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PubMed2002

The Cooper River Bridge Run Study of low back pain in runners and walkers.

Investigations dedicated to examining relationships between low back pain (LBP) and factors specific to running and walking are limited. Current literature suggests runners and walkers may have a lower relative risk for significant LBP. The purpose of this study was to investigate the incidence, prevalence, and possible risk factors for LBP among a group of runners and walkers. A survey was administered to participants who registered for either a 10-kilometer run or 4-mile recreational walk. A total of 539 responses were received. Previous history of LBP was reported by 74% of respondents overall. Prevalence of LBP at the time of survey completion was 13.6%. Low back pain was experienced more frequently by obese runners and by those who reported certain patterns of shoe wear. Regular participation in aerobics correlated with a reduced lifetime risk for LBP. We believe these findings warrant further investigation. This knowledge may benefit not only athletes in training, but other fitness enthusiasts, including casual runners and walkers and those who jog or walk to rehabilitate low back injuries.

Adolescent↗
PubMed1994

Back pain in school children. A study among 1178 pupils.

The purpose of this study was to determine the prevalence of back pain in school children and the role of several contributing factors; 1178 school children of both sexes answered a previously validated questionnaire. The cumulative prevalence of back pain was 51.2%. Lumbar and leg pain, and thoracic pain were more common. After multivariate analysis, five qualitative variables were correlated with back pain with a statistical, significant positive correlation with age, previous back injury, volley-ball, female sex and time spent watching television.

Adolescent↗
PubMed2004

Training can modify back muscle response to sudden trunk loading.

Sudden, unexpected loading to the trunk has been reported in the literature as a potential cause of low-back disorders. This study's aim was to investigate the effect of "readiness training" on the response to sudden back loading among untrained healthy individuals. The study included 19 participants and 19 matched controls. All were employees at the National Institute of Occupational Health. The participants received ten 45-min training sessions during a 4-week period. The training focused on reactions to a variety of expected and unexpected sudden trunk loadings, including balance and coordination exercises. Before and after the training, all subjects were tested for reaction to sudden trunk loading (SL). This entailed applying a horizontal force of 58 N to the subject's upper back. Elapsed time--measured between SL and stopping--decreased significantly in the training group (from 337 to 311 ms) compared with the control group. The improved stopping time was associated with a changed EMG signal, characterized by an increase in the early parts of the response (up to 225 ms) and a subsequent decrease. EMG onset latency was unaffected by training. This study is apparently one of the first to demonstrate that the response to sudden trunk loading can be improved in healthy subjects without an increase in pre-activation and associated trunk stiffness. In perspective, the results indicate a possibility for a training-induced reduction of the risk of low-back injuries, e.g., in nurses exposed to sudden trunk perturbations during patient handling.

Adult↗
PubMed2005

The influence of occupation on lumbar sagittal motion and posture.

The aim of this study was to determine whether sheep shearers have clinically hypothesized adaptive postural and sagittal mobility parameters of the lumbar spine and pelvis. Sixty-four shearers and 64 non-shearers, matched by age and anthropometry and surveyed for present and previous low back pain, participated in a study to determine the effects of occupation on sagittal spinal motion and posture. Lumbar and hip mobility measurements were made with a geometric CAD analysis of lateral photographs using surface reflective markers. Sagittal range of motion demonstrated similar ranges of lumbar flexion between the two groups; however, there was a marked gain in hip flexion in the shearers as well as a marked loss of lumbar extension. The shearers also demonstrated a more lordotic lower lumbar curvature compensated by a flatter (less kyphotic) mid to lower thoracic region. Shearers appear to lose lumbar extension, gain hip flexion and develop an adaptive normal stance. This adaptation appears to be independent of previous or current back pain. Conversely, lumbar extension loss in non-shearers correlates with previous back injury. A stepwise linear regression of all participants indicated that the occupation is the predominant influence on motion and posture followed by age. The implications are one of structural adaptation in this occupational group that does not appear to be correlated with back pain.

Adaptation, Physiological↗
PubMed2005

The Short-Term Effects of Joint Mobilizations on Acute Mechanical Low Back Dysfunction in Collegiate Athletes.

Context: Although a variety of theories and studies have been cited to support the use of joint mobilization in the spine as an integral part of the treatment and rehabilitation process, information about the short-term effects of joint mobilization on acute low back injury with respect to patient pain and strength changes has been limited.Objective: To examine the short-term effects of grade 1 and 2 posteroanterior joint mobilizations at the lumbar spine on subject pain and muscle force after an episode of acute, mechanical low back pain.Design: Group (2) by time (2 or 3).Setting: Athletic training clinic.Patients or Other Participants: Male collegiate athletes (n = 19) with mechanical low back pain as assessed through a standardized evaluation were randomly assigned to a control (n = 10) or experimental (n = 9) group.Intervention(s): All subjects underwent a standardized treatment protocol of cryotherapy and stretching during data collection. Subjects completed the McGill Pain Questionnaire and a visual analog scale (the latter to assess pain levels during range-of-motion activities) and, using a handheld dynamometer, performed 3 maximum voluntary isometric contractions to determine muscle force. Grade 1 and 2 joint mobilizations were administered to the experimental group, whereas the control group was placed in a prone position of comfort for the time it took to perform the joint mobilizations.Main Outcome Measure(s): Baseline, immediate posttreatment, and 24-hour posttreatment measurements of pain and muscle force were taken.Results: Compared with the control group, the experimental group demonstrated significant decreases in the sensory subscale scores of the McGill Pain Questionnaire and in pain during lumbar extension and a significant increase in force production.Conclusions: Grade 1 and 2 joint mobilizations reduced subjects' pain and increased force production in the short-term stages of mechanical low back pain.

Journal Article↗
PubMed1991

Disabling low back Oregon workers' compensation claims. Part III: Diagnostic and treatment procedures and associated costs.

Claimants in Oregon with disabling low back injuries attending chiropractors were found to have more treatments over a longer duration and at greater cost than claimants attending medical physicians with similar clinical presentations. These findings are attributed to: a) a higher proportion of chiropractic claimants than medical physician claimants with low back risk factors which may have adversely affected the course of recovery (chronic or recurrent low back conditions, obesity, extremity symptomatology, frequency of exacerbations); b) differences in age and gender of DC and MD claimants; c) the greater physician-patient contact hours characteristic of chiropractic practice; d) differences in therapeutic modalities employed; and e) the physician reimbursement permitted under Oregon workers' compensation law. The findings of this study emphasize the need for prospective studies of treatment outcome.

Age Factors↗
PubMed1995

[Occupational diseases of the "spine"--guidelines for expert assessment].

Until now there has been no definition of a typical job-related back injury. During the examination the only possibility was to separate all recognizable non-job-influenced injuries from the diagnosis, through which a step-by-step, logically organized progression was proven in practice. If the professional hypothetical claims are fulfilled, then the remaining disability is the outcome of job stress and can so be evaluated. The clinical-functional and neurological evidence delivers a conclusive evaluation in percentages that can be attuned without difficulty to verified standards of traumatic spinal assessment.

Accidents, Occupational↗
PubMed2000

The relationship between psychosocial work characteristics and low back pain: underlying methodological issues.

OBJECTIVE: To evaluate the current epidemiological evidence linking psychosocial work characteristics with low back pain. BACKGROUND: Psychosocial work characteristics have been widely evaluated as potential risk factors for low back injury. However, studies with different study populations and using various types of measures have had conflicting results. METHODS: This review is the most extensive to date, reviewing 66 articles that have provided empirical evidence about the relationship between psychosocial work characteristics and initial reporting of lower back pain. The studies are reviewed with an emphasis on certain methodological issues: controlling for potential confounding; timing of the data collection; and measurement of the exposures and outcomes. RESULTS: The results of this review suggest that controlling for potential confounding from occupational biomechanical demands had a large influence on the associations found between psychosocial work characteristics and lower back pain. In addition, the use of accurate and reliable measures for the occupational exposures (biomechanical and psychosocial) and the lower back pain outcomes appears to influence the strength of the associations found between psychosocial work characteristics and lower back pain. CONCLUSION: Given the methodological concerns discussed in this review, it is difficult to draw strong causal inferences from this literature. However, it does appear that psychosocial characteristics are related to some lower back pain outcomes, and that employees' reactions to psychosocial work characteristics (e.g., job dissatisfaction and job stress) are more consistently related to lower back pain than are the psychosocial work characteristics themselves (e.g., work overload, lack of influence over work, quality of relationships with coworkers). RELEVANCE: This review attempts to identify and address methodological issues in the literature evaluating the relationship between psychosocial work characteristics and lower back pain. Implications for future research are presented.

Humans↗
PubMed2004

Sports and performing arts medicine. 6. Issues relating to dancers.

UNLABELLED: This self-directed study module highlights biomechanics unique to dance that predispose to common injuries of the lower extremity and discusses preventative strategies. It is part of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. OVERALL ARTICLE OBJECTIVE: To summarize lower-limb and back injuries commonly seen in dancers.

Biomechanical Phenomena↗
PubMed2000

Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain.

STUDY DESIGN: A quick-release method in four directions of isometric trunk exertions was used to study the muscle response patterns in 17 patients with chronic low back pain and 17 matched control subjects. OBJECTIVES: It was hypothesized that patients with low back pain would react to sudden load release with a delayed muscle response and would exhibit altered muscle recruitment patterns. SUMMARY OF BACKGROUND DATA: A delay in erector spinae reaction time after sudden loading has been observed in patients with low back pain. Muscle recruitment and timing pattern play an important role in maintaining lumbar spine stability. METHODS: Subjects were placed in a semiseated position in an apparatus that provided stable fixation of the pelvis. They exerted isometric contractions in trunk flexion, extension, and lateral bending. Each subject performed three trials at two constant force levels. The resisted force was suddenly released with an electromagnet and electromyogram signals from 12 trunk muscles were recorded. The time delay between the magnet release and the shut-off or switch-on of muscle activity (reaction time) was compared between two groups of subjects using two-factor analysis of variance. RESULTS: The number of reacting muscles and reaction times averaged over all trials and directions showed the following results: For healthy control subjects a shut-off of agonistic muscles (with a reaction time of 53 msec) occurred before the switch-on of antagonistic muscles (with a reaction time of 70 msec). Patients exhibited a pattern of co-contraction, with agonists remaining active (3.4 out of 6 muscles switched off) while antagonists switched on (5.3 out of 6 muscles). Patients also had longer muscle reaction times for muscles shutting off (70 msec) and switching on (83 msec) and furthermore, their individual muscle reaction times showed greater variability. CONCLUSIONS: Patients with low back pain, in contrast to healthy control subjects, demonstrated a significantly different muscle response pattern in response to sudden load release. These differences may either constitute a predisposing factor to low back injuries or a compensation mechanism to stabilize the lumbar spine.

Adult↗
PubMed2006

Subdural spinal haematoma after epidural anaesthesia in a patient with spinal canal stenosis.

A 60-year-old male with a past history of T12 fracture had epidural analgesia for a radical prostatectomy. It was unknown prior to epidural insertion that the patient had a canal stenosis at T12 from the previous injury. The patient developed severe bilateral buttock pain after epidural catheter removal. Magnetic resonance imaging demonstrated a spinal subdural haematoma from T10 to L2 with mild cord compression. The patient made a successful recovery with conservative management. Neuraxial blockade should be approached with caution in patients with previous back injury, and only after a thorough assessment has been obtained to exclude spinal canal stenosis.

Anesthesia, Epidural↗
PubMed1994

Psychophysically acceptable weights for a combination lifting task using bags with handles.

This paper presents a study on a combination lift and lower manual handling task and was designed to simulate the loading of grocery bags into a car trunk. Twelve male subjects performed an externally paced task of lifting grocery bags loaded with weights from 15 cm above the floor and over a wooden sill. There were two different sill heights of 70 cm and 90 cm, and for each of these heights there were two frequencies of 3 and 6 lifts per cycle. The dependent variables were maximum acceptable weight of lift (MAWOL). A unique lifting sequence and a modified version of the psychophysical methodology were used to determine MAWOL. There was a significant difference in the MAWOL across the two sill heights as well as the MAWOL at the two different frequencies. Plastic bags were determined to increase the average load lifted by 27% as compared to paper bags. At normal grocery bag weights, the increased load carrying capacity represents an increase in the safety factor. Not only can the risk of lower back injuries be decreased by using plastic bags with handles but the risk of developing a cumulative trauma disorder could also be decreased.

Adult↗
PubMed2005

Factors influencing results of functional capacity evaluations in workers' compensation claimants with low back pain.

BACKGROUND AND PURPOSE: Physical and psychosocial factors are hypothesized to influence performance-based assessment. The purpose of this study was to evaluate the association between performance on the Isernhagen Work System Functional Capacity Evaluation (IWS-FCE) and various clinical and psychosocial factors. SUBJECTS: The sample consisted of 170 workers' compensation claimants who were undergoing functional capacity evaluations (FCEs) for low back injuries. METHODS: In this cross-sectional study, claimants completed a battery of work-related measures, including the IWS-FCE, the Pain Disability Index (PDI), a workplace organizational policies and practices scale, and a recovery expectations questionnaire. Functional capacity evaluation performance indicators were the number of tasks in which subjects did not meet work demands and weight lifted on the floor-to-waist lift. Analysis included multivariable regression. RESULTS: Only the PDI, pain intensity, age, and sex independently contributed to floor-to-waist lift performance. The PDI, pain intensity, and duration of injury contributed to the number of failed tasks. DISCUSSION AND CONCLUSION: The results indicate that performance on FCEs is influenced by physical factors, perceptions of disability, and pain intensity. However, perceptions of workplace organizational policies and procedures were not associated with FCE results for workers' compensation claimants with chronic back pain disability. Functional capacity evaluations should be considered behavioral tests influenced by multiple factors, including physical ability, beliefs, and perceptions.

Adult↗
PubMed2006

A tribute to a gifted scholar, Anne Hudson, who has made revolutionary advances in healthcare and patient safety in our nation.

This article describes how Mary Anne Hudson, RN, BSN, turned a devastating spinal injury from lifting patients into a powerful, national-level campaign for safe patient handling in America. Anne Hudson was a well-respected nurse, caring for acutely ill patients in medical-surgical, telemetry, and intermediate care units of a hospital, until a spinal injury from lifting patients ended her hospital career. She discovered that training in "correct" patient lifting technique and body mechanics was inadequate to protect against injury with lifting adult patients of all sizes. The injury led to 2 years of conservative treatment, followed by a two-level, anterior-posterior, lumbar, interbody fusion, with placement of cadaver bone grafts and titanium hardware. During nearly 5 years of dealing with the workers' compensation system, Anne Hudson found that workers' compensation does not assist back-disabled nurses to return to their employment, but, typically re-directs such injured nurses away from nursing, into lower-paying, non-nursing work. With permanent lifting restrictions, Anne Hudson counts herself as quite fortunate to have found other employment as a public health nurse with the county health department. She was aware that a cycle of pain, frustration, and depression is common among injured nurses who are terminated when they can no longer lift. Anne Hudson's response was to seek information on back injury to nurses. (ABSTRACT TRUNCATED)

Accidents, Occupational↗
PubMed2005

Ligamentum flavum hematoma in the lumbar spine.

A 62-year-old male presented with a rare case of ligamentum flavum hematoma manifesting as low back pain and gait difficulty beginning 1 month before consulting our institute. He had no history of lumbar spine surgery or lumbar puncture. However, he might have suffered forgotten back injury while practicing martial arts. Magnetic resonance imaging showed a heterogeneous intensity mass lesion with a cystic component at the L3-4 levels. The lesion was totally removed through a hemilaminectomy. Intraoperative and histological findings confirmed the diagnosis of old hematoma with granulomatous change in the ligamentum flavum. Postoperatively, his low back pain and gait difficulty resolved within a few days.

Hematoma↗
PubMed1994

Isokinetic trunk testing and employment.

Isokinetic trunk testing is often performed to evaluate ability to perform job tasks. The purpose of this study was to evaluate the effectiveness of isokinetic trunk testing in identifying people with limited functional lifting capability and likely future injury potential. Two hundred thirty work applicants for heavy labor in a steel mill underwent job-related lifting ability and isokinetic trunk evaluation. There was no difference between the isokinetic scores of women who did not meet the job lifting criteria and those who did meet the lifting criteria. There was no difference between the isokinetic scores of workers who experienced occupational low back injury and those workers who did not over almost a 6-year follow-up period. In this study isokinetic trunk evaluation was of no value in employee selection.

Adolescent↗
PubMed2002

Balance loss when lifting a heavier-than-expected load: effects of lifting technique.

OBJECTIVES: To compare the lifting techniques of subjects who did and did not maintain their balance with an unexpectedly heavy load, and to examine whether the balance loss increased low back loading. DESIGN: Repeated-measures design. SETTING: A research laboratory. PARTICIPANTS: Fourteen healthy volunteers were assigned to 2 groups in the post hoc analysis. Group 1 (7 men; mean age, 25.6 +/- 4.2yr; height, 1.78 +/-.08m; weight, 83.0 +/- 8.5kg; lifting capacity, 63.2 +/- 8.0kg) maintained balance and was matched to group 2 (7 men; mean age, 26.3 +/- 4.1yr; height, 1.75 +/-.06m; weight, 78.2 +/- 5.3kg; lifting capacity, 64.7 +/- 4.9kg) who lost balance. INTERVENTIONS: Subjects lifted boxes of 5%, 20%, and 35% of their lifting capacity. Load magnitude was expected or unexpected. MAIN OUTCOME MEASURES: Center of mass (COM), lower body mechanics, ground reaction forces, and angular and horizontal momentum. RESULTS: Group 1 consistently showed greater lumbar flexion, less knee flexion, and a higher COM just before and after load liftoff. During the heavier-than-expected 35% lift, the trunk angular velocities lifts indicated that both groups experienced eccentric trunk extensor muscle contractions. CONCLUSIONS: The semisquat technique may protect against balance loss when lifting unexpectedly heavy loads. Eccentric muscle contractions and rapid increases in lumbar joint reaction moments may increase the risk of low back injury when there is a large, unexpected increase in the weight of the lifted load.

Adult↗
PubMed2004

The influence of a back support harness on spinal forces during sheep shearing.

Previous research has classified the occupation of sheep shearing as heavy work where shearers flex their spine and hips for long periods of time, handle awkward loads and expend high amounts of energy. The aim of this research was to investigate the magnitude of spinal forces produced during the shearing phase of the work and to determine whether the use of a commercially available back support harness would reduce these forces. Following discussion on task complexity and risk of back injury with senior shearing instructors, three component tasks of the shearing phase were identified as posing high risk of injury and were prioritized for primary analysis. Although the dragging out of a sheep in preparation for shearing and an unexpected loss of animal control were also identified as being of high risk, technological and instrumentation difficulties precluded their analysis. Twelve experienced shearers were videotaped while shearing with and without the use of a back harness. Surface mounted retro-reflective markers placed on the trunk defined three linked segments: Pelvis, Lumbar and Head, Arms, and Upper Trunk (HAUT). A 3D, link segment, top down, inverse dynamics approach was used to describe the motion and to estimate forces involved during the identified tasks of shearing. The spinal force/time profiles of this sample of shearers demonstrated large compressive and shear forces for all three tasks that are close to the NIOSH and University of Waterloo action limits for compressive and shear forces respectively (McGill 1997, Yingling and McGill 1999, Marras 2000). The use of the back support harness reduced these forces by substantial and statistically significant amounts. This effect was consistent across all three tasks. The results of this study demonstrate the production of high levels of compressive and shear forces within the spine of shearers during the three shearing tasks studied and that the use of a back support harness can substantially reduce these forces. Therefore the use of a back harness may reduce the cumulative load on the spine during shearing thereby moderating damage to the articular structures. However it is not known whether the harness would protect the spine from a sudden or unexpected force.

Adult↗