None listed
Conditions
Brief summary
Physiotherapists sometimes use passive positioning of the body (positioning of the patient’s body by the physiotherapist without the patient helping) to treat for pain and loss of movement. When using such a passive positioning technique, Strain-Counterstrain, digitally tender points are used for assessment and treatment (Jones, Kusunose et al. 1995). This technique has not been researched and so there is little support for its continued use. The aim of this study is to examine the effect of passive body positioning treatment for low back pain in a clinical population. Subjects are to be randomly assigned to either a treatment group or a control group. The treatment group are to receive passive-positioning treatment (Strain-Counterstrain) in addition to exercise instruction while the control group is to receive only exercise instruction. Interventions are to be provided twice in a week for two weeks. Treatment and control interventions are to be provided within half an hour on each occasion. To find digitally tender points and assess these during treatment interventions, it will be necessary for the experimenter to press gently with thumb or forefinger at sites in the lower back, loin, buttock, abdominal, anterior pelvic and pubic areas (Jones, Kusunose et al. 1995) (Kusunose and Wendorff 1990). Subjects may be required to lie on their back or stomach for up to 15 minutes at a time. In this study there is little or no risk of injury if subjects have met the selection criteria for entry into the study. Subjects in the treatment group may experience some temporary discomfort at digitally tender point sites that are pressed during assessment and intervention. Approximately a third of clients have been found to experience a muscle-ache type of discomfort in the day following passive body positioning. Subjects may experience a reduction in low back pain as a result of participating in this study. The study may provide evidence for the effectiveness of passive positioning treatment for low back pain.
Interventions
This group is to receive both the passive positioning intervention and the prescription of home exercises intervention. The passive positioning intervention is to be provided twice a week for two consecutive weeks. Following each passive positioning treatment intervention, supervision of prescribed home exercises is to be undertaken. Additionally, participants are to be instructed to perform the home exercises independently twice per day in a pain-free range.
For the passive-positioning tr
This group is to receive both the passive positioning intervention and the prescription of home exercises intervention. The passive positioning intervention is to be provided twice a week for two consecutive weeks. Following each passive positioning treatment intervention, supervision of prescribed home exercises is to be undertaken. Additionally, participants are to be instructed to perform the home exercises independently twice per day in a pain-free range. For the passive-positioning treatment intervention, a digitally tender point (DTP) is to be treated by passively positioning the participant (that is, the participant does not assist the investigator in positioning the participants body) such that there is a two-thirds reduction in tenderness at the DTP (Jones, Kusunose et al. 1995). Kusunose (Kusunose 1993). Participants are to be asked to consider that their initial DTP tenderness is ‘10’ on a verbal analogue scale where ‘0’ is no tenderness. Appropriate passive positioning is to be assumed to have been reached when the participant rates tenderness at ‘3’ or less on the scale with intermittent probing at the DTP. In addition to reported tenderness with intermittent probing, perceived tissue tension is to be used to guide the experimenter to the appropriate passive position. The participant is to be passively maintained at this point by the experimenter for 90 seconds before being slowly and passively returned to a neutral position (Kusunose 1993) (Jones, Kusunose et al. 1995). A DTP is to be considered successfully treated if a reduction of greater than 70% tenderness is achieved (Kusunose 1993). Experimentally, this is to be determined by asking the participant to again rate their tenderness at the DTP, following passive positioning, with reference to the verbal analogue scale. If tenderness is rated at ‘3’ or less then the DTP is to be considered successfully treated. For the home exercise prescription intervention, exercises are to include: 1) Side-lying abdominal bracing (activation of deep abdominal stabilisers). 2) Supine (on back) alternate knee to chest holds. 3) Supine lumbar rotation (keeping knees together while rolling them side to side).
Sponsors
The University of Queensland
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to 55 Years
Healthy volunteers
Yes
Inclusion criteria
(1) Currently suffering from acute (symptoms for less than 3 months) low back pain (International Association for the Study of Pain definition: either initial episode or acute exacerbation). or surgery in the spine. (2) Willing to sign an informed consent form (3) Able to lie supine and prone. (4) Possessing four or more digitally tender points at prescribed sites in the low back and buttock regions and/or the anterior pelvic and abdominal regions.
Exclusion criteria
(1) History of spinal fractures (2) Diagnosed with an inflammatory disorder (3) Diagnosed with fibromyalgia (4) Suffering from signs of lumbar radiculopathy (5) Of Aboriginal or Torres Strait Islander ancestry
Outcome results
None listed