Chronic Non-specific Low Back Pain Research Articles

Maitland Mobilization versus Core Stability Exercises in Management Chronic Nonspecific LBP

Background: Low back pain (LBP) is one of the main causes that affect mechanical function in human bodies worldwide, 90% of the cases with non-specific LBP. Different options are available for the management of non-specific LBP. While Maitland mobilization and core stability exercises are usually utilized in clinical practice for managing Chronic Nonspecific Low Back Pain, there is now a lack of research examining their comparative effectiveness. Objective: The objective of this study is to assess and compare the efficiency of Maitland mobilization and core stability exercise as treatment modalities for adults suffering from chronic non-specific low back pain. Methods: A total of 36 Non-specific low back pain (NSLBP) patients with ages 18 to 45 years were inducted and given their Informed consent. Subjects were allocated into two groups through simple random sampling. Group A (N=18) received central posterior-anterior vertebral mobilization while group B (N=18) received core stability exercises. Pain and functional disability were assessed using the Visual Analogue scale (VAS) and Oswestry Disability Index (ODI) respectively. Pre & post-treatment scores were documented and compared to achieve the aim of this study. Results: T-test indicated that the results pre- and post-treatment were showed a statistically positive significant difference by applying Maitland mobilization technique with non-specific LBP to improve functional disability (ODI) and reduce pain intensity (VAS) with (p = 0.001), respectively. On the other hand, results for the application of core stability exercises in management NSLBP also showed positive signs in reducing VAS and improving ODI with (p= 0.001) respectively. The findings suggest that there was no statistically significant difference between the Maitland mobilization technique and core stability exercises in treating NSLBP for pain reduction with (p = 0.312) and improvement in ODI with (p = 0.055). For applying Maitland mobilization in NSLBP, Pearson correlation results indicated that there was no relationship between body mass index (KG/M2) and functional disability (ODI) with (p = 0.034) and pain severity (VAS) with (p = 0.808). For core stability exercises, the results of Pearson's correlation indicated that there was no relationship between body mass index (KG/M2) and functional disability (ODI) with (p = 0.959) and pain intensity (VAS) with (p = 0.987). By gender, the results showed there were no statistically significant role for Maitland mobilization and core stability exercises in improving function and reducing pain among patients with chronic non-specific low back pain. Conclusion: Both core stability exercises and Maitland method have demonstrated effectiveness in reducing pain and improving functional disability in patients with chronic nonspecific low back pain.

Clinical effect of suspension training and Mulligan technique in combination with celecoxib in the treatment of chronic non-specific lower back pain

Clinical effect of suspension training and Mulligan technique in combination with celecoxib in the treatment of chronic non-specific lower back pain

Cortical Mechanisms Underlying Effects of Repetitive Peripheral Magnetic Stimulation on Dynamic and Static Postural Control in Patients with Chronic Non-Specific Low Back Pain: A Double-Blind Randomized Clinical Trial.

Patients with chronic non-specific low back pain (CNLBP) often experience impaired postural control, contributing to pain recurrence. Although repetitive peripheral magnetic stimulation (rPMS) combined with core muscle training (CMT) could improve postural control, its neural mechanism remains unclear. This study aims to investigate the postural control-related cortical mechanism of the effect of rPMS on patients with CNLBP. This unicentric, prospective, randomized, double-blind, controlled trial was conducted in a public hospital from May to December 2023. A total of 40 patients (27 females and 13 males, mean age 29.38±7.72) with CNLBP were randomly assigned to either the rPMS group (real rPMS with CMT) or the sham-rPMS group (sham-rPMS with CMT) for 12 sessions over 4weeks. The rPMS was applied to the lumbar paravertebral multifidus muscle on the painful side. Pain and disability were quantified using the visual analog scale (VAS) and Oswestry dysfunction index (ODI) pre- and post-intervention. Furthermore, the sway area and velocity of the center of pressure (COP) were measured using a force platform. The cortical activities in 6 regions of interest during 4 tasks (standing with eyes open/closed on a stable/unstable plane) were recorded by functional near-infrared spectroscopy (fNIRS) pre- and post-intervention. The repeated measure ANOVA was applied for statistical analysis. Spearman's correlation was used to determine the relationships between variables. After the intervention, the rPMS group showed decreased pain intensity (p=0.001) and sway area (unstable eyes-closed task) (p=0.046) compared to the sham-rPMS group. Additionally, the rPMS group exhibited increased activation in left primary motor cortex (M1) (p=0.042) and reduced in left supplementary motor area (SMA) (p=0.045), whereas the sham-rPMS group showed no significant changes. The increased activation of left M1 was negatively correlated to the reduction of pain intensity (r=-0.537, p=0.018) and sway area (r=-0.500, p=0.029) under the static balancing task. Furthermore, there was a positive correlation between sway velocity and VAS (r=0.451, p=0.046) post-rPMS intervention. Repetitive peripheral magnetic stimulation combined with core muscle training demonstrated better analgesic effects and postural control improvements, compared to sham-stimulation. This may be attributed to the increased activation of the left primary motor cortex. The trial was registered on ClinicalTrials.gov (ChiCTR2300070943).

A Comparative Study on the Transcutaneous Electrical Nerve Stimulation versus Intermittent Lumbar Traction in Chronic Non-Specific Low Back Pain Combined with the Extensor Endurance Exercise Regime

A Comparative Study on the Transcutaneous Electrical Nerve Stimulation versus Intermittent Lumbar Traction in Chronic Non-Specific Low Back Pain Combined with the Extensor Endurance Exercise Regime

Functional Patterns and Postural Balance in Young Women With Chronic Non-Specific Low Back Pain and Healthy Individuals

Introduction In the case of chronic low back pain, changes occur at the central nervous system level. It leads to functional limitations, muscle activity, and motor control impairments.Objectives The aim of the study was to analyze the impact of chronic low back pain on the quality of performance functional patterns and postural balance in young women.Material and methods The study involved 60 women with an average of 21.571.07. In Group 1 (n=30), participants reported chronic low back pain, Group 2 (n=30) was the control group. To assess functional efficiency, the Functional Movement Screen was used. Postural stability was evaluated using the FreeMED Posture Base pedobarographic platform. Pain level was determined using the VAS scale, and pelvic anterior tilt was measured using the BROM II.Results In the group of women with chronic low back pain, significantly lower levels of functional efficiency were observed. The length distance covered by the CoP, the area of an ellipse containing the trajectory of the CoP, and the average velocity of the CoP were greater compared to the group of women without pain. In Group 1, significantly greater asymmetry in foot pressure distribution was noted.Conclusions Individuals reported chronic low back pain demonstrate poorer quality of performance functional patterns and postural stability compared to healthy ones. Detecting movement disorders may contribute to a physiotherapist's planning of a therapeutic program that includes the specific movement deficits of patients. It can directly impact the reduction or delay of pain occurrence.

The relationship between single leg balance and proprioception of the knee joint in individuals with non-specific chronic back pain

BackgroundProprioceptive information from the hips, knees, and ankles as well as joint coordination are important for maintaining and controlling balance. Regional receptors in the muscles, joints, skin, and tendons as well as proprioception in the knee joint provide the necessary joint activity and stability. Pain may occur with a decreased sense of balance and proprioception. ObjectiveTo investigate the relationship between single-leg balance and proprioception of the knee joint in individuals with non-specific chronic low back pain. DesignFifty-two individuals with non-specific chronic low back pain, 30 females and 22 males, were included in our study, with a range of 18–50 years (mean age:25.15 ± 8.2 years). MethodPain intensity at rest and activity was assessed using Visual Analogue Scale (VAS), and disability and function were assessed using Oswestry Disability Index (ODI). Single-leg balance measurements were performed using Prokin TecnoBody kinematic balance device. A goniometer was used to evaluate the proprioception of the knee joint. ResultsThere were low-level negative correlations between VAS resting pain intensity and medium-lateral standard deviation value (p = 0.018; r = −0.327) and ellipse area measure (p = 0.039; r = −0.287) from static balance assessments. There were low-level negative correlations between VAS activity pain intensity and medium-lateral standard deviation value (p = 0.039; r = −0.288), ellipse area (p = 0.044; r = −0.281), and perimeter measure (p = 0.043; r = −0.282) from static balance assessments. No correlation was seen between ODI and clinical balance and proprioception assessments (p > 0.05). There was no correlation between clinical balance and proprioception evaluations (p > 0.05). ConclusionAs a result of the study, it was decided that there is a minimal relationship between single-leg balance and knee joint proprioception in people with nonspecific low back pain.

Reliability of tele-assessment of five repetition sit to stand and timed up and go tests in patients with non-specific chronic low back pain

BackgroundTelerehabilitation has become a frequently preferred option in the follow-up and treatment processes of non-specific low back pain (NSLBP) in recent years. One of the most important components in the rehabilitation of patients with NSLBP is a comprehensive assessment. Physical performance assessments such as the Five Repetition Sit to Stand Test (5xSTS) and Timed Up and Go (TUG) stand out as tests often used in clinical measurements in patients with NSLBP.AimsThis study aimed to assess reliability of tele-assessment of 5xSTS and TUG tests in patients with NSLBP.MethodsPatients with NSLBP with low back pain for at least 3 months were included in the study. All tests were performed face-to-face and remotely. Intra-rater and inter-rater reliability were used to determine the intraclass correlation coefficients (ICCs).ResultsInter-rater reliability results between face-to-face and tele-assessment were excellent for both 5xSTS (ICC = 0.966) and TUG (ICC = 0.900). In addition, the intra-rater reliability results obtained between face-to-face and tele-assessment showed excellent for both 5xSTS (ICC = 0.979) and TUG (ICC = 0.958).ConclusionsThis study suggests that these tests can be used reliably at home or remotely in different settings as well as in the clinic.

Effect of Hamstring Tightness, Back Pain and Disability on Sleep Quality

Background: Chronic low back pain (CLBP), defined as pain persisting for more than three months, is associated with disability, functional limitations, musculoskeletal issues, and sleep disturbances in many individuals worldwide. Objective: The main objective of this study was to determine the effect of hamstring tightness, pain intensity, and disability on sleep quality in patients with chronic low back pain. Methods: This cross-sectional study included 387 individuals aged 25-55 years, recruited from various orthopedic units. Data were collected using the Roland-Morris Questionnaire (RMQ) for disability, the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, the Active Knee Extension (AKE) test for hamstring tightness, and the Numeric Pain Rating Scale (NPRS) for pain intensity. Statistical analysis was conducted using SPSS version 25. Descriptive statistics, including means and standard deviations, were calculated for quantitative variables, while frequencies and percentages were calculated for qualitative variables. Chi-square tests were performed to examine the associations between NPRS, RMQ, AKE scores, and PSQI scores, with a p-value of less than 0.05 considered statistically significant. Results: The mean age of the 387 participants was 41.67 ± 13.38 years; 233 were females (60.2%), and 154 were males (39.8%). The mean RMQ score was 11.45 ± 2.34, the mean PSQI score was 8.58 ± 2.60, and the mean NPRS score was 4.97 ± 1.37. The AKE test was positive in 34.6% of participants. Chi-square tests showed a significant positive association between NPRS and PSQI scores (p = 0.001), and between RMQ and PSQI scores (p = 0.048). However, the association between AKE scores and PSQI scores was not significant (p = 0.400). Conclusion: This study highlights the significant association between pain intensity, disability, and sleep quality in patients with chronic nonspecific low back pain. Pain and disability adversely affect sleep quality, while hamstring tightness does not appear to have a significant impact. These findings underscore the importance of addressing pain and disability to manage sleep disturbances in this patient population.

Interventional effect of core stability training on pain and muscle function of youth with chronic non-specific lower back pain: A randomized controlled trial

Nowadays, due to lifestyle changes, the number of young people suffering from chronic non-specific low back pain (CNLBP) is gradually increasing. The recent guidelines for the treatment of low back pain emphasize that exercise therapy is the preferred treatment method for CNLBP. This study take ordinary college male students with CNLBP as objective of the study, focused into how core stability training affected the pain and muscle function of the CNLBP of youth. Herein, 60 male subjects were randomly divided into a control group and an experimental group, and conducted a randomized control trial in the Sports Rehabilitation Laboratory of Guangxi Normal University from September to October 2023. The control group received traditional waist strength training, while the experimental group received core stability training. VAS scores, pain symptoms scores and clinical efficacy grades were evaluated. Waist muscles fitness was evaluated, including back muscle strength, the prone upper body up's static holding time, 1-min modified sit-ups' pcs, the supine abdominal curling's static holding time and the supine leg raising's static holding time. Waist movement function was also evaluated using oswestry disability index (ODI) questionnaire. Surface electromyographic (EMG) signals were collected from rectus abdominis, erector spinae and multifidus. The independent sample t-test was used to compare groups, and the paired sample t-test was used for the data comparison before and post-exercise within the group. The results of the study found that CNLBP was improved in both the experimental and control groups in the post-exercise. Compared to pre-exercise, there are significant decrease in the VAS scores (95%CI: 2.51 to 6.51, p = 0.000), pain symptoms scores (95%CI: 2.95 to 3.55, p = 0.000), waist movement function's evaluation scores for ODI (95%CI: 2.23 to 4.31, p = 0.000), rectus abdominis' IEMG values (95%CI: 2.29 to 4.39, p = 0.000), erector spinae and multifidus' IEMG values (95%CI: 2.18 to 4.45, p = 0.000) of experimental group in the post-exercise. Compared to pre-exercise, there are significant improvement in the back muscle strength (95%CI: 12.85 to 19.49, p = 0.000), the prone upper body up's static holding time (95%CI: 9.67 to 19.17, p = 0.000), the 1-min modified sit-ups' pcs (95%CI: 8.56 to 18.12, p = 0.000), the supine abdominal curling's static holding time (95%CI: 6.73 to 19.14, p = 0.000), and the supine leg raising's static holding time (95%CI: 8.21 to 18.35, p = 0.000) of experimental group in the post-exercise. In the post-exercise,there are significant lower in the VAS scores (95%CI: 1.41 to 4.98, p = 0.000), pain symptoms scores (95%CI: 1.14 to 1.79, p = 0.011), waist movement function's evaluation scores for ODI (95%CI: 1.13 to 2.25, p = 0.000), rectus abdominis' IEMG values (95%CI: 2.36 to 4.47, p = 0.000), erector spinae and multifidus' IEMG values (95%CI: 2.24 to 4.23, p = 0.017) of experimental group than those of control group. In the post-exercise, there are significant higher in the recovery rate (p = 0.000), the prone upper body up's static holding time (95%CI: 4.16 to 8.32, p = 0.008), and the supine abdominal curling's static holding time (95%CI: 3.89 to 7.44, p = 0.000) of experimental group than those of control group. Therefore, it can be concluded that core stability training is significantly effective in treating CNLBP in youth, enhancing lower back muscle function. This therapeutic effect is primarily attributed to the improvement in muscle function.

Effects of Bilateral M1 Anodal Transcranial Direct Current Stimulation on Pain and Mood in Patients with Non-Specific Chronic Low Back Pain

Effects of Bilateral M1 Anodal Transcranial Direct Current Stimulation on Pain and Mood in Patients with Non-Specific Chronic Low Back Pain

Efektivitas Hipnoterapi dalam Manajemen Nyeri pada Gangguan Muskuloskeletal

This study aims to determine the effect of hypnotherapy on pain management in patients with musculoskeletal disorders. The research method used was a systematic review carried out by searching for literature articles using Google Web, namely PubMed, Embraced, Science Direct, and ProQuest. The keywords used in this systematic review are musculoskeletal diseases, hypnotherapy or hypnosis, and pain. Inclusion criteria are male and female gender, adult age, year of publication in the last 10 years (2013-2023), and English language. The research results showed that a search of 402 articles was found, and only 5 articles were selected where hypnotherapy was effective in reducing pain in patients experiencing musculoskeletal problems such as fibromyalgia, chronic nonspecific low back pain, burns, and chronic brachial neuralgia. In conclusion, hypnotherapy can reduce pain in musculoskeletal disorders. Keywords: Hypnotherapy, Musculoskeletal, Pain.

Effects of Rhythmic Stabilization and Mckenzie Techniques on Pain and Function in Patients with Non-Specific Chronic Low Back Pain

Effects of Rhythmic Stabilization and Mckenzie Techniques on Pain and Function in Patients with Non-Specific Chronic Low Back Pain

Appropriateness of exercise therapy delivery in chronic low back pain management: cross-sectional online survey of physiotherapy practice in Germany

BackgroundIn Germany, exercise therapy represents the most commonly prescribed physiotherapy service for non-specific, chronic low back pain (NSCLBP). So far, little is known about current practice patterns of German physiotherapists in delivering this intervention. Thus, the aim of this study was to investigate the appropriateness of exercise therapy delivered to NSCLBP patients in German physiotherapy care and to identify practitioner-related drivers of appropriate exercise delivery.MethodsWe used a vignette-based, exploratory, cross-sectional, online-survey study design (76-items; data collection between May and July 2023). Eligible participants were required to hold a professional degree in physiotherapy and were required to be practicing in Germany. Access links to anonymous online surveys were spread via established German physiotherapy networks, educational platforms, social media, e-mail lists, and snowball sampling. Appropriateness of exercise therapy was calculated by an equally weighted total score (400 points) including scales on shared-decision-making, exercise dose selection, pain knowledge and self-management promotion. “Appropriate exercise delivery” was determined by a relative total score achievement of > 80%. “Partly appropriate exercise delivery” was determined by a relative total score achievement of 50–79%, and “inappropriate exercise delivery” by a score achievement of < 50%. Practitioner-related drivers of exercise appropriateness were calculated by bivariate and multiple linear regression analyses.Results11.9% (N = 35) of 298 physiotherapists’ exercise delivery was considered “appropriate”, 83.3% (N = 245) was “partly appropriate”, and 4.8% (N = 14) was “inappropriate”. In the final multiple regression model, most robust parameters positively influencing appropriate delivery of exercise therapy were increased scientific literacy (B = 10.540; 95% CI [0.837; 20.243]), increased average clinical assessment time (B = 0.461; 95% CI [0.134; 0.789]), increased self-perceived treatment competence (B = 7.180; 95% CI [3.058; 11.302], and short work experience (B = − 0.520; 95% CI [-0.959; − 0.081]).ConclusionAppropriate exercise delivery in NSCLBP management was achieved by only 11.9% of respondents. However, the vast majority of 95.2% of respondents was classified to deliver exercise therapy partly appropriate. Long work experience seemed to negatively affect appropriate exercise delivery. Positive influences were attributed to scientific literacy, the average clinical assessment time per patient as well as the perceived treatment competence in NSCLBP management.RegistrationOpen science framework: https://doi.org/10.17605/OSF.IO/S76MF.

Hip capsular pattern and chronic non-specific low back pain –A case controlled prospective study

BackgroundIndividuals with chronic nonspecific low back pain (CNLBP) presents with altered lumbosacral biomechanics, potentially stemming from compromised hip joint mobility. The objective of our study was to assess hip range of motion (ROM) and hamstring flexibility in individuals with CNLBP to ascertain the presence of a hip capsular pattern in relation to age-matched controls. MethodsThis study was conducted at a tertiary hospital between July 2017 and September 2018, with approval from the institutional review board (JIP/IEC/2017/0044). Inclusion criteria encompassed axial or non-radiating pain primarily in the back for more than 3 months with no definitive pathology. A group of individuals with CNLBP (n = 27) and a control group (n = 30) of age-matched healthy volunteers were included. The observers were blinded to grouping. Bilateral hip range of motion and hamstring flexibility were measured. ResultsIndividuals with CNLBP exhibited a significant mean reduction in hip adduction (9.68 & 8.8o) and internal rotation (7.19 & 7.09°) of the right and left hips, respectively. Additionally, there was a mean increase in flexion (7.68 & 7.71°), extension (6.99 & 8.64°), abduction (7.08 & 8.02°), and external rotation (20.4 & 20.1°) of the right and left hips, respectively, compared to controls (p < 0.01). Notably, hamstring flexibility did not show a significant difference (P > 0.05). ConclusionBased on this study, it is plausible that individuals with CNLBP may exhibit a hip capsular pattern (FABER), with the exception of flexion, when compared to age-matched normal individuals. Also, it was also noted that hamstring tightness did not accompany CNLBP.

Effects of Gluteal Muscle Strengthening Exercise-Based Core Stabilization Training on Pain and Quality of Life in Patients with Chronic Low Back Pain.

Background: The World Health Organization reports that back pain is a major cause of disorder worldwide. It is the most common musculoskeletal disorder with limited pain, muscle tension, and stiffness, and 70-80% of all individuals experience it once in their lifetime, with higher prevalence in women than in men. This study aimed to investigate the effects of gluteal muscle strengthening exercise- based core stabilization training (GSE-based CST) on pain, function, fear-avoidance patterns, and quality of life in patients with chronic back pain. Methods: This study included 34 patients with non-specific chronic low back pain. Seventeen individuals each were included in GSE-based CST and control groups. The GSE-based CST group performed GSE and CST for 15 min, three times a week for four weeks, and the control group performed CST for 30 min a day, three times a week for four weeks. The numeric pain rating scale was used to evaluate pain before and after treatment, Roland-Morris disability questionnaire was used to evaluate function, fear-avoidance beliefs questionnaire was used to evaluate fear-avoidance patterns, and quality of life was measured using the short form-36. Results: In this study, pain, function, and fear-avoidance pattern decreased significantly in both groups (All p < 0.05). During the evaluation of quality of life, both groups showed significant increase in physical and mental factors (p < 0.05). There were significant differences in pain and quality of life (p < 0.05) between the GSE-based CST and control groups. Conclusions: Therefore, GSE-based CST can be used as a basis for effective intervention to enhance pain, function, fear-avoidance patterns, and quality of life, emphasizing the need for gluteal muscle strengthening exercises in patients with non-specific chronic back pain in the future.

The effects of lumbar stabilization exercises with and without jaw movements in non-specific low back pain (A randomized controlled trial).

This study aimed to investigate the added effect of jaw clenching on the efficacy of lumbar stabilization exercises to manage chronic non-specific low back pain. This randomized controlled trial was conducted at the Sindh Institute of Physical Medicine and Rehabilitation (SIPM&R) Karachi from April 2021 to April 2023. Eighty patients with chronic non-specific low back pain participated in this study. Forty patients each were randomly allocated to the lumbar stability exercise (LSE) group' and the lumbar stability exercise with teeth clenching (LSETC) group. Patients in both groups performed respective exercises twice weekly for 12 weeks. The Numeric Pain Rating Scale (NPRS), Roland Morris Disability Questionnaire (RMDQ), and Pressure Biofeedback Unit (PBU) were used to assess pain, disability, and muscle endurance respectively. Data were collected at the baseline, after six weeks and 12 weeks of intervention. A p-value of <0.05 was considered statistically significant. Both groups showed statistically significant improvements in pain, disability, and muscle endurance. Upon further stratification, participants aged 20-30 years in the LSETC group showed significantly higher scores than the LSE group for NPRS, RMDQ, and PBU after 12 weeks. Overall, the LSETC group showed relatively higher improvement in mean scores for NPRS, RMDQ, and PBU than the LSE group. Lumbar stabilization exercises with and without jaw movement are effective for the treatment of chronic non-specific low back pain. The addition of teeth clenching enhanced the effectiveness of lumbar stability exercises, especially in young adults. Trial Registration: Clinicaltrials.gov (NCT04801212), Prospectively registered on March 16, 2021.

The usage of a modified straight-leg raise neurodynamic test and hamstring flexibility for diagnosis of non-specific low back pain: A cross-sectional study.

The main purpose of this research study was to compare mean modified straight-leg raise test (mSLR) and hamstring muscle length (HL) between chronic non-specific low back pain (LBP) and healthy subjects to understand the possibility of neuropathic causes in LBP population as it may impact the diagnosis and treatment of LBP. Another purpose was to compare mean mSLR between those with lumbar nerve root impingement and those without as determine by magnetic resonance imaging (MRI). The design of the study is cross sectional and included 32 subjects with ages ranging from 18-50 years old. Clinical exam objective measures were collected such as patient questionnaires, somatosensory tests, HL range of motion, and a mSLR test, and were compared to the findings from a structural lumbar spine MRI. There were no significant differences in mean HL angulation and mSLR angulation between LBP and healthy subjects (p>0.05). There was no significant difference in mean HL by impingement by versus no impingement (38.3±15.6 versus 44.8±9.4, p = 0.08, Cohen's d = 0.50). On the other hand, there was a significant difference in mean mSLR angulation by impingement (57.6.3±8.7 versus 63.8±11.6, p = 0.05, Cohen's d = 0.60). The mSLR test was found to be associated with lumbar nerve root compression, regardless of the existence of radiating leg symptoms, and showed no association solely with the report of LBP. The findings highlight the diagnostic dilemma facing clinicians in patients with chronic nonspecific LBP with uncorrelated neuroanatomical image findings. Clinically, it may be necessary to reevaluate the common practice of exclusively using the mSLR test for patients with leg symptoms. This study may impact the way chronic LBP and neuropathic symptoms are diagnosed, potentially improving treatment methods, reducing persistent symptoms, and ultimately improving disabling effects.

Increased water content in multifidus muscles of young adults with chronic nonspecific low back pain detected by dual-energy CT and MRI

ObjectivesTo demonstrate the feasibility of better diagnosing young adults with chronic nonspecific low back pain (CNLBP) by measuring water content in paraspinal muscles using water-muscle decomposition technique in dual-energy CT (DECT) and T2-mapping in MRI. MethodsThis prospective cross-sectional study included 110 young individuals (56 with CNLBP at age of 25.7 ± 2.0 years and 54 of asymptomatic at age of 25.1 ± 1.9 years) who underwent both MRI and DECT on the spine. T2 values on T2 mapping in MRI and water density (WD) value on water(muscle) images in DECT were generated at the L1-L4 levels for erector spinae muscle and L2-L5 for multifidus muscle. Pain duration time, Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) were recorded for CNLBP patients. Difference of T2 value and WD between the two patient groups, and correlations between T2 value and WD, and T2 value and WD with clinical indicators were analyzed. ResultsCompared with asymptomatic participants, the mean WD of multifidus muscle at L4-L5 and mean T2 values of multifidus muscle at L5 were significantly higher in CNLBP patients (all P < 0.05). T2 values had moderate to strong positive correlations (r = 0.34–0.60, all P < 0.05) with DECT WD in CNLBP patients and healthy volunteers. There was a weak correlation between VAS and WD in L5-level multifidus muscle (r = 0.29, P < 0.05). ConclusionsThe T2 values in MRI and WD in DECT are higher in multifidus muscles of lower vertebra levels for young CNLBP patients, and there exists positive correlation between WD and T2 values, providing useful information for diagnosing CNLBP.

Associations between pain intensity, pain sensitivity, demographics, psychological factors, disability, physical activity, pain phenotype and COVID-19 history in low back pain: An observational study.

Knowledge of the factors affecting pain intensity and pain sensitivity can inform treatment targets and strategies aimed at personalizing the intervention, conceivably increasing its positive impact on patients. Therefore, this study aimed to investigate the association between demographic factors (sex and age), body mass index (BMI), psychological factors (anxiety and depression, kinesiophobia and catastrophizing), self-reported physical activity, pain phenotype (symptoms of central sensitization, and nociceptive or neuropathic pain), history of COVID-19 and pain intensity and sensitivity in patients with chronic non-specific low back pain (LBP). This was a cross-sectional secondary analysis with 83 participants with chronic non-specific LBP recruited from the community between August 2021 and April 2022. BMI, pain intensity (Visual Analog Scale), pain sensitivity at the lower back and at a distant point [pressure pain threshold], catastrophizing (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia), anxiety and depression (Hospital Anxiety and Depression Scale), pain phenotype (Central Sensitization Inventory and PainDetect Questionnaire), physical activity (International Physical Activity Questionnaire), and disability (Roland Morris Disability Questionnaire) were assessed. Multiple linear regression analyses with pain intensity and sensitivity as the dependent variables were used. The model for pain intensity explained 34% of its variance (Adjusted R2=-0.343, p<0.001), with depression and anxiety (p=0.008) and disability (p=0.035) reaching statistical significance. The model for pain sensitivity at the lower back, also explained 34% of its variance (Adjusted R2=0.344, p<0.001) at the lower back with sex, BMI, and kinesiophobia reaching statistical significance (p<0.05) and 15% of the variance at a distant body site (Adjusted R2=0.148, p=0.018) with sex and BMI reaching statistical significance (p<0.05). This study found that different factors are associated with pain intensity and pain sensitivity in individuals with LBP. Increased pain intensity was associated with higher levels of anxiety and depression and disability and increased pain sensitivity was associated with being a female, higher kinesiophobia, and lower BMI.

Passive intervertebral restraint is different in patients with treatment-resistant chronic nonspecific low back pain: a retrospective cohort study and control comparison

PurposeIn vivo studies of continuous lumbar sagittal plane motion have found passive intervertebral motion to be more uneven in patients with chronic nonspecific low back pain (CNSLBP) than healthy controls, but the mechanisms are unclear. This study aimed to compare patients with CNSLBP with a matched group of pain-free controls for intervertebral restraint during passive recumbent bending.MethodsSeventeen patients with CNSLBP and minimal disc degeneration who had quantitative fluoroscopy investigations were matched to 17 healthy controls from a database acquired using the same imaging protocol. The entire database (n = 136) was examined for clustering of peaking times, magnitudes and ROM of the first derivatives of the intervertebral angle/motion curves (PTFD, PMFD and ROM) during flexion and return that might introduce confounding. The groups were then compared for differences in these variables.ResultsThere were significant segmental ROM differences among clusters in the database when PMFD and ROM were used as clustering variables, indicating heterogeneity. However, in the patient–control study, it was PTFD (velocity) that differentiated the groups. At L5-S1, this was at 10.82% of the motion path compared with 25.06% in the controls (p = 0.0002). For L4-5, PTFD was at 23.42% of the motion path in patients and 16.33% in controls (p = 0.0694) suggesting a reduced initial bending moment there. There were no significant differences for PMFD or ROM.ConclusionPeaking time of passive intervertebral velocity occurs early at L5-S1 in patients with CNSLBP; however, these findings should be treated with caution pending their replication. Future studies should explore relationships with altered disc pressures and biochemistry. Usefulness for monitoring regenerative disc therapies should be considered.