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Propósito: Analizar si la adición de un espaciador interespinoso o la fusión intersomática ofrece ventajas en relación con la microdiscetomía aislada en el tratamiento de la hernia discal lumbar. Métodos: Pacientes con hernia de disco lumbar que iban a someterse a cirugía fueron elegidos para participar. En este estudio de cohorte los pacientes se dividieron en 3 grupos; Microdiscectomía sola (MD), microdiscectomía más espaciador interespinoso (IS) y fusión intersomática lumbar posterior (PLIF). La medida de resultado primaria fue la eficacia clínica mediante el índice de discapacidad de Oswestry (ODI). También evaluamos varios otros parámetros de resultado, entre los que se incluyeron: escala analógica visual para el dolor (EVA) de espalda y piernas, duración de la estancia, coste desde el ingreso hasta el alta hospitalaria, tasa de complicaciones de 90 días y tasa de reoperación tras 1 año. Resultados: Se incluyeron un total de 103 pacientes cuya edad media fue de 39,1 (± 8,5) años. En los 3 grupos se detectó una mejora significativa de la puntuación inicial del dolor de espalda y piernas con ODI y EVA. Las puntuaciones del ODI cambiaron de 62.66 a 13.77 en el grupo MD, 62.93 a 13.50 en el grupo IS, y 59.62 a 17.62 en el grupo PLIF (p <0.001). Después de 1 año, no se encontraron diferencias significativas en el ODI, ni en la EVA de espalda y piernas entre los 3 grupos. Hubo un aumento del 169% en el coste hospitalario en el grupo IS y del 287% en el grupo PLIF, en relación con la MD (p <0,001). La duración de la estancia fue un 86% mayor en el grupo IS y un 384% más en el grupo PLIF en comparación con MD (p <0,001). Las tasas de reoperación a 1 año fueron de 5,6%, 10% y 16,2% (p = 0,33) en los grupos MD, IS y PLIF respectivamente. Conclusión: La mejoría clínica parece deberse a la microdiscectomía, sin que el implante (interespinoso o fusión) agregue ningún beneficio. La adición de espaciador interespinoso o fusión no protegió contra la reoperación, y aumentó la duración de la estancia hospitalaria y los gastos quirúrgicos.

Bakgrund: Graviditetsrelaterad bäcken- och/eller ländryggssmärta kan bero på hormonella och biomekaniska förändringar som vanligen efter förlossningen. Dock kan kvinnor få ihållande smärtbesvär vilket kan påverka funktion och livskvalitet. Bäckenbottenträning, statisk bålträning och dynamisk bålstabiliserande träning har liknande effektmekanism för smärtlindring. Riktlinjer kring fysisk träning efter förlossning saknar en uppdaterad evidensbild för dess smärtlindrande effekt. Syfte: Syftet var att sammanställa evidensläget samt bedöma evidensstyrkan för den smärtlindrande effekten av bäckenbottenträning, statisk bålträning samt dynamisk bålstabiliserande träning vid smärta i bäcken- och/eller lumbalregion efter förlossning.  Metod: En systematisk litteraturöversikt genomfördes med artikelsökning på databaserna PubMed, Cinahl, PEDro och Cochrane. Varje artikel granskades enskilt av respektive författare utifrån en granskningsmall innan en gemensam sammanställning utfördes. Evidensgradering utifrån varje träningsform genomfördes med GRADE. Resultat: Nio randomiserade kontrollerade studier inkluderades med 499 kvinnor där fysisk träning visades ge en smärtlindrande effekt på postpartumsmärta i bäcken- och/eller ländrygg med genomsnittlig metodologisk kvalitet på 50 poäng. Dynamisk bålstabiliserande träning inkluderade sex studier och bäckenbottenträning två studier, samtliga med låg tillförlitlighet (⨁⨁◯◯). Statisk bålträning inkluderade en studie med mycket låg tillförlitlighet (⨁◯◯◯) enligt GRADE. Konklusion: Fysisk träning kan användas som behandling vid postpartumsmärta i bäcken- och/eller ländrygg. Evidensgraden behöver höjas genom fler studier, fler deltagare och blindad resultatuppföljning. / Background: Pregnancy-related pelvic girdle pain and/or low back pain is commonly caused by hormonal or biomechanical changes and tends to disappear after giving birth. However, some women are affected by the pain for an extended period, which will affect their functional status and quality of life. Pelvic floor exercises, static core exercises and dynamic core stabilisation exercises have a similar mechanism behind the pain-relieving effect. Guidelines for physical exercise after childbirth lack an updated picture of evidence for the pain-relieving effect. Purpose: The purpose of this review was to gather evidence and evaluate the strength of the evidence in relation to the pain-relieving effect of pelvic floor exercises, static core exercises, and dynamic core stabilisation exercises on pelvic girdle pain and/or low back pain after childbirth. Method: A systematic literature review was carried out and articles were gathered from the databases PubMed, Cinahl, PEDro and Cochrane. Each article was analysed individually by each author using a review template before a collective assessment was made. GRADE was used to rate the evidence for each form of physical exercise.  Results: Nine randomised controlled trials were included with 499 women where physical exercise was used to try and treat postpartum pelvic girdle pain and/or low back pain with a mean methodological quality of 50 points. Six studies evaluated dynamic core stabilisation exercises and two reviewed pelvic floor exercises, all with an overall low reliability (⨁⨁◯◯). Static core exercise was assessed in one study with very low reliability (⨁◯◯◯) according to GRADE. Conclusion: Physical exercise can be used as a treatment for pelvic gridle pain and/or low back pain postpartum. The level of evidence for each form of physical exercise needs to increase through more studies, more participants and blinded outcome follow-up.

Background and objective: Chronic low back pain (CLBP) is a complex musculoskeletal condition and often the source of the pain is not clear. A correlation has been found to exist between incidences of low back pain (LBP) and those with respiratory diseases such as COPD. This could give reason to believe that the sequence of events could be reversed, and LBP could elicit changes in respiratory function. The purpose of this study is to investigate if CLBP has an influence on breathing mechanics and the positioning of the diaphragm in the trunk. Methods: Volunteers were recruited between the ages of 35-65 years old with and without CLBP. All subjects underwent an MRI for imaging of their diaphragm to find the position of the diaphragm at the end of exhalation and inhalation. The height of the diaphragm at the end of exhalation and inhalation was then measured. Respiratory values were measured that included forced expiratory volume in 1 second (FEV1), and respiratory amplitude at the thoracic and abdominal level both at rest and after a series of functional exercises. Respiratory amplitude was used to measure average displacement of the abdomen and mid-ribcage during normal breathing. FEV1 was measured using a handheld spirometer and respiratory amplitude was measured using band-like respiratory sensors that were wrapped around the participants. Results: A total of 36 participants were recruited for this study (n = 21M; n = 15F), with 18 controls (n = 11M; n = 7F) and 18 with CLBP (n = 10M; 8F). Eleven variables were assessed to compare the results from the control group and CLBP group and see if there were any differences. No statistically significant differences were found for all variables assessed. Conclusion: There was no significant evidence there was a difference in diaphragm positioning and breathing mechanics in those who have CLBP. For future testing, we would want to change categorization to CLBP groups based on pain severity or compare the differences between acute LBP and CLBP. We would also consider changing our method for measuring the diaphragm such as measuring the percent change in area of the diaphragm between inhalation and exhalation. We would also consider other parameters to test that could include more use of the information given in the PROMIS questionnaire or looking at the amount of lumbar lordosis as seen on the MRI and how those values compare to among the different groups.

The diploma thesis evaluates the morphology of the abdominal wall muscles focusing on the assessment of lateral symmetry in elite female floorball players and its relationship with the occurrence of back pain in these players. The theoretical part of the thesis includes an overview of the physiological mechanisms of postural stabilization in comparison with deviations in patients with back pain and describes the principles of sonographic examination and its use in physiotherapy. The theoretical part is also focused on the imagining of the abdominal muscles and the summary of specific findings in floorball players and other athletes, with a predominant one-sided load related to the biomechanics of movement in these sports. Methodology: A total of 20 female players of the highest floorball competition in the Czech Republic participated in this research. The linear parameters of the abdominal muscles (m. RA, m. TrA, m. OI and m. OE) and the whole lateral abdominal muscles were measured in players on both sides at rest using sonography. The participants also filled in an electronic questionnaire evaluating back pain. Results: Significant lateral asymmetry of linear parameters of abdominal muscles was demonstrated in the work (p = 0,017; d = 0,52). The relationship between the lateral asymmetry and the...

Design: A single-blinded, cross-sectional observational study. Objectives: Examine muscle cross-sectional area and symmetry of the lumbar multifidus muscle in elite ballroom dancers with and without low back pain (LBP). Background: The incidence of LBP among elite ballroom dancers is high and at Brigham Young University is 57%. Previous research has linked lumbar multifidus muscle atrophy to low back pain; however this relationship has not been examined in ballroom dancers. Methods and Measures: Lumbar multifidus cross-sectional area was assessed at rest on the right and left side at levels L1-L5. Thirty-seven subjects (age 24 ± 3.2 years; height, 172.8 ± 11.3 cm; mass, 54.6 ± 4.5 kg) were divided into one of three groups. Participants who reported LBP severe enough to interfere with dance training and daily living were allocated to the LBP group (reported pain at rest, during dance, and following dance) (n=15). Subjects who reported LBP that was not strong enough to interfere with training and daily living were allocated to the minimal pain group (reported pain during dance and following dance) (n= 6). And those who reported no back pain were put into the no pain group (n=16). Results: There were no significant difference in demographics between the groups (P>0.05). There was no significant difference between groups in multifidus cross-sectional area (P = .437). Asymmetry was found in all groups with the left side being larger than the right (P < .002). Conclusion: This study provides new information on lumbar multifidus cross-sectional area in elite ballroom dancers. Future research needs to examine other causes of LBP in elite ballroom dancers in an attempt to decrease LBP in these athletes.

Low back pain (LBP) has a global impact on health and is a substantial contributor to long term disability. The economic burden of LBP is immense and it is advancing annually. Costs attributing to LBP in the United States is about $84.1 to $624.8 billion. Physical therapy is commonly recommended for those with LBP since it is linked to improved clinical outcomes. However, patient perceptions can influence how this treatment approach is perceived. It is unclear if these perceptions can influence outcomes for patients suffering from LBP. Therefore, the purpose of this study is to identify the factors associated with positive or negative perceptions of physical therapy care in those with LBP. This was accomplished by developing and administering a comprehensive Qualtrics survey to participants in the Orlando area. Participants who took the survey were screened for eligibility requirements with exclusion criteria being those from vulnerable populations including pregnant women, minors, prisoners, and any person unable to provide informed consent. Screening, demographic, clinical, and perception questions were embedded within the online survey. Those who participated had to be 18 years or older, located within the Orlando area, able to provide informed consent, and speak English. Results from the data identified the five top key indicators which included clear explanation by the physical therapist on the treatment plan, how clear the physical therapist is in explaining the problem, friendliness of the physical therapist, patients perceive physical therapy is very effective in treatment of knee, and patients perceive physical therapy is very effective in treatment of lower back.

No description available.

Back pain and injury are a global health issue and are a leading cause of work and activity absence. Prevention would not only save those affected from the burden of pain and discomfort, but would also save people from loss of over 290 million workdays annually and save the healthcare system billions of dollars in expenses per year. Successful research and development of a wearable technology capable of comprehensively monitoring spinal postures that are leading causes of back pain and injury can result in prevention of mild to severe back pain and injury for high-risk people. To accomplish this, the Smart Spine Tape is being developed with specific focus on accuracy, usability, and accessibility, all of which are important factors to consider when engineering for a wide array of populations. Accuracy was assessed using three human participants, with spinal angle data of the Smart Spine Tape being compared to established motion analysis technology data. Prototypes of the device showed promise in the ability to accurately measure spinal postures, but inconsistencies between samples and trials indicated that further development is necessary. Usability and accessibility were assessed using ten human participants who completed one workout each and reported on the tape’s comfort, durability, and ease of use, as well as their thoughts on how much they would be willing to pay for a fully functional version of the device. Participants reported high comfort, high durability, and moderate ease of use throughout their experiences, with the average price range that they would be willing to pay being between $25 and $75. Future directions have been identified that address inconsistencies in data collected by the Smart Spine Tape, possibly caused by inconsistent resistive properties of the piezoresistive ink and plastic deformation of the tape during testing. These future directions involve modifying testing, material, and fabrication methods.