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Studnicki R, Szymczyk P, Adamczewski T, Studzińska K, Hansdorfer-Korzon R, Silva AF, Kawczyński A. Manual traction is effective in alleviating lumbosacral spine pain: Evidence from a randomized controlled trial. Heliyon 2024; 10:e31013. [PMID: 38799754 PMCID: PMC11126845 DOI: 10.1016/j.heliyon.2024.e31013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Background Manual traction, a therapeutic technique frequently employed in healthcare, involves applying controlled pulling force by hand, usually to the spine, to stretch muscles and decompress joints, thereby alleviating pain. This method can be particularly beneficial for addressing lumbosacral spine pain exacerbated by radicular symptoms, characterized by pain radiating from the lower back due to compression or irritation of spinal nerves. Purpose This study aimed to compare the effects of manual traction against control group in alleviating the lumbosacral spine pain caused by radicular symptoms. Methods A randomized controlled study design was utilized with a sample of 60 patients experiencing lumbosacral spine pain, evenly distributed between an experimental group (n = 30; receiving manual traction) and a control group (n = 30). Patients underwent assessments before and after six treatment sessions, which included the Straight Leg Raise test, modified Bragard's test, Kernig's test, and the visual analogue scale for pain perception. Results Between-group significant differences were found at post-intervention, favoring the experimental group on SLR - Left (°) (p = 0.004; medium effect size), SLR - Right (°) (p = 0.004; medium effect size), Modified Bragard test - Left (°) (p = 0.024; small effect size), Modified Bragard test - Right (°) (p = 0.003; medium effect size), Kernig's Test - Left (°) (p = 0.013; medium effect size) and Kernig's Test - Right (°) (p = 0.010; medium effect size). Additionally, between-group significant differences were found at post-intervention, favoring the experimental group on VAS scores at SLR left (p < 0.001; medium effect size), and right (p < 0.001); medium effect size, Modified Bragard test left (p < 0.001; medium effect size) and right (p < 0.001; medium effect size) and at Kernig's Test left (p < 0.001; medium effect size) and right (p < 0.001; medium effect size). Conclusions In conclusion, manual traction is recommended as an effective approach for alleviating lumbosacral spine pain in patients experiencing symptoms resulting from irritation or compression of a spinal nerve root.
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Affiliation(s)
- Rafał Studnicki
- Sub-Faculty of Physiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Szymczyk
- Sub-Faculty of Physiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Adamczewski
- Medical Rehabilitation Clinic, Chair of Rehabilitation, Faculty of Health Sciences, Medical University of Lódź, Łódź, Poland
| | | | | | - Ana Filipa Silva
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal
- Sport Physical Activity and Health Research & Innovation Center, Viana do Castelo, Portugal
| | - Adam Kawczyński
- Wrocław University of Health and Sport Sciences, Departament of Paralympic Games, Wrocław, Poland
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Vomer RP, York E, DeMatas K, Shah NP, Larick RS, Punj M, Rosario-Concepcion RA, Pujalte GGA. Telemedicine Evaluation of Hip Ailments. Cureus 2023; 15:e38900. [PMID: 37303331 PMCID: PMC10257509 DOI: 10.7759/cureus.38900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Background During the coronavirus disease 2019 (COVID-19) pandemic, telemedicine has provided new means of patient care while still allowing for physical examination and history to be obtained. Hip ailments are a common musculoskeletal problem leading to limited function. Today, we lack a standardized telemedicine hip evaluation protocol. Aim The aim of this manuscript is to provide an efficient means of extracting relevant information while performing telemedicine examinations of the hip. Methods The authors have created a step-by-step evaluation guide for physicians to evaluate hip complaints, including inspection, palpation, range of motion, strength testing, functional assessment, gait analysis, and special testing, with images of each maneuver. Results We have developed a table of evaluation questions and instructions and a glossary of images of each maneuver to facilitate hip examination via telemedicine. Conclusions This manuscript provides a structured template for performing a telehealth examination of hip ailments.
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Affiliation(s)
- Rock P Vomer
- Family Medicine/Research, Mayo Clinic Jacksonville Campus, Jacksonville, USA
- Department of Family and Community Health/Department of Orthopedics, Division of Sports Medicine, Duke University, Durham, USA
| | - Emma York
- Family Medicine, Eastern Virginia Medical School, Norfolk, USA
| | - Kristina DeMatas
- Family Medicine/Sports Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, USA
| | - Neil P Shah
- Family and Community Medicine, Mayo Clinic Jacksonville Campus, Jacksonville , USA
| | - Rayghan S Larick
- Family and Community Medicine, Eastern Virginia Medical School, Norfolk, USA
| | - Mantavya Punj
- Family Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, USA
| | | | - George G A Pujalte
- Family Medicine/Orthopedics/Sports Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, USA
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3
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Mustafa R, Kissoon NR. Approach to Radiculopathy. Semin Neurol 2021; 41:760-770. [PMID: 34826877 DOI: 10.1055/s-0041-1726363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Low back pain and neck pain, often with associated radiculopathy, are two of the most common reasons for referral to the outpatient neurology clinic. A thorough clinical evaluation remains paramount in establishing an accurate diagnosis and subsequently an appropriate treatment plan. In this article, we review anatomic considerations for spondylotic radiculopathy; outline the clinical approach for the evaluation of these patients, including discussion of electrodiagnostic and imaging modalities; and address treatment options based on a stratified treatment approach.
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Affiliation(s)
- Rafid Mustafa
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Narayan R Kissoon
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.,Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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4
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Pesonen J, Shacklock M, Rantanen P, Mäki J, Karttunen L, Kankaanpää M, Airaksinen O, Rade M. Extending the straight leg raise test for improved clinical evaluation of sciatica: reliability of hip internal rotation or ankle dorsiflexion. BMC Musculoskelet Disord 2021; 22:303. [PMID: 33761924 PMCID: PMC7992338 DOI: 10.1186/s12891-021-04159-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/09/2021] [Indexed: 01/23/2023] Open
Abstract
Background The straight leg raise (SLR) is the most commonly applied physical tests on patients with sciatica, but the sensitivity and specificity ratings for disc hernia and neural compression leave areas for improvement. Hip internal rotation tensions the lumbosacral nerve roots and ankle dorsiflexion tensions the sciatic nerve along its course. We added these movements to the SLR (extended SLR = ESLR) as structural differentiators and tested inter-rater reliability in patients with LBP, with and without sciatica. Methods Forty subjects were recruited to the study by the study controller (SC), 20 in the sciatic group and in the control group. Two independent examiners (E1&E2) performed the ESLR and did not communicate to the subjects other than needed to determine the outcome of the ESLR. First, SLR was performed traditionally until first responses were evoked. At this hip flexion angle, a location-specific structural differentiation was performed to confirm whether the emerged responses were of neural origin. Cohen’s Kappa score (CK) for interrater reliability was calculated for ESLR result in detection of sciatic patients. Also, the examiners’ ESLR results were compared to the traditional SLR results. Results The interrater agreement between Examiner 1 and Examiner 2 for the ESLR was 0.85 (p < 0.001, 95%CI: 0.71–0.99) translating to almost perfect agreement as measured by Cohen’s Kappa When the ESLR was compared to the traditional SLR, the overall agreement rate was 75% (30/40). Kappa values between the traditional SLR and the E1’s or E2’s ESLR results were 0.50 (p < 0.0001; 95%CI 0.27–0.73) and 0.54 (p < 0.0001; 95%CI 0.30–0.77), respectively. Conclusions ESLR with the addition of location-specific structural differentiation is a reliable and repeatable tool in discerning neural symptoms from musculoskeletal in patients with radiating low back pain. We recommend adding these movements to the standard SLR with aim of improving diagnostic ability.
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Affiliation(s)
- Janne Pesonen
- Department of Rehabilitation, Kuopio University Hospital, PL100, 70029 KYS, Kuopio, Finland. .,Department of Surgery (incl. Physiatry), University of Eastern Finland, Kuopio, Finland.
| | - Michael Shacklock
- Department of Rehabilitation, Kuopio University Hospital, PL100, 70029 KYS, Kuopio, Finland.,Neurodynamic Solutions, Adelaide, Australia
| | - Pekka Rantanen
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital, Helsinki, Finland.,Department of Physical and Rehabilitation Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Jussi Mäki
- Department of Rehabilitation, Kuopio University Hospital, PL100, 70029 KYS, Kuopio, Finland
| | - Lauri Karttunen
- Department of Rehabilitation, Kuopio University Hospital, PL100, 70029 KYS, Kuopio, Finland.,Department of Surgery (incl. Physiatry), University of Eastern Finland, Kuopio, Finland
| | - Markku Kankaanpää
- Department of Physical and Rehabilitation Medicine, Tampere University Hospital, Tampere, Finland
| | - Olavi Airaksinen
- Department of Rehabilitation, Kuopio University Hospital, PL100, 70029 KYS, Kuopio, Finland.,Department of Surgery (incl. Physiatry), University of Eastern Finland, Kuopio, Finland
| | - Marinko Rade
- Department of Rehabilitation, Kuopio University Hospital, PL100, 70029 KYS, Kuopio, Finland.,Department of Surgery (incl. Physiatry), University of Eastern Finland, Kuopio, Finland.,Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Orthopaedic and Rehabilitation Hospital "Prim. dr. Martin Horvat", Rovinj, Croatia.,Department of Natural and Health Studies, Juraj Dobrila University of Pula, Pula, Croatia
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González Espinosa de los Monteros FJ, Gonzalez-Medina G, Ardila EMG, Mansilla JR, Expósito JP, Ruiz PO. Use of Neurodynamic or Orthopedic Tension Tests for the Diagnosis of Lumbar and Lumbosacral Radiculopathies: Study of the Diagnostic Validity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7046. [PMID: 32993094 PMCID: PMC7579046 DOI: 10.3390/ijerph17197046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lumbar radiculopathy is a nerve root disorder whose correct diagnosis is essential. The objective of the present study was to analyze the reliability diagnostic validity of eight neurodynamic and/or orthopedic tension tests using magnetic resonance imaging as the Gold Standard. METHODS An epidemiological study of randomized consecutive cases which was observational, descriptive, transversal, double blinded and was conducted following the Standards for Reporting Diagnostic accuracy studies (STARD) declaration. The sample size was 864 participants. Internal and external validity (CI = 95%) and reliability, were calculated for all tests performed independently. The diagnostic validity of the combined and multiple tests in parallel was also calculated. RESULTS The analysis indicated that only two tests performed independently had external validity, but neither had reliability or precision. The Straight Leg Raise test and the Bragard test performed in a multiple parallel way showed high sensitivity (97,40%), high negative predictive value (PV- 96,64%) and external validity (Likelihood Ratio- 0,05). The combined test of the Slump test and the Dejerine's triad had internal and external validity. CONCLUSIONS The Straight Leg Raise test and the Bragard test performed in a multiple parallel way and the combined test of the Slump Test and the Dejerine's triad have clinical validity to discard lumbar or lumbar-sacral radiculopathy.
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Affiliation(s)
| | - Gloria Gonzalez-Medina
- Nursing and Physiotherapy Department, Cadiz University, Av. Ana de Viya, 52, 11009 Cadiz, Spain;
| | - Elisa Maria Garrido Ardila
- Department of Medical-Surgical Therapy, Medicine Faculty, Extremadura University, 06006 Badajoz, Spain; (E.M.G.A.); (J.R.M.)
| | - Juan Rodríguez Mansilla
- Department of Medical-Surgical Therapy, Medicine Faculty, Extremadura University, 06006 Badajoz, Spain; (E.M.G.A.); (J.R.M.)
| | - José Paz Expósito
- Andalusian Health Service, Hospital “Puerta Universitario del Mar”, Av. Ana de Viya, 21, 11009 Cádiz, Spain; (F.J.G.E.d.l.M.); (J.P.E.)
| | - Petronila Oliva Ruiz
- Nursing and Physiotherapy Department, Cadiz University, Av. Ana de Viya, 52, 11009 Cadiz, Spain;
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Berthelot JM, Darrieutort-Laffite C, Arnolfo P, Glémarec J, Le Goff B, Maugars Y. Inadequacies of the Lasègue test, and how the Slump and Bowstring tests are useful for the diagnosis of sciatica. Joint Bone Spine 2020; 88:105030. [PMID: 32561431 DOI: 10.1016/j.jbspin.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 01/19/2023]
Abstract
Diagnosis of sciatica mainly relies on pain reproduction by stretching of the lumbar roots since neurological examination and medical history are usually not sufficient to guarantee diagnosis. The Lasègue test is the most popular method, which starts with the straight leg-raising test (SLR). However it is not perfect, and is not always well performed or interpreted. Passive ankle dorsiflexion at the end of the SLR (Bragard test) is more sensitive, but can also remain normal in some cases of sciatica. Other stretching tests can help to recognise lumbar root damage in patients with poorly defined pain in a lower extremity: firstly, the Christodoulides test, i.e. reproduction of L5 sciatic pain by a femoral stretch test; secondly, the Slump test, performed on a patient in a sitting position, by slowly extending their painful leg then passively bending their neck (or the opposite); and thirdly, the Bowstring test, which requires, at the end of the Lasègue test, once the knee has been slightly flexed, pressing on the course of the peroneal and/or tibial nerves in the popliteal fossea to try and reproduce the exact pain felt by the patient. The combination of all these tests takes less than 2minutes, and could improve both the sensitivity and specificity of the physical examination for the diagnosis of sciatica. This article is a review of the limitations of the Lasègue/SLR tests and of the efficacy of these other tests for stretching the lumbar roots.
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Affiliation(s)
- Jean-Marie Berthelot
- Service de rhumatologie, Hôtel-Dieu, CHU of Nantes, 44093, Nantes cedex 01, France.
| | | | - Paul Arnolfo
- Service de rhumatologie, Hôtel-Dieu, CHU of Nantes, 44093, Nantes cedex 01, France
| | - Joëlle Glémarec
- Service de rhumatologie, Hôtel-Dieu, CHU of Nantes, 44093, Nantes cedex 01, France
| | - Benoît Le Goff
- Service de rhumatologie, Hôtel-Dieu, CHU of Nantes, 44093, Nantes cedex 01, France
| | - Yves Maugars
- Service de rhumatologie, Hôtel-Dieu, CHU of Nantes, 44093, Nantes cedex 01, France
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