ORIGINAL ARTICLE   

Minerva Ortopedica e Traumatologica 2017 March;68(1):1-7

DOI: 10.23736/S0026-4911.16.03772-1

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Rehabilitation treatment for chronic lower back pain: new evidence for old methods? A randomized, controlled experimental trial

Sergio RIGONI, Mario SCAPIN ✉

Department of Physical and Rehabilitation Medicine, Asiago Hospital, Bassano del Grappa, Vicenza, Italy

BACKGROUND: Chronic lower back pain is the most common spine disease of our time and is the leading cause of disability in the United States. Nevertheless, evolution of rehabilitative treatments has stalled and the most recent studies conducted in this field are small and not methodologically rigorous. The aim of this paper is to compare the short/medium term efficacy of two rehabilitation methods to treat chronic lower back pain: the McKenzie method and osteopathic manipulation therapy.
METHODS: This is a randomized, controlled, and balanced analysis performed at a single site. From a total population of 52 subjects, we randomly extracted 40 patients, which were then randomly assigned to one of two groups. A baseline assessment was performed at the beginning of the treatment (T0), followed by an ad-interim evaluation after one month (T1) and a final evaluation after two months (T2). A single operator performed treatment and evaluations: the study is therefore single-blinded. The outcome was evaluated using the Roland-Morris scale, the NRS scale, and the bending-relaxation phenomenon measured using electromyography biofeedback (EMG-BFB).
RESULTS: The two groups were homogeneous as to age and sex. Statistically significant results in terms of pain and disability reduction were observed for both methods, but with different timing: while the manipulation therapy proved to be quickly efficacious, the McKenzie method required a longer time to produce similar effects. With regard to EMG results, it should be noted that while for the McKenzie group no changes have been observed, for the manipulation therapy group the observed results are different from what is found in the literature.
CONCLUSIONS: Both methods were proved efficacious in the treatment of chronic lower back pain in terms of pain and disability, but with different timing. It is possible, as proposed by some authors, that manipulation therapy could interfere with pain transmission pathways. Both methods provided a reduction of the disability frequently associated with backache, likely by allowing patients to maintain a certain degree of mobility from the outset. Interpretation of the EMG data is more complex, and we suggest that the flexion-relaxation phenomenon is difficult to apply for the evaluation of this type of patient. Nevertheless, it is intriguing to think that the changes obtained with manipulation therapy are the manifestation of some reorganization of the spinal proprioceptive system.

KEY WORDS: Muscle relaxation - Surveys and questionnaires - Pain measurement - Osteopathic manipulation