Symposium: The role of spine fusion for low-back pain. International Society for the Study of the Lumbar Spine, New Orleans, Louisiana, May 27, 1980.
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Chronic low back pain (CLBP) remains one of the most difficult and costly medical problems in the industrialized world. A review of nineteenth and early twentieth century spine rehabilitation shows that back disorders were commonly treated with aggressive and specific progressive resistance exercise (PRE). Despite a lack of scientific evidence to support their efficacy, therapeutic approaches to back rehabilitation over the past 30 yr have focused primarily upon passive care for symptom relief. Recent spine rehabilitation programs have returned to active reconditioning PRE centered around low back strengthening to restore normal musculoskeletal function. Research has shown that lumbar extension exercise using PRE significantly increases strength and decreases pain in CLBP patients. It appears that isolated lumbar extension exercise with the pelvis stabilized using specialized equipment elicits the most favorable improvements in low back strength, muscle cross-sectional area, and vertebral bone mineral density (BMD). These improvements occur with a low training volume of 1 set of 8 to 15 repetitions performed to volitional fatigue one time per week. CLBP patients participating in isolated lumbar extension PRE programs demonstrate significant reductions in pain and symptoms associated with improved muscle strength, endurance, and joint mobility. Improvements occur independent of diagnosis, are long-lasting, and appear to result in less re-utilization of the health care system than other more passive treatments. Low back strengthening shows promise for the reduction of industrial back injuries and associated costs.
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This case report described the use of a classification system in the evaluation of a patient with chronic low back pain (LBP) and illustrated how this system was used to develop a management program in which the patient was instructed in symptom‐reducing strategies for positioning and functional movement. The patient was a 55‐year‐old woman with a medical diagnosis of lumbar degenerative disk and degenerative joint disease from L2 to S1. Rotation with extension of the lumbar spine was found to be consistently associated with an increase in symptoms during the examination. Instruction was provided to restrict lumbar rotation and extension during performance of daily activities. The patient completed 8 physical therapy sessions over a 3‐month period. Pretreatment, posttreatment, and 3‐month follow‐up modified Oswestry Disability Questionnaire scores were 43%, 16%, and 12%, respectively. Daily repetition of similar movements and postures may result in preferential movement of the lumbar spine in a specific direction, which then may contribute to the development, persistence, or recurrence of LBP. Research is needed to determine whether patients with LBP would benefit from training in activity modifications that are specific to the symptom‐provoking movements and postures of each individual as identified through examination. These investigators propose a model for managing nonspecific low back pain (NSLBP) based on the identification of lumbar spinal dysfunction (symptom‐producing motions and alignments) during functional activities. The basis of the management model is the modification of the spinal movements and alignments that are pain producing through clinical education and a home program. The authors sited an example of using this model with a 55‐year‐old female who presented with a 10‐week history of central LBP that worsened with walking and other daily functional activities. The LBP was accompanied by parasthesias and intermittent sharp pain in the (L) lower extremity that was exacerbated by trunk rotation. After concluding that the patient was suffering from a dysfunction in lumbar extension and rotation, she was treated with movement and posture modification, forward flexion in standing and exercises aimed lengthening the hip flexors and improving gluteus maximus function. The patient demonstrated reduced symptoms, improved scoring on the Oswestry Disability Questionnaire, and improvements in pain‐free function. The investigators suggested that the patient's improvements were attributed to the modification techniques incorporated in the patient's home program and that these techniques may prove to be superior to exercise prescription and generic postural instruction. Comment by Phillip S. Sizer Jr., MEd, P.T. This management model may contribute to a patient's recovery and these patient‐specific measures may serve as a symptom‐alleviating concomitant to a multidisciplinary approach to the management of NSLBP. However, readers should approach the conclusions of these investigators with caution. The investigators did not sufficiently address the long‐term conservative management of segmental hypermobility 1 and adjacent segmental hypomobility that so frequently afflicts patients in this age group who suffer from NSLBP. The investigators also reported that extension and rotation increased the patient's symptoms, while forward flexion did not. Although their recommendation to avoid extension and rotation may have served the patient by avoiding the pain‐producing motion, a conclusion to add flexion to the program may not be advised. Forward trunk flexion increases intradiscal pressure, 2 which can be associated with disc degeneration and resultant symptom generation. 3 Respecting the impact of flexion on intradiscal pressure, Snook et al observed a reduction of NSLBP with patients who avoided flexion for the first 2 h of the day. 4 Additionally, symptoms may have been reduced through the influence of the forward flexion on remodeling the adhesions that typically form between the dura mater and the posterior longitudinal ligament 5 and or inter‐transverse ligaments. 6 These benefits could be attained through more force‐friendly techniques, such as neural flossing in a supine position. Furthermore, the patient's improvements may have been fostered by reduced neural sensitization through activation or a reduction her subjective feelings of disability. 7
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Abstract: Pain Low Back Pain, Lumbar Corset, Back Exercise. Pain is the major complaint that the majority of cases seen in patients with low back pain. This situation has been very disturbing in routine daily activities. The highest incidence of pain is found, the result of abnormal mechanics of motion, or postural abnormalities that lasts for a long time. There are several tools that can be used to reduce pain in low back pain. One means is the use of a corset for the lumbar region (lumbar corset) and perform a back exercise such as muscle strengthening exercises lower back. The study was conducted on patients consisting of mothers of households with children under five with the case, in Karanganyar Fitasoma Physiotherapy Clinic Surakarta, in the period between January to December 2014. This study is a quasi-experimental study. The data collection is done through observation, interview, physical examination, and documentation. 40 respondents sought through observation, to be subjects for further research. Based on this research, it was found that the decrease of pain in the first two weeks, either in a group or a group giving a lumbar corset back giving exercise. In addition, also found functional improvements in lumbar corset administration group after the first week and the provision of back exercise group after the second week.
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The objectives of this study were to examine the relative efficacy of three active exercise programs for work-related, chronic low back pain, and to observe to what extent the programs affected the mechanical stability of the lumbar region. The subjects were 64 employees who were randomly divided into three groups to match the three active exercise programs which were performed 3 times a week for 6 months. All subjects were assessed with the same measurements at a pre-study examination, and then were reassessed at 2 weeks, 3months and 6 months after the study. The pain intensity didn't show any significant difference among the three groups. However, the Oswestry Disability Index showed significant differences among the three groups at 6 months and the lumbar and thoracic exercise groups showed significant decreases compared to the general physiotherapy group (p
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Low back pain (LBP) is a common problem in manufacturing workers. Several strategies have been proposed in order to reduce the pain and/or improve functionality. Among them, lumbar supports are a common solution prescribed for lumbar pain relief. Most of the studies in the literature only consider subjective sensations of the workers for evaluation assessment. This study applies biomechanical tests (a flexion-relaxation test and a functional movement evaluation test) to analyse the effectiveness of flexible lumbar supports in functionality and disability versus placebo intervention, consisting of kinesiotape placed on the low back without any stress. 28 workers participated in the study, randomised in control and intervention groups with a two months’ intervention. None of the biomechanical tests showed statistical differences in between-groups pre-post changes. No benefits of wearing a flexible lumbar support during the workday have been found in these assembly-line workers versus placebo intervention.
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Introduction DIAGNOSTIC Low Back Pain: History and Physical Examination The Appropriate Utilization of Imaging Studies for Disorders of the Lumbar Spine Electrodiagnosis and Lumbar Spine Disorders Diagnostic Spinal Injections for Low Back Pain The Functional Capacity Evaluation TREATMENT Exercise Rehabilitation for Occupational Low Back Pain The Use of Medications in the Treatment of Low Back Pain Therapeutic Injections for Low Back Pain Manual Medicine The Use of Physical Modalities for Occupational Low Back Pain Lumbosacral Orthotics Operative Intervention for Lumbar Spine Disorders PREVENTION Prevention of Occupational Low Back Pain
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The purpose of this study is to prove the effect of the Aquatic Rehab & Exercise on lumbar spine ROM of women patients with chronic low back pain. Accordingly, eleven of women patients suffering from chronic low back pain, who were treated at J-gu health center, were chosen as an experimental group for the test. Their physical characteristics were 55.73±11.51 years, 157.85±6.51 ㎝, and 62.20±11.82 ㎏. They did the Aquatic Rehab & Exercise for sixty minutes, three times a week, ten weeks and changes were statistically measured before exercise, 5 weeks later, and 10 weeks later respectively. Repeated ANOVA(analysis of variance) was conducted for data at the level of significance, P＜0.05. The results of the study are as follows. By training periods of measurement and individual comparison between the periods of measurement, the Aquatic Rehab & Exercise showed significant difference in lumbar spine ROM of women patients with chronic low back pain. As a result of the study, the Aquatic Rehab & Exercise has positive effect on lumbar spine ROM of women patients with chronic low back pain. This study suggests that the Aquatic Rehab & Exercise can improve causes related to low back pain though there is a difference between individuals.
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Introduction: When children reach school age, they go through a series of stages that include growth spurts, the development of balance and coordination, and postural stability. In physical therapy, lumbar stabilization is an active kind of exercise. It helps to prevent low back pain by strengthening muscles that support the spine. The goal of the study was to find out the effectiveness of lumbar stabilization exercise in low back pain with heavy back packs among school children. Methodology: In the study, 30 participants were randomly selected for the study and they were divided into two groups - experimental group and control group. The participants were assessed with the help of VAS, MMST and ODI. The experimental group was given lumbar stabilization exercise along with conventional exercise and control group was given conventional exercise alone. Pre and post test were taken before and after the interventions. Exercises were given three times per week for six weeks. Result: The results were analysed using t-test. Paired t-test was used to compare the result. In both the group there was improvement in pain, functional ability, and ROM within group .When comparing the post-test values between the experimental and control group, the experimental group showed higher results than that of control. Hence, lumbar stabilization exercise is effective in reducing low back pain among school children with heavy back pack. Conclusion: The study concluded that lumbar stabilization exercise is effective in reducing low back pain with heavy back pack among school children. Key words: Lumbar stabilization Exercise, Low Back pain, Bag packs, School Children, Functional disability.
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