Lumbar Radiculopaty
Lumbar Radiculopaty
Lumbar Radiculopaty
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a
Department of Anatomy, Faculty of Medicine, Duzce University, Duzce, Turkey
b
Department of Physical Medicine and Rehabilitation, Malatya Training and Research Hospital, Malatya, Turkey
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c
Department of Anatomy, Faculty of Medicine, İnönü University, Malatya, Turkey
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d
Department of Anatomy, Faculty of Medicine, Karabuk University, Karabuk, Turkey
e
Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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Abstract.
BACKGROUND: Lumbar radiculopathy is characterized by a significant amount of backache causing loss of workforce and is a
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exercises (PE) on ankle proprioception and lumbar pain between patients with lumbar radiculopathy and a healthy control group.
METHODS: In this randomized clinical trial, 89 patients referred to the Physical Medicine and Rehabilitation outpatient clinic
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were selected through convenience sampling. They were randomly assigned to three groups: CT (n = 27), PE (n = 31), CT&PE
(n = 31). Thirty healthy volunteers were included in the study as the control group. Proprioception measurements were made with
an isokinetic dynamometer at 10◦ dorsiflexion (DF), 11◦ , and 25◦ plantarflexion (PF) angles. Lumbar pain was assessed by using
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the Numerical Pain Rating Scale (NPRS). The data were analyzed by IBM SPSS Statistics version 22.0 via the Kruskal-Wallis and
Mann-Whitney U tests.
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RESULTS: There was a statistically significant difference between the groups in terms of ankle proprioception and NPRS
measurements in post-treatment evaluations (p < 0.05). Statistically significant differences were found between CT and PE groups
and CT&PE and control groups. There was no statistically significant difference in comparing CT and PE groups and CT&PE and
control groups within themselves (p > 0.05).
CONCLUSION: The combined use of CT and PE is an effective method that can be used in the clinic to reduce angular
differences in ankle proprioception which is one of the primary factors of balance and coordination and lumbar pain.
1. Introduction 1
∗ Corresponding
Lumbosacral radiculopathy is a term used to describe 2
author: Gokcen Akyurek, Department of Occu-
pational Therapy, Faculty of Health Sciences, Hacettepe Univer-
a pain syndrome caused by compression or irritation of 3
sity, Ankara, Turkey. Tel.: +90 5426136228; E-mail: gkcnakyrk@ nerve roots in the lower back [1]. It can be caused by 4
ISSN 1053-8127/$35.00
c 2021 – IOS Press. All rights reserved.
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6 bra, and narrowing of the foramen where the nerves exit awareness has emerged about the significance of propri- 57
7 the spinal canal [1,2]. While the literature lacks concise oception, and special rehabilitation programs increasing 58
8 epidemiologic data, most reports estimate about a 3% to proprioception have been added in the treatment proto- 59
9 5% prevalence rate of lumbosacral radiculopathy in pa- cols of locomotor system diseases, especially in sports 60
10 tient populations [3]. Symptoms can include numbness, injuries. In patients with lumbar radiculopathy, dam- 61
11 weakness, and loss of reflexes, radiating pain, and gait aged dermatomal and myotomal fields may cause devi- 62
12 abnormalities [1,2]. Untreated lumbar radiculopathies ations in the ankle proprioception angle [5]. Correcting 63
13 will lead to restriction in movements to avoid pain, re- proprioceptive errors enables patients to gain more use 64
14 sulting in disruption of the spine and lower extremity of the treatment, decrease recurrent traumas and assure 65
15 mechanism and inviting secondary radiculopathy [4]. a quicker return to routine daily activities [15,16]. This 66
16 In this respect, it is thought that exercise and physical study hypothesizes that the methods used in routine 67
17 therapy methods have critical importance in this patient physiotherapy can be effective on ankle proprioception 68
19 A problem in any part of the locomotor system causes radiculopathy and can get patients closer to healthy 70
20 too much load on the muscles and joints, and conse- controls. This study aims to compare the effects of con- 71
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21 quently, agonist-antagonist muscle imbalance and se- ventional physiotherapy (CT), proprioception exercises 72
22 rious injuries occur [5–7]. For example, disturbed pro- (PE), and combined use of conventional physiotherapy 73
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23 prioception leads to altered neuromuscular function, and proprioception exercises (CT&PE) on ankle pro- 74
which, if not corrected, may further exacerbate the in- prioception and lumbar pain in patients with lumbar
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24 75
25 jury and lead to a pattern of reinjury [7]. There are stud- radiculopathy. In addition, we aimed to evaluate the
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26 ies reporting impairment in postural balance in lum- effectiveness of the treatment by comparing the post- 77
27 bar radiculopathy [8–10]. While individuals with lum- treatment outcomes with the control group. 78
33 sulting tissue damage [12]. Pain causes the inhibition Research Hospital after approval was obtained from 81
34 of the related muscle activity and imbalance of agonist- the Malatya Clinical Researches Ethics Committee (no. 82
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35 antagonist muscles [13,14]. This instability causes an 2018/68). Eighty-nine out of 115 patients between the 83
36 increase in loads of muscles or joints, which causes ages of 25–65 who were referred to the Malatya Train- 84
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37 them not to fulfill their functions correctly and thus to ing and Research Hospital Physical Medicine and Re- 85
38 get injured. Some studies have shown that injuries and habilitation outpatient clinic and who were diagnosed 86
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39 instability in joints decrease proprioception [15,16]. with lumbar radiculopathy with magnetic resonance 87
40 For good posture, the nervous system and the mus- imaging by a specialist physician were included in the 88
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41 cles and joints should work in harmony and make the study. Twenty-six patients who did not meet the inclu- 89
42 movements fit for purpose [17]. While the nervous sys- sion criteria and delayed the treatment days were not 90
43 tem makes the muscles, an active element of the loco- included in the study. The patients were distributed into 91
44 motor system, work through the sent impulses, it also groups in a randomized controlled manner, as 27 re- 92
45 receives messages from specialized mechanoreceptors ceiving CT, 31 receiving PE, and 31 receiving CT&PE. 93
46 in joints, tendons, ligaments, and the skin [17]. This The flowchart of the study is presented in Fig. 1. 94
47 sense is called proprioception, and it is accepted as one There were no sensory and motor deficits in 30 95
48 of the parameters that ensure the protection of postu- healthy volunteers who were included in the study as 96
49 ral control and balance [18]. The messages originating the control group. Age, height, weight, dominant side, 97
50 from mechanoreceptors and the visual-vestibular sys- pre-treatment, and post-treatment measurements of all 98
51 tem are gathered together; thus, we have information participants included in the study were recorded. 99
52 about the position of our bodies in space [19]. All patients had a full body examination, including 100
53 Although a study on the lumbar region has examined the locomotor system. The patients who had an in- 101
54 the spine’s stability [4], the number of studies evaluat- fectious, inflammatory, tumoral, and metabolic pathol- 102
55 ing the proprioception status, including lower extremity ogy that could cause pain, patients with a history of 103
56 muscles and joints, is quite limited. Recently, a serious spinal surgery, patients who had a spinal instability 104
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physiotherapist. 139
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Fig. 1. Flowchart of the study.
plantarflexion (PF) positions by using an active repro- 148
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105
peating positioning actively and passively. First, the 150
106 (BMI) higher than 30 kg/m2 , severe cardiovascular or
extremity on which the inclinometer was fastened was
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151
107 metabolic disease, pregnant women and those who had
brought to the targeted angle, and the subject was kept 152
108 received physiotherapy and medical treatment for the
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in that position for a minimum of 10 seconds to re- 153
109 lumbar region within the last six months were not in-
member this position. Then, the extremity was taken 154
110 cluded in the study. The healthy volunteers included in
to the initial position. The participant was asked to ac-
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155
111 the control group were examined by a specialist. The
tively bring the extremity to the target angle or indicate 156
112 control group did not have any known systemic, loco-
when s/he reached the predetermined angle passively. 157
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115
bring the extremity actively to the predetermined an- 160
116
receptors, whereas passive positioning primarily mea- 162
117 Conventional physiotherapy agents were as follows: This study evaluated the proprioceptive function as a 164
118 Transcunatenus Electrical Nerve Stimulation (TENS) whole in line with the literature. Following a trial test, 165
was applied on the lumbar region in all patients 20 min-
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119
the subjects were asked to move their ankles to target 166
120 utes a day, five days a week for three weeks with Com- angles three times, and the mean value was recorded as 167
pex Theta MI Pro. In addition, 20 minutes of hot pack
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121
well as the measured average distance. A medical doc- 168
122 application was used as a superficial heat agent. Ul- tor performed the ankle proprioception measurements. 169
123 trasound (US) was used as a deep heat agent and was All of the evaluation methods were conducted on the 170
124 applied with a frequency of 1 MHz and 1.5 watts/cm2 dominant side [25]. 171
125 intensity for 10 minutes [20]. CT agents were applied
126 by the same physiotherapist for five days a week, three 2.4. Pain analysis 172
127 weeks in total.
Pain analysis was evaluated by the Numerical Pain 173
128 2.2. Proprioception exercises Rating Scale (NPRS). The NPRS is a measure of pain 174
129 Exercises for the PE group (balance on one foot with most commonly used is the 11-item NPRS. It is a seg- 176
130 arms open on sides in line with the chest, dorsiflexion- mented numeric version of the visual analog scale in 177
131 plantar flexion, inversion-eversion exercises on the bal- which a respondent selects a whole number (0–10). 178
132 ance board with eyes open and eyes closed (EO, EC), 0 represents no pain, and 10 represents severe pain 179
133 walking training on an uneven surface) were performed (“as bad as you can imagine” and “worst pain imagin- 180
134 with the same physiotherapist for five days a week, able”) [26]. 181
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Table 1
The median (min-max) values of age, weight, height and BMI variables of CT, PE, CT&PE and control groups
Sex Parameter CT PE CT&PE Control p
Male Age (year) 43 (26–62) 44.1 (24–65) 46.5 (22–64) 46.6 (22–63) 0.141
Weight (kg) 83.5 (69–93) 86.2 (65–97) 80 (65–99) 81.1 (73–91.9) 0.138
Height (cm) 176 (168–187) 180 (170–191) 175 (168–191) 177 (167–190) 0.092
BMI (kg/m2 ) 25.1 (22.3–28.6) 24 (21.1–28.3) 26.4 (22–29.6) 25.6 (21.5–27.9) 0.296
Female Age (year) 48 (23–64) 47 (23–60) 47 (24–65) 50 (25–63) 0.091
Weight (kg) 75 (47–91) 71.5 (47–98) 73 (45–101) 74 (44.5–96) 0.123
Height (cm) 160 (148–178) 163 (151–178) 163 (150–183) 162 (151–177) 0.236
BMI (kg/m2 ) 24 (22–27.5) 25.2 (23.2–29) 25.3 (21–28.7) 26.1 (23.1–28.9) 0.178
CT: Conventional physiotherapy, PE: Proprioception exercises, CT&PE: Combined use of conventional physiotherapy
and proprioception exercises, BMI: Body mass index.
Table 2 Table 3
Median (min-max) values and Wilcoxon test analysis results of pre- Median (min-max) values and Wilcoxon test analysis results of pre-
treatment post-treatment ankle proprioception and NPRS measure- treatment post-treatment ankle proprioception and NPRS measure-
ments of male and female patients in the CT group ments of male and female patients in the PE group
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Sex Variables Pre-treatment Post-treatment p Sex Variables Pre-treatment Post-treatment p
Male EO10◦ DF 4.9 (1–8.1) 4.2 (0–7.7) 0.112 Male EO10◦ DF 4.9 (1–7.2) 4.7 (1–6.7) 0.200
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EO11◦ PF 8.8 (1–12.3) 7.3 (0–11.1) 0.048 EO11◦ PF 8.9 (1–14) 6.9 (0–12) 0.033
EO25◦ PF 7.9 (1–13.4) 6.1 (0–11.3) 0.040 EO25◦ PF 8.2 (1–13.9) 6.4 (0–13.1) 0.016
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EC10◦ DF 5.5 (1.5–10.4) 5.4 (0–10) 0.232 EC10◦ DF 6 (1–9.2) 5.5 (0–10.1) 0.172
EC11◦ PF 8.3 (2.8–13.7) 6.3 (1.1–10.7) 0.034 EC11◦ PF 8.9 (1.5–12.3) 6.5 (0–11.7) < 0.001
EC25◦ PF EC25◦ PF 10.2 (1.2–15)
9.2 (1–16.8) 7 (0–13.2) < 0.001
fv 6.8 (0–12.4) < 0.001
NPRS 7 (5–9) 4 (2–7) < 0.001 NPRS 8 (4–10) 4 (0–8) < 0.001
Female EO10◦ DF 5.1 (1–10.2) 4.8 (0–11) 0.098 Female EO10◦ DF 6 (1–9.9) 5.3 (0.5–12) 0.123
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EO11◦ PF 7.2 (1.5–12.1) 6.1 (0–10.3) 0.047 EO11◦ PF 8 (1–11.2) 5.9 (0–9.5) < 0.001
EO25◦ PF 7.5 (2.4–13) 6.2 (0–13.7) 0.440 EO25◦ PF 7.1 (1.5–11) 6 (0–13.7) 0.310
EC10◦ DF 6.3 (3–12.6) 6.3 (0.5–13.4) 0.261 EC10◦ DF 6.4 (2–11) 6 (0–12.3) 0.203
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EC11◦ PF 7.7 (0.5–10.7) 6.7 (0–11.5) 0.038 EC11◦ PF 8.7 (1–11.5) 6.5 (0–13) 0.001
EC25◦ PF 9.7 (2–14.2) 7.7 (1–12) 0.022 EC25◦ PF 9.4 (1–13) 7.2 (0–11.5) 0.005
NPRS 7 (4–9) 4 (1–9) 0.029 NPRS 7 (4–10) 4 (0–10) < 0.001
ed
DF: Dorsiflexion, EO: Eyes Open, EC: Eyes Close, PF: Plantarflex- DF: Dorsiflexion, EO: Eyes Open, EC: Eyes Close, PF: Plantarflex-
ion, NPRS: Numerical Pain Rating Scale. ion, NPRS: Numerical Pain Rating Scale.
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184
185 data were not normally distributed. Kruskal-Wallis test Sex Variables Pre-treatment Post-treatment p
186 was applied to the groups to compare the age, weight, Male EO10◦ DF 5.9 (1–10.1) 3.5 (0–9.2) 0.047
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187 height, BMI, and post-treatment measurement results EO11◦ PF 6.5 (2–12.5) 4.5 (0–11.1) < 0.001
188 of the groups. Wilcoxon matched-pairs test was applied EO25◦ PF 7.4 (0.5–12.5) 3.5 (0–10.8) < 0.001
EC10◦ DF 6.5 (1.2–12) 3.2 (0–9.7) < 0.001
189 on the data to compare pre-treatment, post-treatment EC11◦ PF 6.7 (1–10.9) 5.1 (0–10.5) 0.040
190 proprioception measurements, and NPRS values. The EC25◦ PF 6.6 (0–11.9) 5.1 (1.2–13.4) 0.043
191 Mann-Whitney U test was applied as a post hoc test, NPRS 7 (4–10) 1 (0–5) < 0.001
192 and adjusted p values were given. The data with ab- Female EO10◦ DF 6.3 (2–12.3) 4.1 (0–9.4) < 0.001
EO11◦ PF 6.9 (0–10.2) 5 (0–11.2) 0.027
193 normal distribution were expressed with median and EO25◦ PF 7.2 (1–14) 4.7 (1.9–10.8) < 0.001
194 minimum (min) and maximum (max) values. A p-value EC10◦ DF 6.4 (0–11.5) 5.1 (0.7–10.5) 0.028
195 of < 0.05 was accepted as statistically significant. IBM EC11◦ PF 7.4 (0–13.7) 5.2 (1.1–10.3) < 0.001
196 SPSS Statistics 22.0 for Windows program was used EC25◦ PF 8.2 (1.3–13.5) 5.2 (0.4–12.4) < 0.001
NPRS 7 (3–10) 1 (0–6) < 0.001
197 for statistical analysis.
DF: Dorsiflexion, EO: Eyes Open, EC: Eyes Close, PF: Plantarflex-
ion, NPRS: Numerical Pain Rating Scale.
198 3. Results
(year), weight (kg), height (cm), and BMI (kg/m2 ) 200
199 Table 1 shows median (min-max) values of age of male and female patients in different groups and 201
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Table 5
Median (min-max) values of post-treatment measurements of ankle proprioception and NPRS in CT,
PE, CT&PE and control groups and Kruskall-Wallis test analysis results
Sex Variables CT PE CT&PE Control p
Male EO10◦ DF 4.2 (0–7.7) 4.7 (1–6.7) 3.5 (0–9.2) 3.1 (0–5) 0.055
EO11◦ PF 7.3 (0–11.1) 6.9 (0–12) 4.5 (0–11.1) 3.4 (0–10) 0.031
EO25◦ PF 6.1 (0–11.3) 6.4 (0–13.1) 3.5 (0–10.8) 3.2 (0–8.3) < 0.001
EC10◦ DF 5.4 (0–10) 5.5 (0–10.1) 3.2 (0–9.7) 3.1 (0–7.1) 0.040
EC11◦ PF 6.3 (1.1–10.7) 6.5 (0–11.7) 5.1 (0–10.5) 4.1 (2–8.7) < 0.001
EC25◦ PF 7 (0–13.2) 6.8 (0–12.4) 5.1 (1.2–13.4) 4 (0–11) < 0.001
NPRS 4 (2–7) 4 (0–8) 1 (0–5) 0 < 0.001
Female EO10◦ DF 4.8 (0–11) 5.3 (0.5–12) 4.1 (0–9.4) 3.3 (0–6.5) 0.051
EO11◦ PF 6.1 (0–10.3) 5.9 (0–9.5) 5 (0–11.2) 3.7 (0–9.5) 0.011
EO25◦ PF 6.2 (0–13.7) 6 (0–13.7) 4.7 (1.9–10.8) 3.9 (0–10.3) < 0.001
EC10◦ DF 6.3 (0.5–13.4) 6 (0–12.3) 5.1 (0.7–10.5) 4.4 (0–8.8) 0.023
EC11◦ PF 6.7 (0–11.5) 6.5 (0–13) 5.2 (1.1–10.3) 5 (1–10) 0.036
EC25◦ PF 7.7 (1–12) 7.2 (0–11.5) 5.2 (0.4–12.4) 4.9 (0–9.9) < 0.001
NPRS 4 (1–9) 4 (0–10) 1 (0–6) 0 < 0.001
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CT: Conventional physiotherapy, CT&PE: Combined use of conventional physiotherapy and propriocep-
tion exercises, DF: Dorsiflexion, EO: Eyes Open, EC: Eyes Close, PF: Plantarflexion, PE: Proprioception
exercises, NPRS: Numerical Pain Rating Scale.
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EO10◦ DF, EO11◦ PF, EO25◦ PF, EC10◦ DF, EC11◦
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202 Kruskal-Wallis test analysis results. According to the 235
203 results of the analysis, it was found that there were PF, EC25◦ PF, and NPRS values of female and male 236
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patients (p < 0.05). It was found that the angular dif-
204 no statistically significant differences between the age, 237
205 weight, height, and BMI variables of the groups (p > ferences in post-treatment proprioception scores and 238
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206 0.05) (Table 1). pain decreased in both male and female patients in the 239
207 Table 2 shows median (min-max) values of pre- CT&PE group (Table 4). 240
treatment and post-treatment proprioception measure- Table 5 shows median (min-max) values of post-
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208 241
209 ments and NPRS of the individuals in the CT group in treatment proprioception measurements and NPRS val- 242
210 addition to Wilcoxon test analysis results. According to ues of the individuals in CT, PE, CT&PE, and control 243
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211 the analysis results, a statistically significant difference groups and Kruskal-Wallis test analysis results. Ac- 244
212 was found between pre-treatment and post-treatment cording to the analysis results, a statistically significant 245
213 EO11◦ PF, EO25◦ PF, EC11◦ PF, EC25◦ PF, and NPRS 246
values of female and male patients (p < 0.05). It was EO25◦ PF, EC10◦ DF, EC11◦ PF, EC25◦ PF, and NPRS 247
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214
215 seen that the angular differences in post-treatment pro- parameters of both men and women (p < 0.05). It was 248
216 prioception scores and pain decreased in both male and found that both men and women in CT&PE and control 249
250
217 female patients in the CT group (Table 2).
218 Table 3 shows median (min-max) values of pre- proprioception scores and pain scores than men and 251
252
219 treatment and post-treatment proprioception measure-
220 ments and NPRS of the individuals in the PE group The Mann-Whitney U test was applied to the data 253
234 was found between pre-treatment and post-treatment cant amount of backache that can cause loss of work- 265
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Table 6
Adjusted p values of Mann-Whitney U test applied as post hoc test
Binary
Sex EO11◦ PF EO25◦ PF EC10◦ DF EC11◦ PF EC25◦ PF NPRS
comparison
Male CT-PE 0.125 0.231 0.229 0.315 0.214 0.398
CT-CT&PE < 0.001 < 0.001 0.045 < 0.001 < 0.001 < 0.001
CT-Control < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
PE- CT&PE < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
PE-Control < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
CT&PE-Control 0.288 0.119 0.099 0.375 0.087 0.093
Female CT-PE 0.199 0.214 0.202 0.207 0.096 0.121
CT-CT&PE < 0.001 < 0.001 0.038 < 0.001 < 0.001 < 0.001
CT-Control < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
PE-CT&PE 0.023 < 0.001 0.034 < 0.001 < 0.001 < 0.001
PE-Control < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
CT&PE-Control 0.176 0.312 0.276 0.121 0.067 0.073
CT: Conventional physiotherapy, CT&PE: Combined use of conventional physiotherapy and proprioception
exercises, DF: Dorsiflexion, EO: Eyes Open, EC: Eyes Close, PF: Plantarflexion, PE: Proprioception exercises,
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NPRS: Numerical Pain Rating Scale.
force, is a significant health problem frequently seen provides significant improvement in ankle EO11◦ PF,
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266 300
267 in the general population [27]. A considerable num- EO25◦ PF, EC11◦ PF, EC25◦ PF, and NPRS in indi- 301
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268 ber of patients with lumbar radiculopathy evaluated in viduals with lumbar radiculopathy, it was not found to 302
269 the present study were randomly allocated to treatment have an advantage over CT&PE. 303
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270 groups. At the end of the study, the groups were com- In our daily lives, the localization and proprioception 304
271 pared with the control group. According to the analysis of the lower extremity, and thus the ankle, gain impor- 305
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272 results, when pre-treatment and post-treatment mea- tance in providing and maintaining balance while walk- 306
273 surements were compared between male and female ing and standing. Proprioceptive mechanisms appear 307
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274 patients in CT and PE groups, EO11◦ PF, EO25◦ PF, to play a role in joint stabilization and may serve as a 308
275 EC11◦ PF, EC25◦ PF angular differences and NPRS means for interplay between static stabilizers and dy- 309
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276 scores were found to decrease. When pre-treatment and namic muscular restraints [32]. Malliou et al. reported 310
277 post-treatment measurements in male and female pa- that exercise in the group receiving proprioceptive exer- 311
tients in the CT&PE group were compared, EO10◦ DF, cise had a major improvement effect on proprioception
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278 312
279 EO11◦ PF, EO25◦ PF, EC10◦ DF, EC11◦ PF, EC25◦ PF and reduced lower extremity injuries due to radiculopa- 313
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280 angular differences and NPRS scores were decreased. thy [33]. Lu et al. assessed the efficiency of propriocep- 314
281 In post-treatment assessments, statistically significant tive exercises in patients with LDH and reported a sig- 315
differences were present in both men and women in nificant increase in the post-treatment spinal stabiliza-
co
282 316
283 EO11◦ PF, EO25◦ PF, EC10◦ DF, EC11◦ PF, EC25◦ tions of the exercise group [34]. Lin and Lin reported 317
PF, and NPRS parameters between groups. Statistically that older patients with lumbar nerve root compression
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284 318
285 significant differences were found between CT and PE had weaker leg muscle strength and poorer balance con- 319
286 groups and CT&PE and control groups. In the com- trol than healthy older adults [35]. As a result of this 320
287 parison of CT and PE groups and CT&PE and control study, it was concluded that there were statistically sig- 321
288 groups within themselves, no statistically significant nificant improvements in EO11◦ PF, EO25◦ PF, EC11◦ 322
289 differences were found. PF, EC25◦ PF, and NPRS results of individuals with 323
290 Although lumbar radiculopathy has many alterna- lumbar radiculopathy in the PE group; however, this 324
291 tive treatments such as CT, acupuncture, chiroprac- was not an advantage over the CT&PE group. 325
292 tic manipulation, exercises, traction, epidural injection, Exercises aiming at paraspinal muscle strength, 326
293 and surgery, CT and exercise therapies stand out be- which are frequently applied in routine treatment, pro- 327
294 cause they are easily accessible and non-invasive meth- vide endurance and recovery in spinal mobility. This 328
295 ods [28,29]. The literature remarks that CT is used type of exercise provides the centralization of the nu- 329
296 frequently in the treatment of individuals with low cleus pulposus and ensures the regression of symptoms 330
297 back pain. Statistically significant improvement in ki- in the presence of herniated nucleus pulposus, espe- 331
298 nesiophobia, disability, and pain is reported after treat- cially after the acute phase [36]. Although this situation 332
299 ment [30,31]. In this study, while it was found that CT causes regression in pain and thus positive results in 333
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334 proprioceptive input, proprioceptive exercises applied for physiotherapists, physiatrists, neurosurgeons, spine 382
335 in this study are very valuable in providing a quick surgeons, and clinicians and provide a basis for other 383
336 transformation of the required proprioceptive input for studies to be conducted. 384
342 with LDH was the same as the healthy individuals and curation, methodology, validation, visualization; and 387
343 that postoperative controls showed improvement after writing-original draft. TK, GA, MC: Validation, for- 388
344 surgery [37]. mal analysis, resources; and writing-review and editing. 389
345 When situations such as pain or paraesthesia result- DŞ and DÖ: Conceptualization, methodology, valida- 390
346 ing from radiculopathy regress, the individual can show tion, visualization; writing-review and editing; fund- 391
347 his/her actual motor performance. Although the mech- ing acquisition and supervision. All authors read and 392
348 anism of the association between the increase in mo- approved the final manuscript. 393
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349 tor strength and the development obtained in the pro-
350 prioception is not completely known, it is stated that
Conflict of interest
si
394
351 strengthening the motor component of the sensorimo-
tor system can cause the motor response to be faster
er
352
The authors declare that there is no conflict of inter- 395
353 and more suitable. However, sensory stimulation does est.
fv 396
354 not change [38]. Studies conducted in the literature on
355 low back pain show that patients were reported to have
higher angular deviations than healthy individuals in
oo
356
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