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Horgan D, Purtill H, Ryan E, O’Sullivan K. The impact of manual handling training on beliefs regarding low back pain. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1815837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Diarmuid Horgan
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Helen Purtill
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Eva Ryan
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Kieran O’Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Wernli K, O'Sullivan P, Smith A, Campbell A, Kent P. Movement, posture and low back pain. How do they relate? A replicated single-case design in 12 people with persistent, disabling low back pain. Eur J Pain 2020; 24:1831-1849. [PMID: 32621351 DOI: 10.1002/ejp.1631] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/11/2020] [Accepted: 06/28/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Movement and posture are commonly believed to relate to non-specific low back pain (NSLBP). While people with NSLBP appear to move and posture themselves differently from those without NSLBP, changes in movement and posture infrequently relate to improvements in NSLBP when analysed at a group-level. Additionally, little is known about how movement or posture change when clinical outcome improves. METHODS Within-person relationships were investigated using a replicated, repeated measures, single-case design in 12 people with persistent, disabling NSLBP. Individually relevant movement and posture were captured using wearable sensors on up to 20 occasions over a 22-week period (5-week baseline, 12-week physiotherapy-led intervention, 5-week follow-up), while pain and activity limitation were collected concomitantly. A series of cross-correlation analyses estimated the presence, strength, and direction of relationships. RESULTS Many participants (n = 10/12) had strong (e.g. r = 0.91, p = <0.001) relationships between changes in movement or posture and changes in pain and activity limitation, while some showed no strong association. Where relationships were observed, clinical improvement predominantly (93% or 57/61 relationships) related to increased spinal movement range and velocity during forward bending and lifting, reduced lumbar muscle EMG activity at maximum voluntary flexion, and increased posterior-pelvic-tilt during sitting and standing. CONCLUSION Within-person changes to individually relevant movement and posture appear to often relate to clinical outcome, but not always. When changes were related, movement and posture appear to return towards being 'less protective', however causal directions remain unknown. Important activities, movements, and postural parameters varied across the participants, highlighting the potential importance of individualized management. SIGNIFICANCE Changes to individually relevant movement and posture appear to often relate to clinical outcome, but not always. Patient-specific activities, and movement or postural parameters that related to improved pain and activity limitation, varied across the 12 participants, highlighting the potential importance of individualised management. Where clinical improvements were related to changes in movement or posture, participants consistently returned towards being 'less protective' (increased range and speed of movement, increased posterior-pelvic-tilt during sitting and standing). Mechanisms and generalizability remain unclear.
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Affiliation(s)
- Kevin Wernli
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
- Body Logic Physiotherapy, Perth, Western Australia, Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
- Body Logic Physiotherapy, Perth, Western Australia, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Amity Campbell
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Peter Kent
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Simonet E, Winteler B, Frangi J, Suter M, Meier ML, Eichelberger P, Baur H, Schmid S. Walking and running with non-specific chronic low back pain: What about the lumbar lordosis angle? J Biomech 2020; 108:109883. [PMID: 32635997 DOI: 10.1016/j.jbiomech.2020.109883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/25/2020] [Accepted: 06/06/2020] [Indexed: 01/02/2023]
Abstract
Non-specific chronic low back pain (NSCLBP) is a major health problem, affecting about one fifth of the population worldwide. To avoid further pain or injury, patients with NSCLBP seem to adopt a stiffer movement pattern during everyday living activities. However, it remains unknown how NSCLBP affects the lumbar lordosis angle (LLA) during repetitive activities such as walking or running. This pilot study therefore aimed at exploring possible NSCLBP-related alterations in LLAs during walking and running by focusing on discrete parameters as well as continuous data. Thirteen patients with NSCLBP and 20 healthy pain-free controls were enrolled and underwent a full-body movement analysis involving various everyday living activities such as standing, walking and running. LLAs were derived from markers placed on the spinous processes of the vertebrae L1-L5 and S1. Possible group differences in discrete (average and range of motion (ROM)) and continuous LLAs were analyzed descriptively using mean differences with confidence intervals ranging from 95% to 75%. Patients with NSCLBP indicated reduced average LLAs during standing, walking and running and a tendency for lower LLA-ROM during walking. Analyses of continuous data indicated the largest group differences occurring around 25% and 70% of the walking and 25% and 75% of the running cycle. Furthermore, patients indicated a reversed movement pattern during running, with increasing instead of a decreasing LLAs after foot strike. This study provides preliminary evidence that NSCLBP might affect LLAs during walking and running. These results can be used as a basis for future large-scale investigations involving hypothesis testing.
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Affiliation(s)
- Edwige Simonet
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland
| | - Balz Winteler
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland; Bern University Hospital, Inselspital, Department of Physiotherapy, Bern, Switzerland
| | - Jana Frangi
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland
| | - Magdalena Suter
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland; Balgrist University Hospital, Department of Chiropractic Medicine, Integrative Spinal Research, Zurich, Switzerland
| | - Michael L Meier
- Balgrist University Hospital, Department of Chiropractic Medicine, Integrative Spinal Research, Zurich, Switzerland
| | - Patric Eichelberger
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland
| | - Heiner Baur
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland
| | - Stefan Schmid
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Spinal Movement Biomechanics Group, Bern, Switzerland.
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Nolan D, O’Sullivan K, Newton C, Singh G, Smith BE. Are there differences in lifting technique between those with and without low back pain? A systematic review. Scand J Pain 2019; 20:215-227. [DOI: 10.1515/sjpain-2019-0089] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/17/2019] [Indexed: 12/19/2022]
Abstract
Abstract
Background and aims
To systemically review the literature to compare freestyle lifting technique, by muscle activity and kinematics, between people with and without low back pain (LBP).
Methods
Five databases were searched along with manual searches of retrieved articles by a single reviewer. Studies were included if they compared a freestyle lifting activity between participants with and without LBP. Data were extracted by two reviewers, and studies were appraised using the CASP tool for case-control studies.
Results
Nine studies were eligible. Heterogeneity did not allow for meta-analysis. Most studies (n = 8 studies) reported that people with LBP lift differently to pain-free controls. Specifically, people with LBP lift more slowly (n = 6 studies), use their legs more than their back especially when initiating lifting (n = 3 studies), and jerk less during lifting (n = 1 studies). Furthermore, the four larger studies involving people with more severe LBP also showed that people with LBP lift with less spinal range of motion and greater trunk muscle activity for a longer period.
Conclusions
People with LBP move slower, stiffer, and with a deeper knee bend than pain-free people during freestyle lifting tasks. Interestingly, such a lifting style mirrors how people, with and without LBP, are often told how to lift during manual handling training. The cross-sectional nature of the comparisons does not allow for causation to be determined.
Implications
The changes described may show embodiment of cautious movement, and the drive to protect the back. There may be value in exploring whether adopting a lifting style closer to that of pain-free people could help reduce LBP.
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Affiliation(s)
- David Nolan
- Sheffield Teaching Hospitals NHS Foundation Trust , PhysioWorks, Firth Park Clinic, North Quadrant , Sheffield , UK , Phone: 07725854140
| | - Kieran O’Sullivan
- Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital , Doha , Qatar
- School of Allied Health , University of Limerick , Limerick , Ireland
- Health Research Institute , University of Limerick , Limerick , Ireland
| | - Chris Newton
- Physiotherapy Department , University Hospitals of Leicester NHS Trust , Leicester , UK
- Division of Rehabilitation and Ageing, School of Medicine , University of Nottingham , Nottingham , UK
| | - Gurpreet Singh
- Physiotherapy Department , University Hospitals of Leicester NHS Trust , Leicester , UK
| | - Benjamin E. Smith
- Division of Rehabilitation and Ageing, School of Medicine , University of Nottingham , Nottingham , UK
- University Hospitals of Derby and Burton NHS Foundation Trust , Derby , UK
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Leahy A, O’Keeffe M, Robinson K, O’Sullivan K. The beliefs of healthcare students about the harmfulness of daily activities for their back: a cross-sectional study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1630854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Aoife Leahy
- Barking Havering and Redbridge University Trust, Romford, England
| | - Mary O’Keeffe
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, Sydney, Australia
| | - Katie Robinson
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kieran O’Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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