Specific Chronic Low Back Pain Research Articles

Effects of Transcutaneous Electrical Nerve Stimulation in Patients with Chronic Non-specific Low Back Pain as an Add-on Therapy

Background : Transcutaneous Electrical Nerve Stimulation (TENS) is often used to treat Low-Back Pain (LBP). However, its effectiveness is controversial in non-specific chronic LBP (CLBP). The study aimed to determine TENS’ efficacy in treating non-specific CLBP when added to Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) and Activities of Daily Living (ADL). Materials and methods: This randomized controlled clinical trial was conducted in the Department of Physical Medicine and Rehabilitation of Chittagong Medical College Hospital, Chattogram, over six months from January 2019 to June 2019. Ninety patients suffering from LBP for more than six weeks were enrolled and randomized into Group A, and Group B. Patients in both groups were treated with NSAID+ADL. TENS was added to the patients of Group B. Subjective pain intensity score, Visual Analogue Scale (VAS) Tenderness index, Disability due to pain, Spinal mobility index and Oswestry Disability Index was the outcome parameters assessed at baseline and after eight weeks of intervention. Results: Ten patients were lost to follow-up (Five from each group) giving an effective sample of 80 (40 in each group). Both the groups were similar at enrollment in terms of the demographic, clinical and laboratory parameters. In Group A and B, the VAS score at baseline was 7.06±0.81 and 7.11±0.83, respectively. At eight weeks, the VAS score was 6.55±0.77 and 6.11±0.75, respectively, in Group A and B. Reduction of VAS scores was significant in both groups without any statistical differences. Similarly, Disability due to pain and Oswestry Disability Index scores reduced significantly from baseline to eight weeks after treatment in both groups, without statistically significant differences. Conclusion: The study ascertained no additional benefit of TENS in patients of non specific CLBP when added to NSAID and ADL. IAHS Medical Journal Vol 5(1), June 2022; 82-86

MODERATING EFFECT OF BODY HEIGHT ON THE ASSOCIATION OF BODY WEIGHT AND DISABILITY CAUSED BY NON SPECIFIC CHRONIC LOW BACK PAIN IN WOMEN AND MEN.

The aim of the study was testing the hypothesis that body height has a moderating effect on the association of weight and chronic low back pain (LBP) induced disability, and that this moderating effect is different in women and men. We performed a nested cross-sectional analysis using data collected at baseline in a prospective cohort study conducted in 2008-2009 at a special hospital for medical rehabilitation in Croatia. The outcome was the Roland-Morris Disability Questionnaire (RMDQ) score. The independent variable was body weight. The focal moderators were body height and sex. The moderation analysis was adjusted for seven sociodemographic and clinical covariates. We analyzed data on 72 patients with a median (interquartile range) age of 50 (43-55) years, 36 (50%) of whom were women, treated for nonspecific, chronic LBP. The interaction of sex, body weight and height was a significant predictor of the RMDQ score after adjustments for all covariates (increase of R2=0.13; p=0.001; false discovery rate <5%). In both sexes, the correlation between body weight and the RMDQ score was significantly moderated by body height but in opposite ways. In conclusion, the effects of body weight on physical disability are moderated by body height, but this moderation effect differs between women and men.

Effect of core stability exercise on activation of abdominal muscles and lumbar flexibility in men with specific chronic low back pain

Introduction: Lumbar disc herniation is the most common specific cause of chronic low back pain and exercise therapy is one of the goals of its management. The aim of this study was to investigate the effect of core stability exercises on activation of abdominal muscles and flexibility of lumbar in men with disc herniation.Materials and Methods: The subjects of this clinical trial study were 20 young and middle-aged men with lumbar disc herniation referred to physiotherapy in rasht in first half of year 1399 who were randomly divided into two groups of core stability exercises (n=10) and control (n=10). The electrical activity of the internal oblique, external oblique, and rectus abdominis muscles was measured by electromyography and abdominal muscle strength by straight leg raising test and flexibility by sit and reach test. Training protocol of intervention group included 8 weeks of core stability exercise, while the control group was only followed up. Statistical analysis was performed using paired t test an analysis of covariance test with SPSS software.Results: Activation of 3 muscles and strength and flexibility after 8 week of exercise had a significant improvement(p<0/05)but changes were not significant in control group. However, analysis of covariance showed a difference between two groups in activation of all three muscles and flexibility(p<0/05)But no significant difference was observed in muscle strength.Conclusion: Our findings showed, people with disc herniation experience greater activation, strength, and flexibility in trunk muscles after core stability exercise thus can be considered in rehabilitation.

Evidence for integrating exercise training into the multidisciplinary management of non-specific chronic low back pain.

Worldwide, low back pain (LBP) is the leading cause of disability and affects 16% of the Australian population. Pain that lasts more than 12 weeks and is presumed lumbar musculoskeletal in origin is deemed non-specific chronic LBP. Managing LBP requires a multidisciplinary approach. The aim of this article is to provide evidence for incorporating exercise training into the multidisciplinary treatment plans of patients with non‑specific chronic LBP. There is mounting evidence in support of the integration of exercise training for the multidisciplinary treatment of non specific chronic LBP. Clinically meaningful reductions in pain intensity may be achieved with Pilates, aerobic, stabilisation/motor control and resistance exercise training. Clinically meaningful reductions in disability may be attained with resistance, stabilisation/motor control, water-based, Pilates and yoga exercise. Resistance and aerobic exercise can also improve mental health in this susceptible population group. The evidence suggests it is reasonable to consider including exercise-based services in the care team to enable patients with non-specific chronic LBP to transition to self-management.

Comparison of the effects of spinal manipulation and muscle energy techniques on motor control in Non- Specific Chronic Low Back Pain by Beta-band intermuscular pool coherence

Background: Until now, a variety of techniques have been introduced to address the adverse effects of NS-CLBP, including SMT and MET. However, most of these techniques have focused on pain assessment and disability. In other words, the effectiveness of these techniques on the corticospinal tract function was not studied. Therefore, the purpose of this study was to compare the effects of SMT and MET on corticospinal tract function during flexion-extension task phases in NS-CLBP using PC of Bb-IMC. Methods: A cross-sectional study was designed that in which 20 healthy and twenty-four (20–45 years) NS-CLBP patients men voluntarily participated. The patients had continuous or recurrent symptoms for 3 months or more without any referral pain to the lower extremities. The patients were randomly assigned to two equal intervention groups (SMT and MET) and the techniques were applied as described by Greenman. sEMGs from lumbopelvic muscles was recorded for all participants before and after the intervention while they performed three trials of F-ET and the PC for all muscles was calculated using Bb-IMC analysis. Multivariate analysis of variance test was used to compare the differences between the healthy subjects and patient groups before the interventions. Furthermore, in NS-CLBP patients, comparisons were made before and after the interventions in each group (i.e. SMT and MET groups). Results: There were significant differences in A and B muscle cross in the SMT group before and after the intervention in four phases of F-ET (P < 0.05). However, no significant differences were found in the MET group. Conclusion: These results showed that the SMT intervention was more effective than the MET intervention by reducing the PC of Bb-IMC in all phases of FE-T. Therefore, the PC of Bb-IMC could be considered as an approach for clinicians when designing the rehabilitation protocol to ensure optimal treatment.

The use of the thermographic examination in non-specific low back pain in elderly: controlled study

Background: Chronic low back pain (CLBP) affects an important part of the population worldwide and contributes to increased spending on medicines and imaging tests. An alternative in the diagnosis of nonspecific CLBP is the thermography examination, since it has low cost, good sensitivity and specificity in inflammatory processes. Objectives: The present article aimed to evaluate non - specific CLBP in elderly patients using thermography (TermoScanTD200) and the instrument of inability of Oswestry. Methods: The study included 120 subjects with a mean age of ±78.8 years. Results: the results of the column disability assessment reported that 60% of the sample reported moderate disability and 3% of the sample reported disability. In the thermography examination, 40% of the sample presented alterations in the lumbar 5 (L5), 20% showed changes in lumbar 3 (L3) and lumbar 4 (L4) and 10% of the sample presented changes in lumbar 1 (L1) and lumbar 2 (L2). When comparing lumbar spine follow-up with type of inflammatory process, it was observed that 40% of the sample presented a prevalence of acute inflammatory process in the lumbar 5 (L5), and 30% of the sample presented a prevalence of sub-acute inflammatory process in lumbar 3 (L3) and 40% of the sample presented a prevalence of chronic inflammatory process in lumbar 5 (L5). Conclusion: In view of the above, it is suggested that the thermography examination is an important tool in the diagnosis of nonspecific low back pain in the elderly.

Commentary on "Cognitive Functional Therapy in Patients with Non-Specific Chronic Low Back Pain".

In this issue, you will find a paper by Vibe Fersum et al., entitled “Cognitive Functional Therapy in Patients with Non Specific Chronic Low Back Pain: A Randomized Controlled Trial 3-year Follow Up” (Vibe Fersum et al., 2019). This interesting and well done paper reports on 3 year outcomes from a previously reported randomized trial. The primary findings are lower self-reported disability for those randomized to receive cognitive functional therapy instead of manual therapy and exercise. This is a strong contribution to the literature as there is growing interest in psychologically informed approaches to managing musculoskeletal pain. In particular, the authors are to be commended for reporting 3-year data, as follow up beyond 12 or 24 months is rare in conservative treatment trials for low back pain. This commentary will introduce some issues for readers to consider when interpreting the results of this study. The primary issue when reading this paper is to consider the potential impact that loss to follow up has on the long-term effects of cognitive functional therapy. This issue is mentioned by the authors as a primary limitation in the paper, and I will expand on it briefly. Only 52% (63/121) of those from the original trial provided follow up data at 3 years. The authors have taken appropriate care statistically in accounting for this loss to follow up via sensitivity analyses using mixed models and multiple imputation. However, the fact remains that this was a relatively small trial to begin with and the 3-year attrition rate has substantially eroded the original sample size. The absolute number of subjects providing follow up data is small enough (n< 50 per treatment group) that the precision of reported treatment effects is limited. Further drawing attention to this issue is the evidence of differential loss to follow up that suggests those providing 3-year data had lower psychosocial distress. This is a clinical relevant baseline difference because psychological distress is often an important mediator of treatment outcome. The authors do account for this by adjusting analyses for baseline scores. While that is an acceptable statistical solution, it doesn’t entirely account for the impact selective follow-up could have on the 3-year results. Another issue to consider when reading this paper is the timing of the treatment effects. At 3-years group differences still exist for disability and most of this gain appears to have much earlier (i.e. at 3 month follow up). This is evidence supporting that after an initial period of receiving a treatment a favourable trajectory is established. Statistically the treatment effect was sustained at 3 years but the size of the effect is cut in half from when the benefit was largest (i.e. 3 month follow up). Even with a smaller absolute effect at 3 years, the effect sizes reported remain large when compared to others in this field. This deserves mention both in the “good news” category (i.e. even at 3 years these effect sizes are larger than what you see in the typical trial) but also in the “need more studies” category (i.e. can these effect sizes be replicated when the treatment is delivered by others in different settings). Several of the next steps one could take from this clinical trial are well aligned with recent research priorities identified for psychological informed practice. For example, cognitive functional therapy was associated with improved self-reported disability but identifying specific factors involved in the process of achieving better outcomes were not part of these analyses. Future studies could consider measures of pain intensity, self-efficacy, fear of pain and catastrophizing and identify which are key mediators of favourable outcomes when receiving cognitive functional therapy. Another seemingly informative study would be to investigate the impact of “booster sessions” for cognitive functional therapy that could be delivered as part of group sessions or tele-health. Use of such post-treatment booster sessions could help determine if the size of treatment effects initially obtained able to be maintained at later follow up times. I appreciate the chance to provide additional insight into this article. The authors are to be congratulated for presenting work that provides valuable information on longer term effects of cognitive functional therapy and also helps to plan future clinical research. None declared.

Study of Autonomic Functions in Patients with Non-Specific Low Back Pain

Aim and Objectives To evaluate parasympathetic and sympathetic reactivity and assess any derangement in either or both of the limb of autonomic functions in patients of non specific chronic low back pain. Introduction Non specific chronic low back pain (nCLBP) is prevalent among adults and often leads to functional limitations, psychological symptoms, lower quality of life, and expenditure on health care. The focus of autonomic function and health has been cardiovascular diseases; musculoskeletal syndromes have been paid much less attention. However, there are many epidemiological and other studies suggesting that there is a connection between musculoskeletal disorders and psychological risk factors such as stress. Material and Method Male patients within the age group of 24–45 years(n= 40), who had a history suggesting chronic non specific low back pain were recruited from Orthopedics OPD and the control were the age and BMI matched healthy young adults within the same age bracket as that of study group. Autonomic function was assessed by using conventional autonomic function test. The data collected was evaluated using SPSS 17. Unpaired student “t” test was applied to compare the results P-value ˂ 0.05 was taken as statistically significant. Result The E: I ratio of control group was1.85±0.14 and in study group it1.30±0.17, the difference being statistically significant, Similar observation was made for other parasympathetic reactivity test like 30: 15 ratio. Conclusion Our results and review of literature make us of the view that parasympathetic activity decreases in patients of non specific chronic low back pain.

Comparison between somatosensory-evoked potential parameters in patients with nonspecific versus specific chronic low back pain

Background: Modern pain neuroscience has revolutionized our understanding about pain, including the role of central sensitization in amplifying pain experiences with increased neuronal response to central nervous system stimuli. During external upper and lower limb perturbation, it has been shown that Chronic low back pain (CLBP) was associated with longer reflex response latencies of trunk muscles. One theoretic but rarely examined possibility for longer reflex latencies is related to modulated somatosensory information processing. Objectives: The objective of the study was to compare the somatosensory-evoked potential (SSEP) parameters of the right median and left tibial nerves between patients with nonspecific and specific CLBP. Materials and Methods: The study includes 102 CLBP patients, clinically and radiologically confirmed and divided into two groups: 48 patients with nonspecific pathology and 54 patients with specific pathology. During this SSEP study the right median and left tibial nerves of all patients were examined. Recorded parameters include the latency and amplitudes. Results: The means of the latencies of all the SSEP waves of the right median and left tibial nerves were only significant in the peripheral SSEP waves in the upper and lower limbs (N9 and N10, respectively) and highly significant in cortical right median N20 SSEP wave. Regarding the central sensory conduction time values, both in the median and tibial SSEP study, The significant differences was noted only in the median nerve SSEP study. Regarding the means of the amplitudes of differently studied SSEP components of the right median and left tibial nerves, it was only significant in the peripheral SSEP (N9) wave of the right median nerve and in the subcortical and cortical (P37 and N45) waves in the tibial nerve SSEP study. Conclusions: Results showed a significantly higher SSEP amplitude and latency in nonspecific CLBP patients as compared to their counterpart CLBP patients. This could reflect a higher excitability of sensory cortex and sensory pathways in patients with nonspecific CLBP as compared to their counterpart patients.

Exploration of the Inter-Relationships Between Obesity, Physical Inactivity, Inflammation, and Low Back Pain.

Retrospective analysis wherein 103 patients were considered, and 76 patients were included: 49 were classified as chronic non-specific low back pain (CNSLBP) (Study group) and 27 had identifiable cases of specific chronic low back pain (LBP) (Control group). Elucidate markers of systemic inflammation in patients with CNSLBP. Mechanisms of LBP are poorly understood. Pro-inflammatory cytokines are increased in obesity and involved with pain modulation; we previously proposed a theoretical model of their mediating role in LBP. Demographic information was acquired via questionnaire, chart review, and blood test data. Univariate analysis identified factors associated with CNSLBP and markers of systemic inflammation. A receiver operating curve and Youden Index were used to select optimal cut-off points for elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Multivariable logistic regression analysis calculated the adjusted strength of relationship between factors that were proposed in our theoretical model for CNSLBP. Unadjusted CRP was significantly correlated with ESR (R = 0.63, P < 0.0001) and body mass index (BMI) (R = 0.38, P = 0.0015). Physically inactive patients had significantly higher CRP (6.1 vs. 1.2, P = 0.0050). ESR was significantly correlated with number of comorbidities (R = 0.34, P = 0.0047), BMI (R = 0.38, P = 0.0014), and age (R = 0.36, P = 0.0026). Physically inactive patients (10.4 vs. 3.6, P = 0.0001) and females (11.2 vs. 6.4, P = 0.0422) had significantly higher ESR. Adjusted analyses indicated significant relationships between physical inactivity and markers of systemic inflammation (adjusted odds ratios for ESR and CRP: 15.9, P = 0.0380; 15.2, P = 0.0272, respectively), and between elevated CRP and CNSLBP (adjusted odds ratio: 8.0, P = 0.0126). Systemic inflammation may act as a mediator for physical inactivity and obesity in the pathogenesis of CNSLBP. 2.

Prevalence of Chronic Nonspecific Low Back Pain and Its Associated Factors among Middle-Aged and Elderly People: An Analysis Based on Data from a Musculoskeletal Examination in Japan.

Study DesignA cross-sectional study.PurposeTo clarify the prevalence of chronic nonspecific low back pain (CNSLBP) and its associated factors among middle-aged and elderly Japanese individuals using data from a musculoskeletal examination conducted in general Japanese populations.Overview of LiteratureMost studies evaluating low back pain-associated factors have been conducted in Western countries, but they have not always evaluated CNSLBP.MethodsWe obtained data on 213 subjects aged >50 years who responded to a survey regarding age, gender, body mass index, lifestyle-related diseases (diabetes mellitus, hypertension, and hyperlipidemia), glucocorticoid use, smoking and alcohol-drinking habits, labor intensity, and chronic low back pain (CLBP) and underwent screening for lumbar spinal stenosis, evaluation for quality of life (QOL), and evaluation for specific spinal pathology via thoracolumbar spine X-rays. We investigated the prevalence of CNSLBP and association between CNSLBP and measured variables.ResultsThe prevalence of CNSLBP and chronic specific low back pain (CSLBP) was 15.4% and 9.3%, respectively. Among the subjects with CLBP, 62.2% had CNSLBP. In age-adjusted logistic models, smoking habits (p=0.049, odds ratio [OR]=2.594), low back pain (p<0.001, OR=0.974), lumbar function (p=0.001, OR=0.967), and social function (p=0.023, OR=0.976) in the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were significantly associated with CNSLBP, whereas EQ-5D utility score (p=0.024, OR=0.068), low back pain (p=0.007, OR=0.981), lumbar function (p=0.001, OR=0.963), walking ability (p=0.001, OR=0.968), and social function (p=0.002, OR=0.966) in JOABPEQ were significantly associated with CSLBP.ConclusionsCNSLBP among middle-aged and elderly individuals was associated with smoking habits and decreased QOL; however, CSLBP was considered to be more multilaterally associated decreased QOL.

No immediate analgesic effect of diadynamic current in patients with nonspecific low back pain in comparison to TENS

Background and designChronic nonspecific low back pain (CNSLBP) has major socioeconomic as well as personal impact in many industrialized and developing countries. Physiotherapy is a common intervention for this group of patients and using anti-pain physical modalities is a common part of the physical therapy. In a randomized controlled trial we investigated the immediate effect of the Diadynamic current in comparison to TENS on reducing the pain in patients suffering from non specific chronic low back pain. MethodsThirty patients were randomized into the Diadynamic current and TENS groups. Electrical stimulation was applied for 10 min in the Diadynamic group and for 15 min in the TENS group for one session. Pain, on a 100 mm Visual Analog Scale, and Pressure Pain Threshold (PPT), using an Algometer, was measured before the treatment, after the current application, 20 min later and after 48 h. ResultsPain was decreased significantly after 20 min following the current application only in the TENS group, with no improvement at all measurement points in the group receiving Diadynamic current. PPT was increased immediately after current application in both groups but did not last until later measurements. ConclusionDiadynamic current had no positive effect on prompt relief of pain in patients suffering from recurrent CNSLBP.

단기간 정적․동적 허리 안정화 운동이 만성 허리통증 20대 여대생의 체간 근력 및 근지구력에 미치는 영향

[PURPOSE] The purpose of this study was to evaluate effects of short term static · dynamic lumbar stability exercise on the trunk muscles strength and endurance of chronic low back pain female college students in their 20's. [METHODS] The subjects were consisted of twenty patients who had non specific chronic low back pain. All subjects randomly assigned to the static lumbar stabilizing exercise group(n=10)and dynamic lumbar stabilizing exercise group. Dynamic lumbar stabilizing exercise group received 3D balance, static lumbar stabilizing exercise group received bridge exercise during 4 weeks period. HUR was used to measure the isometric muscle strength. Time watch measure method was used to measure the abdominal and back muscle strength and endurance of trunk flexion and extension. [RESULTS] The trunk muscle strength was significantly difference between group(p .05). [CONCLUSIONS] Short term dynamic lumbar stabilizing exercise group showed increase in trunk muscle strength. Both group were increased endurance of trunk flexion, extension. Therefore, Short term dynamic and static lumbar stabilizing exercise will be available in the intervention of chronic low back pain patients.

Immediate Effects of Core-Stability Exercises and Clinical Massage on Dynamic-Balance Performance of Patients With Chronic Specific Low Back Pain

Context:Previous studies showed improved dynamic-balance (DB) performance after core-stability (CS) exercises in populations with chronic low back pain. Although clinical massage plus exercise is likely to better enhance analgesia than exercise alone, its efficacy on balance remains unclear.Objective:To evaluate the immediate effects of CS exercises plus myofascial trigger-point (MTrP) therapy in comparison with CS exercises alone on DB performance, pressure-pain threshold (PPT), and cross-sectional area of active MTrPs in patients with clinical instability of the lumbar spine and chronic myofascial pain syndrome.Design:Randomized, assessor-blind, test–retest.Setting:University research laboratory.Patients:10 physically active adults (5 men, 5 women).Main Outcome Measures:Single-leg DB performance and side-to-side ratios in 2 planes of motion (frontal, sagittal), as well as PPT and cross-sectional area of active MTrPs, were measured using stabilometry, pressure algometry, and real-time ultrasound scanning, respectively.Interventions:The 1st group performed CS exercises alone, whereas the same exercise program was applied in the 2nd group plus cross-fiber friction on active MTrPs (3.5 min/MTrP).Results:Within-group statistically and clinically significant differences were observed only for group II in PPT. However, group I also exhibited a large effect size with clinically significant changes from baseline on this outcome. Furthermore, patients in group II clinically improved their balance ratios and differed from group I at posttest in sagittal-plane DB performance of the painful side.Conclusion:CS exercises immediately increase the PPT of active MTrPs in physically active adults with clinical instability of the lumbar spine and chronic myofascial pain syndrome. When MTrP therapy is added, side-to-side asymmetries in DB are minimized.

Does Pain Predict Firing Rate in Specific Chronic Low Back Pain Patients?

Does Pain Predict Firing Rate in Specific Chronic Low Back Pain Patients?

Diagnosing and treating chronic musculoskeletal pain based on the underlying mechanism(s).

Until recently, most clinicians considered chronic pain to be typically due to ongoing peripheral nociceptive input (i.e., damage or inflammation) in the region of the body where the individual is experiencing pain. Clinicians are generally aware of a few types of pain (e.g., headache and phantom limb pain) where chronic pain is not due to such causes, but most do not realize there is not a single chronic pain state where any radiographic, surgical, or pathological description of peripheral nociceptive damage has been reproducibly shown to be related to the presence or severity of pain. The primary reason for this appears to be that both the peripheral and central nervous systems play a critical role in determining which nociceptive input being detected by sensory nerves in the peripheral tissues will lead to the perception of pain in humans. This manuscript reviews some of the latest findings regarding the neural processing of pain, with a special focus on how clinicians can use information gleaned from the history and physical examination to assess which mechanisms are most likely to be responsible for pain in a given individual, and tailors therapy appropriately. A critical construct is that, within any specific diagnostic category (e.g., fibromyalgia (FM), osteoarthritis (OA), and chronic low back pain (CLBP) are specifically reviewed), individual patients may have markedly different peripheral/nociceptive and neural contributions to their pain. Thus, just as low back pain has long been acknowledged to have multiple potential mechanisms, so also is this true of all chronic pain states, wherein some individuals will have pain primarily due to peripheral nociceptive input, whereas in others peripheral (e.g., peripheral sensitization) or central nervous system factors ("central sensitization" or "centralization" of pain via augmented pain processing in spinal and brain) may be playing an equally or even more prominent role in their pain and other symptoms.

Osteoporosis and Non Specific Chronic Low Back Pain: Correlation with Sex and Severity of Backache

Osteoporosis and Non Specific Chronic Low Back Pain: Correlation with Sex and Severity of Backache

Immediate Effects of Core-Stability Exercises and Clinical Massage on Dynamic-Balance Performance of Patients With Chronic Specific Low Back Pain.

Previous studies showed improved dynamic-balance (DB) performance after core-stability (CS) exercises in populations with chronic low back pain. Although clinical massage plus exercise is likely to better enhance analgesia than exercise alone, its efficacy on balance remains unclear. To evaluate the immediate effects of CS exercises plus myofascial trigger-point (MTrP) therapy in comparison with CS exercises alone on DB performance, pressure-pain threshold (PPT), and cross-sectional area of active MTrPs in patients with clinical instability of the lumbar spine and chronic myofascial pain syndrome. Randomized, assessor-blind, test-retest. University research laboratory. 10 physically active adults (5 men, 5 women). Single-leg DB performance and side-to-side ratios in 2 planes of motion (frontal, sagittal), as well as PPT and cross-sectional area of active MTrPs, were measured using stabilometry, pressure algometry, and real-time ultrasound scanning, respectively. The 1st group performed CS exercises alone, whereas the same exercise program was applied in the 2nd group plus cross-fiber friction on active MTrPs (3.5 min/MTrP). Within-group statistically and clinically significant differences were observed only for group II in PPT. However, group I also exhibited a large effect size with clinically significant changes from baseline on this outcome. Furthermore, patients in group II clinically improved their balance ratios and differed from group I at posttest in sagittal-plane DB performance of the painful side. CS exercises immediately increase the PPT of active MTrPs in physically active adults with clinical instability of the lumbar spine and chronic myofascial pain syndrome. When MTrP therapy is added, side-to-side asymmetries in DB are minimized.

The effect of non-weight bearing group-exercising on females with non-specific chronic low back pain: A randomized single blind controlled pilot study

The aim of this study was to investigate the effect of active non-weight-bearing (NWB) group exercising on women with non specific chronic low back pain (NSCLBP). Forty females with NSCLBP were assigned in a randomized control longitudinal single blinded pilot study. 20 of them were assigned to a NWB bi-weekly group exercise class and 20 females were included in the control group. The exercises involved the entire lumbo-pelvic spine aimed at improving lumbar mobility/flexibility and stability. Pain intensity (VAS), back specific disability (Rolland Morris questionnaire-RMQ), and lumbar flexion and extension ranges of motion measurements were taken prior to intervention (t(0)), immediately following 4 weeks of intervention (t(1)) and 8 weeks later (t(fu)). Reliability trials were conducted on 10 females. Non-parametric tests were used for statistical significance (p < 0.05). The following significant changes in outcome measures were indicated at t(1) compared with t(0) and control group (p < 0.001): an increase in lumbar flexion and extension (mean difference = 9.26◦ (+54%) for flexion and 5.95◦ for extension(+98%)); reduction in VAS score (mean difference = 2.32 (+58%)) and RMQ score (mean difference = 4.9 (−34%)). All changes remained significant at t(fu). At t(0), lumbar flexion was correlated with extension (r = 0.547) and VAS (r = −0.581),whereas the RMQ score correlated with VAS score (r = 0.599) and negatively with lumbar extension (r = −0.665). At t(1),lumbar flexion correlated with extension (r = 0.664) and negatively with RMQ score (r = −0.54). At t(fu), changes in VAS score were negatively correlated with changes in lumbar flexion (r = −0.522), while changes in lumbar flexion correlated with extension (r = 0.58). A functional program of NWB group exercising improves functional, painful status, lumbar flexion and extension ranges of motion in women suffering from NSCLBP.

Reliability, validity, sensitivity and specificity of Guajarati version of the Roland-Morris Disability Questionnaire

The most common instruments developed to assess the functional status of patients with Non specific low back pain is the Roland-Morris Disability Questionnaire (RMDQ). Clinical and epidemiological research related to low back pain in the Gujarati population would be facilitated by the availability of well-established outcome measures. To find the reliability, validity, sensitivity and specificity of the Gujarati version of the RMDQ for use in Non Specific Chronic low back pain. A reliability, validity, sensitivity and specificity study of Gujarati version of the Roland-Morris Disability Questionnaire (RMDQ). Thirty out patients with Non Specific Chronic low back pain were assessed by the RMDQ. Reliability is assessed by using internal consistency and the intra-class correlation coefficient (ICC). Internal construct validity is assessed by RASCH Analysis and external construct validity is assessed by association with pain and spinal movement. Clinical calculator was used to determine the sensitivity and specificity. Internal consistency of the RMDQ is found to be adequate (> 0.65) at both times, with high ICC's also at both time points. Internal construct validity of the scale is good, indicating a single underlying construct. Expected associations with pain and spinal movement confirm external construct validity. The Sensitivity and Specificity at cut off point of 0.5 was 80% and 84% with respectively positive predictive value (PPV) of 83.33% and negative predictive value (NPV) of 80.76%. The Questionnaire is at the ordinal level. The RMDQ is a one-dimensional, ordinal measure, which works well in the Gujarati population.