Le but de cette thèse est d’étudier s’il existe une méthode de récolte d’informations, autre que celle couramment utilisée, permettant de mieux décrire l’histoire naturelle des lombalgies non spécifiques. Pour cela, une revue de la littérature a été effectuée et une étude prospective dans la population générale danoise a été analysée. Deux méthodes de récolte d’informations sont utilisées pour caractériser cette évolution : la méthode usuelle par questionnaires, permettant de classer les douleurs lombaires en fonction du nombre total de jours avec douleurs dans une année, et une nouvelle méthode par suivi SMS prenant en compte la durée et le rythme des épisodes douloureux dans une année. Les résultats de la revue de littérature et l’analyse de la population générale danoise vont dans le même sens. L’évolution des douleurs lombaires est relativement stable, notamment pour ceux qui n’ont pas de douleurs en début d’étude. Les deux systèmes de classification, issus respectivement des deux méthodes de récolte, répartissent les individus en groupes non similaires. De plus, les associations de ces groupes avec des variables biopsychosociales ne sont pas les mêmes, différenciant ainsi cliniquement les groupes de chaque classification. Le suivi SMS permet d’apporter des informations plus détaillées sur le rythme des douleurs lombaires dans le temps et semble plus appropriée pour caractériser l’évolution d’une affection récurrente comme la lombalgie non spécifique. Ces résultats permettent maintenant de prévoir l’évolution des douleurs lombaires et vont faciliter l’étude plus précise de profils d’évolutions des individus afin d’améliorer le diagnostic qui, pour l’instant, reste un diagnostic d’exclusion. / The aim of this thesis is to study if there is information gathering method, other than that commonly used to better describe the natural history of non-specific low back pain. For this, a literature review was performed and a prospective study in the Danish general population was analyzed. Two methods of gathering information are used to characterize this course: the usual method by questionnaires, classifying low back pain based on the total number of days with pain in one year, and a new SMS-Track method taking into account the duration and rhythm of painful episodes in a year. The results of the literature review and analysis of data on the Danish general population go in the same direction. The course of low back pain is fairly stable, especially for those who do not have pain at baseline. Both classification systems, respectively from the two methods of collection, divide individuals into different groups. In addition, associations of these groups with bio-psychosocial variables are not the same, differentiating clinically the groups of each classification. SMS-Track method provide more detailed information on the rhythm of low back pain over time and seems more appropriate to characterize the course of a recurring condition such as non-specific low back pain. These results now predict the natural history of low back pain and will facilitate the study of individual course patterns to improve the diagnosis, which remains, for now, a diagnosis of exclusion.

<p>SAMMANFATTNING</p><p><p>Ländryggsbesvär är generellt vanligt förekommande i befolkningen och samhällsekonomiskt kostsamt. Riskfaktorer för ländryggsbesvär beskrivs vara flerdimensionella, där nämns främst arbetsrelaterade och psykosociala faktorer. Poliser är en yrkesgrupp där arbetssjukdomar rapporteras vanligt förekommande oavsett kön. Trots det är polisers arbetssituation dåligt utforskad. Syftet med studien är att kartlägga upplevt hälsotillstånd och arbetssituation bland utryckningspoliser med fokus på ländryggsbesvär, som underlag för preventiva åtgärder. Metoden bestod av en tvärsnittsstudie i form av en omfattande enkätundersökning. Urvalet inom polisens utryckningsenhet i Västerås var totalt. Så många som 60 % angav arbetsrelaterade ländryggsbesvär, en större del med besvär var män och förekomst av tunga lyft var vanligare bland svarande med besvär. Personer med ländryggsbesvär tog i mindre utsträckning pauser, kände sig stressade på arbetet och besvärades oftare av kroppslig värk. Deltagarna själva kopplade sina ländryggsbesvär till dåligt utformad arbetsutrustning, dålig sittställning i yrkesfordonen och till fysiska ingripanden. Av litteraturen beskrivna riskfaktorer för ländryggsbesvär var vanligt förekommande inom enheten. Där nämns ogynnsamma arbetsställningar och arbetsmoment samt psykosociala faktorer i form av hög arbetsbelastning, lågt stöd från arbetsledning och låg möjlighet att påverka sin arbetssituation.</p><p>Slutsats: För att förbättra arbetsmiljön för utryckningspoliser bör åtgärder inriktas mot belastningsergonomiska- och psykosociala faktorer i arbetet samt utformning av utrustning och arbetsfordon utifrån ergonomi och säkerhet.</p></p> / <p>ABSTRACT</p><p>Low back pain is a common disorder which causes high economic costs for the society. Risk factors for back pain are described as multidimensional, including both work related and psychosocial factors. Police-officers belong to an occupational group were work related diseases are frequently reported, irrespective of gender. The work situation for these officers however is poorly covered by targeted research. The purpose of this study is to survey the health- and work situation among police-officers with the focus on low back pain. The hope is that the results can be used as a base for preventive interventions. A cross sectional design with an extensive survey was used for the study. The selection was total within the unit of patrolling police officers in Västerås. As many as 60 % reported low back pain, with an overrepresentation among men. Heavy lifting was more common among those with low back pain. Those reporting low back pain more rarely took breaks during the work day, they felt more stressed at work and were more often troubled with physical pain. The study participants linked their back problems to badly designed work equipment, badly adjusted vehicles and to physical interventions. Risk factors for low back pain, described by the literature, were common within the unit. Especially, work tasks involving unfavorable movements and body positions were singled out. Among psychosocial factors, low social support from management and low ability to influence the work situation were associated with low back pain.</p><p>Conclusion: To improve the work environment for patrolling police-officers, measures should be focused on load and strain ergonomics, psychosocial factors as well as to develop equipment and vehicles more on the basis of ergonomics and safety measures.</p>

La lombalgie constitue une affection fréquente de la population adulte des pays industrialisés. Les médias parlent souvent de « mal de dos, mal du siècle ». Les études épidémiologiques révèlent en effet que la majorité des individus souffriront un jour du dos. La lombalgie présente généralement une évolution naturelle favorable. Les répercussions socio-économiques majeures associées aux douleurs lombaires, et qui conduisent certains à employer le terme de « fléau socioéconomique », résultent des lombalgies persistant plus de 3 mois (lombalgies chroniques) qui affectent pourtant moins de 10% des lombalgiques mais dont le traitement constitue un défi considérable pour le monde médical et la société. Ces observations ont motivé notre recherche relative à lévaluation et la revalidation de la lombalgie chronique. En effet, malgré une littérature scientifique abondante, ce sujet reste méconnu et parfois même controversé. Après avoir précisé létat de la question (chapitre II), notre contribution personnelle (chapitre III) concerne lévaluation et la rééducation musculaire du lombalgique chronique. Notre contribution comporte trois parties : La PREMIERE PARTIE déterminera les tests les plus adaptés pour évaluer les muscles extenseurs du tronc de lombalgiques chroniques. A cette fin, nous avons appliqué la procédure suivante : Etape 1 : revue de la littérature, analyse critique et sélection des évaluations disponibles. Etape 2 : analyse comparative des tests sélectionnés sur des sujets sains afin dapprécier leur faisabilité et leur reproductibilité. Etape 3 : étude de la reproductibilité des tests sélectionnés sur des patients lombalgiques chroniques. Etape 4 : évaluation de la sollicitation cardio-vasculaire des épreuves. Etape 5 : validation des épreuves en examinant la sollicitation musculaire. La SECONDE PARTIE appréciera lampleur du déconditionnement physique du sujet lombalgique chronique tout en précisant son caractère global ou local. Cette étude compare, chez des sujets lombalgiques et sains appariés, les performances des extenseurs du tronc mais également dautres muscles du tronc et des membres inférieurs ainsi que du système cardio-respiratoire. La TROISIEME PARTIE examinera lefficacité lefficacité de la nouvelle prise en charge multidisciplinaire (octobre 2004) proposée par le service de Médecine Physique du CHU de Liège aux patients lombalgiques chroniques. Lors de la discussion générale (chapitre IV), nous établirons des recommandations relatives à lévaluation et au traitement des lombalgiques chroniques.

SAMMANFATTNING Ländryggsbesvär är generellt vanligt förekommande i befolkningen och samhällsekonomiskt kostsamt. Riskfaktorer för ländryggsbesvär beskrivs vara flerdimensionella, där nämns främst arbetsrelaterade och psykosociala faktorer. Poliser är en yrkesgrupp där arbetssjukdomar rapporteras vanligt förekommande oavsett kön. Trots det är polisers arbetssituation dåligt utforskad. Syftet med studien är att kartlägga upplevt hälsotillstånd och arbetssituation bland utryckningspoliser med fokus på ländryggsbesvär, som underlag för preventiva åtgärder. Metoden bestod av en tvärsnittsstudie i form av en omfattande enkätundersökning. Urvalet inom polisens utryckningsenhet i Västerås var totalt. Så många som 60 % angav arbetsrelaterade ländryggsbesvär, en större del med besvär var män och förekomst av tunga lyft var vanligare bland svarande med besvär. Personer med ländryggsbesvär tog i mindre utsträckning pauser, kände sig stressade på arbetet och besvärades oftare av kroppslig värk. Deltagarna själva kopplade sina ländryggsbesvär till dåligt utformad arbetsutrustning, dålig sittställning i yrkesfordonen och till fysiska ingripanden. Av litteraturen beskrivna riskfaktorer för ländryggsbesvär var vanligt förekommande inom enheten. Där nämns ogynnsamma arbetsställningar och arbetsmoment samt psykosociala faktorer i form av hög arbetsbelastning, lågt stöd från arbetsledning och låg möjlighet att påverka sin arbetssituation. Slutsats: För att förbättra arbetsmiljön för utryckningspoliser bör åtgärder inriktas mot belastningsergonomiska- och psykosociala faktorer i arbetet samt utformning av utrustning och arbetsfordon utifrån ergonomi och säkerhet. / ABSTRACT Low back pain is a common disorder which causes high economic costs for the society. Risk factors for back pain are described as multidimensional, including both work related and psychosocial factors. Police-officers belong to an occupational group were work related diseases are frequently reported, irrespective of gender. The work situation for these officers however is poorly covered by targeted research. The purpose of this study is to survey the health- and work situation among police-officers with the focus on low back pain. The hope is that the results can be used as a base for preventive interventions. A cross sectional design with an extensive survey was used for the study. The selection was total within the unit of patrolling police officers in Västerås. As many as 60 % reported low back pain, with an overrepresentation among men. Heavy lifting was more common among those with low back pain. Those reporting low back pain more rarely took breaks during the work day, they felt more stressed at work and were more often troubled with physical pain. The study participants linked their back problems to badly designed work equipment, badly adjusted vehicles and to physical interventions. Risk factors for low back pain, described by the literature, were common within the unit. Especially, work tasks involving unfavorable movements and body positions were singled out. Among psychosocial factors, low social support from management and low ability to influence the work situation were associated with low back pain. Conclusion: To improve the work environment for patrolling police-officers, measures should be focused on load and strain ergonomics, psychosocial factors as well as to develop equipment and vehicles more on the basis of ergonomics and safety measures.

Tesis por compendio de publicaciones / El dolor lumbar en niños y adolescentes es un problema de salud que va en aumento. Desde la Fisioterapia se aborda este problema con medidas preventivas y de tratamiento. El objetivo de esta Tesis fue estimar la prevalencia del dolor lumbar en niños y adolescentes, así como, analizar la eficacia de las diferentes modalidades fisioterapéuticas para la prevención y el tratamiento del dolor lumbar en esta población, mediante tres estudios meta-analíticos. Para la búsqueda de los estudios se utilizaron fuentes formales e informales, lo que nos permitió identificar 86 artículos que cumplieron con los criterios de selección. Respecto de los resultados, las tasas de prevalencia de vida en el dolor lumbar de niños y adolescentes fueron más altas en los sujetos de mayor edad, y en los estudios más recientes y de mejor calidad metodológica. Los tratamientos preventivos de Fisioterapia para el cuidado de la espalda en niños y adolescentes fueron eficaces para la adquisición de conocimientos y mejora de las conductas saludables. Para adquirir conductas los tratamientos fueron más eficaces cuando se combinó la adquisición de conocimientos con el entrenamiento de hábitos posturales, cuando se combinó la enseñanza teórica y práctica y cuanto mayor fue el número de horas por semana y el número de horas total de tratamiento que recibió cada sujeto. Los tratamientos de Fisioterapia para el dolor lumbar en esta población fueron eficaces, siendo la combinación de acondicionamiento físico terapéutico y terapia manual el más eficaz. / Low back pain (LBP) in children and adolescents is a health problem that is increasing, and the physiotherapy addresses this problem with preventive and treatment interventions. The aim of this Dissertation was to estimate the prevalence of LBP in children and adolescents and to analyze the effectiveness of different physiotherapic modalities for preventing and treating LBP in this population, by means of three meta-analyses. Formal and informal sources were used to search for the studies, identifying a total of 86 articles for the three meta-analyses that met the selection criteria. Regarding the results, rates of lifetime prevalence for LBP in children and adolescents were higher in older subjects, as well as for more recent studies and with a better methodological quality. Physiotherapy preventive treatments for LBP in children and adolescents were effective in acquiring knowledge and improving healthy behaviors. To modify behaviors, preventive treatments were more effective when combined with knowledge acquisition training postural habits, when combined theoretical and practical teaching and the greater the number of hours per week and the total number of hours of treatment received by each subject. Physiotherapy treatments for LBP were effective in this population, with the combination of therapeutic physical conditioning and manual therapy as the most effective.

Title from PDF of title page. / Document formatted into pages; contains 69 pages. / Thesis (Ph.D.)--University of South Florida, 2001. / Includes bibliographical references. / Text (Electronic thesis) in PDF format. / ABSTRACT: Nursing staff members (registered nurses, licensed practical nurses, and nursing aides) have one of the highest incidence rates of work-related musculoskeletal disorders (WMSDs) of all occupations. Ergonomic research has identified patient handling and movement tasks that put the caregiver at high risk for a WMSD each time they are performed. The purpose of this study was to determine whether the frequency of performing the highest risk tasks, as well as certain other risk factors affecting physical workload, were related to the frequency of musculoskeletal discomfort. Also investigated was whether the manual handling workload varied by job category. The cross-sectional study was conducted at a Veterans' Administration hospital in Tampa, Florida in August 2001 on 11 in-patient units with 113 participants, who completed musculoskeletal discomfort and demographic surveys at the end of a week of observation of their workloads. / ABSTRACT: Multiple regression analysis indicated that the number of high risk patient handling and movement tasks performed per hour, the number of patients cared for who weighed 212 pounds or more, and the interaction of the two were associated with the frequency of knee and wrist pain, but not with low back pain. The following variables were not associated with the frequency of musculoskeletal discomfort in any body part: patient census/able bodied staff ratio, patient classification rating, or number or use of patient handling and movement equipment. Manual handling workload did differ significantly among job categories, with registered nurses performing the fewest at- risk patient handling tasks and nursing aides the most. The seven-day prevalence rate of at least moderate discomfort in at least one body part was 62%. / ABSTRACT: Recommendations include instituting recorded patient assessments to standardize the type of equipment and the number of staff members needed for specific handling and movement activities, as well as improved staff training. Further research is needed on the following: biomechanical forces on the wrist and knee during patient handling and movement tasks; the effect of patient weight on the risk of patient handling and movement tasks; and psychosocial stressors in addition to the physical workload of nursing staff. / System requirements: World Wide Web browser and PDF reader. / Mode of access: World Wide Web.

Key words: lumbar stabilization exercise, multifidus muscle size, low back pain. Low back pain is one of the most common conditions in mankind. Therefore, it is needed an exact diagnostic and the most effective problem solving method. There is an evidence of dysfunction in deep lower back and abdominal muscles in low back pain patients. Accordingly, the aim of this study was to define the influence of lumbar stabilization exercise for chronic low back pain, and to examine L4- L5 multifidus and transversus abdominis muscles size. The objectives of our study: to determine and compare normal and chronic low back pain patients ranges of L4- L5 multifidus and transversus abdominis muscles size; to evaluate deep lower back and abdominal muscles function before and after lumbar stabilization exercise; to estimate chronic low back pain changes duaring stabilization exercise. The methods of our research: ultrasound imaging, the instrument of pressure bio- feedback „Stabilizer“, Oswestry Low Back Pain Disability Index Questionnaire, the analysis of mathematical statistics. This work consists of two studies with different participants. 16 healthy individuals and 16 chronic low back pain patients were studied in ultrasound imaging measurement. 12 chronic low back pain patients (4 women and 8 men) were participated in lumbar stabilization exercise program. Results: L4- L5 multifidus muscle size was larger (27 %) in males than in females, transversus abdominis muscle size was larger (17... [to full text]

Tyrimo problema: lėtinio nugaros juosmeninės dalies skausmo pasikartojimo tikimybė labai didelė, todėl svarbu ištirti ir įvertinti pratimų išliekamąjį poveikį gydant nugaros skausmą. Kol apatiniai stuburo segmentai yra nestabilūs, jokie pratimai, mažinantys nugaros juosmeninės dalies skausmą, nebus efektyvūs. Stuburą stabilizuojančių pratimų dozavimas, jų atlikimo trukmė ir išliekamasis poveikis vis dar kelia diskusijų ir reikalauja išsamesnių tyrimų. Tyrimo hipotezė: 12 savaičių 24 procedūrų stuburą stabilizuojančių pratimų programos išliekamasis poveikis yra nepakankamas, siekiant ilgalaikio gydomojo efekto 40–60 metų amžiaus moterims, kamuojamoms lėtinio nugaros juosmeninės dalies skausmo. Tyrimo tikslas: įvertinti 12 savaičių 24 procedūrų stuburą stabilizuojančių pratimų programos išliekamąjį poveikį 40–60 metų amžiaus moterims, kamuojamoms lėtinio nugaros juosmeninės dalies skausmo. Tyrimo uždaviniai: ištirti liemens lenkiamųjų ir tiesiamųjų raumenų izometrinę jėgą ir ištvermę prieš ir po stuburą stabilizuojančių pratimų programos bei praėjus 4 ir 8 savaitėms po jos; nustatyti tiriamųjų nugaros juosmeninės dalies skausmo lygį ir įvertinti funkcinę būklę prieš ir po stuburą stabilizuojančių pratimų programos bei praėjus 4 ir 8 savaitėms po jos; įvertinti liemens lenkiamųjų ir tiesiamųjų raumenų jėgos ir ištvermės pokyčio įtaką nugaros juosmeninės dalies skausmo intensyvumui bei funkcinei būklei. Tyrimo metodai: Biodex System 3 Pro izokinetinis dinamometras, pilvo ir... [toliau žr. visą tekstą] / The problem of the research: the probability that chronic low back pain will reoccur is very high. For this reason, it is important to examine and evaluate the lastingness of the effect of the exercises while treating back pain. To reduce low back pain spine stabilizing exercises are applied. Dosage of exercises, duration of their performance and lastingness of the effect are still generating discussions and require a more detailed research. The hypothesis of the research: lastingness of twelve-week, 24 procedures, spine stabilizing exercises programme is not sufficient for 40-60 year old women with chronic low back pain while seeking a long lasting healing effect. The aim of the research: to evaluate lastingness of twelve-week, 24 procedures, spine stabilizing exercises programme effect on 40-60 year old women with chronic low back pain. The objectives of the research: to examine isometric force and endurance of back bending and straightening muscles before and after spine stabilizing exercises programme as well as 4 and 8 weeks after it; to determine subjects’ level of low back pain and functional state before and after spine stabilizing exercises programme as well as 4 and 8 weeks after it; to determine the effect of change in strength and endurance of waist bending and straightening muscles on low back pain intensity and functional state. Methods applied in the research: Biodex System 3 Pro isokinetic dynamometer, tests on abdomen and back muscles endurance, Oswestry... [to full text]

Low back pain (LBP) is a common ailment in the United States, affecting up to 80% of adults at least once in their lifetime. Although 90% of LBP cases are considered nonspecific, recent studies show that abnormal mechanics of the lower back can be a major factor. One method of assessing the lower back mechanical environment is through perturbation experiments. An intensive literature review of perturbation systems was used to select and develop a system for the Human Musculoskeletal Biomechanics Lab (HMBL). Following construction, individuals with high/low exposure to day-long physical activity were assessed to quantify daily changes in their lower back mechanics and determine whether complete recovery occurs during overnight rest. Despite significant decrease in maximum voluntary contractions (MVC), intrinsic stiffness of the high exposure group remained constant following day-long physical activity. The final component of this Master’s project is devoted to the design of a wobble chair system for study of trunk stability. Development of the perturbation system and wobble chair are hoped to facilitate future research aimed at a better understanding of trunk mechanical and neuromuscular behaviors to prevent and treat LBP in the future.

From a public health perspective pain from low back and/or pelvis was studied in relation to pregnancy. Two interventions, water gymnastics or Friskis and Svettis ́ gymnastics for pregnant women, were evaluated regarding effects on symptoms and need for sick leave due to low back or pelvic pain. In an intervention study with 390 randomised women, 266 participated in physical activity during 60 minutes once a week during just about half their pregnancies. No one was sick-listed due to low back pain in the water gymnastic group compared to 6 women in the land-based exercise group (p=0.03). Some doubts may be raised regarding recommendations to pregnant women with a history of low back pain to participate in gymnastics. On the contrary, water gymnastics seems to be beneficial regarding low back pain. Methods to prevent pelvic pain in relation to pregnancy are not known. Furthermore, a possible relation between longstanding pelvic pain after pregnancy was investigated. Such a relation has never been described before. Fifteen subjects, women with defined posterior pelvic pain during and after pregnancy and as many controls without anamnesis of such pain were tested for lactose intolerance, using the BH2-test. A correlation was found, p=0.05 but results need to be confirmed in larger studies. The possible link towards explaining such a relation goes through the fact that lactose intolerance and “irritable bowel syndrome”, IBS, often overlap and lactose intolerance test is recommended to be included in investigation of IBS. Can low back/pelvic pain in relation to pregnancy sometimes be correlated to lactose intolerance? / Med utgångspunkt från ett folkhälsoperspektiv studerades smärta från ländrygg och eller bäcken hos gravida kvinnor. Två interventioner, vattengymnastik respektive Friskis och Svettis ́ Vänta-barn-gympa, utvärderades avseende symtom på smärta från ländrygg och bäcken samt sjukskrivning härför i samband med graviditet. I en interventionsstudie med 390 randomiserade kvinnor deltog 266 kvinnor i fysisk aktivitet under en timma per vecka under drygt halva graviditeten. Ingen var sjukskriven för ländryggsmärta i vattengymnastikgruppen jämfört med 6 kvinnor i gymnastikgruppen (p=0.03). Viss försiktighet föreslås när det gäller att rekommendera vanlig gymnastik till kvinnor med anamnes på ryggsmärta under graviditet medan vattengymnastik förefaller ha god effekt för just ländryggsmärta. Någon metod för att förebygga bäckensmärta finns inte beskriven. Vidare studeras ett eventuellt samband mellan laktosintolerans och kvarstående bäckensmärta, något som inte tidigare undersökts. När det gäller sambandet graviditet – laktosintolerans gjordes en pilotstudie med 15 deltagare och lika många kontroller. Ett visst samband kunde konstateras, p=0.05, men resultaten måste verifieras i större studier. Den tänkbara förklaringsmekanismen bakom sambandet med laktosintolerans går via ”irritable bowel syndrome”, IBS. Symtom från IBS och från laktosintolerans överlappar varandra och det rekommenderas att laktosbelastning skall ingå i utredning av oklara buksmärtor. Kan även bäckensmärtor i samband med graviditet i vissa fall ha samband med laktosintolernas?