This project has explored the anatomical and neurophysiological effects of mobilization in the treatment of lumbar condtions. The study also discussed the long, often controversial history of the use of mobilization. The socioeconomic impact of low back pain in the industrialized society was reviewed. The interrelationship between lumbar anatomy, neurclogy, hydrostatic fluid dynamics, and lumbar biomechanics was investigated. In addition, the prevention of low back pain and injury in normal activities of daily living was discussed with suggestions being made for the safest way to perform these activities.

A cognitive behavioural treatment program for chronic lower back pain was designed, implemented and evaluated. The outpatient treatment program included education sessions, goal setting, graded activity training, physical exercise, relaxation training, cognitive techniques, social skills training, and medication reduction. Three participants volunteered to participate in the eightweek treatment program. Of the three participants, only one completed the program successfully. The results were used to critically discuss and evaluate the literature. The successful participant showed significant improvement in activity levels, decrease in subjective levels of pain, as well as decreased levels of anxiety and depression. It was shown that correcting cognitive distortions (e.g. selective abstraction, catastrophising, misattribution) and challenging early maladaptive schemas of abandonment, emotional deprivation and emotional inhibition (Young, 1990) assisted in enhancing coping mechanisms and the belief that the pain episodes would be short-lived and could be controlled. There was considerable improvement for the second participant, although he chose to withdraw from the program prior to its completion. The components of the psycho-education, relaxation and stress management and exercise program were beneficial for him. The third participant failed to accept the treatment formulation, and did not engage collaboratively in the treatment program. The case is presented as a point for examining therapeutic ailures.

Chronic low back pain is a highly prevalent condition in industrialized nations. It is associated with activity limitations, disability, has significant economic impact on society and incurs personal cost. Today's working environment increasingly demands more time spent sitting due to computerization and other advances in technology. Sitting for hours without taking breaks may influence posture, and alignment of the lumbar spine. Therefore, it may influence low back pain. Kenya as a developing country has an increasing number of people involved in sedentary work. The aim of this study was to identify the predisposing factors of chronic low back pain among sedentary office workers in Nairobi. The main objectives were to establish the prevalence of chronc low back pain / to determine the possible predisposing factors of chronic low back pain and to determine the impact of chronic low back pain on work related quality of life among sedentary office workers in Nairobi, Kenya.

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2001. / There are many non-surgical treatments that are available to patients with low back pain but few have been proven effective in controlled clinical trials. Arguably, the treatments with the greatest evidence for efficacy are nonsteroidal anti-inflammatory drugs (NSAIDs), some muscle relaxants and spinal manipulation (Deyo et al.(1983) and Shekelle et al.(1992). Non-steroidal antiinflammatory drugs are the most widely used agents for musculoskeletal pain and inflammation. The widespread use of NSAIDs augments the impact not only of their benefits but also the risk of their adverse effects. The effectiveness of chiropractic management is now firmly established for most patients with acute and chronic low-back pain (Koes et aI.1996). The purpose of this study was to determine the relative efficacy of combined diclofenac sodium therapy and spinal manipulation compared to combined placebo therapy and spinal manipulation in the treatment of mechanical low back pain. Sixty subjects were selected and randomly divided into two groups of thirty subjects. Subjects were treated four times over a two-week period, including a diclofenac or placebo medication course, taken three times daily for five days, starting from the first consultation. The results of the Numerical Pain Rating Scale-101, Revised Oswestry Low Back Pain Disability Questionnaire, Orthopaedic Rating Scale and Algometer readings were taken before the first, third and fourth consultations. The statistical tests used were the parametric two-sample unpaired t-tests and the paired t-tests, and the nonparametric intra-group Friedman test, multiple comparison procedure, Wilcoxon Signed Ranks test and the inter-group Mann Whitney U-test at the 95% level of significance using the SPSS statistical package. There was a statistically significant improvement in both treatment groups for both subjective and objective clinical findings, suggesting that spinal manipulation combined with either an NSAID or placebo medication will ultimately give relief to a patient suffering from lower back pain. The conclusions / M

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Background: Altered muscular function of the deep abdominal and back muscles has been implicated as a factor in the development and continuation of low back pain (LBP) and small-scale studies, on specific subgroups of LBP patients, have reported favourable outcomes when these dysfunctions are addressed using specific exercise training. However, these techniques are increasingly being incorporated into treatment packages for non-specific LBP in the UK despite little evidence of their effectiveness in this patient group. A multi-centered, pragmatic, randomized clinical trial, with 12-month follow-up, was therefore designed to investigate the effectiveness of incorporating specific spinal stabilisation exercises within a physiotherapy treatment package in the management of recurrent LBP patients. Methods: Following ethical approval, consenting patients with recurrent LBP, without significant levels of distress (as measured by the distress risk assessment method {DRAM}), were randomized to two groups; 'conventional' physiotherapy and the provision of an advice booklet (Cl) and 'conventional' physiotherapy, the provision of an advice booklet with the addition of specific spinal stabilisation exercises (SSSE). Randomisation was stratified for laterality, duration of symptoms and initial functional disability level {Roland Morris Disability Questionnaire—RMDQ} using a minimization procedure. Functional disability (RMDQ) was the main outcome, and generic, disease-specific and psychological measures were also collected. The trial was powered to detect a 5-point difference between groups using 90% power. A total of 221 patients were screened for entry into the trial and 97 were recruited from three metropolitan physiotherapy departments within the UK between May 1999 and September 2000. Results: All patients were between the ages of 19 and 60 years (mean 38.6, SD: 10.5) and had an average duration of symptoms of 8.7 (8.1) months. Over 30% of the patients screened for entry to the trial were excluded as they showed evidence of psychological distress. Both groups demonstrated improved functioning, reduced pain intensity and an improvement in the physical component of quality of life. Mean change (95% Cl) for RMDQ scores between baseline to 12-month follow-up were —4.5 (-6.2 to —3.6) for the SSSE group and -5.2 (-6.7 to —3.6) for the CT group. No statistically significant differences between the two groups were demonstrated for any of the outcome variables. Patients in the spinal stabilisation group received a slightly greater mean number of treatment sessions over a longer period than the conventional physiotherapy treatment group (7.5 (2.5) over 11 weeks compared to 5.9 (2.3) over 8 weeks respectively). Exploration of the content of each treatment package revealed a combination of treatments was used, most frequently active exercise and manual therapy, with little use of electrotherapy or mechanical lumbar traction. Discussion and Conclusion: This trial represents the largest to date investigating the effects of specific spinal stabilisation exercises, and the first examining their use in a recurrent LBP population. Results indicate that physiotherapy is effective in reducing functional disability and to a lesser extent pain intensity, with improvements maintained at one year following completion of treatment, but that the addition of spinal stabilisation exercises to conventional physiotherapy and an advice booklet, does not provide any obvious additional benefit in terms of functional disability or pain intensity. These findings are of importance as they support the ongoing use of physiotherapy treatment packages in the management of recurrent LBP patients, without significant levels of distress, but challenge the assumption that stabilisation training provides an additional benefit in this particular group of LBP patients.

Chronic low back pain is a highly prevalent condition in industrialized nations. It is associated with activity limitations, disability, has significant economic impact on society and incurs personal cost. Today's working environment increasingly demands more time spent sitting due to computerization and other advances in technology. Sitting for hours without taking breaks may influence posture, and alignment of the lumbar spine. Therefore, it may influence low back pain. Kenya as a developing country has an increasing number of people involved in sedentary work. The aim of this study was to identify the predisposing factors of chronic low back pain among sedentary office workers in Nairobi. The main objectives were to establish the prevalence of chronc low back pain / to determine the possible predisposing factors of chronic low back pain and to determine the impact of chronic low back pain on work related quality of life among sedentary office workers in Nairobi, Kenya.

M. Tech. / It is well known internationally that the high prevalence of back pain costs the economies of the world many billions of dollars annually. This has prompted a great deal of research abroad into means of reducing the deleterious economic effects of back pain. One of the results of this research is the realisation that Chiropractic treatment of back pain offers an efficacious and cost effective alternative to the conventional medical treatments currently employed in most countries. To this end there has been a move, by health management organisations in the USA and Canada, toward the integration of Chiropractic into their health care systems in a gatekeeper role with notable success in terms of cost reduction. Similar research has not been conducted in the Republic of South Africa and, notwithstanding the evidence emerging from abroad, Chiropractic, although integrated into many health care systems, remains inaccessible to most back pain sufferers, particularly those employed in the lower ranks of industry. This is in large part due to the unavailability of Chiropractic services in the more remote areas of the country where many mines are situated, but also partly due to the lack of incentive for mining companies to make use of Chiropractic services. The data used in this study was obtained from the in-house medical aid of a reputable South African mining company. The data was used to summarise the cost of treatment of selected categories of back pain by the various service providers within the medical fraternity. The medical costs were then compared to the similarly summarised Chiropractic cost of treatment for the same categories of back pain. The results indicate that Chiropractic costs compare favourably with those of the General Practitioner (GP) and Physiotherapists on a stand alone basis. The data indicates however that the medical approach invariable leads to specialist referral that in turn often results in surgery with the associated imaging, theatre and hospitalisation costs. When these costs are considered it becomes obvious that Chiropractic involvement at an early stage has the potential to considerably reduce the cost of treatment of back pain.

This experiment examined the effects of EMG biofeedback and relaxation training as compared with biofeedback alone. The following.dependent variables were examined: manifest anxiety, perceived pain, perceived relaxation, EMG activity, and locus of control. Back pain patients were assigned to one of two treatment groups. Group 1 was treated with both EMG biofeedback and relaxation training. Group 2 was treated with biofeedback alone. It appears that both biofeedback combined with progressive relaxation and biofeedback training alone are effective in lowering muscle activity and perceived pain, and in increasing perceived relaxation. However, from the results of this study, it is impossible to conclude that one treatment method is more effective than the other. Suggestions for future research are discussed.

Thesis (M. Tech.) -- Central University of Technology, Free State, 2008 / The aim of the study was to determine radiation dose levels around the theatre table, on either side of the C-Arm, in order to establish if the radiation dose received by staff during back pain procedures fell within the limits set by the International Commission of Radiological Protection (ICRP). The question that arose from this goal was whether the stance of staff, in relation to the x-ray tube side of the C-Arm, influenced radiation dose levels. In order to apply the ALARA principle, the possibility of lowering the radiation dose in the neurological theatre was explored. The measurement methodology of the study was twofold: measurements were executed by means of TLD meters, as well as with an ionisation chamber. TLD meters were placed on the patient, the neurosurgeon and the radiographer during back pain procedures, and, more specifically, during fluoroscopy, to record the doses with the Image Intensifier (II) above the table as well as with the x-ray tube above the table, at the pelvis and the chest height of the staff. Ionisation chamber measurements were recorded in 25cm intervals around the theatre table with a phantom and the C-Arm positioned in the PA, oblique and lateral positions at 110cm and 133cm heights from the floor. The TLD results indicated that, when compared to the Image Intensifier side, the radiation dose was higher on the x-ray tube side of the C-Arm. The radiation dose was higher at the height closest to the x-ray source. The radiation dose received by the patient was higher with the x-ray tube positioned above the table (PA). The radiation dose to the surgeon’s hand and body was higher with the x-ray tube positioned above the table (PA). Radiation dose levels with the x-ray tube above the table during back pain procedures in the current theatre exceeded the occupational annual recommendation of 500mSv to the neurosurgeons hands, as recommended by the ICRP. The opposite is true with the II positioned above the table. The research question was answered positively in that the x-ray tube under couch orientation has the potential to limit dose levels during back pain procedures. The measurement values resulted in a proposed protocol in terms of positioning of staff and orientation of the C-Arm in order to apply the ALARA principle during back pain procedures. Constant revision of protocols is the responsibility of the radiographer in order to guarantee that the ALARA principle is implemented in every unique situation.