Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Back Injuries”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 793 records · Page 44Linked to original sources
PubMedDate not supplied

Power determination for geographically clustered data using generalized estimating equations.

Study designs in public health research often require the estimation of intervention effects that have been applied to a cluster of subjects in a common geographic area, rather than randomly assigned to individual subjects, and where the outcome is dichotomous. Statistical methods that account for the intracluster correlation of measurements must be used or the standard errors of regression coefficients will be under-estimated. Generalized estimating equations (GEE) can be used to account for this correlation, although there are no straightforward methods to determine sample-size requirements for adequate power. A simulation study was performed to calculate power in a GEE model for a proposed study of the effect of an intervention, designed to reduce lower-back injuries among nursing personnel employed in nursing homes. Nursing homes will be randomly assigned to either an intervention or control group and all employees within a nursing home will be treated alike. Historical injury data indicates that the baseline-injury risk for each home can be reasonably modelled using a beta distribution. It is assumed that the risk for any individual nurse within a nursing home follows a Bernoulli probability distribution expressed as a logit function of fixed covariates, which have values of odds ratios determined from previous studies which represent characteristics of the study population, and a random-intercept term which is specific for each home. Results indicate that failure to account for intracluster correlation can lead to overestimates of power as well as inflation of type I error by as much as 20 per cent. Although the GEE method accounted for the intracluster correlation when present, estimates of the intracluster correlation were negatively biased when no intracluster correlation was present. In addition, and possibly related to the negatively biased estimates of intracluster correlation, we also found inflated type I error estimates from the GEE method.

Algorithms↗
PubMed1995

Human trunk strength profile in lateral flexion and axial rotation.

STUDY DESIGN: To determine the functional capability in asymmetric trunk motion, isometric and isokinetic lateral flexion and axial rotation strengths of a normal and patient samples were measured. Seventy-three normal asymptomatic subjects (41 males and 32 females) and ten patients (9 males and 1 female) were tested. OBJECTIVES: The dual objectives of the study were to develop a database for isometric and isokinetic lateral flexion and axial rotation strength capabilities of a normal sample and to determine the functional impairment of a sample of patients. SUMMARY OF BACKGROUND DATA: More than 60% of low back injuries are associated with trunk twisting. Asymmetric motions are important risk factors. However, strength capability data for axial rotation are sparse and those for lateral flexion nonexistent. METHODS: To achieve the objectives of the study, two devices were designed and fabricated. Isometric lateral flexion was tested bilaterally in neutral posture and at 10 degrees, 20 degrees, and 30 degrees of lateral bending. Isometric axial rotation was tested bilaterally in neutral posture and at 5 degrees, 10 degrees, 15 degrees, and 20 degrees of axial rotation. Isokinetic lateral flexion and axial rotation strengths were tested bilaterally starting from the neutral posture. RESULTS: The strength invariably declined progressively for all groups with increasing postural asymmetry. The strength in isokinetic activities ranged between 60% to 70% of the strength measured in isometric activities. All groups were significantly stronger in lateral flexion compared with axial rotation. The female sample ranged between 60% to 70% values of males for all activities studied. The patient group was weakest, ranging between 45% to 55% for isometric and 52% to 58% for isokinetic activities of their control group.

Adult↗
PubMed1997

Low back loads over a variety of abdominal exercises: searching for the safest abdominal challenge.

Abdominal exercises are prescribed for both the prevention and treatment of low back injury. However, these exercises sometimes appear to have hazardous effects on the lumbar spine. The purpose of this study was to identify quantitatively abdominal exercises that optimize the challenge to the abdominal muscles (rectus abdominis, external oblique, internal oblique) but impose minimal load penalty to the lumbar spine. Nine volunteers performed 12 different abdominal exercises. For a given task the maximum abdominal muscle EMG value was divided by the maximum compression value, resulting in an abdominal challenge versus spinal compression cost index. In general, the partial curl-ups generated the highest muscle challenge-to-spine cost indices. However, those exercises that generated the best challenge-to-cost indices did not necessarily record the lowest compression levels along with the highest EMG activations. No single exercise was found that optimally trained all of the abdominal muscles while at the same time incurring minimal intervertebral joint loads. It was concluded that a variety of selected abdominal exercises are required to sufficiently challenge all of the abdominal muscles and that these exercises will-differ to best meet the different training objectives of individuals.

Abdominal Muscles↗
PubMedDate not supplied

Effects of body mechanics training on performance of repetitive lifting.

OBJECTIVE: To measure the efficacy of body mechanics instruction (BMI) in patients with low back pain. METHOD: The effect of BMI was measured in four participants with back injuries using a standardized lifting protocol. Static strength, weight lifted, number of lifts completed, and motion analysis data to describe the body mechanics were measured before and after work hardening to evaluate treatment effects. The participants' performances were compared with 52 controls from an earlier study. RESULTS: Starting postures, characterized by degrees of hip and knee flexion, varied by participant but favored a squat lift in three participants when compared with the controls. Dynamic motion synchrony of the hip and knee joints was similar to controls in three of the four participants. Posttest data revealed significant changes in static strength, dynamic endurance, and lifting speed. CONCLUSION: Intensive instruction in body mechanics provided during the work-hardening treatment produced major changes in lifting styles, in terms of both starting postures and dynamic aspects of repetitive lifting. The computerized measurement procedures used in this study permitted more careful and detailed analyses of body mechanics, particularly dynamic aspects, than is possible with observational methods. This study demonstrated some of the inherent intricacies in isodynamic lifting and suggests additional areas of performance that may be important to address in BMI.

Adult↗
PubMed1994

Behavioral interventions for managing chronic pain.

Behavioral interventions result in reliable improvements for patients with chronic LBP, RA, and OA. It should be emphasized, however, that these interventions rarely eliminate pain. Nevertheless, they often help patients reduce their suffering and health care costs. There also is evidence that preventive efforts may be especially beneficial to patients with recent back injuries (17, 18). There are two major differences between the outcomes produced by behavioral interventions for LBP and those produced by interventions for RA and OA. Interventions for LBP reduce pain and improve function, whereas treatments for RA and OA primarily reduce pain and psychological distress. Furthermore, in contrast to the effects of interventions for LBP, the beneficial outcomes achieved by patients with RA and OA tend to diminish after treatment termination. These differences probably are due to the fact that patients who have chronic LBP do not experience progressive changes in joint and bone tissues. Therefore, greater effort should be devoted to helping patients with RA and OA adapt to changes in disease progression following treatment termination. Keefe and Van Horn (36) have provided a model for improving patients' post-treatment adaptation that currently is being evaluated in a controlled study. Although physicians often wish to refer patients to pain treatment centers or behavioralists who treat chronic pain, they tend to have difficulty judging the quality of care offered by these centers and specialists. When you select a pain treatment center, first determine whether it meets the standards of the Commission on Accreditation of Rehabilitation Facilities (CARF, 101 North Wilmot Road, Suite 500, Tucson, AZ 85711).(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis, Rheumatoid↗
PubMed2001

Isometric axial rotation of the trunk in the neutral posture.

The purpose of this study was to measure the torque, the magnitude of the electromyogram (EMG) signal and the phase relationship of 14 muscles during trunk axial rotation. Fifty normal healthy volunteers (27 males and 23 females) with no lower-back injury participated in the study. The subjects were seated in an upright position in the axial rotation tester (AROT) after applying surface electrodes bilaterally to the following muscles: pectoralis major, rectus abdominis, external oblique, internal oblique, latissimus dorsi, and erector spinae at T10 and L3. They were stabilized from the hip down, and the shoulder harness of the AROT was applied to their shoulders. These subjects performed maximal isometric axial rotations to the left and right in a random order. The torque and 14 channels of EMG were monitored, and their magnitude, slope of the increase in magnitude, and timing of the anticipation and onset activity were determined. The results revealed that the females produced 65% of the torque of their male counterparts. The pattern and magnitude of EMG in performing these tasks were significantly different between males and females (P<0.01). Males generated the greatest activity in their ipsilateral latissimus dorsi followed by their contralateral external oblique muscles. In the females, maximal EMG activity was observed in their contralateral pectoralis muscle. Thus, under the current experimental conditions, the females employed a different muscle recruitment strategy compared to the males. Each muscle involved in axial rotation was significantly different from the other (P < 0.01). The timing pattern for these activities was inconsistent, implying that there is no fixed-order phasic recruitment of the torso muscles during maximal isometric axial rotation.

Adolescent↗
PubMed2006

Between-day repeatability and symmetry of multifidus cross-sectional area measured using ultrasound imaging.

STUDY DESIGN: Prospective test-retest, intrarater reliability study. OBJECTIVES: To estimate the intrarater reliability, asymmetry, and associated error with measurement of the cross-sectional area (CSA) of the bilateral S1 multifidi when measured by a physical therapist following a short course of self-directed training in ultrasound imaging. BACKGROUND: There is increasing interest in the assessment of the lumbar multifidus during the recovery from low back injury. It is important to know the error associated with the CSA measurements obtained by a physical therapist with limited experience in ultrasound imaging when using a portable unit. METHODS AND MEASURES: Thirty healthy females (mean +/- SD age, 23 +/- 2 years; mean +/- SD mass, 63.1 +/- 9.2 kg; mean +/- SD height, 1.63 +/- 0.06 m) participated. Fourteen subjects returned within 1 to 4 days for repeated measurements. RESULTS: For all 30 subjects, the average (+/- SD) CSA of the left S1 multifidus (4.18 +/- 0.55 cm2) was larger (P<.05) than the right (4.11 +/- 0.57 cm2), with a standard error of the measurement (SEM) of 0.13 cm2 and average +/- SD asymmetry of 3.5% +/- 3.4%. For a subset of 14 subjects, the between-day intrarater reliability for the right S1 multifidus muscle was ICC3,1 = 0.80 (95% CI, 0.49-0.93), while the ICC for the left side was 0.72 (95% CI, 0.34-0.90). The day-to-day average differences for the left and right side were 0.02 cm2 and 0.04 cm2, respectively. For the most conservative estimate, the between-day SEM was 0.37cm2. CONCLUSIONS: A physical therapist, newly trained in ultrasound imaging, obtained reasonable between-day intrarater reliability when imaging the S1 multifidus. A high degree of symmetry was found between the bilateral S1 multifidi in a sample of healthy subjects, which is consistent with previous reports from measurements by skilled ultrasonographers.

Adult↗
PubMed2006

Trunk muscle activation and associated lumbar spine joint shear forces under different levels of external forward force applied to the trunk.

High anterior intervertebral shear loads could cause low back injuries and therefore the neuromuscular system may actively counteract these forces. This study investigated whether, under constant moment loading relative to L3L4, an increased externally applied forward force on the trunk results in a shift in muscle activation towards the use of muscles with more backward directed lines of action, thereby reducing the increase in total joint shear force. Twelve participants isometrically resisted forward forces, applied at several locations on the trunk, while moments were held constant relative to L3L4. Surface EMG and lumbar curvature were measured, and an EMG-driven muscle model was used to calculate compression and shear forces at all lumbar intervertebral joints. Larger externally applied forward forces resulted in a flattening of the lumbar lordosis and a slightly more backward directed muscle force. Furthermore, the overall muscle activation increased. At the T12L1 to L3L4 joint, resulting joint shear forces remained small (less than 200N) because the average muscle force pulled backward relative to those joints. However, at the L5S1 joint the average muscle force pulled the trunk forward so that the increase in muscle force with increasing externally applied forward force caused a further rise in shear force (by 102.1N, SD=104.0N), resulting in a joint shear force of 1080.1N (SD=150.4N) at 50Nm moment loading. It is concluded that the response of the neuromuscular system to shear force challenges tends to increase rather than reduce the shear loading at the lumbar joint that is subjected to the highest shear forces.

Abdomen↗
PubMed2006

Work disability and costs caused by recurrence of low back pain: longer and more costly than in first episodes.

STUDY DESIGN: Retrospective analysis of workers' compensation (WC) claims data for nonspecific low back injuries (LBI) in a single jurisdiction. OBJECTIVE: To examine whether recurrences, defined as post-initial episodes of work disability or medical care, substantially contribute to total medical and indemnity costs, and total duration of work disability. SUMMARY OF BACKGROUND DATA: Previous studies have not measured the proportion of care seeking and work disability that are associated with recurrences in claims for work-related LBI. METHODS: All persons with new lost-time claims for nonspecific LBI reported in New Hampshire to a large WC provider from 1996 to 1999 were selected (N = 1867). Three years of follow-up data, starting at the beginning of the first episode, were collected. Previously validated definitions of recurrence were used identify new episodes of care and new episodes of lost work time (work disability). Total duration of work disability, total medical costs, and total indemnity costs were investigated. For individuals with recurrences, these variables were separated into first-episode and recurrent period duration and costs. RESULTS: The rate of recurrent work disability was 17.2%, and the rate of recurrent care seeking was 33.9%. Individuals with recurrence had significantly higher total length of work disability, and higher medical and indemnity costs. For those with recurrent work disability, 69% of total lost time from work, 71% of associated indemnity costs, and 84% of total medical costs occurred during the recurrent period. For those with recurrence of care, the respective values were 48%, 47%, and 42%. CONCLUSIONS: Recurrences contributed disproportionately to the total burden of work-related nonspecific LBI, through both additional care seeking and work disability. Results imply that those who have recurrences may be an especially important target for secondary prevention efforts.

Adult↗
PubMedDate not supplied

An interdisciplinary approach to mobility and safety education for caregivers and stroke patients.

A cerebrovascular accident (CVA), or stroke, often results not only in hemiplegia, but also in cognitive and perceptual impairments as well. The hemiplegia causes obvious problems with mobility, while cognitive and perceptual impairments might interfere with and delay progress in therapy. Physiotherapists and occupational therapists have extensive knowledge and training regarding the intricacies of movement and mobility. Unfortunately, little emphasis is given to these areas in most nursing programs; yet nurses spend the most time with hospitalized clients, providing 24-hour care. As stroke patients tend to learn by repetition, a consistent rehabilitation program is essential, especially with respect to mobility and safety education. It is important for the rehabilitation nurse to be knowledgeable regarding mobility techniques to prevent back injury to the caregiver and to reduce the degree of risk of injury to the patient.

Activities of Daily Living↗
PubMed2006

Integration and coordination of pain management in primary care.

Pain is one of the most common symptoms reported to primary care providers and has significant implications for health care costs. The primary aim of this article is to describe and illustrate how to integrate the treatment of chronic pain in the primary care setting. First, we address the integration and coordination of care between mental health and primary care. We then present a typical case and discuss the patient's treatment, outcome, and prognosis. The article concludes with a discussion of issues that frequently arise when integrating psychological treatment for pain in primary care settings.

Alcohol Drinking↗
PubMed1988

Ligaments of the lumbar spine: a review.

A thorough knowledge of the anatomy of the intervertebral ligaments is necessary to provide the basis for good clinical management of back injuries. This paper reviews the literature concerning the lumbar ligaments, including the zygoapophyseal joints. While general principles regarding the anatomy of the ligaments is relatively clear, areas of omission or discrepancy exist. There is very little substantiated information on: the dimensional characteristics of the ligaments; the fibre lengths of the facet capsule; the attachments of the anterior longitudinal ligament; the orientation of the interspinous ligament, and the extent of the supraspinous ligament.

Humans↗
PubMed2005

[Trendy sport: golf].

Golf is currently the most frequently played sport in the world and it will continue to grow in importance. Nevertheless, there is a striking deficit in our knowledge of the physical and psychological profile of golfers. In the foreground are not the acute but the chronic sport specific injuries, predominantly of the lumbar spine, the upper extremities (golfer's elbow and golfer's shoulder), and less commonly of the lower limbs (minor injuries to the ligaments). In addition to therapy, prophylaxis should also be used in order to better recognise and influence the sport specific burdens.

Arm Injuries↗
PubMed1999

The health benefits of physical activity in children and adolescents: implications for chronic disease prevention.

UNLABELLED: Clinical, epidemiological and basic research evidence clearly supports the inclusion of regular physical activity as a tool for the prevention of chronic disease and the enhancement of overall health. In children, activities of a moderate intensity may enhance overall health, and assist in preventing chronic disease in at-risk youth. The numerous health benefits of regular exercise are dependent on the type, intensity and volume of activity pursued by the individual. These benefits include reduction of low density lipoproteins while increasing high density lipoprotein; improvement of glucose metabolism in patients with type II diabetes; improved strength, self esteem and body image; and reduction in the occurrence of back injuries. In addition, a progressive, moderate-intensity exercise program will not adversely effect the immune system and may have a beneficial effect on the interleukin-2/natural killer cell system. Furthermore, by decreasing sedentary behaviors and, thus, increasing daily physical activity, individuals may experience many stress-reducing benefits, which may enhance the immune system. CONCLUSION: Moderate intensity exercise of a non-structured nature seems to facilitate most of the disease prevention goals and health promoting benefits. With new guidelines promoting a less intense and more time-efficient approach to regular physical activity, it is hoped that an upward trend in the physical activity patterns, and specifically children at risk for chronic disease, will develop in the near future.

Adolescent↗
PubMed1999

Lumbar spine stability can be augmented with an abdominal belt and/or increased intra-abdominal pressure.

The increased intra-abdominal pressure (IAP) commonly observed when the spine is loaded during physical activities is hypothesized to increase lumbar spine stability. The mechanical stability of the lumbar spine is an important consideration in low back injury prevention and rehabilitation strategies. This study examined the effects of raised IAP and an abdominal belt on lumbar spine stability. Two hypotheses were tested: (1) An increase in IAP leads to increased lumbar spine stability, (2) Wearing an abdominal belt increases spine stability. Ten volunteers were placed in a semi-seated position in a jig that restricted hip motion leaving the upper torso free to move in any direction. The determination of lumbar spine stability was accomplished by measuring the instantaneous trunk stiffness in response to a sudden load release. The quick release method was applied in isometric trunk flexion, extension, and lateral bending. Activity of 12 major trunk muscles was monitored with electromyography and the IAP was measured with an intra-gastric pressure transducer. A two-factor repeated measures design was used (P < 0.05), in which the spine stability was evaluated under combinations of the following two factors: belt or no belt and three levels of IAP (0, 40, and 80% of maximum). The belt and raised IAP increased trunk stiffness in all directions, but the results in extension lacked statistical significance. In flexion, trunk stiffness increased by 21% and 42% due to 40% and 80% IAP levels respectively; in lateral bending, trunk stiffness increased by 16% and 30%. The belt added between 9% and 57% to the trunk stiffness depending on the IAP level and the direction of exertion. In all three directions, the EMG activity of all 12 trunk muscles increased significantly due to the elevated IAP. The belt had no effect on the activity of any of the muscles with the exception of the thoracic erector spinae in extension and the lumbar erector spinae in flexion, whose activities decreased. The results indicate that both wearing an abdominal belt and raised IAP can each independently, or in combination, increase lumbar spine stability. However, the benefits of the belt must be interpreted with caution in the context of the decreased activation of a few trunk extensor muscles.

Abdomen↗
PubMed1984

Restrictions to posture in working environments.

This paper reviews some typical industrial work postures which have to be adopted as a result of either poorly designed machinery or workplace layout. Brief case studies of investigations carried out by the Materials Handling Research Unit (MHRU) are described. They illustrate the dangers associated with the postures and work environments which have been found to contribute to high incidences of industrial back injury. The handling problems considered by this paper will include those associated with cable drums, 200 litre drums, sacks and workstation design.

Journal Article↗