Physiotherapy Department, HES-SO University of Applied Sciences Western Switzerland-HESAV, Avenue de Beaumont, Lausanne 1011, Switzerland.
BMC Musculoskelet Disord. 2012 Aug 28;13:162. doi: 10.1186/1471-2474-13-162.
Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE.
Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8 weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups.
Thirty-seven subjects completed the study. MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session (VAS mean difference between interventions: -0.8; 95% CI: -1.2 to -0.3). Independently from time after treatment, MT + AE induced lower disability (ODI mean group difference: -7.1; 95% CI: -12.8 to -1.5) and a trend to lower pain (VAS mean group difference: -1.2; 95% CI: -2.4 to -0.30). Six months after treatment, Shirado test was better for the ST group (Shirado mean group difference: -61.6; 95% CI: -117.5 to -5.7). Insufficient evidence for group differences was found in remaining outcomes.
This study confirmed the immediate analgesic effect of MT over ST. Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP. Its neurophysiologic mechanisms at cortical level should be investigated more thoroughly.
NCT01496144.
最近的临床建议仍建议对中枢性下腰痛（CNSLBP）患者采用主动运动（AE）。然而，患者对运动的接受程度可能会受到疼痛相关表现的限制。目前的证据表明，手法治疗（MT）通过外周、脊髓和皮质水平的神经生理机制即刻产生镇痛作用。本研究的主要目的是：首先，评估 MT 是否具有即刻的镇痛效果；其次，比较 MT+AE 与假治疗（ST）+AE 对功能障碍的持续影响。
42 例无合并症的 CNSLBP 患者，随机分为 2 个治疗组，分别接受脊柱推拿/松动术（第一干预）+AE（MT 组，n=22）或低频超声（第一干预）+AE（ST 组，n=20）。4 至 8 周内共进行 8 次治疗。通过测量每次治疗的第一干预前后的疼痛强度（视觉模拟评分）来获得即刻镇痛效果。在治疗前、第 8 次治疗后以及 3 个月和 6 个月随访时，评估疼痛强度、残疾（Oswestry 残疾指数）、恐惧回避信念（恐惧回避信念问卷）、竖脊肌和腹肌耐力（Sorensen 和 Shirado 测试）。
37 例患者完成了研究。MT 干预即刻产生了更好的镇痛效果，且不依赖于治疗次数（干预间 VAS 平均差值：-0.8；95%CI：-1.2 至 -0.3）。与治疗后时间无关，MT+AE 组的残疾程度更低（ODI 组间平均差异：-7.1；95%CI：-12.8 至 -1.5），疼痛程度也呈下降趋势（VAS 组间平均差异：-1.2；95%CI：-2.4 至 -0.30）。治疗 6 个月后，ST 组的 Shirado 测试结果更好（Shirado 组间平均差异：-61.6；95%CI：-117.5 至 -5.7）。其他结果均未发现组间差异的充分证据。
本研究证实了 MT 对 ST 的即刻镇痛效果。与对照组相比，在进行特定的主动运动后，MT 治疗可显著降低功能障碍程度，并倾向于更大程度地降低疼痛强度。这些结果证实了 MT 作为 CNSLBP 一种合适治疗方法的临床意义。其皮质水平的神经生理机制应进一步研究。
NCT01496144。
