Vijai P. Sharma

Efficacy of dynamic muscular stabilization techniques (DMST) over conventional techniques in rehabilitation of chronic low back pain.

Kumar, S, Sharma, VP, and Negi, MPS. Efficacy of dynamic muscular stabilization techniques (DMST) over conventional techniques in rehabilitation of chronic low back pain. J Strength Cond Res 23(9): 2651-2659, 2009-Low back pain (LBP) is a common health problems. Although it is multifactorial, its treatment varies considerably, including medication, physical therapy modalities, and exercise therapy, and each have several interventions. Despite their effectiveness, their head-to-head comparisons are limited. This study was aimed at 1 such comparison. A total of 30 hockey players, 18 to 28 years of age, with subacute or chronic LBP were randomly assigned equally in 2 groups. One group was treated with conventional treatment-a combination of 2 electrotherapies (ultrasound and short-wave diathermy) and 1 exercise therapy (lumbar strengthening exercises)-and the other group was treated with dynamic muscular stabilization techniques (DMST), an active approach of stabilizing training. The results showed that both the treatments are effective in the management of LBP, but DMST was found to be more effective than conventional treatment. The walking, stand ups, climbing, and pain improved 4.7, 2.0, 1.4, and 2.1 times, respectively, more with DMST than with conventional treatment. With time (days), walking, stand ups, climbing, and pain improved (correlation) significantly (p < 0.01) higher in DMST (r = 0.83 to 0.92) than in conventional treatment (r = 0.40 to 0.75), and their rate of improvement (regression β coefficients) were also significantly (p < 0.01) higher in DMST (β = −0.16 to 0.73) than in conventional treatment (β = −0.07 to 0.15). Subjects matching were perfect (p < 0.01) and test-retest reliability of all dependent variables was significantly (p < 0.01) high (intraclass correlation coefficient ≈ 1). No major adverse effects were recorded in any of the patients in either group. This study concluded that for early recovery, DMST is more suitable than conventional treatment.

Comparative efficacy of two multimodal treatments on male and female sub-groups with low back pain (part II).

OBJECTIVEnThis study determines the efficacy of two such multimodal treatments in the management of lumbar pain syndrome in males and females.nnnMETHODnTotal subjects of 141 male or female were randomized to treat either with conventional treatment or by DMST (dynamic muscular stabilization techniques). After stratification on the basis of gender (51 male and 21 female) were found in DMST group whereas (40 male and 29 female) were found in conventional group. The primary outcome measures were pain severity, physical strength (BPC and APC), functional ability (Walking, Stairs climbing and Stand-ups) and QOL. All patients were assessed at baseline (day 0), 10 days, 20 days, 90 days and at the end treatment or follow up (day 180).nnnRESULTnIn this study the improvement of pain, BPC, APC, Walking, Stair climbing and stand-ups in females and males were 22.5% and 29.0%, 60.9% and 53.7%, 42.0% and 51.9%, 49.8% and 49.3%, 54.2% and 48.7%, 52.3% and 39.7%, higher respectively in DMST as compared to CONV whereas QOL in females of DMST improved by 53.6% more than the females of CONV while males of DMST improved by 57.9% more than the males of CONV.nnnCONCLUSIONnDMST as well as CONV treatments are more effective in males than the females. Study also concluded that subgroup female may need more clinical attention during the management of LBP.

Efficacy of two multimodal treatments on physical strength of occupationally subgrouped male with low back pain

OBJECTIVESnSome occupations are more prone to low back pain (LBP) due to their static work postures and work place design. Multidisciplinary pain programs have shown their effectiveness in the management of LBP in general population but which treatment and which segment of the population will be benefited more was not investigated yet. This study determines the effect of two treatment protocols on five occupationally subgrouped male LBP patients.nnnMETHODSnA total of 102 occupational male, 20-40 yrs of age, with sub-acute or chronic nonspecific LBP were randomized and treated either with conventional treatment a combination of two electrotherapy (ultrasound and short wave diathermy) and one exercise therapy (lumbar strengthening exercises) or dynamic muscular stabilization techniques (DMST) an active approach of stabilizing training. At the end of the treatment, subjects of both the groups were further stratified in five subgroups on the basis of their occupation. The pain was the primary outcome measure while physical strength [back pressure changes (BPC) and abdominal pressure changes (APC)] the secondary.nnnRESULTSnThe Pain, BPC and APC of all subgroups improved significantly (P < 0.01) in the both treatments but more in DMST. For each variable, improvement in subgroups differed within and between the treatments. Overall improvement in all assessed variables were evident on Desk workers followed by Shop keepers the most while BPC of Movement job, APC of Others and Pain of Sedentary and Shop keepers improved the least.nnnCONCLUSIONSnStudy concluded that for the management of occupational LBP, DMST is more effective than conventional treatment. The Pain of Sedentary and Shopkeepers and physical strength of Movement job and Others may need more clinical attention. Findings of this study may be helpful in the management of occupational LBP.

Effect of dynamic muscular stabilization technique on low back pain of different durations

BACKGROUNDnLow back pain (LBP) has multi-factorial origin and its treatment varies considerably. Multidisciplinary pain programs have shown their effectiveness in the management of LBP but it is not documented whether subjects with difference in chronicity (duration) of pain will respond differently to these regimes. Dynamic muscular stabilization technique (DMST) is an active approach of stabilizing training for lumbar area which involves the training for the co-contraction of the transverse abdominis and multifidus muscles.nnnAIMnThis study determines the efficacy of Dynamic Muscular Stabilization Technique (DMST) in LBP of different durations.nnnDESIGNnFollow-up, comparative study.nnnSETTINGnPhysical medicine and rehabilitation department (PMR) of university.nnnMETHODSnTotal 72 patients were categorized in 5 groups on the basis of duration (chronicity) of their low back pain. The documentation of chronicity was done on the basis of subjective questionnaire. All subjects were treated with DMST. Pain was the primary outcome measure while physical strength (back pressure change: BPC, abdominal pressure changes: APC), physical ability (walking, stair climbing, stand ups) and quality of life (QOL) were the secondary. Variables were assessed at baseline (day 0), 3 months (day 90) and at the end of the follow up (day 180).nnnRESULTSnVariables (Pain, BPC, APC, Walking, Stair climbing, Stand ups and QOL) significantly improved on 90th and 180th day while compared to the baseline. Therefore irrespective of the chronicity of pain, all chronic pain patients will respond positively to the DMST treatment.nnnCONCLUSIONSnThis study concludes that DMST intervention is an effective rehabilitation technique for all chronic low back pain patients irrespective of the duration (chronicity) of their pain.

CORRELATION AND REGRESSION AMONG PAIN, PHYSICAL STRENGTH, FUNCTIONAL ABILITY, QUALITY OF LIFE AND SEXUAL FREQUENCY IN LOW BACK PAIN

Purpose: The present study was undertaken to find out the relationship among outcome variables as well as association between dependent variables with physical characteristics in low back pain (LBP) patients. Correlations between outcome variables [pain, back pressure changes (BPC), abdominal pressure changes (APC), walking, stairs climbing, stand ups, quality of life (QOL) and sexual frequency] of all LBP subjects before and after treatment were assessed. Regression analysis was used to estimate baseline BPC and APC of LBP subjects from their baseline demographic characteristics (age, height, waist circumference, systolic blood pressure, and pulse rate) and severity of pain. Methods: A total of 141 nonspecific chronic LBP patients were recruited. After baseline recording, all subjects were given trunk stabilization training for 20 regular days. After training, the follow-up was done at a gap of each 15 days up to 6 months (180 days). At the last follow-up session (180th day), the outcome variables were recorded again. Findings: The present study found an inverse relation between pain and muscle functions (BPC: r ¼� 0:36;p < 0:01 and APC: r ¼� 0:26;p < 0:01). This study also showed that BPC was more inversely related with the pain than APC. Conclusions: This study concludes that

Circadian rhythm in patients with spinal cord injuries

Spinal Cord Injury (SCI) is damage to the spinal cord that may result in the loss of mobility. Frequent causes of damage are trauma (motor vehicle accident, falls, etc.) or disease (polio, spina bifida, Friedreichs Ataxia, etc.). However, abnormality in circadian rhythm has been observed in SCI. Melatonin is the primary hormone of the pineal gland and acts to regulate the bodys circadian rhythm. Normally, melatonin levels begin to rise in the mid-to-late evening, remains high for most of the night, and then decreases in the early morning hours. Patients with SCI have a lower melatonin secretion during the hours of darkness than in healthy subjects. This may contribute to impaired sleep at night, fatigue during the day and affect pain perception. Disturbed level of melatonin has also been reported in SCI patients that are associated with disturbances in circadian rhythm. Therefore, circadian rhythm can be important in the pathophysiology and treatment of SCI patients and it is important to know the time and the level of melatonin in order to prescribe the appropriate treatment regimen. The expanding science of circadian rhythm biology and a growing interest in human clinical research on circadian rhythm in patients with spinal cord injuries inspired this review. This article reviews the relationship of circadian rhythm in patients with SCI. doi : 10.5214/ans.0972.7531.2009.160110 Competing interests: None. Source of Funding: None Received Date: 14 March 2009 Revised Date: 27 March 2009 Accepted Date: 09 April 2009