News Category: Lumbar Spine

Over the years doctors have tried different ways to fuse the lumbar spine. Interbody fusion has been done off and on without success, until recently. Now cages, commonly made of titanium, are placed between the vertebral bones. These devices help restore the disc space. They also take the pressure off the bone graft that is used to fuse the spine, improving the chances that the graft will heal.

The cages can be inserted from the front of the spine (anterior approach) or from the back of the spine (posterior approach). Which is better? That’s the topic of this study. Doctors at the UCLA School of Medicine compared patients getting anterior lumbar interbody fusion (ALIF) cages to patients receiving posterior lumbar interbody fusion (PLIF) cages.

The authors used type and rate of complications as the measuring stick. They found the risk of complications during and after the operation is much higher for the PLIF group. In this study, major problems tended to be more likely in the PLIF group. Minor problems occurred more often in the ALIF group. The PLIF operation takes longer, and there’s more blood loss with the posterior approach.

Worker’s compensation reports show that low back pain returns in 14 to 45 percent of all clients. That’s a pretty broad range. It’s hard to use this information or make comparisons. Some of the difference is due to how a recurrence of back pain is defined.

Should each new claim filed be counted separately? How much time between episodes should pass before it is called a new problem? Can it be counted as a recurrence if the symptoms are different the second time?

In this study, researchers set up three different ways to count cases of back pain recurrence. The first method was a claim-based definition. In this way of counting, clients can have many episodes of care or work disability all on the same claim. A low count of recurrences is likely with this method.

The second definition uses work disability to figure recurrence rates. This method is called the disability-based recurrence rate. With this definition, each time the worker returns to the job (even temporarily), disability has ended. The next time back pain puts the client out of work, it counts as a new episode of disability.

The third care-based method measures recurrence rates by how much time goes by between doctor or physical therapy visits. The minimum gap between visits was set at seven or more days.

Here’s what the study found about rates of back pain recurrence using these three definitions:

No one needs to get workers back on the job faster than the United States Army. About 80 percent of civilians have back pain at some point in their lives. It’s likely that soldiers have just as many episodes of low back pain as civilians. There aren’t very many military studies that show that for sure yet.

Disc problems account for most of the chronic low back pain (LBP) reported. Intradiscal electrothermal therapy (IDET) is a fairly new way to treat disc disease. Heat is applied directly to the disc to shrink it or even destroy it.

IDET was used on 36 active duty soldiers to treat chronic disc-related LBP. The authors think the military is an ideal place to study the results of IDET. Soldiers all have the same 100 percent insurance coverage, so treatments are usually similar for everyone. And there’s no need for insurance approval once treatment has been prescribed. The soldiers must follow the program as prescribed. They aren’t under pressure to return to work too soon in order to get a paycheck.

Almost half the soldiers had 50 percent or better reduction in pain after IDET. Most had only one IDET session. A smaller number had two trials of IDET. A few had a level above or below the original disc problem also treated with IDET. Quite a few soldiers (19 percent) said their symptoms were actually worse than before IDET. Overall 68 percent of the soldiers would have IDET again if they knew ahead of time what the result would be.

From a military point of view, the authors report that some improvement is better than none. Soldiers didn’t have to have 50 percent or higher improvement to consider IDET a success. Less pain means more function and earlier return to active duty.

These researchers suggest IDET may be a middle step for patients who have tried drugs and physical therapy and don’t want more invasive surgery. In the military, even getting a small number of soldiers back to duty is important. IDET is worth trying if it can help keep soldiers healthy and avoid medical discharge. The authors also note that soldiers who don’t get pain relief with IDET can still have surgery later and get good results.

Almost half of all workers’ compensation claims are for back injuries. For this reason the Worker’s Compensation Board (WCB) in Canada sent out guidelines for family doctors to use. The guidelines are called Clinical Practice Guidelines (CPGs). They are based on the best and most recent scientific studies. Expert panels in other countries have come up with similar ideas for managing patients with back pain.

CPGs tell the doctor what questions to ask, how to examine the patient, what to watch for, and what treatment to suggest. Family doctors were given the CPGs because they are who patients most often turn to for this problem. This study looked at how well family doctors in Canada are following the WCB guidelines. There is a hope that if every health provider followed the guidelines, then patients would be examined and treated the same way. Results could be measured, and the best methods for taking care of acute low back pain would emerge.

The authors report that family doctors were doing a good job reviewing the patient’s history. They usually asked about prior episodes of similar symptoms. Two-thirds of the doctors carried out the kind of examination recommended in the guidelines. However, only five percent of the doctors looked for “red flags” that come with more serious conditions.

Treatment is the area where many doctors didn’t follow the guidelines. For example, 40 percent of the doctors prescribed the use of narcotic drugs more than four weeks after the injury. Half the doctors sent their patients for passive therapies after that point, which the CPGs say is too late. Only a few doctors offered their patients education or reassurance.

Setting up CPGs is the first step in finding the most effective treatments for a problem. Finding ways to get everyone to use the CPGs is the second step. Then studies must be done to show what happens when patients receive treatment based on the guidelines. Short-term and long-term results must be studied. The goal is to reduce the number of patients who have chronic pain.

These Canadian doctors say the final step is to refine the guidelines. All of this research will result in the next generation of CPGs. The process will repeat itself many times until there are guidelines and successful treatments for all kinds of back pain.

Studies show that people with diabetes heal more slowly compared with patients who don’t have diabetes. They also have more problems after surgery. This is true whether the patient with diabetes is insulin-dependent or not.

Spine surgery is no exception. Doctors know there is greater risk of both major and minor problems for the patient with diabetes having a lumbar (low back) decompression. This operation removes a portion of the damaged disc. The idea is to take painful disc pressure off the spinal nerve root.

Sometimes a longer operation is needed. The doctor may have to fuse the spine at one or more levels. Metal plates and screws may be used to hold the spine steady until the fusion is complete. How can diabetes affect a person’s results after lumbar decompression and fusion surgery?

That’s the subject of this study. The authors started out thinking that more surgery means more complications during and after the operation. They compared a group of 94 patients with diabetes to a group of 43 patients without diabetes. Both groups had lumbar decompression surgery followed by spinal fusion.

The authors were right. Patients with diabetes had a 53 to 56 percent increase in problems. Patients without diabetes only had a 21 percent increase. They found that differences were not based on age, gender, or tobacco use. Larger body mass (height and weight) did matter.

Problems were divided into major and minor complications. Major problems were defined as life-threatening. Minor problems had to be addressed, but they didn’t change the patient’s treatment after the operation. Problems included wound infections, nonunion (failure to form a solid bone fusion), urinary tract infections, and nerve damage.

The authors report no difference among patients with diabetes. The results were the same whether people were receiving insulin or not. However, these two groups had worse results than the group of patients without diabetes. The control group had fewer problems of any kind.

Researchers conclude that doctors should warn patients with diabetes of the increased risk with this kind of operation. Longer time in the operating room and more levels of fusion increase the risk even more.

Patients with low back pain (LBP) have one thing in common: they’d like to know what’s causing the pain. Yet doctors are often at a loss to give answers to patients. We do know that two-thirds of all patients have chronic LBP caused by lumbar discs, the small joints on the back of the spinal column (the facet joints), or the sacroiliac (SI) joint.

In this study, physical therapists and radiologists teamed up to test patients for signs of these three problem areas. The therapists measured pain levels and carried out certain tests known to identify the three areas under study. Patients were given injections based on the therapists’ findings.

The placement of the needle helped confirm the diagnosis. Once the needle was in place, a numbing agent was injected. If the patient’s pain went away, the test was positive. That means the injected site was considered to be the problem.

The radiologist told the therapist where the pain was coming from. The therapist then reviewed the results of tests given before the injection. They found all patients with SI problems had pain when moving from a sitting to standing position. SI patients rarely had pain above a certain level of the spine. Usually, their pain was only on one side.

Patients with problem discs also had pain when rising from sitting. In addition, they felt pain in the center of the low back after repeated test movements. Patients with facet joint problems never had pain centered in their back. They also never had pain when rising from a seated position.

The authors conclude it is possible to narrow down the diagnosis in LBP. Better classification of LBP can be done by looking at the pain location and pain patterns. The patient’s history and the examination offer good clues to point doctors and therapists in the right direction.

Spinal fusion is becoming more common all the time. But there’s one thing still puzzling doctors. If two vertebral bones are fused together, and the next disc down looks bad, should that adjacent segment be fused too? If it isn’t fused, will it cause problems? This was the focus of doctors at the Vanderbilt University Spine Center in Tennessee. They suspected the worst. However, they were pleasantly surprised by the results of their study.

Two groups of patients totaling 25 people had lumbar fusion for degenerative instability. This means the discs were damaged, thin, and dried out, leaving the spine at that level loose and unstable. MRI scans were used to see the discs on either side of the fusion site. Patients were divided into normal (NL) or degenerative disc disease (DDD) based on MRI findings. The researchers thought the DDD group would have a worse result than the NL group. As it turns out, there was no difference between the two groups. In fact, the DDD group actually did slightly better.

Measures used in this study included pain, general health, social functioning, and mental health. The patients were followed for two years. The authors think problems at the degenerated level may occur later. Increased load from the fusion site may transfer to the level above or below. So they plan to follow this group for a longer period of time. They also suggest that a larger study be conducted.

Doctors sometimes prescribe antidepressant medicine to treat chronic low back pain (LBP). No one is sure how it works. But certain types of antidepressants do seem to help relieve pain for some other conditions. And chronic LBP is so hard to treat, some patients will try anything that might help.

These authors looked at the research to judge whether antidepressants work on chronic LBP. Results were checked for two kinds of antidepressants. The authors narrowed the field to seven good studies. Tricyclic and tetracyclic antidepressants did give seem to give pain relief. It was unclear if they helped people move and do daily tasks better. Antidepressants known as SSRIs did not show any pain relief in these studies.

None of the studies shed any light on why antidepressants might relieve LBP. The authors note that the pain relief doesn’t seem to be because the patients are necessarily any happier. The authors warn that even if they work, antidepressants won’t be a good treatment for everyone with LBP. Antidepressants can have some serious side effects. Still, the authors feel there is enough evidence to do larger studies on the use of antidepressants for LBP.

The University of Ulster in Northern Ireland may seem far away. But the Internet makes it possible to conduct worldwide research from any spot on the map. Researchers from the School of Rehabilitation Sciences asked the question: Does traction really work for low back pain?

To answer this question, they looked at studies from around the world. A computer-aided search was done for the years 1966 to 2001. Five of the largest medical databases were searched. All studies were in English. A hand search of other journals was also included. In all the studies, patients either received traction, a sham treatment, or some other treatment without surgery. Sham traction is a “pretend” treatment. Sham treatment uses no-weight or low-weight traction that is known to be useless.

The authors review the many reasons why it’s difficult to study traction alone in the treatment of LBP. Traction is usually used by physical therapists. Most physical therapy programs are tailored to fit each patient’s needs. No two patients get the same treatment. Many programs combine traction with advice, exercise, heat, and electrotherapy. It’s hard to tell if just one of those treatments is what works. And traction is applied with different weights for differing lengths of time.

Success was measured using reports of pain relief, improved function, and quality of life. A positive result means traction worked better than other treatments. A negative result is defined as no difference between traction and other treatment. A negative result is also given if traction was the same as other treatments. Results are inconclusive if the results were positive sometimes and negative other times.

The authors conclude that it isn’t possible to tell if traction is a good treatment for low back pain. Studies are poorly done and need to improve before results can be trusted. Better research in this area is needed. And using only studies in English leaves out research on traction in the Netherlands and Germany. This is where many of the studies on traction are done.

You can’t always believe what you hear, see, or read. We’ve all said those words at some point in time. Doctors are especially on guard about test results for new drugs or implants. For example, in 1999 the Food and Drug Administration (FDA) gave its approval for a new interbody fusion cage called the Brantigan carbon fiber cage. These cages are used in posterior spinal fusion.

The original study reported good fusion rates. Complications were also low. A second study looked at the amount of blood loss and how long the operation took. Doctors at the South Texas Orthopaedics and Spinal Surgery clinic thought the values seemed out of line with what they were seeing. So they conducted their own study.

They reviewed the charts of 60 patients who had spinal fusion with the Brantigan carbon fiber cages. The operation is done from the back of the spine. The cages are placed in the back half of the disc space between two vertebral bones.

Cages can also be placed in the front half of the disc space (anterior). Cages placed in from the front tend to help keep the disc space open. They also show improved fusion rates. Cages put in from the back of the spine do the same thing, but there’s a greater risk of nerve damage while putting them in. The spinal nerve roots and protective covering (dura) have to be moved out of the way to insert the cages from behind. Pulling on these tissues can cause neurological injury.

In this study, there was a 100 percent fusion rate using the Brantigan cages. Overall results were similar to the original Brantigan study. There were six cases of dural tears, but the authors don’t think these were caused by cage placement. Three patients had some signs of nerve damage that went away in time.

The length of time in surgery and amount of blood loss was equal to, if not better, than the previous studies. The authors conclude that these special types of fusion cages put in from the back of the spine can be used safely with good results. They advise having an experienced spinal surgeon perform the operation.

Some back problems are easier to treat than others. Take, for example, a simple muscle strain. Treatment is simple: rest, ice, and anti-inflammatory drugs followed by some stretching. Problems such as a disc injury may take more time and more treatment.

One of the most challenging spine conditions is called spondylolisthesis. This is actually a “slipped vertebra.” The main body of the vertebra slips forward over the disc and vertebral body below it. When this happens, the affected spinal segment becomes unstable. The disc may get pressed, and the spinal nerves can get pinched. Surgery may be needed. But it’s not really that simple. Every case is different depending on how much the vertebra has slipped, the patient’s age, and how much the disc has changed with age.

Most studies agree that the spine must be fused from the front (anterior) and the back (posterior). A single fusion just isn’t as good as a combined fusion. Here again, the decision isn’t simple. There are different ways to perform anterior and posterior spinal fusion. In this study, the results of a transforaminal lumbar interbody fusion (TLIF) were studied.

TLIF is done from the side of the spine instead of from the front or back. The surgeon works through an opening on the side of the vertebra to remove the disc. The opening is also used to insert bone graft and a special cage into the disc space. Screws are hold the bones in place until the graft takes hold.

X-rays were taken before surgery, right after surgery, and three to 12 months later. The X-rays were used to look at the disc height, correction of the bones, and position of the cage. The X-rays showed an increase in disc height at first. Then there was a gradual loss of disc height over time.

The forward slip of the vertebra wasn’t changed much. The authors think this is because there isn’t adequate room to put the cage forward far enough to change the angle. They suggest smaller cages might work better. The cage needs to be placed as far forward as possible in the disc space. This study showed that spondylolisthesis can be treated successfully with TLIF.

What do low back pain and a head cold have in common? They are the top two reasons for visits to the doctor. There’s also no known cure for either one. With that in mind, researchers continue to look for a cure for the common cold and ways to treat low back pain.

In this study 457 back pain patients were divided into two groups. One group was examined at a spine clinic. They were told more about back pain and given advice to stay active. The second (control) group was given regular care but not at the spine clinic. No special advice was offered the control group.

The theory behind this study is based on what happens to patients who still have back pain after two months. Fear of moving and new injury to the spine leads to inactivity. The longer a patient is off work, the greater the chance of chronic pain. Getting back to work depends on an early recovery.

A previous study by this same group has already shown one-year benefits from light activity. Returning to work and regular activity is linked with fewer sick days. The current study looks at the effects over three years. The authors want to know answers to several questions. Do the benefits of early activity last? Does early activity cause more injury later? Does it cost more or less to send a worker in group one back to the job after back pain?

The authors found a faster return to work in the group given light activity. This group also had fewer sick days. After six months the active group was still stretching and walking. After 12 months the active group was still stretching. The difference only lasted for the first year. During years two and three, both groups reported equal activity. Reinjury rates were high in both groups. Most patients had at least one or two new bouts of back pain during the three years.

There was a cost savings between the two groups. The active group cost $2,822 less in sick leave. They used fewer sick days during the first year and over the total three years. These numbers could be measured because the study was done in Norway where there is a national social insurance system. This savings reflects a cost-benefit to society.

The authors conclude that giving low back pain patients coping skills to manage their pain is cost effective in the first 12 months. Giving patients information and reassurance along with advice to keep active saves money by reducing the number of worker sick days. The researchers think this is worth it, even when the effects only last a year.

What do you think would happen if you had back pain? Would you get faster pain relief with manipulative treatment, exercises, and a doctor visit? Or would you do better if you just had an hour with the doctor? During this hour, you would get an exam, encouragement, and some instructions about posture, lifting, and stretching.

This was the focus of a study in Finland. The researchers made a guess that manipulative therapy with exercises along with a doctor visit would give better pain relief than just the doctor visit alone. What did they find?

The manipulative treatment and exercise group had a better outcome after five months. The results were equally good after 12 months. People getting manipulative therapy also used muscle exercises to stabilize the pelvis and low back. After the first doctor visit, they met with a physical therapist four times over four weeks.

The group receiving manipulative therapy reported more pain relief and less disability compared to the group who saw a doctor once. Patients in the first group were given individual instructions, including advice about lifting. The also were given exercises to increase back motion and muscle flexibility. The instructions were repeated at the five-month check-up.

Health care costs were also measured and compared for each group. There weren’t any differences in costs between these two groups. The authors conclude that a short, manipulative treatment program that includes exercise may work best patients with low back pain. Patients got fast pain relief, which may translate into fewer missed days at work or school.

What’s the one thing that can prevent falls, raise self-esteem, improve mood, reduce weakness, and slow the effects of aging? Exercise. What’s the biggest problem with this solution? Actually doing it. People often get a good start, but they don’t keep it up. They sometimes say it’s “boring” or that it takes too much time.

When it comes to chronic low back pain from aging, endurance exercise is safe and effective. It improves function and well-being. So says a group of researchers from Boston area medical schools.

They used a program of stationary bicycling to observe the effects of exercise on older adults with low back or leg pain. In all cases the pain was made worse by standing up straight (extension) and better by sitting down (flexion).

Each subject used the bike at home for 12 weeks. The exercise program was done four days a week for 30 minutes each day. This form of exercise is called endurance training.

At the end of 12 weeks most of the subjects actually exercised 2.2 times a week. Those who exercised more had greater gains in strength, function, and mental health. The most common reason for quitting was painful joints. In some cases the patients’ doctors or therapists advised them to stop.

The authors conclude that an at-home bicycle program has many benefits for older adults with certain back conditions. A bike program is a good choice when standing up straight causes pain. Decreased pain, more comfort and distance while walking, and improved quality of life are just a few of the changes reported by the participants.

What would improve America’s health the most? Is it to prevent strokes and heart attacks? Breast or prostate cancer? Cure diabetes? According to the International Forum for Primary Care Research, it would be to solve the mystery of chronic back pain.

Find the best way to treat this problem and you could save billions of dollars in health care costs, not to mention saving millions of back pain sufferers the disability that can come with low back dysfunction (LBD). LBD is thought to be the cause of low back pain for many people.

Dr. Paul Sung, a physical therapist from the Iowa Spine Research Center, is trying to find some exercises that work for LBD. He reports that spinal stabilization exercises may be the answer. These exercises may protect the back from stress, instability, and injury. Deep spine muscles such as the multifidi help position and hold the spine over a period of time. These muscles have an important role in endurance. Improving the multifidi muscle action and endurance might make a difference for patients with LBD.

A small study of 16 subjects did spinal stabilization exercises for four weeks, three times each week. Dr. Sung looked to see if these exercises change multifidus muscle fatigue in people with LBD. He found that peoples’ function improved, even though there were no changes in fatigue. Women improved in endurance while men got much worse. It looks like spinal stabilization exercises do affect back muscle function–just not the way Dr. Sung was expecting.

Something else besides improving endurance of the multifidi muscles is at work here. More study is needed to get find out what effect stabilization exercises have on these important spinal muscles.

“Scalpel.” “Forceps.” “Retractor.” If you’ve watched any TV, you’ve probably heard these words on one of the medical shows. If not, you may still recognize them as tools used in the operating room. This study focuses on one of these tools: the retractor. The retractor is used to pull and hold back skin, blood vessels, nerves, or other soft tissues in the area where the surgeon is working.

Doctors are very careful, but the retractors can damage some of these structures. For example when fusing the lumbar spine from the front (anterior fusion), retractors are used to move aside blood vessels in the abdominal area. Is there any damage when this is done? Doctors have seen a loss of blood supply to the leg on the same side as the blood vessel retraction. There are also some changes in nerve signals. Are these factors related?

That’s what doctors from the University of Southern California studied. They measured oxygen levels and signals in the spinal cord. They looked for changes after putting on the retractors and then taking them off. And they looked at how long it took these measures to return to normal levels.

More than half the patients had major pressure on the left iliac blood vessel. The researchers think this loss of blood flow stops signals in the nerve roots at the end of the spinal cord. Blood loss to the leg also occurs as a direct result of these changes. Once the retractors are taken off, everything goes back to normal. It doesn’t seem to matter how long the retractors cut off the blood supply during the surgery. Most patients recover within eight minutes. Some take as long as an hour.

This was the first study to look at the connection between loss of blood supply in a specific blood vessel and loss of spinal cord signals during anterior lumbar spine fusion. The authors give doctors some guidelines for the use of retractors during this operation based on these results.

Should you take a muscle relaxant for back pain? Do they really work? Is it worth the risk of potential side effects? These are the questions a group of researchers asked in a recent study of back pain sufferers.

The answer is important because doctors prescribe these drugs for one-third of all back pain patients. Muscle relaxants have many possible side effects, including a dry mouth, sleepiness, blurred vision, nausea and vomiting, and headaches. There’s also the possibility of drug dependence and addiction.

Patients with nonspecific low back pain were included in this review. Nonspecific back pain means there’s no known cause of the problem. Each patient was treated with muscle relaxants alone or muscle relaxants combined with other treatment.

These researchers found a strong link between the use of muscle relaxants and short-term pain relief for back pain. This was true even when compared with placebo treatment. Placebo means the patient receives a pill, but the patient doesn’t know it’s a sugar pill. Sometimes patients feel just as good after a placebo as with the drug. That wasn’t the case here.

Many doctors still debate the use of muscle relaxants for low back pain. Everyone agrees the side effects can be severe. For this reason, they are used with caution. This study shows that muscle relaxants are helpful for back pain, but no one knows if they work better than other drugs. These authors propose another study to compare muscle relaxants with pain relievers and anti-inflammatory drugs.

Fusion surgery is one of the possible fixes for low back pain caused by disc
degeneration. Fusion surgery involves using bone grafts and screws to separate and hold two or more vertebrae. The goal is to hold the fused section perfectly still to stop the pain.

This study from Norway casts doubt on whether fusion in the low back is necessary to treat disc degeneration. These authors compared two groups of patients with back pain from disc degeneration. All had low back pain for longer than one year. One group got fusion surgery using screws. They then attended a standard rehabilitation program.

The other group had no surgery. Instead, they took part in an intensive rehab program over six weeks. These patients spent about 25 hours each week on the program. The program included education and exercise classes. Patients also went to group classes. They did three workouts a day. They got individual training and help. And they were always encouraged to use their backs and to do their regular activities.

After one year, both groups showed about the same amount of improvement. There were only a few real differences. Patients in the surgery group were more afraid of doing certain activities. They also had a harder time bending over and touching the floor. The exercise group had somewhat more leg pain.

The authors were surprised by these results. They had expected the surgery group to do much better than the exercise group. Exercise and education can be much less expensive than surgery. The authors note that combining surgery with the education and exercise program could have even better results. The authors suggest that research on bigger groups of patients is needed to truly understand the best way to use lumbar fusion when treating disc degeneration.

Doctors are always looking for ways to limit the length of the incision needed for surgery. Shorter incisions generally mean less damage to surrounding tissues. They usually heal more quickly. But shorter incisions are not always better. Larger incisions can help doctors see and reach structures better.

That’s where research like this comes in. This doctor looked at 114 patients. All of them had surgery for a herniated disc in the low back one year earlier. All patients had surgery on only one side of a single spinal level. The same surgeon operated on all the patients.

But one group had microsurgery using a special microscope to help surgeons view the surgery site. The other group had macrodiscectomy. This traditional approach uses a longer, open incision and does not require a microscope. More of the surrounding bone is removed in the macrodiscectomy.

For the most part, the groups both did well. About 90 percent of all patients had good or excellent results. Both groups reported less pain and more strength. But there were differences. The group who had macrodiscectomy had longer scars. They also spent much less time in the operating room–an average of 25 minutes, compared to 59 minutes for microdiscectomies. The author notes that the shorter operating time was because the surgeon did not need to use a microscope.

However, the group who had the microdiscectomy saw some major benefits. They used less pain medication. They also returned to normal life faster. Of these patients, 85 percent returned to normal activities within a month. This compares to 59 percent of the other group. The author concludes that, in the case of simple herniated discs in the low back, smaller incisions are most often the way to go.

“Lie on your right side. Let your left arm roll back. Now gently press your legs down against my hand here. That’s good. Hold. Hold. Relax.” This is what you might hear a physical therapist say to you while performing a muscle energy technique (MET).

More and more therapists are using METs to treat patients with new cases of low back pain. The patient contracts his or her muscles in a way that gives a corrective force to the spine. The therapist makes sure the muscle contracts in the exact direction needed and with just the right amount of force. The whole exercise may only take five minutes. Patients are shown how to do a similar exercise at home. Home exercises help keep the spine in good alignment after METs.

In this study physical therapists measured the results of METs. Two groups of patients were treated. Both groups got a certain kind of exercise to retrain muscles. One group also got the added METs. After eight sessions over four weeks, the groups were compared. The group getting exercise plus MET came out better. They had better motion and more function with less pain.

The authors point out this is the first study on METs. It’s also a small “get started” or pilot study. The results must be verified by other studies. Research with more patients is needed. METs should be compared to other methods of treatment, too.