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Rodríguez-Pastor JA, Caro-Puértolas B, Caña-Pino A, Sánchez-Preciado AM, Garrido-Ardila EM, Apolo-Arenas MD. Effect of osteopathic manipulation of the sacroiliac joint vs electrotherapy on pain and functional disability in patients with low back pain: A pilot study. J Back Musculoskelet Rehabil 2022; 35:1219-1226. [PMID: 35599463 DOI: 10.3233/bmr-210120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND One of the main problems faced by physiotherapists in primary care is low back pain with or without radiation to lower limbs. There are many different treatment approaches for the management of low back pain. Despite the large amount of published studies, the evidence remains contradictory. OBJECTIVE To evaluate the influence of the osteopathic manipulation of the sacroiliac joint on low back pain with or without radiation to lower limbs. METHOD Single-blind randomized clinical controlled trial. Participants with low back pain with or without lower limb radiation were randomized to osteopathic manipulation of the sacroiliac joint group (intervention, 6 sessions) or to an electrotherapy group (control, 15 sessions) for 3 weeks. Measures were taken at baseline (week 0) and post-intervention (week 4). The primary outcome measures were pain (Visual Analogue Scale), functional disability (Oswestry disability index and Roland Morris questionnaire). The secondary outcome measure was pain threshold at muscular tender points in the quadratus lumborum, pyramidal, mayor gluteus, and hamstrings. RESULTS In all, 37 participants completed the study. The results of the intragroup comparisons showed statistically significant improvements in both groups in the visual analogue scale (Osteopathic manipulation group, P= 0.000; Electrotherapy group, P= 0.005) and Oswestry disability index (Osteopathic manipulation group, P= 0.000; Electrotherapy group- P= 0.026) but not in the Roland Morris questionnaire (P= 0.121), which only improved in the intervention group (P= 0.01). The osteopathic manipulation was much more effective than electrotherapy improving to pain and functional disability. CONCLUSION Osteopathic manipulation of the sacroiliac joint improves pain and disability in patients with sacroiliac dysfunction after three weeks of treatment.
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Affiliation(s)
- José Antonio Rodríguez-Pastor
- Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
| | - Berta Caro-Puértolas
- Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
| | - Alejandro Caña-Pino
- Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
| | | | - Elisa María Garrido-Ardila
- ADOLOR Research group, Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
| | - Ma Dolores Apolo-Arenas
- Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
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The effect of the Alexander Technique on pain intensity in patients with chronic low back pain: A randomized controlled trial. J Bodyw Mov Ther 2022; 29:54-59. [DOI: 10.1016/j.jbmt.2021.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/19/2021] [Accepted: 09/24/2021] [Indexed: 11/21/2022]
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Wu Z, Wang Y, Ye X, Chen Z, Zhou R, Ye Z, Huang J, Zhu Y, Chen G, Xu X. Myofascial Release for Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:697986. [PMID: 34395477 PMCID: PMC8355621 DOI: 10.3389/fmed.2021.697986] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/05/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Chronic low back pain (CLBP) is one of the most common musculoskeletal diseases in the elderly, which has a severe impact on the health of the elderly. However, CLBP treatment is very challenging, and more effective treatment methods are needed. Myofascial release may be an effective therapy for the management of chronic musculoskeletal pain. It is widely used clinically to treat CLBP, but its clinical efficacy is still controversial. Objective: This study aims to systematically evaluate the effectiveness of myofascial release for patients with CLBP. Methods: We selected PubMed, Cochrane Library, EMBASE database, and Web of Science database articles published until April 5, 2021. Randomized controlled trials (RCTs) of myofascial release for CLBP were included. Outcome measures included pain, physical function, quality of life, balance function, pain pressure-threshold, trunk mobility, and mental health. For each outcome, Standardized mean differences (SMD) or mean differences (MD) and 95% confidence intervals (CIs) were calculated. Results: Eight RCTs (n = 375) were included based on inclusion and exclusion criteria. The meta-analysis showed that the overall efficacy of myofascial release for CLBP was significant, including two aspects: pain [SMD = -0.37, 95% CI (-0.67, -0.08), I 2 = 46%, P = 0.01] and physical function [SMD = -0.43, 95% CI (-0.75, -0.12), I 2 = 44%, P = 0.007]. However, myofascial release did not significantly improve quality of life [SMD = 0.13, 95% CI (-0.38, 0.64), I 2 = 53%, P = 0.62], balance function [SMD = 0.58, 95% CI (-0.49, 1.64), I 2 = 82%, P = 0.29], pain pressure-threshold [SMD = 0.03,95% CI (-0.75, 0.69), I 2 = 73%, P = 0.93], trunk mobility [SMD = 1.02, 95% CI (-0.09, 2.13), I 2 = 92%, P = 0.07] and mental health [SMD = -0.06, 95% CI (-0.83, 0.71), I 2 = 73%, P = 0.88]. Conclusions: In this study, we systematically reviewed and quantified the efficacy of myofascial release in treating CLBP. The meta-analysis results showed that myofascial release significantly improved pain and physical function in patients with CLBP but had no significant effects on balance function, pain pressure-threshold, trunk mobility, mental health, and quality of life. However, due to the low quality and a small number of included literature, more and more rigorously designed RCTs should be included in the future to verify these conclusions.
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Affiliation(s)
- Zugui Wu
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Wang
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangling Ye
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zehua Chen
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Rui Zhou
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zixuan Ye
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinyou Huang
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Yue Zhu
- Baishui Health Center, Qujing, China
| | - Guocai Chen
- Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuemeng Xu
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
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Ribas J, Gomes MA, Montes AM, Ribas C, Duarte JA. Resolution of chronic lower back pain symptoms through high-intensity therapeutic exercise and motor imagery program: a case-report. Physiother Theory Pract 2020; 38:1545-1552. [PMID: 33225789 DOI: 10.1080/09593985.2020.1839985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Nonspecific chronic lower back pain (CLBP) is a difficult to manage clinical condition that is more prevalent in adulthood but also affects adolescents, compromising their well-being and activities of daily living. This case report aimed to describe the clinical evolution of a female adolescent with nonspecific and severe CLBP treated successfully through a combination of high-intensity exercise and motor imagery training. Case Description: A 13-year-old girl with CLBP with radicular pain to the lower limbs, spasms, and movement limitations, for whom pharmacological treatment (i.e. analgesic and muscle relaxant agents) and hydrotherapy, hot wet therapy, and muscle relaxation were unsuccessful. After a careful physiotherapy evaluation, the patient underwent a 36-session intervention, performed 3 times/week for 12 weeks, which was composed of high-intensity therapeutic exercise, adjusted for the patient condition, along with motor imagery training. The patient was reevaluated after the intervention and again 3 years later by the same physiotherapist. Outcomes: The intervention led to a favorable clinical outcome, with pain relief, improved posture, and decreased disability. The patient's clinical condition remained stable at the time of the last follow-up evaluation. Conclusion: These results show that the adjusted combined program led to favorable clinical improvement in the condition, with sustained long-term effects after the intervention.
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Affiliation(s)
- Jorge Ribas
- Department of Morphological Sciences, School of Health, Polytechnic Institute of Porto, Porto, Portugal.,Porto Physio Center, Private Practice, Porto, Portugal
| | - Maria Armanda Gomes
- Department of Anesthesiology, Centro Hospitalar De S. João, Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - António Mesquita Montes
- Department of Physiotherapy, Santa Maria Health School, Porto, Portugal.,Department of Physiotherapy and Center for Rehabilitation Research (CIR), School of Health, Polytechnic Institute of Porto, Rua Dr. António Bernardino De Almeida, Porto, Portugal
| | - Cláudia Ribas
- Porto Physio Center, Private Practice, Porto, Portugal
| | - José Alberto Duarte
- Sport Biology Department and Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
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Sethi J, Sarker K, Mohanty U. Comparative clinical effects of spinal manipulation, core stability exercise, and supervised exercise on pain intensity, segmental instability, and health-related quality of life among patients with chronic nonspecific low back pain: A randomized control trial. J Nat Sci Biol Med 2020. [DOI: 10.4103/jnsbm.jnsbm_101_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Boff TA, Pasinato F, Ben ÂJ, Bosmans JE, van Tulder M, Carregaro RL. Effectiveness of spinal manipulation and myofascial release compared with spinal manipulation alone on health-related outcomes in individuals with non-specific low back pain: randomized controlled trial. Physiotherapy 2019; 107:71-80. [PMID: 32026838 DOI: 10.1016/j.physio.2019.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To investigate the effectiveness of spinal manipulation combined with myofascial release compared with spinal manipulation alone, in individuals with chronic non-specific low back pain (CNLBP). DESIGN Randomized controlled trial with three months follow-up. SETTING Rehabilitation clinic. PARTICIPANTS Seventy-two individuals (between 18 and 50 years of age; CNLBP ≥12 consecutive weeks) were enrolled and randomly allocated to one of two groups: (1) Spinal manipulation and myofascial release - SMMRG; n=36) or (2) Spinal manipulation alone (SMG; n=36). INTERVENTIONS Combined spinal manipulation (characterized by high velocity/low amplitude thrusts) of the sacroiliac and lumbar spine and myofascial release of lumbar and sacroiliac muscles vs manipulation of the sacroiliac and lumbar spine alone, twice a week, for three weeks. MAIN OUTCOME MEASURES Assessments were performed at baseline, three weeks post intervention and three months follow-up. Primary outcomes were pain intensity and disability. Secondary outcomes were quality of life, pressure pain-threshold and dynamic balance. RESULTS No significant differences were found between SMMRG vs SMG in pain intensity and disability post intervention and at follow-up. We found an overall significant difference between-groups for CNLBP disability (SMG-SMMRG: mean difference of 5.0; 95% confidence interval of difference 9.9; -0.1), though this effect was not clinically important and was not sustained at follow-up. CONCLUSIONS We demonstrated that spinal manipulation combined with myofascial release was not more effective compared to spinal manipulation alone for patients with CNLBP. CLINICAL TRIAL REGISTRATION NUMBER NCT03113292.
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Affiliation(s)
- Taise Angeli Boff
- Master in Rehabilitation Sciences, Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil; Núcleo de Evidências e Tecnologias em Saúde (NETecS), Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil
| | - Fernanda Pasinato
- Núcleo de Evidências e Tecnologias em Saúde (NETecS), Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil; School of Physical Therapy, Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil
| | - Ângela Jornada Ben
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
| | - Maurits van Tulder
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands; Department Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Rodrigo Luiz Carregaro
- Master in Rehabilitation Sciences, Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil; Núcleo de Evidências e Tecnologias em Saúde (NETecS), Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil; School of Physical Therapy, Universidade de Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil.
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Thiry P, Reumont F, Brismée JM, Dierick F. Short-term increase in discs' apparent diffusion is associated with pain and mobility improvements after spinal mobilization for low back pain. Sci Rep 2018; 8:8281. [PMID: 29844484 PMCID: PMC5974269 DOI: 10.1038/s41598-018-26697-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/17/2018] [Indexed: 12/17/2022] Open
Abstract
Pain perception, trunk mobility and apparent diffusion coefficient (ADC) within all lumbar intervertebral discs (IVDs) were collected before and shortly after posterior-to-anterior (PA) mobilizations in 16 adults with acute low back pain. Using a pragmatic approach, a trained orthopaedic manual physical therapist applied PA mobilizations to the participants' spine, in accordance with his examination findings. ADC all was computed from diffusion maps as the mean of anterior (ADC ant ), middle (ADC mid ), and posterior (ADC post ) portions of the IVD. After mobilization, pain ratings and trunk mobility were significantly improved and a significant increase in ADC all values was observed. The greatest ADC all changes were observed at the L3-L4 and L4-L5 levels and were mainly explained by changes in ADC ant and ADC post , respectively. No significant changes in ADC were observed at L5-S1 level. The reduction in pain and largest changes in ADC observed at the periphery of the hyperintense IVD region suggest that increased peripheral random motion of water molecules is implicated in the IVD nociceptive response modulation. Additionally, ADC changes were observed at remote IVD anatomical levels that did not coincide with the PA spinal mobilization application level.
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Affiliation(s)
- Paul Thiry
- OMT Skills, Private physical therapy practice, La Louvière, 7100, Belgium
| | - François Reumont
- OMT Skills, Private physical therapy practice, La Louvière, 7100, Belgium
| | - Jean-Michel Brismée
- Center for Rehabilitation Research and Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Frédéric Dierick
- Forme & Fonctionnement Humain Lab, Physical Therapy Department, CERISIC, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, 6061, Belgium. .,Université catholique de Louvain, Faculty of Motor Sciences, Louvain-la-Neuve, 1348, Belgium.
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Sung PS, Danial P. Gender difference of shoulder-pelvic kinematic integration for trunk rotation directions in healthy older adults. Clin Biomech (Bristol, Avon) 2017; 50:56-62. [PMID: 28987872 DOI: 10.1016/j.clinbiomech.2017.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/18/2017] [Accepted: 09/24/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The trunk coordination pattern has been extensively studied, and there is a higher pain prevalence and asymmetry in female older adults. However, there is a lack of investigation of different directions of trunk rotation and asymmetrical compensatory strategies of motor control between genders. The purpose of this study was to investigate shoulder and pelvic ranges of motion (ROM) as well as relative phases (RP) for the different directions of trunk rotation between genders in healthy older adults. METHODS There were 62 right hand dominant older adults in this study (31 female subjects (68.4 [5.62]years) and 31 male subjects (68.7 [5.68]years)). The participants performed trunk axial rotation from the left to the right direction (RP1) and then returned to the left side (RP2), three times repeatedly in standing. The measurements included shoulder and pelvic ROM, RP1, and RP2. The RP was defined as the average absolute relative phase, which was the difference between the phase angle of the shoulder and the phase angle of the pelvis during trunk rotation. FINDINGS The female group demonstrated significantly greater pelvic rotation compared to the male group (98.64 [24.67] vs. 86.96 [18.97]; t=2.09, p=0.04) during trunk rotation. The pelvic ROM demonstrated a significant positive correlation with shoulder ROM in both genders; however, the RP was negatively correlated with the pelvis. For pelvic rotation, the male group demonstrated a negative correlation with RP1 (r=-0.68, p<0.01) and RP2 (r=-0.60, p<0.01) while the female group demonstrated a negative correlation with RP2 (r=-0.53, p<0.01). The ageing factor demonstrated negative correlations with ROM for the shoulder and pelvis in both genders. INTERPRETATION Although no gender difference was indicated on the direction of RP, the pelvic ROM was significantly lesser in the male group. The male group demonstrated lesser pelvic rotation in both directions of rotation; however, the female group showed lesser pelvic rotation in RP2. The male group demonstrated stiffened pelvic rotation and greater shoulder rotation in both directions while the female group demonstrated pelvic stiffness only in the direction from right to left rotation. Clinicians need to consider this directional asymmetry of trunk rotation to enhance integrated shoulder-pelvic coordination in female older adults. MINI ABSTRACT A coordinative pattern of different directions of trunk rotation was investigated in healthy older adults. The pelvic range of motion was lesser in the male group compared with the female group. The female group demonstrated pelvic stiffness only in the direction from right to left rotation, while the male group demonstrated pelvic stiffness in both directions. Clinicians need to understand the gender difference of directional coordination as integrated coordination in female older adults.
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Affiliation(s)
- Paul S Sung
- Department of Physical Therapy, Central Michigan University, Health Professions Building 1220, Mt. Pleasant, MI 48859, United States.
| | - Pamela Danial
- Department of Physical Therapy, Central Michigan University, Health Professions Building 1220, Mt. Pleasant, MI 48859, United States
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Xia T, Long CR, Vining RD, Gudavalli MR, DeVocht JW, Kawchuk GN, Wilder DG, Goertz CM. Association of lumbar spine stiffness and flexion-relaxation phenomenon with patient-reported outcomes in adults with chronic low back pain - a single-arm clinical trial investigating the effects of thrust spinal manipulation. Altern Ther Health Med 2017; 17:303. [PMID: 28599647 PMCID: PMC5466774 DOI: 10.1186/s12906-017-1821-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 06/01/2017] [Indexed: 12/28/2022]
Abstract
Background Spinal manipulation (SM) is used commonly for treating low back pain (LBP). Spinal stiffness is routinely assessed by clinicians performing SM. Flexion-relaxation ratio (FRR) was shown to distinguish between LBP and healthy populations. The primary objective of this study was to examine the association of these two physiological variables with patient-reported pain intensity and disability in adults with chronic LBP (>12 weeks) receiving SM. Methods A single-arm trial provided 12 sessions of side-lying thrust SM in the lumbosacral region over 6 weeks. Inclusion criteria included 21–65 years old, Roland-Morris Disability Questionnaire (RMDQ) score ≥ 6 and numerical pain rating score ≥ 2. Spinal stiffness and FRR were assessed pre-treatment at baseline, after 2 weeks and after 6 weeks of treatment. Lumbar spine global stiffness (GS) were calculated from the force-displacement curves obtained using i) hand palpation, ii) a hand-held device, and iii) an automated indenter device. Lumbar FRR was assessed during trunk flexion-extension using surface electromyography. The primary outcomes were RMDQ and pain intensity measured by visual analog scale (VAS). Mixed-effects regression models were used to analyze the data. Results The mean age of the 82 participants was 45 years; 48% were female; and 84% reported LBP >1 year. The mean (standard deviation) baseline pain intensity and RMDQ were 46.1 (18.1) and 9.5 (4.3), respectively. The mean reduction (95% confidence interval) after 6 weeks in pain intensity and RMDQ were 20.1 mm (14.1 to 26.1) and 4.8 (3.7 to 5.8). There was a small change over time in the palpatory GS but not in the hand-held or automated GS, nor in FRR. The addition of each physiologic variable did not affect the model-estimated changes in VAS or RMDQ over time. There was no association seen between physiological variables and LBP intensity. Higher levels of hand-held GS at L3 and automated GS were significantly associated with higher levels of RMDQ (p = 0.02 and 0.03, respectively) and lower levels of flexion and extension FRR were significantly associated with higher levels of RMDQ (p = 0.02 and 0.008, respectively) across the 3 assessment time points. Conclusions Improvement in pain and disability observed in study participants with chronic LBP was not associated with the measured GS or FRR. Trial registration NCT01670292 on clinicaltrials.gov, August 2, 2012
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Goertz CM, Salsbury SA, Vining RD, Long CR, Pohlman KA, Weeks WB, Lamas GA. Effect of Spinal Manipulation of Upper Cervical Vertebrae on Blood Pressure: Results of a Pilot Sham-Controlled Trial. J Manipulative Physiol Ther 2016; 39:369-380. [DOI: 10.1016/j.jmpt.2016.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
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Antinociceptive Effects of Spinal Manipulative Therapy on Nociceptive Behavior of Adult Rats during the Formalin Test. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:520454. [PMID: 26693243 PMCID: PMC4674607 DOI: 10.1155/2015/520454] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/26/2015] [Accepted: 11/09/2015] [Indexed: 01/08/2023]
Abstract
Optimizing pain relief resulting from spinal manipulative therapies, including low velocity variable amplitude spinal manipulation (LVVA-SM), requires determining their mechanisms. Pain models that incorporate simulated spinal manipulative therapy treatments are needed for these studies. The antinociceptive effects of a single LVVA-SM treatment on rat nociceptive behavior during the commonly used formalin test were investigated. Dilute formalin was injected subcutaneously into a plantar hindpaw. Licking behavior was video-recorded for 5 minutes. Ten minutes of LVVA-SM at 20° flexion was administered with a custom-made device at the lumbar (L5) vertebra of isoflurane-anesthetized experimental rats (n = 12) beginning 10 minutes after formalin injection. Hindpaw licking was video-recorded for 60 minutes beginning 5 minutes after LVVA-SM. Control rats (n = 12) underwent the same methods except for LVVA-SM. The mean times spent licking the formalin-injected hindpaw of both groups 1–5 minutes after injection were not different. The mean licking time during the first 20 minutes post-LVVA-SM of experimental rats was significantly less than that of control rats (P < 0.001). The mean licking times of both groups during the second and third 20 minutes post-LVVA-SM were not different. Administration of LVVA-SM had a short-term, remote antinociceptive effect similar to clinical findings. Therefore, mechanistic investigations using this experimental approach are warranted.
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Effects of spinal manipulation on sensorimotor function in low back pain patients--A randomised controlled trial. ACTA ACUST UNITED AC 2015; 21:183-90. [PMID: 26319101 DOI: 10.1016/j.math.2015.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 07/28/2015] [Accepted: 08/03/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Low back pain (LBP) is a major health problem in industrialized societies. Spinal manipulation (SM) is often used for treating LBP, though the therapeutic mechanisms remain elusive. Research suggests that sensorimotor changes may be involved in LBP. It is hypothesized that SM may generate its beneficial effects by affecting sensorimotor functions. OBJECTIVES To compare changes in sensorimotor function, as measured by postural sway and response to sudden load, in LBP patients following the delivery of high-velocity low amplitude (HVLA)-SM or low-velocity variable amplitude (LVVA)-SM versus a sham control intervention. DESIGN A three-arm (1:1:1 ratio) randomized controlled trial. METHODS A total of 221 participants who were between 21 and 65 years, having LBP intensity (numerical rating scale) ≥4 at either phone screen or the first baseline visit and ≥2 at phone screen and both baseline visits, and Quebec Task Force diagnostic classifications of 1, 2, 3 or 7 were enrolled to receive four SM treatments over two weeks. Study outcomes were measured at the first and fifth visits with the examiners blinded from participant group assignment. RESULTS The LVVA-SM group demonstrated a significant increase in medial-to-lateral postural excursion on the soft surface at the first visit when compared to the control group. No other significant between-group differences were found for the two sensorimotor tests, whether during the first visit or over two weeks. CONCLUSIONS It appears that short-term SM does not affect the sensorimotor functions as measured by postural sway and response to sudden load in this study.
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Gay A, Aimonetti JM, Roll JP, Ribot-Ciscar E. Kinesthetic illusions attenuate experimental muscle pain, as do muscle and cutaneous stimulation. Brain Res 2015; 1615:148-156. [PMID: 25935692 DOI: 10.1016/j.brainres.2015.04.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/19/2015] [Accepted: 04/06/2015] [Indexed: 12/28/2022]
Abstract
In the present study, muscle pain was induced experimentally in healthy subjects by administrating hypertonic saline injections into the tibialis anterior (TA) muscle. We first aimed at comparing the analgesic effects of mechanical vibration applied to either cutaneous or muscle receptors of the TA or to both types simultaneously. Secondly, pain alleviation was compared in subjects in whom muscle tendon vibration evoked kinesthetic illusions of the ankle joint. Muscle tendon vibration, which primarily activated muscle receptors, reduced pain intensity by 30% (p<0.01). In addition, tangential skin vibration reduced pain intensity by 33% (p<0.01), primarily by activating cutaneous receptors. Concurrently stimulating both sensory channels induced stronger analgesic effects (-51%, p<0.01), as shown by the lower levels of electrodermal activity. The strongest analgesic effects of the vibration-induced muscle inputs occurred when illusory movements were perceived (-38%, p=0.01). The results suggest that both cutaneous and muscle sensory feedback reduce muscle pain, most likely via segmental and supraspinal processes. Further clinical trials are needed to investigate these new methods of muscle pain relief.
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Affiliation(s)
- André Gay
- La Conception Hospital, APHM, Marseille, France
| | | | - Jean-Pierre Roll
- Aix-Marseille université, CNRS, NIA UMR 7260, 13331 Marseille, France
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Gudavalli MR, Salsbury SA, Vining RD, Long CR, Corber L, Patwardhan AG, Goertz CM. Development of an attention-touch control for manual cervical distraction: a pilot randomized clinical trial for patients with neck pain. Trials 2015; 16:259. [PMID: 26044576 PMCID: PMC4460764 DOI: 10.1186/s13063-015-0770-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/20/2015] [Indexed: 12/16/2022] Open
Abstract
Background Manual cervical distraction (MCD) is a traction-based therapy performed with a manual contact over the cervical region producing repeating cycles while patients lie prone. This study evaluated a traction force-based minimal intervention for use as an attention-touch control in clinical trials of MCD for patients with chronic neck pain. Methods We conducted a mixed-methods, pilot randomized clinical trial in adults with chronic neck pain. Participants were allocated to three traction force ranges of MCD: low force/minimal intervention (0-20 N), medium force (21-50 N), or high force (51-100 N). Clinicians delivered five treatments over two weeks consisting of three sets of five cycles of MCD at the C5 vertebra and occiput. Traction forces were measured at each treatment. Patient-reported outcomes included a pain visual analogue scale (VAS), Neck Disability Index (NDI), Credibility and Expectancy Questionnaire (CEQ), and adverse effects. A qualitative interview evaluated treatment group allocation perceptions. Results We randomized 48 participants, allocating an average of five each month. Forty-five participants completed the trial with three participants lost to follow-up. Most participants were women (65 %) and white (92 %) with a mean (SD) age of 46.8 (12.5) years. Mean traction force values were within the prescribed force ranges for each group at the C5 and occiput levels. Neck pain VAS demonstrated a benefit for high traction force MCD compared to the low force group [adjusted mean difference 15.6; 95 % confidence interval (CI) 1.6 to 29.7]. Participants in the medium traction force group demonstrated improvements in NDI compared to the low force group (adjusted mean difference 3.0; 95 % CI 0.1 to 5.9), as did participants in the high traction force group (adjusted mean difference 2.7; 95 % CI -0.1 to 5.6). CEQ favored the high force group. Most low force participants correctly identified their treatment allocation in the qualitative interview. No serious adverse events were documented. Conclusions This pilot study demonstrated the feasibility of a clinical trial protocol and the utility of a traction-based, minimal intervention as an attention-touch control for future efficacy trials of MCD for patients with neck pain. Trial registration ClinicalTrials.gov NCT01765751 (Registration Date 30 May 2012)
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Affiliation(s)
- M Ram Gudavalli
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, 52803, Davenport, IA, USA.
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, 52803, Davenport, IA, USA.
| | - Robert D Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, 52803, Davenport, IA, USA.
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, 52803, Davenport, IA, USA.
| | - Lance Corber
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, 52803, Davenport, IA, USA.
| | - Avinash G Patwardhan
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL and Department of Orthopedic Surgery & Rehabilitation, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA.
| | - Christine M Goertz
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, 52803, Davenport, IA, USA.
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Vining RD, Potocki E, McLean I, Seidman M, Morgenthal AP, Boysen J, Goertz C. Prevalence of radiographic findings in individuals with chronic low back pain screened for a randomized controlled trial: secondary analysis and clinical implications. J Manipulative Physiol Ther 2014; 37:678-87. [PMID: 25455834 DOI: 10.1016/j.jmpt.2014.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 08/16/2014] [Accepted: 09/01/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study is to measure the prevalence of graded disc degeneration, spondylolisthesis, transitional segmentation, and the distribution of sacral slope in patients 21 to 65 years of age with chronic low back pain (CLBP). METHODS This retrospective study analyzed 247 digital lumbar radiographic series obtained during a randomized controlled trial of chiropractic patients with CLBP. Chronic low back pain was defined as pain in the low back lasting 12 weeks or longer. Radiographic findings of disc degeneration, spondylolisthesis, and lumbosacral transitional segmentation were graded by 2 authors using established classification criteria. Sacral slope was measured with a digital tool contained within imaging software. RESULTS Lumbosacral transitional segments graded I to IV (Castellvi classification) were present in 14% of cases. Lumbar disc degeneration was most prevalent at L3-4 (49%), followed by L4-5 (42%), L2-3 (41%), L5-S1 (37%), and L1-2 (29%). Isthmic spondylolisthesis was present in 5% of cases, with L5 the most common location. Degenerative spondylolisthesis demonstrated a prevalence of 18%, most commonly occurring at L4. The prevalence of degenerative spondylolisthesis was 51% for women aged 50 to 59 years and 24% for men in the same age range. CONCLUSIONS Moderate-severe disc degeneration, multilevel disc narrowing, and degenerative spondylolisthesis were common in individuals with CLBP with age more than 40 years. Isthmic spondylolisthesis was not more prevalent than what has been reported in other populations. Transitional segmentation was identified in a minority of participants, with some of these exhibiting accessory joints or fusion. Mean sacral slope in individuals with CLBP was not substantially different from mean slopes reported in other populations.
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Affiliation(s)
- Robert D Vining
- Associate Professor, Senior Research Clinician, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA.
| | - Eric Potocki
- Research Clinician, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
| | - Ian McLean
- Professor, Director of Clinical Radiology, Palmer College of Chiropractic, Davenport, IA
| | - Michael Seidman
- Research Clinician, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
| | - A Paige Morgenthal
- Research Clinician, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
| | - James Boysen
- Study Coordinator, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
| | - Christine Goertz
- Vice Chancellor for Research and Health Policy, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
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Eligibility determination for clinical trials: development of a case review process at a chiropractic research center. Trials 2014; 15:406. [PMID: 25344427 PMCID: PMC4221721 DOI: 10.1186/1745-6215-15-406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 10/08/2014] [Indexed: 11/12/2022] Open
Abstract
Background Systematic procedures addressing the limitations of eligibility determination are needed to improve the quality of participant recruitment and enrollment in randomized clinical trials. This paper describes an eligibility determination process developed by and in use at a chiropractic research center engaged in community recruitment for clinical trials studying spinal pain conditions. Methods A team of investigators developed a case review process for application across clinical trials involving chiropractic care. Study personnel representing key study roles including research clinicians, study coordinators, a project manager, and at least one investigator convene in person to determine eligibility for participants following baseline study visit examinations. The research clinician who performed the eligibility examination presents the case and a moderator leads the case review panel through a structured discussion including diagnosis, eligibility criteria, definition review, and clinical precautions. Panel members provide clinical recommendations and determine final eligibility using a structured and moderated voting process. Results Through the case review process for three externally funded clinical trials for participants with neck and low back pain, we presented 697 cases, rendering 472 participants eligible for enrollment and excluding 225 individuals. The most common reasons for case review exclusions across the three trials included neck or back pain not meeting diagnostic classifications, safety concerns related to treatment or testing, referral for further evaluation or treatment, and compliance concerns. Conclusions The case review process uses the expertise of study coordinators, research clinicians, project managers, and investigators to render eligibility decisions consistent with study aims for the duration of the trial. This formal eligibility determination process includes steps designed to mitigate the potential for participant misclassification from clinician advocacy or misunderstanding of eligibility criteria, and helps ensure that participants can safely take part in study procedures. Trial registration The three trials discussed in this article were registered in ClinicalTrials.gov with the ID numbers of NCT00830596 (27 January 2009), NCT01312233 (04 March 2011), and NCT01765751 (30 May 2012).
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Xia T, Wilder DG, Gudavalli MR, DeVocht JW, Vining RD, Pohlman KA, Kawchuk GN, Long CR, Goertz CM. Study protocol for patient response to spinal manipulation - a prospective observational clinical trial on physiological and patient-centered outcomes in patients with chronic low back pain. Altern Ther Health Med 2014; 14:292. [PMID: 25106673 PMCID: PMC4139615 DOI: 10.1186/1472-6882-14-292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/31/2014] [Indexed: 02/22/2023]
Abstract
Background Low back pain (LBP) is a major health issue due to its high prevalence rate and socioeconomic cost. While spinal manipulation (SM) is recommended for LBP treatment by recently published clinical guidelines, the underlying therapeutic mechanisms remain unclear. Spinal stiffness is routinely examined and used in clinical decisions for SM delivery. It has also been explored as a predictor for clinical improvement. Flexion-relaxation phenomenon has been demonstrated to distinguish between LBP and healthy populations. The primary objective of the current study is to collect preliminary estimates of variability and effect size for the associations of these two physiological measures with patient-centered outcomes in chronic LBP patients. Additionally biomechanical characteristics of SM delivery are collected with the intention to explore the potential dose–response relationship between SM and LBP improvement. Methods/Design This is a prospective, observational study applying side-lying, high velocity, low amplitude SM as treatment for patients with LBP over a course of 6 weeks. Approximately 80 participants will be enrolled if they present with chronic LBP of 1, 2 or 3 in Quebec Task Force Classification for spinal disorders, a Roland-Morris Disability Questionnaire (RMDQ) score ≥ 6, and persistent LBP ≥ 2 with a maximum ≥ 4 using numerical rating scale. Patient-centered outcomes include LBP using visual analog scale, RMDQ, and PROMIS-29. Lumbar spine stiffness is assessed using palpation, a hand-held instrumented device, and an automated device. Flexion-relaxation is assessed using surface electromyography at the third level of the lumbar spine. Biomechanical characteristics of SM are assessed using a self-reported, itemized description system, as well as advanced kinetic measures that will be applied to estimate forces and moments at the lumbar segment level targeted by SM. Discussion Beside alterations in material properties of the passive components of the spine, increased neuromuscular activity may also contribute to a stiffened spine. Examining changes in both spinal stiffness and flexion-relaxation along the course of the treatment provides an opportunity to understand if the therapeutic effect of SM is associated with its action on active and/or passive components of the spine. Trial registration NCT01670292 on clinicaltrials.gov.
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Vining R, Potocki E, Seidman M, Morgenthal AP. An evidence-based diagnostic classification system for low back pain. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2013; 57:189-204. [PMID: 23997245 PMCID: PMC3743645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION While clinicians generally accept that musculoskeletal low back pain (LBP) can arise from specific tissues, it remains difficult to confirm specific sources. METHODS Based on evidence supported by diagnostic utility studies, doctors of chiropractic functioning as members of a research clinic created a diagnostic classification system, corresponding exam and checklist based on strength of evidence, and in-office efficiency. RESULTS THE DIAGNOSTIC CLASSIFICATION SYSTEM CONTAINS ONE SCREENING CATEGORY, TWO PAIN CATEGORIES: Nociceptive, Neuropathic, one functional evaluation category, and one category for unknown or poorly defined diagnoses. Nociceptive and neuropathic pain categories are each divided into 4 subcategories. CONCLUSION This article describes and discusses the strength of evidence surrounding diagnostic categories for an in-office, clinical exam and checklist tool for LBP diagnosis. The use of a standardized tool for diagnosing low back pain in clinical and research settings is encouraged.
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Affiliation(s)
- Robert Vining
- Corresponding Author, Associate Professor and Senior Research Clinician, Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 741 Brady St, Davenport, IA 52803; Telephone: 563 884-5153 Fax: 1.563.884.5227,
| | - Eric Potocki
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 5433 Bryant Ave, South Minneapolis, MS 55419;
| | - Michael Seidman
- Research Clinician, Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 741 Brady St, Davenport, IA 52803;
| | - A. Paige Morgenthal
- Research Clinician, Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 741 Brady St, Davenport, IA 52803;
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Collaborative Care for Older Adults with low back pain by family medicine physicians and doctors of chiropractic (COCOA): study protocol for a randomized controlled trial. Trials 2013; 14:18. [PMID: 23324133 PMCID: PMC3557195 DOI: 10.1186/1745-6215-14-18] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 01/03/2013] [Indexed: 12/19/2022] Open
Abstract
Background Low back pain is a prevalent and debilitating condition that affects the health and quality of life of older adults. Older people often consult primary care physicians about back pain, with many also receiving concurrent care from complementary and alternative medicine providers, most commonly doctors of chiropractic. However, a collaborative model of treatment coordination between these two provider groups has yet to be tested. The primary aim of the Collaborative Care for Older Adults Clinical Trial is to develop and evaluate the clinical effectiveness and feasibility of a patient-centered, collaborative care model with family medicine physicians and doctors of chiropractic for the treatment of low back pain in older adults. Methods/design This pragmatic, pilot randomized controlled trial will enroll 120 participants, age 65 years or older with subacute or chronic low back pain lasting at least one month, from a community-based sample in the Quad-Cities, Iowa/Illinois, USA. Eligible participants are allocated in a 1:1:1 ratio to receive 12 weeks of medical care, concurrent medical and chiropractic care, or collaborative medical and chiropractic care. Primary outcomes are self-rated back pain and disability. Secondary outcomes include general and functional health status, symptom bothersomeness, expectations for treatment effectiveness and improvement, fear avoidance behaviors, depression, anxiety, satisfaction, medication use and health care utilization. Treatment safety and adverse events also are monitored. Participant-rated outcome measures are collected via self-reported questionnaires and computer-assisted telephone interviews at baseline, and at 4, 8, 12, 24, 36 and 52 weeks post-randomization. Provider-rated expectations for treatment effectiveness and participant improvement also are evaluated. Process outcomes are assessed through qualitative interviews with study participants and research clinicians, chart audits of progress notes and content analysis of clinical trial notes. Discussion This pragmatic, pilot randomized controlled trial uses a mixed method approach to evaluate the clinical effectiveness, feasibility, and participant and provider perceptions of collaborative care between medical doctors and doctors of chiropractic in the treatment of older adults with low back pain. Trial registration This trial registered in ClinicalTrials.gov on 04 March 2011 with the ID number of NCT01312233.
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