24) Allera Longo C, Lanza A, Ferrari S, Vanti C, Stradiotti P, Ausenda C.D. The effects of standing posture with flexion of the trunk on the multifidus muscle in subjects with non-specific LBP. A pilot randomized controlled trial.

BACKGROUND AND AIMS The standing posture with flexion of the trunk is one of the Postural Global Reeducation procedures. This posture is considered the most effective in lengthening the posterior chain, which is usually shortened in patients with low back pain (LBP) (1). Moreover, due to the requested control and maintaining of the physiological lumbar lordosis, this posture could be an effective exercise to activate the multifidus muscle, which is frequently inhibited in LBP (2,3). The aim of this study was to investigate the effects of the cited posture on the thicknesses of multifidus muscle, pain and disability in adult LBP subjects. MATERIALS AND METHODS 14 subjects, referred to an Outpatient Physical Therapy Service to receive a multimodal group treatment, were randomized in two parallel groups: an experimental group (EG) and a control group (CG). Each subject filled in the Numerical Rating Scale (NRS) for pain and the Roland & Morris Disability Questionnaire (RMDQ) for disability. The thicknesses of multifidus muscle at L5 level was measured by a radiologist using an ultrasound device. The CG program consisted of ten graded sessions, alternatively two or three a week, for four consecutive weeks. Sessions, each lasting an hour, were conducted in a large room of the Hospital by a physiotherapist specialized in the treatment of LBP. In the EG program the same treatment was adopted adding at the end of each session the standing posture with flexion of the trunk from 30 to 60 seconds, for 5 time. For both groups the outcome measures were collected at the start of the treatment (T0) and immediately at the end of the treatment (T1 follow-up). Only the EG was requested to repeat the same posture at home with the same mode for another month and after this period the outcome measures were again collected (T2 follow-up). RESULTS Both EG and CG were composed by 7 subjects; no significant difference was found between groups for the main general characteristics. All patients completed the first part of the study. Only 5 patients of the experimental group continued the following part of the study carried out at home. Neither at T1 follow-up nor at T2 follow-up any significant difference in thicknesses of multifidus muscle or pain rating was found for both groups. The statistical analysis showed a higher reduction of disability both at T1 (p=0.018) and T2 (p=0.042). only in the E.G. DISCUSSION Our analyses did not show any significant variation of the thicknesses of multifidus muscle, according to similar studies (4,5). The reason of this result could be attributed to the short duration of the treatment. Otherwise, the positive outcomes on the disability rate in EG may be related to a higher recruitment of stabilizing muscles in loading conditions. CONCLUSIONS Our study did not show any significant difference between groups on the thicknesses of multifidus muscle or on pain. Mean while the flexion of the trunk in standing position was improved in the patients after the training according to the R.M.D.Q for disability. These conclusions should be considered on the light of keeping in mind the small dimension of the samples. REFERENCES 1. Souchard P.E. Lo stretching globale attivo – La rieducazione posturale applicata allo sport. Roma: Marrapese, 1995. 2. Hides JA, Richardson CA, Jull GA. Multifidus Muscle Recovery Is Not Automatic After Resolution of Acute, First-Episode Low Back Pain. Spine 1996; 21(23): 2763- 2769 3. Freeman M.D, Woodham M.A., Woodham A.W. The Role of the Lumbar Multifidus in Chronic Low Back Pain: A Review. PMR 2010;2(2):142-146. 4. Danneels L. A., Vanderstraeten G.G., Cambier D. C., Witvrouw E. E., Bourgois J., Dankaerts W., De Cuyper H. J. Effects of three different training modalities on the cross sectional area of the lumbar multifidus muscle in patients with chronic low back pain. Br J Sports Med 2001;35:186–191 5. Willemink M. J, van Es H. W, , Helmhout P. H, Diederik A. L, Kelder J. C , and van Heesewijk J. P. The Effects of Dynamic Isolated Lumbar Extensor Training on Lumbar Multifidus Functional Cross- Sectional Area and Functional Status of Patients With Chronic Nonspecific Low Back