Cyriax Manipulation in Lumbar Derangement Syndrome
Condition: Derangement; Low Back
Study type: Interventional

Summary: 
      the objective of the study was to determine the effect of Cyriax manipulation for Pain, range
      of motion and quality of life in lumbar internal derangement radiculopathy in single physical
      therapy session. Randomized control trails were carried out in Railway general hospital from
      February 2018 to July 2018 in which 43 patients with Low back pain were randomly divided by
      lottery method into control and experimental group. Single session of treatment was given.
      tools used in the study are visual analog scale, Oswestry disability index and lumber range
      of motion. data was analysed through SPSS (statistical package for social sciences) 21.
    

Detailed description: 
      Human spine is a supporting structure of skeleton consisting of four curves cervical
      (lordosis), thoracic (kyphosis) , lumbar(lordosis) and sacrococcygeal (kyphosis). Cervical
      and lumbar being primary contributes for erect posture. Lumbar spine (lordotic curve) is the
      area of lower back of spine consisting of five vertebrae L1-L5 extending between thoracic and
      sacrum to accommodate progressively increasing loads.it is connected to pelvis where most
      weight bearing and body movement takes place. Over the last few decades, low-back pain has
      become increasingly problematic, placing significant burdens on economy and health system.the
      2019 Global burden of Disease study estimated that low back pain is among the top ten
      diseases. low back pain is common that only a minority of individuals escape it. Eighty
      percent of anatomical and degenerative changes cause pain in lower back area .low back pain
      is extremely common having complex causes, may be acute sub-acute or chronic in nature
      depending upon severity of onset cause. Large forces acts on lumbar spine during functional
      activities such as lifting, running, walking and twisting causes repetitive micro traumas
      leading to low back pain which is distressing feelings.low back pain can be dull ache,
      shooting pain or burning sensation in nature originating from neuro-vascular, vertebral
      bones,facet joints or other vertebral structures. Low back pain which begin under 12th rib
      and on top of the inferior gluteal lines involving one or both lower extremities is called
      radiating low back pain which can be due to any internal derangement in anatomical structures
      of vertebral column. Internal derangement is disturbance of the regular order or arrangement
      of joint in which normal resting position of the articular surfaces of two adjacent vertebrae
      is disturbed as a result of a change in the position of fluid mechanics of disc, joint
      structure, ligaments, vascular and neuro-muscular system of lumbar spine due to mechanical or
      non mechanical stresses.Clinically lumbar internal derangement syndromes are .classified into
      mechanical and non mechanical based on origin internal derangement is disturbance of the
      regular order or arrangement of joint in which normal resting position of articular surfaces
      of two adjacent vertebrae is disturbed as a result of a change in position of fluid mechanics
      of disc, joint structures, ligaments, vascular and neuro-muscular system of lumbar spine due
      to mechanical or non mechanical stresses. Clinically lumbar internal derangement syndrome are
      classified into mechanical and non mechanical based on origin.Non mechanical internal
      derangement syndromes are due to non activity related disorders affecting spine such as
      inflammatory diseases (septic and hematological), tumors and infiltration lesions, metabolic
      disorders and acquired defects in neural arch whereas mechanical derangements are caused by
      placing abnormal stress on lower back disrupting normal order of lumbar spine anatomy.
      Physiotherapy treatments for low back pain includes myofascial release trigger point release,
      stretching of culprit muscles(hamstrings, lumbar erector spinae ,multifidus and piriformis),
      mobilization of vertebrae, traction of lumbar spine and Manipulation of lumbar spine (cyriax
      Manipulations, Osteopathic Manipulations and Chiropractor Manipulations).

      Manipulations is passive movements carried out by clinician with single thrust high velocity,
      low amplitude or sustained pressure not under control of patient in order to return
      displacement to its proper position.Manipulations are used to reduce pain and disability
      caused by any internal derangement and intervertebral cartilaginous structure. Manipulations
      are based on different theories of which reduction of disc protrusions, correction of
      posterior joint dysfunction, mobilization of blocked vertebral joints and reduction of nerve
      root compression are some of them.

      In 2012 John J Kuczynski conducted a systematic review on effectiveness of spinal
      manipulation therapy for treatment of chronic low back pain literature extracted from
      different data base concluded that spinal manipulations are safe and have significant
      clinical outcomes. A study published on 17th May 2018 on spinal manipulation in treatment of
      patient with MRI diagnosed lumbar disc herniation and sacroiliac hypermobility by Esmael
      Shokri et al concluded that lumbar and Sacro-iliac joint manipulations have significant
      effect on pain potential and disability. In March 2006 Muhammad A. Mohseni Bandpelet
      conducted randomized control trial study on spinal manipulation and ultrasound therapy in
      treatment of chronic low back pain. One hundred and twenty people were randomly allocated
      into manipulative group and ultrasound therapy group.They concluded that patient who received
      manipulative therapy showed greater decrease in pain intensity with increased spinal range of
      motions and functional qualities.
    

Intervention name(s): conventional physical therapy; cyriax lumber manipulation group
Intervention type(s): Other; Other
Intervention description(s): hot pack for 15 minutes Myofacial release (10 minutes) and Stretching of hamstrings and Piriformis (5 reps each with 2 second hold); Hot Pack, Myofacial Release, stretching of hamstrings and Piriformis (five reps each with 2 seconds hold) and Cyriax Lumbar Manipulation Techniques
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: interventional
Masking: Single (Investigator)
Primary purpose: Other
Keywords: Conventional physical therapy(CPT); .Low back pain (LBP),; Oswestery disability index (ODI),; Quality of life (QOL),; Range of motion (ROM); Visual analogue scale (VAS)