Low Back Stiffness Research Articles

Reconstruction of Anterior Chest Wall Defect Induced by Sterile Costochondritis: A Case Report of Non-radiographic Axial Spondyloarthritis

Non-radiographic axial spondyloarthritis (axSpA) is a subtype of axSpA characterized by chronic low back pain and stiffness but without radiographic evidence of sacroiliitis or spinal changes. As is the case with axSpA, early initiation of nonsteroidal anti-inflammatory drugs, tumor necrosis factor inhibitor agents, or physical therapy are often recommended for patients with non-radiographic axSpA. While the clinical course of non-radiographic axSpA is less well-known than axSpA, we present a case of a patient with non-radiographic axSpA manifesting as a sterile abscess in the sternum and costal cartilage. In this case report, we describe the diagnostic process for this rare manifestation and reconstruction of the large chest wall defect using a pedicled transverse rectus abdominis musculocutaneous flap.

Correlation between surgical segment mobility and paravertebral muscle fatty infiltration of upper adjacent segment in single-segment LDD patients: retrospective study at a minimum 2 years’ follow-up

ObjectiveThe purpose of this study was to investigate the relationship between surgical segment mobility and fatty infiltration of the adjacent segment paravertebral muscles in patients with single-segment lumbar degenerative disease (LDD) who underwent decompression with fusion or dynamic stabilization.MethodsRetrospective analysis of patients who underwent lumbar decompression combined with titanium rod fixation intertransverse fusion (PITF group), Isobar TTL dynamic stabilization (TTL group) or Isobar EVO dynamic stabilization (EVO group) for single-segment lumbar degenerative disease, from March 2012 to July 2018. The preoperative and final follow-up clinical indexes C-LDSI and the measured imaging indexes (range of motion of the surgical segment and the upper adjacent segment, and Goutallier grade of the upper adjacent segment) were counted, and the differences between the preoperative and final follow-up indexes were compared.ResultsAccording to the inclusion and exclusion criteria, 68 patients were included in this study, 21 in the PITF group, 24 in the TTL group, and 23 in the EVO group. At the final follow-up, the C-LSDI score had significantly higher in the PITF group than the TTL and EVO groups, and the C-LSDI score was a very strongly negatively correlated with ROM of surgical segment (r=-0.7968, p < 0.001). There was a strong negative correlation between surgical segment and upper adjacent segment mobility (r = -0.6959, p < 0.001). And there was a very strong negative correlation between ROM of surgical segment and upper adjacent segment paravertebral muscle Goutallier classification (r = -0.8092, p < 0.001), whereas the ROM of the upper adjacent segment was strong positive correlated with the Goutallier classification (r = 0.6703, P < 0.001).ConclusionCompared with decompression combined with rigid fusion, decompression combined with dynamic fixation for single-segment lumbar degenerative disease can significantly reduce postoperative low back stiffness. And a certain range of increased mobility of the dynamic stabilization device can effectively reduce the compensatory mobility of the upper adjacent segment and slow down the fatty infiltration of the paravertebral muscle in the adjacent segment.

Continued Mat Pilates Exercise Improve Basal Physical Fitness, Core Stability and Back Pain in Healthy College Female

PURPOSE: The purpose of this study was to investigate the effects of 8 weeks of mat Pilates exercise on back pain, muscle mass, isokinetic muscle function, and core stability in healthy college female.METHODS: Twenty healthy college females (aged 21.7±2.5 years) were recruited for the study. The participants were divided into two groups: mat Pilates exercise group (MP, n=10) and non-Pilates control group (CON, n=10). The MP group participated in the mat Pilates exercise program for 60 minutes a day, 3 days per week for 8 weeks. Back pain and basal physical fitness were assessed before and after the experimental period. Left and right core stabilities at 0°, 45°, 90°, 135°, and 180° were measured using Centaur (BFMC, Germany). Isokinetic muscle function (60°/s) of both the knee and trunk was also measured using the isokinetic dynamometer Cybex.RESULTS: After mat Pilates exercise for 8 weeks, there was a significant interaction between the MP and CON groups in back pain during daily activity and lower back stiffness (&lt;i&gt;p&lt;/i&gt;&lt;.05), respectively. There was also a significant interaction between the two groups in the left and right core stability at 45°, 90°, 135°, and 180° (&lt;i&gt;p&lt;/i&gt;&lt;.05, &lt;i&gt;p&lt;/i&gt;&lt;.01, &lt;i&gt;p&lt;/i&gt;&lt;.001), respectively. Additionally, there was a significant interaction between the two groups in the right knee and left knee isokinetic extensor muscle strength (&lt;i&gt;p&lt;/i&gt;&lt;.05, &lt;i&gt;p&lt;/i&gt;&lt;.001, respectively). However, there was no significant interaction between the two groups in trunk isokinetic extensor and flexor muscle strength (NS). There were no significant interactions between two groups in the muscle mass of total body, trunk, and legs (NS), respectively. Regarding basic physical fitness, there were significant interaction effects between the two groups in cardiovascular fitness, sagittal reach, and sit-ups (&lt;i&gt;p&lt;/i&gt;&lt;.05).CONCLUSIONS: These results suggest that continued mat Pilates exercise can improve back pain and core stability with enhancement of leg isokinetic muscle strength independent of the muscle mass of the total body, trunk, and legs.

Obesity phenotypes related to musculoskeletal disorders; a cross-sectional study from RaNCD cohort

BackgroundThis study was evaluated the association between obesity phenotypes and risk of lower torso musculoskeletal disorders including low back pain (LBP), low back stiffness (LBS), arthralgia, and joint stiffness in Ravansar non-communicable diseases (RaNCD) cohort study.MethodsIn this cross-sectional study, 6940 adults were examined for the presence of lower torso musculoskeletal disorders by a physician. Obesity phenotypes including metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) were defined based on the International Diabetes Federation, as well as, body mass index > 30 kg/m2. Metabolically unhealthy non-obesity (MUNO) phenotype was considered as unhealthy metabolic without obesity.ResultsThe prevalence of LBP, LBS, arthralgia, and joint stiffness in MHO, MUO, and MUNO were significantly higher than in healthy participants compared to obesity phenotypes. Logistic regression showed that MHO phenotype was significantly increased with risk of LBP (OR: 1.19, CI 95%: 1.01–1.41), LBS (OR: 1.44, CI 95%: 1.12–1.86), arthralgia (OR: 1.54, CI 95%: 1.33–1.78), and joint stiffness (OR: 1.84, CI 95%: 1.35–2.52). Moreover, MUO phenotype was positively associated with risk of LBS (OR: 1.46, CI 95%: 1.09–1.94) and arthralgia (OR: 1.66, CI 95%: 1.41–1.96). In addition, MUNO phenotype was associated with a higher risk of arthralgia (OR: 1.21, CI 95%: 1.06–1.37).ConclusionAll three phenotypes, MHO, MUO and MUNO were significantly increased the risk of arthralgia. However, MHO phenotype was significantly associated with a higher risk of all examined lower torso musculoskeletal disorders in the current study.

Asymmetric Biomechanical Properties of the Paravertebral Muscle in Elderly Patients With Unilateral Chronic Low Back Pain: A Preliminary Study.

Background: Clinical incidences of chronic low back pain among the elderly are increasing. However, studies have not fully elucidated on changes in biomechanical properties of paravertebral muscles in patients with unilateral chronic low back pain. We evaluated the changes in biomechanical properties of painful and non-painful paravertebral muscles in elderly patients with unilateral chronic low back pain. Methods: Biomechanical properties of paravertebral muscles, including muscle tone and stiffness, in elderly patients with unilateral chronic low back pain were measured using MyotonPRO. Lumbar Lordosis and Sacral Slope were measured by magnetic resonance imaging. Cross-sectional areas of paravertebral muscles were evaluated using ImageJ software version 1.53. Chronic low back pain severity was assessed by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores. The correlations between VAS scores, ODI scores, Lumbar Lordosis, Sacral Slope, cross-sectional areas (painful side), disease duration, and biomechanical properties of paravertebral muscles in the painful side were analyzed. Results: A total of 60 elderly patients with unilateral chronic low back pain were enrolled in this study. The muscle tone and stiffness of paravertebral muscles on the painful side were significantly higher than those on the non-painful side (p < .05). Cross-sectional areas of paravertebral muscles on the painful side at the L3 level were smaller than those of the non-painful side (p < .05). The VAS scores and ODI scores were significantly positively correlated with muscle tone and stiffness of paravertebral muscles on the painful side (p < .05 and p < .01, respectively). There were no significant correlations between disease duration, cross-sectional areas (painful side), Lumbar Lordosis, or Sacral Slope and muscle tone and stiffness of paravertebral muscles on the painful side (p > .05). Conclusion: In elderly patients with unilateral chronic low back pain, muscle tone and stiffness of paravertebral muscles on the painful side are higher than for those on the non-painful side. The asymmetry of biomechanical properties of paravertebral muscles is associated with severity of chronic low back pain.

Effects of capacitive and resistive electric transfer therapy on pain and lumbar muscle stiffness and activity in patients with chronic low back pain.

[Purpose] In this study, we investigated the therapeutic effects of capacitive and resistive electric transfer therapy in patients with chronic low back pain. [Participants and Methods] The study included 24 patients with chronic low back pain (12 patients each in the intervention and sham groups). Pain intensity, superficial and deep lumbar multifidus stiffness and maximum forward trunk flexion and associated activation level of the iliocostalis (thoracic and lumbar component) and lumbar multifidus muscles were measured. [Results] Post-intervention pain intensity and muscle stiffness were significantly lower than pre-intervention measurements in the intervention group. However, no between-group difference was observed in the muscle activation level at the end-point of standing trunk flexion. [Conclusion] Our findings highlight a significant therapeutic benefit of capacitive and resistive electric transfer therapy in patients with chronic low back pain and muscle stiffness.

A CASE STUDY: ANUVASANA BASTI WITH KETAKYADI TAILAM IN LOW BACKACHE

Low back ache is the pain in the lumbo-sacral region triggered by combination of factors like muscle strain, overuse, injury or trauma to muscles, ligaments and disc that support the spine. A diagnosed case of Low back ache came with complaints of pain over low back region, stiffness and limitation in the movements of lumbo-sacral joint since 2 years. There was no history of trauma or fall and other systemic illness. A positive family history was noted. In Ayurveda, it can be correlated with Asthigata vata and deranged Vata dosha is the main cause for pain. The primordial treatment for Vata dushti is Basti, especially Anuvasana vasti. Ketakyadi taila is very effective in Asthigata vata. So Anuvasana Basti with Ketakyadi tailam is administered continuous 9 days. The clinical symptoms like low back pain and stiffness got relieved markedly on 5th day itself. After the entire treatment the condition of the patient improved remarkably.

POS0369 ELEVATED EXPRESSION OF TIM-3 ON NEUTROPHILS CORRELATES WITH DISEASE ACTIVITY AND SEVERITY OF ANKYLOSING SPONDYLITIS

Background:Ankylosing spondylitis (AS) is a type of common, chronic inflammatory disease that compromises the axial skeleton and sacroiliac joints, causing inflammatory low back pain and progressive spinal stiffness, over time some patients develop spinal immobility and ankylosis which can lead to a decrease in quality of life. The last few decades, evidence has clearly indicated that neutrophil also plays key roles in the progression of AS. However, the immunomodulatory roles and mechanisms of neutrophils in AS are poorly understood. T-cell immunoglobulin and mucin domain-containing protein 3 (Tim-3) has been reported as an important regulatory molecule, expressed and regulated on different innate immune cells, plays a pivotal role in several autoimmunity diseases. Recent study indicates that Tim3 is also expressed on neutrophils. However, the frequency and roles of Tim3-expressing neutrophils in AS was not clear.Objectives:In this study, we investigated the expression of Tim3 on neutrophils in AS patients and explored the correlation between the level of Tim3-expressing neutrophils and the disease activity and severity of AS.Methods:Patients with AS were recruited from Guangdong Second Provincial General Hospital (n=62). Age/sex-matched volunteers as Healthy controls (HC) (n=39). The medical history, clinical manifestations, physical examination, laboratory measurements were recorded. The expression of costimulatory molecules including programmed death 1 (PD-1), Tim-3 on neutrophils were determined by flow cytometry. The mRNA expression of PD-1 and Tim-3 was determined by real-time PCR. The levels of Tim3-expressing neutrophils in AS patients were further analyzed for their correlation with the markers of inflammation such as ESR,CRP,WBC and neutrophil count(NE), as well as disease activity and severity of AS. The expression of Tim3 on neutrophils was monitored during the course of treatment (4 weeks).Results:The expression of Tim3 on neutrophils in patients with AS was increased compared to the HC (Figure 1A). However, significant difference was observed in the frequency of PD-1-expressing neutrophils between AS patients and HC (Figure 1B). The expression analysis of Tim-3 mRNA, but not PD-1, confirmed the results obtained from flow cytometry (Figure 1C). The level of Tim3-expressing neutrophils in patients with AS showed an positive correlation with ESR, CRP and ASAS-endorsed disease activity score (ASDAS) (Figure 1D). Moreover, the frequency of Tim3-expressing neutrophils in active patients(ASDAS≥1.3) was increased as compare with the inactive patients (ASDAS&lt;1.3) (Figure 1E). As shown in Figure 1F, the frequency of Tim3-expressing neutrophils decreased after the treatment.Conclusion:Increased Tim-3 expression on neutrophils may be a novel indicator to assess disease activity and severity in AS, which may serves as a negative feedback mechanism preventing potential tissue damage caused by excessive inflammatory responses in AS patients.

The effect of low back pain and neck-shoulder stiffness on health-related quality of life: a cross-sectional population-based study

BackgroundThis cross-sectional study sought to determine the neck-shoulder stiffness/low back pain (NSS/LBP) comorbidity rate in a Japanese community population and to compare the quality of life (QOL) in individuals with comorbid NSS/LBP, asymptomatic individuals, and those with symptoms of NSS or LBP alone.MethodsThe sample included 1122 subjects (426 men; 696 women) with NSS and LBP symptoms in the previous 3 months, and were grouped according to NSS, LBP, comorbid NSS and LBP symptoms (Comorbid), or no symptoms (NP). They completed the MOS 36-Item Short-Form Health Survey (SF-36). Health QOL was evaluated by the eight domain scores and the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores after adjusting for age. The primary outcome was to examine the association between NSS/LBP, NSS, or LBP and bodily pain of the eight domains of SF-36. Secondary outcome was to compare health-related QOL among the four groups.ResultsMorbidity was 45.6% for NSS and 51.9% for LBP. Comorbidity affected 23% of men and 33% of women. Comorbid NSS/LBP, NSS, and LBP alone were independently associated with bodily pain after adjusting for potential confounders. Men who exhibited comorbidity had significantly lower MCS scores than asymptomatic men. Women who exhibited comorbidity and LBP had significantly lower MCS scores than those with no symptoms or NSS alone. Women who exhibited comorbidity had significantly lower MCS scores than those with no symptoms or LBP alone.ConclusionsComorbidity of the two diseases is prevalent in 23% of the men and 33% of women in the Japanese sample. Although NSS, LBP, and comorbidity were independently associated with QOL in terms of pain, QOL was worse in individuals who exhibited comorbidity than in those without symptoms or with NSS alone.

Sacroiliac joint involvement in children with inflammatory bowel diseases.

Objective:Sacroiliitis (SI), an inflammatory arthropathy, may accompany pediatric inflammatory bowel diseases (IBDs), present with non- specific back pain, hence might be unnoticed. The aims of this study were to assess the frequency of the SI in children with IBD and determine the characteristics of the association of SI with the clinical hallmarks of the IBD.Methods:In this prospective, cross sectional study, twenty-seven children with IBD, 7–18 years of age were evaluated. Patients with low back pain or stiffness, alternating buttock pain, or hip pain were examined for the presence of SI. The radiologic manifestations on X-ray suggesting sacroilitis were confirmed with Magnetic resonance imaging (MRI).Results:Twenty-seven children (16 girls, female/male=1.45), with mean age of 12.55±3.6 years, of which 52% had ulcerative colitis (UC), 41% had Crohn’s disease (CD), and two had indeterminate colitis (IC). The median time from IBD diagnosis was 6.0 (18.0) months for patients with SI and 12.0 (13.5) months for patients without SI. Low back pain or stiffness was observed in 13 patients (48%). SI was present in eight (30%) of the children with IBD. The patients with CD were more prone to SI (45% of CD vs. 21% of UC patients). All patients with SI were negative for HLA-B27 genotyping. The disease activity and gender were not associated with increased risk for SI. MRI was remarkable for bone marrow edema in all of the patient, followed by erosions in six of them (75%), synovial enhancement observed in five (63%), and erosion associated enthesitis of the pelvic region was observed in two (25%) of the patients.Conclusion:SI may remain obscured in children with IBD. Children with CD are more prone to SI than those with UC. Pediatric rheumatology-pediatric gastroenterology collaboration might augment screening in at-risk patients.

The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial

The mechanisms underlying pain relief following spinal manipulative therapy (SMT) are not understood fully although biomechanical and neurophysiological processes have been proposed. As such, we designed this randomized trial to elucidate the contributions of biomechanical and neurophysiological processes. A total of 132 participants with low back pain were randomly assigned to receive SMT at either the lumbar segment measured as the stiffest or the segment measured as having the lowest pain threshold. The primary outcome was patient reported low back pain intensity following treatment. Secondary outcomes were biomechanical stiffness and neurophysiological pressure pain threshold. All outcomes were measured at baseline, after the fourth and final session and at 2-weeks follow-up. Data were analyzed using linear mixed models, and demonstrated that the SMT application site did not influence patient reported low back pain intensity or stiffness. However, a large and significant difference in pressure pain threshold was observed between groups. This study provides support that SMT impacts neurophysiological parameters through a segment-dependent neurological reflex pathway, although this do not seem to be a proxy for improvement. This study was limited by the assumption that the applied treatment was sufficient to impact the primary outcome.

A Case Report on Ankylosing Spondylitis in a Pakistani Patient

Background: Ankylosing Spondylitis is the most common type of seronegative spondyloarthropathy. It is characterized by inflammation of multiple articular and para-articular structures, which in turn often leads to osseous ankylosis. Objective: This case is relatively uncommon in Pakistani population especially in females, and to compare the clinical presentation of the condition in this Pakistani patient with what is known around the world using the Criteria widely recognized internationally. Materials and Methods: A case report of a 51-year-old Pakistani woman with a history of back pain and radiographic imagery showing the classical findings of Ankylosing Spondylitis. Results: The Patient is a known case of diabetes mellitus, hypertension and primary hypothyroidism, and has been suffering from chronic lower back pain and stiffness for more than 16 years now. Her symptoms are worst in the morning soon after waking up from sleep. She has restricted movements at hip joints and kyphosis on examination. She also has reduced chest expansion. Her X-rays shows typical bamboo spine appearance with syndesmophytes formation and squaring of vertebral bodies. Her presentation fits both European Spondyloarthropathy Study Group diagnostic criteria for spondyloarthropathies, and the modified New York Criteria. Conclusion: This patient shows typical clinical and radiological findings of the Ankylosing Spondylitis, and fulfills the requirement of the diagnostic criterion

Sexual Dysfunction Secondary to Lumbar Stiffness in Adult Spinal Deformity Patients Before and After Long-Segment Spinal Fusion

Sexual function is an important factor contributing to quality of life. Adult spinal deformity (ASD) patients may have sexual limitations due to lumbar spinal stiffness that may be affected by long-segment fusion. This study utilized a multicenter, prospectively defined, consecutive cohort of ASD patients. The primary outcome in this study was the Lumbar Stiffness Disability Index (LSDI) question 10: "Choose the statement that best describes the effect of low back stiffness on your ability to engage in sexual intercourse". In total, 368 patients were included in this study, including 76 men and 292 women, of which 80.7% (n= 293) underwent 9 or more level fusion and 74.4% (n= 270) had pelvic fixation. Baseline LSDI sexual function scores averaged 1.7 (SD 1.3), which improved to 1.3 (SD 1.2) at 2-year follow-up (P= 0.0008). After adjusting for confounding factors, worse LSDI sexual function score was strongly associated with worse Oswestry Disability Index, Scoliosis Research Society-22r total, and SF-36 Physical Component Summary and Mental Component Summary scores at both baseline and 2-year follow-up (p<0.05 for all comparisons). Predictors of poorer baseline sexual function included older age, increased SVA, and increased back pain (p<0.05 for all comparisons). Predictors of improvement in sexual function at 2-year follow-up included sagittal vertical axis improvement (P= 0.0032) and decreased postoperative back pain (P < 0.0001). This study found that sexual dysfunction scores due to lumbar stiffness significantly improved after surgery for ASD. Additionally, lumbar stiffness-related sexual dysfunction is strongly related to overall outcome measured by Oswestry Disability Index and Scoliosis Research Society-22r total score, highlighting the importance of sexual health on overall outcome in ASD patients.

P82. Sexual dysfunction due to lumbar stiffness is not diminished following adult spinal deformity surgery

BACKGROUND CONTEXT Sexual function is an important contributor to quality of life. Adult spinal deformity (ASD) patients have been shown to have sexual limitations due to their deformity. PURPOSE This investigation sought to assess sexual dysfunction due to lumbar stiffness before and after fusion surgery. STUDY DESIGN/SETTING Retrospective analysis of a multi-center, prospectively-collected, consecutive cohort of ASD patients. PATIENT SAMPLE Only patients with 2-year follow-up were included. In total, 365 patients were included in this study, comprising 76 males and 289 females. OUTCOME MEASURES The primary outcome in this study was the Lumbar Spine Disability Index (LSDI) question 10: “Choose the statement that best describes the effect of low back stiffness on your ability to engage in sexual intercourse.” METHODS Differences in sexual function between baseline and 2-year follow-up were assessed with a Wilcoxon-Mann-Whitney test. Patient factors associated with poor baseline sexual function were evaluated with multiple linear regression. The association between sexual function and HRQOL at baseline and 2-year follow-up was evaluated with multiple linear regression, adjusting for all factors previously included in analyses of baseline sexual function. RESULTS Baseline LSDI sexual function scores averaged 2.7 (SD 1.3), which improved to 2.3 (SD 1.2) at 2-year postsurgical follow-up (p = 0.0009). Predictors of poorer baseline sexual function included older age, BMI, and higher Charlson Comorbidity Index (p CONCLUSIONS This study found that sexual dysfunction due to lumbar stiffness is strongly related to HRQOL measures such as ODI and SRS-22r total score. Further, sexual function was not diminished postoperatively, possibly due to reduced pain that accompanied improved stability. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Ochronotic arthritis and ochronotic Achilles tendon rupture in alkaptonuria

Introduction:Alkaptonuria (AKU) is a rare disease caused by deficiency of homogentisate 1,2-dioxygenase which results in deposition of homogentisic acid (HGA). Ochronotic arthritis, the deposition of excess oxidized HGA in the connective tissues, causes pigmentation and degeneration of the joint tissues ultimately resulting in chronic inflammation and osteoarthritis. The ochronotic arthritis has similar clinical features with osteoarthritis. There is currently no specific treatment for AKU and management is usually symptomatic. In severe cases, total joint arthroplasty is the major treatment approaches. It is rarely reported in China.Patient concerns:Here we reported a case of a patient with bilateral knee pain for more than 1 year. He complained of a 20-year history of chronic, nonspecific low back pain and stiffness. His urine was black since he was a child. Six years after the knee surgery, his Achilles tendon ruptured.Diagnosis:Specific radiographic and magnetic resonance imaging manifestations were observed. Darkly pigmented full-thickness cartilage and subchondral bone were found during the operation. Histological investigation also manifested dark stains in meniscus and synovial tissues. Black-denatured tendon tissue was also found during the operation. The patient was diagnosed as AKU.Interventions:Total knee arthroplasty and Achilles tendon repair were operated separately after the disease was diagnosed.Outcomes:The patient recovered very well after the second surgery. He returned to full activities, described no knee pain, and presented to the clinic walking without any aid. Physical examination revealed 0 to 20 of plantar flexion and 0 to 15 of dorsiflexion of the ankle.Conclusions:Ochronosis is a very rare disease in Asia. This paper supplies new information for study of this disease. The mechanism is still unknown right now. Further studies will be necessary.

The association between insomnia, c-reactive protein, and chronic low back pain: cross-sectional analysis of the HUNT study, Norway.

Chronic low back pain (chronic LBP) is the number one cause for years lived with disability among 301 diseases and injuries analyzed by The Global Burden of Disease study 2013. Insomnia is highly prevalent among people with chronic LBP. To explain the sleep-pain relationship, theoretical models propose that insomnia symptoms may be associated with increased basal inflammation, operationalized as c-reactive protein (CRP) and lead to further pain and disrupted sleep. We aimed to determine the associations between insomnia, chronic LBP, and inflammation (operationalized as CRP), whilst controlling for age, body mass index, smoking, physical activity, depression, anxiety and osteoarthritis. A cross-sectional analysis of the third Nord-Trøndelag Health Study (2006-2008), a rural population survey of 50,666 participants in Norway aged 20-96 years. Insomnia (dichotomous) was defined according to the Diagnostic and Statistical Manual of Mental Disorders 5th Edition, and chronic LBP (dichotomous) as low back pain or stiffness lasting at least 3 months. Data for CRP were obtained from non-fasting serum samples and assessed via latex immunoassay methodology. We excluded participants with the following self-reported chronic somatic diseases: chronic heart failure, chronic obstructive pulmonary disease, rheumatoid arthritis, fibromyalgia or ankylosing spondylosis. Possible associations between presence of insomnia and presence of chronic LBP (dependent), and the level of CRP and presence of chronic LBP (dependent), were assessed using logistic regression models. The possible association between insomnia and CRP (dependent) was assessed using linear regression. Multivariable analyses were conducted adjusting for confounders stated in our aim that achieved p ≤ 0.2 in univariate regressions. We performed stratified analyses for participants with "Normal" (<3 mg/L) "Elevated" (3-10 mg/L) and "Very High" (>10 mg/L) levels of CRP. In our total included sample (n = 30,669, median age 52.6, 54% female), 6.1% had insomnia (n = 1,871), 21.4% had chronic LBP (n = 6,559), and 2.4% had both (n = 719). Twenty four thousand two hundred eighty-eight (79%) participants had "Normal" CRP, 5,275 (17%) had "Elevated" CRP, and 1,136 (4%) had "Very High" CRP. For participants with "Normal" levels of CRP, insomnia was associated with higher levels of CRP (adjusted B = 0.04, 95%CI [0.00-0.08], p = 0.046), but not for people with "Elevated" or "Very High" levels of CRP. There was an association between CRP and presence of chronic LBP in the total sample (adjusted OR = 1.01, [1.00-1.01], p = 0.013) and for people with "Normal" CRP (1.05, [1.00-1.10, p = 0.034]. Insomnia was associated with the presence of chronic LBP in the total sample (adjusted OR = 1.99, 95%CI [1.79-2.21], <0.001) and for people with "Normal", "Elevated" and "Very High". Individuals with insomnia have twice the odds of reporting chronic LBP. Insomnia, CRP and chronic LBP appear to be linked but the role of CRP appears to be limited. Longitudinal studies may help further explore the causal inference between insomnia chronic LBP, and inflammation. Given the strong relationship between insomnia and chronic LBP, screening and management of comorbid insomnia and chronic LBP should be considered in clinical practice. Further longitudinal studies are required to explore whether the presence of insomnia and increased inflammation affects the development of chronic LBP.

The association between insomnia, high sensitive C-reactive protein, and chronic low back pain: cross-sectional analysis of the hunt study, Norway

Purpose: Chronic low back pain is the number one cause for living with disability among 301 diseases and injuries analyzed by The Global Burden of Disease study 2013. Insomnia symptoms are highly prevalent in people with chronic low back pain, with 55-59% reporting symptoms such as poor sleep quality, non-restorative sleep, waking up too early, and difficulty initiating and maintaining sleep. For people with chronic low back pain, insomnia symptoms are associated with increased pain intensity and decreased physical function. People with insomnia have 1.36 times the odds of developing chronic low back pain 17 months later, compared to those without insomnia. To explain the sleep-pain relationship, theoretical models propose that activation of inflammatory markers such as tumor necrosis factor, interleukin 6, and high sensitive C-Reactive Protein (hsCRP), could contribute to increased pain, which may also further disrupt sleep. Of these inflammatory markers hsCRP is of interest as it has been commonly assessed in large population studies for cardiovascular disease risk. The relationship between insomnia and hsCRP, and the relationship between hsCRP and presence of chronic low back pain are not clear. This is partly due to the lack of consistent insomnia and chronic low back pain diagnostic criteria, other comorbidities or associated factors may not have been adequately controlled. Moreover, no study has modelled the associations of insomnia, hsCRP and chronic low back pain within the same sample We aimed to determine the associations between insomnia, chronic low back pain, and hsCRP, whilst controlling for age, body mass index, smoking, physical activity, depression, anxiety and osteoarthritis. Methods: A cross-sectional analysis of the third Nord-Trøndelag Health Study (2006-2008), a rural population survey of 50,666 participants in Norway aged 20-96 years. A comprehensive description of the data collection methodology has been published elsewhere. Insomnia (dichotomous) was defined according to the Diagnostic and Statistical Manual of Mental Disorders 5th Edition, and chronic low back pain (dichotomous) as low back pain or stiffness lasting at least three months. Data for hsCRP was obtained from non-fasting serum samples and assessed via latex immunoassay methodology. We excluded participants with the following self-reported chronic inflammatory diseases: chronic heart failure, chronic obstructive pulmonary disease, rheumatoid arthritis, fibromyalgia or ankylosing spondylosis. This was to ensure that our results reflected the possible associations of between insomnia, hsCRP and chronic low back pain and were not masked by these chronic inflammatory diseases. We compared the median hsCRP of these chronic inflammatory conditions to confirm their suitability for exclusion. Possible associations between presence of insomnia and presence of chronic low back pain (dependent), and the level of hsCRP and presence of chronic low back pain (dependent), were assessed using univariate logistic regression models. Possible association between insomnia and hsCRP (dependent) was assessed using linear regression. Multivariable analyses were conducted adjusting for confounders stated in our aim that achieved p ≤ 0.2 in univariate regressions. We performed stratified analyses for participants with normal (<3mg/L) and elevated (≥3mg/L) levels of hsCRP. Results: In our total included sample (n=30,669, median age 52.6, 54% female), 6.1% of participants reported insomnia (n=1,871), 21.4% had chronic low back pain (n=6,559), and 2.4% had both (n=719) (Figure 1). 24,288 (79.1%) participants had normal hsCRP while 6,429 (20.9%) had elevated hsCRP. Insomnia was associated with the presence of chronic low back pain (adjusted OR=1.99, 95%CI [1.79-2.21], <0.001) (Table 2). There was an association between hsCRP and presence of chronic low back pain (adjusted OR=1.01, [1.00-1.01], p=0.016) (Table 1). For participants with normal levels of hsCRP, insomnia was associated with hsCRP (adjusted B =0.04, 95%CI [0.00-0.08], p=0.037), but not for people within elevated levels of hsCRP (Table 2). Conclusions: In our large populational study, people with insomnia have double the odds of reporting chronic low back pain, and the role of high sensitive c-reactive protein in this relationship appears to be limited. Given the strong relationship between insomnia and chronic low back pain, it may be worth targeting these comorbidities as they may lead to improvements in the other. Longitudinal studies are required to explore whether the presence of insomnia and elevated hsCRP affects the development of chronic low back pain.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Sporadic Hemangioblastoma of the Filum Terminale: Case Report and Review of Literature

Abstract Hemangioblatomas are low grade, highly vascular tumors usually associated with VHL syndrome and most commonly occurs in the cerebellum. They very rarely occur in the spinal nerve roots and an origin in the filum terminale is exceptionl. A 47 year old man presented with low back pain, paresthesias and stiffness of the both lower limbs. He also had urinary retention and constipation. MRI showed an enhancing mass at the L5 vertebral level with multiple dilated and tortuous vessels at both poles of the tumor. Digital subtraction angiogram showed the tumor to be supplied by the anterior spinal artery and dural branches of lumbar arteries. At surgery, a well-defined tumor with orange red hue was found to be arising from the filum terminale. The tumor was excised en bloc. Histopathological examination showed hemangioblastoma which was confirmed with immunohistochemistry. Clinical symptoms improved significantly after surgery. A sporadic hemangioblastoma arising from the filum terminale should be considered as a rare cause of back pain and sciatica. Total excision of the tumor usually cures the patient.

Does kinesiology tape increase trunk forward flexion?

Non specific lower back pain is a common musculoskeletal disorder in manual labourers due to the strenuous nature of their job. Fear of pain can cause restrictions in trunk movement leading to reduced flexibility. Kinesiology Tape (KT) may be an option for treating low back stiffness. The present study investigated the immediate effect of KT on trunk flexion active range of motion. 34 male participants (mean age±SD: 42±11), in physically demanding jobs, asymptomatic of pain, with a history of non specific lower back pain were randomly assigned to: 1) KT Intervention (KTI) or 2) KT Placebo (KTP). Trunk flexion data was collected at baseline and immediately following tape application. ANCOVA was used to examine the differences between groups. The KTI group demonstrated a statistically significant gain in Trunk flexion compared with baseline (2.75cm, P<0.05). Changes from pre to post treatment for the KTP were not significant (1.57cm, P=0.062). No statistically significant differences existed between groups post-treatment (P=0.218). KTI demonstrates an immediate positive effect on trunk flexion when compared with baseline measurements. However, results suggest that KTI performs no better than a comparable placebo.

Back Stiffness Is Associated with Physical Health and Low Back Pain-Related Disability in Community-Dwelling Older Adults.

Back stiffness is a common complaint among older adults with low back pain. Nonetheless, self-reported back stiffness has received little exploration in this patient population. The purpose of this study was to examine the associations of self-reported low back stiffness with physical health and low back pain-related disability among older adults with low back pain. Cross-sectional analysis. Data included in this study were obtained from the Retirement Community Back Pain Study, a population-based survey of older adults. Participants completed the Medical Outcomes Survey Short-Form 36 and the modified Oswestry Low Back Pain Questionnaire. Physical health, derived from the Short Form-36, was represented by the physical component summary score. Back stiffness was rated on a 0-10 scale, where 0 indicated "no back stiffness." Covariates-that is, intensity and duration of low back pain, age, sex, weight, education level, and comorbidities-explained 27% of the variance in physical health ( P < 0.0001) and 38% of the variance in low back pain-related disability ( P = 0.0002). Self-reported stiffness explained an additional 6% of the variance in physical health ( P < 0.0001) and 10% of the variance in low back pain-related disability ( P < 0.0001). Back stiffness in older, community-dwelling adults with low back pain may help explain physical health and low back pain-related disability, above and beyond demographics and pain. Future longitudinal research is needed to evaluate low back stiffness as a predictor of physical health and disability. Ultimately, assessment and treatment of back stiffness in older adults with low back pain may improve patient outcomes.