Intervertebral mobilization for aspecific back pain: effects on posture and pain

Abstract

Low back pain pain can be defined, according to the most recent evidences, as a bio-psycho-social pathology, but in addition to the mechanical factors other elements that play an important role in the lumbar disability come into play. In fact, during the acute phase pain has a nociceptive and mechanical origin, but over time the influence of psychological and social factors causes the maintenance and chronicization of the pathological process. Mobilization and manipulation therapies are widely used by patients with chronic nonspecific spine pain; however, questions remain around the efficacy, dosing and safety of manual approaches, as well as how these approaches compare to other therapies. The aim of our study project is to try to obtain a reduction in pain and disability by administering vertebral mobilizations with muscle energy techniques (MET) to subjects suffering from this disorder. In the scientific literature there are already studies on the effects of muscle energy techniques on vertebral column mobility and pain. The results were often conflicting, whith some researches confirming the efficacy of the technique in the management of back pain and other researches confutating that. However, the studies carried out are not very precise, both because of the difficulty of applying the technique which requires a thorough knowledge of the vertebral structures, and for the small sample of people who participated in the various projects carried out. Moreover, the major difficulty in the proposed approach appears to be represented by the subjectivity of the approach and the lack of unequivocal results in the literature. The purpose of this study is to use an objective assessment of the postural alignement of the patient, in order to create an objective and repeatable treatment personalized for each patient by a standardized evaluation system. Among the outcome measures, a non-invasive digital system was used for the three-dimensional reconstruction of the spine and the study of its postural alignement. A total of 20 subjects were evaluated before and after the whole protocol for parameters attesting the effect of the treatment on disability, mobility, posture and pain; during a cognitive interview, a personalized anamnestic medical record was compiled and the Oswestry Disability Index scale (ODI ) and the VAS visual analogue scale were administered. Furthermore, the participating subjects were evaluated from the postural point of view and through the use of the 3D B.A.K. Body Analysis Kapture with 4 self calibrated cameras (Diasu Health Technologies, Rome, Italy), a computerized postural analysis that allows the 3D reconstruction of the spine, at the beginning and end of the cycle of therapies. At each session, the subjects were evaluated at the beginning and at the end with the Forward Bending Test and Side Bending Test. From the results of 3D computerized postural analysis B.A.K. the data show that, at the end of the therapeutic protocol, patients reached a harmonious symmetry between the two hemisomes and increase the mobility of the spine. The VAS was, on the whole of the parameters examined, the index most influenced by the applied therapy, reporting a decrease of 70.9%; similar results were also found for the ODI scale score, -68.6%. The results show that the MET can be effective at increasing the range of movement of the spine. We can hypotize that the main explanation for these results can be the application of MET on specific areas of the spine starting from the concept of “greatest somatic dysfunction”. The concomitant decrease in pain and increase of vertebral ROM is another key-point of the study; these results contributed to the improvement of the quality of life of patients who participated to the study. However, further scientific researches are needed for this technique to be validated and used more frequently for painful spinal diseases.