title: Effects of a three-month therapeutic exercise programme on flexibility in subjects with low back pain.
abstract: OBJECTIVE
  Spinal and muscle flexibility have been studied intensively and used clinically as outcome measurements in the rehabilitation of subjects with low back pain. The results of previous studies are contradictory and there is a lack of longitudinal data on the effects of long term therapeutic exercise on flexibility.
  
  
  METHODS
  A controlled experimental study was conducted to determine the effects of progressive therapeutic exercise on spinal and muscle flexibility. Eighty-six chronic low back pain subjects fulfilled the inclusion criteria and were divided into three study groups: (1) intensive training group, (2) home exercise group and (3) control group. The intervention period lasted three months and measurements were performed at both the beginning of the study and immediately after intervention. Follow-up measurements were carried out six and 12 months after baseline. Spinal flexibility was measured with lumbar flexion, extension, spinal lateral flexion and rotation, and muscle flexibility was measured with measurements of erector spinae, hamstring and iliopsoas muscles. Also self-reported outcomes of the Oswestry Index and Borg Scale--Back Pain Intensity were used. Associations between change (pre- to post-treatment) were determined for the dependent variables.
  
  
  RESULTS
  The results showed no correlation between flexibility, the Oswestry Index or back pain intensity. After the first three-month period lumbar flexion, extension and spinal rotation decreased among all subjects. Spinal rotation and erector spinae muscle flexibility improved significantly with intensive training. At the nine-month follow-up, erector spine flexibility was still greater than at baseline. Hamstring flexibility increased among the intensive training and home exercise groups from pre- to post-intervention. However, the degree of hamstring flexibility gained during training was subsequently lost following the period without programmed exercise in both training groups. Self-reported outcome variables showed positive changes among the three study groups after the completion of intervention period, but these changes were only able to be maintained during subsequent follow-ups for the intensive training and home exercise groups.
  
  
  CONCLUSIONS
  The findings suggest that flexibility does not play an important role in coping with chronic low back pain for subjects whose functional limitations are not severe. Also, it appears that the achieved gains in spinal and muscle flexibility may not be able to be maintained without continued exercise.
authors.affiliation: Jyväskylä Polytechnic, Finland. kuuktii@jypoly.fi
authors.forename: T
authors.initials: T
authors.lastname: Kuukkanen
authors.forename: E
authors.initials: E
authors.lastname: Mälkiä
mesh_terms: D016022:Case-Control Studies; D002908:Chronic Disease; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000534:rehabilitation*; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D015999:Multivariate Analysis; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010147:Pain Measurement; D018583:Pliability; D016658:Psoas Muscles / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology; D012399:Rotation; D013131:Spine / Q000503:physiopathology*; D013710:Tendons / Q000503:physiopathology; D016896:Treatment Outcome