Abstract
Aim: The aim of this study was to determine whether a single treatment approach of extracorporeal shockwave therapy or chiropractic spinal manipulative therapy, compared to a combined treatment approach of chiropractic spinal manipulative therapy with extracorporeal shockwave therapy is effective with regards to pain, disability and lumbar range of motion in individuals with chronic lumbar facet syndrome. The results were based on the use of the Numerical Pain Rating Scale (NPRS) and the Oswestry Low Back Pain and Disability Questionnaire (ODQ) to assess subjective pain and disability as well as the Digital Inclinometer to assess objective lumbar range of motion. This study also aims to provide chiropractors and other health care practitioners with an alternative/additional modality in treating and managing chronic lumbar facet syndrome. Method: This was a comparative study utilising convenience sampling and random group allocation methods to split thirty male and female participants between the ages of 18 and 35 years into three groups of ten participants each. All the recruited participants presented with low back pain due to chronic lumber facet syndrome. Group one received spinal manipulative therapy, Group two received extracorporeal shockwave therapy, and Group three received a combination of both interventions. Procedure: Each participant recruited in this study was required to attend six treatment consultations and a seventh consultation that was for obtaining the final measurements/data only. All the participants were individually assessed over a four-week clinical trial period. Objective data was obtained using a Digital Inclinometer to assess lumbar spine range of motion. Subjective data was obtained using two methods which were the NPRS and the ODQ. The subjective and objective data was recorded at the beginning of the first, fourth and seventh consultations. Results: The subjective and objective data that was collected by the researcher was analysed by statisticians from STATKON at the University of Johannesburg. With regards to the intragroup and intergroup analysis of this study, non-parametric tests were used to analyse the raw data obtained by the researcher as the Shapiro-Wilk test for normality indicated that the data was not normally distributed. The intragroup analysis was done using the non-parametric Friedman test and post-hoc Wilcoxon Signed Ranks test. The intergroup analysis was done using the Kruskal-Wallis test. vi With regards to the intragroup analysis, the numerical pain rating scale and the Oswestry low back pain and disability questionnaire data showed clinically and statistically significant results for all three groups. The Digital Inclinometer data showed clinically and/or statistically significant results for some ranges of motion for certain groups. Lumbar spine flexion, extension, left lateral flexion and right lateral flexion ranges of motion were tested for each group. However, with the intergroup analysis, all three groups showed no statistically significant results with all the data collection methods. Conclusion: Based on the subjective results obtained in this study, all three groups were effective with regards to the numerical pain rating scale and the Oswestry low back pain and disability questionnaire, with group one showing the largest overall clinical improvement in both. Therefore, the participants of all three groups benefitted from the restoration of their ability to perform normal daily activities. However, spinal manipulative therapy was the most effective in decreasing pain and disability. Based on the objective results obtained in this study, the Digital Inclinometer results for the three groups made it difficult to establish the best treatment protocol for the restoration of the lumbar spine range of motion. This is due to the fact that most of the results were clinically significant and statistically insignificant. However, group two had the most clinically significant results, but group three demonstrated the most clinically and statistically significant results out of the three groups. This suggests that the combination treatment protocol was the most effective in the treatment of LBP due to chronic lumbar facet syndrome with regards to lumbar ROM.
M.Tech. (Chiropractic)