PNF for Chronic Low-back Pain James Luker

Background Hides et al (1992), (1994) first established that ultrasound was a valid method of measuring multifidus CSA, and that this muscle is atrophied ipsilaterally in LBP patients O’Sullivan, Twomey, and Allison (1997) showed that retraining transversus abdominis w/multifidus decreased back pain long-term Hides, Jull and Richardson (2001) reported a decrease in back pain recurrence rate at one-year with a similar training program What can PNF do for us in this population?

PNF Techniques Pelvic D1/D2 Scapular D1/D2 Rhythmic stabilizations

Indications for Use Low-back pain Poor recruitment/use of spinal stabilizers/deep core General strengthening of peri-spinal muscles

The Intervention Effects of Different Treatment for Chronic Low Back Pain as Assessed by the Cross-sectional Area of the Multifidus Muscle PNF vs. NJF (Neuromuscular joint facilitation) vs. NJF + pelvic floor exercises 13 subjects mean age 23.6 with LBP for >6 months Front lower pelvic pattern of PNF used (Presumably D1), traction + resistance given in opposition to PNF pattern. CSA of multifidus measured with ultrasound during maximal contraction NJF+PF > NJF > PNF for maximal CSA

The Effects on the Pain Index and Lumbar Flexibility of Obese Patients with Low Back Pain after PNF Scapular and PNF Pelvic Patterns 30 minute PNF-pattern based exercise session 3x/week for 4 weeks Scapular/Pelvic D1/D2 exercise patterns. Control group strengthening exercises 3x/week for 4 weeks 30 obese males with LBP Lumbar ext ROM increased significantly and ODI decreased significantly in PNF group, relative to baseline and control group

The Effects of Combination Patterns of Proprioceptive Neuromuscular Facilitation and Ball Exercise on Pain and Muscle Activity of Chronic Low Back Pain Patients PNF pattern exercise vs. ball exercise PNF group “sprinter/skater posture” in parallel with PNF in various positions. Ball group pelvic tilts/leg lifts/marching following Janda’s basic program 40 subjects with CLBP mean age 34.7 Both groups showed stat sig. lower VAS after 6 weeks, with PNF>ball. Both groups showed higher muscle activity (EMG) over time for TA/ES, PNF>Ball at 6 weeks though not stat sig.

Effects of Two 4-Week Proprioceptive Neuromuscular Facilitation Programs on Muscle Endurance, Flexibility, and Functional Performance in Women With Chronic Low Back Pain  86 women mean age 40.1 with CLBP 4 weeks of training, 3 groups: Rhythmic stab training, isotonic exercises, control. PNF group: 10s alternating trunk flex/ext isometric contractions, 3x15 at max resistance. Isotonic group: Alternating trunk flex/ext concentric/eccentric 3x15 max resistance. Measures taken at baseline, 4 weeks, 4 weeks post, and 8 weeks post. Both exercise groups showed decreased ODI scores, increased lumbar mobility, increased lumbar muscle endurance, Isotonic > PNF

???? PNF is not well studied Low-power studies usually Some current studies show that other modes of exercise are more effective Much more hands-on than traditional therex – some patients may prefer this while others may not

Summary PNF techniques including scapular/pelvic patterns and rhythmic stabilization can be effective in treating CLBP Few current studies comparing PNF to other treatment modes Useful as an option if other treatments are stalling Further study useful to tease out more specific indications/techniques

References The Intervention Effects of Different Treatment for Chronic Low Back Pain as Assessed by the Cross-sectional Area of the Multifidus Muscle The Effects on the Pain Index and Lumbar Flexibility of Obese Patients with Low Back Pain after PNF Scapular and PNF Pelvic Patterns The Effects of Combination Patterns of Proprioceptive Neuromuscular Facilitation and Ball Exercise on Pain and Muscle Activity of Chronic Low Back Pain Patients Effects of Two 4-Week Proprioceptive Neuromuscular Facilitation Programs on Muscle Endurance, Flexibility, and Functional Performance in Women With Chronic Low Back Pain 

References Hides, J., Jull, G., Richardson, C. (2001). Long-Term Effects of Specific Stabilising Exercises for First-Episode Low Back Pain. Spine, 26(11): E243-E248 Hides, J., Cooper, D, Stokes, M. (1992). Diagnostic imaging for the measurement of the lumbar multifidus muscle in normal young adults. Physiotherapy Theory and Practice, 8:19-26. Hides, J., Stokes, M., Saide, M., Jull, G., Cooper, D. (1994). Evidence of Lumbar Multifidus Muscle Wasting Ipsilateral to Symptoms in Patients with Acute / Subacute Low Back Pain. Spine, 19 (2) : 165- 172 O’Sullivan, P., Twomey, L., Allison, G. (1997). Evaluation of Specific Stabilising Exercise in the Treatment of Chronic Low Back Pain With Radiologic Diagnosis of Spondylosis or Spondylolisthesis