Affects of Different Vertebral Manipulation Techniques on Chronic Low Back Pain

Study Overview
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Brief Summary
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The aim of this study is to investigate the instant effects of direct vertabral manipulation and indirect vertebral manipulation techniques on muscles mechanical properties, pressure-pain threshold and joint range of motion in individuals with chronic low back pain. Another purpose of this study was to compare the effects of both treatment methods on the parameters studied.

Detailed Description
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Resolving chronic low back pain is a costly obstacle. There is a wide spectrum of treatment for chronic low back pain, such as exercise training, pain training and spinal manipulation.It is the recommended spinal manipulation in the short and long term in chronic low back pain. Clinical Spinal manipulation is one of the most preferred methods of reducing pain and disability.

Official Title
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Investigation Of The Effects Of Direct And İndirect Vertebral Manipulation Techniques On Clinical Parameters And Muscle Mechanical Properties İn Chronic Low Back Pain

Conditions
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Chronic Low-back Pain

Intervention / Treatment
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* Other: Lomber roll techniques group (n=23)
* Other: Posterior- anterior central vertebral manipulation techniques (n=23)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18-65 ages Individuals with non-specific chronic low back pain who have continued pain for at least 3 months According to VAS, individuals with pain of at least 3 severity Exclusion Criteria: Pregnancy situation or suspicion Spinal Stenosis Vertebral fracture Cancer Osteoporosis Individuals with BMI over 30 kg/m2 Those with neurological disease that leads to November loss of muscle strength or spasticity-rigidity

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: This research is planned as a double blind randomized controlled trials
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Lomber Roll techniques group<br>Direct manipulation will be applied to the lumbar region with the lumbar Roll technique. Painful segment will be determined. | Other: Lomber roll techniques group (n=23)<br>* Direct manipulation will be applied to the lumbar region with the lumbar Roll technique. Painful segment will be determined.<br>|
| Experimental: Posterior- anterior central vertebral manipulation techniques group<br>Another technique that we will use as a specific vertebral manipulation technique will be Maitland's posterior-anterior central vertebral manipulation and posterior - anterior unilateral central vertebral mobilization technique. | Other: Posterior- anterior central vertebral manipulation techniques (n=23)<br>* After initial assessments were made, both groups had high velocity and low amplitude (HVLA) or V. Level manipulation will be applied in the form of 2 different direct manipulation techniques<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mechanical properties measurements | A MyotonPro was used to measure the mechanical properties of selected muscles. the measurements of the medial gastrocnemius and biceps femoris muscles were performed while individuals were in prone position the knees at full extension, and the ankle at neural position. The measurements of medial gastrocnemius were performed on plumped portion of the muscle at a point 70% of the lower leg length in line with the popliteal crease to the lateral malleolus. For biceps femoris muscle, measurements were performed at the middle points between tuberosity of the ischium and the head of the fibula.the mechanical properties of lumbar extensor muscle were performed while the individuals were prone position the hip and knee at full extension. For lumbar extensor muscle, the measurements were performed at the point 3 cm from the midpoint of the L3/L4 intervertebral space. The average of three consecutive measurements was recorded. | through study completion, an average of 1 hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Oswestry low back pain scale | it measures a total of 10 different aspects, severity of pain, personal care, lifting, walking, sitting, standing, sleeping, degree of pain change, social life, travel to assess the effect of low back pain on daily life activities in the patient. | Through study completion, an average of 1 hour | 
| Roland morris disability scale | This questionnaire is a 24-point questionnaire designed to assess the degree of functional limitation in patients with low back pain. In the survey, the answers vary from yes to no yes: 1 point, no: 0 points, and high scores indicate severe obstacle status | Through study completion, an average of 1 hour | 
| Visual analog scale | VAS was used to measure the severity of the patient's pain. It is usually 10 cm long, horizontal or vertical; it is a line that begins with no pain and ends with unbearable pain. This line can only be a straight line, or divided into equal December, or in pain definition, the definition placed on the line can be found in words. The patient indicates the severity of his pain with a sign where he sees fit on this line. Cm was measured and recorded between the point marked with the onset of decontamination. 0 'means no pain,' 5 'means moderate pain,' 10 means the most severe pain encountered in life. | Through study completion, an average of 1 hour | 
| Fear Avoidance Beliefs Questionnare | Fear avoidance beliefs questionnare has 16 questions and two sub-scales, physical activity and work. The physical activity section consists of 5 questions, and the work section consists of 11 questions. The survey was a Likert-type scale of 7. In the answers given to the survey, the expression I disagree with at all is given 0 points and the expression I fully agree with is given 6 points. | Through study completion, an average of 1 hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acute Manipulation, Chronic manipulation, Low back pain, muscles mechanical treshold, physiotherapy