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Studnicki R, Szymczyk P, Adamczewski T, Studzińska K, Hansdorfer-Korzon R, Silva AF, Kawczyński A. Manual traction is effective in alleviating lumbosacral spine pain: Evidence from a randomized controlled trial. Heliyon 2024; 10:e31013. [PMID: 38799754 PMCID: PMC11126845 DOI: 10.1016/j.heliyon.2024.e31013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Background Manual traction, a therapeutic technique frequently employed in healthcare, involves applying controlled pulling force by hand, usually to the spine, to stretch muscles and decompress joints, thereby alleviating pain. This method can be particularly beneficial for addressing lumbosacral spine pain exacerbated by radicular symptoms, characterized by pain radiating from the lower back due to compression or irritation of spinal nerves. Purpose This study aimed to compare the effects of manual traction against control group in alleviating the lumbosacral spine pain caused by radicular symptoms. Methods A randomized controlled study design was utilized with a sample of 60 patients experiencing lumbosacral spine pain, evenly distributed between an experimental group (n = 30; receiving manual traction) and a control group (n = 30). Patients underwent assessments before and after six treatment sessions, which included the Straight Leg Raise test, modified Bragard's test, Kernig's test, and the visual analogue scale for pain perception. Results Between-group significant differences were found at post-intervention, favoring the experimental group on SLR - Left (°) (p = 0.004; medium effect size), SLR - Right (°) (p = 0.004; medium effect size), Modified Bragard test - Left (°) (p = 0.024; small effect size), Modified Bragard test - Right (°) (p = 0.003; medium effect size), Kernig's Test - Left (°) (p = 0.013; medium effect size) and Kernig's Test - Right (°) (p = 0.010; medium effect size). Additionally, between-group significant differences were found at post-intervention, favoring the experimental group on VAS scores at SLR left (p < 0.001; medium effect size), and right (p < 0.001); medium effect size, Modified Bragard test left (p < 0.001; medium effect size) and right (p < 0.001; medium effect size) and at Kernig's Test left (p < 0.001; medium effect size) and right (p < 0.001; medium effect size). Conclusions In conclusion, manual traction is recommended as an effective approach for alleviating lumbosacral spine pain in patients experiencing symptoms resulting from irritation or compression of a spinal nerve root.
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Affiliation(s)
- Rafał Studnicki
- Sub-Faculty of Physiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Szymczyk
- Sub-Faculty of Physiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Adamczewski
- Medical Rehabilitation Clinic, Chair of Rehabilitation, Faculty of Health Sciences, Medical University of Lódź, Łódź, Poland
| | | | | | - Ana Filipa Silva
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal
- Sport Physical Activity and Health Research & Innovation Center, Viana do Castelo, Portugal
| | - Adam Kawczyński
- Wrocław University of Health and Sport Sciences, Departament of Paralympic Games, Wrocław, Poland
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Samolsky Dekel BG, Sorella MC, Vasarri A, Melotti RM. The Occipital Nerves Applied Strain Test to Support Occipital Neuralgia Diagnosis. Pain Ther 2023; 12:1135-1148. [PMID: 37310572 PMCID: PMC10444928 DOI: 10.1007/s40122-023-00532-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Occipital neuralgia (ON) is a disabling cephalalgia form with demanding diagnostic workflow. We report the description and reliability analyses of the occipital nerves-applied strain (ONAS) test for occipital neuralgia (ON) early-stage diagnosis in cephalalgia patients. METHODS In a retrospective and observational study, we evaluated, among n = 163 consecutive cephalalgia patients, the sensitivity, specificity, and prior probability [positive (PPV) and negative (NPV) predictive values] of the ONAS test against two reference tests (occipital nerve anesthetic block and the painDETECT questionnaire). Multinomial logistic regression (MLR) and χ2 analyses verified the ONAS test outcome's dependence upon independent variables (gender, age, pain site, block test, and painDETECT outcomes). We assessed inter-rater agreement with Cohen's kappa statistic. RESULTS ONAS test showed sensitivity and specificity of 81 and 18%, respectively, against the painDETECT and of 94 and 46%, respectively, against the block test. PPV was > 70% against both tests, while NPV was 81% against the block test and 26% against the painDETECT. Interrater agreement Cohen's kappa was excellent. Significant association (χ2 analyses) and relationship (MLR) were found only between ONAS test and pain site but not with the other independent predictors. CONCLUSIONS The ONAS test showed satisfactory reliability among cephalalgia patients; thus, it might be considered a valuable early stage tool for ON diagnosis in these patients.
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Affiliation(s)
- Boaz G Samolsky Dekel
- Department of Medicine and Surgery Sciences, University of Bologna, Via Massarenti N. 9, 40138, Bologna, Italy.
- Anesthesia and Pain Therapy Unit, IRCCS Azienda Ospedaliera-Universitaria Di Bologna Policlinico S. Orsola-Malpighi, Via Massarenti N. 9, 40138, Bologna, Italy.
- Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Via Massarenti N. 9, 40138, Bologna, Italy.
| | - Maria C Sorella
- Department of Medicine and Surgery Sciences, University of Bologna, Via Massarenti N. 9, 40138, Bologna, Italy
- Anesthesia and Pain Therapy Unit, IRCCS Azienda Ospedaliera-Universitaria Di Bologna Policlinico S. Orsola-Malpighi, Via Massarenti N. 9, 40138, Bologna, Italy
| | - Alessio Vasarri
- Anesthesia and Pain Therapy Unit, IRCCS Azienda Ospedaliera-Universitaria Di Bologna Policlinico S. Orsola-Malpighi, Via Massarenti N. 9, 40138, Bologna, Italy
| | - Rita M Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Via Massarenti N. 9, 40138, Bologna, Italy
- Anesthesia and Pain Therapy Unit, IRCCS Azienda Ospedaliera-Universitaria Di Bologna Policlinico S. Orsola-Malpighi, Via Massarenti N. 9, 40138, Bologna, Italy
- Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Via Massarenti N. 9, 40138, Bologna, Italy
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Zuverlässigkeit des Straight-Leg-Raise-Tests bei Verdacht auf lumbale radikuläre Schmerzen: Ein systematisches Review mit Meta-Analyse. PHYSIOSCIENCE 2022. [DOI: 10.1055/a-1867-3304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Saini R, Sharma A, Dave MB. Clinical Reporting of Magnetic Resonance Imaging, the Way Forward for Patients With Lumbar Disc Herniation: A Prospective Correlational Study. Cureus 2022; 14:e27232. [PMID: 36039233 PMCID: PMC9400709 DOI: 10.7759/cureus.27232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Lower back pain (LBP) is a major cause of increasing years lived with disability. Many adults suffer from LBP once in their lifetime. Multiple environmental, genetic, and acquired factors lead to disc degeneration. Spinal stenosis can be caused due to bony, ligamentous, or discogenic origin. The majority of cases have a combined etiology of bony, ligamentous, and disc disease. Lumbar disc disease (LDD) has been mentioned by various terminologies in the literature. A standardized nomenclature is needed for better research and communication. Our study is based on the correlation between lumbar disc herniation (LDH) and magnetic resonance imaging (MRI) findings. Methodology A prospective observational study was undertaken on patients presenting with signs and symptoms suggestive of LDD to the Department of Orthopaedics at a tertiary care hospital in southern Rajasthan. The purposive sampling technique with a consecutive scheme was used. MRI is a valuable tool for diagnosing LDH. Results Many studies have concluded false-positive results for MRI in cases of LDH. Hence, interpretation with grading systems (Pfirrmann’s and Scizas grading) and correlation with clinical findings are mandatory for accurate diagnosis and management of patients. Conclusions We suggest clinicians adopt clinical reporting of MRI to improve the diagnostic accuracy with clinical and radiological correlation. Reporting can guide professionals in deciding the course of treatment in the form of conservative or surgical management.
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Nee RJ, Coppieters MW, Boyd BS. Reliability of the straight leg raise test for suspected lumbar radicular pain: A systematic review with meta-analysis. Musculoskelet Sci Pract 2022; 59:102529. [PMID: 35245880 DOI: 10.1016/j.msksp.2022.102529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/25/2022] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The passive straight leg raise (SLR) and crossed SLR are recommended tests for lumbar radicular pain. There are no recent reviews of test reliability. OBJECTIVES To summarize SLR and crossed SLR reliability in patients with suspected lumbar radicular pain. DESIGN Systematic review with meta-analysis. METHOD MEDLINE and CINAHL were searched for studies published before April 2021 that reported SLR or crossed SLR reliability in patients with low back-related leg pain. Supplemental analyses also included patients with low back pain only. Study selection, risk of bias assessment (QAREL), and data extraction were performed in duplicate. Kappa, intraclass correlation coefficients, and smallest detectable difference (SDD95) quantified reliability. Meta-analysis was performed when appropriate. Confidence in the evidence was determined by applying GRADE principles. RESULTS/FINDINGS Fifteen studies met selection criteria. One-hundred-eighty-nine participants had low back-related leg pain. Four-hundred-thirty-nine were included in supplemental analyses. Meta-analyses showed at least fair inter-rater reliability when a positive SLR required provocation of lower extremity symptoms or pain. SLR reliability was at least moderate when testing included structural differentiation (e.g., ankle dorsiflexion). A low prevalence of positive crossed SLR tests led to wide-ranging reliability estimates. Confidence in the evidence for identifying a positive SLR or crossed SLR was moderate to very low. SDD95 values for different raters measuring SLR range of motion ranged from 13 to 20°. CONCLUSIONS Reliability data support testing SLR with structural differentiation manoeuvres. Crossed SLR reliability data are inconclusive. Measurement error likely prohibits using SLR range of motion for clinical decision-making.
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Affiliation(s)
- Robert J Nee
- Department of Physical Therapy, Samuel Merritt University, Oakland, CA, USA.
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia; Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Benjamin S Boyd
- Department of Physical Therapy, Samuel Merritt University, Oakland, CA, USA
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Asan Z. The Lasegue Test: Defining its Specificity and Sensitivity based on Geometry. Clin Anat 2022; 35:1064-1069. [PMID: 35514060 DOI: 10.1002/ca.23902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 04/26/2022] [Accepted: 05/03/2022] [Indexed: 11/10/2022]
Abstract
The Lasegue test -also known as the straight leg raise test-, used for diagnostic purposes in cases of lumbar disc herniation can be explained by geometrical rules. This study aimed to describe the relationship between the apical and basal size of the herniated disc and the Lasegue test, and to describe the specificity and sensitivity of the herniated disc as a function of its height, location, and size. The study evaluated cases diagnosed with lumbar disc herniation with available MRI scans and Lasegue test results. The radix length to the foramen was calculated by recording the apical length and the base length of the herniated disc. The level and apical direction of the herniated discs were also recorded to determine the specificity and sensitivity of the test. Data from a total of 865 cases were analyzed. The apical length of the herniated disc was the most critical criterion for determining the Lasegue test. The Lasegue test is most sensitive and specific in lateral herniated discs at the level of L4-5. The specificity and sensitivity are decreased in L3-4, migrated, and sequestered disc herniations. In these cases, false-negative results may occur. Sensitivity decreases in the median and paramedian herniated discs. Compression of the sciatic nerve reduces herniated disc straightness. The Lasegue test is a test that can be defined according to the rules of geometry. Knowing the factors that decrease specificity and sensitivity and cause false positive/negative results will facilitate correct diagnosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ziya Asan
- Department of Neurosurgery, Kirsehir Ahi Evran University, Faculty of Medicine, Turkey
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Samolsky Dekel BG, Sorella MC, Vasarri A, Melotti RM. Evidence for the BUAS-test ability to diagnose lumbar radicular pain. Br J Pain 2022; 16:23-33. [PMID: 35111311 PMCID: PMC8801693 DOI: 10.1177/20494637211005794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Differential diagnosis of low back pain (LBP) is complex and a prominent issue at all health-care levels; guidance may come from patients' history cues and clinical examination signs. Human and animal studies report that diagnosis of lumbar radicular pain (LRP) may come from evaluating subjective responses of injured lumbar nerves to a strain applied at the buttock. The Buttock Applied Strain (BUAS-test) test may guide the differential diagnosis of LBP. Following an ex-adiuvantibus criterion, clinical improvement of LRP, diagnosed with the BUAS-test and congruently treated, may support this test diagnostic ability. METHODS Among 258 LRP patients, who, upon first visit (V1), tested positive on the BUAS-test (with/without positive Straight Leg Raising Test, SLRT), the effect of gabapentin prescription on painDETECT (PD) questionnaire and Brief Pain Inventory (BPI) outcomes was quantified in the follow-up visit (V2). To support BUAS-test diagnostic ability, we hypothesized that, at V2, >50% of the sample would present negative PD outcome, significant (t-test) and ⩾2 points V2-V1 differences for each of the BPI-item's score. We used multinomial logistic regression (MLR) and χ2 analyses to evaluate the PD-V2 outcomes' dependence upon independent variables. RESULTS Of the sample, 77% reported a negative PD-V2 outcome. V2-V1 differences of all BPI items were significant and >2 points. PD-V2 outcomes showed significant associations with SLRT-V1 and PD-V1, respectively, but not with gender, age group or pain site. MLR showed a significant relationship between SLRT-V1 and PD-V2 outcomes. CONCLUSION Among LRP patients, diagnosed by the BUAS-test and treated with gabapentin, all prespecified endpoints were reached. These results may be considered a piece of ex-adiuvantibus evidence for the BUAS-test ability to diagnose LRP. While positive BUAS-test implies potential LRP, the co-presence with positive SLRT may imply a severer LRP condition. Further prospective research, in different settings and direct clinical measures, is needed.
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Affiliation(s)
- Boaz Gedaliahu Samolsky Dekel
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy
- Anesthesia and Pain Therapy Unit, Bologna’s Teaching Hospital, S. Orsola-Malpighi policlinic, Bologna, Italy
- Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Maria Cristina Sorella
- Anesthesia and Pain Therapy Unit, Bologna’s Teaching Hospital, S. Orsola-Malpighi policlinic, Bologna, Italy
| | - Alessio Vasarri
- Anesthesia and Pain Therapy Unit, Bologna’s Teaching Hospital, S. Orsola-Malpighi policlinic, Bologna, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy
- Anesthesia and Pain Therapy Unit, Bologna’s Teaching Hospital, S. Orsola-Malpighi policlinic, Bologna, Italy
- Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
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Rose-Dulcina K, Vassant C, Lauper N, Dominguez DE, Armand S. The SWING test: A more reliable test than passive clinical tests for assessing sagittal plane hip mobility. Gait Posture 2022; 92:77-82. [PMID: 34826697 DOI: 10.1016/j.gaitpost.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/06/2021] [Accepted: 11/08/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Clinical assessment of sagittal plane hip mobility is usually performed using the Modified Thomas Test (for extension) and the Straight-Leg-Raise (for flexion) with a goniometer. These tests have limited reliability, however. An active swinging leg movement test (the SWING test), assessed using 3D motion analysis, could provide an alternative to these passive clinical tests. RESEARCH QUESTION Is the SWING test a more reliable alternative to evaluate hip mobility, in comparison to the clinical extension and flexion tests? METHODS Ten asymptomatic adult participants were evaluated by two investigators over three sessions. Participants performed 10 maximal hip extensions and flexions, with both legs straight and no trunk movement (the SWING test). Hip kinematics was assessed using a 3D motion analysis system. Maximal and minimal hip angles were calculated for each swing and represented maximal hip flexion (SWING flexion) and extension (SWING extension), respectively. The Modified Thomas Test and Straight-Leg-Raise were repeated 3 times for each leg. On the first day, both investigators performed all the tests (SWING + Modified Thomas Test + Straight-Leg-Raise). A week later, a single investigator repeated all the tests. Inter-rater, intra-rater, within-day and between-day reliability were evaluated using intra-class correlation. RESULTS Intra-class correlation coefficients for all the tests were superior to 0.8, except for the Modified Thomas Test's intra-rater, between-day (intra-class correlation 0.673) and the Straight-Leg-Raise's inter-rater, within-day (intra-class correlation 0.294). The SWING test always showed a higher intra-class correlation coefficient than the passive clinical tests. The only significant correlation found was for the Straight-Leg-Raise and SWING flexion (r = 0.48; P < 0.001). SIGNIFICANCE The SWING test seems to be an alternative to existing passive clinical tests, offering better reliability for assessing sagittal plane hip mobility.
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Affiliation(s)
- Kevin Rose-Dulcina
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Geneva, Switzerland.
| | - Cédric Vassant
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Geneva, Switzerland.
| | - Nicolas Lauper
- Division of Orthopaedics and Traumatology, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland.
| | - Dennis E Dominguez
- Division of Orthopaedics and Traumatology, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland.
| | - Stéphane Armand
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Geneva, Switzerland.
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Nam J, Kang K, Kim K, Choi J, Choi M, Yoon J. Translocation of the conus medullaris during dynamic lumbosacral magnetic resonance imaging in dogs. Am J Vet Res 2021; 82:554-559. [PMID: 34166091 DOI: 10.2460/ajvr.82.7.554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the change in the lumbosacral angle (ΔLSA) and conus medullaris (CM) displacement in healthy dogs undergoing dynamic MRI with changes in the posture of their pelvic limbs from neutral posture to flexion or extension posture and to evaluate for potential correlation between ΔLSA and CM displacement. ANIMALS 9 healthy adult Beagles. PROCEDURES Dogs underwent dynamic MRI with their pelvic limbs positioned in neutral, flexion, and extension postures. From T2-weighted sagittal midline plane MRI images, 2 observers measured the lumbosacral angle and CM location in duplicate for each posture for each dog. Intra- and interobserver agreement was assessed, and the Spearman rank correlation coefficient (ρ) was used to assess for potential correlation between ΔLSA and CM displacement for changes in pelvic limb posture from neutral to flexion or extension. RESULTS Overall, the mean ΔLSA and CM displacement for changes in posture were 23° and 9.09 mm (caudal displacement) for the change from neutral to flexion posture, 8.4° and -2.5 mm (cranial displacement) for the change from neutral to extension posture, and 32.2° and 11.64 mm (caudal displacement) for the change from extension to flexion posture. The ΔLSA strongly correlated (ρ = 0.705; 95% CI, 0.434 to 0.859) with displacement of the CM. CONCLUSIONS AND CLINICAL RELEVANCE The use of dynamic MRI, compared with conventional MRI, will better help to characterize clinically normal and abnormal features of the lumbosacral region of the vertebral column and associated spinal cord during postural changes. Further, when limited translocation of the CM is evident on dynamic MRI, veterinarians should suspect underlying lumbosacral pathophysiologic processes or anatomic abnormalities.
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Affiliation(s)
- Jihye Nam
- From the Department of Clinical Sciences, College of Veterinary Medicine, and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Kyuyong Kang
- From the Department of Clinical Sciences, College of Veterinary Medicine, and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Kyeonga Kim
- From the Department of Clinical Sciences, College of Veterinary Medicine, and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Jeongwoo Choi
- From the Department of Clinical Sciences, College of Veterinary Medicine, and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Mincheol Choi
- From the Department of Clinical Sciences, College of Veterinary Medicine, and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea
| | - Junghee Yoon
- From the Department of Clinical Sciences, College of Veterinary Medicine, and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Republic of Korea
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Alshami AM, Alshammari TK, AlMuhaish MI, Hegazi TM, Tamal M, Abdulla FA. Sciatic nerve excursion during neural mobilization with ankle movement using dynamic ultrasound imaging: a cross-sectional study. J Ultrasound 2021; 25:241-249. [PMID: 34036554 DOI: 10.1007/s40477-021-00595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Ankle movement is used as a sensitizing maneuver for sciatica during neurodynamic techniques. In vivo studies on the sciatic nerve biomechanics associated with ankle movement during different positions of neighboring joints are scarce. The aim of this study was to investigate sciatic nerve excursion during ankle dorsiflexion in different positions in a healthy population. METHODS This is a cross-sectional study. High-resolution dynamic ultrasound imaging was used to measure longitudinal excursion of the sciatic nerve in the posterior thigh of 27 healthy participants during ankle dorsiflexion in six positions of the neck, hip, and knee. Both the long and short distance of the nerve excursion were measured. Wilcoxon signed-rank tests were used for data analysis, and Eta squared (r) was used to quantify the effect size. RESULTS Ankle dorsiflexion resulted in distal sciatic nerve excursion that was significantly higher in positions in which the knee was extended (median 0.7-1.6 mm) than in positions in which the knee was flexed (median 0.5-1.4 mm) (P ≤ 0.049, r ≥ 0.379). There were no significant differences in nerve excursion between positions where the neck was neutral compared with positions where the neck was flexed (P ≥ 0.710, r ≤ 0.072) or between positions where the hip was neutral compared with positions where the hip was flexed (P ≥ 0.456, r ≤ 0.143). CONCLUSION The positions of adjacent joints, particularly the knee, had an impact on the excursion of the sciatic nerve in the thigh during ankle movement.
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Affiliation(s)
- Ali M Alshami
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, P.O. Box 2435, Dammam, 31441, Saudi Arabia.
| | - Tadhi K Alshammari
- Physical Therapy Department, Prince Sultan Military Medical City, Riyadh, 11564, Saudi Arabia
| | - Mona I AlMuhaish
- Department of Radiology, Imam Abdulrahman Bin Faisal University, PO BOX 1982, Dammam, 31441, Saudi Arabia
| | - Tarek M Hegazi
- Department of Radiology, Imam Abdulrahman Bin Faisal University, PO BOX 1982, Dammam, 31441, Saudi Arabia
| | - Mahbubunnabi Tamal
- Department of Biomedical Engineering, College of Engineering, Imam Abdulrahman Bin Faisal University, PO Box 1982, Dammam, 31441, Saudi Arabia
| | - Fuad A Abdulla
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, P.O. Box 2435, Dammam, 31441, Saudi Arabia
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Kellis E, Konstantinidou A, Ellinoudis A. Muscle Length of the Hamstrings Using Ultrasonography Versus Musculoskeletal Modelling. J Funct Morphol Kinesiol 2021; 6:jfmk6010026. [PMID: 33809069 PMCID: PMC8006252 DOI: 10.3390/jfmk6010026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022] Open
Abstract
Muscle morphology is an important contributor to hamstring muscle injury and malfunction. The aim of this study was to examine if hamstring muscle-tendon lengths differ between various measurement methods as well as if passive length changes differ between individual hamstrings. The lengths of biceps femoris long head (BFlh), semimembranosus (SM), and semitendinosus (ST) of 12 healthy males were determined using three methods: Firstly, by identifying the muscle attachments using ultrasound (US) and then measuring the distance on the skin using a flexible ultrasound tape (TAPE-US). Secondly, by scanning each muscle using extended-field-of view US (EFOV-US) and, thirdly, by estimating length using modelling equations (MODEL). Measurements were performed with the participant relaxed at six combinations of hip (0°, 90°) and knee (0°, 45°, and 90°) flexion angles. The MODEL method showed greater BFlh and SM lengths as well as changes in length than US methods. EFOV-US showed greater ST and SM lengths than TAPE-US (p < 0.05). SM length change across all joint positions was greater than BFlh and ST (p < 0.05). Hamstring length predicted using regression equations is greater compared with those measured using US-based methods. The EFOV-US method yielded greater ST and SM length than the TAPE-US method. SM showed the highest change in length at different hip and knee joint positions.
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Samolsky Dekel BG, Sorella MC, Vasarri A, Melotti RM. Reply to the Letter "Regarding Samolsky Dekel et al. Reliability of the Buttock Applied Strain Test to Diagnose Radicular Pain in Patients With Low Back Pain". Pain Pract 2020; 20:951-952. [PMID: 32677268 DOI: 10.1111/papr.12941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Boaz Gedaliahu Samolsky Dekel
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Maria Cristina Sorella
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Alessio Vasarri
- Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
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Eun S, Lee J, Song EM, Rosa AD, Lee JH, Park K. Brain functional connectivity changes by low back extension pain model in low back pain patients. PLoS One 2020; 15:e0233858. [PMID: 32479547 PMCID: PMC7263586 DOI: 10.1371/journal.pone.0233858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/13/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Low back pain (LBP) is a common ailment in most developed countries. Because most cases of LBP are known as 'non-specific', it has been challenging to develop experimental pain models of LBP which reproduce patients' clinical pain. In addition, previous models have limited applicability in a steady-pain-state neuroimaging environment. Thus, this study aims to devise a low back pain model with a simple methodology to induce experimental LBP, which has similar pain properties to patients' clinical pain, and to apply the model in a steady-pain-state neuroimaging study. METHODS Our low back extension (LBE) pain model was tested on 217 LBP patients outside the magnetic resonance imaging (MRI) scanner to determine the reproducibility of endogenous pain and the similarity to their own clinical pain (STUDY1), and applied in a steady-pain-state functional MRI study (47 LBP patients and 23 healthy controls) to determine its applicability (induced head motions and brain functional connectivity changes; STUDY2). RESULTS By the LBE pain model, 68.2% of the LBP patients reported increased LBP with high similarity of sensations to their own clinical pain (STUDY1), and the head motions were statistically similar to and correlated with those in resting state (STUDY2). Furthermore, the LBE model altered brain functional connectivity by decreasing the default-mode and the sensorimotor networks, and increasing the salience network, which was significantly associated with the intensity of the induced pain. Conversely, the healthy controls showed increased somatosensory network (but not of the cognitive pain processing). CONCLUSION Our investigations suggest that our LBE pain model, which increased LBP with high similarity to the LBP patients' own pain sensation and induced patient-specific brain responses with acceptable head motion, could be applied to neuroimaging studies investigating brain responses to different levels of endogenous LBP.
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Affiliation(s)
- Seulgi Eun
- Department of Biomedical Engineering, Kyung Hee University, Yongin, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Jeungchan Lee
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, United States of America
| | - Eun-Mo Song
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Alexandra De Rosa
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Kyungmo Park
- Department of Biomedical Engineering, Kyung Hee University, Yongin, Republic of Korea
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14
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Samolsky Dekel BG, Sorella MC, Vasarri A, Melotti RM. Reliability of the Buttock Applied Strain Test to Diagnose Radicular Pain in Patients With Low Back Pain. Pain Pract 2020; 20:829-837. [PMID: 32237018 DOI: 10.1111/papr.12890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/08/2020] [Accepted: 03/19/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Low-back pain (LBP) pathophysiological conditions include nociceptive back pain, somatic referred pain, radicular pain (RP), and radiculopathy. Differential diagnosis is challenging; guidance may come from patients' thorough clinical history and physical examination and, particularly for lumbar RP, from the evaluation of subjective responses of injured lumbar nerves to a strain applied at the buttock (buttock applied strain [BUAS] test). METHODS In a sample of 395 consecutive patients with LBP, sensitivity, specificity, and prior probability (positive predictive values [PPVs] and negative predictive values [NPVs]) of the BUAS test were evaluated against 2 reference tests: the straight leg raising test (SLRT) and the painDETECT (PD) questionnaire. Multinomial logistic regression (MLR) and χ2 analyses were used to evaluate the BUAS test outcomes' dependence upon independent variables (gender, age group, pain localization, SLRT outcomes, and PD outcomes). Cohen's kappa statistic was used to assess inter-rater agreement. RESULTS Compared with the PD questionnaire, the BUAS test showed a sensitivity of 92%, specificity of 100%, PPV of 100%, and NPV of 82%; compared with the SLRT, the BUAS test showed a sensitivity of 82%, NPV of 82%, specificity of 40%, and PPV of 40%. Inter-rater agreement of Cohen's kappa was 0.911. Significant associations were found between BUAS test outcomes and pain localization, SLRT outcomes, and PD outcomes, but not with the predictors gender or age group. MLR showed significant congruent relationships between BUAS test and PD outcomes. CONCLUSION Among patients with LBP, the BUAS test showed satisfactory sensitivity, specificity, prior probability, and inter-rater reliability; thus, it may be considered a useful adjunctive tool to diagnose RP in patients with LBP. For more generalized results, more research, in clinical settings other than pain clinics, is needed.
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Affiliation(s)
- Boaz Gedaliahu Samolsky Dekel
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Maria Cristina Sorella
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
| | - Alessio Vasarri
- Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Anesthesia and Pain Therapy Unit, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy.,Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy
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15
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Markman JD, Czerniecka-Foxx K, Khalsa PS, Hayek SM, Asher AL, Loeser JD, Chou R. AAPT Diagnostic Criteria for Chronic Low Back Pain. THE JOURNAL OF PAIN 2020; 21:1138-1148. [PMID: 32036046 DOI: 10.1016/j.jpain.2020.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 12/15/2022]
Abstract
Chronic low back pain (CLBP) conditions are highly prevalent and constitute the leading cause of disability worldwide. The Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the US Food and Drug Administration and the American Pain Society (APS), have combined to create the ACTTION-APS Pain Taxonomy (AAPT). The AAPT initiative convened a working group to develop diagnostic criteria for CLBP. The working group identified 3 distinct low back pain conditions which result in a vast public health burden across the lifespan. This article focuses on: 1) the axial predominant syndrome of chronic musculoskeletal low back pain, 2) the lateralized, distally-radiating syndrome of chronic lumbosacral radicular pain 3) and neurogenic claudication associated with lumbar spinal stenosis. This classification of CLBP is organized according to the AAPT multidimensional framework, specifically 1) core diagnostic criteria; 2) common features; 3) common medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. PERSPECTIVE: An evidence-based classification of CLBP conditions was constructed for the AAPT initiative. This multidimensional diagnostic framework includes: 1) core diagnostic criteria; 2) common features; 3) medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.
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Affiliation(s)
- John D Markman
- Translational Pain Research Program, Department of Neurosurgery, University of Rochester, Rochester, New York.
| | | | - Partap S Khalsa
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland
| | - Salim Michel Hayek
- Division of Pain Medicine, Department of Anesthesiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Anthony L Asher
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Atrium Health, Charlotte, North Carolina
| | - John D Loeser
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Roger Chou
- Department of Medicine, Oregon Health & Science University, Portland, Oregon
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Normalization of Spinal Cord Displacement With the Straight Leg Raise and Resolution of Sciatica in Patients With Lumbar Intervertebral Disc Herniation: A 1.5-year Follow-up Study. Spine (Phila Pa 1976) 2019; 44:1064-1077. [PMID: 30985566 DOI: 10.1097/brs.0000000000003047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A controlled radiologic follow-up study. OBJECTIVE The aim of this study was to ascertain whether changes in cord excursion with straight leg raise test (SLR) at 1.5-year follow-up time accompany changes in clinical symptoms. SUMMARY OF BACKGROUND DATA Lumbar intervertebral disc herniation (LIDH) is known to be a key cause of sciatica. Previously, we found that a significant limitation of neural displacement (66.6%) was evident with the SLR on the symptomatic side of patients with subacute single level posterolateral LIDH. METHODS Fourteen patients with significant sciatic symptoms due to a subacute single-level posterolateral LIDH were reassessed clinically and radiologically at 1.5 years follow-up with a 1.5T MRI scanner. Displacement of the conus medullaris during the unilateral and bilateral SLR was quantified reliably with a randomized procedure and compared between SLRs and to data from baseline. Multivariate regression models and backward variable selection method were employed to identify variables more strongly associated with a decrease in low back pain (LBP) and radicular symptoms. RESULTS Compared with previously presented baseline values, the data showed a significant increase in neural sliding in all the quantified maneuvers (P ≤ 0.01), and particularly of 2.52 mm (P ≤ 0.001) with the symptomatic SLR.Increase in neural sliding correlated significantly with decrease of both radicular symptoms (Pearson = -0.719, P ≤ 0.001) and LBP (Pearson = -0.693, P ≤ 0.001). Multivariate regression models and backward variable selection method confirmed the improvement of neural sliding effects (P ≤ 0.004) as the main variable being associated with improvement of self-reported clinical symptoms. CONCLUSION To our knowledge, these are the first noninvasive data to objectively support the association between increase in magnitude of neural adaptive movement and resolution of both radicular and LBP symptoms in in vivo and structurally intact human subjects. LEVEL OF EVIDENCE 2.
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Shum G, Cinnamond S, Hutton M, Chan D, Chauhan R, Bloxham S, Choy S, Cheung R, Eldabe S, Clarke A. Decreased tibial nerve movement in patients with failed back surgery syndrome and persistent leg pain. 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 2019; 28:2122-2128. [DOI: 10.1007/s00586-019-06056-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/11/2019] [Accepted: 06/27/2019] [Indexed: 02/28/2024]
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18
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Pagnez MAM, Corrêa LA, Almeida RS, Meziat-Filho NA, Mathieson S, Ricard F, Nogueira LAC. The Variation of Cross-Sectional Area of the Sciatic Nerve in Flexion-Distraction Technique: A Cross-Sectional Study. J Manipulative Physiol Ther 2019; 42:108-116. [PMID: 31029470 DOI: 10.1016/j.jmpt.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 05/23/2018] [Accepted: 03/05/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the cross-sectional area of the sciatic nerve in different positions of spinal manipulation using flexion-distraction technique. METHODS Thirty healthy participants were assessed in 6 different flexion-distraction technique positions of varying lumbar, knee, and ankle positions. Participants stood in the following 3 positions with the lumbar in the neutral position: (A) with knee extended, (B) with knee flexed, and (C) with the knee extended and ankle dorsiflexion. Participants then stood in the following 3 positions with the lumbar flexed: (D) with the knee extended, (E) with the knee flexed, and (F) with knee extended and ankle dorsiflexion. The cross-sectional area (CSA) of the sciatic nerve was measured with ultrasound imaging in transverse sections in the posterior medial region of the left thigh. The CSA values measured at each position were compared. RESULTS We analyzed 180 ultrasound images. The cross-sectional area of the sciatic nerve (in mm2) in position B (mean; standard deviation) (59.71-17.41) presented a higher mean cross-sectional area value compared with position D (51.18-13.81; P =.005), position F (48.71-15.16; P = .004), and position C (48.37-16.35; P = .009). CONCLUSION The combination of knee extension and ankle dorsiflexion reduced the CSA of the sciatic nerve, and flexing the knee and keeping the ankle in the neutral position increased it.
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Affiliation(s)
- Maria Alice Mainenti Pagnez
- Physiotherapy Department, Rehabilitation Science Postgraduate Program, Augusto Motta University Centre, Rio de Janeiro, Brazil; Academic Department, Madrid School of Osteopathy, Rio de Janeiro, Brazil.
| | - Leticia Amaral Corrêa
- Physiotherapy Department, Rehabilitation Science Postgraduate Program, Augusto Motta University Centre, Rio de Janeiro, Brazil
| | - Renato Santos Almeida
- Physiotherapy Department, Rehabilitation Science Postgraduate Program, Augusto Motta University Centre, Rio de Janeiro, Brazil; Physiotherapy Department, Serra dos Órgãos University Centre, Teresópolis, Brazil
| | - Ney Armando Meziat-Filho
- Physiotherapy Department, Rehabilitation Science Postgraduate Program, Augusto Motta University Centre, Rio de Janeiro, Brazil
| | - Stephanie Mathieson
- Musculoskeletal Health Sydney, School of Public Health, The University of Sydney New South Wales, Australia
| | - François Ricard
- Academic Department, Madrid School of Osteopathy, Rio de Janeiro, Brazil
| | - Leandro Alberto Calazans Nogueira
- Physiotherapy Department, Rehabilitation Science Postgraduate Program, Augusto Motta University Centre, Rio de Janeiro, Brazil; Physiotherapy Department, Federal Institute of Rio de Janeiro, Rio de Janeiro, Brazil
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Hines MG, Tillin NA, Luo J, Lee RYW. Passive elastic contribution of hip extensors to joint moments during walking in people with low back pain. Clin Biomech (Bristol, Avon) 2018; 60:134-140. [PMID: 30355537 DOI: 10.1016/j.clinbiomech.2018.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 05/21/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND It has been found that alterations in passive muscle properties may be associated with low back pain, and these may be responsible for the altered gait parameters often observed in subjects with back pain. The purpose of the present study was to assess total hip and passive hip extensor moments in people with or without low back pain during the hip flexion component of walking. METHODS 52 subjects volunteered for this study (low back pain group, n = 25 (male n = 13, female n = 12), control group, n = 27 (male n = 15, female n = 12)). Passive hip moments were calculated using an adapted force transducer during supine testing. A biomechanical model and predictive equation were used to calculate passive hip moments during walking. Total hip moments were calculated with the use of a 9 camera, 3-D motion-capture system. FINDINGS Independent samples t-tests demonstrated no significant differences between groups for gait parameters or hip or knee angles. Results of the ANOVAs demonstrated significant differences in passive hip flexor moments during the second half of hip flexion (P < 0.05).There were also significant differences in hip power and work done during peaks of power absorption and the second peak of power generation (P < 0.05). INTERPRETATION The present data demonstrates that subjects with low back pain have altered passive hip extensor and total power and work done during walking compared with healthy controls. Biomechanical models should include individual measurements of passive joint moments.
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Affiliation(s)
- Mark G Hines
- London South Bank University, School of Applied Sciences, 103 Borough Road, London SE1 0AA, UK; British College of Osteopathic Medicine, 3 Sumpter Close, London NW3 5HR, UK.
| | - Neale A Tillin
- University of Roehampton, School of Life Sciences, Whiteland's College, Holybourne Avenue, London SW15 4JD, UK
| | - Jin Luo
- London South Bank University, School of Applied Sciences, 103 Borough Road, London SE1 0AA, UK
| | - Raymond Y W Lee
- University of Portsmouth, Faculty of Technology, Winston Churchill Avenue, Portsmouth PO1 2UP, UK
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20
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Movements of the lumbo-sacral nerve roots in the spinal canal induced by straight leg raising test: an anatomical study. Surg Radiol Anat 2018; 40:1223-1230. [PMID: 30128897 DOI: 10.1007/s00276-018-2084-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 05/27/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE The pain involved in the herniated discs could be generated by some mobility of the nerve roots during straight leg raising (SLR). SLR produces some movement of nerves, but the magnitude of this displacement needs to be thorough, that is why we have investigated lumbo-sacral nerve root displacement in the spinal canal during the passive straight leg raise (SLR). METHODS Fourteen cadavers underwent laminectomy to mark the nerve roots of L2-S1 with lead balls. X-rays were taken during different movements imposed on the body: bilateral hip extension, left SLR then right and bilateral SLR. By superimposing these images two by two, the displacement of the nerve roots is quantified numerically during the various SLR maneuvers with respect to the reference position corresponding to the bilateral hip extension. RESULTS The median range of the different nerve root movements ranged from 0.10 to 0.51 cm (p < 0.05 except for the L2 root) when the left SLR is applied, from 0.26 to 0.48 cm (p < 0.05) with the right SLR and from 0.30 to 0.65 cm (p < 0.05) with a bilateral SLR. No statistically significant relationship was found between age and movement value. CONCLUSIONS The lumbo-sacral nerve roots in the spinal canal region move statistically significantly in response to the clinically applied SLR test, except for L2 root during the left SLR. This movement is symmetric and greater when a bilateral SLR is applied. These anatomical results are correlated with those observed empirically in clinical practice.
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Sueki D, Almaria S, Bender M, McConnell B. The immediate and 1-week effects of mid-thoracic thrust manipulation on lower extremity passive range of motion. Physiother Theory Pract 2018; 36:720-730. [PMID: 30015546 DOI: 10.1080/09593985.2018.1492056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Research suggests that spinal manipulation may effect motion. Less clear is whether this effect is limited to localized responses or may involve generalizable changes. Objective: To determine whether Mid-thoracic manipulation (MTM) would result in a significant change in the lower extremity passive straight leg raise (PSLR) range of motion immediately and after 1 week. Methods: Twenty-three healthy subjects were randomly assigned in a double-blinded study. An experimental group received MTM and a control group received a sham intervention. PSLR measurements were taken prior to, immediately after, and one week after the intervention. Results: Mixed model repeated measure analysis of variance was used to determine that there was a significant interaction between MTM and time (F(2, 21) = 3.84, p < 0.05). Post hoc tests revealed a significant difference between the pretest to immediate posttest values (p < 0.05, SE = 1.47). PSLR in the MTM group increased 10.3° while the sham group increased 1.9°. Difference was non-significant between pretest and 1-week follow-up (p = 0.129, SE = 2.46). Conclusions: MTM may immediately increase lower extremity passive range of motion, but the effect was lost by the 1-week follow-up. This supports evolving research suggesting that spinal manipulation may have a generalized but transient physiological effect.
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Affiliation(s)
- Derrick Sueki
- Department of Physical Therapy, Azusa Pacific University , Azusa, CA, USA
| | - Shaun Almaria
- Peak Sports Medicine and Rehabilitation , Phoenix, AZ, USA
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22
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Östhols S, Boström C, Rasmussen-Barr E. Clinical assessment and patient-reported outcome measures in low-back pain – a survey among primary health care physiotherapists. Disabil Rehabil 2018; 41:2459-2467. [DOI: 10.1080/09638288.2018.1467503] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Sara Östhols
- Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
- Capio St Göran Hospital, Multidisciplinary Pain Unit, Stockholm, Sweden
| | - Carina Boström
- Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
- Karolinska University Hospital, Department of Allied Health Professionals, Stockholm, Sweden
| | - Eva Rasmussen-Barr
- Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
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Oh S, Kim M, Lee M, Kim T, Lee D, Yoon B. Effect of myofascial trigger point therapy with an inflatable ball in elderlies with chronic non-specific low back pain. J Back Musculoskelet Rehabil 2018; 31:119-126. [PMID: 28826169 DOI: 10.3233/bmr-169696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Myofascial trigger points (MTrPs) are related to low back pain and back muscle stiffening, and secondarily to movement impairment. MTrP therapy with an inflatable ball would improve clinical outcomes for chronic non-specific low back pain (CNSLBP) after 6 weeks. OBJECTIVE The aim of this study was to investigate the effects of MTrPs with an inflatable ball for the elderly with CNSLBP. METHODS Fifteen elderly patients with chronic non-specific low back pain were evaluated for pain, pressure sensitivity, and physical function at baseline and 1, 3, and 6 weeks of therapy. The visual analog scale (VAS) and pressure pain threshold (PPT) were used to measure pain intensity and sensitivity, respectively. Straight-leg-raise (SLR) test, back range of motion (BROM), and Oswestry disability index were used to assess physical function. RESULTS Significant differences were observed between the 3- and 6-week VAS scores (-34.6%; p= 0.03); baseline and 1-week (7%; p= 0.02), 1- and 3-week (-14%; p= 0.01), and 3- and 6-week PPTs (18%; p= 0.01); 3- and 6-week BROMs (Flexion, 7.1%; Extension, 41%; p= 0.048); baseline and 1-week (-6.9%; p= 0.02), 1- and 3-week (3%; p= 0.01), and 3- and 6-week active SLR test scores (7%; p= 0.011); and baseline and 1-week (-2.6%; p= 0.03), 1- and 3-week (8.34%; p= 0.01), and 3- and 6-week passive SLR test scores (5.3%; p= 0.025). CONCLUSION Myofascial trigger point therapy with an inflatable ball relieved pain and improved physical function in the elderly with CNSLBP.
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Affiliation(s)
- Sejun Oh
- Department of Physical Therapy, College of Health Science, Major of Rehabilitation Science, Graduate School, Korea University, Seoul, Korea
| | - Minhee Kim
- Department of Physical Therapy, College of Health Science, Major of Rehabilitation Science, Graduate School, Korea University, Seoul, Korea
| | - Minyoung Lee
- Department of Physical Therapy, College of Health Science, Major of Rehabilitation Science, Graduate School, Korea University, Seoul, Korea
| | - Taeyeong Kim
- Department of Physical Therapy, College of Health Science, Major of Rehabilitation Science, Graduate School, Korea University, Seoul, Korea
| | - Dongshin Lee
- Department of Physical Therapy, College of Health Science, Eulji University, Gyeonggido, Korea
| | - Bumchul Yoon
- Department of Physical Therapy, College of Health Science, Major of Rehabilitation Science, Graduate School, Korea University, Seoul, Korea
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Reduced Spinal Cord Movement With the Straight Leg Raise Test in Patients With Lumbar Intervertebral Disc Herniation. Spine (Phila Pa 1976) 2017; 42:1117-1124. [PMID: 28542104 DOI: 10.1097/brs.0000000000002235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Controlled radiological study. OBJECTIVE To explore whether impairment of neural excursion during the straight leg raise test occurs in patients with sciatic symptoms secondary to lumbar intervertebral disc herniation (LIDH). SUMMARY OF BACKGROUND DATA Earlier studies have shown that during the straight leg raise (SLR) test in asymptomatic volunteers tensile forces are consistently transmitted throughout the neural system and the thoracolumbar spinal cord slides distally. METHODS Fifteen patients with sciatic symptoms due to subacute LIDH were studied with a 1.5 T magnetic resonance scanner. First, a spine specialist diagnosed the LIDH using conventional scanning sequences. Following this subjects were scanned using different scanning sequences for planning and measurement purposes. Displacement of the conus medullaris during the unilateral and bilateral SLR was quantified reliably with a randomized procedure and compared between manoeuvres. RESULTS The results showed 66.6% less excursion of conus medullaris with SLR performed on the symptomatic side compared with excursions measured with SLR performed on the asymptomatic side (p ≤ 0.001). CONCLUSION In patients with LIDH, the neural displacement on the symptomatic side is significantly reduced by the compressing IVD herniation. To our knowledge, these are the first data in intact human subjects to support the limitation of neural movements in the vertebral canal with LIDH. LEVEL OF EVIDENCE 3.
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Mansfield CJ, Bleacher J, Tadak P, Briggs MS. Differential examination, diagnosis and management for tingling in toes: fellow's case problem. J Man Manip Ther 2016; 25:294-299. [PMID: 29449772 DOI: 10.1080/10669817.2016.1260675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Background The diagnosis of chronic exertional compartment syndrome can be challenging as other pathologies involving bone, muscle, nerve and vascular structures can mimic the syndrome. The purpose of this Fellow's Case Problem is to describe the clinical decision-making and physical therapy differential diagnosis regarding a 25-year-old patient with un-resolved neurovascular complaints following chronic exertional compartment syndrome surgical release. Diagnosis After surgery, the patient's previous complaint of numbness and tingling in the plantar surfaces of her first and second toes of right foot was still present. The patient's concordant symptoms in toes were reproduced proximally in the lumbar spine and distally in the tarsal tunnel. Discussion The lumbar spine can refer symptoms to the lower extremities and needs to be ruled out as the source of the patient's complaint whenever neurovascular symptoms such as numbness and tingling are present. The discovery of the relationship of the lumbar spine with the tingling in the toes addressed one of the patient's primary concerns that was not resolved from the surgery. Level of Evidence 4.
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Affiliation(s)
- Cody J Mansfield
- Orthopaedic Manual Therapy Fellowship, OSU Spots Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jake Bleacher
- Orthopaedic Manual Therapy Fellowship, OSU Spots Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Paul Tadak
- Orthopaedic Manual Therapy Fellowship, OSU Spots Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Matthew S Briggs
- Orthopaedic Manual Therapy Fellowship, OSU Spots Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Sierra-Silvestre E, Torres Lacomba M, de la Villa Polo P. Effect of leg dominance, gender and age on sensory responses to structural differentiation of straight leg raise test in asymptomatic subjects: a cross-sectional study. J Man Manip Ther 2016; 25:91-97. [PMID: 28559668 DOI: 10.1080/10669817.2016.1200216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To assess the effect of structural differentiation on sensory responses of asymptomatic individuals to standard neurodynamic tests of straight leg raise (SLR) and to evaluate the relevance of leg dominance, gender, and age. BACKGROUND SLR test is a well-known neurodynamic test among physical therapists; no studies to date have investigated the influence of gender, age, and leg dominance to the sensory responses of this neurodynamic test and its structured differentiating maneuver. METHODS Thirty (16 women) asymptomatic individuals enrolled in this study. Dominancy test was performed for each participant. Pain intensity using visual analogue scale (VAS), symptoms location in a body chart, nature of symptoms evoked, and hip range of motion (ROM) were recorded and compared at ankle neutral position (N-SLR) and dorsiflexion (DF-SLR) in both legs at the point of pain tolerance during SLR (P2). In addition, hip ROM was recorded at the onset of pain (P1). RESULTS There was a statistically significant sex main effect for P1 and P2 between N-SLR and DF-SLR (p < 0.05). Mean hip ROM during the SLR was more than 10° greater in women than men. There was no statistically significant interaction between leg dominance and age group in N-SLR, DF-SLR, and VAS. Pain intensity was moderate for each SLR test. Symptoms most often described were stretch (96.7%), followed by tightness (70%) in the posterior thigh and leg. CONCLUSIONS SLR hip ROM is influenced by sex in asymptomatic individuals, leading to a greater hip ROM in SLR in women. Age and limb dominance are not relevant to SLR hip ROM or pain intensity.
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Affiliation(s)
- Eva Sierra-Silvestre
- Grupo de investigación Fisioterapia en los Procesos de Salud de la Mujer, Departamento de Fisioterapia, Universidad de Alcalá, Alcalá de Henares, Spain.,Grupo de investigación Motion in Brains, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Torres Lacomba
- Grupo de investigación Fisioterapia en los Procesos de Salud de la Mujer, Departamento de Fisioterapia, Universidad de Alcalá, Alcalá de Henares, Spain
| | - Pedro de la Villa Polo
- Grupo de investigación Fisioterapia en los Procesos de Salud de la Mujer, Departamento de Fisioterapia, Universidad de Alcalá, Alcalá de Henares, Spain.,Departamento de Fisiología, Universidad de Alcalá, Alcalá de Henares, Spain
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Shin JS, Lee J, Kim MR, Jung J, Shin BC, Lee MS, Ha IH. The Short-Term Effect of Integrated Complementary and Alternative Medicine Treatment in Inpatients Diagnosed with Lumbar Intervertebral Disc Herniation: A Prospective Observational Study. J Altern Complement Med 2016; 22:533-43. [PMID: 27213976 DOI: 10.1089/acm.2014.0368] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the short-term effect of hospital-based intensive nonsurgical treatment in lumbar intervertebral disc herniation (IDH) inpatients admitted to an integrated hospital that offers both complementary and alternative medicine (CAM) and conventional medicine treatment. DESIGN A prospective observational study. SETTINGS A private Korean medicine hospital inpatient setting in Korea. PATIENTS A total of 524 inpatients diagnosed with lumbar IDH admitted from June 1, 2012, to May 31, 2013. INTERVENTIONS The participants received treatment according to a CAM treatment protocol (herbal medicine, acupuncture, bee venom pharmacopuncture, and Chuna manipulation) and conventional medicine treatment as needed. OUTCOME MEASURES Numeric rating scale (NRS) of low back pain (LBP) and leg pain, Oswestry Disability Index (ODI), and patient global impression of change. The study also assessed whether improvement was obtained over minimal clinically important difference (MCID) in LBP or leg pain. RESULTS The average hospital stay was 24.4 ± 13.2 days. The majority of patients received CAM treatment and a few selected conventional medicine, such as pain killers (22.7%; 4.2 ± 3.0 administrations) or nerve blocks (14.1%; 1.4 ± 0.7 sessions). At discharge, the average reduction in NRS was 3.18 ± 2.29 (95% confidence interval [CI], 2.99-3.38) for LBP and 2.61 ± 2.60 (95% CI, 2.38-2.83) for leg pain the average reduction in ODI was 19.45 ± 19.53 (95% CI, 17.77-21.12). Two-hundred and seventy patients (51.5%) showed improvement over MCID in both NRS and ODI, 150 (28.6%) in either NRS or ODI, and 104 (19.8%) in neither. CONCLUSIONS Integrated CAM treatment during hospitalization was effective for patients with lumbar IDH who had severe LBP and disability. However, these results must be investigated further to assess whether the effects surpass those seen with placebo and are cost-effective.
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Affiliation(s)
- Joon-Shik Shin
- 1 Jaseng Spine and Joint Research Institute , Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Jinho Lee
- 1 Jaseng Spine and Joint Research Institute , Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Me-Riong Kim
- 1 Jaseng Spine and Joint Research Institute , Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Jaehoon Jung
- 1 Jaseng Spine and Joint Research Institute , Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Byung-Cheul Shin
- 2 Division of Clinical Medicine, School of Korean Medicine, Pusan National University , Yangsan, Republic of Korea
| | - Myeong Soo Lee
- 3 Clinical Research Division, Korea Institute of Oriental Medicine , Daejeon, Republic of Korea
| | - In-Hyuk Ha
- 1 Jaseng Spine and Joint Research Institute , Jaseng Medical Foundation, Seoul, Republic of Korea
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Grødahl LHJ, Fawcett L, Nazareth M, Smith R, Spencer S, Heneghan N, Rushton A. Diagnostic utility of patient history and physical examination data to detect spondylolysis and spondylolisthesis in athletes with low back pain: A systematic review. ACTA ACUST UNITED AC 2016; 24:7-17. [PMID: 27317501 DOI: 10.1016/j.math.2016.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND In adolescent athletes, low back pain has a 1-year prevalence of 57% and causes include spondylolysis and spondylolisthesis. An accurate diagnosis enables healing, prevention of progression and return to sport. OBJECTIVE To evaluate the diagnostic utility of patient history and physical examination data to identify spondylolysis and/or spondylolisthesis in athletes. DESIGN Systematic review was undertaken according to published guidelines, and reported in line with PRISMA. METHOD Key databases were searched up to 13/11/15. INCLUSION CRITERIA athletic population with LBP, patient history and/or physical examination accuracy data for spondylolysis and/or spondylolisthesis, any study design including raw data. Two reviewers independently assessed risk of bias (ROB) using QUADAS-2. A data extraction sheet was pre-designed. Pooling of data and investigation for heterogeneity enabled a qualitative synthesis of data across studies. RESULTS Of the eight included studies, two were assessed as low ROB, one of which also had no concerns regarding applicability. Age (<20 years) demonstrated 81% sensitivity and 44% specificity and gender (male) 73% sensitivity and 57% specificity for spondylolysis. Difficulty falling asleep, waking up because of pain, pain worse with sitting and walking all have sensitivity >75% for spondylolisthesis. Step-deformity palpation demonstrated 60-88% sensitivity and 87-100% specificity for spondylolisthesis. The one-legged hyperextension test was not supported for spondylolysis (sensitivity 50-73%, specificity 0-87%). CONCLUSION No recommendations can be made utilising patient history data. Based on one low ROB study, step deformity palpation may be useful in diagnosing spondylolisthesis. No physical tests demonstrated diagnostic utility for spondylolysis. Further research is required.
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Affiliation(s)
- Linn Helen J Grødahl
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Louise Fawcett
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Madeleine Nazareth
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Richard Smith
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Simon Spencer
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Nicola Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Abstract
Introduction: Passive Straight Leg Raising Test (PSLRT) is one of the most commonly performed test in clinical practice. The purpose of this study was to survey the practice and interpretation of PSLRT amongst clinicians working in a tertiary care hospital. Methods: A 15 item questionnaire survey was developed covering various aspects of PSLRT. Orthopaedic surgeons(n=15), neurosurgeons (n=7) and physiotherapists (n=9)were identified as clinicians performing this test regularly and were approached to take part in the survey. Results: The PSLRT was used in all cases of back and leg pain by 68% and correctly performed by 30/31. There was a wide variation in the angle at which it was considered positive (median 45 degrees; range 10-90 degrees). Only 7/31 correctly recognised reproduction of leg pain as indicative of a positive PSLRT. The sitting /distraction SLRT andwell leg / cross SLRT was performed only by 3/31 and 16/31 of clinicians respectively. 90% felt that a positive PSLRT suggested nerve root irritation and 57% thought it was due to stretch of dura and / or nerve root. 23/31 clinicians felt that PSLRT was useful or very useful and 90% reported that result of PSLRT would affect the way they treat a patient. Conclusions: PSLRT is widely used, correctly performed and felt to be useful in practice. But the interpretation of a positive test, understanding of its mechanism and useof variations is poor. There is a need to improve the interpretation and understanding of PSLRT amongst its users.
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Affiliation(s)
- K Pande
- Clinical Specialist in Orthopaedics, Raja Isteri Pengiran Anak Saleha Hospital, Negara Brunei Darussalam
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Lee J, Shin JS, Lee YJ, Kim MR, Ahn YJ, Park KB, Kropf MA, Shin BC, Lee MS, Ha IH. Effects of Shinbaro pharmacopuncture in sciatic pain patients with lumbar disc herniation: study protocol for a randomized controlled trial. Trials 2015; 16:455. [PMID: 26459006 PMCID: PMC4603920 DOI: 10.1186/s13063-015-0993-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 10/02/2015] [Indexed: 11/12/2022] Open
Abstract
Background Lumbar disc herniation is a major cause of sciatica and low back pain and imposes a heavy burden on both individual and society. While use of pharmacopuncture, a combined form of acupuncture and herbal medicine, for lumbar disc herniation is widespread in Korea and China, there is a paucity of research. Methods/Design This study is the protocol for a three-armed, randomized, patient, physician, and assessor-blinded controlled pilot study. Sixty patients with severe non-acute sciatic pain diagnosed with lumbar disc herniation (NRS ≥ 5, onset between 4 weeks and 6 months) will be recruited and randomized 20 each to the Shinbaro pharmacopuncture (pharmacopuncture with acupuncture), acupuncture, and usual care groups, respectively. The 2 acupuncture groups will receive 2 sessions/week of acupuncture alone or with pharmacopuncture for 4 weeks (total 8 sessions), and the usual care group will receive conventional medication 2–3 times/day and physical therapy 2 sessions/week over 4 weeks (total 8 sessions). The initial acupuncture physician will administer acupuncture at 5 acupoints (GB30, BL40, BL25, BL23, GB34) in the 2 acupuncture groups, and mark an additional acupoint. A second acupuncture physician will administer pharmacopuncture to the marked acupoint in the pharmacopuncture group, and acupuncture in the acupuncture group during acupuncture needle retention. The second physician will administer acupuncture and pharmacopuncture in a similar manner in terms of advice and manual stimulation to maintain patient-blinding, treat the patient out of view of the initial physician, remove the additional acupuncture needle immediately, and cover the area with adhesive bandage to maintain physician-blinding. The primary endpoint will be at 5 weeks post-randomization, and the primary outcome will be Visual Analog Scale (VAS) of sciatic pain. Secondary outcomes will be VAS of low back pain, Numeric Rating Scale (NRS) of low back pain and sciatic pain, ODI, SF-36, EQ-5D, and PGIC. Post-treatment evaluations will take place 5, 7, 9, and 12 weeks after randomization. Discussion This trial will evaluate the comparative clinical effectiveness of pharmacopuncture for severe non-acute sciatic pain patients diagnosed with lumbar disc herniation with usual care of conventional medicine and that of Korean medicine (acupuncture), monitor its safety, and serve as basis for a large-scale, multicenter trial. Trial registration ClinicalTrials.gov NCT02384928, registered 27 February 2015.
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Affiliation(s)
- Jinho Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, 135-896, Republic of Korea.
| | - Joon-Shik Shin
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, 135-896, Republic of Korea.
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, 135-896, Republic of Korea.
| | - Me-Riong Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, 135-896, Republic of Korea.
| | - Yong-Jun Ahn
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, 135-896, Republic of Korea.
| | - Ki Byung Park
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, 135-896, Republic of Korea.
| | - Michael A Kropf
- Spine Center, Cedars-Sinai Medical Center, 444 S. San Vicente Blvd, Suites 800/901, Los Angeles, CA, USA. .,LA Spine, Inc., 444 S. San Vicente Blvd, Suite 901, Los Angeles, CA, USA.
| | - Byung-Cheul Shin
- Busan National University, Yangsan campus, 49 Busandaehak-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Republic of Korea.
| | - Myeong Soo Lee
- Division of Medical Research, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon, Republic of Korea.
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 858 Eonju-ro, Gangnam-gu, Seoul, 135-896, Republic of Korea.
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Legge D. Acupuncture Treatment of Chronic Low Back Pain by Using the Jingjin (Meridian Sinews) Model. J Acupunct Meridian Stud 2015; 8:255-8. [PMID: 26433803 DOI: 10.1016/j.jams.2015.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/13/2015] [Accepted: 07/23/2015] [Indexed: 12/19/2022] Open
Abstract
This case report details the unexpected and sustained relief from chronic low back pain in a patient after a single acupuncture treatment. The treatment administered on that occasion was based on the jingjin (i.e., "meridian sinew") model of traditional acupuncture. Treatments based on the jingjin model involve needling the ah shi (i.e., locally tender) points in myofascial tissue along the jingjin pathway. Tight chains can be needled to treat symptoms that are either close to or at some distance from the site of the needling treatment. In this patient, the points were in the gastrocnemius muscle and the hamstring muscles, which are part of the Bladder jingjin pathway. The patient, a 69-year-old woman, had had back pain for more than 40 years. The relief from the pain occurred within a day after the treatment and, at the time of this report, the relief has persisted for 5 months. This report examines two possible mechanisms for such a result: (1) a local increase in the extensibility of the hamstrings could be responsible or (2) the complex interactions within the central nervous system that are involved in acupuncture treatment could be more important factors.
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Affiliation(s)
- David Legge
- School of Science and Health, University of Western Sydney, Sydney, Australia.
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Cohen SP, Furman MB, Weber NH, Singh JR. Single Versus Two-Level Transforaminal Epidural Steroid Injection for Treating Lumbosacral Radicular Pain: What is the Evidence? PM R 2015; 7:883-888. [DOI: 10.1016/j.pmrj.2015.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 12/31/2022]
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Kellis E, Ellinoudis A, Kofotolis N. Hamstring Elongation Quantified Using Ultrasonography During the Straight Leg Raise Test in Individuals With Low Back Pain. PM R 2015; 7:576-83. [DOI: 10.1016/j.pmrj.2014.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 10/03/2014] [Accepted: 12/21/2014] [Indexed: 11/26/2022]
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Short-term effect of spinal manipulation on pain perception, spinal mobility, and full height recovery in male subjects with degenerative disk disease: a randomized controlled trial. Arch Phys Med Rehabil 2014; 95:1613-9. [PMID: 24862763 DOI: 10.1016/j.apmr.2014.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 04/15/2014] [Accepted: 05/01/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the short-term effect on spinal mobility, pain perception, neural mechanosensitivity, and full height recovery after high-velocity, low-amplitude (HVLA) spinal manipulation (SM) in the lumbosacral joint (L5-S1). DESIGN Randomized, double-blind, controlled clinical trial with evaluations at baseline and after intervention. SETTING University-based physical therapy research clinic. PARTICIPANTS Men (N=40; mean age ± SD, 38 ± 9.14 y) with diagnosed degenerative lumbar disease at L5-S1 were randomly divided into 2 groups: a treatment group (TG) (n=20; mean age ± SD, 39 ± 9.12 y) and a control group (CG) (n=20; mean age ± SD, 37 ± 9.31 y). All participants completed the intervention and follow-up evaluations. INTERVENTIONS A single L5-S1 SM technique (pull-move) was performed in the TG, whereas the CG received a single placebo intervention. MAIN OUTCOME MEASURES Measures included assessing the subject's height using a stadiometer. The secondary outcome measures included perceived low back pain, evaluated using a visual analog scale; neural mechanosensitivity, as assessed using the passive straight-leg raise (SLR) test; and amount of spinal mobility in flexion, as measured using the finger-to-floor distance (FFD) test. RESULTS The intragroup comparison indicated a significant improvement in all variables in the TG (P<.001). There were no changes in the CG, except for the FFD test (P=.008). In the between-group comparison of the mean differences from pre- to postintervention, there was statistical significance for all cases (P<.001). CONCLUSIONS An HVLA SM in the lumbosacral joint performed on men with degenerative disk disease immediately improves self-perceived pain, spinal mobility in flexion, hip flexion during the passive SLR test, and subjects' full height. Future studies should include women and should evaluate the long-term results.
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Falavigna A, Righesso O, Teles AR, Kleber FD, Canabarro CT, Silva PGD. Is the lasègue sign a predictor of outcome in lumbar disc herniation surgery? COLUNA/COLUMNA 2013. [DOI: 10.1590/s1808-18512013000400008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: Evaluate the predictive value of the Lasègue sign on self-reported quality of life measures (HRQoL) in patients who undergo microdiscectomy. METHODS: 95 patients with clinical and radiological diagnosis of LDH who underwent microdiscectomy were included. The patients were assessed by a neurological examination and answered validated instruments to assess pain, disability, quality of life, and mood disorder in the preoperative period, and 1, 6 and 12 months after surgery. RESULTS: Preoperative Lasègue sign was identified in 56.8% (n=54/95) of the cases. There was no difference between the groups in the preoperative period regarding HRQoL. At one year follow-up no statistically significant difference in HRQoL was observed in the Lasègue group. The discrimination capacity of the preoperative Lasègue sign to determinate variations in HRQoL outcomes one year postoperatively was low. CONCLUSION: Lasègue sign is not a good predictor of outcome after microdiscectomy for LDH.
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Kim MH, Yoo WG, Choi BR. Differences between two subgroups of low back pain patients in lumbopelvic rotation and symmetry in the erector spinae and hamstring muscles during trunk flexion when standing. J Electromyogr Kinesiol 2013; 23:387-93. [PMID: 23295146 DOI: 10.1016/j.jelekin.2012.11.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 10/12/2012] [Accepted: 11/13/2012] [Indexed: 11/26/2022] Open
Abstract
The present study was performed to examine lumbopelvic rotation and to identify asymmetry of the erector spinae and hamstring muscles in people with and without low back pain (LBP). The control group included 16 healthy subjects, the lumbar-flexion-rotation syndrome LBP group included 17 subjects, and the lumbar-extension-rotation syndrome LBP group included 14 subjects. Kinematic parameters were recorded using a 3D motion-capture system, and electromyography parameters were measured using a Noraxon TeleMyo 2400T. The two LBP subgroups showed significantly more lumbopelvic rotation during trunk flexion in standing than did the control group. The muscle activity and flexion-relaxation ratio asymmetries of the erector spinae muscles in the lumbar-flexion-rotation syndrome LBP group were significantly greater than those in the control group, and the muscle activity and flexion-relaxation ratio asymmetry of the hamstring muscles in the lumbar-extension-rotation syndrome LBP group were significantly greater than those in the control group. Imbalance or asymmetry of passive tissue could lead to asymmetry of muscular activation. Muscle imbalance can cause asymmetrical alignment or movements such as unexpected rotation. The results showed a greater increase in lumbopelvic rotation during trunk flexion in standing among the lumbar-flexion-rotation syndrome and lumbar-extension-rotation syndrome LBP groups compared with the control group. The differences between the two LBP subgroups may be a result of imbalance and asymmetry in erector spinae and hamstring muscle properties.
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Affiliation(s)
- Min-hee Kim
- Institute of Health Science, Yonsei University, Wonju, Republic of Korea
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Diagnostic accuracy of tests and measures for shoulder labral dysfunction. J Shoulder Elbow Surg 2012; 21:e20-1. [PMID: 23084036 DOI: 10.1016/j.jse.2012.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 08/21/2012] [Indexed: 02/01/2023]
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Abstract
This clinical perspective presents an overview of current and potential uses for magnetic resonance imaging (MRI) in musculoskeletal practice. Clinical practice guidelines and current evidence for improved outcomes will help providers determine the situations when an MRI is indicated. The advanced competency standard of examination used by physical therapists will be helpful to prevent overuse of musculoskeletal imaging, reduce diagnostic errors, and provide the appropriate clinical context to pathology revealed on MRI. Physical therapists are diagnostically accurate and appropriately conservative in their use of MRI consistent with evidence-based principles of diagnosis and screening.
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Affiliation(s)
- Gail Dean Deyle
- Army-Baylor University Doctoral Fellowship in Orthopaedic Manual Physical Therapy, Brooke Army Medical Center, Fort Sam Houston, TX, USA
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39
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Boyd BS. Measurement properties of a hand-held inclinometer during straight leg raise neurodynamic testing. Physiotherapy 2012; 98:174-9. [DOI: 10.1016/j.physio.2011.04.352] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 04/24/2011] [Indexed: 11/27/2022]
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40
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Kim MH, Yoo WG. Comparison of the Hamstring Muscle Length and Sciatic Nerve Tension among Computer Workers with Different Subtypes of Lower Back Pain. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Min-hee Kim
- Institute of Health Science, Yonsei University
| | - Won-gyu Yoo
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University & Elderly Life Redesign Institute
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Shin JS, Ha IH, Lee TG, Choi Y, Park BY, Kim MR, Lee MS. Motion style acupuncture treatment (MSAT) for acute low back pain with severe disability: a multicenter, randomized, controlled trial protocol. Altern Ther Health Med 2011; 11:127. [PMID: 22151475 PMCID: PMC3262760 DOI: 10.1186/1472-6882-11-127] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 12/13/2011] [Indexed: 11/24/2022]
Abstract
Background Acupuncture is widely-used to treat patients with low back pain, despite insufficient evidence of the technique's efficacy for acute back pain. Motion style acupuncture treatment (MSAT) is a non-traditional acupuncture treatment requiring a patient to exercise while receiving acupuncture. In Korea, MSAT is used to reduce musculoskeletal pain and improve functional status. The study aims to evaluate the effect of MSAT on acute low back pain with severe disability. Methods/Design This study is a multicenter, randomized, active-controlled trial with two parallel arms. Participants with acute low back pain and severe functional disability, defined as an Oswestry Disability Index (ODI) value > 60%, will be randomly allocated to the acupuncture group and the nonsteroidal anti-inflammatory drug (NSAID) injection group. The acupuncture group will receive MSAT and the NSAID injection group will receive an intramuscular injection of diclofenac. All procedures will be limited to one session and the symptoms before and after treatment will be measured by assessors blinded to treatment allocation. The primary outcome will be measured at 30 minutes after treatment using the numerical rating scale (NRS) of low back pain while the patient is moving. Secondary outcomes will be measured at 30 minutes after treatment using the NRS of leg pain, ODI, patient global impression of change, range of motion (ROM) of the lumbar spine, and degrees of straight leg raising (SLR). Post-treatment follow-up will be performed to measure primary and secondary outcomes with the exception of ROM and SLR at 2, 4, and 24 weeks after treatment. Discussion The results of this trial will be discussed. Trial Registration ClinicalTrial.gov NCT01315561
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Capra F, Vanti C, Donati R, Tombetti S, O'Reilly C, Pillastrini P. Validity of the straight-leg raise test for patients with sciatic pain with or without lumbar pain using magnetic resonance imaging results as a reference standard. J Manipulative Physiol Ther 2011; 34:231-8. [PMID: 21621724 DOI: 10.1016/j.jmpt.2011.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 03/31/2011] [Accepted: 04/03/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this retrospective study was to assess validity of the straight-leg raise (SLR) test using magnetic resonance imaging (MRI) results as a reference standard in a group of patients with L4-L5 and L5-S1 lumbar-herniated disks and sciatic pain. The relationship between diagnostic accuracy of this test, age classes, and grade of lumbar disk displacement was investigated. METHODS The charts of 2352 patients with sciatic pain with/without lumbar pain were examined. Results of the SLR were then compared with previous spinal MRI. A 2 × 2 contingency table was created, and analysis of sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio, likelihood ratio (LR), and receiver operating characteristic (ROC) curve was carried out. Homogeneous age classes were created to compare them statistically. RESULTS Magnetic resonance imaging findings showed lumbar disk herniation (LDH) in 1305 patients. Of these subjects, 741 were positive on SLR testing. Sensitivity was 0.36, whereas specificity was 0.74. Positive and negative predictive values were 0.69 and 0.52, respectively. Positive LR was 1.38, and negative LR was 0.87. Diagnostic odds ratio was 1.59, and ROC analysis showed an area under the curve (AUC) of 0.596. The AUC decreased from 0.730 in the 16- to 25-year subgroup to 0.515 in the 76- to 85-year subgroup. Similar results were obtained in subjects with LDH and nerve root compression. CONCLUSIONS Our results indicate low accuracy of the SLR in diagnosis of LDH if compared with MRI results. The discriminative power of the SLR seemed to decrease as age increased; thus, positive and negative results may be less conclusive in older patients.
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Schulz CA, Hondras MA, Evans RL, Gudavalli MR, Long CR, Owens EF, Wilder DG, Bronfort G. Chiropractic and self-care for back-related leg pain: design of a randomized clinical trial. Chiropr Man Therap 2011; 19:8. [PMID: 21426558 PMCID: PMC3072925 DOI: 10.1186/2045-709x-19-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 03/22/2011] [Indexed: 01/07/2023] Open
Abstract
Background Back-related leg pain (BRLP) is a common variation of low back pain (LBP), with lifetime prevalence estimates as high as 40%. Often disabling, BRLP accounts for greater work loss, recurrences, and higher costs than uncomplicated LBP and more often leads to surgery with a lifetime incidence of 10% for those with severe BRLP, compared to 1-2% for those with LBP. In the US, half of those with back-related conditions seek CAM treatments, the most common of which is chiropractic care. While there is preliminary evidence suggesting chiropractic spinal manipulative therapy is beneficial for patients with BRLP, there is insufficient evidence currently available to assess the effectiveness of this care. Methods/Design This study is a two-site, prospective, parallel group, observer-blinded randomized clinical trial (RCT). A total of 192 study patients will be recruited from the Twin Cities, MN (n = 122) and Quad Cities area in Iowa and Illinois (n = 70) to the research clinics at WHCCS and PCCR, respectively. It compares two interventions: chiropractic spinal manipulative therapy (SMT) plus home exercise program (HEP) to HEP alone (minimal intervention comparison) for patients with subacute or chronic back-related leg pain. Discussion Back-related leg pain (BRLP) is a costly and often disabling variation of the ubiquitous back pain conditions. As health care costs continue to climb, the search for effective treatments with few side-effects is critical. While SMT is the most commonly sought CAM treatment for LBP sufferers, there is only a small, albeit promising, body of research to support its use for patients with BRLP. This study seeks to fill a critical gap in the LBP literature by performing the first full scale RCT assessing chiropractic SMT for patients with sub-acute or chronic BRLP using important patient-oriented and objective biomechanical outcome measures. Trial Registration ClinicalTrials.gov NCT00494065
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Affiliation(s)
- Craig A Schulz
- Northwestern Health Sciences University, Wolfe-Harris Center for Clinical Studies, 2501 West 84th Street, Bloomington, MN 55431, USA.
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Abstract
STUDY DESIGN Experimental study to determine the kinetics of the lumbar spine (LS) and hips during forward and backward bending. OBJECTIVE To investigate the effects of back pain, with and without a positive straight leg raise (SLR) sign, on the loading patterns in the LS and hip during forward and backward bending. SUMMARY OF BACKGROUND DATA Forward and backward bending are important components of many functional activities and are part of routine clinical examination. However, there is a little information about the loading patterns during forward and backward bending in people with back pain with or without a positive SLR sign. METHODS Twenty asymptomatic participants, 20 back pain participants, and 20 participants with back pain and a positive SLR sign performed 3 continuous cycles of forward and backward bending. Electromagnetic sensors were attached to body segments to measure their kinematics while 2 nonconductive force plates gathered ground reaction force data. A biomechanical model was used to determine the loading pattern in LS and hips. RESULTS Although the loading on the LS at the end of the range decreased significantly, the loading at the early and middle ranges of forward bending actually increased significantly in people with back pain, especially in those with positive SLR sign. This suggests that resistance to movement is significantly increased in people with back pain during this movement. CONCLUSION This study suggested that it is not sufficient to study the spine at the end of range only, but a complete description of the loading patterns throughout the range is required. Although the maximum range of motion of the spine is reduced in people with back pain, there is a significant increase in the moment acting through the range, particularly in those with a positive SLR sign.
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Boyd BS, Wanek L, Gray AT, Topp KS. Mechanosensitivity during lower extremity neurodynamic testing is diminished in individuals with Type 2 Diabetes Mellitus and peripheral neuropathy: a cross sectional study. BMC Neurol 2010; 10:75. [PMID: 20799983 PMCID: PMC2940775 DOI: 10.1186/1471-2377-10-75] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Accepted: 08/28/2010] [Indexed: 11/30/2022] Open
Abstract
Background Type 2 Diabetes Mellitus (T2DM) and diabetic symmetrical polyneuropathy (DSP) impact multiple modalities of sensation including light touch, temperature, position sense and vibration perception. No study to date has examined the mechanosensitivity of peripheral nerves during limb movement in this population. The objective was to determine the unique effects T2DM and DSP have on nerve mechanosensitivity in the lower extremity. Methods This cross-sectional study included 43 people with T2DM. Straight leg raise neurodynamic tests were performed with ankle plantar flexion (PF/SLR) and dorsiflexion (DF/SLR). Hip flexion range of motion (ROM), lower extremity muscle activity and symptom profile, intensity and location were measured at rest, first onset of symptoms (P1) and maximally tolerated symptoms (P2). Results The addition of ankle dorsiflexion during SLR testing reduced the hip flexion ROM by 4.3° ± 6.5° at P1 and by 5.4° ± 4.9° at P2. Individuals in the T2DM group with signs of severe DSP (n = 9) had no difference in hip flexion ROM between PF/SLR and DF/SLR at P1 (1.4° ± 4.2°; paired t-test p = 0.34) or P2 (0.9° ± 2.5°; paired t-test p = 0.31). Movement induced muscle activity was absent during SLR with the exception of the tibialis anterior during DF/SLR testing. Increases in symptom intensity during SLR testing were similar for both PF/SLR and DF/SLR. The addition of ankle dorsiflexion induced more frequent posterior leg symptoms when taken to P2. Conclusions Consistent with previous recommendations in the literature, P1 is an appropriate test end point for SLR neurodynamic testing in people with T2DM. However, our findings suggest that people with T2DM and severe DSP have limited responses to SLR neurodynamic testing, and thus may be at risk for harm from nerve overstretch and the information gathered will be of limited clinical value.
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Affiliation(s)
- Benjamin S Boyd
- Physical Therapy, University of California, San Francisco, Graduate Program in Physical Therapy, 1318 7th Avenue, Box 0736, San Francisco, CA 94143-0736, USA
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Falavigna A, Righesso Neto O, Bossardi J, Hoesker T, Gasperin PC, Silva PGD, Teles AR. Qual a relevância dos sinais e sintomas no prognóstico de pacientes com hérnia de disco lombar? COLUNA/COLUMNA 2010. [DOI: 10.1590/s1808-18512010000200016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: a hérnia de disco lombar (HDL) é uma patologia prevalente na atualidade, que acarreta limitações físicas, psiquícas e sociais ao paciente. Os sinais e sintomas mais frequentes são lombociatalgia, distúrbios motores e sensitivos e sinal de Lasègue. Nos pacientes com HDL refrátarios ao tratamento clínico, microdiscectomia é o procedimento padrão para a melhora dos sintomas. OBJETIVOS: estudar a relevância prognóstica dos sinais e sintomas nos pacientes com HDL refratários ao tratamento clínico. MÉTODOS: foram pesquisados, nas principais bases de dados biomédicas, os artigos que estudaram a percentagem de melhora e o valor prognóstico dos sinais e sintomas pré-operatórios dos pacientes com HDL. Os sinais e os sintomas avaliados foram dor lombar, dor na perna, distúrbios motores e sensitivos e sinal de Lasègue. CONCLUSÃO: o índice de sucesso da cirurgia dos pacientes com HDL refratários ao tratamento clínico correlaciona-se com a ausência de lombalgia, a presença de ciatalgia com tempo de evolução de até 6 meses, o déficit sensitivo presente de forma isolada ou associado ao déficit motor e a presença de sinal de Lasègue positivo no período pré-operatório.
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The immediate reduction in low back pain intensity following lumbar joint mobilization and prone press-ups is associated with increased diffusion of water in the L5-S1 intervertebral disc. J Orthop Sports Phys Ther 2010; 40:256-64. [PMID: 20436236 DOI: 10.2519/jospt.2010.3284] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Single-group, prospective, repeated-measures design. OBJECTIVES To determine differences in the changes of diffusion of water in the L5-S1 intervertebral disc between subjects with nonspecific low back pain (LBP) who reported an immediate reduction in pain intensity of 2 or greater on an 11-point (0-10) numeric rating scale after a 10-minute session of lumbar joint mobilization, followed by prone press-up exercises, compared to those who did not report an immediate reduction in pain intensity of 2 or greater on the pain scale. BACKGROUND Combining lumbar joint mobilization and prone press-up exercises is a common intervention for patients with LBP; however, there is conflicting evidence regarding the effectiveness and efficacy of this approach. Increased knowledge of the physiologic effects of the combined use of these treatments, and the relationship to pain reports, can lead to refinement of their clinical application. METHODS Twenty adults, aged 22 to 54, participated in this study. All subjects reported LBP of at least 2 on an 11-point (0-10) verbally administered numeric rating scale at the time of enrollment in the study and were classified as being candidates for the combination of joint mobilization and prone press-ups. Subjects underwent T2- and diffusion-weighted lumbar magnetic resonance imaging scans before and immediately after receiving a 10-minute session of lumbar pressures in a posterior-to-anterior direction and prone press-up exercises. Subjects who reported a decrease in current pain intensity of 2 or greater immediately following treatment were classified as immediate responders, while the remainder were classified as not-immediate responders. The apparent diffusion coefficient, representing the diffusion of water in the nucleus pulposis, was calculated from the midsagittal diffusion-weighted images. RESULTS Following treatment, immediate responders (n = 10) had a mean increase in the apparent diffusion coefficient in the middle portion of the L5-S1 intervertebral disc of 4.2% compared to a mean decrease of 1.6% for the not-immediate responders (P<.005). CONCLUSION In a group of subjects with LBP, who were classified as being candidates for extension-based treatment, the report of an immediate reduction in pain intensity of 2/10 of greater after a treatment of posterior-to-anterior-directed pressures, followed by prone press-up exercises, was associated with an increase in diffusion of water in the nuclear region of the L5-S1 intervertebral disc. Subjects who did not report a pain reduction of at least 2/10 did not have a change in diffusion. J Orthop Sports Phys Ther 2010;40(5):256-264, Epub 12 March 2010. doi:10.2519/jospt.2010.3284.
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Paatelma M, Karvonen E, Heinonen A. Inter- and intra-tester reliability of selected clinical tests in examining patients with early phase lumbar spine and sacroiliac joint pain and dysfunction. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/14038190903582154] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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van der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de Vet HC, Aertgeerts B. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev 2010:CD007431. [PMID: 20166095 DOI: 10.1002/14651858.cd007431.pub2] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Low-back pain with leg pain (sciatica) may be caused by a herniated intervertebral disc exerting pressure on the nerve root. Most patients will respond to conservative treatment, but in carefully selected patients, surgical discectomy may provide faster relief of symptoms. Primary care clinicians use patient history and physical examination to evaluate the likelihood of disc herniation and select patients for further imaging and possible surgery. OBJECTIVES (1) To assess the performance of tests performed during physical examination (alone or in combination) to identify radiculopathy due to lower lumbar disc herniation in patients with low-back pain and sciatica;(2) To assess the influence of sources of heterogeneity on diagnostic performance. SEARCH STRATEGY We searched electronic databases for primary studies: PubMed (includes MEDLINE), EMBASE, and CINAHL, and (systematic) reviews: PubMed and Medion (all from earliest until 30 April 2008), and checked references of retrieved articles. SELECTION CRITERIA We considered studies if they compared the results of tests performed during physical examination on patients with back pain with those of diagnostic imaging (MRI, CT, myelography) or findings at surgery. DATA COLLECTION AND ANALYSIS Two review authors assessed the quality of each publication with the QUADAS tool, and extracted details on patient and study design characteristics, index tests and reference standard, and the diagnostic two-by-two table. We presented information on sensitivities and specificities with 95% confidence intervals (95% CI) for all aspects of physical examination. Pooled estimates of sensitivity and specificity were computed for subsets of studies showing sufficient clinical and statistical homogeneity. MAIN RESULTS We included 16 cohort studies (median N = 126, range 71 to 2504) and three case control studies (38 to100 cases). Only one study was carried out in a primary care population. When used in isolation, diagnostic performance of most physical tests (scoliosis, paresis or muscle weakness, muscle wasting, impaired reflexes, sensory deficits) was poor. Some tests (forward flexion, hyper-extension test, and slump test) performed slightly better, but the number of studies was small. In the one primary care study, most tests showed higher specificity and lower sensitivity compared to other settings.Most studies assessed the Straight Leg Raising (SLR) test. In surgical populations, characterized by a high prevalence of disc herniation (58% to 98%), the SLR showed high sensitivity (pooled estimate 0.92, 95% CI: 0.87 to 0.95) with widely varying specificity (0.10 to 1.00, pooled estimate 0.28, 95% CI: 0.18 to 0.40). Results of studies using imaging showed more heterogeneity and poorer sensitivity. The crossed SLR showed high specificity (pooled estimate 0.90, 95% CI: 0.85 to 0.94) with consistently low sensitivity (pooled estimate 0.28, 95% CI: 0.22 to 0.35).Combining positive test results increased the specificity of physical tests, but few studies presented data on test combinations. AUTHORS' CONCLUSIONS When used in isolation, current evidence indicates poor diagnostic performance of most physical tests used to identify lumbar disc herniation. However, most findings arise from surgical populations and may not apply to primary care or non-selected populations. Better performance may be obtained when tests are combined.
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Sciatic nerve compression related to ossification of the sacrospinous ligament secondary to pelvic balance abnomalities. Orthop Traumatol Surg Res 2009; 95:645-8. [PMID: 19910274 DOI: 10.1016/j.otsr.2009.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 07/20/2009] [Accepted: 08/28/2009] [Indexed: 02/02/2023]
Abstract
The authors report an isolated case of right sacrospinous ligament ossification causing sciatic pain because of compression of the proximal sciatic nerve. The initial conservative treatment of injections in the conflict zone and the intervertebral joints was insufficient. Surgical exploration was undertaken via a posterior approach, demonstrating the conflict between the nerve and the ossified ligament. Resection of the ossified ligament eliminated the symptoms at the cost of transitory buttock hypesthesia. The anatomic and pathologic exam identified simple osseous metaplasia. Lumbar-pelvic coxometry analysis showed sagittalization of the acetabular roofs, excessive bilateral femoral torsion, and a step-off attenuation at the anterior cervicocephalic junction (low anterior cervico-cephalic femoral offset). In addition, reduced lumbar lordosis and accentuated sacral slope were noted, factors that could be related to modifications in the static balance of the lumbar-pelvic complex. This imbalance could be correlated to an increase in the forces applied to the pelvic ligament layers. The etiological hypothesis retained was that this osseous metaplasia was a reaction to excessive stresses on the sacrospinous ligament.
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