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PubMed1995

Low back pain in the young. A prospective three-year follow-up study of subjects with and without low back pain.

STUDY DESIGN: This was a prospective 3-year follow-up study of randomized matched subgroups of 15-year-old school children with or without low back pain initially. OBJECTIVE: In addition to low back pain and leisure time physical activity, spinal mobility, trunk muscle strength, and early degenerative findings of the lumbar spine were evaluated. SUMMARY OF BACKGROUND DATA: Reliable epidemiologic studies on the prevalence of low back pain and development of early degenerative changes of the lumbar spine in young persons have been sparse. Along with several other characteristics, the relationship of these changes to frequent low back pain in young persons is not known. METHODS: After a questionnaire-based survey was administered, subjects with or without low back pain were examined initially and at follow-up with special reference to leisure time physical activity, anthropometry, spinal mobility, trunk muscle strength, and magnetic resonance imaging findings of the lumbar spine. RESULTS: At baseline and at follow-up, those subjects with initial low back pain were characterized by a low frequency of physical activity and decreased spinal function. During follow-up, the occurrence of disc degeneration increased significantly more in the original group with low back pain than among asymptomatic subjects. Furthermore, disc degeneration at baseline significantly predicted future frequent low back pain. Initial disc protrusion also predicted future frequent low back pain. CONCLUSION: After the rapid physical growth period, there seemed to be a causal relationship between the early evolution of the degenerative processes of the lower lumbar discs and frequent low back pain in several subjects.

Adolescent↗
PubMed1997

Movement disturbances of the lumbar spine and abnormal back muscle electromyographic findings in recurrent low back pain.

STUDY DESIGN: A cross-sectional analysis was done of patients with recurrent low back pain referring to the lower limbs. OBJECTIVES: To analyze dynamic radiographs of forward and backward bending of the lumbar back and to determine, using routine neurophysiologic measurements, the functional state of the lower nerve roots in patients with recurrent low back pain radiating to the lower limbs. METHODS: Clinical and neurophysiologic studies showed eight of the 108 patients with low back pain to have ventral root impingement at either L5 or S1 level. The remaining 100 patients, 56 women and 44 men (mean age, 37.6 years; range, 17-62 years), made up the study group for continuing investigation. History of low back pain ranged from 4 months to 20 years. RESULTS: Disturbed intervertebral movement was found in 51 of 100 patients. Twenty-seven percent had L5 or L4 anterolisthetic hypermobility, and 35% had L4 or L3 vertebral retrolisthesis. Vaguely delineated radiating sensations in the lower limbs were common (62%). Back muscle electromyographs were mostly (86%) normal in patients whose low back pain was localized. Conversely, almost three-fourths of those experiencing radiating or referred pain had abnormal electromyographs, consistent with a mild degree of axonal damage in the posterior branch of the lumbar nerve root innervating the medial paraspinal muscles. This finding was most common among patients with retrolisthesis and simultaneous degenerative changes. CONCLUSIONS: Evaluation of low back pain should include tests for degenerative retrolisthesis, especially in patients experiencing radiating sensations with no evidence of root impingement, because abnormal electromyographic findings showing denervation of the paraspinal muscles was most common in patients with degenerative retrolisthesis. To improve the functional support of the lumbar region, rehabilitation should be directed to the medial back muscles because they provide the most effective support for intervertebral motion and because mild disturbances appear to be associated with their innervation in recurrent low back pain.

Adolescent↗
PubMed1997

Psychosocial factors in the workplace--do they predict new episodes of low back pain? Evidence from the South Manchester Back Pain Study.

STUDY DESIGN: A prospective, population-based cohort study of working adults. OBJECTIVES: To determine whether work-related psychosocial factors and social status predict the occurrence of new episodes of low back pain and influence consultation behavior. SUMMARY AND BACKGROUND DATA: Dissatisfaction with work and social status has been associated with low back pain in several studies; few of these studies have been prospective or population based. METHODS: An initial postal survey was returned by 4,501 (59%) adults (18-75 years old) registered with two primary care practices. From this, a cohort of 1,412 people currently in employment and free of low back pain was identified, and baseline information on work-related psychosocial factors and psychologic distress was obtained. Social class was derived from current occupation using a standardized classification. New episodes of low back pain occurring in the next 12 months were identified by continuous monitoring of primary care consulters and by mailing a second questionnaire a year later to identify occurrences of low back pain for which no consultation was sought. RESULTS: The baseline cross-sectional survey showed modest but significant associations between low back pain and perceived inadequacy of income (risk ratio 1.3), dissatisfaction with work (risk ratio 1.4) and social class IV/V (risk ratio 1.2). In the follow-up year, the risk of reporting low back pain for which no consultation was sought doubled in those dissatisfied with their work. Both perceived inadequacy of income (odds ratio 3.6) and social class IV/V (odds ratio 4.8) were strongly associated with consulting with a new episode of low back pain during the follow-up year, an association more marked in women. The associations with work dissatisfaction and perceived adequacy of income were not explained by general psychologic distress or social status. CONCLUSION: People dissatisfied with work are more likely to report low back pain for which they do not consult a physician, whereas lower social status and perceived inadequacy of income are independent risks for working people to seek consultation because of low back pain.

Adult↗
PubMed1987

Medical, psychological, and social factors associated with back abnormalities and self reported back pain: a cross sectional study of male employees in a Swedish pulp and paper industry.

A medical, psychological, and sociological study of 391 male employees in a Swedish pulp and paper industry was performed in 1961. Factors associated with back pain and back abnormality were investigated. Univariate analyses showed associations of back pain with occupational status, low education, duration of employment, low performance on cognitive tests, and neuroticism. Back abnormalities evaluated on the basis of physical examination showed in principle the same associations but the strength as well as the significances were stronger. Multiple logistic regression analyses using data for manual workers showed that neuroticism and duration of employment were directly associated with back pain. The same two variables and low performance on one of the psychological tests were directly associated with back abnormalities. Age showed no direct association with back pain or back abnormalities. Strong associations between back pain and back abnormalities with both perceived health and general working capacity and the doctor's evaluation in the same areas were demonstrated.

Absenteeism↗
PubMed1996

Reduction of Acute Low Back Injuries by Use of Back Supports.

The objective of this study was to determine the effect of a change in back-support-use policy on the occurrence of work-related low back injuries among a large cohort of employees in the retail-trade home improvement industry. Working hours of exposure, back support use, and intensity of materials-lifting requirements were collected from 1989 through 1994. Records of injury-related claims were reviewed for all documented injuries to the lower back among members of the cohort during the same period. Over 101,000,000 working hours were recorded by nearly 36,000 employees; 2,152 employees reported an acute low back injury occurring during working hours as a first report of episode, with medical-physician diagnosis and acute/abrupt onset. Incidence density rates were calculated for persons wearing and not wearing the back support. Rate ratios and prevented fractions were evaluated. Before implementation of a company-wide back-support policy, the employees had a rate of acute low back injuries of 30.6 per million working hours. After implementation, this rate fell to 20.2 per million working hours, a significant reduction of 34.0%. This effect was seen in both genders, in younger workers and in those aged 55+, with low levels of lifting as well as high lifting intensities, and in persons with one to two years of employment with the company. The authors conclude that uniform mandatory implementation of a back-support-use policy significantly reduces the incidence of acute low back injuries incurred in the workplace.

Journal Article↗
PubMed2002

Long-term experience with implanted intrathecal drug administration systems for failed back syndrome and chronic mechanical low back pain.

BACKGROUND: Continuous intrathecal drug delivery has been shown in open studies to improve pain and quality of life in those with intractable back pain who have had spinal surgery. There is limited data on long term effects and and even less for patients with mechanical back pain without prior spinal surgery. METHODS: We have investigated spinal drug administration systems for patients with failed back syndrome and chronic mechanical low back pain by patient questionnaire study of the efficacy of this therapy and a case notes review. RESULTS: 36 patients (97% of 37 approached) completed questionnaires, 24 with failed back syndrome and 12 with chronic mechanical low back pain. Recalled pre-treatment levels with current post-treatment levels of pain and a range of quality of life measures (recorded on 11-point numerical rating scales) were compared. Pain improved significantly in both groups (Wilcoxan signed ranks test, p < 0.005). The majority of quality of life measures improved significantly in the failed back syndrome group (Wilcoxan signed ranks test, p < 0.005) although work interruption and the effect of pain on sex life did not change. There was a trend towards improvement in the majority of quality of life measures in the mechanical back pain group but this did not reach statistical significance due to the smaller numbers in this cohort (p > 0.005, Wilcoxan signed ranks test with Bonferroni correction).Diamorphine was used in all 37 patients, bupivacaine in 32, clonidine in 27 and baclofen in 3. The mean dose of diamorphine increased for the first 2 years but did not change 2-6 years post implant, averaging 4.5 mg/day. Revision surgery was required in 24% of cases, but reduced to 12% in the later years of our experience. CONCLUSIONS: We conclude that spinal drug administration systems appear to be of benefit in alleviating pain in the failed back syndrome and chronic mechanical low back pain but need to be examined prospectively.

Journal Article↗
PubMed2000

Back and hip extensor activities during trunk flexion/extension: effects of low back pain and rehabilitation.

OBJECTIVE: To compare lumbar paraspinal, gluteus maximus, and biceps femoris muscle function during sagittal trunk flexion and extension in patients with chronic low back pain and healthy control subjects, and to assess the influence of rehabilitation in the back pain patients. DESIGN: A cross-sectional study comparing chronic low back pain patients and healthy controls, and a prospective follow-up in back pain patients during rehabilitation. SETTING: Physical medicine and rehabilitation clinic. SUBJECTS: Nineteen women with chronic low back pain, and 19 women without pain (controls). INTERVENTION: Five-week active outpatient rehabilitation (1 hour three times a week) guided by a physiotherapist, followed by 5-week self-motivated exercise at home. OUTCOME MEASURES: Subjects performed sagittal trunk flexion and extension while surface electromyogram was bilaterally recorded of paraspinal (L1-L2 level), gluteus maximus, and biceps femoris muscles. The muscle activity was assessed from the average electromyogram and the relative muscle activation onsets and their duration were calculated. RESULTS: During early flexion, lumbar paraspinal and biceps femoris were activated simultaneously before gluteus maximus. At the end of flexion and during extension all investigated muscles were activated and relaxed in order. Lumbar paraspinal and biceps femoris muscles were activated in a similar order in low back pain patients and healthy controls during flexion and extension. However, the duration of gluteus maximus activity was shorter in the back pain patients than in controls during the trunk flexion (p<.05), and it ended earlier during extension. Active rehabilitation did not change the muscle activities of lumbar paraspinal and biceps femoris in the back pain patients, but in the measurements after rehabilitation the onset of gluteus maximus activity occurred later in flexion and earlier in extension. CONCLUSIONS: The activity of the gluteus maximus muscle during the flexion-extension cycle was reduced in patients with chronic low back pain. The gluteal muscles should be taken into consideration in the rehabilitation of these patients.

Adult↗
PubMed1989

Patient-handling skill, back injuries, and back pain. An intervention study in nursing.

The aim of this intervention was to evaluate the effect of training on patient-handling skills and prospectively to assess the effect of skill on subsequent back pain and back injuries in nursing. Of a total of 255 nurses, 199 were assessed for their skill in patient-handling. One-half (control group) received traditional training in patient-handling, and the other half (trained group) received a curriculum of instruction totaling 40 hours. The skills of both groups were assessed on graduation. The control group was rated as less competent in patient-handling. Nurses in both groups were questioned about the prevalence of back pain and incidence of back injuries in the first year after graduation. In multiple regression analysis, the major risk indicators for back injuries were poor patient-handling skill, low numbers of repetitions in the sit-up test, and high work-load scores. High score on the hysteria scale of Middlesex Hospital Questionnaire was a risk indicator for all kinds of back pain. Though back pain was independent of patient-handling skill, those rated as "bad" or "poor" had more back injuries (24%) than those who had been rated as "good" or "excellent" (2%) (P less than 0.001), but the difference between the trained and control groups was not statistically significant. It was concluded that back injuries may be prevented by the teaching of patient-handling skills.

Back Injuries↗
PubMed1988

Back pain, back abnormalities, and competing medical, psychological, and social factors as predictors of sick leave, early retirement, unemployment, labour turnover and mortality: a 22 year follow up of male employees in a Swedish pulp and paper company.

A total of 391 male employees in a Swedish pulp and paper company were followed up for 22 years. As a part of a health examination in 1961 back pain reported by the subjects and abnormalities of the back as judged by the physicians were investigated with respect to predictive power regarding sick leave, early retirement, unemployment, labour turnover, and mortality during the follow up period. Univariate analysis showed that abnormalities of the back were better than back pain for predicting early retirement. Neither back pain nor back abnormalities had any predictive power with respect to long term sick leave, labour turnover, or mortality. Multivariate analyses of 26 variables were performed. Both self assessment of general health and back abnormalities were predictive for early retirement with a diagnosis of back disorder on the retirement certificate but self assessed health was a stronger predictor. Age, smoking, and neuroticism were predictors regarding early retirement for all diagnoses. Education had a negative association; neuroticism did not predict early retirement with a diagnosis of back disorder.

Absenteeism↗
PubMed1998

Relationship between muscle fiber composition and functional capacity of back muscles in healthy subjects and patients with back pain.

Back muscles are important to the stability of the lumbar spine. Muscle fiber composition may give some indication of the functional capacity of these muscles. This review explores the relationship between muscle fiber composition and functional capacity of back muscles. The reference values for the type and size of the muscle fibers found in the back musculature of healthy subjects and patients with back pain are also presented. A high percentage of type I fibers, which are larger in size than type II fibers, has been found in back muscles at the thoracic and lumbar levels. This is in accordance with the postural function of these muscles. The diameter of type II fibers is smaller in females than males, which may partly explain the lesser strength and greater endurance capacity of back muscles in females. Due to the limited amount of pertinent data, no conclusive evidence is available regarding age-related changes in muscle fiber composition in the musculature of the back. In patients with lumbar disorders, pathological changes and selective atrophy of type II fibers are seen, and these can be changed with adequate exercises. Further research is suggested to address issues related to gender, age, back pain, and exercise and their effects on the apparent back muscle fiber composition.

Aging↗
PubMed2006

Effects of back posture education on elementary schoolchildren's back function.

The possible effects of back education on children's back function were never evaluated. Therefore, main aim of the present study was to evaluate the effects of back education in elementary schoolchildren on back function parameters. Since the reliability of back function measurement in children is poorly defined, another objective was to test the selected instruments for reliability in 8-11-year olds. The multi-factorial intervention lasting two school-years consisted of a back education program and the stimulation of postural dynamism in the class. Trunk muscle endurance, leg muscle capacity and spinal curvature were evaluated in a pre-post design including 41 children who received the back education program (mean age at post-test: 11.2 +/- 0.9 years) and 28 controls (mean age at post-test: 11.4 +/- 0.6 years). Besides, test-retest reliability with a 1-week interval was investigated in a separate sample. Therefore, 47 children (mean age: 10.1 +/- 0.5 years) were tested for reliability of trunk muscle endurance and 40 children (mean age: 10.2 +/- 0.7 years) for the assessment of spinal curvatures. Reliability of endurance testing was very good to good for the trunk flexors (ICC = 0.82) and trunk extensors (ICC = 0.63). The assessment of the thoracic (ICC = 0.69) and the lumbar curvature (ICC = 0.52) in seating position showed good to acceptable reliability. Low ICCs were found for the assessment of the thoracic (ICC = 0.39) and the lumbar curvature (ICC = 0.37) in stance. The effects of 2 year back education showed an increase in trunk flexor endurance in the intervention group compared to a decrease in the controls and a trend towards significance for a higher increase in trunk extensor endurance in the intervention group. For leg muscle capacity and spinal curvature no intervention effects were found. The small samples recommend cautious interpretation of intervention effects. However, the present study's findings favor the implementation of back education with focus on postural dynamism in the class as an integral part of the elementary school curriculum in the scope of optimizing spinal loading through the school environment.

Anthropometry↗
PubMed1996

The affective dimension of low-back pain: its influence on the outcome of back school.

OBJECTIVE: Back School is a rehabilitation treatment for back pain that requires patients to understand an educational message and motivate themselves to modify their behavior to prevent relapses. In examining failed cases, the question arose as to whether the failures could be attributed to affective dimensions of pain that could be reducing tolerance to the pain itself and jeopardizing patients' compliance. We studied the role of the affective component of back pain in Back School failures to see whether this component can be used to predict the treatment's negative results and whether it can be conditioned by the treatment itself. DESIGN: Inception cohort. SETTING: Forty-two subjects with low back pain were treated with Back School at our rehabilitation department. MAIN OUTCOME MEASURES: Evaluation was carried out before Back School treatment and after 2 months, through functional clinical examination and Short Form-McGill Pain Questionnaire (affective and sensory pain indexes). RESULTS: As outcome of the treatment, we considered the modification of spontaneous and evoked pain and the motility of the spine. Unexpectedly, the nonparametric tests did not show a significant correlation between the affective indicators before and after the treatment. As expected, the two dimensions of pain, affective and sensory, are significantly related to each other, both before and after treatment, but this correlation increases after treatment (from r = .50 to r = 88). CONCLUSIONS: The initial hypothesis was not proven. These results show that high affective scores before Back School do not influence the success of the treatment and that the Back School itself is able to modify both the sensorial and affective pain descriptors.

Adult↗
PubMed1998

Age, sex, and body mass index as determinants of back and hip extensor fatigue in the isometric Sørensen back endurance test.

OBJECTIVE: To study the ability of a widely used isometric back endurance test to measure lumbar back erector muscle fatigue and to assess the influence of age, sex, and body mass index (BMI) on back and hip extensor muscle fatigability (EMG spectral indices). DESIGN: Cross-sectional study of men and women without back problems. SETTING: Occupational health center and rehabilitation clinic in Finland. SUBJECTS: Experiment 1 consisted of 233 consecutive occupational health center customers (133 women, 100 men) without back problems. Experiment 2 consisted of 20 healthy women. INTERVENTION: Subjects performed the isometric Sørensen back endurance test up to 240sec in experiment 1 and to the limit of endurance in experiment 2. OUTCOME MEASURES: Raw surface EMG was recorded bilaterally over the belly of lumbar erector spinae muscles at L1-L2 and L4-L5 levels in experiment 1, and bilaterally over the medial paraspinal muscles at L1-L2, L3-L4, and L5-S1 levels and over the major hip extensor muscles (gluteus maximus and biceps femoris) in experiment 2. In both experiments, time to endurance was recorded (in experiment 1 up to 240sec). The EMG spectral median frequency (MF) decrease over time was used for the assessment of back and hip extensor fatigability. RESULTS: In experiment 1, the rate of change in paraspinal MF was greater in men than in women, indicating greater paraspinal fatigability in men. Multiple regression analysis indicated that the rate of MF decrease (fatigue) during the test was dependent on age and BMI in both sexes and that the effects of age and BMI were more pronounced in women than in men. Correlation analysis revealed that the rate of paraspinal muscle MF decrease was associated with endurance time and BMI in women and with endurance time and age in men. In experiment 2, the paraspinal muscles, as well as the hip extensor muscles, biceps femoris, and gluteus maximus, showed clear decreases in MF during the isometric endurance test in women. MF decrease was highly related to endurance time and BMI in women. CONCLUSIONS: Lumbar paraspinal muscle fatigability during the Sørensen test is influenced by subject characteristics. Further, the hip extensor muscles also significantly fatigue, indicating load sharing between back and hip extensor muscles during the test. According to these results, the validity of this widely used back endurance test in specifically measuring lumbar paraspinal muscle endurance is questionable, as is the direct comparison of test results between women and men.

Aging↗
PubMed1992

Low back and neck/shoulder pain in construction workers: occupational workload and psychosocial risk factors. Part 1: Relationship to low back pain.

The prevalence rate of musculoskeletal problems, especially low back pain and severe low back pain in a randomly selected sample of 1,773 construction workers was studied. Its relationship to physical and psychosocial factors was analyzed. The workers answered a postal questionnaire. Workload was measured by means of eight manual materials handling indices and ten psychosocial indices, based on results from factor analyses. The 1-year prevalence rate of low back pain was 54% and of severe low back pain 7%. The relationship to heavy manual materials handling differed with age in such a manner that it could be interpreted as a healthy worker effect. Between severe low back pain and both stooping or kneeling a dose-response relationship was found. The most prominent of the psychosocial factors associated with low back pain and severe low back pain were the stress index and the psychosomatic and psychic indices. The age-standardized prevalence rate ratio of low back pain was 1.6 (95% confidence interval 1.4-1.8) and for severe low back pain 3.1 (95% confidence interval 2.3-4), when workers reporting "high" stress were compared to workers reporting "low" stress.

Adult↗
PubMedDate not supplied

A field trial of back belts to reduce the incidence of acute low back injuries in New York City home attendants.

To determine the effect of black belt use on the incidence of low back injury in home attendants, a cluster-randomized trial involving employees of nine home attendant agencies in New York City was conducted. Nine agencies employing 12,772 home attendants between June 1997 and September 1999 were randomized into three groups-one group received back belts with use instruction, one group received lifting advice only, and one group served as a control. Low back injury rates per 100 full-time equivalents and rate ratios adjusted for potential confounders were estimated with random-effects Poisson regression. The back-belt group had a lower rate of low back injury than did those in both the advice-only and control groups, though the differences were marginally significant. Age, body mass index, history of back injury, years worked as a home attendant, and level of exercise were associated with risk of low back injury. The findings suggest that use of back belts is associated with some reduction in risk of low back injury.

Adolescent↗
PubMed1976

Studies on the low back pain among electric construction workers. Report 2. Workers' attitude to the prevention and the treatment of their low back pain.

In the previous report, the author demonstrated that the electric construction workers were exposed to the high risk of low back pain, and discussed on the ways to prevent and to treat their occupational disorders. He concluded that the improvement of their working conditions, especially lessening of the working load, was necessary to prevent occupational low back pain, and that it was the most helpful effect on their low back pain to take a rest on an after the attack of the disorder, while most of the medical treatment without a rest were almost helpless. In this report, the author studied and discussed on the workers' opinions on the ways to prevent and to treat their low back pain, by means of questionnaire-method. The workers examined were classified by whether they had the disorder or not and also by the grades of their working load. The results are as follow: 1. As for preventive measures, it is the most popular opinion that they should take care not to hurt their low back; nevertheless, as a matter of fact, their low back pain has been mainly resulted from overwork. 2. As for necessary means on the attack of low back pain, many workers believe that medical treatment is the most helpful to the disorder. Fewer workers recognize the low back pain as an occupational disorder and have opinion that they should take a rest on the attack of the disorder. 3. There is much discrepancy between the workers' opinions mentioned above and the occupational health doctors' recommendations that it is most desirable to improve the working conditions and to let the workers take a rest. 4. The more seriously they suffer from the disorder, the more practical and reasonable are the contents of their opinions. 5. In order to let these workers take a rest from labour more easily, the employers should recognize their low back pain as an occupational disorder, including offjob-payment.

Adult↗
PubMed1995

Static back endurance and the risk of low-back pain.

Spinal physical capacity and in particular static back endurance were studied for their prediction of first-time experience of low-back pain. Of a total of 126 persons who were free from back complaints at entry, 33 developed low-back pain during a follow-up of 1 year. The static back endurance test was found to be the only physical capacity measurement that indicated an increased risk of low-back pain. Adjusted for age, sex, and occupation, the odds ratio of a new low-back pain in those with poor performance was 3.4 (95% confidence interval, 1.2-10.0) compared to those with medium or good performance. RELEVANCE--:The simple static back endurance test might have value in health examinations because of its strong predictive value of future low-back pain.

Journal Article↗