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Kim CY, Kang JH. Analysis of electromyographic activities of the lumbar erector spinae caused by inversion traction. J Phys Ther Sci 2016; 28:1238-40. [PMID: 27190459 PMCID: PMC4868219 DOI: 10.1589/jpts.28.1238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/26/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to analyze changes in the electromyographic activities of the lumbar erector spinae caused by inversion traction in order to verify the relaxation effect. [Subjects and Methods] The subjects included 60 healthy male adults who were equally and randomly assigned to a 30-30° group, a 30-60° group, and a 60-60° group. Inversion traction was performed for six minutes, and the electromyographic activities of the lumbar erector spinae (L2, L4) were measured before and after inversion traction. [Results] The root mean square values at the L2 and L4 levels on both sides were statistically significantly higher after inversion traction compared with before inversion traction. Before inversion traction, the root mean square values at the L2 and L4 levels on both sides in the 30-60° group and 60-60° group were significantly higher than those in the 30-30° group, while the root mean square values at the L2 and L4 levels on both sides showed no significant differences between the groups before inversion traction. [Conclusion] The findings of this study indicated that IT is more likely to elicits an increase in muscle tension and prevent relaxation of the lumbar erector spinae.
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Affiliation(s)
- Chung Yoo Kim
- Department of Physical Therapy, Graduate School of Catholic University of Pusan, Republic of Korea
| | - Jong Ho Kang
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea
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Gopalakrishnan N, Nadhamuni K, Karthikeyan T. Categorization of Pathology Causing Low Back Pain using Magnetic Resonance Imaging (MRI). J Clin Diagn Res 2015; 9:TC17-20. [PMID: 25738056 DOI: 10.7860/jcdr/2015/10951.5470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 12/01/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Low backache is the most common ailment flooding the orthopaedic clinic. Most of the population at least once seek medical attention for low back ache. Magnetic Resonance Imaging (MRI) is a non invasive, commonly used diagnosing modality and accurate in diagnosing pathology causing low back ache. AIM To classify and quantify the causes of low back pain referred to radiology department by MRI. MATERIALS AND METHODS Patients with back pain referred to radiology department were subjected to single MRI scan after ruling out any contraindications using the following sequences: T1W Turbo Spin Echo, T2W Turbo Spin Echo, Gradient-echo, Myelogram and short TI inversion recovery (STIR), in all imaging planes. Gadolinium enhanced T1W turbo spin echo sequence was used wherever necessary. RESULTS Data were analysed using Excel 2007, SPSS 14, Students t-test. Degenerative disc diseases were the commonest pathology followed by congenital and traumatic lesions. Neoplastic lesions were the least common. Commonest herniation type being the disc bulge (79%) followed by disc protrusion (15%), disc extrusion (6%) and disc sequestration (<1%). The posterolateral disc herniation as the commonest and foraminal the least. Sacralisation was the most common congenital spinal anomaly, followed by lumbar scoliosis and perineural cyst. There is no sex difference in disc protrusion but male preponderance in disc extrusion with subligmentous extrusion. CONCLUSION MRI is useful in classifying the spinal lesions which again influences the treatment modality and clinical outcome. Degenerative disc disease is the single most common category which accounts for most the Low Back Ache for which a preventing strategy should be drafted.
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Affiliation(s)
- Nirmalkumar Gopalakrishnan
- Assistant Professor, Department of Radiology, Sri Venkateshwaraa Medical College Hospital and Research Centre , Ariyur, Puducherry, India
| | - Kulasekaran Nadhamuni
- Professor & Head of Department, Department of Radiology, Sri Venkateshwaraa Medical College Hospital and Research Centre , Ariyur, Puducherry, India
| | - T Karthikeyan
- Assistant Professor, Department of Anatomy, Sree Balaji Medical College & Hospital (Bharath University) , Chrompet, Chennai, India
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Robertson HC, Lee VL. Effects of back care lessons on sitting and lifting by primary students. ACTA ACUST UNITED AC 2014; 36:245-8. [PMID: 25026053 DOI: 10.1016/s0004-9514(14)60526-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study investigated some of the effects of back care education. Four classes of students aged from 10 to 12 years were given three lessons structured to teach acceptable sitting posture, safe lifting techniques and sports injury prevention procedures. Data on the students' sitting postures and lifting skills were collected over a period of six weeks. The results of the study indicate that lessons on aspects of back care can have an immediate impact on students' sitting and lifting behaviours. Further research along the present lines is indicated to determine whether continued instruction and feedback over a longer interval would produce more durable changes.
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Szpalski M, Hayez JP. How many days of bed rest for acute low back pain? Objective assessment of trunk function. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 1:29-31. [PMID: 20054944 DOI: 10.1007/bf00302139] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Bed rest is usually considered an efficient treatment for acute low back pain. However, the optimal duration of bed rest is still being discussed. The recommended periods vary from 2 days to 2 weeks. The duration of optimum length is an important topic given the economical and physiological drawbacks of prolonged inactivity. The purpose of this work is to measure objectively the efficacy of two different durations of bed rest through a dynamometric measure of trunk function. Some 51 male patients, students or self-employed, being treated for acute low back pain were randomized into two groups. Group I was prescribed a bed rest period of 3 days and group II, a period of 7 days. We used a multi-axis isoinertial trunk testing dynamometric device (Isostation B200, Isotechnologies, USA). Patients were all assessed on day 1 and also on day 5 for group I or on day 9 for group II. The variables measured in the sagittal plane were isometric torques in flexion and extension, unresisted range of motion, average dynamic torques and average velocities. Patients were also asked to fill in a visual analogue pain scale on both assessment days. The improvement of all performance measures were important and highly significant (P < 0.001) in both groups. The results of the functional testing and the visual analogue pain scale showed no significant differences between the groups. In these relatively young and motivated patients, a duration of bed rest of 3 days resulted in the same objective functional improvement of trunk function and pain rating as a period of 7 days. This shorter duration should be considered as preferable, given the same objective results but important physiological and economical advantages.
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Affiliation(s)
- M Szpalski
- Department of Orthopaedic Surgery, Centre Hospitalier Molière Longchamp, Bruxelles, Belgium
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Abstract
The sequelae of disk degeneration are among the leading causes of functional incapacity in both sexes and are a common source of chronic disability in the working years. Disk degeneration involves structural disruption and cell-mediated changes in composition. Mechanical, traumatic, nutritional, and genetic factors all may play a role in the cascade of disk degeneration, albeit to variable degree in different individuals. The presence of degenerative change is by no means an indicator of symptoms, and there is a very high prevalence in asymptomatic individuals. The etiology of pain as the symptom of degenerative disease is complex and appears to be a combination of mechanical deformation and the presence of inflammatory mediators. The role of imaging is to provide accurate morphologic information and influence therapeutic decision making. A necessary component, which connects these two purposes, is accurate natural history data. Understanding the relationship of etiologic factors, the morphologic alterations, which can be characterized with imaging, and the mechanisms of pain production and their interactions in the production of symptoms will require more accurate and reproducible stratification of patient cohorts.
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Affiliation(s)
- Michael T Modic
- Division of Radiology, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA.
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Abstract
Spine imaging accounts for a major share of expenses related to neck and back pain. Improving image quality translates into better morphologic evaluation of the spine. Unfortunately, the morphologic abnormalities on spine imaging are common and nonspecific, obscuring the relevance to patient symptomatology. Furthermore, distinction between degenerative and age-related changes is not clear. The key is clinical correlation of imaging findings. This article presents a concise and illustrated discussion of spinal neuroimaging related to neck and back pain, with emphasis on degenerative disease.
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Affiliation(s)
- Manzoor Ahmed
- Department of Radiology, Louis Stokes VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106-1702, USA.
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Glaves J. The use of radiological guidelines to achieve a sustained reduction in the number of radiographic examinations of the cervical spine, lumbar spine and knees performed for GPs. Clin Radiol 2005; 60:914-20. [PMID: 16039927 DOI: 10.1016/j.crad.2005.02.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2004] [Accepted: 02/18/2005] [Indexed: 10/25/2022]
Abstract
AIM To determine if the use of request guidelines can achieve a sustained reduction in the number of radiographic examinations of the cervical spine, lumbar spine and knee joints performed for general practitioners (GPs). METHODS GPs referring to three community hospitals and a district general hospital were circulated with referral guidelines for radiography of the cervical spine, lumbar spine and knee, and all requests for these three examinations were checked. Requests that did not fit the guidelines were returned to the GP with an explanatory letter and a further copy of the guidelines. Where applicable, a large-joint replacement algorithm was also enclosed. If the GP maintained the opinion that the examination was indicated, she or he had the option of supplying further justifying information in writing or speaking to a consultant radiologist. RESULTS Overall the number of radiographic examinations fell by 68% in the first year, achieving a 79% reduction in the second year. For knees, lumbar spine and cervical spine radiographs the total reductions were 77%, 78% and 86%, respectively. CONCLUSION The use of referral guidelines, reinforced by request checking and clinical management algorithms, can produce a dramatic and sustained reduction in the number of radiographs of the cervical spine, lumbar spine and knees performed for GPs.
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Affiliation(s)
- J Glaves
- Department of Radiology, Chesterfield Royal Hospital, Chesterfield, UK.
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Cherniack M, Dillon C, Erdil M, Ferguson S, Kaplan J, Krompinger J, Litt M, Murphy M. Clinical and psychological correlates of lumbar motion abnormalities in low back disorders. Spine J 2001; 1:290-8. [PMID: 14588334 DOI: 10.1016/s1529-9430(01)00104-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) and low back disorders (LBDs) identify a complex constellation of conditions that frustrate both diagnosis and therapy. Dynamic quantitative assessment and questionnaire instruments directed toward psychosocial and situational variables provide potentially powerful tools for determining functional pathology and potentially outcome. PURPOSE Our goal was to independently assess clinical correlates of a trunk motion measurement device, the lumbar motion monitor (LMM). The reliability of the LMM as a clinical test was assessed by comparison with an independent medical examination and biobehavioral questionnaires. STUDY DESIGN/SETTING There were three study components. A multispecialty physician panel that administered a structured physical examination contributed to a clinical correlation case series study. Standardized outcomes and risk identification questionnaires were administered to the case population. Finally, the LMM was administered in a customary fashion to the same population. PATIENT SAMPLE Nineteen subjects were recruited on the basis of criteria that included symptoms of chronic recurrent low back pain. This was an employed and active, although impaired, population. Eighteen of the subjects were currently employed with limited lost work time, but chronic and recurrent pain was a common feature. OUTCOME MEASURES Questionnaire outcome measures were both characterologic and situation based. In addition to providing diagnoses, the physician panel was also asked to offer certain qualitative assessments, such as rehabilitative potential and functional level pertinent to activities of daily living. The impact of LMM measures on physician decision making was also assessed. Trunk angular measurements were used to assess function of patients with chronic low back disorders. METHODS Kinematic performance on the LMM was expressed as three probability scores. These were the likelihood of abnormality, the "sincerity of effort" (exacerbation or aggravation of impairment), and the likelihood of structural anatomic disease. These variables were examined against established self-report measures of pain and disability. RESULTS The LMM and physician panels were in agreement on the presence or absence of abnormality. LMM findings tended to be more consistent with clinical history than the clinical examination. The LMM results were also generally consistent with the self-reported measures of pain and disability: a high likelihood of structural disease was associated with depression, somatization, poor health perception and diminished vitality. CONCLUSIONS The LMM appears to be a useful assessment tool for gauging the presence of LBP and LBD. It was accurate in detecting abnormality when abnormality was determined by clinical history and physician diagnosis. The LMM's differentiation of mechanical low back disease (nonanatomically specific disorders) from structurally specific low back disease was not consistent with a parallel clinical differentiation. Larger trials in a prospective format and studies on a chronically disabled population seem warranted. In an impaired but less disabled population, elevated pain and somatization did not appear to weaken the effort during testing.
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Affiliation(s)
- M Cherniack
- Ergonomics Technology Center of Connecticut, University of Connecticut Health Center, Farmington, CT 06030, USA
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McIlveen B, Robertson VJ. A Randomised Controlled Study of the Outcome of Hydrotherapy for Subjects with Low Back or Back and Leg Pain. Physiotherapy 1998. [DOI: 10.1016/s0031-9406(05)65898-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Barkin RL, Lubenow TR, Bruehl S, Husfeldt B, Ivankovich O, Barkin SJ. Management of chronic pain. Part II. Dis Mon 1996; 42:457-507. [PMID: 8757198 DOI: 10.1016/s0011-5029(96)90013-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Chronic pain is associated with substantial psychosocial and economic stress coupled with functional loss and various levels of vocational dysfunction. The role of a pain center is to focus on chronic pain in a multidisciplinary, comprehensive manner, providing the patient with the most effective opportunity to manage his or her chronic disease syndrome. This article focuses on methods to manage many types of chronic pain and describes a broad range of pharmacologic and non-pharmacologic interventions and options available to the patient. Part I of this two-part monograph described pharmacotherapeutic interventions and regional nerve blocks. Part II focuses on psychologic assessment and treatment and physical therapy. A multimodal management strategy offers patients the greatest improvement potential for specific chronic pain syndromes. Cognitive and behavioral therapies and physical therapies are described. This combination of therapies may provide patients with the skills and knowledge needed to increase their sense of control over pain. The integration of appropriate pharmacotherapeutic regimens, neural blockades, physical therapy, and psychologic techniques maximizes the patient's effectiveness in dealing with chronic pain. Three case studies are presented in Part II.
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Affiliation(s)
- R L Barkin
- Department of Anesthesiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA
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14
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Magnusson M, Pope MH, Hansson T. Does a back support have a positive biomechanical effect? APPLIED ERGONOMICS 1996; 27:201-205. [PMID: 15677061 DOI: 10.1016/0003-6870(95)00007-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Back supports, or lifting belts, are widely used. Subjects, free of low back pain, lifted in a simulated task, meeting the 1993 NIOSH guidelines. The back support reduced the electromyographic signal in the dorsal muscles. The back support also reduced the height loss as measured by a stadiometer. In most subjects the support also gave a subjective impression of increased support and increased lifting capacity.
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Affiliation(s)
- M Magnusson
- Iowa Spine Research Center, University of Iowa, Iowa City, IA 52242, USA
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Cherkin DC, Deyo RA, Street JH, Hunt M, Barlow W. Pitfalls of patient education. Limited success of a program for back pain in primary care. Spine (Phila Pa 1976) 1996; 21:345-55. [PMID: 8742212 DOI: 10.1097/00007632-199602010-00019] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Low back pain patients seen in primary care were allocated randomly to one of two educational interventions or to usual care. OBJECTIVE To evaluate educational interventions designed to improve the outcomes of primary care for low back pain. SUMMARY OF BACKGROUND DATA Patients with back pain are frequently dissatisfied with their medical care and identify lack of information as the most insufficient aspect. METHODS In a large Health Maintenance Organization clinic, 293 subjects were allocated randomly to receive usual care, an educational booklet, or a 15-minute session with a clinic nurse, including the booklet and a follow-up telephone call. Outcome measures included satisfaction with care, perceived knowledge, participation in exercise, functional status, symptom relief, and health care use. Outcomes were assessed 1, 3, 7, and 52 weeks after the intervention. RESULTS The nurse intervention resulted in higher patient satisfaction than usual care (P < 0.001) and higher perceived knowledge (P < 0.001). Self-reported exercise participation was also higher in the nurse intervention group after a 1-week follow-up period (97% vs. 65% in the other groups; P < 0.0001). There were no significant differences among the three groups in worry, symptoms, functional status, or health care use at any follow-up interval. Differences in self-reported exercise and perceived knowledge were no longer significant after 7 weeks. CONCLUSIONS These findings challenge the value of purely educational approaches in reducing functional impact or health care use related to back pain and also challenge the value of fitness exercise in the most acute phase of back pain.
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Affiliation(s)
- D C Cherkin
- Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA, USA
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17
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Bonner WF, Guest DM, Barlow RA, Schade KC, Bonner FJ. Acute Industrial Rehabilitation. Phys Med Rehabil Clin N Am 1992. [DOI: 10.1016/s1047-9651(18)30628-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cooper M, Miles KA, Wraight EP, Dixon AK. Degenerative disc disease in the lumbar spine: another cause for focally reduced activity on marrow scintigraphy. Skeletal Radiol 1992; 21:247-9. [PMID: 1626292 DOI: 10.1007/bf00243066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A patient is presented in whom a focal reduction in marrow activity in the lumbar spine on both leucocyte and nanocolloid marrow scintigraphy was subsequently shown to be due to fatty infiltration of marrow in association with disc degeneration. Degenerative disease in the lumbar spine has not been previously described as a cause of abnormal bone marrow distribution by such means and needs to distinguished from a more serious pathology, such as malignant infiltration and vertebral infection, which it may mimic. In a retrospective review of 33 nanocolloid bone marrow and 117 leucocyte scintigrams, 8 showed a degree of reduced marrow activity in the lumbar spine consistent with that caused by degenerative changes.
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Affiliation(s)
- M Cooper
- Department of Radiology, Addenbrookes Hospital, UK
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Halpin SF, Yeoman L, Dundas DD. Radiographic examination of the lumbar spine in a community hospital: an audit of current practice. BMJ (CLINICAL RESEARCH ED.) 1991; 303:813-5. [PMID: 1932970 PMCID: PMC1671162 DOI: 10.1136/bmj.303.6806.813] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess general practitioners' decisions to request lumbar spine radiographs according to the guidelines of the Royal College of Radiologists. DESIGN Prospective questionnaire survey of outpatients attending for lumbar spine radiography. SETTING London community hospital. SUBJECTS 100 consecutive adult outpatients attending for lumbar spine radiography at their general practitioner's request. MAIN OUTCOME MEASURES Patient's history and clinical signs; radiological diagnosis; change in management of patients with significant radiological abnormality in response to the radiologist's report. RESULTS 60 patients were aged between 18 and 45, 27 (45%) of whom were women. Five patients were fully examined by their doctor before radiographs were requested, 76 were partially examined, and 19 were not examined. In 37 patients the examinations showed radiologically normal findings; 30 had radiologically significant disc or degenerative disease. Pain score and radiological diagnosis was not correlated (6.43 (range 1-10) for patients with significant disease v 6.14 (range 1-10) for those without, p greater than 0.05). There were no cases of malignancy or infection. One patient with radiologically significant disease was referred to a hospital specialist, and the management of only two such patients was altered by the report. 52 of the examinations should not have been requested if the guidelines had been strictly applied. CONCLUSIONS There is a need to inform doctors of the efficacy of radiological examinations. An awareness of the college's guidelines among general practitioners should be actively promoted by radiologists.
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Affiliation(s)
- S F Halpin
- Department of Radiology, Bolinbroke Hospital, London
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Geusens P, Dequeker J. Locomotor side-effects of corticosteroids. BAILLIERE'S CLINICAL RHEUMATOLOGY 1991; 5:99-118. [PMID: 2070430 DOI: 10.1016/s0950-3579(05)80298-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Glickstein MF, Burke DL, Kressel HY. Magnetic resonance demonstration of hyperintense herniated discs and extruded disc fragments. Skeletal Radiol 1989; 18:527-30. [PMID: 2588032 DOI: 10.1007/bf00351754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Magnetic resonance (MR) imaging is useful in evaluating a variety of spinal pathologies including intervertebral disc disease. Herniated discs are commonly believed to undergo premature degeneration and produce low intensity signal on T2-weighted images. We reviewed 154 patients who were studied for disc herniations or other pathology. Fifty-nine (38%) had disc herniations and 7 of these (5%) had a fragment that was hyperintense with respect to the adjacent intervertebral disc on T2-weighted images. It is hypothesized that some disc fragments may contain a higher water content that causes prolongation of the T2 signal. The bright signal which is therefore seen on long TR long TE (T2-weighted) images may be a useful sign suggesting herniation or extrusion.
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Affiliation(s)
- M F Glickstein
- David W. Devon Medical Imaging Center, Hospital of the University of Pennsylvania, Philadelphia
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23
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Moffit B, Reicher M, Lufkin R, Bentson J. Comparison of T1 and T2 weighted images of the lumbar spine. Comput Med Imaging Graph 1988; 12:271-6. [PMID: 3179982 DOI: 10.1016/0895-6111(88)90037-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In order to develop an optimal routine magnetic resonance (MR) spine scanning protocol, we have compared the relative efficacy of performing T1- and T2-weighted images in patients with various disorders of the lumbar region. Forty cases were randomly selected from studies performed from 1984 to 1987 and the T1- and T2-weighted images of each case were separated and interpreted blindly and independently by two neuroradiologists. Our results indicate no significant difference between T1- and T2-weighted images in the depiction of disc protrusion. The T2-weighted images were superior in depicting disc dessication, but the clinical significance of identifying a dessication disc remains uncertain. No significant difference in the depiction of osteophytes was seen between T1- and T2-weighted images. Cases of tethered cord, metastatic disease, and arachnoiditis were better delineated with T1-weighted images. The increase in signal of cerebrospinal fluid (CSF) with T2-weighting often obscured lesions within the spinal canal. In a signal case of postoperative discitis, the T2-weighted images disclosed disc space abnormalities and epidural fluid collections not appreciated on T1-weighted images. The T1-weighted images, however, did show thecal sac and adjacent epidural extension more clearly. In cases of metastatic disease, increase in the signal of metastases with T2 weighting often rendered them isointense to surrounding medullary bone. Given the lack of superiority of T2-weighted images over T1-weighted images in evaluating intervertebral disc protrusions and the superiority of T1-weighted images in depicting nearly all other abnormalities observed in this series, we no longer acquire T2-weighted images of the lumbar spine on a routine basis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B Moffit
- Department of Radiological Sciences, UCLA School of Medicine 90024
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24
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Langridge JC, Phillips D. Group Hydrotherapy Exercises for Chronic Back Pain Sufferers — Introduction and monitoring. Physiotherapy 1988. [DOI: 10.1016/s0031-9406(10)63190-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Back pain often causes patients great despair, and they expect the primary care physician or orthopedic surgeon to provide a quick, simple solution. Rest and analgesia are the most commonly prescribed treatments, and muscle relaxants, heat, traction, and physiotherapy are also used. If these treatments do not help, the patient may search for relief through faith healing, acupuncture, chiropractic treatment, or other nonconventional forms of treatment. Although chiropractic treatment is a popular alternative, its long-term effect is questionable and the medical literature contains numerous reports of patients whose condition worsened as a result of it. Physicians should be aware of the dangers of chiropractic treatment, particularly in patients with severe spondylitic changes, osteoporosis, fractures, tumors, ankylosing spondylitis, infections, or signs of nerve root pressure.
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Affiliation(s)
- P Shvartzman
- Department of Family Medicine, Ben Gurion University, Beer-Sheeva, Israel
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Abstract
Bed rest is usually recommended for acute low back pain. Although the optimal duration of bed rest is uncertain, a given prescription may directly affect the number of days lost from work or other activities. In a randomized trial, we compared the consequences of recommending two days of bed rest (Group I) with those of recommending seven days (Group II). The subjects were 203 walk-in patients with mechanical low back pain; 78 percent had acute pain (less than or equal to 30 days), and none had marked neurologic deficits. Follow-up data were obtained at three weeks (93 percent) and three months (88 percent). Although compliance with the recommendation of bed rest was variable, patients randomly assigned to Group I missed 45 percent fewer days of work than those assigned to Group II (3.1 vs. 5.6 days, P = 0.01), and no differences were observed in other functional, physiologic, or perceived outcomes. For many patients without neuromotor deficits, clinicians may be able to recommend two days of bed rest rather than longer periods, without any perceptible difference in clinical outcome. If widely applied, this policy might substantially reduce absenteeism from work and the resulting indirect costs of low back pain for both patients and employers.
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Naliboff BD, Cohen MJ, Swanson GA, Bonebakker AD, McArthur DL. Comprehensive assessment of chronic low back pain patients and controls: physical abilities, level of activity, psychological adjustment and pain perception. Pain 1985; 23:121-134. [PMID: 2933624 DOI: 10.1016/0304-3959(85)90054-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A comprehensive functional evaluation designed for patients with chronic low back pain (CLBP) is described. The evaluation includes measures from 4 domains of the CLBP syndrome; physical abilities, level of activity, psychological adjustment and pain perception. New measures for standardized assessment of physical abilities and employment of body mechanics are introduced. Evaluation data from 68 CLBP subjects and 35 age-matched, pain-free, controls is presented. Results indicate important deficits in physical abilities and psychological adjustment for the CLBP group compared to the controls. Factor analysis of the evaluation measures yielded a general conditioning factor and a general psychological adjustment factor but complicated factor structures for report of pain and time in activities. Further analysis demonstrated a strong relationship between objective disability and psychological and psychosocial adjustment but little relationship between level of pain and other disability measures.
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Affiliation(s)
- Bruce D Naliboff
- Veterans Administration Medical Center, Behavioral Medicine Research (151J), Sepulveda, CA 91343, U.S.A. Department of Anesthesiology, UCLA, U.S.A. Department of Psychiatry and Biobehavioral Sciences, UCLA, U.S.A. Graduate School of Education, UCLA, Los Angeles, CA 90024 U.S.A
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Mikhael MA, Ciric IS, Kudrna JC, Hindo WA. Recognition of lumbar disc disease with magnetic resonance imaging. COMPUTERIZED RADIOLOGY : OFFICIAL JOURNAL OF THE COMPUTERIZED TOMOGRAPHY SOCIETY 1985; 9:213-22. [PMID: 2998699 DOI: 10.1016/0730-4862(85)90078-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ten normal adult volunteers, 75 patients with low back pain and/or lumbar radiculopathy, 16 patients following chymopapain treatment, 14 patients with recurrent symptoms following disc surgery, and two patients with distal cord compression were scanned on Fonar 3000 permanent magnet scanner. Of all the patients 98 had additional computed tomography scans (CT) of the lumbar spine and 82 had myelography. Lumbar magnetic resonance imaging (MRI) and CT scans were both diagnostic in cases of herniated and extruded discs. MRI scan showed more information concerning the degenerative state of the intervertebral discs. It was relatively more accurate in detecting, small bulging and herniated discs without ruptured anulus and the relation of the migrated fragments of extruded discs to both the back of the vertebrae and the thecal sac. Moreover, lumbar MRI matched the clinical response of disc disease to chymopapain treatment more than lumbar CT scan. In addition, the MRI studies differentiated more accurately postoperative epidural fibrotic changes from recurrent herniated and/or extruded disc and detected distal spinal cord abnormalities. CT scan easily detected laterally herniated lumbar discs. Myelography was the diagnostic study in cases of arachnoiditis.
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Heinrich RL, Cohen MJ, Naliboff BD, Collins GA, Bonebakker AD. Comparing physical and behavior therapy for chronic low back pain on physical abilities, psychological distress, and patients' perceptions. J Behav Med 1985; 8:61-78. [PMID: 3156999 DOI: 10.1007/bf00845512] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A treatment-outcome study was conducted to study the impact of behavior and physical therapy on components of the chronic low back pain syndrome. Eighteen patients received behavior therapy and 15 patients received physical therapy. All patients had at least a 6-month history of seeking treatment for chronic low back pain. Prior to treatment patients were assessed in four principal areas of functioning: (1) physical abilities; (2) current physical functioning; (3) psychological and psychosocial functioning; and (4) pain intensity and pain perception. Treatments were conducted in a group (five to eight patients) outpatient setting. Both behavior therapy and physical therapy groups met for 10-weekly sessions, each lasting 2 hr. Behavior therapy was designed to address the environmental, social, and emotional components of the low back pain syndrome as well as the depression and decreased activity that result from chronic low back pain. Physical therapy was based upon traditional rehabilitation theory and was designed to improve low back function. Patients were reevaluated at posttreatment, 6 months, and 1 year. The results showed a general improvement for patients in both groups and a few treatment-specific differences in outcome measures.
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Abstract
The purpose of this study was to determine the effects of gravity-facilitated traction (inversion) on intervertebral dimensions of the lumbar spine. Fifteen normal male subjects were fully inverted for a period of 10 minutes. Vertebral separation was measured on lateral roentgenograms both pre- and postinversion by outlining the margins of the intervertebral bodies both anteriorly and posteriorly and the greatest vertical heights of the intervertebral foramina. Fine point engineering calipers were used to facilitate measurements. A student t-test for paired data was used to determine significance of separation between lumbar segments, following 10 minutes of inversion. The alpha level was set at 0.05 for statistical significance. Gravity-facilitated traction produced increased separation at all levels measured. Significant increases in total mean anterior separation, total mean posterior separation, and total mean intervertebral foraminal separation were determined. Mean anterior separation was significant at all levels except L3-L4. Mean posterior separation was significant at all levels except L1-L2 and L5-S1. Mean intervertebral foraminal separation was significant at all levels but L5-S1. If increases in intervertebral dimensions play a role in the relief of low back syndrome, then gravity-facilitated traction may be an effective moda1i;y in the treatment of this condition. J Orthop Sports Phys Ther 1985;6(5):281-288.
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Flor H, Turk DC. Etiological theories and treatments for chronic back pain. I. Somatic models and interventions. Pain 1984; 19:105-21. [PMID: 6235475 DOI: 10.1016/0304-3959(84)90831-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This is the first part of an extended review of the etiology and treatment of chronic back pain (CBP). This paper will address the pathophysiology of CBP, the somatic conceptualizations that have been developed, and the treatment modalities that have been employed to alleviate the symptoms. The adequacy of the different models and treatments will be critically examined. The second paper in this set will examine psychological models and interventions. Common problems to both somatic and psychological approaches will be discussed at the close of the second paper.
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Abstract
Understanding the difference between illness and disease is a prerequisite to the care of patients affected by incurable disorders. Educated palliation in the absence of substantive information regarding this discrepancy is the art of medicine. Because elderly patients often present with several chronic diseases, many of which are irreversible, cure-oriented physicians caring for the elderly are especially vulnerable to frequent disappointments. Multiple influences, such as psychological, social, environmental, and iatrogenous factors, may also substantially limit the possibilities for "total cure." More important, even though many chronic conditions are incurable, the discomfort or disability they produce may be substantially modified. If this concept is not realized and addressed, patients (many of them elderly) with irreversible chronic diseases may receive less than optimal care from physicians seeking cures. Studies need to be directed at defining and quantifying specific interactions between illness and disease and discovering risk factors for chronic disability in the elderly. The degree to which we as physicians can assist the chronically ill may reflect our understanding of human discomfort and our sensitivity to personal distress. If we maintain a purely disease-specific focus, we may have difficulty thinking about strategies to serve the patient. Defining pathologic entities may be less complicated than intervening in the illness of the patient, but the latter constitutes healing.
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Cohen MJ, Heinrich RL, Naliboff BD, Collins GA, Bonebakker AD. Group outpatient physical and behavioral therapy for chronic low back pain. J Clin Psychol 1983; 39:326-33. [PMID: 6223946 DOI: 10.1002/1097-4679(198305)39:3<326::aid-jclp2270390305>3.0.co;2-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Conducted a treatment-outcome study to investigate the effectiveness of behavioral (BT) or physical therapy (PT) for treating chronic low back pain (CLBP). Thirteen patients received BT; 12 patients received PT. All patients had at least a 6-month history of seeking treatment of CLBP. Prior to treatment patients were assessed in four principal areas of functioning: (1) physical abilities; (2) current physical functioning; (3) psychological and psychosocial functioning; and (4) pain intensity and pain perception. Treatments were conducted in a group (5-8 patients) outpatient setting. Both BT and PT met for 10 weekly 2-hour sessions. BT was designed to address the environmental, social, and emotional influences of the pain experience, depression, and decreased activity from CLBP. PT was based upon traditional rehabilitation theory and was designed to improve low back function. The posttreatment results showed general improvement for patients in both groups, but few treatment-specific differences in outcome measures.
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Abstract
Two groups of patients with 'low back pain', comparable regarding sex, age and diagnosis, all hospitalized at the Hospital for Rheumatology, Kristiansand, for a period of 4-6 weeks, were treated as follows: Group I (209 (180) patients): Education program combined with practise of exercises and correct use of the back. Group II (190 (153) patients): Usual physiotherapeutic treatment methods (individual or group exercises in the charge of a physiotherapist). Further, both groups received similar swimming pool exercises and electrotherapy. Group I was studied on the basis of a questionnaire completed by patients before beginning the education program and both groups were studied on a similar basis after 12 months. Results are extracted from these questionnaires. In spite of various and extensive previous treatment (Table I), not many patients in group I had received information prior to the education program. Significantly more patients in group I than in group II stated that they had received tuition at our hospital (p less than 0.01) (Table II). Group I seemed to practise self-care more than group II and was statistically in less need of physiotherapy during the year after leaving the hospital (p less than 0.05). This seems to be beneficial for the patients and of economic importance for society at large. We conclude that education is important and has to be organized in the form of special lessons.
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