Pilates-based exercise in the treatment of a patient with persistent low back pain following transforaminal lumbar interbody fusion.

Background: Low back pain (LBP) is the most commonly reported cause of disability in people under the age of 45 and is estimated to occur in 60-70% of the adult population in the industrialized world. This case report describes the use of Pilates-based exercise (PBE) in the physical therapy management of a patient with persistent chronic low back pain (CLBP) following transforaminal lumbar interbody fusion.Case Description: The patient was a 24-year-old female with a 7-year history of LBP presenting 17 months following surgery. The patient remained with constant LBP and right hip pain at 8/10 on the Numeric Pain Rating Scale (NPRS) after completing a course of physical therapy following the lumbar fusion.Outcomes: The PBE intervention lasted for 22 sessions during which the patient demonstrated complete resolution of right hip pain and remained with intermittent LBP (2/10 NPRS) at discharge. Minimally Clinically Important Difference levels for all self-reported outcome measure instruments were exceeded at discharge. The patient returned to work with lifting restrictions.Discussion: Patients following spine surgery are often excluded in studies of spine stabilization and PBE interventions. This case report describes the use of PBE in the treatment of a patient following spine fusion. Research to elucidate the impact of PBE on patients with CLBP is needed.

Electromyographic and kinetic analysis of two abdominal muscle performance tests.

BACKGROUND: In order to accurately assess the abdominal muscles, clinicians need valid clinical measures. The double leg lowering test (DLLT) and lower abdominal muscle progression (LAMP) are two common tests of abdominal muscle performance. The purposes of this study were to determine the relation between surface electromyographic (EMG) activity during the DLLT and LAMP levels; hip joint resultant moments and DLLT and LAMP levels; and the two measures of DLLT and LAMP. METHODS: Ten healthy participants were tested under both conditions. Surface EMG activity of the abdominal muscles was obtained, while pelvic movement was detected simultaneously. RESULTS: A moderate to strong association was found between rectus abdominus muscle activity and a moderate association with the external obliques with both test levels. For the internal oblique/transversus abdominus, a moderate and weak association was found with the DLLT and LAMP, respectively. A very strong association existed between the hip resultant joint moments (RJM) and the DLLT, while there was a weak correlation between hip RJM and the LAMP. No significant correlation was found between the DLLT and LAMP grades. CONCLUSIONS: This finding suggests that these tests may measure different qualities of muscle performance and provides preliminary support for their use. Further evaluation of these assessments with clinical populations is necessary.

Responsiveness of the double limb lowering test and lower abdominal muscle progression to core stabilization exercise programs in healthy adults: a pilot study.

Low back pain (LBP) is one of the most prevalent and expensive health care problems in the United States. Studies suggest that stabilization exercise may be effective in the management of people with LBP. To accurately assess the effect of stabilization programs on muscle performance, clinicians need an objective measure that is both valid and reliable. The purpose of this study was to determine whether the double limb lowering test (DLLT) and lower abdominal muscle progression (LAMP) can detect a change in abdominal muscle performance after stabilization exercises. Eleven healthy participants (4 men and 7 women) were randomly assigned to either a specific stabilization exercise (SSE) or general stabilization exercise (GSE) group and were evaluated by the DLLT and LAMP before, during, and at the end of 8 weeks of training. Subjects attended exercise sessions twice per week over 8 weeks. No significant difference in pretest performance existed between the 2 groups. No significant difference was detected with the DLLT for either the SSE or GSE over time or when groups were combined. The LAMP detected a significant difference for the combined groups and GSE but not SSE over time. These data indicate that the LAMP is sensitive to change after a spinal stabilization program, whereas the DLLT does not detect a change after these programs. Furthermore, the GSE was more effective in producing these changes. Additional testing of these assessments is necessary to further validate these tests and to identify specific populations for which these tests may be most appropriate.

Quality of systematic reviews on specific spinal stabilization exercise for chronic low back pain.

STUDY DESIGN: Systematic literature review. OBJECTIVE: To evaluate the quality of systematic reviews (SRs) on specific stabilization exercises for chronic low back pain (LBP). BACKGROUND: Multiple SRs regarding the effectiveness of lumbar stabilization exercises for people with chronic LBP have been published. As more SRs are published, the more it is recognized that, like other forms of research, methodological quality affects the validity of, and conclusions drawn from, the data. METHODS: A search of MEDLINE, CINAHL, and Embase was completed. Additionally, the PEDro database was screened and hand searching was completed. Included SRs had to contain randomized controlled trials examining a specific stabilization exercise program for the treatment of chronic LBP. Additionally, the assessed outcome measures had to include pain and/or disability measures. Literature reviews and clinical practice guidelines were excluded. Three reviewers independently assessed each SR for methodological quality. RESULTS: The search produced 665 SRs for review, of which 8 fulfilled the inclusion criteria. Consensus quality assessment scores ranged from 13/26 to 26/26, with an average of 20.7 points. Percent agreement and kappa values for individual criteria scores ranged from 50% to 92% and 0.25 to 0.85, respectively. Agreement was moderate to substantial across individual items, except for criterion 1. The intraclass correlation coefficient for overall score was 0.98 (95% confidence interval: 0.96, 0.99). CONCLUSION: This review of SRs identified several high-quality reviews that indicated some benefit of specific stabilization exercise programs for patients with nonspecific chronic LBP. LEVEL OF EVIDENCE: Therapy, level 1a.

Back pain among health care workers in Pennsylvania 2002-2006.

UNLABELLED: While back pain is common among health care workers in the United States, the epidemiology of back pain is unclear. OBJECTIVE: The purpose of this study was to estimate the incidence and trend of back pain from work-related injuries among health care workers. METHODS: Data from the Pennsylvania Work Injuries and Illnesses Reports from 2002 to 2006 were analyzed. RESULTS: Estimated back injuries account for 24.6% of all reported injuries in healthcare workers in Pennsylvania. From 2002 to 2006, there was a 22.5% increase in the incidence of reported back pain in this population. CONCLUSIONS: Due to a lack of detailed reports regarding the incidence of back pain among Pennsylvania healthcare workers, it is recommended that a survey of healthcare workers who perform patient handling be completed.

Clinical assessment of low-back-pain treatment outcomes in athletes.

PATIENT SCENARIO: A 21-year-old male rodeo athlete complains of acute low back pain (LBP) after a bareback event. The athlete wishes to compete in a rodeo event in 4 d. CLINICAL OUTCOMES ASSESSMENT: Given the questionable validity and reliability of traditional clinical examination techniques for LBP, a treatment subgroup classification system combined with clinical outcomes assessment provides greater insight into suitable clinical interventions and patient response to treatment. Four LBP treatment subgroups based on the patient's clinical presentation and symptoms have been established: manipulation, stabilization, specific exercise, and traction. Manipulation subgroup research has produced a valid clinical prediction rule (CPR). The Visual Analog Scale, Numeric Rating Scale (NRS), Oswestry Low Back Pain Disability Index (ODI), Roland Morris Disability Questionnaire, Short Form 36 (SF-36), and Global Rating of Change Scale are valid, reliable, and responsive outcomes instruments with established values for minimum clinically important difference (MCID). These instruments document important changes in disablement and health-related quality of life in patients with low back injury, as well as demonstrate treatment outcomes. CLINICAL DECISION MAKING: On examination the athlete presents with moderate pain and disability as measured by the NRS, ODI, and SF-36 and meets all 5 criteria for the manipulation subgroup, indicating a high likelihood of success with manipulative therapy when following the guidelines presented in the CPR. Expected outcomes values, based on MCID values, were met after 1 treatment. Preferred outcomes, based on physical activity requirements for sport, were met on day 4. CLINICAL BOTTOM LINE: LBP generators are difficult to establish using traditional clinical examination techniques. The combined use of clinical criteria, using an LBP subgroup system, and baseline outcomes measures should guide treatment. Benchmarks should be guided by established MCID values for each instrument.