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The Effect of Harmonic Technique vs End Range Loading Exercises on Pain and Disability in Patients With Non-Specific Chronic Low Back Pain: A Preliminary Study.

ABSTRACT: OBJECTIVE:The purpose of this study was to compare the effects of end range loading (ERL) vs harmonic technique (HT) on patients with chronic low back pain (LBP). METHOD:Fourteen volunteer patients with LBP were randomly assigned to 2 groups based on a blocked randomization method with 7 patients in the HT group and 7 patients in the ERL group. The patients received 10 sessions of treatment for 5 sessions per week. Pain intensity and disability score were recorded using the numeric pain scale and Roland-Morris Disability questionnaire (RMQ), respectively, before and after the treatment period. RESULTS:Although pain intensity (P = .02) and the RMQ score (P = .03) decreased in the HT technique group, no statistically significant change was found in the ERL group for the RMQ score (P > .05). The effect size for HT was .6 and .3 for numeric pain scale and RMQ, respectively. CONCLUSION:This preliminary study showed that pain intensity and disability improved in subjects with chronic LBP in the HT group. More investigations with larger sample size are needed to clarify these findings.

SUBMITTER: Arab AM

PROVIDER: S-EPMC4812025 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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The Effect of Harmonic Technique vs End Range Loading Exercises on Pain and Disability in Patients With Non-Specific Chronic Low Back Pain: A Preliminary Study.

Arab Amir Massoud AM Saadati Heidar H Sheikhhoseini Rahman R

Journal of chiropractic medicine 20160325 1

<h4>Objective</h4>The purpose of this study was to compare the effects of end range loading (ERL) vs harmonic technique (HT) on patients with chronic low back pain (LBP).<h4>Method</h4>Fourteen volunteer patients with LBP were randomly assigned to 2 groups based on a blocked randomization method with 7 patients in the HT group and 7 patients in the ERL group. The patients received 10 sessions of treatment for 5 sessions per week. Pain intensity and disability score were recorded using the numeri ...[more]

PMID: 27069426

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Project description:Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE.Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8?weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups.Thirty-seven subjects completed the study. MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session (VAS mean difference between interventions: -0.8; 95% CI: -1.2 to -0.3). Independently from time after treatment, MT + AE induced lower disability (ODI mean group difference: -7.1; 95% CI: -12.8 to -1.5) and a trend to lower pain (VAS mean group difference: -1.2; 95% CI: -2.4 to -0.30). Six months after treatment, Shirado test was better for the ST group (Shirado mean group difference: -61.6; 95% CI: -117.5 to -5.7). Insufficient evidence for group differences was found in remaining outcomes.This study confirmed the immediate analgesic effect of MT over ST. Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP. Its neurophysiologic mechanisms at cortical level should be investigated more thoroughly.NCT01496144.

Project description:BACKGROUND: Non-specific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long term sickness amongst the workforce and is associated with high levels of fear avoidance and kinesiophobia. Stabilisation (or 'core stability') exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment within the UK there is a lack of positive evidence to support its use. The aims of this systematic review update is to investigate the effectiveness of stabilisation exercises for the treatment of NSLBP, and compare any effectiveness to other forms of exercise. METHODS: A systematic review published in 2008 was updated with a search of PubMed, CINAHL, AMED, Pedro and The Cochrane Library, October 2006 to October 2013. Two authors independently selected studies, and two authors independently extracted the data. Methodological quality was evaluated using the PEDro scale. Meta-analysis was carried out when appropriate. RESULTS: 29 studies were included: 22 studies (n?=?2,258) provided post treatment effect on pain and 24 studies (n?=?2,359) provided post treatment effect on disability. Pain and disability scores were transformed to a 0 to 100 scale. Meta-analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain and disability with mean difference of -6.39 (95% CI -10.14 to -2.65) and -3.92 (95% CI -7.25 to -0.59) respectively. The difference between groups was clinically insignificant. When compared with alternative forms of exercise, there was no statistical or clinically significant difference. Mean difference for pain was -3.06 (95% CI -6.74 to 0.63) and disability -1.89 (95% CI -5.10 to 1.33). CONCLUSION: There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion.

Project description:BackgroundProprioceptive training (PrT) is popularly applied as preventive or rehabilitative exercise method in various sports and rehabilitation settings. Its effect on pain and function is only poorly evaluated. The aim of this systematic review was to summarise and analyse the existing data on the effects of PrT on pain alleviation and functional restoration in patients with chronic (? 3 months) neck- or back pain.MethodsRelevant electronic databases were searched from their respective inception to February 2014. Randomised controlled trials comparing PrT with conventional therapies or inactive controls in patients with neck- or low back pain were included. Two review authors independently screened articles and assessed risk of bias (RoB). Data extraction was performed by the first author and crosschecked by a second author. Quality of findings was assessed and rated according to GRADE guidelines. Pain and functional status outcomes were extracted and synthesised qualitatively and quantitatively.ResultsIn total, 18 studies involving 1380 subjects described interventions related to PrT (years 1994-2013). 6 studies focussed on neck-, 12 on low back pain. Three main directions of PrT were identified: Discriminatory perceptive exercises with somatosensory stimuli to the back (pPrT, n=2), multimodal exercises on labile surfaces (mPrT, n=13), or joint repositioning exercise with head-eye coordination (rPrT, n=3). Comparators entailed usual care, home based training, educational therapy, strengthening, stretching and endurance training, or inactive controls. Quality of studies was low and RoB was deemed moderate to high with a high prevalence of unclear sequence generation and group allocation (>60%). Low quality evidence suggests PrT may be more effective than not intervening at all. Low quality evidence suggests that PrT is no more effective than conventional physiotherapy. Low quality evidence suggests PrT is inferior to educational and behavioural approaches.ConclusionsThere are few relevant good quality studies on proprioceptive exercises. A descriptive summary of the evidence suggests that there is no consistent benefit in adding PrT to neck- and low back pain rehabilitation and functional restoration.

Dataset Information

The Effect of Harmonic Technique vs End Range Loading Exercises on Pain and Disability in Patients With Non-Specific Chronic Low Back Pain: A Preliminary Study.

Publications

The Effect of Harmonic Technique vs End Range Loading Exercises on Pain and Disability in Patients With Non-Specific Chronic Low Back Pain: A Preliminary Study.

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