Spinal Exercise Research Articles

Finding Predictive Factors of Stabilization Exercise Adherence in Randomized Controlled Trials on Low Back Pain: An Individual Data Reanalysis Using Machine Learning Techniques.

To identify predictors of adherence in supervised and self-administered exercise interventions for individuals with low back pain. Cohort study. Rehabilitation. This preplanned reanalysis within the Medicine in Spine Exercise Network included 1511 participants with low back pain (57% female, mean age 40.9 years, SD ±14 years). Participants underwent an initial 3-week supervised phase of sensorimotor exercises, followed by a 9-week self-administered phase. Biological, psychological, and social factors potentially impacting training adherence were evaluated. During the supervised phase, adherence was tracked through a standardized training log. During the self-administered phase, adherence was monitored via a diary, with adherence calculated as the percentage of scheduled versus completed sessions. Adherence was analyzed both as an absolute percentage and as a dichotomized variable (adherent vs nonadherent, with a 70% adherence cut-off). Predictors for adherence were identified using Gradient Boosting Machines and Random Forests (R package caret). Seventy percent of the observations were used for training, whereas 30% were retained as a hold-out test-set. The average overall adherence was 64% (±31%), with 81% (±28%) adherence during the supervised phase and 58% (±39%) in the self-administered phase. The root mean square error for the test-set ranged from 36.2 (R2=0.18, self-administered phase) to 19.3 (R2=0.47, supervised phase); prediction accuracy for dichotomized models was between 64% and 83%. Predictors of low to intermediate adherence included poorer baseline postural control, decline in exercise levels, and fluctuations in pain intensity (both increases and decreases). Identified predictors could aid in recognizing individuals at higher risk for nonadherence in low back pain exercise therapy settings.

Exploring App-Based Physiotherapy for Somatic Tinnitus: Results from a Pilot Study.

Background: Somatic tinnitus (ST) is a type of tinnitus that is influenced by changes in somatosensory input from the cervical spine or temporomandibular area. Although traditional physiotherapy has been shown to reduce ST symptoms, in-clinic treatment is not always available, and adherence to home exercise programs is often low. This study aims to investigate the effectiveness of an app-based physiotherapy program to enhance the compliance and availability of treatment for ST patients. Methods: This pilot randomised controlled trial included 38 adult patients with chronic somatic tinnitus. Participants were randomly assigned to a treatment group receiving a 9-week app-based cervical spine exercise program or a control group. The primary outcome was tinnitus distress measured using the Tinnitus Handicap Inventory (THI). As a secondary outcome we used the Mini-Tinnitus Questionnaire (Mini-TQ). Results: Participants in the treatment group showed significant reductions in tinnitus distress, with a large effect size for both the THI and Mini-TQ groups (Cohen's d = 1.71 and 1.02, respectively). The control group showed no significant changes. Conclusions: This study provides evidence that an app-based physiotherapy intervention is a feasible and effective treatment for ST. Further research with larger sample sizes and comparisons to traditional in-clinic treatments is needed to confirm these findings. Additional studies on personalised treatment might further improve the treatment.

Concussion Reduction in Division I and II Athletes: Effects of Simple Cervical Spine Exercise Regimen.

Primary preventative medicine lacks a consensus on effective concussion prevention strategies for collegiate athletes. Cervical strength has been identified as a potential factor in concussion risk reduction. This study evaluates the impact of a commercially available, portable cervical muscle stretching and strengthening device, NeckX®, on cervical strength, range of motion (ROM), and concussion incidence in collegiate athletes participating in high-concussion-risk sports. A single-arm prospective cohort study was conducted with 162 collegiate athletes from various sports. Participants underwent a 12-week neck exercise protocol using the NeckX® device. Clinical data, including neck strength and ROM, were collected at weeks 0, 6, and 12. Concussion incidence was self-reported by participants and cross-referenced with records from the athletic department. Data were analyzed for significant neck strength and ROM changes throughout the 12-week study. A two-way analysis of variance multiple comparisons with the Tukey-Kramer significant difference test was utilized, using the Holm-Sidak method, with an alpha of 0.05. All athletic teams experienced a significant increase in cervical strength during the 12-week intervention (α = 0.05, p < 0.05). Increases in cervical flexion and extension force were most consistent between teams. Cervical ROM increased significantly in male and female soccer players (α = 0.05, p < 0.05). The overall incidence of head and neck injuries, including concussions, was reduced to 6.60% during the study period, the lowest recorded value in the university's athletic department history. The use of the NeckX® device for 12 weeks was effective in enhancing pericervical muscle strength and ROM while reducing concussion incidence in collegiate athletes participating in high-concussion-risk sports. Interestingly, the positive outcomes were consistent for both males and females, indicating the universal advantages of neck training among collegiate athletes. These findings support existing research on the benefits of cervical strengthening exercises for reducing concussions in collegiate athletes and highlight the convenience and affordability of using this device.

Enhancing the Management of Non-Specific Neck Pain through Gamification: Design and Efficacy of a Health Application.

Chronic non-specific neck pain (CNNP) poses a substantial health and economic burden in China. This study introduces a gamified motion-sensing health application framework to address the limitations of existing health applications. The gamified cervical spine somatic exercise application employs motion capture technology alongside the smartphone's built-in sensors to simulate accurate somatic interactions. Controlled experiments and data analyses demonstrated that the application significantly outperformed traditional text and video interventions in relieving participants' neck pain by increasing their average daily activity and compliance with the cervical spine exercise routine. The neck pain level of the participants is quantified by the Neck Disability Index (NDI). The results from the controlled experiments demonstrate that this gamified approach significantly decreases the Neck Disability Index (NDI) score from 1.54 to 1.24, highlighting its ability to alleviate neck pain and increase user compliance.

Comparative Analysis of Thoracic Rotation Exercises: Range of Motion Improvement in Standing and Quadruped Variants.

There have been few investigations into the effectiveness of thoracic spine exercises for improving thoracic range of motion (ROM) in any plane. This study assessed the effectiveness of two thoracic spine exercises: one in the quadruped position and one in the thoracic standing position. We determined how these exercises affect thoracic spine mobility ROM over a 2-week intervention period. Thirty-nine healthy participants were enrolled and assigned to a Quadruped Thoracic Rotation group (n=17 participants: 9 females and 8 males) or Flamenco Thoracic Spine Rotation group (n=22: 14 females and 8 males). All participants were administered a KOJI AWARENESSTM screening test, and the initial thoracic spine ROM before intervention exercise was measured in a laboratory setting. Quadruped Thoracic Rotation was performed as the quadruped exercise and Flamenco Thoracic Spine Rotation as the standing exercise. The KOJI AWARENESSTM thoracic spine test and ROM were evaluated on the day after the first exercise session and again after the program. Despite their different approaches to thoracic mobility, the quadruped exercise and standing exercise achieved equivalent improvement in thoracic ROM after 2 weeks. Practitioners have a range of exercise options for enhancing thoracic mobility based on their environmental or task-specific needs.

Intelligent Evaluation Method of Human Cervical Vertebra Rehabilitation Based on Computer Vision.

With the changes in human work and lifestyle, the incidence of cervical spondylosis is increasing substantially, especially for adolescents. Cervical spine exercises are an important means to prevent and rehabilitate cervical spine diseases, but no mature unmanned evaluating and monitoring system for cervical spine rehabilitation training has been proposed. Patients often lack the guidance of a physician and are at risk of injury during the exercise process. In this paper, we first propose a cervical spine exercise assessment method based on a multi-task computer vision algorithm, which can replace physicians to guide patients to perform rehabilitation exercises and evaluations. The model based on the Mediapipe framework is set up to construct a face mesh and extract features to calculate the head pose angles in 3-DOF (three degrees of freedom). Then, the sequential angular velocity in 3-DOF is calculated based on the angle data acquired by the computer vision algorithm mentioned above. After that, the cervical vertebra rehabilitation evaluation system and index parameters are analyzed by data acquisition and experimental analysis of cervical vertebra exercises. A privacy encryption algorithm combining YOLOv5 and mosaic noise mixing with head posture information is proposed to protect the privacy of the patient's face. The results show that our algorithm has good repeatability and can effectively reflect the health status of the patient's cervical spine.

A Prospective, Randomized, Controlled Clinical Study of Cervical Muscle Group Training Improving Radiotherapy Setup Accuracy Repeatability for Head and Neck Tumors

<h3>Purpose/Objective(s)</h3> Studies have shown that head and neck tumors are impossible to achieve an ideal match over the entire length of the neck due to the wide range of radiotherapy target areas. Previous studies have shown random deformation errors of 0.5 to 3.6 mm in the head and neck, the difference between any two different matched areas can reach 2 to 6 mm. we aimed to evaluate the role of neck muscle group training on the repeatability of the pose in patients treated with radiotherapy for head and neck tumors. <h3>Materials/Methods</h3> Patients treated with radiotherapy for head and neck tumors were randomly assigned (1:1) to a study group and a control group. The study group started cervical spine exercises+massage training one week before the start of radiotherapy until the end of radiotherapy. In the control group, conventional treatment without specific interventions was performed. The primary endpoint was the difference in the reproducibility of cervical spine set-up between the two groups, and the secondary endpoints were the differences in cervical curvature changes on lateral cervical radiographs before and after treatment between the two groups, and the differences in the timing and extent of side effects before, during, and after treatment between the two groups. <h3>Results</h3> A total of 947 CBCT scans were performed in 166 patients, including 479 CBCTs in 83 patients in the study group and 468 CBCTs in 83 patients in the control group. 26.51% (22/83) of the study group and 33.73% (28/83) of the control group had an error of ≥3 mm during the first treatment, (P=0.31). Patients with clivus and neck error >3mm in anterior-posterior direction during treatment accounted for 8.43% (7/83) of the study group and 26.51% (22/83) of the control group(P=0.002). The number of repeated setups except the first treatment was 2.42% in the study group and 7.02% in the control group (P=0.01). The error range from clivus to neck was (7, 3, 7) mm. setup error: in the clivus position of the two groups in the X, Y, Z three directions of the Setup error were (0.95 ± 0.89, 1.09 ± 0.94, 1.62 ± 1.18) mm vs (1.02 ± 0.94, 1.14 ± 0.96, 1.82 ± 1.21) mm, p in the z-direction is statistically significant (p = 0.01); The position of the 4,7th cervical vertebra also had statistical significance in the Z direction. Comparison between the surgical study group and non-surgical study group, the errors in the x and Z directions of the clivus and the 7th cervical vertebra were (0.99±0.96, 1.65±1.36 and 1.64±1.23, 1.61±1.37) mm vs (0.80±0.77, 1.85±1.44 and 1.67±1.07, 1.95±1.60) mm, P = 0.02, 0.11, 0.77, 0.01; the results were similar to it when comparing surgical controls to non-surgical controls. It can be seen from the data that in the X and Z directions from the clivus to the neck, the error change of the surgical group is smaller than that of the non-surgical group. There was no difference in toxicity and side effects. <h3>Conclusion</h3> The results show that neck muscle training can improve the anterior and posterior neck deformation error, improve the radiotherapy accuracy and setup efficiency.

Effects of Cervical Spine Exercise Protocol on Neck Pain, Pericervical Muscle Endurance, and Range of Motion in Medical Students: A Prospective Study.

IntroductionNeck pain is a common and debilitating ailment that places a significant burden on the healthcare system. No practical protocols have been published utilizing a portable, commercially available, and affordable device that significantly reduces acute and chronic neck pain.MethodsForty-six young adults with or without mild-to-moderate neck pain completed a six-week neck stretching and strengthening protocol with a portable cervical stretching and strengthening device. The primary outcome was changes to pericervical muscle endurance. Secondary outcomes were changes to cervical range of motion (ROM), neck length, circumference, and subjective pain, flexibility, and strength. Measurements were obtained on study days 0, 21, and 42.ResultsA significant increase in pericervical muscle endurance was demonstrated across all planes of cervical motion, ranging from 84% to 105%. Cervical ROM improved across all planes of motion but was only significant in right-side bending (5.3°), left rotation (6.2°), and right rotation (7.8°). Subjective pain evaluated via the Numeric Rating Scale (NRS) saw statistically significant improvement as well (1.33 to 0.51). Subjective assessment of participant cervical pain, strength, and flexibility improved 61.3%, 95.7%, and 97.8%, respectively.ConclusionsA six-week pericervical muscle stretching and strengthening program increased pericervical endurance and ROM in young adults. Decreased cervical pain was seen using the NRS and modified pain scale across most participants.

Partial Resection of Spinous Process for the Elderly Patients with Thoraco-Lumbar Kyphosis: Technical Report.

Background and objectives: Global sagittal imbalance with lumbar hypo-lordosis can cause low back pain (LBP) during standing and/or walking. This condition has recently been well-known as one of the major causes of reduced health-related quality of life (HRQOL) in elderly populations. Decrease in disc space of anterior elements and an increase in the spinous process height of posterior elements may both contribute to the decrease in lordosis of the lumbar spine. To correct the sagittal imbalance, the mainstream option is still a highly invasive surgery, such as long-segment fusion with posterior wedge osteotomy. Therefore, we developed a treatment that is partial resection of several spinous processes of thoraco-lumbar spine (PRSP) and lumbar extension exercise to improve the flexibility of the spine as postoperative rehabilitation. Materials and Methods: Consecutively, seven patients with over 60 mm of sagittal vertical axis (SVA) underwent PRSP. The operation was performed with several small midline skin incisions under general anesthesia. After splitting the supraspinous ligaments, the cranial or caudal tip of the spinous process of several thoraco-lumbar spines was removed, and postoperative rehabilitation was followed to improve extension flexibility. Results: The average follow-up period was 13.0 months. The average blood loss and operation time were 11.4 mL and 47.4 min, respectively. The mean SVA improved from 119 to 93 mm but deteriorated in one case. The mean numerical rating scale of low back pain improved from 6.6 to 3.7 without any exacerbations. The mean Oswestry Disability Index score was improved from 32.4% to 19.1% in six cases, with one worsened case. Conclusions: We performed PRSP and lumbar extension exercise for the patients with LBP due to lumbar kyphosis. This minimally invasive treatment was considered to be effective in improving the symptoms of low back pain and HRQOL, especially of elderly patients with lumbar kyphosis.

Practice Patterns in Pharmacological and Non-Pharmacological Therapies for Children with Mild Traumatic Brain Injury: A Survey of 15 Canadian and United States Centers.

Given the lack of evidence regarding effective pharmacological and non-pharmacological interventions for pediatric mild traumatic brain injury (mTBI) and the resultant lack of treatment recommendations reflected in consensus guidelines, variation in the management of pediatric mTBI is to be expected. We therefore surveyed practitioners across 15 centers in the United States and Canada who care for children with pediatric mTBI to evaluate common-practice variation in the management of pediatric mTBI. The survey, developed by a panel of pediatric mTBI experts, consisted of a 10-item survey instrument regarding providers' perception of common pediatric mTBI symptoms and mTBI interventions. Surveys were distributed electronically to a convenience sample of local experts at each center. Frequencies and percentages (with confidence intervals [CI]) were determined for survey responses. One hundred and seven respondents (71% response rate) included specialists in pediatric Emergency Medicine, Sports Medicine, Neurology, Neurosurgery, Neuropsychology, Neuropsychiatry, Physical and Occupational Therapy, Physiatry/Rehabilitation, and General Pediatrics. Respondents rated headache as the most prevalently reported symptom after pediatric mTBI, followed by cognitive problems, dizziness, and irritability. Of the 65 (61%; [95% CI: 51,70]) respondents able to prescribe medications, non-steroidal anti-inflammatory medications (55%; [95% CI: 42,68]) and acetaminophen (59%; [95% CI: 46,71]) were most commonly recommended. One in five respondents reported prescribing amitriptyline for headache management after pediatric mTBI, whereas topiramate (8%; [95% CI: 3,17]) was less commonly reported. For cognitive problems, methylphenidate (11%; [95% CI: 4,21]) was used more commonly than amantadine (2%; [95% CI: 0,8]). The most common non-pharmacological interventions were rest ("always" or "often" recommended by 83% [95% CI: 63,92] of the 107 respondents), exercise (59%; [95%CI: 49,69]), vestibular therapy (42% [95%CI: 33,53]) and cervical spine exercises (29% [95%CI: 21,39]). Self-reported utilization for common pediatric mTBI interventions varied widely across our Canadian and United States consortium. Future effectiveness studies for pediatric mTBI are urgently needed to advance the evidence-based care.

Thoracic spine exercise prescription in sport: a narrative review

Purpose: In sport, >80% of physiotherapists use exercises to manage thoracic spine pain and dysfunction, yet the region is lacking evidenced based rehabilitation. The thoracic spine is a central component of an athletes’ kinetic chain, contributing 80% of trunk axial rotation and force generation, for example during a throw. Optimal thoracic spine mobility, motor control and strength are therefore required to minimise excessive load/stress on other kinetic chain components, for example the shoulder. Given the potential impact on performance and wider socioeconomic burden of managing sports injuries, knowledge of exercises targeting the thoracic spine is required to inform personalised exercise prescription. The aim therefore is to review exercise prescription in the thoracic spine, specifically to (1)synthesise and classify thoracic spine exercises according to outcome (mobility, motor control, work capacity and strength), (2)inform research priorities for thoracic spine exercise prescription

Medicine in Spine Exercise [MiSpEx] – a national research network to evaluate back pain

Idiopathic as well as nonspecific low back pain is relevant in health care systems as well as inleisure and high-performance sports. Neuromuscular and/or structural deficits, mostly accompanied by biopsychological factors,are known risk factors for both the onset and chronification of symptoms. Meta-analytic evidence describes positive effects of physical activity. However, type, dose-response relation, minimum of training required and setting-specific implementation has not been fully clarified. Since 2011, the national research network „Medicine in Spine Exercise“ [MiSpEx] has been following a project layout called „Ran Rucken“ focussing on the development and validation of intervention programs including neuromuscular and pain adaptation moderated by individual training status, pain behaviour, allostatic load and social settings. Overall about 8000 patients and athletes have been and are being followed experimentally and clinically in 34 studies. It could be shown that a training program focussing on compensation of external loads elicited by perturbations is effective in prevention and rehabilitation in both athletes and general population. Besides validation of further consecutively developed programs emphasis is put on the evaluation of transfer strategies to medical systems, sports as well as general population. Finally, the evaluation of an efficient dose-response relation is addressed.

코어 안정화 운동 강도 변화가 요추부 근 활성도에 미치는 영향

The purpose of this study was to analyze the effects of core stabilizing exercises (three types of flank movements) on lumbar muscle activity to find adequate exercise time by understanding the relationships of time, intensity, and frequency of exercises. Twelve male participants in their 20s participated in this study. Participants did exercises on front side(20secs), right side(20secs), and left side(20secs) for a total of 60secs and repeated those exercises three times. In addition, participants repeated lumbar spine exercises for 4 minutes. In all of the front, left, and right side postures, there are significant mean differences(p<.05) and interaction effects(p<.05) of erector spinae muscle, rectus muscle, gluteus medius muscle, and rectus femoris for each group and each trial. In the left side posture, the strongest muscle activity was found in rectus muscle, and in the right side posture, the strongest muscle activity was found in erector spinae muscle. Findings showed that the strongest muscle activity in general was found at the time participants did three minutes exercises consisting of three sets of one minute exercises with three types of flank movements. Future studies need to examine not static (i.e., kinetic) flank movements for a better understanding of the effects of core stabilizing exercises on lumbar muscle activity, which contributes to the better quality of life.

Effects of dual-task conditions on cervical spine movement variability.

The potential to accurately perform cervical movements during more challenging tasks might be of importance to prevent dysfunctional motion characteristics. Although sensorimotor function during dual-task conditions are of increasing interest in biomedical and rehabilitation research, effects of such conditions on movement consistency of the neck have not yet been investigated. In this crossover MiSpEx(Medicine in Spine Exercise)-diagnostic study, we aimed to explore differences between single and dual-task conditions on cervical movement variability. Nineteen healthy participants (9 male; 24.5 ± 3.3 y) performed 10 repetitive maximal cervical movements in (1) flexion/extension and (2) lateral flexion, during one single- and during two dual-task test conditions (cognitive, motor) in a randomised and cross-over sequence. Latter consisted of a working memory n-back task (n= 2) and a repetitive ankle movement task. Range of motion (RoM) was assessed using an external three-dimensional ultrasonic movement analysis system. Coefficient of variation (CV) for repetitive RoM was analysed for differences between conditions and controlled for variances in intra-individual movement characteristics. Friedman and post-hoc Bonferroni-adjusted confidence intervals for differences from single- to dual-task values revealed changes in CV in flexion/extension from single-task to motor dual-task (+0.02 ± 0.02 (97.5%CI: 0.01; 0.03); p< 0.05) but not to cognitive dual-task condition (+0.01 ± 0.02 (97.5%CI: 0.003; 0.02)) nor for lateral flexion (p> 0.05). Pearson regression analyses revealed a linear negative (p< 0.01) influence of CV in flexion/extension on differences from single to both cognitive (R=2 0.47) and motor dual-task (R=2 0.55). Results for lateral flexion are comparable, baseline CV negatively impacts differences to cognitive (R=2 0.2) and motor dual-task performance (R=2 0.76; p< 0.01). Participants with comparable low cervical CV at single-task display a profound increase during dual-task conditions while participants with a higher variability remained almost stable or showed a decrease. The results point toward a complex interrelationship of motion patterns and adaptation processes during challenging tasks in respect of cervical CV.

Medicine in spine exercise (MiSpEx) for nonspecific low back pain patients: study protocol for a multicentre, single-blind randomized controlled trial.

BackgroundArising from the relevance of sensorimotor training in the therapy of nonspecific low back pain patients and from the value of individualized therapy, the present trial aims to test the feasibility and efficacy of individualized sensorimotor training interventions in patients suffering from nonspecific low back pain.Methods and study designA multicentre, single-blind two-armed randomized controlled trial to evaluate the effects of a 12-week (3 weeks supervised centre-based and 9 weeks home-based) individualized sensorimotor exercise program is performed. The control group stays inactive during this period. Outcomes are pain, and pain-associated function as well as motor function in adults with nonspecific low back pain. Each participant is scheduled to five measurement dates: baseline (M1), following centre-based training (M2), following home-based training (M3) and at two follow-up time points 6 months (M4) and 12 months (M5) after M1. All investigations and the assessment of the primary and secondary outcomes are performed in a standardized order: questionnaires – clinical examination – biomechanics (motor function). Subsequent statistical procedures are executed after the examination of underlying assumptions for parametric or rather non-parametric testing.DiscussionThe results and practical relevance of the study will be of clinical and practical relevance not only for researchers and policy makers but also for the general population suffering from nonspecific low back pain.Trial registrationIdentification number DRKS00010129. German Clinical Trial registered on 3 March 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1645-1) contains supplementary material, which is available to authorized users.

「제병원후론(諸病源候論)·허로병제후(虛勞病諸候)」에서 제시된 양생방도인법과 현대 운동치료의 비교 연구 - 슬관절과 경부/상지부 중심으로

Objectives The objective of this study is to interpretate Yangsaeng-Doinbub presented in [Jebyungwonhuron Huhrobyungjehu] in a modern kinesiologic approach. Methods Based on the interpretation of [Jebyungwonhuron Huhrobyungjehu] and implementation of its kinesiology, this study presents similar kinesiologies and their purposed, with the reference to various documents on modern kinesiology. Results 1) Exercises in Yangsaeng-Doinbub presented in [Jebyungwonhuron Huhrobyungjehu], which are similar to resistance exercise, can be used for isometric exercise of knee joint extensor and cervical extensor. 2) Exercises in Yangsaeng-Doinbub presented in [Jebyungwonhuron Huhrobyungjehu], which are similar to stretching exercise, has its purpose to stretch semitendinosus m., semimembranous m., gastrocnemius m., quadriceps femoris m., upper trapezius m., levator scapulae m., serratus m., and splenius capitis m. 3) Exercises in Yangsaeng-Doinbub presented in [Jebyungwonhuron Huhrobyungjehu], which are similar to active exercise, can be used for strengthen quadriceps femoris m.. 4) Yangsaeng-Doinibub also describes breathing methods, which help normalization of breathing exercised and increase the efficiency of spine and joint exercises. Conclusions The modern interpretation on kinesiology of Yangsaeng-Doinbub presented in [Jebyungwonhuron Huhrobyungjehu] leads to a conclusion that Yangsaeng-Doinbub consists of various exercises for knee joint, neck and upper extremity.

A Case of Change in Work Out as the Presenting Symptoms of Multiple Myeloma

HISTORY: A 56 year-old active black male presented with 5 months of worsening chronic pain: right hip pain changed location and low back pain flared. His pain had not responded to maintenance exercises (weightlifting, running, stationary cycling), dry needle, massage, stretch, or anti-inflammatories. Past medical history included lumbar disc bulge, lumbar spondylolysis, right superior labral tear, sports lifting-related Osgood-Schlatter’s, cervical laminectomy, chronic right rectus femoris strain. PHYSICAL EXAMINATION: Compared to examination seven months prior, physical examination was significant for decrease in lumbar spine flexion, extension, lateral lean, and rotation and normal symmetric strength testing over the bilateral lower extremities. Forward bending as if to tie shoes, lifting objects, and walking several blocks reproduced his pain. DIFFERENTIAL DIAGNOSIS: 1.Lumbar vertebral body fracture 2.Herniated disc 3.Lumbar or sacroiliac joint sprain or dysfunction 4.Lumbar paraspinal muscles strain 5.Malignancy - primary or secondary 6.Infection - osteomyelitis TESTS AND RESULTS: Serum protein electrophoresis: elevated IgM level Bone marrow biopsy #1: smoldering multiple myeloma Bone scan #1: negative. Lumbosacral x-ray: stable spondylolysis MRI lumbosacral spine: stable lumbar disc bulge, new L2 infiltrative lesion. Non-contrast CT: L2 lytic process with pathologic fracture Bone scan #2: photopenic foci at L2 and right scapula Skeletal survey #1: negative Bone marrow biopsy #2: plasma cell neoplasm Skeletal survey #2: lesions at L2, left pelvis, bilateral proximal femurs as well as bilateral osteoarthrosis of glenohumeral joints and left sacroiliitis FINAL WORKING DIAGNOSIS: Stage 2 multiple myeloma TREATMENT AND OUTCOMES: 1.Radiation and chemotherapy 2.Clamshell TLSO for lumbar lordosis 3.Simplifed exercise program: upright stationary cycle, overhead reach, back extension stretches. Focus on core strength, hip flexibility. 4.Advance to stairs, pool running, captain’s chair, bird dog, and abdominal press 5.Avoid overhead lifting and compressive spine exercises 6.Treatment complicated by pulmonary embolism. 7.Tolerance of bending and lifting improved participation in household activities. 8.Goal: to return to weight lifting exercises and outdoor biking.

A Trend for Reduction of Immune Activation in the Management of Acute Low Back Pain by McKenzie Lumbar Spine Exercise and Sour Cherry Topical Analgesia: A Randomized Controlled Trial

A Trend for Reduction of Immune Activation in the Management of Acute Low Back Pain by McKenzie Lumbar Spine Exercise and Sour Cherry Topical Analgesia: A Randomized Controlled Trial

Immune responses following McKenzie lumbar spine exercise in individuals with acute low back pain: a preliminary study.

This study explores the immune responses following 4 weeks of McKenzie lumbar spine exercise in individuals with acute low back pain (ALBP). Fifteen patients with ALBP and 15 healthy individuals volunteered in this study. Ten ml of peripheral blood were obtained from each patient before and after exercise sessions, and from healthy individuals at the beginning of the study. Flow cytometric analysis was used to evaluate the frequencies of CD4+ T lymphocyte sub-populations and the intracellular cytokine expression within this cell population. Pain perceptions were obtained at baseline and following each week of exercise sessions. In comparison with healthy subjects there was an elevated frequency of memory (CD4+CD45RO+) T cells, helper inducer (CD4+CD29+) T cells, CD3+CD16+CD56+ T cells and a lower frequency of naïve/suppressor (CD4+CD45RA+) T cells at base line in back pain patients (p<0.05). After 4 weeks of McKenzie exercise sessions, pain intensity significantly decreased (p<0.05); however, there was no significant difference in the frequency of memory (CD4+CD45RO+) T cells, helper inducer (CD4+CD29+) T cells, CD3+CD16+CD56+ T cells and naïve/ suppressor (CD4+CD45RA+) T cells at base line relative to these cell populations after exercise sessions. The percentage of Pan (CD3+) T cells expressing IL-8 and TNF-α and the CD3+ T cells expressing the anti-inflammatory cytokine IL-4 increased significantly (p<0.05) following exercise sessions in comparison with baseline and healthy references. The reduction in pain scores did not correlate with elevated anti-inflammatory cytokines. McKenzie exercise sessions induced an immune activation state and simultaneously up regulated anti-inflammatory IL-4 cytokines that boost pain relief.

Effect of repetitive Mckenzie lumbar spine exercises on cardiovascular system

Background& Purpose:McKenzie exercises for the lumbar spine, which are done repeatedly, such as flexion in standing (FIS), extension in standing flexion in lying (FIL) & extension in lying (EIL) have been used in the management of low back pain for over three decades. The cardiovascular effects of exercises that involve postural stabilization, arm exercises and of exercises performed in lying are well known, but there are seldom studies performed to assess the cardiovascular effects of these commonly used McKenzie exercises. Therefore the study focused on evaluating the effects of 4 commonly used McKenzie exercises on the cardiovascular system.Methods: 80 subjects in the age group of 20-59 years were randomly assigned into 4 groups according to their age, such that such that each group comprised of an equal number of subjects & equal number of males & females. Each subject performed all the 4 exercises (FIS, EIS, FIL & EIL) for 10, 15 & 20 repetitions respectively. Heart rate, blood pressure & rate pressure product were recorded before & after each set of repetitions & after each type of exercise. Results: Repetitive McKenzie lumbar spine exercises had cardiovascular effects in apparently healthy subjects (both male & female). Exercises performed in lying were hemodynamically more demanding than that performed in standing, also exercises involving flexion of the lumbar spine elicited greater cardiovascular demand as compared to extension exercises i.e. FIL>EIL>FIS>EIS irrespective of the number of repetitions, 10, 15 or 20. The cardiovascular demand for a given subject increased as the number of repetitions increased, for all the 4 exercises. Conclusion: McKenzie exercises when done repetitively have cardiovascular effects in healthy subjects.