Efficiency of trunk stabilizing exercises in treatment of patients with lumbar pain syndrome

© 2013 Eldad Kaljiæ et al.; licensee University of Sarajevo Faculty of Health Studies. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. UNIVERSITY OF SARAJEVO FACULTY OF HEALTH STUDIES ABSTRACT


INTRODUCTION
Lumbar pain syndrome is the most common cause of temporary work disability in people under 45 years of age (1).In most of the patients the condition is followed by work disability and the need for adequate medical treatment (2).It is defi ned as pain in the area between the 12th thoracic rib and gluteal segment, with or without radiation to the lower extremities (3).It is the second leading cause of pain occurrence (4).If the aforementioned symptomatology lasts less than 6 weeks, then the lumbar pain syndrome is acute.Duration from 6 to 12 weeks indicates the subacute stage, while over 12 weeks is chronic stage (5).Diagnosis is based on medical history, clinical examination, tests for evaluation of functional status and radiological verifi cation.Treatment can be conser-vative (pharmacological and physical therapy), surgical and combined (manual and pharmacological therapy, bed rest, physical therapy and acupuncture).In addition to the treatment of syndrome causes, it is necessary to reduce the risk of re-occurrence with trunk stabilizing exercises leading to the strengthening of the hull muscles and improvement of functional status of patient (6).Eff ects of trunk musculature exercises are refl ected in the reduction of pain and disabilities caused by syndrome and in improvement of function of the lumbar spine (7,8).Studies show that educational programs for exercises significantly improve functional status of offi ce workers (9).Th e aim of this study was to detect the frequency of acute and chronic lumbar pain syndrome in people of both gender, diff erent age structures, diff erent occupations and in active working population, and to determine the effi ciency of trunk stabilizing exercises in their treatment.

Patients
Th e study included 27 patients with diagnosis of acute lumbar pain syndrome and 33 patients with diagnosis of chronic lumbar pain syndrome who were treated in the clinic "Praxis" in the period from 01.01.2010 to 31.12.2012year.Th e patients were of both gender, diff erent age groups and active working respondents of 15 diff erent professions: doctor, veterinarian, teacher, engineer, lawyer, economist, offi cial, laborer, craftsman, farmer, housewife, retired, pupil, student and others.Criteria for inclusion of the respondents in the study: the research included respondents of both gender, diff erent age groups and active working respondents of 15 diff erent professions treated in the mentioned period and with verifi ed lumbar pain syndrome (clinical examination, radiological tests) and estimated condition before treatment (clinical examination).Criteria for exclusion of the respondents in the study were patients without estimated condition after treatment, those who left treatment or did not abide by the treatment protocols.

Research methods
Th e study was conducted as a retrospective, analytical, non-experimental before-and-after study.Data were obtained from a special software program which is used for collecting and analyzing the variables needed for research.Condition of respondents before and after treatment was estimated by the following methodology: 0 -immobile 1 -diffi cult mobility with the assistance of someone else 2 -diffi cult mobility with the help of aids 3 -satisfactory functional status and capable of everyday activities 4 -good functional status 5 -normal functional status for every day life activities and work (10).Method of treatment of lumbar pain syndrome in the clinic "Praxis" consists of trunk stabilizing exercises which include: -trunk stretching exercises -exercises to strengthen ventral abdominal musculature -exercises to strengthen lateral abdominal musculature exercises to strengthen the back musculature Research results were estimated by the following methodology: 0 -condition remains unaff ected 2 -minimal improvement 3 -satisfactory improvement with the consequences of injury or illness 4 -good improvement with satisfactory functional restitution 5 -good functional restitution without sequel 6 -left treatment 7 -further medical treatment, diagnostic or surgical, is required (10).

Statistical analysis
In this research, we used the percentages of representation and the mean values of condition of respondents before and after treatment.

DISCUSSION
By data analysis in the clinic "Praxis" 27 respondents suff ering from acute lumbar pain syndrome and 33 respondents suff ering from chronic lumbar pain syndrome were treated during the period from 01.01.2010 to 31.12.2012year.
Th e age structure of respondents suff ering from acute lumbar pain syndrome consisted of 4 male respondents and 1 female respondent age group from 25 to 34 years, 3 male respondents and 8 female respondents age group from 35 to 44 years, 3 male respondents and 2 female respondents age group from 45 to 54 years and per 2 male respondents and 1 female respondent each age groups from 55 to 64 and over 65 years of age.
For chronic lumbar pain syndrome 1 male respondent and 6 female respondents belonged to the age group from 25 to 34 years, 2 male respondents and 2 female respondents to the group from 35 to 44 years, 3 male respondents and 5 female respondents to the group from 45 to 54 years, 5 male respondents and 2 female respondents to the group from 55 to 64 years and 2 male respondents and 5 female respondents to the age group over 65 years of age.Th e largest number of respondents suff ering from acute lumbar pain syndrome were offi cials by profession 10 (37.04%), the second largest number were economists 5 (18:51%) and lawyers 4 (14.81%).A smaller number of respondents were engineers and retired people 2 (7:40%), while the least represented occupations were doctor, housewife, student and others 1 (3.70%) respondent per each.For chronic lumbar pain syndrome 13 (39.39%) of the respondents were offi cials, followed by retired people 6 (18:18%), engineers 5 (15:15%), economists 3 (9.09%)and lawyers (6.06%), whereas the smallest number of respondents 1 (3.3%) per occupation were doctor, teacher, laborer and housewife.Moore C. and associates have been investigating the occurrence of lumbar pain syndrome in healthcare workers with sitting jobs during the period of one year.Among the respondents who have been doing exercises daily there was no occurrence of lumbar pain syndrome, whereas 60% of respondents of the control group experienced pain in the lumbar spine (11).Th e mean score of condition of respondents with acute lumbar pain syndrome before therapy is 2.96, whereas after treatment is 4.71.Th e mean score of condition of respondents with chronic lumbar pain syndrome before therapy is 3.76, whereas after treatment is 4.63.Mean score of treatment results of patients suff ering from acute lumbar pain syndrome is 4.71, while for chronic lumbar pain syndrome is 4.27.Th e research conducted by França FR. and associates showed that lumbar spine stabilizing exercises lasting for 6 weeks, twice a week for half an hour, are eff ective in reducing pain and disabilities caused by lumbar pain syndrome (12).G. Morone and associates conducted the research about improving quality of life of patients with chronic lumbar pain syndrome.Th ey used a multidisciplinary program of exercises for the back.Th e results showed a signifi cant reduction in pain and disabilities caused by chronic lumbar pain syndrome after three and six months (13).

CONCLUSIONS
From acute lumbar pain syndrome most often suffered female respondents age group from 35 to 44 years old, while in the male respondents was equally represented in all age groups.Chronic lumbar pain syndrome was most often represented in male respondents life age from 55 to 64 years and in female respondents age group from 25 to 34 years old.Respondents who are offi cials by occupation are most commonly aff ected by acute and chronic lumbar pain syndrome.Treatment with trunk stabilizing exercises performed in the clinic "Praxis" leads to an improved scores of condition of respondents after treatment.Ratings of treatment results indicate that the treatment with trunk stabilizing exercises in the early stages of lumbar pain syndrome is more successful.

TABLE 1 .
Gender and age structure of respondents with acute lumbar pain syndrome

TABLE 2 .
Gender and age structure of respondents with chronic lumbar pain syndrome

TABLE 3 .
Structure of the respondents according to occupation -Acute lumbar pain syndrome

TABLE 4 .
Structure of the respondents according to occupation -Chronic lumbar pain syndrome

TABLE 5 .
Condition of respondents before treatment -Acute lumbar pain syndrome

TABLE 6 .
Condition of respondents after treatment -Acute lumbar pain syndrome

TABLE 7 .
Condition of respondents before treatment -Chronic lumbar pain syndrome

TABLE 8 .
. Condition of respondents after treatment -Chronic lumbar pain syndrome

TABLE 9 .
Treatment results -Chronic lumbar pain syndrome