The Study: Immune responses following McKenzie lumbar spine exercise in individuals with acute low back pain: a preliminary study.

The Facts:

a. 40% of acute lower back pain involves the disc.

b. The disc may generate pain due to both mechanical forces and/or inflammation.

c. McKenzie exercises are sometimes used to treat these cases.

d. Cytokines are a pain mediator. Some cytokines are pro-inflammatory, whereas others work to reduce inflammation and promote healing.

e. Suppressing cytokines through the use of anti-inflammatory medications is one method used to treat low back pain cases.

f. The authors ” hypothesize that McKenzie exercises may have an immunoregulatory role that would rationalized pain relief.”

g. They took fifteen patients with acute low back pain who responded to McKenzie exercises (this was determined by noting that the patient had a centralization of their pain by performing the McKenzie exercises.).

h. Blood tests were performed.

i. They concluded that the McKenzie exercises did induce, “an immune activation state and simultaneously up regulated anti-inflammatory IL-4 cytokines that boost pain relief.”

j. Saud Al-Obaidi is from the Department of Physical Therapy in Kuwait University.

Take Home:

In patients that responded to the McKenzie exercises there was an immune activation and up regulation of anti-inflammatory cytokines.

Reviewer’s Comments:

Now let’s see if I have this correct. A mechanical treatment for a spinal problem resulted in an immune activation and up regulation of anti-inflammatory cytokines. Spinal care can result in changes in other systems of the body. Sounds like the physical therapists are talking more like chiropractors than a lot of chiropractors.

Editor’s Comments:

The authors note that it’s difficult to ascertain with certainty whether or not patients felt better because of changes in disc dynamics, or by up regulation of anti inflammatory cytokines. It seems probable that both mechanisms may well be at play, but to what degree each remains unknown. This was a small study but it’s of interest to chiropractors because it demonstrates a positive immune system response to a mechanical therapy of the spine. That’s potentially a good thing for chiropractors interested in rehab and spinal corrective care.

Editor: Mark R. Payne DC

Reviewer: Roger Coleman DC

Reference: Al-Obaidi S, Mahmound F.Immune responses following McKenzie lumbar spine exercise in individuals with acute low back pain: a preliminary study. Acta Med Acad. 2014;43:19-29

Link to Abstract: http://www.ncbi.nlm.nih.gov/pubmed/24893635

Acta Med Acad. 2014;43(1):19-29. doi: 10.5644/ama2006-124.96.
Immune responses following McKenzie lumbar spine exercise in individuals with acute low back pain: a preliminary study.
Al-Obaidi S

Abstract

OBJECTIVE:
This study explores the immune responses following 4 weeks of McKenzie lumbar spine exercise in individuals with acute low back pain (ALBP).

PATIENTS AND METHODS:
Fifteen patients with ALBP and 15 healthy individuals volunteered in this study. Ten ml of peripheral blood were obtained from each patient before and after exercise sessions, and from healthy individuals at the beginning of the study. Flow cytometric analysis was used to evaluate the frequencies of CD4+ T lymphocyte sub-populations and the intracellular cytokine expression within this cell population. Pain perceptions were obtained at baseline and following each week of exercise sessions.

RESULTS:
In comparison with healthy subjects there was an elevated frequency of memory (CD4+CD45RO+) T cells, helper inducer (CD4+CD29+) T cells, CD3+CD16+CD56+ T cells and a lower frequency of naïve/suppressor (CD4+CD45RA+) T cells at base line in back pain patients (p<0.05). After 4 weeks of McKenzie exercise sessions, pain intensity significantly decreased (p<0.05); however, there was no significant difference in the frequency of memory (CD4+CD45RO+) T cells, helper inducer (CD4+CD29+) T cells, CD3+CD16+CD56+ T cells and naïve/ suppressor (CD4+CD45RA+) T cells at base line relative to these cell populations after exercise sessions. The percentage of Pan (CD3+) T cells expressing IL-8 and TNF-α and the CD3+ T cells expressing the anti-inflammatory cytokine IL-4 increased significantly (p<0.05) following exercise sessions in comparison with baseline and healthy references. The reduction in pain scores did not correlate with elevated anti-inflammatory cytokines.

CONCLUSION:
McKenzie exercise sessions induced an immune activation state and simultaneously up regulated anti-inflammatory IL-4 cytokines that boost pain relief.

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