Influence of core stability exercise on lumbar vertebral instability in patients presented with chronic low back pain: A randomized clinical trial.

BACKGROUND: Excessive lumbar vertebrae translation and rotation in sagittal plane has been attributed as an associated factor of lumbar segmental instability (LSI) and low back pain (LBP). Reduction of these abnormalities improves back pain. The aim of this study was to investigate the effect of core stability exercise on the translation and rotation of lumbar vertebrae in sagittal plane in patients with nonspecific chronic LBP (NSCLBP). METHODS: In this randomized clinical trial, 30 patients with NSCLBP due to LSI were included. The participants were randomly divided into two groups of treatment and control. The treatment group received general exercises plus core stability exercise for 8 weeks whereas; the control group received only general exercises. The magnitude of translation (mm) and rotation (deg) of lumbar vertebrae in the sagittal plane was determined by radiography in flexion and extension at baseline and after intervention. The primary outcome measures were to determine the mean changes from baseline in translation and rotation of the lumbar vertebrae in the sagittal plane after 8 weeks of intervention in each group. The secondary outcome was to compare the two groups in regard to translation and rotation of the lumbar vertebrae at the end of the study period. Data were analyzed using paired t-test and independent t-test. RESULTS: Thirty patients aged 18-40 years old with clinical diagnosis of NSCLBP entered the study. Compared with baseline values, mean value of translation and rotation of the lumbar vertebra reduced significantly in both groups (P<0.05), except L3 translation in the control group. At the endpoint, mean translation value of L4 (P=0.04) and L5 (P=0.001) and rotation of the L5 (P=0.01) in the treatment group was significantly lower than the control group. CONCLUSION: These findings indicate that in patients presented with NSCLBP due to lumbar segmental instability, core stability exercises plus general exercises are more efficient than general exercises alone in the improvement of excessive lumbar vertebrae translation and rotation.

Construct validity of center of rotation in differentiating of lumbar segmental instability patients.

PURPOSE: Lumbar Segmental Instability (LSI) is a subgroup of nonspecific Low Back Pain (NSLBP) without any accepted diagnostic tool as a gold standard. Some authors emphasize on quality measure such as centre of rotation (COR) but construct validity of this measure had not been approved. Therefore the purpose of the present study was to evaluate Concurrent and Convergent validity of COR in differentiating LSI. METHODS: A total of 66 volunteered males participated in three groups named control, NSLBP and LSI groups based on clinical examination. Patients were diagnosed as LSI according to screening criteria adopted by Hicks et al. Study variables included CORs of lumbar segments in sagittal plane. Three x-rays were taken in neutral, flexion and extension positions. The variables were calculated using CARA software. The ANOVA and Tukey test were utilized in statistic analysis. RESULTS: ANOVA results demonstrated mean differences between three groups for COR of L4 motion segment in y axis (p= 0/008) and L5 motion segment in y axis (p= 0/005) were significant. Tukey test showed significant difference for COR of L4 motion segment in y axis between LSI and healthy groups (p= 0/038) and between LSI and NSLBP groups (p= 0/009). For COR of L5 motion segment in y axis, tukey test demonstrated mean difference between LSI and healthy groups (p= 0/028) and between LSI and NSLBP groups (p= 0/007) were significant. Tukey test did't show any significant difference between NSLBP and healthy groups for COR of L4 (p= 0/852) and L5 (p= 0/871) motion segments in y-axis. CONCLUSIONS: The COR has ability to differentiate patients with signs and symptoms of LSI from other NSLBP and healthy subjects based on the present study results. However, more researches are needed to develop and support results of this study.

Cohort profile: the Amirkola Health and Ageing Project (AHAP).

This is the first comprehensive cohort study of the health of older people ever conducted in Iran. The aim of this project is to investigate the health status of older people in Amirkola in the northern part of Iran, near the Caspian Sea. The Amirkola Health and Ageing Project (AHAP) is mainly concerned with geriatric medical problems, such as falling, bone fragility and fractures, cognitive impairment and dementia, poor mobility and functional dependence. It is planned that all participants will be re-examined after 2 years. Data are collected via questionnaire, examinations and venepuncture. AHAP started in April 2011 and 1616 participants had been seen by 18 July 2012, the end of the baseline stage of this study. The participation rate was 72.3%. The prevalence of self-reported hypertension (41.2%) and diabetes mellitus (23.3%) are high. Only 14.4% of older people considered their health as excellent or good in comparison with others at this age. The prevalence of osteoporosis (T score≤-2.5) was 57.4% in women and 16.1% in men, and 38.2 % of older people were vitamin D deficient (<20 ng/ml). Researchers interested in using the information are invited to contact the principal investigator Seyed Reza Hosseini (hosseinim46@yahoo.com).

The effects of stabilizing exercises on pain and disability of patients with lumbar segmental instability.

BACKGROUND DATA: Lumbar segmental instability (LSI) is one of the subgroups of non-specific chronic low back pain. Pain, functional disability and reduced muscle endurance are common in such patients. OBJECTIVE: The aim of this study was to determine the effects of stabilization exercise on pain, functional disability and muscle endurance in patients with LSI. METHODS: A randomized clinical trial was carried out on 30 patients who had LSI aged between 18-45 years. They were divided into two groups; the control group underwent routine exercise only while the experimental group performed routine exercise plus stabilization training for 8 weeks. Both had 3 months follow-up. The variables included pain intensity, functional disability and flexion and extension range of motion and flexor, extensor and lateral flexor muscles endurance which were evaluated 3 times; before, post treatment and after three months. The data were analyzed using repeated measurement ANOVA. RESULTS: The results revealed that after treatment, the trunk muscle endurance and flexion range of motion increased significantly and the pain intensity and functional disability decreased significantly in both groups; however the rate of improvement was significantly higher in the experimental group. The process of decreasing pain intensity and functional disability in addition to increasing muscle endurance time %was were significantly faster in the experimental group during the three months follow up. CONCLUSION: Regarding the positive effects of stabilizing exercises with routine exercises in reduction of pain intensity, increasing functional ability and muscle endurance, it is recommended to use this method in treatment of patients with lumbar segmental instability.

The validity of vertebral translation and rotation in differentiating patients with lumbar segmental instability.

BACKGROUND AND PURPOSE: Lumbar segmental instability (LSI) is a sub-group of non-specific low back pain (NSLBP), without any accepted diagnostic tool as a golden standard. Some authors emphasize on clinical findings, and others focus on vertebral translation and rotation, but construct validity of these measures had not been approved. Therefore, the purpose of the study was to evaluate convergent and known group validity of vertebral translation and rotation in differentiating LSI from NSLBP and control subjects. METHODS: Study variables included full-range and mid-range vertebral translation and rotation in sagittal plane. Five x-rays were taken in neutral, full flexion and extension and mid-flexion and mid-extension positions of lumbar spine. The variables were calculated using Computer Aided Radiographic Analysis of Spine (CARA) software after scanning. Sixty-six volunteered males participated in three groups. Twenty-two subjects were in the control group, and 44 NSLBP were divided into LSI and not LSI groups according to the criteria adopted by Hicks et al. The ANOVA and Tukey test were used in statistic analysis. RESULTS: ANOVA results demonstrated differences in three groups; for full-range translation and rotation, were not significant. However, the results of ANOVA demonstrated significant difference in L4-5 mid-range translation and rotation (p < 0/05). Tukey test showed significant difference for L4-5 mid-range translation between control (2.14 mm) and LSI (1.33 mm) groups (p < 0/05). Tukey test demonstrated difference between the control (14.18°) and LSI (11.65°) groups (p < 0/05); the control and not LSI (10.80) groups (p < 0/05) were significant for L4-5 mid-range rotation. CONCLUSIONS: On the basis of the study results, the full-range translation and rotation cannot differentiate LSI from not LSI and control groups. Moreover, the mid-range translation only differentiates control from LSI, whereas mid-range rotation differentiates control from both LSI and not LSI.

Treatment of chronic radiculopathy of the first sacral nerve root using neuromobilization techniques: A case study.

BACKGROUND AND OBJECTIVES: The engagement of the first sacral nerve root is one of the most common etiologies in Sciatic Pain Syndrome (SPS). Different interfering methods are used in the physical therapy of people with SPS including physical modalities, exercise therapy, traction, and joint and neuromobilization, depending on the symptoms and radiculopathy phase. The present case study attempts to describe neuromobilization methods in treating chronic radiculopathy of the first sacral nerve root, as well as its abnormal neurodynamic responses. THE CASE: The patient was a 36-year-old man with lower back pain during construction work 9 months before, and presenting with complaint of burning pain and tingling in his left Posterior part of the thigh and leg. Active extension, rotation, and lateral flexion of the trunk in standing position had a complete range with no pain. SLR and Slump neurodynamic tests revealed that with increasing sensitive elements, there appeared to be abnormal sciatic nerve tension, and complaint due to returning burn and tingling in the posterior part of the thigh and leg. MRI findings revealed intervertebral disc dehydrations at L3-4, L4-5, and L5-S1 levels, as well as postero-lateral protrusion in L5-S1 intervertebral disc. Following three routine physical therapy sessions, with no improvement, neuromobilization technique was used for 6 sessions. RESULTS: The usual routine physical therapy methods did have any visible impact in solving the patient's problems during daily-life activities and physical diagnosis findings, yet, following neuromobilization technique, the assessment at the beginning of the eleventh session and the patient's follow-ups two months later showed that his problems during daily-life activities and in neurodynamic tests were totally solved. DISCUSSION AND CONCLUSION: Abnormal neurodynamic responses and consequently symptoms in patients with chronic radiculopathy may be due to a pathomechanic problem and deficiency in neural adjustment for movement and tension transfer. Neuromobilization techniques can increasingly useful in treatment of abnormal neural tensions and removing chronic radiculopathy symptoms.

Reliability of quality measures of movement in lumbar spine flexion-extension radiography.

BACKGROUND DATA: For center of rotation (COR) and centroid length variables in lumbar flexion-extension radiography, enough reliability information is not available. OBJECTIVE: The objective of this study was to determine the intra-rater reliability of COR and centroid length of lumbar intervertebral movement. METHODS: A methodological research for reliability was designed. Fifteen males with chronic non specific low back pain aged between 22-43 years participated in this study. Study variables included COR of full, flexion and extension arc and centroid length. The proposed method from Putto was used for flexion-extension radiography. Five x-rays were taken in neutral, full flexion and extension, mid-flexion and mid-extension positions. The variables were calculated using Computer Aided Radiographic Analysis of Spine (CARA) software after scanning. The intraclass correlation coefficient (ICC) and standard error of measurement (SEM) were utilized for relative and absolute reliability respectively. RESULTS: The results demonstrated high ICC values on x axis (range: 0.67-0.88) and y axis (range: 0.55-0.90) for full arc COR, high ICC values of flexion arc COR on x axis (range: 0.54-0.97) and y axis (range: 0.48-0.99). ICC values results of extension arc ranged between 0.19-0.60 for x axis and 0.16-0.83 for y axis. ICC values for centroid length ranged between 0.22-0.88. CONCLUSION: Results support previous studies which show very high reliability of full arc COR. In addition, flexion arc COR has desirable reliability and low measurement errors. But, extension arc COR and centroid length have moderate reliability and large measurement errors.