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Medically reviewed by Drugs.com. Last updated on Sep 24, 2019.
After an injury or surgery, an exercise conditioning program will help you return. You strengthen is important for restoring range of motion and preventing injury. Just a few examples include: seated wheelchair exercises, tendon glides, self range of motion exercises, tenodesis grip exercises, and more. This resource is also fantastic for non-exercise related topics too, like one-handed dressing techniques, energy conservation, scar massage and positioning (just to name a few).
- Care Notes
WHAT YOU NEED TO KNOW:
What are passive range of motion exercises?
Passive range of motion exercises help keep a person's joints flexible. Range of motion is how far the person's joints can be moved in different directions. The exercises help you move all the person's joints through their full range of motion.
What do I need to know about passive range of motion exercises?
- Do the exercises every day, or as often as directed by the person's healthcare provider. Regular movement helps prevent contractures. Contractures are severely tightened joints and muscles.
- You may do the exercises in any order. You may spread the exercises out over the course of the day. All the exercises may be done while the person lies in bed.
- Move the person slowly, gently, and smoothly. Avoid fast or jerky motions.
- Support the area near the joint as shown by the person's healthcare provider. Move the person's body part with your other hand.
- Each joint should be moved as far it will go. Move each joint to the point where you feel some resistance. The person may feel discomfort, but do not push to where it hurts. Hold the position a few seconds, and then return the person to a resting position.
- Do the exercises on both sides. Do each group of exercises on one side, and then do the same exercises on the other side.
Neck exercises:
Support the person's head with your hands. Gently return the person's head to the middle, facing forward, after each exercise.
- Head turns: Turn the person's head to the side. Then turn his or her head to the other side.
- Head tilts: Tilt the person's head, bringing the ear toward the shoulder. Then tilt the person's head toward the other shoulder.
- Chin-to-chest: Gently bow the person's head toward his or her chest.
Shoulder and elbow exercises:
Support the person's elbow with one hand. Hold his or her wrist with your other hand.
- Shoulder movement, up and down: Raise the person's arm forward and then up over his or her head. Bring the arm back down to the person's side.
- Shoulder movement, side to side: Raise the person's arm to the side as far as it will go. Bring the arm back down to the person's side.
- Elbow bends: Place the person's arm at his or her side with the palm facing up. Bend and straighten the arm.
Arm and wrist exercises:
Support the person's wrist with one hand. Hold his or her fingers with your other hand.
- Wrist bends: Bend the person's hand back toward his or her shoulder. The fingers should point toward the ceiling. Then bend the person's hand down so his or her fingers point toward the floor.
- Wrist rotation: Rock the person's hand back and forth sideways. Gently roll the person's hand in circles in one direction. Then roll the hand in circles the other direction.
- Palm up, palm down: Tuck the person's elbow against his or her side. Turn his or her hand so the palm faces up toward the ceiling. Then turn the palm so it faces down.
Hand and finger exercises:
Hold the person's hand with both of your hands. Hold his or her hand out toward yourself, with the fingers long.
- Finger bends: Curl the fingers into a fist. Straighten the fingers again. Curl and straighten each finger one at a time. Curl and straighten the thumb.
- Finger spreads: Spread the thumb and first finger apart, then bring them back together. Spread the first finger and middle finger apart, then bring them back together. Do the same with the rest of the fingers.
- Finger-to-thumb touches: Touch the person's fingertips to the pad of his or her thumb, one finger at time.
- Finger rotations: Roll each finger in a circle in one direction. Roll each finger in the other direction. Roll the thumb in each direction.
Hip and knee exercises:
Start with the person's legs straight. Put one hand under his or her knee. Hold the ankle with your other hand.
- Hip and knee bends: Slowly bend the person's knee up as close to his or her chest as possible. Then gently straighten the leg.
- Leg movement, side to side: Move one leg out to the side, away from the other leg. Bring the leg back to the middle and cross it over the other leg.
- Leg rotation, in and out: Roll one of the person's legs toward the other leg so the toes point in. Then roll the leg out toward the side so the toes point out.
Ankle and foot exercises:
Put a rolled towel under the person's thigh. For the ankle exercises, support the person's ankle with one hand, and his or her toes with the other hand. For the toe exercises, allow the person's foot to relax on the bed, and hold only the toes.
- Ankle bends: Bend the person's foot so the toes point toward the ceiling. Then bend the person's foot the other direction so the toes are pointed.
- Ankle rotation: Raise the person's foot slightly off the bed. Roll the foot in circles. Then roll the foot in circles in the other direction.
- Ankle movement, side to side: Tilt the person's ankle in so the sole of the foot points toward the opposite leg. Then tilt the person's ankle out so the sole of the foot points away from the opposite leg.
- Toe bends: Curl the person's toes down toward the sole of the foot. Straighten them. Curl the toes up toward the ceiling. Then straighten them again.
- Toe spreads: Spread the big toe and the second toe apart, then bring them back together. Do the same with the rest of the toes.
When should I contact the person's healthcare provider?
- The person feels pain with any movement.
- You cannot move the person's body, because the joints and muscles have tightened.
- You have questions or concerns about the person's condition, care, or exercise program.
Care Agreement
You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.© Copyright IBM Corporation 2019 Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health
Further information
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Published online 2014 Aug 30. doi: 10.1589/jpts.26.1237
PMID: 25202188
This article has been cited by other articles in PMC.
Abstract
[Purpose] This study aimed to identify the effects of the CORE exercise program on painand active range of motion (AROM) in patients with chronic low back pain. [Subjects andMethods] Thirty subjects with chronic low back pain were randomly allocated to two groups:the CORE group (n = 15) and the control group (n = 15). The CORE group performed the COREexercise program for 30 minutes a day, 3 times a week, for 4 weeks, while the controlgroup did not perform any exercise. The visual analog scale (VAS) and an algometer wereused to measure pain, and pain-free AROM in the trunk was measured before and after theintervention. [Results] The CORE group showed significantly decreased VAS scores at restand during movement and had a significantly increased pressure pain threshold in thequadratus lumborum and AROM in the trunk compared with those in the control group.[Conclusion] This study demonstrated that the CORE exercise program is effective indecreasing pain and increasing AROM in patients with chronic low back pain. Thus, the COREexercise program can be used to manage pain and AROM in patients with chronic low backpain.
Key words: CORE exercise program, Chronic low back pain (CLBP), Active range of motion (AROM)
INTRODUCTION
Low back pain is a prevalent disorder in modern society, with 80% of the populationsuffering from it at least once in their life). Among them, 7–10% will develop chronic low back pain (CLBP), and 1%will have physical disabilities). CLBP isnot only painful but also leads to loss of function, so this condition hampers a healthylifestyle). Low back pain isincreasingly seen in patients in their 20s to 40s, especially due to the economicdevelopment of society and changing working environments).
Low back pain is caused by a degenerated or damaged facet joint or sacroiliac joint withsoft tissue injury on the trunk or by lumbar instability from weakened muscle strength). Lumbar instability restricts musclestrength, endurance, flexibility, and active range of motion (AROM). In particular, patientswith CLBP persisting for more than 6 months restrict trunk movement to minimize pain in thelumbosacral area or leg, which aggravates the level of lumbar muscle weakness in paraspinalmuscles and the multifidus). These changesincrease lumbar instability and raise the recurrence of low back pain. Therefore, abdominaland spinal extensors are crucial in improving lumbar stability. Patients with CLBP sufferfrom deteriorated physical functions and production activities due to weakened musclestrength in the lumbar region. Therefore, exercises that increase muscle strength andflexibility are very important for CLBP patients not only to alleviate low back pain butalso for continued self-care). Inaddition, differences in motor control patterns, such as poor postural control and alteredmuscle recruitment pattern, have been reported.
The CORE exercise program involves active participation to improve lumbar stability byrecovering the ability to control muscles and movements through muscle strengthening). The CORE exercise program, suggested byBrill, focuses on lumbar stabilization by controlling tension of the lumbo-pelvic-hip joint,thereby maintaining lumbar stability, strengthening muscles, increasing endurance, andcorrecting posture9).
One method of the CORE exercise program focuses on abdominal respiration. The abdominalrespiration method supplies oxygen smoothly throughout the body and expands lumbar muscle,thus reducing muscle tension and stress, which ultimately alleviates fatigue. The COREexercise program can easily be conducted at home with almost no restrictions regardingplace, time, and cost, and has a low risk of injury9). It is designed to suit CLBP patients by combining traditional yogamovements and exercises to increase muscle strength and flexibility, and to correct posture.However, the effectiveness of Brill’s CORE exercise program on pain and AROM in CLBPpatients remains unclear. Thus, the purpose of this study was to identify the effects of theCORE exercise program on pain at rest and during movement and on AROM in patients withCLBP.
SUBJECTS AND METHODS
Thirty patients with CLBP at local clinics located in Seoul were recruited for this study.Subjects were randomly assigned to the CORE group (n = 15) or the control group (n = 15).Patients who had a history of spinal or lower limb operation, signs of nerve compression,inflammatory diseases, or signs of aggravated acute pain or had performed stabilizationexercises within 6 months were excluded from the study. All experimental procedures wereconducted in accordance with the guidelines set by the local research ethics committee.
The subjects in the CORE group conducted the CORE exercise program for 30 minutes, 3 timesa week, for 4 weeks. This program is divided into 3 categories: warm up, conditioning, andcool down, which are described in Brill’s book9). The control group received routine care but did not perform theCORE exercise program. The purpose and process of the study were explained to the subjects,and they signed an informed consent form. In order to reduce measurement errors, assessmentswere conducted by the same investigator in the same place before and after theintervention.
All measurements were performed before and 1 day after the intervention. To assess thedegree of pain, a 100-mm visual analogue scale (VAS) was used at rest and during movement.Unpleasant sensation or pain felt when keeping still was considered pain at rest, and painexperienced during full flexion of the trunk was considered pain during movement. Patientswrote down their pain intensity on a 100 mm-long table, and the investigator measured thelength and marked it (mm). Pain pressure threshold (PPT) in the lumbar region was measuredusing an algometer (NeuroDyne Medical, Cambridge, MA, USA). Subjects were fully explainedthe purpose of the experiment. The instrument was placed perpendicular to the quadratuslumborum (2 cm lateral to L3 spinous process)), and then pressure was applied to the region at a consistent paceof 1 kg/s. The subject was instructed to make a sound on experiencing an unpleasant feelingor pain. This was considered the PPT. An inclinometer (Angle/Level, Dejon Tool Co.,Covington, OH, USA) was used to measure AROM without lumbar pain. The tester measured thetotal moved angle of lumbosacral flexion and extension with a single inclinometer placedover the L1-S2 spinous processes.
Statistical analyses were performed using SPSS v15.0. The independent t-test was performedto compare the differences in dependent variables between groups, and the paired t-test wasused to evaluate the differences within groups. The level of probability was set at p <0.05.
RESULTS
The baseline characteristics of the participants are shown in Table 1. There were no significant differences between the two groups in baselinevalues.
Table 1.
General characteristics of the participants in this study
CORE group (n=15) | Control group (n=15) | |
---|---|---|
Gender (male/female) | 6/9 | 5/10 |
Age (years) | 38.1 ± 7.9 | 36.5 ± 7.7 |
Height (cm) | 165.2 ± 7.6 | 164.6 ± 8.2 |
Weight (kg) | 66.5 ± 11.5 | 65.1 ± 10.7 |
Onset time (months) | 14.9 ± 7.5 | 13.4 ± 8.1 |
![Exercise Exercise](/uploads/1/2/5/8/125877823/935718730.png)
Values are expressed as the mean ± standard deviation (SD)
Significant differences were observed in VAS at rest and during movement in the CORE group,while the control group did not show a significant difference. In addition, the improvementin VAS at rest and during movement in the CORE group was significantly greater compared withthat in the control group. Similarly, the PPT of the quadratus lumborum was significantlyincreased, from 4.69 ± 0.62 kg/cm2 to 6.11 ± 0.78 kg/cm2 in the COREgroup (p < 0.05). The control group, however, showed no significant increase in PPT (from4.53 ± 1.03 kg/cm2 to 4.86 ± 1.21 kg/cm2). There was a significantdifference in PPT between groups (p < 0.05, Table2).
Table 2.
Comparison of the changes in the VAS, PPT, and AROM
CORE group (n=15) | Control group (n=15) | |||
---|---|---|---|---|
VAS | VAS at rest | Baseline | 41.6 ± 7.4 | 38.5 ± 8.5 |
Post | 21.5 ± 5.7† | 37.6 ± 10.5 | ||
Post − Baseline | 20.1 ± 6.3* | 0.9 ± 6.5 | ||
VAS during movement | Baseline | 60.8 ± 7.3 | 58.6 ± 8.0 | |
Post | 36.4 ± 5.1† | 57.1 ± 7.9 | ||
Post − Baseline | 24.4 ± 8.7* | 1.5 ± 6.7 | ||
PPT | Quadratus lumborum | Baseline | 4.7 ± 0.6 | 4.5 ± 1.0 |
Post | 6.1 ± 0.8† | 4.9 ± 1.2 | ||
Post − Baseline | 1.4 ± 0.5* | 0.3 ± 0.9 | ||
AROM | Flexion | Baseline | 65.5 ± 10.6 | 66.3 ± 18.3 |
Post | 89.7 ± 11.0† | 68.6 ± 18.7 | ||
Post − Baseline | 24.2 ± 8.9* | 2.3 ± 7.8 |
Values are expressed as the mean ± standard deviation (SD). VAS, visual analoguescale; PPT, pain pressure threshold; AROM, active range of motion. † Significantdifference within the group. * Significant difference compared with the value of thecontrol group at the corresponding time.
After the intervention, the AROM of trunk flexion increased significantly in the CORE group(from 65.47 ± 10.61° to 89.68 ± 10.95°), but a significant increase was not found in thecontrol group. In addition, significant differences were observed in AROM between the 2groups (p < 0.05, Table 2).
DISCUSSION
Pain and loss of flexibility are the main symptoms of CLBP; therefore, their assessment isimportant in determining treatment efficiency). This study applied Brill’s CORE exercise program to CLBP patientsand showed that it is effective in resolving pain and improving AROM.
The VAS actually measures different items); however, no study has separately evaluated pain at rest and duringmovement in patients with CLBP undergoing treatment with the CORE exercise program. Ourstudy measured pain at rest and during movement separately. The CORE group showedsignificant decreases in pain at rest and during movement compared with those in the controlgroup, and the significant pain reduction was sustained after the experiment. This issimilar to the results of Goldby et al., which showed pain reduction in CLBP patients after10 weeks of specific spinal stabilization, and those of Koumantakis, which showed thecontinuation of significant pain reduction in patients with low back pain 3 months afterapplication of stabilization enhanced exercise,). Typically, during the performanceof a specific stabilization exercise, patients learn how to recruit the deep muscles of thespine and gradually reduce undesirable excessive activity of other muscles). Another benefit of the CORE exerciseprogram is the restoration of coordination and control of the trunk muscles to improvecontrol of the lumbar spine and pelvis).Brill’s CORE exercise program, which was used in this study, controls tension of thelumbo-pelvic-hip joint, which maintains lumbar stability to strengthen muscles, increaseendurance, and correct posture. Such exercises showed similar effects in decreasing painintensity.
According to our results, the PPT in the CORE group increased significantly, while that inthe control group did not. This result corresponds to the result of a study by Senthil,which confirmed a statistically significant increase in PPT after applying segmentalstabilization exercise in CLBP patients). Such a result shows that the CORE exercise program applied in CLBPpatients is effective in reducing back muscle spasm. Back muscle spasm is a clinical featureof CLBP and is considered secondary pain). In the case of chronic pain conditions, such as CLBP, abnormalpain processing due to central neuroplastic changes plays an important role. The changes arecaused by continued stimulation rather than by inflammation or damage to peripheralstructures. Therefore, patients experience increased sensitivity to pressure and to painstimuli of a normal degree19, 20). In addition, CLBP patients suffer from muscle weakness inthe lumbar spine). According to thebiomechanical model theory, weakened muscles cause mechanical irritation in the lumbarspine, thereby causing pain by stimulating pain-sensitive structures22, ). Such continuedstimulation serves as an initial cause of central sensitization and chronic pain). The vicious cycle of pain causing spasmand spasm worsening pain is a generally accepted concept at the moment). The CORE exercise program is based on transverseabdominis contraction that can strengthen spinal muscle and enhance lumbar stability bymaintaining spinal balance9). It is assumedthat the CORE exercise program can restore the function of weakened muscles in CLBP patientsand augment the ability to support and control the spine and pelvis, thereby alleviatingmechanical irritation and pain, ultimately reducing spasm in the low back region.
This study measured lumbar AROM after intervention, and the angles of flexion in the COREgroup increased significantly compared with those before treatment. This is similar to theresult of the study by Hicks, in which AROM was increased with application of stabilizationexercise for 4 weeks in CLBP patients).The CORE program includes hamstring stretching, which can increase the flexibility of thehamstring; the double knee to chest exercise, lying spinal twist, which stretches the lumbarregion’s muscles and soft tissues; and the cobra, which relieves tension on the back anddisk pressure.
This study confirmed that the CORE exercise program applied to patients with CLBP waseffective in reducing pain and increasing AROM. Based on our results, Brill’s CORE exerciseprogram could be used as an effective exercise method for managing patients with CLBP andpromoting a healthy lifestyle.
Acknowledgments
This work was supported by the Basic Science Research Program through the National ResearchFoundation of Korea (NRF) and funded by the Ministry of Education, Science and Technology(MEST; 2011-0005415).
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