Evidence-informed management of chronic low back pain with prolotherapy

Effect of Core Stabilizing Training on Young Individuals Presenting Different Stages of Degenerative Disc Disease-Preliminary Report

The aim of this study was to assess the efficacy of stabilizing training for the deep core muscles of the lumbar spine in subjects with degenerative disc disease. This study was conducted on 38 participants. The participants were divided into two groups: the extrusion group (EXT, n = 17) and the protrusion group (PRO, n = 21). All the subjects underwent a four-week-long core stability exercise-based treatment (five sessions/week). Clinical outcome measures were assessed pre-intervention (pre), post-intervention (post) and four weeks after the intervention (follow-up). The primary outcome measures were the spinal range of motion (ROM; Spinal Mouse^® device) and the Oswestry Disability Index (ODI). In the PRO group, the ROM decreased from 88.52° pre-intervention to 83.33° post-intervention and to 82.82° at follow-up (p = 0.01), while the ODI decreased from 16.14 points pre-intervention to 6.57 points post-intervention, with 9.42 points at follow-up (p < 0.01). In the EXT group, the ROM decreased from 81.00° pre-intervention to 77.05° post-intervention, then increased to 77.94° at follow-up (p = 0.03), while the ODI decreased from 22.58 points pre-intervention to 15.41 points post-intervention and to 14.70 points at follow-up (p < 0.001). Although the stabilizing exercise sessions improved the clinical outcomes in each group, we cannot make conclusions as to whether the type of intervertebral disc damage significantly affects the results of stabilizing exercise-based treatment.

Hypertonic dextrose versus corticosteroid local injection for the treatment of osteoarthritis in the first carpometacarpal joint: a double-blind randomized clinical trial

PURPOSE

To compare the advantages of prolotherapy in the treatment of first carpometacarpal osteoarthritis (OA) with those of corticosteroid local injection in the short and long term.

METHODS

We performed a randomized controlled trial from March 2010 to March 2011 in an outpatient clinic at a university hospital. Sixty participants (60 hands) with OA of the first carpometacarpal joint were assigned equally to two groups. For the corticosteroid group, after 2 monthly saline placebo injections, a single dose of 40 mg methylprednisolone acetate (0.5 ml) mixed with 0.5 ml of 2% lidocaine was injected. For the dextrose (DX) group, 0.5 ml of 20% DX was mixed with 0.5 ml of 2% lidocaine and the injection was repeated monthly for 3 months. Pain intensity, hand function and the strength of lateral pinch grip were measured at the baseline and at 1, 2, and 6 months after the treatment.

RESULTS

Mean age (STD) was 63.6 (9.7) years, and mean (STD) visual analog scale (VAS) was 6 (2). The two groups were comparable at 2 months, but significantly different at 1 month, with better results for corticosteroid, and at 6 months with apparently more favorable outcome for DX [mean difference (95% CI) in VAS = 1.1 (0.2, 2.0), p = 0.02]. After 6 months of treatment, both DX and corticosteroid injection increased functional level, but DX seemed to be more effective [mean difference (95% CI) in total function score = 1.0 (0.2, 1.8), p = 0.01].

DISCUSSION

For the long term, DX seems to be more advantageous, while the two treatments were comparable in the short term. Because of the satisfactory pain relief and restoring of function, we would prefer DX prolotherapy for the treatment of patients with OA.

LEVEL OF EVIDENCE

Therapeutic studies--investigating the results of treatment; level I.

The anthropometric match between high school learners of the Cape Metropole area, Western Cape, South Africa and their computer workstation at school

STUDY DESIGN

Descriptive study.

OBJECTIVE

The objective of this study was to present anthropometric data from high school students in Cape Metropole area, Western Cape, South Africa that are relevant for chair design and whether the dimensions of computer laboratory chairs currently used in high schools match linear anthropometrics of high-school students. Summary of Background Data. Learner-chair mismatch is proposed as a cause of poor postural alignment and spinal pain in adolescents. A learner-chair mismatch is defined as the incompatibility between the dimensions of a chair and the anthropometric dimensions of the learner. Currently, there is no published research to ascertain whether the furniture dimensions in school computer laboratories match the anthropometrics of the students. This may contribute to the high prevalence of adolescent spinal pain.

METHODS

The sample consisted of 689 learners, 13-18 years old. The following body dimensions were measured: stature, popliteal height, buttock-to-popliteal length and hip width. These measurements were matched with the corresponding chair seat dimensions: height, depth and width. Popliteal and seat height mismatch was defined when the seat height is either >95% or <88% of the popliteal height. Buttock-popliteal length and seat depth mismatch was defined when the seat depth is either >95% or <80% of the buttock-popliteal length. Seat width mismatch is defined where the seat width should be at least 10% and at the most 30% larger than hip width.

RESULTS

An 89% of learners did not match the seat. Five percent of learners matched the chair depth, the majority was found to be too big. In contrast, 65% of the learners matched the chair width dimension.

CONCLUSIONS

A substantial mismatch was found. The school chairs failed standard ergonomics recommendations for the design of furniture to fit the user. This study supports the conclusion that there is no one-size-fits-all solution. There is an urgent need for chairs that are of different sizes or that are adjustable.

Acute Toxicity Evaluation of Proliferol: A Dose-Escalating, Placebo-Controlled Study in Swine

Prolotherapy is one of the many treatments available for chronic musculoskeletal disorders. A commonly used drug contains dextrose 12.5%, glycerin 12.5%, phenol 1.0%, and lidocaine hydrochloride 0.25% in aqueous solution (recently termed Proliferol). For chronic low back pain, this is injected into lumbosacral ligaments to stimulate connective tissue repair. Despite generally positive clinical results, the toxicity of this drug is not well characterized and was assessed in 48 (24 male, 24 female) Yucatan miniature swine randomly assigned to low (1×), medium (5×), or high (10×) dose or saline placebo. Outcomes included clinical observations, clinical chemistry, hematology, coagulation, urinalysis, toxicokinetics, and full gross and microscopic histopathology after 24 hours or 14 days. Findings attributable to Proliferol after 24 hours included dose-response elevations in alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase, which returned to normal after 14 days. There were no remarkable findings in hematology, coagulation, or urinalysis. Urine concentrations of lidocaine and phenol both peaked after 8 hours. Histopathology findings after 24 hours included hemorrhage, inflammation, necrosis, and vascular changes in the ligaments and adjacent soft tissues at the sites of injection. After 14 days, there was evidence of repair under way, with fibrosis and skeletal muscle regeneration at the injection sites.