Moscon E1, Vanti C1, Pillastrini P1
1University of Bologna, DIBINEM, Bologna, Italy
Background: Scientific evidence supports the effectiveness of manual therapy in older people complaining of Low Back Pain (LBP), however current literature on this topic refers to persons mainly affected by musculoskeletal disorders. Conversely, neurological rehabilitation in persons with stroke is focused on the recovery of daily life activities, with limited attention to diagnosis and treatment of concurrent musculoskeletal pain syndromes. Taking into account several impairments and disabilities due to Central Nervous System (CNS) injuries, manual therapy procedures should be modified in persons with these conditions.
Purpose: The aim of this case report is to describe an integrated treatment including manual therapy and neurological rehabilitation of an older male who presented, at the same time, two of the main causes of disability estimated in the general population: impairments following stroke and chronic LBP. Previously, this person had received medical and physiotherapic treatments for LBP without any relevant benefit.
Methods: An initial 1-hour assessment was conducted by a physiotherapist trained in manual therapy, who concluded that in this case chronic LBP was non-specific, sustained by dysfunctional movements and postures, and complicated by psycho-social negative attitudes. Outcomes measures were the 0-10 Numerical Rating Scale for pain, the duration of pain upon awakening, and a daily diary for pain and daily life activities. Ten individual 1-hour sessions were carried out, including manual antalgic spinal techniques on the painful segments (Maitland II degree mobilizations, 30 seconds for 3 times for each level), followed by active supervised exercise aiming to mobilize the thoracic and lumbar spine and to improve global motor activities. Within this therapeutic approach, the cognitive impairments due to the stroke were constantly taken into consideration and the patient's wife was actively involved as the main caregiver. For these purposes and to correct motor control, the principles of the Bobath concept were followed. At the end of the treatment, a final assessment was carried out and after nine weeks, a telephone survey was done.
Results: At the end of the treatment, pain intensity was decreased (from 8/10 to 2/10), as well as pain duration upon awakening (from 15 to 2 minutes); the patient´s ability to actively manage LBP also improved and the levels of global motor activity and social participation increased. Nine-weeks telephone survey confirmed that the person continued the suggested home exercises and some aerobic activities as walking and cycling.
Conclusion(s): From this case report emerges the chance to effectively integrate neurological and musculoskeletal approaches. Manual therapy procedures can be performed to reduce pain and disability in person with CNS injuries, even if their execution should be partially modified, due to neurological impairments.
Implications: Persons with stroke can also complain of non-specific LBP. Neurological impairments should be considered as a contributing factor for pain and can be treated in an integrated model also including manual therapy techniques. High quality studies should be conducted to investigate the effects of manual therapy in patients with stroke impairments and to inquire the benefits of an integrated treatment.
Keywords: Low Back Pain, Manual Therapy, Stroke
Funding acknowledgements: We declare that this study was unfunded.
Purpose: The aim of this case report is to describe an integrated treatment including manual therapy and neurological rehabilitation of an older male who presented, at the same time, two of the main causes of disability estimated in the general population: impairments following stroke and chronic LBP. Previously, this person had received medical and physiotherapic treatments for LBP without any relevant benefit.
Methods: An initial 1-hour assessment was conducted by a physiotherapist trained in manual therapy, who concluded that in this case chronic LBP was non-specific, sustained by dysfunctional movements and postures, and complicated by psycho-social negative attitudes. Outcomes measures were the 0-10 Numerical Rating Scale for pain, the duration of pain upon awakening, and a daily diary for pain and daily life activities. Ten individual 1-hour sessions were carried out, including manual antalgic spinal techniques on the painful segments (Maitland II degree mobilizations, 30 seconds for 3 times for each level), followed by active supervised exercise aiming to mobilize the thoracic and lumbar spine and to improve global motor activities. Within this therapeutic approach, the cognitive impairments due to the stroke were constantly taken into consideration and the patient's wife was actively involved as the main caregiver. For these purposes and to correct motor control, the principles of the Bobath concept were followed. At the end of the treatment, a final assessment was carried out and after nine weeks, a telephone survey was done.
Results: At the end of the treatment, pain intensity was decreased (from 8/10 to 2/10), as well as pain duration upon awakening (from 15 to 2 minutes); the patient´s ability to actively manage LBP also improved and the levels of global motor activity and social participation increased. Nine-weeks telephone survey confirmed that the person continued the suggested home exercises and some aerobic activities as walking and cycling.
Conclusion(s): From this case report emerges the chance to effectively integrate neurological and musculoskeletal approaches. Manual therapy procedures can be performed to reduce pain and disability in person with CNS injuries, even if their execution should be partially modified, due to neurological impairments.
Implications: Persons with stroke can also complain of non-specific LBP. Neurological impairments should be considered as a contributing factor for pain and can be treated in an integrated model also including manual therapy techniques. High quality studies should be conducted to investigate the effects of manual therapy in patients with stroke impairments and to inquire the benefits of an integrated treatment.
Keywords: Low Back Pain, Manual Therapy, Stroke
Funding acknowledgements: We declare that this study was unfunded.
Topic: Musculoskeletal: spine
Ethics approval required: No
Institution: University of Bologna
Ethics committee: Comitato Etico Indipendente di Area Vasta Emilia Centro
Reason not required: This type of study does not require ethical approval.
All authors, affiliations and abstracts have been published as submitted.
