Multi-factorial causative model for back pain management; relating causative factors and mechanisms to injury presentations and designing time- and cost effective treatment thereof

Investigating scapula positioning in individuals with non-specific lower back pain: A preliminary study

INTRODUCTION

Low back pain (LBP) is an economic and physically disabling burden on individuals and society. With 70% of cases classed as non-specific, there is a need for further research into the causes and consequences associated. The involvement of postural balance in musculoskeletal conditions is gaining increasing interest in research and health practice. However, there is a lack of literature surrounding LBP and posture in distal segments of the body.

OBJECTIVE

The current study investigated scapula positioning in those with non-specific LBP.

METHODS

Scapula angle of rotation, scapula protraction, and scapula elevation were assessed in nine participants with chronic non-specific LBP and compared with that of nine asymptomatic controls (aged 18-60 years). The degree of pelvic tilt was assessed across both groups as a secondary outcome measure.

RESULTS

No difference was identified between the two sample groups for scapula angle of rotation (p = 0.707), protraction (p = 0.755), or elevation (p = 0.691). Anterior pelvic tilt was greater in those with LBP (p = 0.046), supporting previous literature.

CONCLUSION

The findings for the scapula position are novel, given that research in this field is limited. It is concluded that there is no change in scapula positioning in those with non-specific LBP, but there is an increased anterior pelvic tilt.

Diaphragm thickness, thickness change, and excursion in subjects with and without nonspecific low back pain using B-mode and M-mode ultrasonography

Background: Previous studies have demonstrated that respiratory dysfunction has a potential association with low back pain (LBP). Despite the role of the diaphragm for respiration and spinal stability, knowledge of the function of both sides of the diaphragm in subjects with LBP is still limited.Objective: This study aimed to compare the structural integrity and function of the right and left hemidiaphragm by ultrasonography (USG) in subjects with and without nonspecific chronic low back pain (NS-CLBP).Methods: A total of 37 subjects with NS-CLBP and 34 healthy subjects participated in this case-control study. The thickness, thickness change, and excursion of the right and left hemidiaphragm were compared within and between the groups during quiet breathing (QB) and deep breathing (DB) through B-mode and M-mode ultrasound imaging.Results: The LBP group had a significantly smaller degree of right hemidiaphragm thickness change (P = .001) compared with the healthy control group, with a strong effect size. Nevertheless, there was no significant change for diaphragm thickness and excursion between the two groups. The result showed that, in the healthy group, the right hemidiaphragm had a significantly smaller thickness at expiration and larger thickness change compared with the left hemidiaphragm, with a moderate effect size. Based on the multivariate prediction analysis, the right hemidiaphragm thickness change might significantly predict LBP.Conclusion: We found that participants with LBP had a smaller degree of right hemidiaphragm thickness change. Also, the right hemidiaphragm thickness change might significantly predict LBP.

Development and validation of a pre-scoring system for nonspecific low back pain among general population in Guangzhou: a cross-sectional study

Background

Nonspecific Low Back Pain (NLBP) is a common disease with a low cure rate and significant impact on the population. This study aimed to develop and validate a pre-scoring system for identifying the risk of suffering from NLBP among the general population in Guangzhou.

Methods

A total of 1439 eligible subjects were surveyed in Guangzhou by stratified random sampling and was divided randomly into the development dataset (69.6%) and validation dataset (30.4%) subsequently. Based on the development dataset, potential associated factors (average exercise times weekly, the intensity of daily work, etc.) with NLBP were tested by the sequential logistic regression, and a pre-scoring system was formulated with Sullivan’s method and graded afterward. The internal validity of the system was assessed by AUC and calibration plot, and the external validation was performed in the validation dataset.

Results

The prevalence rates of NLBP in the development dataset and the validation dataset were 12.97 and 13.27%, respectively. Age, BMI, average exercise times weekly, gender, educational level, the intensity of daily work, place of residence, monthly income, overall evaluation of health condition and physiology health were identified as significant factors. The total risk score ranged from 0 to 38, which was split into three risk grades: low risk (0 to 18), intermediate risk (19 to 22) and high risk (23 to 38). The pre-scoring system had an adequate calibration and a good discriminating ability with bootstrap-corrected AUC equaling 0.861 in the development dataset and 0.821 in the validation dataset.

Conclusions

A pre-scoring system that could help clinicians to assess the risk of NLBP in the general population was validated. Further validation of the system in a new population or prospective cohort study is suggested.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7564-9) contains supplementary material, which is available to authorized users.

Depression Symptoms Among Older Adults With and Without Subacute Low Back Pain

PURPOSE

Lumbago, or low back pain (LBP), is a common musculoskeletal complaint among older adults that may also be associated with depression. The study objective was to investigate differences in Beck Depression Inventory depression symptoms scores among older adult patients with and without LBP.

DESIGN

This was a case-control study.

METHODS

A total of 152 older adult patients, recruited at an outpatient healthcare clinic (47 men, 105 women; 74.81 ± 6.9 years), were classified as having subacute LBP (n = 76) or non-LBP (n = 76) according to clinic records.

FINDINGS

Beck Depression Inventory scores (mean ± SD) among LBP patients (10.93 ± 6.18) were significantly higher compared to the non-LBP group (7.62 ± 5.70; p = .000085), whose scores indicated no depression symptoms.

CONCLUSION

Subacute LBP may represent a potential risk for increased depression among older adults.

CLINICAL RELEVANCE

Early detection of depression will assist rehabilitation nurses in prescribing the beneficial physical rehabilitation and exercise programs or provide the information and treatment recommendations to older adults with subacute LBP and their families. Also, it should be part of a nursing staff prevention strategy for patients who suffer this common musculoskeletal disorder.

Respiratory characteristics of individuals with non-specific low back pain: A cross-sectional study

Non-specific low back pain (NS-LBP) is known to cause respiratory dysfunction. In this study, we investigated alterations in breathing, respiratory strength and endurance, core stability, diaphragm mobility, and chest expansion among patients with NS-LBP and healthy individuals. The specific aim of the study was to correlate between respiratory function and other variables among NS-LBP patients. Thirty four patients with NS-LBP were matched with 34 healthy participants before undergoing total faulty breathing scale, spirometer, respiratory pressure meter, chest expansion, ultrasound, and pressure biofeedback measurements. There were signs of faulty breathing in the NS-LBP patients when compared to the healthy participants. Diaphragmatic mobility and respiratory muscle endurance were lower in the NS-LBP group. Chest expansion exhibited a significant decrease at the level of the fourth intercostal space in the NS-LBP group, but respiratory muscle strength and core stability were not significant between the two groups. Positive correlations were found to be fairly significant regarding respiratory muscle strength. The findings of this study indicated altered respiratory characteristics in the NS-LBP patients, and suggested that they would improve through respiratory exercises.

Variability in Strength, Pain, and Disability Changes in Response to an Isolated Lumbar Extension Resistance Training Intervention in Participants with Chronic Low Back Pain

Strengthening the lumbar extensor musculature is a common recommendation for chronic low back pain (CLBP). Although reported as effective, variability in response in CLBP populations is not well investigated. This study investigated variability in responsiveness to isolated lumbar extension (ILEX) resistance training in CLBP participants by retrospective analysis of three previous randomized controlled trials. Data from 77 participants were available for the intervention arms (males = 43, females = 34) 37 participants data (males = 20, females = 17) from the control arms. Intervention participants had all undergone 12 weeks of ILEX resistance training and changes in ILEX strength, pain (visual analogue scale; VAS), and disability (Oswestry disability index; ODI) measured. True inter-individual (i.e., between participants) variability in response was examined through calculation of difference in the standard deviation of change scores for both control and intervention arms. Intervention participants were classified into responder status using k-means cluster analysis for ILEX strength changes and using minimal clinically important change cut-offs for VAS and ODI. Change in average ILEX strength ranged 7.6 Nm (1.9%) to 192.1 Nm (335.7%). Change in peak ILEX strength ranged -12.2 Nm (-17.5%) to 276.6 Nm (169.6%). Participants were classified for strength changes as low (n = 31), medium (n = 36), and high responders (n = 10). Change in VAS ranged 12.0 mm to -84.0 mm. Participants were classified for VAS changes as negative (n = 3), non-responders (n = 34), responders (n = 15), and high responders (n = 19). Change in ODI ranged 18 pts to -45 pts. Participants were classified for ODI changes as negative (n = 2), non-responders (n = 21), responders (n = 29), and high responders (n = 25). Considerable variation exists in response to ILEX resistance training in CLBP. Clinicians should be aware of this and future work should identify factors prognostic of successful outcomes.

The impact of flexion or extension movement transfer pattern on the performance of sit-to-stand task in asymptomatic young subjects

To assess the mode of sit-to-stand (STS) task performed in a habitual manner or with flexion or extension pattern transfer in asymptomatic young subjects. It was hypothesized that different initial movements of the lumbar-pelvic region would modify the performance of the STS task: coordination of STS in time and level of vertical ground reaction forces (VGRF).

A convenience sample of 30 young asymptomatic volunteers, both genders, was recruited. The STS task was performed in a habitual manner or with a flexion or extension pattern. A Kistler platform was used to measure the VGRF and time of STS phases.

ANOVAs analysis revealed the main effect in the total time and in maximum VGRF during the STS manoeuvre in three STS tasks (F(2, 58) = 21.67–30.74;

The extension or flexion movement pattern modified STS performance and displayed different coordination in time and level of VGRF. Young asymptomatic participants performed the STS task longer with flexion or extension pattern than in the habitual pattern. The extension pattern of STS had the capacity to produce the lowest VGRF.

How clinicians analyze movement quality in patients with non-specific low back pain: a cross-sectional survey study with Dutch allied health care professionals

Background

Observation of movement quality (MQ) is an indelible element in the process of clinical reasoning for patients with non-specific low back pain (NS-LBP). However, the observation and evaluation of MQ in common daily activities are not standardized within allied health care. This study aims to describe how Dutch allied health care professionals (AHCPs) observe and assess MQ in patients with NS-LBP and whether AHCPs feel the need to have a specific outcome measure for assessing MQ in patients with NS-LBP.

Methods

In this cross-sectional digital survey study, Dutch primary care AHCPs (n = 114) answered one open and three closed questions about MQ in NS-LBP management. Qualitative and quantitative analyses were applied.

Results

Qualitative analyses of the answers to the open questions revealed four main themes: 1) movement pattern features, 2) motor control features, 3) environmental influences and 4) non-verbal expressions of pain and exertion. Quantitative analyses clearly indicated that AHCPs observe MQ in the diagnostic (92%), therapeutic (91%) and evaluation phases (86%), that they do not apply any objective measurement of MQ and that 63% of the AHCPs consider it important to have a specific outcome measure to assess MQ. The AHCPs expressed added benefits and critical notes regarding clinical reasoning and quality of care.

Conclusion

AHCPs recognize the importance of observing MQ in the assessment and management of LBP in a standardized way. However, there is no consensus amongst AHCPs how MQ should be standardized. Prior to standardization, it will be important to develop a theoretical framework to determine which observable and measurable dimensions of MQ are most valid and relevant for patients with NS-LBP to include in the assessment.

Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies

Background

Low back pain (LBP) is an increasingly common condition worldwide with significant costs associated with its management. Identification of musculoskeletal risk factors that can be treated clinically before the development of LBP could reduce costs and improve the quality of life of individuals. Therefore the aim was to systematically review prospective cohort studies investigating lower back and / or lower limb musculoskeletal risk factors in the development of LBP.

Methods

MEDLINE, EMBASE, AMED, CINAHL, SPORTDiscus, and the Cochrane Library were searched from inception to February 2016. No age, gender or occupational restrictions of participants were applied. Articles had to be published in English and have a 12 month follow-up period. Musculoskeletal risk factors were defined as any osseous, ligamentous, or muscular structure that was quantifiably measured at baseline. Studies were excluded if participants were pregnant, diagnosed with cancer, or had previous low back surgery. Two authors independently reviewed and selected relevant articles. Methodological quality was evaluated independently by two reviewers using a generic tool for observational studies.

Results

Twelve articles which evaluated musculoskeletal risk factors for the development of low back pain in 5459 participants were included. Individual meta-analyses were conducted based on risk factors common between studies. Meta-analysis revealed that reduced lateral flexion range of motion (OR = 0.41, 95% CI 0.24-0.73, p = 0.002), limited lumbar lordosis (OR = 0.73, 95% CI 0.55-0.98, p = 0.034), and restricted hamstring range of motion (OR = 0.96, 95% CI 0.94-0.98, p = 0.001) were significantly associated with the development of low back pain. Meta-analyses on lumbar extension range of motion, quadriceps flexibility, fingertip to floor distance, lumbar flexion range of motion, back muscle strength, back muscle endurance, abdominal strength, erector spinae cross sectional area, and quadratus lumborum cross sectional area showed non-significant results.

Conclusion

In summary, we found that a restriction in lateral flexion and hamstring range of motion as well as limited lumbar lordosis were associated with an increased risk of developing LBP. Future research should aim to measure additional lower limb musculoskeletal risk factors, have follow up periods of 6-12 months, adopt a standardised definition of LBP, and only include participants who have no history of LBP.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-017-1534-0) contains supplementary material, which is available to authorized users.

Comparison of the Swedish STarT Back Screening Tool and the Short Form of the Örebro Musculoskeletal Pain Screening Questionnaire in patients with acute or subacute back and neck pain

BACKGROUND

Patients with back and neck pain are often seen in primary care and it is important to provide them with tailored interventions based on risk stratification/triage. The STarT Back Screening Tool (SBT) is a widely used screening questionnaire which has not yet been validated for a population with back and/or neck pain with short duration. Our aim was to compare the concurrent validity of the SBT and the short form of the ÖMPSQ including psychometric properties and clinical utility in a primary care setting.

METHODS

Patients who applied for physiotherapy by direct access (January 2013 to January 2014) at 35 primary care centers in south Sweden, with acute or subacute back and/or neck pain, aged 18-67 years, who were not currently on sick leave or had been on sick leave less than 60 days were asked to complete the SBT and ÖMPSQ-short questionnaire (n = 329). We used the Spearman's rank correlations to study correlations, cross tabulation and Cohen's kappa to analyze agreement of patient classification. Clinical utility was described as clinician scoring miscalculations and misclassifications of total and/or subscale scores.

RESULTS

Completed SBT (9-items) and ÖMPSQ-short (10-items) data were available for 315/329 patients respectively. The statistical correlation for SBT and ÖMPSQ-short total scores was moderately strong (0.62, p < 0.01). In subgroup analyses, the correlations were 0.69 (p < 0.01) for males and 0.57 (p < 0.01) for females. The correlations were lower among older age groups, especially females over 50 years (0.21, p = 0.11). Classification to high or low risk for long-term pain and disability had moderate agreement (κ = 0.42). Observed classification agreement was 70.2%. The SBT had fewer miscalculations (13/315) than the ÖMPSQ-short (54/315).

CONCLUSIONS

The correlation between the SBT and the ÖMPSQ-short scores were moderately strong for individuals with acute or subacute back and/or neck pain. SBT seemed to be clinically feasible to use in clinical practice. We therefore suggest that SBT can be used for individuals with both BP and/or NP in primary care settings but it is important to be aware of that SBT's agreement with the ÖMPSQ-short was poor among females aged over 50 years.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT02609750 Registered: November 18, 2015.

Active self-correction of spinal posture in pain-free women in response to the command "straighten your back"

Evidence is limited regarding the regional changes in spinal posture after self-correction. The aim of the present study was to evaluate whether active self-correction improved standing and sitting spinal posture. Photogrammetry was used to assess regional spinal curvatures and vertical global spine orientation (GSO) in 42 asymptotic women aged 20-24 years. Upper thoracic spine angle and GSO increased in response to self-correction, while the thoracolumbar and lumbosacral angles decreased. Self-correction in the standing position resulted in decreased inclination of the upper thoracic and thoracolumbar spinal angles. Correction of sitting posture reduced the angle of the upper thoracic spine and GSO. The effects of active self-correction on spinal curvature and GSO were different for the standing versus sitting position; the greatest effects of active correction were noted in the thoracic spine. Balanced and lordotic postures were most prevalent in the habitual and actively self-corrected standing positions, whereas the kyphotic posture was most prevalent in the habitual sitting position, indicative that self-correction back posture in the standing position could be an important health-related daily activity, especially during prolonged sitting.

Results of a domiciliary rehabilitation program for chronic low back pain patients

Objective: To evaluate the results of a home rehabilitation program for patients with chronic low back pain through the evaluation of abdominal muscle strength, lumbar mobility, daily activities and improved levels of pain. A secondary objective was to evaluate the adherence of the participants to this program. Methods: We evaluated 99 patients divided into case group (69 patients with chronic low back pain without indication for surgical treatment) and control group (30 patients without low back pain), the following parameters being measured: 1) lumbar mobility, 2) strength of the abdominal muscles, 3) pain by visual analog scale (VAS), 4) limitation in daily activities (Oswestry scale). Patients received individualized guidance on home exercises to be performed during two months. For comparison of groups "control" and "case" the nonparametric Mann Whitney test was applied. For comparison of the times "before" and "after" in the group of patients who returned, the nonparametric Wilcoxon test was applied. Results: Of the 69 patients who agreed to participate, 30 completed the targeted exercises within two months and returned for the final evaluation. At baseline, there was a significant difference (p&lt;0.05) between the case and control groups for lumbar mobility and abdominal strength. In the case group there was significant improvement in all aspects evaluated at the end of the exercise program. Conclusion: The home rehabilitation program was effective as a treatment option for low back pain. Treatment adherence was low, this being the main limiting factor.