Self-stretching exercises for low back pain

Business people walking a tightrope.

Self-stretching exercises for low back pain

Business people walking a tightrope.

A group of physiotherapists in Brazil collaborated on a randomised trial examining whether motor control exercises and global self-stretching exercises have similar effects in people with chronic non- specific low back pain. The senior author, Thais Cristina Chaves, answers some questions about the trial.

Why did you choose to look at these two therapeutic exercise approaches for chronic low back pain?

In Brazil, particularly in the early 2000s, there was so much hype about Global Postural Reeducation exercises.

Today they are still commonly used in clinical practice, but their effect was investigated in a few randomised clinical trials in patients with chronic low back pain and these studies showed several limitations.

In our study, we administered a modified version of Global Postural Reeducation exercises called the Global Active Stretching approach.

Instead of the physiotherapist adjusting the patient throughout the stretching exercises, the patient is verbally instructed and must maintain the postures independently.

This involves stretching and contracting the antagonist muscles to keep the target positions.

Given the scarcity of suitable studies, we decided to run our study comparing the Global Active Stretching exercises (called self-stretching exercises in the manuscript to avoid the problem of using the trademark) to motor control exercises.

So motor control exercise has robust evidence that it is better than control and the global self-stretching exercise approach was being tested against it—is that right?

Motor control exercises demonstrated superior effects for pain intensity (clinically relevant effect) and disability when compared to minimal intervention for patients with chronic low back pain.

When compared to other forms of exercise, the effects appear to be equivalent.

So it is more accurate to say that motor control exercises showed similar effects to other types of interventions and greater effects than a minimal intervention in chronic low back pain.

How long were the interventions administered for and how long was the post-treatment follow-up?

Treatment took place over eight weeks, with a weekly session of 40 minutes. Participants were invited to perform at least one additional home session per week.

We followed the patients at 13 weeks and 26 weeks after randomisation.

What results did you find among the 100 study participants?

The primary outcomes of the study were pain intensity and disability related to low back pain.

The secondary outcomes were fear-avoidance beliefs, global perceived effect of improvement and flexibility.

We found no differences between the groups for all those outcomes.

Given the established effectiveness of motor control exercises and the clear evidence that stretching is equally effective, could either intervention be recommended to people with chronic low back pain? What would the choice of intervention be directed by?

Our findings support the administration of both interventions to treat chronic low back pain.

The choice of treatment should be based on the patient’s preference, as recommended by the National Institute for Health and Care Excellence guideline.

There are patients who don’t like self-stretching exercises (they say ‘it is boring’) and others who report feeling better when stretching.

Physiotherapists can choose the best option based on treatment expectations and patient preferences before considering the best evidence available and clinical expertise.

What do you think research in this field should address next?

We have lots of exciting questions in mind. For example, we need to investigate the association of different interventions, particularly considering the biopsychosocial model.

Is there any additional effect of pain education in addition to self-stretching exercises for pain intensity and disability?

What is the minimal dose necessary to make an impact on pain intensity and disability?

After the eight-week treatment period, which intervention is associated with better exercise adherence?

But ultimately, we really want to deliver the following message. Self-stretching exercises are exercises and not just ‘passive stretching’ because the patients need to keep the positions by contracting the antagonist muscles.

In Brazil, there is a lot of prejudice against self-stretching exercises (particularly Global Postural Reeducation exercises).

Our findings help to clarify that self-stretching exercises are as good as other interventions for managing chronic low back pain.

>> Dr Thais Chaves is a physiotherapist with a PhD in musculoskeletal rehabilitation. She is a college professor and researcher from the Department of Physical Therapy, Federal University of São Carlos, Brazil. She has been supervising master’s and PhD students.


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