Effects of physical therapy on posture, spinal mobility and functional status in chronic low back pain

Chronic low back pain is a health problem which affects a large proportion of the society, that leads significant social and economic loss and limitation of daily activities. Although the relationships between low back pain and posture and spinal mobility were investigated by several studies, no consensus achieved about these issues. There is not much data about the effects of physical therapy on posture and spinal mobility. The purpose of tis study is to investigate the effects of physical therapy on pain, functional status, posture and spinal mobility in chronic low back patients, and also the association of gender, age and BMI with posture and spinal mobility. 100 patients who had mechanical low back pain of at least 3 months duration, and who were evaluated in the outpatient clinics of Akdeniz University Faculty of Medicine, Physical Therapy and Rehabilitation Department were included in our study. The 60 patients in the study group were assigned a physical therapy program consisting of superficial heat (hotpack or infrared), TENS and ultrasound for two weeks, 10 sessions in total. No physical therapy was applied to the 40 patients in the control group. Pain severity of the patients was assessed by VAS and functional status was evaluated by ODI. Posture was assessed by digital inclinometre by measuring lumbosacral angle, standing lumbar and thoracic posture. Spinal mobility was evaluated by digital inclinometre by measuring standing hip flexion and extension, gross lumbar and thoracic flexion and extension, lumbar and thoracic flexion and extension angles. Lomber flexion was also assessed by Schober test. Evaluations were done at baseline, and at the end of the study. At the end of 10-session physical therapy program, significant decreases in VAS and ODI and significant increases in Schober test, posture evaluations, and standing hip flexion and extension, gross lumbar and thoracic flexion and extension and thoracic extension angles were noted in the study group when compared with baseline values (p<0,05). There was also a significant decrease in VAS in control group, but not as distinctive as in study group. In females, all of the postural angles were significantly more excessive when compared with males. Furthermore, in females, schober test and thoracic flexion degrees were significantly less than males. Thoracic kyphosis of the elderly was significantly larger than others and there was a significant and negative correlation between age and gross lumbar flexion and extension, lumbar flexion and extension, and gross thoracic flexion angles (p<0,05). Thoracic kyphosis angles were significantly larger in obese patients. A significant decrease was observed in the schober test and lumbar flexion of the obese patients when compared to non-obese persons (p<0,05). In our study, postural aberrations and decreases in spinal mobility were observed more common in females, obese and eldery patients. Significant improvements in pain severity, functional status, posture and spinal mobility were noted in chronic low back pain patients at the end of physical therapy program. As a conclusion, it was stated that, physical thrapy is an effective option in treatment of low back pain.