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Diab, A. A., and I. M. Moustafa, "The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial", Clinical Rehabilitation, vol. 26, issue 4, pp. 351-361, 2012. Abstract

Objective: To investigate the effect of forward head posture correction on pain and nerve root function in cases of cervical spondylotic radiculopathy.
Design: A randomized controlled study with six months follow-up.
Setting: University research laboratory.
Subjects: Ninety-six patients with unilateral lower cervical spondylotic radiculopathy (C5–C6 and C6– C7) and craniovertebral angle measured less than or equal to 50_ were randomly assigned to an exercise or a control group.
Interventions: The control group (n=48) received ultrasound and infrared radiation, whereas the exercise group (n=48) received a posture corrective exercise programme in addition to ultrasound and infrared radiation.
Main outcome measures: The peak-to-peak amplitude of dermatomal somatosensory evoked potentials, craniovertebral angle, visual analogue scale were measured for all patients at three intervals (before treatment, after 10 weeks of treatment, and at follow-up of six months).
Results: There was a significant difference between groups adjusted to baseline value of outcome at 10 weeks post-treatment for craniovertebral angle, pain, C6 and C7 peak-to-peak amplitude of dermatomal somatosensory evoked potentials P=0.000, 0.01, 0.000, 0.001 respectively and at follow-up for all previous variables (P=0.000).
Conclusion: Forward head posture correction using a posture corrective exercise programme in
addition to ultrasound and infrared radiation decreased pain and craniovertebral angle and increased the peak-to-peak amplitude of dermatomal somatosensory evoked potentials for C6 and C7 in cases of lower cervical spondylotic radiculopathy.
Received: 23 April 2011; accepted: 16 July 2011

Diab, A. A., and I. M. Moustafa, "LUMBAR LORDOSIS REHABILITATION FOR PAIN AND LUMBAR SEGMENTAL MOTION IN CHRONIC MECHANICAL LOW BACK PAIN: A RANDOMIZED TRIAL", Ibrahim M. Moustafa, vol. 35, issue 4, pp. 246-253, 2012. Abstract

Objective: The purpose of this study was to investigate the effects of lumbar extension traction with stretching and
infrared radiation compared with stretching and infrared radiation alone on the lumbar curve, pain, and intervertebral
movements of patients with chronic mechanical low back pain (CMLBP).
Methods: This randomized clinical study with 3-month follow-up was completed at the Cairo University research
laboratory. Eighty patients (age ranged from 40 to 50 years) with CMLBP and a hypolordotic lumbar spine were
randomly assigned to traction or a comparison group. The comparison group (n = 40) received stretching exercises and
infrared radiation, whereas the traction group (n = 40) received lumbar extension traction in addition to stretching
exercises and infrared radiation. The absolute rotatory angle, intervertebral movements, and visual analog scale were
measured for all patients at 3 intervals.
Results: The results revealed a statistically significant difference between the groups at 2 follow-up time points
compared with the baseline values for the translational and sagittal rotational movements of L3-L4, L4-L5, L5-S1, and
L2-L3(posttreatment) and absolute rotatory angle (P b .01). There were no statistically significant changes in pain
(P = .1 and .3) and L1-L2 (P = .072 and .076) or L2-L3 (at follow-up; P = .3), and there was no significant difference
between all the previous variables adjusted to the groups' baseline outcome interaction (P N .01).
Conclusion: Lumbar extension traction with stretching exercises and infrared radiation was superior to stretching
exercises and infrared radiation alone for improving the sagittal lumbar curve, pain, and intervertebral movement in
CMLBP. (J Manipulative Physiol Ther 2012;35:246-253)
Key Indexing Terms: Randomized Trial; Traction; Lordosis; Low Back Pain

Diab, A. A., and I. M. Moustafa, "The efficacy of lumbar extension traction for sagittal alignment in mechanical low back pain: A randomized trial", Journal of Back and Musculoskeletal Rehabilitation, 2013. Abstract

BACKGROUND: There is growing interest in the role of abnormal asymmetrical posture, which is considered one of the most important etiological factors reported to be associated with mechanical low back pain.

OBJECTIVE: This study was conducted to investigate the effect of lumbar extension traction on the pain, function and whole spine sagittal balance as represented in lumbar curvature, thoracic curvature, C7 plumb line, and sacral slope.

METHODS: Eeighty patients with chronic mechanical low back pain (CMLBP) and definite hypolordosis were randomly assigned to traction or a control group. The control group (n=40) received stretching exercises and infrared radiation, whereas the traction group (n=40) received lumbar extension traction in addition to stretching exercises and infrared radiation three times a week for 10 weeks. Back pain rating scale, Oswestry Disability Index, and radiological spine sagittal balance parameters in terms of lumbar lordosis, thoracic kyphosis, sacral slope, and positioning of C7 plumb line were measured for all patients at three intervals (before treatment, after 10 weeks of treatment, and at six months follow-up).

RESULTS: There was a significant difference between the traction and control groups adjusted to baseline value of outcome at 10 weeks post treatment with respect to lumbar lordotic curve (P=0.000), thoracic kyphosis (P=0.013), sacral slope (P=0.001), C7 plump line distance (p=0.001), while there was no significant difference with respect to pain (p=0.29) and Oswestry Disability Index (ODI) (p=0.1). At 6-months follow-up, there were significant differences between both groups for all the previous variables (p< 0.05).

CONCLUSIONS: Lumbar extension traction in addition to stretching exercises and infrared radiation improved the spine sagittal balance parameters and decreased the pain and disability in CMLBP.

Keywords
Traction, mechanical low back pain, randomized controlled trial