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Comparison of matrix rhythm therapy versus pilates on pain, lumbar flexibility, functional impairments, and pelvic inclination in chronic low back pain


 Dr. D.Y. Patil College of Physiotherapy, Pune, Maharashtra, India

Date of Submission03-Jul-2021
Date of Decision08-Apr-2022
Date of Acceptance28-Apr-2022

Correspondence Address:
Divya M Gohil,
Dr. D.Y. Patil College of Physiotherapy, Sant Tukaram Nagar, Pimpri, Pune 411018
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_526_21

  Abstract 


Introduction: Low back pain is one of the leading causes of disease burden globally. Matrix Rhythm Therapy (MRT) is based on rhythmic micro-oscillations of muscle tissue by the action of mechano-magnetic alternating fields. Pilates exercises have been shown to be helpful in low back pain. This study was conducted to compare the effects of MRT and Pilates exercises on chronic low back pain, lumbar flexibility, functional impairments, and pelvic inclination in chronic low back pain. Materials and Methods: Ethical clearance was obtained by ethical committee of Dr. D. Y. Patil Physiotherapy, Pimpri, Pune. 50 patients diagnosed with chronic low back pain were selected as per inclusion criteria after taking informed consent. Patients were randomly allocated to two groups. Group A (n = 25) received MRT. Group B (n = 25) were given Pilates exercise. Both groups received treatment thrice a week for two weeks. Duration of 45 min. Outcome measures were assessed for both groups at the beginning and end of the study. Outcome measures included Numerical Pain Rating Scale for pain, Modified-modified schober's test for lumbar flexibility, pelvic inclination using an inclinometer, and Oswestry Low Back Disabaility Questionnaire for functional impairments. Data were analysed using Winpepi. Results: For all outcome measures, a highly significant improvement (p < 0.001) was seen in Group A, a significant improvement (p < 0.005) was seen in group B. Discussion: Pain, restricted movements, reduced flexibility, and pelvic inclination are the consequences of systemic and local disturbances in the logistics of the living processes due to chronic pain in low back region. MRT and Pilates, both individually are effective in treating the same. Conclusion: Both Groups showed significant improvements in patients with CLBP. However, the findings in MRT group highly statistically significant.

Keywords: Chronic low back pain, matrix rhythm therapy, pilates



How to cite this URL:
Gohil DM, Kothari D, Baxi G, Palekar T. Comparison of matrix rhythm therapy versus pilates on pain, lumbar flexibility, functional impairments, and pelvic inclination in chronic low back pain. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2022 Dec 7]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=346451




  Introduction Top


Low back pain is one of the leading causes of disease burden all over the world, affecting individuals of all ages. The prevalence of low back pain in the general population is 18% and one month prevalence is 30%. The lifetime prevalence for low back pain of an individual is 40%. Low back pain is defined as a chronic condition consisting of varying or continuous pain of low or medium intensity, hindered by periods of no pain or pain exacerbations. Low back pain persisting more than three months is observed as a chronic disorder, and it is associated with functional disability which affects quality of life. A new classification of chronic pain is grown for ICD-11. Here, chronic back pain is classified under a new entity, 'chronic primary pain'. Chronic primary pain is explained as pain in any one anatomical region that persists or recurs for more than three months which is associated with substantial emotional discomfort or functional ailment. Low Back Pain can be stratified by location of pain, muscle tension or stiffness.[1] Low Back Pain is a symptom, its cause might be due to various local as well as systemic factors, that is, failure of structures of the musculoskeletal system, inflammatory and immunological responses, genetic predisposition, excessive static or dynamic loading, emotional state, behavioral and environmental factors and the social consequences following the expression of pain (increased empathy or rejection).[1] Based on chronicity, low back pain can be divided as: acute (less than 6 weeks), sub-acute (6–12 weeks), and chronic (more than 12 weeks). Chronic low back pain patients are treated differently from acute and sub-acute patients. Restricted range of movement of the spine leads to pain and limited movements, which provides additional information with respect to the type of lower back pain.[2]

There are many structures of the lumbar spinal region which can contribute to low back pain. These include biochemically alteration, degenerative damage, or tissue trauma. The main structures responsible for low back pain are the facet joints, spinal muscles, and nerve root compression. The facet joints are formed of posterior arches of the spinal vertebrae. In association with spinal muscles, low back pain has been caused due to multifidus muscle.[2] The “core” is expressed as a muscular box with the abdominals in the anterior, para-spinals and gluteals in the posterior, the diaphragm as the cover, and the pelvic floor and hip girdle musculature as the base.[3] For maintaining equilibrium of lumbar spine, muscles work in local and global groups. The anatomical and biomechanical muscles can be categorized into two types: stabilizers and mobilizers. The structural and functional characteristics of these two muscle types aids the stabilizers for maintaining better posture. The mobilizers are established for rapid ballistic movements. The further division are primary and secondary stabilizers. The primary stabilizers are the muscles which are not able to create notable joint movements like the multifidus and transversus abdominis. These muscles act to stabilize the lumbar spine. The secondary stabilizers are the internal oblique, medial fibres of external oblique and quadratus lumborum which have excellent stabilizing capacity plus helps to move joints of the lumbar spine. Further, the mobilizers can be termed as 'tertiary stabilizers' in which basically they move the joint but also help maintain stability when required. In low back pain, spine becomes rigid hence the flexibility is reduced, hampering normal movement patterns. Thus, in chronic low back pain is a complex regional condition, mainly related with multifidus dysfunction and reduced lumbar flexibility.[3]

Matrix Rhythm Therapy (MRT)

It is an external and dynamic approach, developed by Dr. Ulrich G. Randoll. MRT is a new element in management of pain and restriction of mobility and it is also one of the electrotherapeutic modality which derived from the fundamental research by Dr. Randoll, Germany.[4],[5] According to Dr. U G Randoll's research, the cells in the human body oscillates at a frequency ranging between 8-12 Hz. A specially designed and licensed resonator of Matrixmobil produces mechano-magnetic pulsations. The technique is based on rhythmic micro-extension of muscle tissue by the action of mechano-magnetic alternating fields, that stimulates skeletal muscles within its own natural frequency range of 8-12 Hz. MRT helps restore the vibrations of the extracellular matrix by pulsing gently and harmoniously inducing the cells to accept again their own analogue oscillations, resulting in improved supply of oxygenated blood and nutrition through extra-cellular matrix and elimination of waste products, acids and gases.[4],[5],[6] Indications for MRT are tissue swelling, reduced flexibility, muscular spasm, joint hypo-mobility, acute or chronic painful muscular/neurological conditions and nerve degeneration. MRT is contraindicated over infected skin, any recent non-healed fractures, haemorrhage or haematoma, embolism, direct contact to bones, and eyes.[7]

Pilates

A concept by Joseph H Pilates, involves mind and body. Pilates works on unique key points: Centering, Concentration, Control, Precision, Breathing, Flow. It is a therapeutic approach working on alignment of body posture, with maintenance of normal spinal curvatures and symmetrical weight-bearing of the feet in standing position. There are various difficulty levels while practicing Pilates, and are individually adopted and vary from person to person.[8],[9] The Pilates method as a system of exercise, not only emphasizes on recruitment and strengthening of the core musculature, flexibility, and coordinated breathing, but also promotes stability and controls movement.

Stability of spine is as a result of three interdependent systems: Osseo-ligamentous, muscles, and neural control. Pilates exercise engages the muscular and nervous systems.[10] Pilates covers motor control, activation of deep trunk muscle and activation of pelvic floor muscles. These muscles have an important role in reducing pain and functional disability. The ''core'' typically mentions control of muscles which is required to maintain functional stability and mobility throughout. Research has highlighted the importance of muscular strength and recruitment of the muscles.

Pain, restricted movements, reduced flexibility, and pelvic inclination are the consequences of systemic and local disturbances in the logistics of the living processes due to chronic pain in low back region. Pilates emphasizes on improving spinal mechanics by recruiting the deep stabilizers and thus reducing pain, increasing ROM, increasing flexibility, and correcting pelvic inclination.[10]

While pilates exercises have been shown to be helpful in low back pain, there is a paucity of literature exploring the effect of matrix rhythm therapy on patients with chronic pain in low back region. Hence this study was conducted to explore the effects of MRT on chronic low back pain, and compare it with pilates exercises.


  Methodology Top


The study was carried out at Dr. D. Y. Patil College of Physiotherapy, Pune. Ethical clearance was obtained from the institutional ethics committee (Letter No. DYPCPT/IEC/20/2020 dated 12/03/2020). 50 patients aged between 18 and 35 years with chronic low back pain were enrolled by simple random sampling and were allocated into two group (Group A- MRT) and (Group B-Pilates) by chit method.

Outcome measures were assessed at the beginning and end of two weeks intervention. Pain was assessed using the numerical pain rating scale (NPRS). Lumbar spine mobility was assessed using modified-modified Schober's test. Pelvic inclination was assessed using an inclinometer. Functional impairment was assessed using Oswestry low back pain disability questionnaire.

Procedure in Group A

Group A was given Matrix Rhythm Therapy for 45 min for three sessions per week for two weeks. The patient's was positioned in prone on the bed. Lower back area was exposed. Talcum powder was used to reduce friction while giving the treatment. MRT was given over the painful area of lower back and the flanks [Figure 1]. Outcome measures were assessed at the beginning of the treatment on day one, and at the end of two weeks.
Figure 1: Matrix Rhythm Therapy being given over low back area

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Procedure in Group B

Group B was gives pilates for 45 min for three sessions per week for two weeks. Exercise sessions started with warm-up stretches with hold for 10 seconds and three repetitions for each exercise. The pilates session included the 18 different exercises for core muscles [Figure 2]. Each exercise had 10 repetitions. Three sets were done.[10],[11] The pilates session ended with cool down stretches with hold for 10 seconds and three repetitions for each exercise. Outcome measures were assessed at the beginning of the treatment on day one, and at the end of two weeks.
Figure 2: Pilates exercises

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  Results Top


Data for all outcome measures was collected and compared pre- and post-two weeks treatment. The data were analyzed using Winpepi software. For within the group comparison, Wilcoxon signed rank test was used [Table 1] and for between the group comparison, Man–Whitney test was used [Table 2].
Table 1: Intra-group analysis of all outcome measures between two groups

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Table 2: Inter-group analysis of all outcome measures between two groups

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  Discussion Top


This study compares the effect of Matrix Rhythm Therapy and pilates in patients with chronic pain in low back region. The findings show that matrix rhythm therapy has a highly significant improvement in pain, lumbar flexibility, functional impairments, and pelvic inclination in individuals with chronic low back pain.

Pain, restricted movements, reduced flexibility, and pelvic inclination are the consequences of systemic and local disturbances in the logistics of the living processes due to chronic pain in low back region. MRT has been shown to be effective in many musculoskeletal conditions.

Studies are done to show acute effectiveness of Matrix Rhythm Therapy vs passive stretching on Hamstring Flexibility in Females. The results showed MRT had upper hand in improving hamstring flexibility than passive stretching.[4] Futhermore, studies have found that matrix rhythm therapy is found to be effective in cellular healing, improving sensations and maintaining strength and ROM in burn injured patients.[5] Similar study conducted on implementation of MRT and conventional massage in young females, proved effectiveness of MRT onperipheral blood circulation.[6] A study conducted by Ulrich G. Randol et al.[7] on Matrix Rhythm Therapy Cell Biological Basics, Theory and Practice suggested that deficiency of energy metabolism at cellular level has to be normalized with enough therapies. The cellular level metabolism has to be treated before consecutive macroscopic exercises will move and train the muscles. The phenomenon of re-adaptation of shifted dynamic equilibrium on cellular level has to be stimulated.

A case study was done on patient with scoliosis, matrix rhythm therapy was employed to improve muscle metabolism and helped to loosen peri-articular musculature by lengthening of all neuromuscular elements and deeper tissues, thus increasing ROM of spine.[12]

Ozcan et al.[13] stated the Effect of Matrix Rhythm Therapy in Patients with Chronic Low Back Pain. About 32 participants were involved in the study. Intervention group included 6 sessions of MRT and Control group included 10 sessions of combined physiotherapy program. Pain (McGill Pain Questionnaire), Level of disability (Oswestry Disability Index) and Quality of life (Short Form-36) were measured before and after the treatment program. When pre- and post-treatment results were compared in the intervention group, a significant difference was found in total pain level, disability level. In the control group, significant differences were found in disability level. The conclusion of this article is that both, the combined physiotherapy program and Matrix Rhythm Therapy have a peculiar effect on pain, disability level and quality of life in patients with chronic pain in low back region.

A study conducted by Marika Mattoos states that patient treated with Matrix Rhythm Therapy showed better results clinically by decreasing pain and increasing range of motion than patients treated with a combination of Myofacial release and kinesio Taping.[14]

Our study shows similar results of matrix rhythm therapy on improving chronic low back pain, lumbar flexibility, functional impairments and pelvic inclination in individuals with chronic low back pain. MRT showed significant effectiveness in improving pain, lumbar flexibility, functional impairments, and pelvic inclination.

Pilates exercises also shows effectiveness in pain reduction, functional disability, and range of motion. A RCT was done to show the effectiveness of lumbar stabilization, dynamic strengthening, and pilates on chronic low back pain. It was concluded that lumbar stabilization exercises, dynamic strengthening exercises, and pilates exercises all are beneficial in the treatment of chronic pain in low back region for reduction of pain, improvement in functional ability, increasing ROM and improving core strength.[8] Likewise, Review was done on evaluation of different doses of pilates exercise in patients with chronic low back pain. It suggested that treatment of two sessions per week seems to be better than once per week and provided clinical improvements. Studies compared the effect of pilates and extension based exercise on pain, lumbar spine curve, lumbar ROM, and physical disability. The author concluded that pilates was superior.[9] David Cruz-Díaz et al.[10] studied effect of pilates intervention on disability, pain, and kinesiophobia for 12 weeks in patients with chronic pain in low back region. They found significant changes on disability and kinesiophobia after six weeks of intervention but had no significant difference after 12 weeks (p < 0.001). Intervention group when compared with control group mean difference was 4.00 on Roland Morris Disability Questionnaire and 5.50 in Tampa Scale of Kinesiophobia. Pain showed better results at the end of six weeks with minor statistically significant improvement at 12 weeks with VAS of 2.40 (p < 0.001). Furthermore, a systemic review was done on pilates for pain in low back region. Pilates was effective in improving pain and functional disability.[15] Ali Bozorgmehr et al.[16] states that their is a negative effect of pain on muscular activity and confirming that time dependent changes in soft tissue because of creep and fatigue can lead to alteration in sensory-motor function of muscles. Hence, functional impairment or imbalance of muscles in lumbo-pelvic region is a key to develop chronic low back pain. Our study also states that pilates is proved to be effective in improving pain, lumbar flexibility, functional impairments, and pelvic inclination in patients with chronic low back pain.
Figure 3: Summary of procedure

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Summing up, while comparing Matrix Rhythm Therapy with pilates, MRT showed statistical significant results in improving pain, lumbar flexibility, functional impairments, and pelvic inclination in patients with chronic low back pain. Both the treatments have their own benefits when tailor-made for patients with chronic low back pain.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V, et al. Low back pain, a comprehensive review: Pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep 2019;23:23.  Back to cited text no. 1
    
2.
Vlaeyen JWS, Maher CG, Wiech K, Van Zundert J, Meloto CB, Diatchenko L, et al. Low back pain. Nat Rev Dis Primers 2018;4:52.  Back to cited text no. 2
    
3.
Kumar T, Kumar S, Nezamuddin M, Sharma VP. Efficacy of core muscle strengthening exercise in chronic low back pain patients. J Back Musculoskelet Rehabil 2015;28:699-707.  Back to cited text no. 3
    
4.
Rawtani N, Samson A, Palekar TJ. Acute effects of matrix rhythm therapy versus passive stretching on hamstring flexibility in females. Indian J Physiother Occup Ther 2019;13:11.  Back to cited text no. 4
    
5.
Sarı Z, Polat MG, Özgül B, Aydoğdu O, Camcıoğlu B, Acar AH, et al. The application of matrix rhythm therapy as a new clinical modality in burn physiotherapy programmes. Burns 2014;40:909-14.  Back to cited text no. 5
    
6.
Taspinar F, Aslan UB, Sabir N, Cavlak U. Implementation of matrix rhythm therapy and conventional massage in young females and comparison of their acute effects on circulation. J Altern Complement Med 2013;19:826-32.  Back to cited text no. 6
    
7.
Randoll UG, Hennig FF. Matrix rhythm therapy, cell- biological basics, theory and practice. J PT Zeitschrift Fur Physiotherapeuten 2009;61.  Back to cited text no. 7
    
8.
Bhadauria EA, Gurudut P. Comparative effectiveness of lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain: Randomized clinical trial. J Exerc Rehabil 2017;13:477-85.  Back to cited text no. 8
    
9.
Eliks M, Zgorzalewicz-Stachowiak M, Zeńczak-Praga K. Application of pilates-based exercises in the treatment of chronic non-specific low back pain: State of the art. Postgrad Med J 2019;95:41-5.  Back to cited text no. 9
    
10.
Cruz-Díaz D, Romeu M, Velasco-González C, Martínez-Amat A, Hita-Contreras F. The effectiveness of 12weeks of Pilates intervention on disability, pain and kinesiophobia in patients with chronic low back pain: A randomized controlled trial. Clin Rehabil 2018;32:1249-57.  Back to cited text no. 10
    
11.
Paden L. Pilates. Idiot's Guides Pilates Easy Lessons for Stretching, Lengthening, and Toning Your Body. 2014;5-80.  Back to cited text no. 11
    
12.
Spitz A. Weblog. Improvement in posture and mobility in advanced scoliosis through matrix rhythm therapy; 2016. Available from: http://www.healthyresources.com.au/case-studies/improvement-in-posture-and-mobility-in-advanced-scoliosis-through-matrix-rhythm-therapy/.  Back to cited text no. 12
    
13.
Özcan NT, Çalık BB, Kabul EG. The effectiveness of matrix rhythm therapy in patients with chronic low back pain. Spine (Phila Pa 1976) 2021;46:781-7.  Back to cited text no. 13
    
14.
Basu DS, Baxi DT, Mattos M. A study on matrix rhythm therapy versus combination of myofascial release and kinesio taping on upper trapezius trigger point. Int J Med Sci Innov Res 2018;3:198-205.  Back to cited text no. 14
    
15.
Joyce AA, Kotler DH. Core training in low back disorders: Role of the pilates method. Curr Sports Med Rep 2017;16:156-61.  Back to cited text no. 15
    
16.
Bozorgmehr A, Zahednejad S, Salehi R, Ansar NN, Abbasi S, Mohsenifar H, et al. Conducted a study on “Relationships between muscular impairments, pain, and disability in patients with chronic nonspecific low back pain: A cross sectional study”. J Exerc Rehabil 2018;14:1041-7.  Back to cited text no. 16
    


    Figures

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    Tables

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