Does maintained spinal manipulation therapy for chronic non-specific low back pain result in better long term outcome?

To assess the efficacy of spinal manipulation therapy [SMT] for the management of chronic non-specific LBP and to determine the efficacy of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low-back conditions after an initial phase of treatments. 60 patients with chronic, nonspecific low back pain [LBP] lasting at least 6 months were separated into 3 groups. The first group received 12 treatments of sham SMT. The second group received 12 treatments, consisting of SMT over a one-month period, but no treatments for the subsequent nine months. The third group also received 12 treatments over a one-month period, along with [maintenance spinal manipulation] every week for the following nine months. To determine any difference among therapies, we measured pain and disability scores at baseline and at 1-month, 4-month, 7-month and 10-month intervals. Patients in second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period [P=0.0027 and 0.0029, respectively]. However, only the third group that was given spinal manipulations during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation. In the other two groups, however, the mean pain and disability scores returned back near to their pretreatment level. SMT is effective for the treatment of chronic non specific LBP. To obtain long-term benefit, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy

Carpal tunnel syndrome: a study to assess the improvement of grip strength following open carpal tunnel release without neurolysis

Grip strength following open carpal tunnel release was studied prospectively over three years in Mansoura university hospital. We examined 40 hands from 30 patients [4 males and 26 females] clinically diagnosed as carpal tunnel syndrome. All patients underwent thorough medical history tacking and clinical examination. All the hands were subjected to routine determination of the distal motor latency [DML] and nerve conduction velocity [NCV] along the elbow-wrist segment of both median and ulnar nerves and Median 2L-versus-ulnar INT distal motor latencies. Jamar dynamometer was used to measure grip strength to all patients before and following carpal tunnel release using the standardized positioning and instructions. Grip strength was found to be 16% of the pre-operative level at two weeks. 32% by four weeks, and 70% by six weeks and returned to 96% of the pre-operative level by three months. At six months grip strength had increased to 110% of the pre-operative level and 118% at one year. Our study also showed the efficiency of the use median 2L-versus ulnar in the confirmation of clinical diagnosis of carpal tunnel syndrome. Simple open carpal tunnel without neurolysis is quite enough even in cases with severe muscle atrophy