Comparison of Postural Training versus Physiotherapy Treatments in people with low back pain: effects induced by 10 sessions on disability and postural control

Purpose: Low back pain (LBP) is one of the major spine disorders which seriously impairs many daily activities and limits functional skills. The role of exercise and physiotherapy treatments in LBP management is well documented, even if the debate about the most effective type of intervention is still present. The aim of this study is to compare the effects of 10 sessions of specific training and physiotherapy practice on LBP symptoms and disability, static postural control and gait in adult people suffering from this pathology. Methods: Twenty people (11 females and 9 males) were recruited for the study. All participants were untrained and affected from chronic non-specific LBP. Participants were divided into 2 groups composed by 10 people each one: Training Group (TG - mean age: 47,8 ± 6,2 years old) and Physiotherapy Group (PG - mean age: 45 ± 6,4 years old). TG performed 10 sessions of postural training with focus on respiratory function, lumbar-pelvic stabilization, trunk strength and flexibility exercises, while PG was submitted to 10 sessions of physiotherapy treatments (physical therapy and manual therapy). All participants were assessed pre and post training to evaluate pain and disability (Roland Morris Disability Questionnaire – RMQ), static postural control in eyes open (EO) and closed (EC) conditions (Prokin® stabilometric system), trunk sway and lower body mobility and symmetry during gait (WalkerView® multi-sensor treadmill – GAIT). Results: RMQ significantly improved in both TG and PG (p<0.01), with better results observed in TG. Center of pressure area (COP area) and displacement (COP length) decreased in TG for both EO and EC conditions, with significance evidenced in EO COP area (p<0.05). Conversely, PG significantly increased EO COP length (p<0.05). Both group improved hip and knee range of motion on right and left side during GAIT, even if not significantly. Trunk sway increased in both group, with significance for PG only (p<0.05). Finally, load symmetry during GAIT enhanced in PG (p<0.05). No differences were reported during TG and PG comparison (p>0.05). Conclusions: Previous results suggest that both type of intervention are effective for pain and disability reduction, while only postural training increased static postural control in eyes open condition. In addition, physiotherapy treatments leaded to improvements in load symmetry during gait. Since postural exercises, physical and manual therapy seem to enhance LBP symptomatology and neuromuscular control, the combination of both type of intervention could be useful in people suffering from this pathology. Reference: Pergolizzi J., Lequang J.A., Rehabilitation for Low Back Pain: A Narrative Review for Managing Pain and Improving Function in Acute and Chronic Conditions, Pain Ther. 2020 Jun; 9(1): 83–96