Types Of Low Back Pain Research Articles

Credibility, Accuracy, and Comprehensiveness of Internet-Based Information About Low Back Pain: A Systematic Review.

BackgroundLow back pain (LBP) affects millions of people worldwide, and misconceptions about effective treatment options for this condition are very common. Websites sponsored by organizations recognized as trustworthy by the public, such as government agencies, hospitals, universities, professional associations, health care organizations and consumer organizations are an important source of health information for many people. However, the content of these websites regarding treatment recommendations for LBP has not been fully evaluated.ObjectiveThis study aimed to determine the credibility, accuracy, and comprehensiveness of treatment recommendations for LBP in noncommercial, freely accessible websites.MethodsWe conducted a systematic review of websites from government agencies, hospitals, universities, professional associations, health care organizations and consumer organizations. We conducted searches on Google. Treatment recommendations were coded based on the 2016 National Institute for Health and Care Excellence (NICE) guidelines and the 2017 American College of Physicians guideline on LBP. Primary outcomes were credibility of the website (4-item Journal of the American Medical Association benchmark), accuracy (proportion of website treatment recommendations that were appropriate), and comprehensiveness of website treatment recommendations (proportion of guideline treatment recommendations that were appropriately covered by a website).ResultsWe included 79 websites from 6 English-speaking countries. In terms of credibility, 31% (25/79) of the websites clearly disclosed that they had been updated after the publication of the NICE guidelines. Only 43.28% (487/1125) website treatment recommendations were judged as accurate. Comprehensiveness of treatment recommendations correctly covered by websites was very low across all types of LBP. For acute LBP, an average of 28% (4/14) guideline recommendations were correctly covered by websites. Websites for radicular LBP were the least comprehensive, correctly covering an average of 16% (2.3/14) recommendations.ConclusionsNoncommercial freely accessible websites demonstrated low credibility standards, provided mostly inaccurate information, and lacked comprehensiveness across all types of LBP.

Effectiveness of Slump Stretching on Low Back Pain: A Systematic Review and Meta-analysis.

The slump test is a type of neurodynamic test that is believed to evaluate the mechanosensitivity of the neuromeningeal structures within the vertebral canal. The objective of this review was to investigate the effectiveness of slump stretching on back pain and disability in patients with low back pain (LBP). We searched eight electronic databases (PubMed/Medline, Scopus, Ovid, CINAHL, Embase, PEDro, Google Scholar, CENTRAL). The publication language was restricted to English, and we searched the full time period available for each database, up to October 2017. Our primary outcomes were pain and disability, and the secondary outcome was range of motion (ROM). We identified 12 eligible studies with 515 LBP patients. All included studies reported short-term follow-up. A large effect size (standardized mean difference [SMD] = -2.15, 95% confidence interval [CI] = -3.35 to -0.95) and significant effect were determined, favoring the use of slump stretching to decrease pain in patients with LBP. In addition, large effect sizes and significant results were also found for the effect of slump stretching on disability improvement (SMD = -8.03, 95% CI = -11.59 to -4.47) in the LBP population. A qualitative synthesis of results showed that slump stretching can significantly increase straight leg raise and active knee extension ROM. There is very low to moderate quality of evidence that slump stretching may have positive effects on pain in people with LBP. However, the quality of evidence for the benefits of slump stretching on disability was very low. Finally, it appears that patients with nonradicular LBP may benefit most from slump stretching compared with other types of LBP.

The prevalence of low back pain in the emergency department: a descriptive study set in the Charles V. Keating Emergency and Trauma Centre, Halifax, Nova Scotia, Canada

BackgroundWhile low back pain is a common presenting complaint in the emergency department, current estimates from Canada are limited. Furthermore, existing estimates do not clearly define low back pain. As such, our main objective was to estimate prevalence rates of low back pain in a large Nova Scotian emergency department using various definitions, and to describe characteristics of individuals included in these groups. An additional objective was to explore trends in low back pain prevalence in our emergency department over time.MethodsWe conducted a cross sectional analysis using six years of administrative data from our local emergency setting. We first calculated the prevalence and patient characteristics for individuals presenting with any complaint of back pain, and for groups diagnosed with different types of low back pain. We explored prevalence over time by analyzing presentation trends by month, day of the week and hour of the day.ResultsThe prevalence of patients presenting to the emergency department with a complaint of back pain was 3.17%. Individuals diagnosed with non-specific/mechanical low back pain with no potential nerve root involvement made up 60.8% of all back pain presentations. Persons diagnosed with non-specific/mechanical low back pain with potential nerve root involvement made up 6.7% of presentation and the low back pain attributed to secondary factors accounted for 9.9% of back pain presentations. We found a linear increase in presentations for low back pain over the study period.ConclusionThis is the first multi-year analysis assessing the prevalence of low back pain in a Canadian emergency department. Back pain is a common presenting complaint in our local emergency department, with most of these persons receiving a diagnosis of non-specific/mechanical low back pain with no potential nerve root involvement. Future research should concentrate on understanding the management of low back pain in this setting, to ensure this is the proper setting to manage this common condition.

EVIDENCE- BASED ACTION PLAN OF REHAB CENTERS FOR PATIENTS WITH LOW BACK PAIN

Back pain is common and many people experience long term problems. The goals of physical therapy are to decrease back pain, increase function and provide health education. Low back pain (LBP) is pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, with or without sciatica, and is defined as chronic when it persists for 12 weeks or more. The study objective is to enhance the compliance of Patients to Rehabilitation Regimen to achieve better prognosis and treatment outcomes. The respondents of the study were low back pain patients from three (3) different rehabilitation centers, Rehabilitation Medicine of Cebu Velez General Hospital, Rehab Solutions Incorporated in Perpetual Succor Hospital and Rehab Medics of Chong Hua Hospital. To answer the mean characteristics of the respondents, descriptive statistical procedures were utilized. To determine the differentiating factors, discriminant analysis was used while logistic regression was utilized to determine the predictors of therapy outcomes. This study utilized a quantitative descriptive research design which enabled the researcher to determine if there exists a relationship between the therapy outcomes as the dependent variable to the demographic, employment and clinical variables identified in the study. It can therefore be concluded that of the twelve (12) variables explored, only four (4) clinical variables are significant predictors of low back pain treatment outcomes. These are (a) compliance to treatment regimen, (b) Co-morbidity, (c) Surgical history and (d) Type of low back pain. The rehabilitation centers would take into consideration the results of the study and that they will find a better way encourage compliance of patients to rehabilitation treatment utilizing the proposed evidence-based action plan. With this development, the problem with regard to compliance and result of rehabilitation treatment will be addressed and will greatly contribute to overall wellness and successful outcome of low back pain treatment. It is therefore imperative that physical therapists should focus on these clinical variables in treating for patients with LBP and recommended that rehabilitation centers should follow the evidence-based action plan.

The Reliability and Validity of Gluteal Endurance Measures (GEMs)

Background: The gluteals have unique morphology related to muscle endurance, including moderate fiber sizes and a majority of Type I endurance fibers. Evidence suggests gluteal endurance is related to several classifications of low back pain, work-related musculoskeletal disorders, running kinematics, balance, and pelvic posture. However, there exists a lack of reliable and valid measures specific to gluteal endurance. Purpose: This study aims to examine the intra- and inter-rater reliability of two gluteal endurance measures (GEMs) convenient for clinical use. It also aims to provide validity for the two measures by using electromyography, recording subjective reasons for task failure, and analyzing the differences between subjects with and without recurrent low back pain (LBP). Study Design: Cross-Sectional. Methods: Sixty-eight males and females aged 18-35 years were recruited from a university population (51 without recurrent LBP, and 17 with recurrent LBP). Electromyography electrodes were placed on subjects’ dominant gluteus maximus and gluteus medius, and each subject performed three trials of each of the two GEMs, GEM-A (abduction endurance) and GEM-B (bridging endurance). Hold times, EMG median frequency (MF) data, and subjective reasons for task failure were analyzed. Results: Both GEMs demonstrated high intra-rater reliability (ICC = 0.87-0.94) and inter-rater reliability (ICC = 0.99). The MF slopes of both GEMs were also highly reliable (ICC = 0.70-0.83). Mean hold times were 104.83 ± 34.11 seconds for GEM-A (abduction endurance) and 81.03 ± 24.79 seconds for GEM-B (bridging endurance). No statistically significant difference was found between subjects with and without recurrent LBP. Median frequency data validated gluteus maximus and gluteus medius fatigue during both measures. Posterolateral hip (gluteal) fatigue was reported as the primary reason for task failure in 93% and 86% of subjects for GEM-A and GEM-B, respectively. Conclusion: This seminal study of GEM-A (abduction endurance) and GEM-B (bridging endurance) found both measures to be reliable and valid measures of gluteal endurance. Further examination of the GEMs in samples with different types of LBP or hip pain is recommended.

The association between back muscle characteristics and pressure pain sensitivity in low back pain patients.

Some low back pain (LBP) patients recover after every pain episode whereas others develop chronicity. Research indicates that the amount of atrophy and fat infiltration differs between patients with LBP. Also enhanced pain sensitivity is present only in a subgroup of LBP patients. The relationship between pain sensitivity and muscular deformations in LBP, is however unexplored. This study examined the association between pressure pain sensitivity and the structural characteristics of the lumbar muscles in three different groups of non-specific LBP patients. This cross-sectional study examined the total cross-sectional area (CSA), fat CSA, muscle CSA and muscle fat index (MFI) of the lumbar multifidus (MF) and erector spinae (ES) at level L4 by magnetic resonance imaging in 54 patients with non-specific LBP (23 recurrent LBP, 15 non-continuous chronic LBP and 16 continuous chronic LBP). Pressure pain thresholds were measured at four locations (lower back, neck, hand and leg) by a manual pressure algometer and combined into one "pain sensitivity" variable. As a primary outcome measure, the association between pain sensitivity and muscle structure characteristics was investigated by multiple independent general linear regression models. Secondly, the influence of body mass index (BMI) and age on muscle characteristics was examined. A positive association was found between pain sensitivity and the total CSA of the MF (p=0.006) and ES (p=0.001), and the muscle CSA of the MF (p=0.003) and ES (p=0.001), irrespective of the LBP group. No association was found between pain sensitivity and fat CSA or MFI (p>0.01). Furthermore, a positive association was found between BMI and the fat CSA of the MF (p=0.004) and ES (p=0.006), and the MFI of the MF (p<0.01) and ES (p=0.003). Finally, a positive association was found between age with the fat CSA of the MF (p=0.008) but not with the fat CSA of the ES (p>0.01), nor the MFI of the MF (p>0.01) and ES (p>0.01). A higher pain sensitivity is associated with a smaller total and muscle CSA in the lumbar MF and ES, and vice versa, but results are independent from the LBP subgroup. On the other hand, the amount of fat infiltration in the lumbar muscles is not associated with pain sensitivity. Instead, a higher BMI is associated with more lumbar fat infiltration. Finally, older patients with LBP are associated with higher fat infiltration in the MF but not in the ES muscle. These results imply that reconditioning muscular tissues might possibly decrease the pain sensitivity of LBP patients. Vice versa, therapy focusing on enhancement of pain sensitivity might also positively influence the CSA and that way contribute to the recovery of LBP. Furthermore, the amount of lumbar muscle fat seems not susceptible to pain sensitivity or vice versa, but instead a decrease in BMI might decrease the fat infiltration in the lumbar muscles and therefore improve the muscle structure quality in LBP. These hypothesis apply for all non-specific LBP patients, despite the type of LBP.

Central Sagittal Angle of the Sacrum as a New Risk Factor for Patients with Persistent Low Back Pain after Caesarean Section.

Study DesignRetrospective.PurposeThis study investigated the possible association of persistent low back pain (LBP) with caesarean section (CS) under spinal anesthesia.Overview of LiteratureMany women suffer from LBP after CS, which is commonly performed under spinal anesthesia. However, this type of LBP is poorly understood, and there is poor consensus regarding increased risk after spinal anesthesia.MethodsWe examined two groups of patients who underwent cesarean delivery under spinal anesthesia. Group I included patients who presented to a neurosurgical clinic complaining of LBP for at least 6 months. Group II was a control group with patients without LBP. We analyzed clinical and sagittal angle parameters, including age, body mass index, parity, central sagittal angle of the sacrum (CSAS), and sacral slope (SS).ResultsFifty-three patients participated in this study: 23 (43.1%) in Group I and 30 (56.9%) in Group II. Non-parametric Mann–Whitney U-tests showed that age, parity, and CSAS significantly differed between the two groups at 6 months.ConclusionsAge, parity, and CSAS appear to be associated with increased risk for LBP after CS under spinal anesthesia. Future prospective studies on this subject may help validate our results.

Sagittal lumbopelvic alignment in patients with low back pain and the effects of a high-load lifting exercise and individualized low-load motor control exercises—a randomized controlled trial

Background ContextAssessment of posture and lumbopelvic alignment is often the main focus in the classification and treatment of patients with low back pain (LBP). However, little is known regarding the effects of motor control interventions on objective measures of lumbopelvic alignment. PurposeThe primary aim of this study was to describe the variation of sagittal lumbopelvic alignment in patients with nociceptive mechanical LBP. The secondary aim was to compare the effects of a high-load lifting exercise (HLL) and low-load motor control exercises (LMC) on the change in lumbopelvic alignment with a special emphasis on patients with high and low degrees of lumbar lordosis (lu) and sacral angle (sa). Study DesignThis study is a secondary analysis of a randomized controlled trial evaluating the effects of HLL and LMC. Patient SamplePatients from the primary study, that is, patients categorized with nociceptive mechanical LBP, who agreed to participate in the radiographic examination were included (n=66). Outcome MeasuresLateral plain radiographic images were used to evaluate lumbopelvic alignment regarding the lumbar lordosis and the sacral angle as outcomes, with posterior bend as an explanatory variable. Materials and MethodsThe participants were recruited to the study from two occupational health-care facilities. They were randomized to either the HLL or the LMC intervention group and offered 12 supervised exercise sessions. Outcome measures were collected at baseline and following the end of intervention period 2 months after baseline. Between- and within-group analyses of intervention groups and subgroups based on the distribution of the baseline values for the lumbar lordosis and the sacral angle, respectively (LOW, MID, and HIGH), were performed using both parametric and non-parametric statistics. ResultsThe ranges of values for the present sample were 26.9–91.6° (M=59.0°, standard deviation [SD]=11.5°) for the lumbar lordosis and 18.2–72.1° (M=42.0°, SD=9.6°) for the sacral angle. There were no significant differences between the intervention groups in the percent change of eitheroutcome measure. Neither did any outcome change significantly over time within the intervention groups. In the subgroups, based on the distribution of respective baseline values, LOWlu showed a significantly increased lumbar lordosis, whereas HIGHsa showed a significantly decreased sacral angle following intervention. ConclusionsThis study describes the wide distribution of values for lumbopelvic alignment for patients with nociceptive mechanical LBP. Further research is needed to investigate subgroups of other types of LBP and contrast findings to those presented in this study. Our results also suggest that retraining of the lumbopelvic alignment could be possible for patients with LBP.

Patient-Induced Reaction Forces and Moments Are Influenced by Variations in Spinal Manipulative Technique.

An in vivo biomechanical study. The aim of the present study was to quantify and compare the reaction loads for two spinal manipulation therapy (SMT) procedures commonly used for low back pain using a biomechanical computer model. Contemporary computer-driven rigid linked-segment models (LSMs) have made it feasible to analyze low back kinetics and kinematics during various activities including SMT procedures. Currently, a comprehensive biomechanical model analyzing actual differences in loading effects between different SMT procedures is lacking. Twenty-four healthy/asymptomatic participants received a total of six SMT applications, representing all combinations of two similar SMT procedures within three patient hip flexion angles. All contact forces, patient torso kinematics, and inertial properties were entered into a dynamic three-dimensional LSM to calculate lumbar reaction forces and moments. Peak net applied force along with the maximums, minimums, and ranges for each component of the three-dimensional reaction force and moment vectors during each SMT procedure was analyzed. One specific SMT technique (lumbar spinous pull) produced greater maximum anterior-posterior reaction force and both lateral bending and axial twisting reaction moments compared to the other technique (lumbar push procedure [all P ≤ 0.034]). SMT trials without hip flexion had lower maximum medial-lateral reaction force and range compared to those with 45 and 90 degrees of hip flexion (all P ≤ 0.041). There were no interactions between procedure and hip angle for any of the dependent measurements. The technique used to apply SMT and the participant's initial hip orientation induced significantly different actions on the low back. These findings and future research can improve patient outcomes and safety by informing clinicians on how to best use SMT given specific types of low back pain. 2.

『의학입문(醫學入門)』의 인용서적으로 살펴본 요통(腰痛)의 분류와 기준

Objectives : In order to find how reference books of Yi Xue Ru Men reflect the classification and criterion for low back pain(LBP). Methods : From reference books of Yi Xue Ru Men, select the texts on classification and criterion for LBP. Results : According to the causes of LBP, Chao Yuan Fang(巢元方) in Sui Dynasty assorted to 5 types of LBP at the very first. Chen Wu Ze(陳無擇) in Song Dynasty made 7 divisions by external, internal, and non-external, non-internal causes. According to the pulse of LBP, Yan Yong He(嚴用和) first categorized 4 groups, Zhu Zhen Heng(朱震亨) added another 4 groups. Aside from this standard, Zhu(朱震亨) adopted the cause standard. Depending on Yunqi(運氣), Lou Ying(樓英) classified 5 types. But his classification had been not adopted by any TCM books. According to symptom of 6 varieties(六變), Zhang Jie Bin(張介賓) assorted external(表), internal(裏), deficiency(虛), sufficiency(實), cold(寒) and heat(熱), add 2 groups besides them. But his categorization did not reflect Yi Xue Ru Men. Li Chan(李梴), the author of this book chose causes and pulse classification standards that Zhu Zhen Heng had adopt. Conclusions : In the side of classification and criterion for LBP, Li Chan first divided 2 group, external and internal injury. After it he subdivided both groups to 10 subgroup. His classification is similar to Chen(陳無擇)'s, but actually followed the classification for external and internal injury that was invented by Li Dong Yuan(李東垣).

Traction Table Effect on Lumbar Spine by Using The Finite Element Method and Modeling

Introduction: Low back pain is one of the most important problem that exists worldwide. About 80 to 90% of low back pains are acute. Herniated disc between L4-L5 vertebrae and disc rupture are the main reasons for this type of low back pain. Treatment for this type of back pain is stretching the spine with traction table. Traction table helps low back pain treatment by increasing the height of discs and putting distance between facet joints. Materials and Methods: In this study, 3D model of the lumbar spine of a 31-year-old and 83 kg female was made by using CT scan images and MIMICS10.01 software. This model was imported in Abaqus6.11 software for analysis. In this software, materials properties of spine segments were modeled and traction table loading was applied to the model. Then results were compared with previous experimental studies.The goal of this study was presented a method to evaluated the traction table effect on spine and this method presented by 3D modeling and using finite element method. Results: After loading was applied in Abaqus software, the displacement of discs between L4-L5 and L3-L4 vertebrae was obtained 2.59 mm and 1.81mm, respectively. The results were validated by comparing with previous experimental studies, in which discs displacement were analyzed by using MRI and CT scan images before and after traction. Conclusion: Traction table is effective on discs displacement and reducing the back pain. Key Words: Traction Table, Modeling, Low Back Pain, Finite Element

Response to "commentary on lumbar lordosis in chronic mechanical back pain".

Dear Editor, We are extremely grateful for the opportunity to discuss the details that have been raised by Kothari et al. Although Kothari et al. have conducted an intelligent review, we would like to address a few points raised in their research. Firstly, they have suggested using magnetic resonance imaging to examine disc conditions and exclude patients with advanced disc degeneration. They also believed that we should have excluded patients with paraspinal muscle spasm and hamstring tightness from our study which was not done but we do not think so. Our response to this comment is somewhat hidden in the definition of mechanical low back pain which is the pain that does not receive a specific diagnosis. The majority of patients with mechanical low back pain have a multifactorial cause for their problems, which includes deconditioning; poor muscle recruitment; emotional stress; and changes associated with aging and injury such as disc degeneration, arthritis, and ligamentous hypertrophy. This type of lower back pain can be given many names; a few of the common names for this condition are simple backache, nonspecific lower back pain, lumbar strain, and spinal degeneration [1]. Hence, conditions that Kothari et al. listed as part of the exclusion criteria are some instances of probable causes for mechanical lower back pain. Secondly, in the article, Kothari et al. correctly pointed to the need to present values of the Oswestry Disability Index (ODI). The mean value of ODI was 30.51±13.75 (31.64±14.41 in females and 26.19±9.96 in males) and there was no significant correlation between the Oswestry Disability Questionnaire (ODQ) score and the degree of lumbar lordosis (Pearson's correlation coefficient; r=0.125, p=0.129). The mean value of lumbar lordosis (LL) in our sample was 44.69±11.43 degrees but 23 subjects had LL of more than 56.12 degrees and 20 subjects had LL that was less than 33.26 degrees. The mean ODI in patients in the outlier group (either LL greater than 56.12 degrees or less than 33.26 degrees) was 29.12±12.2 and the mean ODI in patients whose LL was within the average range was 31.02±14.29. The difference between these two groups was not statistically significant (independent samples test; p=0.45). Also, using oneway analysis of variance there was no significant statistical difference between any groups of patients who were out of range regarding the degree of lumbar lordosis (LL greater than 56.12 degrees or LL less than 33.26 degrees) and patients with an average range (p=0.38). Thirdly, we agree that our study has a skewed male to female ratio (F:M=119:31) which we should have mentioned as one of study limitations. However, we don't think that the ages of subjects will create an issue because osteoporosis mainly causes fractures in the upper spine and not the low back (except sacral insufficiency fractures). In addition, in the acute phase, patients usually experience pain in the upper back. Chronic spinal pain due to deformity caused by vertebral wedging and compression, as well as secondary ligamentous strain is often difficult to distinguish from disc deterioration. Chronic spinal pain can also be categorized as mechanical low back pain [2]. Fourthly, we agree with Kothari et al. that pelvic incidence and sacral slope are two of the other main sagittal spinopelvic parameters, which can potentially contribute to developing low back pain [3]. We have already noted this entry and mentioned that future studies should focus more on disability as the main consequence of low back pain when investigating the role of different spinopelvic parameters in chronic mechanical low back pain [4]. Thus, we recommend performing randomized trials to investigate whether there is a relationship between the various spinopelvic alignment parameters and the level of functional disability in patients suffering from chronic mechanical low back pain.

The impact of body weight and depression on low back pain in a representative population sample.

Low back pain (LBP), obesity, and depression are highly prevalent health conditions. We assessed the relative impact of body weight and depression on different types of LBP in a representative population sample. This is a cross-sectional study. Two thousand five hundred ten subjects aged 14-90 years were randomly selected from the German general population in 2012. Pain sites and duration of pain were assessed by the Widespread Pain Index( WPI), depression by the Beck Depression Inventory Primary Care Questionnaire, disability by the European Organization for Research and Treatment of Cancer questionnaire, and current body mass index (BMI, kg/m(2) ) by self-reported body weight and height. Widespread pain was defined by ≥7/19 pain sites in the WPI. Hierarchical logistic regression analyses were performed with different types of LBP as the dependent variable, and age, gender, lifetime employment status as a worker, number of pain sites, BMI, and depression as independent variables. One thousand six hundred eighty-seven (67.1%) of participants reported no pain. Five hundred six (20.2%) reported chronic LBP and 84 (3.3%) reported disabling chronic LBP. Age (odds ratio [OR] 1.05 [95% confidence interval {CI} 1.04-1.06]), BMI (OR 1.08 [95% CI 1.05.-1.11]), and depression (OR 1.38 [95% CI 1.30-1.49]) independently predicted chronic LPB compared with persons without pain. Age (OR 1.07 [95% CI 1.05-1.09]), BMI (OR 1.07 [95% CI 1.03-1.13]), and depression (OR 1.71 [95% CI 1.55-1.88]) independently predicted disabling chronic LPB compared with persons without pain. Age (OR 1.03 [95% CI 1.01-1.05]), widespread pain (OR 5.23 [95% CI 3.04-9.00), and depression (OR 1.34 [95% CI 1.16-1.55]) independently predicted disabling chronic LPB compared with persons with nondisabling chronic LBP. BMI and depression are modifiable risk indicators for chronic disabling LBP.

Efficacy of Low Level Laser Therapy in Lumbar Discopathy Pain (Randomized Controlled Study)

Introduction Finding evidence based and effective method of managing low back pain (LBP) has been always a major dilemma in the field of neuromusculoskeletal system. The focus of this investigation is to establish a treatment regime for the discopathy origin of LBP using low level laser (LLL). This type of LBP is the cause of a significant number of days of sick leave in many countries. LLLT has not yet been fully adopted as a treatment method. Results of studies on LLL suggest that it reduces pain by a range of physiologic responses, such as increase in b-endorphins and depolarization blockage of c-fiber afferent nerves. The purpose of this study is evaluating the effect of LLLT on LBP due to discopathy. Materials and Methods Patients A total of 42 patients between 25 and 65 years old recruited from out-patient clinics with complaints of lumbar chronic pain(at least 6 month). Randomized from all out-patients referred to our department were in both sex (female and male). The diagnosis by MRI and EMG, NCV was discopathy. Environment temperature was 25 degrees. Laser type: scanner semiconductor GA-AS 808 nm. With maximum power output of 400 MW and maximum energy density of 10 J/cm2. polaris2. Methods Subjects sampling selection was by randomization in two groups with 21 patients in each group. G1: LLLT + PT G2: PT Treatment protocol: 2 weeks, five sessions per week, time: 1600 to 1900, time of study: from October 1, 2011 to March 1, 2012. Tests: 1, Trigger point palpation pain. 2. VAS. 3, NHP: Nottingham health profile (NHP). 4, NPAINAD (nonverbal pain assessment in advanced dementia). Time of tests: 1, before treatment. 2, after 2 weeks (end of treatment). 3, follow-up: 2 weeks after end of treatment: First: first pain assessment: before treatment. Second: pain assessment after end of treatment (after 2 weeks). Third: pain assessment 2 weeks after end of treatment (follow-up). Results There was no significant difference between two groups before treatment. There was significant improvement in G1 at the end of treatment and 2 weeks after completion treatment ( p &lt; 0.01). G2: PT alone seemed to aid relieving pain significantly while G2: LLLT with PT had superior significant effect in reducing pain of discopathy within 2 weeks follow-up. G1 *1st and *2nd: p = 0.002 2nd and *3rd: p = 0.001 1st and 3rd: p = 0.001 G2 1st and 2nd: p = 0.005 2nd and 3rd: p = 0.018 1st and 3rd: p = 0.005 Conclusion Therapeutic laser offers a safe often effective, easily utilized primary or adjunctive therapy that is relatively cost effective for clinician and patient. LLLT is more effective in pain relief and in the improvement of functional ability and quality of life thus LLLT can be an important adjunct especially in patients with adverse side effects to drugs and invasive treatment. Disclosure of Interest None declared References Jamal AK, Yaacob WA, Din LB. A Chemical study on Phyllanthus Columnaris. European Journal of Scientific Research 2009;28(1):76-81 Kneebone WJ. Therapeutic laser for chronic low back pain. Practical Pain Management 2007;38–41 Hakgüder A, Birtane M, Gürcan S, Kokino S, Turan FN. Efficacy of low level laser therapy in myofascial pain syndrome: an algometric and thermographic evaluation. Lasers Surg Med 2003;33(5):339–343 Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc 2003;4(1):9–15 Logdberg-Andersson M, Mutzell S, Hazel A. Low level laser therapy (LLLT) of tendinitis and myofascial pains: a randomized, double-blind, controlled study. Laser Therapy 1997;9(2):79-85 Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 1990;13(4):227-236 Labbe RF, Skogerboe KJ, Davis HA, Rettmer RL. Laser photobioactivation mechanisms: in vitro studies using ascorbic acid uptake and hydroxyproline formation as biochemical markers of irradiation response. Lasers Surg Med 1990;10(2):201–207

Childhood and adult socio‐economic position and social mobility as determinants of low back pain outcomes

Low back pain (LBP) is a prevalent problem and tends to be socio-economically patterned. Relatively little is known about life-course socio-economic circumstances as determinants of different types of LBP. Our aim was to examine whether childhood and adult socio-economic position and social mobility are associated with radiating and non-specific LBP and sciatica. Data were derived from the Young Finns Study (n = 2231). Childhood socio-economic position was based on parental education, occupational class and family income at baseline in 1980. Data on own education and LBP outcomes were collected at the end of follow-up in 2007. Social mobility was based on parental and own education. Covariates were composed of age, parental body mass index and smoking. Both childhood and own socio-economic position remained associated with radiating LBP and sciatica after adjustments. However, the associations varied by socio-economic indicator and gender. Stable lower socio-economic position and downward mobility were associated with radiating LBP. Childhood socio-economic circumstances affect the risk of radiating LBP and sciatica in adulthood. To prevent low back disorders, early socio-economic circumstances need to be considered alongside own socio-economic position.

Prognostic factors of sciatica in the Canon of Avicenna

Prognosis studies are fast developing and very practical types of medical research. Sciatica is one of the common types of low back pain and identifying prognostic factors of the illness can help physicians and patients to choose best method of practice. The prognostic factors of sciatica are presented from the Canon of Avicenna, one of the most famous physicians in the history of medicine.

Does going to an amusement park alleviate low back pain? A preliminary study

BackgroundLow back pain is often called nonspecific pain. In this type of low back pain, various emotions and stress are known to strongly affect pain perception. The purpose of this study is to investigate how the degree of low back pain changes in people with chronic mild low back pain when they are inside and outside of an amusement park where people are supposed to have physical and psychological enjoyment.MethodsThe subjects were 23 volunteers (13 males and 10 females) aged 18 to 46 years old with a mean age of 24.0 years who had chronic low back pain. Visual analog scale (VAS) scores of low back pain and salivary amylase levels (kIU/L) of all subjects were measured at five time points: immediately after getting on the bus heading for the amusement park; 10 minutes, 1 hour (immediately after boarding the roller coaster), and 3 hours (immediately after exiting the haunted house) after arriving at the amusement park; and immediately before getting off the bus returning from the park.ResultsThe three VAS values in the amusement park (10 minutes, 1 hour, and 3 hours after arriving at the amusement park) measured were significantly lower (P < 0.05) when compared with the other two values measured immediately after getting on the bus heading for the amusement park and immediately before getting off the return bus. In salivary amylase levels, there were no statistically significant differences among the values measured at the five time points.ConclusionLow back pain was significantly alleviated when the subjects were in the amusement park, which demonstrated that enjoyable activities, though temporarily, alleviated their low back pain.

Is It Time to Rethink the Typical Course of Low Back Pain?

To determine the frequency and the characteristics of low back pain (LBP) recurrences. The research questions were as follows: (1) Are LBP recurrences common? (2) Do episodes worsen with multiple recurrences? (3) Does pain change location in any recognizable pattern during an episode? Single-page self-administered questionnaire. Thirty clinical practices (primary care, physical therapy, chiropractic, and surgical spine) in North America and Europe. A convenience sample of 589 respondents with LBP. There were no exclusions based on type of LBP, history of onset, or comorbidities. The survey was distributed during patients' assessment or initial treatment at their respective clinics. The survey queried the following: (1) the severity of original versus most recent episodes based on the following: pain intensity, interference with leisure and work activities, duration of episodes, and most distal extent of pain; and (2) changes in pain location within episodes. In response to research question 1, a previous episode was reported by 73%; of those, 66.1% reported their first episode lasted ≤3 months, 54% reported ≥10 episodes, and 19.4% reported >50 episodes. In response to research question 2, of those with recurrences, 61.1% reported that at least one of the survey domains was worse in recent episodes (P < .01) and only 36.9% reported that they were better; 20.5% were worse in all domains, whereas 8.6% were better or the same. In response to research question 3, the pain location changed during the episode in 75.6%; of these, 63.2% reported that their pain first spread distally before retreating proximally during recovery; there was a strong trend toward those reporting worsening episodes also reporting proximal-to-distal-to-proximal changes in pain location during their episodes (r = 0.132, P < .06). Recurrent LBP episodes were common and numerous. Recurrences often worsened over time. It seems inappropriate to characterize the typical course of LBP as benign and favorable.

Investigation of Abdominal Muscle Thickness Changes After Spinal Manipulation in Patients Who Meet a Clinical Prediction Rule for Lumbar Stabilization

Prospective case series. To investigate changes in abdominal muscle thickness with ultrasound imaging, after spinal manipulative therapy (SMT), in a subgroup of patients with low back pain (LBP) who meet a proposed clinical prediction rule for lumbar stabilization exercise (LSE). The characteristics of a subgroup of patients with LBP who respond clinically to LSE has been proposed. Although the pathoanatomical characteristics of this subgroup have not been determined, clinicians often assume that this type of LBP is related, in part, to neuromuscular deficits of the lateral abdominal muscles. Recent evidence suggests that SMT may facilitate abdominal muscle activity and, therefore, enhance exercises targeting these deficits. Nineteen patients (mean age ± SD, 32.5 ± 7.8 years; 11 female) with LBP, who met the criteria for LSE, underwent ultrasound imaging of the transversus abdominis (TrA) and internal oblique (IO) muscles before, immediately after, and 3 to 4 days after lumbopelvic SMT. Measurements of resting thickness, contracted thickness during the abdominal drawing-in maneuver, and percent thickness change from rest to contraction of the TrA and IO muscles were analyzed with repeated-measures analysis of variance. Numeric pain rating scale and Oswestry Disability Index data were also collected. No significant differences in resting, contracted, or percent thickness change in the TrA or IO were found over the 3 time periods. There were statistically significant reductions in numeric pain rating scale and Oswestry Disability Index scores, but mean differences failed to meet the minimal clinically important difference. The results provide preliminary evidence that TrA and IO muscle resting and contracted thicknesses do not change post-SMT in patients with LBP in the LSE subgroup. In addition, while reductions in pain and disability were noted, they were not clinically meaningful.

Indicators of adherence to physiotherapy attendance among Saudi female patients with mechanical low back pain: a clinical audit

BackgroundAmong current musculoskeletal interventions used to treat low back pain (LBP), physiotherapy exercise has the highest evidence of effectiveness in avoiding recurrence and chronic disability. However, effectiveness of physiotherapy is thought to be directly related to the patients' adherence to physiotherapy. Since adherence is reported to be directly influenced by socio-cultural factors, this study was conducted to investigate factors related to patients' adherence in a group of Saudi female patients with LBP.MethodsA retrospective chart review was conducted on female LBP patients referred to the department of physiotherapy at a local tertiary hospital over a 12 month period. A total of 98 charts were reviewed. Two physiotherapists specialized in musculoskeletal rehabilitation collected information from the medical files. Data were classified in three categories: patients' personal demographics, patients' medical condition and history, and type of physiotherapy administered. Contingency tables and chi-square test were computed to test for differences in proportions. Spearman rank correlation coefficient was calculated to examine relationships among variables.ResultsSubjects who attended their scheduled appointments were classified as adherent (40%), and those who failed to attend 2 consecutive scheduled appointments and got discharged were classified as non-adherent (60%). Factors that significantly correlated with adherence included: age (r = 0.7, p < 0.05), initial pain intensity (r = 0.5, p < 0.05), and subjective report of improvement (r = 0.7, p < 0.01). Adherence did not correlate with the type of LBP, patient occupation, experience or nationality of the physiotherapist.ConclusionThis study reveals an alarming level of non-adherence to physiotherapy among patients with LBP. It remains unclear as to what level of adherence is required to achieve beneficial effect of treatment. It is quite evident however, that early withdrawal from treatment would not allow the therapeutic benefits of the treatment to be realized. Future research should be directed toward developing strategies to improve adherence.