Shendy W1, Saleh M2, Samir H3, Ragab W1
1Cairo University, Faculty of Physical Therapy, Neurology, Cairo, Egypt, 2Gamal Abdel Nasser Hospital, Physical Therapy, Alexandria, Egypt, 3Cairo University, Faculty of Medicine, Neurology, Cairo, Egypt
Background: Lumbosacral radicular pain is a common symptom affecting 10% to 25% of the general population annually. The core stability approach and McKenzie method are effective, noninvasive treatment for lumbosacral radiculopathy (LSR). The lumbosacral angle (LSA) is important in the management of patients with low back disorders.
Purpose: The study aimed to determine the efficacy of McKenzie exercises on lumbosacral angle in patients with lumbosacral radiculopathy.
Methods: This prospective study was conducted in the department of physical therapy of Gamal Abdel Nasser hospital, Alexandria. It involved 30 patients with discogenic lumbosacral radiculopathy. They were randomly allocated to one of two equal groups. Group A (n=15) received core stability exercises. Group B (n=15) received core stability exercises and McKenzie exercises on the lumbosacral area. The patients were assessed before treatment and two and four weeks after treatment by measurement of pain by visual analogue scale (VAS),functional disability by Oswestry low back disability questionnaire and lumbosacral angle by rippstein plurimeter.
Results: Concerning back pain, in Group A the VAS score before treatment, after 2 weeks and after 4 weeks were 4.4±2.4, 4.5±1.4, and 3.7±1.3, respectively (p=0.172). In Group B, the VAS score decreased significantly after treatment (p 0.001). It was 4.0±1.1, 5.3±1.5, and 2.7±1.1, in the three measurement points, respectively. Back pain intensity was significantly lower in Group B after 4 weeks (p=0.021) but not after 2 weeks (p=0.143). Leg pain intensity decreased significantly after treatment in the two groups (p 0.001, for both) and it was significantly lower in Group B after 2 weeks (p = 0.001) and after 4 weeks (p 0.001). The Oswestry disability index (ODI) in Group A before treatment, after 2 weeks and after 4 weeks were 56.8± 9.8, 53.1± 9.9 and 49.1±10.6, respectively. In Group B, ODI was 52.4±10.0, 43.8±10.5, and 36.7±11.6 in the three readings, respectively. ODI decreased significantly after treatment in the two groups (p 0.001, for both). The ODI was significantly lower in Group B after 2 and 4 weeks (p=0.018 and p=0.005, respectively). In Group A, the lumbosacral angle (in degrees) before treatment, after 2 weeks and after 4 weeks was 58.5±7.4, 55.1±8.1, and 52.1±8.7, respectively. In Group B, the lumbosacral angle (in degrees) was 58.9± 8.1, 53.3±8.1, and 48.6±9.0, in the three readings, respectively. The lumbosacral angle decreased significantly after treatment in the two groups (p 0.001, for both). There was no significant difference between the two groups in the lumbosacral angle after 2 weeks (p=0.550) and after 4 weeks (p=0.282).
Conclusion(s): In patients with discogenic lumbosacral radiculopathy, core stability exercises are effective for reduction of leg pain and functional disability. Adding McKenzie exercises to core stability exercises can decrease back pain, with more reduction of leg pain and functional disability, but it cannot cause further reduction of the lumbosacral angle.
Implications: McKenzie exercises seems to be a good option to improve the effectiveness of core stability exercises in the treatment of discogenic lumbosacral radiculopathy, especially in patients suffering marked back pain.
Keywords: Radiculopathy, lumbosacral angle, McKenzie exercises
Funding acknowledgements: No funding was received to conduct this study.
Purpose: The study aimed to determine the efficacy of McKenzie exercises on lumbosacral angle in patients with lumbosacral radiculopathy.
Methods: This prospective study was conducted in the department of physical therapy of Gamal Abdel Nasser hospital, Alexandria. It involved 30 patients with discogenic lumbosacral radiculopathy. They were randomly allocated to one of two equal groups. Group A (n=15) received core stability exercises. Group B (n=15) received core stability exercises and McKenzie exercises on the lumbosacral area. The patients were assessed before treatment and two and four weeks after treatment by measurement of pain by visual analogue scale (VAS),functional disability by Oswestry low back disability questionnaire and lumbosacral angle by rippstein plurimeter.
Results: Concerning back pain, in Group A the VAS score before treatment, after 2 weeks and after 4 weeks were 4.4±2.4, 4.5±1.4, and 3.7±1.3, respectively (p=0.172). In Group B, the VAS score decreased significantly after treatment (p 0.001). It was 4.0±1.1, 5.3±1.5, and 2.7±1.1, in the three measurement points, respectively. Back pain intensity was significantly lower in Group B after 4 weeks (p=0.021) but not after 2 weeks (p=0.143). Leg pain intensity decreased significantly after treatment in the two groups (p 0.001, for both) and it was significantly lower in Group B after 2 weeks (p = 0.001) and after 4 weeks (p 0.001). The Oswestry disability index (ODI) in Group A before treatment, after 2 weeks and after 4 weeks were 56.8± 9.8, 53.1± 9.9 and 49.1±10.6, respectively. In Group B, ODI was 52.4±10.0, 43.8±10.5, and 36.7±11.6 in the three readings, respectively. ODI decreased significantly after treatment in the two groups (p 0.001, for both). The ODI was significantly lower in Group B after 2 and 4 weeks (p=0.018 and p=0.005, respectively). In Group A, the lumbosacral angle (in degrees) before treatment, after 2 weeks and after 4 weeks was 58.5±7.4, 55.1±8.1, and 52.1±8.7, respectively. In Group B, the lumbosacral angle (in degrees) was 58.9± 8.1, 53.3±8.1, and 48.6±9.0, in the three readings, respectively. The lumbosacral angle decreased significantly after treatment in the two groups (p 0.001, for both). There was no significant difference between the two groups in the lumbosacral angle after 2 weeks (p=0.550) and after 4 weeks (p=0.282).
Conclusion(s): In patients with discogenic lumbosacral radiculopathy, core stability exercises are effective for reduction of leg pain and functional disability. Adding McKenzie exercises to core stability exercises can decrease back pain, with more reduction of leg pain and functional disability, but it cannot cause further reduction of the lumbosacral angle.
Implications: McKenzie exercises seems to be a good option to improve the effectiveness of core stability exercises in the treatment of discogenic lumbosacral radiculopathy, especially in patients suffering marked back pain.
Keywords: Radiculopathy, lumbosacral angle, McKenzie exercises
Funding acknowledgements: No funding was received to conduct this study.
Topic: Musculoskeletal: spine
Ethics approval required: Yes
Institution: Cairo university, Faculty of physical therapy
Ethics committee: Research ethics committee of faculty of physical therapy
Ethics number: P.T.REC/012/001616
All authors, affiliations and abstracts have been published as submitted.
