Rheumatology International

, Volume 33, Issue 7, pp 1737–1744 | Cite as

Is phonophoresis effective in the treatment of chronic low back pain? A single-blind randomized controlled trial

  • Dilek Durmus
  • Gamze Alayli
  • Ahmet Salim Goktepe
  • Mehmet Ali Taskaynatan
  • Ayhan Bilgici
  • Omer Kuru
Original Article

Abstract

The aim of this trial is to investigate and compare the effects of phonophoresis (PP) and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 60 patients with definite CLBP were included in this study. The patients were randomized into three groups. Group 1 (n = 20) was accepted as the control group and was given only exercises. Group 2 (n = 20) received US treatment and exercises. Group 3 (n = 20) received PP and exercises. All of the programs were performed 3 days a week, for 6 weeks. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ and pain disability index, PDI), walking performance (6 min walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk muscle strength was measured with a handheld dynamometer. All of the groups showed statistically significant improvements in pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression. The intergroup comparison showed significant differences in VAS pain, 6MWT, and EMS, among three groups. These differences were statistically significant in groups 2 and 3 compared with the group 1. The intergroup comparison showed significant difference in pain, physical function, and energy subgroups of SF-36. The differences were statistically in group 3 compared with group 1 and 2. We observed that US and PP treatments were effective in the treatment of patients with CLBP but PP was not found to be superior over ultrasound therapy.

Keywords

Chronic low back pain Phonophoresis Ultrasound Trunk muscle strength Pain Disability Endurance Quality of life Depression 

Notes

Acknowledgments

The authors thank Tulin Durmus for the assistance for the editing of the manuscript.

Conflict of interest

None.

References

  1. 1.
    Paolucci T, Morone G, Iosa M et al (2012) Psychological features and outcomes of the Back School treatment in patients with chronic non-specific low back pain. A randomized controlled study. Eur J Phys Rehabil Med 48(2):245–253Google Scholar
  2. 2.
    Frank AO, Souza LD (2001) Conservative management of low back pain. Int J Clin Pract 55:21–31PubMedGoogle Scholar
  3. 3.
    Nicolaisen T, Jorgensen K (1985) Trunk strength, back muscle endurance, and low-back trouble. Scand J Rehab Med 17:121–127Google Scholar
  4. 4.
    Yang EJ, Park W-B, Shin H-I et al (2010) The effect of back school integrated with core strengthening in patients with chronic low-back pain. Am J Phys Med Rehabil 89:744–754PubMedCrossRefGoogle Scholar
  5. 5.
    Liddle SD, Baxter GD, Gracey JH (2004) Exercise and chronic low back pain: what works? Pain 107:176–190PubMedCrossRefGoogle Scholar
  6. 6.
    Rainville J, Hartigan C, Martinez E et al (2004) Exercise as a treatment for chronic low back pain. Spine J 4:106–115PubMedCrossRefGoogle Scholar
  7. 7.
    Ay S, Doğan SK, Evcik D et al (2011) Comparison the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome. Rheumatol Int 31:1203–1208. Epub 2010 Mar 31Google Scholar
  8. 8.
    Rand SE, Goerlich C, Marchand K et al (2007) The physical therapy prescription. Am Fam Physician 1(76):1661–1666Google Scholar
  9. 9.
    Machet L, Boucaud A (2002) Phonophoresis: efficiency, mechanisms and skin tolerance. Int J Pharm 243:1–15PubMedCrossRefGoogle Scholar
  10. 10.
    Windt D, Heijden G, Berg S et al (1999) Ultrasound therapy for musculoskeletal disorders: a systematic review. Pain 81:257–271PubMedCrossRefGoogle Scholar
  11. 11.
    Gam AN, Warning S, Larsen LH et al (1998) Treatment of myofascial trigger—points with ultrasound combined with massage and exercise a randomized controlled trial. Pain 77:73–79PubMedCrossRefGoogle Scholar
  12. 12.
    Duruöz MT, Ozcan E, Ketenci A et al (1999) Cross cultural validation of the revised Oswestry pain questionnaire (ROPQ) in a Turkish population. Arthr Rheum 42(9) (Annual Scientific Meeting. Boston, Massachusetts, P1200)Google Scholar
  13. 13.
    Grönblad M, Hupli M, Wennerstrand P et al (1993) Intercorrelation and test-retest reliability of the pain disability index (PDI) and the oswestry disability questionnaire (ODQ) and their correlation with pain intensity in low back pain patients. Clin J Pain 9:189–195PubMedCrossRefGoogle Scholar
  14. 14.
    Macrael IF, Wright V (1969) Measurement of back movement. Ann Rheum Dis 28:584CrossRefGoogle Scholar
  15. 15.
    Ito T, Shirado O, Suzuki H et al (1996) Lumbar trunk muscle endurance testing: an inexpensive alternative to a machine for evaluation. Arch Phys Med Rehabil 77:75–79PubMedCrossRefGoogle Scholar
  16. 16.
    McGill SM, Childs A, Liebenson C (1999) Endurance times for low back stabilization exercises clinical targets for testing and training from a normal database. Arch Phys Med Rehabil 80:941–944PubMedCrossRefGoogle Scholar
  17. 17.
    Kvien TK, Kaasa S, Smedstad LM (1998) Performance of the Norwegian SF-36 Health Survey in patients with rheumatoid arthritis. II. A comparison of the SF-36 with disease-specific measures. J Clin Epidemiol 51:1077–1086PubMedCrossRefGoogle Scholar
  18. 18.
    Beck AT, Ward CH, Mendelson M et al (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571PubMedCrossRefGoogle Scholar
  19. 19.
    Dogan SK, Tur BS, Kurtais Y et al (2008) Comparison of three different approaches in the treatment of chronic low back pain. Clin Rheumatol 27:873–881CrossRefGoogle Scholar
  20. 20.
    Mannion AF, Müntener M, Taimela S et al (2001) Comparison of three active therapies for chronic low back pain: results of a randomized clinical trial with one-year follow-up. Rheumatology 40:772–778PubMedCrossRefGoogle Scholar
  21. 21.
    Durmus D, Durmaz Y, Canturk F (2010) Effects of therapeutic ultrasound and electrical stimulation program on pain, trunk muscle strength, disability, walking performance, quality of life, and depression in patients with low back pain: a randomized-controlled trial. Rheumatol Int 30:901–910. Epub 2009 July 31Google Scholar
  22. 22.
    Sarrafzadeh J, Ahmadi A, Yassin M (2012) The effects of pressure release, phonophoresis of hydrocortisone, and ultrasound on upper trapezius latent myofascial trigger point. Arch Phys Med Rehabil 93:72–77. Epub 2011 Oct 7Google Scholar
  23. 23.
    Ebadi S, Ansari NN, Henschke N et al (2011) The effect of continuous ultrasound on chronic low back pain: protocol of a randomized controlled trial. BMC Musculoskelet Disord 12:59PubMedCrossRefGoogle Scholar
  24. 24.
    Byl NN (1995) The use of ultrasound as an enhancer for transcutaneous drug delivery: phonophoresis. Phys Ther 75:539–553PubMedGoogle Scholar
  25. 25.
    Hoppenrath T, Ciccone CD (2006) Is there evidence that phonophoresis is more effective than ultrasound in treating pain associated with lateral epicondylitis. Phys Ther 86:136–140PubMedGoogle Scholar
  26. 26.
    Philadelphia Panel (2001) Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation Ânterventions for low back pain. Phys Ther 81:1641–1674Google Scholar
  27. 27.
    Harris GR, Susman JL (2002) Managing musculoskeletal complaints with rehabilitation therapy: summary of the Philadelphia Panel evidence-based clinical practice guidelines on musculoskeletal rehabilitation interventions. J Fam Pract 51:1042–1046PubMedGoogle Scholar
  28. 28.
    Québec Task Force on Spinal Disorders (1987) Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Spine 12:51–59Google Scholar
  29. 29.
    Grubisic F, Grazio S, Jajic Z et al (2006) Therapeutic ultrasound in chronic low back pain treatment. Reumatizam 53:18–21PubMedGoogle Scholar
  30. 30.
    Kozanoglu E, Basaran S, Guzel R et al (2003) Short term efficacy of ibuprofen phonophoresis versus continuous ultrasound therapy in knee osteoarthritis. Swiss Med Wkly 133:333–338PubMedGoogle Scholar
  31. 31.
    Klaiman MD, Shrader JA, Danoff JV et al (1998) Phonophoresis versus ultrasound in the treatment of common musculoskeletal conditions. Med Sci Sports Exerc 30:1349–1355PubMedGoogle Scholar
  32. 32.
    Mason L, Moore RA, Derry S et al (2004) Systematic review of topical capsaicin for the treatment of chronic pain. BMJ 328(7446):991. Epub 2004 Mar 19 ( Review)Google Scholar
  33. 33.
    Shin SM, Choi JK (1997) Effect of indomethacin phonophoresis on the relief of temporomandibular joint pain. Cranio 15:345–348PubMedGoogle Scholar
  34. 34.
    Hicks GE, Fritz JM, Delitto A et al (2005) Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil 86:1753–1762PubMedCrossRefGoogle Scholar
  35. 35.
    Clare HA, Adams R, Maher CG (2004) A systematic review of efficacy of McKenzie therapy for spinal pain. Aust J Physiother 50:209–216PubMedGoogle Scholar
  36. 36.
    Machado LA, de Souza MS, Ferreira PH et al (2006) The McKenzie method for low back pain: a systematic review of the literature with a meta-analysis approach. Spine 31:E254–E262PubMedCrossRefGoogle Scholar
  37. 37.
    van Tulder MW, Malmivaara A, Esmail R et al (2005) Exercise therapy for low back pain. Cochrane Database Syst Rev 20(3):CD000335Google Scholar
  38. 38.
    Hides JA, Jull GA, Richardson CA (2001) Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine 26:E243–E248PubMedCrossRefGoogle Scholar
  39. 39.
    Shaughnessy M, Caulfield B (2004) A pilot study to investigate the effect of lumbar stabilisation exercise training on functional ability and quality of life in patients with chronic low back pain. Int J Rehabil Res 27:297–301PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Dilek Durmus
    • 1
  • Gamze Alayli
    • 1
  • Ahmet Salim Goktepe
    • 2
  • Mehmet Ali Taskaynatan
    • 2
  • Ayhan Bilgici
    • 1
  • Omer Kuru
    • 1
  1. 1.Department of Physical Medicine and Rehabilitation, Medical FacultyOndokuz Mayis UniversitySamsunTurkey
  2. 2.Gulhane Military Medical Academy, Department of Physical Medicine and RehabilitationRehabilitation HospitalBilkent, AnkaraTurkey

Personalised recommendations