Types Of Low Back Pain Research Articles

An accurate validation of a computational model of a human lumbosacral segment

Clinical studies have recently documented that there is sufficient evidence to suggest that abnormal motion may be an indicator of abnormal mechanics of the spine and, therefore, may be associated with some types of low-back pain. However, designating a motion as abnormal requires knowledge of normal motions. This work hence aims to develop an accurate computational model to simulate the bio-mechanical response of the whole lumbosacral spinal unit (L1–S1) under physiological loadings and constraint conditions. In order to meet this objective, computed tomography (CT) scanning protocols, finite element (FE) analysis and accurate constitutive modelling have been integrated. Then the ranges of motion (ROM) under flexion, extension and lateral bending moment were measured and compared with experimental data, finding an excellent agreement. In particular, the ability of the model to reproduce the relative rotation between each couple of vertebrae was proved. Finally, the shear stresses for the most extreme load cases were reported in order to predict which are the most risky conditions and where the maximum damage would be located. The results indicate that the greater values of the stresses were located at L4–S1 levels just in the interfaces between disc and vertebrae across the posterior and posterolateral zone. This result can be clinically correlated with the existence of damage exactly where the stresses were maximal in the proposed finite element model.

Low Back Pain During Labor and Related Factors

A substantial proportion of women in labor suffer from low back pain, yet this issue has only been specifically evaluated in a few Western studies. The purpose of this research was to (1) describe the following characteristics of low back pain during labor: prevalence, anatomic region(s) affected, type, pattern, intensity trend, effective interventions, and exacerbating factors; (2) identify the factors relating to intrapartum low back pain in Taiwan women. A correlational design with repeated measures was used to conduct this investigation. Ninety-three low-risk women in labor were recruited from a medical center in central Taiwan. Low back pain was repeatedly measured during the latent phase (cervix dilated 2-4 cm), early active phase (cervix dilated 5-7 cm), and late active phase (cervix dilated 8-10 cm) of labor. Data were analyzed using descriptive statistics, repeated measurement ANOVA, and logistic regression. The results showed as many as 75.3% of the participants suffered episodes of low back pain during labor. The mean pain scores were 36.66-76.20 in the various stages of labor. Pain intensified as labor progressed. The location of the pain also changed with the progression of labor. The type of low back pain in 54.29% of women in labor was "muscle soreness and pain"; The pattern of pain in 45.71% women was continuous. Massage was chosen as the most effective intervention to alleviate low back pain by 65.3% of women. The women in labor who suffered from low back pain during pregnancy (OR = 3.23; p < .01) and had greater body weight when hospitalized (OR = 1.13; p = .02) were most likely to be in the low back pain group. In conclusion, our study demonstrates low back pain intensified with the progression of labor, suggesting early prevention is necessary, especially in the case of women who had low back pain during pregnancy and heavier body weight when hospitalized.

Biomechanical strains and low back disorders: quantifying the effects of the number of years of exposure on various types of pain

Objective: To assess the effects of duration of exposure to biomechanical strains on various types of low back pain (LBP). Methods: The population study was a random sample from the...

Effectiveness of a specific mobilisation treatment on a certain type of low back pain

Effectiveness of a specific mobilisation treatment on a certain type of low back pain

Differences in Measurements of Lumbar Curvature Related to Gender and Low Back Pain

Cross-sectional. To test the assumption that postural alignment and gender have a bearing on the specific type of low back pain (LBP) a person manifests. Measurements of static sagittal lumbar curvature are used by clinicians in the management of patients with LBP, but no investigator has reported differences in curvature related to specific categories of LBP. We used a computer-interfaced, 3-D, electromechanical digitizer to derive curvature angles for the region of the spine between T12-L1 and S2. Trained clinicians examined the subjects and determined their LBP diagnoses. We used t tests to examine differences in curvature between women and men, those with and those without LBP, and those in 4 different categories of LBP. We used chi2 to examine the relationship between gender and LBP category. Lumbar curvature angle (lordosis) was 13.2 degrees larger for women than for men (t = 6.74; P<.01). There was no difference in lumbar curvature between people with undifferentiated LBP and people without LBP. There were differences in lumbar curvature between people in various categories of LBP, for example, subjects in the lumbar-rotation-with-extension category had 8.4 degrees more lumbar curvature than subjects in the lumbar-rotation-with-flexion category (t = 2.16; P<.05). Based on the frequency distributions, there was a significant relationship between gender and LBP category (chi2 = 10.19; P<.01). Measurements of lumbar curvature should be expected to differ between men and women and may be related to different types of low back pain.

Lumbosacral transitional vertebra: relation to disc degeneration and low back pain.

Cross-sectional magnetic-resonance imaging (MRI) study. OBJECTIVE To investigate the relation of the lumbosacral transitional vertebra to signs of disc degeneration in MRI and to low back pain (LBP). An association between the transitional vertebra and herniation in the disc above has been found in patients with LBP, but knowledge of the relation to other degenerative disc changes detected in MRI and to LBP is lacking. MR images of the lumbar spine of 138 middle-aged working men and 25 healthy young men were evaluated. The presence and type of lumbosacral transitional vertebra and of degenerative changes in intervertebral discs were evaluated. The history of low back symptoms was obtained with a questionnaire from the middle-aged men. The prevalence of transitional vertebra was 30%. Transitional vertebra was associated with an increased risk of degenerative changes in the disc above among the young men and with a decreased risk in the disc below among the middle-aged men. Transitional vertebra, symmetric or asymmetric, was not associated with any type of LBP in the middle-aged men. Lumbosacral transitional vertebra increases the risk of early degeneration in the upper disc. This effect seems to be obscured by age-related changes in the middle age. The degenerative process is slowed down in the lower disc. For these effects, the presence of a transitional vertebra should be noticed when morphologic methods are used in research on lumbosacral spine. Transitional vertebra is not associated with any type of LBP.

Study on lower back pain in home helpers and development of materials for occupational health education

People who are engaged in home health care services often have to transfer clients while in a half standing posture using repetitious movement including gravitational changes. Transferring heavy patients at homes for the severely mental and physical handicapped is equivalent to the care giving work, listed in the "guideline for prevention of lower back pain in work places" (1994/9/6). The purpose of this study was to investigate incidences of lower back pain and injuries among home helpers as well as to determine the relationship between their level of protective knowledge and prevalence of lower back pain. The results of the study revealed that home helpers complained of a mild type of lower back pain. Although almost all of them had the protective knowledge for lower back injuries that was taught in their training courses, they still felt the need for more knowledge through continuous education regarding protective measures for lower back injuries and pain. Regarding the method of teaching, they want to learn by TV programs, books, texts and self-learning materials. Few of them wanted to learn by computer assisted instructions or the internet. Based upon the results of this study, we have developed new teaching materials for home helpers which explain adequate postures in home care through utilizing their protective knowledge to avoid lower back pain.

Personal and occupational predictors of sciatica in the GAZEL cohort.

The objectives of this prospective study were to investigate personal and occupational predictors of sciatica and to compare the risk factors for sciatica and those for low back pain without sciatica. The study analysed data from 841 men, initially free from low back pain, who were followed for 2 years. Subjects were participants in the French GAZEL cohort of employees of the national electricity and gas company. The predictive factors for sciatica and low back pain without sciatica were compared with a polytomous model. Height and driving were predictors only for sciatica, and bending forward and backward at work was a predictor only for low back pain without sciatica. The odds ratio (OR) for sciatica associated with 'height >180 cm' was 3, with a 95% confidence interval (CI) of 1.4-6.5; for driving >2 h daily it was 2 (CI = 0.94-4.10) and for driving >2 h several days a week 2.7 (CI = 1.20-6.10). This study confirmed that height and driving are risk factors for sciatica and that sciatica has specific predictors different from those for other types of low back pain. Future studies should consider sciatica separately from these.

Evidence for Transcutaneous Electrical Nerve Stimulation in the Management of Low Back Pain?

Low back pain is a huge burden on society and the health care system, and cost the UK over £1.5 billion in 1998 alone. One of the modalities available to treat this condition is transcutaneous electrical nerve stimulation (TENS), a form of electrotherapy that is inexpensive and widely used by clinicians and patients alike for many conditions including pain relief. The aim of this review was to determine whether TENS is an effective treatment for pain relief in people with low back pain. This paper outlines the evidence for the use of TENS for low back pain, and recommends that future research should try to map specific TENS parameters with each of the different types of low back pain.

Individual factors, occupational loading, and physical exercise as predictors of sciatic pain.

In this prospective study, a cohort of 2077 workers free of sciatic pain and another cohort of 327 workers with severe sciatic pain were followed up for 1 year. To evaluate the effects of different risk factors on the incidence and persistence of sciatic pain. Sciatic pain seems to differ from other types of low back pain in terms of etiology, occurrence, and prognosis. Yet only a few studies of sciatic pain exist. The role of individual characteristics, occupational loading, and participation in different sports has rarely been assessed in a study with a prospective design among a working population. The subjects of this study, Finnish forest industry workers, replied to a modified version of the Nordic Questionnaire at the baseline of this study and after 1 year. The effects of the predictors on the 1-year incidence and persistence of sciatic pain were studied with multivariable logistic regression modeling. Greater age, mental stress, smoking of long duration, and work-related twisting of the trunk increased the risk of incidental sciatic pain. Joggers had a lower risk for incidental sciatic pain, but a higher risk for persistent symptoms. Walking was positively associated with the risk of incidental pain. Greater age, mental stress, former smoking, jogging, and poor job satisfaction increased the risk for persistent severe sciatic pain. The findings from this study suggest that mental stress and smoking are independent risk factors for incidental sciatic pain. Overall physical exercise and most of the sports activities, except jogging and walking, had no effect on sciatic pain. Physical workload factors seemed to be more involved in the onset of sciatic pain, whereas psychosocial factors were related to the persistence of symptoms.

LOW BACK PAIN IN PORT MACHINERY OPERATORS

The occurrence of several types of low back pain (LBP) was investigated by a standardized questionnaire in a group of 219 port machinery operators exposed to whole-body vibration (WBV) and postural load and in a control group of 85 maintenance workers employed at the same transport company. The group of port machinery operators included 85 straddle carrier drivers, 88 fork-lift truck drivers, and 46 crane operators. The vector sum of the frequency-weighted r.m.s. acceleration of vibration measured on the seatpan of port vehicles and machines averaged 0·90 m/s2 for fork-lift trucks, 0·48 m/s2 for straddle carriers, 0·53 m/s2 for mobile cranes, and 0·22 m/s2 for overhead cranes. The 12-month prevalence of low back symptoms (LBP, sciatic pain, treated LBP, sick leave due to LBP) was significantly greater in the fork-lift truck drivers than in the controls and the other two groups of port machinery operators. After adjusting for potential confounders, the prevalence of low back symptoms was found to increase with the increase of WBV exposure expressed as duration of exposure (driving years), equivalent vibration magnitude (m/s2), or cumulative vibration exposure (yr m2/s4). An excess risk for lumbar disc herniation was observed in the port machinery operators with prolonged driving experience. In both the controls and the port machinery operators, low back complaints were strongly associated with perceived postural load assessed in terms of frequency and/or duration of awkward postures at work. Multivariate analysis showed that vibration exposure and postural load were independent predictors of LBP. Even though the cross-sectional design of the present study does not permit firm conclusions on the relationship between WBV exposure and low back disorders, the findings of this investigation provide additional epidemiological evidence that seated WBV exposure combined with non-neutral trunk postures, as while driving, is associated with an increased risk of long-term adverse health effects on the lower back.

Chiropractic technique procedures for specific low back conditions: Characterizing the literature

Background: Many original clinical trials and several review papers have come to the conclusion that manipulation is safe and effective for the treatment of low back pain. However, it is necessary to determine which specific types of manipulation and nonmanipulative types of chiropractic adjustive care are most effective for particular types of low back pain across both tissue-specific and functional classifications. Objective: To characterize the quantity and quality of literature gathered for an Expert Panel that was convened to rate various specific chiropractic adjustive procedures for the treatment of common types of low back pain, drawing on the clinical expertise of the panel members and the relevant literature. Study Design: Systematic review of treatment-specific, condition-specific trials, studies, and case reports of chiropractic care for low back pain. Methods: Computerized searching and hand searching were used to identify references in the medical and chiropractic literature pertaining to the chiropractic treatment of low back pain in which both the condition and specific treatment procedures were adequately described. This literature was then categorized according to a variety of characteristics and used by a panel to evaluate the specific procedures. Results: The 3 most studied adjustive procedures are side-posture high-velocity, low-amplitude; distraction (mostly flexion distraction); and mobilization, respectively. The clinical condition most commonly addressed by the included studies is low back pain. The procedure with the widest base of evidence support is side posture manipulation for low back pain. (J Manipulative Physiol Ther 2001;24:407-24)

Low back pain in relation to lumbar disc degeneration.

Cross-sectional magnetic resonance imaging (MRI) study. To study the relation of low back pain (LBP) to disc degeneration in the lumbar spine. Controversy still prevails about the relationship between disc degeneration and LBP. Classification of disc degeneration and symptoms varies, hampering comparison of study results. Subjects comprised 164 men aged 40-45 years-53 machine drivers, 51 construction carpenters, and 60 office workers. The data of different types of LBP, individual characteristics, and lifestyle factors were obtained from a questionnaire and a structured interview. Degeneration of discs L2/L3-L5/S1 (dark nucleus pulposus and posterior and anterior bulge) was assessed with MRI. An increased risk of LBP (including all types) was found in relation to all signs of disc degeneration. An increased risk of sciatic pain was found in relation to posterior bulges, but local LBP was not related to disc degeneration. The risks of LBP and sciatic pain were strongly affected by occupation. Low back pain is associated with signs of disc degeneration and sciatic pain with posterior disc bulges. Low back pain is strongly associated with occupation.

Experts' opinions on complementary/alternative therapies for low back pain

Background: Complementary/alternative therapies are used for low back pain more frequently than for any other indication, yet evidence for or against their efficacy is fragmentary. Notwithstanding this void, the high prevalence of such therapies drives their integration into our health care systems. Expert opinions on the use of complementary/alternative therapies for low back pain could therefore be helpful until more data from randomized, controlled trials become available. Objective: A postal questionnaire survey was designed to generate opinion from a systematically identified expert panel on the clinical effectiveness of complementary/alternative therapies for low back pain. Methods: Computerized searches were conducted to systematically identify by objective criteria 50 clinical experts on low back pain. Each panel member received a questionnaire to assess the perceived clinical effectiveness of complementary/alternative therapies for 4 defined categories of low back pain. Results: For acute uncomplicated low back pain, osteopathy and chiropractic were rated as effective by most experts. For chronic uncomplicated low back pain, most experts considered acupuncture as effective. Experts perceived homeopathy generally as ineffective for any type of low back pain. Clinical experience with herbalism as a treatment for low back pain was insufficient to form an opinion. Conclusion: Experts' opinion is in favor of the effectiveness of osteopathy and chiropractic for acute uncomplicated low back pain. Acupuncture is judged to be of some value for chronic, uncomplicated low back pain. Homeopathy is perceived as ineffective for any type of low back pain. Insufficient experience with herbalism as a treatment for low back pain prevents firm conclusions. (J Manipulative Physiol Ther 1999;22:87–90)

SPINAL MANIPULATION: Current State of Research and Its Indications

Based on the most recent and comprehensive systematic reviews, there is moderate evidence of short-term efficacy for spinal manipulation in the treatment of both acute and chronic low back pain. There is insufficient data available to draw conclusions regarding the efficacy for lumbar radiculopathy. The evidence is also not conclusive for the long-term efficacy of spinal manipulation for any type of low back pain.

How emergency physicians approach low back pain: Choosing costly options

To determine ways in which emergency physicians approach the diagnosis and treatment of the common presenting complaint of low back pain, responses of emergency physicians to a questionnaire dealing with three hypothetical patients with different types of low back pain were taken from a stratified national random sample of eight medical specialties. For severe acute (with and without sciatica) or chronic low back pain, physicians were asked which tests and consultants they would use in pursuit of the diagnosis, and which treatments and specialty referrals they would recommend in each of the three scenarios. For diagnosis in the acute cases (pain less than 1 week), up to 22% of emergency physicians recommended computed tomography (CT scan) and 36% recommended magnetic resonance imaging (MRI). Specialist consultation would be sought for 61% of the acute sciatica patients, 32% of the acute nonsciatica patients, and 47% of the chronic patients. In approaching treatment, over 75% of emergency physicians would advise bedrest for an average of 3.5 to 4.5 days. Between 16% and 40% suggested physical therapy for the acute patients. Referrals to surgical specialists (orthopedist or neurosurgeon) were highest (81%) for acute sciatica, compared with 52% for chonic low back pain, and 41% for acute nonsciatic low back pain. In conclusion, given that most cases of acute low back pain resolve with minimal intervention, diagnostic imaging, laboratory testing, and early specialist consultation favored by many emergency physicians would add little except expense to understanding its etiology. For treatment, emergency physician recommendations for bedrest were longer than necessary and, for physical therapy, of no proven benefit. The tendency to refer acute cases to orthopedists and neurosurgeons could set the stage for unnecessary operative intervention. Simpler, less costly, and more reassuring approaches to emergency department patients with low back pain should be considered.

Managing low back pain: attitudes and treatment preferences of physical therapists.

We surveyed physical therapists about their attitudes, beliefs, and treatment preferences in caring for patients with different types of low back pain problems. Questionnaires were mailed to all 71 therapists employed by a large health maintenance organization in western Washington and to a random sample of 331 other therapists licensed in the state of Washington. Responses were received from 293 (74%) of the therapists surveyed, and 186 of these claimed to be practicing in settings in which they treat patients who have back pain. Back pain was estimated to account for 45% of patient visits. The McKenzie method was deemed the most useful approach for managing patients with back pain, and education in body mechanics, stretching, strengthening exercises, and aerobic exercises were among the most common treatment preferences. There were significant variations among therapists in private practice, hospital-operated, and health maintenance organization settings with respect to treatment preferences, willingness to take advantage of the placebo effect, and mean number of visits for patients with back pain. These variations emphasize the need for more outcomes research to identify the most effective treatment approaches and to guide clinical practice.

Physician variation in diagnostic testing for low back pain. Who you see is what you get.

This study examined patterns of diagnostic test use for patients with low back pain. Three specific questions were addressed: 1) What tests do physicians recommend for patients with 3 common types of low back pain? 2) Do physicians in various specialties differ in the tests they would order? and 3) How appropriate are physicians' choices of tests, based on current medical knowledge and expert recommendations? A stratified national random sample of 2,604 physicians in 8 specialties was mailed questionnaires asking about the tests they would order for hypothetical patients with acute back pain, sciatica, or chronic low back pain. Physicians were also asked which procedures they generally used to evaluate suspected lumbar nerve root compression. These responses were compared with guidelines that have been suggested by the Quebec Task Force on Spinal Disorders, based on comprehensive evaluation of the scientific literature. Approximately 1,100 physicians responded to the survey (43% response rate). Magnetic resonance imaging was the most frequently used procedure for evaluating suspected lumbar nerve root compression, although a majority of neurosurgeons would still use myelography. Neurosurgeons and neurologists were twice as likely as other specialists to order an imaging study for patients with acute nonradiating pain or chronic back pain. Physiatrists and neurologists were more than 3 times as likely as other specialists to order electromyograms for acute back pain with sciatica or chronic back pain. Rheumatologists were almost twice as likely as other specialists to order laboratory tests for both acute and chronic back pain. The reported use of imaging and electrodiagnostic tests was generally premature and more extensive than that recommended by the Quebec Task Force. There is little consensus, either within or among specialties, on the use of diagnostic tests for patients with back pain. Thus, the diagnostic evaluation depends heavily on the individual physician and his or her specialty, and not just the patient's symptoms and findings. Furthermore, many physicians may be ordering imaging studies too early and for patients who do not have the appropriate clinical indications. These results suggest a need for additional clinical guidelines as well as better adherence to existing guidelines.

Efficacy of high-velocity low-amplitude manipulative technique in subjects with low-back pain during menstrual cramping

Previous studies have shown that dysmenorrhea produces low-back pain and an electromyographic (EMG) pattern typical of trauma-induced low-back pain. To determine the effects of high-velocity low-amplitude osteopathic manipulative treatment (OMT) on this type of low-back pain, 12 dysmenorrheic subjects were assigned to a group receiving OMT or to a group not receiving OMT (or both). Eight subjects participated in both groups, the other four being equally distributed between groups. Osteopathic manipulative treatment significantly decreased EMG activity during extension of the lumbar spinae erector muscles and abolished the spontaneous EMG activity. These EMG changes coincided with the patient's report of alleviated low-back pain and menstrual cramping. Osteopathic manipulative treatment did not change the creatinine kinase, lactate dehydrogenase or lactate-dehydrogenase isoenzyme activity, or myoglobin concentration.

Low back pain

Low back pain is a very common and significant problem in our society, and there are both mechanical and psychosocial aspects to its etiology. This paper presents a systematic approach to the treatment of common types of low back pain. Treatment, beginning with conservative care, is outlined in this paper in the form of an algorithm. Current research directed at both the diagnostic and treatment aspects of low back pain is addressed.