Email this article 
Comparing the Effects of Different Types of Aquatic Walking on Endurance and Electrical Activities of Spine Extensor Muscles in Men with Nonspecific Chronic Back Pain
Abstract
Background: Chronic back pain is one of the most challenging medical problems worldwide that results in disability, physical problems, and high costs for the family and society. Therefore, it can be very beneficial to find an appropriate treatment with minimum side‑effects for this disease. The present study attempted to compare the effects of different water gait protocols on the endurance and electrical activity of spine extensor muscles in men with nonspecific chronic back pain.
Methods: The study adopted an experimental design in which 30 men with non‑specific chronic back pain were selected through convenience sampling and using simple randomization method assigned into three groups of forward walking, backward walking, and sideways walking. Walking exercises were performed for 8 weeks, three sessions per week for 30 min. Twenty‑four hours before and 48 h after the intervention, the endurance of spine extensor muscles and electrical activities were measured using the Ito test and electromyography, respectively. Data were analyzed in SPSS 23 using paired sample t‑test and analysis of variance.
Results: The results showed that backward walking in water significantly increases endurance and electromyography activities of spine extensor muscles (P < 0.05), while forward and sideways walking had no significant effect on these variables (P > 0.05). The results obtained from Bonferroni post‑hoc test showed a significant difference between the strength of trunk extensor muscles and EMG of spinal cord extensor muscles in forward and backward water gait groups (P = 0.001, 0.006).
Conclusions: According to the findings of this study, it seems that walking backward can be an effective therapeutic method for patients with chronic back pain.
Keywords
Full Text:
PDFReferences
Chou R. Low back pain (Chronic). Am Fam Phys 2011;84:437‑8.
Olson DA, Kolber MJ, Patel C, Pabian P, Hanney WJ. Aquatic
exercise for treatment of low‑ back pain a systematic review of
randomized controlled trials. Am J Lifestyle Med 2013;7:154‑60.
Farahpour N, Esfahani M. Postural deviations from chronic low
back pain and correction through exercise therapy. Tehran Univ
Med J TUMS Publications 2008;65:69-77.
George SZ, Childs JD, Teyhen DS, Wu SS, Wright AC,
Dugan JL, et al. Predictors of occurrence and severity of first
time low back pain episodes: Findings from a military inception
cohort. PloS One 2012;7: e30597.
Wheeler BL, editor. Music Therapy Research: Quantitative and
Qualitative Perspectives. Phoenixville, PA: Barcelona Publishers;
Verbunt JA, Seelen HA, Vlaeyen JW, van der Heijden GJ,
Knottnerus JA. Fear of injury and physical deconditioning in
patients with chronic low back pain. Arch Phys Med Rehabil
;84:1227‑32.
Farahpour N, Marvi M, Alard P. Check deviations point of
gravity of the body in patients with chronic low back pain in
a variety of standing and reclining in comparison with healthy
controls. J Exerc 2006;1:56‑69.
Rosenstiel AK, Keefe FJ. The use of coping strategies in chronic
low back pain patients: Relationship to patient characteristics
and current adjustment. Pain 1983;17:33e44.
Somers TJ, Keefe FJ, Pells JJ, Dixon KE, Waters SJ, Riordan PA,
et al. Pain catastrophizing and pain‑related fear in osteoarthritis
patients: Relationships to pain and disability. J Pain Symptom
Manage 2009;37:863‑72.
Carver CS, Smith RG, Antoni MH, Petronis VM, Weiss S,
Derhagopian RP. Optimistic personality and psychosocial
well‑being during treatment predict psychosocial well‑being
among long‑term survivors of breast cancer. Health Psychol
;24:508‑16.
White AH. A model for conservative care of low back pain: back school, epidural blocks, mobilization. Instructional Course
Lectures 1985;34:78-84.
Moon HJ, Choi KH, Kim DH, Kim HJ, Cho YK, Lee KH, et al.
Effect of lumbar stabilization and dynamic lumbar strengthening
exercises in patients with chronic low back pain. Ann Rehabil
Med 2013;37:110‑7.
Maniadakis N, Gray A. The economic burden of back pain in the
UK. Pain 2000;84:95‑103.
Chung S, Lee J, Yoon J. Effects of stabilization exercise using
a ball on mutifidus cross‑sectional area in patients with chronic
low back pain. J Sports Sci Med 2013;12:533‑41.
Ghamkhar L, Emami M, Mohseni‑Bandpei M, Behtash H.
Application of rehabilitative ultrasound in the assessment
of low back pain: A literature review. J Bodyw Mov Ther
;15:465‑77.
Sung PS. Multifidi muscles median frequency before and
after spinal stabilization exercises. Arch Phys Med Rehabil
;84:1313‑8.
Larivière C, Arsenault AB, Gravel D, Gagnon D, Loisel P.
Surface electromyography assessment of back muscle intrinsic
properties. J Electromyogr Kinesiol 2003;13:305‑18.
Roy SH, De Luca CJ, Casavant DA. Lumbar muscle fatigue and
chronic low back pain. Spine 1989;14:992‑1001.
De Luca CJ. Myoelectric manifestation of localized muscle
fatigue in human performance. Crit Rev Biomed Eng
;11:251‑79.
Biedermann HJ, Shanks GL, Forrest WJ, Inglis J. Power
spectrum analyses of electromyographic activity. Discriminators
in the differential assessment of patients with chronic low back
pain. Spine 1991;16:1179‑84.
Kofotolis N, Sambanis M. The influence of exercise on
musculoskeletal disorders of the lumbar spine. J Sports Med
Phys Fitness 2005;45:84‑92.
Knox MF, Chipchase LS, Schabrun SM, Marshall PW. Improved
compensatory postural adjustments of the deep abdominals
following exercise in people with chronic low back pain.
J Electromyogr Kinesiol 2017;37:117‑24.
Twomey L, Taylor J. Age changes in lumbar vertebrae and
intervertebral discs. Clin Orthop Relat Res 1987;224:97‑104.
Foley A, Halbert J, Hewitt T, Crotty M, Halbert J, Hewitt T,
et al. Does hydrotherapy improve strength and physical function
in patients with osteoarthritis – a randomised controlled trial
comparing a gym based and a hydrotherapy based strengthening
program. Ann Rheum Dis 2003;62:1162‑7.
Geytenbeek J. Evidence for effective hydrotherapy. Physiotherapy
;88:514‑29.
Yalfani A, Naderi E, Shayesterudi Y. Comparing the effectiveness
of hydrotherapy and physiotherapy in the management of knee
osteoarthritis. J Res Rehab Sci 2012;8:328-6.
Cider A, Schaufelberger M, Stibrant Sunnerhagen K,
Anderson B. Hydrotherapy‑‑a new approach to improve function
in the older patient with chronic heart failure. Euro J Heart Fail
;:527‑35.
Waller B, Lambeck J, Daly D. Therapeutic aquatic exercise
in the treatment of low back pain: A systematic review. Clin
Rehabil 2009;23:3‑14.
Astin, JA, Beckner W, Soeken K, Hochberg MC, Berman B.
Psychological interventions for rheumatoid arthritis: A met
analysis of randomized controlled trials. Arthritis Rheum
;47:291‑302.
Becker BE, Aquatic therapy: Scientific foundations and clinical
rehabilitation applications. PM R 2009;1:859‑72.
Brady B, Redfern J, Macdougal G, Williams J. The addition of
aquatic therapy to rehabilitation following surgical rotator cuff
repair: A feasibility study. Physiother Rese Int 2008;13:153‑61.
Chevutschi A, Lensel G, Vaast D, Thevenon A. An
electromyographic study of human gait both in water and on dry
ground. J Physiol Anthropol 2007;26:467‑73.
Barker KL, Dawes H, Hansford P, Shamley D. Perceived and
measured levels of exertion of patients with chronic back pain
exercising in a hydrotherapy pool. Arch Phys Med Rehabil
;84:1319‑23.
Custa‑Vargas A, Adams N, Salazar J, Belles A, Hazanas S,
Arroyo‑Morales M. Deep water running and general practice
in primary care for non‑specific low back pain versus general
practice alone: Randomized controlled trial. Clin Rheumatol
;31:1073‑8.
Pires D, Cruz EB, Caeiro C. Aquatic exercise and pain
neurophysiology education versus aquatic exercise alone for
patients with chronic low back pain: A randomized controlled
trail. Clin Rehabil 2015;29:538‑47.
Sedaghati P, Sedaghati N, Ardjmand A. The impact of
hydrotherapy, extension/flexion exercises on truncal muscle
strength and pain intensity in nonspecific chronic low back pain.
Comp Med J 2017;6:1690‑702
Maher C. Effective physical treatment for chronic low back pain.
Orthop Clin N 2004;35:57‑64.
Morad Parmoon A. The effect of water therapy program on the
treatment of back pain patients. Master thesis. 2005.
Grasso R, Binachi L, Lacquaniti F. Motor patterns for human
gait: Backward versus forward locomotion. J Neurophysiol
;80:1868‑85.
Arata AW. Kinematic comparison of high speed backward and
forward running. Air force academy. 2000:1-4.
Ito T, Shirado O, Suzuki H, Takahashi M, Kaneda K, Strax TE.
Lumbar trunk muscle endurance testing: An inexpensive
alternative to a machine for evaluation. Arch Phys Med Rehabil
;77:75‑9.
Shnayderman I, Katz‑Leurer M. An aerobic walking programme
versus muscle strengthening programme for chronic low back
pain: A randomized controlled trial. Clin Rehabil 2012;27:207‑14.
Pereira Ivye LR, Queiroz B, Loss J, Amorim C, Sacco ICN.
Trunk muscle EMG during intermediate pilates mat exercises
in beginner healthy and chronic low back pain individuals.
J Manipulative Physiol Ther 2017;40:350‑7.
Shamsi MB, Sarrafzadeh J, Jamshidi A, Arjmand N,
Ghezelbash F. Comparison of spinal stability following motor
control and general exercises in nonspecific chronic low back
pain patients. Clin Biomech 2017;48:42‑8.
Rutledge E, Silvers WM, Browder K, Dolny D. Metabolic‑cost
comparison of submaximal land and aquatic treadmill exercise.
Int J Aquatic Res Educ 2007;1:118‑33.
Snell RS. Clinical neuroanatomy. Lippincott Williams and
Wilkins; Printed in China, 2010. p. 114-6.
Thompson PD, Buchner D, Pina I. Treatment and prevention of
osteoarthritis through exercise and sports. Arterioscler Thromb
Vasc Biol 2003;23:42‑9.
Tsuboi H, Nishimura Y, Sakata T, Ohko H, Tanina H, Kouda K,
et al. Age‑related sex differences in erector spinae muscle
endurance using surface electromyographic power spectral
analysis in healthy humans. Spine J 2013;13:1928‑33.
Barker P, Hapuarachchi K, Ross J, Sambaiew E, Ranger T,
Briggs C. Anatomy and biomechanics of gluteus maximus and
the thoracolumbar fascia at the sacroiliac joint. Clin Anatomy
;27:234‑40.
De Ridder EM, Van Oosterwijck JO, Vleeming A, Vanderstraeten GG, Danneels LA. Posterior muscle chain activity
during various extension exercises: An observational study. BMC
Musculoskel Disord 2013;14:204.
Kim YS, Park J, Shim JK. Effects of aquatic backward
locomotion exercise and progressive resistance exercise on
lumbar extension strength in patients who have undergone
lumbar diskectomy. Arch Phys Med Rehabil 2010;91:208‑14.
Mahjur M, Hashemi Javaheri S, Khoshraftar Yazdi N, Norouzi K.
The effect of six weeks exercise therapy in the water on the trunk
extensor muscle endurance in men with chronic non‑specific low
back pain. JNKUMS 2016;8:147‑57.
Hassani Haghighi F, Aliakbar Hashemi Javaheri AA,
Aryamanesh ASh, Khoshraftar Yazdi N. Effect of aquatic
exercise therapy on the quadriceps muscle electromyography and
pain in women with knee osteoarthritis. Mashhad J Param Sci
Rehabil 2016;5:42‑50.
Masumoto K, Hamada A, Tomonaga HO, Kodama K,
Amamoto Y, Nishizaki Y, et al. Physiological and perceptual
responses to backward and forward treadmill walking in water.
Gait Posture 2009;29:199‑203.
Hooper TL, Dunn DM, Props JE, Bruce BA, Sawyer SF,
Daniel JA. The effects of graded forward and backward walking
on heart rate and oxygen consumption. J Orthop Sports Phys
Ther 2004;34:65‑71.
Masumoto K, Takasugi S, Hotta N, Fujishima K, Iwamoto Y.
A comparison of muscle activity and heart rate response during
backward and forward walking on an underwater treadmill. Gait
Posture 2007;25:222‑8.
Cole AJ, Eagleston RE, Moschetti M, Sinnett E. Aquatic
rehabilitation of the spine. Rehab Manag 1996;9:55‑60.
Masumoto K, Takasugi S, Hotta N, Fujishima K, Iwamoto Y.
Muscle activity and heart rate response during backward walking
in water and on dry land. Eur J Appl Physiol 2005;94:54‑61.
Grasso R, Bianchi L, Lacquaniti F. Motor patterns for human
gait: Backward versus forward locomotion. Prosthet Orthotics Int
;34:254‑69.
Kordi M, Alizadeh MH, Mazraeh Farahani P, Kazemi F.
The efficacy of the whole body vibration (WBV) training
on electromyography indexes of knee extensor muscles in
non‑athletic girls. Med J Tabriz Univ Med Sci Health Serv
;35:66‑71.
Chimera NJ, Swanik KA, Swanik CB, Straub SJ. Effects
of plyometric training on muscle‑activation strategies and
performance in female athletes. J Athletic Train 2004;39:
‑31.
Nezhad Roomezi S, Rahnama N. The effect of core stability
training on pain and performance in women patients with
non‑specific chronic low back pain. J Res Rehabil Sci
;8:59‑60. [in Persian]
Afsharzadeh T, Rezaei S, Yusef‑Zadeh S. the relationship
between fear of movement and physical disability in patients
with chronic low back pain. J Tavanbakhshi 2010;11:22‑8.
[in Persian]
Yaghoobi Z, Kahrizi S, Parnianpour M, Ebrahimi Takamjani E,
FaghihZade S. The short effects of two spinal stabilization
exercise on balance tests and limit of stability in men with
non– specific chronic low back pain: Randomized clinical trial
study. J Tavanbakhshi 2012;1:102‑11. [in Persian].