Ospecifik ländryggssmärta är den vanligaste typen av ländryggssmärta och saknar identifierbar patoanatomisk orsak, därför har det blivit en utmaning att utveckla effektiva behandlingar. Det saknas nationella riktlinjer i Sverige för fysioterapeutisk behandling av ospecifik ländryggssmärta. Det är oklart vilka typer av åtgärder som idag används av svenska fysioterapeuter.  Syftet med studien var att kartlägga vilka fysioterapeutiska åtgärder för ospecifik ländryggssmärta som används av fysioterapeuter i Sverige samt undersöka om det föreligger eventuella skillnader i val av åtgärd mellan offentligt och privat anställda fysioterapeuter och mellan kvinnliga och manliga fysioterapeuter.  Studien var en kvantitativ tvärsnittsstudie av deskriptiv och komparativ design. Urvalet var ett bekvämlighetsurval bestående av yrkesverksamma fysioterapeuter i Sverige. Data samlades in via en enkät som besvarades av 105 fysioterapeuter.  De mest frekvent använda åtgärderna var information och råd kring fysisk aktivitet, sedan följde information om ergonomi, information om smärtmekanismer, muskelstärkande träning samt träning av rörlighet. Privat anställda fysioterapeuter använde laserterapi (p=0.020), massage (p=0.006), samt yoga (p=0.013) oftare i genomsnitt jämfört med offentligt anställda. McKenzie träningsprogram (p=0.010) var mer frekvent använt av offentligt anställda i genomsnitt. Kvinnliga fysioterapeuter använde aerob träning (p=0.012), akupunktur (p=<0.001), information om ergonomi (p=0.023), träning av balans (p=0.013), träning av bålstabilitet med motorisk kontroll (p=0.012), träning av rörlighet (p=0.016) samt TENS (p=<0.001) oftare än manliga.      Studien visade att det i övrigt fanns mycket likhet mellan grupper men att typen av anställning samt kön kan påverka till en viss utsträckning val av åtgärder. / Nonspecific low back pain is the most common type of low back pain and lacks an identifiable pathoanatomical cause, which makes it difficult to develop effective treatments. There are no national guidelines in Sweden for this condition and it is unclear what methods are currently used by Swedish physiotherapists. The purpose of the study was to map physiotherapeutic measures for nonspecific low back pain used by physiotherapists in Sweden and to investigate whether there are differences between public and private physiotherapists and between female and male physiotherapists. The study was a quantitative cross-sectional study of descriptive and comparative design. The sample was a convenience sample and the data were collected via a questionnaire that was answered by 105 physiotherapists.  The most frequently used methods were information and advice on physical activity, followed by information about ergonomy, information on pain mechanisms, muscle-strengthening training and training of mobility. Laser therapy (p=0.020), massage (p=0.006) and yoga (p=0.013) were more often used by public physiotherapists while McKenzie training programme (p=0.010) was more often used by public physiotherapists. Female physiotherapists used aerobic training (p=0.012), acupuncture (p=<0.001), information about ergonomy (p=0.023), training of balance (p=0.013), training of core stability with motorical control (p=0.012), träning of mobility (p=0.016) and TENS (p=<0.001) more often than male physiotherapists.  The study showed that there were strong similarities between groups but that the type of employment and gender can affect to a certain degree the choice of measures.

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.

No description available.

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.

Given the prevalence and cost of low back pain, particularly among workers' compensation patients, it is advantageous to understand how various psychological constructs may be related to prolonged disability and failure to return to work. Malingering is a psychological construct that is clearly relevant for worker compensation populations and is a construct that is well suited for experimental control within an analog study. Malingering is the intentional exaggeration of physical or psychological symptoms that are motivated by external incentives such as time away from work. The ability to detect malingering in such a population with psychological assessments is unclear. An analog study was conducted in which we instructed college students to portray themselves as injured workers who received a back injury that required them to be off work while they recovered. Students were then told that they would be seeing a psychologist who would attempt to ascertain their abilities to return to work via the MMPI-2. Students were then randomly instructed to respond to the MMPI-2 in three different ways: a control condition was instructed to respond as if they suffered a workplace back injury that resulted in significant pain; a subtle fake-bad condition who received the control instruction plus were informed they did not enjoy their work and their back injury allowed them to enjoy personal and family time more; and a fake-bad condition that received the control instruction plus were asked to deliberately portray themselves as experiencing physical symptoms severe enough to keep them off work longer. Currently, no assessment of malingering exists within a compensated low back pain population. The purpose of this study was to determine if the MMPI-2 can be used to differentially identify "patients" who are instructed to report symptoms veridically versus "patients" instructed to consciously feign and magnify symptoms in an effort to avoid returning to work. Malingering and non-malingering patients' scores on the MMPI-2 validity and clinical scales were subjected to a cluster analysis to determine if a malingering profile could be accurately identified. A 5-cluster validity solution and 4-cluster clinical (both with K correction) solution were accepted. Substantially lower scores on L and K, elevated scores on F on the 5-cluster validity solutions, distinguished the "malingering" profile. The 4-cluster clinical solution was characterized by elevated scores on the clinical scales of hypochondriasis, depression, paranoia, and schizophrenia, which distinguished the "malingering" profile. The results indicate that the MMPI-2 could be useful in detecting malingering in compensated back pain patients. Results are discussed in the context of pain studies.

No description available.

Propósito: Analizar si la adición de un espaciador interespinoso o la fusión intersomática ofrece ventajas en relación con la microdiscetomía aislada en el tratamiento de la hernia discal lumbar. Métodos: Pacientes con hernia de disco lumbar que iban a someterse a cirugía fueron elegidos para participar. En este estudio de cohorte los pacientes se dividieron en 3 grupos; Microdiscectomía sola (MD), microdiscectomía más espaciador interespinoso (IS) y fusión intersomática lumbar posterior (PLIF). La medida de resultado primaria fue la eficacia clínica mediante el índice de discapacidad de Oswestry (ODI). También evaluamos varios otros parámetros de resultado, entre los que se incluyeron: escala analógica visual para el dolor (EVA) de espalda y piernas, duración de la estancia, coste desde el ingreso hasta el alta hospitalaria, tasa de complicaciones de 90 días y tasa de reoperación tras 1 año. Resultados: Se incluyeron un total de 103 pacientes cuya edad media fue de 39,1 (± 8,5) años. En los 3 grupos se detectó una mejora significativa de la puntuación inicial del dolor de espalda y piernas con ODI y EVA. Las puntuaciones del ODI cambiaron de 62.66 a 13.77 en el grupo MD, 62.93 a 13.50 en el grupo IS, y 59.62 a 17.62 en el grupo PLIF (p <0.001). Después de 1 año, no se encontraron diferencias significativas en el ODI, ni en la EVA de espalda y piernas entre los 3 grupos. Hubo un aumento del 169% en el coste hospitalario en el grupo IS y del 287% en el grupo PLIF, en relación con la MD (p <0,001). La duración de la estancia fue un 86% mayor en el grupo IS y un 384% más en el grupo PLIF en comparación con MD (p <0,001). Las tasas de reoperación a 1 año fueron de 5,6%, 10% y 16,2% (p = 0,33) en los grupos MD, IS y PLIF respectivamente. Conclusión: La mejoría clínica parece deberse a la microdiscectomía, sin que el implante (interespinoso o fusión) agregue ningún beneficio. La adición de espaciador interespinoso o fusión no protegió contra la reoperación, y aumentó la duración de la estancia hospitalaria y los gastos quirúrgicos.

Bakgrund: Graviditetsrelaterad bäcken- och/eller ländryggssmärta kan bero på hormonella och biomekaniska förändringar som vanligen efter förlossningen. Dock kan kvinnor få ihållande smärtbesvär vilket kan påverka funktion och livskvalitet. Bäckenbottenträning, statisk bålträning och dynamisk bålstabiliserande träning har liknande effektmekanism för smärtlindring. Riktlinjer kring fysisk träning efter förlossning saknar en uppdaterad evidensbild för dess smärtlindrande effekt. Syfte: Syftet var att sammanställa evidensläget samt bedöma evidensstyrkan för den smärtlindrande effekten av bäckenbottenträning, statisk bålträning samt dynamisk bålstabiliserande träning vid smärta i bäcken- och/eller lumbalregion efter förlossning.  Metod: En systematisk litteraturöversikt genomfördes med artikelsökning på databaserna PubMed, Cinahl, PEDro och Cochrane. Varje artikel granskades enskilt av respektive författare utifrån en granskningsmall innan en gemensam sammanställning utfördes. Evidensgradering utifrån varje träningsform genomfördes med GRADE. Resultat: Nio randomiserade kontrollerade studier inkluderades med 499 kvinnor där fysisk träning visades ge en smärtlindrande effekt på postpartumsmärta i bäcken- och/eller ländrygg med genomsnittlig metodologisk kvalitet på 50 poäng. Dynamisk bålstabiliserande träning inkluderade sex studier och bäckenbottenträning två studier, samtliga med låg tillförlitlighet (⨁⨁◯◯). Statisk bålträning inkluderade en studie med mycket låg tillförlitlighet (⨁◯◯◯) enligt GRADE. Konklusion: Fysisk träning kan användas som behandling vid postpartumsmärta i bäcken- och/eller ländrygg. Evidensgraden behöver höjas genom fler studier, fler deltagare och blindad resultatuppföljning. / Background: Pregnancy-related pelvic girdle pain and/or low back pain is commonly caused by hormonal or biomechanical changes and tends to disappear after giving birth. However, some women are affected by the pain for an extended period, which will affect their functional status and quality of life. Pelvic floor exercises, static core exercises and dynamic core stabilisation exercises have a similar mechanism behind the pain-relieving effect. Guidelines for physical exercise after childbirth lack an updated picture of evidence for the pain-relieving effect. Purpose: The purpose of this review was to gather evidence and evaluate the strength of the evidence in relation to the pain-relieving effect of pelvic floor exercises, static core exercises, and dynamic core stabilisation exercises on pelvic girdle pain and/or low back pain after childbirth. Method: A systematic literature review was carried out and articles were gathered from the databases PubMed, Cinahl, PEDro and Cochrane. Each article was analysed individually by each author using a review template before a collective assessment was made. GRADE was used to rate the evidence for each form of physical exercise.  Results: Nine randomised controlled trials were included with 499 women where physical exercise was used to try and treat postpartum pelvic girdle pain and/or low back pain with a mean methodological quality of 50 points. Six studies evaluated dynamic core stabilisation exercises and two reviewed pelvic floor exercises, all with an overall low reliability (⨁⨁◯◯). Static core exercise was assessed in one study with very low reliability (⨁◯◯◯) according to GRADE. Conclusion: Physical exercise can be used as a treatment for pelvic gridle pain and/or low back pain postpartum. The level of evidence for each form of physical exercise needs to increase through more studies, more participants and blinded outcome follow-up.

The diploma thesis evaluates the morphology of the abdominal wall muscles focusing on the assessment of lateral symmetry in elite female floorball players and its relationship with the occurrence of back pain in these players. The theoretical part of the thesis includes an overview of the physiological mechanisms of postural stabilization in comparison with deviations in patients with back pain and describes the principles of sonographic examination and its use in physiotherapy. The theoretical part is also focused on the imagining of the abdominal muscles and the summary of specific findings in floorball players and other athletes, with a predominant one-sided load related to the biomechanics of movement in these sports. Methodology: A total of 20 female players of the highest floorball competition in the Czech Republic participated in this research. The linear parameters of the abdominal muscles (m. RA, m. TrA, m. OI and m. OE) and the whole lateral abdominal muscles were measured in players on both sides at rest using sonography. The participants also filled in an electronic questionnaire evaluating back pain. Results: Significant lateral asymmetry of linear parameters of abdominal muscles was demonstrated in the work (p = 0,017; d = 0,52). The relationship between the lateral asymmetry and the...

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.