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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Bertocco P., Montesano A., Baccalaro G., Parisio C., Vismara L.
Italian Auxetic Division IRCSS Piancavallo Hospital, Piancavallo (VB), Italy
Aim. Low back pain is a frequent complication of severe obese patients. The pathogenetic mechanism of low back pain in these patients is still under investigation. Our study try to explain the causes and the therapeutic approach to be carried out. The aim of the study was to assess the efficacy of 2 different rehabilitative treatments on muscle strength, decrease of pain and functional improvement in obese patients with chronic low back pain.
Methods. Cross-sectional, randomized, controlled study (active exercise vs laser-therapy) assessed by an isokinetic troncular device. Twenty-one obese inpatients with low back pain were included and subdivided in 2 groups. The exercise group carried out a standardized protocol, while the other one was treated by a physical therapy (soft-laser and ultrasound therapy) on the back lumbar spine. At the beginning and at the end of the program spinal muscular strength and power were assessed by an isokinetic device (Cybex Norm with trunk extension/flexion adaptor, Elekton) at 30°/s, 60°/s, 90°/s of angular velocity (AV); pain was evaluated by the Visual Analogue Scale (VAS).
Results. Peak torque (PT) and total work (TW) increased at the increase of AV, both in flexor and extensor muscles in the 2 groups. There was a significative decrease of PT and TW at 30° AV in the group treated by physical therapy. The trend of the PT and TW spine improvement at the AVs tested was similar in the 2 groups. VAS decreased similarly in the 2 groups. The coefficient of variation (CV) of the spine movements for flexors and extensors was about 3 and 8, respectively.
Conclusion. Our study points out the importance of an active postural exercise and an associated physical therapy program tailored for obese patients with low back pain. The exercise protocol is likely to improve spine mobility and to decrease back pain, by a better coordination of co-contraction of long erector and rotator spine muscles. The isokinetic trunk device is not able to detect the real and net gain of distrectual motion improvement and spine mobility.