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      Influences of spinal decompression therapy and general traction therapy on the pain, disability, and straight leg raising of patients with intervertebral disc herniation

      research-article
      , MS, PT 1 , , PhD, PT 2 , , PhD, PT 3 , *
      Journal of Physical Therapy Science
      The Society of Physical Therapy Science
      Spinal decompression therapy, Pain, Straight leg raise

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          Abstract

          [Purpose] The purpose of this study was to identify how spinal decompression therapy and general traction therapy influence the pain, disability, and straight leg raise (SLR) ability of patients with intervertebral disc herniation. [Subjects] The subjects were 30 patients with chronic lumbar pain who were divided into a spinal decompression therapy group (SDTG, n=15), and a general traction therapy group (GTTG, n=15). [Methods] The SDTG used a spinal decompression device, and the GTTG used a lumbar traction device. Both groups received conservative physical therapy three times a week for four weeks. A visual analog scale (VAS) was used to measure the degree of pain the patients with chronic lumbar pain. The Oswestry Disability Index (ODI) was used to measure the degree of functional disability. A goniometer was used to measure the patients’ SLR ability. [Results] Both SDTG and GTTG showed statistically significant decreases in VAS and ODI scores and a statistically significant increase in SLR angle. A comparison of the two groups found no statistically significant differences. [Conclusion] Spinal decompression therapy and general traction therapy are effective at improving the pain, disability, and SLR of patients with intervertebral disc herniation. Thus, selective treatment may be required.

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          Mechanical initiation of intervertebral disc degeneration.

          Mechanical testing of cadaveric lumbar motion segments. To test the hypothesis that minor damage to a vertebral body can lead to progressive disruption of the adjacent intervertebral disc. Disc degeneration involves gross structural disruption as well as cell-mediated changes in matrix composition, but there is little evidence concerning which comes first. Comparatively minor damage to a vertebral body is known to decompress the adjacent discs, and this may adversely affect both structure and cell function in the disc. In this study, 38 cadaveric lumbar motion segments (mean age, 51 years) were subjected to complex mechanical loading to simulate typical activities in vivo while the distribution of compressive stress in the disc matrix was measured using a pressure transducer mounted in a needle 1.3 mm in diameter. "Stress profiles" were repeated after a controlled compressive overload injury had reduced motion segment height by approximately 1%. Moderate repetitive loading, appropriate for the simulation of light manual labor, then was applied to the damaged specimens for approximately 4 hours, and stress profilometry was repeated a third time. Discs then were sectioned and photographed. Endplate damage reduced pressure in the adjacent nucleus pulposus by 25% +/- 27% and generated peaks of compressive stress in the anulus, usually posteriorly to the nucleus. Discs 50 to 70 years of age were affected the most. Repetitive loading further decompressed the nucleus and intensified stress concentrations in the anulus, especially in simulated lordotic postures. Sagittal plane sections of 15 of the discs showed an inwardly collapsing anulus in 9 discs, extreme outward bulging of the anulus in 11 discs, and complete radial fissures in 2 discs, 1 of which allowed posterior migration of nucleus pulposus. Comparisons with the results from tissue culture experiments indicated that the observed changes in matrix compressive stress would inhibit disc cell metabolism throughout the disc, and could lead to progressive deterioration of the matrix. Minor damage to a vertebral body endplate leads to progressive structural changes in the adjacent intervertebral discs.
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            The lumbar disc herniation. A computer-aided analysis of 2,504 operations.

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              Systematic literature review of spinal decompression via motorized traction for chronic discogenic low back pain.

              The objective of this study was to systematically review the literature to assess the efficacy of nonsurgical spinal decompression achieved with motorized traction for chronic discogenic lumbosacral back pain. Computer-aided systematic literature search of MEDLINE and the Cochrane collaboration for prospective clinical trials on adults with low back pain in the English literature from 1975 to October 2005. Methodologic quality for each study was assessed. Studies were included if the intervention group received motorized spinal decompression and the comparison group received sham or another type of nonsurgical treatment. Data from 10 studies were fully analyzed. Seven studies were randomized controlled trials using various apparatus types. Because of this low number, we also analyzed three nonrandomized case series studies of spinal decompression systems. As the overall quality of studies was low and the patient groups heterogeneous, a meta-analysis was not appropriate and a qualitative review was undertaken. Sample sizes averaged 121 patients (range 27-292), with six of the seven randomized studies reporting no difference with motorized spinal decompression and one study reporting reduced pain but not disability. The three unrandomized studies (no control group) of motorized spinal decompression found a 77% to 86% reduction in pain. These data suggest that the efficacy of spinal decompression achieved with motorized traction for chronic discogenic low back pain remains unproved. This may be, in part, due to heterogeneous patient groups and the difficulties involved in properly blinding patients to the mechanical pulling mechanism. Scientifically more rigorous studies with better randomization, control groups, and standardized outcome measures are needed to overcome the limitations of past studies.
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                Author and article information

                Journal
                J Phys Ther Sci
                J Phys Ther Sci
                JPTS
                Journal of Physical Therapy Science
                The Society of Physical Therapy Science
                0915-5287
                2187-5626
                17 February 2015
                February 2015
                : 27
                : 2
                : 481-483
                Affiliations
                [1) ] Department of Rehabilitation Science, Graduate School Daegu University, Republic of Korea
                [2) ] Department of Physical Therapy, Youngdong University, Republic of Korea
                [3) ] Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
                Author notes
                [* ]Corresponding author. Gak Hwangbo, Department of Physical Therapy, College of Rehabilitation Science, Daegu University: 12, 15 Jillyang, Republic of Korea. (E-mail: hbgak@ 123456daegu.ac.kr )
                Article
                jpts-2014-499
                10.1589/jpts.27.481
                4339166
                25729196
                1a0dde59-81e3-488a-8568-e375716b78c9
                2015©by the Society of Physical Therapy Science

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License.

                History
                : 25 July 2014
                : 02 September 2014
                Categories
                Original Article

                spinal decompression therapy,pain,straight leg raise

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