EVALUATION OF THE EFFECT OF SWIMMING AND SPECIFIC PHYSICAL
EXERCISE ON MECHANICAL PATHOLOGIES OF THE SPINE
Title.
The effect of swimming and exercise on non-specific
low back pain; a randomized, controlled trial.
Background.
Exercise has been shown to be effective in
the treatment and prevention of chronic non-specific low back
pain. While traditionally swimming has been recommended to
these patients, its effect has not been scientifically evaluated.
On the other hand, in recent years some studies have evaluated
the effect of different programs of physical exercises with
this aim.
Objective tests of muscular strength have also been described
that can be carried out in the doctor's office and whose results
correlate adequately with more expensive and sophisticated
testing and evaluation apparatus. Thus, for example, the abdominal
and paravertebral Toshikazu tests have been shown to correlate
to the corresponding muscle strength.
Objectives.
In relation to physical exercise for the prevention or treatment
of non-specific low back pain:
-
To determine how many weekly sessions are necessary to
generate a perceptible effect on the strength of the abdominal
and paravertebral muscles and how much time it takes for
that effect to appear.
-
To determine what degree of correlation exists between
the improvement of the patient's muscle fitness and the
evolution of his/her pain and disability.
-
To compare, in regard to the above objectives, the effect
of:
Design
Randomized, controlled trial, blind in the randomization, evaluation
and analysis of the results
Methodology.
150 patients with non-specific low back pain
were recruited. The subjects were randomly assigned to three
groups; group A (swimming), group B ("strengthening"
exercises) and group C ("endurance" exercises).
In the subjects from group A, a swimming program, of the
crawl and backstroke, was applied. In the subjects form groups
B and C, a "dry" program of exercises was applied.
In group B, short series were performed, with a maximum of
8 repetitions with a minimum of 80% of maximum effort in each
one of them. In group C, long series were performed, with
a minimum of 12 repetitions, each one of them with a maximum
of 60% of the maximum effort.
The patients were evaluated upon entering the study and once
a month during the follow-up (up to 6 months). In each evaluation,
the low back pain intensity was assessed (on a visual analog
scale), degree of disability (on a Roland-Morris scale), the
use of pharmacological treatment for low back pain, the functional
state of their abdominal and paravertebral muscles (in both
cases, by means of the corresponding Toshikazu test), and
the number of weekly sessions carried out during the period.
When the study ended, the evolution of the different variables
in each group was analyzed, as was the correlation between
the evolution of the muscular parameters (state of the muscle)
and the clinical parameters (pain and disability). Also, the
effect of the number of weekly sessions and the time since
the start of the exercise on these variables was determined.
Participants, along with the Kovacs Foundation
Science Department.
Centers of muscle recovery in Palma de Mallorca
affiliated with the Balearic Island Back School and the Unit
of Clinical Biostatistics at the Hospital Ramón y Cajal.
Status.
A pilot program has been carried out to determine
the viability of recruiting the sample. Its results have demonstrated
that the collaboration of clinical centers in order to recruit
the sample is necessary. The study is on hold until this matter
is resolved and it is viable to carry it out.
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