Is Regression Possible in Lumbal Disc Herniation With Spinal Mobilization Applications?
Condition: Intervertebral Disc Displacement; Disk Herniated Lumbar; Disc Herniation
MeSH terms: Intervertebral Disc Displacement; Hernia
Study type: Interventional

Summary: 
      Spinal mobilization methods are passive maneuvers that are made lighter and do not exceed the
      physiological range of motion in order to increase joint mobility. Mobilization applications
      are easier and safer than manipulation applications involving forceful pushing. Although
      there are many literatures reporting the therapeutic efficacy of long-term mobilization
      applications on LDH, there is no study on the effect of applications on radiological findings
      of LDH.

      In the light of the information mentioned above, the aim of this study is; To examine the
      effect of mobilization applications on radiological findings and functional level in patients
      with LDH
    

Detailed description: 
      Disc herniation is the herniation of the nucleus pulposus, which is the disc material, into
      the spinal canal along the fibers of the annulus fibrosus. Spinal herniations that affect the
      whole spine are most common in the lumbar region, and most often in the L4-L5 and L5-S1
      levels in this region. Lumbar disc herniation (LDH) is a common cause of low back pain,
      radicular pain, and radiculopathy, resulting in disability. Depending on the size of the
      herniation, the nerve is compressed in the lateral recess or in the foraminal or
      extraforaminal space. The pathophysiology of pain includes direct nerve root compression and
      local inflammation. Scientists have found that myelography is not as sensitive as magnetic
      resonance imaging (MRI) in diagnosing lumbar disc herniation, and MRI has a higher positivity
      rate. Compared with computed tomography, it has more imaging parameters, multiple tissue
      variable functions, more flexible and comprehensive, no radiation and no harm to the human
      body, and the diagnostic accuracy is better than CT scanning. Because of these advantages,
      MRI is the gold standard imaging method in the diagnosis of LDH. There are various treatment
      options available for LDH patients. These are basically divided into 2 categories: surgical
      and conservative care. Conservative care includes oral medications, corticosteroid and
      anesthetic infiltrations (nerve root injections), bed rest, exercise therapy,
      flexion/distraction therapy, manipulation and mobilization.Mobilization applications are
      passive movements that do not involve pushing or stimuli, applied within the range of motion
      or up to the physiological range of motion. Mobilization has mechanical effects such as
      increasing tissue flexibility, separating adhesions, relieving joint limitation and reducing
      intra-articular pressure. Evidence suggests that mobilizations cause a neurophysiological
      effect that results in sympathetic arousal, reduced neural mechanical sensitivity, mechanical
      hypoalgesia, and normalized muscle activity, endurance, and pain-free strength.There are many
      studies on the clinical use of mobilization methods. While most of these studies examine the
      effects of mobilization on pain and functional status in patients with low back pain, there
      are also studies examining the effects of mobilization on pain, functional status and
      activities of daily living in patients with LDH. In the literature, it has been determined
      that regression in the lumbar disc herniation distance is achieved with conservative
      treatment and medical treatment approaches. It is observed that there are studies examining
      the effect of manipulation on the herniation distance, which is one of the non-invasive
      Spinal Decompression Therapy method and Manual therapy methods. However, there is no study in
      the literature investigating the regression of spinal mobilization applications in LDH
      patients.The aim of our study is to examine the effects of spinal mobilization applications
      applied in three different planes in addition to stabilization exercises on radiological
      findings such as herniation distance, disc height and facet joint distance in LDH patients.
      Apart from radiological findings, it was also aimed to investigate the effects of patients on
      functional status, pain and flexibility.
    

Intervention name(s): Spinal Mobilization; Stabilization Exercise
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Mobilization applications are passive movements that do not involve pushing or stimuli, applied within the range of motion or up to the physiological range of motion.; Diyafragmatik solunum ile kombine edilen, pasif-aktif kas iskelet sistemi ve nöral sistemi aktive eden bir yaklaşımdır. Bu yaklaşımda derin çekirdek kaslar olarak transversus abdominis, multifudus kasları aktive edilmektedir
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This study was designed as a double-blind randomized controlled clinical trial. In order to carry out the prospectively designed study, ethics committee approval was obtained from the Non-Interventional Clinical Research Ethics Committee of Muş Alparslan University with the decision numbered 21 taken at the meeting dated 29.12.2020 and numbered 15. Informed consent was obtained from all patients included in the study before the study.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Lumbar disc herniation; Manual Therapies; Mobilization; Stabilization Exercises