SIB #360 Pain, Function, Sagittal Alignment And Physical Therapy

The Study: Effects of Physical Therapy on Pain, Functional Status, Sagittal Spinal Alignment, and Spinal Mobility in Chronic Non-specific Low Back Pain.

The Facts:

a. The authors looked at 100 patients with non-specific low back pain (NSLBP).

b. Sixty of the patients went into the physical therapy group which received 10 sessions of heat, TENS, ultrasound in addition to a home exercise program.

c. Forty patients did only the home exercise program.

d. The authors evaluated pain by the use of a Visual Analog Scale (VAS). For the functional evaluation they used the Oswestry Disability Index (ODI). “Spinal sagittal alignment in regard to lumbosacral, lumbar lordosis, and thoracic kyphosis angles and spinal mobility regarding lumbar and thoracic flexion and extension degrees were assessed using a digital inclinometer. Lumbar flexion was also assessed using the modified lumbar Schober test (mLST). Evaluations were performed at baseline and after completing the therapy sessions.”

e. Both groups experienced significant reductions in pain.

f. Only the physical therapy group had improvements in the Oswestry index, the Schober tests, spinal alignment and mobility.

g. “Pain was also significantly reduced in the control group; however, no significant differences were observed among the controls regarding disability, sagittal spinal alignment, and spinal mobility.”

Take Home:

Both groups had a reduction in pain. Only the group receiving heat, TENS and ultrasound had improvements in disability, sagittal alignment and mobility.

Reviewer's Comments:

This is why we report on a variety of articles. Let us examine this one in more detail. I am not surprised about a reduction in pain in both groups as time alone often reduces or alleviates pain and a home exercise program could also very well reduce the pain. I am somewhat surprised that both groups did not have an improvement in mobility as the reduction of pain might be expected to allow for more ease of mobility. I could even see how both groups might have an improvement in spinal alignment as they might have been somewhat antalgic or held themselves in some position that caused less pain and when that pain was gone they stood more naturally or that the home exercise program improved the alignment. But I would not have expected the improvement in sagittal alignment to be only in the physical therapy group receiving the indicated mobilities. The authors state, “In conclusion, despite certain limitations and short treatment duration, the results of the present study revealed that PT had significant effects on pain, sagittal spinal alignment, disability, and spinal mobility in patients with chronic NSLBP. Further randomized controlled long-term studies are needed to confirm these results.” I look forward to future studies.

Reviewer: Roger Coleman DC

 Editor: Mark R. Payne DC

Reference: Filiz MB, Firat SC. Effects of Physical Therapy on Pain, Functional Status, Sagittal Spinal Alignment, and SpinalMobility in Chronic Non-specific Low Back Pain. Eurasian J Med. 2019 Feb;51(1):22-26. doi: 10.5152/eurasianjmed.2018.18126. Epub 2018 Nov 30.

Link to Abstract:https://www.ncbi.nlm.nih.gov/pubmed/30911251