Impact of selected magnetic fields on the therapeutic effect in patients with lumbar discopathy: A prospective, randomized, single-blinded, and placebo-controlled clinical trial

[Physiotherapy in rehabilitation of patients with degenerative disk diseases from positions of evidence-based medicine: a literature review]

Back pain is one of the most urgent problems of rehabilitation. Patients with this pathology have a leading place among neurological patients in terms of the number of days of disability. The high economic costs in society are explained by the need for lumbar surgery (discectomy, spinal fusion and disc prosthesis) and rehabilitation after it. The effectiveness of rehabilitative measures is determined both by the patient's rehabilitative potential and by the choice of rehabilitative methods.

OBJECTIVE

To evaluate the effectiveness of physiotherapy in patients with degenerative disk diseases from positions of evidence-based medicine according to the scientific and technical literature.

MATERIAL AND METHODS

The analysis of scientific and technical literature sources and the study of materials of meta-analyses, systematic reviews (depth of search was 20 years) on the evaluation of effectiveness of physiotherapeutical methods in the rehabilitation of patients with degenerative disk diseases have been conducted.

RESULTS

The ability of pulsed magnetic field to reduce the intensity of pain and improve the functional capacities of the spine in patients with low back pain has been identified. There was a pronounced analgesic end-point of low-level laser therapy in acute and chronic back pain at short and medium-term (up to 12 months) observation, as well as the ability of the method to reduce temporary disability in degenerative disk diseases.

CONCLUSION

The use of magnetotherapy and low-level laser therapy can be recommended for the treatment of patients with degenerative disk diseases (C grade of recommendations, 3rd level of evidence). The recommendation is based on the results of 10 RCTs (1.111 patients with degenerative disk diseases), 3 meta-analyses, 1 systematic review and 1 Cochrane review (a total of 3.431 patients).

Effect of Repetitive Peripheral Magnetic Stimulation on Patients With Low Back Pain: A Meta-analysis of Randomized Controlled Trials

OBJECTIVE

The purpose of this meta-analysis was to investigate the effects of repetitive peripheral magnetic stimulation (rPMS) on pain intensity, functional mobility, and kinesiophobia in individuals with low back pain (LBP).

DATA SOURCES

The PubMed, Physiotherapy Evidence Database, Embase, Cochrane Library, and Web of Science databases were systematically searched from inception until November 25, 2022.

STUDY SELECTION

Eligible randomized controlled trials contained information on the population (LBP), intervention (rPMS), and outcomes (pain intensity, functional mobility, and kinesiophobia). Participants in the rPMS intervention group were compared with those in sham or other control groups. Two independent researchers searched for, screened, and qualified the articles.

DATA EXTRACTION

Two independent researchers extracted key information from each eligible study. The authors' names, year of publication, setting, total sample size, rPMS parameters, baseline/mean difference (MD), and 95% confidence interval (CI) were extracted using a standardized form, and the methodological quality was assessed using the Physiotherapy Evidence Database score and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system.

DATA SYNTHESIS

Of 733 studies identified, 6 randomized controlled trials (n = 139) were included for meta-analysis. Compared with sham rPMS or other therapy, rPMS showed significant efficacy in reducing pain intensity (visual analog scale: MD, -1.89; 95% CI, -3.32 to -0.47; P<.05; very low-quality evidence). Significant efficacy was also found in terms of functional disability (Oswestry Disability Index: MD, -8.39; 95% CI, -13.65 to -3.12; P<.001; low-quality evidence). However, there was no statistically significant between-group difference on the Tampa scale of kinesiophobia (MD, -1.81; 95% CI, -7.60 to 3.98; P>.05; very low-quality evidence).

CONCLUSIONS

This meta-analysis found very low- to low-quality evidence that rPMS can be used to reduce pain intensity and improve functional disability in individuals with LBP. However, no significant effect of rPMS on kinesiophobia was found.

Efficacy of pulsed electromagnetic field on pain and physical function in patients with low back pain: A systematic review and meta-analysis

Objective

To assess the effectiveness of pulsed electromagnetic field (PEMF) on pain and physical function in patients with low back pain.

Data sources

A search of PubMed, Embase, Cochrane Library, and Web of Science was conducted up to December 2021.

Methods

We included randomized controlled trials that investigated the effectiveness of PEMF in patients with low back pain. The primary outcome was pain intensity and the secondary outcome was physical function, both were evaluated by assessment scales. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated for the summary statistics analysis. The registration number of this systematic review in PROSPERO is CRD42020213829.

Results

Fourteen trials involving 618 participants were included. The PEMF treatment showed more significant pain alleviation than placebo or other therapy alone in patients with low back pain (SMD = −1.01, 95% CI −1.42 to −0.6, P < 0.001, I2 = 31%; SMD = −0.36, 95% CI −0.62 to −0.11, P = 0.005, I2 = 37%, respectively.) In addition, a significant difference in pain alleviation was observed in patients with chronic low back pain (SMD = −0.6, 95%CI − 0.94 to −0.25, p < 0.001, I2 = 67%), whereas no significant difference was observed in patients with acute low back pain (SMD = −0.46, 95%CI − 0.99 to 0.07, p = 0.09, I2 = 0%). PEMF did not improve physical function compared with the control treatment (SMD = −0.45, 95% CI − 0.98 to 0.07, p = 0.09, I2 = 86%).

Conclusion

PEMF is beneficial for alleviating pain in patients with chronic low back pain despite having no advantage in improving physical function.

Effect of extremely low frequency magnetic fields on oxidative balance in rat brains subjected to an experimental model of chronic unpredictable mild stress

Background

There has been an increasing interest in researching on the effects of extremely low-frequency magnetic fields on living systems. The mechanism of action of extremely low-frequency magnetic fields on organisms has not been established. One of the hypotheses is related to induce changes in oxidative balance. In this study, we measured the effects of chronic unpredictable mild stress induced-oxidative balance of rat’s brain exposed to extremely low-frequency magnetic fields.

Methods

A first experiment was conducted to find out if 14 days of chronic unpredictable mild stress caused oxidative unbalance in male Wistar rat’s brain. Catalase activity, reduced glutathione concentration, and lipoperoxidation were measured in cerebrum and cerebellum. In the second experiment, we investigate the effects of 7 days extremely low-frequency magnetic fields exposure on animals stressed and unstressed.

Results

The main results obtained were a significant increase in the catalase activity and reduced glutathione concentration on the cerebrum of animals where the chronic unpredictable mild stress were suspended at day 14 and then exposed 7 days to extremely low-frequency magnetic fields. Interestingly, the same treatment decreases the lipoperoxidation in the cerebrum. The stressed animals that received concomitant extremely low frequency magnetic fields exposure showed an oxidative status like stressed animals by 21 days. Thus, no changes were observed on the chronic unpredictable mild stress induced-oxidative damage in the rat’s cerebrum by the extremely low-frequency magnetic field exposure together with chronic unpredictable mild stress.

Conclusions

The extremely low-frequency electromagnetic field exposure can partially restore the cerebrum antioxidant system of previously stressed animals.

A 50 Hz magnetic field affects hemodynamics, ECG and vascular endothelial function in healthy adults: A pilot randomized controlled trial

Application of exposure to 50/60 Hz magnetic fields (MFs) has been conducted in the treatment of muscle pain and fatigue mainly in Japan. However, whether MFs could increase blood flow leading to muscle fatigue recovery has not been sufficiently tested. We investigated the acute effects of a 50 Hz sinusoidal MF at Bmax 180 mT on hemodynamics, electrocardiogram, and vascular endothelial function in healthy young men. Three types of regional exposures to a 50 Hz MF, i.e., forearm, upper arm, or neck exposure to MF were performed. Participants who received three types of real MF exposures had significantly increased ulnar arterial blood flow velocity compared to the sham exposures. Furthermore, after muscle loading exercise, MF exposure recovered hemoglobin oxygenation index values faster and higher than sham exposure from the loading condition. Moreover, participants who received real MF exposure in the neck region had significantly increased parasympathetic high-frequency activity relative to the sham exposure. The MF exposure in the upper arm region significantly increased the brachial artery flow-mediated dilation compared to the sham exposure. Computer simulations of induced in situ electric fields indicated that the order-of-magnitude estimates of the peak values were 100-500 mV/m, depending on the exposure conditions. This study provides the first evidence that a 50 Hz MF can activate parasympathetic activity and thereby lead to increase vasodilation and blood flow via a nitric oxide-dependent mechanism. Trial registration: UMIN Clinical Trial Registry (CTR) UMIN000038834. The authors confirm that all ongoing and related trials for this drug/intervention are registered.

Effectiveness of Ultrasound Therapy on the Management of Chronic Non-Specific Low Back Pain: A Systematic Review

Non-specific chronic low back pain is the most common self-reported kind of musculoskeletal ache associated with substantial health and socioeconomic problem and responsible for most years lived with a disability as compared with any other medical condition. So treating chronic non-specific low back pain is one of the main problems faced among physical therapists in the rehabilitation area. The effects of ultrasound for patients with non-specific chronic low back pain remain unknown, however it is commonly used to treat clients with low back pain in rehabilitation setting. Therefore, the main aim of this review was to evaluate the up-to-date confirmation in the efficacy of ultrasound therapy on the treatment of non-specific chronic low back pain. A comprehensive search of four computerized electronic databases was performed to identify the effectiveness of ultrasound therapy on the management of chronic non-specific low back pain. Searching was done through the Google Scholar, PubMed, ScienceDirect, and Physiotherapy Evidence Databases (PEDro) and reported using preferred reporting items for systematic reviews and meta-analyses guidelines. The qualities of articles were appraised by the PEDro scale. The primary outcome measure visual analog scale was used. Six randomized clinical trials with a total sample size of 699 patients from the electronic database published in English were identified. In this review, the effect of UST in five articles was statically significant in reducing the visual analog scale (p<0.05) score. So this systematic review found ultrasound therapy could be an alternative treatment to reduce the intensity of pain in subjects with non-specific chronic LBP.

Effect of Radial Extracorporeal Shock Wave Therapy on Pain Intensity, Functional Efficiency, and Postural Control Parameters in Patients with Chronic Low Back Pain: A Randomized Clinical Trial

Low back pain (LBP) is the leading cause of disability worldwide, placing a significant economic burden on healthcare systems. Radial extracorporeal shock wave therapy (rESWT) is useful in the rehabilitation of orthopedic diseases; however, there is still limited evidence for patients with LBP. The aim of this study was to assess the effect of rESWT on pain level, functional efficiency, and parameters of postural control in patients with LBP. Participants were randomized into group A (n = 20) treated with rESWT and group B (n = 20) treated with sham rESWT (placebo). Both groups received conventional physiotherapy, including core stability exercises. The following tests were performed: the Laitinen Pain Scale (LPS), the Roland–Morris Questionnaire (RMQ), the original Schober Test (OST), and a stabilometric platform for the assessment of postural sway, including total sway path (TSP). We found that the analgesic effect was higher after rESWT, especially in the follow-up’s (p < 0.05). Similar results were found for functional efficiency and range of motion (p < 0.05). The improved posture stability in placebo group B was not statistically significant (p > 0.05). The stabilometric parameters in group A were still gradually improved and statistically significant, even in follow-ups (p < 0.05). In conclusion, the rESWT had a significant effect on the reduction of pain and the improvement of functional condition compared to a conventional physiotherapy program. Also, rESWT with core stability exercises led to significant improvements in postural sway compared with conventional physiotherapy in patients with LBP.

Baropodometric evaluation of foot load distribution during gait in the group of professionally active nurses

OBJECTIVES

Nurses are extremely exposed to musculoskeletal overloads. Prolonged standing postural balance distributions, functional deficits and pain may affect the symmetry of the load on the feet. The study aimed to assess the distribution of foot load during gait among nurses.

METHODS

The sample of this prospective and observational study consisted of 37 female nurses with mean age of 39 years. The Nordic Musculoskeletal Questionnaire (NMQ) was used to evaluate musculoskeletal disturbances and baropodometric gait analysis (BGA) was performed to register distribution of foot load during gait.

RESULTS

We showed that 68% of nurses declare that they know the principles of workplace ergonomics, but only 14% comply with them. NMQ results indicate that as many as 73% of the respondents feel ailments in the "lower back" area. An asymmetry was observed in the load of IV-V of the metatarsal head between the left and right foot (P = .000) and in the load of the left and right lateral part of the heel (P = .028) in the BGA test. Correlations between ailments occurring in the neck area and loading of the lateral arch of the right foot (P = .032) were found. Moreover, the load in this area correlated positively with the occurrence of "lower back" pain (P = .045).

CONCLUSIONS

Nurses have asymmetric distribution of foot load during gait, which results in a discrepancy between the loads on the three main support points of the foot and which may affect nurses' work productivity.

Effect of 12-Week Whole-Body Vibration Exercise on Lumbopelvic Proprioception and Pain Control in Young Adults with Nonspecific Low Back Pain

BACKGROUND Nonspecific low back pain (NSLBP) accounts for a large proportion of low back pain cases. The present study aimed to investigate the effect of the whole-body vibration (WBV) exercise on lumbar proprioception in NSLBP patients. It was hypothesized that WBV exercise enhances lumbar proprioception. MATERIAL AND METHODS Forty-two patients with NSLBP performed an exercise program 3 times a week for a total of 12 weeks of WBV. The lumbar proprioception was measured by joint position sense. Outcomes were lumbar angle deviation and visual analogue scale (VAS) score. RESULTS After the 12-week WBV exercise, lumbar flexion angle deviation was reduced from 3.65±2.26° to 1.90±1.07° (P=0.0001), and extension angle deviation was reduced from 3.06±1.85° to 1.61±0.75° (P=0.0001), significantly lower than baseline. After participating in the 12-week WBV exercise, a significant pain reduction was observed (P=0.0001). Men in the whole group (n=32) indicated significantly lower angle deviations in flexion and extension, whereas women (n=10) indicated significantly lower flexion angle deviation (P=0.037), and no significant difference was found in extension angle deviation (P=0.052). However, by subdividing the entire group (n=42) into poor and good proprioceptive groups, WBV exercise presented significant enhancement of lumbar proprioceptive ability in the poor flexion proprioception subgroup, poor extension proprioception subgroup, and good extension proprioception subgroup (each P=0.0001), but not in the subgroup with good flexion proprioceptive ability (P=0.165). CONCLUSIONS Lumbar flexion and extension proprioception as measured by joint position sense was significantly enhanced and pain was significantly reduced after 12-week WBV exercise in NSLBP patients. However, the patients with good flexion proprioceptive ability had limited proprioceptive enhancement.