Influences of spinal decompression therapy and general traction therapy on the pain,disability, and straight leg raising of patients with intervertebral disc herniation

[Purpose] The purpose of this study was to identify how spinal decompression therapy and general traction therapy influence the pain, disability, and straight leg raise (SLR) ability of patients with intervertebral disc herniation. [Subjects] The subjects were 30 patients with chronic lumbar pain who were divided into a spinal decompression therapy group (SDTG, n=15), and a general traction therapy group (GTTG, n=15). [Methods] The SDTG used a spinal decompression device, and the GTTG used a lumbar traction device. Both groups received conservative physical therapy three times a week for four weeks. A visual analog scale (VAS) was used to measure the degree of pain the patients with chronic lumbar pain. The Oswestry Disability Index (ODI) was used to measure the degree of functional disability. A goniometer was used to measure the patients’ SLR ability. [Results] Both SDTG and GTTG showed statistically significant decreases in VAS and ODI scores and a statistically significant increase in SLR angle. A comparison of the two groups found no statistically significant differences. [Conclusion] Spinal decompression therapy and general traction therapy are effective at improving the pain, disability, and SLR of patients with intervertebral disc herniation. Thus, selective treatment may be required.Key words: Spinal decompression therapy, Pain, Straight leg raise     

Effect of joint mobilization using KEOMT and PNF on a patient with CLBP and a lumbar transitional vertebra: a case study

[Purpose] The purpose of this case study was to identify the effects of joint mobilization using Kaltenborn-Evjenth orthopedic manual therapy (KEOMT) and proprioceptive neuromuscular facilitation (PNF) techniques on a patient with chronic low back pain (CLBP) and a lumbar transitional vertebra. [Methods] The intervention methods were joint mobilization using KEOMT and PNF techniques. The program consisted of 40-min sessions 3 days a week for 4 weeks. The spinal motion (thoracic and lumbar vertebrae), pain, and thickness of the multifidus were measured. [Results] The angle of spinal curvature increased, and the range of motions (ROMs) flexion and extension increased in the thoracic and lumbar vertebrae. The pain score as measured on a visual analogue scale (VAS) and the Oswestry disability index (ODI) score decreased. The thickness of the multifidus (L4) increased on the left and right sides. [Conclusion] These results suggest that joint mobilization using KEOMT and PNF techniques had a positive effect on the spinal motion, pain, and thickness of the multifidus of a patient with chronic low back pain and a lumbar transitional vertebra.Key words: Lumbar transitional vertebra, Joint mobilization, Proprioceptive neuromuscular facilitation     

The effects of extracorporeal shock wave therapy on pain,disability, and depression of chronic low back pain patients

[Purpose] The purpose of this study was to examine the effects of extracorporeal shock wave therapy on pain, disability, and depression of chronic low back pain patients. [Subjects] In this study, 30 chronic low back pain patients were divided into an extracorporeal shock wave therapy group (ESWTG, n=15) and a conservative physical therapy group (CPTG, n=15). [Methods] The ESWTG received extracorporeal shock wave therapy and the CPTG received general conservative physical therapy two times per week for six weeks. Pain was measured using a visual analog scale (VAS), the degree of disability of the patients was assessed using the Oswestry Disability Index (ODI), and their degree of depression was measured using the Beck depression index (BDI). [Results] In intra-group comparisons, ESWTG and CPTG showed significant decreases in VAS, ODI, and BDI scores. Intergroup comparisons revealed that these decreases in VAS, ODI, and BDI scores were significantly larger in ESWTG than in CPTG. [Conclusion] Extracorporeal shock wave therapy is an effective intervention for the treatment of pain, disability, and depression in chronic low back pain patients.Key words: Extracorporeal shock wave therapy, Pain, Depression     

Effects of complex manual therapy on PTSD,pain, function,and balance of male torture survivors with chronic low back pain

[Purpose] This study aimed to identify the impact of physiotherapy using complex manual therapy as a part of an integrated treatment for sequelae in the musculoskeletal system of torture survivors. [Subjects] This study reviewed 30 male torture survivors presenting with chronic low back pain. They were randomly selected and divided into two groups: an experimental group and a control group. [Methods] For the experimental group, complex manual therapy was performed twice a week for 8 weeks to improve the physical sequelae of patients. Improvement was measured using the PDS-K for Post-traumatic Stress Disorder (PTSD), the Visual Analog Scale (VAS) for pain examination, the Korean Oswestry Disability Index (KODI) for back function assessment, and the Balance System SD as a dynamic balance test. The total period of the intervention for both groups was 8 weeks. [Results] For the experimental group, PDS-K, VAS, KODI, and the dynamic balance test all showed significant improvements after the intervention, which they did not for the control group. In the comparison of the groups, PDS-K, VAS, KODI, and the dynamic balance test all showed significant differences. [Conclusion] Complex manual therapy for torture survivors with chronic low back pain contributes to functional recovery by reducing back pain. The treatment can be considered to have positive effects on sequelae in the musculoskeletal system of torture survivors as they age.Key words: Chronic low back pain, Complex manual therapy, Torture survivor     

The Effect of Swiss Ball Stabilization Exercise on Pain and Bone Mineral Density of Patients with Chronic Low Back Pain

[Purpose] The purpose of this study was to carry out a 16-week treatment of lumbar stabilization exercise with a ball targeting patients with chronic low back pain and investigate its effect on alleviation of low back pain and bone mineral density. [Subjects and Methods] The subjects of this study were 36 patients who were diagnosed with chronic low back pain. They were divided into a conservative treatment group (CTG, n=12), floor exercise group (FEG, n=12), and ball exercise group (BEG, n=12). The degree of recovery from pain was looked into using a visual analogue scale (VAS) and DEXXUM T (OsteoSys, Seoul, Korea) which was used to observe the changes in bone mineral density. [Result] Although the VAS score was reduced in FEG and BEG with treatment, it was not reduced in CTG. Also, the bone mineral density was increased in FEG and BEG, while it was reduced in CTG. [Conclusion] Lumbar stabilization exercises using a ball are thought to be an effective interventional therapy for the alleviation of chronic low back pain and to increase bone mineral density of patients.Key words: Chronic low back pain, Swiss ball exercise, Bone mineral density     

The effect of lumbar stabilization exercises and thoracic mobilization and exercises on chronic low back pain patients

[Purpose] To investigate whether pain, balance, and stabilization of the lumbar region can be improved through thoracic mobilization in addition to lumbar stabilizaing exercises. [Subjects and Methods] This study recruited 36 subjects with chronic low back pain lasting more than 12 weeks. The subjects recruited for this study participated voluntarily, and provided their signed consent to participation. [Results] Improvement in balance was largest in the lumbar stabilization exercise group, followed by the thoracic mobilization and exercise group, and the traditional physical therapy group, in decreasing order of effect. [Conclusion] In conclusion, lumbar stabilization exercises combined with thoracic mobilization had greater effects on stabilization of the lumbar region pain relief, and improvement of the function of the patients with chronic low back pain.Key words: Lumbar stabilization exercises, Thoracic mobilization exercises, Chronic low back pain     

The Evaluation of Chronic Low Back Pain by Determining the Ratio of the Lumbar Multifidus Muscle Cross-sectional Areas of the Unaffected and Affected Sides

[Purpose] The primary purpose of this study was to evaluate chronic low back pain by determining the ratio of the cross-sectional areas of the lumbar multifidus of the unaffected and affected sides at the L5 level using the ultrasound imaging. [Subjects and Methods] The subjects were 24 young people (10 males, 14 females) with chronic low back pain lasting for more than 6 months on one side. The visual analog scale (VAS) value of pain was assessed and the cross-sectional areas of the bilateral multifidus muscle were measured with the subjects in a supine position in a resting state using ultrasound imaging. Correlation and linear regression analysis were performed on the VAS and the ratio of the cross-sectional areas of the lumbar multifidus of the unaffected and affected sides. [Results] The VAS and the ratio of the cross-sectional areas of the lumbar multifidus were linearly correlated. [Conclusion] The results of this research indicate that when the ratio of the cross-sectional areas of the lumbar multifidus of the unaffected and affected sides increases, the symptom of chronic low back pain deteriorates.Key words: Multifidus, Chronic low back pain, Ultrasound imaging     

Effects of the active release technique on pain and range of motion of patients with chronic neck pain

[Purpose] To compare the influences of the active release technique (ART) and joint mobilization (JM) on the visual analog scale (VAS) pain score, pressure pain threshold (PPT), and neck range of motion (ROM) of patients with chronic neck pain. [Subjects] Twenty-four individuals with chronic neck pain were randomly and equally assigned to 3 groups: an ART group, a joint mobilization (JM) group, and a control group. Before and after the intervention, the degree of pain, PPT, and ROM of the neck were measured using a VAS, algometer, and goniometer, respectively. [Results] The ART group and JM group demonstrated significant changes in VAS and ROM between pre and post-intervention, while no significant change was observed in the control group. Significant differences in the PPT of all muscles were found in the ART group, while significant differences in all muscles other than the trapezius were found in the JM group. No significant difference in PPT was observed in any muscle of the control group. The posthoc test indicated no statistically significant difference between the ART and JM group, but the differences of variation in VAS, PPT, and ROM were greater in the ART group than in the JM and control groups. [Conclusion] ART for the treatment of chronic neck pain may be beneficial for neck pain and movement.Key words: Active release technique, Soft tissue, Chronic neck pain     

Effects of Extracorporeal Shockwave Therapy on Patients with Chronic Low Back Pain and Their Dynamic Balance Ability

[Purpose] The purpose of the present study was to examine the effects of extracorporeal shockwave therapy (ESWT) for patients with chronic low back pain and their dynamic balance ability. [Subjects] Twenty-eight patients with chronic low back were divided into an extracorporeal shockwave therapy group (ESWTG: n=13) and a conservative physical therapy group (CPTG, n=15). [Methods] An exercise program that included Williams’ exercises and McKenzie’s exercises was performed by both groups. The program was implemented twice a week for six weeks. The visual analog scale (VAS) was used to measure the chronic low back pain of the patients. Their dynamic balance ability was measured with BioRescue. [Results] The within-group comparison of the VAS of the ESWTG and the CPTG showed significant improvements after the intervention. In the VAS comparison between the groups after the treatment, the ESWTG showed a significantly larger improvement. In the within-group comparison of dynamic balance ability, the ESWTG showed significant improvements after the intervention in SAPLS, SAPRS, SAPFS, SAPBS, and TSA, and the CPTG showed significant improvements in SAPLS and SAPBS. In the between-group comparison of the dynamic balance ability after the treatment, the ESWTG showed significantly larger improvements in their SAPLS, SAPRS, SAPFS, and TSA. [Conclusion] The exercise program combined with the ESWT relieved chronic back pain more than the exercise program combined with the CPT. The former was also more effective at improving the patients’ dynamic balance ability in terms of SAPLS, SAPRS, SAPFS, and TSA.Key words: Extracorporeal shock wave therapy, Balance ability, Conservative physical therapy     

Chronic Mechanical Neck Pain in Adults Treated by Manual Therapy: A Systematic Review of Change Scores in Randomized Controlled Trials of a Single Session

We report a systematic analysis of group change scores of subjects with chronic neck pain not due to whiplash and without headache or arm pain, in randomized clinical trials of a single session of manual therapy. A comprehensive literature search of clinical trials of chronic neck pain treated with manual therapies up to December 2006 was conducted. Trials that scored above 60% on the PEDro Scale were included. Change scores were analyzed for absolute, percentage change and effect size (ES) whenever possible. Nine trials were identified: 6 for spinal manipulation, 4 for spinal mobilization or non-manipulative manual therapy (2 overlapping trials), and 1 trial using ischemic compression. No trials were identified for massage therapy or manual traction. Four manipulation trials (five groups) reported mean immediate changes in 100-mm VAS of −18.94 (9.28) mm. ES for these changes ranged from .33 to 2.3. Two mobilization trials reported immediate VAS changes of −11.5 and −4 mm (ES of .36 and .22, respectively); one trial reported no difference in immediate pain scores versus sham mobilization. The ischemic compression study showed statistically significant immediate decreases in 100-mm pain VAS (average = −14.6 mm). There is moderate-to-high quality evidence that immediate clinically important improvements are obtained from a single session of spinal manipulation. The evidence for mobilization is less substantial, with fewer studies reporting smaller immediate changes. There is insufficient evidence for ischemic compression to draw conclusions. There is no evidence for a single session of massage or manual traction for chronic neck pain.     

The effects of stabilization exercise with an oral assistive device on pain and functionality of low back pain patients

[Purpose] This study examined low back pain patients’ decrease in pain and improvement in functionality after performance of a lumbar stabilization exercise using an oral assistive device, which can replace a lumbar assistive device. [Subjects and Methods] The experimental group (n=12) conducted a stabilization exercise using an oral assistive device after conventional physical therapy. The control group (n=12) received conventional physical therapy. In order to objectively measure pain in this study, a visual analogue scale (VAS) was used. In order to evaluate the subjects’ functional aspects while living with low back pain, the Oswestry Disability Index (ODI) was used. [Results] There were statistically significant improvements in the comparison of the VAS and ODI of the experimental group and the control group. The experimental group’s VAS and ODI significantly improved after the intervention compared to the control group. [Conclusion] The stabilization exercise using the assistive device after conventional physical therapy in the rehabilitation of low back pain patients reduced subjects’ pain and increased their functional activities.Key words: Pain, LBP, Stabilization exercise     

Efficacy of manual therapy.

The use of manual therapy to treat somatic pain syndromes and associated disabilities is widespread. Yet, the efficacy of manual therapy has not been previously established because equivocal findings in the literature prevent definitive conclusions. The purposes of this article are (1) to establish objective criteria for judging the validity of manual therapy research, (2) to identify and discuss the results of those trials that were determined to be valid demonstrations of treatment efficacy or valid demonstrations of nonuseful therapy, and (3) to determine whether patients who benefit from manual therapy have common characteristics. The abstracts or full reports of 146 titles with appropriate key words were reviewed. Of these, 105 studies were not primary studies of manual therapy and were thus eliminated from review. In the 41 remaining studies, 18 did not utilize statistical comparisons or report blinded assessment of outcome measures. Nine controlled studies yielded negative results, but the statistical power or minimum sample size required to detect potential differences between manual therapy and control groups was not described. The 14 studies that met the efficacy criteria were categorized by the following factors: (1) the anatomical region of intervention, (2) pragmatic versus explanatory goals, and (3) primary intervention (manipulation, mobilization, combination). There was a paucity of valid explanatory research in all areas and a particular absence of controlled trials involving manual therapy applied to the peripheral joints. Manual therapy for low back pain, however, was studied extensively. The analysis of valid trials provided clear evidence that manual therapy, particularly manipulation, can be an effective modality when used to treat patients who have low back pain. A preliminary "profile" of the patient with low back pain who would likely benefit from manual therapy included acute symptom onset with less than a 1-month duration of symptoms, central or paravertebral pain distribution, no previous exposure to spinal manipulation, and no pending litigation or workers' compensation. Suggestions for future manual therapy research are discussed.     

Cost-Effectiveness of Manual Therapy for the Management of Musculoskeletal Conditions: A Systematic Review and Narrative Synthesis of Evidence From Randomized Controlled Trials

Objectives

The purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions.

Methods

A comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases.

Results

Twenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (eg, osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain.

Conclusions

Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. However, at present, there is a paucity of evidence on the cost-effectiveness and/or cost-utility evaluations for manual therapy interventions. Further improvements in the methodological conduct and reporting quality of economic evaluations of manual therapy are warranted in order to facilitate adequate evidence-based decisions among policy makers, health care practitioners, and patients.     

Effects of flexion-distraction manipulation therapy on pain and disability in patients with lumbar spinal stenosis

[Purpose] This study examined the effects of flexion-distraction manipulation therapy on pain and disability in patients with lumbar spinal stenosis. [Subjects] Thirty patients with lumbar spinal stenosis were divided into two groups: a conservative treatment group (n=15) and a flexion-distraction manipulation group (n=15). [Methods] The conservative treatment group received conservative physical therapy, and the flexion-distraction group received both conservative physical therapy and flexion-distraction manipulation therapy. Both groups received treatment 3 times a week for 6 weeks. The Visual Analog Scale was used to measure pain intensity, and the Oswestry Disability Index was used to evaluate the level of disability caused by the pain. [Results] The Visual Analog Scale scores for pain were significantly decreased in both groups. In the between-group comparison, the decrease in pain was more significant in the flexion-distraction group. According to the Oswestry Disability Index, the level of disability was significantly decreased in both groups, but the decrease was more significant in the flexion-distraction group. [Conclusion] Flexion-distraction manipulation appears to be an effective intervention for pain and disability among patients with lumbar spinal stenosis.Key words: Spinal stenosis, Flexion-distraction manipulation, Disability     

A comparison of two manual physical therapy approaches and electrotherapy modalities for patients with knee osteoarthritis: A randomized three arm clinical trial

A broad spectrum of physical therapy exercise programs provides symptom relief and functional benefit for patients with knee OA. Manual physical therapy, including tailored exercise programs provide relatively higher level benefit that persists to one year. It is currently unknown if there are important differences in the effects of different manual physical therapy techniques for patients with knee OA and there are virtually no studies comparing manual physical therapy and electrotherapy modalities. The aim of the study was to compare long-term results between three treatment groups (mobilization with movements [MWMs], passive joint mobilization [PJM], and electrotherapy) to determine which treatment is most effective in patients with knee OA. A single-blind randomized clinical trial with parallel design was conducted in patients with knee OA. Seventy-two consecutive patients (mean age 56.11 ± 6.80 years) with bilateral knee OA were randomly assigned to one of three treatment groups: MWMs, PJM, and electrotherapy. All groups performed an exercise program and received 12 sessions. The primary outcome measures of the functional assessment were the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and Aggregated Locomotor Function (ALF) test scores. The secondary outcome measures were pain level, measured using a pressure algometer and a visual analogue scale (VAS), range of motion (ROM), measured using a digital goniometer, and muscle strength, evaluated with a handheld dynamometer. Patients were assessed before treatment, after treatment and after 1 year of follow-up. Patients receiving the manual physical therapy interventions consisting of either MWM or PJM demonstrated a greater decrease in VAS scores at rest, during functional activities, and during the night compared to those in the electrotherapy group from baseline to after the treatment (p < 0.05). This improvement continued at the 1-year follow-up (p < 0.05). The MWMs and PJM groups also showed significantly improved WOMAC and ALF scores, knee ROM and quadriceps muscle strength compared to those in the electrotherapy group from baseline to 1-year follow-up (p < 0.05). In the treatment of patients with knee OA, manual physical therapy consisting of either MWM or PJM provided superior benefit over electrotherapy in terms of pain level, knee ROM, quadriceps muscle strength, and functional level.     

Management of chronic ankle pain using joint mobilization and ASTYM? treatment: a case report

Treatment of ankle sprains predominately focuses on the acute management of this condition; less emphasis is placed on the treatment of ankle sprains in the chronic phase of recovery. Manual therapy, in the form of joint mobilization and manipulation, has been shown to be effective in the management of this condition, but the combination of joint mobilization and manipulation in tandem with ASTYM® treatment has not been explored. The purpose of this case report is to chronicle the management of a patient with chronic ankle pain who was treated with manual therapy including manipulation and ASTYM treatment. As a result of a fall down stairs 6 months previously, the patient sustained a severe ankle sprain. The soft tissue damage was accompanied by bony disruptions which warranted the patient spending 3 weeks in a walking boot. At the initial evaluation, the patient reported difficulty with descending stairs reciprocally and not being able to run more than 4 minutes on the treadmill before the pain escalated to the level that she had to stop running. After five sessions of therapy consisting of joint mobilization, manipulation and ASTYM, the patient was able to descend stairs and run 40 minutes without pain.     

Effects of the CORE Exercise Program on Pain and Active Range of Motion in Patients with Chronic Low Back Pain

[Purpose] This study aimed to identify the effects of the CORE exercise program on pain and active range of motion (AROM) in patients with chronic low back pain. [Subjects and Methods] Thirty subjects with chronic low back pain were randomly allocated to two groups: the CORE group (n = 15) and the control group (n = 15). The CORE group performed the CORE exercise program for 30 minutes a day, 3 times a week, for 4 weeks, while the control group did not perform any exercise. The visual analog scale (VAS) and an algometer were used to measure pain, and pain-free AROM in the trunk was measured before and after the intervention. [Results] The CORE group showed significantly decreased VAS scores at rest and during movement and had a significantly increased pressure pain threshold in the quadratus lumborum and AROM in the trunk compared with those in the control group. [Conclusion] This study demonstrated that the CORE exercise program is effective in decreasing pain and increasing AROM in patients with chronic low back pain. Thus, the CORE exercise program can be used to manage pain and AROM in patients with chronic low back pain.Key words: CORE exercise program, Chronic low back pain (CLBP), Active range of motion (AROM)     

The Effects of Thoracic Manipulation Versus Mobilization for Chronic Neck Pain: a Randomized Controlled Trial Pilot Study

[Purpose] To investigate effects of thoracic manipulation versus mobilization on chronic neck pain. [Methods] Thirty-nine chronic neck pain subjects were randomly assigned to single level thoracic manipulation, single level thoracic mobilization, or a control group. The cervical range of motion (CROM) and pain ratings (using a visual analog scale: VAS) were measured before, immediately after and at a 24-hour follow-up. [Results] Thoracic manipulation significantly decreased VAS pain ratings and increased CROM in all directions in immediate and 24-hour follow-ups. The thoracic mobilization group significantly increased in CROM in most directions at immediate follow-up and right and left rotational directions at the 24-hour follow-up. Comparisons between groups revealed the CROM for the manipulation group to increase significantly more than for control subjects in most directions at immediate follow-up and flexion, left lateral flexion and left rotation at the 24-hour follow-up. The CROM for the thoracic mobilization group significantly increased in comparison to the control group in flexion at immediate follow-up and in flexion and left rotation at the 24-hour follow-up. [Conclusion] The study demonstrated reductions in VAS pain ratings and increases in CROM at immediate and 24-hour follow-ups from both single level thoracic spine manipulation and thoracic mobilization in chronic neck pain.Key words: Single level thoracic manipulation, Single level thoracic mobilization, Chronic neck pain     

Thesis Review

Abstract

We report a systematic analysis of group change scores of subjects with chronic neck pain not due to whiplash and without headache or arm pain, in randomized clinical trials of a single session of manual therapy. A comprehensive literature search of clinical trials of chronic neck pain treated with manual therapies up to December 2006 was conducted. Trials that scored above 60% on the PEDro Scale were included. Change scores that scored above 60% on the PEDro Scale were included. Change scores were analyzed for absolute, percentage change and e ect size (ES) whenever possible. Nine trials were identi ed: 6 for spinal manipulation, 4 for spinal mobilization or non-manipulative manual therapy (2 overlapping trials), and 1 trial using ischemic compression. No trials were identi ed for massage therapy or manual traction. Four manipulation trials (Five groups) reported mean immediate changes in 100-mm VAS of –18.94 (9.28) mm. ES for these changes ranged from .33 to 2.3. Two mobilization trials reported immediate VAS changes of –11.5 and –4 mm (ES of .36 and .22, respectively); one trial reported no difference in immediate pain scores versus sham mobilization. e ischemic compression study showed statistically signi cant immediate decreases in 100-mm pain VAS (average = –14.6 mm). There is moderate-to-high quality evidence that immediate clinically important improvements are obtained from a single session of spinal manipulation. e evidence for mobilization is less substantial, with fewer studies reporting smaller immediate changes. ere is insu cient evidence for ischemic compression to draw conclusions. There is no evidence for a single session of massage or manual traction for chronic neck pain.