Bonnie Y. Tsung

The Immediate Effect of Posteroanterior Mobilization on Reducing Back Pain and the Stiffness of the Lumbar Spine

OBJECTIVE To study the immediate effect of posteroanterior mobilization on back pain and the associated biomechanical changes in the lumbar spine. DESIGN An experimental between-group study. SETTING A biomechanics laboratory. PARTICIPANTS Subjects with low back pain (n=19) and healthy subjects (n=20). INTERVENTIONS Grade III posteroanterior mobilization (3 cycles of 60s) was applied at the L4 level in people with or without back pain on 1 occasion. MAIN OUTCOME MEASURES Pain intensity, active lumbar range of motion, the magnitude of the posteroanterior mobilization loads, bending stiffness of the lumbar spine, and the lordotic curvature of the lumbar spine before and after 3 cycles of posteroanterior mobilization. RESULTS The magnitude of pain of the patients was found to decrease significantly after posteroanterior mobilization treatment. There was also a significant decrease in the bending stiffness of the lumbar spine of the patients, which was derived from the posteroanterior load and the associated change in spine curvature. The stiffness was restored to a level that was similar to that of the asymptomatic subjects. A strong correlation was found between the magnitude of pain and the bending stiffness of the spine before (r=.89) and after posteroanterior mobilization (r=.98). CONCLUSIONS Posteroanterior mobilization was found to bring about immediate desirable effects in reducing spinal stiffness and the magnitude of back pain. The restoration of the mechanical properties of the spine may be a possible mechanism that explains the improvement in pain after manual therapy.

Use of laparoscopic sleeve gastrectomy and adjustable gastric banding for suboptimally controlled diabetes in Hong Kong.

Bariatric surgery has recently been considered as an option for treatment of type 2 diabetes mellitus (T2DM). We assessed the effect of laparoscopic gastric banding and laparoscopic sleeve gastrectomy in a cohort of 39 T2DM Chinese patients with body mass index (BMI) over 30 kg/m2. Their mean body weights and BMI before surgery were 108 kg and 40 kg/m2, respectively, and 18 patients (46%) had suboptimal diabetic control (HbA1c >7%). After a mean follow‐up of 27 months, 4 of 11 insulin‐dependent patients (36%) were able to stop their insulin therapy, and 18 patients (46%) achieved remission of T2DM (HbA1c <6.5% without the use of medication). Glycaemic control remained poor in only nine other patients (27%). Logistic regression analysis showed that a short history of T2DM and high BMI could predict remission of diabetes after restrictive procedures. Our results suggest that restrictive surgery can significantly improve glycaemic control in obese T2DM patients.