Abstract:
Chronic Mechanical Low Back Pain (CMLBP) is a major health condition whose
management poses a challenge to clinicians. Literature suggests specific therapeutic exercise
types to achieve effective management, although the best type of exercise remains
controversial. McKenzie Exercise (ME) and Lumbar Stabilisation Exercise (LSE) have been
reported to be effective in the management of CMLBP. There is paucity of information on
the effectiveness of combined ME and LSE in CMLBP. Given that majority of individuals
with CMLBP have recurrent pain resulting in fear-avoidance, investigating the effect of
Combined McKenzie and Lumbar Stabilisation Exercises (CMLSE) on fear avoidance
beliefs is pivotal. The effects of eight-week CMLSE, ME, and LSE on selected psychosocial
and clinical variables of individuals experiencing CMLBP were investigated.
Participants in the single-blind 8-week randomised controlled trial were 142 consecutively
sampled individuals with CMLBP recruited from LAUTECH Teaching Hospital Ogbomoso,
UniOsun Teaching Hospital, and State Specialist Hospital, Osogbo. Participants were
randomly assigned to ME Group (MEG), LSE Group (LSEG), and CMLSE Group
(CMLSEG). The MEG (n=47) received ME for posterior derangement, LSEG (n=47)
received LSE, while CMLSEG (n=48) received CMLSE. Age was recorded, weight and
height were measured using standard procedures, and BMI was calculated. Pain intensity,
functional disability, and fear avoidance beliefs to physical activity and work were assessed
using the Quadruple Visual Analogue Scale, Oswestry Low Back Pain Disability
Questionnaire, and Fear Avoidance Belief Questionnaire, respectively. Participants were
treated twice weekly, assessed at baseline, and at end of fourth and eighth weeks of study.
Data were summarised with descriptive statistics, and analysed using ANOVA, and repeated
measures ANOVA, with Bonferroni post-hoc test at α= 0.05
Participants’ age was 53.00±12.00years. Age, weight, height, and BMI of participant’s in the
three groups were comparable. At the end of week four, MEG and LSEG compared to
CMLSEG had significantly lower pain scores (28.87±13.73, 26.01±14.79, 37.64±14.58),
functional disability scores (14.47±10.62, 15.54±12.36, 22.94±11.76), fear avoidance beliefs
to physical activity (10.85±2.08, 11.32±3.79, 13.46±3.16), and work scores (8.02±6.03,
8.98±9.13, 15.02±11.08). At the end of eight week eight, MEG had significantly lower
functional disability score (3.04±4.07) than LSEG (6.36±8.40) and CMLSEG (7.57±6.74),
and fear avoidance beliefs to work score (0.45±1.02) than LSEG (2.80±6.85), and CMLSEG
(3.98±4.39), respectively. At the end of week eight, groups were not significantly different
in pain scores (8.80±7.11, 14.13±14.68, 13.19±8.58), and fear avoidance beliefs to physical
activity scores (6.70±1.77, 8.53±4.23, 8.67±5.74) for MEG, LSEG, and CMLSEG,
respectively.
Combined McKenzie and lumbar stabilisation exercises is not effective in producing better
treatment outcomes for functional disability and fear avoidance beliefs to work in the
management of chronic mechanical low back pain. McKenzie exercise is recommended for
effective management of functional disability and fear avoidance beliefs to work in
individuals with chronic mechanical low back pain.
