low back pain

Low back pain (LBP) is a health problem. Rehabilitation could be a suitable therapy for LBP patients. Nonetheless, the effectiveness of movement pattern training on LBP patients has not been assessed scientifically. So, this research examined the effects of movement pattern exercise on general lower limb muscular co-contraction in patients with non-specific chronic LBP during walking.

The current research was quasi-experimental. Forty male adults who experienced non-specific chronic LBP voluntarily enrolled in this study. Twenty samples were assigned in the intervention group and 20 in the control group. The exercise protocol used in this study was based on the Harris-Hayes et al. protocol, which takes 18 supervised training sessions (during 6 weeks). The assessments were conducted before the intervention and again after 6 weeks. General co-contraction of the lower limb muscles was recorded using electromyography while walking, and the total activation of the muscles that abounded the joint was calculated. 

The findings indicate a significant decrease in general co-contraction of the ankle in the intervention group at propulsion (P=0.011, ƞ2=0.160). Also, the results show that at the loading phase, general knee co-contraction is greater in the experimental group compared with the control group (P=0.037, ƞ2=0.110).

Our research reveals that the training program improves the general co-contraction of the lower limb muscles in individuals with LBP.

 Non-specific low back pain (NSLBP) is one of the most prevalent musculoskeletal issues, significantly impacting workers’ quality of life and occupational productivity. This multifactorial condition arises from a combination of occupational, lifestyle, and individual factors. This study aimed to investigate the prevalence and associated factors of NSLBP among workers.

This cross-sectional study was conducted on 406 participants, including 202 workers with NSLBP and 204 without. Demographic and occupational questionnaires, along with the Work Ability Index and Job-Related Physical Demands scales, were completed by all participants. Data were analyzed using descriptive and inferential statistical methods.

Significant associations were identified between longer weekly working hours (p < 0.001), lack of physical activity (p = 0.001), and exposure to occupational hazards (p < 0.05) and NSLBP. Workers exposed to these factors were at a higher risk of developing NSLBP.

NSLBP is significantly associated with a combination of individual and occupational factors. The findings highlight the necessity of preventive interventions, including ergonomic workplace improvements, reduced weekly working hours, and the promotion of regular physical activity. These results can inform occupational health policies and enhance workers’ quality of life. However, the study’s limitations, including its cross-sectional design and relatively small sample size, should be considered when interpreting the findings.

BackgroundLow back pain is a common reason for disability in patients younger than 45 years old who visit physicians. Although there are many attitudes toward treating back pain, there is no commonly accepted approach. This study compared various attitudes toward the examination, diagnosis, and treatment of chronic low back pain among neurologists, neurosurgeons, and orthopedic surgeons. MethodsIn this cross-sectional study, a checklist including four main aspects of history taking, clinical and para-clinical tests, and treatment of chronic low back pain was designed to be completed by 45 specialists (orthopedic surgeons, neurosurgeons, and neurologists). Results Straight Leg Raising (SLR) was the most frequent test during the examination process. The high priorities among the para-clinics were MRI, lumbosacral graph, EMG-NCV, serology lab test, and CT scan, respectively. A significant difference was found in requesting lumbosacral graph among specialties. Moreover, the priorities for nonsurgical treatment were NSAIDs, nonpharmaceutical treatment, muscle relaxants, gabapentin, and corticosteroids, respectively. ConclusionHistory taking, physical examination, diagnostic approaches, and treatments were significantly different among the different specialties. The results revealed the need for consensus on common and well-established guidelines for a clinical approach to chronic low back pain.

Evidence from medical literature implies that back radiculopathy pain is primarily caused by inflammation and disc herniation. Based on our examined sources, this theory was initially put forward in 1934 by two American surgeons, William J. Mixter and Joseph S. Barr. The theory proposes that the intervertebral disc changes shape for various reasons, leading to the compression of nerve fibers in the epidural canal. This compression can result in inflammation, pain, and restrictions in movement. Today, this theory is perceived to be increasingly inconsistent with clinical experiences. Hubert L. Rosomoff was the first to publish the article "Do Herniated Disks Produce Pain?" in 1984. In The Clinical Journal of Pain, he rejected Mixter and Joseph S. Barr's theory, but did not introduce a mechanism for how patients with discopathy do not experience pain.  Recent studies indicate that the human body can adapt to various types of deformities and alleviate the symptoms of a wide range of complications without any measurable change in the pressure or shape of the disc. This study proposes a hypothesis to understand the body's ability to achieve balance and adapt to a deformed disc and radiculopathic pain.

Low back pain (LBP) due to lumbar spinal stenosis presents a significant clinical challenge. Epidural steroid injections (ESIs) are a common treatment option; however, the optimal injection route remains debated.

To compare the clinical outcomes of parasagittal interlaminar (PIL) versus midline interlaminar (MIL) ESI in patients with LBP attributed to lumbar spinal stenosis.

This prospective, randomized study included patients with LBP and lumbar stenosis. Participants were randomly assigned to receive ESI via either the PIL or MIL route. Clinical outcomes, including pain intensity (measured by the Numeric Rating Scale [NRS]) and functional disability (assessed using the Modified Oswestry Disability Index [MODQ]), were evaluated at 1- and 3-months post-injection.

Analysis revealed a significant reduction in pain intensity (NRS) at 3 months post-injection in the PIL group compared to the MIL group (P = 0.014). Additionally, the PIL group demonstrated significantly lower patient satisfaction scores at 3 months (P = 0.033) and higher MODQ scores at 3 months (P = 0.002) compared to the MIL group. No significant differences were observed between groups at baseline or at the 1-month follow-up for any of the assessed outcomes.

This study suggests potential differences in efficacy between parasagittal and midline interlaminar ESIs for lumbar stenosis pain. These findings underscore the need for further research to optimize treatment strategies and improve pain management for patients with this condition.

It is now a well-established fact that paraspinal muscle integrity plays a critical role in low back pain. We aimed  to determine the association of the cross-sectional area (CSA), muscle disc ratio (muscularity), and muscle fat ratio of the paraspinal muscles with chronic low back pain (CLBP) of varied pathologies, and  the effect of aging and BMI.

The CSAs of the muscles did not differ significantly between the two groups except for multifidus (p<0.05) and psoas (p<0.001) at L1-L2, and psoas (p<0.001) at L2-L3. There was significant difference in CSA of disc at L3-L4, L4-L5, L5-S1 (p<0.05), muscle fat ratio (p<0.01) and muscularity of multifidus and psoas (p<0.05) from L1 to L5 levels. There was no correlation of age and BMI with the CSA. Aging led to fatty infiltration in both the groups. The CSAs of muscles and discs were comparable (p>0.05) among subgroups except at few spinal levels. Muscularity among the subgroups varied at different levels. The muscle fat ratio were comparable (p>0.05).

Muscularity and composition rather than overall CSA of important spinal stabilizers  are associated with CLBP. Age and BMI has no correlation to CSA of paraspinal muscles. Various disc and muscle parameters do not differ much among common lumbar pathologies.

The psoas muscle plays an essential role in the hip and lumbar spine. Total hip arthroplasty surgery can change the ipsilateral psoas muscle, which may affect lumbar biomechanics and accelerate disk degeneration. We present a clinical study that suggests a potential association between unilateral psoas muscle atrophy after hip replacement surgery and subsequent low back pain

A 53-year-old man with a history of right total hip arthroplasty for osteoarthritis presented with left lumbosciatalgia 6 years after surgery. In the physical examination, the patient exhibited weakness 2/5 in Kendall’s muscle grading system in the right hip flexion and left extensor hallucis longus and triceps surae. Magnetic resonance imaging revealed a degenerative disk L5-S1 and severe unilateral atrophy of the right psoas muscle. Conservative treatment through physiotherapy was initiated, but persistent pain ultimately necessitated microdiscectomy at the L5–S1 level.

Total hip arthroplasty surgery may lead to long-term unilateral atrophy of the ipsilateral psoas muscle and alter lumbar biomechanics, potentially accelerating the disk degeneration and subsequent low back pain. Investigating this possible correlation may offer greater clarity regarding low back pain after total hip arthroplasty. In our case, conservative treatment through 15 sessions of physical therapy resulted in very limited improvement, and advanced diskopathy required surgical intervention to decompress the affected lumbar root.

Recent evidence suggests a potential association between Modic Changes (MC) and inflammation in nonspecific low back pain patients. Inflammation, characterized by the activation of immune cells and the release of pro-inflammatory molecules, is known to play. This research aims to investigate the clinical and laboratory features suggestive of inflammation in patients with MC on lumbar MRI. 

A retrospective analysis was conducted on 169 patients with MC identified on lumbar Magnetic Resonance Imaging (MRI). Laboratory investigations were also obtained, including Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels. The MC were categorized based on their MRI signal patterns. The presence of inflammatory markers and their association with clinical features was assessed using appropriate statistical methods. 

The majority of patients exhibited type 2 MC (n=139, 82.4%), followed by type 1 MC (n=28, 16.5%) and type 3 MC (n=2, 1.1%). Among the clinical features, patients with type 1 MC had a significantly higher prevalence of nocturnal low back pain (OR=6.76 [95%CI: 2.25-20.24], p<0.001) and morning low back stiffness (OR= 4.27 [95%CI: 1.42-12.85], p=0.006). Additionally, patients with type 1 MC were more likely to have elevated CRP levels (OR=2.61 [95%CI: 1.18-5.78]).

Although the majority of patients had type 2 MC (82.4%), type 1 MC was strongly associated with higher CRP levels, morning stiffness, and nocturnal pain. These associations suggest that type 1 MC may represent a more inflammatory and clinically severe form of the condition, emphasizing the importance of recognizing it in clinical practice.

Lumbar hyperlordosis is a common problem among athletes, characterized by an excessive increase in the lumbar arch which can lead to chronic Low Back Pain (LBP). The central stabilizing muscles of the trunk are crucial for maintaining proper stability and alignment of the spine. Weakness in these muscles can increase the lumbar arch's severity and associated pain. This study aimed to investigate the correlation between the endurance of different groups of core stability muscles and pain in women athletes with lumbar hyperlordosis.

36 female athletes with lumbar hyperlordosis were randomly selected and examined. The study assessed the endurance of the different central stability muscles, including trunk flexors, extensors, and lateral flexors, using McGill tests. Additionally, the athletes' level of LBP was measured using the Visual Analog Scale (VAS). Data analysis used multiple linear regression to assess the correlation between muscle endurance and pain.

None of the endurance variables of the four central stability muscles are significantly associated with the pain of subjects with hyperlordosis (P≥0.05). According to the reported beta values, the endurance of the muscles of the trunk extensor, left lateral flexor, right lateral flexor, and trunk flexor have the greatest association with LBP of athletes with lumbar hyperlordosis (P≥0.05).

These findings suggest that increasing the endurance of the central stabilizing muscles, could not significantly reduce LBP in athletes with lumbar hyperlordosis, for this reason, there is no need to separate the strengthening of the core muscles to reduce LBP These results could be used to develop targeted exercise programs to correct posture and reduce pain in this population.

The major emphasis of physical therapy in patient evaluation is the assessment of physical function, and the Patient-Specific Functional Scale (PSFS) is one of the most commonly used instruments for this purpose. Therefore, the present study aims to translate and cross-culturally adapt the PSFS into Persian and test its psychometric properties in patients with chronic low back pain (CLBP). The PSFS was translated from English to Persian and cross-culturally adapted in accordance with the study by Beaton et al.  Psychometric properties of 100 CLBP patients were assessed. Reliability (internal consistency and test-retest) was examined for 32 participants who completed the Persian version of the PSFS (PSFS-P) twice with one week interval. Construct validity was assessed against the Persian versions of the Oswestry Disability Index (ODI-P) and the Numerical Pain Rating Scale (NPRS-P). The PSFS-P showed excellent reliability (Cronbach’s alpha=0.88, intraclass correlation coefficient [ICC 3, 1] =0.95, 95% CI [0.87 to 0.98]). The construct validity analysis revealed a moderate negative correlation between PSFS-P and NPRS-P (r=-0.47) and a high negative correlation between PSFS-P and ODI-P (r=-0.61). The PSFS-P showed no floor and ceiling effects. The PSFS-P has adequate psychometric properties and is applicable in both clinical settings and research involving the Iranian population with CLBP.        Level of evidence: IV

Low back pain (LBP) is a significant issue in both clinical and public health settings, resulting in high healthcare and social costs. While knee joint pain is more prevalent than hip joint pain, standing posture is influenced not only by spinal alignment but also by hip and knee joint alignment. The knee and spine are interconnected anatomically, and degenerative changes in one area could often cause discomfort in the entire axis, leading to what is known as "knee-spine syndrome". LBP is a common condition associated with knee pain and can significantly affect the results of total knee arthroplasty (TKA). Surgeons need to consider knee-spine syndrome before any surgical intervention in patients with knee or back pain and explain it to the patients before the surgery.

Sacroiliac joint (SIJ) pain poses a significant burden on patients and the healthcare system. Due to its potential for tissue regeneration, minimally invasive administration, and affordability, platelet-rich plasma (PRP) has recently gained attention in the management of SIJ pain. Although PRP is widely used for musculoskeletal conditions, there is limited evidence regarding its application in SIJ pain.

This study aims to assess the impact of PRP injections in patients with chronic SIJ pain that is unresponsive to conservative treatments.

This study is a single-arm, open-label clinical trial. Patients aged between 30 and 80 years with chronic SIJ pain were included. Platelet-rich plasma was prepared from autologous blood and injected into the SIJ under ultrasound (US) guidance. Pain intensity was assessed using the Numeric Rating Scale (NRS), and functional disability was measured using the Modified Oswestry Disability Index (MODI) before the intervention, as well as one month and three months post-injection. Statistical analysis was performed using repeated measures ANOVA in SPSS version 23 to evaluate changes over time.

A total of 16 patients were included in the study. At the one-month follow-up, the mean pain intensity dropped to 5.19 ± 2.66, followed by a slight increase to 5.75 ± 2.54 at the three-month follow-up. The mean MODI score was 67.00 ± 8.42 at baseline, improving to 46.75 ± 21.46 at one month, and slightly increasing to 50.50 ± 19.98 at three months. The overall changes in pain intensity and disability index over the three months were statistically significant (P < 0.001). No significant adverse events were reported.

Platelet-rich plasma injection resulted in significant pain reduction and functional improvement for chronic SIJ pain over three months, suggesting its potential as a minimally invasive therapeutic alternative for patients who are unresponsive to conventional therapies. While PRP appears to be a safe modality for SIJ pain management, further studies with larger sample sizes and extended follow-ups are needed to explore its effectiveness and safety.

Low back pain is a common musculoskeletal disorder among healthcare specialty nurses. Operating room staff are particularly susceptible to experiencing low back pain due to the nature of their work.

We conducted a study to investigate the prevalence of low back pain and the factors associated with it.

A cross-sectional study was conducted on 323 operating room personnel from five hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences. Data was collected using a questionnaire developed by Tavakol et al. This questionnaire included demographic information and assessed the prevalence and dimensions of low back pain. The data was analyzed using IBM SPSS v.26.

The results showed that the prevalence of low back pain (LBP) was 74.3%. In this study, 64.8% of the personnel were women, 63.5% were married, and 72.4% had a bachelor's degree. Additionally, 87% had no history of smoking. The average age was 33.83 ± 7.02 years. There was a significant relationship between the prevalence of LBP and gender (P = 0.044), marital status (P = 0.001), BMI (P = 0.008), age (P = 0.001), shift work (P = 0.001), work experience (P = 0.001), and the average number of shifts (P = 0.037).

We found a high prevalence of LBP among operating room personnel, which is related to both individual and occupational factors. Our recommendations for nursing managers include modifying work shifts, allocating less physically demanding tasks to senior personnel and females, and implementing educational programs that focus on improving ergonomics and reducing physical strain.