Elongation Longitudinaux Avec Decoaption Osteo-Articulaire (ELDOA) in Cervical Disc Protrusion
Condition: Cervical Disc Herniation
MeSH terms: Intervertebral Disc Displacement
Study type: Interventional

Summary: 
      The aim of this research is to find and compare the effect of conventional physical therapy
      and ELDOA stretching exercise on pain, range of motion and disability in patients with
      cervical disc protrusion. The Randomized controlled trials done at Armed Forces Institute of
      Rehabilitation Medicine, Rawalpindi. The sample size was 20. The subjects were divided in two
      groups, 10 subjects in conventional physical therapy group and 10 in ELDOA stretching
      exercise group. Study duration was of 6 months. Sampling technique applied was Convenient
      Sampling technique randomization in group through Lottery method (sealed envelope). Only
      30-60 years individuals with cervical disc protrusion were included. Tools used in the study
      were measurement of ROM by bubble inclinometer, Numeric pain rating scale (NPRS) and neck
      disability index (NDI). Data was analyzed using SPSS 21.
    

Detailed description: 
      Cervical disc protrusion is a significant cause of neck and arm pain and disability in
      majority of individuals. It causes a great burden on physical, social and emotional quality
      of life of patients. The cervical disc protrusion is characterized by prolapsed nuclear
      material through the annulus into the spinal canal. The local mechanical or chemical
      irritation of neural structures typically leads to symptoms of radiculopathy, head and neck
      pain or myelopathy. The disc protrusion may be postero-central to compress the dura matter,
      causing multi segmental pain and affect the scapular area. It can also be postero-lateral
      causing the root signs, which have dermatomal behavior and affect the upper limb in specific
      pattern. Postero-central protrusion can also shift to postero-lateral with symptoms shifting
      from centralization to radiculopathy.

      Symptomatic disc protrusions can occur at any age but have different clinical features
      depending on the age group. In young adults nucleus pulposus can involve which is rare in old
      age. Diagnoses can be established on clinical findings along with patient's history, the
      functional examination and MRI. Disc protrusion can occur in postero-central, lateral and
      Postero- lateral directions.

      Movement of the disc posteriorly causes stress on the posterior longitudinal ligament and
      also on the anterior part of the Dura mater. As a result of this the pain travels in more
      than one segment with dural reference. This typical postero central protrusion causes the
      pain symptoms centrally and bilaterally. Postero lateral disc protrusion may irritate the
      nerve root, which causes a Segmental or root pain and paraesthesia. The goal of treatment in
      disc protrusion problems is to stop the conflict between the displaced disc material and
      affecting sensitive structure. Protruded disc fragment may affect the Dura matter, nerve
      roots and intervertebral joints.

      ELDOA is a series of stretching exercises and body movements that uses the Centre of gravity
      and localizes a target area of the spine that need to be mobilized or re aligned by placing
      and maintaining tension on the fascia. In ELDOA improvement in the tone of the intrinsic
      muscles of the spine combined with reinforcing the extrinsic muscles related to the spine in
      the neck. The stretching of the interlinking Para spinal muscles and finally inter
      independent movement of "Junghans functional unit" is facilitated and it is emphasized that
      micro movement affects macro function. The basic working principle during an ELDOA stretching
      consists of creating a position that will target a specific segment i.e. the functional unit.
      The inferior segment is fixed while the superior segment is mobilized. The position is
      created in such to place all the inferior and superior myofascial chains under tension. The
      effects of ELDOA include decompression of the superior and inferior facet joints, allowing
      for more space, joint play, and the range of motion.

      Except ELDOA the other different treatment methods for intervertebral disc protrusion
      includes the application of physical modalities, mechanical traction, specific physical
      therapeutic exercise, oral anti-inflammatory medication, and patient education. Disc
      decompression therapy, surgery, minimally invasive Oxygen- Ozone therapy that exploits the
      biochemical properties of a gas mixture of Oxygen and Ozone and administration of
      periganglionic injection of corticosteroid and an anesthetic agent.

      Physiotherapy treatment protocol for cervical disc protrusion includes cervical traction,
      neural mobilization and cervical spine strengthening exercises to relieve stress on the
      muscles. ELDOA stretching exercise is a systematic technique that causes decompression of the
      superior and inferior facets of the involved segment, allowing for more space, joint play,
      and the range of motion. This study hypothesize that there is a difference between the
      effects of conventional physical therapy treatment and ELDOA stretching exercise for the disc
      protrusion. The objective of this study is to find the effects of ELDOA stretching technique
      and to compare it with conventional physical therapy treatment in patients with cervical disc
      protrusion.

      Literature review A systematic and evidence based search of relevant literature was performed
      by utilizing PubMed and Google Scholar as search engines.

      Search term for the initial literature review was disc protrusion, prevalence of neck pain,
      causes of neck pain, pathophysiology of disc protrusion, treatment options for disc
      protrusion, effects of ELDOA in disc protrusion. The search was limited to papers in English
      preferably published since 2000 with full text available. Different studies were available
      regarding cervical manipulation and its effects but limited data was available regarding the
      effects of ELDOA on cervical disc protrusion in recent years.

      In 2016,The prevalence of playing related injuries in collegiate violinists and the physical,
      emotional, and mental effects of ELDOA. Conducted an exploratory study to investigate the
      effects of ELDOA on the perceived pain in collegiate violinists at Jacob School of Music
      Indiana University. The study findings were overall decrease in pain and some study
      participants indicated the physical, emotional, and mental benefits after doing ELDOA
      exercises such as improve body posture, increase flexibility, mobility, and range of motion.
      Participants also noticed a change in mental behavior as decrease in stress, anxiety,
      improved sleep patterns and some participants did not observed as much emotional or mental
      benefits as others.

      Quasi experimental short time study on Fascia Stretching Improve the Pain and Functional
      Level in Disc Protrusion Patients: JRCRS; 2016. The study participants were administered
      ELDOA exercises with conservative physical therapy treatment in both cervical and lumbar disc
      protrusions. The result of this study showed that ELDOA has significant result to decrease
      pain and improved functional status of the subjects. The pre and post-treatment frequency and
      intensity of pain showed significant differences.

      In a study on incidence of intervertebral disc protrusion disclosed by postmortem radiography
      and myelography, 60 % of patients over the age of 30 years have multiple anterior and lateral
      disc protrusion of witch 40% were posterior disc protrusions.
    

Intervention name(s): Conservative physical therapy; ELDOA stretching exercise
Intervention type(s): Other; Other
Intervention description(s): Moist hot packs, TENS, Cervical Traction, Neural Mobilization on alternate days Cervical Spine strengthening exercises 10 repetitions×1 set, 4 days/week. Total of 4 sessions were given each consisting of 40 mins.; Experimental group was given ELDOA stretching exercise protocol along with the moist hot packs, TENS, Cervical Traction, and Neural Mobilization on alternate days Cervical Spine strengthening exercises 10 repetitions×1 set, 4 days/week. Total of 4 sessions were given each consisting of 40 mins.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Cervical Disc Protrusion; ELDOA,; Neck Pain; Neck Disability