None listed
Conditions
Brief summary
Disability due to low back pain is a major health issue worldwide. Lumbo-sacral radiculopathy due to nerve root compression caused by disc herniation can result in unilateral loss of lower limb muscle strength. Muscle strength loss and lumbar scoliotic list, a spinal deformity, are the two physical signs of radiculopathy associated with very high compressive pressure on the affected lower lumbo-sacral nerve(s). The societal impact of radiculopathy is considerable as it affects people of working age whose mobility impairment due to muscle weakness can mean reduced participation including unemployment. A previous case study reported that correction of scoliotic list in side-lying resulted in improved muscle strength outcomes when measured by manual muscle tests. The objective is to demonstrate improved muscle strength with correction of scoliotic list in a one group prospective pre- post-intervention study design. In the proposed project, the isometric mid-thigh pull test, if found to be a feasible, reliable and valid measure of muscle strength loss due to radiculopathy, will be used to assess muscle strength outcomes of the side-lying intervention to correct scoliotic list. Patients included in the project will have a clinical diagnosis of lumbo-sacral radiculopathy, non-severe radicular pain, minor ankle dorsiflexion weakness, a lumbar scoliotic list in standing, and will be aged between 20 and 60 years. The project will commence January 2017 and will be completed December 2018. The project will be written up in a thesis in accordance with Auckland University of Technology regulations including introduction and conclusion chapters. The thesis may contribute to a better understanding of primary care intervention for the disabling condition, lumbo-sacral radiculopathy due to nerve compression caused by disc herniation.
Interventions
The research will be conducted in a primary care physiotherapy clinic in the Herne Bay suburb of Auckland. Patients of the clinic who volunteer to participate in the research will be asked to attend twice within a short period of time. The patient will be enrolled at the first session and will be tested within seven days at a second session. The anticipated date of last data collection will therefore be on the 23 November 2017, to collect enrolment data and on 30 November, to collect test data.
The research will be conducted in a primary care physiotherapy clinic in the Herne Bay suburb of Auckland. Patients of the clinic who volunteer to participate in the research will be asked to attend twice within a short period of time. The patient will be enrolled at the first session and will be tested within seven days at a second session. The anticipated date of last data collection will therefore be on the 23 November 2017, to collect enrolment data and on 30 November, to collect test data. The first session is expected to take approximately 30 minutes. The informed choice and consent form and those forms related to exclusion criteria will be completed in this first session. In addition, the patient will be familiarised with the isometric mid-thigh pull test procedure, a test that provides an accurate measure of peak force in semi-upright standing. There will be a period of no more than seven days between this and the second session when testing will be conducted. During this interim period the patient will be asked to abstain from vigorous exercise and to maintain normal daily activity, dietary habits and medication. The second session will involve a warm up prior to testing. This will include wall-support repeated knee bends for several minutes and then warm up trials of the isometric mid-thigh pull test, one at 50% maximal effort and one at 70% maximal effort. The test will be performed with one foot on the force plate, either affected or unaffected leg in randomised order. The test instruction will be to pull on the bar “Gradually build up to a maximum.” A further instruction to maintain effort for three to five seconds will be used. Maximum isometric ankle dorsiflexion strength, will be measured using a hand-held dynamometer with belt fixation, tested in three repeat measures of affected and unaffected lower limbs. An intervention specific to each patient will occur immediately following ‘pre-test’ measurements. The intention of the intervention is to correct the lumbo-sacral list. The direction of list is described according to the position of the superior component, the trunk, relative to the pelvis. To correct the list the pelvis will be translocated in the frontal plane. Therefore, to correct left list the patient will lie in right side-lying. The opposite applies to correction of right list, the patient will lie in left side-lying. The plinth will remain flat with head pillows adjusted to the comfort of the patient and a pillow will be placed between the legs. The corrective position will be maintained for five minutes. The isometric mid-thigh test procedure and the dynamometric measurement of ankle dorsiflexion strength will be repeated, ‘pre-test’ and ‘post-test.’ Measurements of pain and scoliotic list will be taken immediately prior to the ‘pre-test’ and prior to the ‘post-test’ isometric mid-thigh pull and dynamometric tests. The second session is expected to take approximately 60 minutes. The physiotherapist who will conduct the research has postgraduate qualifications in musculoskeletal physiotherapy and has co-authored radiculopathy-related publications in international journals during the last decade.
Sponsors
Kate Haswell
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
20 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
Clinical diagnosis of lumbo-sacral radiculopathy Unilateral ankle dorsiflexor weakness, manual muscle test Grade 4 Observable lumbo-sacral scoliotic list in standing
Exclusion criteria
Severe pain, Characteristic Pain Intensity, score >50/100 Major neurological deficit, manual muscle test grade < 4 and/ or progressive muscle weakness Major functional disability, Modified Roland Morris Functional Status Score 22 or 23/23 Significant depressive disorder that requires referral, Zung Self-Rating Depression Scale > 49/100 History of previous injury or disease to the affected or unaffected lower limb History of cardiovascular disease, diabetes, primary or metastatic cancer, spinal infection, inflammatory joint disease, spondylolisthesis, spinal stenosis, osteoporosis, osteomalacia, aortic aneurysm or bleeding disorder such as haemophilia History of spinal surgery Major surgery within the last six months
Outcome results
None listed