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Effect of Spinal Manipulation on Pain Sensitivity, Postural Sway, and Health

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Effect of Spinal Manipulation on Pain Sensitivity, Postural Sway, and Health Review Article Clinician’s corner Images in Medicine Experimental Research Case Report Miscellaneous Letter to Editor DOI: 10.7860/JCDR/2019/38074.12578 Original Article Postgraduate Education Effect of Spinal Manipulation on Pain Case Series Sensitivity, Postural Sway, and Health- Physiotherapy Section Physiotherapy related Quality of Life among Patients Short Communication with Non-specific Chronic Low Back Pain: A Randomised Control Trial KANCHAN KUMAR SARKER1, JASOBANTA SETHI2, UMASANKAR MOHANTY3 ABSTRACT ergonomic advice (n=30). Primary outcomes were postural Introduction: Spinal manipulation is a technique of specific sways (centres of foot pressure) measured by Win Track directed manual thrust which has been effective in aligning Platform, and pain sensitivity measured by pressure pain a spinal segment, maintaining normal range of motion and threshold (digital algometer) and quality of life measured by reducing pain. Recent studies have reported on management EuroQoL questionnaire score at two weeks and four weeks. of pain and improvement of quality of life of patients suffering Univariate analysis of variance (ANOVA) with post-hoc Tukey’s from mechanical low back pain. multiple comparison tests was carried out to examine treatment effects and the relationship between groups changes across Aim: To analyse the effectiveness of Spinal Manipulation-High- outcome measures. Velocity Low Amplitude Thrust (SM-HVLA) on pain sensitivity, postural sway and quality of life in patients with Chronic Non- Results: For all three treatment groups, outcomes improved after Specific Low Back Pain (CNSLBP). two weeks of treatment. The group received spinal manipulation with ergonomic advice had slightly better outcome than the Materials and Methods: This randomised controlled trial was supervised exercise with ergonomic advice group at two weeks conducted on a sample size of 90 patients with chronic non- (between-group difference) in pain sensitivity (p=0.001); Postural specific low back pain (with duration of pain more than three sway (p=0.001); quality of life (p=0.01) as well as at four weeks months) recruited from Outpatient Department, Department (between-group difference): pain sensitivity (p=0.001); postural of Physiotherapy, Lovely Professional University, Phagwara, sway (p=0.001); quality of life (p=0.01). Punjab, India. Participants were divided into three groups, namely Control Group, Study Group-1, and Study Group-2. Conclusion: The spinal manipulation with ergonomic advice is Control group received supervised exercise with ergonomic effective in treatment of chronic non-specific low back pain. This advice (n=30), whereas SM-HVLA thrust with ergonomic advice is an economic model of back care in clinics can be practised (n=30), and study group-2 received core stability exercise with widely. Keywords: Core stability exercise, High velocity low amplitude thrust, Supervised exercise INTRODUCTION While mechanisms responsible for the therapeutic effects of Chronic Non-Specific Low Back Pain (CNSLBP) is defined as Spinal Manipulation (SM) remains unclear for patients with non- pain located between the costal margin and buttocks and lasts specific low back pain, different theories and mechanisms of action for longer than three months while particular causes of low back for spinal manipulation are still under conversation [6]. Manual pain are unknown, accounting for <15% of all back pain cases therapists, osteopaths, and chiropractors are significantly oriented [1]. About 85% of patients with isolated LBP cannot be given a by biomechanical and physiological mechanism where mechanical specific pathoanatomical diagnosis. NSLBP has been defined as forces are applied to specific vertebral regions may modify tension, soreness, and/or stiffness in the lower back region for segmental biomechanics by releasing trapped menisci lesions, which it is impossible to recognise a specific cause of the pain reducing adhesions and distortions of the annulus fibrosus [5]. This [2]. The condition has a high incidence and prevalence which has mechanism of action enables the vertebral segments to progress been explored in various systematic studies. Reviews explored that in a bigger range of motion and would diminish the mechanical the lifetime incidence of LBP was >70% and one-year prevalence pressure on paraspinal muscles, thus reducing pain and distress. ranges 15% to 45% with point prevalence averaging 30% [3]. However, the mechanisms underlying the effects of SM appears Here is an effort to check the impact of spinal manipulation connected to be more difficult than a simple biomechanical oriented model with CNSLBP on which a great number of management reports have and explained between a combination of biomechanical and non been recommended by European guidelines for the management of biomechanical effects [7]. CNSLBP [4]. These guidelines hold up the use of spinal manipulation Patients with low back pain have altered postural sway compared to with high-velocity low amplitude thrust in patients with chronic low healthy persons. It is hypothesised that the reduced proprioceptive back pain suggest that spinal manipulation is probably useful [5] perception originated from muscle or joint mechanoreceptors can and cost-effective when applied alone or in combination with other be a reason of changed postural sway [8] as well as impaired techniques compared to common practitioner care or universal quick-fix memory that leads to detain in processing postural control physical therapy [4]. information [9]. Journal of Clinical and Diagnostic Research. 2019 Feb, Vol-13(2): YC01-YC05 1 Kanchan Kumar Sarker et al., Effect of Spinal Manipulation on Pain Sensitivity, Postural Sway and Health Related Quality of Life www.jcdr.net It is generally accepted that low back pain has a negative impact Intervention on quality of life [10]. The quality of life of patients with non specific The participants were assigned into three groups by consecutive low back pain is lower in comparison to general population and convenient sampling, each group with 30 patients. All participants much lower with chronic condition. This seriously affects the in the study received two weeks of treatment. The Control Group functional ability and working status of young and adult population. Supervised Exercise and Ergonomic Advice (SE+EA) had received While affecting quality of life and disability the intensity of pain supervised exercise with ergonomic advice alone; whereas Study with CNSLBP is complete individual, psychosocial and work- Group 1 received spinal manipulation and ergonomic advice related [11]. In the current study, spinal manipulation has been (SM+EA), and Study Group 2 received core stability exercise and used to impact proprioceptive input on spinal tissues to improve ergonomic advice (CSE+EA) for 45 minutes per day for two weeks sensorimotor function. As a result, this study might give evidence respectively. to sensorimotor mechanisms that cause the experimental functional deficits associated with LBP as well as the mechanism Supervised Exercise and Ergonomic Advice (SE+EA) of action of SM [12]. The control group had received instruction for the supervised exercises with ergonomic advice (SE+EA) with 45 minutes Exercise therapy is the basic treatment for chronic low back pain sessions. Individualised sessions included advice and instruction but most of the effective exercise approach is still under discussion. on self-care measures, careful ergonomic recommendations for A recent evaluation suggests that separately designed supervised home and work, and demonstration of good lifting techniques. exercise programs including stretching or strengthening may result Simple stretching and strengthening exercises, including lumbar from more functional development and pain relief than supervise extension, bridging, and abdominal crunches, were demonstrated exercise in CNSLBP [13]. and practised. Participants were given a book and laminated The present study aimed to evaluate efficacy of spinal manipulation cards describing these exercises and were encouraged to on postural sway, pain sensitivity and quality of life among patients perform them at home on a daily basis [16]. The patients were with CNSLBP. followed-up in person two weeks later and then instructed to continue with the exercises on their own for the remainder of the MATERIALS AND METHODS intervention phase. This randomised controlled trial was conducted from August 2015 to January 2017 at Outpatient Department (OPD), Department Spinal Manipulation and Ergonomic Advice (SM+EA) of Physiotherapy, Lovely Professional University, India. All The patients (n=30) of Study Group 1 received the protocol of therapeutic interventions were provided within OPD, Department spinal manipulation treatment in addition to ergonomic advice of Physiotherapy, Lovely Professional University. Ethical approval (described above). Spinal manipulation was delivered after a has been granted by Institutional Ethical Committee (Ref. No- systematic physical examination that included manual palpation LPU/IEC/PTY/004; Dt.16/11/16) and CTRI Regn. Ref. No: of the lumbar and sacral areas to assess local tenderness of NCT03016676 segmental dysfunction/hypomobility to be manipulated. Spinal manipulation treatment technique for CNSLBP was generally Patients with Enrollment performed on patients in a side-lying position on a treatment A consecutive convenient sample of 90 patients was recruited couch with the affected side facing upward. The therapists stood (out
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