Abstract The etiology of musculoskeletal disorders remains largely unclear, pain being the predominant complaint. The prevalence of neck pain (NP), shoulder pain (SP), and low back pain (LBP) increases drastically during adolescence. Potentially modifiable risk factors of NP, SP, and LBP should be identified at that age. First, this study evaluated the prevalence of NP, SP, LBP and peripheral pains (upper or lower extremities) and the prevalence of multiple pains. Second, the study determined the role of a set of potentially modifiable risk factors for adolescents’ NP, SP, and LBP (physical activity, inactivity, sedentary activities in cross-sectional study design and quantity and quality of sleep in follow-up study design). The study population belongs to the 1986 Northern Finland Birth Cohort (NFBC 1986), consisting of 9,479 children with an expected date of birth between July 1, 1985 and June 30, 1986 in the two northernmost provinces of Finland, Oulu and Lapland. NP, SP, and LBP were common at the ages 16 and 18, while medical consultations for these pains were less frequent. The prevalence of pain increased with age. Peripheral pains were rare. Surprisingly many adolescents reported multiple musculoskeletal pains. Girls were more likely to report pain than boys. Both low and high level of physical activity, some risk sport activities, high amount of sedentary activities, and insufficient quantity and quality of sleep increased the risk of NP, SP, and LBP in adolescence. It may be possible to reduce the occurrence of musculoskeletal pain by having a positive impact on potentially modifiable risk factors, such as physical activity, sedentary activities and sleep hygiene. Therefore, intervention studies focusing on these factors are needed in the future. / Tiivistelmä Useimmiten tuki- ja liikuntaelinsairauksien tarkka syy jää epäselväksi ja kipu on niiden pääasiallinen ilmentymä. Niska-, hartia- ja alaselkäkipujen esiintyvyys väestössä nousee merkittävästi teini-iässä. Tämän vuoksi niska-, hartia- ja alaselkäkivun riskitekijöitä tulisikin tutkia nuoruudessa, jotta niihin päästäisiin vaikuttamaan ajoissa. Tässä väitöskirjassa selvitettiin niska-, hartia-, alaselkä- ja laaja-alaisten tuki- ja liikuntaelinkipujen esiintyvyyttä nuorilla. Päätavoite oli kuitenkin tutkia liikunnan, eri urheilulajien, liikkumattomuuden, istumisen ja unen laadun ja määrän yhteyttä niska-, hartia- ja alaselkäkipujen esiintyvyyteen. Tutkimusaineisto muodostui Pohjois-Suomen syntymäkohortin 1986 nuorista, joiden laskettu syntymäaika oli 1.7.1985–30.6.1986. Nuorille lähetettiin 16-vuotiaana postikysely, joka sisälsi tuki- ja liikuntaelinoirekyselyn, kysymyksiä liikunnan, istumisen ja unen määrästä ja laadusta, sekä muista elämäntavoista. Kahden vuoden kuluttua, 18-vuotiaana lähetettiin toinen kysely joka sisälsi mm. tuki- ja liikuntaelinoirekyselyn. Tulokset osoittavat että niska-, hartia- ja alaselkäkivut olivat yleisiä nuoruudessa, joskin hoitoa vaativat kivut ja raajojen kipuoireilu olivat harvinaisia. Laaja-alaiset tuki- ja liikuntaelinkivut olivat odotettua yleisempiä. Tytöt oireilivat enemmän kuin pojat ja oireilu lisääntyi iän myötä. Hyvin aktiivinen liikunnan harrastaminen (6h/vko tai enemmän ripeää liikuntaa) ja erityisesti tietyt riskilajit olivat yhteydessä suurempaan niska-, hartia- ja alaselkäkipujen esiintyvyyteen. Samoin suuri istumisen määrä, riittämätön uni ja huono unen laatu lisäsivät kipujen todennäköisyyttä. Nuorten tuki- ja liikuntaelinkipuja voitaisiin mahdollisesti vähentää vaikuttamalla muunneltavissa oleviin riskitekijöihin, kuten vähentämällä istumista, lisäämällä terveysliikuntaa, sekä parantamalla unitottumuksia. Tämän takia jatkossa tarvitaan näihin riskitekijöihin kohdistuvia interventiotutkimuksia.

Abstract Low back pain (LBP) causes enormous costs to society. Certain magnetic resonance imaging (MRI) findings, including disc degeneration and disc herniation, have been associated with LBP in epidemiologic studies. Even though LBP should be considered a biopsychosocial condition, there is a need to define the possible existence of specific pathological conditions beyond LBP. One of these possible conditions is Modic change (MC). Modic changes are subchondral and vertebral bone marrow changes revealed by MRI. Although their association with LBP has been previously studied, some results remain contradictory, and we need to explore MC more thoroughly and to determine whether they are a feature of intervertebral disc degeneration or whether they exist in isolation. Moreover, it is unknown whether heritability is a contributing factor to MC. This study explored the heritability and morphology of MC and their association with severe, prolonged and disabling LBP. The data consisted of two general population samples, TwinsUK from the United Kingdom (mainly female), and the Hong Kong Disc Degeneration Cohort (HKDDC) from Hong Kong, China. The TwinsUK sample included a longitudinal ten-year follow-up, whereas the HKDDC sample was cross-sectional. The heritability of MC was found to be 30%. Modic changes were associated with other MRI findings such as disc degeneration, disc displacement and Schmorl’s nodes. A greater size of MC increased these associations. Type 1 MC were more strongly associated with disc displacement and disc degeneration than Modic type 2 change. Modic changes appeared to be independently associated with disabling LBP; severe, prolonged LBP; and back-related disability. Posterior MC and MC in the whole antero-posterior (AP) length of the vertebral body were more strongly associated with severe, prolonged LBP than other MC. A greater number and size of MC increased this association. In terms of disc degeneration, MC were independently associated with loss of disc height and disc signal intensity. Incident MC were independently associated with loss of disc height and disc bulge in a ten-year follow-up. Modic changes are heritable, and are associated with severe and disabling LBP. The location, size and number of MC affect the association of MC with other MRI findings, LBP and back-related disability. / Tiivistelmä Alaselkäkivusta aiheutuu valtavat kustannukset yhteiskunnalle. Tietyt magneettikuvauslöydökset, kuten välilevyrappeuma ja välilevytyrä, on yhdistetty alaselkäkipuun epidemiologisissa tutkimuksissa. Alaselkäkipua arvioidaan yleensä biopsykososiaalisen mallin avulla, koska sen syytekijät tunnetaan huonosti. Lannerangan Modic-muutoksia pidetään yhtenä mahdollisena alaselkäkivun syytekijänä. Modic-muutokset ovat rustonalaisia, nikaman luuytimen muutoksia, jotka näkyvät magneettikuvantamisella. Tulokset Modic-muutosten ja alaselkäkivun yhteydestä ovat kuitenkin ristiriitaisia. Modic-muutosten sijainnin, koon ja muodon vaikutus alaselkäkipuun tunnetaan edelleen puutteellisesti. Lisäksi niiden perinnöllisyys on epäselvä. Tässä tutkimuksessa tarkasteltiin Modic-muutosten perinnöllisyyttä ja tarkempaa morfologiaa, kuten sijaintia ja kokoa lannerangassa, sekä selvitettiin niiden yhteyttä haittaavaan ja voimakkaaseen alaselkäkipuun. Tutkimus perustui kahteen väestöperäiseen aineistoon: TwinsUK-kaksosaineistoon (pääosin naisia) Yhdistyneistä kuningaskunnista ja Hong Kong Disc Degeneration -kohorttiin Hongkongista, Kiinasta. TwinsUK-aineisto sisälsi seurantatietoja 10 vuoden ajalta, ja Hongkongin aineisto oli kerätty yhdestä aikapisteestä. Modic-muutosten perinnöllisen osuuden todettiin olevan 30 %. Modic-muutokset olivat yhteydessä muihin magneettikuvauslöydöksiin kuten välilevyrappeumaan, välilevypullistumaan ja Schmorlin keräsiin. Tyypin 1 Modic-muutokset olivat voimakkaammin yhteydessä välilevypullistumiin ja -rappeumaan kuin tyypin 2 muutokset. Modic-muutokset olivat yhteydessä toimintakykyä alentavaan ja voimakkaaseen, pitkittyneeseen alaselkäkipuun. Koko nikaman läpimitan käsittävät ja nikaman takaosassa sijaitsevat muutokset olivat voimakkaammin yhteydessä alaselkäkipuun. Muutosten suurempi koko ja yhteislukumäärä lannerangassa voimistivat sen yhteyttä alaselkäkipuun. Modic-muutokset olivat yhteydessä välilevyn madaltumiseen ja signaali-intensiteetin laskuun. Kymmenen vuoden seuranta-aikana ilmaantuneet Modic-muutokset olivat yhteydessä välilevyn madaltumiseen ja välilevypullistumaan. Modic-muutokset ovat perinnöllisiä ja ne ovat yhteydessä voimakkaaseen sekä toimintakykyä heikentävään alaselkäkipuun. Muutosten tyypin lisäksi niiden sijainti, koko ja lukumäärä tulee huomioida alaselkäkipua arvioitaessa.

Abstract Low back pain (LBP) is the leading cause of years lived with disabilities worldwide. Intervertebral disc (IVD) degeneration is a strong contributing factor to LBP. Recent studies have shown that genetic determinants contribute markedly to IVD degeneration but knowledge about the actual genes involved as well as their roles is still limited. The aim of this thesis work was to study genetic factors that may predispose to IVD degeneration. Using both family and case-control association study designs, variants in five genes showed association with IVD degeneration on magnetic resonance imaging (MRI) in a population-based sample and among patients with sciatica due to lumbar disc herniation (LDH). We performed a candidate gene association study of the known variants implicated in IVD degeneration in a Finnish cohort of 538 young individuals with a moderate degree of lumbar IVD degeneration on MRI. We were able to confirm the associations of variants in the IL6, SKT, and CILP genes, which provides further evidence for true associations. Based on our earlier linkage study in Finnish sciatica families, we performed a candidate gene analysis and identified IL17F as a potential candidate gene. To the best of our knowledge this is the first study to observe an association between this gene and discogenic sciatica. Both IL-6 and IL-17 are pro-inflammatory cytokines with elevated expression levels in herniated tissues, which suggest a role in IVD degeneration. Study of the role of genes coding for inflammatory mediators is of interest as it may contribute to the understanding of the overall inflammatory response of the disc. In addition, we reported on the involvement of SKT in the etiology of lumbar disc herniation (LDH) both in Japanese and Finnish case-control samples. Experimental studies in mice have shown that Skt homozygous mutants exhibit disc abnormalities resulting in a kinky tale phenotype. We hypothesized that the human homolog SKT could have long-term importance in the onset of IVD degeneration by making the discs more vulnerable. Finally, through linkage studies and in the subsequent association analyses, the role of CHST3 as a novel risk factor for IVD degeneration was identified. CHST3 encodes an enzyme that catalyzes the sulfation of chondroitin, and mutations in this gene are associated with spondylepiphyseal dysplasia and humerospinal dysostosis. In our study, we identified this gene using genome –wide linkage based on data from a Southern Chinese family and speculated that mild CHST3 reduction caused by the reported susceptibility SNP could result in disc degeneration in adults in conjunction with other risk factors. This thesis provides new information about the genetic background of IVD degeneration and new insights into the etiology of the disease. The specific roles of these genes in the IVD function and pathogenesis of sciatica are not clear however, and need to be elucidated. / Tiivistelmä Alaselkäkipu on yksi yleisimmistä sairauksista ja johtava syy työkyvyttömyyteen. Välilevyrappeuma myötävaikuttaa merkittävästi alaselän kipuun. Vaikka aiemmat tutkimukset ovat osoittaneet, että perintötekijöillä on vahva osuus välilevyrappeumaan, altistavat geenit ja niiden rooli tunnetaan huonosti. Tämän tutkimuksen tavoitteena oli arvioida tiettyjen perintötekijöiden osuutta välilevyrappeumassa ja tunnistaa taudille altistava geeni perheaineistossa aiemmin havaitulta kromosomialueelta. Aineistoina tutkimuksessa olivat perheaineistot sekä laajat potilas-kontrolliaineistot suomalaisesta ja aasialaisista väestöistä. Tutkimuksessa osoitimme, että perimän vaihtelut viidessä tutkitussa geenissä altistivat erilaisille välilevyrappeuman taudin muodoille. Tutkimus, jossa analysoimme aiemmin tunnistettuja alttiusgeenejä, vahvisti IL6, SKT ja CILP geenien vaihteluiden osuuden taudin alttiustekijöinä. Tutkimusaineistona oli pohjoissuomalainen syntymäkohortti, jossa välilevyrappeuma oli määritetty magneettikuvauksella (MRI). Suomalaisessa perheaineistossa tehdyn kokogenomin laajuisen kartoituksen pohjalta analysoimme IL17F geenin mahdollisena uutena alttiusgeeninä oireiselle välilevytaudille. Kahdesta geenin variantista koostuva haplotyyppi assosioitui tautiin merkitsevästi. Lisäksi osoitimme, että SKT-geenin tietty muutos altistaa välilevyn pullistumille sekä japanilaisessa että suomalaisessa potilasaineistossa. Hiirikokeissa on havainnoitu, että SKT-geenin homotsygootti mutaatio johtaa välilevy-poikkeamaan, joka edelleen aiheuttaa hiiren poikkeavan häntäilmiasun-. Hypoteesimme oli, että ihmisen SKT -geeni voi myötävaikuttaa välilevypullistuman kehittymiseen altistamalla välilevyt rappeumalle. Edelleen, laajassa usean populaation aineiston käsittävässä tutkimuksessa osoitimme CHST3-geenin muutoksen altistavan välilevyrappeumalle. Peittyvästi periytyvät muutokset tässä geenissä aiheuttavat perinnöllisiä harvinaisia luusairauksia. Tämä väitöstutkimus tarjoaa uutta tietoa välilevyrappeuman geneettisestä taustasta ja auttaa taudin syiden tutkintaa. Geenien rooli välilevyn toiminnassa ja muutosten vaikutus taudin kulkuun vaativat kuitenkin vielä lisätutkimuksia.

This diploma thesis called "The impact of individual physiotherapy on stereognosis and somatognosis in patients with chronic back pain" contains basic knowledge about stereognostic and somatognostic function, it summarizes significant information about pain and the development of its chronic form, and last but not least it states possible causes of back pain disorders and its functional factors. One special part of the thesis describes non-standardized tests used to examine 21 probands who had been diagnosed chronic back pain and particularly it compares the results of these two examinations, the first of which was carried out before the beginning of physiotherapy and the second one carried out after 14 days of physiotherapeutic treatment. The aim of this thesis was to evaluate the impact of physiotherapy on stereognosis and somatognosis of patients with chronic back pain. All types of medical examination were tested without visual check. As a part of the medical examination a short form of McGill ́s questionnaire and a visual analogue scale indicating the intensity of pain were to be filled in by the probands to explicate their subjective feelings. The results of all but two tests improved after 14 days of physiotherapy, the therapy impact on function of stereognosis and somatognosis of patients with...

Background: The buprenorphine transdermal system (BTDS) is approved in the US for the management of chronic pain. Due to its high affinity for mu-opioid receptors with a slow dissociation profile, buprenorphine may potentially displace or prevent the binding of competing mu-opioid-receptor agonists, including immediate-release (IR) opioids, in a dose-dependent manner. Health care professionals may assume that the use of IR opioids for supplemental analgesia during BTDS therapy is not acceptable. Materials and methods: This post hoc analysis evaluated the use of IR opioids as supplemental analgesia during the management of moderate-severe chronic pain with BTDS at 52 US sites (BUP3015S, NCT01125917). Patients were categorized into IR-opioid and no-IR-opioid groups. At each visit of the extension phase, adverse events, concomitant medications, and information from the Brief Pain Inventory (BPI) were recorded. Results: The most common supplemental IR opioids prescribed during BTDS treatment (n=354) were hydrocodone-acetaminophen and oxycodone-acetaminophen. The mean daily dose of IR opioids (morphine equivalents) for supplemental analgesia was 22 mg. At baseline, BPI pain intensity and BPI - interference scores were higher for patients in the IR-opioid group. In both treatment groups, scores improved by week 4, and then were maintained throughout 6 months of the open-label extension trial. The incidence of treatment-emergent adverse events was similar in both groups. Conclusion: Patients who were prescribed IR opioids reported lower scores for BPI pain intensity and pain interference to levels similar to patients receiving BTDS without IR opioids, without increasing the rate or severity of treatment-emergent adverse events. Patients prescribed concomitant use of IR opioids with BTDS had greater treatment persistence. The results of this post hoc analysis provide support for the concomitant use of IR opioids for supplemental analgesia during the management of moderate-severe chronic pain with BTDS.

BAKGRUND: Personer med amputation på transhumeral nivå har en asymmetrisk anatomi. Det är inte väl studerat hur denna asymmetri påverkar dessa personers stående och gång, och inte heller vilka besvär som detta skulle kunna orsaka. SYFTE: Att undersöka om någon skillnad i stillastående kropps-hållning och gångmönster uppstår då personer med transhumeral amputation använder respektive inte använder protes. Utöver det så är också syftet att undersöka om ryggbesvär förekommer hos personer med denna amputationsnivå. METOD: Två transhumeralt amputerade personer deltog i studien. Statisk undersökning och gånganalys genomfördes med och utan armprotes. En enkätundersökning gällande muskuloskeletala besvär genomfördes på deltagarna. RESULTAT: Inga större skillnader har hittats i bäckenets kinematik och bålens rörelse i sagittalplan då försökspersonerna går utan protes jämfört med när de går med protes. Däremot har vi funnit en thorakal lateralflexion mot den amputerade sidan under gång, som minskar då försökspersonerna använder protes. Då försökspersonerna är stillastående utan protes lutar de mot den amputerade sidan. När de använder protes minskar lutningen. Försökspersonerna led inte av ryggbesvär. SLUTSATS: Användande av armprotes för personer med transhumeral amputation verkar ge en rakare hållning under gång och stående. / BACKGROUND: People with transhumeral amputation have an asymmetrical anatomy. The influence of this asymmetry on gait and standing has not been well studied, neither has the potential problems that this could cause. OBJECTIVE: To investigate if any difference in standing posture and gait kinematics occur when people with transhumeral amputation use a prosthesis compared to when they don’t. Furthermore, the aim is to investigate if back problems are prevalent among people with this amputation level. METHODS: Two transhumeral amputees participated in this study. Static and gait analysis was conducted with and without prosthesis. The participants completed a survey regarding musculoskeletal problems. RESULTS: No major difference has been found in thorax tilt and pelvic kinematics when the subjects walk with compared to without prosthesis. However we have found a thorax obliquity towards the amputated side during walking, which is reduced when the subjects use their prosthesis. The subjects are leaning towards the amputated side when standing without prosthesis. When using the prosthesis the obliquity is reduced. The subjects do not suffer from any back problems. CONCLUSIONS: Use of an arm prosthesis seems to give people with transhumeral amputation a more upright posture during walking and standing.

La lombalgie est un problème de santé public induisant de nombreuses répercussions sur le plan économique et social. Le passage à la chronicité concerne moins de 10% des lombalgies, mais représente 85% des coûts liés à la prise en charge de cette pathologie. Dans ce contexte, il parait indispensable de pouvoir optimiser les programmes de réentrainement à l’effort du lombalgique chronique afin de les rendre le plus efficace et le plus pertinent possible. Ce travail de thèse a pour objectif d’évaluer les facteurs mécaniques des membres inférieurs au moyen des relations moment-vitesse dans des conditions isocinétiques. Dans une première étude, nous avons évalué les muscles extenseurs du genou et les muscles fléchisseurs et extenseurs du tronc chez des sujets lombalgiques et des sujets sains. Nous avons, ainsi mis en évidence une faiblesse significative au niveau de la force et de la puissance des muscles extenseurs du genou chez les sujets lombalgiques associée à la faiblesse musculaire du tronc classiquement évoquée pour cette population. Après avoir mis en place, dans une seconde étude, un protocole d’évaluation permettant d’établir des relations moment- et puissance-vitesse pour les muscles extenseurs et fléchisseurs de la hanche, nous avons évalué la force et la puissance de ces groupes musculaires chez des sujets lombalgiques. Les résultats ont, comme pour la première étude, mis en avant une faiblesse significative au niveau de la force et de la puissance de ces groupes musculaires, par rapport à des sujets sains, avec un déficit plus marqué au niveau des extenseurs, comme pour le tronc. L’ensemble des résultats obtenus dans le cadre de ce travail de thèse démontre qu’il est important de proposer un travail de force et de puissance au niveau des membres inférieurs pour les patients lombalgiques chroniques afin de mieux lutter contre le syndrome de déconditionnement qui touche l’ensemble des chaines musculaires des patients. / Low back pain is a public health problem inducing economical and social consequences. Chronicity involves less than 10% of low back pain, but represents 85% of the total costs related to this pathology. In this context, it seems essential to optimize chronic low back pain rehabilitation programs to make them more effective and relevant. The purpose of this phD was then to evaluate lower limbs mechanical factors using torque- and power-velocity relationships. In a first study, knee extensors muscles and trunk flexor and extensor muscles were evaluated in chronic low back pain and healthy subjects. A significant knee extensor strength and power weakness weas observed for chronic low back pain subjects, associated with the typical trunk weakness referred to this population. The second study focused on establishing a protocol allowing assessing hip flexor and extensor torque- and power-velocity relationships. This protocol was then applied to evaluate flexor and extensor hip muscles in chronic low back pain subjects. Results, in accordance with the first study, highlighted a significant strength and power weakness for hip muscle groups in chronic low back pain relative to healthy subjects, with a greater hip extensor deficit, as it is generally observed for the trunk.In conclusion, these different studies showed the importance of proposing torque and power lower limbs rehabilitation for chronic low back pain patients to better fight against the deconditioning syndrome that affects all muscular chains in this population.

Low back pain in collegiate athletes has been reported at a rate of 37% from a wide array of sports including soccer, volleyball, football, swimming, and baseball. Whereas, in a military population the prevalence of low back pain is 70% higher than the general population. Compensatory movement strategies are often used as an attempt to reduce pain. Though compensatory movement strategies may effectively reduce pain, they are often associated with altered lower extremity loading patterns. Those who suffer from chronic low back pain tend to walk and run slower and with less trunk and pelvis coordination and variability. Individuals with low back pain also tend to run with more stiffness in their knees. Moving with less joint coordination and more stiffness are potential compensatory movement patterns acting as a guarding mechanism for pain. Overall the purpose of this project was to determine how chronic low back pain influences lower extremity biomechanics and shock attenuation in active individuals compared to healthy individuals and examine how the altered lower extremity biomechanics are related to clinical outcome measures. We hypothesized that individuals who present with chronic low back pain are more likely to exhibit higher vertical ground reaction forces and less knee flexion excursion during landing, compared to healthy individuals. We also hypothesized that individuals with chronic low back pain will have a reduced ability to attenuate shock during landing compared to the healthy individuals. This study was a case control design in which physically active individuals suffering from chronic low back pain were matched to healthy controls. All participants reported for one testing session to assess self-perceived knee function in the form of the Knee Osteoarthritis Outcomes Score (KOOS), lower extremity strength and mechanics during three landing tasks. Isometric strength was assessed using an isokinetic dynamometer during hip abduction, hip extension, and knee extension. The landing tasks included a drop vertical jump, a single leg hop, and a crossover hop. A three-dimensional motion analysis system with two in-ground force plates and four inertial measurement units were used to assess lower extremity mechanics during the landing tasks. Individuals with low back pain presented with reduced KOOS scores compared to healthy individuals in four of the five subscales, including Symptoms (p=0.007), Pain (p=0.002), Activities of Daily Living (p=0.021), and Quality of Life (p=0.003). Alternatively, while there were some strength, kinematic, and kinetic between limb asymmetries noted in the low back pain group, there were not between group differences with the healthy individuals. In the low back pain group, individuals presented with greater dominant limb knee extension strength (p=0.039) and greater dominant limb ankle plantarflexion at initial contact during the drop vertical jump, compared to the non-dominant limb (p=0.022). Individuals with low back pain also presented with greater non-dominant limb tibia impact during the single limb hop (p=0.008). While we did not identify any mechanical differences between individuals suffering from chronic low back pain and those who do not, we did identify that an active population suffering from low back pain does present with decreased self-perceived knee function compared to active individuals without low back pain. As these groups biomechanically perform similarly, they do not clinically perform the same, specifically, in terms of the KOOS. Such differences should not be overlooked when treating active populations with low back pain. If this population is presenting with altered self-perceived knee function at a young age, it is likely that it will continue to decline and negatively affect their function.

Objectives: To explore if joint mobility, as a measure of connective tissue quality, could be a predictor for pregnancy-related low back pain after pregnancy and to evaluate local corticosteroid injection treatment in women with persistent pelvic girdle pain long after childbirth. Material and methods: To investigate joint mobility in relation to pain, 200 women were examined repeatedly from early pregnancy until three months after delivery. Their mobility in left fourth finger abduction in early pregnancy was compared with clinically assessed low back and pelvic pain 3 months after delivery. To evaluate local corticosteroid injection treatment, 36 women with persistent PGP were included in a randomised controlled trial (RCT) and randomised to either corticosteroid injection or saline injection on one occasion at the ischial spine bilaterally, with a follow-up after four weeks. In both studies, the women were asked about obstetric history, to complete a pain drawing, estimate their level of pain on a visual analogue scale (0-100) and estimate how they manage their everyday activities on a questionnaire, Disability Rating Index (DRI). In the RCT, the 36 women also completed Short Form 36 (SF-36), a quality of life questionnaire, six-minute walk test (6MWT), and isometric trunk flexion and extension were examined. Results: Women with low back and pelvic pain three months after pregnancy had increased finger laxity in early pregnancy. The larger the finger angle and the more pregnancies, the greater the risk of low back and pelvic pain after pregnancy. In the RCT, at follow-up, the women who received corticosteroid injection treatment improved in walking ability, estimated physical ability and isometric trunk extension more than those who received saline injections. Conclusions: Increased joint mobility, as measured by finger joint mobility, together with the number of previous pregnancies, may be an indicator of low back and pelvic pain postpartum. One single corticosteroid injection treatment to intra-pelvic structures improved function in women with persistent PGP which may indicate a source of pain.

Sammanfattning: Bakgrund: Långvarig ospecifik ländryggssmärta medför stora problem och lidande på ett individuellt plan, men påverkar även samhället då det medför stora kostnader för sjukvården. Dynamisk styrketräning av rygg och bål är ett vanligt behandlingsalternativ. Under de senaste fem åren har det ej genomförts någon litteraturstudie som sammanställer denna träningens effekt på upplevd smärtintensitet. Därmed finns det ett kliniskt värde för fysioterapeuter att litteratur sammanställs.  Syfte: Syftet med denna litteraturstudie var att sammanställa, värdera och jämföra forskningsresultat av dynamisk styrketräning för bål och rygg som behandling för personer med långvarig ospecifik ländryggssmärta och dess effekt på upplevd smärta. Metod: En litteraturstudie genomfördes i databaserna PubMed och PEDro. Samtliga sökträffars titel och abstrakt granskades, studier med potential att möta inklusionskriterier granskades därefter i fulltext varefter relevanta studier slutgiltigen inkluderades. Studier kvalitetsgranskades enligt PEDro-scale och resultatets tillförlitlighet sammanvägdes med GRADEstud. Resultat: 12 RCT-studier identifierades och granskades. Kvalitetsgranskning visade att 9 studier höll hög kvalitet. Studier med hög kvalitet evidensgraderades enligt GRADEstud, där två subgrupperingar identifierades. Dynamisk träning håller en låg (++) tillförlitlighet avseende effekt på upplevd smärta. Resultaten varierade avseende effekt på smärta, utfall och studierna hade olika upplägg vilket har bidragit till att tillförlitligheten bedöms som låg.  Konklusion: Dynamisk styrketräning av rygg och bål tycks inte vara mer effektiv än annan träning för att minska upplevd smärta för personer med långvarig ospecifik ländryggssmärta. / Abstract: Background: Chronic non-specific low back pain causes major problems and suffering for individuals, but also affects society as it entails large costs for healthcare. Dynamic strength-training of the core is a common treatment. In the last five years, no literature study has been conducted. There is a clinical value for physiotherapists in compiling literature for this treatment method. Objective: The purpose of this literature study was to compile, evaluate and compare research results of dynamic strength training for the core as a treatment for people with long-term non-specific low back pain and its effect on perceived pain. Method: A literature study was conducted in the databases PubMed and PEDro. Title and abstract of all studies were examined, studies that met inclusion criteria were examined in full text, after which relevant studies were included.  Studies were quality reviewed according to PEDro-scale and the result reliability was weighed with GRADEstud. Results: 12-RCT studies were included. Quality review showed that 9 studies maintained a high level. High quality studies were graded with GRADEstud, two subgroups were identified. Dynamic strength-training maintains a low (++) reliability regarding the effect on perceived pain. The results varied regarding effect on perceived pain and the studies had different setups which contributed to the low reliability. Conclusion: Dynamic strength-training of the back and core does not seem to be more effective than other training to reduce perceived pain for persons with chronic non-specific low back pain.