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PubMed2003

The association of backpack use and back pain in adolescents.

STUDY DESIGN: A cross-sectional study comprising the first phase of an ongoing, longitudinal prospective study was conducted. OBJECTIVE: To investigate the relation between backpack use and back pain in adolescents. SUMMARY OF BACKGROUND DATA: The prevalence of nonspecific back pain increases dramatically during adolescence from less than 10% in the pre-teen-age years up to 50% in 15- to 16-year-olds. There is widespread concern that heavy backpacks carried by adolescents contribute to the development of back pain. METHODS: A total of 1126 children, ages 12 to 18 years, participated by completing a questionnaire about their health, activities, and backpack use. Each child's body weight, height, and backpack weight were measured. A child was classified as having back pain if one or more of the following were reported during the preceding month: neck or back pain that had interfered with school or leisure, neck or back pain with a severity rating of 2 or more on a scale 0 to 10, a visit to a physician or therapist for neck or back pain, or exemption from physical education or sports because of neck or back pain. RESULTS: Of 1122 backpack users, 74.4% were classified as having back pain, validated by significantly poorer general health, more limited physical functioning, and more bodily pain. As compared with no or low use of backpacks at school, heavy use (odds ratio, 1.98; P < 0.0001) was independently associated with back pain. Female gender and larger body mass index also were significantly associated with back pain. As compared with adolescents who had no back pain, adolescents with back pain carried significantly heavier backpacks that represented a significantly greater percentage of their body weights. CONCLUSION: The use of backpacks during the school day and backpack weights are independently associated with back pain.

Adolescent↗
PubMed2006

The effectiveness of high-intensity versus low-intensity back schools in an occupational setting: a pragmatic randomized controlled trial.

STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To compare high- and low-intensity back schools with usual care in occupational health care. SUMMARY OF BACKGROUND DATA: The content and intensity of back schools vary widely and the methodologic quality of randomized controlled trials is generally weak. Until now, no back school has proven to be superior for workers sick-listed because of subacute nonspecific low back pain. METHODS: Workers (n = 299) sick-listed for a period of 3 to 6 weeks because of nonspecific low back pain were recruited by the occupational physician and randomly assigned to a high-intensity back school, a low-intensity back school, or care as usual. Outcome measures were days until return to work, total days of sick-leave, pain, functional status, kinesiophobia, and perceived recovery and were assessed at baseline and at 3 and 6 months of follow-up. Principal analyses were performed according to the intention-to-treat principle. RESULTS: We randomly allocated 299 workers. Workers in the low-intensity back school returned to work faster compared with usual care and the high-intensity back school, with hazard ratios of 1.4 (P = 0.06) and 1.3 (P = 0.09), respectively. The comparison between high-intensity back school and usual care resulted in a hazard ratio of 1.0 (P = 0.83). The median number of sick-leave days was 68, 75, and 85 in the low-intensity back school, usual care, and high-intensity back school, respectively. Beneficial effects on functional status and kinesiophobia were found at 3 months in favor of the low-intensity back school. No substantial differences on pain and perceived recovery were found between groups. CONCLUSIONS: The low-intensity back school was most effective in reducing work absence, functional disability, and kinesiophobia, and more workers in this group scored a higher perceived recovery during the 6-month follow-up.

Adult↗
PubMed2006

Epidemiology of back pain in a representative cohort of Italian persons 65 years of age and older: the InCHIANTI study.

STUDY DESIGN: Clinico-epidemiologic study in the Chianti area (Tuscany, Italy). OBJECTIVES: To describe prevalence and correlates of back pain in a representative sample of the population. SUMMARY OF BACKGROUND DATA: Back pain is common in old age and is related to functional limitations, but back pain characteristics and correlates in older adults, which may be targeted by specific interventions, are still underinvestigated. METHODS: A total of 1,299 persons aged 65 or older were selected from the city registry of Greve in Chianti and Bagno a Ripoli; 1,008 (565 women; 443 men) were included in this analysis. Back pain in the past 12 months was ascertained using a questionnaire. Potential correlates of back pain were identified in age- and sex-adjusted regression analyses, and their independent association with back pain was tested in a multivariate model. RESULTS: The prevalence of frequent back pain was 31.5%. Back pain was reported less often by men and the very old, was primarily located in the dorsolumbar and lumbar spine, was moderate in intensity and mainly elicited by carrying, lifting, and pushing heavy objects. Among participants who reported frequent back pain, 76.3% had no back pain-related impairments; 7.4% of the overall study population had back pain-related functional limitation. Back pain participants were significantly more likely to report difficulty in heavy household chores, carrying a shopping bag, cutting toenails, and using public transportation. Limited trunk extension, depression, low levels of prior-year physical activity, and hip, knee, and foot pain were independent correlates of back pain. CONCLUSIONS: Frequent back pain is highly prevalent in the older population and is often associated with conditions that are potentially reversible.

Activities of Daily Living↗
PubMed2005

The effects of teriparatide on the incidence of back pain in postmenopausal women with osteoporosis.

OBJECTIVES: Back pain is a major cause of suffering, disability, and cost. The risk of developing back pain was assessed following treatment with teriparatide [rh(PTH 1-34)] in postmenopausal women with osteoporosis. RESEARCH DESIGN AND METHODS: A secondary analysis of back pain findings from the global, multi-site Fracture Prevention Trial was conducted where postmenopausal women with prevalent vertebral fractures were administered teriparatide 20 microg (n = 541) or placebo (n = 544) for a median of 19 months. Treatment-emergent back pain data were collected during adverse event monitoring, and spine radiographs were obtained at baseline and study endpoint. MAIN OUTCOME MEASURES: The risk of back pain stratified by severity of new or worsening back pain and the risk of back pain associated with both number and severity of new vertebral fractures. RESULTS: Women randomized to teriparatide 20 microg had a 31% reduced relative risk of moderate or severe back pain (16.5% vs. 11.5%, P = 0.016) and a 57% reduced risk of severe back pain (5.2% vs. 2.2%, P = 0.011). Compared with placebo, teriparatide-treated patients experienced reduced relative risk of developing back pain associated with findings of: one or more new vertebral fractures by 83% (6.5% vs. 1.1%, P < 0.001), two or more new vertebral fractures by 91% (2.5% vs. 0.20%, P = 0.004), and one or more new moderate or severe vertebral fractures by 100% (5.1% vs. 0.0%, P < 0.001). CONCLUSIONS: Teriparatide-treated women had reduced risk for moderate or severe back pain, severe back pain, and back pain associated with vertebral fractures. The mechanism of the back pain reduction likely includes the reduction both in severity and number of new vertebral fractures.

Back Pain↗
PubMed2003

Back pain.

Back pain is ubiquitous and probably plagues almost everyone in all cultures and ethnic groups at some time (around 20% annually), and in up to 50% of these at least once a year. The WHO-COPCORD epidemiologic investigations have established its prevalence even in countries that had been unaware of its frequency in their populace, and factors involving type of work and training probably accounted for this misperception. Medical journals are replete with articles addressing diagnosis and treatment, but the majority fail to meet the standards needed for metaanalysis or comparison. A task force of the Agency for Health Care Policy and Research of the United States Department of Health and Human Services screened more than 10,000 abstracts, eliminated the majority of these studies and papers, and still was unable to recommend the best approach even to acute back pain; the problem of subacute and chronic back pain is even more formidable. Yet back pain has been identified as perhaps the major cause of disability and absenteeism from the workplace worldwide. WHO chiefly addressed subacute back pain, as most acute back pain is self-limited and ends spontaneously, almost regardless of the treatment. Subacute pain is the intermediate stage toward chronic pain, which defies most treatments. Specific causes for back pain, such as infections, tumors, osteoporosis, spondyloarthropathies, and trauma, actually represent a minority of such pain syndromes, qualifying for specific therapeutic approaches. A major problem in defining the burden of disease for back pain has been a dearth of agreed-upon outcome measures by which to judge the various interventions, and this was the task that the WHO Low Back Pain Initiative took upon itself. Among measures recommended to be included in all studies, so that valid comparisons could be made, were measurement of pain by visual analog scales, somatic perception, the Oswestry disability and modified Zung questionnaires, and a modified Schober test of spinal mobility. These measures are needed for studies, not for diagnosis or treatment of individual patients. They have been translated into various major languages and validated by back-translations, and applied in comparative studies in various cultures to medical, chiropractic, and other common interventions. The importance of such scientifically sound studies cannot be overemphasized, as the costs of health care are mounting everywhere and it therefore becomes imperative to develop cost-effective approaches. All the more so as conversion of acute back pain to chronic back pain is often iatrogenic, with strong psychosocial factors as well, so that not only what to do but also what not to do become important public health issues. The general lack of attention to back pain by governments and organizations probably results from the fact that it is perceived as a syndromic presentation with myriad causes rather than as a specific disease entity. Even if the "disease" names classify like presentations but are not necessarily etiologically discrete, syndromic diagnoses that subsume a variety of causes receive less attention; international rankings of common disabilities and public health problems tend to emphasize the named disorders rather than the grouped disorders. Moreover, back pain is often self-treated with nonprescription medications or alternative therapies, and by nonmedical practitioners or treatments in many parts of the world. Validation of outcomes therefore not only reduces invalidism and direct costs but also reduces the indirect costs of absenteeism and medical care.

Back Pain↗
PubMed2006

Quantifying the extent of a type II SLAP lesion required to cause peel-back of the glenoid labrum--a cadaveric study.

PURPOSE: To quantify the extent of labral disruption required to cause it to peel back when the peel-back test is performed. METHODS: Ten cadaveric shoulders were prepared by removal of the deltoid and rotator cuff muscles. The glenohumeral joint was concentrically reduced and brought into 90 degrees abduction and maximal external rotation. The peel-back of the labrum was graded 0, 1, or 2. The labrum was sequentially detached from the glenoid in the following order: biceps anchor only, 1 o'clock, 2 o'clock, 11 o'clock, and 3 o'clock positions. After each labral cut, the peel-back test was performed. Labral repair was performed with a single suture anchor placed at the 12:30 o'clock position; labral peel-back was reassessed. RESULTS: A progressive increase was noted in peel-back grade with sequential cutting of the labrum posteriorly. However, disruption of the anchor alone did not lead to a positive peel-back sign. Disruption to the 2 o'clock position resulted in a positive peel-back sign overall in 9 of 10 shoulders (5 were grade 1, and 4 were grade 2). No increase was seen in peel-back grade with anterior extension of the labral detachment. Labral repair with a single anchor placed at the 12:30 o'clock position eliminated labral peel-back in 100% of shoulders. CONCLUSIONS: Detachment of the biceps anchor alone does not cause peel-back. The labrum must be disrupted to at least the 2 o'clock position before overt (grade 2) peel-back is observed. A single suture anchor placed at 12:30 o'clock eliminated peel-back of the labrum. CLINICAL RELEVANCE: Validation of the peel-back test as an important diagnostic tool during shoulder arthroscopy.

Adult↗
PubMed1995

The effect of back belts on lumbar muscle fatigue.

STUDY DESIGN: An experiment was conducted to investigate the effect of wearing a weight lifting belt on the endurance and fatigue characteristics of the extensor muscles of the spine. OBJECTIVE: To evaluate the effectiveness of back belts in preserving the endurance characteristics of the spinal musculature. SUMMARY OF BACKGROUND DATA: Previous studies have investigated the use of back belts in increasing intra-abdominal pressure and thus increasing the stabilization of the spine. Other studies have looked at the association of low back disability and wearing back belts. No study has examined the relationship between wearing back belts and measures of spinal muscle fatigue and endurance. METHODS: Thirteen male industrial workers performed a lifting and lowering task from the floor to a 76.2 cm height at 4.3 min-1 2 days a week for 4 weeks. The load was psychophysically determined and averaged 28.1 kg for a total of 28.9 metric tons moved in 4 hours. Subjects lifted for 1, 2, 3, and 4 hours, respectively, for the first 4 days of the experiment. These were considered training days. During the last 4 days, subjects lifted for 4 hours per day; 2 days with a back belt, and 2 days without a back belt. Maximum isokinetic endurance of the extensors was measured for 50 repetitions (5 sets of 10 repetitions) at the end of 4 hours of lifting. Median frequencies of the electromyographic signal from six locations over the back extensors were measured for 30 seconds at 80% of maximum isometric voluntary contraction after 4 hours of lifting. RESULTS: There were no significant differences in maximum isokinetic endurance, or in the slope of median frequency, between lifting with a back belt and lifting without a back belt. Similarly, a modified Borg scale and a postexperiment survey question were unable to distinguish between wearing a back belt and not wearing a back belt. CONCLUSION: There were no significant differences in maximum isokinetic endurance and electromyographic spectral parameters of the back extensor muscles as a result of wearing a back belt during heavy lifting and lowering tasks.

Adult↗
PubMed1996

Learning effects of a back education program.

STUDY DESIGN: This study involved a post-test only, control group design. OBJECTIVES: To analyze the learning effects of back education programs (video and classroom learning). SUMMARY OF BACKGROUND DATA: Previous research has examined lost work time and workers compensation costs but has not addressed the learning effects of back schools. This study used the American Back School as the education intervention. The American Back School teaches students to maintain the lumbarlordosis while lifting. METHODS: The subjects (n = 205) were assigned to three groups through modified randomization. Three employees who previously sustained low back injury were placed in the back school group. The back school group, Group 1, (n = 74) attended a back school program that included cognitive learning strategies and practice in correct lifting. A video group, Group II, (n =64) viewed a similar program that consisted of spinal anatomy and biomechanics and instruction in correct lifting technique. A control group, Group III, (n = 67) received no back education. One week after the education intervention, 145 of the subjects from the three groups had the lumbar lordosis measured with a flexible ruler while assuming a lifting position. The ruler was placed over the lumbar spinous processes, and the lordotic angle was calculated A 12-item multiple choice test and a 10-item. Likert scale were administrated to 199 of the subjects in the three groups to determine the cognitive learning effect and the perceived relevance of the program, respectively. RESULTS: Multivariate analysis of variance was used and demonstrated significant differences between the back school group and the control group on the cognitive, psychomotor, and affective measures at the 0.001 level. No significant differences were found between the video and control groups on the measures with additional univariate testing. CONCLUSIONS: The results indicate that the back school is an effective tool for influencing lifting posture and conveying information regarding spinal mechanics and lifting technique. In addition, the back school videos may not be an effective means of preventing low back injury.

Back Injuries↗
PubMed2005

Isometric back extension endurance testing: reasons for test termination.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: The self-reported reasons for terminating isometric back extension endurance testing and their associations with test performance and other factors were investigated to gain insight into determinants of test performance. BACKGROUND: Factors limiting isometric back extension endurance performance remain unclear. Better understanding the reasons for termination of isometric extension endurance testing could provide insights into what the test actually reflects. METHODS AND MEASURES: Lifetime work, leisure activities and back pain questionnaire data, isometric back extension endurance testing (holding time, as measured in seconds), and reasons for test termination were obtained for a population-based sample of 544 working-age men. RESULTS: The most common reason for test termination was fatigue (62.5%), followed by pain in various parts of the lower extremities (12.6%) and back (3.2%). A history of daily low back pain over the prior 12 months and greater pain intensity of the worst back pain episode over the same period were associated with a greater likelihood of termination due to back pain. In a regression analysis, longer holding time was associated with stopping due to fatigue rather than low back pain, with a trend of 19 seconds (95% confidence interval [CI], -2-40) longer holding time. After controlling for low back pain history, those previously involved in competitive sports were 2.6 times more likely to stop due to pain. Those with a competitive sport history had 14 seconds (95% CI, 5-23) greater holding time than those without such a history. CONCLUSIONS: Isometric back extension endurance testing is most commonly reported to be terminated due to muscle-related capacity as indicated by fatigue. Back pain is more likely to decrease performance time in men with a history of significant (frequent, intense) low back symptoms.

Adult↗
PubMed1995

Back pain in young athletes. Significant differences from adults in causes and patterns.

OBJECTIVES: To determine whether there are significant differences in the causes of back pain in young athletes compared with the general adult population and to review the diagnosis and assessment of young athletic adolescent patients who present with this complaint. DESIGN: Retrospective randomized case comparison study with two cohorts segregated by age and type of activity. SETTING: The adolescent sports medicine clinic of a children's hospital compared with the acute low back pain clinic of an orthopedic hospital. PATIENTS: One hundred adolescent athletes (aged 12 to 18 years; mean age, 15.8 years) with a chief complaint of low back pain were compared with 100 adults (aged 21 to 77 years; mean age, 31.9 years) with acute low back pain. INTERVENTIONS: None. MAIN OUTCOME MEASURES/RESULTS: Sixty-two percent of the adolescents had derangements of their posterior elements associated with the onset of back pain. Forty-seven percent of the 100 adolescents were ultimately shown to have a spondylolysis stress fracture of the pars interarticularis. By contrast, 5% of adult subjects were found to have spondylolysis associated with low back pain. Similarly, discogenic back pain was the final diagnosis in 48 of the 100 subjects in the adult group, while 11 of the 100 in the adolescent group had back pain attributable to disc abnormalities. Muscle-tendon strain accounted for back pain in 27% of the adults, while only 6% of the adolescents were diagnosed as having muscle-tendon strain. These differences were significant. Spinal stenosis and osteoarthritis as causes of back pain were encountered in 10% of the adults, while these conditions were not encountered in the children. CONCLUSIONS: There is a significant differences in the major causes of low back pain in young athletes compared with causes of low back pain in the general adult population. Physicians diagnosing back pain in young athletes must have a specific understanding of these differences to avoid incorrect diagnosis and harmful delays in proper treatment.

Adolescent↗
PubMed2005

Prediction of back strength using anthropometric and strength measurements in healthy females.

OBJECTIVES: The purpose of this study was to develop a regression equation to predict back extensor maximal voluntary contraction (back strength) for females based on several anthropometric and strength measurements using a multiple regression technique. BACKGROUND: Back strength is an important parameter in low back pain studies. However, the measurement of back strength is problematic in certain populations such as low back pain patients and pregnant women. METHODS: Back strength was measured as both moment at L4/L5 and force. Ten anthropometric or strength measurements were chosen to develop the prediction equation. The data used for developing the models were from eighty non-pregnant female subjects, age 18-42 and with no history of back pain in the past year. Backwards stepwise analysis was performed in order to choose the best fit predictors. The predictive ability of each of the models was checked using the cross-validation technique on 20 other subjects. FINDINGS: Two prediction models were developed for moment and force, respectively. The models explained 46.9% and 48.2% of the variance in back strength. No multicollinearity problem was found. The validation study showed that the observed back strength was highly correlated with the predicted back strength. INTERPRETATION: Mass, height, trunk length, grip strength and quadriceps strength are the best predictors of back strength in this study. The models developed in this study can be used for both general female low back pain patients and the pregnancy population.

Adolescent↗
PubMed2006

Comorbidity of low back pain: representative outcomes of a national health study in the Federal Republic of Germany.

BACKGROUND: Unlike other biopsychosocial risk factors, the role of comorbidity in low back pain is largely unknown. AIMS: The purpose is (1) to generate prevalence data on back pain in the total adult population and (2) to identify the most common physical comorbidities in subjects with back pain. This paper also (3) analyses the gender-specific and age-specific comorbidity structure. METHODS: The National German Health Survey is the first study to provide the basis for a representative nationwide analysis of back pain prevalence and the associated comorbidities. The net sample comprises a total of 7124 Germans aged 18-79. RESULTS: One in three Germans (34%) experienced back pain during the seven days prior to being interviewed. The one-year prevalence rate is 59%. All the morbidities investigated by us are more common in subjects with back pain than in individuals without back pain. The most common comorbidities associated with back pain are musculoskeletal disorders like rheumatoid arthritis, osteoarthritis and osteoporosis, followed by cardiovascular and cerebrovascular disease. CONCLUSIONS: The present study investigating 31 physical diseases is the most extensive analysis to date on the topic of back pain and comorbidity. This is an attempt to cast light on the tangled relationships involved in developing and coping with back pain. In view of the large percentage of unspecific back pain, we believe it is important for physicians treating back pain to extend their history and diagnostic analysis skills to embrace comorbidities related to the back pain.

Adolescent↗
PubMed1999

Experts' opinions on complementary/alternative therapies for low back pain.

BACKGROUND: Complementary/alternative therapies are used for low back pain more frequently than for any other indication, yet evidence for or against their efficacy is fragmentary. Notwithstanding this void, the high prevalence of such therapies drives their integration into our health care systems. Expert opinions on the use of complementary/alternative therapies for low back pain could therefore be helpful until more data from randomized, controlled trials become available. OBJECTIVE: A postal questionnaire survey was designed to generate opinion from a systematically identified expert panel on the clinical effectiveness of complementary/alternative therapies for low back pain. METHODS: Computerized searches were conducted to systematically identify by objective criteria 50 clinical experts on low back pain. Each panel member received a questionnaire to assess the perceived clinical effectiveness of complementary/alternative therapies for 4 defined categories of low back pain. RESULTS: For acute uncomplicated low back pain, osteopathy and chiropractic were rated as effective by most experts. For chronic uncomplicated low back pain, most experts considered acupuncture as effective. Experts perceived homeopathy generally as ineffective for any type of low back pain. Clinical experience with herbalism as a treatment for low back pain was insufficient to form an opinion. CONCLUSION: Experts' opinion is in favor of the effectiveness of osteopathy and chiropractic for acute uncomplicated low back pain. Acupuncture is judged to be of some value for chronic, uncomplicated low back pain. Homeopathy is perceived as ineffective for any type of low back pain. Insufficient experience with herbalism as a treatment for low back pain prevents firm conclusions.

Acute Disease↗
PubMed2004

Depressive disorder as a long-term antecedent risk factor for incident back pain: a 13-year follow-up study from the Baltimore Epidemiological Catchment Area sample.

BACKGROUND: The co-occurrence of affective distress and back pain is well documented but the relationship between them is less certain. This study examines the relationship between lifetime occurrence of depressive disorder and incident back pain reported over a 13-year period. METHOD: The Baltimore Epidemiologic Catchment Area Study is a prospective study of a household-residing cohort, selected probabilistically from East Baltimore in 1981. Between 1982-3 (wave 2) and again between 1993-6 (wave 3), a follow-up study of the original cohort was conducted. Questions on depressive disorder and back pain were drawn from the Diagnostic Interview Schedule. Logistic regression analyses were used to evaluate whether depressive disorder acts as a risk factor for incident back pain. RESULTS: In cross-sectional analyses, lifetime occurrence of depressive disorder was a significant correlate of lifetime prevalence of back pain at wave 1 (OR = 1.6, P = 0.01). During the 13-year follow-up, across three data collection points, there was an increase in the risk for incident back pain when depressive disorder was present at baseline (OR = 1.9, 95% CI 1.03, 3.4). However, during the short-term follow-up period of 1 year, between baseline and wave 2, depressive disorder at baseline was unrelated to first-ever reports of back pain. Lifetime depressive disorder in both waves 1 (baseline) and 2 (1 year later) was associated with a more than three times greater risk for a first-ever report of back pain during the 12 to 13 year follow-up period, in comparison to those who did not have depressive disorder at waves 1 or 2 (OR = 3.4, 95% CI 1.4, 7.8). Back pain at wave 1 was not significantly associated with an increased risk for depression in the longitudinal analysis (OR = 0.8, 95% CI 0.5, 1.4). CONCLUSIONS: Depressive disorder appears to be a risk factor for incident back pain independent of other characteristics often associated with back pain. Back pain is not a short-term consequence of depressive disorder but emerges over periods longer than 1 year. Moreover, in this study the alternative pathway of back pain as a risk factor for depressive disorder could not be supported.

Back Pain↗
PubMed1994

Factors associated with back pain after childbirth.

BACKGROUND: Back pain after childbirth is a frequent complaint. The purpose of this study was to determine the incidence of back pain 1-2 months post partum and to identify the factors, including epidural anesthesia for labor and delivery, that may predispose to it. METHODS: Women delivering a viable singleton infant were interviewed 12-48 h after delivery for a history of back pain that occurred before, during, or both before and during the recent pregnancy and for details of their delivery experience. Two months later, the women interviewed were sent a follow-up questionnaire regarding the occurrence of back pain 1-2 months post partum. RESULTS: Follow-up data were available for 1,042 (88%) of the 1,185 women originally interviewed. The incidence of post partum back pain in women who received epidural anesthesia was equivalent to those who did not (44% vs. 45%). Through stepwise multiple logistic regression, post partum back pain was found to be associated with a history of back pain, younger age, and greater weight. However, new-onset post partum back pain was found to be associated with greater weight and shorter stature. No statistically significant association was found between post partum back pain and epidural anesthesia, number of attempts at epidural placement, duration of second stage of labor, mode of delivery, or birth weight. CONCLUSIONS: The overall incidence of back pain 1-2 months post partum in this population was 44%. Predisposing factors were a history of back pain, younger age, and greater weight. Predisposing factors for new-onset post partum back pain were greater weight and shorter stature. Epidural anesthesia for labor and delivery did not appear to be associated with back pain 1-2 months post partum.

Adult↗
PubMed1995

Are radiologic changes in the thoracic and lumbar spine of adolescents risk factors for low back pain in adults? A 25-year prospective cohort study of 640 school children.

STUDY DESIGN: This report was based on a 25-year prospective cohort study and designed as a self-administered questionnaire with low back pain as the main topic. OBJECTIVE: To identify whether radiologic changes in the thoracic and lumbar spine and a history of low back pain in the adolescent period represent risk factors for low back pain in adults. SUMMARY OF BACKGROUND DATA: Six-hundred-forty 14-year-old school children were examined with x-rays of the thoracic and lumbar spine and registered by the school doctor regarding a history of low back pain. METHODS: All of the x-rays and the short journals from the school doctor's registration were reviewed. This primary information was the basis of the investigation 25 years later. RESULTS: Eleven percent of the cohort had a history of low back pain in adolescence, and the results showed an 84% lifetime prevalence of low back pain in these subjects as adults and an increased frequency of low back pain the last month and week before they answered the questionnaire, compared with the rest of the cohort. These problems were associated with increased morbidity and decreased working capacity. Thirteen percent had radiologic abnormalities, mainly Scheuermann changes, in the thoracic and lumbar spine as adolescents, with no positive correlation to low back pain in this period. Unlike other reports, our results did not confirm a positive correlation between x-ray changes in the lower spine in adolescents and a higher prevalence of low back pain in adults. Stepwise logistic regression analyses showed that low back pain in the growth period and familial occurrence of back disease are important risk factors for low back pain later in life, with an observed probability of 88% if both factors are present. CONCLUSION: This study suggests that low back pain in the growth period is "a real problem," with a trend toward aggravation as time passes. Thus, implementing preventive measures in schools may be very important.

Adolescent↗
PubMed1995

Trunk muscle strength in and effect of trunk muscle exercises for patients with chronic low back pain. The differences in patients with and without organic lumbar lesions.

STUDY DESIGN: Trunk muscle strength and the effect of trunk muscle exercises on chronic low back pain were investigated in patients with chronic low back pain. OBJECTIVE: Patients with chronic low back pain include those with organic lumbar lesions and those without such lesions. This study analyzed the differences in trunk muscle strength and effect of trunk muscle exercises between these two groups of patients. SUMMARY OF BACKGROUND DATA: Previous studies have reported lower trunk muscle strength in patients with chronic low back pain and higher efficacy of trunk muscle exercises for treating chronic low back pain. However, no analysis have yet been done of differences in these parameters between patients with chronic low back pain with and without organic lumbar lesions. METHODS: One-hundred-twenty-three patients with chronic low back pain and 126 healthy individuals without low back pain (control group) underwent trunk muscle strength evaluation. The patients were further divided into two groups-- those in group 1 had detectable organic lumbar lesions and those in group 2 had no detectable organic lesions. Seventy-two of these patients performed trunk muscle exercises and the correlation between improvement in low back pain and increase in trunk muscle strength was analyzed. RESULTS: Trunk flexor and extensor strengths were significantly lower in both groups. However, the flexor/extensor ratio of maximum torque was significantly higher in group 1 than in the control group, but was not significantly different between group 2 and the control group. Trunk muscle exercises reduced low back pain in both groups, but were more effective in group 2 than in group 1. The degree of correlation between increase in trunk muscle strength and improvement of low back pain also was higher in group 2 than in group 1. CONCLUSION: This difference in flexor/extensor ratio may have been due to reduced extensor strength resulting from neurogenic muscle weakness induced by the organic lumbar lesions in group 1. The exercise-associated increase in trunk muscle strength did not completely eliminate the low back pain induced by the organic lumbar lesions in group 1. However, increasing trunk muscle strength was extremely effective in patients of Group 2, in which decreased trunk muscle strength was a major factor in chronic low back pain.

Adolescent↗
PubMed1997

The prognosis of low back pain in general practice.

STUDY DESIGN: A prospective cohort study on low back pain in consecutive patients in general practice, in which potential prognostic indicators at baseline and at the 1-year follow-up examination were assessed by means of four weekly questionnaires. OBJECTIVES: To identify prognostic indicators of the duration of low back pain in general practice and the occurrence of a relapse. BACKGROUND: Little is known about the prognosis of low back pain in general practice. Different designs and different results of preceding studies make drawing conclusions about the prognostic indicators, in any, of the course of low back pain in general practice difficult. METHODS: For a period of 2 years, 15 general practitioners from Amsterdam and surrounding areas studied consecutive patients with chronic low back pain and those with a recent onset of low back pain. A large number of potential prognostic indicators were assessed at the initial visit. After the initial visit, each patient was monitored for a period of 12 months. The follow-up assessment was conducted with four weekly postal questionnaires. The associations among the potential prognostic indicators, the duration of the index episode, and the occurrence of a relapse were analyzed using multivariate Cox regression and logistic regression analysis, respectively. RESULTS: Of the 605 patients identified, 443 were included in the follow-up period of assessment; the questionnaires were completed by 269 patients. In general, patients with less severe low back pain participated less often or did not complete the follow-up study. Thirty-five percent of the population still experienced low back pain after 12 weeks, and 10% still experienced it after 1 year. Approximately three of every four patients whose index episode ended before the end of the follow-up period had one or more relapses within a year. The analysis resulted in a model with four variables predicting the duration of the low back pain, including "the duration of the low back pain preceding the initial visit," "receiving physical therapy," "pain intensity", and "history of back surgery." Daily functioning appeared to be the only variable that was significantly associated with the occurrence of a relapse. CONCLUSIONS: Only a few variables appear to be related to the clinical course of low back pain seen in general practice. In particular, the duration preceding the initial visit and, unexpectedly, receiving physical therapy were both associated with a longer duration of low back pain.

Adult↗