59
Utilizing Clinical Practice Guidelines for Treatment of Low Back Pain: Summary
• Massage : Techniques using the hands to promote relaxation of underlying muscle • Dry needling : Intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points and muscular and connective tissues for the management of pain and movement impairments • Traction : Intervention that uses manually or mechanically applied forces with the intention of stretching and distracting the spine: ○ Meta-analysis by Vanti et al. (2021): ■ Mechanical traction to treat lumbar radiculopathy ■ Effective short term for pain and disability ■ Long-term effectiveness not conclusive ○ Meta-analysis by Cheng et al. (2019): ■ Mechanical traction compared to sham or no traction ■ Subjects diagnosed with lumbar disc herniation ■ Reduced pain/increased function short term ■ No statistically significant benefit long term Acute LBP Recommendations: • Strong evidence/A: ○ Thrust and nonthrust joint mobilizations to reduce pain and disability ○ No evidence of differences in outcomes based on mobilization technique • Moderate evidence/B: ○ Soft tissue mobilization to reduce pain Chronic LBP Recommendations • Strong evidence/A: ○ Thrust and nonthrust manipulations to reduce pain and disability
• Also include 2+ days of muscle strengthening exercise • U.S. Department of Health and Human Services (HHS): ○ Include balance training ○ Aerobic activities (moderate intensity) 3×/week for 30- to 45-min bouts ○ Also include muscle strengthening 2×/ week
Postoperative LBP Exercise: • Note: Weak evidence (C) • General exercise training • Surgeries in the literature search: ○ Lumbar discectomy ○ Spinal fusion ○ Decompressive surgery: ■ Laminectomy ■ Hemilaminectomy ■ Laminotomy Key Points for Exercise:
• Many exercise training interventions potentially reduce pain and disability • Not possible to recommend any one type of exercise • No clear evidence of one exercise/ approach when exercise protocols are directly compared • Progressive exercise training recommended in older adults with LBP to reduce pain and disability 2. Manual and Other Directed Therapies Thrust and nonthrust joint mobilization: Continuum of skilled passive movement applied at varying speeds and amplitudes within or at the end range of motion of a joint. Thrust procedures are those provided with low amplitude and high velocity. • Soft tissue mobilization : Skilled passive movement of soft tissue, including fascia, muscles, and ligaments, to reduce pain or improve range of motion. Techniques include myofascial release, trigger point therapy, strain/counterstrain, and so on
Powered by FlippingBook