Academic journal article Journal of Physical Education and Sport

The Effect of a Pilates Exercise Programme Using Fitball on People Suffering from Chronic Low-Back Pain in Terms of Pain Reduction and Function Imrovement

Academic journal article Journal of Physical Education and Sport

The Effect of a Pilates Exercise Programme Using Fitball on People Suffering from Chronic Low-Back Pain in Terms of Pain Reduction and Function Imrovement

Article excerpt

Introduction

Low-back pain is one of the most common and widely studied musculoskeletal problems in the Western world and the leading cause of disability and absence from work among adult people up to 45 years old in industrialised societies (Fonseca, Magini & Freitas, 2009; Rydeard, Leger & Smith, 2006). It has been estimated that 11% to 84% of adults will have an occurrence of low-back pain at least once in their lifetime and about 40% of these patients will develop chronic low-back pain (Walker, 2000). People who will develop chronic low-back pain (7-10%), correspond to a percentage as high as 75-90% of the health cost regarding low-back pain (Twomey & Taylor, 1995).

Chronic low-back pain is a complex phenomenon which can be influenced by many factors, divided into two categories, physical and psychosocial (Manchikanti, 2000). Physical factors associated with low-back pain include muscle weakness and imbalances, repetitive movement disorders, deficient activation of the deep abdominal muscles, poor control of the trunk stabilizer muscles' function and neuromuscular dysfunction (Hodges & Richarson, 1996; O'Sullivan, Twomey & Allison, 1997). Psychosocial factors have been found to play a significant role in chronic low-back pain. Psychological aspects of low-back pain include depression, fear of moving, treatment expectations, self-perception, lack of control and other personal factors (Feuerstein & Beattie, 1995; Lackner & Carosella, 1999,).

Current documentation shows that some of the best outcome indicators regarding chronic low-back pain are of psychosocial nature. The perceived loss of control due to pain, the expected reduced performance and the fear of re-injury are thought to reduce functionality. The fear of re-injury and kinesiophobia are both considered to be accurate predictors of the functional outcome regarding low-back pain (Woby, Watson, Roach & Urmston, 2004). This verifies that inability associated with low-back pain has more to do with the perceived loss of control than the pathological situation itself (Porterfield & Rosa, 1991).

There is a wide range of options for the treatment of low-back pain. These interventions can be categorized as either active or passive, as they are related to physical and psychological factors.

An active intervention is the Pilates method initially practiced almost exclusively by athletes and dancers. However, it recently became popular in the fields of rehabilitation and exercise. Pilates exercises focus on the spine extensors and abdominal muscles, in particular the transverse abdominal muscle, and aim at strengthening the core. The aim of strengthening the core without tension in the peripheral joints is achieved through coordinated breathing and movement, stabilization of the shoulder girdle, thorax and pelvis during movement of the abdominal muscles and correct positioning of the head and neck to avoid neck strain.

Pilates instructors provide physical assistance and verbal feedback to maximize accuracy in performance and safety during exercise. The evolution of the exercises on the ground initially uses a wide support base of the trunk in the prone, lateral and supine position, while moving the ends to differentiate torque trunk muscles. As the individual develops enhanced strength and mobility, support is gradually reduced to retrain proprioceptive mechanisms, while enhancing more efficient movement patterns. This process is similar in principle to the dynamic stabilization exercises that are widely used in the treatment and prevention of low-back pain that supports the effectiveness of deep stabilizers, as well as in the reduction of muscle contraction which is counterproductive to functionality (Anderson, 2000). The proprioception is the link between the musculoskeletal and nervous system and essential for the stability of the spine. It has been shown that inhibition of deep proprioception due to pain or habit can lead people to develop compensatory motor patterns, which prolong the recovery process due to inefficient biomechanics after injury (Anderson, 2000). …

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