Osteopathic Treatment for Chronic Low Back Pain
Condition: Low Back Pain; Osteopathic Manipulative Treatment
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      The relevance of this study is to determine the efficacy of two osteopathic techniques -
      Thrust Technique and Muscle Energy Technique (MET) - in improving of neuromuscular component
      of the trunk and clinical symptoms in adult workers with Chronic Low Back Pain (CLBP). Few
      studies have investigated and compared the physiological responses of these techniques
      quantitatively, and no published study has compared their effects in low back pain subjects
      in terms of symptoms, postural balance and muscle activation. The main outcomes will be
      computed by electromyography measurement so that to assess the trunk neuromuscular activation
      pattern as well as by force platform parameters for determining of postural control. Clinical
      symptoms such as pain intensity, perception of disability and fear and avoidance will also be
      computed.

      This is the first study to compare these two osteopathic techniques using the main biological
      outcomes related to trunk neuromuscular function.
    

Detailed description: 
      The purpose of this study is to assess the efficacy of two osteopathic techniques (Thrust and
      MET) on CLBP adult workers treatment.

      A total of 15 male participants with chronic low back pain, volunteers, active workers aged
      from 35 to 55 years (in aging process) will be recruited by convenience from the community
      local. All participants will sign an informed consent form approved by the North of Parana
      University Ethics Committee for Research on Human Subjects. The intervention will follow the
      CONSORT recommendations for randomized controlled trials. All baseline testing and evaluation
      will be performed by a blinded evaluator to the study intervention. The sample will be
      randomized in two groups from crossover design: Group #1), which will receive the Thrust
      technique applied at the level of dysfunction; and Group #2, which will receive the Muscle
      Energy Technique, also applied at the level of dysfunction. The allocation will be printed in
      cards by sequentially numbered in opaque envelopes.

      The treatment (intervention) will occur in 2 phases of 3 weeks each one. The participants
      will receive only one of techniques in each phase, and after one rest week (washout) they
      will receive the other technique (crossover), totaling 7 weeks. In this study, both
      techniques will be applied at the lumbar vertebral level that present the dysfunction which
      will be diagnosed in the specific evaluation, performed by two specialized physiotherapists
      in osteopathy. Before and after the manipulation (with Thrust or MET) all participants will
      be evaluated in 2 tasks - bipedal without load and bipedal with load (10% of body mass) - on
      the force platform. Parallel to the tasks, the recording of the measurements of EMG surface
      will be computed to determine the pattern of the trunk neuromuscular activation in amplitude
      of the RMS signal as well as muscle fatigue through the median frequency parameters.

      Before performing the tasks on the force platform, a maximum voluntary isometric contraction
      will be performed for the back (paravertebral) and abdominal (rectus) muscles in order to
      normalize the signal EMG for determining of the level muscular activity during each task
      (with or without load). After the intervention, the immediate and final revaluations will
      include all the used measures in the initial evaluation, such as muscle activation of trunk
      (EMG), balance (force platform), and clinical symptoms of pain (Visual Analogue Scale and
      McGill Short Questionnaire), psychosomatic factors (Fear and Avoidance Believe Questionnaire)
      and disability (Roland Morris Questionnaire).

      For the analysis a two-way ANOVA will be used for each dependent variable to compare the two
      groups (G1 versus G2) in both situations (pre and post-immediate, and after 15 days) in the
      clinical measurements, postural balance and EMG. The size effect also will be computed to
      determine the rate of the changes observed.
    

Intervention name(s): G1 - Thrust manipulation; G2 - Muscle Energy
Intervention type(s): Other; Other
Intervention description(s): Osteopathic manipulation with Thrust technique. The Group 1 (G1) will receive the Thrust technique applied at the level of dysfunction. Subject in lateral decubitus, with one lower limb extended and the other in flexion, to the level of the targeted vertebra; upper trunk rotated back until the same vertebra; at the end of the range of movement will be applied the high speed and low amplitude impulse (Thrust).; Osteopathic manipulation with Muscle Energy technique. The Group 2 (G2) will receive the Muscle Energy technique applied at the level of dysfunction. Subject in lateral decubitus, with the upper and lower trunk flexed until the target vertebra, and upper trunk rotated back to the level of the same vertebra; lumbar in lateral flexion (using the subject's feet) until the target vertebra. Following the command the subject will perform an isometric contraction of 3-5 seconds against the therapist's hand (pushing the hand towards the floor), repeated 3 times.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Osteopathic Treatment; Postural control; Neuromuscular activation; Physiotherapy