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Yan H, Zhao P, Guo X, Zhou X. The effects of Core Stability Exercises and Mulligan's mobilization with movement techniques on sacroiliac joint dysfunction. Front Physiol 2024; 15:1337754. [PMID: 38699145 PMCID: PMC11063399 DOI: 10.3389/fphys.2024.1337754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
Purpose Sacroiliac joint dysfunction (SIJD), while being the primary contributor to low back pain, is still disregarded and treated as low back pain. Mulligan's Mobilization with Movement (MWM) Techniques and Core Stability Exercises (CSE) are often used to treat low back pain. There is not much evidence that it is effective in SIJD. To evaluate the effectiveness of CSE coupled with MWM (CSE + MWM) in the treatment of SIJD. Methods 39 patients with SIJD were recruited and randomly divided into distinct groups as follows: control group (n = 13), CSE group (n = 13) and CSE + MWM group (n = 13). The Numerical Pain Rating Scale (NPRS), the Roland Morris Disability Questionnaire (RMDQ), the Range of Motion (ROM), the Pressure Pain Threshold (PPT) and the pelvic tilt angle asymmetry ratio in the sagittal plane (PTAR) were used to gauge the intervention's success both before (M0) and after (M1) it. All experimental data were statistically analyzed. Results The SIJ-related pain metric significantly decreased in both the CSE + MWM group and the CSE group between M0 and M1, as determined by the NPRS and RMDQ. Between M0 and M1, The CSE group's left axial rotation ROM and lumbar flexion ROM were significantly decreased. The CSE + MWM group's extension ROM and left lateral flexion ROM both significantly increased between M0 and M1. In the difference variable (M1-M0), the CSE + MWM group substantially outperformed control group in the left lateral flexion ROM and outperformed the CSE group in the left axial rotation ROM. Conclusion In individuals with SIJD, CSE + MWM is beneficial in lowering pain, disability, and function. Treatment with CSE and MWM approaches for SIJ appears to boost this efficacy.
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Affiliation(s)
- Huiqian Yan
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Peng Zhao
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Xuanhui Guo
- College of Sports Medicine and Physical Therapy, Beijing Sport University, Beijing, China
| | - Xiao Zhou
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
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Şimşek Ş, Yağcı N, Korkmaz MB. Mid-term Effect of Lumbar Sustained Natural Apophyseal Glides in Patients with Non-specific Chronic Low Back Pain: A Randomized Clinical Trial. Eurasian J Med 2023; 55:152-157. [PMID: 37403913 PMCID: PMC10440974 DOI: 10.5152/eurasianjmed.2023.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/03/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE The objective of this study was to compare the standalone and combined mid-term effects of conventional physiotherapy and lumbar sustained natural apophyseal glides on pain, range of motion, fear avoidance belief, and functional status in patients with non-specific chronic low back pain. MATERIALS AND METHODS This randomized clinical study was conducted in a state hospital. Fifty-five patients with non-specific chronic low back pain (mean age: 40.69 ± 6.27 years) were divided into 3 groups. Group I (n=18) received conventional physiotherapy (electrotherapy and heat application) 5 days a week for 3 weeks, group II (n=19) received lumbar sustained natural apophyseal glides 3 days a week for 3 weeks. Group III (n = 18) received conventional physiotherapy plus lumbar sustained natural apophyseal glides. Pain (visual analog scale), flexion range of motion (back range of motion II), functional status (Roland-Morris Disability Questionnaire), and fear avoidance belief (Fear Avoidance Belief Questionnaire) were assessed at baseline, third week, and 6-month follow-up. RESULTS After 3 weeks of intervention, all outcome measures improved in groups II and III. These improve- ments remained significant until 6-month follow-up (P < .05), except fear avoidance belief (P=.06) and flexion range of motion (P=.764) scores of group III. Flexion range of motion (P=.001), functional status (P = .001), and fear avoidance belief (P = .03) differed significantly between the 3 groups at 6-month follow- up; post-hoc analysis revealed that flexion range of motion (P < .0001), functional status (P = .037), and fear avoidance belief (P = .002) scores were significantly improved in group II compared to group I. CONCLUSION Compared with conventional physiotherapy, lumbar sustained natural apophyseal glides improved mid-term range of motion, functional status, and fear avoidance belief, but there was no differ- ence in pain. Conventional physiotherapy added to lumbar sustained natural apophyseal glides provided no additional benefit.
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Affiliation(s)
- Şule Şimşek
- Department of Therapy and Rehabilitation, Pamukkkale University, Sarayköy Vacational School, Denizli, Turkey
| | - Nesrin Yağcı
- Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey
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Hussein HM, Morsi AA, Abdelraoof NA. The immediate effect of sustained natural apophyseal glide on postural stability and pain in individuals presenting with flexion-dominant chronic low back pain: A randomized single-blinded placebo-controlled trial. J Back Musculoskelet Rehabil 2021; 34:1079-1086. [PMID: 34024812 DOI: 10.3233/bmr-200217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Low back pain (LBP) is a common musculoskeletal problem, which commonly affects balance. Sustained natural apophyseal glide (SNAG) is a successful treatment approach for LPB. However, its influence on balance problems has not been studied before. OBJECTIVE To investigate the immediate effect of SNAG on postural stability and pain in individuals with flexion-dominant chronic low back pain (FCLBP). METHODS Randomized placebo-controlled trial in which 64 participants with FCLBP were randomly allocated into two groups (SNAG and sham). SNAG group (n= 32) received central lumbar SNAG on the symptomatic lumbar level(s). Sham group (n= 32) received sham SNAG. The outcome measures were postural stability indices; overall stability index (OSI), anteroposterior stability index (APSI), and mediolateral stability index (MLSI) in addition to pain intensity. Outcomes were assessed using the Biodex Balance System and visual analog scale respectively. Measures were taken before and immediately after interventions. RESULTS There were statistical significance and high effect size (ES) in favor of the SNAG group regarding OSI, APSI, and pain (p< 0.01, cohen's d ES =1.3, 1.4, 1.1 respectively). MLSI showed moderate ES (cohen's d= 0.7) but did not reach a statistically significant level (p= 0.05). CONCLUSION Lumbar SNAG produces an immediate improvement in postural stability and pain in individuals with FCLBP.
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Affiliation(s)
- Hisham Mohamed Hussein
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Department of Physical Therapy, College of Applied Medical Sciences, Hail University, Ha'il, Saudi Arabia
| | - Amal Ahmed Morsi
- Basic Science Department, Misr University for Science and Technology, Giza, Egypt
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Buran Çirak Y, Yurdaişik I, Elbaşi ND, Tütüneken YE, Köçe K, Çinar B. Effect of Sustained Natural Apophyseal Glides on Stiffness of Lumbar Stabilizer Muscles in Patients With Nonspecific Low Back Pain: Randomized Controlled Trial. J Manipulative Physiol Ther 2021; 44:445-454. [PMID: 34456042 DOI: 10.1016/j.jmpt.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/01/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the immediate effect of Mulligan sustained natural apophyseal glides (SNAGs) on muscular stiffness by using ultrasound shear wave elastography, pain, and function in patients with nonspecific low back pain. METHODS In a prospective, randomized, controlled, double-blinded study, 30 participants with nonspecific low back pain were randomly divided into 2 groups: a real SNAG group (aged 21.0 ± 1.7, 5 men, 10 women) and sham SNAG group (aged 20.4 ± 0.5, 4 men, 11 women). Muscular stiffness of the multifidus and erector spinal muscles with ultrasound shear wave elastography, visual analog scale, the sit and reach, flamingo balance, the functional reach, side bridge, and Biering-Sorensen tests were made before and immediately after intervention. The Oswestry Disability Index score was recorded only baseline. RESULTS After intervention, the change in visual analog scale, sit and reach, Biering-Sorensen, and side bridge tests scores were significantly different between real SNAG and sham SNAG groups (P < .05), but there was no significant difference in functional reach and flamingo balance test scores between the groups (P > .05). There was no significant difference for all measurements between pre- and post-intervention in sham SNAG group (P > .05). There was a significant reduction in muscular stiffness in the real SNAG group. But there was no change in muscular stiffness between pre- and postintervention in the sham group (P > .05). CONCLUSIONS This study demonstrated that the Mulligan SNAG technique had a positive effect on pain severity, flexibility, trunk muscle endurance, and muscle stiffness in patients with nonspecific LBP.
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Affiliation(s)
- Yasemin Buran Çirak
- Department of Physiotherapy and Rehabilitation, Istinye University, Istanbul, Turkey.
| | - Işıl Yurdaişik
- Faculty of Medicine, Istinye University, Istanbul, Turkey
| | | | - Yunus Emre Tütüneken
- Department of Physiotherapy and Rehabilitation, Istinye University, Istanbul, Turkey
| | - Kübra Köçe
- Department of Physiotherapy and Rehabilitation, Istinye University, Istanbul, Turkey
| | - Betül Çinar
- Department of Physiotherapy and Rehabilitation, Bezmialem Vakıf University, Istanbul, Turkey
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Kim GS, Weon JH, Kim MH, Koh EK, Jung DY. Effect of weight-bearing wrist movement with carpal-stabilizing taping on pain and range of motion in subjects with dorsal wrist pain: A randomized controlled trial. J Hand Ther 2021; 33:25-33. [PMID: 30871958 DOI: 10.1016/j.jht.2019.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 01/12/2019] [Accepted: 02/12/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Randomized control trial. INTRODUCTION During weight-bearing wrist movement, potential stabilizing forces caused by carpal stabilizing taping (CST) may restrict movement of the carpal bones, allowing greater wrist joint extension. PURPOSE OF THE STUDY The purpose of study was to investigate the effect of CST during weight-bearing wrist movement on pain intensity and range of motion (ROM) of wrist extension in subjects with dorsal wrist pain. METHODS Thirty participants with dorsal wrist pain when weight bearing through the hand were randomly allocated into 2 groups: (1) a CST group using rigid tape and (2) placebo taping (PT) group using elastic tape. Subjects performed weight-bearing wrist movements with CST or PT in 6 sessions for 1 week. Active and passive ROM (AROM and PROM), and the visual analog scale (VAS) were assessed at baseline and after the intervention. RESULTS The AROM and PROM of wrist extension increased significantly in both groups compared with preintervention values (P < .01). Comparing the PT and CST groups, the differences between preintervention and postintervention AROM (mean difference [MD] = +8.6°) and PROM (MD = +6.8°) were significantly greater in the CST group than in the PT group (P < .01). The CST group also showed greater improvement in VAS compared with the PT group (MD = -18 mm) (P < .01). CONCLUSION We recommend CST during weight-bearing wrist movement as an effective intervention for both increasing wrist extension ROM and decreasing pain in patients with dorsal wrist pain during weight bearing through the hand.
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Affiliation(s)
- Geun-Su Kim
- Department of KEMA Therapy, Graduate School of Humanities Industry, Joongbu University, Geumsan, Republic of Korea
| | - Jong-Hyuck Weon
- Department of Physical Therapy, College of Health & Welfare, Kinesiopathologic Science Institute, Joongbu University, Geumsan, Republic of Korea
| | - Moon-Hwan Kim
- Department of Rehabilitation Medicine, Wonju Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Eun-Kyung Koh
- Department of Physical Therapy, Masan University, Changwon, Republic of Korea
| | - Do-Young Jung
- Department of Physical Therapy, College of Health & Welfare, Kinesiopathologic Science Institute, Joongbu University, Geumsan, Republic of Korea.
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Bhat P V, Patel VD, Eapen C, Shenoy M, Milanese S. Myofascial release versus Mulligan sustained natural apophyseal glides' immediate and short-term effects on pain, function, and mobility in non-specific low back pain. PeerJ 2021; 9:e10706. [PMID: 33777508 PMCID: PMC7971081 DOI: 10.7717/peerj.10706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/14/2020] [Indexed: 11/20/2022] Open
Abstract
Background Myofascial 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. Objective To study the comparative effects of MFR and SNAGs on pain, disability, functional ability, and lumbar ROM in NSLBP. Method A 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. Results Within-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. Conclusions Pain 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/).
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Affiliation(s)
- Vignesh Bhat P
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Vivek Dineshbhai Patel
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Charu Eapen
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Manisha Shenoy
- Department of Physical Therapy, Hamad Medical Corporation, Doha, Qatar
| | - Steve Milanese
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
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Seo UH, Kim JH, Lee BH. Effects of Mulligan Mobilization and Low-Level Laser Therapy on Physical Disability, Pain, and Range of Motion in Patients with Chronic Low Back Pain: A Pilot Randomized Controlled Trial. Healthcare (Basel) 2020; 8:E237. [PMID: 32751064 PMCID: PMC7551517 DOI: 10.3390/healthcare8030237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 12/01/2022] Open
Abstract
This study aimed to determine the combined treatment effects of Mulligan sustained natural apophyseal glides (SNAGs) and low-level laser therapy (LLLT) on function, pain, and range of motion (ROM) in patients with chronic low back pain. A total of 49 adults participated in this study and were randomly divided into three groups (SNAGs with LLLT group, SNAGs group, and control group). The participants in the SNAGs with LLLT group received SNAGs for 10 min, LLLT for 10 min, and electrotherapy for 10 min. The SNAGs group received SNAGs for 10 min and electrotherapy for 20 min. The control group received electrotherapy for 30 min. All participants received the assigned treatment for 30 min a day, 3 times a week, for 4 weeks. We used the visual analogue scale (VAS) to measure pain, the modified-modified Schober test (MMST) to measure ROM, and the Roland Morris disability questionnaire (RMDQ) to measure physical disability. Compared to the pre-intervention values, the VAS and MMST scores significantly increased after the intervention in the SNAGs with LLLT group (p = 0.000) and the SNAGs group (p = 0.000). The RMDQ score significantly improved in the SNAGs with LLLT (p = 0.000), SNAGs (p = 0.000) and control (p = 0.025) group after the intervention. The inter-group differences were greater for the SNAGs with LLLT and SNAGs groups than for the control group (p = 0.001), and the difference was greater for the SNAGs with LLLT than for the SNAGs (p = 0.001) with respect to the VAS, MMST, and RMDQ scores. These results indicate that significant improvement in pain, function, and ROM may be achieved by a combination of SNAGs and LLLT to treat chronic low back pain.
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Affiliation(s)
- U-Hyeok Seo
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
| | - Jung-Hee Kim
- Department of Physical Therapy, Andong Science College, Andong 36616, Korea;
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea
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Bitenc-Jasiejko A, Konior K, Lietz-Kijak D. Meta-Analysis of Integrated Therapeutic Methods in Noninvasive Lower Back Pain Therapy (LBP): The Role of Interdisciplinary Functional Diagnostics. Pain Res Manag 2020; 2020:3967414. [PMID: 32256908 PMCID: PMC7109562 DOI: 10.1155/2020/3967414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/07/2020] [Indexed: 12/12/2022]
Abstract
Introduction. Lower back pain (LBP) is almost a problem of civilizations. Quite often, it is a consequence of many years of disturbed distribution of tension within the human body caused by local conditions (injuries, hernias, stenoses, spondylolisthesis, cancer, etc.), global factors (postural defects, structural integration disorders, lifestyle, type of activity, etc.), or systemic diseases (connective tissue, inflammation, tumours, abdominal aneurysm, and kidney diseases, including urolithiasis, endometriosis, and prostatitis). Therefore, LBP rehabilitation requires the use of integrated therapeutic methods, combining the competences of interdisciplinary teams, both in the process of diagnosis and treatment. Aim of the Study. Given the above, the authors of the article conducted meta-analysis of the literature in terms of integrated therapeutic methods, indicating the techniques focused on a holistic approach to the patient. The aim of the article is to provide the reader with comprehensive knowledge about treating LBP using noninterventional methods. Material and Methods. An extensive search for the materials was conducted online using PubMed, the Cochrane database, and Embase. The most common noninterventional methods have been described, as well as the most relevantly updated and previously referenced treatment of LBP. The authors also proposed noninvasive (measurable) diagnostic procedures for the functional assessment of the musculoskeletal system, including initial, systematic, and cross-sectional control. All figures and images have been prepared by the authors and are their property. Results This review article goes beyond combining a detailed description of each procedure with full references, as well as a comprehensive discussion of this very complex and troublesome problem. Conclusions Lower back pain is a serious health problem, and this review article will help educate physicians and physiotherapists dealing with LBP in the options of evidence-based treatment. Ultimately, the article introduces and postulates the need to systematize therapeutic procedures in LBP therapy, with a long-term perspective.
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Affiliation(s)
- Aleksandra Bitenc-Jasiejko
- Department of Propedeutics, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Danuta Lietz-Kijak
- Department of Propedeutics, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University in Szczecin, Szczecin, Poland
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The effects of cervical sustained natural apophyseal glides on neck range of movement and sympathetic nervous system activity. INT J OSTEOPATH MED 2017. [DOI: 10.1016/j.ijosm.2017.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Effect of Mulligan Concept Lumbar SNAG on Chronic Nonspecific Low Back Pain. J Chiropr Med 2017; 16:94-102. [PMID: 28559749 DOI: 10.1016/j.jcm.2017.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/20/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the outcomes of adding lumbar sustained natural apophyseal glide (SNAG) to a conventional therapy program for chronic nonspecific low back pain (LBP). METHODS Forty-two participants with chronic nonspecific LBP were randomly divided into 2 groups. The study group (aged 27.1 ± 8.3, 20 men, 3 women) received a conventional physical therapy program consisted of stretching and strengthening exercises plus SNAG (based on the Mulligan concept) on the affected lumbar levels, and the control group (aged 28.9 ± 7.7, 13 men, 6 women) received the same conventional program without SNAG 3 times per week for 1 month. Outcome measures were repositioning error (the primary outcome), pain, and function measured by an isokinetic dynamometer, visual analog scale, and the Oswestry Disability Index. Measurements were recorded before and after the end of the treatment period. RESULTS The comparison between pretreatment and posttreatment test scores indicated that both study and control groups had significant improvement in all dependent variables (P > .001). However, adding SNAG to the conventional program resulted in higher improvement in terms of repositioning error, pain, and function (P = .02, .002, .008) respectively. CONCLUSIONS This preliminary study indicated improvement in both groups. Adding SNAG to conventional programs in the treatment of chronic nonspecific LBP may result in greater improvement of repositioning error, pain reduction, and improved function.
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Krekoukias G, Gelalis ID, Xenakis T, Gioftsos G, Dimitriadis Z, Sakellari V. Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial. J Man Manip Ther 2016; 25:66-73. [PMID: 28559665 DOI: 10.1080/10669817.2016.1184435] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The aim of the study was to examine the efficacy of spinal mobilization in subjects with low back pain (LBP) and associated spinal disk degeneration. METHODS Seventy-five subjects suffering from chronic LBP (>3 months) were randomly allocated into 3 groups of 25 subjects each. Each group received five treatment sessions with the first group receiving manual therapy (MT) (spinal mobilization), the second a sham treatment, and the third conventional physiotherapy (CP) (stretching exercises, transcutaneous electrical nerve stimulation, and massage). Subjects were assessed for their pain intensity using the numerical pain rating scale and for their self-reported disability using the Oswestry and Roland-Morris Questionnaire at baseline and after the completion of the five treatment sessions. RESULTS Paired t-tests showed a significant improvement for all outcome measures in the MT and CP group (p < 0.05). Analysis of covariance revealed that the MT group had significant improvement in all outcome measures in comparison with the sham and CP group (p < 0.05), whereas no significant difference was observed between the sham and CP group (p > 0.05). DISCUSSION MT is preferable to CP in order to reduce the pain intensity and disability in subjects with chronic LBP and associated disk degeneration. The findings of this study may lead to the establishment of spinal mobilization as one of the most preferable approaches for the management of LBP due to disk degeneration. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Georgios Krekoukias
- Department of Biomechanics, Medical School, University of Ioannina, Ioannina, Greece
| | - Ioannis D Gelalis
- Department of Biomechanics, Medical School, University of Ioannina, Ioannina, Greece.,Department of Orthopedic Surgery, University Hospital of Ioannina, University of Ioannina School of Medicine, Ioannina, Greece
| | - Theodoros Xenakis
- Department of Biomechanics, Medical School, University of Ioannina, Ioannina, Greece
| | - Georgios Gioftsos
- Department of Physiotherapy, School of Health and Caring Professions, Technological Educational Institute of Central Greece, Lamia, Greece
| | - Zacharias Dimitriadis
- Department of Physiotherapy, School of Health and Caring Professions, Technological Educational Institute of Athens, Athens, Greece
| | - Vasiliki Sakellari
- Department of Physiotherapy, School of Health and Caring Professions, Technological Educational Institute of Central Greece, Lamia, Greece
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Waqqar S, Shakil-Ur-Rehman S, Ahmad S. McKenzie treatment versus mulligan sustained natural apophyseal glides for chronic mechanical low back pain. Pak J Med Sci 2016; 32:476-9. [PMID: 27182265 PMCID: PMC4859048 DOI: 10.12669/pjms.322.9127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background and Objective: Chronic mechanical low back pain is common among different age groups and genders. Different manual therapy techniques combined with exercise therapy and electrotherapy modalities play an important role in its management. Our objective was to compare the effects of McKenzie extension exercisesprogram (EEP) versus Mulligan Sustained Natural Apophyseal Glides (SNAGs) for chronic mechanical low back pain (CMLBP). Methods: This randomized control trial (RCT) was conducted at Riphah Physical Rehabilitation Centre, Pakistan Railways General Hospital Rawalpindi, from 1st July to 31st December 2014. The inclusion criteria was patients of both gender and age range 30-70 years with minimum 4 weeks history of CMLBP. A total of 37 patients were screened out as per inclusion criteria and randomly placed into two groups. Twenty patients in group A were treated with Mulligan SNAGs and 17 patients in group B with McKenzie EEP for four weeks at two session per week and single session per day. Visual Analogue Scale (VAS), Oswestry Disability Scale (ODI) and lumber Range of Motion (ROM) were used as an assessment tools and were measured at baseline and at the completion 4 weeks intervention. The data was analyzed with SPSS to draw the statistical and clinical significance of both interventions. Results: At the completion of 4 weeks intervention the pre and post statistical analysis revealed that clinically the McKenzie EEP improved pain (mean 9.12 to 1.46) and disability (73.82 to 6.24) slightly more than Mulligan SNAGs (pain: from 8.85 to 2.55, disability 73.75 to 7.05), while the Mulligan SNAGs improved lumbar ROM more effectively than McKenzie EEP in all directions including flexion, extension, side bending and rotation. Statistically there was no significant difference between the effects of two interventions in managing pain and disability, and improving Lumber ROM. Conclusion: McKenzie EEP is clinically slightly more effective in the management of pain and disability as compared with Mulligan SNAGs, while Mulligan SNAGs are more effective in the improvement of lumbar ROM as compared with Mechanize EEP in the management of CMLBP.
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Affiliation(s)
- Saira Waqqar
- Dr. Saira Waqqar, DPT (Post Professional), Lecturer, Riphah College of Rehabilitation Sciences, Riphah International University, Islamabad, Pakistan
| | - Syed Shakil-Ur-Rehman
- Dr. Syed Shakil-ur-Rehman, MS (MSKPT), Principal/ Associate Professor, Riphah College of Rehabilitation Sciences, Riphah International University, Islamabad, Pakistan
| | - Shakeel Ahmad
- Dr. Shakeel Ahmad, MS (NMSKPT), Assistant Professor, Riphah College of Rehabilitation Sciences, Riphah International University, Islamabad, Pakistan
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Identification of Preliminary Prognostic Indicators for Back Rehabilitation in Patients With Nonspecific Chronic Low Back Pain: A Retrospective Cohort Study. Spine (Phila Pa 1976) 2016; 41:522-9. [PMID: 26536437 DOI: 10.1097/brs.0000000000001262] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVE Our aim was to identify prognostic indicators for success after a back rehabilitation program (BR) in patients with nonspecific chronic low back pain (CLBP). SUMMARY OF BACKGROUND DATA Exercise therapy is recommended for patients with nonspecific CLBP. Consensus on the type of exercises is lacking, largely due to heterogeneity in the studied patient samples. The identification of subgroups through the identification of prognostic indicators is therefore needed. To our knowledge, no specific prognostic indicators for BR are described in the literature. METHODS We retrospectively analyzed the patient files of 49 nonspecific CLBP patients who followed a BR. Patients were selected based on predefined in- and exclusion criteria. All underwent 43 therapy sessions, two times per week. Primary outcome measure and dependent variable was the change in Oswestry Disability Questionnaire (ODI) score. Potential predictive variables were tested for association with the primary outcome and consequently entered in a logistic regression model. RESULTS In this study, the posthoc calculated power was 91%. Based on the change in ODI scores, 24 patients were considered as therapy success (eight points or 50% improvement on change in ODI score) and 25 as therapy failure. Univariate and multiple regression analysis revealed only one significant prognostic indicator: higher scores on the physical function subscale of the SF36 (PF-SF36) corresponded with high risk of therapy failure (odds ratio of 0.791 (95% CI = .662-0.945); sensitivity of 0.79, and specificity of 0.68). CONCLUSION Potentially, the preset exercises of the BR in this study design were not appropriate for the identified subgroup. The results of this study should be replicated in a RCT design that conforms to the necessary methodological steps in the identification of prognostic indicators and clinical prediction rules (CPRs).
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Hidalgo B, Pitance L, Hall T, Detrembleur C, Nielens H. Short-Term Effects of Mulligan Mobilization With Movement on Pain, Disability, and Kinematic Spinal Movements in Patients With Nonspecific Low Back Pain: A Randomized Placebo-Controlled Trial. J Manipulative Physiol Ther 2015. [DOI: 10.1016/j.jmpt.2015.06.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Holland CJ, Campbell K, Hutt K. Increased treatment durations lead to greater improvements in non-weight bearing dorsiflexion range of motion for asymptomatic individuals immediately following an anteroposterior grade IV mobilisation of the talus. ACTA ACUST UNITED AC 2015; 20:598-602. [PMID: 25765456 DOI: 10.1016/j.math.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 02/05/2015] [Accepted: 02/11/2015] [Indexed: 12/26/2022]
Abstract
Manual therapy aims to minimise pain and restore joint mobility and function. Joint mobilisations are integral to these techniques, with anteroposterior (AP) talocrural joint mobilisations purported to increase dorsiflexion range of motion (DF-ROM). This study aimed to determine whether different treatment durations of single grade IV anteroposterior talocrural joint mobilisations elicit statistically significant differences in DF-ROM. Sixteen asymptomatic male football players (age = 27.1 ± 5.3 years) participated in the study. Non-weight bearing (NWB) and weight bearing (WB) DF-ROM was measured before and after 4 randomised treatment conditions: control treatment, 30 s, 1 min, 2 min. NWB DF-ROM was measured using a universal goniometer, and WB DF-ROM using the weight-bearing lunge test. A within-subjects design was employed so that all participants received each of the treatment conditions. A 4 × 4 balanced Latin square design and 1 week interval between sessions reduced any residual effects. Two-way repeated measures ANOVA revealed a significant improvement in DF-ROM following all AP mobilisation treatments (p < 0.001). The within subjects contrasts showed that increases in treatment duration was associated with statistically significant improvements in DF-ROM (NWB DF-ROM control = 0.01%, 30 s = 14.2%, 1 min = 21.6%, 2 min = 32.8%; WB DF-ROM control = 0.01%, 30 s = 5.0%, 1 min = 7.6%, 2 min = 10.9%; p < 0.05). However, WB DF-ROM improvements were below the minimal detectable change scores needed to conclude that improvements were not a consequence of measurement error. This research shows that single session mobilisations can elicit NWB DF-ROM improvements in asymptomatic individuals in the absence of pain, whilst increases in treatment duration confer greater improvements in NWB DF-ROM within this population.
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Affiliation(s)
- Christopher James Holland
- Faculty of Life Sciences and Computing, School of Human Sciences, London Metropolitan University, 166-220 Holloway Road, London, N7 8DB, UK.
| | - Kevin Campbell
- Faculty of Life Sciences and Computing, School of Human Sciences, London Metropolitan University, 166-220 Holloway Road, London, N7 8DB, UK
| | - Kim Hutt
- Faculty of Life Sciences and Computing, School of Human Sciences, London Metropolitan University, 166-220 Holloway Road, London, N7 8DB, UK
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Li CT, Chen YN, Chang CH, Tsai KH. The effects of backward adjustable thoracic support in wheelchair on spinal curvature and back muscle activation for elderly people. PLoS One 2014; 9:e113644. [PMID: 25480152 PMCID: PMC4257911 DOI: 10.1371/journal.pone.0113644] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/27/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the effects of backward adjustable thoracic support on spinal curvature and back muscle activation during wheelchair sitting. METHODS Twenty elderly people were recruited for this study. The backward adjustable thoracic support sitting posture was compared with the slumped, normal, and lumbar support sitting postures. Spinal curvatures (pelvic, lumbar, and thoracic angles) and muscle activations of 4 back muscles on both sides (maximal voluntary isometric contraction of the lumbar multifidus, lumbar erector spinae, iliocostalis lumborum pars thoracis, and thoracic erector spinae at T9) were measured and compared between the different sitting postures using one-way analysis of variance with repeated measures. RESULTS The backward adjustable thoracic support sitting posture showed a relatively neutral pelvic tilt (-0.32±4.80°) when compared with the slumped (22.84±5.27°) and lumbar support (-8.97±3.31°) sitting postures (P<0.001), and showed relatively higher lumbar lordosis (-23.38±6.50°) when compared with the slumped (14.77±7.83°), normal (0.44±7.47°), and lumbar support (-16.76±4.77°) sitting postures (P<0.05). It also showed relatively lower back muscle activity when compared with the normal and lumbar support sitting postures (P<0.05). CONCLUSIONS The backward adjustable thoracic support sitting concept was suggested because it maintains a more neutral pelvic tilt, higher lumbar lordosis, and lower back muscle activation, which may help maintain a better sitting posture and reduce the risk of back pain.
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Affiliation(s)
- Chun-Ting Li
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Nien Chen
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- Metal Industries Research & Development Centre, Kaohsiung, Taiwan
| | - Chih-Han Chang
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- * E-mail: (KHT); (CHC)
| | - Kuen-Horng Tsai
- Graduate Institute of Mechatronic System Engineering, National University of Tainan, Tainan, Taiwan
- * E-mail: (KHT); (CHC)
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Mieritz RM, Bronfort G, Hartvigsen J. Regional Lumbar Motion and Patient-Rated Outcomes: A Secondary Analysis of Data From a Randomized Clinical Trial. J Manipulative Physiol Ther 2014; 37:628-40. [DOI: 10.1016/j.jmpt.2014.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 01/23/2014] [Accepted: 03/24/2014] [Indexed: 11/28/2022]
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Mulligan Concept manual therapy: Standardizing annotation. ACTA ACUST UNITED AC 2014; 19:499-503. [DOI: 10.1016/j.math.2013.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 12/11/2013] [Accepted: 12/21/2013] [Indexed: 12/26/2022]
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Mieritz RM, Bronfort G, Jakobsen MD, Aagaard P, Hartvigsen J. Reliability and measurement error of sagittal spinal motion parameters in 220 patients with chronic low back pain using a three-dimensional measurement device. Spine J 2014; 14:1835-43. [PMID: 24216400 DOI: 10.1016/j.spinee.2013.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 07/29/2013] [Accepted: 10/22/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A basic premise for any instrument measuring spinal motion is that reliable outcomes can be obtained on a relevant sample under standardized conditions. PURPOSE The purpose of this study was to assess the overall reliability and measurement error of regional spinal sagittal plane motion in patients with chronic low back pain (LBP), and then to evaluate the influence of body mass index, examiner, gender, stability of pain, and pain distribution on reliability and measurement error. STUDY DESIGN/SETTING This study comprises a test-retest design separated by 7 to 14 days. PATIENT SAMPLE The patient cohort consisted of 220 individuals with chronic LBP. OUTCOME MEASURES Kinematics of the lumbar spine were sampled during standardized spinal extension-flexion testing using a 6-df instrumented spatial linkage system. METHODS Test-retest reliability and measurement error were evaluated using interclass correlation coefficients (ICC(1,1)) and Bland-Altman limits of agreement (LOAs). RESULTS The overall test-retest reliability (ICC(1,1)) for various motion parameters ranged from 0.51 to 0.70, and relatively wide LOAs were observed for all parameters. Reliability measures in patient subgroups (ICC(1,1)) ranged between 0.34 and 0.77. In general, greater (ICC(1,1)) coefficients and smaller LOAs were found in subgroups with patients examined by the same examiner, patients with a stable pain level, patients with a body mass index less than below 30 kg/m(2), patients who were men, and patients in the Quebec Task Force classifications Group 1. CONCLUSIONS This study shows that sagittal plane kinematic data from patients with chronic LBP may be sufficiently reliable in measurements of groups of patients. However, because of the large LOAs, this test procedure appears unusable at the individual patient level. Furthermore, reliability and measurement error varies substantially among subgroups of patients.
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Affiliation(s)
- Rune M Mieritz
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark.
| | - Gert Bronfort
- Wolfe Harris Center for Clinical Studies, Northwestern Health Sciences University, 2501 W. 84th St, Bloomington, MN 55431, USA; Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
| | - Markus D Jakobsen
- Research Centre for the Working Environment, Lersø Parkalle 105, DK-2100, Copenhagen, Denmark
| | - Per Aagaard
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
| | - Jan Hartvigsen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
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Mieritz RM, Bronfort G, Kawchuk G, Breen A, Hartvigsen J. Reliability and Measurement Error of 3-Dimensional Regional Lumbar Motion Measures: A Systematic Review. J Manipulative Physiol Ther 2012; 35:645-56. [DOI: 10.1016/j.jmpt.2012.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/26/2012] [Accepted: 05/17/2012] [Indexed: 10/27/2022]
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Investigation of the Effects of a Centrally Applied Lumbar Sustained Natural Apophyseal Glide Mobilization on Lower Limb Sympathetic Nervous System Activity in Asymptomatic Subjects. J Manipulative Physiol Ther 2012; 35:286-94. [DOI: 10.1016/j.jmpt.2012.04.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 01/27/2012] [Accepted: 02/16/2012] [Indexed: 11/20/2022]
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Uritani D, Kawakami T, Inoue T, Kirita T. Relationship between Symptoms of Temporomandibular Disorders and Upper Quadrant Posture: a Preliminary Study. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Daisuke Uritani
- Department of Physical Therapy, Faculty of Health Science, Kio University
| | - Tetsuji Kawakami
- Department of Oral and Maxillofacial Surgery, Nara Medical University
| | - Tomohiro Inoue
- Department of Oral and Maxillofacial Surgery, Nara Medical University
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University
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