Musculoskeletal physiotherapy is the most common intervention for chronic low back disorder. Any observation on clinical practice or investigation into the clinical and scientific literature indicates that musculoskeletal physiotherapy encompasses a plethora of treatment modalities and approaches. The aim of the present investigation was to determine the most common intervention(s) that comprise musculoskeletal physiotherapy and to critically explore their empirical therapeutic basis. Two components were highlighted as the most frequently employed interventions; namely manually applied therapy (manual therapy) and exercise(s) to rehabilitate the lumbar spine's stabilising system. In the course of an extensive literature search, work was uncovered that suggested that the mechanisms required for spinal stability could be better facilitated using methods other than those in current clinical use. These discoveries culminated in the creation of a ten-week rehabilitation programme which was primarily developed to facilitate rehabilitation of spinal stabilisation but also permitted an empirical analysis of this component of musculoskeletal physiotherapy. The efficacy of the regime was then assessed in comparison to manual therapy and to a control (an education booklet) in a randomised controlled trial. Following a series of pilot studies, 300 patients with chronic low back disorder were randomly assigned to groups and completed their respective management programmes. Data were collected on pain, disability, handicap, impairment and quality of life prior to entry and at three, six, twelve and twenty-four months post intervention. The results indicated a consistent trend for greater improvement in the spinal stabilisation group in the pain, handicap, impairment, disability, dysfunction and medication variables. These trends reached statistical significance at the three-month follow-up stage as evidenced by quality of life (P = 0.025), at the six-month follow-up stage in pain (P = 0.009) and dysfunction (P = 0.042) and at the one-year follow-up stage in medication (P = 0.007), dysfunction (P = 0.048), disability (P = 0.0098) and quality of life (P = 0.003). It was therefore concluded that the spinal stabilisation programme was a more effective component of musculoskeletal physiotherapy (when analysed in isolation) than manually applied therapy or an education booklet in the management of chronic low back disorder. Various sub-analyses of the data were conducted. Subjects who entered the study with high levels of low back pain (greater than 50 numerical rating scale) demonstrated a statistically Significant reduction in pain levels (P = 0.04) in both the manual therapy group and the spinal stabilisation group in comparison to the education control group at the three-month follow-up stage. These data provide empirical evidence towards the efficacy of these two musculoskeletal physiotherapy management regimes as being effective in pain reduction in comparison to an active control intervention. This has not hitherto been demonstrated on patients with chronic low back disorder.

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Introduction Various authors have proposed that there may be altered hip rotation range of motion (ROM) in patients with low back pain (LBP). However, limited studies have been conducted to investigate the association between hip rotation ROM and LBP specifically in distance runners. The aim of this study was to determine whether there is an association between hip rotation ROM and non-specific LBP in distance runners. Methods A cross-sectional design was used to look at the relationship between hip rotation ROM and LBP. Thirty five runners with LBP (24 males, 11 females) and 51 runners without LBP (29 males, 22 females) participated in the study. A questionnaire was used to divide participants into LBP and no LBP groups and to evaluate certain factors specific to LBP. Passive rotation ROM was measured in prone position using a hand-held inclinometer. Results Results showed no statistically significant difference (p>0.05) in hip rotation ROM between the two groups. Furthermore, no statistically significant difference (p>0.05) was found for factors specific to running, between the two groups. Conclusion Although no association was found between hip rotation ROM and LBP in distance runners, further research is needed into other possible causative factors of LBP in distance runners. Keywords Low back pain, hip biomechanics, hip mobility, hip rotation, sports and running Operational definitions  Low back pain (LBP): pain and discomfort located below the costal margins and above the gluteal folds, with or without associated leg pain (Van Tulder et al 2006).  Non-specific LBP: pain not attributable to a clearly recognisable pathology (Koes et al 2006).  Healthy distance runner: a runner who has had no LBP symptoms within the last 6 months.  Time trial: an unofficial road running race in which participants are timed individually over a set distance, in this case, 4km.

The research reported in this dissertation centered around the prevalence and factors associated with low back pain (LBP) among the undergraduate physiotherapy students at the University of the Witwatersrand. Physiotherapy students are prone to LBP due to a flexion posture while studying, lifting patients and working. After pathology, muscle activity is influenced, affecting optimal function of the spine. Preventative strategies can minimise recurrences of LBP. Physiotherapy students enrolled for 2010 at the University of the Witwatersrand participated in a cross-sectional prevalence study. A questionnaire, multi-stage fitness test and physical assessment were completed. Statistical analysis was done with univariate analysis for associations with LBP. The study revealed that the lifetime LBP prevalence was 35.6% among all four physiotherapy year groups. The prevalence increased from first year to third year but unexpectedly decreased in the fourth year group. Significant associations with LBP were posterior-anterior mobilisations on L4 (p=0.003) and L5 (p≤0.001) centrally, left lumbar multifidus (LM) cross-sectional area (p=0.02), right obliquus internus abdominis (p=0.02) and transversus abdominis (TrA) thickness at rest (p=0.03), both TrA during contraction, left (p=0.02) and right (p=0.01), as well as the pull of the TrA during contraction on the left (p=0.03). The present work is the first study to show measurements with ultrasound imaging of LM and TrA on physiotherapy students. The prevalence of LBP might be reduced if students are more aware of LBP and consequential muscle imbalances that might perpetuate the problem. The dissertation concludes with a discussion of future research avenues. It is suggested that an intervention to make students aware of LBP and risk assessments in South Africa will help to identify and address hazards in the workplace.

The aim of this study was to uncover and understand the reality of living with chronic, intractable nonmalignant back pain, as it is understood by sufferers themselves. A narrative autoethnographic research design was chosen, enabling me to interact with participants during the interview process, as well as have the opportunity to further explore my own experiences, as a long time sufferer of chronic, intractable nonmalignant back pain. Thematic analysis of participant interviews, and a deep, introspective scrutiny of my own journey, resulted in four stories being written. These stories illustrate the startlingly similar experiences we share. Although each story is written around one central character, they are in fact composite characters, representing the participants’ experiences as well as my own. The stories are: ‘The merry-go-round: Searching for a cure’, describing the endless visits to various specialists, in search of the elusive ‘cure’. ‘Mourning the loss’, illustrating the grief-like process we must go through when it becomes apparent that a cure is not possible and pain will be with us for the rest of our lives. ‘Walk a mile in my shoes’, giving a snapshot of issues facing us in our daily lives, and ‘Here we go again’, a description of a ‘typical’ pain management hospital stay. A fifth story, ‘We’re not in Kansas anymore’, was added following a bizarre emergency admission I was forced to endure during the course of my research. It is therefore a story where I am the central character. These stories illustrate the impact chronic back pain has on a sufferer’s life, ranging from loss of mobility to an altered body image. They also illustrate the struggle to maintain normality, including masking the pain and facing labelling and stigma. These stories identify and demonstrate the often hidden aspects of chronic intractable back pain, and have the power to inform practicing nurses, students, teachers and the community of the ‘lived experience’.

Thesis (M. Phil.)--University of Hong Kong, 2010. / Includes bibliographical references (leaves 132-164). Also available in print.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Study Design. Retrospective analysis. Objective. To determine if the use of adjunctive pain medications (subcutaneous bupivacaine, dexmedetomidine infusion, and intravenous ketorolac) will reduce the need for opioids, reduce postoperative pain, and shorten length of hospital stay in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. Methods. Retrospective review of children 10 to 18 years with adolescent idiopathic scoliosis receiving posterior spinal fusion surgery over the past 10 years at Phoenix Children’s Hospital. Physicians managed the patients’ pain postoperatively with adjunctive medications in addition to intravenous and oral opioids. Variables of interest were local anesthetic bupivacaine delivered subcutaneously via elastomeric pain pump, sedative/analgesic dexmedetomidine infused for up to 24 hours postoperatively, and the NSAID ketorolac delivered intravenously. These three medications were used either alone or in some combination determined by the physician’s clinical judgment. Primary outcomes analyzed were normalized opioid requirement after surgery, VAS pain scores, and length of stay in the hospital. Results. One hundred and ninety-six children were analyzed with no significant differences in demographics. Univariate analysis showed that all three adjunct medications improved outcomes. A multivariate regression model of the outcomes with respect to the three medication variables of interest was developed to analyze the effects of the three medications simultaneously. The regression analysis showed that subcutaneous bupivacaine significantly reduced normalized opioid requirement by 0.98 mg/kg (P = 0.001) and reduced VAS pain scores by 0.67 points (P = 0.004). Dexmedetomidine significantly reduced the average VAS pain scores in the first 24 hours by 0.62 points (P = 0.005). Ketorolac had no effect in the multiple regression analysis. Conclusion. The use of subcutaneous bupivacaine provides good analgesia with low pain scores. A reduction in opioid requirement is beneficial and may be directly related to presence of the bupivacaine pump, although this may be limited by potential treatment bias. The three adjunct medications improve our outcomes favorably and should be studied prospectively.