Original researchAnalysis of Patient Outcomes Using the MyoKinesthetic System for the Treatment of Low Back Pain: A Case Series
Introduction
Low back pain (LBP) is a widespread and costly health care epidemic. More than 1000 randomized controlled trials of various interventions used for the management of LBP have been conducted, but the evidence from these trials is contradictory and inconclusive.1, 2, 3 The lack of a gold standard for LBP diagnosis further complicates the problem. Advanced imaging detects many abnormalities in both asymptomatic and symptomatic individuals, which indicates that pathoanatomic structures may not always be responsible for symptoms.4 Radiographic imaging also cannot account for the psychogenic causes that may be the source of chronic LBP in many individuals.5 Because of a complicated etiology, approximately 85% of LBP patients receive the vague diagnosis of nonspecific LBP.2, 3, 6, 7, 8, 9
Many LBP studies lack favorable outcomes because of a heterogeneous population of nonspecific LBP patients and the focus on 1 intervention benefiting everyone.2 In an effort to rectify this problem, classification systems were developed to match patients to an appropriate treatment based on criteria discovered during a triage process of clinical evaluation.10 The primary purpose of treatment-based classification (TBC) systems is to optimize the effects of treatment.11 Because patient outcomes have improved when patients are provided a subgroup-matched treatment,1, 12, 13, 14 research on TBC systems for LBP has become a priority.11, 15
One TBC system, which has not been included in the 4 primary LBP classification systems,11 is the MyoKinesthetic (MYK) System. The MYK System is used for a variety of musculoskeletal conditions, including LBP. Developed and introduced by Dr. Michael Uriarte in 1998, the MYK System is a relatively new paradigm focused on balancing the nervous system by correcting posture abnormalities.16 Researchers have hypothesized that posture imbalances are the result of changes in the central nervous system (CNS) as it responds to afferent feedback from the body.17 The developed posture asymmetries are considered to be compensations that the CNS established in an effort to achieve pain-free, yet dysfunctional, movement.18 In this compensatory state, posture imbalances would result in restricted joint motion and decreased mechanoreceptor firing.16
In the MYK System, a clinician classifies a patient based on postural abnormalities, the presence of peripheral neuropathy, and muscle weakness. The MYK System includes a comprehensive global evaluation process, with the primary component being a full-body posture screen (Fig 1). The posture screen is used to determine the nerve root level with the greatest number of dysfunctions. The patient is then classified into 1 of 16 subgroups, or nerve root levels, based on the results of the posture assessment.16 Each of the 16 subgroups, which correspond to the 16 nerve root levels from C1 to T1 and L1 to S2, contains a matching treatment within the MYK System.16
The MYK System treatment is focused on stimulating the CNS through bilateral movements and muscle sensory stimulation. Bilateral treatment is essential because it mirrors the function of the CNS and allows for the cross-education of strength and motor skills.19, 20, 21, 22 The combination of tactile stimulation and movement stimulates mechanoreceptors of the selected nerve root pathway, resulting in decreased nociceptor firing and muscle relaxation.23, 24 Because pain and dysfunction can alter signal transmission from the CNS, MYK treatment is used to improve communication between the CNS and muscles.16 MyoKinesthetic treatment is theorized to increase afferent stimulation along a specific nerve root pathway, resulting in the generation of efferent feedback, which causes normalization of neural input and output, allowing muscles to function properly.16
Although it was introduced in 1998, the MYK System lacks independent rigorous evaluation. In 1 case study, use of the MYK System on a patient with several posture imbalances and multiple disk herniations (confirmed through magnetic resonance imaging) resulted in improvements in pain, disability, and function.25 Although studies have been conducted to assess the effectiveness of a variety of manual therapy interventions for LBP, no other has targeted the MYK System. Therefore, the purpose of this case series was to test the feasibility of using the MYK System as a TBC system and intervention for a sample of patients with LBP.
Section snippets
Design
The study design was a within-subject repeated-measures case series, with participants representing their own controls. Baseline data did not include data collected at the weekly appointments, discharge, and 1-month follow-up visits. Written informed consent was obtained from all participants prior to the initial evaluation. Patients were provided a waiver, which described the study, and asked to sign if they agreed to participate. The University of Idaho institutional review board approved the
Results
In September and October 2014, 9 consecutive patients (4 females and 5 males) were evaluated in the clinic, and all met the inclusion criteria for the study (Table 2). All 9 patients were treated with only the MYK System, and no patient had to be removed from participation. Additionally, none of the patients completed any rehabilitation exercises while participating in this study. The participants’ mean age was 31.11 years (SD = 16.04). The majority of patients reported chronic LBP (n = 6),
Discussion
In this small sample of patients with LBP, we measured meaningful improvements in pain, disability, and function at discharge and at a 1-month follow-up. Changes in the mean values of the scores on the NRS, DPA Scale, PSFS, OSW, and MYK posture screen over time may be an indication of the effects of the MYK System treatment, and the P values reflect the significance of these effects (Table 3). Additionally, the initial DPA Scale score in this study (M = 33.25) was higher than reported normal
Conclusions
The sample of patients with LBP in this case series had improved pain, disability, function, and posture in patients with LBP. The patients did not require additional treatment following discharge, and all improvements were maintained at a 1-month follow-up. Based on these findings, we suggest that the MYK System may be an appropriate TBC system for patients with LBP, who can be classified within the system, but further research is required to substantiate these findings. This study indicated
Funding Sources and Conflicts of Interest
No funding sources or conflicts of interest were reported for this study.
Contributorship Information
Concept development (provided idea for the research): K.B.
Design (planned the methods to generate the results): K.B.
Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): K.B., R.T.B., A.M.N., J.M.M.
Data collection/processing (responsible for experiments, patient management, organization, or reporting data): K.B.
Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): K.B.
Literature search
References (49)
- et al.
A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study
Ann Intern Med
(2004) - et al.
Subgrouping patients with low back pain: evolution of a classification approach to physical therapy
J Orthop Sports Phys Ther
(2007) - et al.
The cost-effectiveness of a treatment-based classification system for low back pain: design of a randomised controlled trial and economic evaluation
BMC Musculoskelet Disord
(2010) - et al.
Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians
Ann Intern Med
(2011) The Mindbody Prescription
(1999)- et al.
Pragmatic application of a clinical prediction rule in primary care to identify patients with low back pain with a good prognosis following a brief spinal manipulation intervention
BMC Fam Pract
(2005) - et al.
Research methods for subgrouping low back pain
BMC Med Res Methodol
(2010) Subgroups within “nonspecific” low back pain
J Reumatol
(2005)- et al.
Manual therapy and a suggested treatment based classification algorithm in patients with low back pain: A pilot study
J Back Musculoskelet Rehabil
(2007) - et al.
A treatment-based classification approach to low back syndrome: Identifying and staging patients for conservative treatment
Phys Ther
(1995)