of a day compared to controls .
There is no conclusive evidence that patients with chronic low back pain are less active than healthy individuals .
Based on a limited number of studies , there is some evidence that the distribution of activities over the course of a day is different between patients with chronic low back pain and controls
BACKGROUND It is commonly assumed that patients with chronic low back pain are less active than healthy individuals .
There has been a recent increase in the number of studies published comparing the physical activity levels of patients with chronic low back pain and healthy individuals .
OBJECTIVES The aim of this systematic review was to determine , based on the current body of evidence , if patients with chronic low back pain have a lower level and /or altered pattern of physical activity compared with asymptomatic , healthy individuals .