A dor lombar crônica é um tema relevante, porém, poucos estudos abordam a perspectiva da experiência do sujeito nessa condição e no contexto rural. O objetivo deste estudo foi interpretar a experiência e a vivência da dor lombar crônica no cotidiano de mulheres de um assentamento rural. Trata-se de um estudo qualitativo embasado no referencial teórico da Antropologia e da Fenomenologia, que teve como sujeitos da pesquisa seis mulheres adultas com dor lombar crônica que trabalhavam na cooperativa do assentamento rural chamado “Filhos de Sepé”, localizado no município de Viamão, no estado do Rio Grande do Sul – Brasil. Realizamos, com cada participante, três encontros no período de agosto de 2015 a julho de 2016, totalizando 18 entrevistas. Em cada encontro, além da entrevista semiestruturada, fomos construindo junto com as participantes, a partir da técnica de narrativa de mapas corporais (Gastaldo, Magalhães, Carrasco & Davy, 2012), uma representação gráfica do seu corpo fundamentada na temática proposta, a qual envolvia a utilização de elementos como colagens e desenhos. Essa narrativa de mapas corporais teve a função de complementar e explorar com maior profundidade as temáticas desenvolvidas durante as entrevistas semiestruturadas. O diário de campo, também foi um instrumento para registro de informações relevantes durante o período de aproximação com o campo e na realização do estudo. Convivemos com as mulheres que trabalhavam na cooperativa do assentamento um turno por semana durante o período de coleta de informações. A partir desse convívio, conhecemos um pouco da rotina de trabalho dessas mulheres, trocamos ideias, nos aproximamos e fomos convidando-as para participarem das entrevistas. As entrevistas foram gravadas em meio digital e transcritas na íntegra, constituindo-se em material empírico para análise. Iniciamos o processo analítico com uma leitura ampla das entrevistas e, posteriormente, começamos a definição de códigos analíticos e categorização. Como achados, apreendeu-se que as mulheres não problematizam a dor crônica como o fazem com as questões relacionadas ao papel feminino. As repercussões desfavoráveis geradas pelos silêncios sobre certos eventos da vida são percebidas pelas mulheres, fazendo-as contestá-los. Contestam os silêncios e não repetem com as gerações que se seguem. Já a dor, o trabalho, a jornada dupla desde a infância são categorias percebidas no corpo físico, mas não são questionadas ou problematizadas pelo corpo social. O evento de dor existiu, e ele é marcado na vida dessas mulheres. Todas têm clareza de como se deu esse evento, como ele deslocou a vida delas e como enfrentam a dor. Agora, em nenhum momento pensam que poderia ter sido diferente e também não se consideram doentes, de certa forma naturalizando a dor. Tanto os deslocamentos como as estratégias de enfrentamento experenciadas pelas mulheres assentadas são intersubjetivamente construídas e as ações e os comportamentos pertencentes a essas categorias são constituídas nas negociações e renegociações de significados que o grupo vai estabelecendo. Disso tudo fica a importância da interpretação da condição crônica desde uma perspectiva multidimensional para o desenvolvimento de intervenções contextualizada afim de constituir experiências que sejam significativas. / Chronic low back pain is a relevant issue; however, few studies have addressed the perspective of the subject's experience in this condition and in the rural context. The aim of this study was to interpret the experience of chronic low back pain in everyday life of women from a rural settlement. This is a qualitative study grounded in the theoretical framework of Anthropology and Phenomenology and had as research subjects six adult women with chronic low back pain who worked in a cooperative of a rural settlement called "Filhos de Sepé” located in the city of Viamão, in the state of Rio Grande do Sul - Brazil. We conducted with each participant three interviews from July 2015 to July 2016 , totalling 18 interviews. At each meeting , besides semi-structured interview, we built together with participants the body maps narrative technique (Gastaldo, Magellan, Carrasco & Davy, 2012) , a graphical representation of the body based on a proposed theme , which involved the use of elements such as collages and drawings. This narrative of body maps had a complementary function of exploring in greater depth the subjects developed during the semi- structured interview. The field diary was also an instrument to record relevant information during the approach period with the field. We get along with women that worked in the settlement cooperative of one shift per week during the period of information gathering. From this interaction , we got acquainted with the routine work of these women , we exchange ideas, in order to invite them to participate in the interviews. The interviews were recorded in digital media and transcribed, being an empirical material for analysis. The analytical process begun with a broad reading of the interviews and later started the definition of analytical and categorization codes. As findings, it seized that women do not question the chronic pain as they do with issues related to women's role. The unfavorable repercussions generated by silences on certain life events are perceived by women, making them challenge them . Challenge the silence and do not repeat with the generations that follow. Already the pain, work, double journey since childhood are categories perceived in the physical body , but are not questioned or problematized by the social body. The pain event existed, and it is marked in the lives of these women. All have clear how was this event , how it shifted their lives and how difficult is to face the pain . Now, any time they think it could have been different and also do not consider themselves as sick person , in a way of naturalizing pain. Both, shifts as the coping strategies are intersubjectively constructed and the actions and behaviors belonging to these categories are made by negotiations and renegotiations of meanings that the group will establish . Above all the interpretation of the chronic condition should be from a multidimensional perspective to develop contextualized interventions in order to provide a meaningful experiences.

M.Tech. (Chiropractic) / This study was conducted in order to compare the effectiveness of the lumbar spine manipulation versus the foot manipulation/mobilisation for people suffering with chronic low back pain. This research aims to compare the effects of lumbar spine manipulation alone, foot manipulatioil/mobilisation alone or the combination of the two in people suffering with chronic low back pain. Candidates for the study were recruited from the local surrounding area, and through information pamphlets distributed through the Technikon Witwatersrand Doornfontein. The candidates were asked to participate in the study, which was held at the Technikon Witwatersrand Chiropractic day clinic. Only -those candidates that conformed to the selection criteria were allowed to participate in the study. The candidates were assigned to one of three groups. Eac.h group had ten candidates. Group 1 received lumbar spine manipulation alone. Group 2 received foot manipulation/mobilisation alone. Group 3 candidates received lumbar spine manipulation and foot manipulatioil/mobilisation. Subjective data was collected using the Numerical Pain Rating Scale 101 and the Oswestry Low Back Pain and Disability Questionnaire. Objective data was collected using the electronic inclinometer to measure lumbar spine range of motion in flexion, extension, right and left lateral flexion and right and left anterior rotation. The paired Hest was used for statistical analysis, where a statistically significant difference was found; the Student-Newman-Keuls test was performed to identify which statistically significant difference between the groups was found. The results of this study indicate that lumbar spine manipulation alone would appear to have responded better in terms of lumbar spine range ofmotion...

Older adults (65+) are one of the fastest growing segments of the population in the United States. Chronic pain is common among this population, and chronic low back pain (CLBP) in particular is the number one pain complaint among older adults. In addition to larger societal and fiscal costs, CLBP is associated with a host of personal negative consequences such as physical disability, poor psychosocial functioning, and decreased quality of life. Despite being a leading health problem in older adulthood, little is known about how older adults actually experience this type of pain. Thus, the purpose of this dissertation was to understand older adults’ lived experience of CLBP. To improve understanding of CLBP in this understudied population, a qualitative study using a phenomenological method was conducted. Phenomenology, rooted in existential philosophy, is the study of the nature and meanings of phenomena, in which experiences related to the phenomena are the main source of insight. van Manen’s Phenomenology of Practice method specifically guided the investigation with regard to study conception, data collection, and data analysis. Participants were 21 older pain clinic patients living with CLBP who engaged in one-on-one in-depth interviews. Findings suggest that CLBP is an all-encompassing presence in participants’ lives. Seven main themes include: (1) Living a life full of pain; (2) Pain affects everything; (3) With others but a lone in my pain; (4) With pain comes sorrow; (5) Aging painfully; (6) Managing the incurable; (7) You just have to keep going. Implications for social work practice, research, and policy are discussed. By building a deeper understanding of older adult’s experiences and personal meaning of CLBP, social workers may be more able to provide meaningful and effective psychosocial services in the context of interdisciplinary CLBP management.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第22890号 / 人健博第82号 / 新制||人健||6(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 市橋 則明, 教授 林 悠, 教授 妻木 範行 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Bakgrund: Ländryggssmärta är en av de vanligaste typerna av muskuloskeletal smärta och den ledande formen av nedsatt funktion världen över. Styrketräning (ST) är en av de vanligaste formerna av konservativ behandling vid kronisk ospecifik ländryggssmärta (CNSLBP). Det saknas rekommendationer för dosering av ST och effekten av olika doseringar är oklar. Syfte: Syftet med denna systematiska litteraturstudie var att kartlägga rapporterade träningsdoseringar vid CNSLBP samt att jämföra effekten av olika doseringar. Metod: En systematisk granskning av randomiserade kontrollerade studier publicerade de fem senaste åren genomfördes efter sökningar i databaserna MEDLINE, CINAHL och PEDro. En kvalitetsbedömning av studierna genomfördes och träningsdosering av styrketräning som behandling vid CNSLBP kartlades och kategoriserades. I inkluderade studier där liknande träningsupplägg med olika dosering jämförts, utvärderades doseringarnas effekt avseende smärtintensitet och funktion. Resultat: Totalt inkluderades sex artiklar. Risken för systematiska fel bedömdes som genomgående låg till medelhög. Träningsdoseringarna kategoriserades som moderata till medelhöga. Enbart en av de sex inkluderade studierna jämförde olika träningsdosering där komponenten intensitet varierats i två grupper. Högintensiv styrketräning uppvisade signifikanta förbättringar avseende funktion och små ickesignifikanta förbättringar avseende smärtintensitet jämfört med den medelintensiva träningsgruppen. Slutsats: Den här litteraturstudien visade att få studier anger träningsdosering av styrketräning som behandling för patienter med CNSLBP. De kartlagda träningsdoseringarna var moderata till medelhöga och liknar doseringarna som rekommenderas för motionärer. Inga slutsatser kunde dras avseende doseringarnas effekt. Framtida kliniska studier med träning som intervention bör definiera styrketräningsdosering vilket anses relevant för såväl forskare som fysioterapeuter i praktiken. / Background: Low back pain is one of the most common musculoskeletal disorders and the leading cause of disability worldwide. Resistance training (RT) is an effective therapeutic modality for the treatment of patients with chronic non-specific low back pain (CNSLBP). However, recommendations of RT dosages is lacking and the effects of different dosages remains unclear. Objective: The objective of this review was to map and evaluate the effectiveness of reported RT dosages for the treatment of CNSLBP. Method: A systematic search for literature was conducted in the databases MEDLINE, CINAHL and PEDro. Dosages were mapped and categorized. Effect sizes of pain intensity and disability were extracted from articles with comparisons between dosages. The risk of bias was judged for the articles, respectively. Results: A total of six articles were included. The dosages were categorized as moderate to medium high. Comparison between dosages was made in one of the included articles. Significant improvements in pain intensity and non-significant improvements in disability in favour of a high intensity group compared to a low intensity training group was found. The risk of bias was consistently judged as low or moderate. Conclusion: This study showed a lack of correctly reported RT dosages. The mapped dosages where corresponding to the recommendations for a healthy population. No conclusions could be drawn upon the effect of different dosages. A clear definition of the RT dosage in future trials is of importance to further investigate the effect of RT as an intervention for the treatment of CNSLBP.

Chronic low back pain (CLBP) is defined as pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, with or without sciatica, that lasts for at least twelve weeks.1 It is the leading cause of disability and loss of productivity in the United States.2 There is conflicting evidence on what is the most effective nonpharmacological treatment for CLBP. Many studies have shown that any general exercise routine is effective for improving symptoms, but the literature provides conflicting evidence about what specific type of exercise is best.3 A few studies have demonstrated decreased pain and disability with supervised directional preference exercise routines compared to non-directional preference routines. The objective of this study was to determine the effectiveness of a home directional preference exercise/stretch program for reducing disability in mechanical CLBP in patients in a residency clinic and to expand on the limited evidence of directional preference exercise effectiveness. Unlike other directional preference interventional studies, this program’s simplicity and convenience of performing at home potentially could increase patient compliance and therefore effectiveness. Patients were screened at a routine clinic visit and considered eligible if they had a known diagnosis of CLBP. They were excluded if they were in an acute exacerbation. Participating patients were categorized on directional range of motion preference based on their physical exam, either flexion or extension, whichever improved their pain. They were given a simple routine with instructions and pictures consisting of three exercises and stretches that emphasized their specific directional preference. Subjects performed three sets of each routine two to three days per week. Degree of disability score was measured at initial visit by completing the gold standard disability index questionnaire, the Oswestry Disability Index (ODI). Degree of disability was reassessed with ODI at a follow-up assessment four to eight weeks later with five follow-up questions regarding compliance and acute exacerbation. Patients were excluded if they were in an acute exacerbation. Pre-interventional disability scores were then compared to post-interventional disability scores. Twelve total patients enrolled in the program. Seven were lost to follow up. Five completed the study at the proper follow up interval; however, one was in an acute exacerbation so was excluded. Of the four patients included, two had extension and two had flexion preference. Three out of four patients had decreased disability scores at follow up. Total post-intervention score on ODI improved by an average of 10 points compared to pre-intervention score for the patients who improved. The most improved post-interventional ODI score category was walking and changing degree of pain. Seventy-five percent of the patients who completed the study had an improvement in their CLBP disability score. However, due to a small sample size and study power, the results are not statistically significant. Therefore, a conclusion cannot be appropriately drawn about the effectiveness of performing a home directional preference exercise/stretch program for reducing disability in mechanical CLBP in patients at a residency clinic. Nevertheless, the results are promising and deserve further investigation with a larger sample size.

Bakgrund: Smärta är en individuell psykologisk och emotionell reaktion där funktionen är att varna för skada. Långvarig smärta är en smärta som varar i mer än 12 veckor som drabbar 40–50 procent av Sveriges befolkning.  Den vanligaste lokalisationen för smärtan är ländryggen och det är ett av de största folkhälsoproblemen i världen. Orsaken till ländryggssmärta kan vara både fysiologisk och psykologisk, men det är oklart till varför det uppstår en långvarig smärta. Syfte: Syftet var att beskriva patienters upplevelse av att leva med långvarig ländryggssmärta. Metod: En litteraturöversikt gjordes som är baserad på tio kvalitativa vetenskapliga artiklar. Tre databaser användes, CINAHL Complete, Pubmed och Medline och dataanalysen gjordes enligt Fribergs analysmodell. Resultat: Tre huvudteman med tillhörande subtema påfanns under dataanalysen. Första huvudtemat var: Påverkan på vardagen med subteman: Förändringar i vardagen, Familjeroll, Kultur och religion och Acceptans. Andra temat var: Psykisk ohälsa och försämrad sömnkvalitet med subteman: Psykisk påverkan och Sömnsvårighet samt sista temat: Egenvård. Diskussion: Diskussionen är indelad i en metoddiskussion och resultatdiskussion. Metoddiskussionen innehåller en reflektion kring den valda metodens styrkor och svagheter. Resultatdiskussionen innehåller en diskussion om litteraturöversiktens resultat med Katie Erikssons teori som teoretisk utgångspunkt. / Background: Pain is an individual psychological and emotional reaction where the function is to warn of injury. Chronic pain is a pain that lasts for more than 12 weeks, that affects 40–50 percent of the population of Sweden. The most common location for the pain is the lumbar spine and is one of the biggest public health problems in the world. The cause of low back pain is both physiological and psychological, but it is unclear why chronic pain occurs. Aim: The purpose was to describe the patient’s experience of living with chronic low back pain. Method: A litterature review was made based on ten qualitative scientific articles. Three databeases were used, CINAHL Complete, Pubmed and Medline. The data analysis was done according to Friberg´s analysismodel. Results: Three main themes and associated subthemes were found during the data analysis of the result, containing subthemes. The first maintheme was: Impact on everyday life with subthemes: Changes in everyday life, Family role, Culture and religion and Acceptance. The second theme was: Mental illness and insomnia with subthemes: Psychological impact and Sleep deprivation, and the last theme was: Self-care. Discussion: The discussion is divided into a method-discussion and result discussion. The method discussion contains a reflection on the strengths and weaknesses of the chosen method. The result discussion includes a discussion of the results of the literature review with Katie Eriksson´s theory as a theoretical starting point.

Chronic low-back pain is a prevalent and costly problem for many adults in the United States. Currently, multidisciplinary treatment approaches are the treatment of choice for this problem. A meta-analysis was conducted on 43 published studies to describe the nature of these programs, the patients involved in them, treatment efficacy at discharge and follow-up, and possible relationships between these characteristics and outcome. Results show that these programs were often in university medical settings, with an emphasis on active patient participation. Common treatment approaches included physical therapy, skills training, medication management, supportive therapy, and behavior modification. Patients involved in these programs tended to be middle-aged, married, unemployed, and high-school educated, with an average pain duration of about five years. It was concluded that patients do show improvement at treatment completion (at least one-half standard deviation change) in physical fitness, reported distress levels, daily activity, and medication usage. At follow-up improvement over pre-treatment levels was still evidenced in reported distress levels, medication usage, mood, fitness levels, daily activities, and health perceptions. Results of correlational analyses suggest that the more impaired patients in these studies tended to show greater improvement. Data also suggest that patient dropouts rates were negatively correlated to medication usage and mood over time. Thus, improvements in these areas may be artifacts due to patient drop-out rates. Multidisciplinary treatment programs were found to be generally effective in promoting more adaptive functioning in their patients . However, it is recommended that closer attention be given to attrition rates and other potential sources of bias to maximize confidence in treatment effectiveness.

Design: A single-blinded, cross-sectional observational study. Objectives: Examine muscle cross-sectional area and symmetry of the lumbar multifidus muscle in elite ballroom dancers with and without low back pain (LBP). Background: The incidence of LBP among elite ballroom dancers is high and at Brigham Young University is 57%. Previous research has linked lumbar multifidus muscle atrophy to low back pain; however this relationship has not been examined in ballroom dancers. Methods and Measures: Lumbar multifidus cross-sectional area was assessed at rest on the right and left side at levels L1-L5. Thirty-seven subjects (age 24 ± 3.2 years; height, 172.8 ± 11.3 cm; mass, 54.6 ± 4.5 kg) were divided into one of three groups. Participants who reported LBP severe enough to interfere with dance training and daily living were allocated to the LBP group (reported pain at rest, during dance, and following dance) (n=15). Subjects who reported LBP that was not strong enough to interfere with training and daily living were allocated to the minimal pain group (reported pain during dance and following dance) (n= 6). And those who reported no back pain were put into the no pain group (n=16). Results: There were no significant difference in demographics between the groups (P>0.05). There was no significant difference between groups in multifidus cross-sectional area (P = .437). Asymmetry was found in all groups with the left side being larger than the right (P < .002). Conclusion: This study provides new information on lumbar multifidus cross-sectional area in elite ballroom dancers. Future research needs to examine other causes of LBP in elite ballroom dancers in an attempt to decrease LBP in these athletes.

INTRODUCTION: Low back pain (LBP) is often exacerbated by movement and, during functional movements, people with LBP tend to inherently modify their posture and movement patterns to avoid aggravating their pain further. Therefore, analysis of spinal movement in people with LBP is necessary and may lead to the identification of movement-based clusters for optimal treatment. PURPOSE: The overall purpose of this study was to investigate how movement patterns in people with chronic LBP relate to their subjective level of pain-related disability. First, we determined which spinal movements best discriminate between people with chronic LBP and asymptomatic controls; second, we ascertained whether the level of movement dysfunction in people with chronic LBP correlates with the Oswestry Disability Index (ODI). METHODS: 44 volunteers (26 with current chronic LBP, 15 asymptomatic controls) participated in this study. An OPAL (APDM Wearable Technology) inertial measurement unit (IMU) sensor was attached to the skin over the spinal region of L3-L4, which allowed for transmission of motion data from the lumbar spine. Participants were instructed to perform a series of eleven uniplanar and functional multiplanar spinal movements at a comfortable pace. The median peak angular velocity values from the lumbar spine (measured by the gyroscope component of the IMU) were extracted from MATLAB and Python, and all statistical analyses were subsequently performed in RStudio. RESULTS: From a mixed-direction stepwise regression based on the minimization of the Aikake Information Criterion (AIC), a binomial logistic regression model containing kinematic data from Flexion, Extension-Twist, Axial Rotation, and Sit-to-Stand tasks was selected as the best model to predict chronic LBP status (McFadden’s pseudo-R-squared: 0.310). Moreover, compared to sagittal uniplanar tasks, functional multiplanar movements were better at predicting LBP status (AICmulti-uni = −3.2). Lastly, we found no association between the kinematic data from the movements that best predicted LBP status and ODI scores (p-value = 0.405). CONCLUSION: In this study, we found no correlation between self-reported disability and kinematic median peak angular velocity data from Flexion, Extension-Twist, Axial Rotation, and Sit-to-Stand tasks. Therefore, other factors that may modulate physical function, such as psychosocial factors, should be investigated.