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Combining 2 effective treatments is most beneficial for LBP patients
August 3, 2016

No studies have looked at using both treatments together

Low back pain (LBP) is still one of the most common disorders that causes pain, as up to 85% of people will deal with it at least once. In some cases, LBP does not improve and becomes a long-lasting, or chronic condition. Physical therapy is often recommended for patients with chronic LBP and usually consists of different types of exercise, massage, relaxation techniques and counseling. McKenzie method is one type of treatment for chronic LBP that involves movements of the inner core of vertebral discs, which lie in between bones in the spine. Muscle Energy Techniques (METs) are another popular form of treatment meant to improve the flexibility of tissues in the spine. Many studies have shown that both the McKenzie Method and METs lead to positive effects for patients with chronic LBP, but no research has evaluated the use of both of them together. Therefore, a study was conducted that analyzed the effectiveness of the McKenzie method and MET for chronic LBP patients.

All patients go through 10 daily sessions for five days

A group of 60 patients with chronic LBP were randomly assigned to one of three groups: McKenzie method and MET, McKenzie method alone, and standard physical therapy. All patients had 10 daily sessions performed during five consecutive weekdays. For McKenzie method, sessions lasted 30 minutes and included different techniques in which the physical therapist did mobilizations or applied pressure to the back. For the MET, a relaxation technique was used on the back muscles of patients and sessions lasted 40 minutes. In the standard physical therapy group, patients were treated with massage, laser therapy and a device called transcutaneous electrical nerve stimulation. They were also asked to perform exercises to strengthen the abdominal and spinal muscles. All patients were evaluated before the treatments, immediately afterwards, and then again three months later for numerous variables.

McKenzie method and MET most effective overall

Results showed that the combination of the McKenzie method and MET was most effective overall in treating patients with chronic LBP. This combination led to improved mobility of not only the lower back, but also the middle and upper back. It also reduced levels of pain and improved quality of life. Many of these improvements were also found three months later, which shows that they were lasting. This study suggests that McKenzie method and METs may be best used in combination to treat chronic LBP patients, and together they can lead to impressive outcomes.

-As reported in the September’15 issue of Medical Science Monitor

Range of motion of the neck decreases with age, often without pain
May 19, 2016

In most cases of neck pain, there is no specific cause

Neck pain is a common condition that affects the upper (cervical) spine, and most cases are considered nonspecific, meaning there is no specific cause that can be identified. Up to 43% of patients with nonspecific neck pain visit their doctor for advice, and about 61% of them are referred to a physical therapist for treatment. During the examination, physical therapists usually measure the range of motion (ROM) of the neck-how far it can move in various directions-since a goal of treatment is to improve the mobility of the cervical spine. Unfortunately, there is little information about the normal values for cervical ROM (CROM), which makes it difficult to interpret results. Therefore, a study was conducted to establish normal CROM values and to examine the effects of age and sex on these values.

100 participants in four decades are measured

A total of 400 people without any neck complaints participated in the study, with 100 people (50 male, 50 female) for each decade of age from 20-59. A CROM device was used for all measurements because it’s easy to use and very reliable, and works by being placed on the head like spectacles. Volunteers were given clear instructions on their posture and what movements to make, and made a variety of movements three times in each direction before being measured.

Using normal values can help determine if patients lack mobility

Results showed that CROM decreases significantly in all directions in the decade of 50-59 years when compared to people younger than 40. Unsurprisingly, the largest difference for all directions was found between 20-29 and 50-59 years, as there was a significant decrease in CROM from age that seemed to begin between 40-49 and continued into the 50s. Aside from these age differences-which may be due to issues like osteoarthritis-no notable differences were found between males and females. This study now provides normal CROM values for people aged 20-59 without neck pain, and can be consulted by medical professionals during assessments. A future study that performs the same analysis on patients with neck complaints will be an even greater help by being able to compare values of healthy people to those with neck pain.

-As reported in the March ’14 issue of Spine

2 types of physical therapy have similar positive effects on low back
April 28, 2016

Though many agree that therapy is needed, research is lacking

Low back pain (LBP) is one of the most common medical problems in modern society. When this pain lasts for more than three months, it’s called chronic LBP. Some LBP causes like too much physical activity, weak abdominal muscles and bad posture may create instability in back joints that can make LBP worse. Manual therapy, a type of physical therapy that’s performed by a physical therapist’s hands, is believed to be beneficial in treating LBP patients; however, research is lacking on this topic. Based on this, a study was conducted that compared two types of manual therapy with each other and a basic exercise to determine which was most effective for LBP patients.

Small sample of patients randomly divided into three groups

Patients with chronic LBP for more than 12 weeks were recruited, and a total of 36 accepted and were then randomly divided into three groups: the manipulation, mobilization and control group. In manipulation, the physical therapist applied a force to certain joints in the lower back with the patients lying on their backs. Mobilization used a slower, more-controlled stretching of patients’ backs while lying on their chests. All patients also performed a series of exercises, but the control group did not receive any manual therapy. Each intervention was conducted three times a week for six weeks, and all patients were assessed before and afterwards for functional abilities, range of motion (ROM) of their back, and overall mental state.

Manipulation and mobilization lead to similar improvements

Results showed that all groups improved in all measurements taken, but the manipulation and mobilization groups experienced more significant improvements than controls. These two manual therapy groups reported very similar results in both functional abilities and ROM, but the overall mental state was more improved in the manipulation group. These findings suggest that both manipulation and mobilization can lead to significant improvements in patients with chronic LBP. Though the manipulation group had a slight edge, both forms of manual therapy appear to be effective for treating this common condition. Physical therapists should therefore be encouraged to integrate this type of treatment into their strategies for these patients.

-As reported in the Novemeber ’14 issue of journal of Physical Therapy Science

Aggressive physical therapy immediately after surgery is effective
April 21, 2016

In most cases the wrist is immobilized for several weeks following surgery

The radius is the larger of the two bones that make up the forearm, and the end of this bone towards the wrist is called the distal radius. Fractures of the distal radius are very common, most typically occurring from falling on an outstretched arm. In the event of a fracture, a type of surgery called open reduction and internal fixation (ORIF) may be utilized if necessary, which is followed by rehabilitation. The wrist is usually immobilized for several weeks during this process, and exercises to strengthen the wrist typically begin about 6-8 weeks after surgery; however, some suggest that this period of waiting is not necessary. In order to evaluate this, a study was conducted that compared traditional rehab with a more accelerated program in which exercises begin much sooner.

Two groups of patients assessed regularly for six months

Patients who had a distal radial fracture followed by ORIF surgery were recruited and assessed, which led to 78 patients accepted and randomly assigned to the standard or accelerated rehab protocol. Both groups began with range of motion (ROM) exercises of the shoulder, elbow, forearm, wrist and fingers 3-5 days after surgery. Two weeks after surgery, the accelerated group started new ROM exercises, plus light strengthening exercises, and four weeks after surgery, the splints they were using were removed. The standard group wore the splint until six weeks after surgery, at which time they began the other ROM and strengthening exercises. All patients were assessed for numerous outcomes at regular intervals for six months.

Patients in accelerated group have better scores and function than standard group

The accelerated rehab group reported better mobility, strength, and Disabilities of the Arm, Shoulder and Hand (DASH) scores than the standard rehab group. Improvements were noted within the first eight weeks after surgery, and were considered statistically significant. These findings suggest that starting wrist motion within 3-5 days and strengthening exercises at two weeks after surgery can lead to an earlier return to function for patients. Though some surgeons are skeptical of moving the wrist so soon after surgery, this study presents a case that accelerated rehabilitation may lead to better results and a faster return to activities.

-As reported in the October ’14 issue of The Journal of Bone and Joint Surgery

Aerobic exercise leads to greater improvements than balance training
April 7, 2016

Two treatments have not been compared and require further research

Fibromyalgia syndrome is a chronic (long-lasting) condition in which patients typically experience widespread pain, disrupted sleep, fatigue and impaired ability to think. Exercise is commonly recommended to patients with fibromyalgia, and research has shown that aerobic and strength training can lead to numerous improvements for them. Many patients with fibromyalgia also have balance problems, which can increase their chances for a fall, and balance training has therefore been suggested as well. Despite this, no studies have investigated balance training for fibromyalgia patients, and it has not been compared with aerobic training. For this reason, a powerful study called a randomized-controlled trial (RCT) was conducted that compared the effects of aerobic exercise training to balance training in fibromyalgia patients.

Small group of patients undergoes one of two six-week interventions

Women with fibromyalgia were invited to participate and were screened, which led to 33 patients being accepted and randomly assigned to either the aerobic training or balance training group. Both programs lasted six weeks, and patients were evaluated before and after the intervention for pain, physical function, balance, exercise capacity, and quality of life (QoL). The aerobic training group performed three 20-45 minute sessions per week, and the intervention was led by a physical therapist and included a treadmill. Exercises were performed at 60-75% of patients’ heart rate, and either increased or decreased in intensity based on their exertion level. The balance-training group performed three weekly 20-30 minute sessions, which consisted of exercises designed to change patients’ center of gravity and improve balance.

Both groups improve, but aerobic training leads to more significant gains

Results showed that both programs had similar positive effects on reducing pain, improving exercise capacity and enhancing QoL, but patients in the aerobic group experienced greater benefits in pain and physical function than the balance group. These findings confirm previous research that supports aerobic exercise for fibromyalgia, but also shows that balance training may serve an important purpose, as well. Therefore, it’s suggested that the inclusion of balance training be considered in treatment programs for patients with fibromyalgia, especially those who cannot participate in a conventional aerobic exercise-training program. Doing so may lead to even greater improvements for these patients and reduce their risk for falls.

-As reported in the May ’15 issue of the Rheumatology International

A physical activity program reduces mobility issues in older adults
March 30, 2016

Preserving ability to live independently is very important

The life expectancy for older adults has been continuing to increase, and those 65 or older are now the fastest growing portion of the population. As this age group keeps growing, it’s important to help preserve their ability to live independently and function well. Mobility, the ability to walk without assistance, is a major component of functioning independently, and those with low mobility often experience a lower quality of life. Physical activity is believed to prevent or delay the onset of disability issues with mobility, but no studies have tested this over a long period. Therefore, a powerful study called a randomized-controlled trial (RCT) was conducted to evaluate the long-term effects of a physical activity program on the mobility of older adults.

Large group of individuals randomly divided into two groups

Researchers recruited individuals between 70-89 years old who didn’t get much regular physical activity and were at a high risk for mobility disability. Of the 14,831 individuals screened, 1,635 were accepted and randomly assigned to either the physical activity or the health education group. The physical activity program involved strength, flexibility and balance training, and regular walking with a goal of 150 minutes per week. The health education program consisted of weekly (for the first 26 weeks) and monthly (thereafter) workshops. They featured topics important to older adults and some stretching exercises, but no physical activity topics. All patients were assessed every six months for at least two years with questionnaires, but the main outcome was the ability to walk 400 meters within 15 minutes without sitting or any assistance.

Physical activity patients experience significant reduction in mobility disability

Overall, the amount of time patients were followed-up for was 2.6 years. During that time, patients in the physical activity group experienced significant reductions in their mobility disability compared to the health education group. These patients adhered to the program very well and also maintained an average of 218 weekly minutes of walking and activities in the follow-up period. The results of this study, which is considered the largest and longest duration RCT on this topic, suggest that using such a program on at-risk older adults can lead to significant benefits that may increase their abilities and preserve their independence.

-As reported in the June ’14 issue of JAMA

Combination of therapy, exercise and education is best for neck pain
March 17, 2016

There is a lack of evidence regarding the role of education to treat condition

Nonspecific chronic neck pain (CNP)-meaning the pain has been lasting for at least 12 weeks and there is no specific cause identified for its development-is a common condition in which patients typically deal with high levels of disability and pain. Some people may also experience psychological issues like depression and anxiety. Popular treatments such as exercise and manipulations by physical therapists are known to be effective for CNP, but it’s been suggested that education is also needed to address these psychological issues. Unfortunately, there is not much evidence on the role of patient education in treating patients with CNP. Therefore, a powerful study called a randomized-controlled trial (RCT) was conducted to determine how effective a program that combined therapy, exercise and education was for CNP patients.

Small sample of patients divided into three groups

Patients with neck pain for at least 12 weeks were evaluated, and 43 fit the criteria and were randomly assigned to one of three groups. Over one month, all participants received two treatment sessions per week, for eight sessions total. The control group received various manual therapy techniques, in which the physical therapist performed movements and mobilizations of the neck. Experimental group 1 received the same treatment, but with the addition of two patient education sessions, which were meant to improve patients’ beliefs about pain and disability, and to promote coping strategies and independence through activities. Experimental group 2 received the same treatment as group 1, but also was given an exercise program. This consisted of strengthening and stretching exercises for the neck, and was to be performed at least once daily for eight weeks. All patients were evaluated for neck disability and other variables before the intervention and 16 weeks later.

Largest improvements seen in experimental group 2

All groups were found to improve in various measures immediately after treatment and at the 16-week follow-up; however, experimental group 2 experienced the greatest improvements overall in neck disability scores, as well as in measurements for fatigue and neck muscle endurance. Experimental group 1 performed better than the control group, which suggests that the addition of education did in fact lead to greater improvements, but experimental group 2’s superior overall performance shows that exercise is also a necessary component of treatment. The results of this RCT highlight the importance of combining various elements in a treatment program for CNP patients, and show that education and exercise are beneficial in helping to obtain the best outcomes for patients.

-As reported in the October ’15 issue of American Journal of Physical Medicine and Rehabilitation

Many patients found to have back conditions despite lack of symptoms
February 14, 2016

Imaging tests are becoming increasingly common when evaluating patients

Low back pain (LBP) affects about 80% of the population at some point, and it’s associated with major economic consequences. Advanced imaging tests like magnetic resonance imaging (MRI) and computed tomography (CT) scans are becoming increasingly common in to evaluate these patients. These tests often reveal back disorders such as disc degeneration (a condition in which discs in the spine begin to wear away) that are interpreted to be the cause of the pain. This may lead to surgical procedures and other treatments that may not be necessary and sometimes fail to alleviate symptoms. The fact that some people can have abnormal findings on tests without having LBP symptoms helps to explain this. But to get a better idea of just how many people fall into this category, a powerful systematic review was conducted on all relevant literature on the topic.

Three databases searched for appropriate research studies

Three major medical databases were searched. Researchers looked for studies that recorded the prevalence of abnormal spine MRIs and CT scan findings in different age groups of people with no history of LBP (asymptomatic individuals.) Of the 379 articles identified, 33 met the criteria and were analyzed. Of those, 32 reported information on MRIs and one reported information on CT scans.

Abnormal findings are common and often a result of aging

Results showed that 37% of asymptomatic individuals ages 20-29 had disc degeneration. This figure increased to 96% of 80-89 years old, which shows a major increase in prevalence with age. Another abnormal finding called disc signal loss, which is similar to disc degeneration, was found in 54% of asymptomatic individuals 40-49 years old and 86% of 60-69 year olds. Similar trends with prevalence and age were noticed with other findings as well. This systematic review makes it very clear that a large percentage of individuals without any LBP symptoms display abnormal findings on imaging tests, and this increases significantly with age. This suggests that many of these issues may be due simply to the aging process and have little to do with symptoms of LBP. It’s therefore extremely important to interpret results from these tests with caution and keep this review in mind when making any treatment decisions.

-As reported in the November ’14 issue of the American Journal of Neuroradiology

Therapeutic device may not add benefits to exercise and education
January 19, 2016

Physical therapists often use device in addition to other treatments

Knee osteoarthritis (OA) is a common condition in which protective cartilage in the knee gradually wears away, causing pain and weakness. Many treatments are available, and high-quality reviews show that exercise and education are very effective. Physical therapists often combine treatments, sometimes including transcutaneous electrical nerve stimulation (TENS), in which an electric current stimulates nerves to alleviate pain. TENS is used for many conditions, but research to support its effectiveness for knee OA is lacking. Therefore, a powerful study called a randomized-controlled trial was conducted to evaluate the additional effects of TENS on knee OA patients when combined with exercise and education.

Knee OA patients randomly divided into three groups

Individuals with knee OA were recruited, and 224 patients were accepted. Patients were randomly divided into the TENS and knee group, the sham TENS and knee group, or the knee group. All patients participated in the exercise and education program, which consisted of a one-hour session each week for six weeks. The education enhanced patients’ abilities to self-manage their condition, while exercises focused on improving leg strength and function and included a daily home-exercise program. TENS and knee group patients were told to use their device at any time before, during or after exercise. The sham TENS group was given similar instructions, but their device was deactivated. All patients were assessed for pain and function before the study and then again three, six, 12, and 24 weeks later.

All groups improve, but the added effect of TENS is questioned

Results showed that patients in all three groups improved in both pain and function throughout the duration of the study. Patients in the TENS and knee group did not improve any more than those in the other groups, and those in the knee group actually improved more. These outcomes suggest that the exercise and education program is effective for reducing pain and improving function for patients with knee OA, but it calls the use of TENS into question. Based on this, it appears that while TENS devices could be beneficial for some conditions, it’s not as certain with knee OA. Additional research will help to confirm this and determine the true worth of TENS.

-As reported in the March ’14 issue of Arthritis Care & Research

Strength training more effective than balance exercises for stability
January 4, 2016

Previous research inconclusive on strength training alone for preventing falls

Falls are one of the most important issues the elderly population faces, as a fall can lead to serious injury and long-term dependency. Physical inactivity, poor balance, and declining muscle strength are all known to increase the chances of falling. Fall-prevention programs usually combine strength and balance training and are effective for reducing the rate and risk of falling; however, studies on strength training alone have been inconclusive. Based on this, a powerful study called a randomized-controlled trial (RCT) was conducted that evaluated the effectiveness of a strength-training program and a traditional balance exercise program for improving balance in the elderly.

Participants randomly divided into one of three groups

A group of adults 65 and older was screened to determine if they were eligible, and 45 fit the criteria. These patients were randomly divided into either the traditional balance exercise (TBE), the progressive resistance strength-training (PRT) or the combination group. The TBE group received four 45-minute weekly sessions of traditional balance exercises for six months. The sessions consisted of eight components that were each intended to improve balance, and the complexity of training progressed based on the ability of each patient. The PRT group followed the same schedule, but sessions lasted for one hour and were focused on training the key muscles of both legs. Strength exercises were performed using weighted sand bags and focused on muscles of the hips, knees, and ankles. The combined group received identical TBE and PRT alternatively, with two days of each per week.

PRT group experiences greater improvements in balance than TBE group

Results showed that all three groups experienced significant improvements in balance up through study’s six-month duration. When compared, however, the PRT group showed greater improvements than the TBE group, which was indicated by better overall stability. Participants in both the PRT and combined group scored higher on a test that measured their ability to reach, which shows that these patients experienced increased strength from the interventions. Overall, these findings suggest that a program that strengthens muscles is more effective than straightforward balance exercises alone for improving balance, and may therefore be a better strategy for preventing falls in the elderly.

-As reported in the March ’14 issue of the Journal of Clinical and Diagnostic Research