Low back pain (LBP) is the top reason for Soldiers to seek medical care and one of the top reasons to be medically discharged. Mental health problems and psychosocial stressors have been increasing in Soldiers and are also top causes for medical discharge. Dysregulated stress has contributed to many Soldiers and Veterans to develop chronic LBP as well as mental health disorders like post-traumatic stress disorder (PTSD). Research suggests that psychosocial characteristics, as opposed to physical factors or tissue health, contribute to chronic pain the most. Focusing entirely on tissues for individuals seeking care for LBP can increase disability and vulnerability. Attributing physical pain to mental health concerns, however, risks stigmatizing patients or making them feel dismissed. The purpose of this dissertation was to develop a pain neuroscience education (PNE) program for Veterans and Soldiers with LBP and stress and determine if PNE is more effective in improving disability, PTSD symptoms, and beliefs about pain compared to traditional education about back pain and stress. This dissertation demonstrated that Veterans with PTSD can comprehend the neuroscience of pain and PTSD at a comparable level to a highly educated Veteran and medical panel without PTSD when adjusting for education. Since a proportion of participants were concerned that using military examples in PNE might increase PTSD symptoms, however, results from pilot testing suggested that the PNE materials developed for this dissertation should be tested in a clinical trial to ensure they do not increase PTSD symptoms. A systematic review and meta-analysis demonstrated that Veterans with PTSD have higher depression and pain-catastrophizing beliefs for a large effect size compared to Veterans without PTSD. Furthermore, Veterans with PTSD have significantly lower pain self-efficacy with a large effect size. Compared to Veterans without PTSD, Veterans with PTSD have higher pain and disability. These results, however, were not confirmed in Veterans presenting to a Physical Therapy clinic. In fact, this dissertation revealed that many of the negative outcomes previously attributed to PTSD in the literature may be due to the correlation between PTSD symptoms and pain-catastrophizing beliefs rather than from trauma. Furthermore, Veterans with chronic LBP do not appear to have different sensitivity levels to pressure based on PTSD symptoms. Finally, the results from a randomized controlled trial provide evidence that PNE greatly improves the confidence of Veterans and Soldiers to increase participation in social, work, and life roles despite the pain as measured by the pain self-efficacy questionnaire. Participants in the experimental group were more likely to achieve a meaningful reduction in disability at the 8-week follow-up compared to the control group. Furthermore, Veterans and Soldiers with LBP were more satisfied with how PNE explains pain and believed the PNE curriculum connected with their military experiences better than traditional psychosocial education about stress. Participants in the experimental arm were less likely to believe that exercise is harmful compared to traditional education. Finally, PNE improved PTSD symptoms beyond the clinically meaningful threshold in the experimental arm. In conclusion, PNE appears to be an effective treatment for PTSD, disability, and pain-related beliefs in Veterans and Soldiers with chronic LBP. These results should be replicated in a larger sample to ensure generalizability beyond the current study.

Abnormal lumbar movement has been observed in individuals who have a history of low back pain (LBP). Affected individuals display a reduction in lumbar spine rotation during trunk movement tasks, while pelvic rotation increases to compensate. Reduced lumbar contribution to forward bending is associated with increased compressive forces and increased shearing demand of the task on the lower back. This abnormal lumbo-pelvic coordination (LPC) can persist beyond LBP symptom alleviation and may contribute to further occurrences or more severe cases of LBP. This study serves as a first step in investigating if abnormal LPC can be corrected with a hip orthosis by examining the effects of the device on the LPC of healthy individuals. Twenty participants without presence or history of LBP were recruited to participate in a repeated measures study, completing trunk motion tasks with and without a hip orthosis. In a random order, participants completed forward bending and backward return, lateral bending to the left and right, and axial twisting to the left and right. Thoracic, lumbar, and pelvic rotation along with lumbar-thoracic ratio (LTR) were calculated for each of the movement tasks. Thoracic rotation (total trunk movement) was not significantly altered (p > 0.05, F=0.633) by the application of the hip orthosis. LTR was significantly increased (p < 0.001, F=2.96) with the orthosis by 32%, 22%, 12%, 4%, and 12% for axial twisting left, axial twisting right, lateral bending left, lateral bending right, and forward bending, respectively. This indicates lumbar contributions were increased by physically restricting the pelvis. The effects of a hip orthosis should be further investigated in LBP patients to verify correction of an abnormal LPC.

There is a practice gap in the self-management education of patients with chronic low back pain. Insufficient self-management leads to increased frequency of flare-ups of low back pain, disability, loss of productivity, and increased cost of health care. The guiding practice-focused question was focused on the unmet self-management support needs of the chronic low back pain patients in a Midwestern state local pain clinic. The purpose of this descriptive cross-sectional study was to ascertain the unmet needs of patients' self-management support by analyzing the results of a patient study performed by this clinic. The theoretical principles of the model for evidence-based practice change, the chronic care model, and the middle-range theory of self-care of chronic illness were used. The evidence included the analysis of the Patient Assessment of Chronic Illness Care Survey (PACIC) data from 100 patients treated in this pain clinic. The clinic used the PACIC questionnaire to collect data from its 100 chronic low back pain patients, selected by simple random sampling method. The average weighted scores of these patients' responses were below the norm on all PACIC subscales and summary scores. According to study results, this pain clinic did not meet the self-management support needs of its chronic low back pain patients. Evidence-based recommendations were made for the improvement in the medical model of patient care by including nurse-led patient education and support. The positive social change is the improvement in the health status of this growing health population by meeting their identified education and support needs. Positive results from this nurse-led intervention could lead to the dissemination and widespread implementation of these recommendations in other pain clinics.

Epidemiological evidence suggests an association between exposure to non-neutral working postures and work-related musculoskeletal disorders (MSDs) of the low back and shoulder. Accurate and precise quantitative estimation of exposure to non-neutral working postures is, therefore, essential for evaluating worker risk, developing and testing ergonomic interventions, and improving worker health and well-being. Current methods used to directly estimate occupational exposure to non-neutral postures may be obtrusive, often lack sufficient portability for field use, and have limited accuracy and precision when used to measure dynamic or complex motions. Inertial measurement units (IMUs) are emerging instrumentation devices that measure and report an object's orientation and motion characteristics using multiple electromechanical sensors (i.e., accelerometers, gyroscopes, and/or magnetometers). They have been observed to accurately monitor body kinematics over periods of relatively short duration in comparison to laboratory-based optical motion capture systems. Limited research, however, has been performed comparing exposure information obtained with IMUs to exposure information obtained with other field-capable direct measurement exposure assessment methods. Furthermore, insufficient information on the repeatability of IMU-based estimates over a substantial time period (e.g., a full work shift) and inadequate knowledge regarding the effects of different IMU sensor configurations and processing methods on the accuracy and repeatability of estimates of exposure obtained with IMU systems contributes to a lack of their use in epidemiological field studies. This thesis was designed to address these issues and expand upon the current scientific literature regarding the use of IMU sensors as direct measurement devices for assessing exposure to non-neutral working postures in the field. Chapter I provides a background and justification for the work. Chapter II presents the findings of a laboratory-based, manual material handling study that was performed to compare estimates of thoracolumbar trunk motion obtained with a commercially available IMU system with estimates of thoracolumbar trunk motion obtained with a field-capable reference system, the Lumbar Motion Monitor (LMM). The effects of alternative sensor configurations and processing methods on the agreement between LMM and IMU-based estimates of trunk motion were also explored. Chapter III presents the results of a study performed to evaluate the accuracy and repeatability of estimates of trunk angular displacement and upper arm elevation obtained with the IMU system examined in Chapter II over the course of an eight-hour work shift in both a laboratory and field-based setting. The effects of alternative sensor configurations and processing methods on the accuracy and repeatability of estimates of trunk angular displacement and upper arm elevation obtained with the IMU system were also studied. Chapter IV presents the results of a randomized, repeated measures intervention that demonstrates the utility of the IMU system examined in Chapters II and III as a direct measurement instrument for comparing "ergonomic" and conventional examination equipment commonly used by ophthalmologists. Finally, Chapter V summarizes the major findings, discusses their practical implications, and provides suggestions for future research.

<p>Low back pain (LBP) is a growing health and socio-economic problem worldwide, affecting humans from adolescent to adult age. In developed countries, more than 80% of adults are at risk of suffering a disabling episode of LBP at one point during their life time. In developing countries, particularly in Africa, the life time prevalence of LBP varies in population groups, but the disability due to LBP is increasing. The aetiology of LBP is multifactorial, and there is still no consensus on the exact cause and contributing factors to LBP. In addition, little is known about patients&rsquo / knowledge and beliefs on the contributing factors to their LBP. The current study therefore, aimed to identify patients&rsquo / knowledge, attitudes and beliefs on the contributing factors to LBP, among patients attending physiotherapy outpatient departments in Malawi.</p>

Chronic neck pain, a common cause of disability, seems to be the result of several interacting mechanisms. In addition to degenerative and inflammatory changes and trauma, psychological and psychosocial factors are also involved. One common type of trauma associated with chronic neck pain is whiplash injury; this sometimes results in whiplash-associated disorder (WAD), a controversial condition with largely unknown pathogenetic mechanisms. We studied the prevalence of chronic neck pain of traumatic and non-traumatic origin and compared the prevalence of, sociodemographic data, self-perceived health, workload and chronic lowback pain in these groups. In a ready-made questionnaire (MONICA study), we added questions about cervical spine and low-back complaints. 6,000 (72%) completed a self-administered questionnaire. 43% reported neck pain: 48% of women and 38% of men. Women of working age had more neck pain than retired women, a phenomenon not seen in men. 19% of the studied population suffered from chronic neck pain and it was more frequent in women. A history of neck trauma was common in those with chronic neck pain. Those with a history of neck trauma perceived their health worse and were more often on sick-leave. About 50% of those with traumatic and non-traumatic chronic neck pain also had chronic low-back pain. We assessed the subjective and objective neuropsychological functioning in 42 patients with chronic neck pain, 21 with a whiplash trauma, and 21 without previous neck trauma. Despite cognitive complaints, the WAD patients had normal neuropsychological functioning, but the WAD group especially had deviant MMPI results—indicating impaired coping ability and somatization.WAD patients had no alterations in cerebral blood-flow pattern, as measured by rCBF-SPECT and SPM analysis, compared to healthy controls. This contrasts with the non-traumatic group with chronic neck pain, which showed marked blood-flow changes. The blood-flow changes in the non-traumatic group were similar to those described earlier in pain patients but— remarkably enough—were different from those in the WAD group. Chronic neck pain of whiplash and non-traumatic origin appears to be unique in some respects. A better understanding of the underlying pathological mechanisms is a prerequisite for prevention of the development of such chronic pain syndromes and for improvement of the treatment of patients with severe symptoms.

The project has aimed to develop a new kind of back assistive device to reduce the risk of low back problems, mainly focused to industries and workplaces where manual handling are frequently occurring. The idea for the project was introduced in spring 2010, when Martin Paulsen performed internship at Bioservo Technologies AB located in Stockholm. Bioservo Technologies had developed a force-enhancing glove, which responds to the user's movements and produces an assisting grip force, similar to the user´s own muscles. During the training period Martin Paulsen began to consider other features of the technology, which led to this thesis. This project is owned by Bioservo Technologies, conducted by Herbert Eriksson and Martin Paulsen from the Biomechanical program at Halmstad University. The aim has been to develop an idea for a future product for Bioservo Technologies. The goal of the product that has been to reduce the risk of low back problems, mainly the cases of low back pain associated with manual handling at workplaces. In order to find a solution to such complex problems as low back pain, the project has started with three pilot studies. • Literature Study: As this project´s aim has not been to produce a prototype for testing and validation, the project has instead rested heavily on a literature study. The focus of this study was to educate Herbert Eriksson and Martin Paulsen of the problem and the solutions available on the market today. The pilot study can be found as Attachent A: "A literature study about the problems of low back pain and the solutions of today." • Interviews: As the project has been conducted confidentially, no steering group could participate in the project. However, it was important to let the professions that currently work with back problems affect the project, and let their experience and knowledge influence the project. Interviews was instead introduced, and allowed experts to give valuable insight with their unique knowledge on the subject. The pilot study can be found as Appendix B: "Interviews of experts of interest concerning low back pain." • Motion Capture: A measurement of kinematic data was conducted to capture the spine motion for further analysis in Matlab, and to explore the feet´s load patterns while manually lifting. The pilot study can be found as Appendix C: "A Study of Healthy adult's foot pressure pattern in a symmetrical lifting task." These three pilot studies together form a platform for the development of the product´s function and theoretical content. While design and material has been left open, the product description focuses on the product's functional design, mechanics and electronics. In order to validate the product's mechanics, has an Appendix named Appendix D: "Calculations of how the angle alpha depends on the variable theta and the dimensions of the external spine" been added as an Appendix. / Projektet har syftat till att utveckla ett nytt sorts rygghjälpmedel för att reducera risken för ländryggsproblem, främst åt industrier och arbetsplatser där manuella lyft är frekvent förekommande. Idéen till projektet föddes redan våren 2010, då Martin Paulsen praktiserade hos Bioservo Technologies AB i Stockholm. Bioservo Technologies AB hade utvecklat en kraftförstärkande handske, som svarar på användarens rörelser och producerar en assisternade kraftutveckling, lik den egna muskelaturen. Under praktikperioden började Martin Paulsen att fundera på andra funktioner för tekniken, vilket ledde till detta examensarbete. Detta projekt är ägt av Bioservo Technologies AB, utfört av Herbert Eriksson och Martin Paulsen från Biomekanikprogrammet på Högskolan i Halmstad. Syftet har varit att utveckla en idé för en framtida produkt åt Bioservo Technologies AB. Målet med produkten som har utvecklats är att reducera risken för ländryggsproblem, främst de fall av ländryggproblem som är associerat med manuella lyft på arbetsplatser. För att finna en lösning på ett sådant komplex problem som ländryggsproblem, har projektet inledds med tre pilotstudier. • Litteraturstudie: Då projektet inte har syftat till att producera en prototyp för testning och validering, har projektet istället fått vila tungt på en litteraturstudie. Fokus med litteraturstudien var att utbilda Herbert Eriksson och Martin Paulsen om problemet, och vilka lösningar som finns på marknaden idag. Pilotstudien står att finna som Appendix A: ”A literature study about the problems of low back pain and the solutions of today”. • Intervjuer: Då projektet har bedrivits konfidentiellt har ingen styrgrupp kunnat delta i projektet. Det var dock viktigt att låta de arbetsgrupper som idag arbetar med just ryggproblem påverka projektet, och låta deras erfarenheter och kunskaper adapteras i projektet. Med anledning av detta genomfördes istället intervjuer och samtal med tre personer, som har givits tillåtelse att belysa projektet med sina unika kunskaper inom ämnet. Pilotstudien står att finna som Appendix B: “Interviews of experts of interest concerning lowback pain”. • Motion Capture: En mätning av kinematisk data genomfördes för att fånga ryggens rörelse för vidare analys i Matlab, samt för att utforska fötternas belastningsmönster vid manuella lyft. Pilotstudien står att finna som Appendix C: “A study of healthy adult's foot pressure pattern in a symmetrical lifting task”. Dessa tre pilotstudier skapade gemensamt en platå för att utveckla produkten teoretiska funktion och innehåll. Då designval och materialval har lämnats öppna har produktbeskrivningen fokuserats på produktensfunktionella utformning, mekanik och elektronik. För att validera produktens mekanik, har en bilagavid namn Appendix D: ”Calculations of how the angle alpha depends on the variable theta and the dimensions of the external spine” framställts.

Low back disorders (LBDs) are the most common musculoskeletal problem among farmers, with higher prevalence rates than in other occupations. Operators of tractors and other farm machinery such as combines and all terrain vehicles (ATV) can have considerable accumulation of exposure to whole body vibration (WBV). The causal relationship between LBDs and WBV is not fully clear; however, it may be different among farmers as their work context and exposure is unique. Objectives: The objectives of the two studies which form two manuscripts or chapters in this thesis were to: 1) investigate the associations between WBV and LBDs among farmers using a) systematic review (manuscript 1) and cohort studies (manuscript 2). Methods: Objective 1: Nine databases were searched using groups of terms for two concepts: ‘farming’ and ‘low back disorder’. Screening, data extraction and quality assessment was performed by two reviewers independently. The population was adult farmers or agricultural workers globally irrespective of sex. The intervention was considered to be WBV exposure, such tractor, combine and ATV use. The control was no exposure or low exposure to WBV and the outcome was low back disorders. No limits in date of publication and type of study design were applied in the literature search, and only full text, English language studies were considered. Objective 2: The data source was the Saskatchewan Farm Injury Cohort Study. In 2007, baseline data were collected on accumulated yearly tractor, combine, ATV operation, as well as several biopsychosocial covariates thought to be associated with LBDs. Follow-up data on LBDs and related symptoms were collected during 2013 (6 year follow-up) and 2014 (1-year). This resulted in two datasets for each of two cohorts: 1) the first cohort with 1,149 farm people who had been followed for six years, and 2) the second with 605 participants who had been followed for one year. Generalized estimating equation-modified Poisson regressions were performed with low back and hip symptoms as the outcome. Results: Objective 1: After 276 full texts screened, we found 12 articles which analyzed WBV as a risk factor for LBD. Three were case-control, 6 cross-sectional and 3 retrospective cohorts. Four studies showed no association between WBV and LBDs, 4 studies showed a positive association and for the remaining 4 studies, results were mixed depending on the exposure or the outcome measure. Objective 2: The adjusted model in cohort 1 found LBDs to be associated to tractor operation for 1-150 hrs/year (RR=1.23, 95%CI 1.05-1.44), 151-400 hrs/year (RR=1.32, 95%CI 1.14-1.54) and 401+ hrs/year (RR=1.34, 95%CI 1.15-1.56). In addition, tractor operation for 151-400 hrs/year (RR=1.95, 95%CI 1.45-2.62) and 401+ hrs/year (RR=1.79, 95%CI 1.32-2.45) was also found to be related to hip symptoms. Although combine operation ≥ 61 hrs/year and ATV operation 81+ days/year was related to LBD in the bivariate analysis in cohort 1, this association did not persist after adjustment for confounders. Due to limited power, no significant bivariate association was found between WBV and either LBDs and hip symptoms in cohort 2. Conclusions: Objective 1: A firm conclusion is difficult due to heterogeneity in statistical strategy, LBDs definition, type of farm commodity, and study design. Direct comparisons and synthesis were not possible. Although retrospective cohort studies tended to show a relationship, future studies with a prospective cohort design can help clarify this association further. Objective 2: Although duration of tractor operation and older age showed with both LBDs and hip symptoms in farmers in cohort 1, the true prospective cohort 2 found no significant association between WBV and LBDs.

No description available.

Su juosmeninės stuburo dalies skausmu, populiariai dar vadinamu juosmens skausmu, bent kartą per gyvenimą susiduria apie 80 proc. žmonių. Ši patologija rimtai komplikuoja gyvenimo kokybę – ją dažnai lydi neigiamos tiek ekonominės, socialinės (pvz., nedarbingumas), tiek psichologinės (pvz., depresija) pasekmės. Medicininiu požiūriu didžiausia problema, susijusi su šia patologija, yra ta, kad itin komplikuotas juosmeninės stuburo dalies skausmo atsiradimo priežasties nustatymas (net 90 proc. atvejų ji yra nespecifinė, nenustatoma tiksli mechaninė disfunkcija, lemianti sutrikimą). Tai žymiai apsunkina gydymo bei reabilitacijos procesą. Vienas novatoriškiausių būdų nugaros skausmo diagnostikai mokslo pasaulyje – šlaunies sukamųjų (rotaciniai) judesių amplitudės klubo sąnaryje rodikliai. Mokslininkų požiūriai šiuo klausimu iki šiol gan kontraversiški. Tad atsižvelgiant į problemos aktualumą bei svarbą kineziterapiauto praktikai, buvo bandoma detaliau patikslinti hipotezę, kad egzistuoja ryšys tarp lėtinio juosmenin��s stuburo dalies nugaros skausmo ir šlaunies sukamųjų judesių amplitudės klubo sąnaryje. Atliktas tyrimas, kurio pagrindiniai uždaviniai buvo šie: 1. Nustatyti ir įvertinti klubo sąnario sukamųjų judesių amplitudę, žmonių jaučiančių lėtinį juosmeninės stuburo dalies skausmą ir palyginti juos pagal lytį bei amžių. 2. Nustatyti ir įvertinti klubo sąnario sukamųjų judesių amplitudę, žmonių nejaučiančių lėtinio juosmeninės stuburo dalies skausmo ir palyginti juos pagal... [toliau žr. visą tekstą] / Around 80% of the population encounter pain in low back part of the spine, commonly also known as low back pain, at least once in the lifetime. This pathology seriously complicates the quality of life: it is oftentimes accompanied by negative economic and social consequences (e.g. incapacity for work) as well as psychological consequences (e.g. depression). From medical point of view, the biggest problem associated with this pathology is that the diagnostics of the reason for emergence of low back pain is extremely complicated (in even 90% of the cases, this reason is non-specific, no accurate mechanical dysfunction is detected that would result in the disorder). This significantly aggravates the treatment and rehabilitation process. One of the most novel ways of diagnostics for the back pain worldwide is the establishment of indicators for hip rotation range of motion in the hip joint. So far, the views of scientists on this issue are rather controversial. Therefore, taking into account the relevance of the problem and its importance for the practice of a physicaltherapist, the objective was to adjust the hypothesis that a particular relation exists between the pain in the low back part of the spine and the hip rotation range of motion in the hip joint. A research has been made to fulfill the following tasks: 1. Definition and evaluation of the hip rotation range of motion of the people suffering from chronic low back pain and their comparison by sex and age. 2... [to full text]