Exercises for treatment of nonspecific low back pain

The effects of connective tissue massage and classical massage on pain, lumbar mobility, function, disability, and well-being in chronic low back pain: A three-arm randomized controlled trial

BACKGROUND

Chronic low back pain (CLBP) is a common musculoskeletal disorder. Effect of massage in the management of CLBP has been documented, but it is not clear which massage regimen is more effective. This study was carried out to compare the effect of connective tissue massage and classical massage on pain, lumbar mobility, function, disability, and well-being among patients with CLBP.

METHODS

The study included 30 participants who were randomly assigned to one of three intervention groups: the connective tissue massage group (CTMG; n = 10), the classical massage group (CMG; n = 10), and a standard physiotherapy/control group (CG; n = 10). The interventions were administered three times a week for four consecutive weeks. Assessments were conducted at baseline and at the end of the fourth week. Pain severity (Visual Analog Scale), lumbar mobility (Modified Schober Test), function (Back Pain Functional Scale), disability (Roland Morris Disability Questionnaire), and well-being (Short Form-36/SF-36) was evaluated.

RESULTS

All groups exhibited improvements in pain, lumbar mobility, function, and disability after 4 weeks (p < 0.05). The CMG showed enhancements in physical function, bodily pain, role physical, and role emotional subgroups of SF-36. The CTMG demonstrated improvements in all subgroups of SF-36 except general health (p < 0.05), while the CG only improved in the physical function subgroup (p < 0.05). A 2-way repeated measures ANOVA revealed a significant group-time interaction for MST (p = 0.04), Bodily Pain (p = 0.025) and Role Physical (p = 0.015).

CONCLUSIONS

The findings obtained from this study showed that CTMG was superior to CMG and CG in increasing lumbar mobility, and both massage applications were superior to the CG in increasing the well-being.

Efficacy of kinesio tape added to lumbar stabilization exercises on adult patients with mechanical low back pain: A randomized, single-blind clinical trial

BACKGROUND

Lumbar stabilization exercises (LSEs) are beneficial for chronic mechanical low back pain (CMLBP). However, further research focusing on intervention combinations is recommended. This study examined the effect of kinesio tape (KT) with LSEs on CMLBP adult patients.

METHODS

A randomized blinded clinical trial was conducted. Fifty CMLBP patients of both genders were assigned into one of two groups and received 8 weeks of treatment: group A (control): LSEs only, and group B (experimental): KT with LSEs. The primary outcome was back disability, measured by the Oswestry disability index. Secondary outcomes included pain intensity, trunk extensor endurance, and sagittal spinal alignment, as indicated by the visual analog scale, Sorensen-test, and C7-S1 sagittal vertical axis, respectively. The reported data was analyzed by a two-way MANOVA using an intention-to-treat procedure.

RESULTS

Multivariate tests indicate statistically significant effects for group (F = 4.42, p = 0.005, partial η2 = 0.148), time (F = 219.55, p < 0.001, partial η2 = 0.904), and group-by-time interaction (F = 3.21, p = 0.01, partial η2 = 0.149). Univariate comparisons between groups revealed significant reductions in the experimental group regarding disability (p = 0.029, partial η2 = 0.049) and pain (p = 0.001, partial η2 = 0.102) without a significant difference in the Sorensen test (p = 0.281) or C7-S1 SVA (p = 0.491) results. All within-group comparisons were statistically significant (p < 0.001).

CONCLUSION

The combination of KT and LSEs is an effective CMLBP treatment option. Although patients in both groups displayed significant changes in all outcomes, the combined interventions induced more significant reductions in back disability and pain intensity.

Effect of aerobic exercises on patients with chronic mechanical low back pain: A randomized controlled clinical trial

BACKGROUND

Chronic mechanical low back pain (CMLBP) is one of the most prevalent and costly disorders. Determining its most effective treatment approach is a priority for researchers.

PURPOSE

To examine the effects of including aerobic exercise within a conventional therapy regimen for young adults with CMLBP.

METHODS

Fifty CMLBP patients (22 males and 28 females) were randomly and equally assigned to one of two groups to receive the prescribed treatment for 8 weeks. The control group received the traditional program only (infrared, ultrasound, burst TENS, and exercises); for the experimental group, an aerobic training program using a stationary bicycle was added. Back pain intensity was the primary outcome. Secondary outcomes included the Oswestry disability index, back extensor endurance measured by the Sorensen test, and physical performance indicated by the back performance scale and the 6-min walk test. A Two-way MANOVA was used for data analysis.

RESULTS

Multivariate tests revealed statistically significant effects of group (p = 0.002, partial η2 = 0.182), time (p < 0.001, partial η2 = 0.928), and group-by-time interaction (p = 0.01, partial η2 = 0.149). Univariate group-by-time interactions were significant for back disability (p = 0.043), extensor endurance (p = 0.023) and results of the 6-min walk test (p = 0.023) showing greater improvement in the experimental group. However, back pain intensity and the back performance scale revealed no significant group-by-time interactions. Within-group comparisons were significant for all measured variables in both groups (p < 0.001).

CONCLUSION

Although a traditional program of infrared, ultrasound, TENS, and exercises is beneficial for CMLBP treatment, adding aerobic exercises to the program leads to more beneficial outcomes.

Therapeutic Exercise Parameters, Considerations and Recommendations for the Treatment of Non-Specific Low Back Pain: International DELPHI Study

BACKGROUND

Therapeutic exercise (TE) recommendations for non-specific low back pain (LBP) are meant to support therapy choices for people who suffer from this condition. The aim of this study was to reach an agreement on the definition and use of TE in the care of people with LBP.

METHODS

A Delphi study was carried out with a formal consensus procedure and sufficient scientific evidence, using an established methodology. Four rounds of anonymous questionnaires were administered to create useful suggestions and instructions in terms of the therapeutic activity for patients with LBP, and a group consensus conference.

RESULTS

A consensus was reached on most of the questions after 35 physiotherapists completed the questionnaires. Participants agreed that proper TE requires correct posture, body awareness, breathing, movement control, and instruction. Patients with LBP were advised to participate in supervised sessions twice a week for 30 to 60 min for a period of 3 to 6 months. Participants added that tailored evaluation and exercise prescription, monitoring, and functional integration of exercise, as well as using specific equipment, would benefit patients with LBP.

CONCLUSIONS

TE recommendations for patients with LBP should be dosed and customized based on their personal psychological needs, level of fitness, and kinesiophobia.

Effectiveness of Dry Needling and Ischaemic Trigger Point Compression of the Levator Scapulae in Patients with Chronic Neck Pain: A Short-Term Randomized Clinical Trial

BACKGROUND

Chronic neck pain (CNP) may be associated with latent myofascial trigger points (MTrPs) in the levator scapulae (LS), which can be treated with ischemic compression (IC) and dry needling (DN). Variables and elastography changes are evaluated to compare the short-term efficacy of two treatments with DN.

METHODS

A randomized clinical trial is conducted with 80 participants in two groups: the DN group (n = 40) and IC group (n = 40). The duration is 12 weeks, and mechanical heterogeneity index, pressure pain threshold (PPT), and pain intensity are measured at baseline, immediately after, 48 h after, and one week after treatment.

RESULTS

Statistically significant changes were immediately observed between the two groups: PPT decreased in the DN group (p = 0.05), while it increased in the IC group. At 48 h and one week after treatment, these values increased in the DN group and remained higher than in the IC group. The heterogeneity index improved in both groups but more significantly in the DN group than in the IC group.

CONCLUSIONS

In subjects with CNP who had latent plus hyperalgesic MTrPs in the LS muscle, DN outperformed IC in PPT, pain intensity, and mechanical heterogeneity index at 48 h and one week after initiating therapy.

Investigation of Real-Time Diagnostic Ultrasound as a Means of Biofeedback Training in Transversus Abdominus Re-Education of Patients with Non-Specific Low Back Pain: A Prospective Randomized Controlled Pilot Study

Background: It is believed that ultrasound-guided imaging of activation/contraction of the deep abdominal muscles (such as transervsus abdominis) is useful for assisting deep muscle re-education, which is often dysfunctional in non-specific low back pain (NSLBP). Thus, this pilot study aimed to evaluate the use of real-time ultrasound (US) as a feedback device for transverse abdominis (TrA) activation/contraction during an exercise program in chronic NSLBP patients. Methods: Twenty-three chronic NSLBP patients were recruited and randomly assigned to a US-guided (n = 12, 8 women, 47.6 ± 2.55 years) or control group (n = 11, 9 women, 46.9 ± 4.29 years). The same motor control-based exercise program was applied to both groups. All patients received physiotherapy twice per week for seven weeks. Outcome measures, tested at baseline and post-intervention, included Numeric Pain Rating Scale, TrA activation level (measured through a pressure biofeedback unit-based developed protocol), seven established motor control tests, Roland-Morris Disability Questionnaire and Hospital Anxiety and Depression Scale. Results: For each group, all outcome variables yielded statistical differences post-intervention (p < 0.05), indicating significant improvements. However, there were no significant group x time interactions for any of the outcomes (p > 0.05), thus, indicating no superiority of the US-guided group over the control. Conclusions: The addition of US as a visual feedback device for TrA re-education during a motor control exercise program was not proven superior to traditional physiotherapy.

Effectiveness of Dry Needling and Ischemic Trigger Point Compression in the Gluteus Medius in Patients with Non-Specific Low Back Pain: A Randomized Short-Term Clinical Trial

BACKGROUND

The presence of latent myofascial trigger points (MTrPs) in the gluteus medius is one of the possible causes of non-specific low back pain. Dry needling (DN) and ischemic compression (IC) techniques may be useful for the treatment of these MTrPs.

METHODS

For this study, 80 participants were randomly divided into two groups: the dry needling group, who received a single session of DN to the gluteus medius muscle plus hyperalgesia (n = 40), and the IC group, who received a single session of IC to the gluteus medius muscle plus hyperalgesia (n = 40). Pain intensity, the pressure pain threshold (PPT), range of motion (ROM), and quality of life were assessed at baseline, immediately after treatment, after 48 h, and one week after treatment.

RESULTS

Statistically significant differences were shown between the two groups immediately after the intervention, showing a decrease in PPT (p < 0.05) in the DN group and an increase in PPT in the IC group. These values increased more and were better maintained at 48 h and after one week of treatment in the DN group than in the IC group. Quality of life improved in both groups, with greater improvement in the DN group than in the IC group.

CONCLUSIONS

IC could be more advisable than DN with respect to UDP and pain intensity in the most hyperalgesic latent MTrPs of the gluteus medius muscle in subjects with non-specific low back pain, immediately after treatment. DN may be more effective than IC in terms of PPT, pain intensity, and quality of life in treating latent plus hyperalgesic gluteus medius muscle MTrPs in subjects with non-specific low back pain after 48 h and after one week of treatment.

Blessing as a health resource: cross-sectional study with elderly residents of rural areas

OBJECTIVE

To estimate the prevalence and factors associated with the search for folk healers for the treatment of health problems among elderly living in the rural area of the city of Rio Grande-RS.

METHODS

Cross-sectional, p opulation-based study with random sampling, carried out in 2017. The outcome was analyzed in three categories (never used/used in the last 12 months/used for more than 12 months). Multinomial logistic regression was used to analyze theassociated factors.

RESULTS

A total of 1,030 elderly individuals were interviewed. The prevalence of demand for folk healers in the last 12 months and for more than 12 months was 9.5% and 15.8%, respectively. In the adjusted analysis, the characteristics associated with the use of a folk healer for more than 12 months were: being in the age group of 80 years or more and having back problems and arthrosis. Following the evangelical religion was identified as a protective factor for using this resource. On the other hand, the demand for blessing in the last year was related to the age group of 70-79 years, following spiritual religions, presence of disease in the last 12 months, back problems and arthrosis, and preference for the use of urgency and emergency services. Being female was associated only with the use for more than 12 months.

CONCLUSION

This study brings an original contribution to a topic poorly evaluated in epidemiological studies, because the knowledge of the frequency and determinants of the search for this type of popular therapy can be used to improve the quality and access to health services offered to the elderly population in rural areas.

Efficacy of Integrating Cervical Posture Correction With Lumbar Stabilization Exercises for Mechanical Low Back Pain: A Randomized Blinded Clinical Trial

Although current lumbar stabilization exercises are beneficial for chronic mechanical low back pain, further research is recommended focusing on global spinal alignment normalization. This randomized, controlled, blinded trial was conducted to determine the effects of adding cervical posture correction to lumber stabilization on chronic mechanical low back pain. Fifty adult patients (24 males) with chronic mechanical low back pain and forward head posture received 12 weeks treatment of either both programs (group A) or lumbar stabilization (group B). The primary outcome was back pain. The secondary outcomes included the craniovertebral angle, Oswestry Disability Index, C7-S1 sagittal vertical axis, and sagittal intervertebral movements. The multivariate analysis of variance indicated a significant group-by-time interaction (P = .001, partial η2 = .609). Pain, disability, C7-S1 sagittal vertical axis, and l2-l3 intervertebral rotation were reduced in group A more than B (P = .008, .001, .025, and .001). Craniovertebral angle was increased in A when compared to B (P = .001). However, there were no significant group-by-time interactions for other intervertebral movements. Within-group comparisons were significant for all outcomes except for craniovertebral angle within patients in the control group. Adding cervical posture correction with lumber stabilization for management of chronic low back pain seemed to have better effects than the application of a stabilization program only.

Effects of core stabilization exercises on thickness and activity of trunk and hip muscles in subjects with nonspecific chronic low back pain

BACKGROUND

Changes in trunk and hip muscles are believed to be important in subjects with nonspecific chronic low back pain (NSCLBP), but little is known about specific changes, or how they might be affected by core stabilization exercises. The aim of this study was to compare six key muscles before and after these exercises.

METHODS

Thirty two NSCLBP patients were assigned randomly into two groups: exercise (n = 17) and control (n = 15). On 5 days per week for 4 weeks, the Exercise group performed 16 core stabilization exercises and the Control group received transcutaneous electrical nerve stimulation and a 'hot-pack'. Surface electromyography (EMG) was used to assess maximum bilateral activity of transversus abdominis (TrA), multifidus (MF) and gluteus maximus (Gmax) muscles. Ultrasound imaging was used to measure the rest and contracted thickness of these muscles. Pain and disability were assessed using a visual analogue scale (VAS) and the Oswestry Disability Index.

RESULTS

When left and right-side muscle data were combined, two-way ANOVAs showed a nonsignificant interaction effect for all dependent variables (P > 0.05), significant time effects on resting muscle thickness for TrA (P = 0.01), MF (P = 0.041) and Gmax (P = 0.003), EMG signals of TrA (P = 0.038), pain and disability (P = 0.000). There were a significant group effect on contracted thickness for TrA (P = 0.032) and Gmax (P = 0.026) and disability (P = 0.017).

CONCLUSIONS

Core stabilization exercises increased contracted thickness of TrA and Gmax muscles and decreased disability in subjects with NSCLBP.

Cross-cultural adaptation and reliability of the pain response to activity and position questionnaire

BACKGROUND

The World Health Organization reports that one of the main incapacitating conditions in older adults is osteomusculoskeletal disorders, and among these is low back pain. There are few instruments translated and transculturally adapted with psychometric properties evaluated for older adults with this health condition in Brazil. The Pain Response to Activity and Positioning (PRAP) questionnaire enables classification of older adults through functional performance. The objective of this study was to perform a cross-cultural adaptation and verify the reliability of the PRAP for older Brazilian people with chronic low back pain.

METHODS

A cross-sectional methodological study from the international study "Back Complaints in the Elders". We included individuals aged ≥60 years, with chronic lumbar pain complaints lasting ≥3 months. The transcultural translation and adaptation process followed the criteria proposed by Beaton and Guilhemeim, 1993. Reliability was tested using an unweighted Cohen's Kappa.

RESULTS

Thirty-six (36) older adults participated in the study (71.15 ± 7.23 years, 94.4% female). The intra-rater reliability for Low Back Pain (LBP) was between 0.50-1.00 and 0.23-0.84 for lower limbs, while the inter-rater reliability for LBP was between 0.25-0.63 and between 0.18-0.53 for lower limbs. The criteria for low back pain diagnosis showed intra and inter-rater agreement of 0.52 and 0.47, respectively.

CONCLUSION

The Brazilian version of the instrument showed adequate reliability and ability to classify older adults in the diagnosis of LBP by reporting the performance of daily activities, and is indicated for use in the context of research and clinical practice.

TRIAL REGISTRATION

There is no trial registration. This is a methodological study.

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.

Development and structural validity of a Nigerian culture- and environment-friendly low back pain outcome measure: Ibadan Low Back Pain Disability Questionnaire

Background

Low Back Pain (LBP) is the leading cause of disability globally. Standardized outcome measures for measuring LBP disability exist but none was developed with consideration for the Nigerian culture and environment.

Objective

This study was aimed to develop a Nigerian culture- and environment-friendly LBP scale, the Ibadan Low Back Pain Disability Questionnaire (ILBPDQ).

Methods

Items on ILBPDQ were devised from literature review, interview of patients (231 consecutively-sampled patients with chronic non-specific LBP) and 12 professionals experienced in LBP management and were contentvalidated. The first draft of the questionnaire underwent pretesting twice among individuals with chronic non-specific LBP (n=35 and 114 respectively), factor analysis and experts' reviews to produce the final version.

Results

The final scale comprised 18 items with a two-factor structure (common Activity of Daily Living [ADL] and culture-specific ADL). It has eigen value ≥ 1 and explained 60% of variance. Items on ILBPDQ covered important constructs relevant to an average Nigerian patient with LBP.

Conclusion

A scale for assessing disability in LBP is made available for use in Nigeria and similar populations.

Funding

None declared

Influence of Motion Therapy in the Prevention of Lumbar Pain Syndrome Relapse

INTRODUCTION

Lumbar pain syndrome is one of the most common conditions in clinical practice, more common than 290 other pathological conditions, which affect up to 84% of adults in a certain period of their life. The origin of the lower back pain can be classified as mechanical, neuropathic and secondary due to another illness. Patient education and information, muscle strengthening exercises, maintenance of routine daily physical activity and pain therapy are the basis of acute non-specific pain syndrome therapy.

AIM

To determine the success of the motion therapy procedure in the prevention of lumbar pain syndrome relapse.

MATERIAL AND METHODS

The research is prospective, longitudinal, manipulative and controllable. It was conducted in the private practice "Praxis - dr. Pecar" in the period from June 20, 2014 to June 1, 2016, and included 200 respondents with symptoms of lumbar pain syndromes divided into the experimental (n=100) and control (n=100) groups. The presence of lumbar pain syndrome relapse in respondents experimental and control group was recorded in the second and third clinical examination.

RESULTS

In the second examination, 4 (4%) of the respondents from experimental group and 37 (37%) of the control group responded had LBS relapse. In the third examination, the number of respondents with recurrent LBS in the experimental group was 4 (4%), while in the control group was 17 (17%). After the study, no statistically significant difference was observed in the mean age of respondents who had LBS relapse compared to respondents without LBS relapse, as well as significant influence of sex structure on relapse in the experimental and control group during the second and third examination.

CONCLUSION

After the second examination, the relapse rate in the experimental group was statistically significantly higher in the respondents withstanding jobs, while there was no statistically significant difference in the control group and both groups after the third examination.

Risco de sarcopenia em idosas com queixa de dor lombar aguda

RESUMO Verificou-se o risco de sarcopenia em idosas comunitárias com queixa de dor lombar aguda e comparou-se o índice de dor e mobilidade/equilíbrio entre aquelas em risco de sarcopenia e as não sarcopênicas. Pesquisa transversal, subprojeto do estudo epidemiológico e multicêntrico Back Complaints in the Elders (Bace). Participaram idosas com ao menos um episódio de dor lombar aguda no prazo de seis semanas antes da coleta de dados. Avaliou-se a velocidade de marcha (4,6m), a força de preensão palmar (dinamômetro Jamar), o índice de dor (escala analógica de dor) e mobilidade/equilíbrio (Timed Up and Go test). O risco de sarcopenia foi estimado por medida percentual e as comparações pelo teste t para amostras independentes; o nível de significância adotado foi de 5%. Participaram deste estudo 322 idosas: o risco de sarcopenia foi de 54%, ou seja, 173 idosas (71,8±5,2 anos) estavam em risco de sarcopenia e 149 (46%) eram não sarcopênicas (71,5±5,1 anos). Houve diferença quanto à intensidade da dor (p=0,02) e à mobilidade/ao equilíbrio (p=0,01), sendo que aquelas em risco de sarcopenia estavam em piores condições. Os resultados demonstraram risco de sarcopenia entre as idosas com dor lombar aguda. Estas apresentavam maior índice de dor e pior mobilidade/equilíbrio, sugerindo que a sarcopenia, se presente em idosas com essa dor, pode influenciar negativamente na funcionalidade.

Effectiveness of classic physical therapy proposals for chronic non-specific low back pain: a literature review

INTRODUCTION

Chronic low back pain is a pathological process that compromises the functionality and quality of life worldwide. The objective of the study was to evaluate the effectiveness of classical physiotherapy in the management of non-specific chronic low back pain.

METHODS

A literature search in English electronic databases was performed from November to December of 2015. Only those studies addressing chronic non-specific low back pain by manual therapy and different types of exercises methods were included, and those, which combined acute or subacute pain with systematic reviews and clinical practice guidelines, were excluded. Studies involving cognitive-behavioral approaches were also excluded.

RESULTS

487 studies were identified, 16 were analyzed and 10 were excluded. Of the 6 studies reviewed, 5 of them achieved a moderate quality and 1 of them was of a low quality. Back School exercises and McKenzie's method were all ineffective. Osteopathic spinal manipulation proved effective when performed on the lower back and the thoracic area but only immediately after it was received, and not in the medium or long term. Massages proved effective in the short term too, as well as the global postural reeducation although ultimately this study can be considered of a low methodological quality.

CONCLUSIONS

Based on the data obtained, classical physiotherapy proposals show ineffectiveness in the treatment of chronic non-specific low back pain. More multidimensional studies are needed in order to achieve a better treatment of this condition, including the biopsychosocial paradigm.

The effects of a standardized belly dance program on perceived pain, disability, and function in women with chronic low back pain

BACKGROUND

An alternative approach to facilitate movement and control through the trunk and pelvis is belly dancing. Investigations of belly dancing mechanics indicate similar muscular activation patterns of those known to influence chronic low back pain (cLBP). However, no documented studies have examined its effectiveness as a treatment for cLBP.

OBJECTIVE

The purpose of this study was to investigate the influence of a standardized belly dance program in women with cLBP.

METHODS

A single subject design was used to evaluate weekly outcomes during a three-week baseline period, six-week belly dance program, and again at a two-month follow-up. Outcome measures for pain, disability, function, and fear-avoidance beliefs were utilized.

RESULTS

Two subjects completed the program. No significant differences were noted during the baseline assessment period. At two months, subject one demonstrated change scores of -1.12, -1%, and 2.2 for pain, disability, and function respectively while subject two demonstrated change scores of 5.4, 5%, and 1.1 for pain, disability, and function, respectively. Subject one showed a clinically significant change score for both fear avoidance of work and physical activity, with score changes of 4 and 3.3, respectively.

CONCLUSION

The results of this study suggest a standardized belly dance program may positively influence pain and function in women with cLBP.

Low back pain in healthy postmenopausal women and the effect of physical activity: A secondary analysis in a randomized trial

Epidemiological studies on the prevalence of musculoskeletal pain have consistently shown that this is a relevant health problem, with non-specific low back pain (LBP) being the most commonly reported in adult females. Conflicting data on the association between LBP symptoms and physical activity (PA) have been reported. Here, we investigated the prevalence of LBP and the effect of a 24-month non-specific PA intervention on changes in LBP prevalence in a series of Italian healthy postmenopausal women. We performed a secondary analysis in the frame of the DAMA trial, a factorial randomized intervention trial aimed to evaluate the ability of a 24-month intervention, based on moderate-intensity PA, and/or dietary modification, in reducing mammographic breast density in healthy postmenopausal women. The PA intervention included at least 1 hour/day of moderate PA and a more strenuous weekly activity, collective walks and theoretical group sessions. A self-administered pain questionnaire was administered at baseline and at the end of the intervention. The questionnaire was specifically structured to investigate the occurrence of musculoskeletal pain, the body localization, intensity and duration of the pain. Two hundred and ten women (102 randomized to PA intervention, 108 not receiving the PA intervention) filled out the questionnaires. At baseline LBP was present in 32.9% of the participants. Among women randomized to the PA intervention, LBP prevalence at follow up (21.6%) was lower than at baseline (33.3%) (p = 0.02), while in women who did not receive the PA intervention the LBP prevalence at baseline and follow up were 32.4% and 25.9%, respectively (p = 0.30). Overall, there was no significant between-group effect of PA intervention on LBP. Further studies are needed to understand the role of non-specific PA intervention, aimed to improve overall fitness, on LBP prevalence.

Innovative exercise device for the abdominal trunk muscles: An early validation study

BACKGROUND

Exercise is one of the few treatments that provide significant improvements in chronic low back pain (CLBP). We developed an innovative exercise device for abdominal trunk muscles. This device can be used in a sitting or standing position and contains a built-in system to measure abdominal trunk muscle strength. We examined whether subjects can adequately use the device to perform the exercises and measure their abdominal trunk muscle strength.

METHODS

We collected data on the body height, body weight, body mass index, and girth of 30 healthy male volunteers, and measured their grip power and trunk extensor muscle strength using a dynamometer. The volunteers performed a sit-up test as an indicator of trunk flexor muscle strength, and we measured their abdominal muscle strength using the device. We then evaluated the correlations between abdominal trunk muscle strength and anthropometric parameters as well as the strength of other muscles. In subsequent tests, 5 of the 30 subjects participated in two positron emission tomography (PET) series consisting of examinations after a resting period (control study) and during exercise (exercise study). For the exercise study, the subjects performed 2 sets of exercises for 20 minutes using the device before and after an injection of 18F-fluorodeoxyglucose (FDG). PET-computed tomography images were obtained 60 minutes after FDG injection in each study. We compared the skeletal muscle metabolism of the participants in both studies using the standardized uptake value.

RESULTS

The muscle strength measured by the device and the 30-second sit-up frequency were correlated. FDG accumulation within the diaphragm and abdominal rectus muscles was significantly higher in the exercise study.

CONCLUSION

Our innovative exercise device facilitates a coordinated contraction of the abdominal trunk muscles at the anterior aspect and the roof of the core, and enables subjects to measure the strength of these muscles.

Climbing Has a Positive Impact on Low Back Pain: A Prospective Randomized Controlled Trial

OBJECTIVE

Comparison of climbing versus no treatment to treat chronic low back pain.

DESIGN

Prospective randomized controlled trial.

SETTING

Tertiary.

PARTICIPANTS

A total of 30 patients with chronic low back pain were recruited and randomly assigned to 2 different groups: climbing and control. The inclusion criteria were defined as chronic low back pain, age between 18 and 45 years, body mass index lower than 25, and no climbing experience.

INTERVENTIONS

Patients in the climbing group were instructed to climb 5 different climbing routes. A climbing activity of 10 sessions in 8 weeks, at least once a week with a minimum duration of 1 hour, was mandatory.

MAIN OUTCOME MEASURES

The participants were examined before (T0) and after therapy (8 weeks, T8) and after another 6 weeks (T14). The outcome was evaluated using Oswestry Disability Index, Visual Analog Scale (VAS), Likert scale, and magnetic resonance imaging (MRI). Radiologists evaluating MRI were blinded. The study was performed as a single-center study.

RESULTS

Evaluating the Oswestry Disability Index, a significant difference in the time course between the 2 groups was detected (P = 0.022). Significant improvements comparing climbing and control group were also found when assessing VAS in a minimal finger-floor-distance position (P = 0.048). Patients in the climbing group showed a reduction in size of disc protrusion.

CONCLUSIONS

Climbing may be an effective and low-cost therapy option for people with chronic low back pain.

CLINICAL RELEVANCE

Low back pain is a very common disease but still a challenge to treat. Therapy strategies vary from conservative ones, pharmacological treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and weak opioids, to invasive treatment with acupuncture, injections, and operative reconstruction. Some can be costly and not without risks. For instance, many people who use NSAIDs are at risk of common side effects such as gastrointestinal complications (irritation, ulcers, and bleeding) that may lead to hospitalization. Climbing could offer reduction of pain and better performance in daily life, because it offers a closed chain muscle training that has the potential to improve posture, perception of the trunk midline, and muscle control. Climbing may also lead to a better adherence to continuing treatment than traditional physical therapy and exercise due to a more exciting aspect of the sports activity.

The etiologies of low back pain in patients with lumbar disk herniation

BACKGROUND

Low back pain (LBP) is a common complaint in population that lowers the quality of life. The main etiology of LBP is recognized in about 20% of patients while it is attributed to lumbar disk herniation (LDH) in 80% of cases and causes some unnecessary lumbar surgeries without realizing the definite cause.

OBJECTIVES

This study was planned to evaluate the etiologies of LBP in patients who had LDH to clarify whether the disc herniation is the main cause of patients` pain or other diseases were responsible for this kind of pain.

MATERIALS AND METHODS

In this cross-sectional study, we analyzed the medical profiles of the patients with proven LDH in a private clinic in Mashhad City, Iran, between 2005 and 2012, for demographic and the etiologies of LBP with clinical and paraclinical studies. We also calculated the incidence of each etiology by SPSS 13.

RESULTS

In our study, among 1250 patients with proven LDH by MRI, 500 patients (40%) had chronic LBP and the most common causes of LBP were heavy constant working (40.2%), osteoporosis (35.6%), and sacroiliac joint pain (34.6%), consecutively. Interestingly, LDH had the ninth rank among the common cause of LBP.

CONCLUSIONS

In this study, we found that in spite of previous beliefs, discopathies were not common etiologies of LBP. Thus, even in patients with proven LDH by imaging studies, the physician should perform a thorough evaluation for other causes of LBP to avoid unnecessary lumbar surgeries.

Occupational low back pain in nursing workers: massage versus pain

Objective: To assess the efficacy of massage for decreasing occupational low back pain in workers of a Nursing team in an Emergency Room. Method: A randomized controlled trial, using a socio-demographic/morbidity questionnaire and a Pain Numeric Scale. Forty-five subjects were randomly allocated for intervention (G1 – Massage by acupressure), placebo group (G2 – application of Garlium Arseneid Laser 904nm turned off) and control (G3 – no intervention). Results: The main triggering factor, as well as the worsening of pain, was the patient manipulation, both with a prevalence of 34.9%. The main treatment for low back pain before this research was the use of medication, with a prevalence of 44.2%. In accordance with a variance analysis, only G1 presented a significant statistical difference, with a better result after 12 sessions. Massage presented an enormous effect (d = 4.59), corresponding to 86% of reduction in the pain level. Conclusion: Massage was effective to decrease occupational low back pain of those Nursing workers.


Ten-year follow-up of strengthening versus flexibility exercises with or without abdominal bracing in recurrent low back pain

STUDY DESIGN

Randomized prevention trial.

OBJECTIVE

To compare the long-term effect of strengthening versus flexibility exercises and to evaluate the additional effect of abdominal bracing in recurrent low back pain (LBP).

SUMMARY OF BACKGROUND DATA

No conclusions could be made regarding appropriate exercise types or parameters in recurrent LBP. Abdominal bracing increases trunk stiffness; however, its long-term effect has not been evaluated in recurrent LBP yet.

METHODS

Six hundred patients with recurrent LBP participated. They were randomized into 4 groups-150 patients (age: 42.5 ± 12.7) performed strengthening exercises; 150 patients (age: 41.3 ± 11.5) performed flexibility exercises; 150 patients (age: 41.0 ± 13.2) performed strengthening exercises and used abdominal bracing in daily activities/exercises; and 150 patients (age: 40.6 ± 12.3) performed flexibility exercises and used abdominal bracing in daily activities/exercises. At the beginning of the study and at the end of 10 consecutive years were recorded 6 outcomes-frequency, intensity, and duration of pain, as well as frequency, intensity, and duration of exercises.

RESULTS

Regarding the first 4 outcomes-all groups showed improvement from the beginning to the second year, but worsening from the second to the 10th year; there was no difference between strengthening and flexibility groups; bracing groups showed better results versus nonbracing groups. Intensity, frequency, and duration of the pain correlated with each other and with frequency of the exercises, but not with exercise duration or intensity.

CONCLUSION

The exercise frequency is more important than the type, duration, or intensity of the exercise. Abdominal bracing adds to the exercise effect. It could be considered as a "preliminary muscle back belt on demand" increasing the trunk stiffness and the frequency of the trunk muscle contractions/cocontractions without interruption of daily activities, which may remind/convince the patients to exercise more frequently. Frequent exercising and bracing seems effective long-term prevention advices in recurrent LBP.

LEVEL OF EVIDENCE

2.