<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>

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Background: Approximately 40% of low back pain cases are attributed to internal disc disruption. Since mechanical loading directly affects intradiscal pressure and the stresses that the inner annulus fibrosus experiences, the mechanism that leads to disruption of the inner annulus fibrosus may be linked to changes in intradiscal pressure. Hence, there is a need to examine how intradiscal pressure changes over time during a flexion extension cyclic (FEC) loading protocol known to induce internal disc disruption. Purpose: 1) To determine whether a bore-screw pressure sensor system could be used as an alternative sensor for measuring intradiscal pressure, and 2) to characterize changes in intradiscal pressure, moments, and axial deformation using a FEC loading protocol. Study 1 summary: Technical specifications of the bore-screw pressure sensor system were compared to the needle pressure sensor. The error projected at a static compressive load of 1500 N was approximately eight percent and the bore-screw pressure sensor had an excellent dynamic response compared to the needle pressure sensor. Study 2 methods: The bore-screw pressure sensor system was successfully instrumented in 14 porcine specimens. The FEC loading protocol consisted of 3600 cycles of 1 Hz flexion-extension movement while applying a 1500 N compressive load. The four dependent variables collected were intradiscal pressure, moment, axial deformation, and angular displacement. Study 2 results: Intradiscal pressure and specimen height decreased by 45 % and 62 %, respectively, and the peak moment increased by 102 % following the FEC loading protocol. There were strong correlations between average intradiscal pressure and both peak moment and average axial deformation. The angle where maximum pressure occurred demonstrated a significant difference after 2700 cycles. There were no sequential changes in pressure difference after 2100 cycles. Twelve out of 14 specimens showed partial herniation (85.7%); however, the injury type was not correlated to the pressure change. Conclusions: Changes in intradiscal pressure were successfully characterized over time using a new pressure sensor system. Although the change in pressure difference was not predictive of an injury type, its increasing trend over time suggested that the inner annulus fibrosus failure mechanism may be related to fatigue.

Summary: Low back pain is the most common reason for referral to musculoskeletal care in the Canadian military. With healthcare seeking for musculoskeletal care rising over the past five years, and healthcare easily accessible for all military personnel, it is important to investigate factors that may contribute to high usage of the military healthcare system. Objective: To explore the association between LBP prognostic factors and musculoskeletal healthcare seeking for LBP in Canadian military population Methods: Historical cohort study, using data linkage. Results: In our exploratory analysis, fear of movement/(re)injury, Veterans Affairs compensation status, post-traumatic stress disorder, previous high use of musculoskeletal services, history of LBP, and military duty status were associated with healthcare seeking. For our confirmatory analysis, pain-related fear had an independent association with healthcare seeking in this population. Conclusion: Psychological and social factors are associated with the rate of musculoskeletal healthcare seeking in this military population.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014. / Flexion distraction chiropractic technique (FDCT) is a commonly used manual therapy technique which is purported to address various clinical pain syndromes. However, it lacks the credibility of appropriate evidence-based guidelines. An analysis of the literature would be able to inform the development of guidelines. Objectives: The aim of this systematic review was to determine the evidence to support the use of FDCT in clinical practice. Data sources: A systematic review of PubMed and Summons was conducted, using the following search terms: chiropractic, flexion distraction, protocol and / or technique. Study selection: All electronic or paper, English articles, which possessed the required key indexing terms and represented randomised and non-randomised controlled study designs were included. Data extraction: Blinded review of the articles was conducted by three independent reviewers utilising the PEDro (for randomised controlled trials) and NOS for (non-randomised controlled trials). This allowed the methodological rigour of the article to be ranked. This ranking was compared to a critical appraisal of the article in order to achieve an overall decision with regards to the contribution of the article to the level of evidence for FDCT. Data synthesis: 18 review outcomes were aggregated around four clinical categories; two articles each on neck pain, chronic pelvic pain, and physiological outcomes and the remaining twelve on low back pain. There was agreement that the evidence for pelvic pain and physiological function was limited to no evidence and limited respectively. Conflicting evidence existed for neck and low back pain (single and multimodal treatment) with limited and moderate evidence respectively. Conclusion: FDCT is clinically advocated for many conditions. The evidence provided in this review indicates that practitioners should be guarded in their use of FDCT, as the evidence to its widespread use is limited to only those conditions noted in this review. Therefore, further high quality and rigorous studies are required to develop appropriate treatment guidelines for use by practitioners to adequately provide evidence based care in clinical practice.

Darbo tikslas – palyginti dviejų skirtingų kineziterapijos programų poveikį pacientų funkcinei būklei esant skausmui dėl juosmeninės stuburo dalies disko išvaržos. Uždaviniai: 1. Įvertinti kineziterapijos programos vandenyje efektyvumą: skausmui, funkcinei būklei, juosmens–dubens srities stabilumui ir judesių valdymui bei statinei liemens raumenų jėgos ištvermei. 2. Įvertinti kineziterapijos programos salėje efektyvumą: skausmui, funkcinei būklei, juosmens–dubens srities stabilumui ir judesių valdymui bei statinei liemens raumenų jėgos ištvermei. 3. Palyginti kineziterapijos vandenyje ir kineziterapijos salėje programų efektyvumą: skausmui, funkcinei būklei, juosmens–dubens srities stabilumui, judesių valdymui bei statinei liemens raumenų jėgos ištvermei. Metodai: 1. Literatūros šaltinių analizė. 2. Anketinė apklausa. 3. Skausmo intensyvumo vertinimas naudojant skaičių analogijos skalę (SAS). 4. Juosmens–dubens srities stabilumo vertinimas naudojant slėgio matavimo prietaisą su grįžtamuoju ryšiu „Stabilizer“. 5. Juosmens–dubens srities valdymo funkcijos įvertinimas 5 testų rinkiniu pagal Hannu Luomajoki. 6. Nugaros ir pilvo raumenų statinės jėgos ištvermės vertinimas statinės atlikties testais. 7. Testų atlikties filmavimas ir vaizdinės medžiagos analizė. 8. Matematinė statistinė analizė. Tyrimas atliktas VšĮ Vilkaviškio ligoninė. Tyrime dalyvavo 28 tiriamieji (16 moterų ir 12 vyrų), kurie atsitiktine tvarka buvo suskirstyti į dvi grupes: kineziterapija vandenyje (n=14) ir... [toliau žr. visą tekstą] / Aim: to study and to compare impact of different kinezitherapy programs on a functional state of a patient in case of pain due to spinal hernia of waistline. Objectives: 1. to assess the efficiency of kinezitherapy program in water in terms of pain, a functional state, stability of waist – coxa area , management of movements and stamina of static waist muscles’ power; 2. to assess the efficiency of kinezitherapy program in a gym in terms of pain, a functional state, stability of waist – coxa area , management of movements and stamina of static waist muscles’ power; 3. to compare the efficiency of kinezitherapy program in water and in a gym in terms of pain, a functional state, stability of waist – coxa area, management of movements and stamina of static waist muscles’ power. Methods: 1. Analysis of literature sources; 2. Questionnaire; 3. Pain efficiency assessment via the Digital Analog Scale (DAS); 4. Assessment of stability of waist – coxa area with a pressure measurement device with a feedback “Stabilizer“. 5. Assessment of waist – coxa area management function with 5 test kit of Hannu Luomajoki. 6. Assessment of static power stamina of back and abdominal muscles by static exercising tests. 7. Shooting of test exercising and analysis of video material. 8. Mathematical statistical analysis. Research has been conducted at the Public Enterprise Vilkaviškio ligoninė. A total number of respondents: 28 (16 females and 12 males), divided in two groups randomly: kinezitherapy... [to full text]

Movement of different body segments is an essential component for the control of postural stability. Notably, balance impairment has been reported in individuals with chronic low back pain. Various impairments that are likely to affect postural control have been reported in this population, including proprioceptive deficits and altered control of movement at the lumbopelvic region. Although little is known about how movement of the lumbar spine contributes to postural control, spinal movement is likely to be part of the movement strategy when the multisegmental nature of the human body configuration is taken into consideration. The overall objective of this thesis was to investigate the changes in postural stability in individuals with chronic LBP, and the association with altered movement control at the lumbar spine. The control of postural stability was examined with different postural challenges while standing on either a flat surface or a short base. A short base was used to force the subjects to use a “hip strategy”; movement at the lumbopelvic region for postural correction. Kinematics of different body segments including the lumbar spine and hip were recorded to study the movement of the lumbopelvic region. In addition, ground reaction force data were collected with a force platform system to examine postural adjustments during various postural tasks. The studies showed that people with chronic low back pain have difficulty maintaining stance, with increased risk of overbalancing when standing on a short base without any perturbation. Altered motion of the lumbar spine was evident during both expected and unexpected postural perturbations, which indicated impairment of both anticipatory and feedback control of lumbar motion in individuals with chronic low back pain. In addition, subjects took longer to regain postural stability and made more postural adjustments during the recovery period after expected and unexpected perturbations. Together, the studies suggested significant contribution of changes in lumbar motion to postural impairment in people with chronic low back pain. In summary, these findings provide further evidence that spinal movement plays a critical role in the maintenance of postural stability, and altered control of movement affects the quality of postural control in individuals with chronic low back pain.

Low back pain (LBP) remains one of the most common and challenging primary care issues in the developed world. Manual occupations such as nursing are known to involve a high risk of occupational LBP, which is associated with enormous health care expenditure as well as indirect work and disability-related costs. Despite extensive efforts to reduce LBP in nurses, evidence supporting the efficacy of any specific intervention to prevent LBP is limited. / The majority of LBP prevention strategies are directed at occupational risk factors in working nurses. However, as there is some evidence that LBP is already a significant problem in nurses prior to commencing full time employment, it is proposed that nursing students should be the focus of prevention interventions. This would require prevention interventions targeting personal rather than occupational LBP risk factors. As the best personal predictor of future LBP is currently a previous history of LBP, further investigation of modifiable personal LBP risk factors is required. Consequently, the aim of this doctoral research was to identify modifiable personal characteristics that predict LBP in nursing students. / Firstly, a large survey was conducted on undergraduate nursing students and recently graduated nurses to determine patterns of LBP prevalence. Results from this study indicated that LBP prevalence was very high at the commencement of undergraduate training. Prevalence of LBP did not significantly change during nursing training, but did increase further in the first year of commencing work as a nurse. This increase may be partly explained by the reported increase in occupational exposure to bending and lifting. Age was consistent across the undergraduate year groups and did not influence these findings. It was concluded that nursing students would provide a sufficient number of new-onset LBP episodes (and thus sufficient statistical power) for a prospective study design. Further, as these nursing students were not yet exposed to the occupational LBP risk factors of working nurses, a clearer indication of the influence of modifiable personal factors on the development of LBP could be determined by examining a student cohort. / A cross-sectional study investigating the influence of personal physical, psychological and social/lifestyle factors was then conducted on nursing students. Preliminary analysis revealed clear gender differences across multiple domains. Therefore, the focus of further analysis was on the larger female sample. / In Part 1 of the cross-sectional study, an investigation of regional differences in lumbar spine posture and movement was undertaken. Analysis of spinal kinematics in this study supported and extended previous literature that has found global lumbar spine kinematics do not accurately reflect the kinematics of the upper lumbar or lower lumbar spinal regions in common postures and movements. Rather, these two regions have a degree of functional independence. This finding has implications for interpretation of measures of spinal posture, motion and loading. Further, body mass index influenced regional lumbar posture and movement, possibly representing adaptation due to load. It was concluded that regional rather than global lumbar spine measures needed to be investigated in further analyses of this doctoral research. / In Part 2 of the cross-sectional study, personal characteristics associated with LBP were investigated. Approximately one third of all subjects reported significant LBP in the 12-months preceding the study. Analysis of factors associated with LBP supported the biopsychosocial nature of LBP. Higher stress levels and use of passive coping strategies, increased physical activity levels, holding the lower lumbar spine further from end-range flexion during functional tasks and increased age, all contributed independently to the presence of LBP. These findings supported the hypothesis that modifiable personal characteristics were associated with LBP. / The importance of identifying sub-groups of LBP patients has become widely accepted. In Part 3, further exploratory analysis was conducted on this crosssectional data to determine if differences in physical and psychological characteristics were evident in two defined sub-groups of female nursing students with LBP. These sub-groups were based on O’Sullivan’s mechanism based classification system. Results indicated that two sub-groups of LBP subjects had differing physical and psychological characteristics associated with their LBP. Further, control subjects could be distinguished from each of these two sub-groups by different factors. These findings add validity to O’Sullivan’s LBP classification system. Further, the findings may suggest that different combinations of psychological and physical factors are linked to LBP in different sub-groups in this population, and therefore may require different intervention approaches based on these factors. / In the final stage of this doctoral research, the cohort of female nursing students was followed prospectively for 12-months. The focus of further analysis was on identifying modifiable personal predictors in a sub-group of subjects with new-onset LBP. The results of this study strongly supported that personal factors from multiple domains are predictors of new-onset LBP. After controlling for previous LBP, age and body weight, regression analysis identified that smoking, increased physical activity levels (both exercise and spinal loading), higher stress levels, reduced back muscle endurance, greater posterior pelvic tilt in slump sitting and more accurate spinal repositioning in sitting were all independent predictors of new-onset LBP. These findings have implications for the development of prevention and management interventions for LBP in nurses. / Results from this doctoral investigation support the multi-factorial and biopsychosocial nature of LBP. The important distinction of this research when compared to previous work is the selection of a cohort at the beginning of their working life, with a focus on modifiable personal, rather than occupational factors, associated with LBP. Factors from physical, psychological and social/lifestyle domains were all independently associated with significant new-onset LBP in female nursing students. Interventions utilising a prevention approach that targets modifiable characteristics, such as those identified in this cohort of nursing students, may have the potential to reduce the impact of occupational LBP in this group. These preliminary findings have important implications for future LBP research and clinical interventions.

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.