1. Core ExerciseTherapy Improves the outcome of
Chronic Low Back Pain with and without a Sacro-iliac Belt
Introduction Methodology
Results
By Ricardo Marques andVilash Boodhoo
Department of Chiropractic and Somatology Durban University of Technology
Individuals with LBP have lower muscle endur-
ance9
. Among the best forms of treatment cit-
ed for LBP is progressive spinal exercises com-
bined with intermittent and diminishing use of
an SI-belt when not exercising11
.
The effectiveness of a core stability programme
(Sarhmann exercises) with and without the
use of two different SI-belts in patients with
chronic LBP and SI instability was determined
in this study.
Sahrmann Exercise #1 Lie on the floor with
the knees bent. Perform the Basic Breath
and, keeping one knee bent, slowly slide the
other leg out until it’s parallel and just a few
inches off the floor. Bring the leg back and
repeat on the other leg. Once you’re able to
complete 20 reps on each leg, without losing
the abdominal contraction, move to the next
exercise.
Sahrmann Exercise #2 Lie on the floor with
the knees bent. Perform the Basic Breath
and lift one knee towards the chest. Straight-
en the leg so that it is parallel and about 2-3
inches off the floor. Bring the leg back to start
and repeat with the other leg for 5 or more
reps. Once you’re able to complete 20 reps
on each leg, without losing the abdominal
contraction, move to the next exercise.
Sahrmann Exercise #3 Perform the Basic
Breath as you bring the knees up to a 90-de-
gree angle. Keep one leg bent and lower
the other leg towards the floor, tapping the
floor with your toe. Complete 1-5 reps on the
same leg and then switch sides. Once you’re
able to complete 20 reps on each leg, without
losing the abdominal contraction, move to the
next exercise
Sahrmann Exercise #4 Perform the Basic
Breath as you bring the knees up to a 90-de-
gree angle. Keep one leg bent and extend
the other leg out until it’s parallel, but not
touching the floor. Repeat on the other leg,
working up to 10 reps on each side. Once
you’re able to complete 20 reps on each leg,
without losing the abdominal contrac-
tion, move to the next exercise.
Sahrmann Exercise #5 Perform the Ba-
sic Breath and bring the legs into the chest.
Straighten both legs so that they’re perpen-
dicular to the floor. Slowly lower both legs to-
wards the floor, going as far as you can with-
out arching the back. Repeat for 5-10 reps,
working up to 20 reps.
REFERENCES1.Akuthota,V.andNadler,S.2004.CoreStrengthening.AmericanAcademyofPhysicalMedicineandRehabilitation,85(1):86-92. 2.Bell,T.2008.TheGroovi-SI-Belt,Informationforpractitioner.[online]Available
from:http://www.groovi-products.co.za/downloads/Groovi-SI-belt%20practitioner.pdf[Accessed19November2009].3.Esterhuizen,T.(Privatecommunications),3May2010,14:06PM.4.Jull,G.andRichardson,C.2000.Mo-
torControlProblemsinPatientswithspinalPain:ANewDirectionforTherapeuticExercize.ManipulativeandPhysiologicalTherapeutics,23(2):115-117.5.MedacCatalogue.DesignedandPrintedbyB.PoynterPrint(Pty)Ltd6.
Mens,J.M.,Damen,L.,Snijders,CandStam,H.2005.Themechanicaleffectofapelvicbeltinpatientswithpregnancy-relatedpelvicpain,ClinicalBiomechanic,21:122-1277.Moore,KL.1992.ClinicallyOrientedAnatomy.3rd
Edition.WilliamsandWilkins.pp-132,3558.Panjabi,M.2003.Clinicalspinalinstabilityandlowbackpain.JournalofElectromyographyandKinesiology,13:371–379.9.Pool-Goudzwaard,A.,HoekvanDijke,G.,vanGurp,M.,
Mulder,P.,Snijders,C.andStoeckart,R.2004.Contributionofthepelvicfloormusclestostiffnessofthepelvicring.ClinicalBiomechanics,19:564-571.10.Stevens,V.,Witvrouw,E.,Vanderstraeten,G.,Parlevliet,T.,Bouche,K.,
Mahieu,N.andDanneels,L.2006.Therelevanceofincreasingresistanceontrunkmuscleactivityduringseatedaxialrotation.PhysicalTherapyinSport,8:7-13.11.Wolff,M.,Weinik,M.andMaitin,I.2003.Bracingforlowback
pain.InCole,A.,Herring,S.(ed.)TheLowBackPainHandbook.Philadelphia:HanleyandBelfus,Inc.pp.201-218.
SI instability was determined using the active
straight leg raiser (ASLR) test. All eligible
patients had a positive ASLR test.
Interventions
A larger sample size is needed to better predict
the trend of the group wearing the Groovi-SI
Belt®. * The spinal stability programme should
be increased to 10 weeks to better predict the
trends within all three groups.
Illustrated in figure
1 above, all three
groups exhibited sig-
nificant improvement
for the test that is
depicted in picture 3
below. However the
endurance capa-
bilities were higher
in those who used
the Groovi-SI-Belt®
(Group A). The true
mechanism for its su-
periority could not be
determined but was
assumed to be due
to its unique “power
straps”.
Eligible
Patientsn = number of patients
•New exercises taught
•Measurements taken
1stConsult
• Taught Exercises
• Given SI-belt
• Measurements taken
1stConsult
• Taught Exercises
• Given SI-belt
• Measurements taken
1stConsult
• Taught Exercises
• Measurements taken
group
An = 16
Groovi SI-Belt®
+ Exercises
group
Bn = 15
Std.SI-belt
+ Exercises
group
Cn = 15
Exercises alone
2nd
,3rd
and 4th
Consult
randomisation
Picture 1: Active straight leg raiser test
Flow Chart 1: Summary of Methodology
Picture 3: Groovi SI-Belt®
2 Picture 4: Standard SI-belt5
Figure 1: Mean static trunk extensor endurance (p<0.001)3
Figure 2: Mean Quebec disability scale (QDS) – all groups experienced significant decrease in
disability over four weeks (p<0.001)3
Picture 3: Static Trunk Extensor
Figure 1: Mean Numerical pain rating scale (NRS) – all groups experienced significant de-
crease in pain over four weeks (p<0.001)3
Conclusion
All three groups experienced a statistically significant improve-
ment in pain, subjective disability and endurance of the trunk
muscles over the four week trial period. * In each of the graphs
Group A seemed to exhibit a greater improvement from the first
to the fourth week. However, this was not statistically signifi-
cant. * Therefore exercise therapy with and without the use of an
SI-belt improved chronic low back pain significantly.
Recommendations
Picture 2: Sahrmann progression of exercises
SARHMANN EXERCISES
Picture 17: Muscles of the core
• e.g. local muscles: Transversus abdominis and Multifidus
• e.g. global muscles: Rectus Abdominus, Internal obliques and Spinalis