Slacklining as therapy to address non-specific low back pain in the presence of multifidus arthrogenic muscle inhibition

Low back pain(LBP)represents the most prevalent,problematic and painful of musculoskeletal conditions that affects both the individual and society with health and economic concerns.LBP is a heterogeneous condition with multiple diagnoses and causes.In the absence of consensus definitions,partly because of terminology inconsistency,it is further referred to as non-specific LBP(NSLBP).In NSLBP patients,the lumbar multifidus(MF),a key stabilizing muscle,has a depleted role due to recognized myocellular lipid infiltration and wasting,with the potential primary cause hypothesized as arthrogenic muscle inhibition(AMI).This link between AMI and NSLBP continues to gain increasing recognition.To date there is no‘gold standard’or consensus treatment to alleviate symptoms and disability due to NSLBP,though the advocated interventions are numerous,with marked variations in costs and levels of supportive evidence.However,there is consensus that NSLBP management be cost-effective,self-administered,educational,exercise-based,and use multi-modal and multi-disciplinary approaches.An adjuvant therapy fulfilling these consensus criteria is‘slacklining’,within an overall rehabilitation program.Slacklining,the neuromechanical action of balance retention on a tightened band,induces strategic indirect-involuntary therapeutic muscle activation exercise incorporating spinal motor control.Though several models have been proposed,understanding slacklining’s neuro-motor mechanism of action remains incomplete.Slacklining has demonstrated clinical effects to overcome AMI in peripheral joints,particularly the knee,and is reported in clinical case-studies as showing promising results in reducing NSLBP related to MF deficiency induced through AMI(MF-AMI).Therefore,this paper aims to:rationalize why and how adjuvant,slacklining therapeutic exercise may positively affect patients with NSLBP,due to MF-AMI induced depletion of spinal stabilization;considers current understandings and interventions for NSLBP,including the contributing role of MF-AMI;and details the reasons why slacklining could be considered as a potential adjuvant intervention for NSLBP through its indirect-involuntary action.This action is hypothesized to occur through an over-ride or inhibition of central down-regulatory induced muscle insufficiency,present due to AMI.This subsequently allows neuroplasticity,normal neuro-motor sequencing and muscle re-activation,which facilitates innate advantageous spinal stabilization.This in-turn addresses and reduces NSLBP,its concurrent symptoms and functional disability.This process is hypothesized to occur through four neuro-physiological processing pathways:finite neural delay;movement-control phenotypes;inhibition of action and the innate primordial imperative;and accentuated corticospinal drive.Further research is recommended to investigate these hypotheses and the effect of slacklining as an adjuvant therapy in cohort and control studies of NSLBP populations.

Balance Control Comparison between Subjects with and without Non-specific Low Back Pain

Objective:To compare the balance ability between normal people and non-specific low back pain(nsLBP) patients and explore the relationship between balance ability and muscle function in nsLBP patients.Method:Ten nsLBP patients as nsLBP group and 10 age and gender-matched healthy control subjects as control group were investigated.Posturography on balance platform and surface electromyography(sEMG) were performed to assess all the subjects' function of equilibrium and muscle activities of erector spinea(ES),multifidus(MF),abdominal external oblique(EO),hamstring(HS) and maximal gluteus(MG) bilaterally.Result:The nsLBP subjects had greater sway on anterior-posterior direction(Y-speed and Y-extension,P=0.05) on feet-together posture and bigger main axis(P=0.023) on nature standing with eyes closed when compared with controls.The iEMG ratios of right MG in nature standing(eyes closed)/nature standing(eyes open) and feet-together(eyes open)/nature standing(eyes open) in control group were significant higher than that in nsLBP group(P=0.03 and P=0.013).Conclusion:Balance evaluation combined with sEMG measurement on trank and lower limb muscles provided some quantitative information about functional deficits such as postural control and muscle activities in nsLBP patients.This relationship should be emphasized in prevention and rehabilitation of nsLBP.

Anxiety and Depression Disorders in Chronic Non-Specific Low Back Pain in Lomé(Togo)

Chronic non-specific low back pain has an important psychological impact. Objectives: To determine the prevalence of anxiety and depressive disorders (ADD) and factors associated to their apparition in patients suffering from chronic non-specific low back pain in rheumatological consultation in Lomé. Patients and Methods: It was a cross-sectional study, conducted from October 1st, 2015 to 31st March 2016. This study focused on all patients suffering from common chronic low back pain without psychiatric history in the Rheumatology Ward at the Sylvanus Olympio’s Teaching Hospital of Lomé and who have given their consent. The psychological evaluation was carried out through Hamilton scale. The processing, the statistical treatment and analysis of our data have been carried out using Epiinfo software, version 7.1.5. The investigation was approved by the local Ethics Committee. Results: 48 (39 women and 09 men) out of 123 patients with chronic lower back pain presented anxiety and depressive disorders (ADD) accounting for a prevalence rate of 39%. Their average age was 50.3 years old. The most frequent ADD was: psychic anxiety (58.6%), depressive mood (51.3%), difficulties to feel asleep (47.9%) and disturbed or agitated sleep (43.1%). Factors associated with the anxiety and depressive disorders in common chronic low back pain were: female gender (p = 0.02), dependent children (p = 0.02), occupation (reseller (p = 0.002), liberal profession (p = 0.009), monthly financial income (p = 0.002), surroundings family (0.009), medical history (p = 0.0002) and pain’s intensity > 7 (p = 0.04). Conclusion: This study shows the high frequency of anxiety and depressive disorders in common chronic low back pain and their influence by socio-economic and demographic factors.

Efficacy and safety of acupuncture in treating low back and pelvic girdle pain during pregnancy:a systematic review and meta-analysis of randomized controlled trials

Objectives:Low back and pelvic girdle pain(LBPGP)is common during pregnancy.Acupuncture is an effective and safe therapy for pain relief.However,further evidence is required to confirm the efficacy and safety of acupuncture in treating LBPGP during pregnancy.This study aimed to systematically review and investigate the clinical efficacy and safety of acupuncture for the treatment of pregnancy-related LBPGP.Methods:The PubMed,EMBASE,Cochrane Library,CNKI,VIP,and WanFang databases were searched from January 2000 to August 2023.Only the randomized controlled trials(RCTs)involving pregnant women between 16 and 34 weeks of gestation diagnosed with LBPGP were included in the study.A meta-analysis was conducted and pooled risk ratios(RRs)or mean differences(MDs)with 95%confidence intervals(CIs)were compared.Results:Meta-analysis included 12 RCTs involving 1,641 participants.Eleven trials compared acupuncture alone or acupuncture combined with standard care(SC),of which three trials also used non-penetrating or placebo acupuncture as the control group.One trial compared acupuncture alone with non-penetrating acupuncture.Compared with SC,acupuncture combined with SC group significantly decreased visual analog scale score(mean difference(MD)=−2.83,95%CI=−3.41 to−2.26,P<0.00001),cesarean section rate(RR=0.69,95%CI=0.49–0.97,P=0.03),preterm birth rate(RR=0.42,95%CI=0.27–0.65,P<0.0001),labor duration(MD=−1.97,95%CI=−2.73 to−1.20,P<0.0001),and Oswestry disability index score(MD=−9.14,95%CI=−15.68 to−2.42,P=0.008).In addition,acupuncture combined with SC significantly improved 12-Items Short Form Health Survey of physical component summaries(SF12-PCS).No significant differences were observed in the spontaneous delivery rate,newborn weight,drowsiness,and 12-Items Short Form Health Survey of mental component summaries(SF12-MCS)between the two groups.Adverse events such as needle pain and needle bleeding were aggravated in both the SC and acupuncture treatment groups but none were associated with acupuncture during or after the treatment period.Conclusions:Meta-analysis showed that acupuncture combined with SC had better efficacy than SC alone and could be a potential therapy for LBPGP during pregnancy.The safety results imply that acupuncture caused few adverse reactions;however,more evidence is required for further confirmation.

Treating acute low back pain with acupuncture:A randomized controlled study protocol to compare the effectiveness between distal and local acupoints

Objective:To compare the efficacy of using“distal acupoints only”vs.“local acupoints mainly combined with distal acupoints”in cases of acute low back pain(ALBP).Methods: A total of 102 eligible patients aged 18–65 years with ALBP lasting less than 6 weeks will be randomized in a 1:1 ratio to the distal acupoints only group(DPOG)and the local acupoints mainly combined with the distal acupoints group(LPMG).During a 4-week treatment period,patients in the DPOG will receive acupuncture at distal acupoints only(Houxi[SI 3]and Yaotongxue[EX-UE 7])twice a week,while those in the LPMG group will receive acupuncture at local acupoints(mainly Shenshu[BL 23]and Dachangshu[BL 25])combined with distal points(Weizhong[BL 40]).The patients in both groups will be evaluated at every session of treatment,and the follow-up will be performed for 3 months.The primary outcome measure will be the change in ALBP intensity,assessed using visual analogue scale scores before and after treatment.The secondary outcome measure will be the evaluation of functional disability using the Oswestry Disability Index.Discussion: This study compares the DPOG and LPMG to explore the feasibility of the DPOG in the treatment of ALBP.

Prevalence and Factors Associated with Low Back Pain among Healthcare Workers in Two Hospitals in Yaoundé-Cameroon: A Cross-Sectional Study

Background: Low back pain (LBP) is a very common health problem amongst the general population and a major cause of disability that affects work performance and well-being. Healthcare workers (HCWs) are especially at risk of developing LBP because of physical and emotional factors. Little is known about the burden of LBP in Cameroon. Objective: To determine the prevalence of low back pain and identify its associated factors among healthcare workers. Methods: A cross-sectional study using a self-administered questionnaire was conducted among healthcare workers in the Yaound Central Hospital and the Yaound University Teaching Hospital. The questionnaire collected data regarding recent, past year and lifetime occurrences of LBP, socio-demographics and work conditions. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: A total number of 268 HCWs participated in the study, including 197 (73.5%) females and 71 (26.5%) males. The mean age of the study participants was 40.60 8.38 years (extremes of 20 and 65 years). The lifetime, annual, and point prevalences of LBP among the participants were 67.5% (CI: 61.6 - 73.1), 61.5% (CI: 55.6 - 67.1) and 35.7% (CI: 29.7 - 41.5) respectively. Multivariate analysis confirmed a moderate stress level, a sedentary lifestyle, working in the medicine and specialities department, lifting heavy objects and bending to work as associated factors to LBP. Most sufferers had a minimal functional disability (65.7%) while 34.3% had a moderate to severe disability. Conclusions: Healthcare providers have a considerably high prevalence of low back pain. Factors associated with LBP found in this study were similar to those widely recognized in the literature. A substantial proportion of healthcare providers are suffering from functional disability associated with low back pain, affecting their social and work lives. There is a need for multilevel interventions to prevent and control low back pain in this highly vulnerable occupational group.

Prevalence and Factors Associated with Chronic Low Back Pain in the Mining Sector in Burkina Faso

Introduction: Low back pain is nowadays a real public health problem in companies. The objective of the study was to determine the prevalence and factors associated with chronic low back pain among workers of a mining company in Burkina Faso. Material and Methods: This was a descriptive and analytical cross-sectional study with a retrospective collection that took place from August 1, 2021 to March 16, 2022 in a gold mine in Burkina Faso. It focused on mine workers who participated in the 2019 annual medical visit. Results: Out of a total workforce of 880 workers who took part in the annual medical visit in 2019, 165 had chronic common low back pain, i.e. a prevalence of 18.75%. The average age of low back pain workers was 37.21 ± 7.5 years. Among the workers suffering from low back pain, 62 (37.58%) held the position of machine operator. Clinically, mechanical pain was found in 113 low back pain workers (76%) and twenty-nine (17.58%) had radicular pain. Standard radiography of the lumbar spine was abnormal in 129 workers (78.18%. In the univariate analysis, the factors associated with the pathology were sex, level of study, work station and seniority in the position. After a logistic regression, the factors associated with its occurrence were whole-body vibration (Fisher’s test = 12.7541;P = 0.000), male sex (Fisher’s test = 8.363;P = 0.004), and seniority for 4 to 5 years (Chi2 = 4.0234;p = 0.046). Conclusion: The study reveals the existence of chronic low back pain cases among the workers of the mining company. There is a predominance of the pathology in men, workers exposed to vibrations and those with a seniority of 4 to 5 years. It is necessary to establish a policy of prevention of low back pain for the benefit of workers, in particular those exposed to vibrations.

Comparison of Lumbopelvic-Hip Rotation Asymmetry and Pelvic Asymmetry between Individuals with and without Nonspecific Low Back Pain

Background: low back pain affects many individuals, with 80% classified as non-specific low back pain (NSLBP) due to mechanical rather than structural issues. The link between pelvic alignment and lumbopelvic-hip rotation movement for NSLBP is controversial. Methods: twenty males with NSLBP and 20 healthy males participated. Data collected included static pelvic asymmetry and active lumbopelvic-hip rotation with motion capture system for kinematic analysis. Results: Unpaired T test was used to compare the difference of kinematic parameters between two groups. NSLBP group showed significantly larger angles between the ASIS-PSIS line and the z-axis (p Conclusion: Evaluations focusing on bone structure alone may be inadequate. A more comprehensive approach including functional assessments like muscle strength and range of motion could be beneficial. Integrating lumbopelvic-hip movement patterns and pelvic symmetry into clinical assessments should be considered, as they may be influenced by physical activity.

Botulinum toxin type A for treating chronic low back pain:A double blinded randomized control study

BACKGROUND Low back pain(LBP)is a prevalent issue that orthopedic surgeons frequently address in the outpatient setting.LBP can arise from various causes,with stiffness in the paraspinal muscles being a notable contributor.The administration of Botulinum toxin type A(BoNT-A)has been found to alleviate back pain by relaxing these stiff muscles.While BoNT-A is approved for use in numerous conditions,a limited number of randomized clinical trials(RCTs)validate its efficacy specifically for treating LBP.AIM To study the safety and the efficacy of BoNT-A in minimizing pain and improving functional outcomes in patients of chronic LBP(CLBP).METHODS In this RCT,adults aged 18-60 years with mechanical LBP persisting for at least six months were enrolled.Participants were allocated to either the Drug group,receiving 200 Ipsen Units(2 mL)of BoNT-A,or the Control group,which received a 2 mL placebo.Over a 2-month follow-up period,both groups were assessed using the Visual Analog Scale(VAS)for pain intensity and the Oswestry Disability Index(ODI)for disability at the start and conclusion of the study.A decrease in pain by 50%was deemed clinically significant.RESULTS The study followed 40 patients for two months,with 20 in each group.A clinically significant reduction in pain was observed in 36 participants.There was a statistically significant decrease in both VAS and ODI scores in the groups at the end of two months.Nonetheless,when comparing the mean score changes,only the reduction in ODI scores(15 in the placebo group vs 16.5 in the drug group,clinically insignificant)was statistically significant(P=0.012),whereas the change in mean VAS scores was not significant(P=0.45).CONCLUSION The study concludes that BoNT-A does not offer a short-term advantage over placebo in reducing pain or improving LBP scores in CLBP patients.

A Study on the Effect of Exercise Intervention on Function and Pain in Patients with Low Back Pain

Lower back pain(LBP)has a relatively high incidence across various age groups,characterized by discomfort in the lumbosacral and iliosacral regions above the gluteal striatum and within the region below the costal margins.Some patients also experience varying degrees of leg pain,with many experiencing prolonged and recurrent symptoms.International consensus confirms that exercise intervention is an effective treatment method for lower back pain,offering safe and efficient physical therapy.Extensive practical experience suggests that Pilates exercises can effectively regulate the strength of muscle tissue in the peripheral region of the spine,improve muscle endurance,and alleviate low back pain caused by muscular factors.This study analyzes the effects of exercise intervention on the function and pain of patients with lower back pain.It explores various exercise modalities,utilizes SPSS26 statistics to gather data,and draws conclusions with the aim of providing theoretical references for exercise interventions in patients with lower back pain.

Clinical observation of sinew-regulating bone-setting manipulations plus exercise therapy for chronic non-specific low back pain

Objective:To evaluate the clinical efficacy of sinew-regulating bone-setting manipulations plus exercise therapy in treating chronic non-specific low back pain(CNLBP).Methods:A total of 65 CNLBP patients were divided into two groups by the random number table method.Thirty-three cases in the treatment group were intervened by sinew-regulating bone-setting manipulations plus exercise therapy;32 cases in the control group were intervened by medium-frequency electrotherapy plus exercise therapy.Before and after treatment,visual analog scale(VAS),dynamic and static muscle endurance of low back,median frequency(MF)of surface electromyography(sEMG)and Oswestry disability index(ODI)were used to evaluate the low back function.The therapeutic efficacy was estimated after treatment.Results:The two groups each had 2 dropouts during the study.The total effective rate was 90.3%in the treatment group versus 66.7%in the control group,and the between-group difference was statistically significant(P<0.05).After treatment,the VAS score,dynamic and static muscle endurance of low back,MF of sEMG and ODI score all changed significantly in both groups(all P<0.05);all the items in the treatment group were significantly different from those in the control group(all P<0.05).Conclusion:Sinew-regulating bone-setting manipulations plus exercise therapy can effectively release pain in CNLBP patients,increase muscle endurance of the low back and improve the quality of life,and its therapeutic efficacy is more significant than that of medium-frequency electrotherapy plus exercise therapy.

Therapeutic evaluation of lumbar tender point deep massage for chronic non-specific low back pain

OBJECTIVE:To observe the therapeutic effect of lumbar tender point deep tissue massage plus lumbar traction on chronic non-specific low back pain using change in pressure pain threshold,muscle hardness and pain intensity as indices.METHODS:We randomly divided 64 patients into a treatment group(32 cases) and a control group(32 cases).Two drop-outs occurred in each group.Patients in the treatment group received tender point deep tissue massage plus lumbar traction and patients in the control group received lumbar traction,alone.We used a tissue hardness meter/algometer and visual analog scale(VAS) to assess the pressure pain threshold,muscle hardness and pain intensity.RESULTS:Following treatment,we obtained the following results in the treatment and control groups,respectively:the pressure pain threshold difference was 1.5±0.8 and 1.1±0.7;the muscle hardness difference was 4.2±1.6 and 3.5±1.3;and the VAS score difference was 1.9±0.9 and 1.4±0.8.Compared to the control group,the treatment group had higher pressure pain threshold(t=2.09,P<0.05),and lower muscle hardness(t=2.05,P<0.05) and pain intensity(t=2.46,P<0.05).CONCLUSION:Lumbar tender point deep tissue massage combined with lumbar traction produced better improvement in pressure pain threshold,muscle hardness and pain intensity in patients with chronic non-specific low back pain than with lumbar traction alone.

Questionnaire of clinical questions for Clinical Practice Guideline of Acupuncture-Moxibustion:Non-specific low back pain

The questionnaire aims to collect clinical questions for the Clinical Practice Guideline of AcupunctureMoxibustion:Non-Specific Low Back Pain.This questionnaire is consisted of single-choice questions,multiple-choice questions,ranking questions,and open questions.Readers are recommended to complete the open questions by using patients,intervention,comparator and outcome(PICO)framework,referring to the examples.The survey would take about 30 min to finish,and the answers from participants would greatly contribute to the formation of Clinical Practice Guideline of Acupuncture-Moxibustion:Non-Specific Low Back Pain.

Clinical observation of tendon-regulating manipulation plus core stability training for non-specific low back pain

Objective： To evaluate the clinical efficacy of tendon-regulating manipulation plus kinesiotherapy in treating low back pain. Methods： Sixty patients were randomized into a treatment group and a control group by using the random number table, 30 cases in each group. The treatment group was intervened by tendon-regulating manipulation plus kinesiotherapy, while the control group was by the tendon-regulating manipulation alone. The lumbar lordosis was measured by X-ray （side view）, the pain was evaluated by analgesy meter, the lumbar range of motion was by using goniometer, and the function was judged by Oswestry disability index （ODI） before and after treatment, and the therapeutic efficacy was also observed. Results： After treatment, the pain level was significantly reduced, lumbar lordosis was significantly increased, the lumbar range of motion was markedly improved, and the ODI score significantly dropped （all P^O.05） in both groups; the improvement of each item in the treatment group was more significant than that in the control group （all P〈O.05）. The total effective rate was 90.0% in the treatment group versus 63.3% in the control group, and the difference was statistically significant （P〈0.05）. Conclusion＂ In the treatment of low back pain, tendon-regulating manipulation plus kinesiotherapy can mitigate topical pain, improve the motion of low back, enhance the quality of life, and produce a more significant therapeutic efficacy compared to tendon-regulating manipulation alone.

Acupuncture treatment for Subacute Non-specific Low Back Pain A Retrospective Cohort Study in the Role of the Back Exercise in Acupuncture Services for Low Back Pain Sufferers

Objective： To investigate the interrelationship between back exercise and acupuncture curative effect, and unveil the reason that recovery usually delays in a number of low back pain sufferers. Method： The study is designed as a retrospect investigation. Seventy patients who were newly diagnosed with low back pain were sequentially selected and divided into two groups, 44 cases in the observation group treated with acupuncture plus exercise, and 26 cases in the control group only treated with acupuncture. The recurrence rates in the one-year follow.up after the acupuncture service were compared between the two groups. Result and Conclusion： Back exercise is a risk factor associated with frequent back pain recurrence. In contrast, acupuncture is an effective intervention method for the treatment and prevention of non-specific low back pain.

Observation on the therapeutic efficacy of Tuina plus“three-bridge”exercise for non-specific low back pain

Objective To investigate the efficacy of Tuina(Chinese therapeutic massage)plus“three-bridge”exercise for non-specific low back pain(NSLBP).Methods A total of 80 patients with NSLBP were randomly divided into a control group and an observation group according to the random number table method,with 40 cases in each group.The two groups received Tuina treatment,and the observation group received an additional“three-bridge”exercise.The treatment lasted 4 weeks,and a follow-up evaluation was carried out 6 months after treatment.The visual analog scale(VAS),Oswestry disability index(ODI),and the Japanese Orthopaedic Association(JOA)scores for low back pain were used to evaluate patients’conditions before treatment,after 4-week treatment,and at the 6-month follow-up.Results The total effective rate was 92.5%and 85.0%in the observation group,respectively,after 4-week treatment and at the 6-month follow-up,significantly different from the control group(P<0.05).After 4-week treatment and at the 6-month follow-up,the VAS,ODI,and JOA scores of the two groups were improved compared with those before treatment(P<0.05),and all the indicators in the observation group were significantly better than those in the control group(P<0.05).At the 6-month follow-up,the VAS,ODI,and JOA scores in the two groups were improved compared with those before treatment(P<0.05).Conclusion Tuina plus“three-bridge”exercise can effectively alleviate pain,improve function,and have relatively sound long-term effects in treating patients with NSLBP.

Efficacy of acupuncture in treating chronic non-specific low back pain

Objective To provide an update on the evidence of the effectiveness of acupuncture in treating chronic non-specific low back pain(CNSLBP)based on randomized controlled trials(RCTs)of acupuncture for CNSLBP published between 2006 and 2020.Methods A comprehensive literature search was conducted through the University of Malta website,using the HyDi search engine.The‘Advanced Search’option was chosen in order to search for articles that were published in English,and associated with the key words,‘Chronic’,‘Acupuncture’,‘Needle’,‘Needling’,‘Non-specific’and‘Low Back Pain’,which were entered in their‘Subject’field,from the year 2006 till 2020.A comprehensive reading and analysis was done for the search result.Results Through the use of the HyDi search engine,accessible through the University of Malta,eighteen randomized controlled trials that met the criteria of this study were selected.Conclusion Through the analysis and comparison of the studies selected for this literature review,there is evidence providing that acupuncture is significantly more effective than current conservative treatment modalities for patients with CNSLBP in reducing pain and improving function.

Acupuncture for Chronic Non-Specific Low Back Pain: A Case Series Study

Objective: To evaluate the efficacy of acupuncture in treating chronic non-specific low back pain.Methods: Ten patients with chronic low back pain were selected to receive 9 acupuncture treatments over a three-week period with point selection based on syndrome differentiation in Chinese medicine. The BROM Instrument for assessment of back range of motion; subjective evaluation with Visual Analog Scale of Pain (VASP) ratings, Oswestry Disability ratings, objective measurements including Algometry, and Flexion and Extension ratings to investigate the range of motion were used for comparing the large, medium and small effect sizes of baseline, treatment and follow-up phases.Results: Clinical significance of pain relief was shown in all parameters assessed. A large effect size was detected in VASP, Oswestry and Algometry. A small effect size was demonstrated in Flexion/Extension. Needling over short period time (3 weeks) could relieve the pain, but the muscular-skeletal function measured by BROM persists. To treat patients exclusively by needling for statistical purposes can not be justified, because by merely relieving pain, permanent improvement in function may not be achieved.Conclusion: Acupuncture offers an effective alternative for the clinical management of chronic low back pain, significant improvement in most of the parameters evaluated, but the functional improvement was not as satisfactory as pain relieving. Further study with larger sample size focuses on long-term efficacy and functional improvement for chronic low back pain is recommended.

Thermal Therapy in Patients Suffering from Non-Specific Chronic Low Back Pain—A Systematic Review

Thermal therapy is frequently used as an adjunct to treatment in patients suffering from chronic low back pain. It is also an inherent part of patients’ self-administered pain treatment. This review aims to update the evidence for thermal therapy treatments in non-specific chronic low back pain patients and to rate the methodological quality of the corresponding clinical trials. Previous studies have reported contradictory evidence for the effectiveness of thermal therapy. An electronic search on MEDLINE (PubMed), PEDro, CENTRAL and CINHAL databases was conducted between May 2016 and February 2018. Clinical trials comparing local thermal therapy to conservative or no treatment were assessed for eligibility. Pain, physical function and global health were defined as outcome parameters. A total of n = 9 studies met the inclusion criteria. All of them applied an electrophysical agent as the thermal treatment: continuous ultrasound (n = 6), short-wave diathermy (n = 2), microwave diathermy (n = 1). Out of the n = 6 studies on ultrasound treatment, n = 2 reported significant within and between-group results for pain reduction after 4 to 6 weeks of treatment. Both short-wave diathermy studies demonstrated significant between-group results for pain reduction after 3 weeks of treatment. Contradictory results for all other observed outcome parameters were reported regardless of the intervention. Moreover, significant within-group results for the control groups questioned the effectiveness of the intervention treatments. Therefore, the effect of thermal therapy, (electrophysical agents), is not superior to any control treatment except for ultrasound treatment on short-term pain reduction.

Efficacy and safety of thermobalancing therapy with Dr Allen’s Device for chronic low back pain:A randomised controlled trial

BACKGROUND Lumbar disc herniation and non-specific low back pain are common conditions that seriously affect patients’health-related quality of life(HRQoL).Although empirical evidence has demonstrated that novel Thermobalancing therapy and Dr Allen’s Device can relieve chronic low back pain,there have been no randomised controlled trials for these indications.AIM To evaluate the efficacy of Dr Allen’s Device in lumbar disc herniation(LDH)and non-specific low back pain(NSLBP).METHODS A randomised clinical trial was conducted investigating 55 patients with chronic low back pain due to LDH(n=28)or NSLBP(n=27),out of which 15 were randomly assigned to the control group and 40 were assigned to the treatment group.The intervention was treatment with Dr Allen’s Device for 3 mo.Changes in HRQoL were assessed using the Numerical Pain Rating Scale and the Japanese Orthopedic Association Back Pain Questionnaire.RESULTS Thermobalancing therapy with Dr Allen’s Device showed a significant reduction in pain in the treatment group(P<0.001),with no recorded adverse effects.Both pain assessment scales showed a significant improvement in patients’perception of pain indicating improvement in HRQoL.CONCLUSION The out-of-hospital use of Thermobalancing therapy with Dr Allen’s Device for Low Back Treatment relieves chronic low back pain significantly and without adverse effects,improves the level of activity and HRQoL among patients with LDH and NSLBP.This study demonstrates the importance of this safe first-line therapy that can be used for effective at-home management of chronic low back pain.