Low back pain

BACKGROUND CONTEXT: Low back pain (LBP) is associated with high health-care utilization and lost productivity. Numerous interventions are routinely used, although few are supported by strong evidence. Cost utility analyses (CUAs) may be helpful to inform decision makers. PURPOSE: To conduct a systematic review of CUAs of interventions for LBP. STUDY DESIGN: Systematic review. METHODS: A search strategy combining medical subject headings and free text related to LBP and health economic evaluations was executed in MEDLINE. Cost utility analyses combined with randomized controlled trials for LBP were included. Studies that were published before 1998, non-English, decision analyses, and duplicate reports were excluded. Search results were evaluated by two reviewers, who extracted data independently related to clinical study design, economic study design, direct cost components, utility results, cost results, and CUA results. RESULTS: The search produced 319 citations, and of these 15 met eligibility criteria. Most were from the United Kingdom (n58), published in the past 3 years (n512), studied chronic LBP or radiculopathy (n513), and had a follow-up O12 months (n513). Combined, there were 33 study groups who received a mean 2.1 interventions, most commonly education (n517), exercise therapy (n513), spinal manipulation therapy (n57), surgery (n57), and usual care from a general practitioner (n57). Mean baseline utility was 0.57, improving to 0.67 at follow-up; the mean difference in utility improvement between study groups was 0.04.

The knowledge of the onset and cessation timing of the paraspinal muscles that surround the lumbar spine is an important area of research for the understanding of low back pain. This study examined the timing of the erector spinae and external oblique muscle activity in a group of golfers with and without low back pain. The study compared the results of surface electromyography measurements for two groups of golfers. Twelve male golfers who had reported a mild or greater level of pain in the lower back that was experienced while playing golf were examined. A further fifteen male golfers who had reported no history of lower back pain in the previous 12 months were recruited as controls. The results showed that the low back pain golfers switched-on their erector spinae muscle significantly in advance of the start of the backswing. This finding was not evident in the group who did not have low back pain symptoms. Low back pain golfers therefore, may use the erector spinae muscle as a primary spinal stabiliser instead of the stronger deeper muscles such as transversus abdominis and multifidus. These results may have important implications for conditioning programmes for golfers with low back pain.

International standards highlight the steps required by risk assessment and involving first hazard identification, then risk evaluation and finally, if necessary, risk assessment. To check approach appropriateness to "risk evaluation" from manual patient handling through MAPO, a cross study was carried out in view of checking relationship between this new risk assessment model and occurrence of acute low back pain. After proper training the MAPO screening method was assessed in 31 wards, 411 exposed subjects of geriatric hospitals. At the same time health data were collected on occurrence of low back pain episodes during the last year both in the exposed subjects' group and the external reference group (n�237). Risk and clinical assessment data were tutored and checked by EPM research unit. The logistic analysis was used as a method to evaluate the relationship between risk index and acute low back pain. Investigating relationship between acute low back pain episodes a...

The investigators describe their multifaceted approach to the study of the relationship between whole-body vibration and low back pain. In vivo experiments, using percutaneous pin-mounted accelerometers have shown that the natural frequency is at 4·5 Hz. The frequency response was affected by posture, seating, and seat-back inclination. The response appears to be largely determined by the rocking of the pelvis. Electromyographic studies have shown that muscle fatigue occurs under whole body vibration. After whole body vibration exposure the muscle response to a sudden load has greater latency. Vehicle driving may be a reason for low back pain or herniated nucleus pulposus. Prolonged seating exposure, coupled with the whole body vibration should be reduced for those recovering from these problems. Vibration attenuating seats, and correct ergonomic layout of the cabs may reduce the risks of recurrence.

Melalui beberapa tahapan seperti Call for Paper (CFP), penyeleksian dan review dari dewan redaksi dan mitra bestari, Berkala Ilmiah Mahasiswa Kesehatan Masyarakat Indonesia (BIMKMI) resmi merilis Jurnal Volume 9 Nomor 2 Januari - Februari 2022. Jurnal ini berisikan 8 artikel yang membahas tentang permasalahan-permasalahan kesehatan masyarakat.

Selamat membaca,
Salam Ilmiah!

The aim of this study was to assess the associations of overweight and obesity with lumbar radicular pain and sciatica using a meta-analysis. We searched the PubMed, Embase, Scopus, and Web of Science databases from 1966 to July 2013. We performed a random-effects meta-analysis and assessed publication bias. We included 26 (8 cross-sectional, 7 case-control, and 11 cohort) studies. Both overweight ( pooled odds ratio (OR) = 1.23, 95% confidence interval (CI): 1.14, 1.33; n = 19,165) and obesity (OR = 1.40, 95% CI: 1.27, 1.55; n = 19,165) were associated with lumbar radicular pain. The pooled odds ratio for physician-diagnosed sciatica was 1.12 (95% CI: 1.04, 1.20; n = 109,724) for overweight and 1.31 (95% CI: 1.07, 1.62; n = 115,661) for obesity. Overweight (OR = 1.16, 95% CI: 1.09, 1.24; n = 358,328) and obesity (OR = 1.38, 95% CI: 1.23, 1.54; n = 358,328) were associated with increased risk of hospitalization for sciatica, and overweight/obesity was associated with increased risk of surgery for lumbar disc herniation (OR = 1.89, 95% CI: 1.25, 2.86; n = 73,982). Associations were similar for men and women and were independent of the design and quality of included studies. There was no evidence of publication bias. Our findings consistently showed that both overweight and obesity are risk factors for lumbar radicular pain and sciatica in men and women, with a dose-response relationship. back pain; hospitalization; intervertebral disc displacement; obesity; overweight; sciatica Abbreviations: BMI, body mass index; CI, confidence interval; OR, odds ratio. Subtotal (I 2 = 0.0%, P = 0.759) Figure 3. Results of a meta-analysis of the associations of overweight, overweight/obesity, and obesity with hospitalization due to sciatica and of the association of overweight/obesity with surgery due to sciatica, 1966-2013. The size of the gray shaded area indicates the weight of each study. Horizontal lines show the 95% confidence intervals (CIs). ES, effect size. 934 Shiri et al. Am J Epidemiol. 2014;179(8):929-937 by guest on March 26, 2015 http://aje.oxfordjournals.org/ Downloaded from

Background and objective: Several cognitive-behavioral factors contribute to the persistence of pain disability in patients with chronic back pain. Fear-avoidance beliefs and fear of movement/(re)injury in particular have been shown to be strong predictors of physical performance and pain disability. Patients reporting substantial pain-related fear might benefit from exposure in vivo to a set of individually tailored, fear-eliciting, and hierarchically ordered physical movements rather than more general graded activity. Patients and interventions: Six consecutive patients with chronic low back pain who reported substantial fear of movement/(re)injury were included in the study. After a no-treatment baseline measurement period, the patients were randomly assigned to one of two interventions. In the first intervention, patients received exposure in vivo first, followed by graded activity. In the second intervention, the sequence of treatment modules was reversed. Before each treatment module, treatment credibility was assessed. Daily measures of pain-related fear, pain catastrophizing, and pain intensity were completed using visual analog scales. In addition, standardized measures of pain disability, pain-related fear, and pain vigilance were taken before and after each treatment module and at the 1-year follow-up. To obtain more objective data on actual activity levels, an ambulatory activity monitor was carried by the patients during 1 week before and after each treatment module. Results: Time series analysis of the daily measures showed that improvements in pain-related fear and pain catastrophizing occurred only during the exposure in vivo and not during the graded activity, irrespective of the treatment order. Analysis of the pretreatment to post-treatment differences also revealed that decreases in pain-related fear also concurred with decreases in pain disability and pain vigilance and an increase in physical activity levels. All improvements remained at the 1-year follow-up.

There are two patterns of back pain: 1) back-dominant pain and 2) leg pain dominant, greater than back pain. The causes of back pain are very different and numerous, but mostly are due to vertebral, mechanical etiology, and rarely because of non vertebral, visceral etiology. Leg pain greater than back pain is mostly disease of spinal nerve root, generally presented by radicular pain in a dermatomal distribution. Mechanical compression of spinal roots, caused by disc herniation or by spinal stenosis, results in radicular symptoms. Rarely, in about 1% of patients, there are some other reasons except vertebral mechanical cause, like infection, tumor or fracture. There are several causes of pseudoradicular pain like periferal neuropathy, myifascial syndromes, vascular diseases, osteoarthritis. Spondylarthropathies should be taken in cosideration as well. A complete history and physical examination is important to determine further diagnostic evaluation and to provide eficient therapy.

Low back pain (LBP) in children and adolescents was considered for many years to be rare and an indication of serious disease [1]. In the last two decades, epidemi-ological studies have shown that the prevalence of ... Ismail Bejia Nabiha Abid Kamel Ben Salem Mondher Letaief ...

Chronic low back pain (LBP) is an extremely common problem in practice, where it is often labeled idiopathic. No sufficient studies have been conducted to analyze the contribution of hypovitaminosis D to the etiology of chronic LBP in populations wherein vitamin D deficiency is endemic. The present study was, therefore, carried out to examine hypovitaminosis D and its determinants in female patients with chronic LBP during the childbearing period. Sixty female patients complaining of LBP lasting more than 3 months were clinically studied rheumatologically and neurologically. Questionnaires and indices quantifying risk factors associated with vitamin D deficiency were utilized. Biochemical assays of serum calcium, phosphorus, alkaline phosphatase (ALP), parathormone (PTH), and 25-hydroxyvitamin D (25 OHD) were performed and compared to those of 20 matched healthy controls. The determinants of vitamin D levels in patients were examined by stepwise regression. Patients with LBP had significantly lower 25 OHD levels (p<0.05) and significantly higher PTH (p<0.05) and ALP (p<0.001) than controls, although there were no significant group differences in calcium and phosphorus. Hypovitaminosis D (25 OHD < 40 ng/ml) was found in 49/60 patients (81%) and 12/20 (60%) of controls, with an odds ratio of 2.97. Although many risk factors related to sun exposure, clothing, diet, and pregnancy were significantly correlated with vitamin D levels in patients, only limited duration of sun exposure, contributing 55% to the variance of 25 OHD, limited areas of skin exposed (13%), and increased number of pregnancies (2%), were significant determinants of vitamin D levels in patients. Despite the sunny climate, hypovitaminosis D is prevalent among Egyptian women in the childbearing period, especially those presenting with chronic LBP, where it is associated with hyperphosphatasia and hyperparathyroidism, without alterations in serum calcium. The major determinant of hypovitaminosis D in our patients is limited sun exposure.

Pain-related emotions are a major barrier to effective self rehabilitation in chronic pain. Automated coaching systems capable of detecting these emotions are a potential solution. This paper lays the foundation for the development of such systems by making three contributions. First, through literature reviews, an overview of how chronic pain is expressed and the motivation for detecting it in physical rehabilitation is provided. Second, a fully labelled multimodal dataset containing high resolution multiple-view face videos, head mounted and room audio signals, full body 3-D motion capture and electromyographic signals from back muscles is supplied. Natural unconstrained pain related facial expressions and body movement behaviours were elicited from people with chronic pain carrying out physical exercises. Both instructed and noninstructed exercises where considered to reflect different rehabilitation scenarios. Two sets of labels were assigned: level of pain from facial expressions annotated by eight raters and the occurrence of six pain-related body behaviours segmented by four experts. Third, through exploratory experiments grounded in the data, the factors and challenges in the automated recognition of such expressions and behaviour are described, the paper concludes by discussing potential avenues in the context of these findings also highlighting differences for the two exercise scenarios addressed.

Low back pain affects the person&#39;s ability to keep balance, especially in challenging conditions. The purpose of this study was to determine the immediate effects of Pilates exercises on postural sway and dynamic balance of young individuals with non-specific low back pain. Controlled laboratory design. Forty-six participants with non-specific low back pain were randomized to a Pilates (n=23, 10 males; age: 21.8±3.2years) and a control group (n=23, 9 males; age: 22.8±3.6years). Postural sway was assessed with a force platform and dynamic balance with the Star Excursion Balance Test, before and after the intervention or rest period. To assess postural sway, participants stood still on an unstable surface set on the force plate for 90s, with eyes closed. The intervention lasted 20min and consisted on four Pilates exercises: single leg stretch (level 1), pelvic press (level 1), swimming (level 1) and kneeling opposite arm and leg reach. At baseline, no differences were found betwee...

Our aim is to investigate the effects of three therapeutic approaches in the chronic low back pain on pain, spinal mobility, disability, psychological state, and aerobic capacity. Sixty patients with chronic low back pain were randomized to three groups: group 1, aerobic exercise + home exercise; group 2, physical therapy (hot pack, ultrasound, TENS) + home exercise; group 3, home exercise only. Spinal mobility, pain severity, disability, and psychological disturbance of the patients were assessed before and after the treatment and at 1-month follow-up. Aerobic capacities of the patients were measured before and after treatment. All of the groups showed similar decrease in pain after the treatment and at 1-month follow-up, and there was no significant difference between the groups. In group 2, a significant decrease in Beck Depression Inventory scores was observed with treatment. At 1-month follow-up, group 1 and 2 showed significant decreases in General Health Assessment Questionnaire scores. In group 2, there was also a significant improvement in Roland Morris Disability scores. There were similar improvements in exercise test duration and the MET levels in all the three groups. All of the three therapeutic approaches were found to be effective in diminishing pain and thus increasing aerobic capacity in patients with chronic low back pain. On the other hand, physical therapy + home exercise was found to be more effective regarding disability and psychological disturbance.

The aim of the present study was to compare the effect of increased aerobic capacity versus muscle strength rehabilitation of female hospital staff with long-lasting musculoskeletal back pain. Seventy-nine women agreed to participate in the intervention study. After a medical examination, 65 individuals were assigned to one of three balanced groups: Endurance training (aerobic capacity promoting training: ET: n = 22), strength promotion exercise (SP: n = 24) or a control group (CON: n = 19). The active groups met twice a week for 60 minutes of exercise over 15 weeks. Aerobic capacity (VO 2m ax ) and musculoskeletal pain were measured immediately before (T1) and after the intervention period (T2). Aerobic capacity signi cantly increased in the ET group, whereas no change was observed in the SP group, and a signi cant reduction was found in the CON group from T1 to T2. Musculoskeletal pain was signi cantly reduced in both intervention groups, whereas minor changes were observed in the control group. Results from a 7-month follow-up (T3) survey con rmed the bene cial effects of interventions on musculoskeletal pain. In conclusion, improved aerobic capacity appeared not to be a necessary mechanism in musculoskeletal back pain reduction.

Background This study evaluated the effects of a combination of three ergonomic measures designed to reduce the risk of low back complaints among gypsum bricklayers. The measures focused on optimizing working height and reducing carrying distances. Methods A within-subjects (N ¼ 10) controlled field study was used to compare the effects of working with the ergonomic measures with those of working with conventional working methods at the worksite during the course of a full working day. Productivity, work demands, and workload were assessed.

La lombalgie commune constitue un problème de santé publique par sa fréquence et ses conséquences en milieu de travail. Les objectifs de notre étude sont la détermination de la prévalence de la lombalgie commune chez le personnel hospitalier, l'analyse des conséquences médicoprofessionnelles et la recherche de facteurs associés à la lombalgie commune. Méthodes.-Nous avons réalisé une enquête portant sur 350 employés de l'hôpital universitaire Fattouma-Bourguiba de Monastir. Ces employés ont répondu à un questionnaire pré-établi comportant 51 items. Résultats.-La prévalence cumulée de la lombalgie était de 57,1 % des cas, la prévalence annuelle était de 50,1 % des cas, la prévalence de la lombalgie chronique était de 12,8 % des cas. Les soins médicaux étaient nécessaires dans 61,9 % des cas. Les explorations radiologiques étaient effectuées dans 45 % des cas. L'arrêt de travail était observé dans 26,1 % des cas et un changement de poste de travail était nécessaire pour deux agents. Les facteurs associés à la lombalgie étaient l'âge (p < 0,01), le sexe féminin (p = 0,024), le BMI élevé (p = 0,01), le fait d'être marié ou divorcé (p < 0,01), le tabagisme (p = 0,016), les antécédents de lombalgie (p < 0,0001), l'activité extra-professionnelle (p < 0,01), la migraine (p < 0,001), l'ancienneté dans l'établissement (p = 0,007) ainsi que le port de charges lourdes (p = 0,008). Le sport constitue plutôt un facteur protecteur de la lombalgie (p = 0,019). Conclusion.-La prévalence de la lombalgie chez les personnels hospitaliers ainsi que ses répercussions socioprofessionnelles sont importantes. Plusieurs facteurs sont associés à cette lombalgie incitant à entreprendre des mesures préventives de cette affection.

In esteemed disciplines of science, such as physics, truth is not defined by a single publication. If a laboratory announces a new discovery, it is standard practice for other laboratories to promptly replicate the study, in order to confirm or refute its observations. The discovery does not become fact until at least one other laboratory confirms the observations, but preferably there should be multiple, independent confirmations. This principle should apply to the results reported by Peng et al. in this issue [8]. Peng et al. [8] announced astounding results, unprecedented and unrivalled in the history of research into the treatment of chronic discogenic low back pain. The treatment was simply an injection of 1 ml of 1% methylene blue and 1 ml of 2% lignocaine. In a randomized, placebo-controlled trial this treatment achieved reductions of mean scores from 72 to 20 for pain, and from 48 to 13 for disability. Some 19% of their patients achieved complete relief of pain, at 24 months, with a further 72% having only slight pain that required no medication. For these outcomes the number needed to treat was 2. Against these figures, the results of surgery, rehabilitation, behavioural therapy, and any other treatment for back pain pale into insignificance. Although seemingly simple, this treatment is not without foundation. Methylene blue is an inhibitor of nitric oxide-induced guanylate cyclase [1,3,4], and nitric oxide has been implicated in the inflammatory processes of disc degeneration and discogenic pain [2]. Nor should it be a concern that the response rate in the placebo group was low (12%). Not only is it within the expected range of placebo response rates, it is not unreasonable at a twoyear follow-up. If the results of Peng et al. [8] are true, this intervention will revolutionize the treatment of low back pain. Spinal surgery for back pain will be rendered essentially obsolete. Furthermore, and ironically, the treatment is not subject to any patent, and is readily available. Anyone who performs discography will be able to provide the treatment, at trivial extra cost. For ridding the world of back pain, this study would be worthy of nomination for a Nobel Prize; if the results are true. Credibility will be the principal issue that arises once this paper appears. Technically, there are no lethal flaws in the study. Standard techniques of diagnosis and treatment were used, which can be replicated. Validated instruments were used for group outcomes. Statistical significance was well and truly achieved. But those data are overshadowed by the categorical outcomes: 19% completely free of pain, and 72% requiring no medication. The 95% confidence intervals of these proportions are 6-32% and 57-87%, respectively, which is the range of outcomes that those who use this treatment should expect to achieve. The study comes from an esteemed group that has been active in major journals to date [5-7,9,10]. So, the source seems honourable and impeccable. What is not known is whether cultural

A case of acute ei~cephalopathy after lumbar myeIography is reported in a female aged 26 years. Fourteen hours after the procedure, the patient developed coma (GCS 6) and had generalized slowing of EEG activity. This state lasted about 12 h. followed by gradual and full recovery.

Objective: To determine whether preoperative disc space height (DSH) influences the clinical outcomes of patients diagnosed with single-level symptomatic discogenic disease and treated with a standalone anterior lumbar interbody fusion with two tapered threaded fusion cages, we performed a retrospective analysis of 392 patients.

Background: Solid plastic replicas of anatomical structures obtained by stereolithography from computed tomographic images and magnetic resonance imaging are being used as complementary tools for diagnostic purposes and therapy planning for diverse pathologies. Case Descriptions: Case 1-The spine mold of a 62-year-old man with neurologic compromise secondary to degenerative cervical disease was used to study the pathologic features of his spine and to plan and simulate the approach to remove osteophytes before surgery. Also, by examining the replica of his spine, the unconvinced patient was able to understand the nature of his pathology and realize that his neurologic symptoms would disappear only through surgery, as they did. Case 2-A 27-year-old woman had uncontrolled back and leg pain possibly related to anxiety and depression. She had undergone one unsuccessful lumbo-sacral surgery and was now obsessed with the thought that her second surgery, performed by us, likewise had failed, even though her magnetic resonance images proved otherwise. It was not until she held a replica of her repaired spine in her hands that she was able to understand that her pain was unfounded. Once she was able to relax, her chronic pain and anxiety disappeared within a month, using the same antidepressive treatment that formerly had been ineffective. Conclusions: Spine replicas are useful devices for diagnosis, planning, and simulating surgery, and they enable patients to understand the nature of their pathologies and the surgical procedures at hand.

To identify the expectations of service, and degree of satisfaction, with a multidisciplinary service for patients with low back pain, and to examine the strength of association between patients' satisfaction and expectations. Method. A three-stage study design was used: concerns were identified by a focus group; priority issues were identified by ranking by use of a Delphi consensus questionnaire; satisfaction or expectation questionnaires were also used to rate patients' satisfaction and the degree to which expectations were met. Subjects. Three convenience samples of patients with low back pain were recruited. Ten patients attended the focus group, 55 completed the Delphi consensus questionnaire and 40 completed the satisfaction or expectation questionnaires. Results. Patients rated a clear diagnosis and effective treatment as important, and the ease with which they could access the service and post-discharge follow-up as important issues when judging satisfaction. Patients rated their overall satisfaction and meeting their expectations higher than specific service issues, and the strengths of the associations between the two constructs varied from concern to concern. Conclusion. Certain aspects of service provision are rated with greater importance than others when patients judge a service they have experienced. There are differences in the strength of associations between the constructs of patient satisfaction and meeting expectations of service, specific to the individual service concern that is being evaluated. The present study provides more evidence that specific concerns within service provision should be identified before evaluating patients' expectations and satisfaction with the service overall.

Objective: Follow-up data were collected using postal questionnaires and if participants did not respond, then data was collected using telephone interviews. The objectives of this study were to examine, for the two methods, how respondents differed in characteristics and whether the observed treatment difference varied.

The purpose of this project was to determine if subjects with low back pain (LBP) exhibit greater side-to-side weight-bearing (WB) asymmetry compared to healthy control subjects without LBP. This study utilized an observational double cohort design and consisted of 35 subjects with LBP and 31 healthy control subjects. Sideto-side WB asymmetry was calculated as the average of the absolute value of the difference between the right and left lower extremity from three trials. The percentage of the average side-to-side WB asymmetry relative to the total body weight was calculated to normalize expected differences in magnitude of asymmetry based on a subject's total body weight. An 11-point numeric pain rating scale was used to represent the subject's current level of pain. Patients with LBP demonstrated significantly greater normalized side-to-side WB asymmetry than healthy control subjects (8.8% vs. 3.6%, respectively, Po0.001). In patients with LBP, higher magnitudes of side-to-side WB asymmetry were significantly associated with increased pain (r = 0.39, P = 0.021). In conclusion patients with LBP exhibited increased side-to-side WB asymmetry compared to healthy control subjects without LBP. This asymmetry was associated with increased levels of pain. This finding is relevant for planning future studies that will attempt to provide evidence for the construct validity of manipulation by determining if side-to-side WB asymmetry normalizes after a manipulation intervention and if this improvement is associated with improvements in pain and function. r

The aim of the present study was to compare the subjectively reported and objectively assessed activityrelated characteristics of patients with Chronic Low Back Pain (CLBP) who were classified according to their scores on the Patterns of Activity Measure-Pain (POAM-P) into avoiders, persisters, mixed performers (i.e. high scores on both avoidance and persistence behaviour) or functional performers (i.e. low scores on avoidance and persistence behaviour).

The patients of cerebral palsy need assistance for their self activities which expose the caregivers to different risk factors of musculoskeletal disorders. But there is a scarcity of studies revealing the prevalence and the risk factors present among the caregivers of the cerebral palsy children. This lead to formulate a study to identify prevalence and risk factors among the caregivers of cerebral palsy children. Result revealed that most of the caregivers among both the groups were female (63.4% and 69.3%). The common age group of the children who underwent multilevel surgery was at the age group of 6 - 10 years. It has been observed that among the study group 56.5% were totally cooperative children. The Caregiver Strain Index value showed there is no significant difference among both the groups. Regional body pain of shoulder, elbow, upper back, lower back and ankle revealed a higher prevalence among the study group. Clinical diagnosis revealed prevalence of MPS, FMS and TOS amo...

BACKGROUND CONTEXT: Although occupational driving has been associated with low back pain, little has been reported on the incidence rates for this disorder. PURPOSE: To determine the incidence rate and demographic risk factors of low back pain in an ethnically diverse and physically active population of US military vehicle operators. STUDY DESIGN/SETTING: Retrospective database analysis. PATIENT SAMPLE: All active-duty military service members between 1998 and 2006. OUTCOME MEASURES: Low back pain requiring visit to a health-care provider. METHODS: A query was performed using the US Defense Medical Epidemiology Database for the International Classification of Diseases, Ninth Revision, Clinical Modification code for low back pain (724.20). Multivariate Poisson regression analysis was used to estimate the rate of low back pain among military vehicle operators and control subjects per 1,000 person-years, while controlling for sex, race, rank, service, age, and marital status. RESULTS: A total of 8,447,167 person-years of data were investigated. The overall unadjusted low back pain incidence rate for military members whose occupation is vehicle operator was 54.2 per 1,000 person-years. Compared with service members with other occupations, motor vehicle operators had a significantly increased adjusted incidence rate ratio (IRR) for low back pain of 1.15 (95% confidence interval [CI] 1.13-1.17). Female motor vehicle operators, compared with males, had a significantly increased adjusted IRR for low back pain of 1.45 (95% CI 1.39-1.52). With senior enlisted as the referent category, the junior enlisted rank group of motor vehicle operators had a significantly increased adjusted IRR for low back pain: 1.60 (95% CI 1.52-1.70). Compared with Marine service members, those motor vehicle operators in both the Army, 2.74 (95% CI 2.60-2.89), and the Air Force, 1.98 (95% CI 1.84-2.14), had a significantly increased adjusted IRR for low back pain. The adjusted IRRs for the less than 20-year and more than 40-year age groups, compared with the 30to 39-year age group, were 1.24 (1.15-1.36) and 1.23 (1.10-1.38), respectively. CONCLUSIONS: Motor vehicle operators have a small but statistically significantly increased rate of low back pain compared with matched control population. Published by Elsevier Inc.

Background and Purpose. Performing nontraditional abdominal exercises with devices such as abdominal straps, the Power Wheel, and the Ab Revolutionizer has been suggested as a way to activate abdominal and extraneous (nonabdominal) musculature as effectively as more traditional abdominal exercises, such as the crunch and bent-knee sit-up. The purpose of this study was to test the effectiveness of traditional and nontraditional abdominal exercises in activating abdominal and extraneous musculature. Subjects. Twenty-one men and women who were healthy and between 23 and 43 years of age were recruited for this study. Methods. Surface electromyography (EMG) was used to assess muscle activity from the upper and lower rectus abdominis, external and internal oblique, rectus femoris, latissimus dorsi, and lumbar paraspinal muscles while each exercise was performed. The EMG data were normalized to maximum voluntary muscle contractions. Differences in muscle activity were assessed by a 1-way, repeated-measures analysis of variance. Results. Upper and lower rectus abdominis, internal oblique, and latissimus dorsi muscle EMG activity were highest for the Power Wheel (pike, knee-up, and roll-out), hanging knee-up with straps, and reverse crunch inclined 30 degrees. External oblique muscle EMG activity was highest for the Power Wheel (pike, knee-up, and roll-out) and hanging knee-up with straps. Rectus femoris muscle EMG activity was highest for the Power Wheel (pike and knee-up), reverse crunch inclined 30 degrees, and bent-knee sit-up. Lumbar paraspinal muscle EMG activity was low and similar among exercises. Discussion and Conclusion. The Power Wheel (pike, knee-up, and roll-out), hanging knee-up with straps, and reverse crunch inclined 30 degrees not only were the most effective exercises in activating abdominal musculature but also were the most effective in activating extraneous musculature. The relatively high rectus femoris muscle activity obtained with the Power Wheel (pike and knee-up), reverse crunch inclined 30 degrees, and bent-knee sit-up may be problematic for some people with low back problems. [Escamilla RF, Babb E, DeWitt R, et al. Electromyographic analysis of traditional and nontraditional abdominal exercises: implications for rehabilitation and training.

Contralateral transversus abdominis muscle (cTrA) is known to be anticipatory to rapid focal movement. The activation of ipsilateral TrA (iTrA) follows cTrA, but their anticipatory interaction in healthy subjects seems to be delayed in low back pain (LBP) patients. TrA delay in LBP is linked with reorganization of the primary motor cortex (M1), thus supporting that cortical changes underlie the altered postural control. Our study tested whether differences in postural adjustments were present in LBP for TrA onsets and co-activation, and whether these differences were paralleled by cortical motor changes. Thirteen chronic LBP patients and 9 healthy Controls were enrolled. Surface recordings of cTrA/internal oblique (IO) and iTrA/IO were collected during a rapid shoulder flexion task while standing. Transcranial magnetic stimulation of M1 tested TrA/IO corticospinal excitability, active motor threshold and short-interval intracortical inhibition (SICI). In LBP compared to Controls, iTrA/IO activation was delayed, co-activation was absent, timing between TrA/IO onsets was impaired, and SICI was missing. Betweenoutcomes correlations observed in one group were not significant in the other. Delay of iTrA/IO and the lacking co-activation were not explained by between-group differences of transcranial magnetic stimulation outcomes. TrA/IO co-activation is present during rapid focal movement in healthy subjects only. LBP patients displayed an important alteration of the control of spine stability that can be explained by altered mechanisms of M1 motor programming.

Objective: To investigate the Bournemouth Questionnaire (BQ) as a baseline, monitoring of progress, and prognostic instrument in chiropractic patients with persistent low back pain (LBP). Study Design: Predictive and concurrent validation study. Study Participants and Setting: One hundred fifteen Norwegian chiropractors collected prospective data on 875 patients with persistent LBP, defined as LBP for at least 2 weeks at baseline and a minimum of 30 days totaling within the preceding year. Methods: Data collection took place at first consultation, fourth visit, and 3 months using the BQ, the revised Oswestry questionnaire, and a 10-point pain box scale. Follow-up at 12 months included the BQ, Oswestry questionnaire, and additional questions on the number of days with LBP and the number of days off work in the past year. Data Analysis: Frequency of reporting of each 7 items in the BQ at baseline was identified as median value with 10th and 90th percentiles. Concurrent analyses of the 2 questionnaires were made at the 4 points in time with calculation of mean differences with limits of agreement together with Bland-Altman plots. Logistic regression was used to identify and compare the predictive values of the questionnaires and to test the relevance of each individual item in the BQ. Results: The median baseline values of the 7 items in the BQ ranged from 2 to 5. The 2 questionnaires did not agree on patients' status, and mean differences between the Oswestry questionnaire and the BQ were largest when patients reported higher scores. The predictive values for the 2 questionnaires were low, with no significant difference between the 2. The predictive value of the BQ could be improved by removing most of the 7 items. Certain items can predict specific outcomes. Conclusions: The BQ is not a useful instrument to identify baseline status, monitor progress, or predict the 1-year progress in chiropractic patients having persistent LBP. However, certain individual items are useful to predict specific outcomes. (J Manipulative Physiol Ther 2005;28:219-227)

Objectives: Biering-Sorensen test is an isometric back endurance test. Biering-Sorensen test scores have varied in different cultural and occupational groups. The aims of this study were to collect normative data on Biering-Sorensen holding times, to determine the discriminative ability of the Biering-Sorensen test in Turkish coal miners, and to examine the association between Biering-Sorensen test result and functional disability. Methods: One hundred and fifty male coal miners participated in this study. Trunk extensor muscle strength was measured using the Biering-Sorensen test. Oswestry disability index was used to measure the functional disability level of low back pain. Results: The mean Biering-Sorensen holding time for the total subject group was 107.3 AE 22.5 s. The mean time of Biering-Sorensen test of the subjects with and without low back pain were 99.9 AE 19.8 and 128.6 AE 15.2 s, respectively. The difference between the subjects with and without low back pain was statistically significant ( p < 0.001). There was a statistically significant negative correlation between Oswestry functional disability score and Biering-Sorensen holding time (r ¼ À0.824, p < 0.001). Conclusions: Turkish coal miners have low mean back extensor endurance holding times. Biering-Sorensen test had a good discriminative ability in our study group. Trunk muscle strength has a significant effect on the disability level of low back pain. Thus trunk muscle endurance training exercise therapy may be effective for the reduction of disability in patients with low back pain.

BACKGROUND CONTEXT: The relationships between obesity and low back pain (LBP) and lumbar disc degeneration (LDD) remain unclear. It is possible that familial factors, including genetics and early environment, affect these relationships. PURPOSE: To investigate the relationship between obesity-related measures (eg, weight, body mass index [BMI]) and LBP and LDD using twin studies, where the effect of genetics and early environment can be controlled. STUDY DESIGN: A systematic review with meta-analysis. METHODS: MEDLINE, CINAHL, Scopus, Web of Science, and EMBASE databases were searched from the earliest records to August 2014. All cross-sectional and longitudinal observational twin studies identified by the search strategy were considered for inclusion. Two investigators independently assessed the eligibility, conducted the quality assessment, and extracted the data. Metaanalyses (fixed or random effects, as appropriate) were used to pool studies' estimates of association. RESULTS: In total, 11 articles met the inclusion criteria. Five studies were included in the LBP analysis and seven in the LDD analysis. For the LBP analysis, pooling of the five studies showed that the risk of having LBP for individuals with the highest levels of BMI or weight was almost twice that of people with a lower BMI (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.6-2.0; I 2 50%). A dose-response relationship was also identified. When genetics and the effects of a shared early environment were adjusted for using a within-pair twin casecontrol analysis, pooling of three studies showed a reduced but statistically positive association between obesity and prevalence of LBP (OR 1.5; 95% CI 1.1-2.1; I 2 50%). However, the association was further diminished and not significant (OR 1.4; 95% CI 0.8-2.3; I 2 50%) when pooling included two studies on monozygotic twin pairs only. Seven studies met the inclusion criteria for LDD. When familial factors were not controlled for, body weight was positively associated with LDD in all five cross-sectional studies. Only two cross-sectional studies investigated the relationship between obesity-related measures and LDD accounting for familial factors, and the results were conflicting. One longitudinal study in LBP and three longitudinal studies in LDD found no increase in risk in obese individuals, whether or not familial factors were controlled for.

Background: The life-time incidence of low back pain is high and diagnoses of spinal stenosis and disc prolapse are increasing. Consequently, there is a steady rise in surgical interventions for these conditions. Current evidence suggests that while the success of surgery is incomplete, it is superior to conservative interventions. A recent survey indicates that there are large differences in the type and intensity of rehabilitation, if any, provided after spinal surgery as well as in the restrictions and advice given to patients in the post-operative period. This trial will test the hypothesis that functional outcome following two common spinal operations can be improved by a programme of post-operative rehabilitation that combines professional support and advice with graded active exercise and/or an educational booklet based on evidence-based messages and advice.