Association between severe lumbar disc degeneration and self-reported occupational physical loading

Āsana for Back, Hips and Legs to Prevent Musculoskeletal Disorders among Dental Professionals: In-Office Yóga Protocol

Dental professionals are exposed to significant unavoidable physical stress, and theoretical ergonomic recommendations for a sitting workplace are inapplicable in many dental activities. Work-related musculoskeletal disorders (WMSDs) represent a serious health problem among dental professionals (prevalence: 64-93%), showing involvement of 34-60% for the low back and 15-25% for the hips. Muscle stress; prolonged sitting; forward bending and twisting of the torso and head; unbalanced working postures with asymmetrical weight on the hips and uneven shoulders; and others are inevitable for dental professionals. Therefore, the approach for the prevention and treatment of WMSDs must be therapeutic and compensatory. This project was conceived to provide a Yoga protocol for dental professionals to prevent or treat WMSDs from a preventive medicine perspective, and it would represent a Yoga-based guideline for the self-cure and prevention of musculoskeletal problems.

METHODS

Specific Yoga positions (āsana, such as Virāsana, Virabhadrāsana, Garudāsana, Utkatāsana, Trikonāsana, Anuvittāsana, Chakrāsana, Uttanāsana, Pashimottanāsana) have been selected, elaborated on and adapted to be practiced in a dental office using a dental stool or the dental office walls or a dental unit chair. The protocol is specifically devised for dental professionals (dentists, dental hygienists and dental assistants) and targeted for the low back, hips and legs (including knees and ankles). The protocol includes Visranta Karaka Sthiti (supported positions) in sitting (Upavistha Sthiti) and standing (Utthistha Sthiti) positions, twisting/torsions (Parivrtta), flexions/forward bend positions (Pashima) and extensions/arching (Purva) for musculo-articular system decompression and mobilization.

RESULTS

Over 60 Yogāsana-specifically ideated for back detensioning and mobilization, lumbar lordosis restoration, trunk side elongation, hip release and leg stretches and decontraction-are shown and described. The paper provides a meticulous description for each position, including the detailed movement, recommendations and mistakes to avoid, and the breathing pattern (breath control) in all the breath-driven movements (āsana in vinyāsa). An exhaustive analysis of posture-related disorders affecting the lower body among dental professionals is reported, including low-back pain, hip pain and disorders, piriformis syndrome and quadratus femoris dysfunction (gluteal pain), iliopsoas syndrome, multifidus disorders, femoroacetabular and ischiofemoral impingement, spinopelvic mobility, lumbopelvic rhythm, impairment syndromes, lower crossed syndrome, leg pain, knee pain and ankle disorders.

CONCLUSIONS

A detailed guideline of āsana for low-back decompression, hip joint destress, piriformis and gluteal muscle release, lumbar lordosis recovery and a spinopelvic mobility increase has been elaborated on. The designed Yogāsana protocol represents a powerful tool for dental professionals to provide relief to retracted stiff muscles and unbalanced musculoskeletal structures in the lower body.

Low Back Pain in Resident Doctors with Standardized Training in China: A Cross-Sectional Study

Background

Low back pain (LBP) is a prevalent occupational disease with high morbidity among healthcare workers. Since the implementation of standardized residency training in China in 2015, the training intensity has significantly increased, which may lead to a higher incidence of LBP. However, epidemiological studies on LBP among resident doctors with standardized training remain scarce.

Objective

To investigate the prevalence and associated factors of LBP among resident doctors with standardized training in a tertiary hospital in China.

Methods

A cross-sectional study was conducted using self-administered questionnaires to collect information on demographics, lifestyle factors, work-related factors, and LBP from 345 resident doctors. Descriptive statistics were used to analyze the prevalence of LBP. Logistic regression analysis was performed to identify factors associated with LBP.

Results

Among 345 participants, the 1-year prevalence of LBP was 75.9%. Multivariable analysis revealed that physical exercise, weekly working hours, and prolonged sitting were independent risk factors for LBP.

Conclusion

The prevalence of LBP among resident doctors was high. Promoting physical exercise, controlling working hours, and improving sitting posture may help prevent LBP. The study was limited by its cross-sectional design and self-reported data. Future studies should use longitudinal designs, objective measures, and larger and more representative samples to further explore the epidemiology and etiology of LBP among resident doctors with standardized training.

An ergonomic focus evaluation of work-related musculoskeletal disorders amongst operators in the UAE network control centres

Work-related musculoskeletal disorders (WMSDs) have rapidly increased during the last decade, but only a few descriptive surveys have been conducted in the United Arab Emirates (UAE). This study investigated the prevalence of WMSDs and analysed their ergonomic risks amongst operators in the network control rooms across two government organisations, X and Y, in the UAE. Essential data were collected by the Nordic Musculoskeletal Questionnaire (NMQ) and the Maastricht Upper Extremity Questionnaire (MUEQ) from online surveys and direct observations based on the Rapid Office Strain Assessment (ROSA) and the Rapid Upper Limb Assessment (RULA) form and ergonomic measurements for the working environments, respectively. Fifty-three and eighteen operators participated from Organisations X and Y. This study found a high presence of WMSDs in both organisations over the past 12 months. In Organisation X, individual, work-related physical and psychosocial risk factors of high BMI, educational level, morning work shift, high job duration, lack of exercise habit, awkward body posture, high job demand, low job control, and low work social support were associated with WMSDs in different body areas (p < 0.05). In Organisation Y, older age, high BMI, high job duration, lack of exercise habits, unergonomic workstations, awkward body posture, low break time, high job demand, and stress level were associated with WMSDs in different body areas (p < 0.05). The control room operators' most affected body areas were the back, eyes, and neck. Several efficient ergonomic intervention ideas were explored to lessen the detrimental effects of WMSDs and preclude the development of WMSDs amongst the control centre operators.

The association between vertebral endplate defects, subchondral bone marrow changes, and lumbar intervertebral disc degeneration: a retrospective, 3-year longitudinal study

PURPOSE

To investigate the influence of vertebral endplate defects and subchondral bone marrow changes on the development of lumbar intervertebral disc degeneration (DD).

METHODS

Patients > 18 y/o without any history of lumbar fusion who had repeat lumbar magnetic resonance imaging scans primarily for low back pain (LBP) performed at a minimum of 3 years apart at a single institution, and no spinal surgery in between scans were included. Total endplate score (TEPS), Modic changes (MC), and Pfirrmann grading (PFG) per lumbar disc level were assessed. DD was defined as PFG ≥ 4.

RESULTS

Three hundred and fifty-three patients (54.4% female) were included in the final analysis, comprising 1765 lumbar intervertebral discs. The patient population was 85.6% Caucasian with a median age of 60.1 years and a body mass index (BMI) of 25.8 kg/m2. A cutoff score of 5 was identified for the TEPS above which both the prevalence of DD and the odds of developing DD increased. The probability of developing DD did not differ significantly between lumbar disc levels (P = 0.419). In the multivariable analysis with adjustments for age, sex, race, body mass index (BMI), MC, TEPS cutoff > 5, and spinal level, only age (OR = 1.020; P = 0.002) was found to be an independent risk factor for developing intervertebral DD.

CONCLUSION

Our results suggest that TEPS does not unequivocally predict intervertebral DD in patients with LBP, since higher degrees of endplate defects might also develop secondarily to DD, and MC tend to occur late in the cascade of degeneration.

Development, validation, and visualization of a web-based nomogram to predict the effect of tubular microdiscectomy for lumbar disc herniation

Objective

The purpose of this study was to retrospectively collect the relevant clinical data of lumbar disc herniation (LDH) patients treated with the tubular microdiscectomy (TMD) technique, and to develop and validate a prediction model for predicting the treatment improvement rate of TMD in LDH patients at 1 year after surgery.

Methods

Relevant clinical data of LDH patients treated with the TMD technology were retrospectively collected. The follow-up period was 1 year after surgery. A total of 43 possible predictors were included, and the treatment improvement rate of the Japanese Orthopedic Association (JOA) score of the lumbar spine at 1 year after TMD was used as an outcome measure. The least absolute shrinkage and selection operator (LASSO) method was used to screen out the most important predictors affecting the outcome indicators. In addition, logistic regression was used to construct the model, and a nomogram of the prediction model was drawn.

Results

A total of 273 patients with LDH were included in this study. Age, occupational factors, osteoporosis, Pfirrmann classification of intervertebral disc degeneration, and preoperative Oswestry Disability Index (ODI) were screened out from the 43 possible predictors based on LASSO regression. A total of 5 predictors were included while drawing a nomogram of the model. The area under the ROC curve (AUC) value of the model was 0.795.

Conclusions

In this study, we successfully developed a good clinical prediction model that can predict the effect of TMD for LDH. A web calculator was designed on the basis of the model (https://fabinlin.shinyapps.io/DynNomapp/).