Extracorporeal shock wave therapy in the treatment of low back pain

The objective of this study is to assess the effectiveness of Extracorporeal Shock Wave Therapy (ESWT) and to compare verum (2000 pneumatic shocks during a 20 minutes session of 5 Hz; 0.1 mJ/mm2; 2.5 bars) to sham procedure in the treatment of low back pain. The primary study endpoints will be an analysis of pain relief change and functional improvement in two groups of patients (within and intergroup comparison before and after therapy). The secondary endpoints will be a follow-up observation (1 and 3 months after the end of the study - within and intergroup comparisons). Intervention: Patients from group A will receive a focused shockwave therapy utilising the radial type pneumatic device without anaesthesia. The intervention will occur in the clinician's office and be administered by certified physiotherapist. The low back area will receive a total of 2000 shocks during a session (5 Hz; 0.1 mJ/mm2; 2.5 bars). Each patient will have 10 sessions (twice a week) within 5 weeks. Patients from group B will receive a sham therapy (the probe will generate a sound signal, but the treatment parameters will be zeroed and the device will be turned off with a display system in "standby mode"). In addition, all patients will be supplemented with physical exercises performed throughout the therapy period. A single series will last 45 minutes daily and will be carried out five times a week (Monday to Friday). Stabilization training will include: - techniques for the relaxation of the myofascial system on erector spinae muscle; - techniques for activating the neutral position of the lumbo-pelvic-hip complex and deep muscles; - stimulation of proper breathing and correct activation of the transverse abdominal muscle; - coordination of superficial and deep muscles activation; - postural and dynamic training. The physical exercises will occur "one-on-one" method in the gym part of clinician's office and be administered by certified athletic therapist. The training will be with the participants' intensity of 65-75% maximal heart rate (to monitor the application of exercises and the participants' status; the therapist observation diary will be kept).