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A systematic review and meta-analysis on the efficacy of physiotherapy intervention in the management of lumbar prolapsed intervertebral disc

Classic LxH Dynamic Disc Model 5

Goal of the Study?

In this review 1 the authors evaluated the efficacy of physical therapy interventions such as electrotherapy, exercise therapy, lumbar traction and manual therapy in the management of lumbar prolapsed intervertebral disc (PIVD).

Why are they doing this study?

Lumbar PIVD (or herniation) is one of the most common musculoskeletal disorders affecting approximately 10% of the population. It has a significant impact both individually and societally as it is associated with disability, pain and a loss of productivity. Currently, both surgical and non-surgical approaches are used for treatment. However, recently there has been a push to reduce the need for spinal surgery as this approach has several complications, including pain, infection and, in some cases, post-operative paralysis. Unlike surgical interventions, conservative approaches such as physical therapy do not have such complications and are cost-effective. However, there is a need to understand the efficacy of physical therapy for lumbar PIVD.


What was done?

The authors did a systematic review and meta-analysis using randomized controlled trials (RCTs) focused on the efficacy of physical therapy management in lumbar PIVD. They included all trials published in English from the beginning to January 2019. They then used specific software to review the included studies. In total, 2594 studies were collected from the database queries, with 11 fitting the selection criteria; however, six were excluded as they did not contain sufficient data.


What did they find?

This meta-analysis showed statistically significant improvement in pain and disability after physiotherapy treatment in patients with lumbar PIVD, compared to control. While physiotherapy interventions did increase single leg raise (SLR) range, the finding was not statistically significant compared to the control group. 

Overall, the researchers found that physiological and biomechanical interventions such as correction of the displaced disc, decompression, opening of the foramina and increase in intervertebral space may lead to improved spinal mobility, contributing to a reduction in pain and disability.


Why do these findings matter?

Providing evidence-based care for LBP is important for patient quality of life and reducing the economic and societal burden of illness. 


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