• The Korean Journal of Pain
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• v.33 no.1
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• pp.66-72
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• 2020

Background: Low back pain secondary to discopathy is a common pain disorder. Multiple minimally invasive therapeutic modalities have been proposed; however, to date no study has compared percutaneous laser disc decompression (PLDD) with intradiscal injection of radiopaque gelified ethanol (DiscoGel^®). We are introducing the first study on patient-reported outcomes of DiscoGel^® vs. PLDD for radiculopathy. Methods: Seventy-two patients were randomly selected from either a previous strategy of PLDD or DiscoGel^®, which had been performed in our center during 2016-2017. Participants were asked about their numeric rating scale (NRS) scores, Oswestry disability index (ODI) scores, and progression to secondary treatment. Results: The mean NRS scores in the total cohort before intervention was 8.0, and was reduced to 4.3 in the DiscoGel^® group and 4.2 in the PLDD group after 12 months, which was statistically significant. The mean ODI score before intervention was 81.25% which was reduced to 41.14% in the DiscoGel^® group and 52.86% in the PLDD group after 12 months, which was statistically significant. Between-group comparison of NRS scores after two follow-ups were not statistically different (P = 0.62) but the ODI score in DiscoGel^® was statistically lower (P = 0.001). Six cases (16.67%) from each group reported undergoing surgery after the follow-up period which was not statistically different. Conclusions: Both techniques were equivalent in pain reduction but DiscoGel^® had a greater effect on decreasing disability after 12 months, although the rate of progression to secondary treatments and/or surgery was almost equal in the two groups.

• The Korean Journal of Pain
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• v.33 no.3
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• pp.226-233
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• 2020

Background: We aimed to compare interlaminar epidural steroid injections (ILESI) and bilateral transforaminal epidural steroid injections (TFESI) on pain intensity, functional status, depression, walking distance, and the neuropathic component in patients with lumbar central spinal stenosis (LCSS). Methods: The patients were divided into either the ILESI or the bilateral TFESI groups. Prime outcome measures include the numerical rating scale (NRS), Oswestry disability index (ODI), Beck depression inventory (BDI), and pain-free walking distance. The douleur neuropathique en 4 questions score was used as a secondary outcome measure. Results: A total of 72 patients were finally included. NRS, ODI, and BDI scores showed a significant decline in both groups in all follow-ups. Third-month NRS scores were significantly lower in the ILESI group (P = 0.047). The percentages of decrease in the ODI and BDI scores between the baseline and the third week and third month were significantly higher in the ILESI group (P = 0.017, P = 0.001 and P = 0.048, P = 0.030, respectively). Pain-free walking distance percentages from the baseline to the third week and third month were significantly higher in the ILESI group (P = 0.036, P < 0.001). The proportion of patients with neuropathic pain in the bilateral TFESI group significantly decreased in the third week compared to the baseline (P = 0.020). Conclusions: Both ILESI and TFESI are reliable treatment options for LCSS. ILESI might be preferred because of easier application and more effectiveness. However, TFESI might be a better option in patients with more prominent neuropathic pain.

• Journal of Korean Neurosurgical Society
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• v.60 no.1
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• pp.60-66
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• 2017

Objective : Sacral insufficiency fracture (SIF) contributes to severe low back pain. Prolonged immobilization resulting from SIF can cause significant complications in the elderly. Sacroplasty, a treatment similar to vertebroplasty, has recently been introduced for providing pain relief in SIF. The purpose of this study is to investigate the clinical short-term effects of percutaneous sacroplasty on pain and mobility in SIF. Methods : This study is conducted prospectively with data collection. Sixteen patients (3 men and 13 women) with a mean age of 77.5 years (58 to 91) underwent sacroplasty. Patients reported visual analogue scale (VAS; 0-10) and Oswestry disability index (ODI; 0-100%) scores. VAS and ODI scores were collected preoperatively and again at one day, one month, and three months postoperatively. Questionnaires measuring six activities of daily living (ADLs) including ambulating, performing housework, dressing, bathing, transferring from chair, and transferring from bed were collected. Ability to perform ADLs were reported preoperatively and again at three months postoperatively. Results : The mean preoperative VAS score ($mean{\pm}SD$) of $7.5{\pm}0.8$ was significantly reduced to $4.1{\pm}1.6$, $3.3{\pm}1.0$, and $3.2{\pm}1.2$ postoperatively at one day, one month, and three months, respectively (p<0.01). The mean ODI score (%) also significantly improved from $59{\pm}14$ preoperatively to $15.5{\pm}8.2$ postoperatively at one month and $14.8{\pm}8.8$ at three months (p<0.01). All ADL scores significantly improved at three months postoperatively (p<0.01). Conclusion : Percutaneous sacroplasty alleviates pain quickly and improves mobility and quality of life in patients treated for SIF.

• The Journal of Korean Physical Therapy
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• v.33 no.5
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• pp.238-244
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• 2021

Purpose: Menstruation is associated with menstrual symptoms like pain and balance problems which have an impact on the quality of life. Pilates increases pelvic stability and reduces menstrual pain by inducing abdominal muscle contraction. This study was done to evaluate the effects of Pilates on menstrual pain, symptoms, balance, and quality of life when compared to aerobic exercise. Methods: Thirty-nine women with menstrual pain were randomly divided into the Pilates group (n=13), aerobics group (n=13), and control group (n=13). The Pilates group performed lumbar-pelvic stabilization exercises, while the aerobic group ran on a treadmill. The control group did not undergo any intervention. The experimental groups exercised for four weeks (12 sessions) and did not exercise during menstruation. The Y-balance test was performed on the second day of menstruation to evaluate dynamic balance. The questionnaires administered immediately after menstruation were the visual analog scale (VAS), Korea Oswestry Disability Index (ODI), and the modified Menstrual Distress Questionnaire (MDQ). The paired t-test was used to compare the effect of exercise within the three groups and a oneway analysis of variance was used to compare between groups. Results: VAS and MEDI-Q scores significantly decreased in the Pilates group after 4 weeks compared with those in the aerobic and control groups. Moreover, ODI and Y-balance scores increased in the Pilates group compared with those in the aerobic and control groups (p<0.05). Conclusion: The Pilates stabilization exercises are effective and help in improving menstrual pain, balance and other menstrual symptoms assessed through ODI, and MEDI-Q, compared to aerobic exercises.

• Journal of the Korean Society of Physical Medicine
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• v.16 no.2
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• pp.71-79
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• 2021

PURPOSE: Chronic low back pain is one of the main factors that affect the quality of life and cause problems of gait and balance in elderly people. This study investigated the correlation between the Oswestry disability index (ODI), Berg balance scale (BBS), and kinematic data measured while analyzing the gait of elderly people with chronic back pain. METHODS: A total of 29 subjects participated in this study. The ODI, BBS, and kinematic data of lower extremities were measured while walking. All data were analyzed using Pearson's correlation coefficients and the significance was measured at .05. RESULTS: ODI had a significant correlation with 1, 13, and 14 items of BBS (p < .05), and left hip external rotation and right ankle abduction respectively in the stance and swing phase of gait (p < .01). 13 items of BBS had a significant correlation with the right ankle abduction in the stance phase of gait (p < .01). In addition, 14 items of BBS had a significant correlation with right and left ankle abduction in the stance and swing phase of gait (p < .01). CONCLUSION: While attempting to predict chronic low back pain and balance issues, it may be useful to check the right ankle abduction in the stance and swing phase of gait. In the future, it would be helpful if some simple tests could be designed to assess balance in elderly people with chronic low back pain.

• Korean Journal of Acupuncture
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• v.35 no.4
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• pp.239-246
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• 2018

Objective : This case study reports the therapeutic effect of Korean Medicine (KM) treatments including CS(care special pain) and BV(bee venom) pharmacopuncture on herniated intervertebral disc(HIVD) of lumbar spine(L-spine). Methods : Two patients diagnosed with HIVD of L-spine were treated with CS and BV pharmacopuncture on GV3 and EX-B2, acupuncture, cupping, and herbal medicine. The Numeric Rating Scale(NRS), the Oswestry low back pain Disablility Index(ODI) and the Roland Morris Disability Questionnaire(RMDQ) scores were evaluated before and after treatment for comparison. Results : Low back pain(LBP) and radiating pain was improved with a decrease in patients' NRS, ODI and RMDQ scores. Conclusion : These results suggest that KM treatments including combined CS and BV pharmacopuncture could be an effective treatment on patients with HIVD of L-Spine.

• The Korean Journal of Pain
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• v.35 no.1
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• pp.97-105
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• 2022

Background: Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED. Methods: We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work. Results: A total of 451 patients were included in three randomized and two non-randomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001). Conclusions: Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster.

• Journal of The Korean Society of Integrative Medicine
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• v.10 no.2
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• pp.73-83
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• 2022

Purpose : Low back pain (LBP) is reported as a risk of experiencing musculoskeletal disorders due to muscle stiffness and hypokinetics. The lumbar spine in an unstable state causes imbalance and lumbar instability. Therefore, This study examined the effects of lumbar stabilization exercise and self-complex exercise program on pain, function, psychosocial level, static balance ability, and transverse abdominal muscle (TrA) thickness and contraction ratio in patients with lumbar instability. Methods : The design of this is a randomized controlled trial (RCT). Twenty-six LBP patients participated in this study. Screening tests were performed and assigned to the experimental group (n=13) and control group (n=13) using a random allocation program. Both groups underwent a lumbar stabilization exercise program. In addition, the experimental group implemented the self-complex exercise program. All interventions were applied three times per week for four weeks. The quadruple visual analog (QVAS), the Korean version of the Oswestry disability index (K-ODI), Korean version of fear-avoidance belief questionnaire (FABQ), static balance ability, TrA thickness, and contraction ratio were compared to evaluate the effect on intervention. Statistical significance was set at 𝛼=.05. Results : Both groups showed significant differences before and after the intervention in QVAS, K-ODI, FABQ, static balance ability, and TrA thickness in contraction (p<.05). In addition, significant differences in K-ODI and FABQ were observed between the experimental group and control group (p<.05). Conclusion : A lumbar stabilization exercise and self-complex exercise program resulted in reduced dysfunctions, psychosocial stability in patients with lumbar instability. Therefore, Lumbar stabilization exercise and self-complex exercise program for patients with lumbar instability are effective method with clinical significance in improving the function and psychosocial stability.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.28 no.2
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• pp.45-55
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• 2022

Background: This study compared the effects of trunk stabilization exercise and hip joint exercises on the range of motion of the lumbar spine, pain severity, and severity of disability in patients with chronic lower back pain. Methods: A total of 30 participants were enrolled and divided into group 1 (n=10), group 2 (n=10), and group 3 (n=10) were performed by each group thrice a week for a total of 8 weeks. Group 1 performed warm-up exercise (15 min), trunk stabilization exercise (25 min), finish-up exercise (15mins). Group 2 performed warm-up exercise (15 min), hip exercise (25 mins, finish-up exercise (15mins). Group 3 warm-up exercise (15 min), trunk stabilization and hip exercise (25 min), Finish-up exercise (15 min). Participants were assessed for the range of motion of the lumbar spine, pain severity (visual analog scale score; VAS), and severity of disability (Oswestry disability index score; ODI) before and after the interventions. Results: All three groups showed a significant increase in the range of motion of the lumbar spine, but there was no significant difference among the groups. Moreover, the severity of pain and ODI were significantly decreased in all groups; however, the intergroup differences were non-significant. Conclusion: The results from this study confirmed the effectiveness of trunk stabilization and hip joint exercise in improving the lumbar range of motion, pain severity, and chronic lower back pain in patients. Thus, trunk and pelvic stabilization exercises and hip joint exercise can be used as clinical practices to treat and prevent chronic lower back pain.

• PNF and Movement
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• v.20 no.2
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• pp.203-214
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• 2022

Purpose: We investigated the effects of multimodal vs. stabilization exercises on chronic low back pain. Methods: Study participants were randomly assigned to a multimodal exercise (n = 20) or a stabilization exercise group (n = 20). Participants in the multimodal exercise group performed stabilization, stretching, and endurance exercises, whereas those in the stabilization exercise group performed only stabilization exercises. Participants in both groups performed the exercises for 1 hour thrice a week for 5 weeks. The following outcomes were evaluated: pain intensity (numeric rating scale), disability (the Oswestry Disability Index [ODI] and the Roland-Morris Disability Questionnaire [RMDQ]), pain-induced fear (the Fear of Daily Activities Questionnaire [FDAQ], the Fear-Avoidance Belief Questionnaire [FABQ], and the Tampa scale for kinesiophobia-11 [TSK-11]). Outcome measures were evaluated at baseline and after intervention. Results: Significant post-intervention improvement was observed in pain intensity and the RMDQ and FDAQ scores in both groups (p < 0.01). The post-intervention ODI, FABQ, and TSK-11 scores were improved in the multimodal exercise group (p < 0.01). Additionally, significant differences were observed in pain intensity, as well as in the ODI, FDAQ, and FABQ scores in the multimodal exercise group compared with these findings in the stabilization exercise group (p < 0.01). Conclusion: The multimodal and stabilization exercise programs reduced pain intensity, disability, and pain-induced fear. Compared with stabilization exercises, multimodal exercises more effectively reduced pain intensity, disability, and pain-induced fear. This study highlights that musculoskeletal rehabilitation for people with chronic low back pain should include a multimodal exercise program.