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PubMed2000

Behavioural treatment for chronic low back pain.

BACKGROUND: The treatment of chronic low back pain is not primarily focused on removing an underlying organic pathology, but at the reduction of disability through the modification of environmental contingencies and cognitive processes. Behavioural interventions are commonly used in the treatment of chronic (disabling) low back pain. OBJECTIVES: The objective of this systematic review was to determine if behavioural therapy is more effective than reference treatments for chronic non-specific low back pain, and which type of behavioural treatment is most effective. SEARCH STRATEGY: We searched the Medline, PsycLit databases, and the Cochrane Controlled Trials Register up to April 1999, Embase up to September 1999. We also screened references of identified randomised trials and relevant systematic reviews. SELECTION CRITERIA: Only randomised trials on any type of behavioural treatment for non-specific chronic low back pain were included. DATA COLLECTION AND ANALYSIS: Methodological quality assessment and data extraction was done by two reviewers independently. The magnitude of effect was assessed by computing a pooled effect size for each domain (i.e., behavioural outcomes, overall improvement, back pain specific and generic functional status, return to work, and pain intensity) using the random effects model. MAIN RESULTS: Only 6 studies (25%) were high quality. There is strong evidence (level 1) that behavioural treatment has a moderate positive effect on pain intensity (pooled effect size 0.62; 95% CI 0.25, 0.98), and small positive effects on generic functional status (pooled effect size 0.35; 95% CI -0.04, 0.74) and behavioural outcomes (pooled effect size 0.40; 95% CI 0.10, 0.70) of chronic low back pain patients when compared to waiting list controls or no treatment. There is moderate evidence (level 2) that an additional behavioural component to a usual treatment program for chronic low back pain has no positive short-term effect on generic functional status (pooled effect size 0.31; 95% CI - 0.01, 0.64), pain intensity (pooled effect size 0.03; 95% CI - 0.30, 0. 36) and behavioural outcomes (pooled effect size 0.19; 95% CI - 0.08, 0.45). REVIEWER'S CONCLUSIONS: Behavioural treatment seems to be an effective treatment for chronic low back pain patients, but it is still unknown what type of patients benefit most from what type of behavioural treatment.

Behavior Therapy↗

PubMed1996

Back pain in osteoarthritis of the knee.

OBJECTIVE: To compare patients with knee osteoarthritis (OA) who have and do not have back pain, and evaluate the prevalence, characteristics, and consequences of back pain among knee OA patients. METHODS: During a 3-year period, consecutive patients attending an outpatient rheumatology clinic were evaluated for the presence of back pain, and 368 were found to have OA of the knee. Clinical status was evaluated by the Clinical Health Assessment Questionnaire, radiographs, and joint examinations. RESULTS: Back pain was present in 54.6% of patients with OA of the knee. Almost every clinical status measure was worse among those reporting back pain, including Health Assessment Questionnaire (HAQ) disability, pain, global severity, fatigue, and psychological status. Back pain was more common in women and the obese, but was not associated with age, marital status, formal education, smoking history, or knee radiographic scores. In multivariate analyses the strongest correlates of back pain in knee OA patients were anxiety, night pain, HAQ disability, and global severity. CONCLUSION: Back pain is prevalent among OA clinic patients, more common than in rheumatoid arthritis or population studies, is linked to body mass index, and is associated with clinically significant increases in pain and other measures of clinical distress.

Aged↗

PubMed2001

Factors associated with medical care-seeking due to low-back pain in scaffolders.

BACKGROUND: Few studies have demonstrated the consequences of having back pain and the mechanisms underlying decisions to seek medical care. This study aimed to assess the prevalence of back pain and other musculoskeletal complaints and to identify factors that determine specific type of care-seeking due to back pain among scaffolders. METHODS: A cross-sectional study was conducted among 323 scaffolders. A questionnaire was used to collect data on musculoskeletal complaints and type of medical care sought. Logistic regression analysis was performed to study the risk factors for care-seeking for LBP, estimating Prevalence Ratios (PR) as a measure of association. RESULTS: The prevalence of musculoskeletal complaints was high. Severe back pain was reported by 28% of the scaffolders, LBP with sciatic pain by 23%, with sickness absence by 21%, with disability by 21%, and chronic back pain by 14%. Back pain was often accompanied by complaints of neck, shoulder, or knee. A general practitioner was sought by 44% of the workers with LBP, a physiotherapist by 22%, an occupational physician by 20%, and a specialist by 11%. The nature and severity of back pain seemed to determine the decision to visit the GP. Irradiating pain and sickness absence were the strongest predictors for seeking medical care and being referred to a specialist or physiotherapist. CONCLUSION: The particular definition of back pain and the selection process of workers with LBP may partly determine the findings on work-related risk factors and health care utilization.

Adult↗

PubMed2001

Exercises and education as secondary prevention for recurrent low back pain.

BACKGROUND AND PURPOSE: Exercise and education is a common physiotherapy approach in the prevention of low back pain. A Mensendieck exercise programme consisting of exercises and ergonomical education has, in a previous study, been shown to be effective in preventing recurrent low back pain during one-year follow-up. The purpose of the present study was to evaluate the long-term effect of the Mensendieck exercise programme on people with recurrent episodes of low back pain who, when entering the study, had finished treatment for their last episode of low back pain. METHOD: A randomized controlled clinical trial in which 41 women and 36 men were allocated to either a Mensendieck or control group. The Mensendieck subjects received 20 group sessions of exercises and ergonomical education over 13 weeks. The control subjects were not offered any prophylactic therapy, but were free to receive treatment or exercises. Outcome measures were the number of recurrences of low back pain, sick leave, low back function and general functional status. RESULTS: At three-year follow-up, 11 subjects had been lost to the study. Survival analysis showed a significant reduction (p = 0.02) in subjects experiencing recurrent low back pain in the Mensendieck group compared to the control group. Significant improvements in pain and function scores were reported in both groups. There was no significant difference between the groups in pain, function or sick leave. CONCLUSION: A Mensendieck exercise programme seems efficient in reducing recurrent episodes of low back pain at three-year follow-up, but it did not influence sick leave, pain or function scores.

Activities of Daily Living↗

PubMed2003

Perceived pain and self-estimated activity limitations in women with back pain post-partum.

BACKGROUND AND PURPOSE: In the general population many daily activities have an impact on low back pain. The aim of the present study was to describe pain intensity, localization, type of sensation and perceived activity limitation in women with different back pain patterns post-partum. METHOD: In this cross-sectional survey 119 women with back pain persisting for two months after having given birth were interviewed and examined on average 7.2 months (range 6-10 months) post-partum. Based on pain provocation tests, four different back pain pattern groups were identified. Pain could be provoked in the area of the posterior pelvic/sacroiliac joints, in the lumbar spine, both in the posterior pelvic/sacroiliac joints and in the lumbar spine, and in none of the above areas. All women rated pain intensity on a visual analogue scale (VAS, 0-100 mm), and the pain localization and type of sensation were indicated on a pain drawing. They scored their activity limitations by use of the Disability Rating Index (DRI), which covers 12 daily activity items (VAS, 0-100 mm). RESULTS: There was no significant difference (p = 0.12) in pain intensity (range of medians 19.5-10 mm) between the four groups. However, on average, most areas in the lower back (median 5 mm (range 2-14 mm)), were marked in the group with pain in both the posterior pelvic/sacroiliac joints and in the lumbar spine. The women in the three groups where pain was provoked in the lower area of the back had significantly (p < 0.01) more difficulties with movement-related daily activities than the group where no pain could be provoked. CONCLUSIONS: The findings of this descriptive study suggest that back pain post-partum provoked by clinical tests considerably hampers movement-related activities. It seems important to pay special attention to the women where pain could be provoked in the lower back areas. The women should be identified early in the post-partum period to initiate adequate treatment.

Adult↗

PubMed2006

Back pain and degenerative abnormalities in the spine of young elite divers: a 5-year follow-up magnetic resonance imaging study.

Several studies have been published on disc degeneration among young athletes in sports with great demands on the back, but few on competitive divers; however, there are no long-term follow-up studies. Twenty elite divers between 10 and 21 years of age, with the highest possible national ranking, were selected at random without knowledge of previous or present back injuries or symptoms for an MRI study of the thoraco-lumbar spine in a 5-year longitudinal study. The occurrence of MRI abnormalities and their correlation with back pain were evaluated. Eighty-nine percent of the divers had a history of back pain and the median age at the first episode of back pain was 15 years. Sixty-five percent of the divers had MRI abnormalities in the thoraco-lumbar spine already at baseline. Only one diver without abnormalities at baseline had developed abnormalities at follow-up. Deterioration of any type of abnormality was found in 9 of 17 (53%) divers. Including all disc levels in all divers, the total number of abnormalities increased by 29% at follow-up, as compared to baseline. The most common abnormalities were reduced disc signal, Schmorl's nodes, and disc height reduction. Since almost all divers had previous or present back pain, a differentiated analysis of the relationship between pain and MRI findings was not possible. However, the high frequency of both back pain and MRI changes suggests a causal relationship. In conclusion, elite divers had high frequency of back pain at young ages and they run a high risk of developing degenerative abnormalities of the thoraco-lumbar spine, probably due to injuries to the spine during the growth spurt.

Adolescent↗

PubMed2005

Workplace stress, lifestyle and social factors as correlates of back pain: a representative study of the German working population.

OBJECTIVES: To investigate the prevalence of back pain in the German working population and the relationship between back pain and workplace stresses, lifestyle and social factors. METHODS: The first National Health Survey of the Federal Republic of Germany was carried out between October 1997 and March 1999. It comprised a representative epidemiological cross-sectional study of the working population, with a total sample of 3,488 persons between the ages of 18 and 69 years. The participants took part in a medical examination and answered a self-rating questionnaire. The relationship between subjective back pain and workplace stresses and social and lifestyle factors was investigated with bivariate tests and multiple logistical regression analyses. RESULTS: The 7-day prevalence for back pain in the German working population was found to be 34%, and the 1-year prevalence was 60%. The odds ratios were significantly higher in women, persons of lower socioeconomic status, married and depressed persons and non-athletes. Carrying heavy loads or maintaining a single working posture were the most significant work-related correlates of back pain, for members of both the female and male working population, while environmental stress and psychological stress correlated significantly with back pain in men only. CONCLUSIONS: This study reports the first representative epidemiological prevalence data for back pain, and its correlates and potential risk factors, for the German working population. To reduce the negative impact of back pain the most promising behavioural and conditional prevention measures in the workplace would be to reduce carrying stress and to vary working posture. In addition, a more active, athletic lifestyle, plus the avoidance of being overweight, should provide an additional protective or preventive effect.

Adolescent↗

PubMed2000

Return to work after sickness absence due to back disorders--a systematic review on intervention strategies.

OBJECTIVES: The aim was to review the literature with regard to the effectiveness of intervention programmes for the prevention of aggravation of back disorders or prolonged duration of sickness absence. METHODS: A systematic search of the literature was performed using three groups of key words and inclusion/exclusion criteria. Effectiveness was evaluated using two measures: the difference between intervention and referent groups in return to work, and the fraction of sickness absence among referent groups that could be prevented if these referents had undergone the same intervention (preventable fraction). RESULTS: Twelve articles with quantitative information on the effect of ergonomic interventions on return to work were included. In eight studies, introduction of a back-school programme was the preferred intervention, combining exercise and functional conditioning, and training in working methods and lifting techniques. In seven out of eight back-school studies, return to work was significantly better in the intervention group. Intervention after 60 days, in the subacute phase of back pain, showed the most promising results. In these studies the preventable fraction varied between -11% and 80%, largely depending on the stage and phase of back disorders and the time of follow-up. The success of intervention also depended on the profile of the referents when left untampered. In all studies compliance during the intervention was fairly good, but there was a lack of information on sustainability of the intervention during the follow-up and on recurrence of back complaints and consequent sickness absence. CONCLUSIONS: Few studies were performed to assess the outcome return to work after ergonomic intervention. However, there is evidence that intervention in the subacute phase of back pain is preferable. Future intervention studies should address intervention sustainability and recurrence of sickness absence due to back pain over at least a 1-year follow-up period.

Absenteeism↗

PubMed2000

Spinal troubles in sewage workers: epidemiological data and work disability due to low back pain.

OBJECTIVES: To determine the prevalence of spinal troubles (i.e., neck, upper back and low back pain) in a population of sewage workers, and to establish the effect of sociodemographic, work-related, physical, and psychosocial factors on the reported work disability due to low back pain (LBP) during the previous 12 months. METHODS: Data from 255 sewage workers were obtained by standardized questionnaire, structured interview, and standardized physical examination. Data on the prevalence of neck, upper back and low back pain were obtained with the use of the Nordic Questionnaire. The level of disability was assessed from a modified Low-Back Outcome Scale. Work history included physical factors and job perception based on a modified Work APGAR Score. Other questionnaires recorded the psychosocial aspects of the work environment. In addition, we compared the risk factors between sewage workers who had been prevented from doing their normal work, at any time during the preceding 12 months, as a result of LBP (n = 92), and those without any history of work disability during the previous 12 months (n = 157). RESULTS: The 12-month prevalence rates of neck, upper back and low back pain were 52.4%, 54.8%, and 72.8%, respectively. The prevalence of spinal troubles increased with age. Work disability during the preceding 12 months due to LBP was significantly positively associated with age, disability, the weekly duration of stooping and lifting 5 years previously and higher abnormal illness-behavior scores (odds ratio between 1.26 and 0.94). Moreover, when adjusted for age, the results showed that the subjects in the work disability group were more likely to report higher pain intensities, decreased participation in sports activities, higher levels of physical impairment, the belief that their LBP was related to the physical demands of their job, and a lack of drive (P < 0.05). CONCLUSIONS: This study revealed a high incidence of spinal troubles among sewage workers. In a multidisciplinary approach, we demonstrated that not one factor alone but a combination of sociodemographic, work-related and psychosocial factors have shown associations with work disabilities due to LBP. Additional studies evaluating the relative importance of individual risk factors are warranted.

Adult↗

PubMed2005

[Risk factors for back pain in children and adolescents].

Factors that have led to the increasing prevalence of back pain amongst children and adolescents living in industrialized nations are mostly unknown. The following literature review was aimed at determining the risk factors for back pain amongst children and adolescents. We searched both PUBMED and MEDLINE between the years 1985 and 2003 for the keywords "children or adolescents" and "back pain". Only data published in original articles were used. The risk for suffering back pain is influenced by physical, behavioural, emotional and social factors. The effects of physical activity, sitting, muscle status, weight of schoolbags, exercise, television and computer use, as well as age and gender on the development of back pain in children and adolescents were examined. Associations between continuous or recurring back pain and psychosocial factors (lifestyle, emotional factors, social relationships) could be demonstrated. There was no relationship between changes of the spine seen by radiological tests and the development of chronic back pain. Longitudinal epidemiological studies are urgently needed to delineate the risk factors for the development as well as the natural history of chronic back pain in the young.

Adolescent↗

PubMed2001

[Discogenic low back pain and degenerative lumbar spinal stenosis - how appropriate is surgical treatment?].

Surgery in acute and/or chronic low back pain is still a matter of intensive and controversial discussions. A vast number of minimally invasive or so called semi-invasive procedures have been published in the last 3 decades, but evidence-based data on efficacy and benefit of most of these techniques are still lacking. However, empirical data suggest good or at least satisfactory clinical results for a limited number of procedures if they are applied under restrictive indication criteria. Discogenic low back pain and lumbar spinal stenosis belong to the most frequent diagnoses associated with low back pain. This article gives a survey on definitions, indication criteria and modern surgical or semi- invasive techniques used for the treatment of these two pathologic entities. Discogenic low back pain: This clinical and morphological entity is defined as low back pain arising mainly from disc degeneration. Pain generators are usually nociceptors in the cartilaginous endplates, in the outer anulus fibrosus as well as in the periosteum of the vertebral bodies. Clinical symptoms correlate with morphologic changes detected with MR-imaging (modic type I) or with contained disc protrusions mainly without neurological symptoms. Surgery is rarely indicated, spontaneous remissions occur in more than 60% of all cases. Spinal fusion has been the only surgical option in cases which did not respond to conservative therapy. Recently, electro-thermal modulation of the posterior anulus fibrosus has been published as a semi- invasive technique to relieve low back pain generated by fissures in the outer anulus and ingrowing nociceptors (intradiscal electro-thermal therapy, IDET(TM)). First results are promising, however, prospective randomised studies comparing this technique with conservative therapy are still lacking. The same is true for artificial nucleus pulposus replacement using hydrogel cushions implanted in the intervertebral space after removal of the nucleus pulposus from posterior or through an anterior approach (PDN, prosthetic disc nucleus(TM)). In cases with severe disc degeneration total disc replacement is another innovative option (ProDisc(TM)). Two metal endplates with titanium surface coating are implanted through a minimal invasive anterior approach (mini-laparotomy). A polyethylene inlay anchored in the caudal endplate holds the distance between the endplates and preserves the physiological range of motion between the two vertebral bodies. Degenerative lumbar spinal stenosis: Narrowing of the spinal canal due to degenerative changes of the disc, the facet joints and thickening of the yellow ligament is a geriatric disease which is diagnosed in increasing numbers within the last 10 years. More than 80% of the patients present with low back pain in association with neurogenic claudication. Neurological symptoms at rest are less frequently found. The spontaneous course shows progressive symptoms in more than 50% of all patients. More than 35% of the patients have associated diseases which might influence the perioperative course, complication rates and outcomes of surgery. Surgery is indicated in patients with progressive neurological symptoms, unacceptable decrease of quality of life or progressive intractable pain. In patients with mainly "leg symptoms" microsurgical mono- or multisegmental decompression is the procedure of choice. If low back pain is predominant and associated with degenerative instability such as degenerative spondylolisthesis or lumbar scoliosis, decompression must be combined with instrumented spinal fusion. In general a restrictive indication for surgery must be recommended especially for spinal fusion procedures. Non-fusion techniques such as intradiscal electro thermal therapy or spine arthroplasty with replacement of nucleus pulposus or total disc show promising early results; however, little is known about the long-term effect. It should be a principle to apply surgery in the least invasive way.

Diagnosis, Differential↗

PubMed2005

The effect of insoles on the incidence and severity of low back pain among workers whose job involves long-distance walking.

The prevalence and incidence of low back pain in general society is high. Workers whose job involves walking long distances have an even higher tendency to suffer from low back pain. A positive effect of insoles in reducing low back pain was found in professional sports players. This was not examined on people whose job involves walking long distances. In this double blind prospective study we examined the effectiveness of insoles constructed in a computerized method to placebo insoles in 58 employees whose work entailed extensive walking and who suffered from low back pain. The evaluation was performed by the MILLION questionnaire, which is considered as a valid questionnaire for evaluation of low back pain. We calculated the differences of the pain intensity before and after the intervention, in the employees using the insoles manufactured by computer in comparison to the users of the placebo insoles. In each group, the analysis was performed in comparison to the baseline. A total of 81% of the employees preferred the real insoles as effective and comfortable in comparison to 19% of the users of the placebo insoles (P<0.05). The results of this study indicate a substantial improvement in the low back pain after the use of the true insoles. The average pain intensity according to the MILLION questionnaire before the use of the insoles was 5.46. However, after the use of the real insoles and the placebo insoles, the average pain intensity decreased to 3.96 and 5.11, respectively. The difference of the average pain intensity at the start of the study and after the use of the real insoles was significant: -1.49 (P=0.0001), whereas this difference after the use of the placebo insoles was not significant: -0.31 (P=0.1189). The reported severity of pain also decreased significantly: a level 5 pain and above was reported by 77% of the subjects at the start of the study. After the use of the real insoles only 37.9% of the subjects reported a similar degree of pain severity, and 50% of the subjects did so after the use of the placebo insoles (P< 0.05). We did not find a link between low back pain and other variables such as gender, age, number of offspring, work seniority, smoking, previous use of insoles and previous medication. This study demonstrates that the low back pain decreased significantly after the use of real insoles compared to placebo ones.

Adult↗

PubMed2001

Epidemiology of low back pain in the elderly: correlation with lumbar lordosis.

We carried out an epidemiologic study to determine the prevalence of low back pain in elderly Japanese and to examine the correlation with lumbar lordosis in sagittal plane radiographs. Low back pain is an enormous clinical and public health problem. With the increasing use of spinal instrumentation, the measurement of lumbar lordosis is thought to be important. However, in elderly Japanese, the prevalence of low back pain and its correlation with lumbar lordosis is not clear. Five hundred and nine people, aged 50-85 years, were examined, and 489 subjects met our criteria. Clinical findings, physical status, and the visual analogue scale (VAS) of pain were examined in these subjects. Measurements and determination of total lordosis from L1-S1 were made from standing radiographs. Forty-eight percent of the subjects had experienced low back pain within the previous 3 months. Women had low back pain more frequently (P = 0.006). There was a significant difference in lumbar lordosis between the groups with and without low back pain (P = 0.0006). Lumbar lordosis was approximately 4 degrees less in the low back pain group and there was no relationship to age or sex in either group. VAS was significantly inversely correlated with lumbar lordosis (P = 0.025, at rest). The body mass index (BMI) of the low back pain group was higher in women, but the difference was not significant (P = 0.06). In conclusion, lumbar lordosis was defined and its prevalence in elderly Japanese was reported together with VAS and physical data used to compare the two groups.

Aged↗

PubMed2026

Teach-Back in Clinical Communication: A Systematic Review and Meta-analysis.

BACKGROUND: Teach-back has been identified as a high-quality clinical communication strategy. Our aim was to synthesize current literature on teach-back effectiveness. METHODS: We searched MEDLINE, Embase, and CINAHL Complete databases to identify relevant studies published between 2018 and 2026. We also included pre-2018 studies identified in prior systematic reviews. Studies were eligible for inclusion if they involved adult patients and/or care partners, delivered teach-back in a single encounter, had a comparator group, and reported proximal/intermediate patient outcomes (as defined in our conceptual model). Two independent investigators screened each citation at the title/abstract and full-text levels and assessed risk of bias. Study characteristics and results were extracted. When meta-analysis was performed, we used standardized mean differences (SMD) to estimate summary effects. We assessed certainty of evidence (COE) using Grading of Recommendations Assessment, Development and Evaluation (GRADE) domains. RESULTS: Our systematic review included 18 randomized controlled trials (RCTs) involving 1985 participants. Across 9 RCTs assessing knowledge acquisition, conceptual inconsistencies precluded meta-analysis. Overall, there was no clear pattern of the effect of teach-back on knowledge (very low COE). In a meta-analysis of 5 RCTs assessing self-efficacy (416 participants), we found that teach-back interventions led to a large increase in self-efficacy relative to usual care (SMD = 2.40; 95%CI 0.37-4.44) (very low COE). In a meta-analysis of 7 RCTs assessing adherence to health behaviors (571 participants), teach-back interventions led to a large increase in adherence (SMD = 1.04; 95%CI 0.45-1.64) (low COE). Meta-analyses for both self-efficacy and adherence had large confidence intervals that ranged from small to large effect sizes and had substantial heterogeneity. DISCUSSION: In this systematic review and meta-analysis, we did not identify a clear benefit of teach-back on knowledge acquisition but did find evidence that teach-back improves self-efficacy and self-reported, short-term adherence to health behaviors.

clinical communication↗

PubMed1988

The premenstrual syndrome: psychophysiologic concomitants of perceived stress and low back pain.

The effects of experimentally induced and personally relevant stressors on low back EMG activity during 3 phases of the menstrual cycle in women with the premenstrual syndrome (PMS) and premenstrual low back pain were examined. Thirty-nine women reporting either PMS and premenstrual severe low back pain (group 1), PMS with premenstrual moderate low back pain (group 2), or those reporting neither condition (group 3) participated. During each of 3 menstrual phase-specific assessment sessions, participants were exposed to a neutral stimulus, an experimentally induced stressor, and 2 personally relevant stressors in a randomized order. Concomitant monitoring of low back EMG activity and heart interbeat interval was undertaken. Results indicated that participants in group 1 evidenced greater EMG changes in response to personal stressors compared to the neutral stimulus and experimentally induced stress during the premenstrual phase. EMG activity in response to personal stress was also significantly higher during the premenstrual phase than during the menstrual and intermenstrual phases for group 1, and higher than EMG changes evidenced by groups 2 and 3 during the same phase. Group 2, while not reporting as severe premenstrual back pain as did group 1, reported moderate levels of back pain and evidenced greater physiological reactivity to a personal stressor than did group 3. The findings highlight the link between personally relevant stressors and concomitant physiologic responsivity and the role that this arousal may play in the maintenance and exacerbation of premenstrual low back pain.

Adolescent↗

PubMed2004

Effects of low back pain on the relationship between the movements of the lumbar spine and hip.

Previous research had examined the effects of back pain on spinal movements, but information concerning movement coordination between the lumbar spine and hips was limited. The purpose of this study was to examine the effects of back pain and limitation in straight leg raise on the relationship between the movements of the lumbar spine and hip. An electromagnetic tracking system was employed to measure the movements of these joints in asymptomatic subjects (n = 20), and back pain subjects with (n = 24) and without (n = 17) limitation in straight leg raise. Subjects were requested to perform forward, backward and side bending, and twisting of the trunk. Back pain subjects were found to exhibit significant reductions in the magnitude of spine movements in all directions. Back pain was also associated with decrease in the magnitude of hip flexion but not hip movements in other directions. Cross-correlation analysis showed that there were changes in the strength of correlation and the time lag between lumbar spine and hip motions in normal and back pain subjects. In addition, back pain and limitation in straight leg raise were found to cause significant increases in the time required to complete the trunk movements. It was concluded that clinical assessment and treatment planning should take into account of the effects of back pain on the relationship between spine and hip movements.

Adult↗

PubMed2006

Effects of a back-pain-reducing program during pregnancy for Korean women: a non-equivalent control-group pretest-posttest study.

BACKGROUND: Although many pregnant women experience back pain, it has not considered an important health problem. No study has investigated the effects of a back-pain-reducing program (BPRP) during pregnancy for Korean women. OBJECTIVE: The purpose of this study was to evaluate the effect of a program designed to reduce back pain in pregnant women. METHODS: A non-equivalent control-group pretest-posttest design was used. Pregnant women who attended an antenatal clinic and experienced back pain during their pregnancy were included in an intervention group (n=29), and their intensity of back pain, functional limitation and anxiety were compared with women in a control group from another antenatal clinic (n=27). The data were collected at three time points: prior to intervention, and 6 and 12 weeks after intervention. RESULTS: At 12 weeks after intervention, the intensity of back pain experienced by the intervention group was significantly lower than that of the control group. However, there were no statistically significant differences between the groups with respect to functional limitations and anxiety. CONCLUSIONS: The findings show that the pain-reducing program developed for this study was effective in reducing the intensity of back pain experienced by pregnant women. Promoting good posture and regular exercise can be recommended as a method to relieve back pain in pregnancy women. Further studies are needed to confirm the effect of the BPRP during pregnancy.

Activities of Daily Living↗

PubMed2005

A novel method to estimate the stiffness of the equine back.

Diagnosis of back problems in equine orthopedics can be a difficult task. The aim of our study was to develop a new method for estimating the stiffness of the equine back in vivo. We measured the activity of the long back muscle at two locations on both sides at thoracic vertebrae T12 and T16 of 15 horses flexing and extending their back at stance using telemetric surface electromyography, while simultaneously recording the motion of the back with a video camera system. Out of these paired data sets we computed a transfer function in the frequency domain and evaluated its capability of capturing the biomechanical behavior. The transfer function was evaluated via correlation between calculated and actual motion resulting in correlation coefficients of 0.89 for lateral flexion and 0.83 for ventral extension at T16 and 0.82 for lateral flexion and 0.83 for ventral extension at T12. The transfer function was fitted to a filter polynomial of second order, and related to the motion equation. By comparison of coefficients we gained an estimate for the stiffness of the back resulting in a mean value of approximately 6100 N/m for lateral flexion and 650 N/m for ventral extension. This new method enables clinicians in equine orthopedics to estimate back stiffness in horses, and it also provides reality grounded values for biomechanical models of the equine back.

Animals↗