Deans' stroke musings: Effects of lumbar joint mobilization on trunk control, balance, and gait in patients with stroke: study protocol for a randomized controlled trial

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, February 12, 2025

Effects of lumbar joint mobilization on trunk control, balance, and gait in patients with stroke: study protocol for a randomized controlled trial

I can't easily figure out what this is, so you're on your own with your therapist.

Effects of lumbar joint mobilization on trunk control, balance, and gait in patients with stroke: study protocol for a randomized controlled trial

Trials volume 26, Article number: 50 (2025) Cite this article

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Abstract

Background

After stroke, most patients have impairments in trunk control, balance, and gait. These dysfunctions are closely related to the ability to perform activities of daily living. Therefore, restoring these functions has become the primary rehabilitation goal for stroke patients. Lumbar joint mobilization can activate the spine and surrounding muscles, increase the sensory perception of lumbar joints, restore the stability and symmetry of the trunk. Few studies have focused on the use of lumbar joint mobilization in stroke patients. The purpose of this study was to explore the effects of lumbar joint mobilization on trunk control, balance, and gait in stroke patients.

Methods

Sixty stroke patients will be recruited from the Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. The participants will be randomly divided into a control group (n = 30) and an intervention group (n = 30). Both groups will receive conventional physical therapy once a day for 4 weeks, 5 days a week. The intervention group will receive an additional 10 min of lumbar joint mobilization at the end of each conventional physical therapy session. The primary outcome measure is the Trunk Impairment Scale (TIS), the secondary outcome measures are Berg Balance Scale (BBS), Time Up & Go test (TUG) and Functional Gait Assessment (FGA). Patients will be assessed for the outcome measures at baseline and at the 4th week at the end of treatment.

Discussion

The results of this study will provide preliminary data on the efficacy of lumbar joint mobilization combined with conventional physical therapy on trunk control, balance, and gait in stroke patients.

Trial registration

The trial was registered in the Chinese Clinical Trial Registry on September 3, 2023, with the registration number ChiCTR2300075377. The URL of trial registry record: https://www.chictr.org.cn/showproj.html?proj=206313.

Peer Review reports

Background

Approximately 15 million new stroke patients are reported worldwide each year, with one-third of these patients experiencing permanent physical dysfunction. Stroke patients commonly experience diminished proprioception of the joint position due to muscle contractures and weakness, leading to limited trunk movement and impaired control [1]. Limited trunk control contributes to decreased balance [2] and walking ability [3]. Dysfunction of trunk control, balance, and gait are major functional impairments in stroke patients and are manifested as decreased ability to perform activities of daily living and social participation activities. Thus, restoring trunk control, balance and gait is a vital priority when considering poststroke rehabilitation plans.

After stroke, the pontine reticulospinal tract, which is responsible for controlling postural stability and walking function, becomes inactive due to damage to the central nerve conduction pathway. As a result, stroke patients commonly experience reduced trunk control and walking ability [4,5,6]. Additionally, they may exhibit specific limitations in trunk flexion, lateral flexion, and rotation muscle strength [7]. Limitation of trunk movement can lead to decreased proprioception of spinal joints in stroke patients [8]. To address this issue, it is necessary to implement proprioceptive stimulation techniques targeting the trunk. These interventions aim to improve the movement of spinal joints, activate the muscles of lumbar segments (such as the multifidus, transversus abdominis, and internal and external oblique muscles), and ultimately activate the pontine reticulospinal tract.

Joint mobilization is a passive manipulative technique that is performed by a physical therapist to improve physiological or accessory movements of joints, promote joint mobility and aid in proprioception recovery. Joint mobilization is primarily used in patients with musculoskeletal injuries and patients with severe central nervous system injuries accompanied by joint disorders or musculoskeletal disorders, including degeneration of joints and stiffness of tissue around joints [9]. Studies have indicated that lumbar joint mobilization can enhance the sense of position in lumbar spine joints, activate the paraspinal muscles, and improve muscle weakness, muscle tone and joint stiffness [10].

While lumbar joint mobilization shows promise as a beneficial technique for stroke rehabilitation, particularly in improving trunk control and balance, much remains to be explored. In South Korea, lumbar joint mobilization with physical therapy shows promise for improving trunk control in stroke patients. Larger studies, especially on chronic cases, are needed to confirm its effectiveness and safety [11]. In the U.S., lumbar joint mobilization is mostly used for low back pain, with limited stroke studies. Small trials show benefits for postural stability, but large RCTs are needed to confirm its effectiveness [12]. In Europe, lumbar mobilization is used in stroke rehab to improve postural symmetry and reduce stiffness, though not widely. Larger, multicenter trials are needed to assess safety and combined therapy effects [13]. To move the field forward, large-scale RCTs, and further studies on functional outcomes and adverse events are essential. By addressing these gaps, lumbar joint mobilization may become an important component of stroke rehabilitation worldwide.

Based on the above studies, we designed a large-scale RCTs and hypothesize that lumbar joint mobilization could improve trunk control, balance function and gait in stroke patients. The aim of this study was to investigate the hypothesis that lumbar joint mobilization can improve trunk control, balance function and gait in stroke patients. The outcome measurements included the Trunk Impairment Scale (TIS), the Berg Balance Scale (BBS), the Time Up & Go (TUG) test and the Functional Gait Assessment (FGA).