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Spinal manipulation and electrical dry needling as an adjunct to conventional physical therapy in patients with lumbar spinal stenosis: a multi-center randomized clinical trial

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Randomized Controlled Trial

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Structural and chiropractic

Spine J. 2024 Apr;24(4):590-600. doi: 10.1016/j.spinee.2023.12.002. Epub 2023 Dec 14.

Authors:

Ian Young, James Dunning, Raymond Butts, Paul Bliton, Noah Zacharko, Jodan Garcia, Firas Mourad, Casey Charlebois, Patrick Gorby, César Fernández-de-Las-Peñas

Abstract.

Background context: Nonoperative management of lumbar spinal stenosis (LSS) includes activity modification, medication, injections, and physical therapy. Conventional physical therapy includes a multimodal approach of exercise, manual therapy, and electro-thermal modalities. There is a paucity of evidence supporting the use of spinal manipulation and dry needling as an adjunct to conventional physical therapy in patients with LSS. Purpose: This study aimed to determine the effects of adding thrust spinal manipulation and electrical dry needling to conventional physical therapy in patients with LSS. Study design/setting: Randomized, single-blinded, multi-center, parallel-group clinical trial. Patient sample: One hundred twenty-eight (n=128) patients with LSS from 12 outpatient clinics in 8 states were recruited over a 34-month period. Outcome measures: The primary outcomes included the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI). Secondary outcomes included the Roland Morris Disability Index (RMDI), Global Rating of Change (GROC), and medication intake. Follow-up assessments were taken at 2 weeks, 6 weeks, and 3 months. Methods: Patients were randomized to receive either spinal manipulation, electrical dry needling, and conventional physical therapy (MEDNCPT group, n=65) or conventional physical therapy alone (CPT group, n=63). Results: At 3 months, the MEDNCPT group experienced greater reductions in overall low back, buttock, and leg pain (NPRS: F=5.658; p=.002) and related-disability (ODI: F=9.921; p<.001; RMDI: F=7.263; p<.001) compared to the CPT group. Effect sizes were small at 2 and 6 weeks, and medium at 3 months for the NPRS, ODI, and RMDI. At 3 months, significantly (p=.003) more patients in the MEDNCPT group reported a successful outcome (GROC≥+5) than the CPT group. Conclusion: Patients with LSS who received electrical dry needling and spinal manipulation in addition to impairment-based exercise, manual therapy and electro-thermal modalities experienced greater improvements in low back, buttock and leg pain and related-disability than those receiving exercise, manual therapy, and electro-thermal modalities alone at 3 months, but not at the 2 or 6 week follow-up. Keywords: Dry needling; Exercise; Lumbar; Mobilization; Spinal manipulation; Stenosis.

Publication Date: 

2024 Apr

OEID: 

7152

Young, I., Dunning, J., Butts, R., Bliton, P., Zacharko, N., Garcia, J., Mourad, F., Charlebois, C., Gorby, P., Fernández-de-las-peñas, C. (2024) 'Spinal manipulation and electrical dry needling as an adjunct to conventional physical therapy in patients with lumbar spinal stenosis: a multi-center randomized clinical trial', Spine J. 2024 Apr;24(4):590-600. doi: 10.1016/j.spinee.2023.12.002. Epub 2023 Dec 14.

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