Changes in muscle activity and stature recovery after active rehabilitation for chronic low back pain

Abstract

Patients with low back pain often demonstrate elevated paraspinal muscle activity compared to asymptomatic controls. This hyperactivity has been associated with a delayed rate of stature recovery following spinal loading tasks. The aim of this study was to investigate the changes in muscle activity and stature recovery in patients with chronic low back painfollowing an active rehabilitation programme. The body height recovery over a 40-min unloading period was assessed via stadiometry and surface electromyograms were recorded from the paraspinal muscles during standing. The measurements were repeated after patients had attended the rehabilitation programme and again at a six-month follow-up. Analysis was based on 17 patients who completed the post-treatment analysis and 12 of these who also participated in the follow-up. By the end of the six months, patients recovered significantly more height during the unloading session than at their initial visit (ES = 1.18; P < 0.01). Greater stature recovery immediately following the programme was associated with decreased pain (r = -0.55; P = 0.01). The increased height gain after six months suggests that delayed rates of recovery are not primarily caused by disc degeneration. Muscle activity did not decrease after treatment, perhaps reflecting a period of adaptation or altered patterns of motor control.

Copyright © 2014 Elsevier Ltd. All rights reserved.

KEYWORDS:

Electromyography, Low back pain, Stature change

Influence of body mass index on low back pain

Abstract

Low back pain (LBP) is a common problem affecting 70% of the population in the developed countries and prevalence is also increasing in the developing countries. We conducted a clinic based cross-sectional study in the city of Dhaka and Chittagong during the period of January 2009 to December 2011. Participants (n=357) were interviewed and examined through a structured questionnaire after a non purposive sampling to explore the influence of body mass index (BMI) on LBP. BMI was assessed by the equation weight (Kg)/hight² (m²) and LBP was assessed by modified visual analogue scale. Association between LBP and BMI was tested by Chi-square test. Among 357 patients the incidence of LBP was common in the age group between 40-59 years and it was 172(48.17%) followed by 60-79, 20-39 and ≥80 years group with 21.29%, 17.65% and 12.89% respectively. Female presented more with LBP, i.e. 196(54.91%) than the male 161(45.09%). The more study population was found to have BMI within normal range, i.e. 167(46.78%). This was followed by overweight group which amounted 137(38.37%) while the obese group was the least, i.e. 53(14.85%). Maximum study population presented with severe LBP which amounted 140(39.22%) while others presented with moderate and mild LBP and amounting 118(33.05%) and 99(27.73%) respectively. Among the normal BMI group most patient presented with mild pain (n=82) followed by moderate (n=55) and severe (n=30) pain. Participants with overweight presents with severe pain mostly (n=58) but obese participants presented with severe low back pain(n=25). Statistically the association of LBP with BMI was found to be highly significant (p<0.0001). In this study, 137(46.78%) participants of normal BMI presented with LBP but majorities (n=82) presented with mild LBP and overweight and obese participants mostly presented with severe LBP. On the basis of these findings, careful evaluation of risk factors and deliberate assessment of the therapeutic as well as preventive measure for the management of patient of LBP is highly recommended.

PMID:

 

24584385

 

[PubMed - in process]

Total disc replacement

Abstract

Total disc replacement (TDR) (partial disc replacement will not be described) has been used in the lumbar spine since the 1980s, and more recently in the cervical spine. Although the biomechanical concepts are the same and both are inserted through an anterior approach,lumbar TDR is conventionally indicated for chronic low back pain, whereas cervical TDR is used for soft discal hernia resulting in cervicobrachial neuralgia. The insertion technique must be rigorous, with precise centering in the disc space, taking account of vascular anatomy, which is more complex in the lumbar region, particularly proximally to L5-S1. All of the numerous studies, including prospective randomized comparative trials, have demonstrated non-inferiority to fusion, or even short-term superiority regarding speed of improvement. The main implant-related complication is bridging heterotopic ossification with resulting loss of range of motion and increased rates of adjacent segment degeneration, although with an incidence lower than after arthrodesis. A sufficiently long follow-up, which has not yet been reached, will be necessary to establish definitively an advantage for TDR, particularly in the cervical spine.

Copyright © 2014 Elsevier Masson SAS. All rights reserved.

KEYWORDS:

Cervical herniation, Cervical total disc replacement (CTDR), Cervicobrachial neuralgia, Low back pain, Lumbar total disc replacement (LTDR)

PMID:

 

24412045

 

[PubMed - as supplied by publisher]

Type 1 Modic changes was a significant risk factor for 1 year outcome in sick-listed low back pain patients: a nested cohort study using magnetic resonance imaging of the lumbar spine

Abstract

BACKGROUND CONTEXT:

It is not clear whether Modic changes (MC) is associated with low back pain (LBP) outcome.

PURPOSE:

To study associations between baseline degenerative manifestations and outcome in sick-listed LBP patients.

STUDY DESIGN:

Prospective nested cohort study based on a randomised controlled trial.

PATIENT SAMPLE:

Out of 325 sick-listed LBP patients, 141 patients were consecutively examined by magnetic resonance imaging (MRI) and included, and 140 patients completed the study.

OUTCOME MEASURES:

Degenerative manifestations of the lumbar spine were quantified, and associations were studied in relation to the three primary outcomes 1) change of back+leg pain and 2) change of function as measured by Roland-Morris questionnaire and 3) one-year U-RTW.

METHODS:

By using a previously validated MRI-protocol, a specialist in radiology, who had no access to clinical data, described the images. Associations were studied by linear and logistic regression with adjustment for previously identified prognostic factors for one-year pain and function and for unsuccessful return to work (U-RTW).

RESULTS:

Clinically, 43% of the patients had radiculopathy. Degenerative changes were prevalent with altered disc contours in 84%, high intensity zones in 70% and nerve root touch or impingement in 63% of the patients. MC was identified in 60% of the patients, 18% with type 1 changes and 42% with type 2 changes, type 1 including both type 1 and type 1 in combination with type 2. Patients with type 1 changes reported more back pain and did not improve in pain or disability. They increased to include 30% of the patients with U-RTW at one year. Patients with type 2 changes did not differ significantly from patients without MC, but differed significantly from patients with type 1 changes in all three outcomes. Other degenerative manifestations were not significantly associated with any of the three outcomes.

CONCLUSIONS:

The only degenerative manifestation negatively associated with outcome was type 1 MC which affected 18% of the cohort at baseline and implied an increased risk for no improvement in pain and function and for U-RTW, even after adjustment for other prognostic factors.

Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS:

Low back pain, Modic changes, disc herniation, prognosis, return to work, sick-listing

PMID:

 

24534386

 

[PubMed - as supplied by publisher]