1. Introduction
1.1. Background and Epidemiology
Low back pain (LBP) is a common cause of disability affecting one’s performance at work and quality of life (Duthey 2013). LBP prevails in all ages especially the adult working population and approximately 80% of adults will experience an episode of LBP during their lifetime (Rubin 2007). Of which, the prevalence of chronic low back pain (CLBP) is 23% and 11-12% of the population are disabled by it (Airaksinen et al. 2006). 62% of people who experienced their first episode of LBP will develop chronic symptoms (Hestbaek et al. 2003) lasting more than 12 weeks, hence the term “chronic low back pain” (van Tulder et al. 2003).
The Global Burden of Disease Study 2010 showed that globally, LBP is …show more content…
2003, Guo et al. 1999) and 100 million in the United Kingdom (Department of Health 2000). This incurred a hefty cost on employers which estimated to be 200 billion dollars annually in the US (Stewart et al. 2003, Ricci et al. 2006) and £624 million in the UK (Department of Health 2000).
1.2 Concepts of Non-specific LBP
Despite this, the majority of low back pain is not attributable to a specific known pathology; hence, the etiology of non-specific LBP remains unclear (Balagué et al. 2012b). Several mechanisms have been proposed to explain the underlying cause of non-specific LBP. Panjabi suggested that spinal instability is controlled by 3 subsystems which include the 1) passive subsystem (consisting of ligaments, joint capsule and bones), 2) active subsystem (consisting of muscles) and 3) nervous system (consisting of the peripheral nervous system and central nervous system) (Panjabi 1992b, Panjabi 1992a). Sub failure of any subsystems causes micro- trauma and injures the mechanoreceptors, resulting in a dysfunction in motor control (Panjabi …show more content…
2012b). However, Wang and colleagues’ definition of “core stability exercises” were those performed on unstable surfaces (Wang et al. 2012b) rather than focussing on the activation of specific core muscles and translating it into functional activities (Smith et al. 2014). In addition, none of the reviews included clinical pilates as part of MCE. Clinical pilates is a form of therapeutic exercise that focus on core stability and movement re-education (La Touche et al. 2008). It has been recommended in the management of people with CLBP (La Touche et al. 2008, Owsley 2005). Despite its popularity, there seems to be inconclusive evidence if pilates is superior to other forms of exercise (Lim et al. 2011, Miyamoto et al. 2013). MCE has a strong theoretical foundation and is currently a popular treatment for CLBP amongst physical therapist worldwide (Wang et al. 2012b, Byström et al. 2013b). Nonetheless, there is no general consensus as to whether MCE is superior to other forms of general exercises. As physical therapists, it is therefore, important to ensure that the most effective exercise based on scientific evidence is prescribed to patients in the management of
1.1. Background and Epidemiology
Low back pain (LBP) is a common cause of disability affecting one’s performance at work and quality of life (Duthey 2013). LBP prevails in all ages especially the adult working population and approximately 80% of adults will experience an episode of LBP during their lifetime (Rubin 2007). Of which, the prevalence of chronic low back pain (CLBP) is 23% and 11-12% of the population are disabled by it (Airaksinen et al. 2006). 62% of people who experienced their first episode of LBP will develop chronic symptoms (Hestbaek et al. 2003) lasting more than 12 weeks, hence the term “chronic low back pain” (van Tulder et al. 2003).
The Global Burden of Disease Study 2010 showed that globally, LBP is …show more content…
2003, Guo et al. 1999) and 100 million in the United Kingdom (Department of Health 2000). This incurred a hefty cost on employers which estimated to be 200 billion dollars annually in the US (Stewart et al. 2003, Ricci et al. 2006) and £624 million in the UK (Department of Health 2000).
1.2 Concepts of Non-specific LBP
Despite this, the majority of low back pain is not attributable to a specific known pathology; hence, the etiology of non-specific LBP remains unclear (Balagué et al. 2012b). Several mechanisms have been proposed to explain the underlying cause of non-specific LBP. Panjabi suggested that spinal instability is controlled by 3 subsystems which include the 1) passive subsystem (consisting of ligaments, joint capsule and bones), 2) active subsystem (consisting of muscles) and 3) nervous system (consisting of the peripheral nervous system and central nervous system) (Panjabi 1992b, Panjabi 1992a). Sub failure of any subsystems causes micro- trauma and injures the mechanoreceptors, resulting in a dysfunction in motor control (Panjabi …show more content…
2012b). However, Wang and colleagues’ definition of “core stability exercises” were those performed on unstable surfaces (Wang et al. 2012b) rather than focussing on the activation of specific core muscles and translating it into functional activities (Smith et al. 2014). In addition, none of the reviews included clinical pilates as part of MCE. Clinical pilates is a form of therapeutic exercise that focus on core stability and movement re-education (La Touche et al. 2008). It has been recommended in the management of people with CLBP (La Touche et al. 2008, Owsley 2005). Despite its popularity, there seems to be inconclusive evidence if pilates is superior to other forms of exercise (Lim et al. 2011, Miyamoto et al. 2013). MCE has a strong theoretical foundation and is currently a popular treatment for CLBP amongst physical therapist worldwide (Wang et al. 2012b, Byström et al. 2013b). Nonetheless, there is no general consensus as to whether MCE is superior to other forms of general exercises. As physical therapists, it is therefore, important to ensure that the most effective exercise based on scientific evidence is prescribed to patients in the management of