Musculoskeletal Medicine and PainOriginal ArticleCME

Manual treatment for kidney mobility and symptoms in women with nonspecific low back pain and urinary infections

Francesca Lo Basso, PT; Alessandra Pilzer, PT; Giulio Ferrero, MD; Francesco Fiz, PhD; Emanuele Fabbro, MD; Daniele Oliva, PT; Clizia Cazzarolli, MSc(PT); and Andrea Turrina, PT
Notes and Affiliations
Notes and Affiliations

Received: November 9, 2020

Accepted: November 20, 2020

Published: March 11, 2021

  • Francesca Lo Basso, PT, 

    Private Practice, Studio Fisioterapico Loano, Loano, Italy

  • Alessandra Pilzer, PT, 

    ASL CN2, Alba, Italy

  • Giulio Ferrero, MD, 

    Diagnostic and Interventional Radiology Unit, Ospedale Santa Corona, Pietra Ligure, Italy

  • Francesco Fiz, PhD, 

    Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

  • Emanuele Fabbro, MD, 

    Radiology Unit, Ospedale S Croce e Carle, Cuneo, Italy

  • Daniele Oliva, PT, 

    Private Practice, Studio Fisioterapico Loano, Loano, Italy

  • Clizia Cazzarolli, MSc(PT), 

    Escuela de Osteopatia de Madrid, Mozzecane, Italy

  • Andrea Turrina, PT, 

    Escuela de Osteopatia de Madrid, Mozzecane, Italy

Abstract

Context: Recent studies have suggested a connection between low back pain (LBP) and urinary tract infections (UTI). These disturbances could be triggered via visceral-somatic pathways, and there is evidence that kidney mobility is reduced in patients suffering from nonspecific LBP. Manual treatment of the perinephric fascia could improve both kidney mobility and LBP related symptoms.

Objectives: To assess whether manual treatment relieves UTI and reduces pain in patients with nonspecific LBP through improvement in kidney mobility.

Methods: Records from all patients treated at a single physical therapy center in 2019 were retrospectively reviewed. Patients were included if they were 18 years of age or older, had nonspecific LBP, and experienced at least one UTI episode in the 3 months before presentation. Patients were excluded if they had undergone manipulative treatment in the 6 months before presentation, if they had one of several medical conditions, if they had a history of chronic pain medication use, and more. Patient records were divided into two groups for analysis: those who were treated with manipulative techniques of the fascia with thrust movement (Group A) vs those who were treated without thrust movement (Group B). Kidney Mobility Scores (KMS) were analyzed using high resolution ultrasound. Symptoms as reported at patients’ 1 month follow up visits were also used to assess outcomes; these included UTI relapse, lumbar spine mobility assessed with a modified Schober test, and lumbar spine pain.

Results: Of 126 available records, 20 patients were included in this retrospective study (10 in Group A and 10 in Group B), all of whom who completed treatment and attended their 1 month follow up visit. Treatments took place in a single session for all patients and all underwent ultrasound of the right kidney before and after treatment. The mean (± standard deviation) KMS (1.9 ± 1.1), mobility when bending (22.7 ± 1.2), and LBP scores (1.2 ± 2.6) of the patients in Group A improved significantly in comparison with the patients in Group B (mean KMS, 1.1 ± 0.8; mobility when bending, 21.9 ± 1.1; and LBP, 3.9 ± 2.7) KMS, p<0.001; mobility when bending, p=0.003; and LBP, p=0.007). At the 1 month follow up visit, no significant statistical changes were observed in UTI recurrence (secondary outcome) in Group A (−16.5 ± 4.3) compared with Group B (−20.4 ± 7) (p=0.152).

Conclusions: Manual treatments for nonspecific LBP associated with UTI resulted in improved mobility and symptoms for patients in this retrospective study, including a significant increase in kidney mobility.

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