Study Design

A randomized controlled trial with a 6-month follow-up period was conducted. Objective. To compare lumbar extension exercise and whole-body vibration exercise for chronic lower back pain.

Summary of Background Data

Chronic lower back pain involves muscular as well as connective and neural systems. Different types of physiotherapy are applied for its treatment. Industrial vibration is regarded as a risk factor. Recently, vibration exercise has been developed as a new type of physiotherapy. It is thought to activate muscles via reflexes.

Methods

In this study, 60 patients with chronic lower back pain devoid of "specific" spine diseases, who had a mean age of 51.7 years and a pain history of 13.1 years, practiced either isodynamic lumbar extension or vibration exercise for 3 months. Outcome measures were lumbar extension torque, pain sensation (visual analogscale), and pain-related disability (pain disability index).

Results

A significant and comparable reduction in pain sensation and pain-related disability was observed in both groups. Lumbar extension torque increased significantly in the vibration exercise group (30.1 Nm/kg), but significantly more in the lumbar extension group. No correlation was found between gain in lumbar torque and pain relief or pain related disability.

Discussion

The results of this study suggest that both lumbar extension and whole-body vibration exercise can relieve pain and improve pain-related limitation in everyday life for patients with CLBP. Moreover, a gain in lumbar extension torque was observed in both groups, whereas a reduction in the tendency to depression was observed only in the lumbar extension group. The reason is unknown. The patients enrolled in this study had CLBP. On the basis of our daily practice, they seem to be representative of a more general population. There was no group difference in baseline data, except in age and height. It would be more desirable, of course, to compare groups of the same age and height. On the other hand, it is not very likely that the group differences would have had a major influence on the main outcome of the study: pain relief. There are indications that lower back pain has a greater tendency to become chronic in older patients, but that height is no risk factor for chronification. Thus, if group differences did play a role, the therapeutic effect in the current study will have been underestimated in the VbX group with respect to the LEX group. There is another, in this case systematic, group difference that requires discussion. In the LEX group, training and assessment of force and motility (LET and ROM) was performed on the same device. This implies 4 measurement units and 18 exercise units in the LEX group, whereas the VbX group had only the 4 measurement units on the LEX device. It may be not too surprising, therefore, that the LEX group had a greater gain in LET and ROM. No aggravation of pain or limitations was observed in the VbX group. The dropouts in the VbX group (15%) were for nonspecific reasons and comparable with those in the LEX group and with the dropouts reported in other studies.

Thus VbX seems to be applicable in CLBP. This is in apparent contrast to the literature, in which whole-body vibration in industrial and nonindustrial circumstances generally is regarded as a risk factor for the development of lower back pain and its chronification. There are differences, of course, between industrial and therapeutic whole-body vibration, namely, the method of application, the subject's posture, the frequency of application, and the temporal duration of exposure and the resulting fatigue. Currently, we apply vibration exercise for training and therapeutic purposes for no longer than 7 minutes. Patients usually learn to tolerate whole-body VbX quite rapidly, but the first 1 to 2 exercise units should be performed under surveillance. Our results also may be of some interest with respect to the pathophysiology of CLBP. There is general agreement that patients with CLBP have a reduced lumbar torque.

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