Comparison of lumbar spine stabilization exercise versus general exercise in young male patients with lumbar disc herniation after 1 year of followup dolor lumbar y mareos

In this study, we focused on comparison of the effectiveness of LSSE with GE on pain and functional capacity in LDH patients. However, our preliminary investigation indicated that the LSSE program cannot be accepted by acute LDH patients, while LPL therapy can effectively reduce the intensity of low back and leg pain. Therefore, before performing LSSE or GE, all of the patients in both groups received LPL therapy during the first week of the onset of LDH. We found that LPL therapy reduced pain intensity in the lower back and legs. Both of the LSSE and GE programs further reduced pain intensity in the lower back and legs, and improved functional capacity. Moreover, at 12 months post-exercise, patients in the LSSE group showed a significantly reduced mean score of the VAS for low back pain and the ODI compared with the GE group.Dolor lumbar y mareos


this result suggests that the LSSE and GE programs can relieve pain intensity in the lower back and legs, and improve functional capacity in LDH patients. LSSE was superior to GE in the treatment of LDH with regard to low back pain and functional capacity in the long term.

LPL therapy can effectively relieve low back and leg pain by a reduction in the size of the herniated mass of patients with acute LDH [ 11]. Our patients accepted LPL therapy only for 1 week, and we did not assess the change in disc size by MRI. However, LPL therapy significantly reduced the pain intensity of the lower back and legs, and provided a good basis for our patients to perform the LSSE or GE program. Most patients could begin these exercise programs 5-7 days after LPL therapy, while they hardly performed any exercise pre-LPL therapy in this study.Dolor lumbar y mareos

GE is the most common exercise therapy. GE can improve the range in movement of the spine by stretching exercises, increase muscle power by strengthening exercises, and correct posture deficits by control exercises. These active exercises can significantly reduce pain and improve functional abilities by improving the range in movement, muscle strength, and body posture [ 16, 17]. LSSE is a comprehensive rehabilitation program involving postural training, deep muscle reactivation, stretching and strengthening of the prime movers of the spine, and subsequent progression to functional exercises [ 8, 11, 12]. LSSE also improves the range in movement, muscle strength, and body posture by stretching and strengthening of the prime movers of the spine and postural training [ 8, 12].Dolor lumbar y mareos therefore, the mechanism of GE and LSSE for relieving low back and leg pain and improving functional capacity in young male LDH patients is probably associated with improved range in movement of the spine, muscle strength, and body posture.

LSSE is characterized by improvement of dynamic stability of the spine by training the deep trunk muscles, such as the tra and LM, and correction of motor control [ 8, 10- 12]. Accordingly, the LSSE program significantly reduced the mean score of the VAS for low back pain and the ODI at 12 months post-exercise compared with the GE program. A possible explanation for this finding is improved spinal stability associated with the LSSE program.

Several studies have shown that LSSE improves musculature of the tra [ 18], activation of the tra [ 18] and LM [ 19], and proprioception[ 23].Dolor lumbar y mareos improvement of the musculature of the tra and proprioceptive action, as well as co-contraction of the tra and LM muscles increase lumbo-sacral segmental stability [ 8, 11- 13, 18]. This improved lumbo-sacral segmental stability helps to reduce compressive overloads, and attenuates or eradicates back pain associated with instability. This leads to improvement in functional capacity and helps prevent degenerative disc disease [ 21], based on evidence from previous studies and the relationship between disc degeneration and instability [ 22- 26].

To the best of our knowledge, this is the first study to compare the effects of LSSE and GE programs on pain and functional capacity in LDH patients. Our results are consistent with a recent review of the efficacy of motor control exercise for non-specific LBP patients [ 10].Dolor lumbar y mareos this review showed that motor control exercise appears to be superior to the GE program for reduction of pain and disability.

However, cairns et al reported that LSSE did not present an additional benefit to GE and manual therapy in patients with nonspecific, recurrent LBP [ 27]. Another meta-analysis in chronic LBP patients demonstrated that core stability exercise is more effective than the GE program in improvement of pain and physical function in the short term, rather than the long term [ 12]. These discrepancies in the effects of LSSE and GE in different studies may be due to differences in the patients, and differences in the exercise programs in terms of duration, frequency, and intensity of the procedures that were used.

In the current study, notably, all of the patients in both groups reported that they still kept performing their exercise program at home during the follow-up period.Dolor lumbar y mareos the reasons for this finding could be because of the development of the economy and a change in lifestyle in china, and also because exercise results in higher satisfaction and self-confidence in young male adults. The fact that both of the LSSE and GE programs are easily applicable, not expensive, and can be performed in any location is considered to be an important contributing factor for young male adults maintaining their exercise program without supervision. Accordingly, at 12 months post-exercise rather than 3 months post-exercise, patients in the LSSE group showed a significantly reduced mean score of the VAS for low back pain and the ODI compared with the GE group. This result suggests that only long-term regular LSSE is superior to GE in the treatment of LDH.Dolor lumbar y mareos

There are several limitations in this study. We had a small number of patients, and no placebo laser, LSSE, or GE treatment was included in this study because of the results of our preliminary investigation. Another limitation of our study is that we did not measure activation of deep trunk muscles, muscle strength, and lumbar stability. We focused on the effect of exercise therapy on pain and functional capacity in LDH patients, not the associations between physical changes of deep muscle and improvement in pain and functional capacity. Further studies are required to explore the underlying mechanisms to clarify the effect of these exercises on pain intensity and functional capacity.

In summary, LSSE and GE can effectively reduce pain intensity in the lower back and legs, and improve functional capacity in young male LDH patients.Dolor lumbar y mareos moreover, in the long term, LSSE is more effective than GE in reducing pain intensity in the lower back, and in improving functional capacity. However, during the acute phase of LDH, physical therapy, such as LPL, is needed to relieve pain intensity. These results suggest that LSSE should be an essential component of the treatment plan for LDH patients, and that combination of LSSE with physical therapy, such as LPL, is an effective and performable program.