|dc.description.abstract||The low back and the lower limb are generally viewed as two isolated regions,
however, there are many authors who believe that these two regions are
functionally related. This is due to the two regions being connected to each other
through the kinematic chain of the lower extremity.
The lumbar spine is the link between the lower extremities and the trunk, and
plays a significant role in the transfer of forces through the body via the kinematic
chain. The physical link between the low back and the lower limb is supplied by
the thoracolumbar fascia, which plays an important role in the transfer of forces
between the spine, pelvis and legs.
Although a relationship between the lower extremity and low back pain is often
assumed, little research has been published to demonstrate the association. Most
of the evidence so far has been anecdotal, without scientific research to support it.
This study was designed to compare the relative effectiveness of lumbar spine
manipulation, compared to combined lumbar spine and subtalar manipulation for
the treatment of chronic mechanical low back pain, using subjective and objective
measures, for the management of chronic mechanical low back pain.
The study design was a quantitative clinical trial, using purposive sampling. It
consisted of forty voluntary participants with chronic mechanical low back pain.
There were two groups of twenty participants each, each of whom received six
treatments within a three week period. Group A received manipulation of the
lumbar spine only, whilst Group B received manipulation of both the lumbar spine
and subtalar joint.
The outcome measures included the response of the participants to the Numerical
Pain Rating Scale-101 and the Quebec Low Back Pain and Disability
Questionnaire. Objective data was obtained from three digital Algometer
measures. Data was collected prior to the initial, third and sixth treatment.
Statistically both groups showed improvements, subjectively and objectively, with
regards to chronic mechanical low back pain. Inter-group testing for NRS over time
showed no significant effect for both treatment groups. There was a significant
treatment effect for Algometer Average TP1 while the treatment effect for
Algometer Average TP2 was not significant. However, inter-group testing for the
Quebec LBP over time showed no significant effect for both treatment groups.
Inter-group analysis demonstrated no statistical significance between the two
groups for subjective and objective measurements, thus suggesting that there is
no additional benefit in treating the subtalar joint in the management of mechanical
low back pain.
Further studies will also benefit greatly from the use of larger sample sizes to
improve statistical relevance of data.||en_US