Abstracts

31 Are core stability exercises an effective treatment for nonspecific chronic low back pain? A systematic
review with meta-analysis
B. Thompson 1 * • S. Sadler 1 • V. Chuter 1 • M. Spink 1 • X. Janse de Jonge 1
1
University of Newcastle
Thursday 22 October
Background: Nonspecific chronic low back pain (CLBP) is a common condition associated with significant socioeconomic and healthcare costs.
A proposed mechanism for the aetiology and persistence of nonspecific CLBP is dysfunction of the muscles responsible for stability and control of the
spine. Core stability programs are designed to retrain optimal trunk muscle recruitment patterns, improve core muscle strength and endurance, and
re-establish coordinated functional movements. Although these programs are widely used for rehabilitation, previous systematic reviews have not
established the effectiveness of core stability exercise for the treatment of nonspecific CLBP compared with alternative interventions. The aim of this
review was to investigate the effect of core stability exercise on pain and disability outcomes in patients with nonspecific CLBP.
Methods: Databases were searched for published reports of randomised controlled trials that compared core stability exercise for the treatment
of CLBP of nonspecific origin with control or another intervention. Relevant trials were independently reviewed and selected by two authors.
Methodological quality of the studies was rated using the PEDro scale. Data were pooled using random-effects meta-analyses to allow for variability
between the studies.
Results: Eighteen studies (n = 1,724) provided post-treatment effect on pain and disability and 7 studies (n = 1,125) provided data at
six month follow-up. Cohen’s d effect sizes were calculated for both mean pain and disability scores and converted to Hedge’s g. Meta-analysis at
post-treatment showed a moderate and significant effect for core stability exercise compared with control or alternative treatment for pain (Hedges g
= -0.65, 95% CI = -0.88 to -0.41, p < 0.05) and disability (Hedge’s g = -0.44, 95% CI = -0.65 to -0.22, p = < 0.05). At six month follow-up the
effects were smaller yet still significant for pain (Hedges g = -0.15, 95% CI = -0.28 to -0.03, p < 0.05) and disability (Hedges g = -0.19, 95%
CI = -0.33 to -0.04, p < 0.05).
Discussion: The results of this pooled meta-analysis suggest that in patients with nonspecific CLBP, core stability exercise is superior to other
interventions for reducing pain and disability in the short-term. The effect of core stability exercise compared with other treatments reduces with
time which may be due to a detraining effect when the participants cease the exercise program. Future research is required to determine the
sufficient dosage required to maintain improvements following core stability interventions in order to improve long-term patient outcomes.
32 Spinal Cord Stimulation (SCS) of the Dorsal Root Ganglion (DRG) for Peripheral Causalgia and Other
Neuropathic Pain Conditions: First Commercial Experience in Australia
B. Mitchell 1 * • P. Verrill 1 • D. Vivian 1 • A. Barnard 1
1
Metro Pain Group
Background: Spinal cord stimulation (SCS) of the dorsal root ganglion (DRG) is an emerging neuromodulation technique to treat intractable
neuropathic pain conditions. Data from multiple prospective studies and reviews indicate long-term stability of pain relief and good concordance of
coverage of discrete pain regions, including areas that are difficult to treat with conventional SCS.
Objective: To evaluate outcomes of the first commercially implanted patients in Australia receiving SCS of the DRG.
Methods: We assessed 51 consecutive cases in whom SCS of the DRG had been trialed to treat chronic neuropathic pain, post-surgical pain, failed
back surgery syndrome, peripheral nerve injury post trauma and other chronic pain conditions. Questionnaires, along with patients’ histories were
used to evaluate pain (Numerical Rating Scale, NRS), analgesic use, disability (Oswestry Disability Index, ODI) and patient satisfaction. Patients were
evaluated at baseline, trial end, and at 3-, 6- and 12-months following implant, or as required per standard of care. The study was IRB approved.
Results: Of the temporary trial patients, 35 reported a positive outcome with 29 proceeding to a permanent implant and 6 awaiting implantation.
Patients reported significant reductions in mean back pain NRS scores following implantation (baseline 7.3±1.2 vs. 2.8±1.4, 2.5±1.4, 2.8±1.5 and
2.5±1.6 at end of trial, 3-, 6- and 12-months, respectively; all p≤0.01). A statistically and clinically significant improvement in the ODI was observed
at 6-month follow-up (43.7±14.4 vs. 19.0±4.2, p=0.013). Walking, standing and sitting tolerance times showed a trend towards improvement.
Psychological state remained steady, whilst decreases in analgesic use were reported. No major adverse events or complications were observed.
Conclusion: Early results in this challenging cohort indicate that SCS of the DRG is a promising technique to treat multiple neuropathic pain
conditions and a useful alternative in conditions that do not respond optimally to traditional SCS therapy.
33 Increased cross-education of muscle strength and reduced corticospinal inhibition following eccentric
strength training
D. Kidgell 1 * • A. Frazer 2
1
Department of Rehabilitation, Nutrition and Sport, La Trobe University • 2 Centre for Physical Activity and Nutrition Research, Deakin Univedrsity
Introduction: The neural control of muscle activity during voluntary concentric and eccentric contractions differs, with the observation that
corticospinal excitability and inhibition is lower during eccentric than concentric contractions. Interestingly, strength training one limb results in a
substantial increase in strength of the untrained limb; however, it remains unknown what the corticospinal responses are following either eccentric or
concentric strength training and how this relates to the cross-education of strength. Therefore, the aim of this study was to determine if eccentric or
concentric unilateral strength training differentially modulates corticospinal excitability, inhibition and the cross-transfer of strength.
Methods: Changes in contralateral (left limb) concentric strength, eccentric strength, short-interval intracortical inhibition and silent period durations
were analysed in groups of young adults who exercised the right wrist flexors with either eccentric (N = 9) or concentric (N = 9) contractions for 12
sessions over 4 weeks. Control subjects (N = 9) did not train.
Results: Following training, both groups exhibited a significant strength gain in the trained limb (concentric group increased concentric strength by
64% and eccentric group increased eccentric strength by 62%) and the extent of the cross-transfer of strength was 28% and 47% for the concentric
18 • 2015 ASICS Sports Medicine Australia Conference