Comparative Effects of SWT and Maitland LM in Mechanical LBP

May 31, 2022 updated by: Riphah International University

Comparative Effects of Shockwave Therapy and Maitland's Lumbar Mobilization on Pain, Disability and Range of Motion in Patients With Mechanical Low Back Pain

Low back pain is a common neuro-musculo-skeletal problem affecting 40% of world's population at some point in their life and causes significant disability with loss of productive working hours. Low back pain is usually non-specific or mechanical and its mechanical origin is identified by the presence or absence of signs and symptoms i-e local or radicular pain, tenderness, spasm associated with different postures or movements. This study aims to compare the therapeutic effects of shockwave therapy and Maitland lumbar mobilizations on pain, disability and range of motion in patients having mechanical low back pain.

Current study will be randomized clinical trial in which convenience sampling technique will be used. Sample size will be 26. Subjects with age group of 25 to 45 years and who meet the inclusion and exclusion criteria will be included in this study and they will be randomly allocated into two groups. Group A will be given shockwave therapy treatment, while the group B will be given Maitland lumbar PA glide mobilizations. Each groups will also receive the conventional physical therapy treatment that includes lumbar stretching exercises and core strengthening exercises. Both the therapeutic techniques will be conducted for 4 weeks, two sessions per week for each group. Before, after two weeks and after four weeks of the treatment sessions, effects of treatment will be noted and quantitative data will be analyzed using SPSS software version 25.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Low back pain (LBP) is increasingly becoming one of the main health concerns nowadays. It affects daily life and work routine and leads to medical consultations. The prevalence of NSLBP is approximately 10 to 25% in young and middle-aged individuals. Even though degenerative changes are minimal in this age group, more physical activities consequently make this group vulnerable to various physical strains. Approximately 10% of LBP cases have an identifiable pathology, while the remaining 90% are non-specific LBP (NSLBP), reflecting LBP of unknown underlying pathology, characterized by pain, muscle tension, and stiffness between 12th rib and inferior gluteal fold. Based on duration, LBP can be categorized as acute (less than six weeks), sub-acute (six to twelve weeks), and chronic (more than twelve weeks). Common symptom is the pain that gets worse with activity and relieved by rest. There are different methods for LBP treatment like surgery, oral medication, injection at lumbar region, psychotherapy, chiropractic and physiotherapy. Physiotherapy modalities and techniques like electrotherapy, low level laser, ultrasound, massage, shortwave, traction, superficial heat, spinal manipulation and exercise therapy are used to treat such cases. Extracorporeal Shock Wave Therapy (ESWT) has emerged as a popular tool for treatment of musculoskeletal disorders such as lateral epicondylitis, painful shoulder syndrome and plantar fasciitis. The two primary types of shock waves are the Focused Extracorporeal Shock Wave (fESW) and the Radial Extracorporeal Shock Wave (rESW). They differ in terms of the manner and extent of the acoustic energy propagation, the shape of the beam and its physical properties. Maitland mobilization techniques are thought to benefit patients with lumbar mechanical pain through the stimulation of joint mechanoreceptors.

A systematic review and meta-analysis of RCTS was conducted in 2020 to check the effectiveness and safety of extracorporeal shockwave treatment on low back pain. Multiple electronic databases including PubMed, Embase, Cochrane's library, China National Knowledge Infrastructure (CNKI), and Wan Fang Data were searched until December, 2019 to identify studies assessing the effectiveness and safety of EPSW for LBP. The main outcome was pain intensity which was measured using visual analogue scale (VAS) and numeric pain rating scale (NPRS).Functional status, quality of life and psychological outcomes were also measured using oswestry disability index (ODI). Findings of all these studies concluded that the use of focused ESWT is effective in alleviating pain and improving general functional state of patients with low back pain. The effectiveness of Maitland spinal mobilization therapy in the treatment of non-specific low back pain. It was a prospective study that involved ninety (90) subjects who completed the recommended four-week program. All subjects were given spinal mobilization therapy using Maitland method. The conclusions of this study indicated that manual therapy is a consideration in treatment of non-specific LBP and as an alternative to conventional treatment methods.

The effects of shockwave therapy and Maitland lumbar mobilizations have been seen to be the effective approaches in the treatment of mechanical or non-specific low back pain. But these treatment approaches have seen independently in treating low back pain. But there is no literature available that compares the effect of both techniques. So to see the comparative effects of these two techniques will be the main goal of this study.

Study Type

Interventional

Enrollment (Anticipated)

26

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • Punjab
      • Faisalabad, Punjab, Pakistan, 38000
        • Recruiting
        • Bin Inam's Clinic
        • Contact:
        • Sub-Investigator:
          • Rida Ejaz, MSPT-OM

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

23 years to 43 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Age: 25-45 years
  • Gender: both male and female
  • Patients that reports in physiotherapy OPD or referred from orthopedic department, diagnosed with mechanical low back pain having pain for more than 2 weeks.

Exclusion Criteria:

  • Patients with surgical interventions to lumbar vertebral region.
  • Spondylosis
  • Disc prolapse
  • Spondylolisthesis
  • Spinal tumor or inflammatory disease such as rheumatism

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Shockwave Therapy
Common Treatment : Conventional physical therapy (lumbar stretching exercises and core strengthening exercises) Group A: Shockwave Therapy
Device: Shockwave Therapy

Subjects in Group A will receive conventional physical therapy treatment that involves lumbar stretching exercises (bridges, knee to chest, press-up back extensions, bird dogs) and core strengthening exercises (partial crunches, pelvic tilts, wall sits, hip stretches) for ten minutes. After the conventional therapy, this group will be given shockwave therapy treatment twice a week for four weeks.

After exposing and cleaning the treated area with alcohol, adequate amount of gel will be placed on the lower back region, and the machine will be adjusted at (2000 shock per session, 8 sessions 2 per week for 4 weeks, energy flux density 0,18mJ per mm square, 2 bars of pressure, frequency 10hz), with using 20mm D-Actor head.
Experimental: Maitland's Lumbar Mobilizations
Common Treatment: Conventional Physical Therapy (lumbar stretching exercises and core strengthening exercises) Group B: Maitland's Lumbar mobilizations
Other: Maitland's lumbar mobilizations

Subjects in Group B will receive conventional physical therapy treatment that involves lumbar stretching exercises (bridges, knee to chest, press-up back extensions, bird dogs) and core strengthening exercises (partial crunches, pelvic tilts, wall sits, hip stretches) for ten minutes.

After the conventional treatment, Group B will be given Maitland's lumbar postero-anterior glide mobilizations initiating from Grade 1, with 3-4 sets of oscillations of 40 counts in each set, 2 sets of oscillations will be given below and above the affected joint level.This whole mobilization treatment will also be given twice a week for 10 minutes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Numerical Pain Rating Scale (NPRS)
Time Frame: 10 Months
Patient level of pain will be assessed using this scale. This scale ranges from 0 to 10. 0 indicates "no pain" and 10 indicates "worst pain". NPRS have shown high test-retest reliability (r = 0.96 and 0.95, respectively)
10 Months
Oswestry Disability Index (ODI)
Time Frame: 10 Months

The Oswestry Disability Index (also known as the Oswestry Low Back Pain Disability Questionnaire) is an extremely important tool that researchers and disability evaluators use to measure a patient's permanent functional disability. The test is considered the 'gold standard' of low back functional outcome tools The final score/index ranges from 0-100.

A score of 0-20 reflects minimal disability, 21-40 moderate disability, 41-60 severe disability, 61-80 crippled, and 81-100 bed-bound
10 Months
Bubble Inclinometer
Time Frame: 10 Months
The simple bubble inclinometer has excellent clinical reliability (ICC >.90) for measuring lumbar lordosis and thoracic kyphosis in standing.
10 Months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Riphah International University

Investigators

  • Principal Investigator: Saba Rafique, ppdpt, Riphah International University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 1, 2022

Primary Completion (Anticipated)

February 28, 2023

Study Completion (Anticipated)

March 31, 2023

Study Registration Dates

First Submitted

May 31, 2022

First Submitted That Met QC Criteria

May 31, 2022

First Posted (Actual)

June 3, 2022

Study Record Updates

Last Update Posted (Actual)

June 3, 2022

Last Update Submitted That Met QC Criteria

May 31, 2022

Last Verified

May 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • REC/RCR&AHS/22/0127

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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