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| |  AAN: Souchard Physical Therapy Techniques Linked to Better Results Than Other Conservative Interventions or Surgery for Back Pain By Paula Moyer MIAMI, FL -- April 14, 2005 -- A physical therapy technique known as Souchard's global postural re-education (GPR) restores most people to complete physical condition and therefore produces results that are superior to other conservative interventions or surgery in people with back pain, according to a findings presented here April 14th at the American Academy of Neurology 57th Annual Meeting. "Among 102 patients who had exhausted all other options, 92 returned to complete activities of daily living," said principal investigator Conrado J. Estol, MD, director of the Neurologic Center for Treatment and Rehabilitation, Buenos Aires, Argentina. "These patients had lived with back pain for an average of 9 months and all had been treated with multiple modalities before being treated with GPR." Dr. Estol described GPR as a series of maneuvers in which the patient is in the supine, sitting, and standing positions. The physical therapist's maneuvers involve stretching the paraspinal muscles and those of the abdominal wall so that the joints are relieved of the compression that is typically the source of their pain. The technique is named after the French physical therapist who developed it, Philippe Souchard, and was originally intended as a treatment for scoliosis. Treatment is typically at least 4 months in duration, with 2 to 4 sessions per week in the first week or more, depending on the severity of the patient's condition, and then once weekly thereafter. Conservative interventions for chronic back pain, including rest, various physical therapy interventions, chiropractic manipulation, traction, and epidural steroid injections, as well as surgery have shown limited outcomes, Dr. Estol said. Whether treated conservatively or with surgery, long-term outcomes are similarly disappointing, he said. Unlike patients with acute injury, who typically recover spontaneously with minimal or no intervention, some patients with chronic back pain have a limited recovery if any, he said. Therefore, with colleagues, Dr. Estol recruited 48 women and 56 men who were consecutive patients at their clinic. Subjects were 25 to 91 years old and were an average of 43 years old. They had clinical findings and magnetic resonance imaging (MRI) studies that showed disc protrusions, canal stenosis, or other changes affecting the joints and bone. Cervical pain was reported in 20 cases and lumbar pain in 82. Enrollment criteria included either moderate or severe limitations of activities of daily living, as identified in the qualifying consultation. Those with moderate restrictions (75%) could walk no more than 10 city blocks without pain, and those with severe restrictions could walk no more than 5 blocks and had either quit working or had restrictions on their activities at work. The treatment was administered for an average of 5 months. All patients had received different combinations of treatment for an average of 7 months. Their prior therapies consisted of conventional physical therapy, McKenzie method therapy, rest, oral and intramuscular medications, acupuncture, and epidural steroid injections. Among these patients, 90% were able to return to full activities of daily living and 4% had slight discomfort with strenuous sport activity. Six patients (6%) did not respond to therapy, of whom 4 had had previous back surgery, 1 had a Chiari malformation, and 1 improved after quitting a job in which she was dissatisfied. Most patients (85%) noted considerable improvement by 3 weeks. After an average follow-up of 22 months, none of the responders reported pain recurrence in either clinic visits or telephone interviews. The results were very promising, Dr. Estol said, and noted that patients' own prior refractory pain could be seen as historical controls. However, he stressed that the results need to be validated in a randomised, controlled trial.
[Presentation title: Improvement of Severely Symptomatic Chronic Cervical and Lumbo Sacral Stenotic and Disc Disease With a Specific Spinal Rehabilitation Method. Abstract S51.003]
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