A dissertation submitted in partial compliance with the requirements for the Master's Diploma in Technology: Chiropractic, Durban Institute of Technology, 1996. / Focus during this investigation was directed towards determining alterations in the size of the lumbar intervertebral disc in patients symptomatic with low back pain and sciatic distribution pain, in response to chiropractic management of this condition. The efficacy of chiropractic management for low back pain with associated radiculopathy has been examined. Flexion distraction technique and side posture rotatory adjustment technique of the lumbar spine have been used during this trial. / M

A dissertation presented in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Technikon Natal, 2000. / Lower back pain represents as a common disorder, with between 60% and 80% of the general population being affected (Kirkaldy-Willis 1992:2). This, apart from just the health aspects, has serious financial implications which are an ongoing concern to industry (Frymoyer 1991: 137). This study was designed to determine the effectiveness of combined spinal manipulation and "Action Potential" therapy versus spinal manipulative therapy and placebo "Action Potential" therapy in the treatment of mechanical lower back pain. It is currently accepted that spinal manipulation is of great benefit in the treatment of lower back pain (Di Fabio 1992), and it appears that "Action Potential Simulation" therapy, a new low-frequency electrical current therapy, would fit the criteria necessary to address the dysfunctional phase of low back pain as set out by the authors such as Kirkaldy- Willis (1988). / M

Low back pain is a common problem that affects a significant portion of the adult population. Given the prevalence of both acute and chronic complaints of low back pain, the use and efficacy of available treatment methods is an important area for investigation. The purpose of this study was to identify and describe current treatment methods for low back pain and to explore the role of the nurse in its management. The methodology of the study consists of a literature review of research and other related journal articles published primarily between the years of 1994 and 1999 on the subject of low back pain. The availability of both conservative and alternative treatment methods was reported in the literature reviewed. Low back pain treatments ranged from pharmacological agents to acupuncture. The primary role in most treatments is implemented by physicians, chiropractors, physical therapists, and acupuncture practitioners. The current role of nursing includes patient assessment, education, and psychosocial support. Implications for nursing practice includes a more active role in preventive education and case management in order to improve the overall management of low back pain.

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

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.

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.

Thesis (Ph. D.)--University of Hawaii at Manoa, 2005. / Includes bibliographical references (leaves 152-158). / Also available by subscription via World Wide Web / xii, 158 leaves, bound ill. 29 cm

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 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.

published_or_final_version / Orthopaedics and Traumatology / Doctoral / Doctor of Philosophy