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Effects of Low Grade Axial Loading on Discogenic Low Back Pain: A Case Report

  • Chang, Duncan;Boby, Arantxa;Madonna, James
    • Journal of International Academy of Physical Therapy Research
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    • v.9 no.4
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    • pp.1683-1686
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    • 2018
  • Low back pain (LBP) is the most common reason for seeking physical therapy (PT) care. Recent studies suggest that axial loading can have a positive impact on the intervertebral disc by improving its tensile strength. Further, whole body vibration (WBV) appears to improve spinal muscle relaxation. Therefore, this case study describes the use of axial loading using a mini-trampoline in a female with chronic LBP. This case report is a single subject design. This patient is a 29-year-old female with a six-month history of low back pain following a motor vehicle accident. MRI found herniated discs at L4 and L5, clinical tests were positive for pain in the L4 and L5 dermatome and myotome the slump test was positive for neural tension, and LBP was constant at 4-6/10 over the past four months. She received axial loading exercises using a mini-trampoline and performed six sessions that were, scheduled twice a week for three weeks. Her Oswestry Disability Index (ODI) score improved from 40% at the time of her first visit to 22% at her final visit. Pain measure on the Numeric Pain Rating Scale (NPRS) after the first treatment was 7/10, and her pain after the final treatment was 0/10. These changes in the pain scores are clinically significant and exceed the minimal clinically important difference (MCID). This patient had a significant improvement in her pain using the NPRS and the ODI. This case study suggests that axial loading may be an effective treatment for some individuals with discogenic chronic low back pain.

Magnetic Resonance Imaging Follow-Up Case Study on Changes in a Lumbar Herniated Intervertebral Disc Treated with Korean Conservative Treatment (보존적 한방치료를 진행한 요추 추간판 탈출증 환자의 시간에 따른 영상의학적 추간판 크기 변화 1례)

  • Roh, Ji-ae;Lee, Ji-won;Jang, Jae-won;Jeong, Wu-jin;Noh, Je-heon
    • The Journal of Internal Korean Medicine
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    • v.39 no.5
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    • pp.879-885
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    • 2018
  • Background: A herniated intervertebral disc (HIVD) triggers low back pain (LBP). Korean conservative treatment can decrease the herniated disc size without traditional surgery, but detailed prognosis is unclear. Case summary: One patient presented with LBP and bilateral sciatica. She was diagnosed with lumbar HIVD by magnetic resonance imaging (MRI) and treated by Korean medicine (acupuncture, decoction, and physical therapy). For 6 months, MRI follow-up exams showed the aggravation and migration of L5-S1 followed by distinct improvement of the same lumbar vertebra. Conclusion: The disc size in a patient with lumbar HIVD was reduced by Korean conservative treatment, and periodic radiologic examination showed the previously unrecognized process of absorbing the disc.

The Effect of Dynamic Lumbar Stabilization Exercise to Be Affected with Improvement and Maintenance of Trunk Stability after Opened Microscopic Laser Discectomy (개방형 현미경적 요추간판 제거술 후 동적 요부 안정화 운동에 따른 체간 안정성의 개선과 유지)

  • Nam, Kun-Woo;Kim, Jong-Soon
    • The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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    • v.11 no.1
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    • pp.37-48
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    • 2005
  • Objects: This study is designed to analysis improvement and maintaince of trunk stability targeting patients who need post operative rehabilitation exercise after undergoing opened microscopic laser discectomy(OMLD) due to HNP. Method: Between March 2004 and February 2005 a total sixty patients who underwent OMLD due to $L_4/L_5$, $L_5/S_1$ HNP and who agreed to the experiment were subject for this study. Experimental group consisted of 18 subjects, and they underwent 45 minutes dynamic lumbar stabilization exercise And control group consisted of 18 subjects who conducted conservative physical therapy based on the use of physical modality for 45 minutes except to exercise. Results: Experimental group that was lumbar extensor's isometric peak torque, weight distribution of both leg, trunk muscle balance and Oswestry LBP disability index increased during 12 weeks in a statistically significant manner compared to before exercise (p<.05). When re-test was tried, isometric peak torque (p>.05) and Oswestry LBP disability index(p<.05) maintained 12th week level or improved. Weight distribution rate of both leg and trunk muscle balance maintained the level of 8th week of exercise execution(p<.05). Control group that was lumbar extensor's isometric peak torque, weight distribution rate of both leg and trunk muscle balance aggravated during 12 weeks compared to pre-test(p>.05) But, Oswestry LBP disability index increased in a statistically significant level compared to pre-test(p<.05). When re-test was tried, isometric peak torque increased slightly compared to pre-test, but decreased when at least $60^{\circ}$ flexion angle(p>.05). Weight distribution rate of both leg and trunk muscle balance also aggravated compared to pre-test(p>.05), and Oswestry LBP disability index was similar to the 4th week of physical therapy execution(p>.05). Conclusion: Successive postoperative Especially, Application of dynamic lumbar stabilization exercise program is important than traditional lumbar strengthening exercise program in the maintaince of spinal stability.

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The Clinical Case of Oriental Medical Treatment at Tender Point for Patient with Lower Back Pain Suggesting of Amyotrophic Lateral Sclerosis (요통을 호소하는 ALS환자에 대한 한의학적 치료 효과 증례 보고)

  • Yeon, Chang-Ho;Pak, Hyun-Gun;Jo, Yoong-Ki;Jung, Jae-Young;Lee, Sang-Min;Kim, Sung-Soo
    • The Journal of Churna Manual Medicine for Spine and Nerves
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    • v.5 no.2
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    • pp.103-111
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    • 2010
  • Objectives : This study was performed to report the effect of oriental medical treatment in the lower back pain(LBP) with amyotrophic lateral sclerosis(ALS). Methods : A 32-years-old man who diagnosed as ALS was admitted with LBP. We treated him by burning acupuncture, herbal medicine, acupuncture, electroacupuncture, moxibustion, cupping therapy and physical therapy from 11th May 2010 to 10th June 2010. Results : After treatment, there was improvement in LBP. Pain Intensity estimated by visual analog scale(VAS) as percentile Pain Intensity Difference(PID), Korean Owestry Disbility Index(KODI) was also improved. Korean version of Amyotrophic lateral sclerosis Functional rating scale-revised(K-ALSFRS-R) shows that the patient's physical ability has been improved. Conclusions : Our study suggests that oriental medical treatment are significantly effective in the LBP due to ALS. And further studies will be aid to identify underlying mechanism of treatment.

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Effect of Swiss Ball Exercise Combined with Taping on Pain, Disability, and Quality of Life in Women with Pregnancy-Related Low Back Pain (테이핑과 병행한 스위스볼 운동이 임신성 요통 환자의 통증과 기능장애 및 삶의 질에 미치는 효과)

  • Jung, Kyoung-Sim;In, Tae-Sung
    • Journal of Korea Entertainment Industry Association
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    • v.14 no.6
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    • pp.301-309
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    • 2020
  • The purpose of this study was to determine whether swiss ball exercise combined with taping would improve low back pain, disability and quality of life in women with pregnancy-related Low Back Pain (PR-LBP). Sixteen patients with PR-LBP were recruited and were randomly divided into two groups: taping and swiss ball exercise group (n=8) and taping and stretching group (n=8). The taping and swiss ball exercise group was treated with swiss ball exercise with kinesio taping, while the taping and stretching group received only taping. The taping and swiss ball exercise group performed swiss ball exercise for 30 minutes a day, 5 times a week for 4weeks, while the taping and stretching group conducted stretching exercise for the same amount of time. VAS was used to assess pain level of low back. Disability was measured using a Roland Morris Disability Questionnaire(RMDQ). Quality of life were measured by SF-36. The pain intensity of low back in the taping and swiss ball exercise group improved significantly greater than the taping and stretching group (p<0.05). Significant improvement in the disability was observed in the taping and swiss ball exercise group compared to the taping and stretching group (p<0.05). The SF 36 in the taping and swiss ball exercise group improved significantly greater than the taping and stretching group (p<0.05). Our findings indicate that swiss ball exercise combined with taping is beneficial and effective to improve low back health and quality of life in women with PR-LBP.

An Efficient Processor Synchronization Scheme on Shared Memory Multiprocessor (공유메모리 다중처리기에서 효율적인 프로세서 동기화 기법)

  • 윤석한;원철호;김덕진
    • Journal of the Korean Institute of Telematics and Electronics B
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    • v.32B no.5
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    • pp.683-692
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    • 1995
  • Many kinds of large scale multiprocessing and parallel-processing systems have recently been developed. The contention on the shared data caused by multiple processors may degrade system performance. So, processor synchronization has become one of the important issues in these systems. To solve the synchornization issues, a lot of software and hardware schemes based on spin lock have been proposed. Although software schemes are easy to implement, hardware schemes are preferred in many systems to gain optimized performance. This paper proposes an efficient processor synchronization scheme, called QCX,and describes its design considerations, hardware, algorithm, protocol. Also, in this paper, the performance of QCX has been evaluated with QOLB[5] and LBP[7] using a simulation. The simulation, with varying the number of processor and the contention on shared variables, measured the average execution times of a workload. The simulation results show that the performances of QCX is best when practicability is considered. QCX is more efficient than QOLB and LBP in two aspects. First, the hardware of QCX is more simple and cost-effective because the cache structure need not be changed. Secondly, QCX is more general because it uses a generic atomic instruction.

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Difference of Lumbar Lordosis in Patients with Low Back Pain and Controls

  • Yi, Seung-Ju;Bae, Sung-Soo;Park, Rae-Joon;Kim, Chung-Sun;Chun, Byung-Yeol;Kim, Byung-Gon
    • The Journal of Korean Physical Therapy
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    • v.13 no.2
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    • pp.373-380
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    • 2001
  • Objectives: The purpose of this study was to compare the difference of Lumbar Lordosis Angle (LLA)between patients with Low Back Pain (LBP) and control groups. Methods: Questionnaires were completed by 40 adults LBP patients seeking physical therapy services and by 40 controls at the department of Physical Therapy, SaeJong Neurosurgical Clinic in Taegu city, South Korea from October 1999 to March 2000. LLA was measured on lateral x-ray films with standing position. The angle between a line parallel to tile top of the first Lumbar (Ll) and the top of the fifth Lumbar (L5) was defined LLA. Results: LLA of 29.88$^{\circ}$ for LBP patients was statistically significant decrease from that of 35.31$^{\circ}$ for controls in the difference of lumbar lordosis (p<0.01). There were statistically significant differences between genders in patients groups. Females(32.22$^{\circ}$) had significantly greater angles than males (27.32$^{\circ}$) (p<0.05), while 36.63$^{\circ}$ for female was also greater than 34.12$^{\circ}$ for male in the controls. No significant difference was found between age. In patient groups, 27.95$^{\circ}$ for below age 40 was a smaller than 32.32$^{\circ}$ for above, however, 35.82$^{\circ}$ for below age 40 was a little greater than 34.27$^{\circ}$ for above in controls. Patients in sitting posture had greater LLA (31.35$^{\circ}$). than those standing (28.93$^{\circ}$), however. values for controls were similar to each other. Conclusions: Results from this study indicate that distinct difference exist among patients and controls and gender, whereas little difference exists in age and working posture.

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Symptomatic Post-Discectomy Pseudocyst after Endoscopic Lumbar Discectomy

  • Kang, Suk-Hyung;Park, Seung-Won
    • Journal of Korean Neurosurgical Society
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    • v.49 no.1
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    • pp.31-36
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    • 2011
  • Objective: The objectives of this study were to determine the frequency of symptomatic postdiscectomy pseudocyst (PP) after endoscopic discectomy and to compare the results of surgical and conservative management of them. Methods: Initial study participants were 1,503 cases (1,406 patients) receiving endoscopic lumbar discectomy by 23-member board of neurosurgeons from March 2003 to October 2008. All patients' postoperative magnetic resonance imaging (MRI) scans were evaluated. On the postoperative MRI, cystic lesion of T2W high and T1W low at discectomy site was regarded as PP. Reviews of medical records and radiological findings were done. The PP patients were divided into two groups, surgical and conservative management by treatment modality after PP detection. We compared the results of the two groups using the visual analogue scale (VAS) for low back pain (LBP), VAS for leg pain (LP) and the Oswestry disability index (ODI). Results: Among 1,503 cases of all male soldiers, the MRls showed that pseudocysts formed in 15 patients, about 1.0% of the initial cases. The mean postoperative interval from surgery to PP detection was 53.7 days. Interlaminar approach was correlated with PP formation compared with transforaminal approach. (p=0.001).The mean VAS for LBP and LP in the surgical group improved from 6.5 and 4.8 to 2.0 and 2.3, respectively. The mean VAS for LBP and LP in the conservative group improved from 4.4 and 4.4 to 3.9 and 2.3, respectively. There was no difference in treatment outcome between surgical and conservative management of symptomatic PP. Conclusion: Although this study was done in limited environment, symptomatic PP was detected at two months' postoperative period in about 1% of cases. Interlaminar approach seems to be more related with PP compared with transforaminal approach.

A Study of Spinal Curvature in Female and Male University Students (남녀 대학생의 척추만곡에 관한 연구)

  • Lee, Byung-Kyu;Nam, Ki-Seok;Yi, Chung-Hwi
    • Physical Therapy Korea
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    • v.5 no.3
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    • pp.72-87
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    • 1998
  • This study examined the rates of spinal abnormal curvature and the correlation of the Body Mass Index (BMI), Low Back Pain (LBP) and spinal curvature by measuring scoliosis, kyphosis, and lordosis in university students. The study population included 67 male, 92 female university students, making a total of 159, in Wonju City. Spinal curvature was measured by an electrogoniometer in a computerized skeletal analysis system. Lateral curvature of spine of more than 10 degrees was considered as nonspostural scoliosis. The correlation of BMI, LBP and the spinal curvature was analysed by Pearson's correlation coefficient and t-test. The following results were obtained: 1. The overall incidence and rate of scoliosis in cases with a greater than 10 degree curve in males was an incidence of 8 and a rate of 11%. In females the incidence was 36 and the rate 39.2%. 2. The overall incidence and rate of kyphosis of less than 20 degrees in males was a rate of 9 and an incidence of 11.9%. In females, the rate was 5 and the incidence 5.4%. In kyphosis cases of more than 40 degrees, the male rate was 5 and the incidence 7.7%. For female the rate was 13 and the incidence 14.2%. 3. The overall incidence and rate of lordosis with curves of less than 20 degrees was a rate of 6 for males and an incidence of 9.0%. For females, the rate was 5 and the incidence 5.4%. In cases of more than 50 degrees lordosis, the female rate was 2 and the incidence 2.2%. There were no males in this category. 4. There was a negative correlation between kyphosis and BMI. The greater the kyphotic curve, the less the BMI in males (p<0.05). There was no significant BMI difference by gender in either scoliosis or lordosis. There was, however, a significantly decreased sacral angle in the female group with LBP. The results of this study cannot be generalized to the general population because the subjects were all from one university. The measurements were quite reliable because the angles determined by the Metrocom System were highly correlated with radiologic findings. This study shows the need for a regular screening system for spinal curvatures in university health examination procedures.

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The study of difference between HIVD group and simple low back pain group by Current Perception Threshold test (요추추간판탈출증군과 단순요통군간의 Current Perception Threshold상의 차이에 관한 연구)

  • Kim Cheol-Hong;Lee Byung-Hoon;Kwon Hye-Yeon;Lim Chun-Woo;Seo Jung-Chul;Youn Hyoun-Min;Song Choon-Ho;Jang Kyung-Jeon;Ahn Chang-Beohm
    • Journal of Acupuncture Research
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    • v.18 no.6
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    • pp.59-69
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    • 2001
  • Objective : The aim of this study is to assess the ability of the CPT test to dignosis radiculopathy in Korean with NeuvalTM CPT database. Method : Electrical stimulation(at 2000, 250, and 5Hz) using Neurometer was applied to the 19 patients who felt back and sciatic pain with herniated intervertevral disc(HIVD) of L-spine, dignosisd by lumbar CT or MRI, and the 33 patients who felt only back or hip or leg pain without HIVD, stenosis, spondylolisthesis which causing radiculopathy. The test sites were toe1, toe3 and toe5 related to L4, L5 and S1 nerve roots. Results : The mean values of the CPT of HIVD group was stiatically lower than LBP group at toe1-250Hz, toe3-2000Hz, 250Hz and toe5-250Hz, 5Hz. The grading CPT score of HIVD group was stastically higher than LBP group at the toe3(L5). The VAS of HIVD group was stastically higher than LBP group. Conclusion : These results suggest that the CPT test can be a valuable testing for diagnosing radiculopathy in Korean. In using CPT test further study is needed for the diagnosis and evaluation of sensory nerve dysfunction in the musculoskeletal disease.

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