Mechanical Spinal Pain Research Articles

Effects of Progressive Physiotherapy Along with or Without Active Bed Rest at Hospital for the Management of Chronic Low Back Pain (LBP) Patients in Bangladesh

Background: Low Back Pain (LBP) is a significant health condition globally suffered by the middle and older aged population due to its impact on work disability, absenteeism and costs. Physiotherapy with active rest and therapeutic intervention, including mobilization, manipulation, exercise therapy and electrotherapy, is the choice of treatment as conservative management, whereas surgery is required in case of advanced neurological involvement. Specific level-induced spinal mobilization has a greater impact on correcting the faulty biomechanics of the spinal column if considered active rest at an early stage, whereas generalized spinal physiotherapy without rest is also effective for managing mechanical spinal pain. Objective: To determine the effects of physiotherapy with or without active rest for chronic low back pain. Method: Experimental research design with simple random sampling was used in this study to find out the effects of Progressive Physiotherapy along with or without active rest at the hospital for the management of patients with chronic Low Back Pain (LBP) in Bangladesh of 20-55 years of aged peoples with pre and posttest basis. Results: The study showed that physiotherapy with or without active rest effectively reduces pain and back disability for low back pain patients, whereas physiotherapy with active rest is more effective than physiotherapy without active rest for back pain patients. Comparison of within-group and between-group results showed that the P<0.05. The comorbidities were about 40% diabetic, 33% spinal deformity and 6.67% spinal and other surgical conditions which influence LBP. The experimental group reduced 64% pain and the control group reduced 24% pain. Conclusion and Recommendations: Physiotherapy with active rest is more effective than physiotherapy without active rest for LBP patients, whereas both treatment groups are significantly effective individually. RCT study can proceed for further evaluation.

Evaluation outcome of the regional approach of physiotherapy, conventional approach of physiotherapy and non-steroidal anti-inflammatory drugs (NSAID) on anxiety for chronic mechanical spinal pain disorder

Evaluation outcome of the regional approach of physiotherapy, conventional approach of physiotherapy and non-steroidal anti-inflammatory drugs (NSAID) on anxiety for chronic mechanical spinal pain disorder

Back pain in the under 20s would appear to be a ‘red flag’ of dubious significance: Results of a retrospective case note analysis

Purpose To assess whether being under the age of 20 is a significant ‘red flag’ in the presentation of first time low back pain. Method Retrospective case note analysis of patients under 20 years of age, referred into a secondary care service with pain (not deformity) over a 1-year period. Results The case notes of 86 new patients were reviewed. One patient with a serious pathology was identified, an eosinophilic granuloma. Fifty-six patients presented with non-specific mechanical spinal pain. Nine patients presented with a spondylolysis with or without associated spondylolisthesis and seven with disc degeneration/prolapse with nerve root pain. Thirteen patients (15%) received invasive treatment, six undergoing surgery (pars inter-articularis repair and discectomies), and seven had an injection (pars inter-articularis blocks, facet joint injections, transforaminal nerve root blocks or caudal epidural). Conclusion This study does not support the hypothesis that being aged under 20 years at the time of pres...

Fractures transversales du rachis ankylosé : une série de 17 cas

Transverse fractures of the spine are rare. They occur in ankylosed spine and may lead to neurological complications. We report a series of 18 cases observed in 17 patients with ankylosing spondylitis (AS). The objective of this study were to describe the clinical, diagnostic and therapeutic features of our series and to compare our results with those of the literature. We conducted a retrospective study from 1975 to 2008 in the neurosurgery and rheumatology departments of the university hospital (CHU) of Clermont-Ferrand. Eighteen transverse spine fractures were documented in 17 patients (one female patient had two fractures of the lumbar vertebrae). The 13 male and four female patients included in this series had a mean age of 57.4 ± 17.2 years and AS for a mean time of 21.3 ± 12 years (5-40). All patients had spinal ankylosis with a "bamboo" spine appearance. The reasons for hospital admission were suspicion of AS flare (n=10) and suspected traumatic fracture (n=8). Trauma, in most cases minor, was noted in 15 patients. Fourteen patients presented with mechanical spinal pain and three had both mechanical and inflammatory pain. Three patients experienced severe pain on mobilization. Two patients had pyramidal syndrome. The mean time to diagnosis of the fracture was 6.8 ± 8.4 weeks (0-22). The fracture was located in cervical spine (n=2), dorsal spine (n=8) and lumbar spine (n=8). It was transdiscal and transcorporeal in nine cases each. Standard radiographs (n=18) identified the fracture in nine cases. The fracture was demonstrated in all CT-scan (n=13). Magnetic resonance imaging (MRI) (n=6) showed the fracture in five cases and epidural hematoma in one. Eleven patients had orthopedic treatment and six underwent surgery. Outcome was favorable in 16 patients. One paraplegic patient died of pulmonary embolism. Transverse fractures of the spine are rare and diagnosis should be considered in a patient with AS and ankylosed spine who presented mechanical spine pain following even minor trauma. If standard radiographs are normal, further investigations should be performed using MRI, CT-scan, or both.

Who wants expert patient programmes for chronic mechanical spinal pain?: An investigation into the value of, and recruitment to, an expert patient programme as part of the physiotherapy management of chronic spinal pain

Objective To investigate the recruitment to, and value of, an expert patient programme as part of the physiotherapy management of patients with chronic spinal pain. Design A qualitative design incorporating semi-structured audiotaped interviews subsequently transcribed and coded. Interviews were held with patients as individuals and a group of nine physiotherapists participating in a single focus group. Setting Interviews were held in a physiotherapy department within a small community hospital. Method Initially an expert patient programme was organised and 20 patients were recruited. Interviews were held with five patients who had declined to participate and five patients who agreed. Those who agreed were interviewed before and after participation in the programme. Nine physiotherapists involved in recruiting patients to the programme were interviewed collectively in a one-off focus group. Results Patients and physiotherapists were not well-informed about the expert patient programme and were uncertain as to its value. There was resistance amongst patients to join the programme for logistical, perceptual and personal reasons. Recruitment was time-consuming for the physiotherapists involved and required persistence, commitment and persuasiveness. Some physiotherapists felt that they had inadequate time to recruit patients and were uncertain as to who would be suitable. Attendance on the single programme studied was poor, with two out of a potential 12 patients attending all six of the sessions. Participants who attended the programme found it a positive and useful experience. Conclusions This study confirms previous work that found a low uptake of places on programmes and difficulties in recruiting. Physiotherapists managing patients with chronic spinal pain are unsure as to the efficacy of expert patient programmes but feel that they could be useful for a small number of patients who are psychologically ready and sufficiently motivated to join. Patients who are successfully recruited to a programme can gain benefits including empathy and support. Further work needs to be carried out to demonstrate the value of the programme to both patients and physiotherapists.

M cKenzie classification of mechanical spinal pain: Profile of syndromes and directions of preference

The purpose of this study was to develop a profile of the use of McKenzie classifications of diagnosis and treatment, by physiotherapists credentialed in the McKenzie method in New Zealand. This system has been in common use for more than 20 years and the inter-rater reliability of the assessment has been previously established for therapists at this level of training. Prior studies identifying the classification of patients according to syndrome and directional preference have been mainly for the lumbar spine. The 34 participants for this study each assessed and classified 10 consecutive spinal patients during a 10-week period. Of the 340 patients assessed, 19 were excluded. Of those with pain arising from the lumbar spine; 140/187 were classified as reducible derangement syndrome, 11/187 were classified as irreducible derangement, 11/187 as dysfunction syndrome, 1/187 as posture syndrome and 24/187 as ‘other’. For treatment in the reducible derangement syndrome; 98/140 were given extension, 8/140 were given flexion and 34/140 were given lateral movements of either side gliding or rotation. Classifications and treatment for the cervical and thoracic spine groups followed similar patterns. These findings add to the external validity of the McKenzie method, and support mechanical evaluation of spinal patients according to directional preference.

Long-Term Follow-up of a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture, and Spinal Manipulation for Chronic Mechanical Spinal Pain Syndromes

To assess the long-term benefits of medication, needle acupuncture, and spinal manipulation as exclusive and standardized treatment regimens in patients with chronic (>13 weeks) spinal pain syndromes. Extended follow-up (>1 year) of a randomized clinical trial was conducted at the multidisciplinary spinal pain unit of Townsville's General Hospital between February 1999 and October 2001. Of the 115 patients originally randomized, 69 had exclusively been treated with the randomly allocated treatment during the 9-week treatment period (results at 9 weeks were reported earlier). These patients were followed up and assessed again 1 year after inception into the study reapplying the same instruments (ie, Oswestry Back Pain Index, Neck Disability Index, Short-Form-36, and Visual Analogue Scales). Questionnaires were obtained from 62 patients reflecting a retention proportion of 90%. The main analysis was restricted to 40 patients who had received exclusively the randomly allocated treatment for the whole observation period since randomization. Comparisons of initial and extended follow-up questionnaires to assess absolute efficacy showed that only the application of spinal manipulation revealed broad-based long-term benefit: 5 of the 7 main outcome measures showed significant improvements compared with only 1 item in each of the acupuncture and the medication groups. In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit.

Slitlike syrinx cavities: a persistent central canal.

The authors review their experience in the diagnosis and management of 32 patients with slitlike syrinx cavities. There were 18 men and 14 women with a mean age of 40 years. Presenting symptoms that prompted magnetic resonance (MR) imaging evaluation were mechanical spinal pain (13 patients), radicular pain (seven patients), paresthesia (six patients), numbness (five patients), and muscle spasm (one patient). In 12 patients neurological examination demonstrated normal status, and in the remainder only minimal sensory or motor abnormalities were found. The mean diameter of the syrinx cavity was 2 mm (range 1-5 mm), and on average it covered three vertebral levels. The cavities were limited to the cervical region in 16 patients, the thoracic in 12, and both regions in four patients. The mean follow-up time for changes in clinical condition and repeated MR imaging features were 38 and 32 months, respectively. Thirty-one patients were treated nonoperatively, and one was treated surgically. During the follow-up period clinical improvement was documented in six patients, worsened status in seven, and no change was demonstrated in the clinical status of 19 patients. None of the syrinx cavities changed in size. In 16 patients medical workup revealed alternative diagnoses that were determined to be the true causes of each patient's symptoms. Slitlike cavities likely do not represent true syringomyelia but rather remnants of the central canal detected in a small percentage of adults. Review of the authors' experience indicates that these cavities are asymptomatic and are unlikely to change in size. They can be considered an incidental finding, and in many of these patients another condition explaining the patient's symptoms may be found.