Effects of supplemental heat therapy in multimodal treated chronic low back pain patients on strength and flexibility

      Highlights

      • Strength and flexibility are closely related to conditions of low back pain patients.
      • In a multimodal setting, supplemental heat wrap therapy improves the patient's core strength.
      • Heat wrap therapy within a multimodal treatment concept can be recommended.

      Abstract

      Background

      The beneficial effects of thermotherapy on analgesia and relaxation are widely known for various diseases. To date, however, thermotherapy in chronic low back pain is not explicitly recommended in international guidelines. The effects of thermotherapy on biomechanical parameters within a multimodal back pain treatment concept are also unknown.

      Methods

      Within a multimodal treatment concept, 176 patients with chronic low back pain were treated either with or without supplemental heat wrap therapy. The range of movement and strength parameters of the trunk in flexion, extension, lateral flexion and rotation were measured before and after 12 weeks of treatment.

      Findings

      The range of movement as well as strength parameters of the trunk improved on average within the multimodal treatment. Patients receiving additional thermotherapy supplemental to basic multimodal treatment showed a further improvement of strength parameters regarding extension ( P = 0.09, 1 − β = 0.41), rotation to the right ( P = 0.09, 1 − β = 0.41) and rotation to the left ( P = 0.08, 1 − β = 0.42) in comparison to those conducting only the multimodal treatment. No group differences were detected in flexibility.

      Interpretation

      The implementation of thermotherapy for several hours a day (heat wrap therapy) in daily clinical practice additional to an individualized, evidence-based multimodal treatment concept can be recommended to enhance strength parameters. The potential causes of improved strength parameters as well as the meaning for the patients in activity of daily living are discussed.

      Keywords

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      References

        • Adams M.A.
        Biomechanics of back pain. Acupuncture in medicine.
        J. Br. Med. Acupunct. Soc. 2004; 22: 178-188
        • Airaksinen O.
        • Brox J.I.
        • Cedraschi C.
        • Hildebrandt J.
        • Klaber-Moffett J.
        • Kovacs F.
        • Mannion A.F.
        • Reis S.
        • Staal J.B.
        • Ursin H.
        • Zanoli G.
        Chapter 4. European guidelines for the management of chronic nonspecific low back pain.
        Eur. Spine J. 2006; 15: S192-S300
        • Alfuth M.
        • Cornely D.
        Chronic low back pain: comparison of mobilization and core stability exercises.
        Orthopade. 2016; 45: 579-590
        • Alfuth M.
        • Welsink D.W.
        Pain and functional outcomes after outpatient physiotherapy in patients with low back pain.
        Orthopade. 2017; 46: 522-529
        • Alter M.J.
        Science of Flexibility.
        3 ed. Human Kinetics, Champaign2004
        • Baerga-Varela L.
        • Abreu Ramos A.M.
        Core strengthening exercises for low back pain.
        Bol. Asoc. Med. P. R. 2006; 98: 56-61
        • Balague F.
        • Mannion A.F.
        • Pellise F.
        • Cedraschi C.
        Non-specific low back pain.
        Lancet. 2012; 379: 482-491
        • Barker T.
        • Henriksen V.T.
        • Rogers V.E.
        • Trawick R.H.
        Improvement in muscle strength after an anterior cruciate ligament injury corresponds with a decrease in serum cytokines.
        Cytokine. 2015; 73: 199-202
        • Berger-Roscher N.
        • Casaroli G.
        • Rasche V.
        • Villa T.
        • Galbusera F.
        • Wilke H.J.
        Influence of complex loading conditions on intervertebral disc failure.
        Spine (Phila Pa 1976). 2017; 42: E78-E85
        • Bergmann A.
        • Bolm-Audorff U.
        • Ditchen D.
        • Ellegast R.
        • Grifka J.
        • Haerting J.
        • Hofmann F.
        • Jager M.
        • Linhardt O.
        • Luttmann A.
        • Meisel H.J.
        • Michaelis M.
        • Petereit-Haack G.
        • Schumann B.
        • Seidler A.
        Do occupational risks for low back pain differ from risks for specific lumbar disc diseases? Results of the German lumbar spine study (EPILIFT).
        Spine (Phila Pa 1976). 2017; 42: E1204-E1211
        • Borys C.
        • Lutz J.
        • Strauss B.
        • Altmann U.
        Effectiveness of a multimodal therapy for patients with chronic low back pain regarding pre-admission healthcare utilization.
        PLoS One. 2015; 10e0143139
        • Bredow J.
        • Bloess K.
        • Oppermann J.
        • Boese C.K.
        • Lohrer L.
        • Eysel P.
        Conservative treatment of nonspecific, chronic low back pain: evidence of the efficacy — a systematic literature review.
        Orthopade. 2016; 45: 573-578
        • Chou R.
        • Huffman L.H.
        Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline.
        Ann. Intern. Med. 2007; 147: 505-514
        • Dagenais S.
        • Tricco A.C.
        • Haldeman S.
        Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines.
        Spine J. 2010; 10: 514-529
        • Delitto A.
        • George S.Z.
        • Van Dillen L.R.
        • Whitman J.M.
        • Sowa G.
        • Shekelle P.
        • Denninger T.R.
        • Godges J.J.
        Low back pain.
        J. Orthop. Sports Phys. Ther. 2012; 42: A1-57
        • Durall C.J.
        • Udermann B.E.
        • Johansen D.R.
        • Gibson B.
        • Reineke D.M.
        • Reuteman P.
        The effects of preseason trunk muscle training on low-back pain occurrence in women collegiate gymnasts.
        J. Strength Cond. Res. 2009; 23: 86-92
        • Fairbank J.C.
        • Pynsent P.B.
        The Oswestry disability index.
        Spine (Phila Pa 1976). 2000; 25 (discussion 2952): 2940-2952
        • Fairbank J.C.
        • Couper J.
        • Davies J.B.
        • O'Brien J.P.
        The Oswestry low back pain disability questionnaire.
        Physiotherapy. 1980; 66: 271-273
        • Fett D.
        • Trompeter K.
        • Platen P.
        Back pain in elite sports: a cross-sectional study on 1114 athletes.
        PLoS One. 2017; 12e0180130
        • Freiwald J.
        • Beermann W.
        Langgutachten zur Beurteilung der Wirksamkeit der computergestützten Physiotherapie zur Behandlung von chronischen Rückenschmerzenpatienten innerhalb eines integrierten Versorgungsvertrages mit Versicherten der Deutschen Angestellten Krankenkasse über einen Zeitraum von einem Jahr.
        Bergische Universität Wuppertal, Mühlheim2010
        • Freiwald J.
        • Krajewski J.
        Gutachten zur Beurteilung der Wirksamkeit der computergestützten Physiotherapie zur Behandlung von chronischen Rückenschmerzpatienten innerhalb eines integrierten Versorgungsvertrages mit Versicherten der BKK Essanelle über den Zeitraum von einem Jahr.
        Bergische Universität Wuppertal, Wuppertal2010
        • Freiwald J.
        • Baumgart C.
        • Krajewski J.
        Gutachten zur Beurteilung der Wirksamkeit der computergestützten Physiotherapie zur Behandlung von chronischen Rückenschmerzpatienten innerhalb eines integrierten VersorgungsvertragesVersorgungs-vertrages mit Versicherten der BKK Essanelle über den Zeitraum von einem Jahr.
        Bergische Universität Wuppertal, Mülheim2011: 146
        • French S.D.
        • Cameron M.
        • Walker B.F.
        • Reggars J.W.
        • Esterman A.J.
        A Cochrane review of superficial heat or cold for low back pain.
        Spine (Phila Pa 1976). 2006; 31: 998-1006
        • German Medical Association [BÄK], National Association of Statutory Health Insurance Physicians [KBV], Association of Scientific Medical Societies [AWMF]
        National Disease Management Guideline ‘Low back pain’.
        2 ed. 2017 (Available from:)
        • Gordon R.
        • Bloxham S.
        A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain.
        Healthcare. 2016; 4
        • Greenland S.
        • Senn S.J.
        • Rothman K.J.
        • Carlin J.B.
        • Poole C.
        • Goodman S.N.
        • Altman D.G.
        Statistical tests, P values, confidence intervals, and power: a guide to misinterpretations.
        Eur. J. Epidemiol. 2016; 31: 337-350
        • Guzman J.
        • Esmail R.
        • Karjalainen K.
        • Malmivaara A.
        • Irvin E.
        • Bombardier C.
        Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain.
        Cochrane Database Syst. Rev. 2002; 1: 1465-1858
        • Hakkinen A.
        • Kuukkanen T.
        • Tarvainen U.
        • Ylinen J.
        Trunk muscle strength in flexion, extension, and axial rotation in patients managed with lumbar disc herniation surgery and in healthy control subjects.
        Spine (Phila Pa 1976). 2003; 28: 1068-1073
        • Hakkinen A.
        • Ylinen J.
        • Kautiainen H.
        • Airaksinen O.
        • Herno A.
        • Tarvainen U.
        • Kiviranta I.
        Pain, trunk muscle strength, spine mobility and disability following lumbar disc surgery.
        J. Rehabil. Med. 2003; 35: 236-240
        • Hildebrandt J.
        • Pfingsten M.
        • Saur P.
        • Jansen J.
        Prediction of success from a multidisciplinary treatment program for chronic low back pain.
        Spine (Phila Pa 1976). 1997; 22: 990-1001
        • Hoheisel U.
        • Mense S.
        Inflammation of the thoracolumbar fascia excites and sensitizes rat dorsal horn neurons.
        Eur. J. Pain. 2015; 19: 419-428
        • Hoheisel U.
        • Taguchi T.
        • Mense S.
        Nociception: the thoracolumbar fascia as a sensory organ.
        in: Schleip R. Findley T.W. Chaitow L. Huijing P.A. Fascia: The Tensional Network of the Human Body. Churchill Livingstone, Kidlington2012: 95-101
        • Hoy D.
        • Brooks P.
        • Blyth F.
        • Buchbinder R.
        The epidemiology of low back pain.
        Best Pract. Res. Clin. Rheumatol. 2010; 24: 769-781
        • Hoy D.
        • March L.
        • Brooks P.
        • Blyth F.
        • Woolf A.
        • Bain C.
        • Williams G.
        • Smith E.
        • Vos T.
        • Barendregt J.
        • Murray C.
        • Burstein R.
        • Buchbinder R.
        The global burden of low back pain: estimates from the Global Burden of Disease 2010 study.
        Ann. Rheum. Dis. 2014; 73: 968-974
        • Jurmain R.
        Trauma, degenerative disease, and other pathologies among the Gombe chimpanzees.
        Am. J. Phys. Anthropol. 1989; 80: 229-237
        • Jurmain R.
        Degenerative joint disease in African great apes: an evolutionary perspective.
        J. Hum. Evol. 2000; 39: 185-203
        • Kelsey J.L.
        • Githens P.B.
        • White 3rd, A.A.
        • Holford T.R.
        • Walter S.D.
        • O'Connor T.
        • Ostfeld A.M.
        • Weil U.
        • Southwick W.O.
        • Calogero J.A.
        An epidemiologic study of lifting and twisting on the job and risk for acute prolapsed lumbar intervertebral disc.
        J. Orthop. Res. 1984; 2: 61-66
        • Kirkaldy-Willis W.
        • Bernard T.J.
        The anatomy of the lumbosacral spine.
        in: Managing Low Back Pain. 4 ed. Churchill Livingstone, New York, NY1999
        • Koes B.W.
        • van Tulder M.
        • Lin C.W.
        • Macedo L.G.
        • McAuley J.
        • Maher C.
        An updated overview of clinical guidelines for the management of non-specific low back pain in primary care.
        Eur. Spine J. 2010; 19: 2075-2094
        • Last A.R.
        • Hulbert K.
        Chronic low back pain: evaluation and management.
        Am. Fam. Physician. 2009; 79: 1067-1074
        • Latimer B.
        The perils of being bipedal.
        Ann. Biomed. Eng. 2005; 33: 3-6
        • Liang C.Z.
        • Li H.
        • Tao Y.Q.
        • Zhou X.P.
        • Yang Z.R.
        • Li F.C.
        • Chen Q.X.
        The relationship between low pH in intervertebral discs and low back pain: a systematic review.
        Arch. Med. Sci. 2012; 8: 952-956
        • Liang C.
        • Li H.
        • Tao Y.
        • Shen C.
        • Li F.
        • Shi Z.
        • Han B.
        • Chen Q.
        New hypothesis of chronic back pain: low pH promotes nerve ingrowth into damaged intervertebral disks.
        Acta Anaesthesiol. Scand. 2013; 57: 271-277
        • Lidgren L.
        The bone and joint decade 2000–2010.
        in: Bulletin of the World Health Organization. 81. 2003: 629
        • Lovell N.
        Patterns of Injury and Illness in the Great Apes: A Skeletal Analysis.
        Smithsonian Institution Press, Washington, D.C.1990
        • Mayer J.M.
        • Ralph L.
        • Look M.
        • Erasala G.N.
        • Verna J.L.
        • Matheson L.N.
        • Mooney V.
        Treating acute low back pain with continuous low-level heat wrap therapy and/or exercise: a randomized controlled trial.
        Spine J. 2005; 5: 395-403
        • Mense S.
        • Gerwin R.D.
        Muscle Pain: Understanding the Mechanisms.
        1 ed. Springer-Verlag, Berlin Heidelberg2010 (pp. XIII, 323)
        • Michlovitz S.L.
        • Bellew J.W.
        • Nolan Jr., T.P.
        Modalities for Therapeutic Intervention.
        5 ed. F.A. Davis, Philadelphia2011
        • van Middelkoop M.
        • Rubinstein S.M.
        • Kuijpers T.
        • Verhagen A.P.
        • Ostelo R.
        • Koes B.W.
        • van Tulder M.W.
        A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain.
        Eur. Spine J. 2011; 20: 19-39
        • Monie A.P.
        • Price R.I.
        • Lind C.R.
        • Singer K.P.
        Assessing the clinical utility of combined movement examination in symptomatic degenerative lumbar spondylosis.
        Clin. Biomech. 2015; 30: 558-564
        • Muller-Schwefe G.
        • Morlion B.
        • Ahlbeck K.
        • Alon E.
        • Coaccioli S.
        • Coluzzi F.
        • Huygen F.
        • Jaksch W.
        • Kalso E.
        • Kocot-Kepska M.
        • Kress H.G.
        • Mangas A.C.
        • Margarit Ferri C.
        • Mavrocordatos P.
        • Nicolaou A.
        • Hernandez C.P.
        • Pergolizzi J.
        • Schafer M.
        • Sichere P.
        Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms.
        Curr. Med. Res. Opin. 2017; : 1-12
        • National Collaborating Centre for Primary Care
        National Institute for Health and Clinical Excellence: Guidance, Low Back Pain: Early Management of Persistent Non-specific Low Back Pain.
        in: Royal College of General Practitioners (UK). Royal College of General Practitioners, London2009
        • Neidlinger-Wilke C.
        • Wurtz K.
        • Urban J.P.
        • Borm W.
        • Arand M.
        • Ignatius A.
        • Wilke H.J.
        • Claes L.E.
        Regulation of gene expression in intervertebral disc cells by low and high hydrostatic pressure.
        Eur. Spine J. 2006; 15: S372-S378
        • Neidlinger-Wilke C.
        • Galbusera F.
        • Pratsinis H.
        • Mavrogonatou E.
        • Mietsch A.
        • Kletsas D.
        • Wilke H.J.
        Mechanical loading of the intervertebral disc: from the macroscopic to the cellular level.
        Eur. Spine J. 2014; 23: S333-S343
        • Neubauer E.
        • Junge A.
        • Pirron P.
        • Seemann H.
        • Schiltenwolf M.
        HKF-R 10 — screening for predicting chronicity in acute low back pain (LBP): a prospective clinical trial.
        Eur. J. Pain. 2006; 10: 559-566
        • Norlund A.
        • Ropponen A.
        • Alexanderson K.
        Multidisciplinary interventions: review of studies of return to work after rehabilitation for low back pain.
        J. Rehabil. Med. 2009; 41: 115-121
        • Oliveira C.B.
        • Franco M.R.
        • Maher C.G.
        • Tiedemann A.
        • Silva F.G.
        • Damato T.M.
        • Nicholas M.K.
        • Christofaro D.G.D.
        • Pinto R.Z.
        The efficacy of a multimodal physical activity intervention with supervised exercises, health coaching and an activity monitor on physical activity levels of patients with chronic, nonspecific low back pain (Physical Activity for Back Pain (PAyBACK) trial): study protocol for a randomised controlled trial.
        Trials. 2018; 19: 40
        • Pfingsten M.
        • Hildebrandt J.
        • Leibing E.
        • Franz C.
        • Saur P.
        Effectiveness of a multimodal treatment program for chronic low-back pain.
        Pain. 1997; 73: 77-85
        • Philadelphia Panel Members
        Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain.
        Phys. Ther. 2001; : 1641-1674
        • Rennie S.
        • Michlovitz S.L.
        Therapeutic heat.
        in: Michlovitz S.L. Bellew J.W. Nolan Jr., T.P. Modalities for Therapeutic Intervention. 5 ed. F.A. Davis Company, Philadelphia2012: 59-83
        • Schneider S.
        • Schmitt H.
        • Zoller S.
        • Schiltenwolf M.
        Workplace stress, lifestyle and social factors as correlates of back pain: a representative study of the German working population.
        Int. Arch. Occup. Environ. Health. 2005; 78: 253-269
        • Schneider S.
        • Lipinski S.
        • Schiltenwolf M.
        Occupations associated with a high risk of self-reported back pain: representative outcomes of a back pain prevalence study in the Federal Republic of Germany.
        Eur. Spine J. 2006; 15: 821-833
        • Schneider S.
        • Mohnen S.M.
        • Schiltenwolf M.
        • Rau C.
        Comorbidity of low back pain: representative outcomes of a national health study in the Federal Republic of Germany.
        Eur. J. Pain. 2007; 11: 387-397
        • Shmagel A.
        • Foley R.
        • Ibrahim H.
        Epidemiology of chronic low back pain in US adults: data from the 2009–2010 National Health and Nutrition Examination Survey.
        Arthritis Care Res. 2016; 68: 1688-1694
        • Tesarz J.
        • Hoheisel U.
        • Wiedenhofer B.
        • Mense S.
        Sensory innervation of the thoracolumbar fascia in rats and humans.
        Neuroscience. 2011; 194: 302-308
        • Trompeter K.
        • Fett D.
        • Platen P.
        Prevalence of back pain in sports: a systematic review of the literature.
        Sports Med. 2016; 47: 1183-1207
        • van Tulder M.W.
        • Touray T.
        • Furlan A.D.
        • Solway S.
        • Bouter L.M.
        Muscle relaxants for nonspecific low back pain: a systematic review within the framework of the cochrane collaboration.
        Spine. 2003; 28: 1978-1992
        • van Tulder M.
        • Becker A.
        • Bekkering T.
        • Breen A.
        • del Real M.T.
        • Hutchinson A.
        • Koes B.
        • Laerum E.
        • Malmivaara A.
        Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care.
        Eur. Spine J. 2006; 15: S169-S191
        • Wasserstein R.L.
        • Lazar N.A.
        The ASA's statement on p-values: context, process, and purpose.
        Am. Stat. 2016; 70: 129-133
        • Weinkauf B.
        • Deising S.
        • Obreja O.
        • Hoheisel U.
        • Mense S.
        • Schmelz M.
        • Rukwied R.
        Comparison of nerve growth factor-induced sensitization pattern in lumbar and tibial muscle and fascia.
        Muscle Nerve. 2015; 52: 265-272
        • Wilke H.J.
        • Neef P.
        • Caimi M.
        • Hoogland T.
        • Claes L.E.
        New in vivo measurements of pressures in the intervertebral disc in daily life.
        Spine. 1999; 24: 755-762
        • Wilke H.J.
        • Urban J.
        • Kumin M.
        The benefits of multi-disciplinary research on intervertebral disc degeneration.
        Eur. Spine J. 2014; 23: S303-S304
        • Wilke H.J.
        • Kienle A.
        • Maile S.
        • Rasche V.
        • Berger-Roscher N.
        A new dynamic six degrees of freedom disc-loading simulator allows to provoke disc damage and herniation.
        Eur. Spine J. 2016; 25: 1363-1372
        • Zaciorskij V.
        • Aruin A.
        • Selujanov V.
        Biomechanik des menschlichen Bewegungsapparates.
        SVB Sportverlage, Berlin1984