Complexos de Subluxação vertebral são disfunções biomecânicas articulares que cursam com hipomobilidade, disfunção neural e de tecido conectivo. Avaliou-se a presença de complexos de subluxação vertebral (CS) em 492 equinos praticantes da atividade de salto, observados na rotina clínica de um examinador com 9 anos de experiência em quiropraxia veterinária. Os animais incluídos no estudo formam divididos por sexo e 4 grupos de idade. As idades variaram entre 4 e 19 anos (média de 9,9 anos), sendo 207 machos castrados, 249 fêmeas e 36 garanhões. O número médio de complexos de subluxação encontrado na coluna dos animais foi de 11,9 num total de 30 segmentos motores vertebrais avaliados. O número médio de complexos de subluxação da coluna cervical foi de 2,7; de 5,8 na coluna torácica, e de 2,6 na coluna lombar. Os segmentos motores acometidos com maior frequência foram L3, L2 e L1, nesta ordem. Não houve diferença significativa (p>0,05) nas médias do número de complexos de subluxação entre os sexos. Também não houve diferença significativa nas médias do número de complexos de subluxação entre grupos de idade para a coluna lombar e torácica, porém houve diferença significativa (p=0,028) no número médio de complexos de subluxação entre os grupos de idades de 0-5anos e acima de 15 anos na coluna cervical. Apresentaram complexo de subluxação no sacro 24,4% dos animais. A maioria dos animais não apresentou dor à palpação muscular, porém demonstraram aumento do tônus muscular. Pode-se concluir que a incidência de complexos de subluxação na coluna cervical aumenta com a idade. / Vertebral subluxation complexes are dysfunctional spinal segments characterized by hypomobility with altered neural and connective tissue function. Data collected from 492 showjumping horses evaluated by a veterinary chiropractor with 9 years of experience was analyzed for the presence of Vertebral Subluxation Complexes. The animals were divided into age groups and sex categories. Their age varied from 4 to 19 (mean=9.9) and there were 207 geldings, 249 females and 36 stallions included in the study. The animals had in average 11.9 vertebral subluxation complexes in 30 analyzed spinal segments along their spine. Per spinal segment, the animals presented in average 2.7 cervical, 5.8 thoracic and 2.6 lumbar subluxation complexes and 24,4% of the horses had subluxation complex in the sacrum. The most affected vertebrae were L3, L2 and L4, in this order. There was no significant difference (p>0.05) in the mean of subluxation complexes between sexes and between age groups for the lumbar and thoracic spine. There were significant difference (p=0.028) in the mean of subluxation complexes at the cervical spine between the age groups of 0-6 years and 15 years and above. Most of the animals had no pain to muscle palpation, but they showed an increase in muscle tone. It was concluded that the prevalence of subluxation complexes in the cervical spine increases with age.

A Estenose de Canal Lombar (ECL) é caracterizada pela redução do espaço de elementos neurais ou vasculares da coluna lombar. Os sintomas incluem dor e/ou parestesia em membros inferiores, região lombar, e glúteos e Claudicação Intermitente Neurogênica. O tratamento conservador é a escolha inicial para o manejo de pacientes com ECL, por isso é importante a identificação de diferentes estratégias para o tratamento conservador, e a compreensão das alterações em parâmetros funcionais que estes tratamentos geram. O presente estudo objetivou comparar os efeitos de 24 sessões de Fisioterapia Aquática (GFA) e de Fisioterapia Solo (GFS) nos parâmetros espaço-temporais de marcha, equilíbrio, nível de dor percebida, incapacidade, capacidade física funcional, medo de movimento e níveis de depressão em indivíduos com ECL. Para observação das diferenças entre os grupos e momentos foi realizado o teste de Equações de Estimativa Generalizada no software SPSS versão 20.0. Para todas as análises o índice de significância adotado foi de 95% (α=0,05). Os níveis de incapacidade, dor, e estados depressivos reduziram, bem como a velocidade de caminhada autosselecionada e o índice de reabilitação locomotora aumentaram após as intervenções sem diferenças entre os grupos. O GFA apresentou melhora dos parâmetros espaço-temporais de marcha em velocidade fixa, redução da ingesta de medicação analgésica, e redução da média semanal de dor mais cedo que o GFS. O GFS demonstrou maior melhora da mobilidade funcional indicando um melhor equilíbrio após a intervenção em comparação ao GFA. Tratamentos fisioterapêuticos estruturados com associação de exercícios de estabilização de tronco, alongamentos e terapia manual mostram-se eficazes para melhora da incapacidade, dor, depressão e parâmetros de marcha em indivíduos com Estenose da Canal Lombar, sendo o meio aquático potencializador da resposta analgésica e da melhora em parâmetros espaço temporais de marcha e o solo potencializador da melhora do equilíbrio. / Lumbar Spinal Stenosis (LSS) is characterized by a reduction in the space of vascular and neuronal elements of the spinal canal space. Symptoms include pain and/or paresthesia in lower limbs, lumbar region and buttocks, and Neurogenic Intermittent Claudication. Conservative treatments are the choice for initial management of patients with LSS, therefore it is important to identify different conservative treatments strategies and understanding of the changes in functional parameters that those treatments cause. The present study aimed to compare the effects of 24 physiotherapy sections of Aquatic Physiotherapy (GFA) and Ground Physiotherapy (GFS) in spatiotemporal gait parameters, balance, perceived level of pain, disability, functional exercise capacity, fear of movement, and clinical depression in individuals with LSS. Generalized Estimating Equations were made to observe the differences between groups and moments on SPSS software version 20.0. For all tests, the significance level was 95% (α = 0,05). Disability, pain and depressive symptoms reduced and selfselected walking speed and locomotor rehabilitation index increased after interventions with no differences between groups. GFA improve spatiotemporal gait parameter in fixed speed, reduced analgesic medication, and show an earlier reduction in weekly pain. GFS improve functional mobility indicating a better balance in comparison to GFA. Physiotherapeutic treatments structured with the association of stabilization exercises, stretching exercises and manual therapy are efficient in improving disability, pain, depression and gait parameters in Lumbar Spinal Stenosis patients, water environment potentiate analgesic and spatiotemporal improvements, and land potentiate balance improvements.

Apesar de ser reconhecidamente gerada por causas multifatoriais, as investigações a respeito da dor lombar crônica (DLC) são em sua maioria unidirecionais, dificultando uma visão mais ampla desse quadro. A proposta desse estudo foi investigar a DLC a partir de uma abordagem multidisciplinar, analisando parâmetros biomecânicos, morfológicos e inflamatórios. O experimento 1 objetivou a caracterização de portadores de DLC; e o Experimento 2, a influência de dois protocolos de treinamento de força na DLC, um de baixa intensidade e baixo volume (TB) e outro de alta intensidade e alto volume (TA). Em ambos os experimentos foram analisados intensidade de dor e nível de incapacidade funcional (escala analógica de dor e Índice Oswestry), Força de Reação de Solo (FRS - plataformas de força AMTI BP600900 - 2000), cinemática de membros inferiores (centrais inerciais - Noraxon) e atividade muscular do reto abdominal, oblíquos externos, multífidos lombares, glúteo médio, vasto lateral e bíceps femoral (TeleMyoDTS), durante a marcha e o sentar e levantar, citocinas inflamatórias por Multiplex em amostras de sangue e área de secção transversa (AST) dos multífidos lombares por imagem de ultrassom. No experimento 1, o grupo de portadores de DLC (n=35) em comparação ao grupo controle (n=20) apresentou maior inflamação sistêmica evidenciada por concentrações elevadas de Eotaxina e MCP-1, menor AST de multífidos lombares (8.11±0.98 vs 9.942±1.05cm²), maior e antecipado primeiro pico da FRS durante a marcha (1.19±0.11 vs 1.09±0.09 PC; 0.16±0.032 vs 0.18±0.031s), menor flexão de quadril (99.47±12.3 vs 107.44±8.46º) e menor atividade de multífidos lombares (41.08±16.15 vs 52.25±12.97 RMS) no sentar e levantar. Os resultados mostraram que os portadores de DLC apresentaram alterações biomecânicas relacionadas ao controle de carga mecânica, inflamação sistêmica aumentada e menor AST de multífidos, apontando para um ambiente catabólico associado a prejuízos nas funções do aparelho locomotor. No experimento 2, embora o grupo TA (n=13) tenha apresentado maior decréscimo no score do Índice Oswestry em relação ao grupo TB (n=13), (24.31±7.89 TA pré vs 9.69±6.97 TA pós; 25.15±9.05 TB pré vs 19.73±13.35 TB pós), ambos apresentaram resultados muito semelhantes nos parâmetros analisados após intervenção: as citocinas inflamatórias foram moduladas numa direção anti-inflamatória, a AST dos multífidos lombares aumentou 15,63% e o primeiro pico da FRS diminuiu na marcha (1.21±0.03 TA pré vs 1.19±0.03 TA pós, 1.15±0.07 TB pré vs 1.09±0.07 PC TB pós), a atividade de reto abdominal diminuiu na fase de balanço da marcha (41.38±12.9 TA pré vs 24.87±12.9 TA pós; 38.86±14.13 TB pré vs 32.5±14.13 RMS TB pós) e os multífidos lombares apresentaram atividade aumentada no sentar e levantar (27.25±2.36 TA pré vs 37.59±2.36 TA pós; 30.16±2.75 TB pré vs 30.72±2.75 RMS TB pós). Assim, independentemente de intensidade e volume estudados, o treinamento de força não apenas reduziu a percepção de dor e a inflamação sistêmica, como também afetou posistivamente parâmetros biomecânicos indicativos de desempenho e controle de carga / Although it is known that CLBP have a multifactorial etiology, the investigations about it are mostly specific to each investigation area, making difficult to understand this complex condition. The purpose of the present study was to investigate CLBP from a multidisciplinary approach, analyzing biomechanical, morphological and inflammatory parameters in two different experiments: one aiming to characterize the CLBP patients and the second to compare the influence of two strength training protocols, one of low intensity and low volume (LIT) and one of high intensity and high volume (HIT). In both experiments, pain intensity and level of functional disability were analyzed (by analogue scale of pain and Oswestry Index), Ground Reaction Forces (GRF - AMTI BP600900 - 2000 force plate), kinematics of lower limbs (Inertial Sensors by Noraxon) and electromyography of the rectus abdominis, external oblique, lumbar multifidus, medial gluteus, vastus lateralis and biceps femoris muscles (TelemyoDTS) during gait and sit-to-stand, inflammatory cytokines by Multiplex in blood samples and cross-sectional area (CSA) of the lumbar multifidus by ultrasound imaging. In the experiment 1, the CLBP group (n = 35) compared to the group of asymptomatic subjects (n = 20) presented higher systemic inflammation evidenced by high concentrations of Eotaxin and MCP-1, lower CSA of lumbar multifidus (8.11±0.98 vs 9.942±1.05cm²), higher and anticipated first peak of GRF during gait (1.19±0.11 vs 1.09±0.09 PC; 0.16±0.032 vs 0.18±0.031s), lower hip flexion (99.47±12.3 vs 107.44±8.46º) and lower activity of lumbar multifidus (41.08±16.15 vs 52.25±12.97 RMS) in sit-to-stand. These results showed that CLBP patients presented biomechanical changes related to mechanical load control, higher systemic inflammation and smaller lumbar multifidus CSA, pointing to a catabolic environment with deficit in body functionality. In the experiment 2, although the high intensity group (HIT; n = 13) presented a greater decrease in the Oswestry Index score than the low intensity group (LIT; n = 13), both presented very similar results after intervention from analyzed parameters: the inflammatory biomarkers were modulated in in an anti-inflammatory sense, the CSA of the lumbar multifidus increased 15,63%, and the GFR first peak decreased during gait (1.21±0.03 HIT pre vs 1.19±0.03 HIT pos, 1.15±0.07 LIT pre vs 1.09±0.07 BW LIT pos), rectus abdominis activity decreased in the balance phase of the gait (41.38±12.9 HIT pre vs 24.87±12.9 HIT pos; 38.86±14.13 LIT pre vs 32.5±14.13 RMS TB pós) and the lumbar multifidus presented increased activity in sit-to-santand (27.25±2.36 HIT pre vs 37.59±2.36 HIT pos; 30.16±2.75 LIT pre vs 30.72±2.75 RMS LIT pos). Thus, independently of intensity and volume analyzed, the strength training not only reduced chronic pain perception of CLBP patients, as improved biomechanical parameters related to load control, modulated inflammatory biomarkers and influenced in lumbar multifidus hypertophy

A dor é uma experiência emocional e sensorial desagradável, associada ao dano real ou potencial de alguma região do corpo. Segundo a International Association for the Study of Pain, ela é sempre subjetiva, pois sua percepção é aprendida com a vivência pessoal de cada indivíduo. A lombalgia atinge cerca de 80% da população adulta e sua cronicidade pode estar relacionada com diversos fatores. Objetivou-se compreender a dinâmica psíquica das pessoas com lombalgia crônica por artrose facetária selecionadas para o estudo, partindo da perspectiva da psicossomática (campo de conhecimento que trabalha na interface entre os aspectos mentais, físicos e sociais) em uma compreensão biopsicossocial. Constitui-se em uma pesquisa descritiva de caráter clínico-qualitativo. Como método, foram definidas duas frentes de trabalho: revisão bibliográfica e estudo de campo. Na primeira realizou-se revisão bibliográfica acerca do tema dor e psicologia. A base de dados utilizada foi Biblioteca Virtual em Saúde (BVS-PSI). Levantou-se todo tipo de publicação através de uma terminologia padronizada no site BVS-PSI. Foram mantidas para análise de conteúdo do texto completo as publicações que fizeram referência à dor crônica lombar e que apontarem presença de psicologia, personalidade e/ou dinâmica psíquica no título ou no resumo. Na segunda etapa foi formulada avaliação psicológica de 6 pessoas, 3 do sexo feminino e 3 do sexo masculino, com idade de 20 a 60 anos, sendo que todos possuíam diagnóstico de lombalgia crônica devido a artrose facetária. Foram realizadas, nesta ordem, entrevista clínica semi-dirigida, Escala Visual de Dor (EVA) e Teste de Apercepção Temática (TAT). A partir d levantamento bibliográfico constatou-se que nenhuma pesquisa desenvolveu descrição detalhada da psicodinâmica de pacientes com dor lombar crônica. Cada participante apresentou dinâmica psíquica única, dando sentido a sua dor e ao seu tratamento a partir de sua experiência peculiar. No entanto, a dor foi percebida pelos participantes como um sinal de que eles têm limites. A relação estabelecida pelos participantes com sua dor e com seu tratamento esta diretamente relacionada com o modo como lidam com a vida. Conclui-se que tanto a dor lombar por artrose facetária altera a subjetividade e a objetividade da vida dos participantes da pesquisa, como o modo como lidam com a vida interfere em sua dor e tratamento. Compreender a dinâmica destes pacientes pode auxiliar no manejo de tratamentos mais eficazes. Por este motivo destaca-se a necessidade de olhar para o ser humano acometido pela dor, e não somente para a dor que acomete o ser humano. Propõe-se que mais pesquisas sejam realizadas a partir desta compreensão, o que implicará uma clinica preocupada com o ser humano em seu complexo funcionamento / Pain is an unpleasant sensory and emotional experience associated with actual or potential damage of any region of the body. According to the International Association for the Study of Pain, it is always subjective, once its perception is learned through personal experience of each individual. Low back pain affects about 80% of the adult population and its chronicity may be related to several factors. This study aimed to understand the psychological dynamic of the selected people with chronic low back pain by facet arthrosis, from the perspective of psychosomatic (field of knowledge working at the interface between the mental, physical and social aspects) in a biopsychosocial understanding. This is a descriptive research using clinical and qualitative approach. The methodology used was literature review and field study. The literature review was held on the subjects of pain and psychology. The database used was the Biblioteca Virtual em Saúde (BVS-PSI). Every type of publication was raised through a standardized terminology in BVS-PSI website. For full-text content analysis the publications were selected if they had reference to chronic low back pain and the presence of the terms psychology, personality and /or psychic dynamics on the title or abstract. In the second stage of the study, the psychological evaluations of 6 people, 3 females and 3 males were done. They aged 20-60 years, and all had been diagnosed with chronic low back pain due to facet arthrosis. Then, it was carried out, in order, the semi-directed clinical interview, the Pain Visual Scale (VAS) and the Thematic Apperception Test (TAT). From the literature it was found that no research has developed detailed description of the psychodynamics of patients with chronic low back pain. Each participant had unique psychic dynamics, and they gave meaning to pain and treatment from their peculiar experience. However, the pain was perceived by participants as a sign that they have limits. The relationship established by the participants with their pain and its treatment is directly related to the way they deal with life. We concluded that both the low back pain by facet arthrosis changes the subjectivity and objectivity of the participants life, so do the way they deal with life interferes on their pain and treatment. The understanding of the dynamics of these patients may help the management of more effective treatments. Therefore there is the need to look at the human being affected by pain, not only at the pain that affects the human being. It is proposed that more research is done on this understanding, which will lead to a clinical practice that is concerned about the human being on his complex operation

Orientadores: Maria Jose Duarte Osis, Anibal Faundes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-11-09T13:14:09Z (GMT). No. of bitstreams: 1 Gil_ViniciusFernandesBarrionuevo_M.pdf: 1434222 bytes, checksum: f4a027c69e49d31c0d56f6589b5c11d3 (MD5) Previous issue date: 2009 / Resumo: A dor lombar é considerada distúrbio comum na população em geral e é queixa frequente durante a gestação. Estudos recentes mostram que aproximadamente 80% das gestantes relatam dores nas regiões lombar e pélvica, sendo que 51% apresentam dor que interfere significativamente em suas atividades físicas e qualidade de vida. Objetivo: Avaliar o efeito da Reeducação Postural Global (RPG) no tratamento da lombalgia durante a gravidez e sua associação com as limitações funcionais das gestantes. Sujeitos e Métodos: Foi realizado um estudo clínico comparativo, de caráter exploratório, em três centros de saúde e um hospital privado na cidade de Campinas, com 34 gestantes nulíparas que apresentavam queixa de dor lombar. As participantes foram alocadas em dois grupos: um deles submetido a sessões de RPG durante oito semanas consecutivas, e o outro seguiu apenas as orientações médicas no pré-natal para controle da dor lombar. A cada sessão de RPG foi avaliada a intensidade da dor através da escala análogo-visual da dor, antes e depois dos procedimentos fisioterapêuticos, e registrada a existência de algum outro tipo de tratamento para a dor lombar. O grupo de controle foi acompanhado pelo mesmo período, com três avaliações (admissão, quatro e oito semanas) sobre a intensidade da dor lombar e as recomendações médicas recebidas. Para os dois grupos foi aplicado o questionário de Roland-Morris para avaliar as limitações funcionais, ao início e ao final do estudo. Foram realizadas análises bivariada e de covariância para avaliar a evolução da intensidade da dor percebida pelas mulheres ao longo do seguimento e sua associação ou não com a realização de RPG e as variáveis de controle. Resultados: No grupo submetido à RPG verificou-se decréscimo estatisticamente significativo na intensidade da dor ao se compararem os momentos antes e depois das sessões; depois de quase todas as sessões a mediana foi igual a zero, e na última sessão a mediana da dor foi zero nos dois momentos. Ao longo do estudo, as mulheres submetidas à RPG tiveram medianas de intensidade da dor e médias do escore de limitações funcionais significativamente menores que as do grupo-controle. A análise de covariância revelou que o tratamento com RPG estava fortemente associado ao menor escore de dor ao final do período de seguimento, além da menor idade das mulheres e o maior escore de dor ao início do estudo. A utilização de medicamentos para dor foi mais frequente no grupo de controle do que entre as mulheres que fizeram RPG. Conclusões: A RPG pode dar uma importante contribuição no tratamento da dor lombar durante a gestação, reduzindo, ao mesmo tempo, as limitações funcionais. Os resultados obtidos sugerem, ainda, que o tempo de tratamento proposto (oito semanas) foi suficiente para o controle da dor lombar, porém, como a observação se limitou ao período de tratamento, não é possível saber por quanto tempo persistiu a remissão da dor / Abstract: Low back pain is considered a common condition in the general population and it is a frequent symptom during pregnancy. Recent studies pointed out that 80% of pregnant women reported low back and pelvic pain, while 51% of them had a pain level that significantly interfered with their physical abilities and quality of life. Objective: To evaluate the effectiveness of Global Postural Reeducation (GPR) in low back pain treatment during pregnancy, its association with pregnancy evolution and pregnant women functional limitations. Subjects and Methods: A clinical comparative and exploratory study was carried out with 34 nulliparous women attended in 3 public health units and 1 private hospital in Campinas. All women were at 20-25 weeks gestation and experiencing low back pain. They were allocated to two groups: 17 women were submitted to 8 GPR weekly consecutive sessions and 17 followed the routine recommendations for treating lumbar pain. In each GPR session the low back pain severity was assessed, before and after procedures. The control group was followed-up for the same period and had 3 low back pain intensity and treatment evaluation sessions (at admission, 4 and 8 weeks). Roland Morris questionnaire was applied to both groups in order to assess functional limitations in the beginning and at the end of follow-up. Results: Women in the GPR group had a significant decrease of low back pain severity, before and after each session. Throughout the study, women in the GPR group had significantly lower pain medians and lower functional limitations score means than women in the control group. Covariance analysis pointed out that GPR treatment was strongly associated to lower perceived pain intensity at the end of the follow-up. (87% versus 12% respectively). Conclusions: GPR can be an effective alternative for treating low back pain during pregnancy, with the advantage of not interfering with the gestational period. GPR can be an important contribution to the low back pain treatment during pregnancy and also it would help to reduce the damage caused by functional limitations. The proposed duration of treatment (8 weeks) was enough for pain control, but as the observation was limited to that period, we can not know for how long the pain remission persisted / Mestrado / Mestre em Tocoginecologia

Atualmente novos métodos de exercício físico vêm sendo pesquisados no campo da promoção da saúde, prevenção e tratamento de doenças. Uma estratégia inovadora e com expressiva aceitação no meio científico é a utilização da tecnologia de realidade virtual nas sessões terapêuticas para pessoas com distúrbios neurológicos e treinamento preventivo contra quedas em idosos, apresentando resultados promissores, motivando novos desenhos de estudos nessa área, porém com indivíduos de características clínicas diferenciadas. O objetivo da presente dissertação é abordar a tecnologia de realidade virtual, assim como seus dispositivos, na avaliação do equilíbrio corporal e treinamento de idosos. O artigo de confiabilidade da medida faz uma abordagem inovadora da medida quantitativa da estabilidade corporal, sendo esta avaliada por um instrumento de baixo custo e validado em relação ao padrão-ouro. Nesse artigo concluiu-se que o instrumento testado apresenta confiabilidade. O experimento controlado e randomizado com duplo cegamento é apresentado no formato de artigo original, contendo um resumo, introdução, finalizada pelo objetivo do estudo, que esclarece o que será estudado; depois segue a parte de materiais e métodos que descreve a amostra, as intervenções, as avaliações das respostas dos participantes e a análise dos dados, mostrando como foi realizado o estudo; seguido dos resultados, discussão, conclusão e referências. Nesse experimento concluiu-se que o treinamento com realidade virtual foi capaz de melhorar a autonomia funcional de idosas para sentar. / Currently new exercise methods have been studied in the field of health promotion, prevention and treatment of diseases. An innovative strategy and significant acceptance in scientific circles is the use of virtual reality technology in therapeutic sessions for people with neurological disorders and preventive training against falls in the elderly, with promising results, encouraging new designs of studies in this area, but with individuals different clinical characteristics. The purpose of this dissertation is to address the virtual reality technology, as well as their devices, the assessment of body balance and training of older people. Reliability article measure is an innovative approach to quantitative measurement of body stability, which is evaluated by an instrument inexpensive and validated against the gold standard. In this article it is concluded that the tested instrument has reliability. The randomized controlled double-blind experiment is presented in the original paper format, containing a summary, introduction, completed by the purpose of the study, which clarifies what will be studied; then follows the part of materials and methods that describes the sample, interventions, assessments of participants' responses and data analysis, showing how the study was conducted; followed by results, discussion, conclusion and references. In this experiment it was concluded that training with virtual reality was able to improve the functional autonomy of elderly to sit.

La lombalgie (LBP) touche 80% de la population mondiale adulte et devient chronique dans 10 à 15% des cas. Pour la grande majorité des cas adultes (85%), aucune cause ne peut être clairement identifiée pour expliquer ces douleurs et l’on parle alors de lombalgie chronique « non-spécifique » (NSCLBP). Chez l’enfant et l’adolescent, la prévalence de la NSCLBP est semblable à celle de l’adulte. Malgré la faible incidence de pathologies graves associées, la lombalgie de l’enfant et de l’adolescent implique, souvent dans sa prise en charge diagnostique, une exposition augmentée aux radiations et un stress parental important. Cependant, la présence d’anomalies radiologiques est aussi fréquente dans la population asymptomatique que dans la population avec NSCLBP. Ceci remet en question l’intérêt clinique de la radiologie pour dépister une cause possible de NSCLBP. Dans ce contexte, il est nécessaire d’identifier de nouveaux outils, si possible non-irradiants et peu coûteux, pour identifier des caractéristiques spécifiques aux enfants et adolescents souffrant de NSCLBP et ainsi améliorer la compréhension de cette pathologie.L’analyse électromyographique (EMG) de l’activité des muscles paravertébraux lombaires s’est avérée cliniquement pertinente dans la population adulte pour discriminer les patients souffrant de NSCLBP des participants asymptomatiques. Plusieurs paramètres EMG enregistrés lors de différentes tâches ont été identifiés chez l’adulte pour caractériser les participants NSCLBP. Les paramètres EMG des muscles lombaires les plus couramment rapportés dans la littérature sont : un temps de maintien réduit ainsi qu’une fatigue musculaire accélérée pendant le test d’endurance des muscles extenseurs du tronc, la réduction ou l’absence du phénomène de flexion-relaxation (FRP) pendant la tâche de flexion maximale du tronc ainsi qu’un pattern atypique supportant l’hypothèse de précaution pendant la marche à différentes vitesses. Si ces caractéristiques EMG spécifiques aux patients souffrant de NSCLBP ont été bien établies chez l’adulte, la question est désormais de savoir ce qu’il en est chez l’enfant et l’adolescent souffrant de NSCLBP.Dans ce contexte clinique, l’objectif de ce travail doctoral était d’évaluer les caractéristiques EMG décrites ci-dessus dans une cohorte d’enfants et d’adolescents souffrant de NSCLBP en comparaison à des participants asymptomatiques (CTRL). Pour y répondre, plusieurs études complémentaires ont été effectuées.Dans leur ensemble, les travaux de cette thèse de doctorat ont montré que les phénomènes EMG reportés dans une population adulte avec NSCLBP ne sont pas retrouvés dans une population pédiatrique avec NSCLBP. Ces résultats remettent en question le diagnostic et la prise en charge actuelle des enfants et adolescents souffrant de NSCLBP, qui est, à ce jour, calquée sur le modèle adulte. Des études supplémentaires sont cependant nécessaires pour confirmer ces résultats sur une cohorte plus importante. Il serait aussi intéressant d’évaluer une même cohorte à partir de l’enfance jusqu’à l’âge adulte afin d’évaluer quels facteurs pourraient prédire l’apparition des phénomènes rapportés dans la littérature adulte. / The majority of the worldwide population (80%) suffers from low back pain (LBP) over life. LBP becomes chronic (CLBP) in 10 to 15% of (all) adult cases yielding important functional and socio-economic adverse repercussions. The majority of LBP (85%) is classified as “non-specific” (NSCLBP), i.e. with an absence of any identified cause. LBP prevalence on children and adolescents is comparable to adults. Despite the low incidence of serious associated diseases, the fear of missing them increased patient’s exposure to radiation. However, an absence of significant correlation between radiology changes in the lower spine and low back pain was reported for school children. In this context, it is necessary to identify new tools, if possible non-irradiating and inexpensive, to identify specific characteristics of children and adolescents suffering from NSCLBP and thus improve the understanding of this pathology.An interesting tool, highlighted in adult population, is to evaluate surface electromyography (EMG) of low back muscles. Existing EMG phenomena were reported to discriminate adults with and without NSCLBP: reduced trunk muscle endurance, absence of flexion-relaxation phenomenon and guarding hypothesis during gait at different velocities. These EMG characteristics have not yet been confirmed for children and adolescents suffering of NSCLBP.This clinical context justifies the present doctoral work. The aim was to evaluate EMG characteristics in children and adolescents with NSCLBP in comparison with control participants. To achieve these objectives, several complementary studies were successively conducted.Taken together, the results of this doctoral work showed that the EMG characteristics frequently reported for NSCLBP in adults were absent or reduced in children and adolescent suffering from NSCLBP. These findings are inconsistent with the existing literature on adults and might affect the future therapeutic management of children and adolescents with NSCLBP, which is, to date, an imitation of the adult model. It would be interesting to confirm these results on the basis of a larger cohort and to reassess the same children and adolescents in adulthood to identify whether the EMG phenomenon, as known in NSCLBP adults, appears over time.

Management and control of the low back pain as an important health problem in the industrial societies necessitates to investigate how the risk of this disease is affected by aging. Since the abnormalities of the lumbopelvic kinematics are related to the existence or risk of low back injuries, the objective of this dissertation was set to find the age-related differences in lumbopelvic kinematics when performing basic trunk motions reaching to range of motion in different anatomical planes. A cross-sectional study was designed where sixty asymptomatic individuals between 20–70 years old with no confounding health condition, no current or previous highly physically demanding occupation and a body mass index between 22 and 30, were divided in five equally-sized and gender-balanced age groups, and attended two sessions of data collection to perform three repetitions of self-selected slow and fast trunk forward bending and backward return, as well as one left and right lateral bending and axial twist. Following an extensive literature review, the lumbar contribution (LC) to the trunk motion, the mean absolute relative phase (MARP) between the thoracic and pelvic motions as well as variation in MARP under repetitive motions, denoted by deviation phase (DP) were selected and used for the assessment of age-related differences in lumbopelvic kinematics during forward bending and backward return tasks. Lumbopelvic kinematics during the lateral bending and axial twist tasks were assessed using the lumbar and pelvic ranges of motion (ROMs) and coupled motion ratios (CMRs) as respectively the maximum flexion/rotation in the primary (i.e., intended) and the secondary (i.e., coupled) planes of trunk motion, where the latter was normalized to the conjugate ROM for better comparison. The results showed age-related differences between the age groups above and under 50 years of age generally. A smaller LC during the forward bending and backward return tasks were observed in the older versus younger age groups, suggesting that the synergy between the active and passive lower back tissues is different between the older and younger people, which may affect the lower back mechanics. Also, smaller MARP and DP suggesting a more in-phase and more stable lumbopelvic rhythm were observed in the older versus younger age groups, which may be a neuromuscular strategy to protect the lower back tissues from excessive strain, in order to reduce the risk of injury. Furthermore, the coupled motion of lumbar spine in the transverse plane during the lateral bending to the left, and the coupled motion of pelvis in the sagittal plane during the axial twist to the right were larger in older versus younger age groups. In summary, the lumbopelvic kinematics changes with aging, especially after the age of 50 which implies alterations in the active and passive tissue responses to the task demands, as well as the neuromuscular control patterns. Drawing a conclusion regarding ii the effect of aging on the risk of low back pain from these results requires a further detailed knowledge on age-related differences in spinal active and passive tissue properties.

Abnormalities in lumbopelvic rhythm (LPR) play a role in occurrence/recurrence of low back pain (LBP). The LPR before spinal fusion surgery and its changes following the surgery are not understood. A repeated measure study was designed to investigate timing and magnitude aspects of LPR in a group of patients (n = 5) with LBP before and after a spinal fusion surgery. Participants completed a forward bending and backward return task at their preferred pace in the sagittal plane. The ranges of thoracic and pelvic rotations and lumbar flexion (as the magnitude aspects of LPR) as well as the mean absolute relative phase (MARP) and deviation phase (DP) between thoracic and pelvic rotations (as the timing aspects) were calculated. Thoracic, pelvic, and lumbar rotations/flexion were respectively 2.19° smaller, 17.69° larger, and 19.85° smaller after the surgery. Also, MARP and DP were smaller during both bending (MARP: 0.0159; DP 0.009) and return (MARP: 0.041; DP: 0.015) phases of the motion after surgery. The alterations in LPR after surgery can be the result of changes in lumbar spine structure due to vertebral fusion and/or new neuromuscular adaptations in response to the changes of lumbar spine structure. The effects of altered LPR on load sharing between passive and active components of lower back tissues and the resultant spinal loads should be further investigated in patients with spinal fusion surgery.

Employees who develop and report nontraumatic acute low back pain that occurs while performing work duties, or shortly thereafter, are classified as having occupational isolated acute low back pain (OIALBP). The purpose of this project was to identify and implement an evidence- based time frame to refer occupational isolated acute low back pain patients (OIALBPPs) to physical therapy (PT) that returns them to full duty work (FDW) more quickly. The diffusion of innovation theory aided the project leader and health care providers to develop strategies to overcome barriers in implementing the project's results into the practice. A total of 932 medical records of OIALBPPs who presented to the organization from 2009 through 2015 were retrieved and abstracted by the organization's occupational health providers. The project leader analyzed the data and identified the best time frame to refer their OIALBPPs to PT. A t test, Chi-square, and an Analysis of Variance were used in the data analysis. The results were employed to design and construct tables in Excel. Early PT is defined as a PT initial evaluation that occurs < 10 days after back pain onset. A significant (p < 0.001) difference of 13.5 days between early and delayed PT groups was identified. Significant differences persisted when evaluated by sex, age bracket, occupational group, and incidence of failure to return to FDW. In conclusion, OIALBPPs who receive early PT return to FDW nearly 2 weeks sooner than do those who delay PT. Early PT may reduce health care cost, reduce lost employee income, increase productivity, increase company revenue, and lower insurance costs. Referring OIALBPPs to PT early may lower the economic burden placed on health care budgets and society as a whole.