The aim of this study was to determine assessment and treatment choices of physiotherapists treating non-specific low back pain in Rwanda. The main objectives were to identify the common types of low back pain treated by physiotherapists, to determine the

Low back pain (LBP) is a common health problem that contributes to the high cost of health care. Improvement in trunk range of motion has been considered to be an important factor in ameliorating the symptoms of LBP. Kinesio® taping is a prominent therapeutic modality commonly used in the variety of populations for treating musculoskeletal conditions. However, previous research on the efficacy of Kinesio® taping for LBP is limited. The purpose of this study was to investigate the immediate and short-term effects of Kinesio® taping with the muscle inhibition technique on active trunk flexion range of motion. Twenty-five subjects with no history of LBP in the past 6 months or LBP lasting over six weeks at any point in past were recruited from a Division I athlete population. Each subject underwent two Kinesio® taping trials in a cross-over design with a 7-10 day washout period (placebo application and inhibition technique application), during which several trunk flexion range of motion measurements were made. Subjects wore the tape for 48 hours, and active trunk flexion range of motion was measured at baseline, immediate post-tape application, and 48 hours post-tape application. A significant trial by time interaction was found (F = 9.629; p = 0.002), and follow-up analysis of the inhibition technique trial revealed a significant increase in active trunk range of motion between baseline and 48-hours post-tape. No significant differences were noted in the placebo trial. The findings suggest that the inhibition Kinesio® taping technique may eventually prove to be a beneficial therapeutic modality for improving active trunk flexion range of motion in patients with LBP.

The prevalence of low back pain has assumed an upsurge trend in the last five decades despite the many interventional strategies. One interventional strategy that has been unsuccessful has been patient education. Lack of positive results from many of the existing patient education programmes is probably due to the type of health information that has been presented and the method that has been used. Many of the health education programmes have been planned according to what the medical professionals assumed the individuals needed to know, assumptions that could have ignored some crucial aspects. This study explored the perceived health education needs of individuals with low back pain at the Nairobi Hospital Rehabilitation Unit in Kenya, the method used to educate the individuals, the appropriateness of the method according to the individuals in addition to identifying the source of the health education that the individuals had.

The aim of this study was to determine assessment and treatment choices of physiotherapists treating non-specific low back pain in Rwanda. The main objectives were to identify the common types of low back pain treated by physiotherapists, to determine the

The prevalence of low back pain has assumed an upsurge trend in the last five decades despite the many interventional strategies. One interventional strategy that has been unsuccessful has been patient education. Lack of positive results from many of the existing patient education programmes is probably due to the type of health information that has been presented and the method that has been used. Many of the health education programmes have been planned according to what the medical professionals assumed the individuals needed to know, assumptions that could have ignored some crucial aspects. This study explored the perceived health education needs of individuals with low back pain at the Nairobi Hospital Rehabilitation Unit in Kenya, the method used to educate the individuals, the appropriateness of the method according to the individuals in addition to identifying the source of the health education that the individuals had.

Magister Scientiae (Physiotherapy) - MSc(Physio) / The aim of this study was to determine assessment and treatment choices of physiotherapists treating non-specific low back pain in Rwanda. The main objectives were to identify the common types of low back pain treated by physiotherapists, to determine the / South Africa

In today's health care environment tremendous efforts are being made by Health Maintenance Organizations (HMOs) to deliver appropriate patient care while controlling utilization of services and costs. One area of concern over the past two years has been the apparent over-utilization of spinal surgeries within a local Senior HMO. This HMO has no specific plan or physician guidelines for the management of low back pain. Utilization of spinal surgeries is measured in incidence of admissions per thousand members of the Senior HMO. Over the past two years the incidence of spinal surgeries per thousand has grown from 2.4 in 1995, 4.1 in 1996 and 7.4 during the first quarter of 1997. This is compared to a suggested rate of 1.5 per thousand for similar HMO populations around the country. The purpose of this study was to determine the effectiveness of the presentation of a treatment algorithm and physician guidelines for the management of low back pain (LBP). In order to determine the effectiveness of the presentation of the algorithm, the incidence of spinal surgeries per thousand for nine quarters prior to the presentation was compared to the incidence per thousand for the three quarters following the presentation. Results of this comparison showed a slight drop, but statistically insignificant (P = .62), in the rate of surgeries compared to the previous year. When compared to the previous two years the rate was actually slightly higher, but statistically insignificant (P = .57) after the presentation. Although the comparisons were determined to be insignificant, trend analysis indicated a gradual rise in the incidence during the initial five quarters, a plateau during the next four quarters, and a slight decrease in the rate of surgeries during the last three quarters which followed the introduction of the treatment algorithm. At this time it would be appropriate to continue the analysis of quarterly data and continue feedback and education to the primary care physicians in an attempt to promote proper utilization of spinal surgeries and overall management of LBP.

Intervertebral disc (IVD) degeneration is a major cause of low back pain (LBP) worldwide which is expected to affect 80% of the world’s population. IVD degeneration (IDD) is a key player in the degenerative cascade associated with LBP. Pro-inflammatory cytokines and mediators, such as nitric oxide, have been shown to be triggers and mediators of IDD. Due to the avascular nature of the adult IVD, the disc is unable to heal or regenerate when damaged. The multi-components of the IVD, namely glycosaminoglycan (GAG)-rich nucleus pulposus (NP), a concentric collagen dense annulus fibrosis (AF), and cartilage endplates (CEPs), further complicate possible regenerative solutions. Cell therapies show promise. This is supported by studies that demonstrate the use of mesenchymal stem cells (MSCs) in animal models showing potential in mitigating inflammatory signaling as well as recovering proteoglycan content. Despite these promising findings, several gaps in knowledge remain. While the biochemical and mechanical properties of an injured disc (via physical or chemical stimulation) have been characterized, the resulting inflammatory signaling cascades remain undefined. A growing body of evidence suggests that TLR4 is involved in the pathogenesis of the IVD. However, it is unknown how TLR4 mediates injury responses of the IVD. Second, it is unknown how mechanical loading of IVDs can influence the transcriptome or secretome of the IVD. The IVD is normally exposed to multimodal loading (e.g., compression, tension, shear, hydrostatic pressure, and osmotic pressure). Both frequency and magnitude regulate whether loading is beneficial or detrimental to disc integrity, which will be explored. Furthermore, the secretome of the IVD, especially during loading, may be essential to creating therapies targeted for regeneration of the IVD. There may be key, distinct paracrine factors that are released in IVD conditioned loading media which can influence the regenerative and anti-inflammatory capabilities of cell-based therapies. To address these gaps, this thesis describes a series of experiments employing novel ex vivo organ culture model to study the response of the IVD to various injury modalities (inflammatory stimulation, puncture injury, compressive loading), and resulting changes in inflammatory, biomechanical, and biochemical responses. Through methods such as RNA sequencing and proteomics, we now have expanded the characterization to beyond candidate genes or proteins, and are more informed on (1) the IVD response to injury, (2) the role of TLR4 signaling in this ex vivo organ culture model, in addition to (3) the downstream effects of loading and how paracrine factors can be used to improve and develop potential cell and molecular therapies. Sex-based differences, in male and female rat caudal IVDs, were also identified and are analyzed in the context of response to injury.

Thesis (MScPhysio)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Aim: The aim of the study was to improve understanding of the hip joint kinematics in cricket fast bowlers and to ascertain whether a relationship exists between hip joint biomechanical parameters, including kinematics, ROM characteristics and lumbar symptoms. Study design: A descriptive cross-sectional study was conducted. Participants: Sixteen adult male fast bowlers between the ages of 18 and 40 years old, playing first-club league, were featured in the study. Main outcome measures: To obtain data with regards to the training history, as well as the nature of lumbar-spine symptoms experienced by the cricket fast bowlers, a newly designed questionnaire was compiled. For analysis of the front foot hip joint ROM and kinematics, the biomechanical equipment used included: a two-dimensional Canon MV950 Digital Video Camcorder, a Kodak EasyShare C310 camera and XSENS Motion Tracking equipment (Xsens Technologies B. V., Enschede, Netherlands). Results: Eight of the sixteen bowlers in our study experienced LBP in the season with seven of these bowlers presenting with recent symptoms most of which are experienced after bowling a spell and described as “tightness” or a “stabbing pain” in the lower back. Intensity of LBP ranged between 1/10 to 8/10. Front foot hip joint kinematics of fast bowlers showed highly individualised patterns of movement between different subjects. Medium amplitude movements in the flexion/extension as well as the rotation plane of movement showed a significant difference in bowlers with- and without LBP. No significant differences between groups with LBP and without LBP were found in the three passive hip ROM measurements. Conclusions: It has proved to be very difficult to improve the understanding of the front foot hip biomechanics in cricket fast bowlers due to the high inter-subject variability. Variability in movement patterns remains under-researched by sports biomechanics. Although decreased hip mobility could alter mechanical forces transmitted to the lumbar spine and therefore predispose or be a causative factor in LBP development, this study found no significant relation between these parameters. The sample size was very small in this study which will influence the validity of results. Our study confirmed the high incidence of LBP and preventative efforts for bowlers should therefore be strongly supported. / AFRIKAANSE OPSOMMING: Doelwit: Die doelwit van die studie was om die heupgewrig kinematika van krieket snelboulers beter te verstaan en om vas te stel of daar ‘n verwantskap bestaan tussen heupgewrig biomeganiese parameters, insluitende kinematika, omvang van beweging karakter en lumbale simptome. Studie ontwerp: ‘n Deursneë beskrywende studie is onderneem. Deelnemers: Sestien volwasse manlike snelboulers tussen die ouderdomme van 18 en 40 jaar oud wat eerste liga speel maak deel uit van die studie. Hoof uitkoms maatreëls: ‘n Nuut ontwerpte vraelys is opgestel om data aangaande oefen geskiedenis sowel as aard van lumbale simptome wat deur krieket snelboulers ervaar word in te samel. Die biomeganiese apparaat wat gebruik is vir die analiese van die voorvoet heup omvang van beweging, sowel as die kinematika, sluit in: ‘n twee dimensionele Canon MV950 Digitale Video Camcorder, ‘n Kodak EasyShare C310 kamera en XSENS beweging volgende apparaat (Xsens Technologies B. V., Enschede, Netherlands). Resultate: Agt van die sestien boulers in ons studie het lae rug pyn in die seisoen ervaar. Sewe van die boulers het gepresenteer met onlangse simptome waarvan die meeste na ‘n bouler se boulbeurt ervaar is en beskryf was as ‘n “styfheid” of “steekpyn” in die lae rug. Die intensiteit van die lae rug pyn het gewissel tussen 1/10 en 8/10. Voorvoet heup kinematika van snelboulers het hoogs individualistiese patrone van beweging getoon tussen verskillende deelnemers. Medium amplitude bewegings in die fleksie/ekstensie sowel as die rotasie plein van beweging het ‘n beduidende verskil tussen boulers met- en sonder lae rug pyn getoon. Geen beduidende verskille tussen die groep met- en sonder rugpyn is gevind met die drie passiewe heup omvang van beweging meetings nie. Gevolgtrekkings: Dit blyk baie moelik te wees om die voorvoet heup biomeganika in krieket snelboulers beter te verstaan a.g.v. die hoë inter-deelnemer veranderlikheid. Veranderlikheid in bewegings patrone is nog nie genoeg nagevors deur sport biomeganici nie. Alhoewel ingekorte heup mobiliteit meganiese kragte wat deur die lumbale werwelkolom gaan kan wysig, en sodoende die ontwikkeling van lae rug pyn kan predisponeer of ‘n oorsakende faktor kan wees, het hierdie studie nie ‘n beduidende verwantskap tussen die parameters gevind nie. Die steekproef groote was baie klein en dit sal die geldigheid van die resultate beïnvloed. Ons studie het die hoë insidensie van lae rug pyn bevestig en pogings tot voorkomende maatreëls moet daarom ten sterkste ondersteun word.

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