Variable and unpredicted perturbations to the spine may lead to increased muscle strength and pain reduction in patients with chronic nonspecific low back pain, according to results from a randomized controlled trial published in the European Journal of Applied Physiology.

The efficacy of random perturbation rehabilitation training exercises was evaluated in patients with chronic nonspecific low back pain. In this exercise, initiated with a 10-minute-long warm-up, “continuously variable and unpredictable disturbances were applied to the spine [in the lower back pain area],” for a period of 70 minutes, during which “disturbances in the anteroposterior and mediolateral axes of the trunk” were performed using a device developed for this purpose. Patients were randomly assigned to receive 26 training sessions twice a week for 1.5 hour (n=20) or to continue normal physical activity with no added training (control group; n=20).

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Patients receiving the perturbation therapy reported a 35% reduction in low back pain and a 15% to 22% increase in muscle strength. No association between pain scores at baseline and a percentage increase in trunk stiffness after therapy was established. Participants in the intervention group also displayed increased strength of trunk extensor muscles during isokinetic and maximal isometric contractions (P =.001).

Although this study does provide insight into the effects of perturbation-based therapy vs no intervention, it does not provide a direct comparison against other interventions designed to improve low back pain. Because the control group continued their normal routines, participants in this group may have performed other exercises that could have provided comparative value.

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This perturbation-based therapy may “enhance trunk muscle capability as well as sensory information processing within the motor system during sudden loading,” resulting in improvement in trunk stabilization, concluded the researchers.

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Arampatzis A, Schroll A, Catalá MM, et al. A random-perturbation therapy in chronic non-specific low-back pain patients: a randomised controlled trial [published online October 19, 2017]. Eur J Appl Physiol. doi: 10.1007/s00421-017-3742-6