Comparing the Effect of Chiropractic Manipulation and Spinal Decompression Device Treatment
Condition: Chronic Low-back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      This study is aimed to compare the effects of chiropractic spinal manipulative therapy and
      spinal decompression device treatment on lower extremity muscle strength, balance
      performance, lumbar range of motion and mobility, functional status, pain, and quality of
      life in patients with chronic low back pain.

      After the approval of the ethics committee, the research was carried out in the physical
      therapy and rehabilitation clinic of Medipol Mega University Hospital. Individuals between
      the ages of 18-60, who had complaints of low back pain for the last three months and who
      voluntarily agreed to participate in the study were included in the study. 40 participants
      with low back pain existing more than 3 months were randomized into one of two groups as
      Chiropractic Spinal Manipulative Therapy (CSMT) and Spinal Decompression (SD). Lumbar region
      chiropractic HVLA (High Velocity, Low Amplitude) spinal manipulation and/or sacroiliac joint
      chiropractic HVLA manipulation was applied to CSMT group, and lumbar region spinal
      decompression (traction) device therapy was applied to SD group, and as a standard of
      treatment was given a hot pack for 15 minutes before applying and a cold pack for 10 minutes
      after applying. Both groups were treated three times with an interval of three days. Before
      and after treatment were evaluated lower extremity (hamstring and quadriceps) muscle strength
      with an isokinetic dynamometer (CSMI Humac-Norm), balance performance with BBS (Biodex
      Balance System), lumbar range of motion and mobility with inclinometer and hand finger floor
      distance (HFFD), low back pain intensity with visual analog scale (VAS), functional status
      with Modified Oswestry low back pain disability questionnaire (OSW), quality of life with
      Short form-36 (SF-36) in both groups. SPPS 25 (IBM Corp. Released 2017. IBM SPSS Statistics
      for Windows, Version 25.0. Armonk, NY: IBM Corp.) version was used to analyze the data.
    

Detailed description: 
      This study is aimed to compare the effects of chiropractic spinal manipulative therapy and
      spinal decompression device treatment on lower extremity muscle strength, balance
      performance, lumbar range of motion and mobility, functional status, pain, and quality of
      life in patients with chronic low back pain.

      Chronic low back pain is a multifactorial disease that occurs especially in adults and has
      many negative effects on daily quality of life. This disease, which affects 70-80 percent of
      adults throughout their lives, creates significant limitation and high psycho-social burden
      in daily life due to the fact that the pain lasts more than 12 weeks. This leads to high
      health costs as well as loss of labor and economic burden.

      The etiology of chronic low back pain varies according to the patient population, but the
      most common is mechanical and non-specific. 80-90 percent of low back pain is caused by
      mechanical low back pain, and 15-25 percent of these patients have chronic facet
      joint-induced low back pain caused by chronic inflammation and degeneration of the lumbar
      facet joints. Chronic low back pain is often thought to be caused by disc and/or vertebral
      degeneration, musculoskeletal sprain or strain, position of the spine, or movement-related
      disorders.

      Limitation of movement increases due to pain and spasm seen in individuals with low back
      pain, and physical endurance decreases as a result of decreasing muscle strength and
      deteriorating posture due to non-use. As a result of this situation, the functional capacity
      and quality of life of individuals with low back pain are adversely affected.

      In studies in individuals with low back pain, atrophy in multifidus and paraspinal muscles,
      delay in stimulation of the transversus abdominus muscle, decrease in hip abductor muscle
      strength and trigger points in the gluteus medius muscle have been shown. It has also been
      shown to have a decrease in hip extensor muscle strength, a decrease in hip flexion, and a
      significant decrease in hamstring muscle flexibility. In a study investigating knee extensor
      muscle strength, it was shown that the maximum voluntary contraction and isokinetic muscle
      strength of the knee extensors were reduced. It has been shown that individuals with chronic
      low back pain also have a weakened ability to balance due to decreased muscle strength,
      flexibility, endurance, and many physical changes.

      Multifaceted treatment approaches are important because of the long-term and high cost of low
      back pain treatment. Medical treatment and conservative treatment (electrophysical agents,
      massage, traction, manipulation, exercise, etc.), public health and preventive rehabilitation
      programs constitute an important part of the treatment of low back pain.

      Traction therapy is a broad term used to refer to any method of separation of the spine along
      its lower axis using mechanical force. It is used to reduce pain, especially in the cervical
      and lumbar regions. Traction therapy, which is one of the many treatments that mechanically
      drain the spine to treat chronic low back pain, has different types such as spinal traction,
      distraction, and non-surgical spinal decompression.

      Spinal decompression (SD) therapy is a new method used as a conservative treatment for low
      back pain. Using movement and positioning with a traction table or similar motorized device
      is used to reduce pressure that can cause severe pain in the spine without any surgical
      procedure. Although it is generally suggested that this traction-based treatment is superior
      to existing classical traction devices, its basic principle is spinal distraction, which is
      thought to increase the distance between interververtebral discs by relaxing neural
      structures with its mechanical effects . Disc herniation or bulging creates a negative
      intervertebral pressure for the withdrawal and repositioning of disc material, and thanks to
      low pressure, it increases the fluid in the disc and the flow of fluids that nourish the
      disc.

      Chiropractic consists of the Greek words chiro (hand) and practic (practice) and means
      "manual practice." Chiropractic, which is an evidence-based primary health care, is generally
      preferred by people with low back and neck pain in developed countries. In biomechanical
      disorders of the musculoskeletal and spinal systems that have not reached the surgical level,
      the complex of vertebral subluxation caused by isolated axis disorders, mechanical movement
      integrity and disruption of physiological functions or their negative effects on the nerve,
      muscle, ligaments, circulation and movement systems Chiropractic manipulations applied for
      the purpose of correction are an easy-to-apply, non-invasive, cost-effective and low form of
      treatment with side effects.

      Although there are many studies in the literature in which the effects of conservative
      treatments used in the treatment of individuals with chronic low back pain are independently
      examined or compared with each other, there have been no studies comparing chiropractic
      manipulation and non-surgical spinal decompression treatments.

      After the approval of the ethics committee, the research was carried out in the physical
      therapy and rehabilitation clinic of Medipol Mega University Hospital. Individuals between
      the ages of 18-60, who had complaints of low back pain for the last three months and who
      voluntarily agreed to participate in the study were included in the study. 40 participants
      with low back pain existing more than 3 months were randomized into one of two groups as
      Chiropractic Spinal Manipulative Therapy (CSMT) and Spinal Decompression (SD). Lumbar region
      chiropractic HVLA (High Velocity, Low Amplitude) spinal manipulation and/or sacroiliac joint
      chiropractic HVLA manipulation was applied to CSMT group, and lumbar region spinal
      decompression (traction) device therapy was applied to SD group, and as a standard of
      treatment was given a hot pack for 15 minutes before applying and a cold pack for 10 minutes
      after applying. Both groups were treated three times with an interval of three days. Before
      and after treatment were evaluated lower extremity (hamstring and quadriceps) muscle strength
      with an isokinetic dynamometer (CSMI Humac-Norm), balance performance with BBS (Biodex
      Balance System), lumbar range of motion and mobility with inclinometer and hand finger floor
      distance (HFFD), low back pain intensity with visual analog scale (VAS), functional status
      with Modified Oswestry low back pain disability questionnaire (OSW), quality of life with
      Short form-36 (SF-36) in both groups. SPPS 25 (IBM Corp. Released 2017. IBM SPSS Statistics
      for Windows, Version 25.0. Armonk, NY: IBM Corp.) version was used to analyze the data.
    

Intervention name(s): Chiropractic Manipulation; Spinal Decompression Device Treatment
Intervention type(s): Other; Other
Intervention description(s): 20 participants with low back pain existing more than 3 months was included in the CSMT group. Lumbar region chiropractic HVLA (High Velocity, Low Amplitude) spinal manipulation and/or sacroiliac joint chiropractic HVLA manipulation were applied to participants. Participants were treated three times with an interval of three days. Before and after treatment were evaluated lower extremity (hamstring and quadriceps) muscle strength with an isokinetic dynamometer (CSMI Humac-Norm), balance performance with BBS (Biodex Balance System), lumbar range of motion and mobility with inclinometer and hand finger floor distance (HFFD), low back pain intensity with visual analog scale (VAS), functional status with Modified Oswestry low back pain disability questionnaire (OSW), quality of life with Short form-36 (SF-36).; 20 participants with low back pain existing more than 3 months was included in the SD group. Lumbar region spinal decompression (traction) device therapy was applied to participants, and as a standard of treatment was given a hot pack for 15 minutes before applying and a cold pack for 10 minutes after applying. Participants were treated three times with an interval of three days. Before and after treatment were evaluated lower extremity (hamstring and quadriceps) muscle strength with an isokinetic dynamometer (CSMI Humac-Norm), balance performance with BBS (Biodex Balance System), lumbar range of motion and mobility with inclinometer and hand finger floor distance (HFFD), low back pain intensity with visual analog scale (VAS), functional status with Modified Oswestry low back pain disability questionnaire (OSW), quality of life with Short form-36 (SF-36).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The individuals are randomly allocated into the CSMT or the SD groups
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Balance; Chiropractic; Chronic low back pain; Muscle strength; Manipulation; Spinal decompression; Pain measurement; Range of motion; Recovery of function; Quality of life