INTRODUÇÃO: A hérnia de disco lombar (HDL) acomete cerca de 5% dos pacientes com de dor lombar e o tratamento cirúrgico nestes casos é cada vez menos indicado, optando-se, na maior parte dos casos, pelo conservador. Embora o método estabilização lombar (EL) e a estimulação elétrica nervosa transcutânea (TENS) tenham mostrado bons resultados em indivíduos portadores de dor lombar inespecífica, há escassa literatura que tenha verificado a eficácia destes tratamentos isoladamente em sujeitos acometidos por hérnia de disco lombar. OBJETIVO: Comparar a eficácia dos exercícios de estabilização lombar e da TENS na dor, incapacidade funcional, e capacidade de ativação do músculo transverso do abdome (TrA) de indivíduos com hérnia de disco lombar. METODOLOGIA: Participaram da pesquisa 40 indivíduos com idade variando de 25 a 58 anos com dor lombar e hérnia de disco, e foram randomizados em dois grupos: Grupo estabilização lombar (EL) (exercícios específicos para os músculos TrA e multífido lombar(ML)) (n=20) e Grupo TENS (GT) (n=20) que receberam atendimento com corrente de estimulação elétrica nervosa transcutânea. Foram avaliados quanto à dor (Escala Visual Analógica e Questionário McGill de Dor), incapacidade funcional (Índice de Incapacidade de Oswestry), e capacidade de recrutamento do TrA (Unidade de Biofeedback Pressórico-UBP). Os grupos foram tratados em duas sessões semanais com duração de 60 minutos por oito semanas. Cada indivíduo foi avaliado antes e após o tratamento. O nível de significância estabelecido foi de alfa=0,05. RESULTADOS: Após oito semanas, o grupo estabilização lombar mostrou melhora significativa na dor (p < 0,001), incapacidade funcional (p < 0,001), e capacidade de ativação do TrA (p < 0,001). O grupo TENS apresentou diferença estatisticamente significante apenas na dor (p < 0,012). A estabilização foi superior à TENS na melhora na dor (p < 0,001), incapacidade funcional (p < 0,001), e capacidade de ativação do TrA (p < 0,001). CONCLUSÃO: Os resultados indicam que a estabilização é efetiva na melhora da dor, incapacidade funcional, e capacidade da ativação do TrA, e a TENS apenas na dor. A estabilização foi superior à TENS em todas as variáveis / INTRODUCTION: Lumbar disc herniation (LDH) affects about 5% of low back pain (LBP) patients. Surgical treatment in these cases is increasingly less suitable, opting, in most cases, for the conservative. Although lumbar stabilization method and transcutaneous electric nerve stimulation (TENS) have shown good results in patients with nonspecific low back pain, there is scarce literature that has verified the effectiveness of these treatments alone in subjects suffering from lumbar disc herniation.OBJECTIVE: To compare the effectiveness of lumbar stabilization exercises and transcutaneous electrical nerve stimulation (TENS), on pain, functional disability and activation of the transversus abdominis muscle (TrA), in individuals with lumbar disc herniation (LDH). METHODS: This study involved 40 patients (age range 25-58 years) with lumbar disc herniation randomized into two groups: Stabilization group (SG: n=20); which received of stabilization exercises (transversus abdominis and lumbar multifidus muscles) and TENS group (TG: n=20), which received electrotherapy. The following instruments were used: visual analogue pain scale and McGill Pain Questionnaire for pain, Oswestry Disability Index for functional disability, and pressure biofeedback unit (PBU) for ability to contract the TrA. Analyses within and between groups were performed after treatment. Groups underwent 16 sessions, for 60 minutes, twice a week and they were evaluated before and after eight weeks. Significance level was set at alfa= 0.05. RESULTS: After eight weeks, lumbar stabilization group showed significant improvements in pain (p < 0.001), functional disability (p < 0.001), and the ability to contract the TrA (p < 0.001). There were no significant differences in TENS group in terms of disability (p < 0.264) or ability to contract the TrA muscle (p < 0.181), however, improvement in pain was demonstrated (p < 0.012). The stabilization was superior to TENS in terms of improvements in pain (p < 0.001), functional disability (p < 0.001), and ability to contract the TrA (p < 0.001). CONCLUSION: The results indicate that stabilization is effective in improving pain, functional disability, and the ability to contract the TrA in individuals with LDH. In the TENS group, the only improvement after treatment was in terms of pain. Stabilization was superior to TENS in all outcomes

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Background: The increasing cost and prevalence of chronic low back pain (LBP), has resulted in more resources being devoted to its treatment and management than ever before, despite only approximately 10% of acute cases progressing to chronicity. Determining prognostic factors for the short-term improvement of acute and chronic patients with LBP has become a research focus area to try and identify baseline factors that may affect a patients’ improvement with conservative treatment. Internationally studies have been conducted in developed countries however similar studies are lacking in developing settings like South Africa. It is unclear if the prognostic factors identified would be similar across populations. Thus, this study aimed to determine if pain, disability (social and physical), anxiety, depression, work fear-avoidance and locus of control, were associated with short-term prognosis, as determined by self-reported improvement using a Patients Global Impression of Change (PGIC) scale, in acute and chronic LBP patients attending the Durban University of Technology Chiropractic Day Clinic (DUT CDC). Method: Consecutive patients seeking treatment at the DUT CDC with a new episode of non-specific LBP, who met the study criteria, were approached for participation in the study. On agreeing to participate they were given the Bournemouth Questionnaire (BQ), a demographic questionnaire and a letter of information and consent (LOIC) at the initial consultation by student chiropractors. Those participants that were still attending treatment at the 4th/5th and tenth visit were required to complete the BQ and the PGIC. Results: A hundred participants were enrolled in the study, 65% had acute LBP and 52% were male. Only 20% of the initial group were still attending treatment at the 4th/5th follow-up. Baseline comparisons of those with acute and chronic pain revealed no significant difference in gender or age. Acute patients at the initial visit had higher levels of disability (social and physical), anxiety, depression and fear-avoidance beliefs than the chronic pain participants. At the 4th/5th treatment, the acute pain patients showed a significant decrease in pain (p=0.002) and disability (p=0.032), with all other measures decreasing from baseline measures. Similarly, chronic pain participants had a significant decrease in pain (p=0.038) but a significant increase in depression (p=0.015) scores, with all other prognostic factors being rated higher than at the initial consultation. The majority of participants (85%) in this study reported a clinical improvement in their LBP. In the acute pain sufferers, all but one participant reported improvement, thus identification of prognostic factors or this group was not possible. In the chronic pain participants, no factors were identified as prognostic for improvement, regardless of the low numbers still attending at the 4th/5th visit. Conclusions: Trends suggested that chronic pain sufferers were less likely to report decreases in the prognostic factors (except for pain), when compared to the acute pain participants. In the chronic LBP participants, no factors were associated with improved prognosis. The predictive value in determining which patients were less likely to improve was limited in the current study due to a small sample size. / M

Background Chronic low back pain (LBP) is a common health problem, with a large potential for primary prevention. Health utilities (HU) reflect which proportion of their expected remaining life time individuals would hypothetically trade to be alleviated of a health condition of interest. A value of 0 means “prefer to die immediately”, a value of 1 means “not willing to trade any life time”. The aim of this cross-sectional study was to assess HU for LBP patients and for healthy participants and to examine whether HU for LBP are useful indicators to substantiate preventive and therapeutic decision making. Methods Healthy participants (n = 126) and LBP patients (n = 32) were recruited mainly among the employees of a tertiary care hospital in Germany. Standardized LBP scenarios were presented to all participants and HU values were assessed using the time-trade-off method. Results Median HU for LBP were 0.90 (IQR 0.31) for participants and 0.93 (IQR 0.10) for LBP patients. Measurements were consistent across illness severity ratings with HU and with a visual analogue scale (VAS); in the healthy sample the intraclass correlation coefficient (ICC) was 0.61 (95% CI 0.23–1.00, F(1125) = 190, p < .001), in the patient sample the ICC was 0.66 (95% CI = 0.24–1.00, F(1,31) = 62, p < .001). 8% of participants reported HU of 1. There was no statistically significant relation between HU and age, income, or gender. Conclusion On average, participants chose a 7 to 10% shorter life expectancy to avoid LBP, but almost 1 in 10 participants were not willing to trade any life years. The results indicate a certain stability of HU due to the comparability of HU ratings across patients and healthy participants, the measurement consistency when comparing VAS and HU ratings, and the lack of association between demographic variables and HU. This underlines the usefulness of HU for measuring illness severity in comparative health economics evaluations of preventive and therapeutic measures that address chronic LBP or other pain-characterized diseases. Future studies should focus on different LBP intensities and derive stratified HU that reflect the distribution of pain intensity in the population.

Cette thèse propose de faire le point sur les indicateurs disponibles pour la surveillance épidémiologique des lombalgies liées au travail, notamment les données de réparation de maladies professionnelles (MP) et les données issues du réseau pilote de surveillance des troubles musculo-squelettiques des Pays de la Loire.La part de hernie discale opérée (utilisée comme traceur de lombalgie) attribuable à l’activité professionnelle était particulièrement élevée pour les ouvriers des deux sexes et les employées femmes. La lombalgie est un phénomène complexe et ne peut être surveillée grâce à un indicateur unique. Les données de MP, malgré leurs limites, donnent des résultats comparables aux autres sources de données et présentent l’avantage de ne nécessiter aucun recueil spécifique. Les données de cohortes, basées sur un questionnaire standardisé, sont nécessaires pour permettre des comparaisons internationales. Enfin, les données chirurgicales issues des bases de données des hôpitaux et cliniques, fournissent l’information la plus fine, si elles sont complétées de données professionnelles. Il s’agit cependant d’un indicateur mixte de morbidité et de soins. Les fortes disparités territoriales qu’il révèle au sein d’une région incitent à la mise en place de programmes de prévention différenciés.En complément de ces trois indicateurs, il serait intéressant d’ajouter un indicateur d’invalidité ou d’incapacité dans le système de surveillance pour mieux cibler les actions de prévention en fonction du risque de désinsertion professionnelle, dimension importante en termes d’impact social pour les individus et de coût pour la société. / This thesis proposes to review the available indicators for the epidemiological surveillance of work-related low back pain, including compensation data of occupational diseases and data from the pilot surveillance system for musculoskeletal disorders in the Pays de la Loire region.The proportion of cases of lumbar disc surgery (used as sentinel event of low back pain) attributable to occupational activity was particularly high among blue-collar workers of both genders and lower-grade female white-collar workers. Low back pain is a complex phenomenon and cannot be monitored using a single indicator. Compensation data, despite their limitations, give results comparable to other data sources and don’t require specific gathering. Cohorts’ data, based on a standardized questionnaire, are necessary for international comparisons. Finally, surgical data from private and public hospitals databases provide the finest information, if they are completed with occupational data. However, this is a mixed indicator of morbidity and care. It shows large local disparities in a region, encouraging the development of differentiated prevention programs.In addition to these three indicators, it would be interesting to add a disability or incapacity indicator in the surveillance system to better target prevention programs according to occupational exclusion which is an important dimension in terms of social impact for people and cost for the society.

Background Chronic low back pain (LBP) is a common health problem, with a large potential for primary prevention. Health utilities (HU) reflect which proportion of their expected remaining life time individuals would hypothetically trade to be alleviated of a health condition of interest. A value of 0 means “prefer to die immediately”, a value of 1 means “not willing to trade any life time”. The aim of this cross-sectional study was to assess HU for LBP patients and for healthy participants and to examine whether HU for LBP are useful indicators to substantiate preventive and therapeutic decision making. Methods Healthy participants (n = 126) and LBP patients (n = 32) were recruited mainly among the employees of a tertiary care hospital in Germany. Standardized LBP scenarios were presented to all participants and HU values were assessed using the time-trade-off method. Results Median HU for LBP were 0.90 (IQR 0.31) for participants and 0.93 (IQR 0.10) for LBP patients. Measurements were consistent across illness severity ratings with HU and with a visual analogue scale (VAS); in the healthy sample the intraclass correlation coefficient (ICC) was 0.61 (95% CI 0.23–1.00, F(1125) = 190, p < .001), in the patient sample the ICC was 0.66 (95% CI = 0.24–1.00, F(1,31) = 62, p < .001). 8% of participants reported HU of 1. There was no statistically significant relation between HU and age, income, or gender. Conclusion On average, participants chose a 7 to 10% shorter life expectancy to avoid LBP, but almost 1 in 10 participants were not willing to trade any life years. The results indicate a certain stability of HU due to the comparability of HU ratings across patients and healthy participants, the measurement consistency when comparing VAS and HU ratings, and the lack of association between demographic variables and HU. This underlines the usefulness of HU for measuring illness severity in comparative health economics evaluations of preventive and therapeutic measures that address chronic LBP or other pain-characterized diseases. Future studies should focus on different LBP intensities and derive stratified HU that reflect the distribution of pain intensity in the population.

The diploma thesis invastigates the effect of specifically designed six-week clinical Pilates program on posture and low back pain. The theoretical part contains an overview of the Pilates method - the history, principles and its usage in rehabilitation. It also briefly describes the concept of Dynamic Neuromuscular Stabilization (DNS), which, along with the original Pilates method and the Spiraldynamic concept, has created the current Pilates Clinic Method. Furthermore, one chapter is devoted to the system of training Pilates teachers in the Czech Republic. The main objective of the practical part is to evaluate and compare the effect of an organized and an individual six-week Pilates exercise programme in patients with faulty posture and low back pain. Subsequently, constitutive objectives are set on the basis of selected examination methods. Firstly, evaluation of the exercise programme by the means of clinical objective tests combined into 5 groups: standing and balance, spinal mobility, DNS tests, somatognosia (shoulder width) and respiratory amplitude. Secondly, with the instrumental measurement of Bodystat's values: height, weight, waist circumference, hip circumference, fat, active body mass, water and body mass index. Thirdly, subjective evaluation using standardized questionnaires the...

Variables predicting the effects of surgery in patients with low back pain Abstract The theoretical part of the thesis summarizes the knowledge about pain and its types, especially chronic pain. Than we focus on low back pain and currently used approaches in the treatment of this syndrome. In this work we summarize the influence of central sensitization and adverse life experineces and posttraumatic stress disorder on pain (especially low back pain). In the practical part, we investigated the effect of central sensitization and adverse life events and posttraumatic stress disroder on the effect of spinal surgery in low back region. The results were obtained using Central Sensitization Inventory (CSI), PTSD Cecklist dor DSM-5 (PCL- 5) a Life Event Checklist (LEC-5 Standard), Short Form 36 Helth Survey Questionnaire (SF- 36), NASS Lumbar Spine Questionnaire. The obtained data were statistically evaluated and processed. Higher scores of CSI and LEC-5 (more adverse life events) were both statistically significantly correlated with worse low back surgery outcomes. At the same time, a statistically significant relationship between PCL-5 (checklist of PTSD symptoms) and CSI was confirmed. Keywords Pain, central sensitization, adverse life experiences, adverse life events, PTSD, posttraumatic stress disorder,...

Objetivo: Estimar la prevalencia y factores asociados a inestabilidad lumbar y/o lumbalgia en estibadores del Mercado Mayorista de Lima. Método: Se realizó un estudio transversal analítico en 250 estibadores. Se utilizó la Escala Visual Analógica (EVA) para valorar el dolor lumbar al momento de la entrevista y, asimismo, se usó el Índice de Dolor de Espalda (IDE) para valorar la lumbalgia en 5 movimientos. Con respecto a la valoración de la inestabilidad lumbar se empleó la prueba clínica Extensión Lumbar Pasiva (ELP). Finalmente para efectos de análisis se creó la variable ambas alteraciones (IDE/ELP). Resultados: La prevalencia de lumbalgia en los últimos 3 meses en estibadores fue de 68,8% (172/250), y la inestabilidad lumbar fue de 34,4% (86/250). Se encontró asociación de Ambas Alteraciones con años de trabajo ≥ 11 años ([IC 95%= 1,08 - 3,42]; p= 0,03). Con respecto al IDE con años de uso de faja existe asociación ([IC95%= 1,01 - 1,24]; p= 0,04). En el modelo ajustado no se encontró resultados estadísticamente significativos. Conclusiones: La lumbalgia e inestabilidad de la columna tuvieron como factor de asociación el año de uso de faja. Otro factor a considerar es los años de trabajo ya que realizar la actividad mayor a 11 años podría conllevar a una lumbalgia e inestabilidad lumbar. / Objective: To estimate the prevalence and associated factors to lumbar instability and/or low back pain on the stevedores of the Mercado Mayorista de Lima. Methods: An analytical cross-sectional study was carried out in 250 stevedores. The Visual Analogue Scale (VAS) was used to estimate the low back pain at the moment of the interview. Also, the Backache Index (BAI) was used to evaluate the low back pain in 5 movements. For the evaluation of the lumbar instability, the clinic test of Passive Lumbar Extension (PLE) was used. Finally, for analysis purposes, the variable ambas alteraciones (IDE / ELP) was created. Results: The prevalence of low back pain in the last 3 months in the stevedores was 68, 8%, (172/250), and for lumbar instability was 34, 4% (86/250). An association between the variable ambas alteraciones with years of work ≥ 11 years was found ([IC 95%= 1, 08 - 3, 42]; p= 0, 03). There was also association between the Backache Index (BAI) and years of use of the lumbar belt ([IC95%= 1, 01 - 1, 24]; p= 0, 04). In the adjusted model, no significative results were found. Conclusions: The low back pain and spine instability had as an associative factor the years of use of the lumbar belt. Another factor to have in consideration is the years of work, because working more than 11 years could end in the development of low back pain and lumbar instability. / Tesis

<p>Lumbalni bol predstavlja jedan od najučestalijih zdravstvenih problema dana&scaron;njice. Pružanje zdravstvene nege je stresan i težak fizički posao, te spada u grupu visoko-rizičnih poslova za nastanak lumbalnog bola, pa samim tim medicinske sestre &ndash; tehničari predstavljaju vulnerabilnu populaciju. Osnovni ciljevi ovog istraživanja bili su da se utvrdi prevalencija i faktori rizika za nastanak lumbalnog bola kod medicinskih sestara- tehničara, kao i mere prevencije. Istraživanje je sprovedeno u pet zdravstvenih ustanova sa područja Vojvodine u obliku studije preseka, anketiranjem medicinskih sestara &ndash; tehničara. Za ispitivanje je kori&scaron;ćen modifikovani Nordijski upitnik. Rezultati pokazuju veoma visoku prevalenciju lumbalnog bola među medicinskim sestrama- tehničarima, oko 94%. Ispitanici su bili uglavnom ženskog pola, prosečne starosti oko 38 godina. Najveći broj ispitanika ima srednju stručnu spremu. Istraživanjem je utvrđeno da postoji statistički značajna povezanost lumbalnog bola sa porastom godina života i dužine ekspozicionog radnog staža. Takođe, statistički visoko značajna korelacija nalazi se između porasta BMI i lumbalnog bola. Najzastupljeniji poslovi zdravstvene nege koje ispitanici sa lumbalnim bolom obavljaju su: pozicioniranje pacijenata, podizanje i presvlačenje pacijenata u postelji i podela terapije. Statistički značajno veća zastupljenost lumbalnog bola javlja se kod ispitanika koji sami obavljaju negu u odnosu na one koji imaju pomoć. Medicinske sestre &ndash; tehničari koji pripadaju grupi sa vi&scaron;im nivoom stresa na radnom mestu imaju znatno veći rizik za pojavu lumbalnog bola. Smenski rad (naizmenične dnevne i noćne smene od 12 sati) i prekovremeni rad duži od 8 sati dnevno, podizanje tereta većeg od 25 kg i broj pacijenata koje medicinska sestra &ndash; tehničar zbrinjava tokom radnog vremena nemaju značajnu povezanost sa pojavom lumbalnog bola. Oko tri četvrtine ispitanika nije izostajalo sa posla zbog bola. Samo oko 8% ispitanika je promenilo radno mesto zbog lumbalnog bola i ide redovno na periodične lekarske preglede. Kod mera prevencije neophodno je staviti akcenat na smanjenje fizičkog opterećenja donjeg dela leđa i smanjenje ručnog preno&scaron;enja tereta. Primenom adekvatnog ergonomskog pristupa, boljom organizacijom rada, podsticajnom atmosferom na poslu i spremno&scaron;ću nadležnih struktura da iskažu veću brigu prema zaposlenima, smanjila bi se učestalost pojave lumbalnog bola.</p> / <p>One of the today&rsquo;s most frequent health problems is the low back pain. Nursing is stressful and hard physical job which belongs to the group of high-risk jobs that could cause low back pain and therefore medical nurses/technicians represent the vulnerable population. Determination of prevalence, risk factors and prevention of the low back pain were the main goals of this research. The research in the form of cross-sectional study was conducted with nurses filling in the surveys within five medical institutions in Vojvodina. The modified Nordic questionnaire was used for the surveys. The results show very high prevalence of the low back pain, cca 94%, among medical nurses. Most of the respondents were females, who finished high school education, at average age of 38 years. The study showed that there is a statistically significant coherence between low back pain, ageing and working experience as a nurse. There is also a statistically significant coherence between the low back pain and the increase of the BMI. The most common nursing jobs that respondents with the low back pain do are: positioning of patients, lifting patients, dressing patients in bed and giving therapy. The low back pain with the respondents who do the nursing just by themselves is statistically significantly more present then with the respondents who do the nursing with help. Nurses who suffer more stress at their workplaces have a significantly higher risk to develop low back pain. Working 12 hour shifts (alternately day and night shifts), overtime work, more then 25 kg weight lifting and number of patients for nursing per nurse during working hours have no significant correlation with the low back pain occurrence. About three quarters of the respondents had no absence from work caused by the low back pain. Only 8% of the respondents changed their workplace because of the low back pain and have regular health checks. To prevent the low back pain it is necessary to emphasize the physical reduction of the load on the lower back and manual handling of loads. The frequent low back pain with the nurses could be reduced with the appropriate ergonomic access, better work organization, a supportive atmosphere at work and the willingness of responsible authorities to express greater concern about the employees.</p>

Antecedentes: el dolor lumbar (DL) y el esguince de tobillo son lesiones muy prevalentes en los bailarines de ballet. Diferentes estudios relacionan ambas lesiones, por lo que se sugiere realizar una investigación al respecto. Objetivo: determinar si existe asociación entre el esguince de tobillo y la presencia de DL en bailarines de ballet mayores de 18 años en el último año. Diseño del estudio: transversal, analítico, prospectivo y observacional. Métodos: se contactaron a 114 bailarines de diferentes escuelas y compañías de ballet de Lima, quienes respondieron una encuesta online relacionada con la presencia de DL en los últimos seis meses, los esguinces de tobillo en los últimos 12 meses, y otras variables sociodemográficas (edad, talla, peso, índice de masa corporal - IMC, años practicando ballet, y horas de práctica a la semana); así como covariables de inestabilidad de tobillo, lesión en el miembro inferior, hiperlaxitud ligamentaria, entre otras. Resultados: 47 participantes se incluyeron en el análisis del estudio, donde el 61.7 % era de sexo femenino y presentaba una mediana de 22 años de edad. Asimismo, el 57.5 % presentaba DL; y el 25.5 %, esguince de tobillo en los últimos 12 meses. Al asociar las variables al DL se encontró una relación significativa (p<0.05) con peso, IMC e inestabilidad de tobillo. Aun así, no se confirmó una asociación entre el esguince de tobillo y el DL. Conclusión: los hallazgos proporcionan un alto porcentaje de presencia de DL y una asociación significativa con respecto a padecer de inestabilidad de tobillo. / Background: low back pain (DL) and ankle sprain are very prevalent injuries in ballet dancers. Different studies relate both injuries, so it is suggested to carry out an investigation in this regard. Purpose: to determine if there is an association between ankle sprain and the presence of DL in ballet dancers older than 18 years old in the last year. Study design: analytical, prospective, observational and cross-sectional. Methods: 114 dancers from different schools and ballet companies in Lima were contacted; these responded to an online survey related to the presence of DL in the last six months, ankle sprain in the last 12 months, and other sociodemographic variables (age, height, weight, body mass index - BMI, years practicing ballet, and hours of practice per week); as well as covariates of ankle instability, lower limb injury, ligament hypermobilty, among others. Results: 47 participants were included in the study analysis, 61.7 % of which were female and were a median age of 22 years old. Also, 57.5 % had DL and 25.5 % had an ankle sprain in the last 12 months. When associating the variables to DL, a significant association (p<0.05) with weight, BMI and ankle instability was found. Nevertheless, an association between ankle sprain and DL was not confirmed. Conclusion: the findings provide a high percentage of the presence of DL and a significant association with suffering from ankle instability. / Tesis