Lumbar Flexion Range Research Articles

Short-term clinical efficacy of the pulsed Nd: YAG laser therapy on chronic nonspecific low back pain: A randomized controlled study.

Background:Chronic non-specific low back pain (LBP) is gradually increasing among populations worldwide and affects their activities. Recently, the Nd:YAG laser has been presented in the rehabilitation field.Objectives:This study aims to explore the short-term effects of the Nd:YAG laser on chronic non-specific LBP individuals.Methods:Thirty-five individuals with chronic nonspecific LBP were included in the study from December 2019 to March 2020. Randomly, they were categorized to Nd:YAG group (n = 18) and sham laser as a control (n = 17) thrice weekly for a 6-week intervention. Modified Oswestry disability index (MODI), pain disability index (PDI), visual analogue scale (VAS), and lumbar flexion range of motion (ROM) have been assessed pre and post-6 weeks of the intervention.Results:Significant improvements were observed in the Nd:YAG group (MODI, P < .001; PDI, P = .007; VAS, P < .001; lumbar ROM, P = .002), whereas the sham group showed no significant changes (MODI, P = .451; PDI, P = .339; VAS, P = .107; lumbar ROM, P = .296) after 6-week intervention. Between-group comparisons showed significant differences in tending toward the Nd:YAG group (MODI, P < .001; PDI, P = .046; VAS, P < .001; lumbar ROM, P = .003).Conclusions:Regarding the present study outcomes, short-term pulsed Nd:YAG laser (6 weeks) may reduce functional disabilities and pain intensity, and improve the lumbar flexion ROM in patients with chronic nonspecific LBP. Further well-designed randomized controlled studies with large sample sizes should be conducted regarding laser treatment.

Clinical features as predictors of histologically confirmed inflammation in patients with lumbar disc herniation with associated radiculopathy

BackgroundAn understanding of the clinical features of inflammation in low back pain with or without leg symptoms may allow targeted evaluations of anti-inflammatory treatment in randomised-controlled-trials and clinical practice.PurposeThis study evaluated the diagnostic accuracy of clinical features to predict the presence/absence of histologically confirmed inflammation in herniated disc specimens removed at surgery in patients with lumbar disc herniation and associated radiculopathy (DHR).Study designCohort Study.MethodsDisc material from patients with DHR undergoing lumbar discectomy was sampled and underwent histological/immunohistochemistry analyses. Control discs were sampled from patients undergoing surgical correction for scoliosis. Baseline assessment comprising sociodemographic factors, subjective examination, physical examination and psychosocial screening was conducted and a range of potential clinical predictors of inflammation developed based on the existing literature. Multi-variate analysis was undertaken to determine diagnostic accuracy.ResultsForty patients with DHR and three control patients were recruited. None of the control discs had evidence of inflammation compared to 28% of patients with DHR. Predictors of the presence of histologically confirmed inflammation included back pain < 5/10, symptoms worse the next day after injury, lumbar flexion range between 0 and 30° and a positive clinical inflammation score (at least 3 of: constant symptoms, morning pain/stiffness greater than 60-min, short walking not easing symptoms and significant night symptoms). The model achieved a sensitivity of 90.9%, a specificity of 92.9%, and a predictive accuracy of 92.3%.ConclusionIn a sample of patients with lumbar DHR a combination of clinical features predicted the presence or absence of histologically confirmed inflammation.Clinical relevanceThese clinical features may enable targeted anti-inflammatory treatment in future RCTs and in clinical practice.

A Comparative Study Effectiveness of Conventional Physiotherapy versus Yoga Therapy on Pain, Core Muscle Endurance, Lumbar Flexion Range of Motion and Functional Disability in Patients with Chronic Mechanical Low Back Pain

Introduction: Low back pain (LBP) is one of the most common and significant clinical, social, economic,and public health problem affecting people all over the world. Physical therapists deal with considerablenumber of patients with LBP on a daily basis. Yoga has also been a promising treatment option over yearsfor LBP patients. Thus, this study will help to compare the effectiveness of conventional physiotherapytreatment versus yoga therapy with respect to pain, lumbar range of flexion, endurance of Transversusabdominis (TA) and functional disability in patients with chronic mechanical LBP.Methodology: Fifty four participants were included in an experimental study after screening for inclusionand exclusion criteria. Pretreatment measures for pain by numerical pain rating scale, lumbar range of flexionby Modified Schober’s test, Transversus Abdominis endurance by prone test with pressure biofeedback anddisability level by Modified Oswestry Disability Index (MODI) were taken.Conclusion: The findings of this study suggest that yoga therapy is more effective in reducing pain, disabilityand improving lumbar flexion range whereas physiotherapy is more effective in increasing core muscleendurance in patients with chronic mechanical LBP.

Effectiveness of Dry Needling and Low-Level Laser Therapy in Nonspecific Low Back Pain

Introduction: Musculoskeletal spinal disorders are an immense problem in industrialised societies resulting in tremendous personal and economic costs. Younger adults (30 to 60-year-old) are more likely to experience Low Back Pain (LBP) from the disc space or from back muscle strain or other soft tissue strain. Experiencing it earlier in life may lead to recurrent and chronic LBP in adulthood. Dry Needling (DN) which are utilised to treat low back torment in current patterns. Low Level Laser Treatment (LLLT) is utilised to treat LBP by concentrating on the trigger focuses. Aim: To identify the effectiveness of DN and LLLT in the management of selected outcome variables among patients with nonspecific LBP. Materials and Methods: The Quasi experimental study was conducted among a total of 30 subjects who met the inclusion criteria. The subjects were divided into 15 each as group A (DN) and group B (LLLT). The Numerical Pain Distress Scale (NPDS), Quebec Back Pain Disability Scale (QBPDS) and lumbar flexion range of motion were assessed, before and after two weeks of intervention program to identify the effectiveness. Data analysis was done through SPSS and graph pad, using paired t-test and independent t-test. Results: Both groups have shown improvement after two weeks of intervention treatment program. Both groups showed significant difference in relieving pain, reducing disability and improving lumbar range of motion on nonspecific LBP individually. However, there was no significant difference found between the groups, thus null hypothesis was accepted and rejecting the alternate hypothesis. Conclusion: Both the techniques are equally effective in reducing the pain, disability level and improving range of motion individually after two weeks of intervention.

EFFECTIVENESS OF NEURAL MOBILIZATION IN THE MANAGEMENT OF CHRONIC LOW BACK PAIN WITH RADICULOPATHY: A RANDOMIZED CONTROLLED TRIAL

Background: Neural mobilization (NM) constitutes the most effective, common method for assessing and treating several neuromuscular disorders. The study at hand aims to determine the effectiveness of the NM technique compared to lumbar stabilization exercise (LSE) and Radial Extracorporeal Shock Wave Therapy (rESWT) in the physical therapy management of chronic low back pain (CLBP) with radiculopathy.Methods: Two groups comprising 30 participants and randomly chosen formed the basis of this investigation: Group A (NM, LSE, and rESWT) and Group B (LSE and rESWT). The period of three to six weeks constituted the time it took to measure the results herein reached baseline. The results of the observations focused on pain assessed by numerical pain rating scale (NPRS), Lumbar flexion range of motion (Lumbar FROM) by Schober’s method, and disability level as measured by the Modified Oswestry Disability Questionnaire (MODQ).Results: In the control group, the mean scores of pain, lumbar FROM, and MODQ at baselines showed a high level of similarity (6.47, 2.87, and 43.71 respectively in the intervention group, and 6.20, 2.93 and 44.66. Both groups showed improvement in their pain scores at three weeks (P<0.05). However, only lumbar FROM and MODQ showed statistically significant improvement in favor of the intervention group at three weeks (P<0.05). By week 6, both groups achieved a statistically significant difference in the values of all variables.Conclusion: NM with LSE and rESWT is more effective than LSE and rESWT in the third week, and was similarly effective in the sixth week of the treatment. NM with LSE and rESWT may be an alternative treatment option in the treatment of CLBP.

RETURN TO ADVANCED STRENGTH TRAINING AND WEIGHTLIFTING IN AN ATHLETE POST-LUMBAR DISCECTOMY UTILIZING PAIN NEUROSCIENCE EDUCATION AND PROPER PROGRESSION: RESIDENT'S CASE REPORT

Case Report. The use of pain neuroscience education (PNE) is indicated when there are psychosocial contributions to a person's pain experience. The scientific literature has established the efficacy of the use of PNE in a population with chronic pain but there is a paucity of evidence to support the use of PNE in athletic populations. The purpose of this case report is to describe the use of PNE and graded exposure exercises specific to an athlete returning to Olympic weightlifting. The patient underwent an L5-S1 discectomy to resolve paresthesia in his leg, completed a bout of post-operative rehabilitation but returned 15 months after the surgery. He presented with the chief complaint of low back tightness and fear of lumbar flexion. When asked to touch his toes during the lumbar flexion range of motion examination, he demonstrated aberrant lumbar movement by hinging at the hips with a straight back due to fear that flexing would damage his lumbar spine. The patient was seen for four weeks with a focus on PNE and graded exposure to weightlifting activities. The patient returned to Olympic weightlifting and decreased his Fear Avoidance Behavior Questionnaire (FABQ) score from 22 to 4 during the course of physical therapy. His Tampa Scale of Kinesiophobia (TSK) score also decreased from 55 to 31. By discharge, he was able to bend at the lumbar spine with full flexion and no longer believed the motion to cause damage. The case is unique because it describes the implementation of PNE in an athlete returning to weightlifting, and the scientific literature for use of PNE in this population is lacking. The identification of kinesiophobia and implementation of PNE and graded exposure exercises lead to an optimal outcome for this patient. Level 4.

Comparison of two mobilization techniques in management of chronic non-specific low back pain

AimThe aim of the study was to compare between the effects of Maitland's postero-anterior (PA glide) mobilization and Mulligan's sustained natural apophyseal glide (SNAG) on pain, mobility, muscle activation and functional disability in subjects with chronic, non-specific low back pain. MethodsThe study was a two arm repeated measure design with random allocation of subjects (n = 33). Subjects in group 1 received Maitland's PA glide mobilization and those in group 2 received Mulligan's SNAG. Along with the respective mobilization technique, individualized exercises were common for subjects in both the groups. Subjects in both groups received treatment for 4 days a week for 4 weeks. The outcome measures were numeric pain rating scale (NPRS) scores, lumbar flexion and extension range of motion, erector spinae muscle activity and Oswestry low back pain disability questionnaire score. ResultsThe outcome measure scores showed statistical significance in time effect on NPRS (p = 0.001); lumbar flexion and extension range of motion (p = 0.001); erector spinae muscle activity (0.001); Oswestry low back pain disability questionnaire score (p = 0.001); group effect on lumbar flexion (p = 0.03) and extension range of motion (p = 0.05); and interaction effect (time x group) on lumbar flexion (p = 0.003) and extension range of motion (p = 0.002); and, erector spinae muscle activity (p = 0.05) at the 3rd lumbar vertebral level. ConclusionThe addition of Maitland or Mulligan mobilization techniques of the spine does not show a difference in the improvement of symptoms associated with chronic non-specific low back pain.

Effect of mulligans mobilization versus manipulation, along with mulligans taping in anterior innominate dysfunction – A randomized clinical trial

Background and Objective: Low back pain is one of the major causes for disability and absenteeism at workplace. The anterior innominate dysfunction is a common type of dysfunction leading to low back pain in which the joint adapts to an abnormal position locking it in an anterior pelvic tilt thus leading to low back or buttock pain that may radiate to lower extremity pain. Mulligan mobilization particularly helps restoration of joint movement in a pain free manner and has reported to be effective in increasing range of motion and reducing pain. Manipulation, on the other hand has also proved to be effective in inhibiting pain receptors causing relaxation of muscle and increasing range of motion. Since there is a dearth of literature stating the comparative effects of both techniques, the current study has aimed at finding out the effectiveness of both techniques on anterior innominate dysfunction. Materials and Methods: A clinical trial conducted on 30 subjects with a mean age of 37.57±10.32 years were randomly assigned into two groups, Group A (n = 15) received Postero-medial SI Mulligan mobilization and Mulligan taping technique + Conventional Therapy and Group B (n = 15) received SI Manipulation and Mulligan taping technique + Conventional Therapy. Patients were assessed at baseline and on 6th day of therapy using Visual Analogue Scale (VAS), Modified Oswestery Disability Questionnaire (MODQ), Modified Schober's lumbar range of motion and Pelvic Inclinometer scale Results: Pre and post mean difference in group A were 6.56±1.01 cm for VAS, 27.33±7.76 for MODQ, 1.90±0.68° for lumbar flexion range, 2.19±0.45° for lumbar extension range and 2.00±1.46 mm for pelvic tilt. While the pre and post mean difference in group B were 6.56±1.01 cm for VAS, 27.33±7.76 for MODQ, 1.90±0.68° for lumbar flexion range, 2.19±0.45° for lumbar extension range and 2.00±1.46 mm for pelvic tilt. The intra-group comparison was statistically significant with P = 0.0001 (VAS, MODQ, Lumbar flexion and extension ROM) and P Conclusion: The present study concluded that Mulligan mobilization with Mulligan taping technique showed superior effects than Manipulation with Mulligan taping technique.

Time-course changes associated with PA lumbar mobilizations on lumbar and hamstring range of motion: a randomized controlled crossover trial

ABSTRACTObjective: We aimed to compare the post-intervention time-course changes in active knee extension (AKE) and active lumbar flexion (ALF) range of motion in response to unilateral posterior–anterior (UPA) mobilizations of the lumbar spine (L4/5 zygapophyseal).Methods: Twenty-four asymptomatic participants (maleness: 0.58, age [mean ± standard deviation]: 32 ± 8 years, body mass index 25.9 ± 2.6 kg m2) were recruited to a fully controlled crossover trial. Following either the intervention (L4/5 zygapophyseal mobilizations) or control, participants immediately performed the AKE and ALF tests, which were also performed at baseline. Subsequent tests were made at intervals of 5, 10, 15, 20, 25, 30, 45 and 60 min.Results: After adjustment for baseline (mean AKE: 37.2° from full extension, mean ALF: 14.37 cm), sex and age, UPA lumbar mobilizations had a most likely moderate effect on AKE (9.8° closer to full extension; ±1.9) and a likely moderate effect on ALF (1.34 cm; ±90% confidence limits 0.43). The magnitude of the AKE effect became most likely small 20-min posttreatment (5.3; ±1.7) and possibly small/possibly trivial 60-min posttreatment (2.1; ±1.4). For ALF, the magnitude of the effect became most likely small 15-min posttreatment (0.76; ±0.25), possibly small/possibly trivial 25-min posttreatment (0.38; ±0.18) and likely trivial 60-min posttreatment (0.26; ±1.8).Discussion: UPA lumbar mobilizations increased lumbar Range of Motion and hamstring extensibility by a moderate magnitude, with the effect reducing after 10–20-min posttreatment. Clinicians should consider these time-course changes when applying UPA lumbar mobilizations.Clinical Trials Registry: NCT03273400Evidence Level: 2b

Acute effect of full time office work in real environment on postural actions and lumbar range of motion

IntroductionProlonged sitting is often proposed as a risk factor for low back pain development. The purpose of this study was to evaluate the acute effect of full time office work on sensorimotor trunk functions. MethodsSeventeen healthy office workers participated in the study. Maximal lumbar flexion range of motion, anticipatory postural adjustments and postural reflex reactions were tested before and after full time office work in a real life environment. ResultsThere were longer onset latencies of postural reflexive reactions and decreased response amplitudes of anticipatory postural adjustments after full time office work, but these were significant only for the obliquus externus abdominis muscle. No changes in lumbar range of motion was found. ConclusionTo our knowledge this is the first study that evaluates the effect of full time office work on postural actions and lumbar RoM. We found an absence of normal human circadian flexibility in the lumbar spine and some changes in postural actions. We propose that active trunk stiffness increase to compensate for decreased passive stiffness after prolonged seated work. Further studies are needed to confirm this assumption.

Alterations in trunk bending stiffness following changes in stability and equilibrium demands of a load holding task

The contribution of the trunk neuromuscular system (TNS) to spine stability has been shown in earlier studies by characterizing changes in antagonistic activity of trunk muscles following alterations in stability demands of a task. Whether and/or how much such changes in the response of TNS to alteration in stability demand of the task alter spinal stiffness remains unclear. To address this research gap, a repeated measure study was conducted on twenty gender-balanced asymptomatic individuals to evaluate changes in trunk bending stiffness throughout the lumbar spine’s range of flexion following alterations in both stability and equilibrium demands of a load holding task. Trunk bending stiffness was determined using trunk stiffness tests in upright posture on a rigid metal frame under different equilibrium and stability demands on the lower back. Increasing the stability demand by increasing the height of lifted load ∼30 cm only increased trunk bending stiffness (∼39%) over the lower range of lumbar flexion and under the low equilibrium demand condition. Similarly, increasing the equilibrium demand of the task by increasing the weight of lifted load by 3.5 kg only increased trunk bending stiffness (55%) over the low range of lumbar flexion and under the low stability demand condition. Our results suggest a non-linear relationship between changes in stability and equilibrium demands of a task and the contribution of TNS to trunk bending stiffness. Specifically, alterations in TNS response to changes in stability and equilibrium demand of a given task will increase stiffness of the trunk only if the background stiffness is low.

Variation in lifting kinematics related to individual intrinsic lumbar curvature: an investigation in healthy adults

ObjectiveLifting postures are frequently implicated in back pain. We previously related responses to a static load with intrinsic spine shape, and here we investigate the role of lumbar spine shape...

Efficacy of high intensity laser therapy in treatment of patients with lumbar disc protrusion: A randomized controlled trial.

This study aims to evaluate the effect of high intensity laser therapy (HILT) in patients with lumbar disc protrusion (LDP). This study included 63 patients suffering from protrusion of lumbar intervertebral disc; they were divided into Groups 1 (n= 32) and 2 (n= 31). Group 1 was treated with HILT and spinal decompression system (SDS). Patients in Group 2 received SDS alone. Evaluations were conducted on oswestry disability index (ODI), lumbosacral portion pain, and lower limb radiation pain with visual analogue scale (VAS) of two patient groups before treatment, two weeks after treatment, and 1 month after follow-up visit. Lumbar flexion range and angle of straight leg raising before treatment and 2 weeks after treatment. After two weeks of treatment of two patient groups, ODI, VAS, lumbar flexion range and angle of straight leg raising significantly improved compared with their conditions before treatment (P< 0.01). A significant difference was noted in ODI, lumbar flexion range, and angle of straight leg raising between groups after two weeks of treatment (P< 0.05). Non-statistical significant difference was observed in lumbosacral portion pain and lower limb radiation pain with VAS (P> 0.05). However, difference in was VAS smaller in Group 1. All groups showed significantly different results in terms of ODI, lumbosacral portion pain, and lower limb radiation pain with VAS. As one of available treatments for LDP, HILT can speed up improvement in lumbar segment motion, angle of straight leg raising, and overall function and allow early return of patients to their family and society. Treatment effect is long-lasting and can be widely promoted and applied clinically.

Effect of Hip Abduction Maximal Voluntary Isometric Contraction on Lumbar Motion and Power Output During the Back Squat

Background: Post-activation potentiation (PAP) is a neuromuscular phenomenon that has been shown to augment muscular force generating attributes as well as neural and sensory recruitment. While PAP has demonstrated to acutely enhance muscular performance during high-intensity activities, the effect of PAP on lumbopelvic kinematics under load remains unknown. Objectives: The purpose of this study was to examine the potential PAP effect of a hip abduction maximal voluntary isometric contraction (MVIC) on lumbar motion and power output during the barbell back squat. Methods: Nine resistance-trained men (22.9±2.3 y; 85.0±13.8 kg; 174.3±5.1 cm) performed a set of 5 repetitions of the barbell back squat using 80% one-repetition maximum with and without a hip abduction MVIC prior to performance. Experimental and control trials were randomized and counterbalanced among participants. MVIC was carried out via manual long-lever hip abduction. During the back squat exercise, lumbar motion analysis was performed using wireless motion-sensor technology, and power output was assessed via an accelerometer. Results: No significant differences were observed between trials for lumbar flexion range of motion (ROM) (p=0.32), lumbar flexion maximum deviation (p=0.32), lumbar lateral flexion ROM (p=0.81), lumbar lateral flexion maximum deviation (p=0.98), lumbar rotation maximum deviation (p=0.70), average peak power (p=0.98), or average mean power output (p=0.99) during the squat protocol. Conclusions: Implementation of a manual long-lever hip abduction MVIC prior to the back squat exercise did not significantly alter lumbar motion or augment power output in resistance trained males.

Short-Term Changes in Algometry, Inclinometry, Stabilometry, and Urinary pH Analysis After a Thoracolumbar Junction Manipulation in Patients with Kidney Stones.

To determine the efficacy of a high-velocity low-amplitude manipulation of the thoracolumbar junction in different urologic and musculoskeletal parameters in subjects suffering from renal lithiasis. Randomized, controlled blinded clinical study. The Nephrology departments of two hospitals and one private consultancy of physiotherapy in Valencia (Spain). Forty-six patients suffering from renal lithiasis. The experimental group (EG, n = 23) received a spinal manipulation of the thoracolumbar junction, and the control group (CG, n = 23) received a sham procedure. Pressure pain thresholds (PPTs) of both quadratus lumborum and spinous processes from T10 to L1, lumbar flexion range of motion, stabilometry, and urinary pH were measured before and immediately after the intervention. A comparison between pre- and postintervention phases was performed and an analysis of variance for repeated measures using time (pre- and postintervention) as intrasubject variable and group (CG or EG) as intersubject variable. Intragroup comparison showed a significant improvement for the EG in the lumbar flexion range of motion (p < 0.001) and in all the PPT (p < 0.001 in all cases). Between-group comparison showed significant changes in PPT in quadratus lumborum (p < 0.001), as well as in the spinous processes of all of the evaluated levels (p < 0.05). No changes in urinary pH were observed (p = 0.419). Spinal manipulation of the thoracolumbar junction seems to be effective in short term to improve pain sensitivity, as well as to increase the lumbar spine flexion.

Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies

BackgroundLow back pain (LBP) is an increasingly common condition worldwide with significant costs associated with its management. Identification of musculoskeletal risk factors that can be treated clinically before the development of LBP could reduce costs and improve the quality of life of individuals. Therefore the aim was to systematically review prospective cohort studies investigating lower back and / or lower limb musculoskeletal risk factors in the development of LBP.MethodsMEDLINE, EMBASE, AMED, CINAHL, SPORTDiscus, and the Cochrane Library were searched from inception to February 2016. No age, gender or occupational restrictions of participants were applied. Articles had to be published in English and have a 12 month follow-up period. Musculoskeletal risk factors were defined as any osseous, ligamentous, or muscular structure that was quantifiably measured at baseline. Studies were excluded if participants were pregnant, diagnosed with cancer, or had previous low back surgery. Two authors independently reviewed and selected relevant articles. Methodological quality was evaluated independently by two reviewers using a generic tool for observational studies.ResultsTwelve articles which evaluated musculoskeletal risk factors for the development of low back pain in 5459 participants were included. Individual meta-analyses were conducted based on risk factors common between studies. Meta-analysis revealed that reduced lateral flexion range of motion (OR = 0.41, 95% CI 0.24-0.73, p = 0.002), limited lumbar lordosis (OR = 0.73, 95% CI 0.55-0.98, p = 0.034), and restricted hamstring range of motion (OR = 0.96, 95% CI 0.94-0.98, p = 0.001) were significantly associated with the development of low back pain. Meta-analyses on lumbar extension range of motion, quadriceps flexibility, fingertip to floor distance, lumbar flexion range of motion, back muscle strength, back muscle endurance, abdominal strength, erector spinae cross sectional area, and quadratus lumborum cross sectional area showed non-significant results.ConclusionIn summary, we found that a restriction in lateral flexion and hamstring range of motion as well as limited lumbar lordosis were associated with an increased risk of developing LBP. Future research should aim to measure additional lower limb musculoskeletal risk factors, have follow up periods of 6-12 months, adopt a standardised definition of LBP, and only include participants who have no history of LBP.

The Long-Term Course of Outcomes for Lumbar Intervertebral Disc Herniation following Integrated Complementary and Alternative Medicine Inpatient Treatment: A Prospective Observational Study.

A prospective observational study was conducted in 524 lumbar intervertebral disc herniation (LDH) inpatients to report the long-term effects of complementary and alternative medicine (CAM) treatment. Participants received integrative CAM treatment during hospitalization, from June 2012 to May 2013, and long-term outcomes were assessed from July to August 2016. Numerical rating scales (NRSs) of back and leg pain, the Oswestry disability index (ODI), satisfaction, surgery, recurrence, and current care status were investigated. Baseline characteristics were analyzed to determine factors that predicted long-term satisfaction. A total of 367 patients were available for follow-up. The long-term change in NRS of back and leg pain and ODI was 3.53 (95% CI, 3.22, 3.83), 2.72 (2.34, 3.11), and 32.89 (30.21, 35.57), respectively, showing that improvements were well sustained. Regarding satisfaction, 86.11% responded that they were “slightly improved” or better. Range of lumbar flexion ≤ 60° and both legs' pain at admission were significant predictors of “much improved” or better satisfaction in the long term. Overall, LDH patients who received CAM treatment maintained favorable states in the long term. However, as an uncontrolled observational study, further studies with placebo and/or active controls are warranted. Trial Registration. This trial is registered with ClinicalTrials.gov NCT02257723 (date of registration: October 2, 2014).

Whiplash Injury Might Reduce Lumbar Spine Range of Motion Following Trauma

Whiplash is the common denominator of a syndrome consisting of several disorders affecting different body areas, termed whiplash-associated disorders. One of the most common such disorders in low back pain. While the occurrence of low back pain following whiplash is well known, little is known regarding the effect of whiplash on spinal range of motion. The current study quantitatively assessed this effect. A cohort of 156 patients at least one year after a whiplash injury was evaluated for the accident mechanics, radiological findings and lumbar flexion range. 60.2% of the patients had associated low back pain. About one third of the cohort developed the low back pain only after the accident. The lumbar flexion range was lower in this cohort than in whiplash patients without low back pain. Low back pain is particularly common following head-on and sideways injury mechanisms. In conclusion, it appears that whiplash associated low back pain is often accompanied by a decreased range of motion of the lumbar spine.

An Unusual Case of Polyostotic Fibrous Dysplasia in a 53-Year-Old Woman With Low Back Pain

ObjectiveThe purpose of this case report is to describe the features of an unusual presentation of fibrous dysplasia. Clinical FeaturesA 53-year-old woman had low back pain and numbness in the anterior upper left thigh that started 3 years earlier after a fall. She experienced pain during active lumbar flexion and extension range of motion. Radiographic examination demonstrated an oval geographic osteolytic lesion in the left ilium and abnormal trabecular architecture with variable-sized osteolytic lesions and both ill-defined and well-defined borders along the sacroiliac joint margin. Intervention and OutcomeBecause of the aggressive osteolytic appearance, magnetic resonance imaging of the pelvis with gadolinium contrast was obtained for additional characterization of the lesions. There were 3 additional mixed signal lesions located within the left femoral neck and extending to the greater trochanter that enhanced with contrast. Because of the suspicion of malignancy, needle biopsy was performed. The pathologic findings in combination with the radiographic appearance confirmed the diagnosis of polyostotic fibrous dysplasia. ConclusionThis case demonstrated a rare aggressive appearance of polyostotic fibrous dysplasia located in the left innominate and the left proximal femur that prompted a diagnostic imaging workup and biopsy for suspected skeletal malignancy. These lesions may require careful evaluation by an experienced team of physicians, radiologists, and pathologists to ensure proper diagnosis and treatment.

Mobilisation of the thoracic spine in the management of spondylolisthesis

Segmental instability due to lumbar spondylolisthesis is a potential cause of chronic low back pain. Hypomobility of the spine results in compensatory segmental hypermobility of the segment above or below restricted segments. Therefore, the aim of the study is to determine the effects of mobilisation of the hypomobile upper thoracic spine along with conventional flexion exercises and stretching of short hip flexors on the degree of slippage and the functions of the persons with lumbar spondylolisthesis. All patients with spondylolisthesis were randomly assigned into two groups: Group I - Experimental group, treated with mobilisation of the thoracic spine along with the conventional physiotherapy and Group II - Conventional group, treated with conventional stretching, strengthening, and lumbar flexion exercise programme. The experimental group treated with mobilisation of the thoracic spine shows a significant reduction in the percentage of vertebral slip from pre-treatment to post-treatment measurements. Low back pain due to spondylolisthesis may be benefited by mobilisation of the thoracic spine along with stretching of short hip flexors, piriformis, lumbar flexion range of motion exercises, core strengthening exercises, etc.