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A 30-year older woman was presented to the outpatient
department for the treatment of numbness and the sharp pain in her right leg.
The intensity of the pain and numbness was severe enough to interfere with her
work and daily activities. The initial symptoms were developed about 18 months
ago, but those were mild, and thus never affected her daily activities. She was
a working woman for past eight years of her life, and her job required her to
be in a standing position for at least 6-8 hours a day. Though she was a
married woman, she had not given birth to any child until the day of her
hospital visit. She weighed almost 75 kgs and never complained of having any
heart ailment, diabetes-related signs or any other chronic diseases.
The most likely diagnosis of this presentation
is
Low back pain (LBP) is one of the most common conditions
affecting almost 60–90% of the population at least once in their lifetime. It
is characterized by severe pain and/or stiffness, altered muscles and muscle
activity around the lumbar spine that persists for more than 12 weeks. Low
back pain lasting for less than 12 weeks is categorized as acute low back pain. The
constant force applied to the spine can lead to the weakening of the muscles
around the spine, thereby affecting the movement. Chronic
low back pain negatively affects the range of motion, trunk muscle strength,
endurance, and flexibility, thus affecting day-to-day living and social
activities and the quality of life. Although CLBP may
affect anyone, irrespective of age, race and gender, it is closely associated
with some occupational risk factors like carrying heavyweights, continuous
standing or sitting for long hours, desk jobs, etc., that causes the imbalance
of posture and muscles. Therefore, it is also considered as an occupational
disorder.
A female patient diagnosed with chronic low back pain and lumbar transitional vertebra was given joint mobilization using KEOMT and PNF techniques. The patient had significant improvement in spinal motion, pain, and thickness of the multifidus muscle.
The patient was examined for the spinal
movement (which involved the measurement of spinal curvature, flexion, and
extension) severity of pain, and thickness of the multifidus. The severity of
pain was recognized by the Visual analogue scale (VAS) and the Oswestry
disability index (ODI). Imaging studies (computed tomography) were performed to
measure the thickness of the multifidus.
The treatment plan for this patient
included joint mobilization scheduled for about 40-minute session, thrice a
week, for a month. Kaltenborn-Evjenth orthopaedic manual therapy (KEOMT) and
proprioceptive neuromuscular facilitation (PNF) techniques were opted for joint
mobilization. KEOMT consisted of lumbar segmental traction while the PNF
exercise consisted of shoulder flexion, abduction, and external rotation in a
supine position, and slow reversal of the antagonist. After the complete
treatment, the angle of spinal curvature in the thoracic vertebra and overall
range of motion was found to be significantly increased (flexion from 13° to
20°, and extension from 2° to 4°). The angle of spinal curvature was improved
from 12° to 20° in the lumbar vertebra, and the range of motion of the flexion
and extension was increased to 46°, and 8°, respectively. The VAS score was
reduced from 8.5 to 2, indicating reduced severity of the pain and the ODI
percentage score was decreased from 44.00 to 23.22. The thickness of the
multifidus measured at the fourth lumbar vertebra increased from 570.10 to
666.10 mm2 (left), and 479.84 to 530.90 mm2 (right).
Ample of rest, home remedies like heat or cold treatment, massage, physiotherapy, sonography, electrical simulation, traction, joint mobilization, manipulation and physical therapy can be considered as a treatment approach for CLBP. Physical therapy (exercise) is found to have a significant role in the speedy recovery and also in preventing recurrence. Therefore, it is considered as a mainstream therapy for CLBP.
Various types of exercise treatments are recommended for CLBP, but Williams flexion exercise and Mckenzie expansion exercise are considered to have a significant effect on painful symptoms. The most effective treatment for CLBP remains elusive, but joint mobilization is believed to improve symptoms, including pain, muscle strength, alignment and motion. To be specific, KEOMT (traction or gliding on one-side) has shown to improve range of motion and intensity of the pain. The PNF technique helps to improve the symptoms like lumbar back pain, range of motion, the thicknesses of the multifidus and muscular strength.
According to the recent evidence, joint
mobilization has a positive effect on spinal motion, whereas PNF reduced the
pain, and improved muscle muscular endurance and activity in CLBP and a lumbar
transitional vertebra. Another study has also highlighted the role of PNF in
improving muscle activity, flexibility, and stability. According to a
comparative study, PNF and a trunk exercise program improved the symptoms of
CLBP, including balance and stability. Still, the PNF had a significant effect
than the trunk exercise approach.
Assessments after the treatment showed the
increased angle of spinal curvature and improved range of motion which suggests
the positive effects of joint mobilization using KEOMT and PNF.
J Phys Ther Sci. 2015 May; 27(5): 1629–1632.
Effect of joint mobilization using KEOMT and PNF on a patient with CLBP and a lumbar transitional vertebra: a case study
Si-Eun Park et al.
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