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Biomedical subjects

J A Porterfield

Publications and source records attributed to J A Porterfield.

5 recordsLinked to original sources

A physical therapy model for the treatment of low back pain.

Low back pain is commonly seen in physical therapy practice, and many methods of treatment are used to reduce it. In this article, we discuss the magnitude of the low back pain problem, outline the various treatment methods, and develop a strategy to classify and standardize the treatment of the patient who has low back pain. We will develop this thought process by discussing five management considerations: (1) the dilemma of diagnosis, (2) the information gained from the assessment, (3) a patient classification system, (4) the objectives of the low back treatment process, and (5) a proposed physical therapy intervention model that matches the objectives of treatment to the classification of the patient.

Acute Disease

Isokinetic lifting strength and occupational injury. A prospective study.

One hundred seventy-one nurses had their back strength evaluated on an isokinetic lifting device and filled out an epidemiologic questionnaire. They were then followed prospectively for 2 years to determine the incidence of job-related low-back injuries. The data were analyzed to determine if the injury incidence correlated with any of the strength or epidemiologic variables collected during the original evaluation. Average peak force measured during the isokinetic lift was 63.8 kg + 13.6 kg at a lift speed of 30.5 cm/sec and 59.1 kg + 14.9 kg at a lift speed of 45.7 cm/sec. Sixteen nurses reported an occurrence of job-related low-back pain or injury during the 2-year prospective period. Discriminate statistical techniques showed that none of the strength or epidemiologic variables correlated with the incidence of pain or injury or explained significant amounts of variance when the variables were regressed on strength or work calculated from the lift force/lift height data. It was concluded that in this high risk population, in which loads are heavy and lifting postures are variable, the use of low-back strength or prior history of pain or injury are poor predictors as to subsequent low-back pain or injury.

Adult

Myoelectric activity and sequencing of selected trunk muscles during isokinetic lifting.

Trained weight lifters lift heavy loads without a concomitant degree of acute low-back injuries. To study the process by which large loads are lifted with minimal injury, integrated electromyographic signals were recorded from four large muscle groups: gluteus maximus, quadriceps, latissimus dorsi, and erector spinae in 4 weight lifters and 11 asymptomatic control subjects. These signals were recorded during a floor-to-knuckle-height isokinetic lift (dead lift) at 30.5 and 45.7 cm/sec. The signals were normalized for the height of the lift and the maximal isokinetic integrated electromyographic activity. The weight lifters achieved maximal force at 50% of maximal lift height, whereas the control subjects achieved it at 67%. Although not statistically significant, the weight lifters used the gluteus maximus more during the early stages of the lift, perhaps contributing to earlier development of force. This process would stabilize the pelvis and permit the erector spinae to extend the trunk more efficiently. The weight lifter then completed the lift with prolonged and increasing activity in the quadriceps. This technique may minimize the required force in the erector spinae and the forces on the low-back structures. Clinical implications include more effective strength training of lifting muscle groups other than spinal extensors and the teaching of lifting strategies employed by weight lifters in low-back rehabilitation and work-hardening programs.

Back

Simulated lift testing using computerized isokinetics.

Eighty-four volunteer asymptomatic men between 18 and 40 years of age were evaluated as to their ability to lift. An innovative isokinetic device was used to measure lifting force. This device does not isolate any specific body part, yet it measures the muscular force of lifting an object whose speed of ascent is controlled. Two lifting methods (bent knee, straight leg) and two foot positions were used. The results indicate the bent-knee lift method and forward-foot position was the position of optimal force production. Force production increase was inversely proportional to age. The authors concluded that the isokinetic lift device has promising capabilities to produce repeatable data and may be advantageous in generating standards for rehabilitation and specific job criteria.

Adolescent