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Πέμπτη, 18 Σεπτεμβρίου 2008

Nerve reflexology in the treatment of chronic low back pain: A pilot study.English Version

Nico Pauly, Physiotherapist, Manual Neurotherapist, Nerve Reflexologist, Member of I.A.S.P.
MNT-NR International®, info@mnt-nr.com, http://www.mnt-nr.com/

This article is a summary of the aim and results of a pilot study on nerve reflexology for chronic low back pain. The original article is submitted for publication in Complementary Therapeutic Medicine Journal.

Introduction.
Nerve Reflexology (NR) is a special treatment method developed from classic foot reflexology. It can be combined with other manual treatment methods including, but not limited to, physiotherapy, massage and chiropractic treatment. In many cases NR is combined with special neuroreflectory manual techniques on the body, for example: soft tissue friction techniques, spine tuning and visceral mobilisations. This combination is known as Manual Neurotherapy.

In NR special nerve reflex points, located on the bones of the foot skeleton, are pressed utilising a constant pressure. Each point has a reflectory relationship with a nerve or a nerve structure and its innervation field.
For example: pressing the nerve reflex point for the sciatic nerve (fig.1) acts directly on the nerve impulses generated by the sciatic nerve, but also on the muscles, joints and blood flow of the posterior lower limb.
Knowledge of nerve reflex points covers all the different parts of the peripheral and central nervous system.








Figure 1: Nerve reflex point of the sciatic nerve


MNT-NR International® has developed its own concept for working with nerve reflex points. The central idea of this concept is the fact that the nervous system is responsible for pain and for the modulation of pain. With collaboration from qualified Nerve Reflexologists in the Netherlands, MNT-NR International® agreed a pilot study on the effects of NR in chronic low back pain patients.

Chronic Low Back Pain (CLBP) is a very common complaint in civilised countries.
30 to 40 % of the European population suffers from low back pain at least once in their lifetime, whilst 10% of that population suffers from low back pain on a regular scale with fluctuating intensity and functional disability (Andersson 1997). Many different treatment methods exist, from drug therapy over joint infiltration techniques, manual therapy, muscle rehabilitation and surgery. The results are variable (Poole et al. 2007, Assendelft et al. 2003, Ostelo et al. 2008, Van Den Hoogen et al. 1997). There is general agreement in the literature that muscle and movement rehabilitation is the most effective non invasive form of treatment for CLBP. However 20 to 30% of CLBP patients are non responders to this form of treatment (Bandix et al. 1995).
A recent study in the European Journal of Pain confirms that classic foot reflexology has no effect on improving functioning in CLBP (Quinn et al. 2008), however it does demonstrate an overall improvement in pain modulation and other studies confirm this (Poole et al. 2007).
A recent PhD study by Samuel, reflexologist and qualified nerve reflexologist demonstrated that classic foot reflexology provided attenuation of pain threshold and tolerance in an ice-pain experiment in healthy human subjects (Samuel et al. 2007).

Aims and Objectives
There are no previous experiments on the value of nerve reflexology for CLBP. The aim of this pilot study is to measure the effect of NR on mobility, pain and function in CLBP patients. Results of this pilot study will inform future proposals for a fully blinded randomised controlled trial using NR.

Method.
Compilation of the cohort:
Eight qualified Nerve Reflexologists from the Netherlands selected, in a randomised way, a number of patients suffering from CLBP corresponding to the following criteria.
Inclusion/Exclusion criteria:- Age range 25 - 65 years.
- Suffering from low back pain for more than 12 weeks with varying intensity of pain and disability.
- Pain restricted to thoraco-lumbar, lumbar, the lumbo-sacral and/or gluteal region without radiation to one or both legs.
- Patients free from established pathology of rheumatoïd arthritis, M.S., fibromyalgia and others.
- Patients with no fever.
- The pain can go together with visceral complaints.
- Medication is restricted to NSAI’s and painkillers like paracetamol and other necessary medication for the patients health.
- Patients taking psychopharmaca are excluded.

All patients signed an informed consent after being introduced the aims of the study.

Outcome Measures
1. Pain intensity was measured by the Visual Analogue Pain Scale (V.A.S). The V.A.S is internationally recognised as a reliable instrument for measuring pain. (Miller & Ferris 1993, Pesudovs et al. 2005, Boonstra et al. 2008).
The V.A.S. was recorded prior to the start of the first session and after the last session. It was represented by a horizontal 10cm line, free from verbal and numeric indicators. Patients were asked to put a mark on the line for two values, the intensity of their pain at the worst level and at the best level. The patients were told that the left end of the line was equal to “no pain at all” and the right end equal to “unbearable pain”. The indicated values were measured by the project leader by dividing the line over 10 centimetres.

2. Ventral flexion and side bending mobility measurement.
- Ventral flexion mobility was measured by the Schöber index. This is the increase in distance expressed in centimetres, of the processi spinosi of L5 and T12 on bending forward (fig. 2). Better ventral flexion mobility means an increase in Schöber index.











Figure 2: Demonstration of the Schöber index measurement



-Side bending mobility was measured by the finger-knee index. This is the distance between the top of the middle finger and the lateral femur condyl. The patient performs a side bend whilst gliding his hand over the lateral side of the upper leg. Better side bending mobility is expressed in a decreasing finger-knee index. (Fig.3).








Figure 3: Finger-knee index measurement.








3. Measuring functional disability by the Quebec Back Pain Disability Scale (QBPDS).
This scale covers 20 questions about normal daily activities. Each question has a score from
0 - 5. Where 0 represents “no problem at all” and 5 represents “can not perform ”. (Table 1)
The QBPDS is a reliable, internationally sustained tool (Kopec et al. 1995, Kopec et al. 1996), Schoppink et a. 1996). Patients were asked to fill in the questionnaire on the evening before the first treatment session and on the evening the day after the last session.

Table 1. De Quebec Back Pain Disability Scale.




Collecting and processing research data
- All data were collected by the project leader
- Nine sessions were performed at a frequency of one treatment a week.

Treatment scheme
Each patient was treated according to a standard treatment scheme. The main points of the scheme were:
1. Nerve reflex points for the innervation of the lumbar and sacral spine and the paravertebral muscles,
2. nerve reflex points for the innervation of the psoas , quadratus lumborum and abdominal muscles,
3. nerve reflex points for innervation of blood and lymph supply,
4. nerve reflex points for the abdominal and pelvic organs related to CLBP. (Fig. 4)










Figure.4: Some of the reflex points indicated in the treatment scheme.


Results.

The data from twenty patients was collected.
Age, gender and profession.
- 9 male and 11 female patients with an average age of 47 years.
- 9 patients were independent workers with lots of physical activity, 4 were independent workers with lots of intellectual activities.
- 1 patient was an office worker and 6 were retired from work.


Results for the V.A.S.


Figure 5: V.A.S. evolution

The mean value for the worst pain was 7.50 prior to the initial treatment decreasing to 3.50 after the last treatment.
The mean value for the best pain was 2.50 at the intake and 0.90 after the last treatment, thus indicating a sensitive decrease in pain.
Results for Mobility a) Schöber index.


Figure 6: Schöber index evolution.








The mean scores for mobility increase from 3.00 to 4.50 centimetres. In patients with a healthy spine the normal Schöber-index is around 8 to 10 cm .

b) The finger-knee index .


Figure 7: Finger-Knee index evolution




The mean scores of the finger-knee index decrease from 7.50cm to 5.40cm. on the right side and from 5.70cm to 3.30cm. on the left side.
The normal finger-knee index should be 0cm.

Results of the Quebec Back Pain Disability Scale.


Fig 8: Quebec Back Pain Disability
evolution





There is a clear and sensitive influence on daily life functioning. The mean values decrease from 28.50 to 12.30 points resulting in a good and acceptable level of functioning.

Conclusions.
This novel pilot study was performed using nerve reflexology on CLBP, measuring three important factors of mobility, pain and function. The patient population and its demographic spread was high enough for a reliable conclusion. However it is limited by the fact that there was no control group. Results can however be compared with other studies on reflexology and rehabilitation training. In comparison to the studies of classic foot reflexology and CLBP, this study clearly shows the advantage of nerve reflexology for CLBP, since there is a sensitive influence on both mobility and function in addition to pain.
In comparison to the research on rehabilitation training this pilot study also demonstrates a notable impact on mobility and function. It would be very interesting to set up a trial on treatment combining nerve reflexology and rehabilitation training.


REFERENCES

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