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Assessing the Impact of Closed and Open Kinetic Chain Hydrotherapy on Vertical Ground Reaction Force, Rate of Loading, Lumbo-Pelvic Stability, Pain Intensity, and Kinesiophobia in Men with Non-Specific Chronic Low Back Pain: A Randomized Clinical Trial

Document Type : Original Articles

Authors

1 Faculty of Physical Education and Sport Sciences, Bu Ali Sina University,Hamedan, Iran. Instructor Department of Physical Education and Sport Sciences, Payame Noor University, Tehran, Iran.

2 Department of Sport Rehabilitation, Faculty of Sport Sciences, Bu Ali Sina University, Hamedan, Iran.

3 Departments of Neurosurgery, Hamadan University of Medical Sciences, Hamadan, Iran.

10.30476/jrsr.2024.101742.1468

Abstract

Background: Chronic non-specific low back pain (CNSLBP) is a leading cause of work absenteeism and increased dependence on healthcare services and insurance. Despite its prevalence, limited research has explored the effects of open and closed kinetic chain (O/CKC) exercises performed in water on improving CNSLBP-related outcomes. This study aimed to assess the impact of hydrotherapy-based closed and open kinetic chain exercises on lumbo-pelvic stability, pain intensity, kinesiophobia, rate of loading (ROL), and vertical ground reaction force (vGRF) in men with CNSLBP.
Methods: The double-blind randomized controlled trial was designed with a pre-post test in men aged 40–60 (48.10 ± 5.97) with CNSLBP. Patients were randomly assigned to two hydrotherapy groups—CKCE and OKCE—and a control group. Pain intensity, kinesiophobia, lumbo-pelvic stability (LPS), rate of loading (ROL), and vertical ground reaction force (vGRF) were measured using the visual analog scale, Tampa Kinesiophobia Scale, biofeedback pressure device, and plantar pressure device. The intervention groups performed prescribed exercises for eight weeks, with three sessions per week. Covariance analysis was used to compare group differences.
Results: In the comparison within the OKCE and CKCE groups, significant differences were observed between the pre- and post-intervention measurements (p < 0.05). Moreover, statistically significant differences were found in pain (p = 0.001) and kinesiophobia scores (p = 0.001), both with a large effect size. Additionally, noteworthy differences were noted in vGRF (p = 0.003), ROL (p = 0.012), and LPS (p = 0.022).
Conclusion: The study results indicate that hydrotherapy exercises involving open and closed kinetic chains benefit individuals with CNSLBP. It is recommended that healthcare professionals, including physicians, physiotherapists, and occupational therapists, incorporate these exercises into comprehensive rehabilitation programs for such patients.

Keywords

References
  1. Phattharasupharerk S, Purepong N, Eksakulkla S, Siriphorn A. Effects of Qigong practice in office workers with chronic non-specific low back pain: a randomized control trial. Journal of bodywork and movement therapies. 2019;23[2]:375-81.
  2. Mousavi SJ, Akbari ME, Mehdian H, Mobini B, Montazeri A, Akbarnia B, et al. Low back pain in Iran: a growing need to adapt and implement evidence-based practice in developing countries. Spine. 2011;36(10):E638–46.
  3. Yalfani A, Ahmadnezhad L, Gholami Borujeni B, Khoshnamvand Z. The effect of six weeks core stability exercise training on balance, pain and function in women with chronic low back pain. Journal of Health and Care. 2017;10;18[4]:336-46.
  4. Alexander IJ, Chao EY, Johnson KA. The assessment of dynamic foot-to-ground contact forces and plantar pressure distribution: a review of the evolution of current techniques and clinical applications. Foot & ankle. 1990;
  5. Baena-Beato PÁ, Artero EG, Arroyo-Morales M, Robles-Fuentes A, Gatto-Cardia MC, Delgado-Fernández M. Aquatic therapy improves pain, disability, quality of life, body composition and fitness in sedentary adults with chronic low back pain. A controlled clinical trial. Clinical Rehabilitation. 2014;
  6. Kwon YJ, Park SJ, Jefferson J, Kim K. The effect of open and closed kinetic chain exercises on dynamic balance ability of normal healthy adults. Journal of physical therapy science. 2013 Jun 25;
  7. Sciascia A, Cromwell R. Kinetic chain rehabilitation: a theoretical framework. Rehabilitation research and practice. 2012;2012.
  8. Lephart SM, Henry TJ. The physiological basis for open and closed kinetic chain rehabilitation for the upper extremity. Journal of Sport Rehabilitation [Internet]. 1996;1;5[1]:71-87. Available from: https://journals.humankinetics.com/view/journals/jsr/5/1/article-p71.xml
  9. Ghafouri M, Teymourzadeh A, Nakhostin-Ansari A, Sepanlou SG, Dalvand S, Moradpour F, et al. Prevalence and predictors of low back pain among the Iranian population: Results from the Persian cohort study. Annals of Medicine and Surgery. 2022;74(103243).
  10. Dufek JS, Bates BT. Biomechanical factors associated with injury during landing in jump sports. Sports medicine. 1991;(v;12:326-37. DOI):10 2165 00007256-199112050–00005.
  11. FATOLLAHİ A, BARGHAMADİ M, DARVİSHANİ MA. Effect of Hydrotherapy on Muscle Activities and Running Kinetics in Adult Males with Pronated Foot: A Randomized Clinical Trial. Pamukkale Journal of Sport Sciences. 2023 Dec;313(..\GRF).
  12. Lee H, Hübscher M, Moseley GL, Kamper SJ, Traeger AC, Mansell G. How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain. Pain. 2015;156[6]:988-97.
  13. Rum L, Brasiliano P, Vannozzi G, Laudani L, Macaluso A. Non-specific chronic low back pain elicits kinematic and neuromuscular changes in walking and gait termination. Gait & Posture. 2021;84:238–44.
  14. Bento PC, Pereira G, Ugrinowitsch C, Rodacki AL. The effects of a water-based exercise program on strength and functionality of older adults. Journal of aging and physical activity. 2012 Oct;1;20[4]:469-70.
  15. Christakou A, Boulnta F. The effectiveness of hydrotherapy in patients with chronic low back pain. Physiotherapy Quarterly [Internet]. 2020;1;28[3]:32-8. Available from: Rate\DOI\20.pdf
  16. Hewett, T. E., et al. (2005). "Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study." The American journal of sports medicine 33(4): 492-501.
  17. Roussel N, Nijs J, Truijen S, Vervecken L, Mottram S, Stassijns G. Altered breathing patterns during lumbopelvic motor control tests in chronic low back pain: a case–control study. European Spine Journal. 2009;18:1066–73.
  18. Asar S, Gandomi F, Dehcheshmeh PF, Kermanshah I. Relationship between LumboPelvic Motor Control Deficiency and Non-Specific Chronic Low Back Pain: A Systematic Review. The Scientific Journal of Rehabilitation Medicine. 2019 Dec;15;8[4]:311-9.
  19. Grosdent S, Demoulin C, Cruz C, Giop R, Tomasella M, Crielaard JM, et al. Lumbopelvic motor control and low back pain in elite socer players: a cross-sectional study. Journal of sports sciences. 2016;2;34[11]:1021-9.
  20. Fadaei Dehcheshmeh, P., et al. (2021). "Effect of lumbopelvic control on landing mechanics and lower extremity muscles’ activities in female professional athletes: implications for injury prevention." BMC Sports Science, Medicine and Rehabilitation 13(1): 101.
  21. Ariyoshi M, SONODA K, NAGATA K, MASHIMA T, ZENMYO M, PAKU C, et al. Efficacy of aquatic exercises for patients with low-back pain. The Kurume medical journal. 1999 Jun 14;
  22. Yalfani A, Raeisi Z, Koumasian Z. Effects of eight-week water versus mat pilates on female patients with chronic nonspecific low back pain: double-blind randomized clinical trial. Journal of Bodywork and Movement Therapies. 2020;5(DOI).
  23. Brody LT, Geigle PR, Geigle P, editors. Aquatic exercise for rehabilitation and training. Human Kinetics [Internet]. 2009; Available from: https://us.humankinetics.com/products/aquatic-exercise-for-rehabilitation-and-training
  24. Gomes Neto, M., et al. (2020). "Effects of water-based exercise on functioning and quality of life in people with Parkinson’s disease: a systematic review and meta-analysis." Clinical Rehabilitation 34(12): 1425-1435.
  25. Tagesson S, Öberg B, Good L, Kvist J. A comprehensive rehabilitation program with quadriceps strengthening in closed versus open kinetic chain exercise in patients with anterior cruciate ligament deficiency: a randomized clinical trial evaluating dynamic tibial translation and muscle function. The American journal of sports medicine. 2008;Feb;36[2]:298-307:17-.
  26. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P, Group CONSORT. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Annals of internal medicine. 2008;19;148[4]:295-309. DOI:10 7326 0003-4819-148-4-200802190–00008.
  27. Wong CK, Mak RY, Kwok TS, Tsang JS, Leung MY, Funabashi M, et al. Prevalence, incidence, and factors associated with non-specific chronic low back pain in community-dwelling older adults aged 60 years and older: a systematic review and meta-analysis. The journal of pain. 2022;1;23[4]:509-34.
  28. Rustøen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C. Age and the experience of chronic pain: differences in health and quality of life among younger, middle-aged, and older adults. The Clinical journal of pain. 2005 Nov;1;21[6]:513-23.
  29. Hüllemann, P., et al. (2018). "Clinical manifestation of acute, subacute, and chronic low back pain in different age groups: low back pain in 35,446 patients." Pain Practice 18(8): 1011-1023.
  30. Kim Y, Vakula MN, Waller B, Bressel E. A systematic review and meta-analysis comparing the effect of aquatic and land exercise on dynamic balance in older adults. BMC geriatrics. 2020;
  31. Wearing SC, Urry S SR, J.E. Ground reaction forces at discrete sites of the foot derived from pressure plate measurements. Foot & Ankle International. 2001;
  32. Zulkifli SS, Loh WP. A state-of-the-art review of foot pressure. Foot and Ankle Surgery. 2020 Jan;1;26[1]:25-32.
  33. Kovács, I., et al. (1999). "Foot placement modifies kinematics and kinetics during drop jumping." Medicine and Science in Sports and Exercise 31(5): 708-716.
  34. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Academic emergency medicine. 2001;
  35. Jafari, H., et al. (2010). "Psychometric properties of Iranian version of Tampa Scale for Kinesiophobia in low back pain patients." Archives of Rehabilitation 11(1): 0-0.
  36. Hosseinifar M, Akbari M, Akbari A, Ghiasi F. Comparison of Lumbo-Pelvic Stability between Patients with Chronic Low Back Pain and Healthy Subjects. International Journal of Medical Research & Health Sciences. 2016 Jan;1;5[10]:122-7.
  37. Beyranvand R, Sahebozamani M, Daneshjoo A, Seyedjafari E. Assessment and comparison the effect of exercise in different depth of water on postural stability and balance recovery strategies of older people: a clinical trial.
  38. Olkoski MM, Silva MF, Guenka LC, Pelegrinelli AR, LF DB, Dias JM, et al. Comparing the effects of aquatic exercises with or without high intensity on the functional status, muscular endurance, and performance of patients with chronic low back pain. The Journal of Sports Medicine and Physical Fitness. 2020 Dec;14;61[5]:699-706. DOI:10 23736 0022-4707 20 11265-9.
  39. Dundar U, Solak O, Yigit I, Evcik D, Kavuncu V. Clinical effectiveness of aquatic exercise to treat chronic low back pain: a randomized controlled trial.
  40. Richardson JT. Eta squared and partial eta squared as measures of effect size in educational research. Educational research review. 2011;Jan;1;6[2]:135-47.
  41. Lamoth, C. J., et al. (2006). "Effects of chronic low back pain on trunk coordination and back muscle activity during walking: changes in motor control." European Spine Journal 15: 23-40.
  42. Heywood S, McClelland J, Mentiplay B, Geigle P, Rahmann A, Clark R. Effectiveness of aquatic exercise in improving lower limb strength in musculoskeletal conditions: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation. 2017;
  43. Delitto A, George SZ, Dillen L, Whitman JM, Sowa G, Shekelle P, et al. Low back pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. Journal of orthopaedic & sports physical therapy [Internet]. 2012; Available from: https://www.jospt.org/doi/10.2519/jospt.2012.42.4.A
  44. Alaca N, Kaba H, Atalay A. Associations between the severity of disability level and fear of movement and pain beliefs in patients with chronic low back pain. Journal of Back and Musculoskeletal Rehabilitation. 2020 Jan;1;33[5]:785-91. DOI:10 3233-171039.
  45. Pires D, Cruz EB, Caeiro C. Aquatic exercise and pain neurophysiology education versus aquatic exercise alone for patients with chronic low back pain: a randomized controlled trial. Clinical rehabilitation. 2015 Jun 29;
  46. Irandoust, K. and M. Taheri (2019). "The effect of aquatic training on kinematic walking patterns of elderly women." International Archives of Health Sciences 6(1): 1-5.
  47. Khojastehpour B, Atri AE, Javaheri SA. Comparison the effect of core stabilization training in water and on land on pain and dynamic postural stability in women with chronic non-specific low back pain. J Anesth Pain. 2019;10[2]:75-90.
  48. Borujeni BG, Yalfani A. Reduction of postural sway in athletes with chronic low back pain through eight weeks of inspiratory muscle training: a randomized controlled trial. Clinical Biomechanics. 2019;69(215–20):10 1016 2019 09 006.
  49. Monticone M, Ferrante S, Rocca B, Baiardi P, Dal Farra F, Foti C. Effect of a long-lasting multidisciplinary program on disability and fear-avoidance behaviors in patients with chronic low back pain: results of a randomized controlled trial. The Clinical journal of pain. 2013;(v 1;29[11]:929-38).
  50. Tavakoli MN, Mirghaemi TS. The Effectiveness of Cognitive-Behavioral Group Therapy Anger and Assertiveness of Adolescents. International Journal of Education and Applied Sciences [Internet]. 2023 Jan;1;3[4]:20-8. Available from: Rate\DOI\47.pdf
  51. Carayannopoulos AG, Han A, Burdenko IN. The benefits of combining water and land-based therapy. Journal of exercise rehabilitation. 2020;Feb;16[1]:20.
  52. Cuesta-Vargas AI, Adams N, Salazar JA, Belles A, Hazañas S, Arroyo-Morales M. Deep water running and general practice in primary care for non-specific low back pain versus general practice alone: randomized controlled trial. Clinical rheumatology. 2012;31:1073–8.
  53. Baena-Beato PÁ, Artero EG, Arroyo-Morales M, Robles-Fuentes A, Gatto-Cardia MC, Delgado-Fernández M. Aquatic therapy improves pain, disability, quality of life, body composition and fitness in sedentary adults with chronic low back pain. A controlled clinical trial. Clinical Rehabilitation. 2014;
  54. Rahimi A, Arab AM, Nourbakhsh MR, Hosseini SM, Forghany S. Lower limb kinematics in individuals with chronic low back pain during walking. Journal of Electromyography and Kinesiology. 2020;51(102404).
  55. Solana-Tramunt M, Ortegón A, Morales J, Nieto A, Nishishinya MB, Villafañe JH. Diagnostic accuracy of lumbopelvic motor control tests using pressure biofeedback unit in professional swimmers: A cross-sectional study. Journal of orthopaedics. 2019 Nov;1;16[6]:590-5.
  56. Becker BE. Aquatic therapy: scientific foundations and clinical rehabilitation applications. Pm&r. 2009 Sep;1;1[9]:859-72.
  57. Wu CY, Yang CL, Chuang LL, Lin KC, Chen HC, Chen MD, et al. Effect of therapist-based versus robot-assisted bilateral arm training on motor control, functional performance, and quality of life after chronic stroke: a clinical trial. Physical Therapy. 2012 Jul;1;92[8]:1006-16.

 

 

Journal of Rehabilitation Sciences & Research
Volume 12, Issue 3
September 2025
Pages 43-54
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