EFFECTS OF COMBINED McKENZIE TECHNIQUE AND LUMBAR STABILISATION EXERCISE ON SELECTED PSYCHOSOCIAL AND CLINICAL VARIABLES OF INDIVIDUALS WITH CHRONIC MECHANICAL LOW BACK PAIN

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.