The main aim of the presented diploma thesis was to record objective and subjective changes after therapy with DNS concept in a group of 13 people with LBP. Moiré projection topography was used to record postural changes after 5.5 week therapeutic intervention. It was not clear, whether DNS exercise would help them to achieve visible postural changes and whether this technique is able to record these changes, which would mean that it is a suitable option for objectivisation of therapies focusing on correction of stabilisation and postural functions. Pedoscan was used for further objectivisation of the effect of DNS concept. The chosen correlate of the mentioned objective evaluation was Oswestry disability index, evaluating limitations of common everyday activities resulting from pain in the lower back, and the Numeric pain scale. Patients underwent 5 hour-long physiotherapeutic lessons, the recommended frequency of exercises in the household environment was 3-4 times per day. The probands exercised with the use of DNS concept according to the individual examination findings, especially in the area of the integrated spine stabilisation system. The data were statistically elaborated by Wilcoxon Signed-Rand test, which a non-parametric variant of the pair T-test. It is obvious from the results that...

The main target of this thesis was to detect objective changes in the implementation of four postural locomotor tests DNS and during walking. The movements were recorded using the optical MoCap - the kinematic analysis Qualisys. The particular interest of the investigation was to determine the current stabilization of the spine system in individual subjects aged 25 to 55 years, which was documented by means of the angular deflection of each segment, the flat segment deviation or the shift of the marker in a coordinate system. The measurement results were compared between ten individuals with LBP and ten persons without any difficulty who were placed into the control group. The data were collected using the software QTM and Visual3D and subsequently were statistically processed. A statistically significant difference was observed during walking when comparing the angular deflection of the pelvis to the chest at the rotation and lateroflexion (ř). The significant difference of the pelvis shift toward the chest during flexion and rotation (ř) was showed in a deep squat test, but the difference was not confirmed in lateroflexion (ř). Furthermore, no statistical difference of the lateral deflection of the same segment (pelvis or chest) (cm) in patients with LBP compared to all subjects during the...

Title: A systematic review of pain assessment tools Objectives: The aim of this thesis is to create a systematic review of the most widely used multidimensional tools (questionnaires) for assessing pain in patients with nonspecific pain of the cervical and lumbar spine. From the available sources, describe their use, the purpose it was generated for, their reliability, validity, and finally arrange the questionnaires from the most used and assess their advantages and disadvantages for use in clinical practice of physiotherapist. Method: The thesis is processed through a systematic review. The subject of the thesis are pain evaluating tools, especially in the cervical and lumbar spine. The studies containing questionnaires used to assess pain in the cervical and lumbar spine were searched out. Data extraction was carried out according to pre-specified criteria. Unsatisfactory studies were excluded. After the relevant questionnaires selection a content analysis of each tool was conducted, built a systematic review of the most commonly used questionnaires and their critical evaluation. Results: On the basis of the entire set of relevant studies I described and evaluated 14 questionnaires. Five of them are designed specifically for low back pain. They are the Roland Morris Disability Questionnaire,...

La lombalgie compte parmi les causes principales d’incapacité chez des membres des Forces armées canadiennes (FAC). Une prise en charge efficace de cette condition est donc primordiale afin de maintenir des forces opérationnelles. Les études randomisées contrôlées réalisées auprès de la population générale suggèrent que la direction préférentielle (DP) est efficace pour guider la prise en charge de la lombalgie. Toutefois, aucune étude n’a investigué l’efficacité d’une telle approche en contexte réel ou auprès de la population militaire. L’objectif de ce mémoire était d’évaluer, dans le contexte réel de la pratique clinique, l’efficacité d’une prise en charge guidée par la DP parmi des membres des FAC souffrant de lombalgie. Pour ce faire, une étude observationnelle de cohorte incluant 44 membres consentant des FAC a été réalisée. Les patients du groupe exposé (n=22) ont reçu des interventions guidées par la DP. Les patients du groupe non-exposé (n=22) ont reçu les soins usuels, soit des interventions déterminées par leur physiothérapeute, mais pas d’approche guidée par la DP. Les données ont été colligées et comparées entre les deux groupes au début de l’étude, à 1 mois, et à 3 mois grâce à un questionnaire autoadministré concernant la douleur (intensité, localisation, fréquence), l’incapacité perçue, la consommation de médicaments, et l’effet global perçu (douleur, fonctionnement et état général). La perte de productivité et l’utilisation de soins de santé ont été mesurées à 3 mois grâce au dossier médical électronique. Des différences statistiquement significatives en faveur du groupe exposé à une prise en charge guidée par la DP ont été observées pour l’intensité de la douleur (Δ à 1 mois : 1,9/10; Δ à 3 mois : 1,3/10), l’incapacité perçue (Δ 1 mois : 4,3/24; Δ 3 mois : 3,5/24), l’amélioration de l’effet global perçu à 1 mois (douleur : 86,4 % vs 57,1 %; fonctionnement : 81,8 % vs 47,6 %; état général : 86,4 % vs 57,1 %) et à 3 mois (douleur : 95,5 % vs 71,1 %; état général : 95,5 % vs 66,7 %), et l’amélioration du statut au travail à 3 mois (54,5 % vs 23,8 %). Malgré les limites de notre étude, nos résultats suggèrent qu’en conditions réelles de pratique, la prise en charge guidée par la DP est plus efficace que les soins usuels pour réduire la douleur et l’incapacité chez les membres des FAC souffrant de lombalgie. / Abstract : Low back pain (LBP) is a leading cause for disability in Canadian Armed Forces (CAF) members. Efficacious and cost-effective management for LBP is thus essential to maintaining operational capabilities. In randomized controlled trials among the general population, directional preference (DP) was shown useful to guide treatment of LBP, but no studies have investigated this in real-life settings or in military personnel. The purpose of this study was to evaluate, in real-life clinical practice, the effectiveness of DP to guide management of LBP in CAF members when compared to usual care. To that purpose, we conducted a cohort study including 44 consenting CAF members with LBP. Patients in the exposed group (n=22) were assessed for DP and received matching interventions. Patients in the non-exposed group (n=22) received interventions as determined by their treating physiotherapist, excluding any DP-guided treatments. Data were collected and compared between groups at baseline, at 1-month and at 3-month follow-up using self-administered questionnaires regarding pain (intensity, location, frequency), perceived disability, medication, and perceived global effect (pain, function, overall status). Work loss and health care utilization were measured at 3 months using electronic health records. Statistically significant differences, favoring the exposed group, were observed for pain intensity (Δ at 1 month: 1.9/10; CI 95%; 0.97 – 2.89; Δ at 3 months: 1.3/10; CI 95%: 0.35 – 2.31), disability (Δ at 1 month: 4.3/24; CI 95%: 2.12 – 6.38; Δ at 3 months: 3.5/24; CI 95%; 1.59 – 5.33), perceived global effect at 1 month (pain: 86.4% vs 57.1%; function: 81.8% vs 47.6%; overall status: 86.4% vs 57.1%) and at 3 months (pain: 95.5% vs 71.1%; overall status: 95.5% vs 66.7%) with p-values <.05, and improvement in work status (3 months: 54.5% vs 23.8%). Our data suggest that DP-guided management is more effective than usual care physiotherapy to reduce pain and improve function in CAF members with LBP. Our findings are useful to inform clinicians and policy makers to improve management strategies for CAF members.

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<p>Uvod: Lumbalni bolni sindrom (LBS) podrazumeva tegobe u vidu bolova, u lumbalnom ili lumbosakralnom segmentu kičmenog stuba, sa ili bez iradijacije u donje ekstremitete, uz poremećaj funkcije umbosakralnog dela kičmenog stuba, za&scaron;titnu mi&scaron;ićnu reakciju na bol (spazam) uz moguće znake senzitivnog poremećaja. Laser male snage (LMS) ima &scaron;iroku primenu u fizikalnoj medicini i rehabilitaciji zbog analgetskog, antiinflamatornog, antiedematoznog i biostimulativnog dejstva. Cilj rada: Glavni ciljevi su bili da se utvrdi da li fizikalna terapija primenom LMS utiče na smanjenje bola, povećanje pokretljivost lumbalne kičme, smanjenje spazma pravertebralne muskulature, kao i na smanjenje funkcionalne osnesposobljenosti u subakutnom LBS. Materijal i metode: Sprovedena je prospektivna studija na 123 pacijenata (50 mu&scaron;karaca i 73 žene), različitih profesija, izabranih metodom slučajnog izbora, prosečne životne dobi 32.59&plusmn;5.67 godina (ispitivana grupa 31.87&plusmn;5.84, kontrolna grupa 33.31&plusmn;5.45, raspon od 19-45). U studiju su uključeni ispitanici koji su prvi put doživeli lumbalni bolni sindrom koji su pregledani u Odeljenju za fizikalnu medicinu i rehabilitaciju Doma zdravlja Novi Sad. Ispitivanu grupu je činio 61 ispitanik koji su uključeni u fizikalni tretman, primenom laseroterapije i kineziterapije uz medikamentoznu terapiju. Kontrolnu grupu je činilo 62 ispitanika koji koji su uključeni u fizikalni tretman primenom kineziterapije uz medikamentoznu terapiju. Svim ispitanicima je uzeta anamneza, obavljen klinički pregled, izvr&scaron;ena samoprocena bola i popunjavali su upitnike. Navedeno ispitivanje je sprovedeno na početku tretmana, nakon 6 nedelje i nakon sprovedenog tretmana. Kori&scaron;ćeni su sledeći upitnici: vizuelna analogna skala (VAS), standardizovani upitnici za merenje funkcionalnog ishoda - The Oswestry Disability Index (ODI), The Rolland&amp;Morris Disability Questionnaire (RMDQ) i SF-36 upitnik. Rezultati: Rezultati ukazuju da se intenzitet bola meren VAS skalom u obe ispitivane grupe značajno smanjivao tokom svih posmatranih perioda ispitivanja, pri čemu dobijena razlika između dve grupe nije statistički značajna (p=0.904). Pokretljivost lumbalne kičme u obe ispitivane grupe tokom posmatranog perioda se značajno povećala tokom svih posmatranih perioda ispitivanja, pri čemu dobijena razlika između dve grupe nije statistički značajna (p=0.798). U obe ispitivane grupe spazam paravertebralne muskulature se značajno smanjivao tokom svih posmatranih perioda ispitivanja, dok dobijena razlika između grupa nije statistički značajna (p=0.453). Funkcionalna onesposobljenost pacijenata (procenjivana smanjenjem funkcionalne onesposobljenosti ODI i RMDQ) se značajno smanjivala u obe ispitivane grupe pacijenata tokom svih posmatranih perioda ispitivanja. Dobijena razlika u skorovima procenjivana RMDQ između ispitivanih grupa pacijenata nije statistički značajna (p=0.648), kao i putem ODI skora između ispitivanih grupa (p=0.311). Procena funkcionalne onesposobljenosti putem procene kvaliteta života (SF-36), ukazuje da se kvalitet života značajno povećavao u svim ispitivanim skorovima u obe ispitivane grupe tokom svih posmatranih perioda ispitivanja. Nema razlika u funkcionalnoj onesposobljenost (SF-36), odnosno nema razlike u kvalitetu života u skorovima fizičko funkcionisanje, ograničenje zbog emocionalnih problema, socijalno funkcionisanje, mentalno zdravlje, telesni bol, energija i vitalnost, sumarni skor fizičkog i sumarni skor mentalnog zdravlja između ispitivanih grupa. Dimenzije kvaliteta života u skorovima ograničenje zbog fizičkog zdravlja je značajno bolje u kontrolnoj grupi ispitanika (p=0.028). Dimenzija kvaliteta života u skoru op&scaron;te zdravlje je značajno bolje u ispitivanoj grupi pacijenata (p=0.041). Zaključci. Primenom LMS u subakutnom LBS do&scaron;lo je statistički značajnog smanjenja intenziteta bola, povećanja pokretljivosti lumbalne kičme, smanjenja spazma paravertebralne muskulature, kao i smanjenja funkcionalne onesposobljenosti. S obzirom da ne postoji koncenzus oko primene LMS, kao ni drugih metoda fizikalne terapije u subakutnom stadijumu LBS, navedeni rezultati bi mogli doprineti usvajanju kliničkih smernica, odnosno dijagnostičkih i terapijskih protokola za subakutni LBS.</p> / <p>Introduction: Low back pain syndrome (LBP) implies pain in the lumbar or lumbosacral segment of the spine, with or without irradiation into the lower extremities, with a disorder to the function of the lumbosacral part of the spine, a protective muscular reaction to pain (spasm) and possible signs of a sensory processing disorder. Low-Level Laser Therapy (LLLT) has broad application in physical medicine and rehabilitation due to analgesic, antiinflammatory, anti-edematous and biostimulative effects. Objective: The main objective of this study was to determine whether physical therapy with a LLLT has an effect on reducing pain, increasing mobility in the lumbar spine, reducing spasms of the paravertebral muscle, as well as in reducing functional incapacity in subacute LBP. Material and methods: A prospective study was conducted on 123 patients (50 men and 73 women), of different professions, chosen through random selection, with a mean age of 32.59 &plusmn; 5.67 years (examined group 31.87 &plusmn; 5.84, control group 33.31 &plusmn; 5.45, range 19-45). The study included respondents who had experienced lumbar pain syndrome for the first time and who had been examined in the Department of Physical Medicine and Rehabilitation of the Novi Sad Health Center. The examined group consisted of 61 respondents undergoing physical treatment with the application of LLLT and kinesiotherapy with medication therapy. The control group consisted of 62 respondents undergoing physical treatment with the application of kinesiotherapy with medication therapy. All patients were subject to an anamnesis, a clinical examination, a selfassessment of pain and were required to complete questionnaires. The above study was carried out at the beginning of treatment, after 6 weeks, and after treatment was completed. The following questionnaires were used: Visual Analogue Scale (VAS), standardized questionnaires for assessing functional outcomes &ndash; The Oswestry Disability Index (ODI), The Rolland &amp; Morris Disability Questionnaire (RMDQ) and the SF-36 questionnaire. Results: Results indicate that pain intensity assessed using the VAS scale was significantly decreased, in both examined groups, during all observed study periods, where the difference between the two groups was not statistically significant (p = 0.904). Mobility of the lumbar spine was significantly increased, in both examined groups, during all observed study periods, where the obtained difference between the two groups was not statistically significant (p = 0.798). In both examined groups, spasm of the paravertebral musculature significantly decreased during all observed study periods, while the difference between the groups was not statistically significant (p = 0.453). Functional disability of patients (assessed by a reduction of functional disabilities of ODI and RMDQ) significantly decreased in both examined groups of patients during all observed examination periods. The obtained difference in scores assessed via the RMDQ, between the studied patient groups, was not statistically significant (p = 0.648), as well as via the ODI score between the researched groups (p = 0.311). Assessment of functional disability through the assessment of quality of life (SF-36) indicates that the quality of life increased significantly, for all examined scores in both examined groups, during all observed testing periods. There is no difference in functional disability (SF-36), that is, there is no difference in quality of life in score physical functioning, restrictions due to emotional problems, social functioning, emotional wellbeing, bodily pain, energy/vitality, physical and mental health, between the examined groups. The dimensions of quality of life in score role limitations due to physical health problems are significantly better in the control group (p = 0.028). The quality of life dimension in the general health perceptions is significantly better in the examination group (p = 0.041). Conclusions: The application of LLLT in subacute LBP resulted in a statistically significant reduction in pain intensity, increased lumbar spine mobility, decreased spasms of paravertebral musculature, and decreased functional disability. Given that there is no consensus on the use of LLLT, nor any other methods of physical therapy, during the subacute LBP, these results could contribute to the adoption of clinical guidelines, that is, diagnostic and therapeutic protocols for subacute LBP.</p>

Objetivo: Verificar a eficácia da associação do alongamento do tronco com exercícios de estabilização segmentar em pacientes com dor lombar crônica inespecífica (LCI). Métodos: Trinta e quatro indivíduos com diagnóstico de lombalgia crônica inespecífica de ambos os sexos, com idade entre 18 e 65 anos, foram randomizados em dois grupos: Grupo Alongamento Placebo + Estabilização Segmental (GAPES) e Grupo Alongamento + Estabilização Segmentar (GAES). Cada grupo realizou 12 sessões de tratamento de uma hora, duas vezes por semana. Os desfechos primários foram: intensidade da dor (Escala Numérica de Dor-END); avaliação qualitativa da dor (Questionário McGill-QMG); e incapacidade funcional (Questionário de Incapacidade de Rolland e Morris-QRM). Os desfechos secundários foram: percepção do efeito global (PEG); estado emocional (Inventário de Depressão de Beck-IDB e Escala Visual Analógica para Ansiedade-EVA-A); sinais e sintomas adversos; e satisfação do paciente (MedRisk). Cada sujeito foi avaliado no início e no fim do tratamento (seis semanas) e seguido três e seis meses após a intervenção. O nível de significância definido em alfa é igual a 0,05. Resultados: Não houve diferença significativa entre os dois grupos de tratamento na redução da intensidade e na qualidade da dor, na incapacidade funcional, na ansiedade e nos índices emocionais após o término do tratamento e durante o follow up. Conclusão: As duas propostas são efetivas no tratamento de LCI, com resultados estatisticamente significantes nos desfechos estudados. No entanto, a associação de exercícios de alongamento de tronco com os de estabilização segmentar não foi mais efetiva do que o uso isolado de estabilização segmentar lombar (ESL) / Objective: To verify the effectiveness of the association of trunk stretching with segmental stabilization exercises in patients with non-specific chronic low back pain (LCI) Methods: Thirty-four individuals with a diagnosis of non-specific chronic low back pain of both sexes, aged between 18 and 65 years. They were randomized into two groups: Group Stretching Placebo + Segmental Stabilization (GSPSS) and Group Stretching + Segmental Stabilization (GSSS), each group received 12 sessions of one hour, twice a week. The primary outcomes were pain intensity (Numerical Rating Scale-NRS); qualitative pain assessment (McGill Questionnaire); functional disability (Rolland and Morris Questionnaire-RMQ). The secondary outcomes were perception of the overall effect Global Effect; emotional state (Beck Depression Inventory-BDI and Analog Visual Scale for Anxiety-VAS-A); adverse signs and symptoms; and patient satisfaction (MedRisk). Each subject was assessed at the baseline and in the end of treatment (six weeks) and followed up three and six months post-intervention. The significance level set at Alpha = 0.05. Results: There was no significant difference between the two treatment groups in reducing intensity and quality of pain, functional disability, anxiety and emotional indexes after the end of the treatment and during follow up. Conclusion: The two treatment proposals are effective in the treatment of LCI, with statistically significant results in the outcomes studied, but the association of trunk elongation exercises with those of segmental stabilization was not more effective than the isolated use of ESL

A lombalgia tem consequências como dor, incapacidade funcional e diminuição da qualidade de vida, que pode acometer cerca de 70 a 90% da população brasileira em algum período de sua vida. A fisioterapia dispõe de inúmeros recursos dentre eles a Mobilização Neural, que facilita a condutibilidade nervosa, melhorando consequentemente o quadro álgico. O tratamento consiste em restaurar a mobilidade e a elasticidade do sistema nervoso periférico por meio de tensões, oscilações e angulações articulares. Neste sentido, este estudo teve como objetivo avaliar os efeitos da técnica e avaliar o comportamento álgico, bem como o possível envolvimento de citocinas pró e anti-inflamatórias após o tratamento. A técnica foi aplicada três vezes por semana, num total de 10 intervenções, com duração de dez minutos cada sessão. Participaram deste estudo 46 indivíduos (28 mulheres e 18 homens), que foram alocados em três grupos: grupo MOB, grupo MOB+MED e Grupo CONTROLE. Foram utilizadas ferramentas para avaliar tais efeitos, dentre elas: Escala Visual Analógica (EVA); Teste da Distância do 3º dedo ao solo; Goniometria; Fotogrametria; Avaliação da qualidade de vida - WHOQOL-bref; Questionário de incapacidade de Roland Morris; Índice de Oswestry sobre Incapacidade e Ensaios de Multiplex para a dosagem de citocinas no tecido sanguíneo.Os resultados demonstraram uma melhora significativa na intensidade da dor (p<0,02) e mobilidade lombar (p<0,04), quando comparamos as medidas antes e após o tratamento, e consequentemente, uma melhora significativa na qualidade de vida e incapacidade dos pacientes. Ao analisarmos as citocinas (p<0,05), houve uma redução estatisticamente significativa nas citocinas pró-inflamatórias (IL-1&#946;, IL-6 e TNF&#945;) e aumento estatisticamente significativo de citocina anti-inflamatória (IL-4). Esperamos, por meio deste estudo, contribuir e compreender alguns mecanismos envolvidos durante o processo de reabilitação com a Mobilização Neural. / Low back pain has consequences such as pain, functional disability and decreased quality of life, which can affect approximately 70 to 90% of the Brazilian population in some period of their life. Physiotherapy has innumerable resources, among them Neural Mobilization, which facilitates the nervous conductivity, consequently improving the pain. The treatment consists in restoring the mobility and the elasticity of the peripheral nervous system through tensions, oscillations and articular angulations. In this sense, this study aimed to evaluate the effects of the technique and to evaluate the algic behavior, as well as the possible involvement of pro and anti-inflammatory cytokines after treatment. The technique was applied three times a week, in a total of 10 interventions, lasting ten minutes each session. A total of 46 individuals (28 women and 18 men) participated in this study, which was allocated in three groups: MOB group, MOB + MED group and CONTROL group. Tools were used to evaluate such effects, among them: Visual Analog Scale (EVA); 3rd finger distance test to the ground; Goniometry; Photogrammetry; Quality of life assessment - WHOQOL-bref; Roland Morris Inaptation Questionnaire; Oswestry Index on Disability and Multiplex Assays for dosing cytokines in blood tissue. The results showed a significant improvement in pain intensity (p <0.02) and lumbar mobility (p <0.04), when we compared the measures before and after treatment, and consequently, a significant improvement in the quality of life and disability of patients. When we analyzed the cytokines (p <0.05), there was a statistically significant reduction in the proinflammatory cytokines (IL-1&#946;, IL-6, and FTN&#945;) and a statistically significant increase in anti-inflammatory cytokine (IL-4). We hope, through this study, to contribute and understand some mechanisms involved during the rehabilitation process with Neural Mobilization.

INTRODUÇÃO: A hérnia de disco lombar (HDL) acomete cerca de 5% dos pacientes com de dor lombar e o tratamento cirúrgico nestes casos é cada vez menos indicado, optando-se, na maior parte dos casos, pelo conservador. Embora o método estabilização lombar (EL) e a estimulação elétrica nervosa transcutânea (TENS) tenham mostrado bons resultados em indivíduos portadores de dor lombar inespecífica, há escassa literatura que tenha verificado a eficácia destes tratamentos isoladamente em sujeitos acometidos por hérnia de disco lombar. OBJETIVO: Comparar a eficácia dos exercícios de estabilização lombar e da TENS na dor, incapacidade funcional, e capacidade de ativação do músculo transverso do abdome (TrA) de indivíduos com hérnia de disco lombar. METODOLOGIA: Participaram da pesquisa 40 indivíduos com idade variando de 25 a 58 anos com dor lombar e hérnia de disco, e foram randomizados em dois grupos: Grupo estabilização lombar (EL) (exercícios específicos para os músculos TrA e multífido lombar(ML)) (n=20) e Grupo TENS (GT) (n=20) que receberam atendimento com corrente de estimulação elétrica nervosa transcutânea. Foram avaliados quanto à dor (Escala Visual Analógica e Questionário McGill de Dor), incapacidade funcional (Índice de Incapacidade de Oswestry), e capacidade de recrutamento do TrA (Unidade de Biofeedback Pressórico-UBP). Os grupos foram tratados em duas sessões semanais com duração de 60 minutos por oito semanas. Cada indivíduo foi avaliado antes e após o tratamento. O nível de significância estabelecido foi de alfa=0,05. RESULTADOS: Após oito semanas, o grupo estabilização lombar mostrou melhora significativa na dor (p < 0,001), incapacidade funcional (p < 0,001), e capacidade de ativação do TrA (p < 0,001). O grupo TENS apresentou diferença estatisticamente significante apenas na dor (p < 0,012). A estabilização foi superior à TENS na melhora na dor (p < 0,001), incapacidade funcional (p < 0,001), e capacidade de ativação do TrA (p < 0,001). CONCLUSÃO: Os resultados indicam que a estabilização é efetiva na melhora da dor, incapacidade funcional, e capacidade da ativação do TrA, e a TENS apenas na dor. A estabilização foi superior à TENS em todas as variáveis / INTRODUCTION: Lumbar disc herniation (LDH) affects about 5% of low back pain (LBP) patients. Surgical treatment in these cases is increasingly less suitable, opting, in most cases, for the conservative. Although lumbar stabilization method and transcutaneous electric nerve stimulation (TENS) have shown good results in patients with nonspecific low back pain, there is scarce literature that has verified the effectiveness of these treatments alone in subjects suffering from lumbar disc herniation.OBJECTIVE: To compare the effectiveness of lumbar stabilization exercises and transcutaneous electrical nerve stimulation (TENS), on pain, functional disability and activation of the transversus abdominis muscle (TrA), in individuals with lumbar disc herniation (LDH). METHODS: This study involved 40 patients (age range 25-58 years) with lumbar disc herniation randomized into two groups: Stabilization group (SG: n=20); which received of stabilization exercises (transversus abdominis and lumbar multifidus muscles) and TENS group (TG: n=20), which received electrotherapy. The following instruments were used: visual analogue pain scale and McGill Pain Questionnaire for pain, Oswestry Disability Index for functional disability, and pressure biofeedback unit (PBU) for ability to contract the TrA. Analyses within and between groups were performed after treatment. Groups underwent 16 sessions, for 60 minutes, twice a week and they were evaluated before and after eight weeks. Significance level was set at alfa= 0.05. RESULTS: After eight weeks, lumbar stabilization group showed significant improvements in pain (p < 0.001), functional disability (p < 0.001), and the ability to contract the TrA (p < 0.001). There were no significant differences in TENS group in terms of disability (p < 0.264) or ability to contract the TrA muscle (p < 0.181), however, improvement in pain was demonstrated (p < 0.012). The stabilization was superior to TENS in terms of improvements in pain (p < 0.001), functional disability (p < 0.001), and ability to contract the TrA (p < 0.001). CONCLUSION: The results indicate that stabilization is effective in improving pain, functional disability, and the ability to contract the TrA in individuals with LDH. In the TENS group, the only improvement after treatment was in terms of pain. Stabilization was superior to TENS in all outcomes

Introdução: Programas de exercícios para pacientes lombálgicos tem sido amplamente descritos na literatura; contudo a efetividade de programas de exercícios para esta condição clínica ainda encontra-se controversa. Objetivo: Avaliar a efetividade de um programa de exercícios baseado em abordagem postural e funcional sobre a capacidade funcional e a qualidade de vida de pacientes com lombalgia crônica. Desenho Experimental: Randomized Controlled Trial. Amostra: 30 pacientes do sexo feminino com lombalgia crônica não-específica. Instrumentos de Análise: Capacidade Funcional (Roland-Morris Disability Questionnaire), Qualidade de Vida (SF-36) e intensidade de dor (Escala Numérica de Dor). Métodos: As pacientes foram divididas em Grupo Controle (GC) e Grupo Experimental (GE). Pacientes em ambos os grupos foram submetidas a três avaliações durante seis semanas, em intervalos de três semanas envolvendo o preenchimento dos questionários Roland-Morris, SF-36 e Escala Numérica de Dor. O grupo experimental foi submetido a um programa de exercícios durante seis semanas objetivando a melhora do recrutamento muscular para melhor manutenção postural e treino de funcionalidade. O grupo controle, após o período de observação, recebeu intervenção idêntica à recebida pelo grupo experimental. Grupos controle e experimental foram comparados através do teste t – student. Resultados: O grupo experimental apresentou melhora significativa na capacidade funcional (p= 0,0), qualidade de vida (SF 36;escalas variando com p = 0,0 até 0,02) e intensidade de dor (p= 0,0) ao ser comparado com o grupo controle. Após a intervenção em ambos os grupos, a melhora manteve-se significativa. Conclusão: O programa de exercícios baseado em abordagem postural e funcional mostrou-se eficiente na melhora da dor, capacidade funcional e qualidade de vida de pacientes com lombalgia crônica. / Background: Exercise programs for low back pain have been largely studied; however its effectiveness on this clinical condition is still controversial. Purpose: To assess the effects of a postural and functional approach-based exercise program on functional capacity, quality of life and pain condition of subjects with chronic low back pain (CLBP). Study Design: Randomized Controlled Trial. Patient Sample: 30 women with nonspecific CLBP. Outcome Measures: functional capacity (RMQ, Roland-Morris Disability Questionnaire), quality of life (SF-36 subscales) and pain condition (NRS, Numerical Rating Scale). Methods: Patients were randomly assigned to control (CG) and treatment groups (TG). Patients from both groups were submitted to a three-week interval evaluation involving the completion of RMQ, SF-36 and NRS. TG was submitted to a six-week program of treatment addressing improvement of muscular recruitment for better postural maintenance and functional training. The CG was submitted to the same intervention program, after six weeks of no intervention. CG and TG were compared by applying t student test to the variables. Results: TG showed significant improvement in functional capacity (p= 0.0), quality of life (SF 36 subscales with p ~ 0.0 to 0.02) and pain condition (p= 0.0) compared to CG. The refferences remained significant when the results of intervention in the control group were added to the treatment group and compared to the control group baseline. Conclusions: The postural and functional approach-based exercise program showed efficient in improving the functional capacity, quality of life and pain condition of CLBP patients.