Efficacy and safety of acupuncture in treating low back and pelvic girdle pain during pregnancy:a systematic review and meta-analysis of randomized controlled trials

Objectives:Low back and pelvic girdle pain(LBPGP)is common during pregnancy.Acupuncture is an effective and safe therapy for pain relief.However,further evidence is required to confirm the efficacy and safety of acupuncture in treating LBPGP during pregnancy.This study aimed to systematically review and investigate the clinical efficacy and safety of acupuncture for the treatment of pregnancy-related LBPGP.Methods:The PubMed,EMBASE,Cochrane Library,CNKI,VIP,and WanFang databases were searched from January 2000 to August 2023.Only the randomized controlled trials(RCTs)involving pregnant women between 16 and 34 weeks of gestation diagnosed with LBPGP were included in the study.A meta-analysis was conducted and pooled risk ratios(RRs)or mean differences(MDs)with 95%confidence intervals(CIs)were compared.Results:Meta-analysis included 12 RCTs involving 1,641 participants.Eleven trials compared acupuncture alone or acupuncture combined with standard care(SC),of which three trials also used non-penetrating or placebo acupuncture as the control group.One trial compared acupuncture alone with non-penetrating acupuncture.Compared with SC,acupuncture combined with SC group significantly decreased visual analog scale score(mean difference(MD)=−2.83,95%CI=−3.41 to−2.26,P<0.00001),cesarean section rate(RR=0.69,95%CI=0.49–0.97,P=0.03),preterm birth rate(RR=0.42,95%CI=0.27–0.65,P<0.0001),labor duration(MD=−1.97,95%CI=−2.73 to−1.20,P<0.0001),and Oswestry disability index score(MD=−9.14,95%CI=−15.68 to−2.42,P=0.008).In addition,acupuncture combined with SC significantly improved 12-Items Short Form Health Survey of physical component summaries(SF12-PCS).No significant differences were observed in the spontaneous delivery rate,newborn weight,drowsiness,and 12-Items Short Form Health Survey of mental component summaries(SF12-MCS)between the two groups.Adverse events such as needle pain and needle bleeding were aggravated in both the SC and acupuncture treatment groups but none were associated with acupuncture during or after the treatment period.Conclusions:Meta-analysis showed that acupuncture combined with SC had better efficacy than SC alone and could be a potential therapy for LBPGP during pregnancy.The safety results imply that acupuncture caused few adverse reactions;however,more evidence is required for further confirmation.

Treating acute low back pain with acupuncture:A randomized controlled study protocol to compare the effectiveness between distal and local acupoints

Objective:To compare the efficacy of using“distal acupoints only”vs.“local acupoints mainly combined with distal acupoints”in cases of acute low back pain(ALBP).Methods: A total of 102 eligible patients aged 18–65 years with ALBP lasting less than 6 weeks will be randomized in a 1:1 ratio to the distal acupoints only group(DPOG)and the local acupoints mainly combined with the distal acupoints group(LPMG).During a 4-week treatment period,patients in the DPOG will receive acupuncture at distal acupoints only(Houxi[SI 3]and Yaotongxue[EX-UE 7])twice a week,while those in the LPMG group will receive acupuncture at local acupoints(mainly Shenshu[BL 23]and Dachangshu[BL 25])combined with distal points(Weizhong[BL 40]).The patients in both groups will be evaluated at every session of treatment,and the follow-up will be performed for 3 months.The primary outcome measure will be the change in ALBP intensity,assessed using visual analogue scale scores before and after treatment.The secondary outcome measure will be the evaluation of functional disability using the Oswestry Disability Index.Discussion: This study compares the DPOG and LPMG to explore the feasibility of the DPOG in the treatment of ALBP.

Prevalence and Factors Associated with Low Back Pain among Healthcare Workers in Two Hospitals in Yaoundé-Cameroon: A Cross-Sectional Study

Background: Low back pain (LBP) is a very common health problem amongst the general population and a major cause of disability that affects work performance and well-being. Healthcare workers (HCWs) are especially at risk of developing LBP because of physical and emotional factors. Little is known about the burden of LBP in Cameroon. Objective: To determine the prevalence of low back pain and identify its associated factors among healthcare workers. Methods: A cross-sectional study using a self-administered questionnaire was conducted among healthcare workers in the Yaound Central Hospital and the Yaound University Teaching Hospital. The questionnaire collected data regarding recent, past year and lifetime occurrences of LBP, socio-demographics and work conditions. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: A total number of 268 HCWs participated in the study, including 197 (73.5%) females and 71 (26.5%) males. The mean age of the study participants was 40.60 8.38 years (extremes of 20 and 65 years). The lifetime, annual, and point prevalences of LBP among the participants were 67.5% (CI: 61.6 - 73.1), 61.5% (CI: 55.6 - 67.1) and 35.7% (CI: 29.7 - 41.5) respectively. Multivariate analysis confirmed a moderate stress level, a sedentary lifestyle, working in the medicine and specialities department, lifting heavy objects and bending to work as associated factors to LBP. Most sufferers had a minimal functional disability (65.7%) while 34.3% had a moderate to severe disability. Conclusions: Healthcare providers have a considerably high prevalence of low back pain. Factors associated with LBP found in this study were similar to those widely recognized in the literature. A substantial proportion of healthcare providers are suffering from functional disability associated with low back pain, affecting their social and work lives. There is a need for multilevel interventions to prevent and control low back pain in this highly vulnerable occupational group.

Prevalence and Factors Associated with Chronic Low Back Pain in the Mining Sector in Burkina Faso

Introduction: Low back pain is nowadays a real public health problem in companies. The objective of the study was to determine the prevalence and factors associated with chronic low back pain among workers of a mining company in Burkina Faso. Material and Methods: This was a descriptive and analytical cross-sectional study with a retrospective collection that took place from August 1, 2021 to March 16, 2022 in a gold mine in Burkina Faso. It focused on mine workers who participated in the 2019 annual medical visit. Results: Out of a total workforce of 880 workers who took part in the annual medical visit in 2019, 165 had chronic common low back pain, i.e. a prevalence of 18.75%. The average age of low back pain workers was 37.21 ± 7.5 years. Among the workers suffering from low back pain, 62 (37.58%) held the position of machine operator. Clinically, mechanical pain was found in 113 low back pain workers (76%) and twenty-nine (17.58%) had radicular pain. Standard radiography of the lumbar spine was abnormal in 129 workers (78.18%. In the univariate analysis, the factors associated with the pathology were sex, level of study, work station and seniority in the position. After a logistic regression, the factors associated with its occurrence were whole-body vibration (Fisher’s test = 12.7541;P = 0.000), male sex (Fisher’s test = 8.363;P = 0.004), and seniority for 4 to 5 years (Chi2 = 4.0234;p = 0.046). Conclusion: The study reveals the existence of chronic low back pain cases among the workers of the mining company. There is a predominance of the pathology in men, workers exposed to vibrations and those with a seniority of 4 to 5 years. It is necessary to establish a policy of prevention of low back pain for the benefit of workers, in particular those exposed to vibrations.

Comparison of Lumbopelvic-Hip Rotation Asymmetry and Pelvic Asymmetry between Individuals with and without Nonspecific Low Back Pain

Background: low back pain affects many individuals, with 80% classified as non-specific low back pain (NSLBP) due to mechanical rather than structural issues. The link between pelvic alignment and lumbopelvic-hip rotation movement for NSLBP is controversial. Methods: twenty males with NSLBP and 20 healthy males participated. Data collected included static pelvic asymmetry and active lumbopelvic-hip rotation with motion capture system for kinematic analysis. Results: Unpaired T test was used to compare the difference of kinematic parameters between two groups. NSLBP group showed significantly larger angles between the ASIS-PSIS line and the z-axis (p Conclusion: Evaluations focusing on bone structure alone may be inadequate. A more comprehensive approach including functional assessments like muscle strength and range of motion could be beneficial. Integrating lumbopelvic-hip movement patterns and pelvic symmetry into clinical assessments should be considered, as they may be influenced by physical activity.

Botulinum toxin type A for treating chronic low back pain:A double blinded randomized control study

BACKGROUND Low back pain(LBP)is a prevalent issue that orthopedic surgeons frequently address in the outpatient setting.LBP can arise from various causes,with stiffness in the paraspinal muscles being a notable contributor.The administration of Botulinum toxin type A(BoNT-A)has been found to alleviate back pain by relaxing these stiff muscles.While BoNT-A is approved for use in numerous conditions,a limited number of randomized clinical trials(RCTs)validate its efficacy specifically for treating LBP.AIM To study the safety and the efficacy of BoNT-A in minimizing pain and improving functional outcomes in patients of chronic LBP(CLBP).METHODS In this RCT,adults aged 18-60 years with mechanical LBP persisting for at least six months were enrolled.Participants were allocated to either the Drug group,receiving 200 Ipsen Units(2 mL)of BoNT-A,or the Control group,which received a 2 mL placebo.Over a 2-month follow-up period,both groups were assessed using the Visual Analog Scale(VAS)for pain intensity and the Oswestry Disability Index(ODI)for disability at the start and conclusion of the study.A decrease in pain by 50%was deemed clinically significant.RESULTS The study followed 40 patients for two months,with 20 in each group.A clinically significant reduction in pain was observed in 36 participants.There was a statistically significant decrease in both VAS and ODI scores in the groups at the end of two months.Nonetheless,when comparing the mean score changes,only the reduction in ODI scores(15 in the placebo group vs 16.5 in the drug group,clinically insignificant)was statistically significant(P=0.012),whereas the change in mean VAS scores was not significant(P=0.45).CONCLUSION The study concludes that BoNT-A does not offer a short-term advantage over placebo in reducing pain or improving LBP scores in CLBP patients.

A Study on the Effect of Exercise Intervention on Function and Pain in Patients with Low Back Pain

Lower back pain(LBP)has a relatively high incidence across various age groups,characterized by discomfort in the lumbosacral and iliosacral regions above the gluteal striatum and within the region below the costal margins.Some patients also experience varying degrees of leg pain,with many experiencing prolonged and recurrent symptoms.International consensus confirms that exercise intervention is an effective treatment method for lower back pain,offering safe and efficient physical therapy.Extensive practical experience suggests that Pilates exercises can effectively regulate the strength of muscle tissue in the peripheral region of the spine,improve muscle endurance,and alleviate low back pain caused by muscular factors.This study analyzes the effects of exercise intervention on the function and pain of patients with lower back pain.It explores various exercise modalities,utilizes SPSS26 statistics to gather data,and draws conclusions with the aim of providing theoretical references for exercise interventions in patients with lower back pain.

Impact of Multifidus Muscle Morphometry on the Clinical Evolution of Chronic Low Back Pain

Purpose: The multifidus muscle is an important extensor muscle of the lumbar spine. It plays a major role in the stability and realization of axial rotation movements of the thoraco-lumbar spine. Its atrophy by fatty degeneration would be at the origin of the occurrence of chronic low back pain which constitutes a public health problem in Senegal. Taking into account its anatomy is essential for the etiopathogenic analysis and the treatment of low back pain. The purpose of our work was to investigate the impact of multifidus muscle morphometry on the anatomy-clinical evolution of low back pain. Material and method: this was a prospective study over a period of 30 months from November 2019 to May 2022. It involved 100 patients seen in the neurology department of Fann Hospital for chronic low back pain and who had already had a scanner falling within the criteria for low back pain. We used 3D Slicer, SPSS 20, Excel 2016 software to model and analyze the morphometric data of the multifidus muscle after physiotherapy and control lumbar scans. Results: The sex ratio was 2.23. The average age of the patients was 45 ± 7 years. On the initial CT scan, according to the Hadar classification, we noted a predominance of grade 2 with 56% in L5/S1, followed by grade 1 with 32% and grade 3 with 14%. In L4/L5, the majority of patients, 67%, had grade 1. A conflicting circumferential disc bulge with the roots predominating in L5/S1 was present in 94% of men (p-value = 0.02). Before physiotherapy, the average volume of the multifidus was 193 mm3 ± 39, after physiotherapy it was 203 mm3 ± 42 with a progression rate of 5.2%. Clinically, severe type pain had regressed from 86% before physiotherapy to 0% after physiotherapy (p-value = 0.03). Conclusion: Taking into account the morphometry of the multifidus is an essential element in the management of chronic low back pain.

Efficacy and safety of thermobalancing therapy with Dr Allen’s Device for chronic low back pain:A randomised controlled trial

BACKGROUND Lumbar disc herniation and non-specific low back pain are common conditions that seriously affect patients’health-related quality of life(HRQoL).Although empirical evidence has demonstrated that novel Thermobalancing therapy and Dr Allen’s Device can relieve chronic low back pain,there have been no randomised controlled trials for these indications.AIM To evaluate the efficacy of Dr Allen’s Device in lumbar disc herniation(LDH)and non-specific low back pain(NSLBP).METHODS A randomised clinical trial was conducted investigating 55 patients with chronic low back pain due to LDH(n=28)or NSLBP(n=27),out of which 15 were randomly assigned to the control group and 40 were assigned to the treatment group.The intervention was treatment with Dr Allen’s Device for 3 mo.Changes in HRQoL were assessed using the Numerical Pain Rating Scale and the Japanese Orthopedic Association Back Pain Questionnaire.RESULTS Thermobalancing therapy with Dr Allen’s Device showed a significant reduction in pain in the treatment group(P<0.001),with no recorded adverse effects.Both pain assessment scales showed a significant improvement in patients’perception of pain indicating improvement in HRQoL.CONCLUSION The out-of-hospital use of Thermobalancing therapy with Dr Allen’s Device for Low Back Treatment relieves chronic low back pain significantly and without adverse effects,improves the level of activity and HRQoL among patients with LDH and NSLBP.This study demonstrates the importance of this safe first-line therapy that can be used for effective at-home management of chronic low back pain.

Systematic Review and Meta-analysis of Efficacy and Safety of Tenghuang Jiangu Tablet(藤黄健骨片)in the Treatment of Discogenic Low Back Pain

Objective:To systematically evaluate the efficacy and safety of Tenghuang Jiangu Tablet(藤黄健骨片)in the treatment of discogenic low back pain.Methods:CNKI,WanFang,CBM,VIP,PubMed,EMbase,Cochrane Library and Web of Science were systematically searched to collect the randomized controlled trials(RCTs)of Tenghuang Jiangu Tablet in the treatment of discogenic low back pain.Literature screening and data extraction according to the set criteria were conducted.Cochrane Risk Bias assessment tool was used to evaluate the quality of included RCTs,and Meta-analysis was performed using RevMan 5.4.1 software.Results:A total of 4 studies were included,with a total sample size of 404 cases.The results of Meta-analysis suggested that Tenghuang Jiangu Tablet combined with conventional treatment in the treatment of discogenic low back pain was superior to conventional treatment alone in terms of total clinical response rate(RR=1.21,95%CI[1.09,1.35],P=0.0004),excellent rate of curative effect(RR=1.24,95%CI[1.10,1.41],P=0.0007),lower VAS score(MD=-0.62,95%CI[-0.79,-0.44],P<0.00001)and JOA score(MD=1.84,95%CI[1.35,2.33],P<0.00001).There was no statistical significance in the incidence of adverse reactions between Tenghuang Jiangu Tablet combined with conventional treatment and conventional treatment alone(RR=0.76,95%CI[0.04,15.42],P=0.86).Conclusion:Based on existing research and methods,Tenghuang Jiangu Tablet combined with conventional therapy is effective on discogenic low back pain.Conventional therapy combined with Tenghuang Jiangu Tablet for the treatment of discogenic low back pain may be better than conventional therapy alone.All the adverse reactions occurred during the treatment were mild.There is no evidence that Tenghuang Jiangu Tablet can cause serious adverse reactions.However,the number of existing clinical studies is small and the quality is generally not high.It is suggested to carry out more large-sample and high-quality RCTs,and pay more attention to the long-term efficacy of drugs and the occurrence of adverse reactions,so as to further verify the above conclusions.

Pathophysiology, diagnosis, and treatment of discogenic low back pain

Discogenic low back pain is a serious medical and social problem, and accounts for 26%-42% of the patients with chronic low back pain. Recent studies found that the pathologic features of discs obtained from the patients with discogenic low back pain were the formation of the zones of vascularized granulation tissue, with extensive innervation in fissures extending from the outer part of the annulus into the nucleus pulposus. Studies suggested that the degeneration of the painful disc might originate from the injury and subsequent repair of annulus fibrosus. Growth factors such as basic fibroblast growth factor, transforming growth factor β1, and connective tissue growth factor, macrophages and mast cells might play a key role in the repair of the injured annulus fibrosus and subsequent disc degeneration. Although there exist controversies about the role of discography as a diagnostic test, provocation discography still is the only available means by which to identify a painful disc. A recent study has classified discogenic low back pain into two types that were annular disruption-induced low back pain and internal endplate disruption-induced low back pain, which have been fully supported by clinical and theoretical bases. Current treatment options for discogenic back pain range from medicinal anti-inflammation strategy to invasive procedures including spine fusion and recently spinal arthroplasty. However, these treatments are limited to relieving symptoms, with no attempt to restore the disc's structure. Recently, there has been a growing interest in developing strategies that aim to repair or regenerate the degenerated disc biologically.

Risk Factors of Low Back Pain among the Chinese Occupational Population:A Case-control Study

Objective To explore the risk factors of low back pain among the Chinese occupational population in several major industries. Methods A total of 7200 subjects （3600 cases and 3600 controls） were randomly sampled from a cross-sectional study, and they were investigated for individual and occupational factors of low back pain. The potential risk factors were first selected by using chi-square tests. Secondly, collinearity diagnosis proceeded by using the Kendall＇s rank correlation. Finally, binary logistic regression model was used for multi-factor analysis. Results Collinearity diagnosis showed that there was a severe collinearity problem among the potential risk factors of low back pain. Logistic regression model included 20 variables with statistical significance. Bending neck forward or holding neck in a forward posturefor long periods （0R=1.408） was the most important risk factor inducing low back pain in this study, followed by bending heavily with the trunk （0R=1.402）, carrying out identical work almost for the whole day （0R=1.340）. Additionally, suHicient normal break was a protective factor of low back pain. Conclusion Low back pain among the Chinese occupational population was associated with body height, occupation, work organization, physical work, working posture, and others. All these risk factors could be regarded as the indicators of low back pain, and some relevant preventive measures should be taken to reduce low back pain risk.

Do people with low back pain walk differently? A systematic review and meta-analysis

Background:The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain(LBP).Despite substantial research,it is still unclear whether consistent and generalizable changes in walking or running gait occur in association with LBP.The purpose of this systematic review was to identify whether there are differences in biomechanics during walking and running gait in individuals with acute and persistent LBP compared with back-healthy controls.Methods:A search was conducted in PubMed,CINAHL,SPORTDiscus,and PsycINFO in June 2019 and was repeated in December 2020.Studies were included if they reported biomechanical characteristics of individuals with and without LBP during steady-state or perturbed walking and running.Biomechanical data included spatiotemporal,kinematic,kinetic,and electromyography variables.The reporting quality and potential for bias of each study was assessed.Data were pooled where possible to compare the standardized mean differences(SMD)between back pain and back-healthy control groups.Results:Ninety-seven studies were included and reviewed.Two studies investigated acute pain and the rest investigated persistent pain.Nine studies investigated running gait.Of the studies,20%had high reporting quality/low risk of bias.In comparison with back-healthy controls,individuals with persistent LBP walked slower(SMD=-0.59,95%confidence interval(95%CI):-0.77 to-0.42)and with shorter stride length(SMD=-0.38,95%CI:-0.60 to-0.16).There were no differences in the amplitude of motion in the thoracic or lumbar spine,pelvis,or hips in individuals with LBP.During walking,coordination of motion between the thorax and the lumbar spine/pelvis was significantly more in-phase in the persistent LBP groups(SMD=-0.60,95%CI:-0.90 to-0.30),and individuals with persistent LBP exhibited greater amplitude of activation in the paraspinal muscles(SMD=0.52,95%CI:0.23-0.80).There were no consistent differences in running biomechanics between groups.Conclusion:There is moderate-to-strong evidence that individuals with persistent LBP demonstrate differences in walking gait compared to back-healthy controls.

Resting-state connectivity in the default mode network and insula during experimental low back pain

Functional magnetic resonance imaging studies have shown that the insular cortex has a signif- icant role in pain identification and information integration, while the default mode network is associated with cognitive and memory-related aspects of pain perception. However, changes in the functional connectivity between the defauk mode network and insula during pain remain unclear. This study used 3.0 T functional magnetic resonance imaging scans in 12 healthy sub- jects aged 24.8 ± 3.3 years to compare the differences in the functional activity and connectivity of the insula and default mode network between the baseline and pain condition induced by intramuscular injection of hypertonic saline. Compared with the baseline, the insula was more functionally connected with the medial prefrontal and lateral temporal cortices, whereas there was lower connectivity with the posterior cingulate cortex, precuneus and inferior parietal lobule in the pain condition. In addition, compared with baseline, the anterior cingulate cortex exhibited greater connectivity with the posterior insula, but lower connectivity with the anterior insula, during the pain condition. These data indicate that experimental low back pain led to dysfunction in the connectivity between the insula and default mode network resulting from an impairment of the regions of the brain related to cognition and emotion, suggesting the impor- tance of the interaction between these regions in pain processing.

Efficacy of Low Dose Naltrexone on Pain Reduction in Chronic Pain Syndromes: A Meta Analysis

Chronic pain is a multifaceted debilitating experience often associated with significant physical and emotional burden. Low dose naltrexone (LDN) has gained attention in recent years for its potential utility in the management of fibromyalgia, irritable bowel syndrome, multiple sclerosis, and painful diabetic neuropathy. LDN’s analgesic effects have been associated with its ability to increase the production of endorphins while reducing the production of tumor necrosis factor-alpha, interleukin-6, reactive oxygen species and nitric oxide. This meta-analysis aims to systematically review and synthesize the available evidence on efficacy of LDN as an analgesic in pain syndromes, with a focus on chronic (neuro) inflammatory diseases. The goal is to provide clinicians with a more comprehensive estimate of the effectiveness of LDN as a non-opioid option for managing chronic pain and guide future research in the area. Thirteen randomized control trials, published from 1990 to 2022, were selected for the analysis that satisfied inclusion criteria. The overall effects in these studies were calculated using the standardized mean difference (SMD) between the LDN and placebo groups. We found an overall SMD of -10.77 (95% CI: -13.96 to -7.58) with a p-value of 0.002. This indicated that the LDN group experienced a statistically significant reduction in pain compared to placebo. This meta-analysis provides evidence for the potential efficacy of low dose naltrexone in reducing pain and enhancing analgesia in various pain syndromes. LDN may be a useful treatment option for patients suffering from chronic pain, particularly with fibromyalgia, multiple sclerosis, or diabetic neuropathy. However, further research is needed to confirm the efficacy and safety of low dose naltrexone for chronic pain conditions, especially with larger sample sizes, standardized dosing regimens and treatment durations.

The Effects of Functional Training on Pain, Function, and Performance in Taekwondo Players with Mechanical Low Back Pain

Background: The aim of this study was to assess the effects of functional training (FT) on pain, function, and performance in elite male taekwondo players with CMLBP. Method: 27 elite male taekwondo players (mean ± standard deviation: age 24.4 ± 4.9 years, body mass 75.7 ± 15.1 kg, height 181.4 ± 7.8 cm) were allocated to two experimental (n = 15) and control (n = 12) groups. The eight-week FT was divided into four distinct phases for the subjects of the experimental group. Variables of pain and function were assessed by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), respectively. The movement time of Ap Douliou Chagi kick (MTAK) and speed of Ap Douliou Chagi kick (SAK) was used for the variable of performance. Results: Considering the results of pretest before the implementation of the scores protocol, after FT intervention, VAS (p = 0.004), ODI (p = 0.005), MTAK on the right leg (p = 0.029) and the left leg (p = 0.013) decreased and SAK on both legs (p = 0.000) increased significantly in comparison with the control group. Conclusion: It is assumed that FT can reduce the pain intensity and improve the function and performance in taekwondo players.

Improvement in Radicular Symptoms but Continued Facet Arthropathy and Axial Back Pain Following Rupture of a Facet Joint Synovial Cyst

Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient’s low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient’s radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.

Low Back Pain among Nurses: Prevalence, and Occupational Risk Factors

Objectives: Low back pain is a major occupational problem especially among nursing staff. The objectives of our study are to evaluate the prevalence of low back pain among nurses and to look for physical and psychosocial risk factors. Methods: It is a cross-sectional study based on a self-administered questionnaire destined for all nurses working in Farhat Hached Teaching hospital of Sousse (Tunisia). Results: Our study included 203 nurses with an average age of 39.8 years. The prevalence of low back pain over the last twelve months was 58.1%. The factors that are significantly associated to low back pain were: high BMI, number of pregnancies, arthritis, poor physical condition, daily frequency of inappropriate posture for the activity being performed, and the layout of materials in the workplace. Conclusion: Our study evidenced the high prevalence of LBP among nurses and allowed bringing to light the role of individual and ergonomic physical factors in the genesis of LBP. Such identification permits to undertake targeted preventive actions. The association between psychosocial factors and LBP was not emphasized.

Morphological changes of the lateral abdominal muscles in adolescent soccer players with low back pain: A prospective cohort study

Background:Most papers examining the lateral abdominal muscles(LAMs)and low back pain(LBP)are cross-sectional,with groups of participants being divided into a control and an LBP group.We hypothesized that morphological measurements of the LAMs in adolescent soccer players may predict future LBP incidence.The aim of this study was to examine the associations between the morphology of LAMs and LBP incidence rate among adolescent soccer players.Methods:Ninety-seven adolescent male soccer players with no LBP at baseline were recruited into the prospective cohort study.The thickness of the LAMs was measured at baseline by ultrasound imaging in a supine rest position.Nine cases of LBP occurred during the follow-up 6-month observation.Results:An obliquus internus(OI)asymmetry was related to increasing LBP risk(odds ratio=19.99;95%CI:2.4-167.9).Spearman correlation also showed a linear relationship between OI asymmetry value and duration of LBP(R=0.75,p=0.02).An OI side-to-side difference greater than 1.25 mm suggests possible LBP incidence in the 6-month observation among adolescent soccer players.Conclusion:The morphological changes of the OI may be related to LBP’s incidence in adolescent soccer players.The presence of OI asymmetry increases the odds of LBP by at least 2.4 times.Hypertrophy of the OI on one side of the body may contribute to trunk muscle imbalance.

McKenzie Therapists Adhere More to Evidence-Based Guidelines and Have a More Biopsychosocial Perspective on the Management of Patients with Low Back Pain than General Physical Therapists in Japan

Design: Cross-sectional. Objective: Aim 1 was to preliminarily explore the contributions of the following factors to adherence to LBP practice guidelines using regression modeling: 1) the credential qualification of Mechanical Diagnosis and Therapy (MDT);2) balance of biomedical and behavioral (i.e. biopsychosocial) oriented approach for low back pain (LBP);3) demographics;4) academic degree and 5) the attitude towards updating information for evidence-based clinical practice. Aim 2 was to investigate whether therapists credentialed in MDT (Cred.MDT) were more behavioral oriented and less biomedical oriented than general physical therapists. Summary of Background Data: LBP practice guidelines are not adhered to by every physical therapist. MDT is a behavioral modification approach. Thus, it was hypothesized that the Cred.MDT therapist was more behavioral oriented and more adherent to LBP practice guidelines compared with general physical therapists. Methods: One-hundred-twenty Cred.MDT therapists and 2000 general physical therapists in Japan were contacted. For regression modeling, the dependent variable was adherent to guidelines using a questionnaire with a vignette. Independent variables included balance of biomedical and behavioral perspectives for LBP using the Pain Attitudes and Beliefs Scale for Physiotherapist (PABS-PT), demographics, academic degree and the attitude towards updatinginformation for evidence-based clinical practice. The ratio of the two mean scores of the biomedical and behavioral subscales in the PABS-PT was compared between the Cred.MDT therapist group and the general physical therapists group. Results: Data of 46 general physical therapists and 44 Cred.MDT therapists were available. The Cred.MDT therapist group was significantly (P < 0.05) more behavioral oriented and more adherent to LBP practice guidelines compared with the general physical therapist group. The regression indicated significance of the two predictors of adherence to guidelines, Cred.MDT (β = 0.58, P < 0.001) and academic degree (β = 0.19, P = 0.03). Conclusions: Cred.MDT therapists are more guideline-consistent and have a more biopsychosocial treatment orientation than general physical therapists in Japan.