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[Back exercises for patients with chronic low back pain].

The training therapy, which most back therapists consider an indispensable basic element in attempts to treat chronic low back pain, is reviewed, with an historical survey and description of the basic research in the field. Epidemiological studies show concurrence between chronic low back pain and reduced endurance of the back musculature and that the combination of a weak back and a back-straining occupation greatly increases the risk of low back trouble. On the basis of these studies, it is concluded that use of isometric back exercises in low dosage, which are central to the internationally acknowledged Swedish back school, only results in strengthening and increased endurance of the back muscles with difficulty. The author recommends introduction of intensive dynamic back extensor exercises which result in strength and endurance of the muscles. The back muscle training ought to be lifelong; thus, the exercises must be simple, learned over a longer period of time, so that the patients perceive the training as a natural and necessary part of everyday life.

Back Pain

Previous back pain and risk of developing back pain in a future pregnancy.

Four hundred twenty-nine pregnant women who had back pain before pregnancy and 375 pregnant women with no previous back pain were followed at regular intervals from the 12th week of pregnancy until delivery; back-pain complaints were recorded. Overall , back pain occurred twice as often in the group with a back-pain history (period prevalence) (P less than 0.001). The point prevalence of back pain in weeks 12, 24, 30, and 36 was three times higher in the group who had had back pain before pregnancy indicating that pain was not only more prevalent but also lasted longer in that group. Women who had been pregnant previously tended to have an increased risk of back pain, and there was a statistically significant correlation between multiparity and longer periods of back pain (P less than 0.001). Young age increased the risk of back pain (P less than 0.001). Pain intensity was higher in the younger women during the first part of their pregnancies but not later on (P less than 0.05).

Adult

Medical, psychological, and social factors associated with back abnormalities and self reported back pain: a cross sectional study of male employees in a Swedish pulp and paper industry.

A medical, psychological, and sociological study of 391 male employees in a Swedish pulp and paper industry was performed in 1961. Factors associated with back pain and back abnormality were investigated. Univariate analyses showed associations of back pain with occupational status, low education, duration of employment, low performance on cognitive tests, and neuroticism. Back abnormalities evaluated on the basis of physical examination showed in principle the same associations but the strength as well as the significances were stronger. Multiple logistic regression analyses using data for manual workers showed that neuroticism and duration of employment were directly associated with back pain. The same two variables and low performance on one of the psychological tests were directly associated with back abnormalities. Age showed no direct association with back pain or back abnormalities. Strong associations between back pain and back abnormalities with both perceived health and general working capacity and the doctor's evaluation in the same areas were demonstrated.

Absenteeism

Patient-handling skill, back injuries, and back pain. An intervention study in nursing.

The aim of this intervention was to evaluate the effect of training on patient-handling skills and prospectively to assess the effect of skill on subsequent back pain and back injuries in nursing. Of a total of 255 nurses, 199 were assessed for their skill in patient-handling. One-half (control group) received traditional training in patient-handling, and the other half (trained group) received a curriculum of instruction totaling 40 hours. The skills of both groups were assessed on graduation. The control group was rated as less competent in patient-handling. Nurses in both groups were questioned about the prevalence of back pain and incidence of back injuries in the first year after graduation. In multiple regression analysis, the major risk indicators for back injuries were poor patient-handling skill, low numbers of repetitions in the sit-up test, and high work-load scores. High score on the hysteria scale of Middlesex Hospital Questionnaire was a risk indicator for all kinds of back pain. Though back pain was independent of patient-handling skill, those rated as "bad" or "poor" had more back injuries (24%) than those who had been rated as "good" or "excellent" (2%) (P less than 0.001), but the difference between the trained and control groups was not statistically significant. It was concluded that back injuries may be prevented by the teaching of patient-handling skills.

Back Injuries

Back pain, back abnormalities, and competing medical, psychological, and social factors as predictors of sick leave, early retirement, unemployment, labour turnover and mortality: a 22 year follow up of male employees in a Swedish pulp and paper company.

A total of 391 male employees in a Swedish pulp and paper company were followed up for 22 years. As a part of a health examination in 1961 back pain reported by the subjects and abnormalities of the back as judged by the physicians were investigated with respect to predictive power regarding sick leave, early retirement, unemployment, labour turnover, and mortality during the follow up period. Univariate analysis showed that abnormalities of the back were better than back pain for predicting early retirement. Neither back pain nor back abnormalities had any predictive power with respect to long term sick leave, labour turnover, or mortality. Multivariate analyses of 26 variables were performed. Both self assessment of general health and back abnormalities were predictive for early retirement with a diagnosis of back disorder on the retirement certificate but self assessed health was a stronger predictor. Age, smoking, and neuroticism were predictors regarding early retirement for all diagnoses. Education had a negative association; neuroticism did not predict early retirement with a diagnosis of back disorder.

Absenteeism

Low back and neck/shoulder pain in construction workers: occupational workload and psychosocial risk factors. Part 1: Relationship to low back pain.

The prevalence rate of musculoskeletal problems, especially low back pain and severe low back pain in a randomly selected sample of 1,773 construction workers was studied. Its relationship to physical and psychosocial factors was analyzed. The workers answered a postal questionnaire. Workload was measured by means of eight manual materials handling indices and ten psychosocial indices, based on results from factor analyses. The 1-year prevalence rate of low back pain was 54% and of severe low back pain 7%. The relationship to heavy manual materials handling differed with age in such a manner that it could be interpreted as a healthy worker effect. Between severe low back pain and both stooping or kneeling a dose-response relationship was found. The most prominent of the psychosocial factors associated with low back pain and severe low back pain were the stress index and the psychosomatic and psychic indices. The age-standardized prevalence rate ratio of low back pain was 1.6 (95% confidence interval 1.4-1.8) and for severe low back pain 3.1 (95% confidence interval 2.3-4), when workers reporting "high" stress were compared to workers reporting "low" stress.

Adult

Studies on the low back pain among electric construction workers. Report 2. Workers' attitude to the prevention and the treatment of their low back pain.

In the previous report, the author demonstrated that the electric construction workers were exposed to the high risk of low back pain, and discussed on the ways to prevent and to treat their occupational disorders. He concluded that the improvement of their working conditions, especially lessening of the working load, was necessary to prevent occupational low back pain, and that it was the most helpful effect on their low back pain to take a rest on an after the attack of the disorder, while most of the medical treatment without a rest were almost helpless. In this report, the author studied and discussed on the workers' opinions on the ways to prevent and to treat their low back pain, by means of questionnaire-method. The workers examined were classified by whether they had the disorder or not and also by the grades of their working load. The results are as follow: 1. As for preventive measures, it is the most popular opinion that they should take care not to hurt their low back; nevertheless, as a matter of fact, their low back pain has been mainly resulted from overwork. 2. As for necessary means on the attack of low back pain, many workers believe that medical treatment is the most helpful to the disorder. Fewer workers recognize the low back pain as an occupational disorder and have opinion that they should take a rest on the attack of the disorder. 3. There is much discrepancy between the workers' opinions mentioned above and the occupational health doctors' recommendations that it is most desirable to improve the working conditions and to let the workers take a rest. 4. The more seriously they suffer from the disorder, the more practical and reasonable are the contents of their opinions. 5. In order to let these workers take a rest from labour more easily, the employers should recognize their low back pain as an occupational disorder, including offjob-payment.

Adult

Isometric back strength of low back pain patients and healthy controls.

The primary objective of this study was to determine the back strength of low back pain patients and to compare their values with healthy control subjects. Using the back and leg dynamometer, we measured the isometric back strength of 21 patients (14 men and 7 women), with chronic low back pain and 21 (14 men and 7 women) healthy (control) subjects. Both groups are comparable (p greater than 0.05) in age, body weight, height and Quetelet index (weight/height2). The back strength of the low back pain patients is not significantly (p greater than 0.05) different from their sex, age and anthropometric matched healthy controls. However, the males in the study were stronger (p less than 0.01) than their female counterparts. Based on our findings, we conclude that weakness of the paraspinal extension muscles is not the likely primary cause of idiopathic low back pain.

Adult

Back symptoms in nursing aides in a geriatric hospital. An interview study with special reference to the incidence of low-back symptoms.

The incidence of back symptoms, particularly in the lumbar region, was investigated in 267 female nursing aides in a geriatric hospital. The overall incidence of low-back symptoms was 46.8%. Low-back insufficiency was present in 40%, lumbago in 18.4% and sciatica in 7.6%. Nursing aides with low-back symptoms had a higher incidence of cervical and thoracic spine symptoms than those without low-back symptoms. Recurrence of low-back symptoms had been common, appearing in 82%. Nursing aides with lowback symptoms considered their work more stressful to the spine than those without low-back symptoms. No relationship was found between different kinds of lifting technique and the incidence of low-back symptoms.

Adolescent

An in vivo comparison of the step-back technique versus a step-back/ultrasonic technique in human mandibular molars.

This study compared the in vivo debridement efficacy of the step-back preparation versus a step-back/ultrasound preparation in the mesial root canals of vital human mandibular molars. Group 1 consisted of 15 teeth prepared with a step-back technique using intermittent irrigation with 5.25% sodium hypochlorite. Group 2 consisted of 23 teeth prepared with a step-back technique as in group 1 followed by 3 min of ultrasonic instrumentation (Cavi-Endo) using 5.25% sodium hypochlorite (30 ml per min). Group 3 consisted of 21 teeth which were uninstrumented and served as controls. Following extraction and histological preparation, the 1- and 3-mm levels of the canal and isthmus were evaluated for percentage of tissue removal using a compensating polar planimeter. At the 3-mm level, there were no statistical differences in canal or isthmus cleanliness between the step-back group and the step-back/ultrasound group. At the 1-mm apical level, statistical analysis indicated that the step-back/ultrasonic technique was superior to the step-back technique in canal (99.6% versus 88%) and isthmus (86% versus 10%) cleanliness.

Adult

The value of preemployment roentgenographs for predicting acute back injury claims and chronic back pain disability.

Preemployment roentgenographs have long been used in industry to screen job applicants. Roentgenographs have had little effect, however, in curbing the cost of back problems in industry. This study evaluates the capabilities of preemployment roentgenographs for predicting acute back injury claims within the longshoring industry and for predicting back problems that lead to back disability of more than six months. The data indicate that lumbosacral roentgenographs are not helpful in predicting who is more likely to make a back injury claim, or those few who make up the vast majority of the costs for industrial back pain by becoming disabled for more than six months. Lumbosacral roentgenographs have little link to back disorders and may be viewed as discriminatory. The radiation exposure is not justified by their predictive value as a preemployment screening tool.

Acute Disease

Relationships between strength of low back muscle contraction and reported intensity of chronic low back pain.

The electromyographic patterns produced by recording the left and right paraspinal muscles of subjects while in motion (bending and rising) and still (standing upright, sitting supported and unsupported, and prone) were contrasted for people with: 1) no history of back pain; 2) past episodes of low back pain but currently pain free; and 3) chronic low back pain with various diagnosed etiologies. Each of the 83 individuals recorded during episodes of low back pain produced a unique pattern of muscle contraction which was relatively stable between weekly recording sessions. In every case, at least one of the six positions showed elevated contraction levels significantly above that of the 15 subjects with no history of back pain and the 28 with no current back pain. For nine of the eleven subjects who reported changes in pain intensity between recording sessions, a clearly positive correlation occurred between the reported intensity of pain and the level of contraction in the one position most different from the reference group. No diagnostic subgroup of low back pain subjects produced a single unique pattern. Furthermore, no single aspect of the EMG signal, such as bilateral asymmetry, had predictive value for any individual subject. Our recordings did not differ with respect to diagnostic category so further research will have to be done to determine whether the diagnostic categories currently in use do not fit the physiological bases for the problems and/or whether prolonged abnormal levels of muscle contraction eventually produce problems such as disc displacement.

Adolescent

Classification of nonspecific low back pain. I. Psychological involvement in low back pain. A clinical, descriptive approach.

An unselected sample of outpatient subjects (n = 330) with localized nonspecific low back pain (LBP) was studied. Investigation consisted of clinical assessment, physical examination, and psychiatric interview based on the DSM-III classification. A psychiatric disorder, according to the DSM-III criteria (axis I) was found in 41% of the subjects. Multiple correspondence analysis and cluster analysis were used to objectively identify clinical subtypes without preconceived theoretical models. Correspondence analyses suggested the existence of a 'psychological pain' syndrome consisting of several of the following symptoms: diffuse back pain, impossibility to assess intensity of pain on a pain scale, aggravation of pain by changing climate, by domestic activities or by psychological factors and dysesthesias in the back. Cluster analysis provided support for a four-group classification of low back pain, which may be interpreted through the relationships between psychological disturbances and the LBP clinical features. The results call for further investigation of the complex relationship between psychological disturbances and back pain. However, clinicians must be aware of the interest of a minimal psychiatric assessment in low back pain patients: psychiatric disorders frequently appear in these patients and an appropriate treatment of the psychiatric syndrome may reduce back pain.

Adolescent

Electric behavior of low back muscles during lumbar pelvic rhythm in low back pain patients and healthy controls.

UNLABELLED: The functioning of low back muscles of back pain patients during flexion and reextension has not been properly investigated. In this study, we analyzed rectified, averaged electric activity (RMS EMG) and corresponding raw intramuscular (IM) EMG from lumbar paraspinal muscles to quantify the activity level during simple bending cycles in 87 back pain patients compared to 25 able-bodied controls. THE RESULTS: All functional phases seen in raw IM EMG were also shown in surface RMS EMG. Surface RMS EMG pattern seems to yield more information from activity level than IM EMG pattern. The RMS EMG patterns of back pain patients differed from those of controls as follows: (1) There was clearly noticeable activity during standing in back pain patients. (2) There was only a partial decrease of EMG activity after flexion in back pain patients with current pain. (3) The ratio of mean reached at maximal activity level during extension and flexion was less in patients (1.8, SD = 0.5, p less than .001) than able-bodied controls (3.2, SD = 0.8). (4) Segmental differences were observed in IM EMG activities in patients having hypermobility in bending x-ray. (5) Large peak potentials occurred during movements in patients having segmental hypermobility. THE RESULTS indicate that averaged surface recording is a valuable tool in the investigation of dynamic spine functions in back pain patients.

Adult

Back pain and isometric back muscle strength of workers in a Danish factory.

105 factory workers (38 females and 67 males) have been questioned about their frequency of back pain. 60% of the females and 61% of the males have previously experienced episodes of back pain. 21% of the females and 37% of the males have been absent from work due to back pain. The incidence of back pain is not related to age, height, sort of work, or isometric muscle strength of the back (IS). For the males the incidence rises with increasing weight, i.e. combination of height and obesity, but is not related to any two single factors. For the females there is no correlation between the incidence of pain and weight. IS is correlated to height and age in the males but not in the females. Standards for IS are presented and suggested as a guide to evaluation of the working capabilities of individual subjects with back pain.

Adult

Back pain in physiotherapists involved in back care education.

The pattern of back pain in physiotherapists was compared to that in a control group, matched for age and sex, using a self-administered questionnaire. The annual incidence and prevalence, point and life-time prevalence as well as anatomical distribution were similar in both groups to that found previously in nurses and the general population despite the fact that almost all the physiotherapists had been involved with back care education. The recurrence rate was also similar despite the physiotherapists taking earlier steps to avoid further back pain. Physiotherapy was seen to be a stressful occupation in terms of the presence of occupational factors associated with back pain. Physiotherapists were more likely to attribute their back pain to work and the initial onset to a work-related incident. Newly qualified physiotherapists were particularly vulnerable, although they were more satisfied with their training in lifting skills than their older colleagues. Although further research is required, an ergonomics approach to the clinical working environment and a critical appraisal of the value of training in lifting skills and back education programmes are recommended.

Adult

Effects of spinal flexion and extension exercises on low-back pain and spinal mobility in chronic mechanical low-back pain patients.

It has been estimated that one fourth to one half of all patients treated in physical therapy clinics suffer from low-back pain. The purpose of this study was to compare the effects of spinal flexion (Group I) and extension (Group II) exercises on low-back pain severity and thoracolumbar spinal mobility in chronic mechanical low-back pain patients. Both groups had significantly less low-back pain after treatment (P less than .10). There was no significant difference, however, between the spinal flexion and extension exercises in reduction of low-back pain severity. The results indicated a significant difference between the groups in increasing the sagittal mobility (P less than .10). The results did not indicate any significant difference between and within groups in increasing the coronal and transverse mobility of the thoracolumbar spine. Either the spinal flexion or extension exercises could be used to reduce chronic mechanical low-back pain severity, but the flexion exercises had an advantage in increasing the sagittal mobility within a short period of time.

Adult