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Low back pain: Evaluation of osteopathic manipulation therapy via biomechanical modeling, electromyography, muscle rigidity and pain quantification

Journal: Unpublished PhD thesis Rutgers University, Date: 1990/01, , type of study: controlled clinical trial

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Keywords:

biomechanical modeling [1]
controlled clinical trial [283]
electromyography [21]
low back pain [413]
OMT [2951]
osteopathic manipulative treatment [2973]

Abstract:

Low back pain (LBP) is a major medical and economic problem. This study provides a set of parameters to evaluate osteopathic manipulation therapy treatment effects on LBP, for the first two weeks of treatment (can be used for other conservative treatments) via integrated electromyography (IEMG), pain, disability, muscle rigidity and range of motion data and a model of spinal muscle forces. IEMG data was obtained via surface electrodes from muscles at L3-L4 lumbar spinal level for standing isometric flexion resistance tasks, for 5 external loads (10 sec duration). Slope values, change in IEMG with load, were calculated. Pain-free control group did not show significant change in erector spinae (ES) IEMG slope between sessions. However, LBP patient group did show significant ES IEMG slope decrease with treatment for session one, which persisted until final session. Results suggest that manipulation therapy increases efficiency of lumbar muscle electrical activity (decreases IEMG slope), particularly multifidus muscle (cause of several LBP syndromes) for session one. Possible causes for decrease in IEMG with treatment are decreased: fatigue, muscle tension/spasm, psychological stress of pain, muscle guarding (change in muscle forces) and/or increased muscle endurance. Controls and patients did not show significant left/right ES IEMG slope asymmetry. There was a trend with treatment to increasing symmetry, for all sessions. Patients with pain on left side showed: (1) greater left ES IEMG slope, may be due to spasm and (2) equally significant bilateral decreases in slope, may represent spasm and contralateral guarding decrease. Biomechanical muscle force model was derived. Pain and disability decreased significantly from session one to four. Range of motion did not significantly change with treatment. Palpation of muscle rigidity level decreased with treatment for all sessions and correlated with force-displacement meter data for session one.


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