|Year : 2014 | Volume
| Issue : 1 | Page : 10-14
The efficacy of interferential therapy and exercise therapy in the treatment of low back pain
OA Olawale1, CM Agudzeamegah2
1 Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
2 Department of Physiotherapy, Regional Hospital, Hohoe, Volta Region, Ghana
|Date of Web Publication||1-Jul-2014|
O A Olawale
Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos, PMB 12003, Lagos
Source of Support: None, Conflict of Interest: None
Background/Purpose: Low back pain (LBP) is an important public health problem. It is one of the most expensive conditions in musculoskeletal health care; hence the need for a safe, efficacious and cost effective management. The aim of the study was to determine the efficacy of interferential therapy and exercise therapy in the treatment of LBP. Materials and Methods: Sixty-five subjects diagnosed with low back pain participated in the study. The subjects (29 males and 36 females) were aged between 20-66 years (mean age 46.45 ± 11.90 years). Each subject was treated with interferential therapy (IFT) and some specific spinal-based therapeutic exercises thrice weekly. Assessment of pain intensity and spinal range of movements were carried out with Visual Analogue Scale (VAS) and Modified Schober Technique (MST) respectively. Measurements were carried out before and after eight weeks of treatment. Results: There was a statistically significant decrease in pain from 6.29 ± 2.16 before treatment to 2.54 ± 1.86 after treatment (P < 0.001). Spinal flexion increased from 3.44 ± 1.7 cm pretreatment to 5.22 ± 1.59 cm after 8 weeks of treatment (P < 0.01). Also, spinal extension increased from 1.2 ± 0.62 cm pretreatment to 2.29 ± 0.63 cm after 8 weeks of treatment (P < 0.001). Subjects with pain localized to the lower back and those with pain radiating to lower limbs had significant improvements from the treatment. Conclusion: The results of this study showed that interferential therapy combined with exercise therapy could help to reduce pain intensity and increase spinal range of motion in patients with low back pain.
Keywords: Exercise therapy, interferential therapy, low back pain, physiotherapy
|How to cite this article:|
Olawale O A, Agudzeamegah C M. The efficacy of interferential therapy and exercise therapy in the treatment of low back pain. Niger J Exp Clin Biosci 2014;2:10-4
|How to cite this URL:|
Olawale O A, Agudzeamegah C M. The efficacy of interferential therapy and exercise therapy in the treatment of low back pain. Niger J Exp Clin Biosci [serial online] 2014 [cited 2019 Jul 18];2:10-4. Available from: http://www.njecbonline.org/text.asp?2014/2/1/10/135610
| Introduction|| |
Low back pain (LBP) is an important public health problem that is associated with poor quality of life and disability.  It is a localized or diffuse pain felt in the lumbosacral region of the back, and which may radiate down one or both legs.  It is one of the leading causes of disability and absenteeism from work. According to epidemiological studies, 50% of the American population experience LBP by 20 years of age, and this increases to 80% by 60 years.  Lifetime incidence of LBP ranges from 60-90%, with a 5% annual incidence.  Most people affected are between the ages of 25-60 years, with those from 50-60 years more likely to become disabled.  Peak incidence is at 40 years, with 12-26% of children and adolescents also experiencing LBP. Ninety percent of cases resolve without medical attention in 6-12 weeks, with 70-90% having recurrent episodes. 
LBP has been described as a twentieth century health care disaster.  In the United Kingdom, its management was estimated to cost the National Health Service (NHS) 151 million pounds per annum.  LBP appears as common in Sub-Saharan Africa as in Western countries. A study conducted in Togo showed that, 35.34% (3,203 out of 9,065) of patients seen, had LBP.  In the same study it was also observed that among rheumatology outpatients, the prevalence rate of LBP is 33.33%. 
The causes of LBP include degenerative disorder or injury to any of the spinal structures (ligaments, vertebrae, or muscles), as in muscle strain, spondylosis, spondylolisthesis, spinal stenosis, and disc herniation.  The aging process, genetic factors, infections, atherosclerosis, pregnancy, osteoporosis and psychosocial factors predispose individuals to symptoms of LBP. Risk factors for LBP include heavy lifting and twisting movements, bodily vibration and poor conditioning of the back.  The type, location and severity of the symptoms depend on the underlying cause. These range from lumbar muscle spasm and pain, sciatica, paraesthesia, anesthesia, to muscle weakness. , LBP can be diagnosed by obtaining history of the condition, observation of the patient and physical examination. Also, laboratory investigations and diagnostic imaging techniques may be used.  Simple preventive measures of LBP are exercises that increase strength and flexibility in the lower back and abdominal muscles, and the use of proper body mechanics. 
The best way to manage LBP has always stimulated debate.  However, multidisciplinary management programs are known to be the most effective.  Rest coupled with as much activity as tolerable shortens the time of disability from LBP.  Treatment options for LBP include medications, physical therapy, and surgery. Medications used include: analgesics, muscle relaxants, sedative-hypnotics and antidepressants. Surgical options include: laminectomy, discectomy, facetectomy, foraminotomy, and fusion. ,,
Physiotherapists use an array of interventions in the management of LBP. The effectiveness of most of these interventions has not been well-studied.  The physiotherapy modalities used include heat, cryotherapy, massage, ultrasound, traction, acupuncture and electrical stimulation.  Transcutaneous electrical nerve stimulation (TENS) and interferential current are the most used electrotherapy methods, although there is little scientific evidence to support their use.  Indications for the use of interferential therapy (IFT) (interferential electrical stimulation) for the treatment of LBP had been reported. , Exercise therapy or programs that combine aerobic conditioning with specific strengthening of the back and lower limb muscles can decrease the frequency of recurrence of LBP.  Hence, this study was carried out to determine the efficacy of IFT combined with exercise therapy in the treatment of LBP.
| Materials and methods|| |
The subjects for this study included both male and female patients with sub-acute (up to 12 weeks) or chronic (longer than 3 months) LBP. Patients with LBP due to pregnancy or pelvic inflammatory diseases; and those with conditions that are contraindicated for IFT or therapeutic exercises (pacemakers, malignancy, bacterial infections, metallic implants, thrombosis, and epilepsy) were excluded. The study was conducted at the Physiotherapy Department, Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Subject selection was done on a convenient basis from a cohort of patients with LBP who were receiving treatment during the study period. Sixty-five subjects (29 males, 36 females) met the inclusion criteria and were treated with IFT and exercise therapy for 8 weeks.
Treatment Procedures and Measurements
Assessment of spinal ranges of movement
Spinal flexion and extension range of movement was measured using the Modified Schober Flexion Technique. This was done with the subject in the standing position. A horizontal landmark was drawn between the two posterior superior iliac spines (PSIS) as zero/reference point on the subject. Another landmark was marked 10 cm above the zero point along the spine. Subject was asked to touch his/her toes with knees in extension, and stop flexing when an uncomfortable pain was felt. The vertical distance between the two landmarks is the flexion distance, and the difference between the 10 cm and this figure was recorded as the flexion range of movement.  For measurement of spinal extension range, the subject was asked to hyperextend the back until an uncomfortable pain was felt. The vertical distance between the two landmarks was measured as extension distance and then subtracted from the 10 cm and recorded as extension range of movement. 
Each subject was assessed for skin sensation prior to treatment. Interferential current was applied with the subject in prone lying, for 20 minutes, three times a week. The 2-pole electrodes were placed over the painful area and or over the spinal nerve root. Electrodes were placed on the patient's skin to stimulate underlying nerves, including those responsible for carrying pain sensations.
In addition to the IFT, each subject went through a 15-minute session of spinal based exercises. The exercises utilized were back extension, posterior pelvic tilt, bridging exercises, and partial sit-ups. They were carried out as follows:
- Back extension: Subjects were asked to lie in prone position with arms by the sides. They were then instructed to lift the head and upper body off the couch and hold for 5 seconds, return to initial position and relax.
- Posterior pelvic tilt: Subjects were asked to lie in supine position and bend the knees with feet flat on the couch. They were then instructed to tighten the stomach muscles and tilt the pelvis backwards, and then to flatten the lower back against the couch.
- Bridging exercise: Subjects were asked to lie supine and bend the knees with feet flat on the couch and arms by the side. They were then instructed to lift the pelvis and lower back off the couch and hold for 5 seconds, return to original position and relax.
- Partial sit-ups: Subjects were asked to lie supine and bend the knees with feet flat on the couch and arms across the chest. They were then instructed to raise the shoulders about 15 cm off the couch, exhale on the way up and inhale on the way down, and then relax.
Each exercise was repeated five times.
The intensity of pain was determined for each subject by using the visual analogue scale (VAS). This measurement was taken before and after 8 weeks of treatment.
Informed consent was obtained from the subjects before they were enrolled into the study. The research protocol was approved by the Ethical and Protocol Review Committee of the School of Allied Health Sciences, College of Health Sciences, University of Ghana.
The data was analyzed using Epi-Info designed by Centre for Disease Control and Prevention (CDC) and Statistical Package for Social Sciences (SPSS). Descriptive statistics of mean and standard deviation (SD) were calculated for all the variables. The t-test was used to compare the various categories at a P < 0.05 level of significance. Data from subjects who withdrew from the study before the fifth week of treatment were not used for analysis.
| Results|| |
Socio-demographic characteristics of the subjects
Sixty-five 65 subjects with low back pain participated in the study. The subjects consisted of 36 females (55.4%) and 29 males (44.6%). Their ages ranged from 20-66 years, with a mean age of 46.5 ± 11.9 years, and modal age was 50 years. The mean age for females was 47.0 ± 10.8 years and 45.5 ± 13.3 years for males. There was no significant difference between the male and female subjects in terms of age (P > 0.05). Of the 65 subjects, 34 (52.3%) were manual workers and 31 (47.7%), sedentary workers, 6 subjects (9.2%) had centralized pain and the remaining 59 subjects (90.8%) had low back pain radiating to either or both lower limbs. Thirty-nine subjects (60%) had LBP related to degenerative changes in the spine, while 26 (40%) had mechanical LBP [Table 1].
Changes in outcome measures
The changes in outcome measures for all subjects are shown in [Table 2]. Significant reductions in low back pain were reported for all subjects after 8 weeks of treatment (P < 0.05). Spine flexion and extension also increased significantly after the same period. The results also showed that the manual and sedentary workers reported significant decrease in pain and increase in spinal flexion and extension (P < 0.001) [Table 3].
In a similar vein, subjects with degenerative and mechanical LBP reported significant pain relief and increases in spinal mobility (P < 0.001) [Table 4]. Also, subjects with centralized or radiating pain had significant reductions in pain and increases in spinal flexion and extension (P < 0.05) [Table 5].
|Table 4: Changes in outcome data for subjects with degenerative or mechanical LBP|
Click here to view
|Table 5: Changes in outcome data for subjects with centralized and radiating pain|
Click here to view
| Discussion|| |
In this study, we evaluated the efficacy of interferential therapy and exercise therapy in the treatment of low back pain (LBP). The results of the study showed significant pain relief and increases in spine flexion and extension, after the subjects were treated with interferential therapy and therapeutic exercise for eight weeks. The study utilized a single-centre, one-group protocol. This is one limitation of the study since a control group was not available to enable a strong assessment of the efficacy of the treatment modalities to be made.
LBP is the leading cause of disability and absenteeism from work. Most people affected are between the ages of 25 and 60 years, with those from 50 to 60 years more likely to become disabled.  The subjects in this study belonged to a similar age group as their ages ranged from 20 to 66 years, with about 40% over 50 years old. According to the National Institute of Neurological Disorders and Stroke, LBP occurs with equal frequency in both men and women.  However, it has also been reported that women have a higher incidence of LBP than men.  A similar observation was made in this study, where 55.4% of the participants were females and 44.6% were males.
Significant differences were obtained between pre- and post- treatment values for their pain intensity, spine flexion and, spine extension. This implies that there was significant pain relief and increase in range spinal flexion and extension. In another study with similar design as the present study, it was observed that IFT significantly reduced functional disability and pain in acute LBP subjects.  Also, in a randomized controlled trial, it was reported that in individuals with chronic non-specific low back pain, interferential current electro-massage achieved a significantly greater improvement in disability, pain and quality of life in comparison to superficial massage after 20 treatment sessions.  Furthermore, in a survey on a group of nurses, it was observed that, after completing a prescribed program of exercises, significant alleviation of back pain was observed in the study group.  Also, exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic low back pain. 
Significant improvements in the outcome measures were made by the subjects in this study. Although no reason could be adduced for this, it was observed that the male subjects had more significant decrease in pain intensity and greater improvement in spine extension, while their female counterparts had better improvement in spine flexion. In terms of occupations of the subjects, both manual and sedentary workers had significant improvements in the outcome measures. Similarly, the subjects recorded significant pain relief and increase in spinal range of motion irrespective of whether they had degenerative or mechanical LBP. It was also observed that subjects had significant improvements in all aspects of outcome measures irrespective of whether they had centralized pain or radiating pain. However, those with radiating pain had more significant improvement. These results indicated the efficacy of interferential therapy and exercise therapy in the treatment of LBP and confirmed earlier reports made in other studies. ,,,
| Conclusion|| |
This study demonstrated that interferential therapy combined with exercise therapy might be useful in treating low back pain.
| References|| |
|1.||Correa JB, Costa LO, de Oliveira NT, Sluka KA, Liebano RE. Effects of the carrier frequency of interferential current on pain modulation in patients with chronic nonspecific low back pain: A protocol of a randomised controlled trial. BMC Musculoskelet Disord 2013;14:195. |
|2.||Porter S. The intervertebral disc in health and disease: An introduction to back pain. Tidy's Physiotherapy. In: Porter S, editor. 13 th ed. Oxford: Butterworth Heinemann; 2003. p. 99-111. |
|3.||Ellenberg M, Honet JC. Low Back Pain. Physical Medicine and Rehabilitation Secrets. In: O'Young BJ, Young MA, Stiens SA, editors. 2 nd ed. Philadelphia: Hanley and Belfus; 2002. p. 254-7. |
|4.||Bucko CC, Young JL, Cole AJ, Stratton SA, Press JM. Physical therapy options for Lumbar Spine Pain. In: Low Back Pain Handbook A Guide for the Practising Clinician. 2 nd ed. Philadelphia: Hanley and Belfus Inc.; 2003. p. 151-66. |
|5.||Corbin CB, Lindsey R, Welk G, Corbin WR. Concepts of Fitness and Wellness. 4 th ed. New York: McGraw-Hill; 2002. |
|6.||Waddell G. Biopsychosocial analysis of low back pain. Baillieres Clin Rheumatol 1992;6:523-57. |
|7.||Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain 2000;84:95-103. |
|8.||Mijiyawa M, Oniankitan O, Kolani B, Koriko T. Low back pain in hospital outpatients in Lome (Togo). Joint Bone Spine 2000;67:533-8. |
|9.||Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001;344:363-70. |
|10.||Anderson GB. Epidemiologic features of low-back pain. Lancet 1999;354:581-5. |
|11.||Magee DJ. Orthopaedic Physical Assessment. 4 th ed. Oxford: Elsevier Sciences; 2002. p. 467-557. |
|12.||Foster NE, Thompson KA, Baxter GD, Allen JM. Management of nonspecific low back pain by physiotherapists in Britain and Ireland: A descriptive questionnaire of current clinical practice. Spine (Phila Pa 1976) 1999;24:1332-42. |
|13.||Brander VA, Malhotra S, Jet J, Heinemann AW, Stulberg SD. Outcome of hip and knee arthroplasty in persons aged 80 years and older. Clin Orthop 1997;345:67-78. |
|14.||Poitras S, Blais R, Swaine B, Rossignol M. Management of work-related low back pain: A population-based survey of physical therapists. Phys Ther 2005;85:1168-81. |
|15.||Facci LM, Nowotny JP, Tormem F, Trevisani VF. Effects of transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) in patients with nonspecific chronic low back pain: Randomized clinical trial. Sao Paulo Med J 2011;129:206-16. |
|16.||Werners R, Pynsent PB, Bulstrode CJ. Randomized trial comparing interferential therapy with motorized lumbar traction and massage in the management of low back pain in a primary care setting. Spine (Phila Pa 1976) 1999;24:1579-84. |
|17.||Zambito A, Bianchini D, Gatti D, Viapiana O, Rossini M, Adami S. Interferential and horizontal therapies in chronic low back pain: A randomized, double blind, clinical study. Clin Exp Rheumatol 2006;24:534-9. |
|18.||Lahad A, Malter AD, Berg AO, Deyo RA. The effectiveness of four interventions for the prevention of low back pain. JAMA 1994;272:1286-91. |
|19.||Williams R, Binkley J, Block R, Goldsmith CH, Minuk T. Reliability of the modified Schober and double inclinometer methods for measuring lumbar flexion and extension. Phys Ther 1993;73:33-44. |
|20.||National Institute of Neurological Disorders and Stroke. Low back pain Fact Sheet 2010. Available from: http: //www.ninds.nih.gov [Last accessed on 2013 Oct 10]. |
|21.||Lara-Palomo IC, Aguilar-Ferrandiz ME, Mataran-Penarrocha GA, Saavedra-Hernandez M, Granero-Molina J, Fernandez-Sola C, et al. Short-term effects of interferential current electro-massage in adults with chronic non-specific low back pain: A randomized controlled trial. Clin Rehabil 2013;27:439-49. |
|22.||Rok S, Wytrazek M, Bilski B. Efficacy of therapeutic exercises in low back pain surveyed in a group of nurses. Med Pr 2005;56:235-9. |
|23.||Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev 2005:CD000335. |
|24.||Hurley DA, McDonough SM, Dempster M, Moore AP, Baxter GD. A randomized clinical trial of manipulative therapy and interferential therapy for acute low back pain. Spine (Phila Pa 1976) 2004;29:2207-16. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]