Low back pain (LBP) is regarded as a major health and economic problem in western industrialised countries even at this time in the twenty-first century. Researchers estimate that it has increased to affect about 45% of the population in 2011. This increase creates a major burden on the health care services, social structures and the economy in terms of absenteeism from work. CNSLBP is still poorly understood. Main reasons for the poor understanding of CNSLBP discussed in this study are the limited understanding of the effect of the spine as kinetic chain which includes the head and pelvic girdle and with its attachments to the scapulae . The process of development of ISMS dysfunction are discussed as a combination of abnormal spinal loading, soft and neural tissue plasticity that result in biomechanical malalignment, adaptive and maladaptive movement patterns, pain processing integrated with psychosocial factors that influence the biomechanical, pain processing and psychological responses are discussed as possible mechanisms in the development of CNSLBP. The researcher developed a multidimensional manual therapy model to manage patients with CNSLBP based on metacognitive reflection on her clinical reasoning over a period of 40 years as the research methodology. The metacognitive reflection has been performed within the interpretive paradigm The model that resulted from the metacognitive reflection is dialectic in nature because it entails the understanding of the patient‘s problem from an interpretive as well as from an empirico-analytical perspective. The model is conceptualised in three stages: Firstly the conceptualisation of the integrated spinal movement system (ISMS), to indicate that the spine, head, shoulder and pelvic girdles function as a closed kinematic chain. Secondly the process of the development of ISMS dysfunction as a major concept in the clinical picture of patients with CNSLBP is based on functional anatomy of the ISMS and the researcher‘s clinical observation in clinical practice. The researcher indicates how the development of ISMS dysfunction and characteristic adaptive behaviour are integrated components of the patient‘s complex heterogenic clinical picture. The underlying process for the development of ISMS dysfunction as a possible mechanism for CNSLBP is described as plasticity of soft and neural tissues (including the brain) which result in chronicity over time. Thirdly a multidimensional manual therapy model to manage patients with CNSLBP‘s heterogenic condition is discussed. The model indicates how the mechanisms underlying the development of ISMS dysfunction is addressed in a multidimensional approach to patient management. Finally the multidimensional manual therapy model is discussed in relation to other relevant intervention approaches. The model finally serves as a point of departure for planning and conducting appropriate research in basic and clinical sciences. The multidimensional manual therapy model for the management of patients with CNSLBP has been developed in clinical practice and is presented as a practicetheory in the form of a model. / Thesis (PhD)--University of Pretoria, 2013. / gm2013 / Physiotherapy / Unrestricted

La lombalgie est une douleur de la région lombaire du rachis. Un des moyens communément utilisés pour soulager cette douleur est le port d’orthèses lombaires. Bien que l’efficacité de ces orthèses soit démontrée, leur mode d’action reste mal connu. L’objectif de ce projet est d’analyser ce mode d’action dans le cas de ceintures de soutien lombaire.En lien avec des médecins et un industriel, trois approches ont été mises en œuvre. Premièrement, une approche expérimentale a permis de déterminer les propriétés mécaniques des ceintures de soutien lombaire et d’évaluer la pression appliquée suivant ces propriétés. Secondairement, la pression appliquée par les ceintures a été mesurée par une approche clinique. Cette pression a été liée à la diminution de la douleur engendrée par les ceintures, au bien-être ressenti, à la modification de la posture et à la déformation de la ceinture. Troisièmement, une approche numérique a servi à montrer les paramètres influents sur le soulagement de la douleur.Un des modes d’action des ceintures de soutien lombaire, mis en évidence dans ce projet, est la pression appliquée sur le tronc qui engendre une variation des pressions abdominale et intradiscale, ainsi qu’une modification de la posture. La pression appliquée dépend, entre autres, des caractéristiques mécaniques des ceintures. Les résultats mettent en évidence l’importance de maitriser cette pression appliquée ainsi que la spécificité du patient sur les effets mécaniques des ceintures.Les différentes approches sont complémentaires ; elles sont des moyens de caractérisation des orthèses qui pourraient être utilisés pour d’autres orthèses et également aider au développement de produits. / Low back pain is a pain felt in the lumbar region of the spine. Lumbar orthotics might be used to relieve this pain. Efficacy of lumbar orthotics was proved, but mechanical effects remain unclear. Aim of this project if to analyze these mechanical effects for lumbar belts, a specific lumbar orthotic.In relation with clinicians and manufacturer, three different approaches were developed. First, experimental approach permits to determine mechanical properties of lumbar belts and to evaluate applied pressure related to these mechanical properties. Second, applied pressure by lumbar belts was measured using a clinical approach. This pressure has been related to the decrease in pain, to the wellbeing felt, to the modification of posture and to the lumbar belts strain. Third, numerical approach was used to demonstrate the influential parameters on pain relief.One of mechanical effects of lumbar belts, highlighted in this project, is the pressure applied on the trunk which causes change in abdominal and intradiscal pressure and posture. The applied pressure depends on the mechanical properties of the belts. Results demonstrate the importance of mastering the applied pressure and the specificity of the patient on the mechanical effects of belts. The different approaches are complementary; they are orthotics characterization tools that could be used for others orthotics and also helps in the development of new products.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Low back pain (LBP) is a significant problem among the nursing population worldwide. Manual lifting and shifting of heavy objects and patients are primary contributing factors. Nurses are supposed to be knowledgeable about the risk factors and preventive measures and effectively apply it into practice to prevent them from sustaining back injuries. Strategies to reducing the incidences of LBP in nurses have been previously implemented but with little outcomes. The purpose of this study was to explore the relationship between occupational risk factors and the prevalence of LBP in nurses at MOI, Tanzania. Therefore, the study examined; the prevalence of LBP amongst nurses, work-related risk factors contributing to LBP, knowledge and effectiveness of back care techniques, and barriers to effective back care techniques in clinical nurses. / South Africa

Introdução: A dor lombar crônica inespecífica é um importante problema de saúde e de ordem socioeconômica responsável por alto índice de absenteísmo no trabalho e redução do desempenho funcional. A utilização da acupuntura manual como terapia alternativa no tratamento de dor lombar e a eletroacupuntura para potencializar o tratamento, tem se mostrado eficaz, entretanto, com poucas evidências sobre sua efetividade. Objetivo: Comparar a efetividade da eletroacupuntura versus acupuntura manual no tratamento da dor e incapacidade funcional em pacientes com dor lombar crônica inespecífica Método: Sessenta e seis pacientes com dor lombar crônica inespecífica foram distribuídos aleatoriamente em dois grupos: Grupo eletroacupuntura (GE n=33) e grupo acupuntura (GA n=33). Os desfechos clínicos primários foram dor, avaliada com a escala numérica de dor e incapacidade funcional pelo questionário de Incapacidade Roland Morris e os desfechos secundários foram: qualidade da dor medida com o questionário McGill de dor, percepção global com escala da percepção do efeito global, qualidade de vida por meio do Short-Form Health Survey questionnaire (SF-36), depressão com o inventário Beck de Depressão, e cinesiofobia com a Escala Tampa de Cinesiofobia. Os grupos foram tratados duas vezes por semana com duração de 40 minutos, durante seis semanas, totalizando 12 sessões. Foram realizadas três avaliações: inicial, final e follow-up de três meses. O nível de significância foi de alfa < 0,05. Resultados: Ambos os grupos relataram melhora na intensidade da dor e incapacidade funcional, sem diferença entre os grupos. Na intensidade e incapacidade escores de dor entre os grupos foram -0,4 (95% intervalo de confiança [IC] = -1,7 a -0,8) e -2,5 pontos (IC 95% = -5,6 a 0,6), respectivamente. Nos desfechos secundários, observamos uma diferença entre grupos apenas para cinesiofobia (diferença = -4.1 pontos, IC95% = -7,0 a -1,1) no grupo acupuntura manual. Conclusão: A eletroacupuntura e a acupuntura manual são eficazes na melhora da dor e incapacidade funcional em pacientes com dor lombar crônica inespecífica / Introduction: Chronic nonspecific low back pain is significant problem of health and socioeconomic order responsible for high rate of absenteeism at work and reduced functional performance. The use of manual acupuncture as an alternative therapy in the treatment of low back pain and electroacupuncture to enhance the treatment has been proven effective, however, with little evidence of effectiveness. Objective: Compare the effectiveness of electroacupuncture versus manual acupuncture in patients with chronic nonspecific low back pain. Methods: Sixty-six patients with chronic nonspecific low back pain were divided into: electroacupuncture (n=33) and acupuncture group (n=33). The primary clinical outcomes were pain, assessed with the numerical Scale of Pain and functional disability by questionnaire Disability Roland Morris and secondary outcomes were quality of pain measure with the McGill Pain Questionnaire, global perception with the perception of the Global Scale Effect, quality of life through the Short-Form Health Survey questionnaire (SF- 36), depression with the Beck depression inventory, and kinesiophobia with Tampa Scale kinesiophobia. The groups were treated twice a week lasting 40 minutes for six weeks, 12 sessions. Were three evaluations: baseline, post treatment and follow-up of three months. The level of significance was alfa < 0.05. Results: Both groups reported improvements in pain intensity and disability with no difference between groups. Differences in intensity and disability scores of pain between groups were -0.4 (95% confidence interval [CI] = -1.7 to - 0.8) and -2.5 points (95% CI = -5 6 to 0.6), respectively. Regarding secondary outcomes, we observed a difference between-groups for kinesiophobia (difference= -4.1 points, 95% CI - 7.0 -1.1) in acupuncture group. Conclusion: Electroacupuncture and manual acupuncture have similar efficacy in reducing pain and disability in patients with chronic nonspecific low back pain

Objetivo: Comparar a efetividade da atividade gradual versus programa de exercícios supervisionados em pacientes com dor lombar crônica não específica para os desfechos intensidade da dor, qualidade da dor, incapacidade funcional, qualidade de vida, percepção do efeito global, retorno ao trabalho, atividade física, capacidade física e cinesiofobia. Método: Participaram do estudo 66 indivíduos com idade entre 18 a 65 anos com dor lombar crônica não específica, randomizados em dois grupos: Grupo atividade gradual (n=33) e Grupo fisioterapia (n=33). Os desfechos primários foram: intensidade da dor (Escala Numérica de dor) e incapacidade funcional (Questionário de Incapacidade de Roland Morris) e os defechos secundários: Qualidade da dor (Questionário de dor de McGill) qualidade de vida (Short-Form Health Survey Questionnaire), Percepção do Efeito Global (Escala de Percepção do Efeito Global), retorno ao trabalho, atividade física (Questionário de atividade física habitual de Baecke), capacidade física (Teste sentado para de pé e Teste de Caminhada de 15,2 metros), cinesiofobia (Escala Tampa para Cinesiofobia). As intervenções foram individualizadas, com duração de uma hora, por seis semanas e frequência de duas vezes por semana. Cada indivíduo foi avaliado na linha de base e no follow up de seis semanas, três e seis meses após o tratamento. O nível de significância estabelecido foi de ?=0,05. Resultados: Após seis meses, ambos os grupos melhoraram, porém não houve diferença significante entre os grupos para intensidade da dor (média da diferença de 0,1 pontos; IC a 95% -1,1 a 1,5) e incapacidade funcional (média da diferença de 0,0; IC a 95% -2,9 a 3,0). Não foram encontradas diferenças estatisticamente significante entre os grupos para os demais desfechos. Conclusão: Nossos resultados sugerem que atividade gradual e fisioterapia apresentam efetividade similar na redução da intensidade da dor e melhora da incapacidade funcional em pacientes com dor lombar crônica não específica / Objective: To compare the effectiveness of graded activity versus physiotherapy in patients with chronic nonspecific low back pain for pain intensity, quality of pain, disability, quality of life, global perceive effect, return to work, physical capacity and kinesiophobia. Methods: Sixty-six patients between 18 to 65 years old with chronic nonspecific low back pain were randomized into two groups: Graded activity group (n=33) and physiotherapy group (n = 33). The primary outcomes were: Intensity pain (Numerical Pain Scale) and disability (Roland Morris Disability Questionnaire). The secondary outcomes were: Quality of pain (McGill Pain Questionnaire), quality of life (Short-Form Health Survey Questionnaire), Global perceived effect (Global perceived effect scale), return to work, physical activity (Baecke Questionnaire of Habitual Physical Activity), physical capacity (sit-to-stand test and 15.24m walk test) and kinesiophobia (Tampa Scale of Kinesiophobia) The intervention was individualized, twice a week, one hour for six weeks. The participants were assessment for a blind assessor in the baseline and six weeks, three and six month\'s follow-up. The level of significance was established in ?=0.05. Results: After six weeks, both groups improved, but we not observed significance difference between groups (mean difference 0.1 points; CI 95% -1.1 a 1.5) and disability (mean difference 0.0; IC a 95% -2.9 a 3.0). We not observed statistical difference between groups for all outcomes. Conclusion: Our study provide high quality evidence that graded activity and physiotherapy have similar effectiveness reducing intensity pain and disability in patients with chronic nonspecific low back pain

In this study, the use of hypnosis in the treatment of chronic low back pain is described in terms of Ecosystemic thinking, as opposed to traditional conceptualisations of hypnosis. Six case studies were used. Each is described in detail, as well as the therapeutic rationale behind each case, in order to present the reader with an understanding of the thinking behind using Ecosystemic hypnotherapy. / Psychology / M.A. (Psychology)

L'objectif de ce travail de thèse est de compléter le diagnostic et le suivi des patients lombalgiques chroniques par l'analyse biomécanique de leurs comportements moteurs lors de la réalisation de différents mouvements du tronc et lors de l'initiation de la marche. Ainsi, afin de participer à l’optimisation de la prise en charge de ce type de patient, trois études sont réalisées.Dans l'étude 1, la comparaison des paramètres cinématiques du tronc entre une population saine et une population de patients lombalgiques chroniques révèle non seulement la présence d’un déconditionnement physique, mais aussi d'un déconditionnement moteur, chez les patients réalisant différents mouvements du tronc à vitesse rapide. Dans l'étude 2, le suivi des patients à court et à long terme après un programme de restauration fonctionnelle du rachis (fin programme, 3 mois, 6 mois et 1 an) montre que ce déconditionnement moteur est résistant au traitement malgré des améliorations importantes au niveau des capacités physiques (souplesse, force, endurance). Dans l'étude 3, l'évaluation spatiotemporelle, cinématique et dynamique de l'initiation de la marche confirme la présence d'un déconditionnement moteur lors de l'initiation de la marche qui est, lui aussi, résistant au programme de restauration fonctionnelle du rachis.En conclusion, ce travail de thèse montre que la résolution du problème croissant de la lombalgie chronique ne consiste pas uniquement en la lutte contre le déconditionnement physique mais, aussi, en la lutte contre le déconditionnement moteur Il est possible que la prise en charge de ce déconditionnement moteur permette d'avoir de meilleurs résultats à long terme favorisant alors le retour des patients à la vie active. / The main aim of this PhD thesis is to complete the diagnosis and the monitoring of chronic low back pain patients by analyzing their motor behaviors during different trunk movements and during gait initiation. Then, in order to take part in the optimization of the care proposed to this type of patients, three studies are then conducted.Study 1 shows that, in addition to a physical deconditioning, chronic low back pain patients exhibit a motor deconditioning when asked to move there trunk as fast as possible. In Study 2, short-term and long-term monitorings following a functional restoration program (end of the program, 3 months, 6 months and 1 year) show a preservation of this motor deconditioning in chronic low back pain patients, despite improvements in physical abilities (flexibility, strength, endurance). Study 3 highlights that chronic low back pain affects the motor control during gait initiation and, as observed in Study 2, this motor deconditioning is preserved following functional restoration program.In conclusion, this PhD thesis shows that the resolution of the growing problem of chronic low back pain cannot be reached by only resolving the physical deconditioning but, also, by resolving the motor deconditioning detected within this research work. The reduction or annihilation of this motor deconditioning would allow better long-term results, promoting the return of patients to active life.

Title: Physiotherapy of patients with low back pain of viscerovertebral etiology. Objectives: The objective of this study is to verify the significance of inclusion of procedures of a comprehensive therapeutic approach according to Eastern techniques to classical physiotherapy and to find out whether these Eastern techniques can contribute to the enrichment of standard physiotherapy. Another goal is to develop appropriate regimen measures according to TCM and Ayurveda, to create a yoga regimen suitable for patients who have renal and bladder dysfunction according to TCM and whose main common symptom is chronic non-specific low back pain. The study is based upon a comparison of a four-week physiotherapy program according to the physician's indication and a physiotherapy program enriched with compiled regimen measures and yoga exercises in selected probands. Methods: This diploma thesis is an experimental qualitative pilot study. The theoretical part of the thesis was elaborated on the basis of information from book and electronic sources in the Czech and English language in the form of a research. For the practical part two groups of probands were used - experimental and control group. There were 6 probands in each group. The effect of the four-week therapy, which took place twice a week for 60...

This thesis is focusing on objectifying the postural function of diaphragm with a biofeedback sensor in patients with low back pain (LBP). The theoretical part provides an overview of known facts about the postural function of the abdominal muscles and diaphragm and the connection between their activation and the change in intra-abdominal pressure and the origin of LBP. The thesis gives specifics of LBP, its etiology and possible methods of classification of non-specific LBP, as well as the methods of evaluating subjective disability. Other methods of objectifying postural functions other than the one used in this thesis are mentioned briefly. Methodology: In the experimental part, we used a capacitive force sensor to test 31 patients with non-specific chronic LBP (aver. age 25.25, SD ± 4.66, aver. height 176.77 cm, SD ± 9.97, aver. weight 77.93 kg, SD ±18.40) in 3 posturally different seated scenarios - resting breathing, with added external load when the subjects held a dumbbell of 20 % of their body weight) and with maximum voluntary increase in intra-abdominal pressure (the diaphragm test). The sensor position was on lumbar triangle and in the groin area. Oswestry Questionaire v2.1a was used to evaluate subjective disability. Results: An independent t-test analysis showes increase in the...

Introduction: Muscle fatigue can contribute to acute flare-ups of lower back pain with associated consequences such as pain, disability, lost work time, increased healthcare utilization, and increased opioid use and potential abuse. The SPINE Sense system is a wearable device with 16 high deflection nanocomposite strain gauge sensors on kinesiology tape which is adhered to the skin of the lower back. This device is used to correlate lumbar skin strains with the motion of the lumbar vertebrae and to phenotype lumbar spine motion. In this work it was hypothesized that the SPINE Sense device can be used to detect differences in biomechanical movements consequent to muscle fatigue. A human subject study was completed with 30 subjects who performed 14 functional movements before and after fatiguing their back muscles through the Biering-Sørensen endurance test with the SPINE Sense device on their lower back collecting skin strain data. Various features from the strain gauge sensors were extracted from these data and were used as inputs to a random forest classification machine learning model. The accuracy of the model was assessed under two training/validation conditions, namely a hold-out method and a leave-one-out method. The random forest classification models were able to achieve up to 84.22% and 78.37% accuracies for the hold-out and leave-one-out methods respectively. Additionally, a system usability study was performed by presenting the device to 32 potential users (clinicians and individuals with lower back pain) of their device. They received a scripted explanation of the use of the device and were then instructed to score it with the validated System Usability Score. In addition they were given the opportunity to voice concerns, questions, and offer any other additional feedback about the design and use of the device. The average System Usability Score from all participants from the system usability study was 72.03 with suggestions of improving the robustness of electrical connections and smaller profiles of accompanying electronics. Feedback from the potential users of the device was used to make more robust electrical connections and smaller wires and electronics modules. These improvements were achieved by making a two-piece design: one piece contains the sensors on kinesiology tape that is directly attached to the patient and the other one contains the wires sewn into stretch fabric to create stretchable electronic connections to the device. It is concluded that a machine-learning model of the data from the SPINE Sense device can classify lumbar motion with sufficient accuracy for clinical utility. It is also concluded that the device is usable and intuitive to use.