Effects of a protocol with manual therapy and postural techniques for non-specific low back pain
Daniele Alves da Silva, Maria Ester Ibiapina Mendes de Carvalho, Laiana Sepúlveda de Andrade Mesquita
Background: The effects of postural reeducation on low back pain (LBP) are well documented in the literature, as well as studies using manual therapy (MT). However, no studies were found that investigate the use of a protocol using both MT and postural techniques. Objective: To verify the effects of a protocol that associates the MT and postural techniques in pain symptoms and functionality of subjects with chronic non-specific LBP. Methods: The participants of this study were 09 patients from the physiotherapy outpatient clinic of a public hospital. The evaluation of the subjects was carried out with the application of the Visual Analog Scale for Pain, Oswestry Disability Index (ODI) and Pressure Algometry. Patients were treated with a protocol composed of manipulative and postural techniques performed twice a week for five weeks. Two new evaluations were performed after the 5th and 10th sessions. For statistical analysis, the ANOVA test was used followed by the Tukey post-hoc test, considering p< 0.05. Results: In all the evaluated variables it was observed a greater difference of the scores between the initial and the tenth evaluation. There was significant improvement in the pain (p = 0.0167) and in the algometry of the piriformis and quadratus lumborum. There was no significant difference in disability (p = 0.0595). Conclusion: The protocol with MT and postural techniques promoted improvement of pain and increase of pressure sensitivity threshold in patients with chronic non-specific LBP.
1. Van Tulder M, Becker A, Bekkering T, Breen A, Del Real MT, Hutchinson A, et al. Chapter 3 European guidelines for the management of acute nonspecific LBP in primary care. Eur Spine J. 2006; 15(2): 169-91
2. Hoy D, March L, Brooks P, Blyth F, Woolf A Bain C, et al. The global burden of LBP: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014; 73: 968-74
3. Filho NM, Silva GA. Invalidez por dor nas costas entre segurados da Previdência Social do Brasil. Rev Saúde Pública. 2011; 45(3): 494-502
4. Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Berna, RTI. Fatores associados à dor crônica na coluna em adultos no Brasil. Rev Saude Publica. 2017; 51(Suppl 1)
5. Deyo RA, Weinstein JN. Low Back Pain.N Engl J Med. 2001; 344(5): 363-70
6. Maher C, Underwood M, Buchbinder R, Non-specific LBP. The Lancet. 2017; 389: 736–47
7. Ferreira GE, Barreto RGP, Robinson CC, Plentz, RDM; Silva, MF. Global Postural Reeducation for patients with musculoskeletal conditions: a systematic review of randomized controlled trials. Braz J Phys Ther. 2016; 20(3): 194-205
8. Bonetti F, Curti S, Mattioli S, Mugnai R, Vanti C, Violante FS, et al. Effectiveness of a ‘Global Postural Reeducation’ program for persistent LBP: a nonrandomized controlled Trial. BMC Musculoskeletal Disorders. 2010; 11: 285
9. Castagnoli C, Cecchi F, Canto AD, Paperini A, Boni R, Pasquini G, et al. Effects in Short and Long Term of Global Postural Reeducation (GPR) on Chronic LBP: A Controlled Study with One-Year Follow-Up. The Scientific World Journal. 2015
10. Briganó JU, Macedo CSG. Análise da mobilidade lombar e influência da terapia manual e cinesioterapia na lombalgia. Semina: Ciências Biológicas e da Saúde. 2005; 26(2): 75-82
11. Hidalgo B, Detrembleur C, Hall T, Mahaudens P, Nielens, H. The efficacy of MT and exercise for different stages of non-specific LBP: an update of systematic reviews. Journal of Manual and Manipulative Therapy. 2014; 22(2): 59-74
12. Lawand P, Júnior IL, Jones A, Sardim C, Ribeiro LH, Natour J. Effect of a muscle stretching program using the global postural reeducation method for patients with chronic LBP: A randomized controlled trial. Joint Bone Spine. 2015; 82(4): 272-77
13. Ulger O, Demirel A, Oz M, Tamer S. The effect of MT and exercise in patients with chronic LBP: Double blind randomized controlled trial. J Back Musculoskelet Rehabil. 2017; 30(6): 1303-09
14. Breivik H, Borchgrevink PC, Allen SN, Rosseland LA, Romundstad L, Hals EKB, et al. Assessment of pain. British Journal of Anaesthesia. 2008; 101(1): 17–24
15. Falavigna A, Teles AR, Braga GL, Barazzetti DO, Lazzaretti L, Tregnado AC. Instrumentos de avaliação clínica e funcional em cirurgia da coluna vertebral. Coluna/Columna. 2011; 10(1): 62-7
16. Imamura M, Alfieri FM, Filippo TRM, Battistella LR. Pressure pain thresholds in patients with chronic nonspecific LBP. Journal of Back and Musculoskeletal Rehabilitation. 2016, 29: 327-36
17. Almeida LC. Reeducação postural e sensoperceptiva: fundamentos teóricos e práticos. Rio de Janeiro: Medbook, 2006.
18. Ajimsha MS, Daniel B, Chithra S. Effectiveness of Myofascial release in the management of chronic LBP in nursing professionals. 2014; 18: 273-81.
19. Cunha ANV, Burke TN, França FJR, Marques AP. Effect of global posture reeducation and of static stretching on pain, range of motion, and quality of life in women with chronic neck pain: a randomized clinical trial. CLINICS. 2008, 63(6): 763-70
20. Silva EM, Andrade SC, Vilar MJ. Evaluation of the effects of global postural reeducation in patients with ankylosing spondylitis. Rheumatol Int. 2012; 32: 2155-2163.
21. Alleva J, Hudgins T, Belous J, Origrnes AK. Chronic LBP. Disease a Month. 2016
22. Schleip R, Findley T, Chaitow L, Huijing P. Fascia: the tensional network of the human body. Churchill Livingstone Elsevier, Edinburgh. 2012.
23. Chaitow L. Terapia manual para disfunção fascial. Artmed, Porto Alegre: 2017
24. LimaL , Jesus D, Lima A , Ermida V, Pacheco A , Pacheco I, et al. Mecanotransdução: Importância de Impor Stress na Reparação Tecidual, I Revista da Sociedade Portuguesa de Medicina Física e de Reabilitação. 2017; 29(1)
25. Langevin HM, Fox JR, Badger GJ, Greenan-Naumann AC, Bouffard NA, Konofagou EE, et al. Reduced thoracolumbar fascia shear strain in human chronic LBP. BMC Musculoskeletal Disorders. 2011; 12:203
26. Soares RS, Silva JAMG, Silva MGMG, Navega MT. Relação entre incapacidade funcional, amplitude de movimento e dor em indivíduos com e sem lombalgia. Ter Man. 2013; 11(51): 43-7