• Juan Francisco Lisón, Borja Ortega-Santana, Álvaro Antón-Nogués, Palmy González-Requena, Cristina Vera-Hervás, Julio Doménech-Fernández, Daniel Sánchez-Zuriaga, and Pablo Salvador-Coloma.
• 1 Department of Medicine, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain.
• Clin Rehabil. 2018 May 1; 32 (5): 654-662.

ObjectiveTo investigate the effects that wearing unstable shoes has on disability, trunk muscle activity, and lumbar spine range of motion (ROM) in patients with chronic lower back pain (CLBP).DesignRandomized controlled trial.SettingOrthopedic Surgery Service.ParticipantsWe randomized 40 adults with nonspecific CLBP either to an unstable shoes group ( n = 20) or to the control group ( n = 20).InterventionThe participants in the unstable shoes group were advised to wear these shoes for a minimum of six hours a day for four weeks. Control group participants were asked to continue wearing their regular shoes.Outcome MeasuresOur primary outcome was measurement of back-related dysfunction, assessed using the Roland-Morris Disability Questionnaire. Secondary outcomes included changes in electromyographic (EMG) activity of erector spinae (ES), rectus abdominis (RA), internus obliquus (IO), and externus obliquus (EO) muscles, and changes in lumbar spine ROM.ResultsBetween-group analysis highlighted a significant decrease in disability in the unstable shoes group compared to the control (-5, 95% confidence interval (CI) = -8.4 to -1.6). Our results revealed a significant increase in the percentage of RA, ES, IO, and EO EMG activity and in lumbar spine ROM in the unstable shoes group compared to the control group. Moreover, our results showed a significant negative correlation between disability and the percentage of ES, RA, and IO muscle activity at the end of the intervention.ConclusionThis study shows that the use of unstable shoes contributes to improvements in disability, which are likely related to increased trunk muscle activity and lumbar spine ROM.

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