The effects of adding imagery to therapeutic exercises on pain reduction, flexibility, functional performance, and quality of life in women with chronic low back pain

Abstract

Background: Mental imagery (MI) is frequently used in rehabilitation, often in stationary settings. However, recent studies indicate that incorporating MI during exercise could substantially alleviate pain. Purpose: The objective of this study is to determine whether combining myofascial training with MI is more effective than exercise alone in reducing pain, enhancing flexibility, improving functional performance, and increasing quality of life in women with chronic low back pain (CLBP). Materials and Methods: Thirty women were assigned to one of three groups: the "Exercise Group" (EG), the "Exercise plus MI Group" (MIG), and the "Control Group" (CG). The exercise sessions included stretching and self-myofascial release (SMR) using foam rollers (FRs). Both experimental groups (EXGs) performed identical exercises; however, the MIG also received MI instructions during the workouts. Measurements were taken at four time points: baseline, after 9 sessions, after 18 sessions, and 2 weeks after intervention. The assessed variables included pain intensity, hamstring and spinal flexibility, functional performance in daily activity simulations, and quality of life as measured by the RAND SF-36. Results: Significant pain reduction was observed only in the MIG. Both EXGs showed significant improvements in flexibility, with MIG achieving some scores superior to those of the CG. Functional performance improved across all tests in both EXGs, with more pronounced gains in the MIG. For the RAND SF-36, the EG showed better results in the "Bodily Pain" dimension. In the "Physical Functioning" dimension, both EXGs demonstrated similar positive results. However, significant improvements in "Vitality" and "Health Change" were observed only in the MIG. Conclusions: Myofascial training was effective in reducing pain and improving functional capacity and quality of life in women with CLBP. However, incorporating MI instructions during exercise produced more substantial benefits, suggesting a promising new approach for managing chronic musculoskeletal disorders.