Reha Kongresse 2018
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P18

Movement Control Exercise for Women with Low back Pain and Generalized Joint Hypermobility

C. Müller1, G. Luder2, U. Stutz2, M. Verra2 (1Grenchen ; 2Bern)


Introduction

Generalized joint hypermobility (GJH) is defined by an exceeded range of motion in several joints. When GJH is associated with pain and disability it is termed hypermobility spectrum disorder (HSD). Chronic low back pain (LBP) is common in patients with HSD and might be in relation to their hypermobility. Several studies have shown that persons with GJH as well as those with LBP have reduced neuromuscular abilities and disturbed body-perception. This project investigated the effect of physiotherapy (PT) with focus on motor control exercises on pain and disability in women with GJH and chronic LBP.

Méthodologie
A single case experimental study for young women with Beighton score 5/9 or more and LBP was conducted. Baseline measures included the Visual Analog Scale (VAS) to record pain, the Roland and Morris Disability Questionnaire (RMDQ), the Bristol Impact of Hypermobility Questionnaire (BIoH) and tests for motor control dysfunction (MCD) The treatment comprised a standardized protocol with exercises to improve function of specific muscles of the lower back and the control of posture and movement.
Résultats

The patient was a 18 year old women with Beighton score 5/9 and nonspecific LBP for about four years. After nine sessions of PT she was able to use the core stabilisation during activities of daily life and improved their ergonomics in movements during work, sports and daily life. Pain intensity recorded in VAS was before treatment 5/10 and after 2/10. The RMDQ score (maximum limitation 24/24) was 8/24 before treatment and 4/24 after. For the BloH (maximum limitation 360/360) the values before PT were 151/360 and afterwards 125/360. In the MCD (maximum 6/6, positive when 2/6) before PT the score was 3/6 and after treatment 2/6.

Discussion et conclusions

The patient showed a better core stability during her movements. However, in the RMDQ the minimal clinically important difference of 5 points was not reached.  BIoH was clearly reduced and the MCD improved, but still remained positive after the treatment. In summary a positive tendency was seen after 9 PT sessions. However further cases are needed to confirm this result. Future studies then might focus on the investigation of groups and implement randomization and blinding.

Importance pour la pratique

A physiotherapy treatment with exercises to improve motor control reduced pain and complaints in daily life in a women with GJH and chronic LBP. Therefore, the therapy conducted might be an option for such patients.