JOBA & Chronic LOw BAck Pain

Background and rational

1. Definition Low back pain is a clinical condition characterized by pain felt between the bottom edge of the costal arch and the inferior gluteus folds, sometimes radiating to the back side of the thigh.

It may be responsible for functional limitation and inability to perform normal activities of daily living. Low back pain is defined as acute if symptoms have a duration less than 4 weeks, sub-acute if the duration is between 4 weeks and 3 months, and chronic if it lasts beyond 3 months. It is considered recurrent when episodes shorter than 4 weeks alternate with periods of relief from pain. 2. Epidemiology Low Back Pain is the most common musculo-skeletal disorder, and, along with common cold, is the most frequent disease among humans.

Up to 60-80% of population is expected to suffer from Low Back Pain at some time in life. Annual prevalence of Low Back Pain ranges from 30 to 50% amongst people in the working period of their life; out of these individuals, a percentage between 15 and 20% do necessitate medical assistance. Low Back Pain is the fifth-ranking cause of medical referral and the second symptomatic condition. A proportion ranging from 25 and 50% of patients with acute Low Back Pain will suffer from new pain episodes in the following year and 6-10% will progress toward a chronic form.Chronic Low Back Pain is responsible for about 75% of all medical expenses made for the treatment of all types of Low Back Pain. Direct annual costs (medications, medical visits, physiotherapy, hospitalizations) of Chronic Low Back Pain have been estimated to be approximately € 3.100 for patients (year 2002); indirect costs, mainly due to absence from work, represent about 85% of total costs and match up about € 17.600 for patient for year. In conclusion, Chronic Low Back Pain is a disease with very high prevalence and incidence, evenly affecting men and women in their 30's and 50's, which is extremely costly for individuals and society, both in terms of diagnostic interventions and treatments, and of reduction of productivity and functional limitation in everyday life. 3. Non-Pharmacologic treatments Non-Pharmacologic treatments of Chronic Low Back Pain include: acupuncture, back school, psychological interventions, functional restoration, interdisciplinary rehabilitation, interferential therapy, low-level laser therapy, lumbar support, massage, short wave diathermy, spinal manipulations, tractions, superficial heat, transcutaneous electrical nerve stimulations (TENS), ultrasound therapy, yoga and physical exercise.

A recent meta-analysis based on 43 clinical controlled trials involving 3.907 subjects with Chronic Low Back Pain demonstrated that physical exercise is effective in reducing pain and improving functional level. The most recent Guidelines, published in October 20007, underline that, along with cognitive-behavioural therapy, spinal manipulations and interdisciplinary rehabilitation, physical exercise is the only non pharmacologic treatment having a positive effect on Chronic (or subacute) Low Back Pain. 4. Vertebral instability and physical exercise Several theories link the etiology of Low Back Pain clinical signs and symptoms to the mechanical instability of the lumbar spine. Stability of the lumbar spine requires both passive stiffness, through the osseous and ligamentous structures, and active stiffness, through "core" muscles, such as rectus abdominis, external oblique, internal oblique, transversus abdominis, quadratus lumborum, multifidi, psoas major, iliocostalis, gluteus major. It has been shown that therapeutic exercise improves vertebral stability through stretching and strengthening of "core" muscles, but also by enhancing neuromuscular proprioceptive facilitation. This is the reason why physical exercise programs usually do include strengthening and trunk-stabilizing exercises. 5. Joba® Core Trainer Joba® Core Trainer is a gym equipment which makes use of the counterbalance principle to efficiently engage trunk muscles, including both abdominals and trunk extensors. This equipment has been proved to be effective in improving cardio-respiratory fitness level, increasing resting energy expenditure, reducing weight and enhancing glycaemic control in diabetic patients. Furthermore it significantly strengthens diverse muscular groups (abdominals, trunk extensors, abductors, thigh flexors and extensors).