Sh. Snook et al., The reduction of chronic nonspecific low back pain through the control of early morning lumbar flexion - A randomized controlled trial, SPINE, 23(23), 1998, pp. 2601-2607
Study Design. Eighteen-month, randomized controlled trial with partial cros
sover.
Objectives. To test the hypothesis that the control of lumbar flexion in th
e early morning will significantly reduce chronic, nonspecific low back pai
n.
Summary of Background Data. Previous studies have indicated an increased ri
sk of low back pain with bending forward in the early morning, primarily be
cause of increased fluid content in the intervertebral discs at that time.
Methods. After 6 months of recording baseline data, 85 subjects with persis
tent or recurring low back pain were randomly assigned to treatment and con
trol groups. The treatment group received instruction in the control of ear
ly morning lumbar flexion. The control group received a sham treatment of s
ix exercises shown to be ineffective in reducing low back pain. six months
later, the control group received the experimental treatment. diaries were
used to record daily levels of pain intensity, disability, impairment, and
medication usage.
Results. significant reductions in pain intensity (P < 0.001) were recorded
for the treatment group, but not for the control group (point estimate, 33
%; 95% confidence interval, 11-55%). After receiving the experimental treat
ment, the control group responded with similar reductions (P < 0.05). Signi
ficant reductions also were observed in total days in pain, disability, imp
airment, and medication usage.
Conclusions. Controlling lumbar flexion in the early morning is a form of s
elf-care with potential for reducing pain and costs associated with chronic
, nonspecific low back pain.