Effectiveness of Progressive Inhibition of Neuromuscular Structures (PINS) and Spinal Mobilization with Leg Movement (SMWLM) in Lumbar Disk Herniation with Radiculopathy: A Case Report with Two Year Follow-up
Abstract- Background and aim: Lumbar disc herniation with radiculopathy has been one of the most difficult conditions to manage in orthopedic manual therapy. While there are many clinical studies concerning the standardization of surgical treatment, there is to date no standardized literatures for the most effective non-operative care for lumbar disc herniation with radiculopathy which suggest that extreme measures to ameliorate lumbar disc herniation with radiculopathy are urgently warranted. In this study, a 35 year old man who was diagnosed with lumbar disc herniation and was planned for lumbar surgery due to failure of medical interventions was successfully treated using non-operative management.
Method: The management of the patient included Progressive Inhibition of Neuromuscular Structures (PINS), Spinal Mobilization with Leg Movement (SMWLM) and Therapeutic exercises inform of lumbar stabilization and stretching exercises. The patient was seen three times in a week over the period of 6 weeks after which the patient was discharged home without having lumbar surgery. Patient was assessed before and after treatments and during one and two year follow-ups using; Visual Analogue Scale (VAS) in the back and leg, Sciatica Bothersome Index (SBI), Sciatica Frequency Index (SFI) and Rolland-Morris Disability Questionnaire (RMDQ) for sciatica.
Results: After six weeks of management the patient had decreased in functional limitation (from 19 to 6), back pain (from 8 to 0), leg pain (from 10 to 2), sciatica frequency (from 18 to 8) and sciatica bothersomeness (from 18 to 8). These outcomes were maintained after one and two year follow-ups.
Conclusion: Progressive inhibition of neuromuscular structures and spinal mobilization with leg movement are effective in the management of patients diagnosed with lumbar disc herniation with radiculopathy.
Implication: Progressive inhibition of neuromuscular structures and spinal mobilization with leg movement may be considered as useful therapeutic non-operative measures for patients diagnosed with lumbar disc herniation with radiculopathy.
Index Terms- Progressive Inhibition of Neuromuscular Structures; Spinal Mobilization with Leg Movement; Lumbar Disc Herniation with Radiculopathy.
In this presentation the author, David Lopez Chiropractor DC and Kinesiologyst (PT) from Chile expose about the different principles under the scope of the osteopathic manipulation of the spine. Dr. Lopez is director of the progran in Chiropractic for healh professional of the "Universidad Central de Chile" and director of the Diplomats in Manual Therapy of the "Universidad Santo Tomas de Chile. The interest is to review the fundamentals to understand the approach of the Osteopathy to the practice of the manual therapy and healthcare. This vision was exposed in Poland in the framework of an international symposium of Physiotherapy.
Dr. Richard Chmielewski, DO, FACEP, NMM/OMM gave a lecture on the ins and outs of Osteopathy and Osteopathic Medicine, including various techniques used by the Doctor on a daily basis.
Abstract
Objective: To assess the outcome of arthroscopic release in patients with cronicalchronic lateral epicondylitis. Materials and methods: Arthroscopic release in three patients with lateral epicondylitis was performed. The Mayo Elbow Performance Index (or Mayo Elbow Performance score) was used pre and post surgical treatment. Sample: Two females and one male. The patients were principal labourers and not athletes. Patients had significant pain and pain was the principal symptom that affected the score of the performance index.
Results: Scores on the performance index improved after surgery. No neurological complications were reported and early return to normal daily activities was noted.
Conclusion: Arthroscopic treatment was an alternative safe and effective method for treating chronic lateral epicondiyitis in three cases. This method makes it possible to simultaneously scan the articulation to diagnostic and treatment associated diseases. It is necessary most wide assays and comparative studies for establish sure treatment protocols.
Objective: Tennis elbow is an inflammatory condition of the common extensor origin over the lateral epicondyle. This condition does not affect tennis players only. It often follows an injury or sudden contraction of the common extensor origin.There is many treatments and approaches towards Tennis elbow but physiotherapy is the best modern conservative treatment. The aim of this study is to evaluate the effectiveness of movement with mobilization in reducing pain and increasing strength in patients with chronic lateral epicondylitis. Design and setting: A randomized controlled study design was used to examine the differences between conventional physical therapy and physical therapy with manual mobilization approach for study duration of 15 days. Subjects: Twelve subjects of both male and female gender were divided into 2 groups. Experimental group treated with ultrasound therapy, mobilization and progressive resisted exercises. Control group treated with ultrasound therapy and progressive resisted exercises only the results were analyzed. The procedure was done in Physiotherapy Department at Masterskill college of Nursing and health. Outcome Measurement: Two outcome measures were used. NPRS for the measurement of severity of pain and various weighted sand bags (0.25 kg to 2kg) were used to measure the strength. Results: The data shows a significant difference in the post test values of pain and strength between experimental group and control group. Experimental group shows much decrease in pain and increase in strength than the control group. Conclusion: The study concludes that the manual mobilization with movement along with ultrasound therapy and progressive resisted exercises is effective in reducing pain and increasing strength than that of progressive resisted exercise along with ultra sound therapy in adults with chronic lateral epicondylitis.
In this presentation the author, David Lopez Chiropractor DC and Kinesiologyst (PT) from Chile expose about the different principles under the scope of the osteopathic manipulation of the spine. Dr. Lopez is director of the progran in Chiropractic for healh professional of the "Universidad Central de Chile" and director of the Diplomats in Manual Therapy of the "Universidad Santo Tomas de Chile. The interest is to review the fundamentals to understand the approach of the Osteopathy to the practice of the manual therapy and healthcare. This vision was exposed in Poland in the framework of an international symposium of Physiotherapy.
Dr. Richard Chmielewski, DO, FACEP, NMM/OMM gave a lecture on the ins and outs of Osteopathy and Osteopathic Medicine, including various techniques used by the Doctor on a daily basis.
Abstract
Objective: To assess the outcome of arthroscopic release in patients with cronicalchronic lateral epicondylitis. Materials and methods: Arthroscopic release in three patients with lateral epicondylitis was performed. The Mayo Elbow Performance Index (or Mayo Elbow Performance score) was used pre and post surgical treatment. Sample: Two females and one male. The patients were principal labourers and not athletes. Patients had significant pain and pain was the principal symptom that affected the score of the performance index.
Results: Scores on the performance index improved after surgery. No neurological complications were reported and early return to normal daily activities was noted.
Conclusion: Arthroscopic treatment was an alternative safe and effective method for treating chronic lateral epicondiyitis in three cases. This method makes it possible to simultaneously scan the articulation to diagnostic and treatment associated diseases. It is necessary most wide assays and comparative studies for establish sure treatment protocols.
Objective: Tennis elbow is an inflammatory condition of the common extensor origin over the lateral epicondyle. This condition does not affect tennis players only. It often follows an injury or sudden contraction of the common extensor origin.There is many treatments and approaches towards Tennis elbow but physiotherapy is the best modern conservative treatment. The aim of this study is to evaluate the effectiveness of movement with mobilization in reducing pain and increasing strength in patients with chronic lateral epicondylitis. Design and setting: A randomized controlled study design was used to examine the differences between conventional physical therapy and physical therapy with manual mobilization approach for study duration of 15 days. Subjects: Twelve subjects of both male and female gender were divided into 2 groups. Experimental group treated with ultrasound therapy, mobilization and progressive resisted exercises. Control group treated with ultrasound therapy and progressive resisted exercises only the results were analyzed. The procedure was done in Physiotherapy Department at Masterskill college of Nursing and health. Outcome Measurement: Two outcome measures were used. NPRS for the measurement of severity of pain and various weighted sand bags (0.25 kg to 2kg) were used to measure the strength. Results: The data shows a significant difference in the post test values of pain and strength between experimental group and control group. Experimental group shows much decrease in pain and increase in strength than the control group. Conclusion: The study concludes that the manual mobilization with movement along with ultrasound therapy and progressive resisted exercises is effective in reducing pain and increasing strength than that of progressive resisted exercise along with ultra sound therapy in adults with chronic lateral epicondylitis.
The professor David Lopez, PT and DC expose about the theorical basis of manual therapy in Osteopathy for extremities. In a short approach inted demonstrate the differences and similarities with other manual therapy concepts
Conference of the Tense Active Motor Control in the Shoulder. XIVth Federation of European Societies for Surgery of the Hand, FESSH Congress 3rd to 6th of June 2009 Poznan, Poland. The author explain how the connective system is determinant to control the motions in the shoulder, an special joint deeply dependent of the tissue deformation of the connective and sof tissues to build the adequate movements. Are the connective tissues a passive sub system? Dr. López proposed a new vision how understand the role of Fascias, ligaments, Capsules and other connective tissues during the movements and posture.
How to Prevent and Treat Shoulder Subluxation After Stroke?Techcare Innovation
Shoulder subluxation is a common post-stroke complication affecting up to 80% of the stroke patients. In this sharing session, Ms. Yvonne will share the proven physio exercises and tips on how to prevent and treat shoulder subluxation after stroke.
Webinar Link : https://www.youtube.com/watch?v=tvDoEeaRzYk
Speaker : Ms. Yvonne Khor, Senior Physiotherapist
Ms. Yvonne is a senior physiotherapist as well as the founder of YK Natural Physio & Academy. She has a Master in Rehabilitation Technology and has 8 years of experience in physiotherapy field including treating stroke patients, Parkinson patient, sports patients, etc.
Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Studyiosrjce
Study objective: To define the best splinting wear times, night or day, in pain relief for female patients with
idiopathic chronic CTS in exacerbation phase.
Design: Quasi experimental comparative design.
Method and measurements: 24 female patients (42 wrists) from military hospital in Riyadh participated in
this study. Their CTS was diagnosed by the nerve conduction velocity (NCV). On basis of splint wear time
patients were divided into two groups; day time and night time. Thermoplastic, custom-made,neutral
wristsplints were given to both groups (21 wrists each). Patients completed 3 consecutive weeks of follow-up.
Pain (pressure) threshold through, algometer, was used to measure the pain in both groups. Four
measurements were applied; one at the initial assessment and 3 during follow-up weeks.
Results: The current study showed a statistical s i g n i f i c a n t improvement (p = 0.0001) in pain threshold
with splint wear. This was true for both groups. Patients received splint in day time showed little increase in
pain threshold when compared with night time wear instruction but without significant difference.
Conclusion: W rist splint is an effective conservative treatment for CTS. No difference was found between
night or day time splint wear. Patient should wear the splint at their most adherent time
Prevention and management of hemiplegic shoulder pain among stroke survivorsAyobami Ayodele
A common sequela of stroke that can hamper functional recovery and subsequently lead to disability is hemiplegic shoulder pain. HSP is a shoulder pain that is present at rest, during passive or active movement on the hemiplegic side after stroke with no direct relation to trauma or injury. HSP can begin as early as 2 weeks post-stroke but typically occurs within 2-3 months post-stroke.
Epidural adhesiolysis has been accepted as a treatment for post laminectomy syndrome, failed back syndrome, & radicular syndromes.
The efficacy of caudal approach epidural adhesiolysis depends on the proper diagnosis, patient’s condition, and better techinuqe.
The combined use of long term patient education for neural flossing exercises & the inclusion of the facet-delayed treatment in the algorithm further improves patient outcome.
Additional studies are underway to further refine the technique & indications.
Effect of yogic asana on Adhesive capsulitis (frozen shoulder) to increasing ...Sports Journal
Frozen shoulder is a condition that causes restriction of motion in the shoulder joint. Frozen shoulder
cause the capsulitis surrounding the shoulder joint to contract and from scar tissue. Yogic exercise is vital
in maintaining good range of motion (ROM) with joint and the flexibility of muscles. though there are
different yogic asana for the treatment of frozen shoulder but the aim of the study was to compare the
effect of sleeper stretch and yogic asana intervention for increasing the internal rotation in frozen
shoulder and which one is more beneficial for the treatment of frozen shoulder and to increase its internal
rotation which can be recommended for the treatment.
The McKenzie method was developed in 1960’s by Robin McKenzie , a physical therapist in new Zealand and A central tenet of McKenzie Method is that self-healing and self-treatment are important for patient’s pain relief and rehabilitation.
Physical Therapy Practice Guidelines: Thoracic manipulation is both safe and effective in treating mechanical neck pain (neck pain with mobility deficits).
There are evidence in History of treatment by Passive stretching techniques.
Over past 30-40 years many therapists have worked to identify and learn the techniques which are are more suitable and effective for the patient’s problem.
Joint mobilisations and manipulations techniques are used to safely stretch or snap structures to restore normal joint mechanics with less trauma.
Ppt paper presentation percutaneous discectomySunil Thakur
This ppt. was prepared and presented by Dr Sunil D.Thakur at NZISACON 2014 organised by Deptt. of Anaesthesiology and Critical Care Acharya Shri Chander College of Medical Sciences and Hospital Jammu. IT was presented under the guidance of Prof. Surinder Singh Sodhi HOD Anaesthesia IGMC Shimla and Dr Girish Sharma Associate Prof. Department of anaethesia IGMC Shimla.
The professor David Lopez, PT and DC expose about the theorical basis of manual therapy in Osteopathy for extremities. In a short approach inted demonstrate the differences and similarities with other manual therapy concepts
Conference of the Tense Active Motor Control in the Shoulder. XIVth Federation of European Societies for Surgery of the Hand, FESSH Congress 3rd to 6th of June 2009 Poznan, Poland. The author explain how the connective system is determinant to control the motions in the shoulder, an special joint deeply dependent of the tissue deformation of the connective and sof tissues to build the adequate movements. Are the connective tissues a passive sub system? Dr. López proposed a new vision how understand the role of Fascias, ligaments, Capsules and other connective tissues during the movements and posture.
How to Prevent and Treat Shoulder Subluxation After Stroke?Techcare Innovation
Shoulder subluxation is a common post-stroke complication affecting up to 80% of the stroke patients. In this sharing session, Ms. Yvonne will share the proven physio exercises and tips on how to prevent and treat shoulder subluxation after stroke.
Webinar Link : https://www.youtube.com/watch?v=tvDoEeaRzYk
Speaker : Ms. Yvonne Khor, Senior Physiotherapist
Ms. Yvonne is a senior physiotherapist as well as the founder of YK Natural Physio & Academy. She has a Master in Rehabilitation Technology and has 8 years of experience in physiotherapy field including treating stroke patients, Parkinson patient, sports patients, etc.
Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Studyiosrjce
Study objective: To define the best splinting wear times, night or day, in pain relief for female patients with
idiopathic chronic CTS in exacerbation phase.
Design: Quasi experimental comparative design.
Method and measurements: 24 female patients (42 wrists) from military hospital in Riyadh participated in
this study. Their CTS was diagnosed by the nerve conduction velocity (NCV). On basis of splint wear time
patients were divided into two groups; day time and night time. Thermoplastic, custom-made,neutral
wristsplints were given to both groups (21 wrists each). Patients completed 3 consecutive weeks of follow-up.
Pain (pressure) threshold through, algometer, was used to measure the pain in both groups. Four
measurements were applied; one at the initial assessment and 3 during follow-up weeks.
Results: The current study showed a statistical s i g n i f i c a n t improvement (p = 0.0001) in pain threshold
with splint wear. This was true for both groups. Patients received splint in day time showed little increase in
pain threshold when compared with night time wear instruction but without significant difference.
Conclusion: W rist splint is an effective conservative treatment for CTS. No difference was found between
night or day time splint wear. Patient should wear the splint at their most adherent time
Prevention and management of hemiplegic shoulder pain among stroke survivorsAyobami Ayodele
A common sequela of stroke that can hamper functional recovery and subsequently lead to disability is hemiplegic shoulder pain. HSP is a shoulder pain that is present at rest, during passive or active movement on the hemiplegic side after stroke with no direct relation to trauma or injury. HSP can begin as early as 2 weeks post-stroke but typically occurs within 2-3 months post-stroke.
Epidural adhesiolysis has been accepted as a treatment for post laminectomy syndrome, failed back syndrome, & radicular syndromes.
The efficacy of caudal approach epidural adhesiolysis depends on the proper diagnosis, patient’s condition, and better techinuqe.
The combined use of long term patient education for neural flossing exercises & the inclusion of the facet-delayed treatment in the algorithm further improves patient outcome.
Additional studies are underway to further refine the technique & indications.
Effect of yogic asana on Adhesive capsulitis (frozen shoulder) to increasing ...Sports Journal
Frozen shoulder is a condition that causes restriction of motion in the shoulder joint. Frozen shoulder
cause the capsulitis surrounding the shoulder joint to contract and from scar tissue. Yogic exercise is vital
in maintaining good range of motion (ROM) with joint and the flexibility of muscles. though there are
different yogic asana for the treatment of frozen shoulder but the aim of the study was to compare the
effect of sleeper stretch and yogic asana intervention for increasing the internal rotation in frozen
shoulder and which one is more beneficial for the treatment of frozen shoulder and to increase its internal
rotation which can be recommended for the treatment.
The McKenzie method was developed in 1960’s by Robin McKenzie , a physical therapist in new Zealand and A central tenet of McKenzie Method is that self-healing and self-treatment are important for patient’s pain relief and rehabilitation.
Physical Therapy Practice Guidelines: Thoracic manipulation is both safe and effective in treating mechanical neck pain (neck pain with mobility deficits).
There are evidence in History of treatment by Passive stretching techniques.
Over past 30-40 years many therapists have worked to identify and learn the techniques which are are more suitable and effective for the patient’s problem.
Joint mobilisations and manipulations techniques are used to safely stretch or snap structures to restore normal joint mechanics with less trauma.
Similar to Effectiveness of Progressive Inhibition of Neuromuscular Structures (PINS) and Spinal Mobilization with Leg Movement (SMWLM) in Lumbar Disk Herniation with Radiculopathy: A Case Report with Two Year Follow-up
Ppt paper presentation percutaneous discectomySunil Thakur
This ppt. was prepared and presented by Dr Sunil D.Thakur at NZISACON 2014 organised by Deptt. of Anaesthesiology and Critical Care Acharya Shri Chander College of Medical Sciences and Hospital Jammu. IT was presented under the guidance of Prof. Surinder Singh Sodhi HOD Anaesthesia IGMC Shimla and Dr Girish Sharma Associate Prof. Department of anaethesia IGMC Shimla.
Ppt paper presentation percutaneous discectomySunil Thakur
This ppt was presented by Dr Sunil Dutt JR Depart. of Anaesthesia IGMC Shimla at NZISACON-2014 at Acharya Shri Chander College of Medical Sciences and Hospital Jammu
Abstract
A total of 50 procedures were performed, 25 patients were treated using SpineView decompressor and 25 patients by Nucleoplasty using the Arthrocare Coblation technology. The total population had leg pain (sciatica), 30 of which had low back pain (discogenic pain) . Mean age of patients was 30 – 60 years. The mean follow-up period was 1 year. Follow up was done weekly for the first 2 months then monthly for the first year post-procedure according to Visual Analogue Scale , Urs Muller et.al.(2008) as well as featured neurological examination.
Analgesic consumption was stopped or reduced in 9 of the 15 patients with sciatica and low back pain treated with SpineView decompressor (60%) at 2 months (66%) 4months after the procedure, and in 9 of the 15 patients with sciatica and low back pain treated by Nucleoplasty using the Arthrocare Coblation technology (60%) at 2 months (66%) 4months after the procedure.
The patients who had sciatica only has shown reduction in analgesic consumption in 9 of the 10 patients who were treated with SpineView decompressor (90%) at 2 months, and in 2 of the 10 patients who were treated by Nucleoplasty using the Arthrocare Coblation technology (20%) at 2 months.
Our results encourage us to use SpineView decompressor in carefully selected patients with sciatica and small contained disc protrusion . Also we find that applying Nucleoplasty using the Arthrocare Coblation technology in those patients with low back pain and small contained disc protrusion can give satisfactory results. These results need further efforts and researches in order to be general recommendations.
Identifying Lateral Knee Pain Using Sodium Channel Blockers “Distally” at ankle.inventionjournals
Common complaint of lateral or para patellar knee pain seen in outpatient is sometimes perplexing. It is seen in younger age group may be labelled as chondromalacia, in midage seen as bursitis, tendinitis and aged group as osteoarthrosis or related pain. We have seen a new symptom and sign group of lateral knee pain. We have devised a clinical test to diagnose and confirm this pain by new methodology based on gore sign.
Crimson Publishers - Efficacy of Core Strengthening Exercise on a Geriatric S...CrimsonpublishersMedical
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Management of Non Disco-genic low back pain: Our Experience of 40 Cases of RF...Apollo Hospitals
RF) rhizotomy or neurotomy is a therapeutic procedure
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Hand rehabilitation following flexor tendon injuriesAbey P Rajan
hand rehabilitation following flexor tendon injuries include introduction, clinical anatomy, tendon nutrition, tendon healing, post op. management, special cases, summary
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Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
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Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
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VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
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Effectiveness of Progressive Inhibition of Neuromuscular Structures (PINS) and Spinal Mobilization with Leg Movement (SMWLM) in Lumbar Disk Herniation with Radiculopathy: A Case Report with Two Year Follow-up
1. International Journal of Scientific and Research Publications, Volume 9, Issue 1, January 2019 313
ISSN 2250-3153
http://dx.doi.org/10.29322/IJSRP.9.01.2019.p8542 www.ijsrp.org
Effectiveness of Progressive Inhibition of Neuromuscular
Structures (PINS) and Spinal Mobilization with Leg
Movement (SMWLM) in Lumbar Disk Herniation with
Radiculopathy: A Case Report with Two Year Follow-up
Musa Sani Danazumi (PT, MSc)1,2
, Shehu Usman Ibrahim (PT, MSc)1
1
Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria.
2
Department of Physiotherapy, Federal Medical Center, Nguru, Yobe State, Nigeria.
DOI: 10.29322/IJSRP.9.01.2019.p8542
http://dx.doi.org/10.29322/IJSRP.9.01.2019.p8542
Abstract- Background and aim: Lumbar disc herniation with
radiculopathy has been one of the most difficult conditions to
manage in orthopedic manual therapy. While there are many
clinical studies concerning the standardization of surgical
treatment, there is to date no standardized literatures for the most
effective non-operative care for lumbar disc herniation with
radiculopathy which suggest that extreme measures to ameliorate
lumbar disc herniation with radiculopathy are urgently warranted.
In this study, a 35 year old man who was diagnosed with lumbar
disc herniation and was planned for lumbar surgery due to failure
of medical interventions was successfully treated using non-
operative management.
Method: The management of the patient included Progressive
Inhibition of Neuromuscular Structures (PINS), Spinal
Mobilization with Leg Movement (SMWLM) and Therapeutic
exercises inform of lumbar stabilization and stretching exercises.
The patient was seen three times in a week over the period of 6
weeks after which the patient was discharged home without
having lumbar surgery. Patient was assessed before and after
treatments and during one and two year follow-ups using; Visual
Analogue Scale (VAS) in the back and leg, Sciatica Bothersome
Index (SBI), Sciatica Frequency Index (SFI) and Rolland-Morris
Disability Questionnaire (RMDQ) for sciatica.
Results: After six weeks of management the patient had decreased
in functional limitation (from 19 to 6), back pain (from 8 to 0), leg
pain (from 10 to 2), sciatica frequency (from 18 to 8) and sciatica
bothersomeness (from 18 to 8). These outcomes were maintained
after one and two year follow-ups.
Conclusion: Progressive inhibition of neuromuscular structures
and spinal mobilization with leg movement are effective in the
management of patients diagnosed with lumbar disc herniation
with radiculopathy.
Implication: Progressive inhibition of neuromuscular structures
and spinal mobilization with leg movement may be considered as
useful therapeutic non-operative measures for patients diagnosed
with lumbar disc herniation with radiculopathy.
Index Terms- Progressive Inhibition of Neuromuscular
Structures; Spinal Mobilization with Leg Movement; Lumbar
Disc Herniation with Radiculopathy.
I. INTRODUCTION
he term radiculopathy which commonly referred to as sciatica
describes the symptoms of sciatic nerve pain radiating down
the posterior leg [1]. It has also been used to describe paresthesia
from the low back to below the knee or referred to the posterior
thigh, calf, and foot [2]. Sciatica is strongly associated with low
back pain (LBP), and it has multiple causes among which lumbar
disk herniation (LDH) is one [3, 4].
Studies comparing surgical management of LDH to
different forms of conservative treatment tend to favor surgery
with respect to short-term outcome [5, 6]. However, there are less
striking differences observed in long-term follow-up of 1 year or
more [2, 7]. For this reason, there is a general consensus that
treatment of sciatica should be conservative in the first 6 to 8
weeks after onset because most new cases resolve in the short term
[8]. For patients failing six weeks of conservative care, the current
literature supports surgical intervention or prolonged conservative
management as appropriate treatment options for lumbar
radiculopathy in the setting of disc herniation [9].
However, there are no standardized guidelines for
appropriate non-operative care which suggest that more treatment
options to ameliorate lumbar radiculopathy are urgently warranted
[10]. In this study, we reported the management of a 35 year old
man who was diagnosed with LDHR and was planned for lumbar
surgery due to failure of medical interventions.
II. MATERIALS AND METHODS
2.1 Case reports
Two years ago, a 35 year old man (BMI=25.23kh/m2
) with
no history of previous back problems wakened with pain in his left
buttock area. Two days after the onset of his buttock pain it spread,
overnight, down the left leg with tingling into the big toe area of
his left foot. Some days later the big toe tingling alternated with
tingling along the lateral border of his foot and into the lateral two
toes. He had undergone numerous forms of treatments for over 6
months, but without significant success. However, following
lifting of a 50kg back of maize two years ago, which exacerbated
his disorder he had a lumbar puncture (which proved negative) and
T
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skeletal traction for a week. Following this, his left buttock pain
increased which came with a severe low back pain. At no time
prior to skeletal traction had he ever experienced worsening lower
limb pain. This was so serious that the patient could not even stand
or sit on the treatment bed due to unbearable pain. The MRI of the
patient revealed L5-S1 diffuse annular bulge with posterior left
paracentral disc protrusion and inferior migration along with a
small sequestration causing spinal canal compromise and
indenting the left exiting and traversing nerve roots (see Figure 1).
The patient was diagnosed as having pre-cauda equina syndrome
and was booked for lumbar surgery. Prior to surgery, a consult was
sent to physiotherapy department requesting physiotherapists to
commence pre-operative management while the patient was on a
waiting list.
2.2 Examination
On more positive questioning to determine his area of pain,
it was interesting to note that, although his main lower leg pain
was posterior, he had what he described as a different pain in the
middle of the left buttock. Standing and sitting provoked pain in
his left leg, and he was unable to bend forwards because of
increased leg pain. Coughing caused both back pain and left leg
pain but leg pain was the most incapacitating. Passive straight leg
raise (SLR) on the left was causing posterior leg pain at 35̊. Passive
SLR with neck flexion and ankle dorsiflexion produced severe
lower leg pain. Manual muscle testing revealed weakness of the
calf muscles. Tingling was felt in the big toe and lateral border of
the foot. In addition, the patient reported that anything that caused
his back pain also caused his leg pain but at times the pains used
to come differently with leg pain being the most. Manual palpation
revealed pain and tenderness around L4 through S1 coupled with
left piriformis tightness. Further palpation revealed active trigger
points at the central fibers of the piriformis muscle around the
middle two-thirds of the left buttock. This was reported by the
patient as the most painful and was considered as the primary
point. The secondary point was found just above the archilles
tendon around the distal part of the left leg.
2.3 Treatment
The treatment of the patient included Progressive Inhibition
of Neuromuscular Structures (PINS) which was applied for 10
minutes during the first two visits. During the third visit, spinal
mobilization with leg movement (SMWLM) was introduced
which was given after each successful PINS application. The
patient was seen three times in a week over the period of 6 weeks
after which he was discharged home without having lumbar
surgery. Patient was assessed before and after treatments and
during one and two year follow-ups using; Visual Analogue Scale
(VAS) in the back and leg, Sciatica Bothersome Index (SBI),
Sciatica Frequency Index (SFI) and Rolland-Morris Disability
Questionnaire for sciatica (RMDQ) [7, 8] (see Table
1).Therapeutic exercises (lumbar stabilization and stretching
exercises) were given as home regimens and the patient was asked
to keep coming to the hospital after every 8 weeks in order to
ascertain the effectiveness of the administered interventions or
should in case the therapist would encounter something
manageable during follow-ups but nothing significant was
obtained.
2.3.1 Progressive Inhibition of Neuromuscular Structures
(PINS)
Participant Positioning: The patient was placed in a prone
position.
Therapist Positioning: The therapist assumed a stride
stance with the feet widely apart and facing the patient’s affected
lower extremity.
Treatment Procedure: The technique was performed by
palpating two related points termed primary point and secondary
or end point. Primary and end points are areas of most and least
sensitivities respectively found along the continuum of
neuromuscular structures. In this technique, a moderate ischemic
compression was steadily maintained on the end point by the use
of an index finger of the right hand without relieving pressure up
to the completion of the technique. The index finger of the left
hand was used to apply pressure on the primary point for about 30
seconds after which another sensitive point was palpated by the
middle finger of same hand proximal to the end point without
relieving pressure on the index finger. If the patient indicated that
this latter point was more sensitive than the posterior point, then
pressure was maintained on the second point and relieved on the
first point without relieving the end point pressure. This was
maintained for 30 seconds before the third point was identified.
When the third point was identified as more sensitive than the
second point, pressure was relieved from the second point and
maintained on the third point for another 30 seconds. The same
pattern was followed progressively along the dysfunctional
neuromuscular structure (sciatic nerve) until the last point
approximately 2 cm proximal to the end point is found. Pressure
was then maintained simultaneously on the two points (the last
point and the end point) for 30 seconds and then relieved [11] (see
Figure 2).
2.3.2 Spinal Mobilization with Leg Movement (SMWLM)
Participant Positioning: The patient was placed in a side
lying position.
Therapist Positioning: The therapist assumed a stride
stance with the feet widely apart and facing the patient by the side.
Treatment Procedure: This technique was performed
with the patient in a side lying position, with the affected leg
uppermost. The patient lied on the unaffected side facing the
therapist, and an assistant therapist supporting his affected leg.
The therapist flexed over patient and placed one thumb reinforced
over other on the spinous process of the herniated vertebra (L5
vertebra) as palpated with reference to posterior superior iliac
crest. The therapist then pushed down on the L5 spinous process
and maintained that pressure while the patient was asked to
actively perform Straight Leg Raise (SLR) for the leg supported
by the assistant therapist provided there is no too much pain. This
position was maintained for 30 seconds after which the therapist
released the pressure on the L5 spinous process and the patient was
asked to lower his supported leg down to the couch. The patient
rested for 2 minutes before another repetition was performed. On
day one, three (3) repetitions were only applied and this lasted for
about 10 minutes. After this was successful during the first visit
then, on the subsequent visits as the patient improved, the assistant
therapist applied over-pressure on the supported leg of the patients
as the patient performed the SLR [12]. This was sustained for 30
seconds after which the leg was lowered to the starting position
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and then without resting, the patient performed SLR again against
the assistant therapist’s over-pressure for another 30 seconds. The
patient rested for 60 seconds after each 2 sets of consecutive
mobilizations which made 1 complete repetition. 2 sets of
consecutive mobilizations for 3 repetitions with 60 seconds rest
period after each repetition was given to the patient within the time
limit of 10 minutes (see Figure 3).
2.3.3 Therapeutic Exercises
These exercises comprised of Lumbar Stabilization
Exercises (LSEs) and Stretching Exercises (SEs):
1. Lumbar Stabilization Exercises
Lumbar Stabilization Exercises in form of curl-ups,
horizontal side bridge and bird-dog [13] were given as home
regimens. These exercises were performed for 10 minutes, given
by 8 repetitions for 8 seconds each followed by a rest period of 10
seconds between successive repetitions.
• Curl-ups: The patient was in supine position with hands
supporting lumbar spine and both knees bent at 90
degrees and hips bent at 45 degrees. The patient then
lifted up the thoracic and cervical spine as one unit
maintaining rigid block position with no cervical motions
(chin poking or chin tucking) and held the position for 8
counts.
• Horizontal Side Bridge: The patient assumed a side line
position and supported his/her body weight using the
ipsilateral elbow. The patient then crossed the
contralateral arm against the chest and contralateral foot
in front of the ipsilateral food. The patient then bridged
by lifting the hip up while maintaining the trunk straight
and supporting the whole body on elbow and feet. This
position was held for a count of 8 after which the patient
came back to the starting position before carrying out
another repetition.
• Bird dog: The patient was on his hands and knees
(quadruped position). The patient then simultaneously
rose up the contra-lateral arm and ipsi-lateral leg above
the flow and stretched them out completely. After a count
of 8 the patient then switched limbs and did the exercise
for the same duration.
2. Stretching Exercises
Stretching exercises in form of plantar stretching, calf stretching
and hamstrings stretching [14] were given to the patient. These
exercises were performed for 10 minutes just like the lumbar
stabilization exercises.
• Plantar stretching: The patient was sitting on a chair
with the feet resting on the flow. He then placed a tennis
ball under his foot. The patient then put weight into
various parts of the plantar surface from the front of the
heel out to the ball of the foot, looking for places that hurt
or feel tight. The patient gave enough weight to reach that
point between pleasure and pain, and sustained the
pressure on each point for at least 20 seconds.
• Calf stretching: The patient stood erect, leaned forward
and rested his forearms on the wall. The patient then
stretched the lower leg section of the SBL by putting one
foot back and resting into the heel. After the heel reached
the floor, then the patient flexed the knee forward toward
the wall to increase the stretch on the soleus.
• Hamstrings stretching: The forward bends described
above for calf stretching was used to lengthen the
hamstring group. Swinging the upper body left and right
during these bends was done to ensure that the entire
hamstrings muscle group, not just one line through it, got
activated and stretched.
III. RESULTS
Following PINS application, patient reported that his leg
pain had reduced and was able to sit up for 2 minutes. At no time
prior to PINS application had the patient ever had the chance to sit
up with bearable pain. During the second visit, the patient was able
to take few steps after PINS application. During the third visit,
when SMWLM was introduced, the patient reported decreased in
symptoms and was able to sit up for more than an hour. Since then
the patient kept reporting significant improvement in symptoms
up to the completion of the study which lasted for six weeks. After
six weeks of management the patient had decreased in functional
limitation (from 23 to 6), back pain (from 8 to 0), leg pain (from
10 to 2), sciatica frequency (from 24 to 8) and sciatica
bothersomeness (from 24 to 8). All these outcomes were
maintained after one and two year follow-ups (see Table 1).
IV. DISCUSSIONS
Lumbar disc herniation is a common condition that
frequently affects the spine in young and middle-aged patients
[15]. The lumbar intervertebral disc is a complex structure
composing of collagen, proteoglycans, and sparse
fibrochondrocytic cells that serve to dissipate forces exerted on the
spine. As part of the normal aging process, the disc
fibrochondrocytes can undergo senescence, and proteoglycan
production diminishes [16]. This leads to a loss of hydration and
disc collapse, which increases strain on the fibers of the annulus
fibrosus surrounding the disc. Tears and fissures in the annulus can
result, facilitating a herniation of disc material, should sufficient
forces be placed on the disc [15, 17].
Regardless of etiology, herniations represent protrusions of
disc material beyond the confines of the annular lining and into the
spinal canal. Back pain may occur due to disc protrusions that do
not enter the canal or compromise nerve roots [15]. The more
treatable condition of lumbar radiculopathy, however, arises when
extruded disc material contacts, or exerts pressure, on the thecal
sac or lumbar nerve roots [15, 16]. The pain associated with
lumbar radiculopathy occurs due to a combination of nerve root
ischemia and inflammation resulting from local pressure and
neurochemical inflammatory factors present within the disc
material [15-19].
The literature supports both conservative management and
surgical intervention as viable options for the treatment of
radiculopathy caused by lumbar disc herniation [2, 5-7]. However,
methodological drawbacks limit the effect that published RCTs
can have on informing clinical practice for this condition [9].
Surgical intervention may result in faster relief of symptoms and
earlier return to function [5, 6], although long-term results appear
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to be similar regardless of type of management [2, 7]. Therefore,
the ultimate decision regarding type of treatment should be based
on a surgeon-patient discussion, in light of proper surgical
indications, duration of symptoms, and patient wishes [9, 17].
In this study, we presented the management of a 35 year old
man who was diagnosed with lumbar dick herniation and was
booked for lumbar surgery due to the ineffectiveness of all medical
interventions. After the surgical decision, the patient requested
that a physiotherapist should first attend to his condition prior to
having lumbar surgery. Physiotherapists were invited and
following PINS and SMWLM application the patient symptoms
were abolished within 6 weeks of treatment after which the patient
was discharged home without having lumbar surgery.
V. CONCLUSIONS
Our finding suggests that PINS and SMWLM may be used
in the management of patients diagnosed with lumbar disc
herniation with radiculopathy (LDHR). Despite the limitations of
the study to make cause and effect conclusions, the degree of
improvement achieved over a very short period of time and after
two year follow-ups should not be overlooked. It is therefore
recommended that randomized clinical trials (RCTs) may be
conducted to establish the efficacy of these findings.
ADVERSE EFFECT
The patient reported slight increased pain after some hours
of PINS application which subsided within the first twenty four
hours.
ACKNOWLEDGEMENT
We acknowledge the effort of our participant without
whom the study would not have been successful. We equally
acknowledge the efforts of our assistant therapist who had always
been available at the time of each treatment session.
AUTHORS’ STATEMENTS
Research funding: This study did not receive any funding.
Conflict of interest: We declare no any conflict of interest.
Informed consent: Informed consent has been obtained
from the patient.
AUTHOR CONTRIBUTIONS
PT. Danazumi developed this idea and administered the
treatment to the patient. PT. Ibrahim helped with the supervision
of the whole manuscript.
REFERENCES
[1] Peul WC, Houwelingen HC, van der Hout WB, Brand R, Eekhof JAH, Thj
Tans J, Thomeer RTWM, Koes BW. Prolonged conservative treatment or
‘early’ surgery in sciatica caused by a lumbar disk herniation: rational and
design of a randomized trial. BMC Musculoskeletal Disorders 2005; 6(8):
1471–2474. Available from: http//www.biomedcentral.com/1471-2474/6/8.
[2] Peul WC, Houwelingen HC, van der Hout WB, Brand R, Eekhof JAH, Thj
Tans J, Thomeer RTWM, Koes BW. Surgery versus Prolonged Conservative
Treatment for Sciatica. N Engl Med 2007; 356(22): 2245–2256.
[3] Andrew J, Hahne J. Functional Restoration for a Chronic Lumbar Disk
Extrusion with Associated Radiculopathy. Physical Therapy 2006; 86: 1668–
1680.
[4] John AN, Ronald M. Lumbar disc herniation. Clinical Orthopaedics and
Related Research 2006; 443: 183–197.
[5] Weinstein JN, Lurie JD, Tosteson TD, Skinner JS, Hanscom B, Tosteron
ANA, Herkowitz H, Fischgrund J, Cammisa FP, Albert T, Deyo RA. Surgical
vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient
Outcomes Research Trial (SPORT) Observational Cohort. JAMA 2006;
296(20): 2451–9.
[6] Weinstein JN, Lurie JD, Tosteson TD, Skinner JS, Hanscom B, Tosteron
ANA, Blood EA, Herkowitz H, Abdu WA, Hilibrand A, Albert T, Fischgrund
J. Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: Four-
Year Results for the Spine Patient Outcomes Research Trial (SPORT) JAMA
2008; 296(20): 2441–50.
[7] Peul WC, van den Hout WB, Brand R, Thomeer RTWM, Koes BW.
Prolonged conservative care versus early surgery in patients with
sciatica caused by lumbar disc herniation: two year results of a
randomised controlled trial. BMJ (Clinical research ed.) 2008; 336(7657):
1355–8.
[8] Valat JP, Genevay S, Marty M, Rozenberg S, Koes B. Sciatica. Best Pract
Res Clin Rheumatol 2010; 24(2): 241–252.
[9] Schoenfeld AJ, Weiner BK. Treatment of lumbar disk herniation: Evidence-
based practice. Int J Med 2010; 3: 209–214.
[10] Dan-Azumi, MS, Bello B, Rufai SA, Abdurrahman MA. Surgery versus
conservative management for lumbar disc herniation with radiculopathy: A
systematic review and meta-analysis. Journal of Health sciences 2008; 8(1):
42–53.
[11] Dowling DJ. Progressive Inhibition of Neuromuscular Structures
Techniques. J Am Osteopathic Assoc 2000; 100(5): 285–298.
[12] Mulligan B. Manual Therapy “Nags”, “Snags”, and “Mwms” etc. 5th
edition
2004; part I: page 76-80.
[13] Ye C, Zhang J, Wang C, Liu Z, Li F, Sun T. Comparison of lumbar spine
stabilization exercise versus general exercisen in young male patients with
lumbar disc herniation after 1 year of follow up. Int J Clin Exp Med 2015;
8(6): 9869–9875.
[14] Myers T. Anatomy Trains. 3rd
edition 2014; chapter 3: page 92. Churchill
Livingstone, Edinburgh.
[15] Anderson PA, McCormick PC. Angevine PD. Randomized controlled trials
of the treatment of lumbar disk herniation. J Am Acad Orthop Surg 2008; 16:
566–573.
[16] McCulloch JA, Edwards CCII, Riew KD. Lumbar microdiscectomy. In:
Bradford DS, Zdeblick TA, editors. Master Techniques in Orthopaedic
Surgery. The Spine 2002; Philadelphia, PA: Lippincott Williams & Wilkins.
[17] Bono CM, Wisneski R, Garfin SR. Lumbar Disc Herniations. In Herkowitz,
HN, Garfin SR, Eismont FJ, Bell GR, Balderston RA, editors, Rothman
Simeone. The Spine 2006; volume II, chapter 59, pages 979–80. Saunders,
Philadelphia, 5th edition.
[18] Carragee E. Surgical treatment of disk disorders. JAMA 2006; 296: 2485–
2487.
[19] Majlesi J, Togay H, Unalan H, Toprak S. The sensitivity and specificity of
the slump and the straight leg raising tests in patients with lumbar disc
herniation. J Clin Rheumatol 2008; 14: 87–91.
AUTHORS
First Author: Musa Sani Danazumi (PT, MSc), Department of
Physiotherapy, Faculty of Allied Health Sciences, College of
Health Sciences, Bayero University, Kano, Nigeria. Email
address: musadanazumisani@gmail.com, +2348145123496.
Second Author: Shehu Usman Ibrahim (PT, MSc), Department
of Physiotherapy, Faculty of Allied Health Sciences, College of
Health Sciences, Bayero University, Kano, Nigeria. Email
address: usmanik28@gmail.com, +2348145123496.
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Corresponding Author: Musa Sani Danazumi, Department of
Physiotherapy, Faculty of Allied Health Sciences, College of
Health Sciences, Bayero University, Kano, Nigeria. Email
address: musadanazumisani@gmail.com, +2348145123496.
Figure 1: Magnetic Resonance Imaging of the Patient.
Table 1: Study Outcomes with 2 year follow-up
Outcomes Baseline 6 Weeks 1 Year 2 Years
RMDQ 19 6 0 0
VAS Back 8 0 0 0
VAS Leg 10 2 0 0
SBI 18 4 0 0
SFI 18 4 0 0
Key:
RMDQ=Rolland-Morris Disability Questionnaire: A 23-item scale, higher values indicate high level of disability.
VAS Back= Visual Analogue Scale for back pain: A 10-point scale, higher values indicate high level of pain.
VAS Leg= Visual Analogue Scale for leg pain: A 10-point scale, higher values indicate high level pain.
SBI=Sciatica Bothersome Index: A 24-point scale, higher values indicate increase in bothersomeness of sciatica.
SFI=Sciatica Frequency Index: A 24-point scale, higher values indicate increase in frequency of sciatica.
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Figure 2: PINS application image
Figure 3: SMWLM application image