Objective: The purpose of this study was to investigate the outcomes of adding lumbar sustained natural apophyseal glide (SNAG) to a conventional therapy program for chronic nonspecific low back pain (LBP). Methods: Forty-two participants with chronic nonspecific LBP were randomly divided into 2 groups. The study group (aged 27.1 ± 8.3, 20 men, 3 women) received a conventional physical therapy program consisted of stretching and strengthening exercises plus SNAG (based on the Mulligan concept) on the affected lumbar levels, and the control group (aged 28.9 ± 7.7, 13 men, 6 women) received the same conventional program without SNAG 3 times per week for 1 month. Outcome measures were repositioning error (the primary outcome), pain, and function measured by an isokinetic dynamometer, visual analog scale, and the Oswestry Disability Index. Measurements were recorded before and after the end of the treatment period. Results: The comparison between pretreatment and posttreatment test scores indicated that both study and control groups had significant improvement in all dependent variables (P N .001). However, adding SNAG to the conventional program resulted in higher improvement in terms of repositioning error, pain, and function (P = .02, .002, .008) respectively. Conclusions: This preliminary study indicated improvement in both groups. Adding SNAG to conventional programs in the treatment of chronic nonspecific LBP may result in greater improvement of repositioning error, pain reduction, and improved function. (J Chiropr Med 2017;16:94-102)

Objective: Currently, there is a lack of objective means to quantify myofascial trigger points (MTrPs) and their core features. Our research compares (1) MTrPs and surrounding myofascial tissue using twodimensional grayscale ultrasound (2DGSUS) and vibration sonoelastography (VSE); (2) the accuracy of both modes in visualizing MTrPs; (3) 'active' and 'latent' MTrPs, using VSE; and (4) the accuracy of both modes in visualizing deep and superficially located MTrPs. Methods: Fifty participants with more than two MTrPs in their quadratus lumborum, longissimus thoracis, piriformis, and gluteus medius muscles were assigned to an active MTrP (low back pain) group or a latent (currently pain free) MTrP group. MTrP identification was based on their essential criteria. An electronic algometer measured repeatedly the tenderness of MTrPs with reference to pressure pain threshold values. A handheld vibrator was applied over MTrPs, while VSE and 2DGSUS readings were taken using an EUB-7500 ultrasound scanner. Results: There was a significant difference between MTrP strain and that of the immediately surrounding myofascial tissue, as measured using VSE (P50.001). VSE visualized all superficial and deep MTrPs with an accuracy of 100% (for both groups); the blinded results obtained using 2DGSUS achieved 33% and 35% accuracy, respectively. There was no significant difference found between the tissue strain ratios of active and latent MTrPs (P50.929). Discussion: Sonoelastography can visualize superficial and deep MTrPs, and differentiate them from surrounding myofascial structure through tissue stiffness and echogenicity. VSE was more accurate than 2DGSUS in visualizing and imaging MTrPs.

Objective: To investigate the effect of kinesio taping versus cervical traction posture pump on mechanical neck dysfunction. Design: A randomized controlled trial. Setting: Physical therapy outpatient clinic. Subjects: Fifty four patients with mechanical neck dysfunction participated in this study. Interventions: Participants were assigned randomly into three groups; group (A) received Kinesio taping every 4 days for 8 sessions with exercises program, group (B) received cervical traction posture pump with exercises program 3 days/week for 12 sessions, and control group (C) received exercises program only inform of stretching, postural and isometric exercises for neck and shoulder joint 3 days/week for 12 sessions. Main measures: Absolute rotatory angle, pain intensity and neck function disability were measured pre and post treatment by digital radiography, visual analogue scale and neck disability index, respectively. Results: There was a significant increase in absolute rotatory angle, significant decrease in visual analogue scale and neck disability index for experimental groups (A) and (B).The control group (C) had a significant decrease in visual analogue scale and neck disability index with least effect, but with no effect on Absolute rotatory angle. Conclusion: The combined therapy of kinesio taping or cervical traction posture pump with exercise program are effective in improving the absolute rotatory angle, pain intensity and function neck disability in mechanical neck dysfunction more than exercise alone.

Adjusting pulse amplitude of transcutaneous electrical nerve stimulation does not produce a difference in the effect of transcutaneous electrical nerve stimulation used to treat chronic low back pain.

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