The goal of this project is to assess if Chronic Low Back Pain (CLBP) participant's movement quality and balance variables can change after training that decreases their pain and disability. It will also compare the difference between structural exercise (SE) and isolated trunk exercise (ITE). The main questions it aims to answer are: 1. What are the effect of the training on the participant's movement quality and balance. 2. What are the difference between different types of trunk muscle training on people with CLBP. Researchers will compare SE, ITE and control. Control group will receive back school education that was shown not to be effective in reducing pain and disability. Participants will: 1. Do home and in-lab based SE or ITE training, or maintain active daily living over 2 months. 2. Complete the pain and disability questionnaire and do several physical functioning tests while having their trunk and lower limb movement and muscle activation measured.
Both ITE and SE training are equalized in terms of training intensity based on rate of perceived exertion, training duration per session, training frequency, and intervention period. Training intensity measurement does not use other methods of quantification as ITE training does not increase heart rate or blood lactate significantly regardless of the intensity.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
60
Multi-joint limb movement with force vector through the spine. The spine is held at neutral position
Holding the spine in neutral position with no limb movement, with static loading through the spine
Patient education that has been proven to not be effective and has been used as control in past low back pain intervention studies
The Hong Kong Polytechnic University
Hong Kong, Hong Kong
RECRUITINGLower lumbar active range of motion
active range of motion of the lower lumbar area during five-repetitions sit-to-stand test.
Time frame: Same day as first day of intervention and within one week after intervention
Segmental movement coordination
Lumbar-to-pelvis and pelvis-to-femur movement coordination as quantified by mean absolute relative phase angle during five-repetitions sit-to-stand. Smaller number indicates greater coordination between the two segments.
Time frame: Same day as first day of intervention and within one week after intervention
Segmental movement stability
lumbar-to-pelvis and pelvis-to-femur movement stability as quantified by deviation phase during five-repetitions sit-to-stand. Greater number indicates lesser segmental movement stability.
Time frame: Same day as first day of intervention and within one week after intervention
Postural stability
Center-of-pressure normalized mean velocity during Y-balance test. Smaller number indicate greater stability
Time frame: Same day as first day of intervention and within one week after intervention
Postural Control
normalized leg reach during y-balance test, with larger number indicating greater postural control.
Time frame: Same day as first day of intervention and within one week after intervention
Perceived pain
score from numerical pain rating scale from zero (0) to ten (10), with 0 indicating no pain.
Time frame: Same day as first day of intervention and within one week after intervention
Perceived disability
Score based on oswestry disability index scoring from zero (0) to one hundred (100) percent, with zero indicating no disability.
Time frame: Same day as first day of intervention and within one week after intervention
5RSTS time
Time required to complete five-repetitions sit-to-stand with smaller time indicating better performance.
Time frame: Same day as first day of intervention and within one week after intervention
LAP performance
time required to complete the lift and place test with lesser time indicating greater performance
Time frame: Same day as first day of intervention and within one week after intervention
Muscle synergy
Muscle synergy as measured by the surface electromyography (SEMG) output of the latissimus dorsi, longissimus pars thoracis, longissimus pars lumborum, external oblique, rectus abdominis, gluteus maximus and biceps femoris muscle both on left and right side during all functional tests. SEMG signals would then be processed using non-negative matrix factorization to find the underlying muscle synergies
Time frame: Same day as first day of intervention and within one week after intervention
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