High frequency of McKenzie's postural syndrome in young population of non-care seeking individuals

Lumbar interspinous pressure pain threshold values for healthy young men and women and the effect of prolonged fully flexed lumbar sitting posture: An observational study

BACKGROUND

Low back pain (LBP) is a common condition with large burden worldwide. Exposure to prolonged sitting with a flexed lumbar posture has been suggested in the literature to be a potential risk factor for self-reported LBP. No study has previously investigated whether exposure to prolonged flexed sitting posture provokes discomfort/pain and decreased interspinous pressure pain thresholds for healthy young men and women without back pain, despite this being a suggested risk factor for LBP.

AIM

To investigate whether sitting in a prolonged flexed lumbar posture provokes discomfort and lowers interspinous pressure pain thresholds in the lumbar spine for healthy young men and women without previous LBP.

METHODS

This is a an observational before and after study of 26 participants (13 men, 13 women) between 20-35 years old. Algometry was used to examine the pain threshold for pressure applied between spinous processes of the lumbar spine L1-L5. Pressure algometer measures were performed in prone before and after participants were instructed to sit in a fully flexed posture for a maximum of 15 min or until discomfort was experienced in the low back (Borg CR10 = 7/10). Wilcoxon signed-rank test was used for analyze values from the before and after test conditions. Mann-Whitney U test was used to investigate potential gender difference.

RESULTS

Fully flexed lumbar spine sitting posture up to 15 min provoked temporary discomfort but the proportion of participants experiencing discomfort 7/10 in the low back was 62%. For all pain pressure threshold locations tested, there was a significant difference for the study population with moderate-large decreased (r = -0.56) pressure pain threshold after exposure to prolonged flexed sitting posture (P < 0.01). Comparisons between gender did not show any significant difference.

CONCLUSION

The result showed that exposure to fully flexed lumbar sitting posture for up to 15 min produced temporary discomfort in the low back in young healthy adults with no previous history of LBP and significantly reduced lumbar interspinous pressure pain thresholds. No gender-based differences were observed.

An international survey of the comprehensiveness of the McKenzie classification system and the proportions of classifications and directional preferences in patients with spinal pain

BACKGROUND

Classification of spinal pain has been a key goal identified in the research. However it is not clear if existing classification systems are comprehensive.

OBJECTIVE

To examine the comprehensiveness and distribution of classifications within the McKenzie classification system (MDT), and the directional preference in consecutive patients with spine pain.

STUDY DESIGN

Prospective, observational study.

METHODS

Clinicians with a Diploma in MDT provided data on patients that they had assessed, classified, managed, and then confirmed their classification at discharge. They provided data on the spinal area, the MDT classification, and the loading strategy used in management.

RESULTS

Fifty-four clinicians from at least 15 different countries provided data on 750 patients: lumbar 64.8%, cervical 29.6%, thoracic 5.6%. The distribution of classifications was as follows: Derangement 75.4%, OTHER 22.8%, Dysfunction 1.7%, Postural syndrome 0.1%. In Derangements 82.5% had a directional preference for extension, 12.9% for lateral forces, and 4.6% for flexion. Those patients classified as one of the OTHER subgroups were given specific classifications.

CONCLUSION

Derangement was the most common classification and extension was by far the most common directional preference. A substantial proportion were classified as OTHER subgroups, for whom management is less straightforward.