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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 49-51

Management of lumbar degenerative spondylolisthesis by integrated naturopathy and yoga therapy: a case report


Department of Acupuncture and Energy Medicine, Government Yoga and Naturopathy Medical College & Hospital, Chennai, Tamil Nadu, India

Date of Submission07-Oct-2021
Date of Decision15-Jan-2021
Date of Acceptance16-Feb-2021
Date of Web Publication16-Apr-2021

Correspondence Address:
Dr. Sujithra Sreekumari Thanudhas
Government Yoga and Naturopathy Medical College and Hospital Arumbakkam, Chennai 600106, Tamil Nadu.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_97_20

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  Abstract 

Spondylolisthesis is the forward displacement of a vertebra relative to the vertebra below, and it arises as a result of a pars defect. Lumbar degenerative spondylolisthesis is an established condition, and it classically involves the L4/L5 level with mild degenerative changes; the symptoms vary from lower back pain to lower limb radiculopathy depending on the severity. The present case reported was of a 57-year-old married woman diagnosed with lumbar degenerative spondylolisthesis after an accidental fall; her symptoms began with severe pain and numbness in both legs radiating from her buttock region. This case study was done to investigate the effectiveness of combined Yoga and naturopathy therapy in relieving degenerative pain. The subject received a specific yoga protocol, which includes Yogasanas, Pranayama, and relaxation techniques along with naturopathy treatments, including hydrotherapy, acupuncture, and natural diet therapy for 30 days. According to the findings of the visual analogue scale (VAS) and SF-MPQ-2 scale, the pain symptoms score changed from 9.2 to 1.3 and from 79 to 20, respectively. This result shows that the combined effect of Yoga and naturopathy treatment helps in relieving pain and improves the quality of life in patients with degenerative spondylolisthesis.

Keywords: Acupuncture, integrated therapy, lumbar degenerative spondylolisthesis, meridian massage, naturopathy, Yoga therapy


How to cite this article:
Thanudhas SS, Narayanasamy M, Poornachandran P. Management of lumbar degenerative spondylolisthesis by integrated naturopathy and yoga therapy: a case report. J Indian Sys Medicine 2021;9:49-51

How to cite this URL:
Thanudhas SS, Narayanasamy M, Poornachandran P. Management of lumbar degenerative spondylolisthesis by integrated naturopathy and yoga therapy: a case report. J Indian Sys Medicine [serial online] 2021 [cited 2021 Jun 14];9:49-51. Available from: https://www.joinsysmed.com/text.asp?2021/9/1/49/313706




  Introduction Top


Spondylolisthesis is a common condition that occurs in the spinal cord of the lumbar vertebrae due to the repetitive microtrauma to the posterior facets: pars interarticularis of the vertebral arch.[1] The incidence ranges from 2% to 6% in the populations with lower back pain.[2] Depending on the severity of the misplacing, it is broadly classified into Grade I to Grade IV and the percentage of displacement varies from <25% for Grade I; 26–50% for Grade II; 51–75% for Grade-III; and > 75% for Grade IV. According to Wiltse, spondylolisthesis is divided into six types (Etiological Classification): degenerative, isthmic (A and B), dysplastic, traumatic, pathologic, and iatrogenic. Degenerative and isthmic (spondylolytic) types are more common in people younger than 50 years.[3] The symptoms include low back pain, back tenderness, stiffness of lower back, radiating pain, and numbness over the buttock and lower limbs. The treatment of spondylolisthesis includes medications (NSAIDs, oral steroids), epidural steroid injections, and spondylolisthesis surgery to reduce inflammation and pain on the affected site. The majority of the population may also adopt alternative therapies such as heating therapy, physiotherapy, acupuncture, Yoga therapy, and hydrotherapy for pain management and speedy recovery of the affected joint.[4]

In this study, the integrated approach of Yoga therapy and naturopathy treatment modalities such as hydrotherapy, diet therapy, acupuncture, and meridian massage were implemented to reduce the pain threshold, increase the spinal flexibility, and improve the quality of life in patients with lumbar spondylolisthesis.[5]


  Case report Top


A 57-year-old female presented to our department with a chief complaint of lower back pain for the past four years. The pain was continuous and shooting in nature, radiated to the lateral thigh muscle, and was associated with numbness in the bilateral buttock region. The pain was aggravated on physical activity and relieved on taking rest. The patient had a previous history of accidental trauma way back in 2016, and she was diagnosed with severe multilevel spinal canal stenosis from L2-S1 with a disk protrusion of ligamentum flavum with mild degenerative listhesis at L4-L5 (MRI imaging). She was on oral analgesic medication for the pain, and she did not undergo any surgical procedures.

The patient’s vitals were normal, and she presented with a dull physical attitude. On clinical evaluation, her buttocks were flat with lumbar hyper-lordosis and spastic gait was observed due to calf muscle stiffness. On palpation, tenderness was seen in the lumbar region (para spinal muscle), gluteal maximus muscle, and hamstring tightness on leg rising. Lumbar spine flexion and extension were limited and painful. Straight leg raising test and crossed SLR test were positive on both sides. Loss of sensation was noted on the L4/L5 dermatome (buttock and lateral thigh), with other neurological functions intact.

Based on the clinical evaluation and MRI findings, she was diagnosed as having mild lumbar spondylolisthesis L4/L5 with spinal stenosis. She was informed about the integrated treatment modalities, and after getting her informed consent, she got admitted in the inpatient department of our hospital. Therapeutic Yoga sessions (morning and evening), which include loosening exercises, lumbar stretch yogasanas, pranayama, and relaxation, were given, along with a mud pack to the abdomen and eyes (20 min) on a daily basis for 30 days. Acupuncture needling was given with 1 t-sun filiform needles at the specific points of UB-40, GV-6, UB-30, Sp-6, Liv-13, SI-11, K-3, GB-30, and GB-31, regularly for 15 days along with meridian massage on the kidney channel and Back Shu points on alternate days. After 30 days of admission, the patient felt an improvement in pain and stiffness and was completely free from her numbness. The details of the treatment module, dietary module, and pre- and posttreatment data are given in [Table 1], [Table 2] and [Table 3], respectively.
Table 1: Treatment module

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Table 2: Diet module for 30 days

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Table 3: Pre- and postdata

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  Discussion Top


The present case report was aimed at exploring the effect of integrated yoga and naturopathy treatment in reducing the severity of pain, spinal disability and at improving the lumbar spine flexibility, psychological well-being in patients with lumbar spondylolisthesis. In the study, VAS, Oswestry low back pain disability questionnaire, and Short form McGill Pain Questionnaire 2 (SF-MPQ-2) were used to assess the pain intensity. When compared with the predata, there was a drastic decrease in the post-pain score, which is in correlation with a previous study by Joon-Shikshin et al., which suggested that motion style acupuncture therapy helps in alleviating pain by around 30% among 58 patients by increasing the endorphins in the nervous system.[6] Yoga practice increases the brain-derived neurotropic factor (BDNF) level, and this, in turn, enhances the serotonin norepinephrine reuptake inhibitors (SNRIs), which are widely used in the treatment of pain and psychiatric symptoms.[7] A study conducted in 2015 indicated that yoga increases the flexibility of the hamstring, thereby improving the forward and backward bending of the spinal segments.[8] The findings of this case are in accordance with the earlier evidence, which shows that integrated yoga and naturopathy therapies help in relieving pain, improving the joint mobility and overall well-being of the individual.


  Conclusion Top


The findings suggest that when yoga and naturopathy were employed together, there was a significant reduction in spinal disability, pain intensity and an improvement in the quality of life in patients with lumbar spondylolisthesis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Niggemann P, Kuchta J, Beyer HK, Grosskurth D, Schulze T, Delank KS Spondylolysis and spondylolisthesis: Prevalence of different forms of instability and clinical implications. Spine (Phila Pa 1976) 2011;36:E1463-8.  Back to cited text no. 1
    
2.
Magora A Conservative treatment in spondylolisthesis. Clin Orthop 1976;117:74-9.  Back to cited text no. 2
    
3.
Huijbregts PA HSC 11.2.4. Lumbopelvic region: Aging, disease, examination, diagnosis, and treatment. In: Wadsworth C, editor. HSC 11.2. Current Concepts of Orthopaedic Physical Therapy. LaCrosse, Wl: Orthopaedic Section APTA; 2001.  Back to cited text no. 3
    
4.
Morita T, Ikata T, Katoh S Pathogenesis of spondylolysis and spondylolisthesis in young athletes based on a radiological and MRI study. In: North American Spine Society/Japanese Spine Research Society Spine across the Sea Meeting, Maui, Hawai; 1994.  Back to cited text no. 4
    
5.
Rastogi R Current approaches of research in naturopathy: How far is its evidence base? J Homeopath Ayurvedic Med 2012;1: 1000107.  Back to cited text no. 5
    
6.
Shin JS, Ha IH, Lee J, Choi Y, Kim MR, Park BY, et al. Effects of motion style acupuncture treatment in acute low back pain patients with severe disability: A multicenter, randomized, controlled, comparative effectiveness trial. Pain2013;154:1030-7.  Back to cited text no. 6
    
7.
Lee M, Moon W, Kim J Effect of yoga on pain, brain-derived neurotrophic factor, and serotonin in premenopausal women with chronic low back pain. Evid Based Complement Alternat Med 2014;2014:203173.   Back to cited text no. 7
    
8.
Nishikawa Y, Aizawa J, Kanemura N, Takahashi T, Hosomi N, Maruyama H, et al. Immediate effect of passive and active stretching on hamstrings flexibility: A single-blinded randomized control trial. J Phys Ther Sci 2015;27:3167-70.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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