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PubMed1996

Back pain during pregnancy: a prospective study.

STUDY DESIGN: A longitudinal, prospective, observational, cohort study. OBJECTIVES: To describe the natural history of back pain occurring during pregnancy and immediately after delivery. SUMMARY OF BACKGROUND DATA: Back pain during pregnancy is a frequent clinical problem even during the early stages of pregnancy. The cause is unclear. METHODS: A cohort of 200 consecutive women attending an antenatal clinic were followed throughout pregnancy with repeated measurements of back pain and possible determinants by questionnaires and physical examinations. RESULTS: Seventy-six percent reported back pain at some time during pregnancy. Sixty-one percent reported onset during the present pregnancy. In this group, the prevalence rate increased to 48% until the 24th week and then remained stable and declined to 9.4% after delivery. The reported pain intensity increased by pain duration. The pain score correlated closely to self-rated disability and days of sickness benefit. CONCLUSIONS: Back pain during pregnancy is a common complaint. The 30% with the highest pain score reported great difficulties with normal activities. The back pain started early in pregnancy and increased over time. Young women had more pain than older women. Back pain starting during pregnancy may be a special entity and may have another origin than back pain not related to pregnancy.

Adolescent↗
PubMed1996

Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials.

STUDY DESIGN: Systematic review of randomized clinical trials. OBJECTIVES: To assess the efficacy of spinal manipulation for patients with low back pain. SUMMARY OF BACKGROUND DATA: The management of low back pain remains controversial. Spinal manipulation is a widely used treatment option for low back pain. Recently issued clinical guidelines suggest that spinal manipulation may be effective for patients with acute low back pain. METHODS: A computer-aided search for published papers was conducted, and the methods of the studies identified were assessed. Scores were assigned for quality of methods (based on four main categories: study population, interventions, measurement of effect, and data presentation and analysis), the conclusion of authors regarding spinal manipulation, and the results based on the main outcome measure. RESULTS: Thirty-six randomized clinical trials comparing spinal manipulation with other treatments were identified. The highest score of a trial was 60 points (maximum score was set at 100 points), indicating that most were of poor quality. Nineteen studies (53%) showed favorable results for manipulation. In addition, five studies (14%) reported positive results in one or more subgroups only. Among the five studies with 50-60 points, three were positive, and two were positive only for a subgroup of the study population. Eleven trials compared manipulation with some placebo therapy, with inconsistent results. There appeared to be no clear relation between the methodologic score and the overall outcome of the studies. Twelve trials included patients with acute low back pain only. Of these, five reported positive results, four reported negative results, and three reported positive results in a subgroup of the study population only. There were eight trials comparing manipulation with other conservative treatment modalities, focusing on patients with subacute or chronic low back pain. Of these, five reported positive results, two reported negative results, and in one study no conclusion was presented. There were only 16 studies that included an effect measurement of at least 3 months. In only six of these do the authors report positive effects of manipulation. CONCLUSIONS: The efficacy of spinal manipulation for patients with acute or chronic low back pain has not been demonstrated with sound randomized clinical trials. There certainly are indications that manipulation might be effective in some subgroups of patients with low back pain. These impressions justify additional research efforts on this topic. Methodologic quality remains a critical aspect that should be dealt with in future studies.

Chiropractic↗
PubMed1997

A cross-sectional study comparing the Oswestry and Roland-Morris Functional Disability scales in two populations of patients with low back pain of different levels of severity.

STUDY DESIGN: This cross-sectional study compares the Oswestry and Roland-Morris disability scales in two groups of patients with low back pain of different clinical and electromyographic severity. OBJECTIVES: To evaluate the correlation between functional disability and diagnoses. SUMMARY OF BACKGROUND DATA: There is an increasing need for functional disability measurements to be applied to the evaluation of therapy and outcome in patients experiencing low back pain. METHODS: Two very different groups of patients with low back pain completed the Oswestry and Roland-Morris self-administrated functional disability questionnaires. One group included patients presenting with an episode of mechanical low back pain with no clinical radiculopathy. The other group consisted of patients with low back pain and clinical and electromyographic evidence of radiculopathy. RESULTS: Patients diagnosed with low back pain who exhibited signs of radiculopathy on electromyography had a mean score of 49.1 +/- 17.1 on the Oswestry disability questionnaire; a mean score of 33.0 +/- 14.7 was found for patients who experienced "simple" low back sprain (with no radiculopathy). This difference was statistically significant (P < 0.0001). On the Roland-Morris questionnaire, the mean score obtained by the group of patients with radiculopathy was 59.1 +/- 21.8 compared with 45.4 +/- 19.4 for those with no radiculopathy. This difference was also statistically significant (P < 0.0001). Moreover, there exists a moderate correlation between both functional scales within each group of patients: 0.72 (P < 0.0001) in the group with radiculopathy and 0.66 (P < 0.0001) among those without radiculopathy. CONCLUSIONS: The authors conclude that both functional disability scales accurately discriminated between these two groups of patients with low back pain of very different clinical and electromyographic severity.

Adult↗
PubMed1997

Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies.

STUDY DESIGN: A systematic review of published observational studies. OBJECTIVES: To examine the causal relationship between radiographic findings and nonspecific low back pain. SUMMARY OF BACKGROUND DATA: The causal relationship between radiographic findings and nonspecific low back pain still is controversial. METHODS: Two reviewers independently scored the methodologic quality of all relevant, available studies using a standardized set of criteria. The association between radiographic findings and nonspecific low back pain was expressed as an odds ratio with a corresponding 95% confidence interval. RESULTS: Degeneration, defined by the presence of disc space narrowing, osteophytes, and sclerosis, turned out to be associated with nonspecific low back pain with odds ratios ranging from 1.2 to 3.3. Spondylolysis and spondylolisthesis, spina bifida, transitional vertebrae, spondylosis, and Scheuermann's disease did not appear to be associated with low back pain. The validity scores of the observational studies ranged from 0% to 91% of the maximum score. Only two studies used a prospective design, and most studies lacked control for confounding, an appropriate test for nonspecific low back pain, and blinded assessment of radiographs and low back pain status. CONCLUSIONS: There is no firm evidence for the presence or absence of a causal relationship between radiographic findings and nonspecific low back pain.

Evaluation Studies as Topic↗
PubMed1997

Lumbar-hip flexion motion. A comparative study between asymptomatic and chronic low back pain in 18- to 36-year-old men.

STUDY DESIGN: The amount of lumbar and hip flexion and the relative contribution within movement during standing forward bending was recorded on a group of asymptomatic men and a group of men with a history of chronic low back pain. OBJECTIVES: To compare the relative contribution of the hip and lumbar spine to forward bending in the two groups. SUMMARY OF BACKGROUND DATA: The hips and lumbar spine both contribute to the forward bending motion, and an aberrant pattern of contribution in one or both regions could be related to the presence of chronic low back pain. METHODS: Thirty-two white men aged 18-36 years (15 with chronic low back pain and 17 asymptomatic) were assessed using a three-dimensional motion analysis system that allowed uninterrupted forward bending. RESULTS: The men with chronic low back pain demonstrated a significant reduction in the mean total range and mean maximum lumbar flexion relative to the asymptomatic group. Mean hip flexion was not significantly different. Data analysis for 120 degrees of gross flexion revealed a subgroup of men with chronic low back pain with a significant decrease in hip flexion. CONCLUSIONS: When assessing the relative motion of the lumbar spine and hips in standing forward flexion, there was measurable difference between asymptomatic men and a group of chronic low back pain patients. In particular, two subgroups of individuals with chronic low back pain appeared; one moved relatively similarly to the asymptomatic group, whereas the other sub-group demonstrated reduced hip mobility. These findings indicate the importance of assessing the lumbar and hip flexion motion in chronic low back pain patients to determine if a movement abnormality is present.

Adolescent↗
PubMed1998

The influence of muscle fiber size and type distribution on electromyographic measures of back muscle fatigability.

STUDY DESIGN: This was a cross-sectional study carried out on a group of 31 healthy, consenting volunteers with no history of low back pain (17 men, 14 women). OBJECTIVES: To evaluate the relationship between electromyographic measures of erector spinae fatigability and the muscle's fiber type characteristics. SUMMARY OF BACKGROUND DATA: Using electromyographic techniques, a pronounced fatigability of the muscles of patients with low back pain has been identified. It has been postulated that this is the result of an unfavorable back muscle fiber type distribution, although an association between electromyographic measures of fatigue and the muscle's fiber type characteristics has never been established. METHODS: Two tests of back extensor fatigability were performed (on separate days), each to the limit of endurance: 1) maintenance of 60% total maximum voluntary contraction of the back extensors, and 2) performance of the Biering-Sørensen test. Pairs of surface electrodes were attached to the skin overlying the belly of the erector spinae, bilaterally, at T10 and L3. The median frequency was computed from the electromyographic power spectrum, and fatigability was given by the slope of the linear regression of median frequency on time (MFgrad; %.s-1). One week later, two percutaneous erector spinae muscle biopsy samples were obtained from the same sites described for electromyography (left side only). Samples were prepared for histochemistry for the identification of muscle fiber types. Fiber sizes (cross-sectional areas) were quantified using computerized image analysis. RESULTS: The mean fiber size at each erector spinae region showed a significant correlation with maximum back extensor strength. In the thoracic region, the relative area of the muscle occupied by Type I fibers (which accounts for the relative size and distribution of the fiber types) showed a significant relationship with MFgrad recorded during each fatigue test. A similar relationship was observed for the lumbar region, but for the Biering-Sørensen test only. CONCLUSIONS: The electromyographic changes recorded in back muscles during fatigue appear to be related to the underlying muscle fiber type area distribution. This confirms the usefulness of electromyography in reflecting such muscle characteristics in a noninvasive manner, when monitoring changes in function consequent to the development of, or rehabilitation from, low back pain.

Adult↗
PubMed1998

Claim rates of compensable back injuries by age, gender, occupation, and industry. Do they relate to return-to-work experience?

STUDY DESIGN: A retrospective cohort study of Michigan workers' compensation cases involving back injuries in 1986 and 1987 with incidence and outcome data. OBJECTIVE: To determine claim rates by age, gender, and industry or occupation for compensable back injuries and to investigate the relation between occupation and return to work. SUMMARY OF BACKGROUND DATA: The cohort of 24,094 Michigan workers' compensation cases from 1986 and 1987 in which claimants were compensated for back injuries was reviewed. Compensation eligibility requires more than 7 days' disability after injury. METHODS: Claim rates for back injuries by age, gender, and industry or occupation using employment data interpolated from 1980 and 1990 Census 1% Public Use Microdata Samples. Cox proportional hazards analysis was performed for return to work in the first 8 weeks after injury, with occupation coded at the three-digit level. RESULTS: All-age claim rates for Michigan compensable back injuries by occupation ranged between 0.03% and 1.7% annually (0.39% for all cases) and were generally higher in women in white collar occupations and in men in blue collar occupations. The claim rate peaked in men in the 25-34 year range, with the highest rates in manual labor occupations. The peak claim rates by age were less marked in women, tending to occur broadly throughout the 25-44-year range. Similar all-age values were recorded by industry. The male-to-female risk ratio over all occupations does not vary by age and is approximately 1.4:1. As the classification of occupation became more detailed, large differences in risk were documented within major occupation groups. The highest risk in this study was approximately 6% annually for 25-44 year old men in driver-sales (beverage truck drivers and delivery workers). Only 7 of 40 occupation categories showed a significant relative hazard for return to work in the first 8 weeks after injury, and these were blue collar occupations with earlier return than the reference sales category. For Michigan compensable back injuries, a rough estimate of the true annual incidence of new claims is 94% of the reported claim rate. CONCLUSIONS: The relative risk of compensable back injury is generally higher for females in white collar occupations, higher for males in blue collar occupations and approximately equal in service occupations. Although the risk of back injury is related to occupation, the same occupational factors do not operate as a barrier to return to work.

Adolescent↗
PubMed1998

Capacity of the clinical picture to characterize low back pain relieved by facet joint anesthesia. Proposed criteria to identify patients with painful facet joints.

STUDY DESIGN: Prospective randomized study to compare the efficacy of facet joint injection with lidocaine and facet joint injection with saline in two groups of patients with low back pain, with and without clinical criteria that were determined in a previous study to implicate the facet joint as the primary source of the pain. OBJECTIVES: To assess the efficacy of single facet joint anesthesia versus placebo (saline injections) and to determine clinical criteria that are predictive of significant relief of LBP after injection. SUMMARY OF BACKGROUND DATA: There is no syndrome that discriminates between lower back pain caused by facet joint and that caused by other structures. Single or double facet joint anesthesia, and single photon emission computed tomography are expensive and time-consuming procedures for selecting patients in controlled clinical trials with large populations. METHODS: Results of a previous study showed that seven clinical characteristics were more frequent in patients who responded to facet joint anesthesia than in those who did not. In the current study, a group of 43 patients with lower back pain who met at least five criteria were compared with 37 patients who met fewer criteria. Patients randomly received injection of either lidocaine or saline into the lower facet joints. The result was considered positive if more than 75% pain relief was determined by visual analog scale. The patient, the radiologist, and the investigator were blinded. An analysis of variance was used to seek an interaction between clinical group effect and injection effect, and logistic regression analysis to select the best set of variables that would be predictive of minimum pain relief of 75% after the injection. RESULTS: There was a significant interaction between clinical group and injection effect (P = 0.003). In patients with back pain, lidocaine provided greater lower-back pain relief than saline (P = 0.01). Lidocaine also-provided greater pain relief in the back pain group than in the nonpain group (P = 0.02). The presence of five among seven variables (age greater than 65 years and pain that was not exacerbated by coughing, not worsened by hyperextension, not worsened by forward flexion, not worsened when rising from flexion, not worsened by extension-rotation, and well-relieved by recumbency), always including the last item, distinguished 92% of patients responding to lidocaine injection and 80% of those not responding in the lidocaine group. CONCLUSIONS: A set of five clinical characteristics can be used in randomized studies to select lower back pain that will be well relieved by facet joint anesthesia. These characteristics should not, however, be considered as definite diagnostic criteria of lower back pain originating from facet joints.

Adult↗
PubMed1998

Components of initial and residual disability after back injury in nurses.

STUDY DESIGN: A pre- versus postintervention with concurrent control group design was used to investigate the effect of a workplace-based early intervention program on perception of disability in nurses with low back injury. OBJECTIVES: This report examines changes over time in the components of the Oswestry Low Back Pain and Disability Questionnaire in two groups of back-injured nurses-those who received the early intervention program (study) and those who were not offered the program (control). SUMMARY OF BACKGROUND DATA: Early intervention programs can decrease morbidity, time lost from work, and compensation costs. Although perception of disability decreases, some residual disability remains, the nature of which is not clear. METHODS: The Oswestry Low Back Pain and Disability Questionnaire scores of 40 study nurses and 118 control nurses at time of injury and at 6 months after injury were examined. Analysis of variance was used to compare changes in mean overall scores over time. The proportion of nurses reporting disability on individual components of the Oswestry Low Back Pain and Disability Questionnaire at each time period was compared with the results of a chi-square test. RESULTS: Overall Oswestry Low Back Pain and Disability Questionnaire scores were similar between study and control nurses at time of injury, but were significantly lower in study nurses at 6 months after injury. However, scores of individual Oswestry Low Back Pain and Disability Questionnaire components that related to job demands increased over time; this was most apparent in lifting, particularly in study nurses. CONCLUSIONS: Although overall perception of disability decreased 6 months after injury, particularly in study nurses, disability in job-related activities persisted. Residual disability after back injury should be addressed in workplace-based prevention programs.

Adult↗
PubMed1999

Use of a subjective health measure on Chinese low back pain patients in Hong Kong.

STUDY DESIGN: A prospective observational study on the use of the Aberdeen Low Back Pain Disability Scale. OBJECTIVE: To evaluate the reliability, validity, and responsiveness of the Chinese adaptation of the Aberdeen Low Back Pain Scale in Chinese patients in Hong Kong who have back pain. SUMMARY OF BACKGROUND DATA: Frontline clinicians, researchers, and health care managers in Hong Kong are urgently in need of a Chinese adaptation of a low back pain outcome measure that has been subjected to a rigorous process of psychometric and clinical testing. METHODS: Four samples with 473 consecutive adult patients with low back pain from six physiotherapy outpatient departments in Hong Kong who completed the Aberdeen Low Back Pain Scale were observed and measured at time points including the beginning physiotherapy; 10 days, 3 weeks, and 6 weeks after physiotherapy; and when discharged from treatment. RESULTS: The test-retest reliability coefficient was 0.94 (0.94 in the original English version; figures from the English version are reported in parentheses). The Cronbach alpha coefficient was 0.85 (0.80). The Spearman correlation coefficient, when the Aberdeen score was correlated with that of a generic current 42-item questionnaire regarding the patient's perceived health to establish cross-sectional construct validity, was 0.59 (0.36-0.66, with the Short Form 36 scale). The effect sizes (responsiveness) at weeks 3 and 6 after treatment began were 0.59 and 0.81, respectively (a high of 0.62 reported in the English version). CONCLUSIONS: The Chinese version of the Aberdeen Low Back Pain Disability Scale retained the high levels of reliability, validity, and responsiveness of the original English version when tested in Hong Kong in four samples of Chinese patients with low back pain.

Adolescent↗
PubMed1999

The association between static pelvic asymmetry and low back pain.

STUDY DESIGN: A cross-sectional case-control approach was used to estimate the association between low back pain of less than 12 months' duration and pelvic asymmetry among 21-50-year-old patients seeking physical therapy services. OBJECTIVE: To evaluate the premise that asymmetrical positioning of the innominates of the pelvis is a source of low back pain. SUMMARY OF BACKGROUND DATA: No published studies have been conducted to evaluate systematically the association between low back pain and pelvic asymmetry in a clinic-based sample. METHODS: Pelvic landmark data were obtained in 144 cases and 138 control subjects. The associations of low back pain with levels of pelvic asymmetry were estimated by use of odds ratios and 95% confidence intervals. Effect modification and confounding of the low back pain-pelvic asymmetry association by several factors was assessed and alternative asymmetry measures considered. RESULTS: Pelvic asymmetry was not positively associated with low back pain in any way that seemed clinically meaningful. Asymmetry of posterior superior iliac spine landmarks showed some evidence of a weak positive association with low back pain. CONCLUSIONS: In the absence of meaningful positive association between pelvic asymmetry and low back pain, evaluation and treatment strategies based on this premise should be questioned.

Adult↗
PubMed1999

Smoking and low back pain. A systematic literature review of 41 journal articles reporting 47 epidemiologic studies.

STUDY DESIGN: A systematic review of the epidemiologic literature on smoking and low back pain. OBJECTIVES: To establish whether smoking causes low back pain and whether cessation of smoking reduces the incidence and/or prevalence of low back pain. SUMMARY OF BACKGROUND DATA: It seems to have become increasingly commonly accepted that smoking causes low back pain and that abstinence from smoking is an effective means for its prevention and treatment. Does the evidence in the epidemiologic literature support this concept? METHODS: Forty-one original research reports reporting 47 studies, published between 1974 and 1996, were systematically reviewed for strength of association, dose-response correlation, temporality, reduction of symptoms with smoke cessation, and consistency of findings. In addition, the presence of positive findings was viewed in light of definition of low back pain, representativeness of the study sample, sample size, and in relation to whether the prime objective had been to study the smoking-low back pain issue. Two reviews were performed by the author, blindly and separated by a 2-month interval. RESULTS: There was no consistency of statistically significant positive associations between smoking and low back pain. The association, when present, was usually weak and clearly apparent only in large study samples. No other study characteristics had an effect on the frequency of positive associations. Additional analyses were therefore performed only on studies with large samples. In general, these did not contain consistent positive findings in relation to dose-response, temporality, or reversibility. Signs of causality were consistently evident only in the study with the largest sample (n > 30,000). CONCLUSIONS: Presently, smoking should be considered a weak risk indicator and not a cause of low back pain.

Humans↗
PubMed1999

Smoking. A risk factor for development of low back pain in adolescents.

STUDY DESIGN: A prospective, repeated-measures cohort design with high school students from Montreal, Canada. OBJECTIVES: To determine whether smoking was a risk factor for the development of low back pain or other musculoskeletal pain in a cohort of adolescents. SUMMARY OF BACKGROUND DATA: Smoking has been associated with low back pain in adults. Many adolescents smoke, and the prevalence of low back pain in this age group is 30%. A history of low back pain is predictive of future problems. METHODS: A total of 502 students from grades 7 to 9 were assessed from 3 schools. Data were collected at 3 times: at the beginning of the study, at 6 months, and at the end of a 12-month period. Students responded to a questionnaire addressing musculoskeletal health and life-style factors, which included smoking. Measurements of height, weight, trunk and leg flexibility, and trunk strength were obtained. Low back pain occurring at a frequency of at least once a week in the past 6 months was defined as the outcome. Multivariate methods were used to model the repeated-measures dichotomous outcome as a function of smoking and other covariates. RESULTS: Smokers experienced low back pain more than nonsmokers (odds ratio, 2.4; 95% confidence interval, 1.3-6.0). There was also a dose-response relationship between amount smoked and development of low back pain. Smokers tended to experience more upper limb or lower limb pain than nonsmokers, although this result was not significant. CONCLUSIONS: Smoking was found to increase the risk for low back pain in this cohort of adolescents.

Adolescent↗
PubMed2000

Physical and psychosocial factors related to low back pain during a 24-year period. A nested case-control analysis.

STUDY DESIGN: A retrospective nested case-control study. OBJECTIVES: To identify occupational factors related to low back pain, and to study how interactions between psychosocial and physical factors, and between work-related and leisure-related factors affect low back pain in women and men. SUMMARY OF BACKGROUND DATA: A cohort of 484 subjects drawn from the general population was examined in 1969 and 1993, with a focus on occupational working conditions and musculoskeletal disorders. METHODS: Information about the physical and psychosocial working conditions and low back pain during the period 1970 to 1993 was collected retrospectively. Odds ratios and confidence intervals were calculated for different potential risk factors. RESULTS: During the 24-year period, 46% of the subjects became patients with low back pain. Among women, heavy physical workload, sedentary work, smoking, and the combination of whole-body vibrations and low influence over work conditions were associated with an excess risk of low back pain. Among men, excess risk for low back pain was seen in heavy physical workload, sedentary work, high perceived load outside work, and the combination of poor social relations and overtime. CONCLUSIONS: Factors at work were seen to be risk indicators for low back pain among both genders. Low influence over work conditions among women and poor social relations at work among men, in combination with other factors, seem to be of high relevance for the occurrence of low back pain.

Adolescent↗
PubMed2000

Bridging the gap between science and practice in managing low back pain. A comprehensive spine care system in a health maintenance organization setting.

STUDY DESIGN: A case study of spine care system changes in a multispecialty group practice health maintenance organization setting. OBJECTIVES: To reduce unnecessary use of imaging and specialty referrals for low back pain in the primary care setting and to reduce spine surgery rates. SUMMARY OF BACKGROUND DATA: Results of previous research indicate that diagnostic and therapeutic procedures for low back pain are frequently used even though there is no scientific evidence of their efficacy. This indicates that low back pain care can be made more efficient by reducing the use of unproven diagnostic and therapeutic interventions for low back pain. METHODS: Rates of diagnostic imaging and specialty referral rates for low back pain were monitored for 9 months before and 9 months after primary care physician education regarding appropriate low back pain evaluation and management. Spine surgery rates were also monitored before and after implementation of a nonsurgical spine clinic. RESULTS: Large reductions in rates of imaging and specialty referrals for low back pain were achieved after primary care physician education. After spine clinic implementation, visits to spine surgeons dropped by approximately 50%, and spine surgery rates per thousand health plan members were reduced by 35%. CONCLUSIONS: Primary care physician education regarding low back pain management can reduce use of imaging and specialty referrals without reductions in patient satisfaction, and implementation of a nonsurgical spine clinic for complex or chronic spine patients can significantly reduce spine surgery consultations and spine surgery rates.

Diagnostic Imaging↗
PubMed2001

Influences of nonspecific low back pain on three-dimensional lumbar spine kinematics in locomotion.

STUDY DESIGN: A three-dimensional kinematic analysis of lumbar spinal movements with an ultrasonic measuring system was used to distinguish patients with chronic low back pain from those without such pain. OBJECTIVES: To investigate the effects of chronic low back pain on the three-dimensional movements of the lumbar spine, and to identify variables that would allow discrimination among patients with chronic low back pain and control subjects. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, no previous studies have described or identified altered spinal and pelvic gait kinematics caused by nonspecific chronic low back pain in all anatomic planes. METHODS: In this study, 34 participants with chronic low back pain and 22 subjects without such pain were monitored during treadmill gait. Data from the measuring system operating at 30 Hz were low-pass filtered and normalized to a percentage of the gait cycle. RESULTS: Cross-correlations showed almost identical patterns of pelvic (S1) and thoracic (T12) movement curves in all anatomic planes between groups. No statistical group differences were detected for either pelvic or thoracic oscillation amplitudes. However, Student's t test showed significantly higher coefficients of variation (P < 0.01) in all anatomic planes of patients with chronic low back pain than in healthy control patients. CONCLUSIONS: The phasic patterns and angular spinal displacements of patients with nonspecific low back pain were shown to be within normal limits. However, the patients demonstrated higher degrees of stride-to-stride variability, representing increased fluctuations in dynamic thoracic and pelvic oscillations. These findings, resulting in less than optimal gait patterns, must be considered in the rehabilitation of patients with chronic low back pain.

Adult↗
PubMed2002

Pelvis-thorax coordination in the transverse plane during walking in persons with nonspecific low back pain.

STUDY DESIGN: Transverse pelvis and thorax rotations were studied during walking in 39 patients with nonspecific low back pain and 19 healthy participants. OBJECTIVES: To gain insight into the consequences of low back pain for gait and to identify clinically useful measures for characterizing the quality of walking in patients with low back pain. SUMMARY OF BACKGROUND DATA: Gait studies in patients with low back pain have reported a decrease in walking velocity. In normal gait, in-phase pelvis-thorax coordination (synchronicity) evolves toward antiphase coordination (counterrotation) as walking velocity increases. This study examined the effect of walking velocity on pelvis and thorax rotations in patients with low back pain. METHODS: Amplitudes of pelvis and thorax rotations were calculated, and spectral analyses were performed. Pelvis-thorax coordination was characterized in terms of relative Fourier phase, and coupling strength was assessed by means of cross-spectral analysis. RESULTS: In comparison with healthy participants, relative Fourier phase was significantly smaller in low back pain patients for walking velocities of 3.8 km/h and higher, whereas coupling strength was significantly higher for velocities from 1.4 to 3.0 km/h. No significant group differences were found in amplitude or spectral content of individual pelvis and thorax rotations. CONCLUSION: In comparison with healthy participants, the gait of patients with low back pain was characterized by a more rigid, less flexible pelvis-thorax coordination in the absence of significant differences in the kinematics of the component rotations. This result suggests that coordination measures are more adequate in assessing quality of walking in patients with low back pain than are kinematic measures pertaining to the individual segment rotations, and that conservative therapy should use methods aimed at improving intersegmental coordination.

Adult↗
PubMed2002

Back extension endurance and strength: the effect of variable-angle roman chair exercise training.

STUDY DESIGN: A pre- and postintervention randomized, controlled trial was conducted. OBJECTIVE: To evaluate the effect of progressive resistance exercise training using a variable-angle Roman chair on the development of lumbar extensor endurance and strength. SUMMARY OF BACKGROUND DATA: Progressive resistance exercise for the lumbar extensors has been used successfully for low back pain rehabilitation, but the limitations of currently available back exercise devices have negatively affected its use. METHODS: For this study, 36 healthy volunteers were randomized into one of two groups: a variable-angle Roman chair exercise group (n = 18) that performed one set of 15 to 25 repetitions of dynamic progressive resistance back extension exercise on a variable-angle Roman chair three times per week for 8 weeks or a control group (n = 18) that did not perform resistance exercise. Before training and after 4 and 8 weeks of training, static back extension endurance (seconds) and isometric lumbar extension strength (Newton.meters) were recorded. RESULTS: The variable-angle Roman chair exercise group displayed a 42% increase in static back extension endurance at the 4-week and 8-week tests relative to the pretraining measure (P < 0.05). The control group did not increase back endurance time at either the 4-week or 8-week tests (P > 0.05). Neither the variable-angle Roman chair exercise group nor the control group displayed an increase in lumbar extension strength at the 4-week or 8-week tests (P > 0.05). CONCLUSIONS: Dynamic progressive resistance exercise training on a variable-angle Roman chair is capable of developing back extension endurance. Future research is needed to determine the clinical applicability of variable-angle Roman chair exercise training for patients with low back pain patients.

Adult↗