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      Effect of Radial Extracorporeal Shock Wave Therapy on Pain Intensity, Functional Efficiency, and Postural Control Parameters in Patients with Chronic Low Back Pain: A Randomized Clinical Trial

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          Abstract

          Low back pain (LBP) is the leading cause of disability worldwide, placing a significant economic burden on healthcare systems. Radial extracorporeal shock wave therapy (rESWT) is useful in the rehabilitation of orthopedic diseases; however, there is still limited evidence for patients with LBP. The aim of this study was to assess the effect of rESWT on pain level, functional efficiency, and parameters of postural control in patients with LBP. Participants were randomized into group A ( n = 20) treated with rESWT and group B ( n = 20) treated with sham rESWT (placebo). Both groups received conventional physiotherapy, including core stability exercises. The following tests were performed: the Laitinen Pain Scale (LPS), the Roland–Morris Questionnaire (RMQ), the original Schober Test (OST), and a stabilometric platform for the assessment of postural sway, including total sway path (TSP). We found that the analgesic effect was higher after rESWT, especially in the follow-up’s ( p < 0.05). Similar results were found for functional efficiency and range of motion ( p < 0.05). The improved posture stability in placebo group B was not statistically significant ( p > 0.05). The stabilometric parameters in group A were still gradually improved and statistically significant, even in follow-ups ( p < 0.05). In conclusion, the rESWT had a significant effect on the reduction of pain and the improvement of functional condition compared to a conventional physiotherapy program. Also, rESWT with core stability exercises led to significant improvements in postural sway compared with conventional physiotherapy in patients with LBP.

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          Efficacy of Selected Electrical Therapies on Chronic Low Back Pain: A Comparative Clinical Pilot Study

          Background In the currently available research publications on electrical therapy of low back pain, generally no control groups or detailed randomization were used, and such studies were often conducted with relatively small groups of patients, based solely on subjective questionnaires and pain assessment scales (lacking measurement methods to objectify the therapeutic progress). The available literature also lacks a comprehensive and large-scale clinical study. The purpose of this study was to assess the effects of treating low back pain using selected electrotherapy methods. The study assesses the influence of individual electrotherapeutic treatments on reduction of pain, improvement of the range of movement in lower section of the spine, and improvement of motor functions and mobility. Material/Methods The 127 patients qualified for the therapy (ultimately, 123 patients completed the study) and assigned to 6 comparison groups: A – conventional TENS, B – acupuncture-like TENS, C – high-voltage electrical stimulation, D – interferential current stimulation, E – diadynamic current, and F – control group. Results The research showed that using electrical stimulation with interferential current penetrating deeper into the tissues results in a significant and more efficient elimination of pain, and an improvement of functional ability of patients suffering from low back pain on the basis of an analysis of both subjective and objective parameters. The TENS currents and high voltage were helpful, but not as effective. The use of diadynamic currents appears to be useless. Conclusions Selected electrical therapies (interferential current, TENS, and high voltage) appear to be effective in treating chronic low back pain.
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            Effects of Extracorporeal Shockwave Therapy on Patients with Chronic Low Back Pain and Their Dynamic Balance Ability

            [Purpose] The purpose of the present study was to examine the effects of extracorporeal shockwave therapy (ESWT) for patients with chronic low back pain and their dynamic balance ability. [Subjects] Twenty-eight patients with chronic low back were divided into an extracorporeal shockwave therapy group (ESWTG: n=13) and a conservative physical therapy group (CPTG, n=15). [Methods] An exercise program that included Williams’ exercises and McKenzie’s exercises was performed by both groups. The program was implemented twice a week for six weeks. The visual analog scale (VAS) was used to measure the chronic low back pain of the patients. Their dynamic balance ability was measured with BioRescue. [Results] The within-group comparison of the VAS of the ESWTG and the CPTG showed significant improvements after the intervention. In the VAS comparison between the groups after the treatment, the ESWTG showed a significantly larger improvement. In the within-group comparison of dynamic balance ability, the ESWTG showed significant improvements after the intervention in SAPLS, SAPRS, SAPFS, SAPBS, and TSA, and the CPTG showed significant improvements in SAPLS and SAPBS. In the between-group comparison of the dynamic balance ability after the treatment, the ESWTG showed significantly larger improvements in their SAPLS, SAPRS, SAPFS, and TSA. [Conclusion] The exercise program combined with the ESWT relieved chronic back pain more than the exercise program combined with the CPT. The former was also more effective at improving the patients’ dynamic balance ability in terms of SAPLS, SAPRS, SAPFS, and TSA.
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              The Effects Of Myofascial Release Technique Combined With Core Stabilization Exercise In Elderly With Non-Specific Low Back Pain: A Randomized Controlled, Single-Blind Study

              Purpose To evaluate the effects of Myofascial Release Technique (MRT) with a roller massager combined with core stabilization exercises (CSE) in elderly with non-specific low back pain (NSLBP). Patients and methods A total of forty-five participants were randomly divided into two groups (CSE and CSE+MRT). A core stabilization exercise program was applied for the participants in the CSE group for 3 days per week for a total of 6 weeks. In addition to the core stabilization exercises, myofascial relaxation technique with a roller massager was performed for 3 days per week for 6 weeks for the participants in the CSE+MRT group. Participants were assessed in terms of pain, low back disability, lower body flexibility, kinesiophobia, core stability endurance, spinal mobility, gait characteristics and quality of life both pre- and post-treatment. Results It was found that the improvement in core stability endurance (p=0.031) and spinal mobility (in the sagittal plane) (p=0.022) was greater in the CSE+MRT group compared to the CSE group. There was no significant difference between the two groups in terms of pain, low back disability, lower body flexibility, kinesiophobia, gait characteristics and quality of life (p>0.05). Conclusion The current study suggests that myofascial release technique with a roller massager combined with core stabilization exercises can be a better choice in the treatment of NSLBP in elderly. ClinicalTrials.gov Identifier NCT03898089.
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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                19 February 2020
                February 2020
                : 9
                : 2
                : 568
                Affiliations
                [1 ]Faculty of Physiotherapy, Opole Medical School, 45-060 Opole, Poland; karolina.w101@ 123456wp.pl
                [2 ]Institute of Physiotherapy and Health Sciences, Academy of Physical Education, 40-065 Katowice, Poland; j.taradaj@ 123456awf.katowice.pl
                [3 ]College of Rehabilitation Sciences, University of Manitoba, Winnipeg, R106-771 MB, Canada
                [4 ]Department of Conservative Dentistry and Pedodontics, Wroclaw Medical University, 50-425 Wroclaw, Poland; maciej.dobrzynski@ 123456umed.wroc.pl
                [5 ]Department of Nervous System Diseases, Wroclaw Medical University, 61-618 Wroclaw, Poland; mirek.sopel@ 123456gmail.com
                [6 ]Department of Physiotherapy, Wroclaw Medical University, 51-355 Wroclaw, Poland; mateusz.kowal@ 123456umed.wroc.pl (M.K.); kptaszkowski@ 123456gmail.com (K.P.)
                Author notes
                [* ]Correspondence: r.dymarek@ 123456gmail.com ; Tel.: +48-71-784-18-39
                Author information
                https://orcid.org/0000-0002-4272-8978
                https://orcid.org/0000-0002-1796-5832
                https://orcid.org/0000-0003-2368-1534
                https://orcid.org/0000-0002-5690-5226
                https://orcid.org/0000-0002-2806-1775
                Article
                jcm-09-00568
                10.3390/jcm9020568
                7074373
                32092987
                0101f893-d670-49b0-aea9-85d2e2d4d05f
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 09 January 2020
                : 16 February 2020
                Categories
                Article

                extracorporeal shock wave therapy,orthopedic diseases,low back pain,functional ability,pain level,postural stability,rehabilitation

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