Consort flowchart for enrollment, randomization, and treatment of the participants. Intervention Group: completed cases using the intention-to-treat analysis.
anxiety, knees, musculoskeletal pain, pain, depression
CONTRACTION, DECUBITUS
The inclusion criteria were CNLBP for ≥3 months, no history of irradiation to the lower limbs, pain intensity ≥3 points on the 10-point pain scale, pain frequency of at least three times a week, age 18-72 years, both sexes, and ability to attend the sessions.Exclusion criteria were body mass index >30 kg/mTreatments were delivered by the researcher twice a week, totaling 12 sessions of 1 h for each patient. Patients were instructed not to participate in any other treatment during the study period, including physical activity, and inform if they needed medication for musculoskeletal pain, depression, and anxiety.Patients were divided into two groups of 18 participants each: the intervention group, which received 20 min of continuous SWD application and the control group, which received placebo SWD, that is, they were positioned similarly to the intervention participants, with the plates maintained under the lumbar region for 20 min with the equipment in off mode.The equipment used was shortwave diathermy (THERMOWAVEFor both groups, the Pilates protocol was performed for 40 min (mat Pilates modality), totaling 12 exercises with 15 slow repetitions each and a rest interval of three to five breaths. All exercises were performed individually and were supervised by the researcher (Awareness and activation of the pelvic floor muscles and abdominal core: a) Neutral Hip Position: dorsal decubitus with knees flexed and feet supported with contraction of the abdomen and pelvic floor; b) Rail Abdominal: dorsal decubitus with extended hips and legs and trunk elevation.Engagement of the arm muscles: a) Hundred: dorsal decubitus with knees flexed, feet supported, and arm swing.Stretching and strengthening of the flexor and extensor muscles of the ankles: a) Leg Stretch with Foot Movement: dorsal decubitus with one leg raised with foot flexion and extension, and the other flexed with foot supported.Strengthening of the extensor muscles of the knees: a) Single Leg Stretch I: dorsal decubitus with raised leg and knee flexion and extension, and the other knee flexed with foot supported.Strengthening of the extensor and flexor muscles of the hips: a) Bridge: dorsal decubitus with knees flexed, feet supported, and hips elevated; b) Single table top: dorsal decubitus raising and lowering one leg flexed at 90 degrees, and the other with knee flexed and foot supported; c) Single leg stretch II: dorsal decubitus raising and lowering one leg outstretched, and the other with knee flexed and foot supported.Strengthening of the adductor and abductor muscles of the hip: a) Oyster Frontal: dorsal decubitus opening and closing knees with feet supported; b) Lateral Oyster: lateral decubitus with flexed knees, moving the top knee apart and closer.Stretching of the spine: a) Hug Legs: dorsal decubitus hugging bent legs; b) Dog Stretch: four supports with glutes in the heels and spine elongated downwards.Pilates emphasizes strengthening and activation of the deep muscles of the trunk, posterolateral and anteromedial chains of the hips and thighs, sacroiliac stabilization, flexibility of the lower limbs and spinal muscles, and overall muscles resistance (All participants were instructed on appropriate postures during sleep, activities of daily living, and work. These guidelines were followed for both groups during the initial three sessions of SWD (