<p>Uvod: Mikrodiskektomija je jedan od savremenih hirur&scaron;kih metoda u lečenju osoba sa lumbalnim sindromom, čiji je uzrok hernijacija intervertebralnog diska. Na postoperativni oporavak, ishod rehabilitacije i funkcionalno stanje, veliki uticaj imaju i biopsihosocijalni faktori. Cilj: Glavni cilj istraživanja je bio procena uticaja biopsihosocijalnih faktora na ishod lečenja i funkcionalni status bolesnika sa lumbalnim sindromom nakon mikrodiskektomije i sprovedenog rehabilitacionog tretmana. Materijal i metode: Sprovedena je prospektivna studija na 200 pacijenata (96 mu&scaron;karaca i 104 žene), različitih profesija, prosečne životne dobi 50.20 &plusmn; 10.26 godina (raspon 29&ndash;69 godina). U istraživanje su uključeni pacijenti nakon operativnog lečenja hernijacije diska, putem mikrodiskektomije, preme&scaron;teni sa Klinike za neurohirurgiju na Kliniku za medicinsku rehabilitaciju, Kliničkog centra Vojvodine u Novom Sadu. Stratifikacija ispitanika je izvr&scaron;ena prema njihovim biolo&scaron;ko-demografskim, socio-ekonomskim, psiholo&scaron;kim i funkcionalnim obeležjima, uz kori&scaron;ćenje podataka iz anamneze, kliničkog pregleda, raspoložive medicinske dokumentacije i odgovarajućih upitnika i testova. Kori&scaron;ćeni su sledeći upitnici: za procenu bola-vizuelna analogna skala (VAS), upitnik o bolu (Pain Detect Test), za procenu psiholo&scaron;kih karakteristika Spilbergerovi testovi za trenutnu i op&scaron;tu anksioznost (Spielberger Anxiety Inventory-State and Trait Test), Bekova skala depresije (BDI), upitnik za procenu prisustva straha od fizičke aktivnosti i posla i njihovog izbegavanja (The Fear-Avoidance Beliefs Questionnaire - Physical activity and Work), a za procenu funkcionalnog statusa Osvestrijev upitnik o onesposobljenosti (ODI) i Kvebek skala onesposobljenosti osoba sa lumbalnim sindromom. Fleksibilnost i indeks pokretljivosti lumbalnog segmenta kičme su procenjivani pomoću &Scaron;oberovog i Tomajerovog testa. Navedena ispitivanja su obavljena postoperativno pre početka sprovođenja rehabilitacionog tretmana (0. mesec), potom posle mesec dana i zatim 3 i 6 meseci posle mikrodiskektomije. Rezultati: Na doživljavanje bola i na funkcionalnu sposobnost imali su signifikantnog uticaja sledeći navedeni činioci. Pol: subjektivno doživljavanje bola je bilo jače kod žena nego kod mu&scaron;karaca, ali je stepen funkcionalne onesposobljenosti (prema ODI i Kvebek skali) bio signifikantno veći (p&lt;0.01) kod mu&scaron;karaca. Životna dob: Stepen oporavka pacijenata nakon mikrodiskektomije je tokom vremena u pojedinim starosnim grupama bio promenljiv, ali je u celini bio lo&scaron;iji kod starijih osoba. Navika pu&scaron;enja: intenzitet bola (VAS) i stepen funkcionalne onesposobljenosti (prema ODI i Kvebek skali ) su bili veći kod pu&scaron;ača nego kod nepu&scaron;ača (p&lt;0.01). Mehaničko opterećenje kičme: manji stepen oporavka su imali ispitanici čije zanimanje je povezano sa većim dinamičkim i statičkim opterećenjem kičmenog stuba. Socijalni faktori: redovno zaposlenje i novčana primanja su povezani sa boljim funkcionalnim oporavkom. Psiholo&scaron;ki status i stepen optimizma: anksioznost i strahovi od fizičke aktivnosti i posla, strah od gubitka posla, depresija, negativni stavovi i pesimizam su signifikantno če&scaron;će prisutni kod ispitanika koji su imali manji stepen funkcionalnog oporavka tokom praćenog perioda. Zaključci: Na doživljavanje bola i na funkcionalnu sposobnost i oporavak pacijenata nakon mikrodiskektomije imali su signifikantnog uticaja sledeći biopsihosocijalni faktori: pol, životna dob, navika pu&scaron;enja, mehaničko opterećenje kičme, socijalno-ekonomski faktori, psiholo&scaron;ki status i stepen optimizma pacijenta. Primenom odgovarajućih upitnika i registrovanjem ovih faktora, može se kreirati model za predviđanje stepena funkcionalnog oporavka i za primenu dopunskih terapijskih postupaka posle načinjene mikrodiskektomije.</p> / <p>Introduction: Microdiscectomy is one of the modern surgical methods for the treatment of people with low back pain, caused by a herniated intervertebral disc. On postoperative recovery, rehabilitation outcome and functional status, among others, great influence have also biopsychosocial factors. Goal: The main goal of the research was to assess which biopsychosocial factors have a significant impact on treatment outcome and functional status of patients with low back pain after lumbar microdiscectomy and the subsequent physical therapy. Material and methods: The research was conducted as a prospective study on 200 patients (96 men and 104 women), of various professions and mean age 50.20 &plusmn; 26.10 years (range 29-69 years). The study involved patients after surgical treatment of disc herniation by microdiscectomy, who were transferred from the Clinic for neurosurgery to the Clinic for medical rehabilitation, in Clinical center of Vojvodina, Novi Sad, in order to perform physical therapy and rehabilitation. Stratification of patients was performed according to their biological, demographic, socio-economic, psychological and functional characteristics, using data from the health history, clinical examination, the available medical records and appropriate questionnaires and tests. Among the questionnaires were those that are used for assessment of pain, psychological and psychosocial characteristics and functional status of patients with low back pain, including a visual analogue scale, Pain Detect Test, Spielberger Anxiety Inventory-State and Trait, Beck Depression Inventory, The Fear-Avoidance Beliefs Questionnaire (Physical activity and Work), Oswestry Low Back Pain Disability Questionnaire (ODI) and Quebec Back Pain Disability Scale. The flexibility of the lumbar segment of the spine and its movement index were assessed by Schober&#39;s and Thomayer&#39;s tests. All of these above mentioned assessments were carried out just before the start of the rehabilitation treatment (month 0), at the beginning of physical therapy (month 0), one month later and then 3 and 6 months after microdiscectomy. Results: On the pain and functional ability / disability the significant influences had following listed factors. Gender: subjective perception of pain was stronger among women than among men, but the degree of functional disability (ODI and Quebec Scale) was significant higher in the group of men (p&lt;0.01). Age: The degree of recovery among patients after microdiscectomy over time in different age groups was varying, but in general was worse in the group of older people. Smoking habits: pain intensity and degree of functional disability were higher among smokers than nonsmokers (p&lt;0.01). Mechanical loading of the spine: lower degree of recovery had subjects whose job is associated with a higher dynamic and static loading of the spine. Social factors: regular employment and cash income are associated with better functional recovery. Psychological status and the degree of optimism: anxiety and fear of physical activity and work as well as the possibility of job loss, depression, negative attitudes and pessimism, were significantly more often present in the group of patients who had a lower degree of functional recovery during the studied period. Conclusions: On the experience of pain, on functional ability and recovery of patients after microdisectomy, significant influences have the following biopsychosocial factors: gender, age, smoking habits, the mechanical loading of the spine, socio-economic factors, psychological status and the degree of optimism of the patient. Using the appropriate questionnaires and registering mentioned factors, it is possible to create a model for predicting the degree of functional recovery and for the application of additional therapeutic procedures after microdisectomy.</p>

Bakgrund: Ländryggssmärta är vanligt förekommande och ger konsekvenser både på individ- och samhällsnivå. För individen kan ländryggssmärta leda till begränsning i funktion och aktivitet samt är ofta relaterad till olika grad av rörelserädsla. Kliniska riktlinjer för ländryggssmärta rekommenderar bland annat individanpassad träning samt att relevant information och förklaringsmodeller ges till patienten. Det finns tidigare studier som kvantitativt utvärderar träning riktad mot bålstabilitet och motorisk kontroll och som visar på effekt på utfallsmått som smärta och funktion. Den här studien ger en kvalitativ beskrivning av hur patienter upplever begreppet bålstabilitet och bålstabiltetsträning i grupp. Syfte: Att beskriva hur personer med ländryggsmärta uppfattar begreppet bålstabilitet samt deras upplevelse av att träna bålstabilitet i grupp. Metod: För att besvara syftet valdes en kvalitativ metod. Tio personer som deltagit i bålstabiliserande träning i grupp intervjuades. Intervjumaterialet analyserades med innehållsanalys. Resultat: Informanternas upplevelse av begreppet bålstabilitet är att ha bra och starka muskler i rygg och mage och framför allt att man även har bra kontroll på de inre små magmusklerna. Det leder till förbättrad förmåga posturalt och i rörelse och aktivitet samt kan förebygga eller behandla smärta. Studien visar att träning i en grupp där det finns en engagerad ledare som ger individanpassad introduktion och feedback och som ser alla deltagare är positivt för upplevelsen av träning och ger ökad motivation. För att gruppdeltagarna ska uppnå egen kunskap om träningen och hur den ska genomföras önskar deltagarna individanpassad feedback på rätt nivå under hela inlärningsprocessen. Bålstabiliserande träning i grupp ger upplevelse av förbättring och ökad medvetenhet och tillit till sin rygg och sin förmåga. Konklusion: Studien bekräftar klinisk erfarenhet om det positiva med att träna i grupp och visar att gruppträning är tillämpbart trots att bålstabilitetsträning kräver individanpassad feedback. / Background: Low back pain is a common problem with consecuences for both comunity and individual. For the individual the pain can give limitations i function and activity and is often correlated with different levels of fear of movement. Clinical guidelines for low back pain recommends individualized exercise and that relevant explainations are given to the patient. There are previous studies that quantitatively evaluates training directed towards corestability and motor control and these show that the interventions gives effects on outcomemeasures such as pain and function. This study provides a qualitative description of how patients experience the concept of corestability and training of corestability in a group. Aim: To describe how people with low back pain experience the concept of corestability and their experience to train corestability in a group. Methodology: To answer the purpose a qualitative method was chosen. Ten people whom had participated in a corestabilizing traininggroup were interviewed. The interviewmaterial was analyzed using content analysis. Results: The informants experience of the concept of corestability is to have good strong muscles in the back and abdomen and also good control over the local small abdominal muscles. This leads to improved ability in postural- and movementactivities and can prevent or treat pain. This study shows that training in a group where there is a committed leader that provides individualized introduction and feedback and that notice all participants is positive for the experience of training and provides increased motivation. For the participants to achieve their own knowledge about the training they wish for individualized feedback throughout the learningprocess. Corestabilitytraining in a group gives an experience of improvement and increased awareness and trust in ones back and ones ability. Conclusion: The study confirms clinical experience of positive impact of groupexercise and shows that groupexercise is applicable although stabilitytraining requires individualised feedback.

Low back pain has long been estimated to be the most prevalent and debilitating source of chronic pain. The present study first reviews the literature addressing the various theories of pain, the physiological and psychological variables important in pain research, and the psychotherapeutic approaches that have been used to date to reduce pain. Thirty-seven hospitalized chronic back pain patients were administered the cold-pressor test and a medical pain stimulus procedure which was medically relevant to their back pathology. A card-sort method was utilized in order to assess the coping strategies employed by the patients during these two pain stimulus tasks. These procedures were repeated following treatment. Coping strategies used by patients during the two pain tasks were compared. Results demonstrated that there was a significant difference in the manner in which patients coped with the two types of pain. Cold-pressor measures of pain threshold and tolerance were not significantly different between pretreatment and post-treatment. These measures were also not positively correlated with treatment outcome. A multiple regression approach demonstrated that particular coping strategies were significantly predictive of treatment outcome. The medical pain stimulus procedure was found to provide more significant pedictor variables than the cold-pressor test. At pre-treatment assessment, patients who relied on dramatized coping strategies were less likely to be successful in treatment. Breathing activity and pain acknowledgement were positive coping techniques highly predictive of successful outcome in this study. The use of computers for assessment and other recommendations for future research were discussed.

Title: Evaluation of the Effectiveness of Back Schools in Vertebrogenic Syndromes of Low Back Objectives: To compare the effectiveness of particular back schools. The main goals were to prove the successfulness of back schools in patients with vertebrogenic algic syndrome, to find out jobs with the most promising response to back schools and to reveal possible use of back schools in children. Methods: The dissertation has a descriptive-analytical character and was conducted as a literature review. Results: The results showed the effectiveness of the back schools concept in chronic low back pain. The effect was particularly obvious after two-month duration of the programmes. The most promising results were observed in professionals whose lumbar spine is overexerted due to heavy loads lifting or due to daily routines set into ergonomically inconvenient workplace. The back school concept might be used in children as well, who can mainly take advantage of active exercises and correct ergonomics. This dissertation also sums up other physiotherapeutic concepts relating to this subject. Key words: Back school, low back pain, prevention

Alguns pacientes com dor lombar crônica classificados no grupo de otimização funcional pelo método de classificação Treatment based classification (TBC), apesar de apresentarem bons resultados em questionários funcionais, ainda referem dor e limitação em várias tarefas funcionais. Este estudo teve como objetivo explorar as diferenças de performance entre os pacientes com dor lombar crônica e indivíduos saudáveis submetidos a um conjunto de testes de força isométrica do quadril e resistência lombopélvica, além de identificar valores de corte classificatórios com acurácia aceitável de testes e razões entre esses testes que possam discriminar significativamente os pacientes com dor lombar crônica e indivíduos saudáveis. Trezentos e cinquenta indivíduos (saudáveis n = 170 e pacientes com dor lombar crônica n = 180) foram estratificados por idade, gênero e nível de atividade física. Os pacientes com dor lombar crônica foram incluídos se apresentassem resultado no questionário de função Oswestry Disability Index (ODI) <20%. O conjunto de testes consistiram de: testes de força isométrica de abdutores, extensores e flexores de quadril, teste de resistência da musculatura abdominal profunda e testes de resistência de ponte lateral, ponte frontal, flexores e extensores lombares. Os pacientes com dor lombar crônica apresentaram maiores valores de força isométrica dos flexores do quadril (p> 0,001) e teste de resistência da musculatura abdominal profunda (p> 0,001), mas menor resistência na ponte lateral (p> 0,05), ponte frontal (p> 0,001), flexores (p> 0,001) e extensores lombares (p> 0,05) em comparação com saudáveis. A acurácia foi considerada aceitável para os valores de corte do teste de flexores lombares (91,4seg; AUC = 0,84), flexores/extensores lombares (0,95; AUC = 0,82), ponte lateral/flexores lombares (0,57; AUC = 0,79), ponte frontal/flexores lombares (0,79; AUC = 0,75) e extensores /flexores de quadril (0,67; AUC = 0,73). Sendo assim, conclui-se que pacientes com dor lombar crônica classificados no grupo de otimização funcional pelo TBC, apesar de apresentarem boa pontuação no questionário funcional, apresentaram diferenças de performance em alguns testes. Além disso, as análises de acurácia dos valores de corte de testes e razões permitiram discriminar os pacientes com dor lombar, o que pode auxiliar no programa de tratamento e decisão de alta no retorno á atividades com níveis de demanda elevada no trabalho, atividade física ou mesmo diárias. / Some chronic low back pain (LBP) patients classified on the functional optimization subgroup by the Treatment based classification method (TBC), although presenting acceptable score in functional questionnaires, they still experience pain and limitations in several functional tasks and in sports activities. This study aimed to explore differences in performance between chronic LBP patients and healthy individuals submitted to a set of isometric hip strength and lumbar endurance tests, and to identify accurate tests and ratios classificatory cut-off values to significantly discriminate patients with chronic low back pain and healthy individuals. Three hundred and fifty subjects (Healthy n=170 and chronic LBP patients n=180) were stratified by age, gender and physically active or sedentary. LBP patients were included if they had Oswestry Disability Index (ODI) < 20%. The set of tests consisted of: Isometric strength tests of hip abductors, extensors, flexors, deep abdominal functional test, and endurance tests of lateral bridge, frontal bridge, lumbar flexors and extensors. The LBP patients presented higher strength values of hip flexors (p> 0.001) and deep abdominal function test (p>0.001), but lower endurance on lateral bridge (p>0.05), frontal bridge (p>0.001), lumbar flexors (p>0.001) and extensors tests (p>0.05) compared to healthy individuals. The accuracy was considered acceptable for lumbar flexors test (91.4 sec; AUC = 0.84), lumbar flexors/extensors (0.95; AUC = 0.82), lateral bridge/ lumbar flexors (0.57; AUC = 0.79), frontal bridge/lumbar flexors (0.79; AUC = 0.75) and hip extensors/flexors (0.67; AUC = 0.73). Some chronic LBP patients, despite having acceptable score in functional scores, presented differences in lumbopelvic and hip performance tests and, based on some accurate cut-off classificatory ratios and tests, allowed to discriminate LBP patients, what may be considered in treatment program and decision making for patient\'s discharge when returning to higher demand levels of work, physical or even daily activity.

Introdução: A lombalgia cônica apresenta prevalência entre 12 a 33% na população adulta e a causa de sua cronicidade ainda é desconhecida. Um provável fator são as alterações no controle postural e os estudos ainda não são conclusivos, principalmente em atividades funcionais. Objetivo: avaliar o controle postural em indivíduos com e sem lombalgia crônica não específica durante atividades funcionais ortostatismo e apoio unipodálico. Métodos: A amostra foi composta por 44 indivíduos divididos em: Grupo Lombalgia (GL, n=21) com lombalgia crônica e Grupo controle (GC, n=23) sem lombalgia. O controle postural foi avaliado com plataforma de força modelo NeuroCom Balance Master utilizando dois testes: a) Modified Clinical Test of Sensory Interaction and Balance (CTSIBm) que mensurou o centro de pressão (COP) em quatro condições experimentais em ortostatismo: olhos abertos e superfície estável; olhos fechados e superfície estável; olhos abertos e superfície instável; olhos fechados e superfície instável; e b) Teste de Apoio Unipodálico que mensurou as medidas do COP em uma condição experimental: olhos abertos e superfície estável, apoiando primeiro o membro inferior esquerdo e em seguida o direito. A intensidade da dor foi avaliada com a escala visual analógica e a incapacidade funcional com o questionário Roland-Morris. A análise estatística utilizou o teste de normalidade Shapiro-Wilk, na comparação entre os grupos o teste t de Student para as variáveis com distribuição normal e o teste Mann Whitney quando a distribuição não era normal. Considerou-se nível de significância de 5%. Resultados: Os grupos são homogêneos nas variáveis idade, peso, altura e índice de massa corporal. O GL apresenta déficit no controle postural, com maior oscilação no COP na postura ereta quieta na condição de olhos fechados e superfície instável nos testes do CTSIBm: Deslocamento Total [GL 1432,82 (73,27) vs GC 1187,77 (60,30)], Velocidade Média Total [GL 12,97 (0,84) vs GC 10,55 (0,70)], Root Mean Square (RMS) ântero-posterior [GL 1,21 (0,06) vs GC 1,04 (0,04)] e Área [GL 24,27 (2,47) vs GC 16,45 (1,79)] com diferença estatisticamente significante (p<0.05). No Teste de apoio unipodálico o GL apresentou maior oscilação no plano frontal: RMS médiolateral [GL 0,43 (0,02) vs GC 0,55 (0,04)] e p<0.05. Conclusão: indivíduos com lombalgia crônica apresentam maior déficit no controle postural comparado ao grupo controle, evidenciado pelo aumento da oscilação do COP na postura ereta quieta, tanto em velocidade quanto em deslocamento, sendo mais acentuado nas condições de obstrução visual e superfície instável / Introduction: Chronic low back pain (CLBP) affects from 12-33% of the adult population and the cause of its chronicity still unknown. Change in postural control is a factor involved and studies are not conclusive, mainly in functional activities. Objective: To assess postural control in individuals with and without non-specific CLBP during functional activities orthostatic and one leg stand. Methods: Sample consisted of 44 individuals divided into: Chronic Low Back Pain (CLBP, n = 21) with CLBP and Control Group (CG, n = 23) without CLBP. They had their balance assessed in a force platform NeuroCom Balance Master using two tests: a) Modified Clinical Test of Sensory Interaction and Balance (CTSIBm) that measured the center of pressure (COP) in four experimental conditions in standing position: eyes open and stable surface, eyes closed and stable surface, eyes open and unstable surface, eyes closed and unstable surface; and b) One leg stand test that measured the COP on one experimental condition: eyes open and stable surface, standing on the left leg first and then the right. Pain severity was assessed by a visual analogue scale and disability by the Roland-Morris Questionnaire. Statistical analysis: normality was assessed using the Shapiro-Wilk test. Normally distributed variables were compared with the Student ttest. Non-parametric variables were compared using the Mann-Whitney test. Significance was established at the 5% level. Results: The groups are homogeneous in age, weight, height and body mass index. CLBP group shows deficits in postural control compared to CG showing greater postural sway in quite standing condition with eyes closed and unstable surface in CTSIBm (p<0.05): Trace length [CLBP 1432.82 (73.27) vs CG 1187.77 (60.30)], Mean velocity [CLBP 12.97 (0.84) vs CG 10.55 (0.70)], Root Mean Square (RMS) sagittal plane [CLBP 1.21 (0.06) vs CG 1.04 (0.04)] and area [CLBP 24.27 (2.47) vs CG 16.45 (1.79)]. CLPB group showed greater sway in frontal plane in the one leg stand test (p<0.05): RMS frontal plane [CLBP 0.43 (0.02) vs CG 0.55 (0.04)]. Conclusion: Individuals with non-specific CLBP have impaired postural control relative to their controls, as evidenced by increased oscillation of COP. Differences were more pronounced in eyes closed condition and unstable surface

O objetivo geral deste estudo foi avaliar a dor percebida, em indivíduos com dor lombar crônica, e as correlações existentes entre a variável intensidade de dor, incapacidade e depressão. Os objetivos específicos foram caracterizar sociodemograficamente os indivíduos com dor lombar crônica, mensurar a intensidade de dor percebida, identificar a incapacidade relacionada às atividades de vida diária, identificar os níveis de depressão, estabelecer correlações entre as variáveis estudadas e identificar os descritores de maior e menor atribuição na caracterização da dor. Trata-se de estudo transversal descritivo-exploratório. Utilizou-se um questionário contendo os itens para a coleta de dados sociodemográficos e econômicos e perguntas relacionadas à percepção da dor, a Escala Multidimensional de Avaliação de Dor, o Questionário Roland-Morris de Incapacidade e o Inventário de Depressão de Beck. A coleta de dados ocorreu na Clínica para o Tratamento da Dor do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brasil. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto, USP. Foi realizada uma análise exploratória dos dados e aplicado o coeficiente de correlação de Spearman para correlacionar as variáveis de interesse. A amostra foi composta por 60 sujeitos que apresentavam dor lombar crônica com idade média de 54,8 anos e prevalência do sexo feminino (63,33%). A média da intensidade de dor encontrada foi de 7,38 pontos, da incapacidade foi 19,87 e da depressão, 24,98, portanto, os participantes apresentaram alta intensidade de dor, incapacidade e depressão. Os cinco descritores de dor de maior atribuição, considerando as médias aritméticas e o desvio-padrão, foram: desconfortável, enjoada, dolorosa, terrível e prejudicial, sendo os sensitivos (desconfortável e dolorosa), afetivos (enjoada e terrível) e cognitivo (prejudicial) e os cinco descritores de menor atribuição foram: angustiante, desgraçada, assustadora, desastrosa e deprimente, e todos indicam componente afetivo. Os resultados mostraram uma correlação positiva fraca entre intensidade de dor e incapacidade e entre intensidade de dor e depressão, já as variáveis incapacidade e depressão apresentou correlação positiva moderada. Ao considerar a complexidade do fenômeno estudado, ressalta-se que os achados do presente estudo mostram- se consistentes com os resultados de outras pesquisas, portanto, considera-se adequado conhecer as variáveis inter-relacionadas, a fim de propiciar adequado manejo da dor lombar crônica demonstrando a sua multidimensionalidade / The general purpose of this study was to evaluate the perception of pain in individuals with chronic low back pain and existing correlation among pain intensity, disability and depression in such individuals. The specific purpose was to characterize socio-demographic individuals with such diagnosis, measuring the intensity of chronic low back pain felt, identifying the disability related to daily activity in them, identify levels of depression, to establish correlation among variables studied and identify descritptors of major and minor attribution to characterize pain. This is a transverse descriptive exploratory study. It was used a questionnaire containing the items for socio-demographic and economic data collection as well as the questions related to pain perception, the Multidimentional Scale for Pain Evaluation, the Roland-Morris Disability Questionnaire and the Beck Depression Inventory. The data collection took place at the Clinic for Pain Treatment at Hospital das Clínicas - Faculdade de Medicina in Ribeirão Preto from Universidade de São Paulo, Brazil. The study was approved by the Ethic Committee for Research of Escola de Enfermagem in Ribeirão Preto, USP. It was performed an exploratory analysis of the data and it was applied the coefficient of correlation from Spearman to correlate the variables of interest. The sample was composed by 60 individuals who showed chronic low back pain and their age was about 54.8 years old average, they were predominantly women (63.33%). The average intensity of pain was 7.38 points, of disability was 19.87 and of depression 24.98. Therefore, participants showed high intensity of pain, disability and depression. The five descriptors of pain of larger attribution within arithmetical average and standard deviation were: uncomfortable, nauseous, painful, terrible and harmful, considering sensitive (uncomfortable and painful); affective (nauseous and terrible) and cognitive (harmful) and the five descriptors of lesser attribution were: anguised, disgraceful, scary, disastrous and depressing and all of them indicate an affective component. The results showed one positive weak correlation between the intensity of pain and disability and between the intensity of pain and depression, although the variables: disability and depression showed a moderated positive correlation. When considering the complexity of the studied phenomena it is highlighted that the findings of the present study are consistent with the results of other researches, therefore, it is appropriate to know the interrelated variables in order to propitiate suitable dealings of the chronic low back pain demonstrating its multidimensionality.

Este estudo teve como objetivo caracterizar a capacidade de estabilização da coluna frente a perturbações de equilíbrio em uma população com dor lombar. Estudos revelaram uma préativação dos músculos estabilizadores do tronco de forma a preparar a coluna para a perturbação resultante de momentos reativos associados. Entretanto, esta reação de estabilização postural apresentou-se atrasada ou mesmo ausente em portadores de dor lombar. Apesar de conhecida esta alteração postural nesta população, o padrão de recrutamento muscular, ou seja, suas sinergias em indivíduos com dor lombar ainda são limitados. Este estudo teve como objetivo avaliar o padrão de atividade muscular em indivíduos com dor lombar. Foram realizadas 4 tarefas diferentes capazes de produzir alteração postural em diferentes condições: alcance anterior, alcance lateral, flexão dos ombros e sobrecarga repentina. Foram feitas as coletas dos sinais eletromiográficos dos músculos multífido, reto abdominal, vasto medial, bíceps femoral, tibial anterior, gastrocnêmio medial e deltóide anterior e médio, simultaneamente ao uso do acelerômetro. Os resultados mostraram maior ativação em todas as tarefas de DA e BF no APO. Os Índices R e C sofreram efeito da articulação e do grupo; entretanto, não houve efeito dos ajustes. Os Índices tiveram maior intensidade no grupo DOR e na articulação do joelho.Tanto os valores de RMS quanto inibição recíproca e coativação foram maiores no grupo dor. Este estudo pode concluir que independente da tarefa realizada, a modulação do movimento foi a mesma em todas as fases e em ambos os grupos Dor e Controle. Desta forma, uma melhor investigação sobre a coordenação e sinergia muscular se faz necessária para a melhor compreensão das variáveis do movimento e sua relação com os mecanismos de lesão da coluna lombar / This study aimed to characterize the ability to stabilize the spine on isturbance of equilibrium in a population with low back pain. Studies had revealed a pre-activation of the stabilizing muscles of the trunk in order to prepare the column for the disturbance resulting from reactive moments associated. However, the postural stabilization is delayed or even absent in patients with low back pain. Despite this known postural change in this population, the pattern of muscle recruitment, ie, their synergies in subjects with low back pain are still limited. This study aimed to evaluate the pattern of muscle activity in individuals with low back pain.. The subjects did four different tasks that can produce postural change under different conditions: prior range, reach, lateral flexion of the shoulders and sudden overload. The electromyographic of muscle multifidus, rectus abdominis, vastus medialis, biceps femoris, tibialis anterior, medial gastrocnemius and anterior and middle deltoid was recorded and so the accelerometer. The results showed greater activation in all tasks of DA and BF in the APO. The indices R and C were affect by the joint and group although there was no effect by the adjustments. The indices R and C were higher in the PAIN group and knee. RMS values, coactivation and reciprocal inhibition were higher in pain. This study had concluded that the modulation of movement was the same at all postural adjustments and in both groups (Pain and Control). Therefore, futures researchers about muscular coordination and synergy is needed to better understand the variables of the movement and its relation to the mechanisms of injury to the lumbar spine

Introdução: A lombalgia cônica apresenta prevalência entre 12 a 33% na população adulta e a causa de sua cronicidade ainda é desconhecida. Um provável fator são as alterações no controle postural e os estudos ainda não são conclusivos, principalmente em atividades funcionais. Objetivo: avaliar o controle postural em indivíduos com e sem lombalgia crônica não específica durante atividades funcionais ortostatismo e apoio unipodálico. Métodos: A amostra foi composta por 44 indivíduos divididos em: Grupo Lombalgia (GL, n=21) com lombalgia crônica e Grupo controle (GC, n=23) sem lombalgia. O controle postural foi avaliado com plataforma de força modelo NeuroCom Balance Master utilizando dois testes: a) Modified Clinical Test of Sensory Interaction and Balance (CTSIBm) que mensurou o centro de pressão (COP) em quatro condições experimentais em ortostatismo: olhos abertos e superfície estável; olhos fechados e superfície estável; olhos abertos e superfície instável; olhos fechados e superfície instável; e b) Teste de Apoio Unipodálico que mensurou as medidas do COP em uma condição experimental: olhos abertos e superfície estável, apoiando primeiro o membro inferior esquerdo e em seguida o direito. A intensidade da dor foi avaliada com a escala visual analógica e a incapacidade funcional com o questionário Roland-Morris. A análise estatística utilizou o teste de normalidade Shapiro-Wilk, na comparação entre os grupos o teste t de Student para as variáveis com distribuição normal e o teste Mann Whitney quando a distribuição não era normal. Considerou-se nível de significância de 5%. Resultados: Os grupos são homogêneos nas variáveis idade, peso, altura e índice de massa corporal. O GL apresenta déficit no controle postural, com maior oscilação no COP na postura ereta quieta na condição de olhos fechados e superfície instável nos testes do CTSIBm: Deslocamento Total [GL 1432,82 (73,27) vs GC 1187,77 (60,30)], Velocidade Média Total [GL 12,97 (0,84) vs GC 10,55 (0,70)], Root Mean Square (RMS) ântero-posterior [GL 1,21 (0,06) vs GC 1,04 (0,04)] e Área [GL 24,27 (2,47) vs GC 16,45 (1,79)] com diferença estatisticamente significante (p<0.05). No Teste de apoio unipodálico o GL apresentou maior oscilação no plano frontal: RMS médiolateral [GL 0,43 (0,02) vs GC 0,55 (0,04)] e p<0.05. Conclusão: indivíduos com lombalgia crônica apresentam maior déficit no controle postural comparado ao grupo controle, evidenciado pelo aumento da oscilação do COP na postura ereta quieta, tanto em velocidade quanto em deslocamento, sendo mais acentuado nas condições de obstrução visual e superfície instável / Introduction: Chronic low back pain (CLBP) affects from 12-33% of the adult population and the cause of its chronicity still unknown. Change in postural control is a factor involved and studies are not conclusive, mainly in functional activities. Objective: To assess postural control in individuals with and without non-specific CLBP during functional activities orthostatic and one leg stand. Methods: Sample consisted of 44 individuals divided into: Chronic Low Back Pain (CLBP, n = 21) with CLBP and Control Group (CG, n = 23) without CLBP. They had their balance assessed in a force platform NeuroCom Balance Master using two tests: a) Modified Clinical Test of Sensory Interaction and Balance (CTSIBm) that measured the center of pressure (COP) in four experimental conditions in standing position: eyes open and stable surface, eyes closed and stable surface, eyes open and unstable surface, eyes closed and unstable surface; and b) One leg stand test that measured the COP on one experimental condition: eyes open and stable surface, standing on the left leg first and then the right. Pain severity was assessed by a visual analogue scale and disability by the Roland-Morris Questionnaire. Statistical analysis: normality was assessed using the Shapiro-Wilk test. Normally distributed variables were compared with the Student ttest. Non-parametric variables were compared using the Mann-Whitney test. Significance was established at the 5% level. Results: The groups are homogeneous in age, weight, height and body mass index. CLBP group shows deficits in postural control compared to CG showing greater postural sway in quite standing condition with eyes closed and unstable surface in CTSIBm (p<0.05): Trace length [CLBP 1432.82 (73.27) vs CG 1187.77 (60.30)], Mean velocity [CLBP 12.97 (0.84) vs CG 10.55 (0.70)], Root Mean Square (RMS) sagittal plane [CLBP 1.21 (0.06) vs CG 1.04 (0.04)] and area [CLBP 24.27 (2.47) vs CG 16.45 (1.79)]. CLPB group showed greater sway in frontal plane in the one leg stand test (p<0.05): RMS frontal plane [CLBP 0.43 (0.02) vs CG 0.55 (0.04)]. Conclusion: Individuals with non-specific CLBP have impaired postural control relative to their controls, as evidenced by increased oscillation of COP. Differences were more pronounced in eyes closed condition and unstable surface

Estudos anteriores mostraram que indivíduos com lombalgia crônica tem comprometimento do controle motor dos músculos do tronco durante as tarefas dos membros superiores. No entanto, pouco se sabe sobre o controle motor dos músculos do tronco e quadril durante os movimentos dinâmicos de membros inferiores. O movimento de ajoelhado para semi ajoelhado é comumente utilizado na avaliação de pacientes neurológicos e foi escolhido para analisar os músculos do tronco e do quadril com a mínima interferência do movimento das articulações distais (tornozelos e joelhos). Esta tarefa pode ajudar os fisioterapeutas como uma ferramenta de triagem de pessoas com o controle motor do tronco e do quadril alterados e definir o tratamento mais eficaz... Objetivo: Comparar a atividade dos músculos do tronco e do quadril em pacientes com dor lombar crônica e indivíduos saudáveis durante a transferência de ajoelhado para semi-ajoelhado. Métodos: Vinte e nove mulheres com lombalgia crônica inespecífica (GL), (idade=45,8 ± 14,37 anos, IMC= 24,15 ± 3,95 Kg/cm²) e trinta mulheres assintomáticas (GC), (idade=44,57 ± 13,65 anos anos, IMC=23,77 ± 2,18 Kg,cm²) participaram deste estudo e estavam livres de dor durante a transferência de ajoelhado para semi-ajoelhado movimento. A atividade eletromiográfica (EMG) dos músculos Oblíquo Interno (OI), Eretor lombar (EL) e Glúteo Médio (GM) foi registrada bilateralmente, enquanto os participantes realizaram a transferência de ajoelhado para semi ajoelhado sobre uma plataforma de força. A plataforma de força e o sistema de EMG foram sincronizadas de modo que a curva obtida na plataforma de força permitiu estabelecer o início e o fim do movimento. Os sinais de EMG foram filtrados, e tratados matematicamente para se obter variáveis de pico, instante do pico e integral da atividade muscular de cada músculo. O teste de Mann-Whitney foi aplicado para comparar as variáveis entre os grupos. Resultados: Durante o movimento, observou-se no GL, maior integral e pico de contração maior e mais precoce dos músculos ELD e ELE, comparado ao GC, enquanto este apresentou maior integral e pico de contração maior e mais precoce dos músculos OI e GM, bilateralmente. Os resultados mostraram evidências sobre a hipótese de que pacientes lombálgicos utilizam diferentes padrões de ativação lombo-pélvica, exigindo maior atividade dos Eretores Lombares. enquanto o grupo controle realiza o movimento a partir dos músculos OI e GM. Conclusão: Sujeitos com lombalgia crônica têm atividade diferente dos músculos do tronco e quadril comparados com sujeitos assintomáticos durante o movimento de ajoelhado para semi-ajoelhado / Previously studies have shown that chronic low back pain subjects have compromised motor control of trunk muscles during upper limb tasks. However little is known about the motor control of trunk and hip muscles during dynamic movements of lower limbs. Kneeling to halfkneeling movement is commonly used in the evaluation of neurologic patients and was chosen to analyze trunk and hip muscles with minimum interference of distal joints movements (ankles and knees). This task might help physical therapists to use as a screening tool of people with altered motor control of trunk and hip to better address an effective treatment. Objective: to compare the activity of trunk and hip muscles in patients with chronic low back pain and pain-free individuals subjects during the transfer from kneeling to half-kneeling position. Methods: Twenty-nine women with non-specific chronic low back pain (CLBPg) and thirty asymptomatic ones subjects (Cg) participated in this study. Cg had mean(SD) age of 44,57(13,65) years, body mass index of 23,77(2,18) kg/cm² and CLBP had age of 45,8(14,37) years, body mass index of 24,15(3,95) kg/cm² and were pain-free during the transfer from kneeling to half-kneeling movement. ccc Electromyography activity (EMG) of obliquus internus abdominis (OI), lumbar erector spinae (LES) and gluteus medius (GM) muscles was recorded bilaterally while participants performed the transfer from keeling to half-kneeling position on a force platform. The force platform and the EMG system were synchronized so that the curve obtained in the force platform allowed to establish the beginning and the end of the movement in the EMG signal. EMG signal were filtered, and treated to obtain variables as the peak power, time to xiv peak achievement and integrated EMG of each muscle. Main-Whitney was applied to compare variables between groups. Results: Man-Whitney test showed differences between groups. Asymptomatic subjects had an increased integrated EMG, peak power and earlier time to peak of bilateral obliquus internus abdominis and gluteus medius muscles while chronic low back pain patients had an increased integrated EMG, peak power and earlier time to peak of bilateral muscle activation of lumbar erector spine during the movement. Conclusion: Chronic low back pain subjects have different activity of trunk and hip muscles compared to asymptomatic ones during kneeling to half-kneeling movement