Influence of exercises and creatine supplementation on muscle responsible for deep stabilization of lumbar spine in patients after first microdiscectomy (preliminary report)

Author(s): WOJCIECH SKROBOT, WOJCIECH WASILEWSKI, KRZYSZTOF DĘBSKI, JOLANTA SZAMOTULSKA, WIESŁAW ZIÓŁKOWSKI, WIESŁAWA NYKA, JAROSŁAW CIECHOMSKI, ANDRZEJ ZAWADZKI, ELŻBIETA RAJKOWSKA-LABON, STANISŁAW BAKUŁA, BEATA ŻMUDZIŃSKA, WOJCIECH KLOC

Introduction: Number of so called lifestyle diseases increases with the development of civilization. The most frequently occurring reasons of pain ailments of lumbar spine are among others sitting lifestyle and ignorance of ergonomics rules. There are many theories explaining their causes but always attention is paid on significance of muscular apparatus, which plays key role in a mechanism of spinal column stabilization. Two types of spinal stabilization can be distinguished: passive and active. In case of active stabilization straight posture is maintained by so called global stabilizers (straight abdominal muscle, abdominal oblique muscles, extensor muscle) and so called local stabilizers (multifidi muscles, transversus abdominis muscle, internal oblique muscles – fibres linked with thoracolumbar fascia) are responsible for spinal segmental stabilization. Therefore, studies concerning effectiveness of physiotherapeutic procedures in patients after first microdiscectomy in lumbar spine and influence of creatine supplementation effectiveness on acceleration of muscle regeneration period were performed. Materials and methods: Nine patients after first procedure of microdiscectomy within bottom segments of spine on the height of L4-L5 or L5-S1 were qualified. The patients after the surgical procedure were randomly assigned to a creatine-supplemented group or placebo group – supple-mented with glucose. Rehabilitation process begun six weeks after the surgical procedure. Patients were medically and physiotherapeutically examined three times – before the operation, before rehabilitation and afterrehabilitation. Physiotherapeutic examination included evaluation of posture, range of spine mobility and circumferences of lower extremities. Specialist tests valuating power of postural muscles and tests estimating lowest body quadrant in terms of effectiveness of muscles responsible for so called deep stabilization of lower spinal segment were performed. USG examinations of multifidi muscles, recognized as the most important for spinal segmental stabilization, were performed three times to objectivate the efficiency of the applied treatment. Results: Average value of multifidi muscles cross-section before rehabilitation in placebo group amounted to 4.4 cm2 for right side and 4.2 cm2 for left side and in creatine supplemented group the values amounted to 3.0 cm2 and 2.9 cm2, respectively. As a result of rehabilitation program multifidi muscles cross-section in placebo group remained at the same level as before exercises, while in creatine-supplemented group it increased of 33% and of 11% for right and left side, respectively. The range of spine mobility in linear measurements in both examined groups increased after rehabilitation in comparison with the measurements performed before operation. The range of side bend improved in placebo group in comparison with creatinesupplemented group, but higher flexibility in tests evaluating spine mobility in sagittal plane was obtained in creatine- supplemented group. Improvement of muscles responsible for deep stabilization after rehabilitation was noted in both groups in measurements of lower spinal segment stabilization. Reduction of pain ailments evaluated in VAS scale was also reported after rehabilitation period in both groups. Confirmation of creatine supplementation effectiveness was increased level of creatinine (creatine metabolite) of 24% in serum of patients receiving this supplement. Conclusions: Increase in cross-sections of multifidi muscles after 6 weeks long rehabilitation period was obtained in both groups, but in bigger degree in creatine-supplemented group. Lower spinal segment stabilization and increase of its mobility were reported as well.