Reduces back pain
Evidence summary
Chronic low back pain is known to be prevalent in lower limb prosthetic users, with surveys suggesting up to 64% are affected [1,2]. One study identified that up to 40% of lower limb prosthetic users report restricted ability to undertake regular physical activity due to low back pain [1]. A prospective study of 19 lower-limb prosthetic users with chronic lower back pain identified that an 8-week lumbar strengthening programme significantly reduced their pain [3]. Back school interventions and home exercise programmes that include lower limb strengthening, core strengthening, lower limb stretching, spinal stabilisation and dynamic stump exercises have also been shown to significantly improve lower back pain in this cohort [4].
Quality of evidence
Low
Strength of recommendation
Strong
Conclusion
While there is a paucity of high-quality evidence for physical activity interventions in lower limb prosthetic users with low back pain, it is a common problem in this population and the limited evidence shows a benefit. In addition, it is known that similar interventions in the general population are effective. Lower limb prosthetic users with lower back pain should be offered targeted programmes to address this, and regular physical activity should be advised.
Lower limb amputations are performed for a number of clinical indications. Although most evidence around physical activity relates to prosthetic users and for dysvascular amputees, the benefits of physical activity are not exclusive to these groups and should be shared with all lower limb amputees. Lower limb amputees wishing to increase their physical activity levels should be encouraged to do so.
References
- Devan H, Tumilty S, Smith C. Physical activity and lower-back pain in persons with traumatic transfemoral amputation: A national cross-sectional survey. Journal of Rehabilitation Research and Development 2012;49(10):1457-66. doi: 10.1682/yrrd.2011.09.0155
- Devan H, Hendrick P, Hale L, et al. Exploring Factors Influencing Low Back Pain in People With Nondysvascular Lower Limb Amputation: A National Survey. Pm&R 2017;9(10):949-59. doi: 10.1016/j.pmrj.2017.02.004
- Shin MK, Yang HS, Yang H-E, et al. Effects of Lumbar Strengthening Exercise in Lower-Limb Amputees With Chronic Low Back Pain. Annals of Rehabilitation Medicine-Arm 2018;42(1):59-66. doi: 10.5535/arm.2018.42.1.59
- Anaforoglu B, Erbahceci F, Aksekili MAE. The effectiveness of a back school program in lower limb amputees: a randomized controlled study. Turkish Journal of Medical Sciences 2016;46(4):1122-29. doi: 10.3906/sag-1503-131