Occurrence Of Low Back Pain Research Articles

Factors contributing to work related low back pain among personal care workers in old age

This study aims to preliminary explore the work related and individual factors that contributed to the occurrence of low back pain (LBP) that affected work activities of Personal Care Workers (PCWs). A cross-sectional study was conducted to 36 PCWs in an old age home of Hong Kong. The study is divided into three parts: 1) a questionnaire to document the workload exposure factors and the musculoskeletal symptoms survey of the PCWs, 2) work posture evaluation; and 3) an evaluation of the physical fitness and lifting capacity of the PCWs. Univariate analyses were used to explore the risk factors associated with LBP that affected work activities. The results indicated that individual physical profile and lifting capacities did not contribute to occurrence of low back pain at work. For the work demand factors, the perceived physical demands in lifting and lowering heavy objects, awkward sustain neck and back postures, loading on the back, and perceived effort of cleaning task contributed to the occurrence of LBP. For the physical environment factors, thermal stress and improper ventilation were associated with the occurrence of LBP cases. For the individual factor, LBP cases were associated with workers' self perceived muscular effort, and perceived risk of mental illness in response to work requirements.

A Cross-Sectional Survey of Nonspecific Low Back Pain Among 2083 Schoolchildren in China

A cross-sectional survey of 2083 schoolchildren. To investigate the prevalence of nonspecific low back pain (LBP) among schoolchildren aged between 10 and 18 years in China. LBP have been a serious health problem in schoolchildren. On the basis of literature, the lifetime occurrence of nonspecific LBP in children and adolescents varies between 7% and 72%, but little is known about LBP among this demographic group in China. Schoolchildren aged 10 to 18 years were sampled from two grades in an elementary school and four grades in a secondary school. Participants were asked to fill in a questionnaire on LBP. The questionnaire addressed demographic items, anthropometric factors and characteristics of nonspecific LBP, such as frequency, duration, nature, pain scale. Nonspecific LBP is defined as the pain in the back from the 12th ribs to the buttock area without organic factors. A total of 2235 questionnaires were distributed, of which 2100 were answered, a response rate of 93.7%. Among those answers, 2083 (977 from male students and 1106 from female students) provided measurable data. The occurrence of nonspecific LBP was high, with 29.1% students suffering from this condition in the past 3 months (24.7% in boys, 33.1% in girls). In addition, an increased occurrence was observed with age. The occurrences of LBP in 10 to 14 years and 15 to 18 years were 21.5% and 38.2%, respectively. In several aspects of LBP, statistically significant differences were observed between boys and girls, including the frequency of the pain (P = 0.003), the nature of the pain (P = 0.000), the likelihood of seeking for medical assistance (P = 0.007), the impact on normal daily life (P = 0.016), and the occurrence of LBP after bending over the desk for a period of time (P = 0.024). Female students had more frequent LBP and were less willing to see a physician. In addition, more female students (45/366) had LBP accompanied with radiating pain than male students (20/241). There is a high prevalence of LBP in Chinese schoolchildren. The occurrence of LBP increases with age in both sexes. LBP is significantly more prevalent in girls.

Neuromuscular adaptations induced by a short rehabilitation program in chronic low back pain

Significant correlations between isokinetics total work at 120◦/s in flexion (r = 0.461) and in extension (r = 0.475) were observed with the body mass index. A high correlation was also found between the total work at 120◦/s in extension (r = 0.668) and the number of hours per week of sport activities. The mean power in extension at 120◦/s was correlated positively (r = 0.453) to the lumbar radiological lordosis. The endurance of agonist (flexors) and antagonist (extensors) ratio were high in both populations compared to expected values in general population (0.91 vs 0.89). Conclusion.– This study reveals no significant difference in the isokinetic trunk strength of both flexors and extensors in the two groups. Based on the results, the usefulness of studying the effect of isokinetic rehabilitation is to remove the inhibition at high speed. So, isokinetic strength parameters, as measured in this study, do not seem to explain the occurrence of low back pain among children. ReferencesExercise reduces the intensity and prevalence of low back pain in 12–13-year-old children: a randomised trial. Gina L Fanucchi, Aimee Stewart et al. Australian Journal of Physiotherapy 2009;55:97–104.The Association between isoinertial trunk muscle performance and low back pain in male adolescents. Federico Balague, Evelyne Bibbo et al. Eur Spine Journal 2010;19;624–32.

Risk factors for new-onset low back disability among Japanese workers: results from the Cultural and Psychosocial Influences on Disability (CUPID) study

ObjectivesWe investigated physical and psychosocial risk factors for incident low back pain (LBP) with disability (LBD) among Japanese workers who were initially pain-free.MethodsAs a part of the international CUPID study,...

Prevalence of and Biopsychosocial Factors Associated with Low Back Pain in Commercial Airline Pilots

The aim of this study was to examine the 12-mo prevalence of low back pain (LBP) and to identify individual, flight-related, and psychosocial factors associated with the prevalence of LBP in commercial airline pilots. A cross-sectional survey was conducted with a self-administered questionnaire delivered by hand to 708 Thai airline pilots visiting the Institute of Aviation Medicine, Royal Thai Air Force, for their regular medical examinations. A multivariable logistic regression model was used to assess the associations between the prevalence of LBP and statistically significant factors. A total of 684 subjects (97%) returned the questionnaires. The 12-mo prevalence of self-reported LBP among commercial airline pilots was 55.7%. An elevated risk of experiencing LBP was associated with occasionally to frequently encountering turbulence in the previous year, lifting luggage four or more times per duty period, perception of noise in the cockpit as being too loud, and perception of work hazards at intermediate to high levels, assessed by the JCQ Thai version. On the other hand, the factors that reduced the risk of experiencing LBP were performing vigorous exercise regularly and having 5-23 h rest breaks between flights. LBP is common among commercial airline pilots. Our findings suggest that LBP in commercial airline pilots is occupation-related. Interventions aimed at reducing the occurrence of LBP in commercial airline pilots should focus on work condition adjustment and mental stress reduction.

Low Back Pain Among Personal Care Workers in an Old Age Home: Work-Related and Individual Factors

This cross-sectional study explored the work-related and individual factors that contributed to the occurrence of low back pain and affected activities of 36 personal care workers at an old age home in Hong Kong. The study was divided into four parts: (1) a questionnaire documenting workload exposure factors; (2) a musculoskeletal symptoms survey documenting the prevalence of low back pain in this group of workers; (3) a worksite evaluation focusing on personal care workers' work postures and the work environment; and (4) an evaluation of physical fitness and lifting capacities of personal care workers. Univariate followed by multiple logistic regression analyses were used to identify the risk factors associated with low back pain that affected work activities. The results revealed that low back pain was associated with the perceived physical demands of cleaning tasks (odds ratio [OR] = 7.28, 95% confidence interval [CI] = 1.35-39.35, p < .05), perceived demands of awkward sustained back (OR = 4.46, CI = 0.86-22.97, p = .074) and neck (OR = 0.18, CI = 0.04-0.81, p < .05) postures, and thermal stress at work (OR = 49.80, CI = 0.70-3541.79, p = .072). The results of the current study indicated that the work environment contributed to low back pain at work. Workers perceived that exertion in workplaces has a role in assessing workplace risk. To avoid progression of low back pain in the workplace, work adjustment or modification should be considered when workers report high levels of perceived exertion at work.

Low Back Pain among Personal Care Workers in an Old Age Home

This cross-sectional study explored the work-related and individual factors that contributed to the occurrence of low back pain and affected activities of 36 personal care workers at an old age home in Hong Kong. The study was divided into four parts: (1) a questionnaire documenting workload exposure factors; (2) a musculoskeletal symptoms survey documenting the prevalence of low back pain in this group of workers; (3) a worksite evaluation focusing on personal care workers' work postures and the work environment; and (4) an evaluation of physical fitness and lifting capacities of personal care workers. Univariate followed by multiple logistic regression analyses were used to identify the risk factors associated with low back pain that affected work activities. The results revealed that low back pain was associated with the perceived physical demands of cleaning tasks (odds ratio [OR] = 7.28, 95% confidence interval [CI] = 1.35–39.35, p &lt; .05), perceived demands of awkward sustained back (OR = 4.46, CI = 0.86–22.97, p = .074) and neck (OR = 0.18, CI = 0.04–0.81, p &lt; .05) postures, and thermal stress at work (OR = 49.80, CI = 0.70–3541.79, p = .072). The results of the current study indicated that the work environment contributed to low back pain at work. Workers perceived that exertion in workplaces has a role in assessing workplace risk. To avoid progression of low back pain in the workplace, work adjustment or modification should be considered when workers report high levels of perceived exertion at work.

School Bag Weight and the Occurrence of Shoulder, Hand/Wrist and Low Back Symptoms among Iranian Elementary Schoolchildren.

Schoolchildren usually use school bags to carry their school materials. Carry-ing heavy school bags can cause several problems such as musculoskeletal problems among schoolchildren. The aim of this study was to investigate the association between the weight of school bags and the occurrence of low back, shoulder and hand/wrist symptoms among pri-mary school children. This cross-sectional, descriptive-analytical study was conducted among a sample of 307 elementary school children in Tabriz, Iran. Data were collected using a questionnaire and from measurement of the school bag weight, body weight and height of each participant. Data were analysed using SPSS software. The average load carried by schoolchildren was 2.9 kg, representing approximately 10% of the children's body weight. Girls and lower grade children carried a greater percent-age of their body weights. Approximately 86% of the children reported some kind of muscu-loskeletal symptoms. The occurrence of shoulder, wrists/hands, and low back pain among school-children was 70%, 18.5% and 8.7%, respectively. The results of binary logistic regres-sion indicated that the school bag weight (expressed as a percentage of body weight) was only significantly associated with hand/wrist symptoms (P<0.05). Girls were more likely to com-plaint from low back pain than boys were. Age was significantly negatively associated with hand/wrist symptoms. Body mass index was also significantly associated with shoulder symptoms. The results indicate a high prevalence of musculoskeletal symptoms among elemen-tary schoolchildren. Preventive measures and appropriate guidelines with regard to safe load carriage in schoolchildren are therefore needed to protect this age group.

The relationship between pelvis inclination, exercise and low back pain (LBP) during pregnancy

Background: Pain in the lower region of the back and pelvis - also called "Low Back Pain" (LBP) - is very frequent during pregnancy. According to many authors it is a major complaint of more than half of all pregnant women; it causes mental and physical discomfort. The etiology of LBP during pregnancy is still not fully known. Objective: The main aim of our research was to objectify the relationship between the presence of LBP, the training level of the postural muscles and the degree of the pelvic inclination of women in the third trimester of pregnancy. That is why the relationship between pelvic inclination and LBP occurrence is compared within the context of two groups - reasonable physically active as compared to physically inactive women. Methods: Twenty-seven pregnant probands aged 20 - 35 years and in the second half of their third trimester were included in the experiment. All of them complained of pain in their lumbar spine and in the pelvicarea. They were divided into two groups: 14 physically inactive women and 13 physically active women, who have been performing physical activity for at least 135 minutes per week for at least 1 year before conception and for at least 90 minutes per week during pregnancy. The exercises were focused on the functioning of the postural system, e.g. yoga, Pilatespilatek and exercises by Mojzisova. We measured the inclination of the pelvis (using non-invasive anthropometric measuring) and observed the presence of pain in the selected area: clinically via the Patrick-Faber test and posterior pelvic pain provocation test and subjectively with the aid of a standardized LBP related survey. The statistical methods used were the t-test, the median and Wilcoxon-White test and the Spearman factor of serial correlations. Results: We observed a statistically significant difference between the pelvic inclination of physically active and inactive women (using a t-test for non-pair values with a significance level of p = 0.01). Another significant difference was evident between the subjective pain sensation of regularly exercising and non-exercising women, which was proven by both the median and the Wilcoxon-White tests (p = 0.01). A significant relationship between pelvic inclination and the sensation of pain classified in a survey by means of a 1-10 scale was proven by the Spearman factor of serial correlations (p = 0.01). Conclusions: Using mathematical statistical methods, our study has proven the important role of physical activity during pregnancy - its relationship to pain sensation and to the degree of pelvic inclination. We consider these results to be very important, especially from the perspective of LBP prevention during pregnancy.

Physical activity and low back pain: a systematic review of recent literature

The objective of the study is to systematically evaluate the available evidence on the association between physical activity (i.e. occupational load and non-occupational physical activities) and low back pain (LBP). A systematic approach was used to explore the literature between 1999 and 2009. Studies were selected for inclusion following a comprehensive search of Medline, Embase and CINAHL. The methodological quality of each study was assessed. Studies were considered to be of 'high quality' if they met the cut-off criterion of 60% of the maximum available quality score. Thirty-six cohort or case-control studies were retrieved. Heavy workload and the accumulation of loads or frequency of lifts were moderate to strong risk factors for LBP. Strong associations were found for flexed, rotated and the awkward positions of the lumbar spine. Inconsistent results were found for leisure time physical activities, sports and physical exercise. Studies focusing on daily habitual physical activities (e.g. domestic activities and commuting) in association with LBP are lacking. In conclusion, the occurrence of LBP is related to the nature and intensity of the physical activities undertaken. However, physical activities can be subdivided into separate types and intensities and the ultimate physical load is the sum of all these activities. This makes it difficult to designate one particular activity as the cause of LBP.

Individuals with Low Back Pain Breathe Differently Than Healthy Individuals During a Lifting Task

Case control, repeated-measures, experimental laboratory study. To determine if, during a whole-body lifting task, individuals with low back pain (LBP) breathe differently than age-matched controls. Breath control may be optimized to provide increased intersegmental control of the lumbar spine through the generation of intra-abdominal pressure. Consequently, impairments in respiratory and trunk muscle coordination during lifting tasks may contribute to the occurrence or maintenance of LBP. Participants without LBP (n = 30) were matched by gender and age with those presenting with chronic mechanical LBP (n = 32) of at least 1 year in duration. Participants completed a total of 8 self-paced lifts of a crate from the floor to a table, with the crate empty during 4 of the lifts and loaded to 25% of the participant's body weight during 4 of the lifts. The amount of volume in the lungs, measured as a percentage of the individual's vital capacity (%VC), was identified at 9 points during the lifting task. A 2 × 2 × 2 × 9 (group by gender by load by time) mixed-model analysis of covariance (ANCOVA), with age as the covariate, was used to identify differences among conditions and groups of %VC used during the lift. Individuals with LBP performed the lifting task with more volume in their lungs (48.2 %VC) than healthy peers (40.9 %VC). Age significantly affected %VC used during the lift: with increasing age, participants with LBP increased inspired volume and participants without LBP decreased inspired volume. Individuals with LBP performed a lifting task with more inhaled lung volume than individuals without LBP. These findings are consistent with the theoretical link between breath control, intra-abdominal pressure, and lumbar segmental control.

Muscle Atrophy and Changes in Spinal Morphology

prospective longitudinal study. to evaluate the effect of bed-rest on the lumbar musculature and soft-tissues. earlier work has suggested that the risk of low back injury is higher after overnight bed-rest or spaceflight. Changes in spinal morphology and atrophy in musculature important in stabilizing the spine could be responsible for this, but there are limited data on how the lumbar musculature and vertebral structures are affected during bed-rest. nine male subjects underwent 60-days head-down tilt bed-rest as part of the second Berlin Bed-Rest Study. Disc volume, intervertebral spinal length, intervertebral lordosis angle, and disc height were measured on sagittal plane magnetic resonance images. Axial magnetic resonance images were used to measure cross-sectional areas (CSAs) of the multifidus (MF), erector spinae, quadratus lumborum, and psoas from L1 to L5. Subjects completed low back pain (LBP) questionnaires for the first 7-days after bed-rest. increases in disc volume, spinal length (greatest at lower lumbar spine), loss of the lower lumbar lordosis, and move to a more lordotic position at the upper lumbar spine (P < 0.0097) were seen. The CSAs of all muscles changed (P < 0.002), with the rate of atrophy greatest at L4 and L5 in MF (P < 0.002) and at L1 and L2 in the erector spinae (P = 0.0006). Atrophy of the quadratus lumborum was consistent throughout the muscle (P = 0.15), but CSA of psoas muscle increased (P < 0.0001). Subjects who reported LBP after bed-rest showed, before reambulation, greater increases in posterior disc height, and greater losses of MF CSA at L4 and L5 than subjects who did not report pain (all P < 0.085). these results provide evidence that changes in the lumbar discs during bed-rest and selective atrophy of the MF muscle may be important factors in the occurrence of LBP after prolonged bed-rest.

Prevalence and Risk Factors for Low Back Pain in Industrial Workers

The aim of the present study was to determine the prevalence of low back pain (LBP) in industrial workers, check for possible LBP related risk factors and investigate the associations between physical activity and severity of low back pain. We conducted a cross-sectional study among 430 workers of an industrial company over the previous 12 months. The industrial workers were given questionnaires and assigned to two groups: (1) with low back pain, (2) without low back pain. Group 1 was then divided into three subgroups according to the answer to question (a) LBP without irradiation, called mild cases, (b) LBP with irradiation above the knee, called moderate cases, LBP with the irradiation below the knee, called severe cases. LBP was found in 61.6% of workers. The prevalence of LBP was significantly associated with physical activity (p = 0.03). There was a significant difference between frequent physical activity and severity of LBP (p = 0.01). Work-related physical factors showed strong associations with LBP. The main risk factors for low back pain among production workers were extreme trunk flexion (OR = 3.5, 95% CI 1.7-7.3), as well as lifting of loads (OR = 3.5, 95% CI 1.9-6.2), pushing or pulling heavy loads (OR = 3.5, 95% CI 1.9-6.2) and exposure to whole body vibration (OR = 1.7, 95% CI 1.0 -3.0). Daily life conditions, job-related factors are associated with the occurrence of low back pain. These results suggest that individuals with LBP should avoid nonspecific physical activities to reduce pain and improve psychological health.

Core Muscle Response Times and Postural Reactions in Soccer Players and Nonplayers

Decreased core stability has been suggested to be associated with a higher occurrence of lower extremity injuries and low back pain. In a physical contact sport like soccer, direction-specific muscle reflex responses are crucial in maintaining core stability. Delayed core muscle response times repeatedly have been reported in patients with low back pain, but no study has compared core muscle reflex latencies and postural control between soccer players and less active nonplayers. The goal of this study was to investigate whether soccer players will exhibit shorter average core muscle reflex latencies along with less postural sway in response to a sudden trunk perturbation compared with nonplayers. A second goal was to see whether postural control measures are a valid, more practical alternative for the use of surface EMG in measuring reflexive core neuromuscular control. Sudden trunk loading in the frontal and sagittal plane was used in 10 high-level amateur soccer players and 11 less active nonplayers to study core muscle reflex latencies, using surface EMG of six major trunk muscles. Simultaneously, kinematic response data of a balance seat were obtained using gyroscopes measuring seat angular velocity. Soccer players demonstrated shorter reflex latencies compared with nonplayers for the rectus abdominis, erector spinae, and externus obliquus muscles in response to sagittal plane perturbations. These shorter reflex latencies went along with greater seat movement in response to sudden trunk loading, with moderate correlations between the two measures. The results showing shorter reflex latencies and greater balancing movements for soccer players add to the debate whether more postural sway is an appropriate indicator of having less neuromuscular control.

Prevalence of Spondylolysis and Its Relationship with Low Back Pain in Selected Population

BackgroundTo determine the prevalence of spondylolysis in a selected population and evaluate the association of spondylolysis with low back pain (LBP). Spondylolysis is widespread in the general population but the prevalence of spondylolysis and its relationship with LBP in the Korean population is controversial.MethodsA sample of 855 participants (age, 20 to 86 years) from our medical center who underwent multidetector computed tomography (CT) imaging to assess abdominal and urological lesions were enrolled in this study. The occurrence of LBP requiring medication in the preceding 12 months was evaluated using a self-report questionnaire (a modified Nordic Low Back Pain Questionnaire). The presence of spondylolysis was characterized by CT imaging. Multiple logistic regression models were used to examine the association between spondylolysis and LBP, while adjusting for gender and age.ResultsSeventy-eight study subjects (9%) demonstrated spondylolysis on CT imaging. There was no significant difference between the age groups (p = 0.177). The p-value of gender was 0.033 but this was not significant due to the selected population bias. Three hundred eleven study subjects (36%) had back pain. There was a significant difference between gender (p = 0.001). No significant association was identified between spondylolysis and the occurrence of LBP.ConclusionsThe prevalence of LBP was 36.37% and the prevalence of lumbar spondylolysis in a selected population, who visited hospital for abdominal or urological lesions except LBP, was 9.12% based on CT imaging. Males demonstrated a similar presence of LBP to females but a significantly higher incidence of spondylolysis (p = 0.033). The prevalence of spondylolysis was not associated with the presence of LBP and age in adulthood.

Non spesific low back pain in group of young adult men

Low back pain (LBP) is a common symptom that causes enormous social, psychological, and economical problems. We studied LBP occurrence in a group of young adults referred to an army hospital for a planned health check and evaluated possible causative factors by prospective questionnaires. This article is based on a prospective study of 871 novice soldiers of the Turkish Army. Studied factors were combined in the form, which was filled by 5 doctors on the basis of self-reports, interview and physical examination of the participants. They were evaluated by factors; low back pain episodes, monthly income, smoking habits, BMI, labor conditions, and educational status. The median age of the studied population was 21.14±1.4. Complains regarding LBP were observed in 325 (37%) of participants. Twelve participants had pain episodes up to 10 points. 83.69% of the participants with LBP had psychological problems. Heavy lifting and driving for long periods were determined as serious risk factors. Determining the impact factors of LBP in primary care groups can help to prevent development of more serious problems.

Low back pain in childhood and adolescence: assessment of sports activities

A cross-sectional study that targeted a total of 43,630 pupils in Niigata City, Japan was performed. The objective of the study was to evaluate the association between sports activities and low back pain (LBP) in childhood and adolescence in Japan. Regarding risk factors of LBP, a large number of studies have been conducted that have examined gender differences, height and weight, body mass index, sports time, differences in lifestyle, family history, and mental factors; however, no definitive conclusion has yet been made. A questionnaire survey was conducted using 43,630 pupils, including all elementary school pupils from the fourth to sixth grade (21,893 pupils) and all junior high pupils from the first to third year (21,737 pupils) in Niigata City (population of 785,067). 26,766 pupils who were determined to have valid responses (valid response rate 61.3%) were analyzed. Among the 26,766 pupils with valid responses, 2,591 (9.7%) had LBP at the time of the survey, and 8,588 (32.1%) had a history of LBP. The pupils were divided between those who did not participate in sports activities except the physical education in school (No sports group: 5,486, 20.5%) and those who participated in sports activities (Sports group: 21,280, 79.5%), and the difference in lifetime prevalence between No sports group and Sports group was examined. The odds ratio for LBP according to sports activity was calculated by multiple logistic regression analysis adjusted for gender, age, and body mass index. In addition, the severity of LBP was divided into three levels (Level 1: no limitation in any activity, Level 2: necessary to refrain from participating in sports and physical activities, and Level 3: necessary to be absent from school), and Levels 2 and 3 were defined as severe LBP; the severity was compared between No sports group and Sports group and in each sport's items. Moreover, in Sports group, the amount of time spent participating in sports activities were divided into three groups (Group 1: less than 6h per week, Group 2: 6-12h per week, and Group 3: 12.1h per week or more), and the dose-response between the amount of time spent participating in sports activities and the occurrence of LBP were compared. In No sports group, 21.3% experienced a history of LBP; in Sports group, 34.9% experienced LBP (P<0.001). In comparison to No sports group, the odds ratio was significantly higher for Sports group (1.57), and also significantly higher for most of the sports items. The severity of LBP was significantly higher in Sports group (20.1 vs. 3.2%, P<0.001). The amount of time spent participating in sports activities averaged 9.8h per week, and a history of LBP significantly increased in the group which spent a longer time participating in sports activities (odds ratio 1.43 in Group 3). These findings suggest that sports activity is possible risk factors for the occurrence of LBP, and it might increase the risk for LBP in childhood and adolescence.

Der Nutzen von Sporttherapie in der Prävention und Rehabilitation von akuten und chronischen Rückenschmerzen unterschiedlicher Ätiologie

Summary Regular physical activities and an unspecific exercise therapy including group-dynamic effects are useful for the prevention in recurring low back pain. There is no clear evidence that physiotherapy and exercise therapy are beneficial in the first month after the occurrence of low back pain. Even with radicular irritation, prolonged bed rest or immobilization through back pain, is only necessary in individual cases. Patients should return to normal daily activities and work as soon as possible. For subacute (> 6 weeks) or chronic (> 12 weeks) low back pain, a combined rehabilitation programme becomes more important and is evident. This includes physiotherapy and back-specific exercise therapy under supervision together with education about back-friendly normal physical activities supported by psychotherapy if required. The aim is to initiate a self-responsible regulation of pain in order to prevent further chronification of pain. The type, extent and intensity of exercise therapy in patients suffering from degenerative spine disease e.g. spondylolisthesis or following lumbar disc surgery has to be aligned to the degree of functional and structural organic deficits. A back-specific exercise therapy has to be recommended in this case.

Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study

The objectives of the study were to evaluate the association between lumbar paraspinal muscle density, evaluated on computed tomography (CT) and age, sex and BMI; and to evaluate the association of those changes with low back pain (LBP) and spinal degeneration features in a community-based sample. This study was an ancillary project to the Framingham Study. A sample of 3,529 participants aged 40-80 years had a CT scan performed to assess aortic calcification. 187 individuals were randomly enrolled in this study. LBP in the last 12 months was evaluated using self-report questionnaire. Density (in Hounsfield units) of multifidus and erector spinae was evaluated on CT. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (FJOA), spondylolysis, spondylolisthesis and spinal stenosis were also evaluated. We used linear regression models to examine the association of paraspinal muscles density with age, sex, BMI, LBP, and spinal degeneration features. The results show that in our study, men have higher density of paraspinal muscles than women, younger individuals have higher density than older ones and individuals with lower weight have higher muscle density than overweight. No differences between individuals with and without LBP were found. Significant association was found between L4 multifidus/erector spinae density and FJOA at L4-L5; between multifidus at L4 and spondylolisthesis at L4-5; and between erector spinae at L4 and L5 with disc narrowing at L4-5 and L5-S1, respectively. We conclude that the paraspinal muscle density decreases with age, and increases BMI. It is associated with at some levels FJOA, spondylolisthesis and disc narrowing at the same level, but not associated with occurrence of LBP.

Physical characteristics of the back are not predictive of low back pain in healthy workers: A prospective study

BackgroundIn the working population, back disorders are an important reason for sick leave and permanent work inability. In the context of fitting the job to the worker, one of the primary tasks of the occupational health physician is to evaluate the balance between work-related and individual variables. Since this evaluation of work capacity often consists of a physical examination of the back, the objective of this study was to investigate whether a physical examination of the low back, which is routinely performed in occupational medicine, predicts the development of low back pain (LBP).MethodsThis study is part of the Belgian Low Back Cohort (BelCoBack) Study, a prospective study to identify risk factors for the development of low back disorders in occupational settings. The study population for this paper were 692 young healthcare or distribution workers (mean age of 26 years) with no or limited back antecedents in the year before inclusion. At baseline, these workers underwent a standardised physical examination of the low back. One year later, they completed a questionnaire on the occurrence of LBP and some of its characteristics. To study the respective role of predictors at baseline on the occurrence of LBP, we opted for Cox regression with a constant risk period. Analyses were performed separately for workers without any back antecedents in the year before inclusion ('asymptomatic' workers) and for workers with limited back antecedents in the year before inclusion ('mildly symptomatic' workers).ResultsIn the group of 'asymptomatic' workers, obese workers showed a more than twofold-increased risk on the development of LBP as compared to non-obese colleagues (RR 2.57, 95%CI: 1.09 – 6.09). In the group of 'mildly symptomatic' workers, the self-reports of pain before the examination turned out to be most predictive (RR 3.89, 95%CI: 1.20 – 12.64).ConclusionThis study showed that, in a population of young workers wh no or limited antecedents of LBP at baseline, physical examinations, as routinely assessed in occupational medicine, are not useful to predict workers at risk for the development of back disorders one year later.