Efficacy of Ultrasound Versus Short Wave Diathermy in the Treatment of a Slipped Disc of the Lower Back
Condition: Radiculopathy; Low Back Pain, Mechanical; Herniated Disk Lumbar
MeSH terms: Intervertebral Disc Displacement; Radiculopathy; Back Pain; Low Back Pain; Hyperthermia
Study type: Interventional

Summary: 
      Chronic low back pain is a common problem which results in reduced functionality, quality of
      life and general well being. Conservative treatment includes patient education, exercise,
      maintaining a healthy body mass index and appropriate modifications to activities of daily
      living. Physical modalities are used to support the mainstay of treatment and include
      superficial heat, transcutaneous electrical nerve stimulation (TENS), ultrasound, short wave
      diathermy , traction, and complimentary therapies.

      In the clinical practice of the investigators, diathermy, in the form of ultrasound and short
      wave, is used to heat deeper tissues, increase tissue elasticity and metabolic rate and
      reduce pain and muscle spasm. The medical literature to date states that further studies are
      required to compare the efficacy of different diathermy modalities in the treatment of lower
      back pain.

      The aim of this study was to compare the efficacy of ultrasound to that of short wave
      diathermy and a treatment program which does not include diathermy in the treatment of a
      slipped disc.
    

Detailed description: 
      Chronic lumbar pain is a common problem which results in reduced functionality, quality of
      life and well being. Chronic low back pain also results in many missed days of work and so is
      an economic burden as well as a social one. Subacute and chronic conservative treatment of
      low back pain secondary to a herniated disc of the lower back includes education, lifestyle
      modifications, and maintenance of a normal body mass index. Physical therapy includes range
      of motion, strengthening and aerobic exercises alongside use of physical therapy modalities
      such as superficial heating, low frequency analgesic modalities such as TENS and deep heating
      modalities such as ultrasonic waves and short wave diathermy.

      In Physical Medicine and Rehabilitation departments in Turkey, diathermy is commonly used as
      an adjunct to exercise in the inpatient treatment of disc herniation of the lumbar region.
      However, systematic reviews of the effects of diathermy in the form of ultrasound and short
      wave emphasise the necessity for further studies of their efficacy in the treatment of pain
      and impact on functionality and quality of life.

      Therefore, in this study the investigators aim to compare the efficacy of ultrasound and
      short wave diathermy in treating pain, improving disability and quality of life in patients
      with chronic low back pain secondary to disc herniation of the lumbar vertebrae.
    

Intervention name(s): Ultrasound group; Short wave diathermy group; Control group
Intervention type(s): Device; Device; Other
Intervention description(s): Ultrasound 1 MHz, 1.5 W/cm2 for a total of 10 min applied to the lower back; SWD frequency of 27.12MHz applied in continuous mode (thermic) applied to the lower back for twenty minutes; superficial heat, analgesic physical modality and exercise only
Other intervention name(s): TENS, hotpack, exercise; Curapuls 419 SWD (Enraf-Nonius, Delft, The Netherlands); TENS, hotpack, exercise; TENS, hotpack, exercise
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: Three groups of patients, each containing 31 patients, will be included in the study. Patients in each group will receive a total of ten sessions of physical therapy over a two week period. Each week the patients will receive five sessions of physical therapy on consecutive days. The first group will be treated with a hotpack (20minutes) transcutaneous electrical nerve stimulation applied to the lower back (frequency, ultrasound 1MHz frequency (ten minutes), abdominal and lower back muscle strengthening exercises. The second group will be treated with hotpack, TENS and exercises as previously described plus short wave diathermy at 27.12MHz frequency for ten minutes applied to the lower back. The third group will receive hotpack, TENS applied to the lower back and strengthening exercises as previously described.
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: lumbar vertebrae; herniated disc; radiculopathy; low back pain; short wave therapy; diathermy; ultrasonic waves