Abstract

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Lumbago is common and affects 80%-90% of the population over age 25-50 years. Objectives: Treatment of pain and improvement of articular amplitudes in patients with chronic lumbago with electrotherapy and exercises in the cabinet. The prospective study was done in the Physiotherapy Center of the University hospital center “Mother Teresa”, Tirana, during a period of 6 months: May 2012- November 2012. Study were taken in 36 cases (18 F: 18 M) diagnosed with lumbago clinical clonicete of the group age 20-60 years old.

In this study we showed that patients with chronic lumbago treated with physiotherapy have significant improvements in the level of the pain, muscular force and articulated ROM were improved.

Patients in the opening balance muscular strength had grade 3 muscle and after 10 sessions of physiotherapy the final balance of muscular force becomes 6 grade muscular.

The ROM-articulated in the opening balance flexion is 48°, and then the final flexion balance becomes 64.7°.

The ROM-articulated in the opening balance extension average is 14.7° and we made extension final balance averaging 18.1°.

ROM articulated in the opening balance of lateral inclination is averaging 22.7°, the balance becomes final average 26.5° inclination.

Based on these reports we conclude that: Rehabilitation Physiotherapy is the proper treatment for chronic lumbago, because improves the condition of patients, CLE and has no side effects.  

It is recommended to perform physiotherapy twice in year.

Introduction

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Lumbagia is a localized pain in the lumbo-sacral part, but not beyond to the knee, pain that lasts for at least three months, almost, daily, without improvement trend, associated with paravertebral muscle spasm, movement difficulties hindering CLE (2;5;7).

Lumbago may be unilateral or in common. Lumbago‘s  causes might  be: 1. Mechanical in 80-90% as trauma;   spondiloliza and spondilolistezis; deformations of the column as Scoliosis and Sacral; osteoarthrosis of the vertebral column as degeneration of the intervertebral disc, almost all people over 60 years old, discopatia, the narrow lumbar canal; colons.  Not normal fractures of different  lengths of legs, or 2-Inflammatory, Spondilitis  ankilozante ;rheumatoid arthritis ; sacrolitis  osteomielitis  metabolic 3-neoplazmatik, 4 osteoporosis  osteomalacia, osteocontrosis  5-6 postural psychological, not stay in correct position 7-pregnancy in 50-70% of pregnant women experience lumbar pain(2;3;4;5).

Epidemiology: Lumbago is common and affects 80%-90% of the population over age 25-50 years. About 85% of the population is affected at least once during their lives. Segments are often affected by L4 –L5, L5 –S1 mainly at age 35, and the incidence increases with increasing of age. (4; 6)

Favorable factors are:  lack of physical activity or hyperactivity, obesity, bad posture, depression bad way of eating, smoking.

Diagnosis of lumbago is placed of: History taking, radiological imaging examination, physical examination of the patient. The patient is observed naked and measures the amplitude of movements in the three study designs. (4, 5, 6)

Treatment of chronic lumbago is subject to: AINST as drug treatment (15) , rehabilitation and surgical treatment  when there are  affective treatments though these rehabilitations. The treatment occupies an important place in treating chronic lumbagos (9;10;11;12;13;14).         

Objectives: Treatment of pain and improvement of articular amplitudes in patients with chronic lumbago with electrotherapy and exercises in the cabinet.

Methods

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Material and methods of study

The prospective study was done in the Physiotherapy Center of the University hospital center “Mother Teresa”, Tirana, during a period of 6 months: May 2012- November 2012. Study were taken in 36 cases (18 F: 18 M) diagnosed with lumbago clinical clonicete of the group age 20-60 years old.

The treatment protocol: Patients were treated for 10 days with sessions of physiotherapy (electrotherapy and exercises in the cabinet). In the last five sessions, as we reach the reduction of pain, in addition to therapeutic modalities do the exercises, exercises to increase muscular force, in active-passive way, while in the last three sessions, active exercises are like in the table below. Rehabilitation of the patient has involved 10 sessions of physiotherapy (8;9;10).

See Table 1, Table 2 and Table 3

Muscular force evaluation is done and lumbar articular amplitudes at the beginning of treatment and at the end of treatment have noticed that:

Opening balance of muscular force average grade was 3.

Articular Amplitude	Flexion	Extension	Lateral inclination of Left/right
Average initial balance	48 °	14.7°	22.7° / 22.7°

The final balance after 10 days treatment rehabilitees noted that: muscular strength by   third grade at the beginning of treatment muscular runs in 6 grade muscular.

Amplitude articular	Flextion	Extension	Lateral inclination of Left/ right
Average final balance	64.7°	18.1°	26.2° / 26.5°

 

 

 

 

In This table are presented 36 cases, grouping by age group and initial and final balance, which      seems clear improvement of muscular force and ROM using electrotherapy rehabilitation.

See Illustration 4

Conclusion

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In this study we showed that patients with chronic lumbago treated with physiotherapy have significant improvements in the level of the pain, muscular force and articulated ROM were improved.

Patients in the opening balance muscular strength had grade 3 muscle and after 10 sessions of physiotherapy the final balance of muscular force becomes 6 grade muscular.

The ROM-articulated in the opening balance flexion is 48°, and then the final flexion balance becomes 64.7°.

The ROM-articulated in the opening balance extension average is 14.7° and we made extension final balance averaging 18.1°.

ROM articulated in the opening balance of lateral inclination is averaging 22.7°, the balance becomes final average 26.5° inclination.

Patients who use medication for pain relieve had improvement only for a short time, and  had to take again these  preparations, which are often associated with side effects such as drug allergies, HTA, gastritis etc..

Most of the patients followed a physiotherapy rehabilitation for a 2-week period and all reported that the level of the pain was decreased, improvement of muscular force and increased amplitudes and prevention of articular surgical intervention.

Based on these reports we conclude that: Rehabilitation Physiotherapy is the proper treatment for chronic lumbago, because improves the condition of patients, CLE and has no side effects.

It is recommended to perform physiotherapy twice in year.

References

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2. ‘Anatomia Umana’ Dr. Nicola Piscitelli.
3. ‘Fizioterapia E Crregullimeve Osteomuskulare’; Wardavoir Helyett – Ilya Prigogine.
4. N Bernard and W H Kirkaldy-Willis, "Recognizing specific characteristics of nonspecific low back pain," Clinical Orthopaedics and Related Research, no. 217 (April 1987) 266-280. Andersson GB. The epidemiology of spinal disorders. In: Frymoyer JW, ed. The Adult Spine: Principles and Practice. 2nd ed. New York, N.Y.: Raven Press, 1997:93–141.
5. Lower Back Pain – Symptoms , 2008 – 06 – 16.
6. The CIBA Collection of Medical Illustrations, Volume 11, Ottobre – Dicembre 1974. ( faqe : 83 – 114 ).
7. Acute low back problems in adults. Clinical Practice Guideline No. 14. AHCPR Publication No. 95–0642. Rockville, Md.: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, December 1994.
8. Cyriax J. The treatment of lumbar disc lesions. British Medical Journal 1950; (Dec 23):1434-1438. Acute low back problems in adults: assessment and treatment. US Department of Health and Human Services; 1994 Dec; Rockville, MD.
9. Andersson GB. The technique massage of spinal disorders. In: Frymoyer JW, ed. The Adult Spine: Principles and Practice. 2nd ed. New York, N.Y.: Raven Press, 1997:93–141.
10. The George Institute for Global Health, Sydney, Australia and EMGO Institute for Health & Care Research, Amsterdam, the Netherlands. Waddell G. The Back Pain Revolution. Edinburgh, U.K.: Churchill Livingstone, 1998.
11. Bogduk M (2003). "Management of chronic low back pain". Medical Journal of Australia 180 (2): 79–83.
12. Pivetta 1977, pag. 86, 96; Valleti 1892  - pag. 53, Descovich-Savorelli-Bernardini; 1964, pag. 143.
13. "Exercise Physiology: Energy, Nutrition and Human Performance"; William D. McArdle, Frank I. Katch, Victor L. Katch; 2006.
14. Floyd, R., & Thompson, Clem. (2008). Manual of structural kinesiology. New York, NY: McGraw-Hill Humanities.
15. "Nonpharmacological treatment for low back pain". Journal of Musculoskeletal Medicine 27.

Source(s) of Funding

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None

Competing Interests

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None