Effect of Sustained Natural Apophyseal Glides on Stiffness of Lumbar Stabilizer Muscles in Patients With Nonspecific Low Back Pain: Randomized Controlled Trial.

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.

Motor Neuron Excitability Attenuation as a Sequel to Lumbosacral Manipulation in Subacute Low Back Pain Patients and Asymptomatic Adults: A Cross-Sectional H-Reflex Study.

OBJECTIVE: The purpose of the study was to compare a time series of tibial nerve H-reflex trials between patients with subacute low back pain (LBP) and asymptomatic adults using pre and post high-velocity, low-amplitude (HVLA) spinal manipulation (SM) and control procedures. METHODS: Asymptomatic adults (n = 66) and patients with subacute LBP (n = 45) were randomized into 3 lumbosacral procedures: side-posture positioning, joint preloading with no thrust, and HVLA SM. A time series of 40 Hmax/Mmax ratios at a rate of 0.1 Hz were recorded in blocks of 10 trials at baseline and after the lumbosacral procedures at time points corresponding to immediately after, 5 minutes after, and 10 minutes after the procedure. Descriptive time series analysis techniques included time plots, outlier detection, and autocorrelation functions. A mixed analysis of variance model (group × procedure × time) was used to compare the effects of lumbosacral procedures on Hmax/Mmax ratios between the patients with subacute LBP and asymptomatic participants. RESULTS: The time series analysis and the significant lumbosacral × time interaction term (P < .05) indicated that inhibition of the Hmax/Mmax ratios at the 10-second postlumbosacral procedure time point was greatest after the HVLA SM procedure. The effects of lumbosacral procedures on Hmax/Mmax ratios were similar between patients with subacute LBP and asymptomatic participants. CONCLUSIONS: Although nonspecific effects of movement or position artifacts on the Hmax/Mmax ratio were present, a reliable and valid attenuation of the Hmax/Mmax ratio occurred as a specific aspect of HVLA SM in both asymptomatic adults and patients with subacute LBP.

Minimal-invasive pain procedures are effective in different degenerative pain generators in CLBP: A prospective cohort study.

BACKGROUND: It is estimated that a significant number of spinal surgeries are performed, but many patients do not often benefit. OBJECTIVE: Our aim was to determine how effective minimally invasive pain procedures (MIP) are in chronic low back pain (CLBP) patients with proven degenerative causes (specific low back pain). METHODS: 386 eligible patients with CLBP/sciatica resistant to conservative therapy and scheduled for open surgery were screened, and 167 could be enrolled in this study. Indications for MIP in the remaining 150 individuals were made by one experienced spinal surgeon. Before and 6 months after the intervention, the numeric rating scale (NRS) and Oswestry Disability Index (ODI) were recorded. MIP was performed, such as radiofrequency of the facet and SI-joint, intradiscal electrothermal therapy in case of discogenic pain, as well as epidural neuroplasty in patients with disc herniation/epidural fibrosis. RESULTS: There was a statistically significant decrease in NRS (p< 0.05), as well as a significant increase in ODI (p< 0.001) 6 months after the procedures. This was also true for the results of all different pain generators and subsequent performed procedures alone. CONCLUSIONS: The indication of MIP should be routinely reviewed in patients with CLBP to avoid potentially open surgery and a burden on healthcare costs.

Comparison of Chiropractic Treatment Outcomes Depending on the Language Region in Switzerland: A Prospective Outcomes Study.

OBJECTIVES: Switzerland has optimal conditions for research of language-based cultural influences on low back pain (LBP). The aim of this study was to compare LBP treatment outcomes after chiropractic care between patients from the German- and French-speaking regions of Switzerland. METHODS: Baseline Numeric Rating Scale for pain (NRS), demographic, and Oswestry Disability Index (ODI) data were collected from patients presenting to 51 Swiss-German and 12 Swiss-French chiropractors. Prospective outcome data included the proportion reporting clinically relevant improvement on the Patient Global Impression of Change scale and the NRS change scores collected at 1 week; 1, 3, and 6 months; and 1 year. ODI change scores were collected until 3 months. The proportion improved between the 2 groups was compared using the χ2 test. NRS and ODI change scores were compared using the unpaired t test. RESULTS: At baseline, only patient age comparing 853 Swiss-German and 215 Swiss-French patients revealed a significant difference. The Patient Global Impression of Change, NRS, and ODI had no significant differences between both patient groups up to 6 months. Between 6 months and 1 year the proportion reporting improvement continued to increase to 83.5% for German-speaking Swiss but reduced to 73.1% for French-speaking Swiss (P = .01). The NRS change scores were also higher for German speaking Swiss at 1 year compared with Swiss-French citizens (P = .01). CONCLUSION: Treatment outcome data for LBP are comparable in the German and French parts of Switzerland until the 1-year time point, when people located in the French-speaking regions are more likely to have an increase in pain levels.