Clinical Efficacy of Mechanical Traction as Physical Therapy for Lumbar Disc Herniation: A Meta-Analysis

In search of biomarkers for low back pain: can traction therapy effectiveness be prognosed by surface electromyography or blood parameters?

Background: Lumbar traction therapy is a common method to reduce low back pain (LBP) but is not always effective. The search for biomarkers that would prognose the effectiveness of LBP management is one priority for improving patients' quality of life. Objectives: 1) To determine the phenotype of patients benefiting most from lumbar traction therapy. 2) To correlate systemic and electromyographic biomarkers with pain and pain-related disability. Methods: Data on muscle bioelectrical activity (surface electromyography [SEMG]) in the flexion-extension task, the concentrations of twelve systemic biochemical factors, LBP intensity (Visual Analog Scale), the Oswestry Disability Index, and the Roland-Morris Disability Questionnaire (RMDQ) were collected before and 72 h after 20 sessions of lumbar traction therapy. Patients were divided into responders and nonresponders based on the criterion of a 50% reduction in maximal pain. Results: The responders had lower maximal muscle bioactivity in the extension phase on the left side (p < 0.01) and higher flexion-extension ratios on both sides of the body in the SEMG (left: p < 0.05; right: p < 0.01), and higher adipsin, interleukin-2, interleukin-4, and interleukin-10 concentrations (p < 0.05) than nonresponders. Patients with higher interleukin-4 concentrations before therapy achieved greater reductions in maximal pain in the sitting position, bioelectrical muscle activity in flexion, and flexion-relaxation ratio on the left side of the body. Changes in adipsin and interleukin-4 concentrations correlated with changes in LBP intensity (r = 0.68; r = -0.77). Changes in stem cell growth factor and interleukin-17A correlated with changes in RMDQ (R = 0.53) and bioelectrical muscle activity in extension (left: R = -0.67; right: R = -0.76), respectively. Conclusion: Responders to traction therapy had SEMG indices of less favorable muscle activity in the flexion-extension task and elevated indices of inflammation before the study. For the first time, interleukin-4 was indicated as a potential biomarker for prognosing post-therapy changes in pain intensity and muscle activity.

On Putting an End to the Backlash Against Electrophysical Agents

Electrophysical agents (EPAs) are core therapeutic interventions in academic physical therapy curricula around the world. They are used concomitantly with several other therapeutic interventions such as exercise, manual therapy techniques, medications, and surgery for the management of a wide variety of soft tissue disorders. Over the past decade, the practice of EPAs has been the subject of intense scrutiny in the U.S. This has been colored by some physical therapists publicly engaging in bashing rhetoric that has yet to be officially and publicly addressed by the guiding organizations which, together, regulate the practice of physical therapy in this country. Published in world renowned public media are unsubstantiated mocking remarks against the practice of EPAs and unethical allegations against its stakeholders. This rhetoric suggests that EPA interventions are "magical" treatments and that those practitioners who include them in their plans of care may be committing fraud. Such bashing rhetoric is in striking contradiction to the APTA's Guide to Physical Therapist Practice 4.0, which lists EPAs as one of its categories of interventions, the CAPTE's program accreditation policy, and the FSBPT's national licensing exam. The purpose of this commentary is to expose the extent of this discourse and to call to action the APTA, CAPTE, and FSBPT organizations, as well as physical therapists, with the aim at putting an end to this rhetoric.

A Severe Disc Herniation Mimics Spinal Tumor

Lumbar disc herniation (LDH) is prevalent among adults aged 25-55 years who spend a considerable proportion of their time sitting or standing with heavy workloads. We report the case of a 33-year-old male waiter with severe LDH, causing compression of the nerve roots and spinal cord with neurological dysfunction, who presented to a chiropractic clinic. Magnetic resonance imaging (MRI) revealed a radiological differential diagnosis comprising LDH and an epidural mass lesion. To rule out serious pathology, a second MRI with contrast was ordered, which confirmed the diagnosis of severe LDH. Diagnosing large LDH may be challenging, and severe disc herniation often mimics spinal tumors. This study offers insights into the differential diagnosis of LDH and spinal tumors, as well as the design of a treatment strategy for severe LDH in the chiropractic clinic.

A Pragmatic Comparison Between Aerobic Exercise and Suryanamaskar in Stress Management in Medical Professionals: A Quasi-experimental Study

Background

Stress is an episodic process in an individual’s life that depends upon the circumstances that elicit this process, later jeopardizing an individual’s mental balance and leading to depression and anxiety. Yoga is a traditional component of physical activity that contains three main domains, namely, maintaining the correct posture (asanas), control over one’s breath (pranayama) and meditation with complete concentration (dhyana), which are proven to be effective in enhancing the psychological, physical, and spiritual wellbeing of an individual along with mindfulness. The purpose of the present study was to compare aerobic exercise (AE) and Suryanamaskar (SN) in terms of the best intervention in lowering the level of stress in medical professionals (MPs).

Methods

A quasi-experimental study including a pragmatic comparison was conducted involving 30 participants who were divided into two groups A and B. The participants in group A did treadmill walking and the participants in group B were made to perform the complete cycle of SN with all the 12 asanas for four weeks.

Results

The outcomes demonstrated that both AE and SN had significant statistical values in terms of pre- and post-intervention Perceived Stress Scale (PSS) scores, resting heart rate, and systolic and diastolic blood pressure. Also, when post-intervention mean values of both the groups were compared for all the parameters, only mean PSS values were found to be statistically significant.

Conclusion

The current study concluded that both AE and SN were beneficial in decreasing the level of stress in MPs with SN being statistically more significant in reducing stress levels than AE. Both interventions are safe to perform.

Impact of Dorn Therapy on a Patient With a Prolapsed Intervertebral Disc: A Case Report

A prolapsed intervertebral disc (PIVD) refers to herniation of the nucleus pulposus out of the intervertebral space. Mechanical nerve compression brought on by a protruding nucleus pulposus and an increase in chemokines in the affected area causes the underlying pain, which is typically treated conventionally with surgery or medication. Nonetheless, these management strategies may not always be effective and may impact a person’s quality of life. This report highlights the case of a 31-year-old male patient, who complained of neck and low back pain associated with tingling sensations for two months, and was treated with Dorn Therapy (DT) which is the basis of pain management intervention in conjunction with spinal traction, spinal mobilization, stretching, muscular strength training, and transcutaneous electrical nerve stimulation. Following a week of pain management techniques, DT significantly reduced pain, improved range of motion, and enhanced muscle strength. This case report highlights the impact of DT on pain associated with a PIVD, which may curtail an individual’s well-being.