Low Back Pain Intensity Research Articles

The Relationship Between Pregnancy-Related Low Back Pain, Kinesiophobia, and Physical Activity in the Third Trimester

Objective: The aim of this study is to examine the relationship between pregnancy-related low back pain, kinesiophobia, and physical activity during the third trimester of pregnancy.
 Methods: Fifty-one pregnant women between the ages of 18-40, at the gestational age of 27 weeks and above were included in the study. The intensity of pregnancy-related low back pain was assessed with the Numerical Pain Scale, kinesiophobia with the Tampa Kinesiophobia Scale, and physical activity levels with the short form of the International Physical Activity Questionnaire.
 Results: Only 4 (7.8%) subjects had high levels of physical activity, 12 (23.5%) had moderate, and 35 (68.6%) had low levels of physical activity. A strong positive correlation was found between low back pain and kinesiophobia in the third trimester of pregnancy (r = 0.796; p < 0.001). There was no statistically significant relationship between low back pain and physical activity or between kinesiophobia and physical activity (r=– 0.097; p= 0.498 and r= – 0.212; p= 0.135 respectively).
 Conclusion: Pregnancy-related low back pain can cause kinesiophobia during pregnancy, and kinesiophobia may cause limitations of movements. Considering the negative effects of pregnancy-related low back pain and kinesiophobia during pregnancy, the evaluation of pain, and kinesiophobia by health professionals is important during this period.

Comparative effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain: systematic review and network meta-analysis

ObjectiveTo evaluate the comparative effectiveness and safety of analgesic medicines for acute non-specific low back pain.DesignSystematic review and network meta-analysis.Data sourcesMedline, PubMed, Embase, CINAHL, CENTRAL, ClinicalTrials.gov, clinicialtrialsregister.eu, and World Health...

Does type 2 diabetes affect the efficacy of therapeutic exercises for degenerative lumbar spinal stenosis?

DesignPropensity-matched retrospective study.ObjectivesTo determine whether type 2 diabetes mellitus (T2D) would affect prognosis in patients with degenerative lumbar spinal stenosis (DLSS) who underwent therapeutic exercises.MethodsThis study included consecutive patients with or without T2D who underwent therapeutic exercises for symptomatic DLSS from December 2018 to January 2020. Baseline demographics and clinical and radiological data were collected. The 2 groups of patients were further matched in a 1:1 fashion based on the propensity score, balancing the groups on pre-treatment factors including age, sex, leg and back pain, and low back disability. The primary outcomes included self-reported leg pain intensity (Numerical Rating Scale, NRS) and low back disability (Oswestry Disability Index, ODI) and the secondary outcomes included low back pain intensity and walking capacity (self-paced walking test, SPWT) were compared at baseline, 6 weeks, and 12 weeks.ResultsForty-one pairs of patients were selected by propensity matching. After 6-week therapeutic exercises, patients with T2D achieved a lower improvement in leg pain at 6 weeks (NRS leg change, 1.21 ± 0.40 vs. 1.78 ± 0.52, P = 0.021) and 12 weeks (NRS leg change, 1.52 ± 0.92 vs. 2.18 ± 0.96, P = 0.007) above minimal clinically important difference (MCID), with a significant Group × Time interactions (F1,80 = 16.32, p < 0.001, ηp2 = 0.053). However, the two groups showed no difference in the improvement of ODI, although the sample had significant improvements at 6 weeks (ODI change 3.02 [95% CI, 2.08 to 2.77], P < 0.001) and 12 weeks ([ODI change 3.82 [95% CI, 4.03 to 4.90], P < 0.001), 46% of the patients achieved an MCID.ConclusionSix-week therapeutic exercises have an inferior effect on DLSS patients with T2D. Findings from this study will provide an increased understanding of exercise treatment in patients with DLSS.

Prevalence of low back pain among students

&lt;b&gt;Introduction.&lt;/b&gt; Low back pain is a very common G-force (Gravity-force) illness. Approximately 80% of the population suffer from low back pain at least once in their lifetime. The main causes of this condition are: an improper preparation of the spine to the erect position within the evolutionary process, weak muscles and a lack of basic knowledge concerning the biomechanics of the human body. Low back pain most frequently affects people at the working age, i.e. from 30 to 60 years old. It has been observed that low back pain tends to be recurring and frequently becomes chronic. &lt;b&gt;Aim.&lt;/b&gt; The aim of this study was to analyse the prevalence of low back pain in the group of 40 students. This group was selected for the research because of their lifestyles which may contribute to the appearance of low back pain. The following factors were analysed: causes of low back pain, its frequency and intensity. &lt;b&gt;Materials and methods.&lt;/b&gt; This study involved a group of 40 third year students of Nursery at the Faculty of Medical Science of the University of Warmia and Mazury in Olsztyn. The selected students were between 21 and 27 years of age. The questionnaire method was applied to carry out the research. &lt;b&gt;Results and conclusions.&lt;/b&gt; The obtained results indicate that the age of people who suffer from low back pain is dropping. 75% of the respondents, aged between 21 and 27, manifested low back pain. The risk factors for such ailments include: additional work, sitting lifestyle and mental exhaustion. The presence of low back pain was connected with: G-force (Gravity-force) – in 35.09% of the cases, work – 21.05% of the cases, standing for a long time – in 21.05% of the cases. The frequency of low back pain was high in 50% of the cases, i.e. the respondents experienced pain several times a month. 50% of the respondents suffered from low back pain more often than once a month, 30% once a month, and the remaining 20% less frequently. The intensity of low back pain amounted, on average, to 4.17 points in the visual–analog scale. The obtained results should not be generalized. Further research needs to be carried out involving a bigger group of people and the results should be verified.

Characteristics and Outcomes of Patients Receiving Physical Therapy for Low Back Pain with a Nociplastic Pain Presentation: A Secondary Analysis.

Individuals with low back pain (LBP) may be classified based on mechanistic descriptors, such as a nociplastic pain presentation (NPP). The purpose of this secondary analysis was to examine the frequency and characteristics of patients with a NPP referred to physical therapy with LBP. Additionally, we characterized patients with LBP meeting the criteria for NPP by demographic, clinical, psychological, and pain sensitivity variables. Finally, we examined short- and long-term clinical outcomes in patients with a NPP compared to those without a NPP. Patients referred to physical therapy for LBP completed the Patient Self-report Survey for the Assessment of Fibromyalgia. Participants were categorized as "LBP with NPP" or "LBP without NPP" based on the threshold established in this measure. A rank sum test examined for differences in pain-related psychological factors and pressure-pain threshold between groups. Next, a Friedman test examined if LBP intensity and disability trajectories differed by groups at one and six months after initiation of physical therapy. 22.2% of patients referred to physical therapy for LBP met the criteria for a NPP. Patients with a NPP reported significantly greater disability, pain catastrophizing, depression, anxiety, and somatization compared to individuals without a NPP (p < 0.05). Pressure-pain threshold did not differ between groups (p > 0.05). Individuals with LBP with a NPP demonstrated nonsignificant, small to medium reductions in pain and disability at one and six months. Individuals experiencing LBP without a NPP demonstrated significant reductions in pain and disability in the short- and long term. Patients with LBP with a NPP displayed greater negative pain-related psychological factors but similar pain sensitivity compared to LBP without NPP.

Spinal cord stimulation for low back pain.

Spinal cord stimulation for low back pain.

Effect of Foot Reflexology on Low Back Pain Intensity and Functional Abilities Among Pregnant Women

Effect of Foot Reflexology on Low Back Pain Intensity and Functional Abilities Among Pregnant Women

Localization diagnosis of low back pain in a population-based study of a Japanese mountain village.

The purposes of this study were to investigate 1) the location of low back pain (LBP) and 2) the relationships between the location of LBP and the LBP intensity or the quality of life (QoL) in a population-based study. The location of LBP was categorized into four areas using palpation: midline of the lumbar region, paravertebral muscles, upper buttock, and sacroiliac joint. The extent of LBP in the situations/positions was assessed. The relationships between the location of LBP and the extent of LBP on the QoL were statistically analyzed. 174 participants (average age: 72.3 years-old) were analyzed in this study. 93 participants (53.4% of the total) who had experienced LBP in the past three months were included in the LBP-positive group. Numerical rating scale (NRS) scores of the LBP-positive group were highest in the standing position. 51.6% of the LBP-positive group had LBP at the midline of the lumbar region, 40.9% at the paravertebral muscles, 28.0% at the upper buttock, and 15.1% at the sacroiliac joint. In the standing position, NRS scores of LBP at the upper buttock were significantly higher than those at the midline of the lumbar region and the paravertebral muscles (P<0.05). The Oswestry Disability Index scores of participants who had pain at the upper buttock were significantly higher than those at the midline of the lumbar region or paravertebral muscles (P<0.05). Our study was the first report to investigate the location of LBP using palpation in a population-based study. LBP localization was significantly associated with LBP intensity and LBP-related QoL.

A Clinical Measure of Trunk Neuromuscular Function Predicts Falling in Older Adults With Chronic Low Back Pain.

Older adults with low back pain (LBP) are at risk for falling, but condition-specific mechanisms are unknown. Trunk neuromuscular function is critical for maintaining balance during mobility tasks and is often impaired in older adults with LBP. The purpose of this study was to assess whether aberrant lumbopelvic movements (or aberrant movements), a clinical index of trunk neuromuscular function, were associated with increased fall risk among older adults with chronic LBP over a 12-month follow-up period. This study analyzed data from a prospective cohort study of 250 community-dwelling older adults with chronic LBP. Participants were screened for 4 aberrant movements during 3 trials of forward flexion from a standing position: instability catch, painful arc, altered lumbopelvic rhythm, and Gower's sign. Aberrant movements were totaled to yield a summary score (ie, 0-4). Prospective falls were monitored via monthly fall calendars for 12 months. A generalized linear model with Poisson distribution and log link function was used to evaluate the association between aberrant movements and prospective fall risk. Age, sex, body mass index, LBP intensity, dynamic balance performance, prior falls, anxiolytic medication usage, and hip osteoarthritis characteristics were included as covariates in the model. Baseline aberrant movements were independently associated with greater fall risk (risk ratio = 1.249, 95% CI = 1.047-1.491, P = .014); each 1-unit increase in aberrant movement score imparted a 24.9% increase in the risk of falling. Aberrant movements increased the risk of falling among older adults with chronic LBP over a 1-year span.

Analysis of intervertebral disc CCR6 and IL-6 gene levels with short-term postoperative low back pain after spinal fusion in lumbar degenerative disease.

Previous studies have reported that specific pro-inflammatory cytokines or chemokines are more highly expressed in painful than in nonpainful intervertebral discs (IVDs). However, few studies have investigated their correlation with postsurgical outcomes or the relationship between postoperative pain and inflammatory cytokines in IVDs. Thus, the present study examined the correlation among the gene expression levels of pro-inflammatory cytokines and chemokines in IVD tissues removed during surgery and low back pain (LBP), leg pain (LP), and leg numbness (LN) at one year after spinal fusion surgery in patients with a lumbar degenerative disease (LDD). Chemokine and cytokine gene expression levels were measured in IVD samples from 48 patients with LDD. The associations between chemokine and cytokine gene expression levels and pain intensity (numeric rating scale [NRS]) were also analyzed. A correlation analysis was performed between gene expression in each IVD and preoperative and postoperative pain intensity. In the preoperative analysis, CCR6 was associated with NRSLBP (r = -0.291, P = 0.045). Postoperative pain analysis revealed correlations between postoperative NRSLBP and CCR6 (r = -0.328, P = 0.023) and between postoperative NRSLBP and IL-6 (r = -0.382, P = 0.007). Furthermore, patients with high postoperative LBP intensity (NRSLBP ≥ 7) also had high LBP intensity (NRSLBP ≥ 6) before surgery, and a correlation was observed (r = 0.418, P = 0.003). None of the gene mRNAs correlated with NRSLP or NRSLN, respectively. CCR6 and IL-6 gene expression in the IVD was associated with postoperative LBP intensity and may indicate a need for postoperative pain management.

Chronic low back pain prevalence in Federal Highway Police Officers: A cross-sectional study.

Police officers are exposed to specific occupational tasks, which require lifting, trunk flexion and rotation, carrying weight, and frequent standing periods, which may be associated with an increased risk of experiencing low back pain (LBP). To describe the prevalence and intensity of chronic LBP (CLBP) in Brazilian Federal Highway Police officers (FHPO) from the Rio Grande do Sul state and evaluate its associated factors. A total of 208 FHPOs participated in this study. The participants answered an electronic questionnaire containing sociodemographic, behavioral, and occupational questions, and CLBP history. Data analysis comprises descriptive statistics and Poisson regression models. Most of the FHPO were male, aged 41 or more, lived with a partner and were physically active. Sixty-seven percent of FHPO had CLBP, and the median pain intensity was 3.0 (IQR = 0- 5). Participants who lived with a partner were less likely to report CLBP (PR = 0.80; 95% CI = 0.64; 0.99). On the other hand, those who worked as FHPO for more than 11 years were more likely to report CLPB (PR = 1.32; 95% CI = 1.06; 1.63), and high pain intensity (β= 0.95; 95% CI = 0.19; 1.71). The high CLBP prevalence among FHPO from Rio Grande do Sul state indicates a need to highlight the importance for police organizations to promote CLBP prevention and implement workplace management programs.

Factors influencing the long-term outcomes of instrumentation surgery for degenerative lumbar spondylolisthesis: a post-hoc analysis of a prospective randomized study

BACKGROUND CONTEXTLumbar spinal canal stenosis caused by degenerative lumbar spondylolisthesis is one of the most common indications for spinal surgery. However, the factors that influence its long-term (>10 years) outcomes remain unknown. DESIGNThis is a post-hoc analysis of a prospective randomized study. PURPOSEThis study aimed to determine factors that influence the long-term outcomes of instrumentation surgery for lumbar spinal canal stenosis due to degenerative lumbar spondylolisthesis. PATIENT SAMPLEPatients aged ≤75 years with single L4/5 level lumbar canal stenosis caused by degenerative lumbar spondylolisthesis prospectively underwent instrumentation surgery at two hospitals between May 1, 2003, and April 30, 2012; the final follow-up examination was on May 20, 2021. OUTCOME MEASURESThe following data were collected: modified Japanese Orthopedic Association (JOA) score, JOA score recovery rate, visual analog scale (VAS) score for lower back and leg pain, and scores from eight short-form 36 (SF-36) subscales preoperatively and at the final follow-up examination. METHODSSpearman's correlation analysis and univariate and multivariate regression analyses were used to examine preoperative factors that affect the JOA score recovery rate in patients who underwent instrumentation surgery for lumbar spinal canal stenosis at the L4/5 level due to degenerative lumbar spondylolisthesis. RESULTSA total of 42 patients who underwent instrumentation surgery for degenerative lumbar spondylolisthesis and had a long-term follow-up period were included. Of these, 25 and 17 underwent posterolateral fusion and Graf stabilization, respectively. The mean postoperative follow-up duration was 12.5 years. Spearman's correlation analysis revealed that the long-term recovery rate was correlated with the preoperative VAS score for low back pain. In the univariate regression analysis, sex, preoperative VAS score for low back pain, and the SF-36 general health score were significantly associated with the long-term recovery rate. Meanwhile, the multiple stepwise regression analysis identified the preoperative VAS score for low back pain as an independent predictor of the long-term recovery rate. CONCLUSIONSThis study identified the preoperative VAS score for low back pain as an independent predictor of the long-term recovery rate following instrumentation surgery for degenerative lumbar spondylolisthesis. Therefore, when performing posterolateral fusion or Graf stabilization for degenerative lumbar spondylolisthesis, attention should be paid to the intensity of preoperative low back pain and considerations should be given to whether these procedures can improve the patient's symptoms in the long term.

Multimorbidity in patients with low back pain in Danish chiropractic practice: a cohort study

BackgroundPeople with multimorbidity, defined as the co-existence of two or more chronic conditions in an individual, often suffer from pain and functional limitations caused by musculoskeletal disorders and the chronic conditions. In chiropractic practice, two thirds of patients are treated for low back pain (LBP). It is unknown to what extent LBP is accompanied with chronic conditions in chiropractic practice. The objective was to determine the prevalence of multimorbidity among patients with LBP in chiropractric practice and to investigate if multimorbidity affects pain intensity, self-rated health, physical and mental health. Finally, to explore if individuals with multimorbidity have a different recovery for the LBP.MethodsPatients presenting with a new episode of LBP were recruited from 10 chiropractic clinics in 2016–2018. Patient-reported data concerning socio-demographics, self-rated health, pain intensity, history of LBP, mental health and chronic conditions were collected at baseline. The prevalence of multimorbidity was determined. To evaluate differences in recovery from the LBP, we estimated changes in the Roland Morris Disability Questionnaire (RMDQ) score and use of pain medication at baseline, 2 weeks, 3 months and 12 months. The analyses were adjusted using regression models.Results2083 patients were included at baseline and 71%, 68% and 64% responded to follow-up questionnaires at 2 weeks, 3 and 12 months. 1024 (49%) participants reported to have at least one chronic condition and 421 (20%) had multimorbidity (≥ 2 chronic conditions). The presence of multimorbidity was associated with increased odds of poor self-rated health (OR 2.13), physical fitness (OR 1.79), poor muscular strength (OR 1.52), poor endurance (OR 1.51), and poor balance (OR 1.33). Patients with high LBP intensity combined with multimorbidity showed a poorer recovery than patients without chronic diseases (mean difference in RMDQ score 3.53 at 12 months follow-up). More patients with multimorbidity used pain medication for LBP at 12 months follow-up compared to those without chronic disease (OR 2.36).ConclusionsChiropractors should be aware that patients with LBP may suffer from multimorbidity with poor general health. Patients with multimorbidity also have poorer recovery from LBP than people without chronic disease and clinical follow-up may be indicated.

Movement-Evoked Pain Versus Widespread Pain: A Longitudinal Comparison in Older Adults With Chronic Low Back Pain From the Delaware Spine Studies

It is currently unknown which pain-related factors contribute to long-term disability and poorer perceived health among older adults with chronic low back pain (LBP). This investigation sought to examine the unique influence of movement-evoked pain (MeP) and widespread pain (WP) on longitudinal health outcomes (ie, gait speed, perceived disability, and self-efficacy) in 250 older adults with chronic LBP. MeP was elicited with 3 standardized functional tests, while presence of WP was derived from the McGill Pain Map. Robust regression with HC3 standard errors was used to examine associations between these baseline pain variables and health outcomes at 12-month follow-up. Covariates for these models included age, sex, body mass index, resting and recall LBP intensity, LBP duration, depression, pain catastrophizing, and baseline outcome (eg, baseline gait speed). Greater MeP was independently associated with worse 12-month LBP-related disability (b = .384, t = 2.013, P = .046) and poorer self-efficacy (b = -.562, t = -2.074, P = .039); but not gait speed (P > .05). In contrast, WP and resting and recall LBP intensity were not associated with any prospective health outcome after adjustment (all P > .05). Compared to WP and resting and recall LBP intensity, MeP is most strongly related to longitudinal health outcomes in older adults with chronic LBP. PerspectiveThis article establishes novel independent associations between MeP and worse perceived disability and self-efficacy at 12-months in older adults with chronic LBP. MeP likely has biopsychosocial underpinnings and consequences and may therefore be an important determinant of health outcomes in LBP and other geriatric chronic pain populations.

Longitudinal changes of serum cytokines in patients with chronic low back pain and Modic changes

To explore serum cytokine levels over time in patients with chronic low back pain (cLBP) and Modic changes (MCs), difference in change between treatment groups in the Antibiotics in Modic Changes (AIM) study and associations between change in cytokines and low back pain. Serum concentrations of 39 cytokines were measured at baseline and 1year from 73 participants in the AIM study; 30 randomized to placebo, 43 to Amoxicillin. Low back pain intensity was measured by numeric rating scale. Change in cytokine levels over time were assessed by paired t-tests. Difference in change in cytokine levels between treatment groups and associations between changes in LBP and cytokine levels were assessed by linear regression models. Networks of cytokine changes in each treatment groups were explored by Pearson's correlations. Five cytokines changed from baseline to 1year, (mean change, log transformed values with CI) C-X-C motif chemokine ligand (CXCL) 10 (IP-10) (0.11 (0.01-0.20)), CXCL13 (0.61 (0.00-0.12)), C-C motif chemokine ligand (CCL)26 (0.05 (0.01-0.1)), granulocyte macrophage-colony stimulating factor (GM-CSF) (-0.12 (-0.23 to 0.00)) and CXCL11 (0.12 (0.03-0.22)). Treatment group only influenced change in CCL21 (β 0.07 (0.01-0.12)), and IL-6 (β-0.17 (-0.30 to-0.03)). Change in CXCL13 (β 2.43 (0.49-4.38)), CCL27 (β 3.07 (0.46-5.69)), IL-8 (β 1.83 (0.08-3.58)) and CCL19 (β 3.10 (0.86-5.43)) were associated with change in LBP. The correlation networks of cytokine changes demonstrate small differences between treatment groups. Cytokine levels are relatively stable over time in our sample, with little difference between treatment groups. Some cytokines may be associated with LBP intensity. The differences between the correlation networks suggest that long-term Amoxicillin-treatment may have longstanding effects to be further explored.

Short-term impact of COVID-19 pandemic on low back pain: data from the PAMPA Cohort, Brazil

BackgroundTo evaluate the short-term impact of COVID-19 pandemic on low back pain (LBP) outcomes in southern Brazil.MethodsData from the PAMPA Cohort were analyzed. Adults were recruited between June and July 2020 in the Rio Grande do Sul state using online-based strategies. Participants responded a self-reported, online questionnaire on LBP with two timepoints: before (retrospectively) and during COVID-19 pandemic. We assessed LBP experience, LBP-related activity limitation (no/yes), and LBP intensity (0 to 10 [strongest pain]).ResultsFrom a total sample of 2,321 respondents (mean age: 37.6 ± 13.5; 75.4% women), the prevalence of LBP did not change significantly from before (74.7% [95%CI 72.3; 76.9]) to the first months of pandemic (74.2% [95%CI 71.9; 76.3]). However, an increased pain levels (β: 0.40; 95%CI 0.22; 0.58) and a higher likelihood for activity limitation due to LBP was observed (PR 1.14; 95%CI 1.01; 1.29). Longitudinal analyzes showed that age, gender, BMI, chronic diseases, physical activity, and anxiety and depression symptoms, were associated with LBP in the first pandemic months.ConclusionAlthough the prevalence of LBP did not change at the first months of COVID-19 pandemic, LBP-induced impairment in daily activities and pain intensity was higher when compared to before the pandemic.

Association of meeting 24-hour movement guidelines with low back pain among adults.

According to recently published 24-hour movement guidelines, adults should spend: ≥150 minutes/week in moderate-to-vigorous physical activity (MVPA); <8 hours/day in sedentary behaviour (SB); and 7-9 hours/day sleeping. We explored the association between meeting these recommendations and low back pain (LBP)-the most common musculoskeletal disorder. We collected self-reported data from 2333 adults about: MVPA, SB and sleep duration; frequency and intensity of LBP; and sociodemographic and lifestyle characteristics. Meeting a combination of SB and sleep recommendations was associated with lower odds of LBP in the past week and past month (adjusted odds ratio [OR]: 0.64 and 0.52, respectively; p < 0.05 for both). Among LBP sufferers, meeting any combination of recommendations that includes sleep was associated with lower odds of frequent (OR range: 0.49-0.61; p < 0.05 for all) and intense (OR range: 0.39-0.66; p < 0.05 for all) LBP in the past week, while meeting a combination of SB and sleep recommendations or all three recommendations was associated with lower odds of intense LBP in the past month and past year (OR range: 0.50-0.68; p < 0.05 for all). The likelihood of experiencing higher frequency and intensity of LBP decreased with the number of recommendations met (p for linear trend < 0.05). Meeting the SB and sleep recommendations in combination is associated with a lower likelihood of LBP, while adhering to the overall 24-hour movement guidelines or any combination of recommendations that includes sleep is associated with lower frequency and intensity of LBP among LBP sufferers.

LOW BACK PAIN ESTIMATES IN PROFESSIONAL SOCCER: A SYSTEMATIC REVIEW AND META-ANALYSIS.

To evaluate the epidemiological and clinical characteristics of low back pain (LBP) in adult professional soccer players. Systematic review and meta-analysis. The review included 44 studies. The pooled prevalence of LBP during ≤ 1 season was 1% (95%CI = 0-4%) in men. The pooled point prevalence of LBP was 25% (95%CI = 16-36%) in men and 28% (95%CI = 20-37%) in women. The pooled past-year prevalence of LBP was 34% (95%CI = 24-44%) in men. The pooled lifetime prevalence of LBP was 32% (95%CI = 25-39%) in men and 50% (95%CI = 32-69%) in women. The pooled frequency of LBP/total number of injuries was 2% (95%CI = 1-3%) in men and 4% (95%CI = 2-5%) in women. The pooled incidence rate of LBP/1,000 player-hours of exposure was 0.30 (95%CI = 0.17- 0.53) in men and 0.32 (95%CI = 0.06 -1.87) in women. The recurrence of LBP ranged from 3% to 63% in men. The intensity of LBP ranged from 1.68 (2.39) to 4.87 (2.14) points on a 0-10 scale (minimum = 0 and maximum = 8 points). The severity of LBP (days absent from professional activities due to pain) ranged from 2 (0) to 10 (19) days (minimum = 1 and maximum = 28 days). Adult elite soccer players have a substantial prevalence of LBP. The frequency and incidence of LBP (compared with other conditions and sports) seems to be low. Estimates of the recurrence, intensity, and severity of LBP are uncertain. Level of Evidence II, Systematic Review of Level II Studies.

The effectiveness of erector spinae plane block in patients with chronic low back pain.

The erector spinae plane block (ESPB) has been widely used as a treatment strategy for a variety of acute and chronic painful conditions. The purpose of this study was to determine the analgesic efficacy of ESPB in patients with chronic low back pain and radicular symptoms who had lumbar disc herniation. Patients aged 18 to 80 years who had chronic low back pain with radicular symptoms associated with pain from lumbar disc herniation and had undergone ESPB were included in the study retrospectively. As part of a routine clinical procedure, the patient's age, gender, weight, height, body mass index, injection site, level of the injection, disc herniation level and visual analog scale score, Oswestry Disability Index, and five-point patient satisfaction questionnaire were recorded before and following the procedure. A total of 96 patients were included in this study. The mean age was 52.28±14.12 and 55 (57.3%) of the patients were female. The mean visual analog scale value and Oswestry Disability Index score were significantly decreased consecutively after the procedure (p<0.05). The mean patient satisfaction questionnaire score increased gradually compared to the baseline scores (p<0.05). Our results suggest that ESPB is an effective strategy to reduce the intensity of chronic low back pain with radicular symptoms in patients with lumbar disc herniation.

Spontaneous Rupture of the Fornix Following an Obstructive Distal Lithiasis of the Ureterovesical Junction: A Case Report and Literature Review

Spontaneous rupture of the fornix is a rare urological pathology. The urinary tract obstruction is the most frequent etiology. We report here a case with short review of spontaneous rupture of the fornix due to distal lithiasis of the left ureter. The patient was 26 years old, with no particular pathological medical or surgical history, admitted for sudden and intense left low back pain, suffered from the past five days and increasing in intensity with onset of fever. The patient consulted a general practitioner on local clinic where an infectious assessment was requested before the prescription of anti-inflammatory and board spectrum antibiotic to decapitate a probable urinary tract infection. The pain did not disappear under the treatment. The decision was then to refer the patient for urology specialized care. Spontaneous rupture of the fornix is rare but must always be taken into account in the differential diagnosis of pathologies occurring in a febrile patient or presenting with an acute abdomen after episodes of acute low back pain. The often non-specific clinical symptoms will regress after the rupture except in certain cases like ours. The diagnosis is guided by the interrogation, suspected on ultrasound, and confirmed by computed tomography. With a low pressure system by urinary diversion and antibiotic treatment in some cases, the result is excellent. Endoscopic drainage for a better urinary diversion contributes to a good evolution of the patients.