Back Strains Research Articles

Value of preplacement examination of the lumbar spine.

There is no single condition where skilled labor is involved that causes more loss of man-hours than low back symptoms (Runge). Coulter found that 79 per cent of back strains were in the lumbosacral area, as compared with only one-third of fractures. He believes that the lumbosacral spine is especially vulnerable to injury for two reasons: first, it is least protected by supporting structures in the region; second, it is more often subjected to excessive strain in lifting and bending than are other sections of the vertebral column. To be considered also is the fact that the lumbosacral region is more frequently the site of anomalies than any other part of the body. Colcher and Hursch point out that pain and disability could be and often are consistent with the anomalous findings. For these reasons, preplacement roentgen examinations of the lumbosacral spine have passed the stage of innovation. Cushway and Maier reported on routine examination of the spine for industrial employees in March of 1929.In their series of 931 examinations, 414 men were found to have a total of 510 anomalies and abnormalities. The necessity for preplacement examinations has been further emphasized by the steady increase in the number of so-called “industrial backs” in the recent past. Becker reported that from 1940 to 1950 Ohio had an increase of 31 per cent in employment and that during that period there was a 132 per cent increase in back injuries. In the same decade, with an increase of only 7 per cent in the industrial force of New York, back injuries increased 43 per cent. Becker also cites the experience of Minnesota, with a 57 per cent increase in its industrial force and 80 per cent increase in back injuries. The monetary significance of these observations is illustrated by a year's experience in the Commonwealth of Pennsylvania, with over 6,900 back injuries reported and nearly $1,500,000 in related compensation payments. According to Carney, these conditions cost the American railroads 29 million dollars in claims in 1941. In 1951 and each year thereafter, over 100 million dollars have been paid out, even though accidents were reduced. Any traumatic cause of backache, superimposed upon a pre-existing low back affection, causes a difficult medical problem, from the point of view of both patient and physician. The greatest difficulty is the estimation of the actual significance of the patient's complaints as compared with the physical signs of injury and its effect on the pre-existing low back condition. As Flaxman has pointed out, many patients with low back affections work and carryon a normal life until trauma aggravates a pre-existing lesion. It may be that the complaint of backache is so common that hardly anyone gives it much attention until an injury aggravates the pain.

Belt for back strain: a resilient, self-adjusting low back support for men and women.

During the past 35 years I have prescribed, from time to time, an ordinary polo belt for certain back disorders, chiefly sprains and strains at waist level. Ten years ago I modified the regular polo belt by having a 3 in. wide gusset of heavy elastic webbing inserted at each side of the belt. The cuts were made on the bias. This provides some resiliency without sacrifice of compression support. It also permits the belt to be worn at a lower level and thereby to support the lumbosacral and sacroiliac joints. The original belt selected should be one size smaller than the person's waist measurement. I have found the belt helpful in the following situations: lumbago, shoveling snow, playing golf, amateur gardening, and carrying the baby. It is useful for wear at night as well as during the day. It is not a substitute for a back brace or a

Low back sprain: The sacroiliac syndrome

D ISABILITY due to pain in the Iower back is being drawn to our attention more and more frequentIy. We see cases constantIy in Iarge orthopedic chnics, especiahy the type with involvement of the sacroiIiac joint and of traumatic origin. Interest in the Iatter cases has undoubtedly been stimuIated by their frequent appearance at Compensation Commission hearings. Even a casua1 survey of the Iiterature on sacroiIiac disease in the past five years reveaIs that it is becoming more and more recognized as a distinct syndrome. We shah here consider onIy the traumatic and relaxed types of sacroiliac syndromes. Many etiological factors enter into these low back disabiIities, varying from static strain on the ligaments due to constant standing with muscIes of the back relaxed, as with many young women, producing the sacroiliac reIaxation described by Baer, to the vioIent attempts to Itft heavy weights, producing the severe sacroiIiac subIuxations or arthritis and back strains of a different type. They vary from faIIs to obstetric Iabors. Many patients awake from an anesthetic to compIain bitterIy of pain in the Iower back after lying on a flat tabIe a protracted time. The number of wrenched backs occurring in wrestIing, footbaI1 and in the industries is Iegion. Before anything can be said concerning sacroiliac subIuxation or arthritis or syndrome, caI1 it what you wiI1, essential points in anatomy must be brought out for a clearer understanding of the mechanics of the disturbance. We are concerned here with a true diarthrodia1 joint (Figs. I and 2), in which the opposing surfaces are partIy in contact but, in the main, are separated by synovia1 fluid. This has been brought out by GoIdthwait, Albee, Roberts of EngIand and others. As the sacrum is broader in front than behind and above than beIow, the joint surface faces backward, outward and downward and is compIeteIy covered by the overhanging posterior superior spine of the iIium. The joint surfaces mesh like two oyster shelIs pIaced one within the other; especiahy is this so in the maIe. They are covered with cartilage, thicker on the sacral than on the iIiac side. The capsuIe of the synovia1 cavity is formed by the surrounding ligaments. Of these the most important structure, for it receives a11 the weight of the erect body above the peIvis, is the posterior sacroiIiac Iigament. It not only is the suspensory ligament of the body but the pivot ligament of the sacroiIiac joint itself. It pIays an important r6Ie in the mechanics of subluxation. It arises from the posterior superior spine of the iIium and runs forward to the sacrum, fanning out and fihing in the notch formed by the overhanging posterior superior spine of the iIium and the body of the sacrum. This ligament, especiaIIy the horizontal and main segment, forms one of the strongest fiber masses in the body. No amount of force has been abIe to tear it without fracturing the bony structures of its insertions. The upper part of the sacrum is, therefore, abso1uteIy prevented from moving forward. Two other Iigaments have an important bearing on the mechanism of sacroiliac syndrome. They are the greater and Iesser sacrosciatic Iigaments. The former is attached by a broad base to the posterior inferior spine of the ilium, to the fourth and fifth transverse tubercIes of thesacrum,

A Diagnostic Line for Determining Subluxation of the Fifth Lumbar Vertebra

CONDITIONS obtaining in the lumbo-sacral region are becoming of more and more importance. Many disabilities, formerly classified as lumbago, back strains, etc., are now being recognized as due to displacements, either permanent or temporary, of the fifth lumbar vertebra from its normal relationship to the sacrum, or to strain primarily due to structural weakness in this region. Displacements of the fifth lumbar, when fairly marked, are easily recognized either by antero-posterior or lateral roentgenograms, but there are numerous instances where distinct subjective symptoms are present but the roentgenologist's report is negative. We are not now in position to say whether certain positions of the lumbo-sacral joint are within normal limits or not. That is, to say that the position seen cannot be responsible for the symptoms, for variation in symptomless individuals is common. It is very necessary, therefore, that we have a fixed average norm, a deviation from which constitutes a definite abnormality. The object of this report is to suggest observation of a large number of symptomless individuals, as well as those with symptoms, to determine how far from a definite sacral base line, here described, the fifth lumbar vertebra may be placed and still be within the norm. If this can be established it is believed that many back strains, which are now reported as negative roentgeno-graphically, will be found due to comparatively slight displacements, anterior or posterior, beyond a definite average norm. The base line suggested by the author is established on a lateral view of the lumbo-sacral region as follows: So far as can be determined at present, it is unimportant whether the tube be centered over the joint or over the third or fourth lumbar vertebra. Neither is it necessary to have a true lateral. Two points are taken on the edge of the sacral articular surface, as far apart as practicable. These points are then connected by a straight line which is projected forward until it intersects a line which is either the anterior margin of the sacrum or a prolongation of it. If the anterior-superior margin of the sacrum is an angle the articular surface line will intersect the anterior surface line at the point of the angle. If rounded, both lines must be prolonged until they intersect. A line at 90 degrees to the articular surface line is now erected at this point of intersection. It is believed that this line, perpendicular to the sacral articular surface, should pass well in front of the anterior-inferior margin of the fifth lumbar unless there is an anterior displacement of this vertebra. No symptomless individuals have so far been found where this is not true, and in one instance where the fifth lumbar was just short of touching the line, there were marked symptoms and considerable disability. In a patient of Dr. W. B. Bowman's, with distinct anterior displacement, the line cut through the body of the fifth lumbar.

Notes on Treatment of Low Back Strains

Notes on Treatment of Low Back Strains