Low back pain among Italian runners: A cross-sectional survey

A cross-sectional study of musculoskeletal injuries related to exercise among gym members in Saudi Arabia in 2022: prevalence, common types, and predictor factors

BACKGROUND

Despite the importance of enhancing exercise, exercising can cause injuries that lead to disability and increase the load on the medical sector. This study aimed to estimate the prevalence of exercise-related injuries among gym members in the Kingdom of Saudi Arabia (KSA) and evaluate the more common types of such injuries. It also investigated the association between injury prevalence and the factors selected.

METHODS

A cross-sectional study with a self-reported survey was conducted targeting members of Fitness Time gyms across the KSA. The survey consisted of three parts: part one concerns participant demographic data and part two contains four questions regarding the participants' training experience. Part three contains ten questions targeting those with a history of injury. Descriptive statistical analysis was performed using frequencies and percentages for categorical variables. Crosstabs and chi-squared tests were used to assess the prevalence of exercise-related injuries when appropriate. Binary logistic regression was employed to investigate the association between injury prevalence and the potential associated factors. Odds ratios and their 95% confidence intervals were calculated and the threshold for statistical significance was set at p ≤ 0.05.

RESULTS

A total of 713 subjects participated in the study. The mean age was 36.5 ± 11.2 years and (n = 422, 59.2%) of the participants were female. The study found a prevalence of injury among gym members of about (n = 404, ~57%). The most commonly reported types of injuries were muscle strain (n = 126, 37%) and bruising (n = 45, 13%). The most prevalent anatomical location of injury was the knee (n = 287, 84.3%), followed by the shoulder (n = 283, 83.3%), and the least common was the head/neck (n = 7, 2.1%). The present study suggests some factors associated with exercise-related injury. A significant statistical association (p < 0.5) was found between injury prevalence and age, gender, educational level, period of training, and presence of a trainer. However, no association was detected between injury prevalence and Body Mass Index (BMI), place of residence, or source of advice.

CONCLUSION

Over half of the participants of this study reported at least one exercise-related injury. This study identifies factors associated with injury prevalence related to exercise among gym participants. Promoting safety and minimizing the incidence of injuries are crucial.

The Effectiveness and Optimal Dose of Resistance Training in Patients With Subacute and Persistent Low Back-Related Leg Pain: A Systematic Review

A subgroup of patients with low back pain (LBP) suffers from low back-related leg pain (LBLP), which can be classified as radicular pain, or somatic referred pain without nerve root involvement. LBLP is considered an obstacle to recovery and a strong negative prognostic factor for medium- and long-term disability. In this review, we aimed to investigate the effectiveness and optimal dose of resistance training (RT) in patients with subacute or persistent LBLP to provide clinical recommendations for practice. This systematic review was conducted by adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the recommendations of the Cochrane Collaboration. We conducted a literature search on PubMed, PEDro, Cochrane Library, Scopus, and Web of Science databases. Only randomized controlled trials (RCTs) involving patients ≥18 years of age were included. The risk of bias in the included studies was assessed using "the Cochrane Collaboration's tool for assessing risk of bias" (RoB) and the inter-rater agreement for full-text selection was evaluated using Cohen's Kappa (K). The search elicited a total of 4.537 records, and two RCTs involving a total of 196 participants were identified through a selection process based on title, abstract, and full-text assessment. Both studies had a low to moderate risk of bias. The inter-examiner concordance index for the selection of full text was excellent (K=1). RT seems to be an effective and safe intervention for patients with LBLP, but its long-term effectiveness, superiority over other types of exercise-based therapies, and optimal dosage still constitute a gray area in the literature.

Designing, Conducting, and Reporting Survey Studies: A Primer for Researchers

Survey studies have become instrumental in contributing to the evidence accumulation in rapidly developing medical disciplines such as medical education, public health, and nursing. The global medical community has seen an upsurge of surveys covering the experience and perceptions of health specialists, patients, and public representatives in the peri-pandemic coronavirus disease 2019 period. Currently, surveys can play a central role in increasing research activities in non-mainstream science countries where limited research funding and other barriers hinder science growth. Planning surveys starts with overviewing related reviews and other publications which may help to design questionnaires with comprehensive coverage of all related points. The validity and reliability of questionnaires rely on input from experts and potential responders who may suggest pertinent revisions to prepare forms with attractive designs, easily understandable questions, and correctly ordered points that appeal to target respondents. Currently available numerous online platforms such as Google Forms and Survey Monkey enable moderating online surveys and collecting responses from a large number of responders. Online surveys benefit from disseminating questionnaires via social media and other online platforms which facilitate the survey internationalization and participation of large groups of responders. Survey reporting can be arranged in line with related recommendations and reporting standards all of which have their strengths and limitations. The current article overviews available recommendations and presents pointers on designing, conducting, and reporting surveys.

What do people believe to be the cause of low back pain? A scoping review

OBJECTIVE

To explore how causal beliefs regarding non-specific low back pain (LBP) have been quantitatively investigated.

METHODS

A scoping review based on the guidelines by the JBI (former Joanna Briggs Institute) was conducted. We searched Medline, Embase, Psychinfo, and CINAHL for relevant studies and included peer-reviewed original articles that measured causal beliefs about non-specific LBP among adults and reported results separate from other belief domains.

RESULTS

A total of 81 studies were included, of which 62 (77%) had cross sectional designs, 11 (14%) were cohort studies, 3 (4%) randomized controlled trials, 4 (5%) non-randomized controlled trials, and 1 (1%) case control. Only 15 studies explicitly mentioned cause, triggers, or etiology in the study aim. We identified the use of 6 questionnaires from which a measure of causal beliefs could be obtained. The most frequently used questionnaire was the Illness Perception Questionnaire which was used in 8 of the included studies. The studies covered 308 unique causal belief items which we categorized into 15 categories, the most frequently investigated being causal beliefs related to "structural injury or impairment", which was investigated in 45 (56%) of the studies. The second and third most prevalent categories were related to "lifting and bending" (26 studies [32%]) and "mental or psychological" (24 studies [30%]).

CONCLUSION

There is a large variation in how causal beliefs are measured and a lack of studies designed to investigate causal beliefs, and of studies determining a longitudinal association between such beliefs and patient outcomes. This scoping review identified an evidence gap and can inspire future research in this field.

Environmental polycyclic aromatic hydrocarbon exposure is associated with low back pain

Several studies have assessed the influence of several often-ignored environmental factors on low back pain (LBP), but the effects of environmental polycyclic aromatic hydrocarbon (PAH) exposure on LBP are unclear. During the 2001-2004 cycle of the National Health and Nutrition Examination Survey (NHANES), our study was given to a representative sample of US participants older than 20 (N = 2743). Environmental PAH exposure was calculated using urinary PAH metabolite concentrations. Weighted logistic regression was performed to assess the connection between PAH levels and LBP, with mediation analysis utilised to explore the underlying mechanism. Levels of 1-hydroxynaphthalene (1-OHNa), 2-hydroxynaphthalene (2-OHNa) and total PAHs had a statistically significant positive association with LBP. The odds ratios per 1-unit increase for log-transformed levels of urinary 1-OHNa, 2-OHNa, and total PAHs with LBP were 1.01 (95% CI 1.02-1.19), 1.19 (95% CI 1.04-1.36) and 1.16 (95% CI 1.03-1.32), respectively. The results revealed a strong dose-response association between 1-OHNa, 2-OHNa, total PAHs, and LBP risk. Subgroup analysis indicated that 2&3-OHPh may increase the risk of LBP in the lower family income subgroup. Gamma-glutamyl transaminase (GGT), known as a biomarker of oxidative stress, was strongly related to PAHs. The relationship between total PAHs and LBP was mediated in part by GGT. Our study demonstrates associations between environmental PAH exposure and LBP that need more research to determine the precise effects of various PAH compounds on LBP.

Prevalence and risk factors of chronic low back pain in university athletes: a cross-sectional study

AIM

This study aimed to establish the prevalence of chronic low back pain (CLBP) in university-level athletes and to examine the influence of age, sex, body mass index (BMI), sports discipline, sleep, anxiety, and depression on CLBP. The secondary purpose was to check the association of certain variables in athletes having CLBP with the sports discipline and chronicity of LBP.

METHODS

A total of 340 players (100% response rate) from different sports, aged 18-30 years with at least 1 year of participation in sports at the university level were screened for the present study. The subjects completed a detailed, semi-structured questionnaire that gathered data regarding their demographic variables, personal and pain-related factors. The study was registered on the clinical trials registry, India (CTRI/2021/09/036675).

RESULTS

The results revealed the sport-wise point prevalence as follows: cricket (18.5%), basketball (15.6%), volleyball (20.0%), football (11.4%), badminton (7.7%) and tennis (7.7%). A higher number of years at university-level participation (>4 years), smoking, anxiety and BMI (>25 kg/m²) are risk factors for CLBP. The type of LBP, the intensity of the pain (current and last week), variation of the pain intensity, disability, intake of oral medications, physiotherapy for CLBP, number of missed days of training and number of missed matches are not significantly related to the chronicity of LBP or the sports discipline. Only the number of missed days of training had a significant association with the chronicity of LBP.

CONCLUSIONS

CLBP is a common complaint in Indian university athletes, and our findings indicate the necessity for a specific prevention program.

Patient Concerns and Beliefs Related to Audible Popping Sound and the Effectiveness of Manipulation: Findings From an Online Survey

OBJECTIVE

The purpose of this study was to assess whether beliefs about the origin of the popping sound and the effects of thrust manipulation (TM) were in agreement with current scientific evidence and whether a practitioner's explanation could influence patient beliefs of theoretical mechanisms.

METHODS

A cross-sectional online survey was conducted in Italy from January 7, 2019 to April 20, 2019. The questionnaire was sent to 900 Italian adults through online recruitment, including people with and without a history of manipulation, such as given by physiotherapists, chiropractors, osteopaths, and manual medicine physicians to manage musculoskeletal disorders. The questionnaire consisted of 11 multiple-choice questions and could be completed within 15 weeks. The Likert scale was used to investigate participants' attitudes. Sex and previous experience of TM variables were evaluated using a Student's t-test; a 1-way F analysis of variance test was performed to evaluate age, educational qualification, and the professional who performed the TM.

RESULTS

We retrieved 478 questionnaires, including 175 participants with no TM history and 303 with TM history. There were 31% of participants (n = 94) with a history of TM who reported they did not receive explanations regarding manipulation. The participants' beliefs mostly disagreed with the current hypotheses provided by the scientific literature on the theoretical mechanisms of popping sound (tribonucleation and cavitation). There were 9.9% (n = 30) of participants who answered "realignment of bone positional fault" to explain the mechanism behind TM. There was a high degree of agreement with the belief that the popping sound should be present for a successful TM (respectively, 2.8 standard deviation [SD; 1.2] and 2.6 SD [1.2] for TM+ and TM- participants). No statistically significant differences were found between participants with and without a history of TM.

CONCLUSION

The participants in this study reported a belief that popping was related to effectiveness of TM. A high percentage of this sample had beliefs about TM mechanisms for the audible popping sound that were inconsistent with current literature. Beliefs were similar between groups, suggesting that instructions given by TM practitioners did not seem to be an influence on these patients' beliefs.

Impact of the COVID-19 Pandemic on Elderly Patients with Spinal Disorders

During the ongoing coronavirus disease 2019 (COVID-19) pandemic, home-quarantine has been necessary, resulting in lifestyle changes that might negatively affect patients with spinal disorders, including a reduction in their quality of life (QoL) and activities of daily living (ADLs). However, studies on this impact are lacking. This study aimed to investigate the age-related changes in QoL and ADLs in patients with spinal disorders, and also identify factors associated with decline in ADLs. This multicenter cross-sectional study included patients who visited four private spine clinics for any symptoms. The study participants either had a clinic reservation, were first-time clinic visitors, or had a return visit to the clinic. The participants completed several questionnaires at two points: pre-pandemic and post-second wave. Changes in patient symptoms, exercise habits, ADLs, and health-related QoL were assessed. A logistic regression model was used to calculate the odds ratio (OR) of each variable for decline in ADLs. We included 606 patients; among them, 281 and 325 patients were aged <65 and ≥65 years, respectively. Regarding exercise habits, 46% and 48% of the patients in the <65 and ≥65-year age groups, respectively, did not change their exercise habits. In contrast, 40% and 32% of the patients in the <65 and ≥65-year age groups, respectively, decreased their exercise habits. In the multivariate analysis, the adjusted ORs for sex (female), decreased exercise habit, and age >65 years were 1.7 (1.1–2.9), 2.4 (1.4–3.9), and 2.7 (1.6–4.4), respectively. In conclusion, there was a decline in the ADLs and QoL after the COVID-19 outbreak in patients with spinal disorders. Aging, reduction of exercise habits, and female sex were independent factors related to decline in ADLs.

Quantitative and Qualitative Running Gait Analysis through an Innovative Video-Based Approach

Quantitative and qualitative running gait analysis allows the early identification and the longitudinal monitoring of gait abnormalities linked to running-related injuries. A promising calibration- and marker-less video sensor-based technology (i.e., Graal), recently validated for walking gait, may also offer a time- and cost-efficient alternative to the gold-standard methods for running. This study aim was to ascertain the validity of an improved version of Graal for quantitative and qualitative analysis of running. In 33 healthy recreational runners (mean age 41 years), treadmill running at self-selected submaximal speed was simultaneously evaluated by a validated photosensor system (i.e., Optogait—the reference methodology) and by the video analysis of a posterior 30-fps video of the runner through the optimized version of Graal. Graal is video analysis software that provides a spectral analysis of the brightness over time for each pixel of the video, in order to identify its frequency contents. The two main frequencies of variation of the pixel’s brightness (i.e., F1 and F2) correspond to the two most important frequencies of gait (i.e., stride frequency and cadence). The Optogait system recorded step length, cadence, and its variability (vCAD, a traditional index of gait quality). Graal provided a direct measurement of F2 (reflecting cadence), an indirect measure of step length, and two indexes of global gait quality (harmony and synchrony index). The correspondence between quantitative indexes (Cadence vs. F2 and step length vs. Graal step length) was tested via paired t-test, correlations, and Bland–Altman plots. The relationship between qualitative indexes (vCAD vs. Harmony and Synchrony Index) was investigated by correlation analysis. Cadence and step length were, respectively, not significantly different from and highly correlated with F2 (1.41 Hz ± 0.09 Hz vs. 1.42 Hz ± 0.08 Hz, p = 0.25, r² = 0.81) and Graal step length (104.70 cm ± 013.27 cm vs. 107.56 cm ± 13.67 cm, p = 0.55, r² = 0.98). Bland–Altman tests confirmed a non-significant bias and small imprecision between methods for both parameters. The vCAD was 1.84% ± 0.66%, and it was significantly correlated with neither the Harmony nor the Synchrony Index (0.21 ± 0.03, p = 0.92, r² = 0.00038; 0.21 ± 0.96, p = 0.87, r² = 0.00122). These findings confirm the validity of the optimized version of Graal for the measurement of quantitative indexes of gait. Hence, Graal constitutes an extremely time- and cost-efficient tool suitable for quantitative analysis of running. However, its validity for qualitative running gait analysis remains inconclusive and will require further evaluation in a wider range of absolute and relative running intensities in different individuals.