Journal of International Academy of Physical Therapy Research (국제물리치료학회지)

International Academy of Physical Therapy Research (국제물리치료연구학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of Lumbar Mobilization on the Paravertebral Muscle Activity and Muscle Tone in Patients with Lumbar Spinal Stenosis

  • Go, Junhyeok (Department of Physical Therapy, Kyungbok University) ;
  • An, Hojung (Department of Physical Therapy, Dongnam University)
  • Received : 2021.01.15
  • Accepted : 2021.02.28
  • Published : 2021.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Patients with lumbar spinal stenosis show abnormal changes in muscle activity due to pain and limited range of motion of the lumbar spine. Excessive increased muscle tone and decreased muscle activity patterns threaten the patients' quality of life. However, there have been a few studies showing how to improve muscle performance in patients with lumbar spinal stenosis. Among these, joint mobilization is one way of improving muscle performance through pain relief and increasing the range of motion. Objectives: To investigate the effect of lumbar mobilization by orthopedic manual physical therapy on paravertebral muscle activity and tone in patients with lumbar spinal stenosis. Design: A randomized controlled trial. Methods: In this study, 24 patients with lumbar spinal stenosis were randomized (1:1 ratio) into two groups. The experimental group underwent lumbar posteroanterior mobilization, and the control group underwent conventional physical therapy (conventional transcutaneous electrical nerve stimulation) for 15 minutes each. For outcome measures, Myoton®PRO was used to evaluate muscle tone when resting of the paravertebral muscle in the pain area. For muscle activity evaluation, the reference voluntary contraction of the paravertebral muscle was evaluated using surface electromyography. Results: Muscle tone and activity were significantly improved after intervention in both the experimental and control groups. In addition, the experimental group showed more significant decrease in muscle tone and activity than the control group. Conclusion: These results suggest that lumbar mobilization improving muscle performance in patients with lumbar spinal stenosis.

Keywords

References

  1. Kalichman L, Cole R, Kim DH, et al. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine. 2009;9:545-550. https://doi.org/10.1016/j.spinee.2009.03.005
  2. Binder DK, Schmidt MH. Weinstein PR. Lumbar spinal stenosis. Semin Neurol. 2002;22(2):157-166. https://doi.org/10.1055/s-2002-36539
  3. Kasukawa Y, Miyakoshi N, Hongo M, et al. Lumbar spinal stenosis associated with progression of locomotive syndrome and lower extremity muscle weakness. Clin Interv Aging. 2019;14:1399-1405. https://doi.org/10.2147/CIA.S201974
  4. Atsushi I, Koji K, Yu O, et al. Trunk muscle activity during lumbar stabilization exercises on both a stable and unstable surface. J Orthop Sports Phys Ther. 2010;40(6):369-375. https://doi.org/10.2519/jospt.2010.3211
  5. Lee SR. Factors related to lumbar spinal stenosis incidence over middle-aged adults. Asia-pa J Multimed Serv Converge Art Hum Soc. 2017;7(8):863-870.
  6. Sharif F, Ahmad A, Gilani SA. The operative versus conservative approaches in the management and treatment of lumbar spinal stenosis. Pak J Med Dent. 2021;10(1):30-36.
  7. Johnsson KE, Rosen I, Uden A. The natural course of lumbar spinal stenosis. Clin Orthop Relat Res. 1992;6(279):82-86.
  8. Mazanec DJ, Podichetty VK, Hsia A. Lumbar canal stenosis: start with nonsurgical therapy. Cleve Clin J Med. 2002;69(11):909-917. https://doi.org/10.3949/ccjm.69.11.909
  9. Tomkins CC, Dimoff KH, Forman HS, et al. Physical therapy treatment options for lumbar spinal stenosis. J Back Musculoskelet Rehabil. 2010;23(1):31-38. https://doi.org/10.3233/BMR-2010-0245
  10. Godges JJ, Mattson-Bell M, Thorpe D, Shah D. The immediate effects of soft tissue mobilization with proprioceptive neuromuscular facilitation on glenohumeral external rotation and overhead reach. J Orthop Sports Phys Ther. 2003;33(12):713-718. https://doi.org/10.2519/jospt.2003.33.12.713
  11. Johnson M. Transcutaneous electrical nerve stimulation: mechanisms. clinical application and evidence. Rev Pain. 2007;1(1):7-11. https://doi.org/10.1177/204946370700100103
  12. Carlo A, Pierre C, Rampersaud YR, et al. Effect of active TENS versus de-tuned TENS on walking capacity in patients with lumbar spinal stenosis: a randomized controlled trial. Chiropr Man Therap. 2019;27(1):1-10. https://doi.org/10.1186/s12998-018-0230-y
  13. Nair K, Masi AT, Andonian BJ, et al. Stiffness of resting lumbar myofascia in healthy young subjects quantified using a handheld myotonometer and concurrently with surface electromyography monitoring. J Bodywork and Movement Ther. 2016;20(2):388-396. https://doi.org/10.1016/j.jbmt.2015.12.005
  14. Stegeman DF, Hermens HJ. Standards for surface electromyography: the European project "Surface EMG for non-invasive assessment of muscles (SENIAM). Enschede: Roessingh Research and Development. 2007.
  15. Sousa ASP, Tavares JMRS. Surface electromyographic amplitude normalization methods: a review. Electromyography: New Developments, procedures and Applications. 2012
  16. Willett E, Hebron C, Krouwel O. The initial effects of different rates of lumbar mobilisations on pressure pain thresholds in asymptomatic subjects. Manual ther. 2009;15(2):173-178. https://doi.org/10.1016/j.math.2009.10.005
  17. Shum GL, Tsung BY, Lee RY. The immediate effect of posteroanterior mobilization on reducing back pain and the stiffness of the lumbar spine. Arch Phys Med Rehabil. 2013;94(4):673-679. https://doi.org/10.1016/j.apmr.2012.11.020
  18. Park JH, Song BB. Effect of frequency and intensity of transcutaneous electrical nerve stimulation on patients with chronic low back pain. The Korea Contents Association. 2012;12(6):361-370. https://doi.org/10.5392/JKCA.2012.12.06.361
  19. Jarrett S, Morey JK, Kristen CS, et al. The influence of exercise on perceived pain and disability in patients with lumbar spinal stenosis: a systematic review of randomized controlled trials. Am J Lifestyle Med. 2016;10(2):136-147. https://doi.org/10.1177/1559827615571510
  20. Christopher MP, Kornelia K, James H, Gabrielle B. Segmental mobility of the lumbar spine during a posterior to anterior mobilization: assessment using dynamic MRI. Clin Biomech. 2003;18(1):80-83. https://doi.org/10.1016/S0268-0033(02)00174-2
  21. Fang Y. Treating lumbar spinal stenosis using lumbar and abdominal muscle training. J New Chin Med. 2015;47(11):113-114.
  22. Yang DJ, Uhm YH. The effect of the lumbar segmental mobilization technique on chronic low back pain patients' the characteristics of the muscles, and limited of stability. J Korean Soc Integr Med. 2020;8(4):191-202. https://doi.org/10.15268/KSIM.2020.8.4.191
  23. Chesterton P, Payton S. Effects of spinal mobilisations on lumbar and hamstring ROM and sEMG: A randomised control trial. Physiother Pract Res. 2017;38(1):17-26. https://doi.org/10.3233/ppr-160081
  24. Irene R. Manual therapy for lumbar spinal stenosis: a comprehensive physical therapy approach. Phys Med Rehabil Clin N Am. 2003;14(1):103-110. https://doi.org/10.1016/S1047-9651(02)00077-3
  25. Kobayashi S. Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis. Orthop. 2014;5(2):134-145.
  26. Zarife K, Suheda O, Koncuy S, Alp G, Selcuk K. Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis. Spine. 2009;34(10):985-989. https://doi.org/10.1097/BRS.0b013e31819c0a6b
  27. Wang JS. Therapeutic effects of massage and electrotherapy on muscle tone, stiffness and muscle contraction following gastrocnemius muscle fatigue. J Phys Ther Sci. 2017;29(1):144-147. https://doi.org/10.1589/jpts.29.144
  28. Carlo A, Pierre C, Raja R, et al. Effect of TENS versus placebo on walking capacity in patients with lumbar spinal stenosis: a protocol for a randomized controlled trial. J Chiropr Med. 2016;15(3):197-203. https://doi.org/10.1016/j.jcm.2016.04.001