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Studies in 30 subjects which are involved in a trial investigating the effect of an intervention.

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Author/s Dr. Tabish Aziz (MPT ORTHO-SPORTS)

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Abstract

Pilates was proposed as the best treatment strategies to improve muscle strength and endurance along with flexibility, posture and balance in non-specific type of LBP in adolescent.The objective was to find out effectiveness of Pilates in adolescent with LBP. This study results showed that Pilates had significantly decreased pain and improved quality of life in adolescent.

Background

Non- specific type of LBPis common in adolescent and is also a disabling condition as they grow. There are many techniques of physiotherapy as well as others associated therapy such as yoga etc…but there efficiency is unknown.
Pilates was proposed as the best treatment strategies to improve muscle strength and endurance along with flexibility, posture and balance in non-specific type of LBP in adolescent.

Objectives

1. To study the effects of Pilates on adolescent with LBP.
2. To study the effects of Pilates on muscle strength in adolescent with LBP.
3. To assess the effects of Pilates on muscle flexibility in adolescent with LBP.
4. To assess the effects of Pilates on posture in adolescent with LBP.
5. To assess the effects of Pilates on muscle endurance in adolescent with LBP.

Methods

Experimental study design (Pre test-Post test)

Study selection or eligibility criteria

• Informed consent.
• Age between 12-18yeras.
• Both genders.
• Suffering from back pain from last 2months.
• Back pain due to Hamstrings muscle tightness or abdominal muscle weakness.

Interventions

Two types of Pilates were used as intervention-

1. Teaser

• Lying flat on back.
• Feet on the floor, knees fully extended.
• Arms and hands along your side.
• Slowly lift both legs.
• Simultaneously lift chest, head, and both upper limbs.
• Return to normal position.
• Slowly breaths in as you lift your body and out as you return to the floor.
• Repeat 5-10 times.

2. Swimming

• Lying on prone position with arms stretched position.
• Feet on the floor, knees fully extended.
• Squeeze your inner thighs and heels together.
• Squeeze your butt and try to keep pressing your pubic bone down to the mat
• Raise your head and upper back, simultaneously right arm and left leg.
• Then switch arms and legs and begin swimming rhythm alternating arms and legs.
• Extending your body as much as possible.
• Repeat 5-10 times.
• Then come up to your resting position, pressing back to the rest position.

Measures and variables

• Pain: Visual analogue scale (VAS)
• Function and Disability: Modified Oswestry Low Back Pain Questionnaire (MOLBPDQ)
Both were highly reliable and valid questionnaire .

VAS and MODQ are the outcome measure used on all subjects to quantify the change in pain and function of back before the interventions and after the 4th week on all subjects.

Study appraisal and synthesis methods

SAMPLE DESIGN:

Stratified random sampling

SAMPLE SIZE:

30 subjects fulfilling the inclusion criteria

DURATION OF STUDY:

Duration of the study 9-12 months.

The data (total number 30, male-15,female-15) was analysed by Wilcoxon Signed Rank Test and Mann-Whitney Test. The results stated that there was decreasing in pain in vas and improvement in quality of life of the subjects following above interventions.
The further analysis of data had found that there was significant decrease in pain as well as and also there was significant improvement in quality of life of the participants. The study proved that Pilates program is effective in adolescent with LBP.

Results

The study was carried out using Pilates Teaser and Swimming exercises on the subjects with non-specific LBP. The total number of subjects was 30. All subjects were treated with both exercises.
LBP is more common in girls with increase age, and high and low level of activity during period of rapid growth literature published by Russell Jago.
In this study method of assessment was done through VAS and MODQ. It was used to assess overall function of back as its validity and reliability has already been established. MODQ includes all those activities where joint mechanisms of the lumber spine are relatively understood and therefor it is very easy to determine which task increase or decrease mechanical deformation.
The pain assessment was done by Visual Analogue Scale (VAS). In this study, subjects showed highly significant improvement in pain relief. This study also reveals that age is also a significant factor to pain relief.
MODQ was used to assess the improvement in all the functions. The subjects were assessed for the performance of daily living activities. After the interpretation it has been proved that subjects showed a significant improvement. This study also reveals that age is not a significant factor to the improvement in functions.
MODQ activities noted by this scale such as personal care, lifting, walking, sitting, standing, social life, sleeping, travelling and employment/ home making. All this showed a significant improvement in pre and post data except travelling which result as not significant to the interventions.
VAS and MODQ scores across baseline and post interventions showed a highly significant improvement statistically in their mean score.
When compare to gender interventions showed not significant result.
Improvement of pain and disability may also be due to improvement in strength and endurance of core musculature of lumbar spine. This helps decreasing in the stress and abdominal loads on the spine by demanding a proper Neuromuscular control and coordination which is essentials for maintenance of body mechanism and posture when it is required to carry a load and to perform common daily activities.
According to the study of RaminKordi et alon study Low Back Pain in Children and Adolescents: an Algorithmic Clinical Approach, and concluded that In children younger than 7 years and particularly in those younger than 3, as a rule, back pain should be alarming for a hidden underlying pathology until proven otherwise. Commonly LBP in children is non-specific and will be managed by simple conservative treatments in short term. However in some groups especially those involved in sport activities other reasons such as Spondylolysis and Spondylolisthesis need to be considered. The role of psychosocial factors in treatment of the children with back pain should never be forgotten particularly in teens with positive family history of anxiety14.

Karen Grimmer et al, also supported the prevalence of LBP in adolescent. In their study, a longitudinal study of LBP in Australian adolescent with an aim to track reports of LBP in adolescent each year over a five-year period (13-17 years). A significant increasing prevalence of LBP was reported for girls and boys. The odds of girls reporting in the final year study compared with the first year was 4.4 (95%) for boys 1.6(95%). New cases of girls LBP decreased consistently over the study (90% in 2000, 46.1 in 2001, 42.1 in 2002, and 33% in 2003). New boys cases decreased in second and third year (85% in 2000, 45% in 2001) then increased (45.8% in 2002, 63.6% in 2003)48.

Jones MA et al suggested about higher prevalence of LBP in school going children. They conducted a school based survey of recurrent non-specific LBP to estimate the prevalence and consequences in children from northwest England. A cross section sample of 500 (males-251, females-249) aged between 10-16 years participated in the study. They reported that the average lifetime prevalence of LBP was 40.2%44.

Pilates is a technique use to improve muscle strength and endurance as well as flexibility and to improve posture and balance.
The study suggested that Pilates exercise have shown significant improvement in non-specific LBP in adult, but the effectiveness of this treatment protocol in the adolescent population is still unknown. But there is lack of evidence suggesting effectiveness of Pilates in adolescent with LBP, so there is a need to find out the effectiveness of Pilates in adolescent with LBP.
EDWIN CHOON, et al (2011) supported the effects and usefulness of Pilates in LBP. They did a meta- analysis on effects of Pilates-Based Exercises on Pain and Disability in Individuals with Persistent Nonspecific Low Back Pain and they found Pilates-based exercises are superior to minimal intervention for pain relief. This is an exercise to reduce pain and disability for patients with persistent nonspecific low back pain.Pilates exercises are effective than minimal intervention or other exercise interventions to reduce disability related to chronic low back pain59.

Pilates also effective to improve flexibility and stability.SUREEPORN PHROMPAET et al (2011) studied on Effects of Pilates Training on lumbo-Pelvic Stability and Flexibility and their result suggested that Pilates can be used as an adjunctive exercise program to improve flexibility, enhance control-mobility of trunk and pelvic segments. They also suggested that The results of this study indicate the specificity of Pilate-based exercise as an appropriate volume to contribute to physiological benefits which occur after 4 weeks of training as follows:
1. Enhances lumbo-pelvic stability
2. Improves flexibility of lower back and legs
It may also help in preventing and attenuating the injury and dysfunction of musculoskeletal system18.
This study supports that Pilates can be used to enhance lumbo-pelvis stability as well as flexibility.
Pilates also improve strengthening of core muscles and helpful in activation of core muscles. Susan Sorosky recommended Pilates method would be beneficial for patients with LBP because it improves absolute core strength and moreover encourages proper activation patterns of core musculature60.
According to Lim et al (2011) Pilates-based exercise is superior to minimal intervention for pain. Pilates whether it is Mat or Equipment based, both are effective and beneficial in LBP.

The results of this study also showed highly significant values towards pain (VAS) and quality of life (MODQ).
The finding of this study is similar to the various studies done on Pilates in LBP on adolescent, that Pilates is superior to minimal intervention for pain. It is also improve muscle endurance, posture, balance, stability, and also facilitate breathing pattern.

Limitations/Discussion

• Study included only 30 subjects which is a small sample size. Larger study involving increased number of participant should be employed.
• Duration of study was short (4 weeks). Hence long duration intervention is necessary for better outcome measures.

Conclusion

The objective was to find out effectiveness of Pilates in adolescent with LBP. This study results showed that Pilates had significantly decreased pain and improved quality of life in adolescent.
Pilates produced highly significant improvement in reducing pain (VAS score) and improvement in function (MODQ score) at the 4th week when compared to baseline values in subject with non-specific type of LBP.
Based on the above discussion and conclusion, it has been proved that this study supports the alternate hypothesis.

Funding and Declerations

NO

Registration number

if appropriate

Author Biography

include a short biography for each author and a link to their profile in Physiopedia

References

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1) H N Herkowitz, J Dvorak, G Bell, M Nordin D Grob. The 3rd edition, USA: Lippincott Williams and Wilkins;2004.p.4
2) Biering-Sorensen F.A. Prospective study of low back pain in general population. Scandinavian journal of Rehabilitation Medicine 1983;15:71-79.
3) Cassidy LD, Carroll LJ, Cote P. the Saskatchewan health and back pain survey:the prevalence of low back pain and related disability inSaskatchewan adults. Spine 1998;23:1860-1867.
4) Lebeouf-Yde C, Klougart N, Lauristen T. how common is low back pain in the Nordic population? Spine 1996;21:1518-1526.
5) Papageorgiou AC, Croft PR, Ferry S, Jayson MIV, Silman AJ. Estimating the prevalence of low back pain in the general population: Evidence from the South Manchester pain survey. Spine 1995;20:1889-1894.
6) Saudicani P, Hansen K, Gyntelberg F. low back pain in steel plant workers. Occupational medicine.1994;44:217-221.
7) Walsh K, Varnesh N, Osmond C, Styles R, Coggon D. Occupational causes of low back pain. Scandinavain journal of work and environmental health.1989;15:54-59.
8) Matsui H, Maeda A, Tsuji H, Narsue Y. Risk indication of low back pain among workers in Japan: association of familial and physical factors with low back pain. Spine.1997;22:1242-1248.
9) Bratton RL.Assessment and management of acute low back pain. Am Fam Physician.1999;62:299-308.
10) Frymoyer J. Back pain and sciatica.1998.N E J;318:291-300.
11) Johan W S Vlaeyen and Steven J Linton. Fear avoidance model of chronic musculoskeletal pain: 12 years on. 2012.IASP PAIN;153:1144-1147.
12) Catherine cavallarogoogman. Differential diagnosis of Physical Therapy.3rd edition:11.
13) David G.Borenstien Sam W.Wisel and Scott D.Boden. Low back pain.1995;2nd edition.
14) RaminKordi, MD, MSc, PhD and Mohsen Rostami : Low Back Pain in Children and adolescents: an Algorithmic Clinical Approach.2011, September;21(3):259-270.
15) Antonia Gómez-Conesa, and Julio Sánchez-Meca: Physical therapy treatments for low back pain in children and adolescents: a meta-analysis. BMC MusculoskeletDisord.2013; 14: 55.
16) Balagué F, Nordin M, Skovron ML, Dutoit G, Yee A, Waldburger M. Non-specific low- back pain among schoolchildren: a field survey with analysis of some associated factors.J Spinal Disord. 1994;7:374–379.
17) Kovacs FM, Gestoso M, del Real MT G, López J, Mufraggi N, Méndez JI. Risk factors for non-specific low back pain in schoolchildren and their parents: a population based study. Pain. 2003;103:259–268.
18) SureepornPhrompaet, MSc, AatitPaungmali, MPhty, PhD,* UbonPirunsan, MPhty, PhD, and PatrapornSitilertpisan, MSc, PhD: Effects of Pilates Training on Lumbo-Pelvic Stability and Flexibility. Asian J Sports PMCID. 2011 March; 2(1): 16–22.
19) Kazunori itoha, Satokaitoh, Yasukazu Katsumi, Hiroshi Kitakozi. A pilot study on acupuncture and TENS to treat chronic non-specific low back pain, Complementary Therapies in clinical practise.2009;vol.15:22-25.
20) Taimella S, Kujala U, Salminen J, ViljanenT.The prevalence of LBP in children an adolescent. A nation wise co-hort based questionnaire survey in Finland. Spine.1997;22:1132-36.
21) Todd L Olsen et al. Olsed TD, Andrew RL, Kriska AM, Cauley JL, Aron DJ. The epidemiology of low back pain in an adolescent population. Am j Public Health.1992;82(4):606-608.Medline.
22) Balague F, Dutoit G, Waldburger M. LBP in school children:an epidemiological study. Scandinavian Journal of Physical Therapy.1998;20:175-79.
23) Hestbak L, Leboeuf-yde C, Kyvik KO, Manniche C. The course of LBP from adolescent to adulthood:eight years follow-up of 9600 twins.
24) S. Donzelli: Two different techniques in the rehabilitation treatment of low back pain:a randomized controlled trial. Vol. 42 - No. 3 Europa Medicophysica 205.
25) JuhaAuvinen: Neck, shoulder amd low back pain in adolescence. Temper 2010.
26) Fritz JM, Irrgang JJ: A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. PhysTher. 2008 Jan;88(1):138-9.
27) A.G.E.M. de Boer et al: Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life? Arch 2004; 13(2): 311-320.
28) Abenhaim L, Rossignol M, ValatJP.The role of activity of the therapeutic management of low back pain.Report of the International Paris task Force in back pain. spine 2000;25:33.
29) Faas A. Exercise: which ones are worth trying, for which patients and when? Spine.1996;21:2874-78.
30) KoesBWAssendelft WJ, Van der Haijden GJ. Spine manipulation and mobilization for back and neck pain.a blinded review. Br Med J.1991;303:1298-03.
31) Shah, J S Hampson W.G.H. The distribution of surface strain in the cadaveric lumbar spine. Journal of bone and surgery;60:246.
32) Jagmohansingh, Text book of electrotherapy. 1st edition 2005:128.
33) Moffett JK, Torgerson D, Bell-Syer S, Jackson D, Llewlyn-Phillips H, Farrin A, Barber J. Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences. BMJ. 1999;319:279–283.
34) Aure OF, Nilsen JH, Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up. Spine. 2003;28:525–531.
35) Jones M, Stratton G, Reilly T, Unnithan V. The efficacy of exercise as an intervention to treat recurrent nonspecific low back pain in adolescents.PediatrExerc Sci. 2007;19:349–359.
36) Ahlqwist A, Hagman M, Kjellby-Wendt G, Beckung E. Physical therapy treatment of back complaints on children and adolescents. Spine. 2008;33:721–727.
37) Vasseljen O, FladmarkAM. Abdominal muscle contraction thickness and function after specific and general exercises: A randomized controlled trial in chronic low back pain patients. Man Ther. 2010;15:482–9.
38) Critchley D. Instructing pelvic floor contraction facilitates transversusabdominis thickness increase during low-abdominal hollowing. Physiother Res Inter. 2002;7:65–75.
39) Muscolino E. Pilates and the "powerhouse"-1. J Body Work MovTher. 2004;8:15–24.
40) Latey P. Updating the principles of the Pilates method-Part 2.J Body Work MovTher. 2002;6:94–101.
41) Julie M. Fritz, PhD, PT, ATC* and Shannon N. Clifford, PhD, PT: Low Back Pain in Adolescents: A Comparison of Clinical Outcomes in Sports Participants and Nonparticipants. J Athl Train. 2010 Jan-Feb; 45(1): 61–66.
42) Birgit Skoffer and Anders Foldspang.Physical activity and low-back pain in schoolchildren.Eur Spine J. 2008 March; 17(3): 373–379.
43) Tsuyoshi Sato, Takui Ito, [...], and Naohito Tanabe. Low back pain in childhood and adolescence: a cross-sectional study in Niigata City. Eur Spine J. 2008 November; 17(11): 1441–1447.
44) Jones MA, Straton G, Reilly T, Unnithan VB. A school based suevey of recurrent non-specific low back pain prevalence and consequences in children.2004Jun;193(3)284-9.
45) Sam Murphy, Peter Buckle, Dave Stubbs.Back pain among school children and associates risk factors.
46) Balague F, Skovron ML, Nordin M, Dutoit G, Waldburger M. Low back pain in school children. Spine.1995;20:1265-70.
47) Ismail Bejia, NabihaAbid, Kamelben Salem, Mohammed Younes, MongiTouziNaceurBergaoui. Low back pain in a cohort of 622 Tunisian school children and adolescent.An epidemiological study. European Science Journal.Vol.14.2005;31-36.
48) Mohseni-Bandepi MA, Bagheri-Nesami M. Non-specific LBP in 5000 Iranian school children. J Pediatr Orthop.2007;27(2):126-9.
49) Poverty and adolescent girls health.
50) Debbi Ef, Ian S ,Michel R, Lucian A. Risk factors for the development of LBP in adolescent. American Journal of Epidemiology.2001;Vol.154:30-36.
51) R. Gunzburg, F. Balague, M. Nordin, D Duyck, D Bell. Low back pain in a population of school children. European Science Journal.Vol.8;1999:439-43.
52) Todd, Fairbanks J, Pysent P, Van, Philip H. Influence of anthropometric factors and joint laxity in incidence of adolescent with back pain.Spine.1996;20:2323-28.
53) Fritz JM, Irrgang JJ: A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. PhysTher. 2008 Jan;88(1):138-9.
54) Michael Vianin. Psychometric properties and clinical usefulness of Oswestry Disability Index. J Chiropr Med, 2008 Dec;7(4):161-3.
55) A.G.E.M. de Boer et al: Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life? Arch 2004; 13( 2): 311-320.
56) Boonstra AM, SchiphorstPreuper HR, Reneman MF. Reliability and validity of the VAS for disability in patients with chronic msculoskeletal pain.Int J Rehab Res.2008;31 (2):165-9.
57) X. Badia, S. Monserrat, M. Roset, M. Herdman. Feasibility, validity and test–retest reliability of scaling methods for health states: The visual analogue scale and the time trade-off. June 1999, Volume 8, Issue 4:303-310.
58) Olagun, Matthew et al. Reliability of rating LBP with a VAS and a Semantic Differential Scale. Physiotherapy Theory and Practise.20:135-42.
59) ) Edwin ChoonWyn Lim, PT1, Ruby Li ChooPoh, PT, MClinPhty(Manip)2, Ai Ying Low, PT, 2, Wai Pong Wong, PT, MPH, PhD: Effects of Pilates-Based Exercises on Pain and Disability in Individuals With Persistent Nonspecific Low Back Pain: A Systematic Review With Meta-analysis. Published: Journal of Orthopaedic & Sports PhysicalTherapy.2011; 41(2): 70-80.
60) Susan Sorosky, 1,2 Sonja Stilp,3,4 and VenuAkuthota : Yoga and pilates in the management of low back pain. Musculoskelet Med. 2008 March; 1(1).
61) Stolze LR, Allison SC, Chids JD.Derivation of a preliminary clinical prediction rule for identifying a subgroup of patients with low back pain likely to benefit from Pilates-based exercise.J Ortho Sports Phys Therapy.2012 May;42(5):425-36. doi: 10.2519/jospt.2012.3826. Epub 2012 Jan 25.
62) RusselJago, Marriam, Tom Barranswoski. Effect of 4 weeks of Pilates on the body composition of young girls.Elsevier BV 2013 Science Direct.
63) MaurícioAntônio da Luz, Leonardo Oliveira Pena Costa, Fernanda Ferreira Fuhro, Ana Carolina Taccolini Manzoni, NaianeTeixeiraBastos de Oliveira and Cristina Maria Nunes Cabral. Effectiveness of mat Pilates or equipment-based Pilates in patients with chronic non-specific low back pain: a protocol of a randomised controlled trial. BMC Musculoskeletal Disorders 2013, 14:16 doi:10.1186/1471-2474-14-16 .
64) Gisela C, Miyamoto, Leonardo O.P., Costa and Cristina M.N. Cabral. The efficacy of the addition of the Pilates method over a minimal intervention in the treatment of chronic nonspecific low back pain: a study protocol of a randomized controlled trial. J Chiropr Med. Dec 2011; 10(4): 248–254.doi: 10.1016/j.jcm.2011.06.007.
65) Jayant Joshi, PrakashKotwal. Essential of orthopaedics and applied physiotheraphy., Churchill Livingstone. 5th editin:400.
66) Amir Massoud Arab, Mohammad Reza Nourbakhsh, and Ali Mohammadifar: The relationship between hamstring length and gluteal muscle strength in individuals with sacroiliac joint dysfunction. J Man ManipTher. 2011 February; 19(1): 5–10.
67) Yang, EunJoo MD; Park, Won-Beom MD, PhD; Shin, Hyung-Ik MD, PhD; Lim, Jae-Young MD, PhD: The Effect of Back School Integrated with Core Strengthening in Patients with Chronic Low-Back Pain. September 2010 ;89 ( 9) :744-754.
68) Kristin M Houghton: Review for the generalist: evaluation of low back pain in children and adolescents. PediatrRheumatol Online J. 2010; 8.
69) Ahlqwist A, Hagman M, Kjellby-Wendt G, Beckung E. Physical therapy treatment of back complaints on children and adolescents. Spine. 2008;33:721–727.
70) Jones M, Stratton G, Reilly T, Unnithan V. The efficacy of exercise as an intervention to treat recurrent nonspecific low back pain in adolescents.PediatrExerc Sci. 2007;19:349–359.
71) Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain.Eur Spine J. 2006;15:Suppl 2:S192–300.
72) Anderson B, Spector A. Introduction to Pilates-based rehabilitation. OrthopPhysTherClin N Am. 2000;9:395–410.
73) Bryan M, Hawson S. The benefits of Pilates exercise in orthopaedic rehabilitation. Tech Orthop. 2003;8:126–129.
74) .da Silva A, Mannrich G. Pilates on rehabilitation: a systematic review [Portuguese]. PhysTher Movement. 2009;22:449–455.
75) Ekici G, Bingul O, Yakut E. Effects of pilates-based exercises on tranversusabdominus in females with non-specific chronic low back pain: a pilot study [Turkish]. FizyoterapiRehabilitasyon. 2008;19:201.

76) Johnson Olubusola Esther.Therapeutic Exercises in the
Management of Non-Specific Low Back Pain.Johnson Olubusola Esther (2012). Therapeutic Exercises in the Management of Non-Specific Low Back Pain,
Low Back Pain, Dr. Ali AsgharNorasteh (Ed.), ISBN: 978-953-51-0599-2.