Exercises on a balancе cushion to influence of lumbar vertebral syndrome

Introduction

Many authors work in the area of low back pain, defining it as a health problem with a large social economic impact (De Castro et al., 2020). According to Botov, Shnyakin, Osipov and Zhavner (2018) today, it is generally accepted that most people experience low back pain (LBP) throughout their lives and this pain becomes chronic with age (Botov, Shnyakin, Osipov and Zhavner, 2018). Janura et al. (2015) noted that LBP is a painful disease which results in limitations on normal daily physical activities related to self-care, social contact and communication (Janura et al., 2015). In 2015 Gotova, Filipova and Popova ported that approximately 75-85% of the elite female rhythmic gymnasts worldwide have had at least one episode of lumbar spine pain during their racing career (Gotova, Fillipova and Popova, 2015).

Lower back pain can occur or develop by many kinds of factors like age, gender, height, weight, body mass index (BMI) and general health (Alperovitch-Najenson et al., 2010). Zlatkov (2019a) shares that the pain in this region can be of a different nature – neurological, traumatic, psychological, etc. Determining the type and location of pain in the lumbosacral region helps to diagnose correctly, which aids to choose the right treatment (Zlatkov, 2019a). Konstandinu et al. (2016), studying tennis players, report that the causes of lumbar pain are various – single or multiple external injuries, osteoporosis, static overload, muscle strain, as well as stress (Konstandinu et al., 2016). According to Zlatkov (2020) one of the reasons for the distribution of lumbar pain is lifestyle – the lack of physical activity, which leads to detraining of the muscles that support the spine (Zlatkov, 2020).

Zlatkov (2019b) reports that one of the causes of pain in the lumbar region is vertebral syndrome, which can affect people of different ages (Zlatkov, 2019b). According to Todorova, Georgieva and Gavrailov (2015) vertebral syndrome is characterized by smoothed physiologic lordosis, functional scoliosis, rigid paravertebral musculature, hypomobility, button symptom, impaired posture and locomotion (Todorova, Georgieva and Gavrailov, 2015).

Stoyanov, Avamova, Mitova and Gramatikova in 2020 summarize that low back pain leads to a loss of full life, which negatively affects the quality of life of patients. The authors report that there are various methods of treating chronic spine pain syndrome (Stoyanov, Avramova, Mitova and Gramatikova, 2020). There is a wide range of options for treating low back pain. According to Pappas, Panou and Souglis (2013) these interventions can be categorized as active or passive (Pappas, Panou and Souglis, 2013).

Lowe, Swanson, Hudock and Lotz (2015) share that use of a backrest support surface for the lumbar spine reduces activation of trunk muscles and aligns the spine in a more optimal lordosis, or “S-shaped”, posture. The unstable (stability ball) seating practice is predicated on deliberately inducing a trunk muscle (or “core activation”) challenge to create an exercise stimulus and a beneficial physiological response for the individual (Lowe, Swanson, Hudock and Lotz, 2015).

Wang, Weiss, Haggerty and Heath (2014) note that active seating is classified as the use of an unstable seating surface that requires the user to engage in more movement of the carcass to maintain an upright sitting posture. According to the authors this type of seating can be performed on an extremely compatible surface such as a stability ball or a moderately compatible air cushion placed on the seat of the chair (Wang, Weiss, Haggerty and Heath, 2014).

Lee, Lim, Won and Kim (2018) administered to drivers with low back pain therapy with a gel cushion for a period of three months and found that their condition improved (Lee, Lim, Won and Kim, 2018).

We suggest that patients suffering from low back pain exercise on a balance cushion. Exercises improve the condition of patients by influencing the mobility of the lumbar spine, reducing pain and relaxing the muscles. As the mobility in the lumbar region improves, the trophism of the nucleus pulposus also improves.

From the literature reference we did not find authors who indisputably prove the effectiveness of the application of a balance cushion in patients with low back pain. Therefore, we believe that our article is important and original and should enrich the means used to affect low back pain.

Methods

Procedure

We introduced patients to the nature of the study. After receiving informed consent and approval from the Commission for Ethics of Scientific Research at South- West University “Neofit Rilski”, Blagoevgrad, we proceeded to conduct the study. Written informed consent for publication of their details was obtained from the study participant. We applied exercises on a balance cushion for a period of one month. After conducting research (VAS, Schober test, measurement of lateral flexion and Straight leg raise test) on the participants in the study and determining their condition, the therapy was started. At the beginning of the procedures, each participant was given a manipulative massage and treatment of trigger points in the back, lumbar region, buttocks and lower limbs. They then proceeded to perform the exercises on a balance cushion. Each exercise was demonstrated by us in order for it to be learned correctly and to be performed independently at home. The exercises were the following:

Exercise 1. Sitting on the balance cushion. Inclination and declination of the pelvis (Figure 1). Performed 8-10 times.

Figure 1. Increase the inclination of the pelvis.

Exercise 2. Seat on a balance cushion. Elevation of the pelvis to the left and right. It was performed 7-8 times for each country (Figure 2).

Figure 2. Elevation of the pelvis to the left and right.

Exercise 3. Seating on a balance cushion. Circles of movements with the pelvis. They were performed 7-8 times for each side (Figure 3).

Figure 3. Circular movements with the pelvis.

The duration of the exercises was approximately 10 minutes altogether. They should be performed several times a day. Subjects who had been in a sitting position at work for a long time were advised to use a balance cushion there as well. The duration of the study period was one month, during which patients strictly performed the exercises at home and once a week we applied manual manipulative techniques on our part.

Results

The dynamics of the studied indicators were monitored before and after the kinesitherapy. The evaluation of research results were realized by statistical and mathematical methods and procedures using Graph Pad Prism 3.0. We calculated the mean and standard deviation of the studied indicators. In term to calculate statistically, significant differences we use Wilcoxon signed-rang test to compare independent quantitative variables.

The mean age of the participants in our study was 29.8 ± 3.89 years. Participants in our study were men (n = 10) with a mean age of 29.4 ± 4.69 years and women (n = 10) with a mean age of 30.2 ± 3.08 years.

The degree of pain is measured with a visual-analogue scale. Before our treatment, the mean values ($\overline{\mathrm{X}}$ ± SD) of the degree of pain in the participants were 6.7 ± 1.08, and after it - 0.4 ± 0.75. Prior to kinesitherapy, 12 subjects reported severe pain and 7 had moderate pain. At the end of therapy, 15 of the patients indicated that they were without pain and 5 with mild pain.

The mean values of the measured mobility in the lumbar region according to the Schober test are 1.87 ± 0.23 cm before the therapy with a balance cushion and 3.035 ± 0.15 cm after it. We compared the mean values for statistical reliability by Wilcoxon test at p ˂ 0.05.

In Table 1 we present the mean ($\overline{\mathrm{X}}$) ± standard deviation (SD) of the measured lateral flexion before and after the exercises with a balance cushion. The measured values are in cm. We see an improvement of 3.27 cm to the left and 2.88 cm to the right.

Before and after applying the exercises with a balancе cushion, we measured the degrees reached from the Straight leg raise test. Before treatment, the mean values ($\overline{\mathrm{X}}$ ± SD) of the test were 48.45 ± 5.94 °, and after it - 76.25 ± 3.34 °. We compared the mean values of the Wilcoxon signed - rang test for statistical reliability at p ˂ 0.05.

Discussion

In recent years, there has been a decline in the age of those affected by disc herniation. In our practice, we are seeing younger people with lumbar spine problems.

When assessing the degree of pain through the visual-analog scale (VAS), we clearly see improvement in patients after a month of therapy with a balance cushion. 75% of participants reported no pain at the end of the study, and 25% reported mild pain, which indicates how effective it is to exercise on a balance cushion. Islam et al. (2020) assessed the degree of VAS pain in motorcyclists with low back pain divided into two groups. At the beginning of the study, she had grades 7 and 8 in the VAS. After 6 weeks of middle assessment performance, successful progressions were observed at 37.1% and 40.0% to the respective participants persisted at the range of 4 and 5 into VAS (Islam et al., 2020).

The measured values from the Shober test after the therapy show a clear improvement in lumbar mobility. It is normal for the measured distance to be increased from 3.5 to 4 cm (Pashkunova, 2015). The mean obtained at the end of balancе cushion therapy approaches normal values. The observed improvement from the application of exercises on a balance cushion proves their applicability in patients with lumbar vertebral syndrome. Yen et al. (2015) examined healthy subjects and found that the rate of decrease in lumbar mobility, as measured by the Schober test in men, was very significant from an average of 5.0 cm in the youngest group to 3.1 cm in the oldest group and 3.6 cm to 2.4 cm among women (Yen et al., 2015).

Measurement of lateral flexion shows a significant improvement in the patient’s condition immediately after performing exercises on a balancе cushion. It was essential for us to keep this improvement. Therefore, we recommended that you exercise several times a day for 5-7 minutes, for a long time (1 month). For the same time period in 2011, Krastev, Nikolovska, Stratorska, and Vasileva noted an improvement in the lateral flexion of 1.7 cm and 1 cm to the left and 1.8 cm and 0.8 cm to the right by applying manual therapy and classic therapeutic massage, analytical exercises in patients with chronic lumbosacral pain (Krastev, Nikolovska, Stratorska, and Vasileva, 2011).

The improvement in test values Straight leg raise test at the end of a balancе cushion therapy indicated an effect on neurological symptoms in study participants. The distinction between muscular and nerve root pain causes many clinicians to use various additional confirmatory tests (e.g., the Bragard test). According to Hall and McIntosh (2014), the use of additional tests is not required in the correct application and interpretation of the Straight leg raise test (Hall and McIntosh, 2014). By measuring the values of the Straight leg raise test, we prove digitally the effectiveness of our methodology for responding to lumbar vertebral syndrome.

Conclusions

The lumbar vertebral syndrome, as a result of various causes, is increasingly common in the younger population. The use of various conservative methods to influence them aims to improve the quality of life of those affected. The application of exercises with a balance cushion enriches the kinesitherapeutic practice. Their implementation in the daily lives of those affected by this problem allows in a short time to affect the pain and mobility in the lumbar spine to fully perform their work and professional activities.