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Moustafa, I. M., and A. A. Diab, "The effect of adding forward head posture corrective exercises in the management of lumbosacral radiculopathy: a randomized controlled study", J Manipulative Physiol Ther, vol. 38, issue 3, pp. 167-78, 2015.
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, "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

Moustafa, I. M., and A. A. Diab, "Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial", Clinical Rehabilitation, vol. 27, issue 1, pp. 51-62, 2013. Abstract

Objective: To investigate the effects of lumbar extension traction in patients with unilateral lumbosacral radiculopathy due to L5–S1 disc herniation.

Design: A randomized controlled study with six-month follow-up.

Setting: University research laboratory.

Subjects: Sixty-four patients with confirmed unilateral lumbosacral radiculopathy due to L5–S1 disc herniation and a lumbar lordotic angle less than 39°, randomly assigned to traction or control group.

Interventions: The control group (n = 32) received hot packs and interferential therapy, whereas the traction group (n = 32) received lumbar extension traction in addition to hot packs and interferential therapy.

Main outcome measures: Absolute rotatory angle, back and leg pain rating scale, Oswestry Disability Index, Modified Schober test, H-reflex (latency and amplitude) and intervertebral movements were measured for all patients three times (before treatment, after 10 weeks of treatment and at six-month follow-up).

Results: There was a significant difference between the traction group and the control group adjusted to baseline values at 10 weeks post treatment with respect to: absolute rotatory angle (P < 0.001), Oswestry Disability Index (P = 0.002), back and leg pain (P = 0.009, P = 0.005), Modified Schober test (P = 0.002), latency and amplitude of H-reflex (P = 0.01, P < 0.001), intervertebral movements (P < 0.05). At six-month follow-up there were statistically significant differences between the study and control groups for all the previous variables (P < 0.05).

Conclusion: The traction group receiving lumbar extension traction in addition to hot packs and interferential therapy had better effects than the control group with regard to pain, disability, H-reflex parameters and segmental intervertebral movements.