Beneficial and harmful effects of physical activity on care-seeking for low back pain: the AUTBACK study.

PURPOSE: People who seek more care for low back pain (LBP) tend to experience poorer recovery (e.g. higher pain and disability levels). Understanding the factors associated with care-seeking for LBP might improve patient outcomes and potentially alleviate the burden of LBP on global health systems. This study aimed to investigate the relationship between different intensities, volumes, and domains of physical activity and care-seeking behaviours, in people with a history of LBP. METHODS: Longitudinal data from adult twins were drawn from the AUstralian Twin BACK study. The primary outcome was the total self-reported frequency (counts) of overall utilisation of care for LBP, over 1 year. Secondary outcomes were the utilisation of health services, and the utilisation of self-management strategies, for LBP (assessed as total frequency over 1 year). Explanatory variables were device-based measures of sedentary behaviour and moderate-to-vigorous intensity physical activity, and self-reported physical workload, and work, transport, household, and leisure domain physical activity, at baseline. RESULTS: Data from 340 individuals were included. Median age was 56.4 years (IQR 44.9-62.3 years) and 73% of participants were female. Medium-to-high baseline volumes of sedentary behaviour were significantly associated with greater counts of overall care utilisation (IRR 1.60, 95%CI 1.04-2.44) and utilisation of self-management strategies (IRR 1.60, 95%CI 1.02-2.50) for LBP, over 1 year. Medium-to-high baseline volumes of household domain physical activity were significantly associated with greater counts of utilising self-management strategies for LBP over 1 year (IRR 1.62, 95%CI 1.04-2.53). No explanatory variables were associated with the utilisation of health services for LBP. CONCLUSION: People who engage in higher baseline volumes of sedentary behaviour or physical activity in the household setting (e.g. housework, gardening, yard work, general household maintenance) utilise 1.6 times more care for LBP over 1 year. Findings suggest that higher volumes of these behaviours may be harmful for LBP. No intensities, volumes, or domains of physical activity demonstrated clear benefits for LBP. Where feasible, patients and clinicians should collaborate to screen and develop strategies to reduce engagement in sedentary behaviour or physical activity in the household setting. Contextual factors (e.g. patient symptom severity, sociocultural roles, occupational demands) should be considered when devising appropriate behaviour change strategies.

Current concepts in joint pain in knee osteoarthritis.

Joint pain attributable to osteoarthritis (OA) is complex and influenced by a myriad of factors beyond local joint pathology. Current practice continues to predominantly adopt a biomedical approach to OA despite emerging evidence of the importance of a more holistic approach. This paper will summarise evidence for the presence of multidimensional pain profiles in knee joint pain and the presence of subgroups characterized by systemic features such as psychological distress, high comorbidity load or sensitisation of the nervous system. These factors have the potential to influence patient outcomes making them relevant for clinicians and highlighting the necessity of a broader multifactorial approach to assessment and treatment. This review describes the current state of the evidence for treatments of people with knee OA-related pain, including those receiving strong recommendations from current clinical guidelines, namely exercise, weight loss, self-management advice and pharmacological approaches. Other pain-modulating treatment options are emerging such as sleep and psychological interventions, pain education and multisensory retraining. The evidence and rationale for these newer therapeutic approaches is discussed. Finally, this review will highlight some of the limitations of current international guidelines for the management of OA and make recommendations for future research.

Causal mechanisms in the clinical course and treatment of back pain.

In recent years, there has been increasing interest in studying causal mechanisms in the development and treatment of back pain. The aim of this article is to provide an overview of our current understanding of causal mechanisms in the field. In the first section, we introduce key concepts and terminology. In the second section, we provide a brief synopsis of systematic reviews of mechanism studies relevant to the clinical course and treatment of back pain. In the third section, we reflect on the findings of our review to explain how understanding causal mechanisms can inform clinical practice and the implementation of best practice. In the final sections, we introduce contemporary methodological advances, highlight the key assumptions of these methods, and discuss future directions to advance the quality of mechanism-related studies in the back pain field.

Short-term effects of acupuncture and stretching on myofascial trigger point pain of the neck: a blinded, placebo-controlled RCT.

OBJECTIVES: This trial aimed to evaluate the short-term effectiveness of acupuncture plus stretching to reduce pain and improve range of motion in patients afflicted by cervical myofascial pain syndrome. DESIGN: Randomized, blinded, placebo-controlled crossover study. INTERVENTION: Nineteen patients (11 females, eight males, 33 ± 14 years) with myofascial neck pain in randomized order received the following treatments with one week washout between: acupuncture, acupuncture plus stretching, and placebo laser acupuncture. MAIN OUTCOME MEASURES: Mechanical pain threshold (MPT, measured with a pressure algometer) represented the primary outcome. Secondary outcomes were motion-related pain (Visual Analogue Scale, VAS) and cervical range of motion (ROM, recorded by means of an ultrasonic 3D movement analysis system). Outcomes were assessed immediately prior as well as 5, 15 and 30 min post treatment. Friedman tests with post hoc Bonferroni-Holm correction were applied to compare differences between treatments. RESULTS: Both acupuncture as well as acupuncture plus stretching increased MPT by five, respectively, 11 percent post treatment. However, only acupuncture in combination with stretching was superior to placebo (p<0.05). There were no significant differences between interventions at 15 and 30 min post treatment. VAS did not differ between treatments at any measurement. Five minutes after application of acupuncture plus stretching, ROM was significantly increased in the frontal and the transversal plane compared to placebo (p<0.05). CONCLUSIONS: The combination of acupuncture and stretching could represent a suitable treatment option to improve cervical movement behavior and reduce trigger point pain in the short-term. However, additional studies further discriminating the placebo effects are still warranted.

[Influence of spinal orthosis on gait and physical functioning in women with postmenopausal osteoporosis]. / Einflüsse einer Wirbelsäulenorthese auf Gangparameter und Alltagsfunktion bei Postmenopausaler Osteoporose.

INTRODUCTION: Osteoporosis is a widespread chronic bone disease leading to an increased risk of bone fractures. The most common clinical consequences are back pain, hyperkyphosis, limitations of physical functioning and activities of daily living as well as reduced quality of life. Furthermore, osteoporosis is associated with decreased strength and deficits of gait and balance, all together resulting in an increased risk of falls and a subsequent aggravation of fracture risk. Besides pharmaceutical and exercise therapy, back orthoses are increasingly being used in the therapy of osteoporosis and rehabilitation after vertebral fractures. Previous studies have shown that wearing a spinal orthosis results in a reduction of pain as well as improvements of posture and back extensor strength. To date there is no study that has evaluated the effects of a spinal orthosis on gait stability and physical functioning in patients with osteoporosis. Therefore the purpose of the present study was to assess the effects of a spinal orthosis on gait and pain-induced limitations of activities of daily living (ADL) in women with osteoporosis. METHODS: A total of 69 postmenopausal osteoporotic women with and without vertebral fractures were randomly assigned to receive either a spinal orthosis (Thämert Osteo-med intervention group n=35; average age 74 ± 8.3 years, height 158.3 ± 6.3 cm, weight 62.8 ± 9.6 kg, t-score -2.6 ± 1.0, number of vertebral fractures 1.4 ± 2.0) or to a waiting list control group (n= 34, age 74.1 ± 7.7 years, height 159.6 ± 5.9 cm, weight 65.4 ± 11.3 kg, t-score -2.9± 0.8, number of vertebral fractures: 0.9 ± 1.2). The following outcome measures were collected at baseline and at 3 and 6 months follow-up: gait parameters including gait analysis: velocity, stride length and width, double support time (% of gait cycle) and perceived limitations in activities of daily living (numeric rating scale 1-10; 1=best, 10= worst situation). RESULTS: The ANCOVA indicated a significant reduction of the double support time at 6 months in the intervention group (p < 0.05) without a significant influence of the covariate vertebral fractures status. The other parameters remained unchanged (p > 0 .05). Regarding the pain-related ADL limitations there were significant differences in the amount of change over the study period depending on the baseline value. Stratified into terciles (≤ 2.5; 2.6-5.0; >5) patients with initially high values showed a significantly greater reduction in perceived ADL restrictions compared to patients in the lowest tercile (-2.7 ± 2.7 versus 1.5 ± 2.1). CONCLUSION: The study demonstrated that wearing a spinal orthosis introduced a reduction in double support time associated with a beneficial impact on gait stability. Furthermore, there was a positive effect on pain-related restrictions of ADL evident in women with a high level of limitations at baseline. Besides previously shown reductions in pain, improvements in back extensor strength and correction of posture, the application of a spinal orthosis may induce advantages for gait stability and physical functioning in women with postmenopausal osteoporosis. Future studies should consider a longer follow-up to evaluate possible effects on the risk of falling and fractures.

Reproducibility of muscle oxygen saturation.

The present study evaluated the reproducibility of tissue oxygenation in relation to oxygen consumption (VO2) across cycle exercise intensities in a test-retest design. 12 subjects (25.7±2.1 years; 24.7±1.9 kg · m(-2)) twice performed an incremental bicycle exercise protocol, while tissue oxygen saturation (StO2) in the vastus lateralis muscle was monitored by a commercially available NIRS unit and VO2 determined by an open-circuit indirect calorimetric system. Coefficients of variation across rest, workloads corresponding to 25, 50 and 75% of individual maximum capacity, and maximum load were 5.8, 4.6, 6.1, 8.0, 11.0% (StO2) and 7.6, 6.0, 3.7, 3.4, 3.1% (VO2), respectively. 95 % CI of relative test-retest differences ranged from -5.6 to +5.4% at 25% load to -17.2 to +7.5% at maximum load for StO2 and from -7.3 to +7.7% at rest to -3.3 to +3.2% at maximum load for VO2. With advancing exercise intensity, within-subject variability of StO2 was augmented, whereas VO2 variability slightly attenuated. NIRS measurements at higher workloads need to be interpreted with caution.

[Prospective evaluation of the effects of a spinal orthosis on physical function and quality of life in women with osteoporosis]. / Prospektive Evaluation funktions- und lebensqualitätsbezogener Effekte einer Wirbelsäulenorthese bei Frauen mit Osteoporose.

AIM: The aim of this study was to investigate the short- and intermediate-term effects of a flexible spinal orthosis on postural control, neuromuscular performance, physical activity, fall-related self-efficacy, quality of life and perceived pain in osteoporosis. METHOD: 72 postmenopausal osteoporotic women with and without vertebral fractures were randomly assigned to receive either a spinal orthosis (Thämert Osteo-Med) for 6 months or to a waiting list control. The following outcome measures were assessed at baseline and at 3- and 6-months follow-up: postural sway, maximum isometric voluntary force of the back extensors and quadriceps femoris, physical activity (IPAQ), fall-related self-efficacy (FES-I), health-related quality of life (QUALEFFO-41) and perceived pain. RESULTS: For the orthosis group, repeated measures ANOVA revealed a significant increase in trunk extensors muscle strength at 3- and 6-months follow-up and self-perceived pain reduction within the 5th month of evaluation in comparison to the control group. The remaining parameters showed non-significant changes while wearing the orthosis. CONCLUSIONS: The application of the orthosis introduces neuromuscular trunk strength improvement in conjunction with pain reduction in women with spinal osteoporosis. Future research should evaluate long-term effects on habitual physical activity, fall-related fracture risk and health-related quality of life.

Postural correction by osteoporosis orthosis (Osteo-med): a randomized, placebo-controlled trial.

Currently available therapeutic options for the correction of osteoporotic posture changes are not effective. Rigid or semi-rigid orthoses are only applicable in the early phase after vertebral body fractures, and the knowledge about the efficacy of flexible spinal orthoses is limited. Therefore, the present study is aimed at investigating the efficacy of a flexible spinal orthosis without any stabilizing components in terms of posture improvement. Forty women aged (65.9 +/- 8.4 years) with a proven osteoporosis (DXA < or = -2.5) were randomized to receive either of three treatment regimens: (i) Orthosis (Thämert Osteomed) with paravertebral/lumbosacral air chamber pads (as commercially available); (ii) The same orthosis without air chamber pads; and (iii) Placebo body stocking. Measurements were performed with a 3D real-time ultrasound topometry system (Zebris(R) CMS 70). The posture correction was substantially and significantly more marked in the first group (38% of the maximally possible intentional erection) as compared to the second (21%) and third group (13%). The orthosis with air chamber pads causes a clinically meaningful trunk support in patients with osteoporotic posture changes. Since the device contains no rigid stabilizing elements, the change in posture is considered to be a result of muscle activation due to sensomotor stimulation by the air chamber pads.

[Efficiency of a postoperative treatment after rotator cuff repair with a continuous passive motion device (CPM)]. / Effektivität der postoperativen Behandlung mittels motorisierter Bewegungsschienen (CPM) bei Patienten mit Ruptur der Rotatorenmanschette.

AIM: The main objective of this study was to prove that a postoperative combined continuous passive motion (CPM) and physiotherapy treatment protocol (CPM group) can achieve 90 degrees active abduction in the shoulder joint earlier than physiotherapy alone (PT group). The indication was a complete tear of the rotator cuff. METHOD: The study was conducted under in-patient and out-patient conditions. 55 patients were included in this study. The prospective, randomized multicenter study design complies with DIN EN 540. The primary endpoint was the time span until 90 degrees active abduction was achieved by the patients. RESULTS: Patients in the CPM group reached the primary endpoint on average 12 days earlier than the control group. This difference was statistically significant (p = 0.0292). Analyzing the secondary endpoints, e. g., pain and disablement, the results in the CPM group showed again advantages of the combined treatment protocol (CPM + physiotherapy). CONCLUSION: The postoperative treatment of a total tear of the rotator cuff with a combined continuous passive motion and physiotherapy protocol provided a significantly earlier range of motion in the shoulder joint than physiotherapy alone. There was no report of CPM-related adverse effects.