Non-specific Low Back Pain Patients Research Articles

3D Stereophotogrammetric Quantitative Evaluation of Posture and Spine Proprioception in Subacute and Chronic Nonspecific Low Back Pain.

The literature shows that low back pain causes a reduced lumbar range of movement, affecting patients’ proprioception and motor control. Nevertheless, studies have found that proprioception and motor control of the spine and posture are vague and individually expressed even in healthy young adults. This study aimed to investigate the standing posture and its modifications induced by an instinctive self-correction manoeuvre in subacute and chronic nonspecific low back pain (NSLBP) patients to clarify how NSLBP relates to body upright posture, proprioception, and motor control and how these are modified in patients compared to healthy young adults (121 healthy young adults: 57 females and 64 males). A cohort of 83 NSLBP patients (43 females, 40 males) were recruited in a cross-sectional observational study. Patients’ entire body posture, including 3D spine shape reconstruction, was measured using a non-ionising 3D optoelectronic stereophotogrammetric approach. Thirteen quantitative biomechanical parameters describing the nature of body posture were computed. The statistical analysis was performed using multivariate methods. NSLBP patients did not present an altered proprioception and motor control ability compared to healthy young adults. Furthermore, as for healthy subjects, NSLBP patients could not focus and control their posture globally. Proprioception and motor control in natural erect standing are vague for most people regardless of gender and concurrent nonspecific low back pain. Self-correction manoeuvres improving body posture and spine shape must be learned with specific postural training focusing on the lumbar spine.

Evaluation of Chest Expansion among Non-Specific Low Back Pain Patients

Evaluation of Chest Expansion among Non-Specific Low Back Pain Patients

Psychometric properties of a set of 73 movement biomarkers aiming to discriminate non-specific chronic low back pain patients from an asymptomatic population

Psychometric properties of a set of 73 movement biomarkers aiming to discriminate non-specific chronic low back pain patients from an asymptomatic population

Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial

BackgroundTherapeutic exercises are used in clinical practice for patients with low back pain (LBP). Core stabilization exercises can retrain the important function of local trunk muscles and increase the accuracy of the sensory integration process for stability of the spine in individuals with LBP. The aim of this study was to compare the effects of two different exercise regimes, Core stabilization exercises (CSE) and Strengthening exercise (STE), on proprioception, balance, muscle thickness and pain-related outcomes in patients with subacute non-specific low back pain (NSLBP).MethodsThirty-six subacute NSLBP patients, [mean age, 34.78 ± 9.07 years; BMI, 24.03 ± 3.20 Kg/m2; and duration of current pain, 8.22 ± 1.61 weeks], were included in this study. They were randomly allocated into either CSE (n = 18) or STE groups (n = 18). Exercise training was given for 30 min, three times per week, for up to 4 weeks. Proprioception, standing balance, muscle thickness of transversus abdominis (TrA) and lumbar multifidus (LM), and pain-related outcomes, comprising pain, functional disability and fear of movement, were assessed at baseline and after 4 weeks of intervention.ResultsThe CSE group demonstrated significantly more improvement than the STE group after 4 weeks of intervention. Improvements were in: proprioception [mean difference (95% CI): − 0.295 (− 0.37 to − 0.2), effect size: 1.38, (p < 0.001)], balance: single leg standing with eyes open and eyes closed on both stable and unstable surfaces (p < 0.05), and percentage change of muscle thickness of TrA and LM (p < 0.01). Although both exercise groups gained relief from pain, the CSE group demonstrated greater reduction of functional disability [effect size: 0.61, (p < 0.05)] and fear of movement [effect size: 0.80, (p < 0.01)]. There were no significant adverse effects in either type of exercise program.ConclusionDespite both core stabilization and strengthening exercises reducing pain, core stabilization exercise is superior to strengthening exercise. It is effective in improving proprioception, balance, and percentage change of muscle thickness of TrA and LM, and reducing functional disability and fear of movement in patients with subacute NSLBP.Trial registrationThai Clinical Trial Registry (TCTR20180822001; August 21, 2018).

Test-retest Reliability of EMG β-Band Intermuscular Coherence of Non-specific Chronic Low Back Pain During Flexion-extension Task

Introduction: This study aimed to investigate the reliability and agreement of the Beta-band Intermuscular Coherence (Bb-IMC) as a clinical assessment tool for Non-Specific Chronic Low Back Pain (NS-CLBP) patients and healthy subjects by studying four phases of the Flexion-Extension Task (F-ET): standing, flexion, relaxation, and extension phases. Materials and Methods: Twenty-four men with NS-CLBP and 20 healthy subjects voluntarily participated in this study. All subjects performed three trials of F-ET while the surface electromyography was recorded from the lumbar erector spinal, gluteus maximus, and hamstring muscles of both sides. Beta-band intermuscular coherence analysis was used to calculate the pool coherence and the pairwise coherence for all mentioned muscles. Afterward, the Intra-class Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC) for four phases of F-ET were used to analyze the intra- rater reliability and agreement of the measurements. Results: The investigation of ICC, SEM, and MDC showed that the reliability was moderate to a high level for pool and pairwise coherence of Bb-IMC in all mentioned muscles for four phases of the flexion-extension task in NS-CLBP patients and healthy subjects. Yet, the agreement was low because the measurement error was relatively large. Conclusion: So far, no studies have used the Bb-IMC method to study low back pain, which is carried out in our research to check the reliability of this new method. Our findings revealed that pool and pairwise coherence obtained during F-ET have moderate to a high level of reliability for using Bb-IMC and could be considered a tool for the NS-CLBP patients’ assessment. Despite the small sample size investigated, in clinical practice the using Bb-IMC measure can help to study the interaction of corticospinal in NS-CLBP and also in healthy subjects. This measure requires larger sample sizes in addition to studying other circumstances and functional movements such as lifting weight. Further, more research appears to be warranted by the observed effectiveness of a particular intervention in modulation mechanisms of corticospinal tract function by Bb-IMC in NS-CLBP.

Development of a Portable Chronic Non-specific Low Back Pain Measurement System

We developed a portable non-specific low back pain measurement system EasiLBP and evaluated its performance in collecting EMG signals:during the wearer's movement without the assistance of a doctor, the collection of EMG signals by portable devices met problems such as large noise interference, difficulty in accurately calibrating the start and end points of the action interval, and imbalanced samples for feature recognition, et al. To challenge these problems, we proposed a small group-based noise removal method, a dynamic dual-threshold automatic method for identifying the start and end points of the motion interval, and a sampling method to balance group samples, respectively. Portable device and a medical EMG acquisition equipment Thought Technology FlexComp Infiniti 10 were used to perform EMG measurements on 15 patients with non-specific low back pain and 15 normal people. Clinical experiments and statistical analysis show that the portable EMG acquisition system has significant differences in EMG signal characteristics between normal people and non-specific low back pain patients, and it has good measurement consistency and accuracy with the medical EMG acquisition equipment.

The Effects of Whole-Body Vibration Exercise on Anticipatory Delay of Core Muscles in Patients with Nonspecific Low Back Pain.

Objective The objective of this study is to determine the effect of whole-body vibration (WBV) exercise on the anticipatory delay of core muscles in nonspecific low back pain (NSLBP) patients. Methods Forty participants with NSLBP were randomly divided into the WBV group and the control group. The sEMG signals of deltoid, erector spines (ES), multifidus (MF), rectus abdominis (RA), and transversus abdominus/internal oblique muscles (TrA/IO) were recorded before and after the intervention in the weight-shifting task. The relative activation time of each muscle was calculated. Results In the WBV group, the relative activation time of bilateral MF and bilateral TrA/IO was significantly reduced on shoulder flexion (right MF: P=0.014; left MF: P=0.011; right TrA/IO: P=0.008; left TrA/IO: P=0.026). As for shoulder abduction, except for the left TrA/IO and the left RA, the relative activation time of other muscles was significantly reduced (right ES: P=0.001; left ES: P < 0.001; right MF: P=0.001; left MF: P=0.009; right TrA/IO: P < 0.001; right RA: P=0.001). In the control group, there was no significant difference in the relative activation time of each muscle before and after the intervention (P > 0.05). Conclusions WBV exercise can effectively alleviate the anticipatory delay of core muscles in NSLBP patients, but the long-term effects still need further study. This trial is registered with ChiCTR-TRC-13003708.

Biomechanical Analysis of the Pelvis Angular Excursion in Sagittal Plane in Response to Asymmetric Leg Loading Tasks in Females with and without Non-specific Chronic Low Back Pain.

Background: Controlling pelvic excursions is the focus of stabilization exercises such as legs loading tasks in rehabilitation of non-specific chronic low back pain (NSCLBP) patients. Progression of these exercises is based on the ability to perform tasks with minimal sagittal pelvic excursions. In spite of emphasis on minimizing pelvic motions, no previous studies have investigated kinematic analysis of the pelvic excursions during leg loading exercises in NSCLBP patients. Objective: This study aims to investigate the sagittal pelvis excursion during performing asymmetric leg loading tasks in individuals with and without NSCLBP.Material and Methods: In this cross-sectional study, kinematic data were collected from 15 NSCLBP patients and 15 asymptomatic participants by a motion analysis system during right and left leg loading tasks with 2 levels of difficulty. Pelvis segments were modeled using Visual3D motion analysis software. Maximum pelvic excursion in the sagittal plane was calculated during each task. Mixed model analysis of variances (group, task difficulty level, side) was performed for statistical analysis.Results: The maximum sagittal pelvic excursion values of all tasks in NSCLBP were smaller than those in the control group; however, no significant main effects and interactions were found between two groups. Conclusion: These results suggest that NSCLBP patients completed loading tasks without differences in sagittal pelvic excursions as compared to controls. Assessment of NSCLBP patients only based on pelvic angular excursion may not be sufficient for clinical decision making. Furthermore, asymptomatic individuals may need to practice for controlling pelvic excursion during leg loading exercises similar to the CLBP patients.

Lumbo-pelvic proprioception in sitting is impaired in subgroups of low back pain-But the clinical utility of the differences is unclear. A systematic review and meta-analysis.

Altered spinal postures and altered motor control observed among people with non-specific low back pain have been associated with abnormal processing of sensory inputs. Evidence indicates that patients with non-specific low back pain have impaired lumbo-pelvic proprioceptive acuity compared to asymptomatic individuals. To systematically review seated lumbo-pelvic proprioception among people with non-specific low back pain. Five electronic databases were searched to identify studies comparing lumbo-pelvic proprioception using active repositioning accuracy in sitting posture in individuals with and without non-specific low back pain. Study quality was assessed by using a modified Downs and Black's checklist. Risk of bias was assessed using an adapted tool for cross-sectional design and case-control studies. We performed meta-analysis using a random effects model. Meta-analyses included subgroup analyses according to disability level, directional subgrouping pattern, and availability of vision during testing. We rated the quality of evidence using the GRADE approach. 16 studies met the eligibility criteria. Pooled meta-analyses were possible for absolute error, variable error, and constant error, measured in sagittal and transverse planes. There is very low and low certainty evidence of greater absolute and variable repositioning error in seated tasks among non-specific low back pain patients overall compared to asymptomatic individuals (sagittal plane). Subgroup analyses indicate moderate certainty evidence of greater absolute and variable error in seated tasks among directional subgroups of adults with non-specific low back pain, along with weaker evidence (low-very low certainty) of greater constant error. Lumbo-pelvic proprioception is impaired among people with non-specific low back pain. However, the low certainty of evidence, the small magnitude of error observed and the calculated "noise" of proprioception measures, suggest that any observed differences in lumbo-pelvic proprioception may be of limited clinical utility. CRD42018107671.

Effect of Physiotherapy Treatment in the Autonomic Activation and Pain Perception in Male Patients with Non-Specific Subacute Low Back Pain.

Introduction: Physiotherapy treatment is a common intervention for low back pain (LBP) patients. These interventions have been related to physiological effects in the central nervous system. Thus, the aim of this study was to analyze the effect of physiotherapy treatment in patients with LBP in the autonomic nervous system activation and subjective pain perception of patients. Methods: A total of 30 male subjects diagnosed with non-specific subacute LBP received a 50 min session consisting of (a) a manual therapy based on joint mobilization and soft tissues techniques in the lumbo-pelvic area, (b) a stretching program, and (c) motor control exercises of the core muscles. The autonomic modification of participants was assessed prior to and after the physiotherapy treatment. Results: Heart rate variability (HRV) analysis reported a significant increase in average RR (p = 0.001), RMSSD (p = 0.008), LRMSSD (p = 0.001), SDNN (p = 0.005), and PNN50 (p = 0.024) after the session. Frequency-domain measures showed a significant increase in LF (p = 0.030) and HF (p = 0.014), and a decrease in LF/HF ratio (p = 0.046). A significant decrease was found in minimum HR values (p = 0.001) and average HR (p = 0.001). Moreover, maximal HR decreased its value from 116.7 ± 26.1 to 113.7 ± 40.8 after intervention. In addition, subjective pain perception (VAS scores) was significantly lower (p = 0.001) in the post-session assessment. Conclusions: Physiotherapy treatment produced an increase in parasympathetic nervous system activation and a decrease in subjective pain perception in non-specific subacute LBP patients.

Slacklining as therapy to address non-specific low back pain in the presence of multifidus arthrogenic muscle inhibition.

Low back pain (LBP) represents the most prevalent, problematic and painful of musculoskeletal conditions that affects both the individual and society with health and economic concerns. LBP is a heterogeneous condition with multiple diagnoses and causes. In the absence of consensus definitions, partly because of terminology inconsistency, it is further referred to as non-specific LBP (NSLBP). In NSLBP patients, the lumbar multifidus (MF), a key stabilizing muscle, has a depleted role due to recognized myocellular lipid infiltration and wasting, with the potential primary cause hypothesized as arthrogenic muscle inhibition (AMI). This link between AMI and NSLBP continues to gain increasing recognition. To date there is no ‘gold standard’ or consensus treatment to alleviate symptoms and disability due to NSLBP, though the advocated interventions are numerous, with marked variations in costs and levels of supportive evidence. However, there is consensus that NSLBP management be cost-effective, self-administered, educational, exercise-based, and use multi-modal and multi-disciplinary approaches. An adjuvant therapy fulfilling these consensus criteria is ‘slacklining’, within an overall rehabilitation program. Slacklining, the neuromechanical action of balance retention on a tightened band, induces strategic indirect-involuntary therapeutic muscle activation exercise incorporating spinal motor control. Though several models have been proposed, understanding slacklining’s neuro-motor mechanism of action remains incomplete. Slacklining has demonstrated clinical effects to overcome AMI in peripheral joints, particularly the knee, and is reported in clinical case-studies as showing promising results in reducing NSLBP related to MF deficiency induced through AMI (MF-AMI). Therefore, this paper aims to: rationalize why and how adjuvant, slacklining therapeutic exercise may positively affect patients with NSLBP, due to MF-AMI induced depletion of spinal stabilization; considers current understandings and interventions for NSLBP, including the contributing role of MF-AMI; and details the reasons why slacklining could be considered as a potential adjuvant intervention for NSLBP through its indirect-involuntary action. This action is hypothesized to occur through an over-ride or inhibition of central down-regulatory induced muscle insufficiency, present due to AMI. This subsequently allows neuroplasticity, normal neuro-motor sequencing and muscle re-activation, which facilitates innate advantageous spinal stabilization. This in-turn addresses and reduces NSLBP, its concurrent symptoms and functional disability. This process is hypothesized to occur through four neuro-physiological processing pathways: finite neural delay; movement-control phenotypes; inhibition of action and the innate primordial imperative; and accentuated corticospinal drive. Further research is recommended to investigate these hypotheses and the effect of slacklining as an adjuvant therapy in cohort and control studies of NSLBP populations.

Similar Pain Intensity Reductions and Trunk Strength Improvements Following Whole-Body Electromyostimulation vs. Whole-Body Vibration vs. Conventional Back-Strengthening Training in Chronic Non-specific Low Back Pain Patients: A Three-Armed Randomized Controlled Trial.

The aim of this multicenter trial was to compare the effects of whole-body electromyostimulation (WB-EMS) and whole-body vibration (WBV) with conventional back-strengthening training (CT) on changes in mean back pain intensity (MPI) and trunk strength in patients suffering from chronic non-specific low back pain (CNLBP). Two-hundred and forty CNLBP patients (40–70 years; 62% female) were randomly assigned to three intervention arms (WB-EMS: n = 80 vs. WBV: n = 80 vs. CT: n = 80). All training intervention programs were performed for 12 weeks in their usual commercial training setting. Before and during the last 4 weeks of the intervention, MPI was recorded using a 4-week pain diary. Additionally, maximal isometric trunk extension and -flexion strength was assessed on the BackCheck® machine. A moderate but significant decrease of MPI was observed in all groups (WB-EMS: 29.7 ± 39.1% (SMD 0.50) vs. WBV: 30.3 ± 39.3% (SMD 0.57) vs. CT: 30.5 ± 39.6% (SMD 0.59); p < 0.001). Similar findings were observed for maximal isometric strength parameters with a significant increase in all groups (extension: WB-EMS: 17.1 ± 25.5% vs. WBV: 16.2 ± 23.6% vs. CT: 21.6 ± 27.5%; p < 0.001; flexion: WB-EMS: 13.3 ± 25.6% vs. WBV: 13.9 ± 24.0% vs. CT: 13.9 ± 25.4%; p < 0.001). No significant interaction effects for MPI (p = 0.920) and strength parameters (extension: p = 0.436; flexion: p = 0.937) were observed. WB-EMS, WBV, and CT are comparably effective in improving MPI and trunk strength. However, training volume of WB-EMS was 43 or 62% lower, compared with CT and WBV.

Efficacy of Innovative Table for Traction, Myofascial Release Along with Medicated Steam (Swedan) in Non-Specific Low Back Pain Patients: A Research Protocol

Background: Low back pain (LBP) is a common condition associated with work absenteeism, disabilityand large health care costs with an annual prevalence range from 22% to 65%.Chronic low back pain is thecondition where the back pain lasts for more than three months. Lumbar traction is the process of applying astretching force to the lumbar vertebrae through body weight, weights, and/or pulleys to distract individualjoints of the lumbar spine. Myofascial release (MFR) is a form of manual medicine which involves theapplication of a low load, long duration stretch to the myofascial complex, intended to restore optimallength, decrease pain, and improve function. Medicated steam therapy is a method of giving medicatedsteam over the affected muscular area in order to provide local effect of pain relief. All the three methodswill be applied together to see the effect.Methods/Design: The study will be designed as a pilot study. A total of 30 samples will be taken withnonspecific low back pain. NPRS and Modified Oswestry Disability index was taken before treatment.Intervention including traction, myofascial release therapy and medicated steam will be given. . Two sessionswill be given once a week for 3 weeks and outcome will be recorded.Discussion: Various studies have been conducted over the effect of lumbar traction over low back pain.Traction distracts the muscles and the joint helps in relieving the pain. One of the therapeutic options istraction, which can be combined with other physical therapy modalities. Combining effect of traction withhot fermentation has been effective study have shown. It has been claimed that traction therapy results inlessening the muscle spasm

Myofascial release versus Mulligan sustained natural apophyseal glides' immediate and short-term effects on pain, function, and mobility in non-specific low back pain.

BackgroundMyofascial release (MFR) and Mulligan Sustained Natural Apophyseal Glides (SNAGs) are manual therapy techniques routinely practiced in the management of non-specific low back pain (NSLBP). As a solo intervention or along with other therapies, both methods have reported positive results for individuals with NSLBP. However, which technique improves NSLBP-related pain, restricted range of motion (ROM) and disability, warrants further research.ObjectiveTo study the comparative effects of MFR and SNAGs on pain, disability, functional ability, and lumbar ROM in NSLBP.MethodA parallel-group study was conducted at tertiary care hospitals. Sixty-five Sub-acute or chronic NSLBP patients were allocated to receive strengthening exercises along with either MFR (n = 33) or SNAGs (n = 32) for six treatment sessions over one week. An independent assessor evaluated outcome measures such as the Visual Analog Scale (VAS), Patient-Specific Function Scale (PSFS), and ROM at baseline, immediate (after 1st treatment), and short-term (post-sixth day of the intervention). The Modified Oswestry disability index (MODI) was assessed at baseline and short-term.ResultsWithin-group analysis found clinically and statistically significant (p < 0.05) changes for VAS and PSFS at immediate and short-term for both the groups. The lumbar extension also showed improvement immediately and in the short-term. Improvement in Lumbar flexion was seen only in the SNAGs group over the short-term. A statistically significant improvement was seen for MODI in both the groups but was not clinically significant in the MFR group. The analysis observed no statistically significant difference (p < 0.05) between the groups at both the immediate and short-term.ConclusionsPain and restricted function associated with NSLBP can be improved using SNAGs or MFR, along with strengthening exercises. For limited lumbar flexion ROM, Mulligan SNAGs have a better outcome than MFR over the short-term. Hence, both manual therapy techniques can be incorporated along with exercises for immediate and short-term management of sub-acute to chronic NSLBP.Clinical Trial Registration. CTRI/2018/12/016787 (http://ctri.nic.in/Clinicaltrials/).

A systematic review of movement and muscular activity biomarkers to discriminate non-specific chronic low back pain patients from an asymptomatic population

The identification of relevant and valid biomarkers to distinguish patients with non-specific chronic low back pain (NSCLBP) from an asymptomatic population in terms of musculoskeletal factors could contribute to patient follow-up and to evaluate therapeutic strategies. Several parameters related to movement and/or muscular activity impairments have been proposed in the literature in that respect. In this article, we propose a systematic and comprehensive review of these parameters (i.e. potential biomarkers) and related measurement properties. This systematic review (PROSPERO registration number: CRD42020144877) was conducted in Medline, Embase, and Web of Knowledge databases until July 2019. In the included studies, all movements or muscular activity parameters having demonstrated at least a moderate level of construct validity were defined as biomarkers, and their measurement properties were assessed. In total, 92 studies were included. This allowed to identify 121 movement and 150 muscular activity biomarkers. An extensive measurement properties assessment was found in 31 movement and 14 muscular activity biomarkers. On the whole, these biomarkers support the primary biomechanical concepts proposed for low back pain. However, a consensus concerning a robust and standardised biomechanical approach to assess low back pain is needed.

Effects of spinal manipulative therapy on inflammatory mediators in patients with non-specific low back pain: a non-randomized controlled clinical trial

BackgroundThe inflammatory profiles of patients with acute and chronic nonspecific low back pain (LBP) patients are distinct. Spinal manipulative therapy (SMT) has been shown to modulate the production of nociceptive chemokines differently in these patient cohorts. The present study further investigates the effect(s) of SMT on other inflammatory mediators in the same LBP patient cohorts.MethodsAcute (n = 22) and chronic (n = 25) LBP patients with minimum pain scores of 3 on a 10-point numeric scale, and asymptomatic controls (n = 24) were recruited according to stringent exclusion criteria. Blood samples were obtained at baseline and after 2 weeks during which patients received 6 SMTs in the lumbar or lumbosacral region. The in vitro production of tumor necrosis factor (TNFα), interleukin-1 β (IL-1β), IL-6, IL-2, interferon ɣ (IFNɣ), IL-1 receptor antagonist (IL-1RA), TNF soluble receptor type 2 (sTNFR2) and IL-10 was determined by specific immunoassays. Parametric as well as non-parametric statistics (PAST 3.18 beta software) was used to determine significance of differences between and within study groups prior and post-SMT. Effect size (ES) estimates were obtained using Cohen’s d.ResultsCompared with asymptomatic controls, SMT-related change scores were significant (P = 0.03–0.01) in reducing the production levels of TNFα in both patient cohorts and those of IL-6, IFNɣ and sTNFR2 (P = 0.001–0.02) in patients with chronic LBP. Above-moderate to large ES (d > 0.6–1.4) was observed for these mediators. Compared with respective baselines, a significant post-SMT reduction (P = 0.01) of IL-6 production was detected only in patients with chronic LBP while a significant increase of IL-2 production (P = 0.001 vs. control, and P = 0.004 vs. chronic LBP group) and a large ES (d = 0.87) were observed in patients with acute LBP. Pain and disability scores declined significantly (P < 0.001) in all LBP patients, and were positively correlated (P = 0.03) with IFNɣ and IL-2 levels in the acute LBP cohort.ConclusionThe short course of SMT treatments of non-specific LBP patients resulted in significant albeit limited and diverse alterations in the production of several of the mediators investigated in this study. This exploratory study highlights the potential of SMT to modulate the production of inflammatory components in acute and chronic non-specific LBP patients and suggests a need for further, randomized controlled clinical trials in this area.Trial registrationThis study was prospectively registered April 2012 with Clinical Trials.gov (#NCT01766141).https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0003ZIL&selectaction=Edit&uid=U0001V74&ts=2&cx=-axvqtg

Efficacy of hydrotherapy treatment for the management of chronic low back pain.

The study investigated the influence of hydrotherapy method-based McKenzie and Williams among patients with non-specific low back pain (NSLBP). Semi-experimental pretest-posttest with a control group design trial was conducted at Health Service Center, Qazvin, Iran. Twenty-eight NSLBP patients (16 men and 12 women, age: 42.5 ± 7years) were recruited. Hydrotherapy program developed based on McKenzie and Williams therapy was performed individually 3days per week for 20 sessions. Therefore, the study compared a hydrotherapy group (based on McKenzie and Williams therapy) to a control group. Participants attended a hydrotherapy program under the supervision of a hydrotherapist. The Numeric Pain Rating Scale (NPRS), Roland-Morris Disability Questionnaire (RMDQ), and Straight Leg Raise Test (SLRT) were measured at the beginning, middle, and at the end of the 20 sessions to determine pain and functionality of the patient's improvement. Overall, NPRS, RMDQ, and SLRT scores were improved in hydrotherapy group in the 10th session and 20th session compared with baseline (p ≤ 0.001) and control group (p ≤ 0.001). No difference in the treatment variables between the 10th session and the 20th session was observed (p > 0.05). The results indicated that the NSLBP symptom was improved after 10 sessions of hydrotherapy program developed based on McKenzie and Williams therapy.

Effects of proprioceptive neuromuscular facilitation techniques in treating chronic nonspecific low back pain patients

IntroductionAs one of the highly prevalent musculoskeletal disorders, low back pain incurs high medical care costs. Proprioceptive neuromuscular facilitation has been used in treating chronic low back pain. This study aimed to investigate the effects of multiple proprioceptive neuromuscular facilitation techniques on endurance of the trunk musculature, spinal mobility, and impairment of function in cases of chronic low back pain.MethodsPatients in this study were randomly assigned into 3 groups. Group A received rhythmic stabilization training, group B received a combination of isotonic exercises, while group C received a combination of both rhythmic stabilization training and combination of isotonic exercises. Trunk endurance was evaluated with trunk flexion and trunk extension endurance tests, spinal mobility was assessed with a modified Schober test, and functional impairment was measured with Oswestry Disability Index.ResultsANOVA showed significant differences (&lt;i&gt;p&lt;/i&gt; &lt; 0.05) among the groups after treatment in the measured outcomes. Tukey’s honest significant difference post-hoc test revealed a highly statistically significant improvement in the measured outcomes of group C in comparison with the other groups in the post-intervention conditions.ConclusionsThe application of the rhythmic stabilization training technique of proprioceptive neuromuscular facilitation followed by a combination of isotonic exercises was more effective than implementing either technique alone in the treatment of patients with chronic low back pain.

Acupuncture for the Management of Low Back Pain.

This evidence-based systematic review will focus on the use of acupuncture and its role in the treatment of low back pain to help better guide physicians in their practice. It will cover the background and the burden of low back pain and present the current options for treatment and weigh the evidence that is available to support acupuncture as a treatment modality for low back pain. Low back pain (LBP), defined as a disorder of the lumbosacral spine and categorized as acute, subacute, or chronic, can be a debilitating condition for many patients. Chronic LBP is more typically defined by its chronicity with pain persisting > 12weeks in duration. Conventional treatment for chronic LBP includes both pharmacologic and non-pharmacologic options. First-line pharmacologic therapy involves the use of NSAIDs, then SNRI/TCA/skeletal muscle relaxants, and antiepileptics. Surgery is usually not recommended for chronic non-specific LBP patients. According to the 2016 CDC Guidelines for Prescribing Opioids for Chronic Pain and the 2017 American College of Physicians (ACP) clinical practice guidelines for chronic pain, non-pharmacologic interventions, acupuncture can be a first-line treatment for patients suffering from chronic low back pain. Many studies have been done, and most show promising results for acupuncture as an alternative treatment for low back pain. Due to non-standardized methods for acupuncture with many variations, standardization remains a challenge.

Clinical effectiveness of "long snake moxibustion" for cold-dampness type chronic non-specific low back pain patients with negative emotions

To observe the clinical efficacy of long snake moxibustion and Ashi-point moxibustion in the treatment of cold-dampness type chronic non-specific low back pain (CNLBP) patients. A total of 120 cold-dampness type CNLBP patients who signed the informed consent were randomly and equally divided into control, long snake moxibustion and Ashi-point moxibustion groups. Ginger-separated moxibustion was applied to the region between Dazhui (GV14) and Yaoshu (GV2) for patients of the long-snake moxibustion group, or to the tenderness spot of the waist for patients of the Ashi-point moxibustion group. The treatment was conducted for 40 min each time, once every other day for a total of 8 sessions. Patients of the control group did not receive any intervention. The visual analogue scale (VAS) was used to assess low back pain severity. The Oswestry Disability Index (ODI) was employed to assess ten aspects of patients' daily-life activities (pain intensity, personal care, lif-ting, walking, sitting, standing, sleeping, sex life, social life, and traveling). The cold-damp syndrome scores (pain property, symptoms, ranges of motion, waist palpation, tongue and pulse condition) were achieved by consulting the textbook "Differential Diagnostics of Traditional Chinese Medicine Syndromes". The Hospital Anxiety and Depression Scale (HADS, a self-made assessment instrument) was used to assess the patients' severity of emotional disorder.The plasma cortisol level was detected by ELISA. Before treatment, there were no significant differences among the three groups in the levels of all the indexes (P>0.05). After moxibustion, the VAS scores during rest and movement, ODI score, cold-damp syndrome score and anxiety score in both long snake moxibustion and Ashi-point moxibustion groups, and the HADS depression score and plasma cortisol content in the long snake moxibustion group were significantly reduced compared with their own pre-treatment (P<0.05). The difference values between pre and post-treatment of VAS scores during rest and movement, ODI score, cold-damp syndrome score, anxiety score, depression score and cortisol content were obviously higher in the long snake moxibustion and Ashi-point moxibustion groups than those in the control group. The difference values between pre- and post-treatment of VAS scores during rest and movement, ODI score, cold-damp syndrome score, anxiety score, depression score and cortisol content were obviously higher in the long snake moxibustion group than in the Ashi-point group (P<0.05). Both ginger-separated long snake moxibustion and Ashi-point moxibustion can relieve low back pain, daily-life activities, cold-damp syndrome, negative emotions, and reducing cortisol level in cold-dampness type CNLBP patients，and the therapeutic efficacy of long snake moxibustion is obviously better.