Low back pain (LBP) remains one of the most common and challenging primary care issues in the developed world. Manual occupations such as nursing are known to involve a high risk of occupational LBP, which is associated with enormous health care expenditure as well as indirect work and disability-related costs. Despite extensive efforts to reduce LBP in nurses, evidence supporting the efficacy of any specific intervention to prevent LBP is limited. / The majority of LBP prevention strategies are directed at occupational risk factors in working nurses. However, as there is some evidence that LBP is already a significant problem in nurses prior to commencing full time employment, it is proposed that nursing students should be the focus of prevention interventions. This would require prevention interventions targeting personal rather than occupational LBP risk factors. As the best personal predictor of future LBP is currently a previous history of LBP, further investigation of modifiable personal LBP risk factors is required. Consequently, the aim of this doctoral research was to identify modifiable personal characteristics that predict LBP in nursing students. / Firstly, a large survey was conducted on undergraduate nursing students and recently graduated nurses to determine patterns of LBP prevalence. Results from this study indicated that LBP prevalence was very high at the commencement of undergraduate training. Prevalence of LBP did not significantly change during nursing training, but did increase further in the first year of commencing work as a nurse. This increase may be partly explained by the reported increase in occupational exposure to bending and lifting. Age was consistent across the undergraduate year groups and did not influence these findings. It was concluded that nursing students would provide a sufficient number of new-onset LBP episodes (and thus sufficient statistical power) for a prospective study design. Further, as these nursing students were not yet exposed to the occupational LBP risk factors of working nurses, a clearer indication of the influence of modifiable personal factors on the development of LBP could be determined by examining a student cohort. / A cross-sectional study investigating the influence of personal physical, psychological and social/lifestyle factors was then conducted on nursing students. Preliminary analysis revealed clear gender differences across multiple domains. Therefore, the focus of further analysis was on the larger female sample. / In Part 1 of the cross-sectional study, an investigation of regional differences in lumbar spine posture and movement was undertaken. Analysis of spinal kinematics in this study supported and extended previous literature that has found global lumbar spine kinematics do not accurately reflect the kinematics of the upper lumbar or lower lumbar spinal regions in common postures and movements. Rather, these two regions have a degree of functional independence. This finding has implications for interpretation of measures of spinal posture, motion and loading. Further, body mass index influenced regional lumbar posture and movement, possibly representing adaptation due to load. It was concluded that regional rather than global lumbar spine measures needed to be investigated in further analyses of this doctoral research. / In Part 2 of the cross-sectional study, personal characteristics associated with LBP were investigated. Approximately one third of all subjects reported significant LBP in the 12-months preceding the study. Analysis of factors associated with LBP supported the biopsychosocial nature of LBP. Higher stress levels and use of passive coping strategies, increased physical activity levels, holding the lower lumbar spine further from end-range flexion during functional tasks and increased age, all contributed independently to the presence of LBP. These findings supported the hypothesis that modifiable personal characteristics were associated with LBP. / The importance of identifying sub-groups of LBP patients has become widely accepted. In Part 3, further exploratory analysis was conducted on this crosssectional data to determine if differences in physical and psychological characteristics were evident in two defined sub-groups of female nursing students with LBP. These sub-groups were based on O’Sullivan’s mechanism based classification system. Results indicated that two sub-groups of LBP subjects had differing physical and psychological characteristics associated with their LBP. Further, control subjects could be distinguished from each of these two sub-groups by different factors. These findings add validity to O’Sullivan’s LBP classification system. Further, the findings may suggest that different combinations of psychological and physical factors are linked to LBP in different sub-groups in this population, and therefore may require different intervention approaches based on these factors. / In the final stage of this doctoral research, the cohort of female nursing students was followed prospectively for 12-months. The focus of further analysis was on identifying modifiable personal predictors in a sub-group of subjects with new-onset LBP. The results of this study strongly supported that personal factors from multiple domains are predictors of new-onset LBP. After controlling for previous LBP, age and body weight, regression analysis identified that smoking, increased physical activity levels (both exercise and spinal loading), higher stress levels, reduced back muscle endurance, greater posterior pelvic tilt in slump sitting and more accurate spinal repositioning in sitting were all independent predictors of new-onset LBP. These findings have implications for the development of prevention and management interventions for LBP in nurses. / Results from this doctoral investigation support the multi-factorial and biopsychosocial nature of LBP. The important distinction of this research when compared to previous work is the selection of a cohort at the beginning of their working life, with a focus on modifiable personal, rather than occupational factors, associated with LBP. Factors from physical, psychological and social/lifestyle domains were all independently associated with significant new-onset LBP in female nursing students. Interventions utilising a prevention approach that targets modifiable characteristics, such as those identified in this cohort of nursing students, may have the potential to reduce the impact of occupational LBP in this group. These preliminary findings have important implications for future LBP research and clinical interventions.

This thesis evaluates the possibility of using objective measurements to assess the postural function of abdominal muscles. The theoretical part provides an overview of findings regarding postural function of the abdominal muscles and the context for their co-activation using intra-abdominal pressure. The results are summarized in the form of research studies relating postural function and low back pain (LBP). The overview of the methods used to measure intra-abdominal pressure and the abdominal muscle activity is the main focus. In this section, we present a new methodology for measuring the activity of the abdominal muscles by using pressure sensors attached to the abdominal wall in the areas of the groin and the lumbar triangle. Methodology: In the experimental part, we tested 35 healthy subjects (average age 21.26t, SD ± 1,62) in 3 posturally different seated scenarios: 1. resting breathing, 2. with added external load (the subjects held a dumbbell 20% of their body weight) and 3. with maximum voluntary increase in intra-abdominal pressure (the diaphragm test). Results: An independent samples t-test indicated that the pressure created by the abdominal wall for both sensors in situation resting breathing increases in situation external load (HA1: upper sensor p=0.0079, lower sensor p=0.0009). We...

The main aim of the presented diploma thesis was to record objective and subjective changes after therapy with DNS concept in a group of 13 people with LBP. Moiré projection topography was used to record postural changes after 5.5 week therapeutic intervention. It was not clear, whether DNS exercise would help them to achieve visible postural changes and whether this technique is able to record these changes, which would mean that it is a suitable option for objectivisation of therapies focusing on correction of stabilisation and postural functions. Pedoscan was used for further objectivisation of the effect of DNS concept. The chosen correlate of the mentioned objective evaluation was Oswestry disability index, evaluating limitations of common everyday activities resulting from pain in the lower back, and the Numeric pain scale. Patients underwent 5 hour-long physiotherapeutic lessons, the recommended frequency of exercises in the household environment was 3-4 times per day. The probands exercised with the use of DNS concept according to the individual examination findings, especially in the area of the integrated spine stabilisation system. The data were statistically elaborated by Wilcoxon Signed-Rand test, which a non-parametric variant of the pair T-test. It is obvious from the results that...

The main target of this thesis was to detect objective changes in the implementation of four postural locomotor tests DNS and during walking. The movements were recorded using the optical MoCap - the kinematic analysis Qualisys. The particular interest of the investigation was to determine the current stabilization of the spine system in individual subjects aged 25 to 55 years, which was documented by means of the angular deflection of each segment, the flat segment deviation or the shift of the marker in a coordinate system. The measurement results were compared between ten individuals with LBP and ten persons without any difficulty who were placed into the control group. The data were collected using the software QTM and Visual3D and subsequently were statistically processed. A statistically significant difference was observed during walking when comparing the angular deflection of the pelvis to the chest at the rotation and lateroflexion (ř). The significant difference of the pelvis shift toward the chest during flexion and rotation (ř) was showed in a deep squat test, but the difference was not confirmed in lateroflexion (ř). Furthermore, no statistical difference of the lateral deflection of the same segment (pelvis or chest) (cm) in patients with LBP compared to all subjects during the...

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