Chronic low back pain from zygapophyseal joint origin Musculoskeletal Diseases Low back pain
Conditions
Interventions
All subjects are randomly allocated into two groups, the intervention group was treated with muscle energy technique as intervention group, and the control group with lumbar stabilization exercise.
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Sponsors
Mahidol University
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Patients of both genders who met the following criteria were included in the study: 1. 18-60 years old 2. Recurrent or chronic LBP at least 3 months 3. Pain severity from mild to moderate (21 to 69 mm on VAS) Nine criteria for diagnosing of zygapophyseal joint origin according to Wilde et al were used for including the subjects. The diagnosing criterias as follows: 1. Localized unilateral back pain 2. Pain, if referred to the leg, was above the knee 3. Replication or aggravation of pain by unilateral pressure over the lumbar zygapophyseal joint or transverse process 4. No radicular features such as sign of nerve root irritation (dermatomal pain and paresthesia) and nerve root compression (dermatomal sensory loss, myotomal weakness, and loss of reflex) 5. Pain eased in flexion 6. Passive accessory movement showed reduced ROM or increased stiffness on the side of lumbar zygapophyseal joint pain. 7. Unilateral muscle spasm over the affected lumbar zygapophyseal joint 8. Pain in extension 9. Pain in 3D movement (extension, lateral flexion, and rotation) to the ipsilateral side
Exclusion criteria
Exclusion criteria: 1. Fever 2. Pain referring below-knee 3. Women with pregnancy 4. Women within menstruation period 5. Any other spinal problems: osteomalacia, inflammatory, osteoporosis, spondylolysis, spondylolisthesis, foraminal or central stenosis, scoliosis or deformity of the spine 6. Previous back surgery 7. Disc herniation or prolapse with neurologic signs 8. Received other treatments such as injection or medication for pain reduction within 24 hours 9. Red flag for the low back region: 9.1. Back-related tumor: history of cancer, unexplained weight loss, failure of conservative therapy 9.2. Back-related infection (spinal osteomyelitis): recent infection (e.g., urinary tract or skin infection), concurrent immunosuppressive disorder 9.3. Cauda equina syndrome: urine retention or incontinence, fecal incontinence, saddle anesthesia, global or progressive weakness in the lower extremities, sensory deficits in the feet (L4, L5, and S1 areas), ankle dorsiflexion and plantar flexion weakness 9.4. Spinal fracture: history of trauma, prolonged use of steroids
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Kinematics of lumbar spine (active range of motion (AROM) of flexion, extension, left and right lateral flexion, and left and right rotation), measured using 3D Vicon Nexus 1.8.4 motion systems before and immediately after intervention 3D Vicon Nexus 1.8.4 motion systems was used. A reflective markers using the spinal wand model was attached over specific anatomical landmark on 12th thoracic segment. For pelvis segment, the markers were placed over the left and right anterior superior iliac spines and the midpoint between the left and right posterior superior iliac spines. The movements measured included flexion, extension, right lateral flexion, left lateral flexion, right rotation, and left rotation. The measurement protocols were as follows. For flexion, the subject stood with feet shoulders’ width apart. Running both hands down front of both legs, the subject was instructed to flex spine as far as possible while keeping knees extended. The subject then returned to starting position. For extension, position was similar with flexion, except the subject placing hands on waists, and bent backward as far as possible while keeping knees extended. The subject then returned to starting position. For right and left lateral flexion, the subject was asked to running hand down side of leg, then laterally flexed spine as far as possible. The subject kept knees extended and did not bend trunk forward or backward while performing movement. The subject then returned to starting position. For right and left rotation, the subject sat erect on stool, arms crossed and hands on opposite shoulders. The subject was asked to rotate spine as far as possible without arms and hand moving. During rotation, no lateral flexion occurred. The subject then returned to starting position. All movement procedures were repeated 3 times and the data were used based on average value. Measurement was conducted twice, before and immediately after intervention at motion analysis laboratory. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Pain intensity, assessed using horizontal VAS consisting of a line, 100-mm long, with ends labeled as the extremes of pain from ‘no pain’ to ‘pain as bad as it could be’. Patients were asked to indicate which point along the line best representing their level of pain intensity and put a mark on the line. Measurement was conducted three times; before, immediately after treatment, and at next visit after 2 days. 2. Disability level, assessed using Thai version of modified Oswestry disability questionnaire according to Sakulriprasert et al. The items included pain intensity, personal care (washing, dressing, etc), lifting, walking, sitting, standing, sleeping, social life, traveling, and employing/home making. Each item was scored on a 0-5 scale, with 0 representing no disability and 5 representing the highest disability for each function. If all items were completed, the scoring was represented with percentage by total score/total possible score that completed (maximum score 50) X 100%. Disability level measurement was conducted twice, first, before treatment as pre-treatment score. Second measurement was conducted at next visit as post-treatment score. The duration between visits is 2 days. | — |
Countries
Thailand
Outcome results
None listed