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Back pain is a very common musculoskeletal impairment in most Americans. Average annual occurrence of back pain is reported around 30% of the population and is the most common cause of activity limitation in people younger than 45 years old. Eighty percent of the back pain presents in the lumbar spine. Although this ailment is very prevalent in the American population, there is a lack of empirical evidence supporting the common clinical diagnosis and intervention back pain strategies. The frequency of back pain and the lack of treatment methods were the motivation for this investigation. It is important to better understand spine dynamics during ambulatory tasks of daily activities to identify possible biomechanical mechanisms underlying back pain. Current biomechanical quantification methods for spine dynamics are either too invasive or not detailed enough to fully comprehend detailed spinal movement. Therefore, a non-invasive but detailed procedure to calculate spine dynamics was developed and tested. In this study, multi-segmented spine dynamics (kinematics and kinetics) were calculated during four activities of daily living (level walking (W), obstacle crossing (OC), stair ascent (SA) and stair descent (SD)). Our findings suggested an in-vivo multi-segmented spine surface marker set is able to detect different and repeatable motion patterns during walking among various spinal segments. The sacrum to lower lumbar (SLL) joint had the largest range of motion (ROM) when compared to the other more superior joints (lower lumbar to upper lumbar and upper lumbar to lower thoracic). Furthermore, SA task demonstrated more flexion ROM than both W and SD tasks. In addition to task influence, joints at different spine levels also demonstrated different ROMs, where SLL had a greater ROM than upper lumbar to lower thoracic (ULLT) in the transverse plane. Age was found to not significantly affect the segmental spinal ROM or peak angles. The vertical segmental joint reaction forces were different between tasks, where SD yielded larger vertical reaction forces than W. Overall, findings from this dissertation work were able to show that a multi-segment spine marker system could be an effective tool in determining different spinal dynamics during various activities of daily living. This dissertation includes unpublished co-authored material.

Made available in DSpace on 2014-06-11T19:22:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-06-07Bitstream added on 2014-06-13T19:28:12Z : No. of bitstreams: 1 nascimento_prc_me_prud.pdf: 2117913 bytes, checksum: 76ca018a3d60c5ded0fc7231909206b0 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A lombalgia é uma afecção de alta incidência que gera grandes custos ao sistema de saúde. Indivíduos que experimentam um quadro álgico agudo na região lombar geralmente têm um bom prognóstico com recessão dos sintomas em algumas semanas, porém, uma parte das manifestações torna-se crônica e em sua grande maioria não apresentam uma causa, sendo assim denominada, lombalgia crônica não específica (LCNE). Entretanto, alguns relatos mostraram que fatores psicossociais estão fortemente ligados na manutenção ou regressão dos sintomas. Como alguns pacientes apresentam resposta positiva ao tratamento e outros não manifestam melhora, nos é permitido pensar que há outros fatores condicionantes da manifestação que precisam ser levantados. Através deste estudo buscamos averiguar a existência de uma associação entre a formação de um vínculo positivo entre paciente e terapeuta avaliada através do inventário de aliança terapêutica (IAT) e o recrutamento adequado dos músculos abdominais profundos. Participaram deste estudo 13 indivíduos com LCNE, estes sujeitos foram envolvidos em um programa de tratamento englobando exercícios de controle motor com oito semanas de duração. Ao final do estudo as variáveis de interesse foram analisadas revelando a existência de uma tendência na melhora do recrutamento do músculo transverso abdominal (TrA) quando há o estabelecimento de... / The low back pain is a high incidence condition which has enormous economic costs to the health system. Subjects who experience an acute painful episode in the lumbar region generally have a good prognosis with recession of symptoms in a few weeks, but some of these events become chronics and mostly do not have a cause, being so named, non-specific chronic low back pain (NS-CLBP). However, some reports have showed that psychosocial factors are strongly connected with the maintenance or regression of the symptoms. As some patient present positive response to treatment and others not show get better we can think that there are others factors conditioning of the manifestation which need to be raised. In this study we sought to determine the existence of an association between a formation of the positive bond between patient and therapist assessed by the working alliance inventory (WAI) with adequate recruitment of the deep abdominal muscles. Thirteen individual with NS-CLP participated of this study, these subjects were involved in a treatment program that included motor control exercise with 8 weeks of duration. After the study, the variables of interest were analyzed revealing the existence of trend for improve recruitment of the transversus abdominis muscle (TrA) when there is development... (Complete abstract click electronic access below)

Orientador: Rúben de Faria Negrão Filho / Banca: Fabio Micolis de Azevedo / Banca: Leonardo Oliveira Pena Costa / Banca: Maria Rita Masselli / Resumo: A lombalgia é uma afecção de alta incidência que gera grandes custos ao sistema de saúde. Indivíduos que experimentam um quadro álgico agudo na região lombar geralmente têm um bom prognóstico com recessão dos sintomas em algumas semanas, porém, uma parte das manifestações torna-se crônica e em sua grande maioria não apresentam uma causa, sendo assim denominada, lombalgia crônica não específica (LCNE). Entretanto, alguns relatos mostraram que fatores psicossociais estão fortemente ligados na manutenção ou regressão dos sintomas. Como alguns pacientes apresentam resposta positiva ao tratamento e outros não manifestam melhora, nos é permitido pensar que há outros fatores condicionantes da manifestação que precisam ser levantados. Através deste estudo buscamos averiguar a existência de uma associação entre a formação de um vínculo positivo entre paciente e terapeuta avaliada através do inventário de aliança terapêutica (IAT) e o recrutamento adequado dos músculos abdominais profundos. Participaram deste estudo 13 indivíduos com LCNE, estes sujeitos foram envolvidos em um programa de tratamento englobando exercícios de controle motor com oito semanas de duração. Ao final do estudo as variáveis de interesse foram analisadas revelando a existência de uma tendência na melhora do recrutamento do músculo transverso abdominal (TrA) quando há o estabelecimento de... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The low back pain is a high incidence condition which has enormous economic costs to the health system. Subjects who experience an acute painful episode in the lumbar region generally have a good prognosis with recession of symptoms in a few weeks, but some of these events become chronics and mostly do not have a cause, being so named, non-specific chronic low back pain (NS-CLBP). However, some reports have showed that psychosocial factors are strongly connected with the maintenance or regression of the symptoms. As some patient present positive response to treatment and others not show get better we can think that there are others factors conditioning of the manifestation which need to be raised. In this study we sought to determine the existence of an association between a formation of the positive bond between patient and therapist assessed by the working alliance inventory (WAI) with adequate recruitment of the deep abdominal muscles. Thirteen individual with NS-CLP participated of this study, these subjects were involved in a treatment program that included motor control exercise with 8 weeks of duration. After the study, the variables of interest were analyzed revealing the existence of trend for improve recruitment of the transversus abdominis muscle (TrA) when there is development... (Complete abstract click electronic access below) / Mestre

Motion and motor patterns of low back pain (LBP) sufferers have been demonstrated as different compared to those without LBP. The mechanism behind such movement alterations is not well known but is believed to be related to pain. Current biomechanical measurement of lumbar curvature and kinematics has limitations for routine clinical use. The aims of this research were to (1) investigate new motion analysis technology for dynamic lumbar curvature (fibre-optic sensors) and higher order kinematic assessment (inertial sensors) within a clinical environment; (2) determine the effect of pain relief on lumbar curvature, kinematics and muscle function in acute low back pain (ALBP) and chronic low back pain (CLBP) sufferers. Dynamic lumbar curvature was found to be reliably measureable in the clinic. Additional analysis demonstrated that regional curvature, as well as sequencing of curvature change measurement was possible. ALBP sufferers display less peak curvature during flexion and lifting compared to CLBP sufferers and both groups demonstrated the greatest curvature change in the second quartile for flexion and lifting and first for extension. Partial pain relief did not increase curvature in either group, and neither group was more likely to respond to pain relief by increasing curvature or altering sequencing. Higher order kinematics could be reliably and readily indentified in the clinic using inertial sensors. Movement-velocity plots were employed to describe the movement trajectory and irregularity. Multivariate analysis of variance revealed that neither partial pain relief (pre vs post) nor chronicity (acute vs chronic) had any effect on lumbar kinematics. Individuals appeared to exhibit different electromyography profiles. Those individuals with little deviation in muscle activation commonly displayed lower kinematic values. Partial pain relief did not alter the pattern of EMG profile, muscle onset timing or peak amplitude. These results suggest that clinicians should not expect automatic alterations in motion and motor patterns following interventions which target and achieve partial pain relief.

The neuromuscular response to prolonged lumbar flexion has recently been extensively studied in felines but has not been examined in humans. Animal studies suggest that prolonged lumbar flexion disturbs neuromuscular control of paraspinal muscles. This disturbance was linked to creep deformation of passive spinal tissues. Past research indicates that disturbance of paraspinal reflexes may limit spinal stability. The current study aimed to examine this behavior in humans. We hypothesized that prolonged lumbar flexion will disturb paraspinal reflex behavior in human subjects. Reflex behavior was quantified following a fifteen minute period of static flexion. There was a trend suggesting an increase in reflex magnitude after flexion (p = 0.055). This trend was only significant in female subjects (p < 0.003). Increased reflex following flexion was associated with a transient period of EMG hyperexcitability similar to felines. A second study was performed to quantify reflex behavior and creep deformation during flexion and recovery. Results indicated that creep occurred during prolonged flexion (p < 0.001). Reflexes were inhibited following flexion (p < 0.03). Both creep deformation and paraspinal reflex (p > 0.05) failed to exhibit significant recovery during the length of the test. Inhibited paraspinal reflexes may contribute to spinal instability and risk of low back pain for workers using flexed postures, due to the inability of the neuromuscular system to coordinate an appropriate muscle response following an unexpected loading event. Future studies must examine appropriate work/rest intervals for workers using flexed postures to limit reflex disturbance from prolonged ligament strain. / Master of Science

Low back pain (LBP) is associated with altered neuromuscular control of the trunk, as well as impaired performance during functional tasks highly dependent upon trunk neuromuscular control. Comparing measurements between individuals with and without LBP does not distinguish whether the LBP individual exhibits altered neuromuscular control only while experiencing LBP versus at all times. Additional insight was gained on the relationship between trunk neuromuscular control and LBP by investigating individuals who experience recurrent exercise-induced LBP (eiLBP). To differentiate the effects of LBP from individual differences, comparisons were made between episodes of pain and no pain within eiLBP individuals, and between eiLBP individuals while pain free and a group of healthy controls. Three studies were completed based on repeated measurements from both eiLBP and healthy individuals. Study 1 investigated effects of eiLBP on fundamental measures of neuromuscular control, including intrinsic trunk stiffness and the paraspinal reflex delay using a series of pseudo-random position perturbations. eiLBP individuals exhibited increased stiffness compared to healthy controls unaffected by the presence of pain, and increased reflex delays concurrent only with pain. Study 2 investigated effects of eiLBP on seated sway during a functional task involving maintaining balance. Seat and trunk kinematics were obtained while participants balanced on a wobble chair at two difficulty levels. eiLBP individuals exhibited impaired seat measures at all times, with altered trunk measures only while in pain and when the task was not challenging. Study 3 investigated effects of eiLBP on the underlying control of seated sway using a model of wobble chair balance. Quantified neuromuscular control indicated increases in proportional and noise gains for a challenging level compared to an easy level, more so for eiLBP individuals compared to controls and while experiencing pain compared to pain free. Overall, fundamental measures, seated sway measures, and identified control parameters using a model of wobble chair balance were all affected by the presence of pain within the eiLBP individuals and/or the eiLBP individuals compared to healthy controls. Therefore, this study shows that some characteristics appear to be inherent to the LBP individual, while others are only concurrent with pain. / Ph. D.

Yes / /Aims: This research explored the reasons why patients with low back pain chose not to return to physiotherapy following an assessment. Methods: Qualitative, semi-structured interviews were conducted using five participants with low back pain. Data were analysed to produce codes, categories and themes. Findings: Data analysis produced expectations, communication and satisfaction as key themes. Findings suggest that expectations may and may not be linked to previous physiotherapy experience, with no clear link between expectations and satisfaction. Communication including sufficient time, listening skills, empathy, and caring qualities were highly regarded. Satisfaction levels were rated highly, despite not returning to physiotherapy. Participants reported pain resolution and personal choice as reasons for not returning. Conclusions: Findings support previous research suggesting expectations are multifaceted and individualised and not always linked to previous experience. Findings suggest the physiotherapist's excellent communication skills ensured an overall positive patient experience, maintaining high satisfaction levels.

Yip Yin Bing. / "July 1999." / Thesis (Ph.D.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (p. 163-177). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese. / Yip Yin Bing.