Object: postoperative treatment of herniated intervertebral disc with stability exercises. Problem: degeneration of the intervertebral disc from a combination of factors can result in herniation. Disk herniation is the protrusion of the gelatinous material of the disk (nucleus pulposus) through the annulus fibrosus (Fardon & Milette, 2001). The presence of pain, radiculopathy and other symptoms depends on the site and degree of herniation. Many treatment modalities have been suggested for lumbar disc herniation, but studies often provide conflicting results (Humphreys & Eck, 1999). Postoperative treatment is very important. Doctor B.Spakauskas with co-authors (2002) says that after operative treatment condition of patient is getting worse. Hypothesis: back stability exercises applied in postoperative herniated disc period using stabilizer should improve endurance of lumbar spine muscles more than applying traditional exercises. The aim of this study was to evaluate effectiveness of back stability exercises in postoperative herniated intervertebral disc period. The tasks: to evaluate static endurance of trunk muscles, strength of hip, calf and foot muscles and low back pain before and after applying back stability exercises; to evaluate static endurance of trunk muscles, strength of hip, calf and foot muscles and low back pain before and after applying traditional (stretching, strengthening) exercise program; to determine which exercise program had better effect on... [to full text]

Musculo – skeletal stress in nursing staff and its association with health disorders Aim of the study was to investigate health complaints and work pressure among nursing staff, and to evaluate the associations of musculo - skeletal stress with their health disorders. Methods. During October - December, 2003, 300 employees of one Kaunas hospital were interviewed. In this case - control study, 100 respondents were included into the case group, and 200 were controls. The main criterion for the selection of controls was no engagement in activities characteristic of a nurse and an assisting nurse. The questionnaire was anonymous. Statistical analysis of the obtained findings was performed using SPSS 12 statistical software package. Results. Nurses whose work was not related to lifting weights (the control group) more frequently complained of pains in the neck (87,5 %), the shoulder girdle (91,7 %), and the back (93,2 %), whereas those whose work was related to lifting weights, more frequently complained of pains around the waist (73,0 %) and in the legs (94,9 %). The study showed that the pain syndrome in the arms by two times more frequently occurred in the control group (12,1 % compared to 6,0 % in the case group), which is characteristic of the sedentary job, especially computer work. Pain syndrome in the legs by four times more frequently occurred in the case group, compared to controls, which is typical of work related to weight lifting. The evaluation of the activities... [to full text]

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Tyrimo problema: lėtinio nugaros juosmeninės dalies skausmo pasikartojimo tikimybė labai didelė, todėl svarbu ištirti ir įvertinti pratimų išliekamąjį poveikį gydant nugaros skausmą. Kol apatiniai stuburo segmentai yra nestabilūs, jokie pratimai, mažinantys nugaros juosmeninės dalies skausmą, nebus efektyvūs. Stuburą stabilizuojančių pratimų dozavimas, jų atlikimo trukmė ir išliekamasis poveikis vis dar kelia diskusijų ir reikalauja išsamesnių tyrimų. Tyrimo hipotezė: 12 savaičių 24 procedūrų stuburą stabilizuojančių pratimų programos išliekamasis poveikis yra nepakankamas, siekiant ilgalaikio gydomojo efekto 40–60 metų amžiaus moterims, kamuojamoms lėtinio nugaros juosmeninės dalies skausmo. Tyrimo tikslas: įvertinti 12 savaičių 24 procedūrų stuburą stabilizuojančių pratimų programos išliekamąjį poveikį 40–60 metų amžiaus moterims, kamuojamoms lėtinio nugaros juosmeninės dalies skausmo. Tyrimo uždaviniai: ištirti liemens lenkiamųjų ir tiesiamųjų raumenų izometrinę jėgą ir ištvermę prieš ir po stuburą stabilizuojančių pratimų programos bei praėjus 4 ir 8 savaitėms po jos; nustatyti tiriamųjų nugaros juosmeninės dalies skausmo lygį ir įvertinti funkcinę būklę prieš ir po stuburą stabilizuojančių pratimų programos bei praėjus 4 ir 8 savaitėms po jos; įvertinti liemens lenkiamųjų ir tiesiamųjų raumenų jėgos ir ištvermės pokyčio įtaką nugaros juosmeninės dalies skausmo intensyvumui bei funkcinei būklei. Tyrimo metodai: Biodex System 3 Pro izokinetinis dinamometras, pilvo ir... [toliau žr. visą tekstą] / The problem of the research: the probability that chronic low back pain will reoccur is very high. For this reason, it is important to examine and evaluate the lastingness of the effect of the exercises while treating back pain. To reduce low back pain spine stabilizing exercises are applied. Dosage of exercises, duration of their performance and lastingness of the effect are still generating discussions and require a more detailed research. The hypothesis of the research: lastingness of twelve-week, 24 procedures, spine stabilizing exercises programme is not sufficient for 40-60 year old women with chronic low back pain while seeking a long lasting healing effect. The aim of the research: to evaluate lastingness of twelve-week, 24 procedures, spine stabilizing exercises programme effect on 40-60 year old women with chronic low back pain. The objectives of the research: to examine isometric force and endurance of back bending and straightening muscles before and after spine stabilizing exercises programme as well as 4 and 8 weeks after it; to determine subjects’ level of low back pain and functional state before and after spine stabilizing exercises programme as well as 4 and 8 weeks after it; to determine the effect of change in strength and endurance of waist bending and straightening muscles on low back pain intensity and functional state. Methods applied in the research: Biodex System 3 Pro isokinetic dynamometer, tests on abdomen and back muscles endurance, Oswestry... [to full text]

Low back pain (LBP) is a common ailment in the United States, affecting up to 80% of adults at least once in their lifetime. Although 90% of LBP cases are considered nonspecific, recent studies show that abnormal mechanics of the lower back can be a major factor. One method of assessing the lower back mechanical environment is through perturbation experiments. An intensive literature review of perturbation systems was used to select and develop a system for the Human Musculoskeletal Biomechanics Lab (HMBL). Following construction, individuals with high/low exposure to day-long physical activity were assessed to quantify daily changes in their lower back mechanics and determine whether complete recovery occurs during overnight rest. Despite significant decrease in maximum voluntary contractions (MVC), intrinsic stiffness of the high exposure group remained constant following day-long physical activity. The final component of this Master’s project is devoted to the design of a wobble chair system for study of trunk stability. Development of the perturbation system and wobble chair are hoped to facilitate future research aimed at a better understanding of trunk mechanical and neuromuscular behaviors to prevent and treat LBP in the future.

From a public health perspective pain from low back and/or pelvis was studied in relation to pregnancy. Two interventions, water gymnastics or Friskis and Svettis ́ gymnastics for pregnant women, were evaluated regarding effects on symptoms and need for sick leave due to low back or pelvic pain. In an intervention study with 390 randomised women, 266 participated in physical activity during 60 minutes once a week during just about half their pregnancies. No one was sick-listed due to low back pain in the water gymnastic group compared to 6 women in the land-based exercise group (p=0.03). Some doubts may be raised regarding recommendations to pregnant women with a history of low back pain to participate in gymnastics. On the contrary, water gymnastics seems to be beneficial regarding low back pain. Methods to prevent pelvic pain in relation to pregnancy are not known. Furthermore, a possible relation between longstanding pelvic pain after pregnancy was investigated. Such a relation has never been described before. Fifteen subjects, women with defined posterior pelvic pain during and after pregnancy and as many controls without anamnesis of such pain were tested for lactose intolerance, using the BH2-test. A correlation was found, p=0.05 but results need to be confirmed in larger studies. The possible link towards explaining such a relation goes through the fact that lactose intolerance and “irritable bowel syndrome”, IBS, often overlap and lactose intolerance test is recommended to be included in investigation of IBS. Can low back/pelvic pain in relation to pregnancy sometimes be correlated to lactose intolerance? / Med utgångspunkt från ett folkhälsoperspektiv studerades smärta från ländrygg och eller bäcken hos gravida kvinnor. Två interventioner, vattengymnastik respektive Friskis och Svettis ́ Vänta-barn-gympa, utvärderades avseende symtom på smärta från ländrygg och bäcken samt sjukskrivning härför i samband med graviditet. I en interventionsstudie med 390 randomiserade kvinnor deltog 266 kvinnor i fysisk aktivitet under en timma per vecka under drygt halva graviditeten. Ingen var sjukskriven för ländryggsmärta i vattengymnastikgruppen jämfört med 6 kvinnor i gymnastikgruppen (p=0.03). Viss försiktighet föreslås när det gäller att rekommendera vanlig gymnastik till kvinnor med anamnes på ryggsmärta under graviditet medan vattengymnastik förefaller ha god effekt för just ländryggsmärta. Någon metod för att förebygga bäckensmärta finns inte beskriven. Vidare studeras ett eventuellt samband mellan laktosintolerans och kvarstående bäckensmärta, något som inte tidigare undersökts. När det gäller sambandet graviditet – laktosintolerans gjordes en pilotstudie med 15 deltagare och lika många kontroller. Ett visst samband kunde konstateras, p=0.05, men resultaten måste verifieras i större studier. Den tänkbara förklaringsmekanismen bakom sambandet med laktosintolerans går via ”irritable bowel syndrome”, IBS. Symtom från IBS och från laktosintolerans överlappar varandra och det rekommenderas att laktosbelastning skall ingå i utredning av oklara buksmärtor. Kan även bäckensmärtor i samband med graviditet i vissa fall ha samband med laktosintolernas?

Darbo tikslas: palyginti paviršinių ir giliųjų liemens raumenų aktyvumo ir liemens stabilumo matavimų duomenis tarp asmenų, jaučiančių apatinės nugaros dalies skausmą (tiriamoji grupė) ir šio nusiskundimo neturinčių (kontrolinė grupė), pagrindinėse padėtyse. Pasirinktam darbo tikslui įgyvendinti buvo iškelti šie uždaviniai: 1. Palyginti giliųjų ir paviršinių liemens raumenų aktyvumą bei liemens stabilumą, atliekant izoliuotą skersinio pilvo raumens susitraukimą, tarp tiriamosios ir kontrolinės grupės. 2. Palyginti giliųjų ir paviršinių liemens raumenų aktyvumą bei liemens stabilumą, atliekant testus gulint ant pilvo, tarp tiriamosios ir kontrolinės grupės. 3. Palyginti giliųjų ir paviršinių liemens raumenų aktyvumą bei liemens stabilumą, atliekant testus gulint ant šono, tarp tiriamosios ir kontrolinės grupės. 4. Palyginti giliųjų ir paviršinių liemens raumenų aktyvumą, atliekant testus gulint ant nugaros, tarp tiriamosios ir kontrolinės grupės. Tyrimas atliktas poliklinikoje, Kaune. Tyrime dalyvavo 62 tiriamieji (28 vyrai ir 34 moterys). Tyrimo metodai: 1. Anketinė apklausa. 2. Elektromiografas su diferenciniu slėgio jutikliu (4 kanalų EMG + Stabilizer pressure biofeedback). 3.Statistinė analizė. Rezultatai: 1. Atliekant izoliuotą skersinio pilvo raumens susitraukimą, gauta, kad asmenų jaučiančių apatinės nugaros dalies skausmą tiesiamojo nugaros raumens juosmeninės dalies ir tiesiojo pilvo raumens apatinės dalies elektrinis aktyvumas buvo didesnis, o dauginio raumens ir... [toliau žr. visą tekstą] / The aim of the Master’s work is to compare the deep and surface torso muscle activity and stability measurement data, collected during main physical positions, of individuals that suffer from lower back pain (research group) and those who don’t (control group). The achievement of the works goal consists of the following tasks: 1. To compare deep and surface muscle activity and stability of the torso between both the research and control group individuals, during isolated transverse abdominal muscle contraction. 2 To compare deep and surface muscle activity and stability of the torso between both the research and control group individuals, during tests while lying on the abdomen. 3 To compare deep and surface muscle activity and stability of the torso between both the research and control group individuals, during tests while lying on the side. 4. To compare deep and surface muscle activity and stability of the torso between both the research and control group individuals, during tests while lying on the back. The study was conducted at a clinic in Kaunas. The study included 62 subjects (28 men and 34 women). Methods used within the study: 1. A questionnaire. 2. Electromyograph with a differential pressure sensor (4 channel EMG + Stabilizer pressure biofeedback). 3.Statistic analysis. The results: 1. It was found that while performing an isolated contraction of the transverse abdominal muscle, individuals with lower back pain had a considerably smaller electrical muscle... [to full text]

Aims This study examines the effects of surgery for chronic low back pain (CLBP) as well as fear avoidance, disability and levels of rated physical activity in patients treated in 2011. An additional aim was to assess patient’s experience of physiotherapy in primary care following the surgery as well the effect of physiotherapy on above mentioned outcome measures. Method A cross-sectional study design was used and a stratified random sample from 189 patients who were treated surgically in a hospital setting. This resulted in a sample of 112 respondents, half of whom where female. Ages ranged between 25-78 years. Questionnaires were sent by mail and data from 79 patients was collected. Non-parametric statistics were used. Outcome measures used were Tampa Scale for Kinesiophobia, Roland Morris Disability Questionnaire and the physical activity scale. Results More than one in four patients reported high levels of kinesiophobia, more than one in three experienced disability and less than a third were physically active. Patients with total disc replacement had better outcome than patients with lumbar fusion. A higher degree of kinesiophobia correlated significantly to experiencing more disability (rs=0.53, p<0.001) and being less physically active (rs=-0.48, p<0.001), and there were significant negative correlations between disability and levels of rated physical activity (rs=-0.37, p<0.001). Rehabilitation in primary care did not affect the results significantly. Conclusions The results of this study hint that the fear avoidance model is relevant in patients treated surgically for chronic low back pain. Physiotherapists and other health care professionals should screen for these beliefs and try to target them. This may assist patients to pursue health promoting activities and activities in daily life. / Syfte och frågeställningar Denna studie undersöker effekterna av kirurgi för kronisk ländryggssmärta liksom kinesiofobi, funktionsnedsättning och skattade fysiska aktivitetsnivåer hos patienter som behandlats under 2011. Ett annat syfte var att utvärdera patienternas upplevelser av sjukgymnastik i primärvård samt effekten av sjukgymnastik på ovannämnda utfallsmått postoperativt. Metod Tvärnsittsstudie med stratifierat randomiserat urval från 189 patienter som behandlats kirurgiskt i sjukhusmiljö. Detta resulterade i 112 respondenter, varav hälften var kvinnor. Åldrarna sträckte sig från 25-78 år. Enkäter från 79 patienter kunde analyseras. Icke-parametrisk statistik användes för analys. De utfallsmått som användes var Tampaskalan för kinsiofobi, Roland Morris funktionsnedsättningsskala och en skala för fysisk aktivitet. Resultat Mer än en fjärdedel av alla patienter rapporterade höga nivåer av kinesiofobi, mer än en tredjedel upplevde funktionsnedsättning och mindre än en tredjedel skattade sig som fysiskt aktiva. Patienter som opererats med diskprotes hade bättre resultat än patienter som opererats med steloperation. En högre grad av kinesiofobi korrelerade signifikant med att uppleva en större funktionsnedsättning (rs=0.53, p<0.001)  och lägre skattad fysisk aktivitet (rs=-0.48, p<0.001). Det fanns även en signifikant negativ correlation mellan funktionsnedsättning och skattad fysisk aktivitet (rs=-0.37, p<0.001). Rehabilitering i primärvård påverka inte resultatet signifikant. Slutsats Resultaten i denna studie pekar mot att rädsla-undvikande-modellen är relevant hos patienter som behandlats kirurgiskt för kronisk ländryggssmärta. Sjukgymnaster och annan häslo- och sjukvårdspersonal bör undersöka om dessa tankar finns hos denna patientgrupp och behandla dem. Detta för att underlätta för patienter att delta i aktiviteter för förbättrad hälsa och aktivitet i dagliga livet.

Nurses report high rates of back pain with consequent disability, work absenteeism and attrition from the profession. In the current climate of an international nursing shortage, efficacious interventions to reduce the impact of back pain must be developed. It is uncertain what components a back pain preventive intervention should comprise. Appropriate and reliable means to assess back pain and disability in nurses is also undetermined. The first aim of this thesis was to undertake a mixed methods program of research to inform the development of an intervention to prevent back pain in nurses. The second aim of the thesis was to examine the psychometric and measurement properties of back pain and disability outcome instruments frequently applied in nursing samples. Epidemiological studies were undertaken to examine factors associated with back pain in nursing cohorts. In student nurses, a history of manual handling work was found to be significantly associated with neck and back pain outcomes. In a large population cohort study of nurses and midwives, pain characteristics (pain severity and radiation), pain-related cognitive and behavioural factors (kinesiophobia and passive pain coping), job characteristics (job classification and manual handling task frequency) as well as demographic interactions explained sick leave due to back pain. A systematic review was undertaken to determine the efficacy of interventions aiming to prevent back pain and back injury in nurses. Due to methodological heterogeneity, a qualitative synthesis of evidence was undertaken on the 16 studies that met inclusion criteria. The review identified moderate level evidence from multiple trials that manual handling training in isolation is not effective and multidimensional interventions are effective in preventing back pain and injury in nurses. Single trials provided moderate evidence that stress management programs do not prevent back pain and limited evidence that lumbar supports are effective in preventing back injury in nurses. There was conflicting evidence regarding the efficacy of exercise interventions and the provision of manual handling equipment and training. A qualitative description study was employed to explore the beliefs and perceptions of nursing stakeholders regarding risk factors for back pain and strategies to prevent back pain in nurses. Stakeholders identified individual, intrapersonal, organisational and environmental risk factors that were consistent with the social ecological view of health. They believed that interventions targeting the individual would be ineffective in the absence of workplace and other reforms. At the individual level, they recommended strategies that address physical, psychological and occupational preparedness for nursing work. In addition, they suggested ecological intervention strategies to induce change at the intrapersonal, organisational, community and policy levels. A mixed method synthesis of evidence was performed to develop an evidence-based and stakeholder-relevant intervention that aims to reduce the impact of back pain in nurses. The proposed intervention incorporates evidence-based multidimensional strategies that address individual and organisational level factors, and proposes ecological factors that may warrant inclusion once evidence of their causal association with back pain is established. Methodological studies examined the psychometric and measurement properties of key instruments used to assess back pain and disability in nursing populations. An extended version of the Nordic Musculoskeletal Questionnaire – that is frequently modified when applied in nursing cohorts - was developed and deemed to have acceptable test-retest reliability. The Oswestry Disability Index was found to have unacceptable measurement properties for application in nursing samples, and is therefore not recommended for future studies of back pain related disability in the nursing population. In summary, this program of research contributes novel insights that can meaningfully inform understanding of back pain prevention in nurses. Factors not previously assessed in nursing populations have been examined and shown to be significantly related to back pain outcomes. The strength of existing evidence for the prevention of back pain and injury in nurses has been established, and methodological advances regarding appropriate and reliable measurement of back pain and disability have been made. The views and perceptions of stakeholders from multiple levels and vantage points have been considered and integrated within the interpretation of evidence from multiple mixed method studies. In fact, stakeholders have played a crucial role in the identification of an appropriate theoretical framework – the social ecological paradigm - to conceptualise back pain causality in nurses and identify relevant solutions. A future research agenda of expanded scope is implicated to adequately address back pain prevention in nurses.

Diss. (sammanfattning) Stockholm : Stockholms universitet, 2005. / Härtill 4 uppsatser.