This post was based on the following article, referenced:
Vilas Boas Fernandes, Walkyria & Rodriguez-Blanco, Cleofas & Politti, Fabiano & de Cordoba Lanza, Fernanda & Lucareli, Paulo & Carlos Ferrari Corrêa, João. (2018). The effect of a six-week osteopathic visceral manipulation in patients with non-specific chronic low back pain and functional constipation: Study protocol for a randomized controlled trial. Trials. 19. 151. 10.1186/s13063-018-2532-8.
From a rehabilitation sciences lab in Brazil comes plans to observe and analyze alternative treatment methods for non-specific lower back pain and functional constipation. Such conditions of chronic pain lead to disability, incapacity and are a severe burden on many individuals. Chronic pain, specifically lower back pain, is a public health concern. Researchers of Nove de Julho University and the Federal University of Mato Grosso have proposed a study to address this concern and hope to help those suffering from lower back pain and functional constipation to find relief.
The study is planned to include patients aged 18-65 who will be randomly assigned to a group that will receive osteopathic visceral manipulation (OVM) or another group that will receive ‘sham’ OVM. The individuals will receive the treatment over 6 weeks and will be assessed: before treatment, after the first intervention session, after the 6-week treatment, and three months after the treatment as a follow-up.
OVM treatment utilizes visceral manipulation techniques. For this study, each patient will be treated by an osteopath after an initial evaluation. The sessions will consist of “light or deep manual fascial releases as well as specific small and large intestine mobilization in the abdomen, as appropriate.” The ‘sham’ OVM sessions will appear only involve light touches without deep mobilization or movement for the same duration and locations as the OVM treatments to ensure that there is an appropriate control group.
The outcome of the treatment will be assessed with multiple tests. Pain and functionality will be monitored through evaluation of lower back pain intensity and the Oswestry Disability Index. To assess the psychological effects, the Fear-Avoidance Beliefs Questionnaire will be administered. Additionally, the electrical activity of lower back muscles will be recorded and analyzed with electromyography (EMG) techniques and devices. The participants of the study will be asked to first perform the Biering-Sorensen test to establish a reference for the EMG data.
EMG data will be recorded during the Flexion-relaxation phenomenon (FRP). FRP is the phenomenon in which there is decreased or absent EMG activity in the paraspinal muscles during full trunk flexion. FRP occurs in individuals without symptoms of back pain. It has been found in past studies that individuals experiencing lower back pain, FRP does not occur. Researchers and clinicians see this as an opportunity, as FRP may be used to assist diagnosis and treatment of those suffering with lower back pain.
For the acquisition of EMG signals, the FREEEMG 1000 will be used from BTS Bioengineering. The FREEEMG system consists of multiple probes connected to gelled electrodes to adhere to the specific muscle to be monitored. A wireless connection to a computer transfers the data to be processed and analyzed through specialized software. The FREEEMG system offers the ability to acquire accurate muscle activity data wirelessly, minimizing the effects of the system on the natural movement of the patients.
This study utilizes various technologies and methods for the assessment of the OVM treatment, combining objective measurements such as the FREEEMG with valuable subjective information from the patients such as the questionnaires. The results of this study will help researchers and clinicians understand the effectiveness of the OVM treatments which can help find relief for those suffering from lower back pain and functional constipation.