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Introduction: About 10 million people have low back pain (LBP) disability in Brazil. Several therapies are used to treat this condition, such as kinesiotherapy, manual therapy (MT), and photobiomodulation (PBM). Although the use of these methods in LBP has been investigated, studies evaluating the efficacy of the association between these techniques are still needed. Objective: To evaluate the activation of the lumbar region muscles by PBM or MT associated with kinesiotherapy for the treatment of LBP. Methods: Twenty individuals with chronic LBP were randomly divided into two groups. The first group (MT) received vertebral mobilization associated with a kinesiotherapy exercise program. The second group (830nm-PBM) received PBM associated with the exercise program, twice a week for 8 weeks. Evaluation of pain perceived was performed by the visual analogic scale (VAS), lumbar disability by the Oswestry questionnaire, muscle strength by strain gauge, and activation through surface electromyography (EMG). Data were collected before and after the treatment. EMG data was analyzed by MatLab®. The ANOVA two-way test was used (degree of significance p≤0.05), and the size of the effect by the Hedge test. Results: Considering pain, the two groups presented a significant result (p<0.05). In muscle activation, only the multifidus was different during the side bridge (p<0.05) when compared intragroup. None of the variables were different when evaluating intergroup. Conclusion: Both MT and PBM associated with kinesiotherapy for 8 weeks are effective in reducing pain, and improving motor control and stability of the lumbar spine in patients with chronic LBP.
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2. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(67):2356-68. http://doi.org/10.1016/S0140-6736(18)30480-X
3. Choi J, Hwangbo G, Park J, Sangyong Lee S. The Effects of Manual Therapy Using Joint Mobilization and Flexion-distraction Techniques on Chronic Low Back Pain and Disc Heights. J Phys Ther Sci. 2014;26(8):1259-62. http://doi.org/10.1589/jpts.26.1259
4. França VL, Koerich MHAL, Nunes GS. Sleep quality in patients with chronic low back pain. Fisioter Mov. 2015;28(4):803-10. https://doi.org/10.1590/0103-5150.028.004.AO17
5. Possebom M, Bernardi DL, Alves IA. Lombalgia: the pharmaceutical role in identification, accompanying, managing and prevention. Rev Interdisc Ciênc Saúde Biol. 2019;3(1):86-100. http://dx.doi.org/10.31512/ricsb.v3i1.2932
6. Dorta HS. Relationship between the ischiotibial and paravertebral muscles and low back pain. Coluna/Columna. 2016;15(3):241-3. http://doi.org/10.1590/S1808-185120161503137772
7. Rossi DM, Morcelli MH, Cardozo AC, Denadai BS, Gonçalves M, Navega MT. Rate of force development and muscle activation of trunk muscles 1 in women with and without low back pain: a case-control study. Phys Ther Sport. 2017;26:41-8. http://doi.org/10.1016/j.ptsp.2016.12.007
8. Melo Filho J, Menossi BRS, Preis C, Bertassoni Neto L, Stabelini Neto A. Lumbopelvic stabilization musculature analysis in young subjects with and without low back pain. Fisioter Mov. 2013;26(3):587-94. https://doi.org/10.1590/S0103-51502013000300012
9. Miyamoto GC, Franco KFM, van Dongen JM, Franco YRDS, Oliveira NTB, Amaral DDV, et al. Different doses of Pilates-based exercise therapy for chronic low back pain: a randomised controlled trial with economic evaluation. Br J Sports Med. 2018;52(13):859-68. https://doi.org/10.1136/bjsports-2017-098825
10. Searle A, Spink M, Ho A, Cuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015;29(12):1155-67. https://doi.org/10.1177/0269215515570379
11. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Internal Med. 2017;166(7):493-505. https://doi.org/10.7326/M16-2459
12. Alayat MSM, Atya AM, Ali MME, Shosha TM. Long-term effect of high-intensity laser therapy in the treatment of patients with chronic low back pain: a randomized blinded placebo-controlled trial. Lasers Med Sci. 2013;29(3):1065-73. http://doi.org/10.1007/s10103-013-1472-5
13. Glazov G, Yelland M, Emery J. Low-level laser therapy for chronic non-specific low back pain: a metaanalysis of randomised controlled trials. Acupunct Med. 2016;34(5):328-41. http://doi.org/10.1136/acupmed-2015-011036
14. Maitland GD, Hengeveld E, Banks K, English K. Maitland´s vertebral manipulation. 7 ed. Philadelphia: Elsevier Butterworth Heinemann, 2007.
15. Ali MN, Sethi K, Noohu MM. Comparison of two mobilization techniques in management of chronic non-specific low back pain. J Bodyw Mov Ther. 2019;23(4):918-23. http://doi.org/10.1016/j.jbmt.2019.02.020
16. Kreiner DS, Matz P, Bono CM, Cho CH, Easa JE, Ghiselli G, et al. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain. Spine J. 2020;20:998-1024. https://doi.org/10.1016/j.spinee.2020.04.006
17. Meroni R, Piscitelli D, Ravasio C, Vanti C, Bertozzi L, De Vito G, et al. Evidence for managing chronic low back pain in primary care: a review of recommendations from high-quality clinical practice guidelines. Disabil Rehabil. 2021;43(7):1029-43. https://doi.org/10.1080/09638288.2019.1645888
18. Delitto A, George SZ, Van Dillen L, Whitman JM, Sowa G, Shekelle P, et al. Low back pain. J Orthop Sports Phys Ther. 2012; 42(4): A1-57. http://doi.org/10.2519/jospt.2012.42.4.a1
19. Costa LOP, Maher CG, Latimer J, Hodges PW, Herbert RD, Refshauge KM, et al. Motor control exercise for chronic low back pain: a randomized placebo-controlled trial. Phys Ther. 2009;89(12):1275-86. https://doi.org/10.2522/ptj.20090218
20. Ay S, Doğan SK, Evcik D. Is low-level laser therapy effective in acute or chronic low back pain? Clin Rheumatol. 2010;29(8):905-10. http://doi.org/10.1007/s10067-010-1460-0
21. Calonego CA, Rebelatto JR. Comparação entre a aplicação do método Maitland e da terapia convencional no tratamento de lombalgia aguda. Rev Bras Fisioter. 2002;6(2):97-104.
22. Hermens HJ. Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. 2000;10(5):361-74. http://doi.org/10.1016/s1050-6411(00)00027-4
23. Alves MC, Souza Neto RJ, Barbosa RI, Marcolino AM, Kuriki HU. Effects of a Pilates protocol in individuals with non-specific low back pain compared with healthy individuals: Clinical and electromyographic analysis. Clin Biomechanics. 2020;72:172-178. https://doi.org/10.1016/j.clinbiomech.2019.12.009
24. Ferreira MGS, Melo LC, Nascimento LSG, Ferreira APL, Araújo MGR. Eficácia do Método Maitland no tratamento da dor lombar crônica em estudantes de fisioterapia. Anais do Congresso Brasileiro de Fisioterapia. 2016;1(1).
25. Tavares FAG, Chaves TC, Silva ED, Guerreiro GD, Gonçalves JF, Albuquerque AAA. Efeitos imediatos da mobilização articular em relação à intervenção sham e controle na intensidade de dor e incapacidade em pacientes com dor lombar crônica: ensaio clínico aleatorizado controlado. Rev Dor. 2017;18(1):2-7. https://doi.org/10.5935/1806-0013.20170002
26. Isenburg K, Mawla I, Loggia ML, Ellingsen D, Protsenko E, Kowalski MH, et al. Increased salience network connectivity following manual therapy is associated with reduced pain in chronic low back pain patients. J Pain. 2021;22(5):545-55 6. https://doi.org/10.1016/j.jpain.2020.11.007
27. Djavid GE, Mehrdad R, Ghasemi M, Hazan-Zadeh H, Sotoodeh-Manesh A, Pouryaghoub G. In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomised trial. Australian J Physiother. 2007;53(3):155-60. https://doi.org/10.1016/S0004-9514(07)70022-3
28. Machado PM, Alves MC, Hendler KG, Benetti VB, Souza Neto RJ, Barbosa RI, et al. Effectiveness of the Pilates method for individuals with nonspecific low back pain: clinical and electromyographic aspects. Motriz. 2017;23(4):e101721. http://doi.org/10.1590/S1980-6574201700040009
29. Kim DH, Kim TH. Comparison of the effects of stability exercise and balance exercise on muscle activity in female patients with chronic low back pain. J Exerc Rehabil. 2018;14(6):1053-8. http://doi.org/10.12965/jer.1836438.219
30. Bae CR, Jin Y, Yoon BC, Kim NH, Park KW, Lee SH. Effects of assisted sit-up exercise compared to core stabilization exercise on patients with non-specific low back pain: A randomized controlled trial. J Back Musculosk Rehabil. 2018;31(5):871-80. http://doi.org/10.3233/BMR-170997
31. Ferreira LCM, Araujo AC, Oliveira CBS, Jassi FJ, Oliveira VC, Negrão Filho RF. Associação entre recrutamento de músculos abdominais com desfechos clínicos e risco prognóstico em indivíduos com dor lombar crônica não específica: estudo preliminar. Fisioter Pesqui. 2016;23(1):45-51. http://doi.org/10.1590/1809-2950/14560723012016