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Exercise, Manual Therapy, and Education with or Without High-Intensity Deep-Water Running for Nonspecific Chronic Low Back Pain: A Pragmatic Randomized Controlled Trial

Cuesta-Vargas, Antonio Ignacio PT, MSc, PhD; García-Romero, Jerónimo Carmelo MD, PhD; Arroyo-Morales, Manuel PT, MD, PhD; Diego-Acosta, Ángel Mario PhD; Daly, Daniel J. PhD

American Journal of Physical Medicine & Rehabilitation: July 2011 - Volume 90 - Issue 7 - p 526-538
doi: 10.1097/PHM.0b013e31821a71d0
CME Article • 2011 Series • Number 4: Back Pain

Objectives: The aim of this study on persons with nonspecific chronic low back pain was to evaluate the effect of a multimodal physical therapy program with or without the addition of deep-water running on pain, physical disability, and general health.

Design: A randomized controlled trial involving 46 subjects with nonspecific chronic low back pain were treated three times a week for 15 wks. Each group received 60 mins of multimodal physical therapy program (an individualized exercise program; manual therapy; and back care, pain education, and information on an active lifestyle), whereas one group performed additional 20-min sessions of deep-water running at an individual workload of the aerobic threshold.

Results: Both interventions resulted in significant improvements in pain, disability, and physical health. The mean change in pain, disability, and physical health state were −36.1 ± 25.1 mm on the visual analog scale, −3.0 ± 4.8 points for the Roland Morris Questionnaire, and 10.6 ± 12.9 points for the Short Form-12 for the physical therapy plus deep-water running group and −34.1 ± 26.0 mm on the visual analog scale, −1.6 ± 1.5 points for the Roland Morris Questionnaire, and 8.9 ± 13.0 points for the Short Form-12 for the physical therapy alone group.

Conclusions: Pain, disability, health status, muscle strength and endurance, and lumbar range of motion significantly improved in both groups. The addition of a deep-water running program at an individual workload of the aerobic threshold to the multimodal physical therapy program produced a significant improvement in pain in patients with nonspecific chronic low back pain, but this was not significantly different when compared with multimodal physical therapy program alone. Disability, health status, muscle strength and endurance, and lumbar range of motion significantly improved to a similar level in both intervention groups.

From the Department of Physical Therapy (AIC-V), and Department of Human Physiology, School of Medicine, University of Málaga, Málaga, Spain (JCG-R, ÁMD-A); Physiotherapy Department, Health Sciences School, University of Granada, Granada, Spain (MA-M); and Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (DJD).

CME Objectives: Upon completion of this article, the reader should be able to: 1) Describe the benefits of a multi-modal treatment program including exercise, manual therapy and education for non specific chronic low back pain 2) Recognize that deep water running (DWR) can be a safe and well tolerated aerobic exercise in non specific chronic low back pain; 3) Describe the benefits of deep water running in individuals with non specific chronic low back pain.

Level: Advanced

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.

All correspondence and requests for reprints should be addressed to: Antonio Ignacio Cuesta-Vargas, PT, MSc, PhD, Department of Physical Therapy, School of Medicine, University of Málaga, Málaga 29080, Spain.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Presented, in part, at the International Congress of the South African Physiotherapy Association, The Full Circle: Exercise and Education, on May 2009 in Cape Town, South Africa.

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.