Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain
When researchers look at spinal manipulation techniques they tend to use an either-or scenario. Two modalities are pitted against each other and like boxers in a ring, the strongest survives. As an example, in my last article, physiotherapy went up against surgery for the undisputed crown of knee pain treatment. As it turned out, their grudgematch ended in a draw.
This research article used a 2×2 fractorial design. It looked at two options for treating lower back pain: ultrasound therapy and manipulation. In this design, there were four study groups:
- Ultrasound and sham manipulation
- Ultrasound and manipulation
- Sham ultrasound and manipulation
- Sham ultrasound and sham manipulation
The methods for the study were well described and follow the pattern of treatment that a person would find in my St George Chiropractic office.
The US intervention was delivered after the manipulation intervention, using the Sonicator 730 (Mettler Electronics Corp), with a 10 cm2 applicator at an intensity of 1.2 W/cm^2 and frequency of 1 MHz in continuous mode. Conductivity gel was used to enhance absorption and produce deep muscle thermal effects. About 150 to 200 cm^2 of the lower back were treated. Sham UST was delivered in the same manner at a subtherapeutic intensity (0.1 W/cm^2).
The manipulation techniques were delivered after a standard diagnostic evaluation at each treatment session. The lumbosacral, iliac, and pubic regions were targeted using high-velocity, low-amplitude thrusts; moderate-velocity, moderate-amplitude thrusts; soft tissue stretching, kneading, and pressure; myofascial stretching and release; positional treatment of myofascial tender points; and patient’s isometric muscle activation against the physician’s unyielding and equal counter-force. Time permitting, optional techniquescould be used if the physician judged 1 or more of the 6 designated techniques to be contraindicated or ineffective.
Treatment lasted 12 weeks
The patients treated each week and at the end of 12 weeks, the pain was evaluated. The results of the study demonstrated that the manipulation group had better pain responses than the groups without manipulation. The results also showed that the group which had manipulation and ultrasound therapy responded the best.
This proves a point I have made for years, that proper chiropractic application should involve three components:
- Inflammation reduction
- Muscle balancing across the joints
- Improved joint mechanics
In our St George chiropractic office, we have a specific physiotherapy protocols to address the soft-tissue component as well as multiple manipulation techniques to restore joint mechanics. Our office provides the HVLA techniques as well.
Dr. Andrew White | St George Chiropractor
Featured image courtesy of FreeDigitalPhotos.net and samuiblue
Ann Fam Med March/April 2013 vol. 11 no. 2 122-129