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Comparison Between Transcutaneous Electrical Nerve Stimulation and Stabilization Exercises in Fatigue and Transversus Abdominis Activation in Patients With Lumbar Disk Herniation: A Randomized Study

2018; Elsevier BV; Volume: 41; Issue: 4 Linguagem: Inglês

10.1016/j.jmpt.2017.10.010

1532-6586

Luiz Armando Vidal Ramos, Bianca Callegari, Fábio Jorge Renovato França, Maurício Oliveira Magalhães, Thomaz Nogueira Burke, Ana Paula Carvalho‐e‐Silva, Gabriel Peixoto Leão Almeida, Josielli Comachio, Amélia Pasqual Marques,

Spine and Intervertebral Disc Pathology

Objective The purpose of this study was to compare transcutaneous electrical nerve stimulation (TENS) and stabilization exercises in an attempt to prevent fatigue and improve muscle activation in patients with lumbar disk herniation associated with low back pain. Methods This study involved 29 patients (age range 25-58 years) randomized into 2 groups: the segmental stabilization group (n = 15), who received stabilization exercises on the transversus abdominis (TrA) and lumbar multifidus muscles; and the TENS group (n = 14), who received electrotherapy. Groups underwent 16 sessions, for 60 minutes, twice per week, and they were evaluated before and after intervention. Pain was measured using a visual analog scale, functional disability using the Oswestry Disability Index, muscle activation and fatigue with electromyography, and patients’ ability to contract the TrA with a pressure biofeedback unit. Analyses within and between groups were performed. Results The stabilization group improved lumbar multifidus fatigue (median frequency [MF] initial [P = .002], MF final [P < .001], MF slope [P = .001], and resistance time [P < .001]), ability to contract the TrA (P < .001), pain (P < .001), and functional disability (P < .001). TENS only was effective for pain (P = .012). Conclusion Although it relieved pain, TENS was not effective as a single treatment to prevent fatigue, increase TrA contraction, and reduce functional disability in herniated disk patients. Stabilization exercises alone improved all measured outcomes.