Background: Low back pain (LBP) is considered the leading cause of inactivity and lost employment time. It can be extremely difficult to treat as most conventional therapies have poor success rates. People with LBP need to be made more aware of the diverse and economical treatments available in order to save on expenses and diminish stress. Patients and healthcare professionals have many choices when deciding on the best plan of care; however, it is often difficult to determine which option is best. Objectives: The purpose of this systematic review was to determine if aerobic exercises play a role in reducing pain in the low back. Methods: A computerized electronic search was performed using CINAHL, Medline, and Cochrane Central Register of Controlled Trials with key words including low back pain or lumbar pain combined with aerobic and exercise. Inclusion criteria consisted of studies that were randomized controlled trials or controlled clinical trials, peer reviewed, published in the English language, identified low back pain as the primary concern, and identified aerobic exercises as one of the treatment options. Results: The initial search of the database revealed a total of 40 studies. Hand searching of the references had also revealed an additional 7. Of those 47 studies, 13 were selected as potentially meeting the inclusion criteria. Ultimately, 10 studies were retained for the final results of the systematic review. Conclusion: The evaluations provided evidence to suggest that aerobic exercise has positive effects on subjects with LBP. Aerobic exercise encourages strength, flexibility, and muscular endurance. This outcome has also shown to promote levels of activity, leaving the subject feeling better both physically and mentally.

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Introduction: Low back pain (LBP) is a common, globally occurring, and difficult to treat health issue. In Swedish primary health care, there is an issue with health care providers not using up-to-date practice when dealing with LBP. BetterBack😊 is an evidence-based model of care (MOC) providing guidelines for assessment and treatment of LBP to facilitate working with LBP for caregivers. Purpose: To investigate if patients treated by clinicians educated in the BetterBack😊 MOC in primary care leads to (a) patients having greater improvements in functional impairments and activity limitations according to physiotherapist assessment and (b) are receiving different treatment, compared to controls, compared to usual care. Method: Prospective cluster randomised trial with linear mixed model analysis was used to compare functional impairment and activity limitations based on the Clinical Reasoning and Process Evaluation tool. Chi2-test was used to analyse differences in choice of treatment between groups. Result: Analysis showed statistically significantly greater reduction in level of exercise tolerance and movement related functional impairments (0.25, 95%CI=0.04-0.46, p=0.02) and limitations of dynamic activities of daily living (0.35, 95%CI=0.17-0.69, p=0.04) in the intervention compared to control group. The intervention group was more frequently treated with behavioural medicine interventions and less with manual therapy interventions (18.4% vs. 30.1%, p<0.05) and physical modalities (4.9% vs 10.8%, p<0.05) compared to the control group. Conclusion: The use of the BetterBack😊 MOC can lead to better treatment outcomes, more use of behavioural medicine interventions and less use of manual therapy and physical modalities. / Introduktion: Ländryggssmärta (LBP) är ett vanligt förekommande globalt och svårbehandlat hälsoproblem. I svensk primärvård finns ett problem att vårdgivare inte följer senaste evidens vid hantering av LBP. BättreRygg😊 är ett evidensbaserat vårdprogram med riktlinjer för undersökning och behandling för att underlätta för vårdgivare att möta patienter med LBP. Syfte: Undersöka om patienter som behandlats av kliniker utbildade i BättreRygg😊 i primärvården leder till att (a) patienter, enligt utvärdering av fysioterapeut, har förbättrats mer gällande funktionsnedsättningar och aktivitetsbegränsningar samt (b) behandlas med andra interventioner, jämfört med ordinarie behandling vid tre månaders uppföljning. Metod: Prospektiv klusterrandomiserad studie med mixed model-analysjämförde funktionell och aktivitetsbaserad status genom Clinical Reasoning and Process Evaluation-verktyget. Chi2-test genomfördes för att analyseraskillnader av behandlingsval mellan grupperna. Resultat: Analysen visade att interventionsgruppen hade signifikant mer minskning av aktivitetstolerans och rörelserelaterade funktionsnedsättningar(0,25, 95%CI=0.04-0.46, p=0,02) och relaterade till dynamiska vardagsaktiviteter (0,35, 95%CI=0,17–0,69, p=0,04) jämfört med kontrollgrupp. Interventionsgruppen använde mindre sällan manuell terapi (18,4% vs. 30,1%, p <0,05) samt fysiska modaliteter (4,9% vs 10,8%, p <0.05). Konklusion: BättreRygg😊 kan bidra till bättre behandlingsresultat av LBP, ökat användande av beteendemedicinska åtgärder och minskat användande av manuell terapi och fysiska modaliteter.

The effectiveness of exercise has been increasingly studied as exercise has been popular for the improvement of physical performance and rehabilitation of lumbar spine. A variety of exercises have been used to reduce back pain or spinal degeneration. However, there are no studies to determine effects of exercise on lumbar spine kinematics, including lumbar-pelvic coordination and instantaneous axis of rotation. The current study aimed to examine these lumbar spine kinematical changes due to exercise and therapy. We hypothesized that exercise and therapy will affect the changes of lumbar spine kinematics. Lumbar-Pelvic motions were recorded from 86 healthy subjects while performing lifting and lowering tasks of 10% and 25% of body weight. The influence of exercise was quantified from coefficients of curve-fitting for pelvic and lumbar angles. There was a significant difference (p<0.05) for the range of lumbar motion (distribution, D) between the control group and the cardiovascular exercise group after 12-week program. However, there was no significance for lumbar-pelvic coordination, C. A second study was performed to investigate the changes of instantaneous axis of rotation (IAR) at which trunk angle reached 25º. Results indicated that a superior-inferior location of IAR was significantly (p<0.05) modified by the cardiovascular exercise after 12 weeks, but there was no significant effectiveness of the physical therapy exercise. Finding of lumbar spine kinematics during lifting and lowering a weight which are the most popular manual handling activities may provide great understanding of the exercise effectiveness. Future studies are recommended to assess whether the changes of lumbar spine kinematics lead to the decrease instances of lumbar spine injuries or low back pain. / Master of Science

The stability of the spine can be estimated from kinematic variability and nonlinear analyses of seated balance tasks. However, processing methods require sufficient signal duration and test-retest experiments require that the assessment must be reliable. Our goal was to characterize the reliability and establish the trial duration for spine stability assessment. Stationarity, kinematic variability and nonlinear dynamic stability were quantified from kinetic and kinematic data collected during balance performance. Stationarity results showed that a minimum 30 seconds test duration is necessary. Intra-session reliability was excellent, however inter-session reliability needed more test trials to achieve excellent reliability. Few studies have investigated the spinal stability during pushing and pulling exertions. Past studies suggest that the spine can be stabilized by paraspinal muscle stiffness as well as reflexes. We hypothesized that the stability of the spine decreases with exertion force and decreases during pushing more than during pulling exertion. Kinematic variability and nonlinear dynamic stability measurements were quantified from the balance performance during isometric pushing and pulling tasks. Results demonstrated that spinal stability decreased with exertion force and decreased a greater amount during pushing task than during pulling task. Stiffness alone may be insufficient to stabilize the trunk. Results may be able to be explained by slower reflex delay. The results suggested that pushing and pulling exertions have a potential risk of low-back disorders. / Master of Science

Few studies have investigated the neuromuscular recruitment and stabilizing control of the spine during pushing and pulling exertions. Past theoretical investigation suggest that co-contraction of the of the paraspinal muscles is necessary to stabilize the spine during pushing exertions. We hypothesized greater levels of co-contraction during pushing exertions. Co-contraction of trunk musculature was quantified during isometric pushing and pulling tasks. The mean value of co-contraction during pushing was two-fold greater (p < 0.01) than during extension. Co-contraction has been shown to increase the stiffness of the ankle but this effect has not been demonstrated in the trunk. Trunk stiffness was measured as a function of co-activation during extension exertions. Results demonstrate trunk stiffness was significantly (p < 0.01) greater with co-activation. Trunk stiffness was calculated during isometric pushing and pulling exertions. We hypothesized trunk stiffness would be greater during pushing tasks due to increased levels of co-contraction to maintain stability of the spine. Results demonstrate trunk stiffness was significantly (p < 0.05) greater during pushing compared to pulling exertions. Results suggest that trunk isometric pushing tasks require more co-contraction than pulling tasks enable to maintain spinal stability. Greater levels of co-contraction during pushing exertions caused trunk stiffness to be greater during pushing compared to pulling tasks. Results may indicate greater risk of spinal instability from motor control error during pushing tasks than pulling exertions. Future studies need to consider co-contraction and neuromuscular control of spinal stability when evaluating the biomechanical risks of pushing and pulling tasks. / Master of Science

Low back pain (LBP) is a common occupational problem and continues to be the leading cause of occupational disability.  Among diverse known risk factors, sitting is commonly considered as an important exposure related to LBP.  Both modern living and contemporary work involve increased sedentary lifestyles, including more frequent and prolonged sitting.  At present, however, the causal role of sitting on LBP development is controversial due to the contribution of several moderating factors (e.g., task demands, duration of exposures, and presence of muscle fatigue).  A few studies have assessed low back loads in seated postures, but none has investigated the effects of prolonged sitting or time-dependent variations on spinal structure and spinal loading.  Adverse effects of muscle fatigue on low back pain are well documented, yet the specific relationship between muscle fatigue and sitting-related low back pain are not fully established.  In addition to these fundamental limitations in our understanding of the physical consequences of sitting, there is also little evidence regarding the effects of task requirements on muscle fatigue and spine loading.   Therefore, the main objectives of this work were, in the context of sitting, to: 1) develop and evaluate a method to assess paraspinal muscle fatigue using electrical stimulation; 2) develop and evaluate a method (model) to quantify biomechanical loads on the lumbar spine in a seated posture; and 3) quantify the effects of prolonged seated tasks on low back loads, body discomfort, and localized muscle fatigue (LMF).  The primary hypothesis was that exposure to sitting-related LBP risks is influenced by task requirements and sitting duration.   A muscle stimulation protocol was developed to measure stimulation responses in the lumbar extensors.  A stimulation protocol, which included one conditioning train along with three 16-second stimulation train at 2 Hz, was recommended as appropriate to measure those muscles potentially fatigued during prolonged seated tasks.  A three-dimensional, sitting-specific, fatigue-sensitive, time-dependent, electromyography (EMG)-based biomechanical model of the trunk was developed to investigate the effects of seated tasks and time-dependent variations on lumbosacral loading during sitting. Reasonable levels of correspondence were found between measured and predicted lumbosacral moments under a range of seated tasks.  Lastly, the effects of prolonged sitting and psychosocial work stress on low back were quantitatively identified.  Only prolonged sitting significantly increased trunk flexion angles and led to muscle fatigue.  Relatively weak correlations were found between subjective and objective measures, though the two fatigue measurement methods (based on EMG and stimulated responses) showed a good level of correspondence.   Overall, this work provides a quantitative assessment of biomechanical exposures associated with seated tasks.  The methods developed in this work make a contribution in terms of measurement/modeling approaches that can be used to assess LBP-relevant risks during prolonged sitting.  The results of this work provide a better understanding of the effects of prolonged sitting on the risk of developing sitting-related LBP.  Finally, results regarding the influences of prolonged sitting and psychosocial demands can be used to guide future job design. / Ph. D.

Yes / / Chronic low back pain (CLBP) is a global musculoskeletal challenge, resulting in pain and disability on individuals. Laser therapy can be used to treat CLBP. This review evaluates the effectiveness of laser therapy including high level laser therapy (HLLT) and low level laser therapy (LLLT) on CLBP in relation to pain or functional disability. Methods: The authors conducted a systematic review of randomised controlled trials (RCTs) and searched the Cochrane Library, MEDLINE, CINAHL, AMED and PEDro from their start to June 2015. All studies that met predetermined inclusion and exclusion criteria were appraised with The Cochrane Collaboration’s tool for assessing risk of bias and Critical Appraisal Skills Programme Tools in June, 2015. Findings: Six RCTs met the inclusion criteria: two RCTs reported significant improvement in pain and functional disability with the use of HLLT but with small sample size (n=103); one RCTs (n=61) reported significant improvement and three RCTs (n=215) reported insignificant improvement in pain and functional disability with the use of LLLT. Conclusion: On the strength of the evidence available HLLT and LLLT are not currently recommended to be replaced or be offered in addition to conventional treatment. Further rigorous research is required to confirm the potential use of laser therapy on individuals presenting with CLBP.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.

The Efficacy of Kinesio Taping as an Adjunct Intervention to Traditional Physical Therapy in the Treatment of Nonspecific Acute Low Back Pain: A Prospective Randomized Controlled Trial Background: Acute low back pain (LBP) is a significant health problem worldwide and is one of the leading causes of disability. Objective: The purpose of this study was to examine the effect of Kinesio Taping (KT) on disability, fear-avoidance beliefs, and pain intensity in patients with acute, nonspecific LBP. Research Design and Methods: A prospective, randomized controlled study of consecutive patients referred to physical therapy with a primary complaint of LBP. Seventy-eight patients with acute, nonspecific LBP were randomized to an experimental group that received traditional physical therapy plus KT and a control group that received traditional physical therapy alone. Interventions were administered twice a week for 4 weeks. Assessment tools used were Ronald Morris Disability Questionnaire (RMDQ) for disability, Fear-Avoidance Beliefs Questionnaire (FABQ) for fear-avoidance beliefs, and Numerical Pain Rating Scale (NPRS) for pain intensity. Assessments were conducted at baseline, end of week 1, end of week 2, end of week 3, and end of week 4. Analysis: Repeated measures mixed model analysis of variance (ANOVA) was used to examine the effect of treatment on each variable. The group type was the between-subjects variable and the time was the within-subjects variable. A significance level of .05 was used in the analyses. Results: Both groups showed statistically significant lower disability, fear-avoidance beliefs, and pain levels over time compared with baseline scores (p < .0001). The experimental group showed statistically significant lower RMDQ scores at week 2, 3, and 4 (p < .05), statistically significant lower FABQ-physical activity subscale scores at the end of week 1 (p < .01), at the end of week 2 (p < .01), at the end of week 3 (p < .01), and at the end of week 4 (p < .05), statistically significant lower FABQ-work subscale scores at week 3 (p < .05) and week 4 (p < .01), and statistically significant lower NPRS scores at week 1, 2, 3, and 4 (p < .05). Conclusion: Kinesio Taping can be considered a useful adjunct intervention to reduce disability and pain and to modulate fear-avoidance beliefs in patients with acute, nonspecific LBP.