The efficacy of surface electromyographic biofeedback assisted stretching for the treatment of chronic low back pain : a case-series

Abstract

Chronic low back pain is a major problem to both the individual and society. The negative impact of Chronic Low back pain (LBP) includes its large direct and indirect treatment costs, and associated disability and suffering. Low back pain is discussed in the literature review, including information of the various models of diagnosis and classification. As it is well recognised that chronic pain is a multidimensional issue, models of mechanical, neurological and iopsychosocial influences are presented. Common motor control impairments are briefly explored. Flexion Relaxation (FR) is a commonly observed muscle pattern of lumbar paraspinal relaxation (electrical silence) near the end range of flexion. Flexion Relaxation is observable to some degree in most asymptomatic individuals. Impaired FR, displayed as continued muscle activation at maximal voluntary flexion (MVF), is commonly identified in those with chronic LBP. The study presented in section two of the thesis, investigated the effects of a surface electromyographic assisted stretching (SEMGAS) programme on impaired FR patterns in individuals with chronic LBP. Nine volunteers with chronic LBP that displayed impaired FR were recruited from the general public, and took part in a biofeedback SEMGAS intervention including an at-home stretching component over five weeks. Outcome measures included FR, Oswestry Disability Index, Numeric Pain Rating Scale and Sit and Reach, and were recorded pre and post-intervention as well as at a four to six-week follow-up. The aim was to investigate if improved FR is associated with improved range of motion, pain intensity and disability in individuals with chronic LBP. Of the nine participants included, three improved FR to statistically significant levels. All three also achieved a clinically important change in pain intensity scores. The results suggest SEMGAS may provide benefits to some individuals with chronic LBP and impaired FR, although larger scale investigation of SEMGAS as a unimodal therapy in a larger population is indicated.