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PubMedDate not supplied

Disabling low back Oregon workers' compensation claims. Part I: Methodology and clinical categorization of chiropractic and medical cases.

This paper reports on a case-control study of 201 randomly selected workers' compensation cases involving disabling low back injuries. To control for claim severity prior to comparison studies on time loss and treatment cost, a classification scheme based on documented clinical signs and symptoms was used to subgroup the claims from two provider groups, chiropractic (DC) and medical (MD), into three categories of clinical presentation. Soft tissue strain/sprain predominated in both provider groups. The two provider groups differed in the proportion of claimants who had physical factors contributing to low back compromise. DC claimants were less likely than MD claimants to have sought initial treatment in the emergency room, more likely to have a history of chronic, recurrent low back pain and more likely to have suffered exacerbation episodes. These differences suggest a greater level of chronicity among chiropractic claimants.

Back Pain↗
PubMed2002

Physical and psychological correlates of primary headache in young adulthood: a 26 year longitudinal study.

OBJECTIVES: To determine if physical and/or psychological risk factors could differentiate between subtypes of primary headache (migraine, tension-type headache (TTH), and coexisting migraine and TTH (combined)) among members of a longitudinal birth cohort study. METHODS: At age 26, the headache status of members of the Dunedin Multidisciplinary Health and Development Study (DMHDS) was determined using International Headache Society criteria. Headache history and potential physical and psychological correlates of headache were assessed. These factors included perinatal problems and injuries sustained to age 26; and behavioural, personality, and psychiatric disorders assessed between ages 5 to 21. RESULTS: The 1 year prevalences for migraine, TTH, and combined headache at the age of 26 were 7.2%, 11.1%, and 4.3%, respectively. Migraine was related to maternal headache, anxiety symptoms in childhood, anxiety disorders during adolescence and young adulthood, and the stress reactivity personality trait at the age of 18. TTH was significantly associated with neck or back injury in childhood (before the age of 13). Combined headache was related to maternal headache and anxiety disorder at 18 and 21 only among women with a childhood history of headache. Headache status at the age of 26 was unrelated to a history of perinatal complication, neurological disorder, or mild traumatic head injury. CONCLUSIONS: Migraine and TTH seem to be distinct disorders with different developmental characteristics. Combined headache may also have a distinct aetiology.

Adult↗
PubMed1992

A prospective evaluation of preemployment screening methods for acute industrial back pain.

Preemployment screening methods have been ineffective in predicting those at risk, and in curbing the impact of back problems in industry. Such methods have centered on individual physical factors (capacities and clinical examination). This study evaluates commonly used physical examination measures and simple historical data for its ability to predict individuals at risk for future back injury reporting in the aircraft industry. In this study, once simple historical information about previous pain treatment was known, information gained from physical factors added no significant predictive value.

Adult↗
PubMed2003

The responses of leg and trunk muscles to sudden unloading of the hands: implications for balance and spine stability.

OBJECTIVE: To examine the anticipatory and responsive actions of leg and trunk muscles, and their role in whole-body and spine control in situations of sudden unloading of the hands in the sagittal plane. DESIGN: EMG and force plate measures were used to determine the baseline, anticipatory responses and post unloading responses of selected trunk and leg muscles under different conditions of unload timing knowledge. BACKGROUND: Postural muscles have been observed to increase activation in anticipation of a known loading situation to decrease the overall effect of an impulsive load delivered to the spine. It is thought that this increased activation places the spine in a more stable state, thereby reducing the likelihood of injury. Comparisons have not been made previously of the responses of postural muscles to unloading conditions where the certainty of unload timing is varied. METHODS: Eleven male subjects, holding a 6.8 kg load in the hands, were subjected to three different unloading conditions: (1) voluntary load drop; (2) known timing of load release; (3) unknown timing of load release. Anterior-posterior center of pressure data, as well as EMG activity on 8 right side muscles, were collected for 10 trials in each condition. RESULTS: Anterior-posterior center of pressure responses were significantly different (P<0.05) between each of the three conditions. Lumbar erector spinae and thoracic erector spinae significantly decreased anticipatory activity as knowledge of the unload timing increased. Five of the eight monitored muscles demonstrated significantly decreased response levels as knowledge of the timing of unloading increased. CONCLUSIONS: When an unload is self-triggered, preparatory adjustments can be made which reduce the overall postural perturbation to the body, and the spine in particular, while minimizing the responsive activity of trunk muscles. RELEVANCE: Spinal instability has been identified as a risk factor for low back injury during trunk loading. This study demonstrates that, in situations of sudden unloading, knowledge of the timing of the unloading may lead to anticipatory actions of postural muscles which actually decrease spinal stability, thereby increasing the risk of injury were an unexpected perturbation to occur.

Abdomen↗
PubMed2006

Electromyographic activity of selected trunk muscles during bicycle ergometer exercise and walking.

Recently, active treatment such as exercise has been increasingly advocated for CLBP (chronic low back pain). Specially, exercise to improve fitness has been recommended for the prevention of back injuries. The bicycle ergometer or walking have often been used to improve the fitness of CLBP patients. However, little is known about the activity levels of the trunk muscles during such exercise. In this study, the electromyographic (EMG) activities of the trunk muscles during bicycle ergometer exercises and walking were compared and the load level on these muscles during such exercises was investigated. The present study provides basic information concerning fitness exercise in CLBP patients. Eleven healthy male volunteers (21.7 +/- 2.5 years old) without low back pain participated in the study. Bipolar surface electrodes were attached to the right side of the rectus abdominis, the obliquus externus abdominis and lower back extensor muscles (L3). EMG signals were continuously recorded while walking and during gradual loading exercises and normalized to maximal voluntary contractions (% MVC). One way analysis of variance (ANOVA) was performed on the % MVC from each exercise and walking for each of the three trunk muscle sites (p < 0.05). The rectus abdominis muscle showed activity of about 6% MVC during any grade of exercise and walking and no significant differences were found between these forms of exercise. The obliquus externus abdominis muscle showed about 30% MVC during any grade of exercise and walking, but no significant difference was found between them. The low back muscles showed activity of about 12% MVC while walking, whereas activity level increased as the exercise load using the bicycle ergometer increased. More significant low back muscles activity was observed while walking than during exercises of 25 w and 50 w. The results of this study indicated that exercise using the bicycle ergometer should be useful for maintaining or improving fitness in CLBP patients, because it results in less load on the trunk muscles and relatively more oxygen uptake than walking.

Abdominal Muscles↗
PubMed1989

Risk indicators in low back pain.

Injuries leading to low back pain can occur by direct trauma, overexertion or repetitive trauma. Overexertion is claimed by 60% of low back pain patients as the cause of injury. Of these patients with overexertion injuries, 66% implicated lifting and 20% pushing or pulling. It is, however, difficult to relate the workplace to the complaint of low back pain in a specific worker, and low back pain is found quite often in those with sedentary occupations. The incidence, severity and potential disability are all related to the demands on the individual in the workplace. Among the factors implicated are the requirements for lifting (particularly when compared to the worker's lifting capacity), pushing and pulling, posture, and cyclic loading. Drivers of heavy vehicles have two to four times the average incidence of serious low back pain. This is probably due to the cyclic loading environment. The general psychosocial environment (including that at work) is an important risk factor. The first attack of low back pain occurs in the teens or twenties. Low back pain is as frequent in females as males, although women in manual materials handling jobs are at greater risk. Posture, anthropometry and mobility measures have limited prognostic value. Muscle strength and physical fitness probably have some value. Radiographic findings have little pragmatic value.

Age Factors↗
PubMed1986

Acromegalic arthropathy: a reversible rheumatic disease.

Acromegalic arthropathy may be the initial manifestation of growth hormone over-production. The presence of an underlying endocrinopathy may go unrecognized for a long period of time because of the predominance of articular signs and symptoms. We describe 2 cases of acromegaly presenting with rheumatologic manifestations, the first resembling seronegative rheumatoid arthritis, the second, post traumatic low back syndrome. Unlike previous reports, both our cases showed resolution of musculoskeletal symptoms after pituitary surgery.

Acromegaly↗
PubMed1975

Non-fatal injuries sustained by back seat passengers.

Of 2,275 cases of non-fatal injuries sustained by all categories of road users 185 were inflicted on back seat passengers. Twenty-six such passengers sustained severe and 66 moderately severe injuries. Only two patients (aged 18 months and 3 years) wore any form of restraint. Back seat passengers may be injured by impact with the rear of the front seat or other objects in the rear compartment; by objects in the front compartment; or by being thrown out of the car completely. An adequate restraint system, such as the lap-and-diagnoal type of seat belt, would reduce the incidence and severity of injuries.

Abdominal Injuries↗
PubMed1997

Self-directed patient education in soft-tissue rehabilitation: rationale and analysis of a pilot project.

OBJECTIVES: To determine the compliance level and topic choice selection frequency of rehabilitation patients in a self-directed education program offered in conjunction with a rehabilitation exercise program. DESIGN: Descriptive study. SETTING: Soft-tissue injury rehabilitation clinic located within a chiropractic college. SUBJECTS: Twenty-four rehabilitation patients with injured spines who were enrolled in a daily in-clinic program. OUTCOME MEASURES: Data was collected from patient log-book pages, which recorded frequency of use, topic, medium and personal satisfaction for each selected resource. Clinic attendance data was collected by the clinical staff. RESULTS: Eighty-one percent (81%) of the patient group voluntarily used the learning center. Average frequency of use was approximately one visit per patient per week. Of the 13 subject areas included in the resource center collection, back injury care (30), nutrition (22) and fitness/exercise (14) received the most use. Patient satisfaction with the resources' value/interest averaged 78.4%. CONCLUSIONS: Most (81%) patients in this group were willing to spend some of their own time learning information that they thought was important. The results may allow for patient education program designs that put more responsibility for learning with the patient and allow for more efficient clinician time allocation.

Adult↗
PubMed2005

Differential diagnosis of spondylolysis in a patient with chronic low back pain.

STUDY DESIGN: Resident's case problem. BACKGROUND: A 26-year-old male sought physical therapy services via direct access secondary to a flare-up of a chronic low back pain condition. The patient complained of recent onset of lumbosacral joint pain, including (1) constant right-sided deep-bruise sensation, (2) intermittent right-sided sharp stabbing pain, and (3) constant bilateral aching. The patient's past medical history included a hyperextension low back injury while playing football at age 17. Physical examination revealed (1) deep pain with palpation over the right lumbosacral joint region, (2) sharp right lumbosacral joint pain with 1 repetition of active trunk backward bending, and (3) a marked increase in pain and joint hypomobility with right unilateral joint assessment at the L4 and L5 spinal levels. DIAGNOSIS: The examining therapist referred the patient for radiographic evaluation due to strong suspicions of a pars interarticularis bony defect. Lumbar plain films, oblique views, revealed an L5 bilateral pars defect, leading to a diagnosis of a longstanding bilateral L5 spondylolysis. DISCUSSION: Patients with low back pain often seek physical therapy services. Identification of pathology requiring examination by other health care providers, leading to patient referral to other health care practitioners, is a potential important outcome of the therapist's examination. This resident's case problem illustrates the importance of a systematic examination scheme, including a thorough medical screening component that led to a patient referral for radiographic evaluation. The resultant diagnosis, although not representing serious pathology, did impact the therapist's patient plan of care.

Adult↗
PubMed1984

Transcutaneous electrical nerve stimulation: its role in the control of chronic pain.

An assessment was made of the effectiveness of long-term transcutaneous electrical nerve stimulation (TENS) in the treatment of chronic posttraumatic pain. Compensation Board files showed that 846 patients received TENS from 1975 to 1979, with more than 70% having intractable back pain. Of this group using TENS, 44.6% were free of disability, and an additional 36.2% were capable of modified work. Questionnaire responses were obtained from 563 of 637 patients receiving TENS in 1978 or 1979. At the six-month follow-up, most respondents (472, 83.8%) reported continuing benefit from TENS, including a reduction of pain (418, 74.2%), less need for medication (322, 57.2%), and improved sleep patterns (331, 58.8%). Only 13.6% of those who had returned to work reported no benefit from TENS, while 18.4% of those still unemployed reported no benefit. Among those who had returned to work (264 cases, 46.9% of respondents), benefit was reported equally by those with back injuries and by those with other injuries. The responses observed in this trial seem larger and more long-lasting than could be obtained by a placebo effect, and further attempts at a controlled trial may be warranted. However, there are major practical difficulties to such an investigation, and the resulting controversy could reduce the therapeutic effectiveness of TENS in conditions where alternative treatments are either ineffective or undesirable.

Back Pain↗
PubMed1996

Quantitative assessment of the control capability of the trunk muscles during oscillatory bending motion under a new experimental protocol.

OBJECTIVE: A new quantitative technique for measuring the trunk control capability/coordination was to be developed in this study. DESIGN: Fitts' experimental paradigm was employed to quantify the information processing capacity (bits/s) of the trunk as well as dynamic motor performance such as velocity and acceleration during flexion and extension. BACKGROUND: The quantification of functional capability of the trunk such as range of motion, strength, and endurance have been used to evaluate low back pain patient. Especially, dynamic trunk motion during flexion and extension has been studied not only to quantify the severity of the low-back impairment but to classify patients. METHOD: A lumbar motion monitor was used to record the time series of range of motion (RoM) and compute the velocity and acceleration of the trunk motion. Twenty male subjects without any back pain in the past 6 months and previous history of back injury participated. Each subject performed 22 controlled flexion/extension at predetermined RoMs as well as one ballistic trunk flexion/extension at a self-selected RoM. RESULTS: The information processing capacity of the trunk among healthy subjects was found to have a mean of 4.23 (SD 1.43) bits/s based on Fitts' law. Also, the velocity of dynamic trunk motion was measured with a considerable reduction in intersubject variability when the RoMs were controlled. A short but still accurate experimental protocol was suggested via a series of statistical analyses to provide an objective and easy-to-use method to evaluate the functional capacity of low-back pain patients.

Journal Article↗
PubMed2005

Adaptive system identification applied to the biomechanical response of the human trunk during sudden loading.

Epidemiological evidence indicates that sudden loading of the torso is a risk factor for low back injury. Accurately quantifying the time-varying loading of the spine during sudden loading events and how these loading profiles are affected by workplace factors such as fatigue, expectation, and training can potentially lead to intervention strategies that can reduce these risks. Electromyographic and trunk motion data were collected from six male participants who performed a series of sudden loading trials with varying levels of expectation (no preview, 300-ms audible preview), fatigue (no fatiguing exertion preceding sudden load, short duration/high intensity fatiguing exertion preceding sudden load), and training (untrained, trained). These data were used as inputs to an adaptive system identification model wherein time-varying lower back stiffness, torque, work, and impulse magnitudes were calculated. Results indicated that expectation significantly increased peak and average stiffness by 70% and 113%, respectively, and significantly decreased peak torque, work, and impulse magnitudes by 36%, 50%, and 45%, respectively. Training significantly decreased peak torque and work by 25% and 34%, respectively. The results also showed a significant interaction between expectation and training wherein training had a positive effect during the trials with preview but no effect during the trials with no preview (increased peak stiffness by 17% and decreased impulse magnitude by 43%).

Abdomen↗
PubMed1995

Predicting outcome of chronic back pain using clinical predictors of psychopathology: a prospective analysis.

This study evaluated whether a comprehensive assessment of psychosocial measures is useful in characterizing those acute low back pain patients who subsequently develop chronic pain disability problems. A cohort of 324 patients was evaluated, with all patients being administered a standard battery psychological assessment tests. A structured telephone interview was conducted 6 months after the psychological assessment to evaluate return-to-work status. Analyses, conducted to differentiate between those patients who were back at work at 6 months versus those who were not because of the original back injury, revealed the importance of 3 measures: self-reported pain and disability, the presence of a personality disorder, and scores on Scale 3 of the Minnesota Multiphasic Personality Inventory. These results demonstrate the presence of a psychosocial disability variable that is associated with those injured workers who are likely to develop chronic disability problems.

Adult↗
PubMed1995

[An epidemiological study on the relationship between musculoskeletal disorders and work load].

965 workers engaged in working tasks of work intensity grade 2, 3, 4 (based on Chinese National Standard) were investigated on the musculoskeletal disorders with a questionnaire. The lumbar vertebra of 136 randomly chosen workers were also radiologically examined. The result revealed that the prevalence of low-back disorders was 51.2% on average and it was obviously correlated with such factors as age, standing, previous back injury, education level, sport activity, work intensity, working posture, satisfaction with the tools as well as work condition and house work. Heavy work load and unneutral working posture were proved to be the main factors as revealed by the multifactor analysis and further supported by the findings of X-ray examination.

Adult↗
PubMed2006

Diagnosis of low back pain: role of imaging studies.

Approximately 70% of North Americans experience low back pain during their lifetime, with most of them demonstrating improvement within 2 to 4 weeks. The use of early radiographic evaluation is often unnecessary for uncomplicated acute low back injuries. Select patient populations have been identified for early evaluation. If the following red flags are associated with the pain, spinal imaging is indicated: possible fracture, neoplasm, infection, and cauda equina syndrome. High suspicion for the presence of one of these entities should prompt more formal evaluation of the spine. This article provides an overview of the commonly used diagnostic procedures in the evaluation of lumbar spine disorders.

Humans↗