Non-specific Low Back Pain Research Articles

Exploring temporal congruence in motor imagery and movement execution in non-specific chronic low back pain

Chronic non-specific low back pain (NSCLBP) is linked to sensorimotor dysfunctions and altered motor planning, likely due to neuroplastic changes. Motor imagery (MI) and movement execution share neural pathways, but the relationship between imagined and executed movements in NSCLBP patients remains underexplored. This study aimed to assess the temporal congruence between imagined and executed movements in NSCLBP sufferers, with secondary goals of investigating group differences in movement chronometry, psychological well-being, and disability, as well as possible correlations among these factors. Fifty-six participants, including 28 NSCLBP patients and 28 asymptomatic subjects (AS), performed lumbar flexion and Timed Up and Go (TUG) tasks. NSCLBP patients showed significant temporal incongruence in both tasks, executing movements more slowly than imagined, whereas AS displayed incongruence only in the TUG task. NSCLBP patients also took longer to imagine and execute lumbar flexion movements compared to AS, with correlations observed between execution delays, higher disability, and greater fear of movement. The findings highlight a lack of temporal congruence in NSCLBP patients, especially in lumbar flexion, emphasizing the complex relationship between chronic pain, motor ability, and psychological factors. These results suggest that integrated treatment approaches addressing cognitive and emotional aspects are crucial for managing NSCLBP.

A comparative analysis of lumbar paraspinal muscle morphology between two movement system impairment subgroups of chronic nonspecific low back pain

BackgroundBased on the kinesiopathologic model, the Movement System Impairment (MSI) classification of LBP has shown that repetitive movements could contribute to pathoanatomic tissue changes. However, these changes have not been evaluated in different MSI classification subgroups of patients with LBP. ObjectiveThis study compared the grades of fatty infiltration as one of the muscle's pathologic changes in the lower lumbar paraspinal and psoas muscles between the two subgroups of patients diagnosed with MSI syndromes having opposite movement direction impairments. DesignObservational cross-sectional study. MethodForty-five participants with chronic LBP were enrolled in the study, with 23 patients in the lumbar flexion-rotation (FlexRot) subgroup and 22 in the lumbar extension-rotation (ExtRot) subgroup of MSI. Magnetic resonance imaging (MRI) and the Goutallier Classification System (GCS) were used for fatty grading of lumbar paraspinal and psoas muscles. After the reliability of this grading scale was evaluated, the results were compared between the two subgroups. ResultsThe Mann–Whitney U Test showed significantly higher fat infiltration of lower lumbar multifidus and erector spinae muscles in the lumbar ExtRot subgroup, with no significant difference between the two subgroups in terms of psoas muscles (P ≤ 0.05). Inter-rater reliability of GCS was acceptable to excellent, and intra-rater reliability was good to excellent. ConclusionThe fatty infiltration grade of lumbar paraspinal muscles in L4-L5 and L5-S1 levels are significantly different between the two LBP subgroups of MSI that have two opposite movement direction impairments. The lumbar paraspinal muscles, which contribute to extension, have a higher grade of fat in the ExtRot subgroup, whose symptoms are aggravated by lumbar extension.

Validation of the Pelvic Floor and Core Exercise Protocol in Indian Women with Chronic Non-specific Low Back Pain

Validation of the Pelvic Floor and Core Exercise Protocol in Indian Women with Chronic Non-specific Low Back Pain

Combined exercise Intervention protocol validation in sedentary workers health risk with Nonspecific Chronic low back pain People

Background: Most chronic low back pain is nonspecific as the cause of the pain is unknown. Hence exercise protocol focussing on one area of fitness is not appropriate. A general exercise programme that combines muscular strength, flexibility and aerobic fitness would benefit the rehabilitation of Nonspecific Chronic Low Back Pain and its health risk. The present study aimed to validate the content of the combined exercise intervention protocol. Methods: The development and expert judgement stages are part of the content validation process. The development of the exercise protocol was based on a comprehensive literature review. The protocol was created in a step-by-step progressive manner. Exercises for flexibility (20 minutes), stabilisation and strengthening (20 minutes), and aerobic (20 minutes) make up the three main parts of the exercise protocol. 12 independent professionals with a minimum of 10 years of experience were invited. Ten of the twelve specialists consented to take part in the study. In India, all of the professionals were engaged in orthopaedic and musculoskeletal physical therapy. There are two professors, three associate professors, and five senior physiotherapists among the experts. Responses were gathered by mail. During the validation phase, The Exercise protocol was graded by the experts on relevance and ease of performance using a 5-point scale. After collecting the responses content validity index and kappa values were calculated. Results: 37 out of 39 items in the combined exercise intervention protocol showed good agreement. Treadmill walking with 60-75% and 80% and above target heart rate showed a kappa value of 0.66 for relevance and 0.50 for ease of performance. Conclusions: The designed exercise protocol exhibited good content validity.

Italian versions of the optimal screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) and the Örebro Musculoskeletal pain screening questionnaire (ÖMPQ-21) and their short forms, in patients with low back pain: Cross-cultural adaptation, reliability and validity

BackgroundLow back pain (LBP) is a leading cause of disability worldwide. Early detection of prognostic factors using the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) or the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPQ-21) can predict improvement in pain and disability for patients with nonspecific LBP. ObjectivesTo translate and cross-culturally adapt the OSPRO-YF and the ÖMPQ-21 with their short versions into the Italian language and to test their measurement properties in patients with LBP. DesignClinimetric study. MethodsOSPRO-YF and ÖMPQ-21 were translated and administered to LBP patients with questionnaires on pain intensity, disability, pain self-efficacy, and pain catastrophizing. We evaluated test-retest reliability, measurement error, and construct validity. ResultsEighty-three patients with LBP were included. No floor or ceiling effects were reported. Test-retest reliability of the OSPRO-YF, the ÖMPQ-21, and their short forms were excellent. The measurement error analysis revealed a Standard Error of Measurement (SEM) of 6.7 points, a Minimal Detectable Change (MDC) of 18.6 points for ÖMPQ-21, a SEM of 2.3 points, and a MDC of 6.4 points for OSPRO-YF. The construct validity of the OSPRO-YF and ÖMPQ-21 and its 10-item short version was satisfactory and moderate. OSPRO-YF performed better than ÖMPQ-21 on all three measurement properties. ConclusionOSPRO-YF, ÖMPQ-21, and their short versions are reliable and valid for identifying ‘yellow flags’ in Italian patients with LBP, with the former generally performing better than the latter. Further research is needed to confirm their ability to predict outcomes in patients with LBP.

Key Factors Driving Physiotherapy Use in Patients with Nonspecific Low Back Pain: Retrospective Clinical Data Analysis

Background/objectives: Understanding the factors that influence physiotherapy (PT) service use among patients with nonspecific lower back pain (LBP) is necessary to optimize treatment strategies, healthcare resource allocation, and the planning of value-based initiatives. We report factors that influence the number of PT visits per episode of care (defined as a referral from a physician) for an LBP population in Saudi Arabia, and compare them with patients experiencing their first and recurrent episodes of LBP. Methods: LBP patients were retrospectively enrolled from a clinical dataset derived from an outpatient PT clinic in Saudi Arabia. The primary outcome variable was the number of PT visits performed per episode of care. Multiple linear regression analysis was performed to examine the relationships between the numbers of PT visits per episode of care and independent variables. Results: The number of PT sessions per week (β 0.34, p < 0.001), compliance with PT sessions (β 0.31, p < 0.001), and pre-pain scores (β 0.29, p < 0.001) explained 41.8% (adjusted R2 0.32) of the variance in the total number of PT visits per episode of care (p < 0.001). Conclusions: Factors that might improve value-based care for LBP patients are reported. The more PT sessions per week, compliance with these sessions, and higher baseline pain scores predict a higher number of PT visits per episode of care among these patients. While reported for a Saudi Arabian population, there is no reason to believe that these findings do not apply internationally.

Management of patients with chronic low back pain in outpatient practice: a clinical observation

Back pain is one of the most common reasons for visits to the doctor and temporary disability. In non-specific chronic low back pain (CLBP) most effective approach is a complex (multidisciplinary) approach, aimed at relieving pain and improving the quality of life by using an educational program, kinesiotherapy, psychological methods and optimization of drug therapy. We present the observation of a 48-year-old patient with CLBP whose treatment was ineffective during one year. The patient was repeatedly prescribed medications, and the methods of magnetotherapy, massage, phonophoresis with hydrocortisone. Educational program, kinesiotherapy and psychological methods were not applied. The examination of the patient revealed emotional disorders, misconceptions about the disease and a pronounced functional impairment due to pain. The application of a complex therapy, which included an educational program, individual kinesiotherapy, psychological methods, Dexalgin as a non-steroidal anti-inflammatory drug, led to a significant reduction in pain after 7 days and a complete regression of symptoms after 2 months. The issues of efficacy and safety of the use of Dexalgin and the possibility of introducing the complex approach into the clinical practice of management of patients with chronic back pain are discussed.

Ultrasound Evaluation of Onset Core Muscle Activity in Subjects with Non-Specific Lower Back Pain and Without Lower Back Pain: An Observational Case-Control Study.

Lower back pain (LBP) has been the leading cause of disability since 1990. Objectives: The main objective of this observational case-control study was to evaluate, using ultrasound, whether there were differences in the onset and ratio of core muscle contraction between subjects with non-specific chronic lower back pain and healthy subjects. Methods: A total of 60 participants (52% women), split between those with non-specific chronic lower back pain (n = 26) and healthy (n = 34) subjects, were recruited. Initial muscle contraction of the lateral abdominal wall, pelvic floor, lumbar multifidus, and respiratory diaphragm was measured using ultrasound. The abdominal drawing-in maneuver, contralateral arm elevation, the Valsalva maneuver, and voluntary contraction of the pelvic floor in seated and standing positions were performed. The muscle thickness of the lateral abdominal wall and lumbar multifidus and excursion of the pelvic floor and diaphragm at rest and during testing were also analyzed. Results: No differences were found between the groups in the initial contraction. Statistically significant differences were found in the following variables: diaphragm excursion (p = 0.032, r = 0.277) and lumbar multifidus ratio (p = 0.010, r = 0.333) in the standing-abdominal retraction maneuver; pelvic floor excursion (p = 0.012, r = 0.325) in the standing-contralateral arm raise; and transverse abdominis ratio (p = 0.033, r = 0.275) in the sitting-contralateral arm raise. A statistically significant interaction between the groups and body mass index was observed in resting diaphragm excursion (p = 0.018, partial eta squared = 0.096) during sitting-voluntary pelvic floor contraction. Conclusions: It cannot be concluded that there is a specific pattern of core activation in any of the groups. However, statistically significant differences were found in the contraction indexes of the lumbopelvic musculature.

Relationship between the flexion relaxation phenomenon and kinematics of the multi-segmental spine in nonspecific chronic low back pain patients

The flexion relaxation phenomenon (FRP) is characterized by the reduction of paraspinal muscle activity at maximum trunk flexion. FRP is reported to be altered (persistence of spinal muscle activity) in more than half of nonspecific chronic low back pain (NSCLBP) patients. Little is known about how the multi-segmental spine affects FRP. The aim of this observational study was to investigate the relationship between FRP and kinematic parameters of the multi-segmental spine in NSCLBP patients. Forty NSCLBP patients and thirty-five asymptomatic participants performed a standing maximal trunk flexion task. Surface electromyography was recorded along the erector spinae longissimus. The kinematics of the spine were assessed using a 3D motion analysis system. The investigated spinal segments were upper thoracic, lower thoracic, thoracolumbar, upper lumbar, lower lumbar, and lumbopelvic. Upper lumbar ROM, anterior sagittal inclination of the upper lumbar relative to the lower lumbar in the upright position, and ROM of the upper lumbar relative to the lower lumbar during full trunk flexion were significantly correlated with the flexion relaxation ratio (Rho 0.42 to 0.58, p < 0.006). The relative position and movement of the upper lumbar segment seem to play an important role in the presence or absence of FRP in NSCLBP patients.

Positional Release Technique vs. Cognitive Behavioral Therapy on Pain Intensity in Chronic Non-specific Low Back Pain: A Randomized Control Trail

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The effectiveness of massage gun treatment combined with passive stretching in reducing non-specific lower back pain

Non-specific lower back pain is a common condition characterized by strain, muscle spasms, or weakness of the paraspinal muscles, particularly the multifidus muscle, which affects adjacent musculature such as the gluteus, hamstrings, and quadriceps. This study aimed to investigate whether massage gun treatment combined with passive stretching could reduce non-specific low back pain in patients experiencing subacute and chronic phases of this condition. This pseudo-experimental research employed a one-group pretest-posttest design with three treatments. Participants were selected using purposive sampling based on inclusion criteria: suffering from non-specific low back pain, willingness to participate, and age between 20 and 65 years. Exclusion criteria included anatomical abnormalities of the spine, fractures, open wounds, and specific spinal disorders. The visual analog scale (VAS) was used to measure pain intensity before and after each treatment session. Initial VAS scores averaged 65.6 units. Following the first treatment, scores decreased significantly to 52.1 units; subsequent reductions occurred at 42.1 units post-second treatment and 33.5 units post-third treatment. Statistical analysis revealed a significant difference across all three treatment sessions (p = 0.000 0.05), indicating a progressive improvement in pain control over time. Massage gun therapy coupled with passive stretching demonstrated efficacy in reducing non-specific lower back pain among participants. These findings suggest that repeated application of these interventions can lead to sustained improvements in pain management for individuals suffering from subacute and chronic non-specific low back pain conditions

Tuina versus physiotherapy or a combination of both for the management of chronic nonspecific low back pain: A randomized controlled trial

ObjectiveTo rigorously evaluate the short-term and long-term effectiveness of Tuina (TN), alone and in combination with physiotherapy (PT), for Chronic nonspecific low back pain (CNLBP) through a comprehensive, high-quality clinical trial. MethodsThis randomized, single-blind trial was conducted from September 2020 to July 2023, involving 204 CNLBP patients from the First Affiliated Hospital of Jinan University. Participants underwent a baseline assessment, 6 treatment sessions over 8 weeks, a post-treatment evaluation in the 9th week, and a 20-week follow-up. Participants were randomly assigned to TN, PT, or a combination of TN and PT (TP) groups. Each treatment involved 6 sessions with a minimum 7-day interval, each lasting 30 minutes. Primary outcome was the change in Visual Analog Scale (VAS) for pain. Secondary outcomes included the Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36), Range of Motion (ROM) of the spine, Traditional Chinese Medicine Syndrome Scale (TCMSS), and adverse events (AE). ResultsAmong the 204 participants, 67.16 % were female, and 88.73 % completed the 20-week follow-up. All groups showed significant reductions in VAS scores post-treatment and at follow-up. Secondary outcomes improved significantly, with notable decreases in ODI and TCMSS scores. Pairwise comparisons within groups indicated statistical significance, particularly in ODI scores, with clinical relevance. No significant differences were found between the groups. ROM and SF-36 showed statistical but not clinical significance. Only one AE (0.49 %) was reported, with no severe incidents. ConclusionAll treatment groups, including TN, TP, and PT, demonstrated significant reductions in VAS scores for CNLBP patients, with effects lasting up to 20 weeks. While TN and TP showed substantial improvements in secondary outcomes, particularly in ODI scores, no significant differences were found between the groups. These findings suggest that all treatments can be effective for managing CNLBP, supporting clinical practitioners in selecting appropriate interventions for patients, especially for those unable to engage in active exercises, utilizing passive movements like TN to enhance health outcomes.

Gender Differences in the Relationship between Physical Activity, Postural Characteristics and Non-Specific Low Back Pain in Young Adults.

Background/Aim: University students are a particularly vulnerable population, as they spend increasing amounts of time sitting, which poses a major threat to their musculoskeletal health and posture. The aim of this cross-sectional study was to investigate gender differences in the relationships between physical activity (PA) and sedentary behavior, spinal curvatures and mobility, the endurance and balance of the trunk muscles, and the possible presence of non-specific low back pain (NS-LBP) in young adults aged 18-25 years. Methods: A total of 139 students completed all required tests. Results: Male students engaged in significantly more PA related to recreation, sports and leisure and were significantly more likely to be hyperkyphotic than female students. The more the male students participated in sports, the more pronounced the thoracic kyphosis. Female students had significantly more pronounced lumbar lordosis and anterior pelvic tilt that correlated with lumbar lordosis. Female students generally had significantly higher trunk extensor endurance and more balanced trunk musculature than males. NS-LBP correlated with PA in female students who generally had higher levels of NS-LBP than male students, with a statistically significant difference between those who practiced the most PA. Conclusions: Our results suggest that female students practice less PA and have pronounced lordosis and trunk extensor endurance, in contrast to males who practice more PA and have pronounced trunk flexor endurance and hyperkyphosis. Our findings suggest that more PA should be encouraged but implemented with caution and as an individualized gender-specific approach to prevent postural deformities and chronic musculoskeletal disorders, including NS-LBP.

Comparative analysis of Kinesio taping and dry-needling: effects on pain and disability in patients with mechanical low back pain

Background &amp; Objective: Low back pain (LBP) is an ever-increasing menace in the young men as well as women. Many factors causing it have been identified, the most common being improper spinal posture. LBP has been targeted by physicians, anesthetists, surgeons and rehabilitation medicine specialists. We compared the effects of Kinesio Taping and dry needling on pain reduction and disability improvement in patients diagnosed with mechanical chronic LBP. Method: A randomized control trial (RCT) was conducted at Rawal General and Dental Hospital and Al-Nafees hospital in Islamabad from January 2020 to October 2021. Probability-based sampling method was used to select participants for the study (simple random sampling). Thirty patients, aged 18 to 75 y were included. Sample size was calculated with Epitools. The selected patients were divided in two groups i.e., 15 patients in the Kinesio taping group (KT group) and 15 in the dry needling group (DN group). Two patients in the needling group were dropped. Numeric Pain Rating Scale (NPRS) and Roland-Morris Disability Index Questionnaire (RMDQ) were used to assess the pain and the disability at baseline, two weeks post-intervention and four weeks post-treatment. Chi-Square test was use to find association. Results: The mean age of the patients was 39.60 ± 13.69 y for KT group and 37.15 ± 12.54 y for DN group. The mean BMI for KT group was 27.15 ± 6.70 kg/m2 and for DN group 27.52 ± 5.13 kg/m2. Before treatment, there were no differences between the groups for NPRS and RMDQ. Both dry needling and Kinesio taping produced significant improvements in NPRS and RMDQ after two and four weeks of treatment (P &lt; 0.05). However, statistical analysis results showed that there was no association between pain and disability in patient with non-specific low back pain. (P &gt; 0.05). Conclusion: Both, Kinesio taping and dry needling, significantly reduced pain and disability after two- and four-weeks treatment in patients with low back pain, but there was no statistical differences between the pain and disability in both groups. Keywords: Disability; Dry Needling; Kinesio Tape; Low Back Pain; Numeric Pain Rating Scale; Physiotherapy Citation: Asad A, Irshad A, Hassan T, Kiran Q, Kouser S, Hassan F. Comparative analysis of Kinesio taping and dry-needling: effects on pain and disability in patients with mechanical low back pain. Anaesth. pain intensive care 2024;28(5):933−938; DOI: 10.35975/apic.v28i5.2561 Received: April 26, 2024; Reviewed: July 16, 2024; Accepted: July 18, 2024

Prevalence and characteristics of lumbar ribs: a meta-analysis with anatomical and clinical considerations.

Lumbar ribs (LR) are a rare and relatively unknown anatomical abnormality of the lumbar spine. The literature provides better understanding regarding other spinal congenital variations like cervical ribs or lumbosacral transitional vertebrae, which are rather commonly recognised conditions. Thus, this meta-analysis aimed to provide data on prevalence and key characteristics of LR. Relevant databases were systematically searched for studies reporting the prevalence, laterality and geographic distribution of LR. No exclusion criteria based on language and date of original articles were employed. The pooled prevalence estimates (PPE) were calculated using a random-effects model. To assess the between-study heterogeneity, the I2 statistic and Chi-square test were utilized. Throughout the investigation, the PRISMA guidelines were adhered to scrupulously. Evaluation of the included studies' reliability was made with the AQUA tool. In total, 9 studies were included in this meta-analysis. The pooled prevalence estimate (PPE) of LR was 2.1% (95%CI: 1.0-4.6). In studies based on CT imaging, LR were found in 1.6% (95%CI: 0.6-4.3) of patients and in Xray based studies in 2.1% (95%CI: 0.4-11.1) of patients. Lumbar ribs were bilateral in majority of individuals (65.4%, 95%CI: 39.4-84.6) and could be most frequently encountered in Europe with PPE of 2.8% (95%CI: 3.0-20.0), then in East Asia with PPE of 1.5% (95%CI: 1.0-19.2) and Middle East with PPE of 1.1% (95%CI: 0.6-20.0). The findings of our study indicate that LR are a common anatomical variation of lumbar spine, contrary to previous beliefs. In a clinical practice, when a patient presents with a non-specific low back pain, a possible occurrence of LR should be taken into consideration. The presence of LR may be misleading for surgeons and result in wrong-level spine surgeries.

Efficacy of antidepressants in the treatment of chronic nonspecific low back pain: a systematic review and meta-analysis.

Aim: This study reassesses the efficacy and safety of antidepressants in treating nonspecific chronic low back pain (NCLBP).Materials & methods: A systematic review was conducted following PRISMA guidelines, including randomized clinical trials (RCTs) from PubMed, Embase, Scopus, LILACS, SciELO and Cochrane CENTRAL, published through August 2024. Studies compared antidepressants with placebo or active comparators. The primary outcomes were pain relief and quality of life. Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42023307516.Results: Nine RCTs involving 1758 patients were analyzed. The antidepressants examined included duloxetine, escitalopram, bupropion, amitriptyline, imipramine and desipramine. Duloxetine 60mg significantly reduced pain (MD=-0.57; 95% CI=-0.78 to -0.36) and improved quality of life compared with placebo, with side effects that were generally tolerable. Notably, higher doses of duloxetine (120mg) were associated with an increase in adverse events. However, other antidepressants like amitriptyline and escitalopram demonstrated only modest or inconsistent effects.Conclusion: Duloxetine at 60mg provides consistent pain relief and improves the quality of life in NCLBP, but higher doses increase adverse events. Escitalopram might offer modest benefits but should be considered a third-line treatment. Other antidepressants, such as amitriptyline, bupropion, imipramine and desipramine, have limited evidence supporting their efficacy and are associated with adverse effects.

Treatment Strategies for Unknown Anatomic Pathology Ventriculus Terminalis Case Series: Single Center Experience

The ventriculus terminalis is a cavity in the conus medullaris, bounded by ependymal cells, associated with the central canal. It is an anatomical structure that is very rare in adults, with a limited number of surgical cases that have been reported in the literature. In children, it is regarded as a normal congenital variation, known to regress before five years of age, and very few symptomatic cases have been reported in both pediatric and adult populations. It is often asymptomatic in adults and is detected incidentally. Although potentially nonsignificant individually, symptoms can range from nonspecific low back pain to sphincter dysfunction and focal neurologic deficits. Our purpose is to discuss our management strategy in comparison to the existing literature. A retrospective review was conducted of all adult patients (aged 17 years and older) diagnosed with ventriculus terminalis who were referred to the hospital between 2010 and 2020. Clinical classification was made according to the classification defined by Batista. In addition, Ganau's classification was also used. Five patients were included in the study. The majority of these patients (n=4, 80%) were symptomatic at the time of diagnosis, with nonspecific back pain being the most common symptom (n=3, (60%). None of the patients required neurosurgical intervention during the follow-up period of 21.6±8.9 months, as there was no clinical deterioration observed. Ventriculus terminalis is a rare pathology that may develop de novo in adults, often remaining undiagnosed until the cyst enlarges, and can manifest with a wide spectrum of symptoms. When identified, it requires careful management, involving surgery when necessary and a conservative approach when appropriate.

Running is acceptable and efficacious in adults with non-specific chronic low back pain: the ASTEROID randomised controlled trial

ObjectivesRunning is one of the most accessible forms of exercise, yet its suitability for adults with chronic low back pain (LBP) is unknown. This study assessed the efficacy and acceptability...

Effects of osteopathic manipulative treatment associated with transcranial direct current stimulation in individuals with chronic low back pain: A double-blind, randomised placebo-controlled trial

Objective To evaluate the effectiveness of osteopathic manipulative treatment (OMT) associated with transcranial direct current stimulation (tDCS) in reducing pain, disability, and improving quality of life in participants with non-specific chronic low back pain. Design A randomised double-blind clinical trial. Setting Clinical outpatient unit. Subjects 72 participants with non-specific chronic low back pain were randomised into three groups: active tDCS + OMT (n = 24), sham tDCS + sham OMT (n = 24), and sham tDCS + OMT (n = 24). Interventions Evaluations were performed before, after the intervention, and one month post-intervention. tDCS consisted of ten 20-minute sessions over two weeks (five sessions per week). OMT was administered once per week, with two sessions conducted before the first and sixth tDCS sessions. Main measures Pain, disability, and quality of life were assessed at baseline, after two weeks, and at one month of follow-up. Results The visual analogue scale showed a significant decrease in all groups (p < 0.001). However, tDCS + OMT and sham tDCS + OMT demonstrated a clinically significant reduction compared to the sham combination (effect size n² = 0.315). Roland-Morris scores decreased across all groups without specific group effects. EuroQoL 5-Dimension 3-Level improvement was observed only in the tDCS + OMT and sham tDCS + OMT groups (significant difference between T2 and T0, p = 0.002). Conclusion The combination of OMT and tDCS did not provide clinically significant improvement over OMT alone in participants with non-specific chronic low back pain.

Examining spinal mobility, aerobic capacity and functional movement in patients with non-specific chronic low back pain: a case-control study

Background/Aims The increasing cost and incidence of non-specific chronic low back pain means that many physiotherapists are reconsidering the management of this condition. The primary aim of this study was to examine spinal mobility, aerobic capacity and functional movement screen in patients with non-specific chronic low back pain. The secondary aim was to determine the factors affecting the disability level. Methods Participants aged between 18–65 years old diagnosed with non-specific chronic low back pain for &gt;3 months were recruited as a study group, while those without low back pain in the last 3 months were the control group. Outcome measures included the Functional Movement Screen for functional movement, the 2-Minute Step Test for aerobic capacity, the Spinal Mouse for spinal mobility and Oswestry Disability Index for disability level. Results A total of 60 participants, 30 people with non-specific chronic low back pain (42.7 ± 10.6 years) and 30 people without low back pain (42.0 ± 7.3 years), were included in this study. There were statistically significant differences in the total sagittal plane angle (P&lt;0.001), total frontal plane angle (P=0.03), 2-Minute Step Test (P&lt;0.001) and Functional Movement Screen (P&lt;0.001) scores between groups. Pain and aerobic capacity explained 42.4% of the variance as determinants of disability in the study group. Conclusions In people with non-specific chronic low back pain, sagittal and frontal plane range of motion and aerobic capacity were decreased and their functional movements were impaired. Pain intensity and aerobic capacity affect the disability level of non-specific chronic low back pain. Implications for practice People with non-specific chronic low back pain have reduced spinal mobility, aerobic capacity and functional movement. These parameters should be included when determining treatment programmes. At the same time, the level of disability can be reduced by decreasing pain intensity and increasing aerobic capacity of people with low back pain.