Physical Activity
in Daily Life in Patients 6 Months after Lumbar Disk Surgery: Relationship
Between Pain, Disability and Accelerometer Data
Plaas,
H, Fischbein B, Willburger R, Hasenbring M (Bochum, Germany)
Study design
Cross-sectional analysis of the factors influencing the relationship between
pain, self-reported and overt physical activity
Aims
To investigate the role of different pain-related coping modes for the
relationship between pain and physical functioning.
Summary of Background Data In chronic LBP, the interrelation between pain and
physical activity remains unclear. It has been shown, that there is a
significant relationship between pain and self-reported data whereas this
relation disappeared in the case of overt behavioral data (e.g. cycle tests,
accelerometer data). Cognitive-behavioral models of pain chronicity
(fear-avoidance-model, avoidance-endurance-model) suggest subgroups of LBP
patients with opposite relationships between pain and overt physical activity.
Methods
26 patients, 6 months after primary lumbar disc surgery completed
questionnaires (VonKorff Chronic Pain Grade CPG, Kiel Pain Inventory KPI,
Funktionsfragebogen Hannover FFbH) and underwent an 8-hour accelerometer
assessment in their daily life (Physical activity level PAL, number of constant
postures CP). By median split, the KPI led to 3 subgroups: Adaptive Coping AC,
Fear Avoidance Coping FAC and Endurance Coping EC.
Results
Self-reported pain and physical functioning were significant interrelated in
the whole group, PAL and CP displayed no correlation with pain. While FAC and
EC showed higher pain, disability and fatigue compared to AC, only FAC revealed
a tendency to less overt physical activity. EC showed significant more CP in
daily life compared to AC and FAC.
Conclusions The
assessment of pain-related coping modes leads to an important differentiation
between subgroups of LBP. Endurance copers displayed more unfortunate postures
in their daily life than adaptive copers. Patients with fear-avoidance coping
tend to less physical activity and constant postures.
Keywords low back pain, activity monitoring, Coping,
Fear-Avoidance, Endurance
Effect
of Manipulation in Lumbar Roll; Analysis by 3D Reconstruction of CT Data
B. Poortmans¹, P.M.
Dugailly¹ ², V. Feipel².
¹Centre de Réadaptation de l’Appareil Locomoteur,
Erasme Hospital, U.L.B., Brussels, Belgium
²Laboratory of Functional Anatomy, U.L.B., Brussels,
Belgium.
Introduction Analysis of
lumbar kinematics is commonly reported in the literature but results are very
controversial regarding coupling of motion. During axial rotation, ipsilateral
bending is usually observed but some authors have reported contralateral
bending. Moreover, additional movements are also reported such as flexion. A
review of the literature describing the effects of the lumbar roll on lumbar
vertebral kinematics remained unsuccessful. Thus, it seems interesting to
analyze the vertebral kinematics of L3 to S1 by medical imaging and to
appreciate the effects of the manipulation called in lumbar roll.
Material and method Imaging CT
data and 3D reconstruction of L3 to S1 were acquired. Spatial location of bony
landmarks was computed using a Numonics table. Side-bending, flexion and
extension as well as the gaping of the facets were analyzed. 12 healthy
volunteers participated to the study (24 +/-1 years). 3 sequences of CT
acquisitions were processed in neutral position (supine), in position of left
lumbar roll before and after manipulation of the right L5-S1 level.
Results An association between right rotation and
left side-bending was found for the levels of L3 to L5 and between right
rotation and right side-bending for the L5-S1 level as well as for pre- than
for post-manipulative positions. All levels were in flexion. No statistically significant difference was
shown between the pre- and post-vertebral manipulation inter-segmental values.
The facet joints on the
side of rotation gaped significantly.
Discussion and
conclusions These results confirm those found in
previous studies concerning coupling motion between side-bending and axial
rotation. During patient positioning in lumbar roll, there was a contralateral
association between side-bending and rotation for the levels L3 to L5 and an
ipsilateral association for the L5-S1 segment. Moreover, facet joints gaping was significantly
demonstrated on the side of rotation. To our best knowledge, such results have
not yet been described in the literature.
How
We Use and Abuse Our Spines: A Persistent Cause of Low Back Pain
Dr Osnat Wende, President of
the Israeli Society of Musculoskeletal Medicine;
Back and Neck Clinic, Clalit
Health Fund, Rehovot, Israel.
email: dowende@urbis.net.il
Posture
is something we as physicians often neglect to address as to the cause of and
prevention of low back pain (LBP). Poor posture not only continually strains
ligaments, but also when these are lengthened and in poor shape, their ability
to hold various structures, such as discs in place is reduced. Furthermore, various
muscles are lengthened and weakened, and others are contracted and shortened,
resulting in myofascial pain as well as the pathological posture to be
discussed. Good posture requires a proper balance between agonist and
antagonist muscles of the whole of the spinal column and pelvis. In order to
prevent further morbidity from spinal pain, proper homeostasis is to be
achieved. In this session, examples of various pathological postures are
brought, their effects discussed on the spinal column, and appropriate
strengthening and stretching exercises prescribed. This approach is based on
the teachings of Travell and Simons, and Professor Sahrmann.
Pain Related Cognitions and Coping
Strategies as Predictors of Disabling Back Pain -
Results of The German Longitudinal Back
Pain Survey
Carsten
Oliver Schmidt1, Monika Hasenbring2, Thomas Kohlmann1.
1Institute of
Community Medicine, University of Greifswald,
2Department of
Medical Psychology and Sociology, Ruhr-University Bochum.
Aims To analyse the role of pain related cognitions and
coping strategies for the development of disabling back pain in the general
population.
Methods
The German Longitudinal Back Pain
Survey survey is designed as a population-based longitudinal multi-center study
in five German regions. This report is based on longitudinal results of the
Bochum sample. It comprised 3,000 women and men aged 18 to 75 years, drawn at
random from the municipal population register. Subjects received a postal
questionnaire and up to two reminders. 1687 of the study population returned
the completed questionnaire at baseline. 805 baseline participants responded to
the follow-up survey 12 months later. Graded back pain was determined according
to Von Korff et al. (1992). Sociodemographic variables were assessed, using
demographic standard information, as detailed by Deck et al. (1999). Pain
related cognitions (Catastrophizing, Helplessness, Thought Suppression) and
coping strategies (Avoidance Behavior, Search for Social Support, Endurance
Behavior) were measured with the Kiel-Pain Inventory. Backward logistic
regression was used for the risk-factor analysis.
Results The
point, 3-month, 12-months, and lifetime prevalence of back pain was 34%, 65%,
74%, and 85%, respectively. Among subjects with back pain in the last three
months 66% belonged to grade 1, 15% to grade 2, and 19% experienced disabling
back pain of grade 3 or 4. At follow-up, the respective rates were similar
(67%, 16% and 17%). Sociodemographic variables did not significantly predict the
development of disabling back pain to follow-up in subjects with back pain of
grade 1 and 2 at baseline. Only the pain related cognitions “Helplessness” and
“Thought Suppression” predicted future episodes of disabling back pain (OR =
1.4 , CI = 1.1-1.9; OR 1.2, CI = 1.0-1.6). The persistence of chronic back pain
among subjects with disabling back pain at baseline (Grade 3-4) was
significantly predicted by the “Helplessness” cognitions (OR = 1.9, CI = 1.4 –
2.7) but not by sociodemographic variables.
Conclusions Disabling
back pain occurs in a substantial minority of those affected by back pain. Pain
related cognitions showed moderate effects on the development or on the
persistence of disabling back pain in the general population. Compared with
pain related cognitions behavioral coping strategies are less important for
predicting graded back pain.
Acknowledgement Funded by the
German Ministry for Education and Research grant 01 EM 011.
The
project is organized within the German Back Pain Research network (DFRS).
The
Impact of Anthropometric Factors on Appearance of Low Back Pain
Autors: Čelan D, Turk Z
Introduction The
causes for one of the most outstanding modern humans health troubles - the low
back pain (LBP) are numerous. The endogenous factors represent properties of
human body. Some of them are analysed
in the present article.
Aim
To evaluate the presence
of:
-
differences in human body dimensions between people with LBP and controls
without these troubles;
-
differences in human body dimensions between people with frequent LBP and
work-loss in contrast to controls without these troubles;
-
differences in incidence of LBP dependent on size of each anthropometric
parameter observed.
Study design Observational
research, case-control study.
Subjects Sample of population, 122
male buss drivers, average age 44,2 years, average working years 24,4.
Methods The history of LBP was
evaluated by use of questionnaire. Direct measurement of several anthropometric
parameters were made on each subject. The following anthropometric indexes were
calculated: Quetelet's index, relative body weight, Olivier's typological
index, Lorenzo's constitutional index, muscular index and pressure on
intervertebral disc L5-S1.
Results Results showed no
statistical significant differences in any of the observed anthropometric
parameters between test group (people
with LBP) and controls. The same was true for subjects with frequent LBP and
work-loss and controls.
Even when the subjects were divided in
groups according to different size of individual anthropometric parameter there
were also no statistical significant differences in presence of LBP.
Conclusion In the observed sample of
subjects the impact of the degree of nourishment, body building and
constitution on the appearance of LBP showed no statistical significance. Also
the physical burdening of intervertebral disc measured as pressure on disc L5-S1
seems to be irrelevant for appearance of LBP in observed population.
Relation between Symptoms and Treatment Results in Female And Male
Patients with Ankylosing Spondylitis
Tosun Ç.Ö.,Arın B.A.,Demirören Ü.,Akbulak A.,Gülören D., Sucu, A.B.,Tesbihci
N., Kara H.,ozge.celiker@deu.edu.tr
Balçova SPA therapy, Balçova Thermal Treatment and Physical Therapy
Center,İzmir, TURKEY
Introduction The objective
of this study is to investigate the relation between symptoms and
treatment results assessed by standard evaluation methods in male and female
patients with ankylosing spondylitis (AS).
Materials and methods This
retrospective study is completed in Balçova Thermal Treatment Centre between
January 2003-January 2005 in 574 patients from Norway which have AS diagnosis.
All the patients had a combined treatment program for four
weeks (spa, physical therapy, group exercises, massage). % 60.27 (346) of
the participants were male and % 39.73 (228) were female. In these patients
age, sex, tra-wall distance, lumb-side flexion, cervical rotation,
intermalleolar distance, thorax expansion, range of motion (ROM), muscle
strength, functional classification, muscle shortness, morning stiffness, sleep
disorders, chronic disorders, chronic fatigue were assessed before and after
treatment.
Results The measurements of
lumb-side flexion, cervical rotation, intermalleolar distance, visual analogue
scale (VAS) before treatment in male patients were lower than female patients
(p<0.05). The tra-wall distance and number of limited joints before
treatment in females were significantly lower than males (p<0.05). VAS,
number of limited joints, morning stiffness before and after treatment in males
were lower than females (p>0.05). Tra-wall distance, schober, morning
stiffness, functional classification, VAS, number of limited joints in female
and males were significantly lower after treatment (p<0.05). Cervical
rotation, lumb-side flexion, intermalleolar distance, thorax expansion in
female and male were significantly higher after treatment (p<0.05).
Conclusion This study has shown
that the severity of symptoms in female AS patients more than in male. Similar
results were seen in male and female patients with this standard treatment.
The Correlation between
Symptoms and Mobility
Tests in Ankylosing
Spondilitis Patients of
Different Age Groups
Aplak A.B.,Demirören Ü.,Tosun Ç.Ö.,Akça
G.,Özütemiz Ö.,Maru N.,Akyol G.,Yavuz H.
Balçova SPA Therapy Physical Therapy
And Rehabilitation Center
Izmir/TURKEY
Aim The aim
of this study is to
evaluate and determine
the correlation between
mobility and symptoms
before and after
conventional physical therapy.
Materials-Methods
Our retrospective study is performed
with 197 cases,101
patients under age of 40 and 96 patients over age of 60.It consists of ankylosing
spondilitis cases treated at
our center in
years 2003-2004. Every patient
received a combined therapy during the
three weeks. In order
to evaluate the
spinal mobility of
the patients ,we used occiput-wall distance, schober test,
cervical rotation, lumbar lateral flexion, intermalleolar distance and thorax expansion. The
range of motion of upper and
lower extremities were
assessed with goniometric
measurements. The morning stiffness ,sleep disturbance and chronic fatigue were questioned .Pain measurement
was done by VAS.
Findings Significant
increases in spinal mobility
of the cases under 40
year were found in
post-treatment evaluations,
besides the significant decrease in
morning stiffness, chronic fatigue, pain and number of
limited joints. No similar results
was detected in
group of patients
over 60 years when compared with pre and post treatment evaluations in terms of schober
tests, cervical rotation and
lumbar lateral flexion
measurements and morning stiffness. As the two groups of patients were compared with these
results, the spinal mobility
increase and the
improvement in symptoms
were found statistically significant in younger
group, under the age of
40.Schober tests ,cervical rotation, occiput-wall measurements were moderately correlated in both groups.
Result Our study confirms that spinal mobility and
other disease symptoms
deteriorate with age in
ankylosing spondilitis patients.
The Correlation between Disease Duration and Symptoms, Traditional
Evaluation Methods in
Ankylosing Spondilitis Patients
Aplak A.B.,Demirören Ü.,Tosun Ç.Ö., Özütemiz
Ö.,Maru N., Akça G.,Akyol G.,Yavuz H.
Balçova SPA Therapy Physical
Therapy And Rehabilitation Center Izmir/TURKEY
Objective Our purpose
is to determine the relation between symptoms and traditional
evaluation methods in
ankylosing spondilitis(AS) patients
who have disease
durations less or
more ten years.
Material-Methods
254 AS patients
enrolled to our
retrospective study who were
participated to our
treatment programs in years 2003-2004. The number
of patients who
have less than 10 years
of disease duration were 125 and the number
of patients who
have more than
10 years diseases
duration were 129.In order to evaluate the spinal
mobility of the patients, we used
occiput-wall distance, schober test, cervical rotation, lumbar lateral
flexion, Intermalleolar distance
and thorax expansion .The range
of motion of
upper and lower
extremities were assessed
with goniometric measurements. Trunk, upper and lower
muscles force were
evaluated by manual
muscle test. The morning
stiffness, sleep disturbance and chronic
fatigue were questioned. Pain measurement was
done by VAS.
Findings When the
both groups are compared
according to pre-treatment symptom evaluation, significantly high in morning stiffness, sleep disturbance, chronic
fatigue and pain were determined in cases who have
more than 10 years disease duration. Significantly high of trunk, upper and lower extremities
muscles force measures were
found in cases
who have less than
10 years disease duration. Significantly low
in intermalleolar distance,
schober, lumbar lateral flexion and
thorax expansion in the cases
who have more
than 10 years disease
duration were established in pre-treatment evaluations. When the both groups are
compared, positive differences in
intermalleolar distance,
lumbar lateral flexion, thorax expansion and pain, morning stiffness, fatigue in
cases who have
less than 10 years
disease duration were
significantly found.
Result Our study confirms that
spinal mobility, muscle force and
symptoms deteriorate with
disease duration in
AS patients.
Influence of Osteopathic
Treatment on Proprioception and Pain in Patients with Chronic LBP
J. Rysman1, P. Klein2, P.M.
Dugailly1,2, P. Salvia1, M. Rooze1, V. Feipel1
1Laboratory of Functional Anatomy, 2Manual
Therapy Research Unit, University of Brussels, Belgium
Introduction Only few studies have focused on lumbar
proprioception, although it is currently accepted that proprioception is a key
element for posture and for prevention of LBP. There is no consensus regarding
the presence of a proprioceptive deficit in patients with chronic LBP [1] and
the effect of therapy remains poorly studied. To contribute to progress in this
field, this study aimed at comparing pain and several indicators of lumbar
proprioception obtained in patients with chronic LBP before and after
osteopathic treatment (OT) using a validated protocol [2].
Material
and methods Global lumbar 3D
kinematics was sampled using a CA 6000 Spine Motion Analyser (OSI, Union City,
CA, USA) in a volunteer sample of 12 adult patients with chronic LPB aged 20 to
60 years. All tests were carried out before treatment (d1) and two weeks later
(d14). Between d1 and d14, each patient attended two sessions of
patient-specific OT. The tests at d1 and d14 consisted in a Dallas pain
questionnaire [3] and kinematics assessment, including range of motion tests
(flexion-extension, lateral bending, axial rotation), repositioning tests (in
flexion and in flexion combined to axial rotation) and seated balance tests on
an unstable support (antero-posterior and lateral oscillations).
Repeated-measures ANOVA was used to determine the influence of test day on
motion ranges (ROM) and velocities, repositioning error (RE) in neutral
position and in flexion or combined postures and, for seated balance tests,
total ROM, maximal velocities, time in equilibrium and median frequency (MF) of
the power density spectrum obtained using a fast Fourier transform.
Results No
significant change was found for ROM, RE and balance variables after OT. The
pain score, however, was significantly decreased by 46% (SD 9%, p=1.6x10-7).
All sub-scores (daily and work-leisure activities, anxiety-depression, social
interest) were also significantly decreased (p<5.5x10-3).
Discussion and conclusion OT has been
reported to be at least as efficient and safe as other treatments in patients
with LBP [4,5], although its mode of action remains poorly understood. Despite
weaknesses related to the small sample and the absence of control and
randomization, this study suggests a decrease in pain after OT. Global lumbar
ROM and proprioception were, however, unchanged. A controlled study on the
long-term effects of OT on lumbar ROM, proprioception and pain in patients with
chronic LPB is required.
References [1] Koumantakis GA et al. J
Orthop Sports Phys Ther 2002; 32: 327-35 - [2] Feipel V et al. Clin Biomech
2003; 18: 612-8 - [3] Lawlis GF at al. Spine 1989; 14: 511-6 [4] Andersson GB
et al. N Engl J Med 1999; 341: 1426-31 [5] Lecocq J et al. Ann Readapt Med Phys
1996; 39: 396-8.
The Role of Pain-Related Endurance in the Process of the Development of Chronic Back Pain
Monika
Hasenbring (Bochum, Germany)
On the basis of several
empirical reviews published recently 1,2 , the first part of this
lecture will highlight the role of emotional, cognitive and behavioral
variables, which have been shown as high risk factors for the development of
chronic low back pain and which are related to the well known fear avoidance
model of chronic pain. In a second part, the role of cognitive and behavioral responses to individual pain experiences in
daily life were elucidated. To be active despite severe pain on the one hand
and pain-related cognitive suppression of pain experiences on the other belong
to opposite modes of coping with pain which also may contribute to the
development of chronic back pain. Data from two prospective longitudinal
studies in 111 patients with acute/subacute sciatic pain ³ and in 190 patients
with acute/subacute local back pain will be presented, which included 6 and
12-months follow-ups. Multiple regression analyses among others have shown,
that besides somatic predictors (neuroorthopedic findings) and social
predictors (age, gender, education), psychological predictors play a major role
in the process of development of persistent or recurrent low back pain. Among
the psychological predictors, typical fear avoidance parameters as well as
variables of endurance cognitions and behaviour belong to the important risk
factors of chronicity. The role of fear avoidance as well as endurance coping
will be underlined by results of several objective measures which have been
assessed in experimental laboratory studies (muscular fatigue in a static
endurance test assessed with surface EMG) as well as in daily life (assessment
of physical activity by an accelerometer). The results of these studies will
elucidate the role of the individual pain-related coping behaviour as a
predictor for a better matching of these patients to the several medical and
perhaps also psychological treatment procedure.
1 Linton SJ (2000) A review
of psychological risk factors in back and neck pain. Spine 25, 1148-1156.
² Boersma K, Linton SL
(2005). Screening to identify patients at risk: profiles of psychological risk
factors for early intervention. Clin J Pain 21: 38-43.
³ Hasenbring M, Marienfeld G,
Kuhlendahl D, Soyka D (1994) Risk factors of chronicity in lumbar disc
patients. A prospective investigation of biologic, psychologic, and social
predictors of therapy outcome. Spine
19, 2759-2765.
4 Hallner D, Hasenbring M (2004)
Classification of psychosocial risk factors (yellow flags) for the development
of chronic low back and leg pain using artificial neural network. Neurosci.Lett. 361, 151-154.
5 Vlaeyen JWS, Morley S
(2005). Cognitive-behavioral treatments for chronic pain: what works for whom?
Clin J Pain 21: 1-8
Why
is so Much of Low Back Pain Undiagnosed: Are We Missing Simple Treatable
Entities?
Dr Osnat Wende, President of
the Israeli Society of Musculoskeletal Medicine
Back and Neck Clinic, Clalit
Health Fund, Rehovot, Israel.
email: dowende@urbis.net.il
Background Although low
back pain (LBP) is a leading cause of disability and morbidity, physicians have
as yet no scientifically based approach for treatment of patients with the
complaint. About 75 percent of patients have non-specific LBP, with no specific
diagnosis towards which one can direct a treatment. Much of LBP is caused by
myofascial pain syndrome, usually secondary to another phenomena. Travell and Simons
have done much work demonstrating how much of the “non-specific LBP” really
does have a specific diagnosis; we don’t always look for it.
Objective and
Discussion The aims of this session are: a) to present a thorough
approach to the clinical diagnosis of low back pain. b) to discuss therapeutic options including myofascial release
and stretching, intramuscular
stimulation, exercises back schools and surgery. c) to introduce myofscial
stretching and intramuscular
stimulation, both effective treatment methods which can easily be practiced in
the primary care clinic, and d) to
demonstrate a few exercises which can be prescribed for acute and chronic low
back pain.
Peloid
Balneotherapy of Patients with Chronic Non-Specific Low Back Pain
Helena Jamnik dr.med.
Zdravilišče Terme Palace Portorož
Lepa
Veljanovič dr.med. Zdravilišče Terme Palace Portorož
Thalassotherapy
Department and Physiotherapy Department
Introduction superficial
thermo therapy is a common measure when treating patients with low back pain.
The effects are homodynamic (vasodilatation decreasing chronic inflammation and
altering metabolic activity), neuromuscular, modification of collagen tissue
and changing in pain threshold. Mud packs are a popular self-helping measure of
people suffering from low back pain. Like radiant heat (infrared radiation) mud
packs are a form of superficial heating with heating effects primarily in the
skin and superficial subcutaneous tissue.
Methods and subjects 51 subjects
diagnosed with non-specific low back pain persisting at least 6 months have
participated, randomised in 3 groups. Group 1 received exercise, massage and
electrotherapy. Group 2 the same as group 1 and mud packs, group 3 the same as
group 1 and infrared radiation. Outcome measures: schober index, pain with
numeric VAS, functional status with Oswestry Low Back Pain and Disability
questionnaire, multidimensional Bournemouth questionnaire reflecting disease
specific quality of life. All the tests except schober index which was measured
2 times were applied 3 times: at the beginning of treatment, at the end of
treatment and one month after the treatment.
Findings At the end of
the treatment schober index improved in all groups, but only in IR group
statistically significant (p=, 035472).
Pain improved in all three groups but only in mud pack group
statistically significant (P=, 037641). Oswestry index remained the same
through the study, except in mud pack group (P=, 026096). Bournemouth score improved in all three groups
(group1 P=, 031257, group 2 P=, 001398,
group 3 P=, 012115). After 1 month the scores were still improved
but not statistically significant.
Conclusion All groups
improved mainly at the level of disease specific quality of life. Changes at
the level of pain and functional status were less significant. Peloid
balneotherapy seems to improve patients’ status in a short term better than
physiotherapy alone either with or without an alternative heat therapy. There
is no evidence for long term benefit of these treatments.
Neck, Trunk and Hip Muscle Force in Patient with Chronic Low Back Pain
(Clbp)
M.Sc. Vesna Leskovec,
P.T., Kinesiologyn, Bojana Bauman-Silic, M.D., Suzana Tomazic, M.D.,
General Community Medical
Centre Maribor, Maribor, Slovenia, Europe
Abstract The basic purpose
of this research was to discover the differences in the muscle force of neck,
trunk, and in the pelvis area muscles of patients with CLBP. It was discovered
that the reduction of the power of the trunk muscles and the flexibility of the
spine influence the crossing to the CLBP (Sorensen, 1984). The comparison was carried out on 500
subjects with CLBP ( 274 females and 226 males) from 11 to 75 years of age.
Strength tests were applied to neck flexors (NF), trunk flexors (TF), hip
flexors - left and right (HFL, HFR); neck extensors (NE), trunk extensors (TE),
hip extensors - left and right (HEL, HER); trunk rotators - left and right
(TRL,TRR); and hip abductors – left and right (HAL, HAR), using a Myorom
dynamometer (Blankenship, Macon, USA). All the tests proved to have a high
degree of reliability. Out of the 274 measured women, 168 had strong, 46
medium, and 60 weak osteomuscular constitution. Out of the 226 measured men,
183 had strong, 24 medium, and 19 weak osteomuscular constitution.
The imbalance of all the
measured muscle groups was statistically significant for subjects with CLBP.
Strong positive correlation was found with four pairs of muscle groups:
HFL&HFR, HEL&HER, HAL&HAR, and NF+TF&NE+TE. Medium positive
correlation was found with other pairs: NF&NE, TF&TE, and
HFL+HFR&HEL+HER. The relations between the pairs of muscle groups were all
statistically significant, except for two pairs of muscle groups: HEL-HER, and
HAL-HAR (95% Confidence Interval of the Difference).
The results of all the measurements
(HEL-HER, HAL-HAR, and HFL + HFR/ HEL+HER) revealed statistically significant
differentiation between pairs of muscles in men subjects. Significant differences were not found with
the female and male subjects in the age and height, and ratios between TF and
TE, HEL/HER and HAL/HAR.
Methods; Subjects The
subject sample consisted of 500
subjects (274 females and 226 male) with CLBP. Their average age was 44,5 x
years. All of them were chosen after physical assessment was completed (by Ph.
D. Bojana Bauman-Silic and Ph. D. Suzana Tomazic), and confirmation that there
were no medical contraindications to the testing. None of the subjects was
active in sports, none was pregnant and none of them was sedentary for more
than four hours per day. All were psychosocially stable with normal reflexes in
their upper and lower extremities, and in the trunk. For the purpose of this
study, we excluded all subjects with acute LBP, tumours, injuries, congenital
deformations, and cardiac and neurological patients. Subjects with muscle
atrophy and/or prior neck or back (injury) surgery were also excluded. None of
the subjects was on anti-pain medications and during the time of our study none
of them experienced pain.
Measurements To assess the
force of neck, trunk, and hip muscles 12 isometric strength tests were used.
The tests were constructed for the force measurement of: neck flexors (NF),
neck extensors (NE), trunk flexors (TF), trunk extensors (TE), trunk rotators -
left and right (TRL, TRR), hip flexors
- left and right (HFL, HFR), hip extensors - left and right (HEL, HER) and hip
abductors - left and right (HAL, HAR).
Anthropometrical measurements were also constructed: body weight (BW),
body height (BH) and the placing into the table of the ideal body weight (IBW)
- (Pokorn, 1995).
Statistics The data were
analysed using the SPSS program (SPSS program inc. Chicago USA). Basic
statistics and the Kolmogorov – Smirnov test were calculated. The t- test for
independent samples was used. The correlation coefficient between repeated
measurements was calculated. Statistical significance was acceptable with a
five- percent margin of error alpha (two-way testing).
Conclusion The results
of the testing permit to make the following conclusions:
1. For all tests of the
force of muscle groups, the reliability coefficient was calculated to be 0.994
– 1.000 (a high level of reliability).
2.
The relations between pairs of muscle groups were all statistically
significant, except for the 2 pairs of muscle groups: HEL and HER and HAL and
HAR (95 % Confidence Interval of the Difference).
3. Significant differences were not found with the
female and male subjects in the age,
height, and ratios between TF and TE, HEL/HER and HAL/HAR.
4. Out of the 500 measured subjects, as many as 351
had strong osteomuscular constitution.
Discriminant functions
revealed the largest differences in those muscles that constitute the muscle
corset, produce greater abdominal pressure, and trunk fixation. There is a functional connection between abdominus
oblique muscles and contralateral flexors of the hip, where the path through
the symphisis leads to a production of the mechanism of "force
closure" (Lee, 1995). It is possible to determine the functional
connection between the muscles: biceps femoris, gluteus maximus, latissimus
dorsi and erector spine. There are two systems in the pelvic belt that take
part in providing stability:
-
The
Osteoarticularligamentous System (Form Closure);
-
The Myofascial System
(Force Closure).
Together, they take care
for the "self - locking" mechanism or the mechanism of self
stabilization of a certain part of the body (Vleeming, 1995).
Reference
1.
Lee D.: Instability of the sacroiliac joint and the consequences to gait.
Second Interdisciplinary World Congress on Low Back and Pelvic Pain (1995) San
Diego: Part II
2. Pokorn D.: Zdrava
prehrana in dietni jedilniki. – Zdravstvena kultura (1995) 14: 37
3. Sorensen F. B.:
Phisical measurements as risk indicators for low back trouble over a one year
period. – Spine (1984) 9: 106 - 1
4. Vleeming A. et all: The posterior layer of the
thoracolumbal fascia. – Second Interdisciplinary World Congress on Low Back and
Pelvic Pain (1995) San Diego: Part I .
Relation between the Lumbar and Cervical Mobility in Ankylosing
Spondylitis Patients
Tosun Ç.Ö.,Arın B.A.,Demirören Ü.,Sucu A.B.,Akbulak A.,Gülören D.,Tesbihci,
N., Kara H.,ozge.celiker@deu.edu.tr
Balçova SPA therapy, Balçova Thermal Treatment and Physical Therapy Center,
İzmir, TURKEY
Introduction The objective of this
study is to investigate the relation between lumbar mobility, cervical mobility
and symptoms in Ankylosing Spondylitis (AS) patients
Materials and Methods This
retrospective study is completed in Balçova Thermal Treatment Center
between January 2003-January 2005 with 588 patients from Norway which
have AS diagnosis. All patients had a combined treatment program for four weeks
(spa, physical therapy, massage, hydrotherapy). In this patients tra-wall
distance, right cervical rotation, left cervical rotation (for cervical
mobility assessment), schober, lumb-side flexion (for lumbal mobility
assessment), visual analogue scale (VAS), morning stiffness, thorax expansion,
muscle shortness, sleep disorders, muscle strength were assessed before and
after treatment.
Results The patients had
significantly lower tra-wall distance [before treatment (BT):16,14±4,980, after
treatment (AT):13,97±4,702], right cervical rotation [BT: 14,88±10,119, AT:
13,74±12,041], left cervical rotation [BT: 13,60±6,217,AT: 13,06±5,174], VAS,
morning stiffness, totally the numbers of painful regions after treatment
than before treatment. Schober [BT:4,27±3,675, AT: 4,64±2,423], lumb-side
flexion [BT:18,59±17,588, AT: 21,27±14,965], intermalleolar distance, thorax
expansion were significantly higher after treatment (P=0,000). There was a
moderate significant correlation negatively between morning stiffness, tra-wall
distance, schober and lumb-side flexion both before and after treatment
(P=0,000). The measurements of lumb-side flexion increased as also schober
measurements both before and after treatment. There was a moderate positively
significant correlation between these measurements.
Conclusion The combined
treatment program for the AS patients increases the cervical and lumbal
mobility. There is a relation between cervical and lumbal mobility in AS
patients.
Relation between Symptoms and Pain in Patients with AS
Tosun Ç.Ö.,Arın B.A.,Demirören Ü.,Tesbihci N.,Akbulak A.,Gülören D., Sucu,
A.B.,Kara H.,ozge.celiker@deu.edu.tr
Balçova SPA therapy, Balçova Thermal Treatment and Physical Therapy
Center,İzmir, TURKEY
The objective of this study is to investigate relation between symptoms
and pain before and after treatment in Ankylosing Spondylitis (AS) patients
This retrospective study is completed in Balçova Thermal Treatment Center
between 2003- 2005 in 588 patients have AS diagnosis. All patients had a
combined treatment program for three weeks .In these patients tra-wall
distance, schober, cervical rotation, lumb-side flexion, intermalleolar
distance, thorax expansion, visual analogue scale(VAS), number of muscle
shortness, morning stiffness, sleep disorders, chronic fatigue, range of
motion, muscle strength, HLAB27, rheumatoid factor and walking distance
were assessed before and after treatment. The total number of painful regions
and scores of VAS were significantly lower after treatment than before
treatment. The total number of painful regions, number of limited joints,
degree of functional classification,
walking distance increased both before and after treatment. There was a
moderate positive significant correlation between VAS and these symptoms
(p<0,05). The total number of painful regions, morning stiffness, scores of
VAS and schober increased while tra-wall distance increased both before and
after treatment (p<0,05). There was a mild significant correlation
positively between total number of painful regions, morning stiffness,
values of VAS and schober. There was a mild negative significant correlation
between the total number of painful regions and tra- wall distance
(p<0,05). Morning stiffness was the most related symptom with the pain. Pain
and
other symptoms may affect each other. More studies are needed about the
relationship between the pain and the other symptoms of AS.
Hip Problems in Patients with Ankylosing Spondylitis
Tosun Ç.Ö.,Arın B.A.,Demirören Ü., Sucu A.B.,Tesbihci
N., Kara H.,Akbulak, A.,Gülören D.
Ozge.celiker@deu.edu.tr
Balçova SPA therapy,
Balçova Thermal Treatment and Physical Therapy Center, İzmir, TURKEY
The objective of this study is to investigate the symptoms and treatment
results between patients with and without hip problems in Ankylosing
Spondylitis (AS) patients All the patients had a combined treatment program for
four weeks .108 of the participants had
hip problems and 468
didn't have hip problems. In this patients age, lumb-side flexion,
intermalleolar distance, visual analogue
scale (VAS), number of
limited joints, morning stiffness, sleep disorders, gait problems, chronic
fatigue, range of motion, muscle strength were assessed before and after
treatment. 89 of the patients had limited range of motion on their right hips
and 91 of the patients had limited ROM on their left hips before
treatment. The scores of VAS, number of limited joints, morning stiffness were
lower in patients with
hip problems before and after treatment (P>0.005). Lumbal extensor, hip
flexor, hamstring and gastrosoleus muscle shortness, gait problems, chronic
fatigue, trunk and lower extremity muscle strength were significantly different
before and
after treatment between
the patients with and without hip problems (P<0,05). Lumb-side flexion and
intermalleolar distance were significantly higher in both the patients with and
without hip problems after treatment. And also, VAS, number of weak muscles and
limited joints, morning stiffness were significantly lower in patients with and
without hip problems after treatment than before
treatment (P<0,05).
This study has shown that patients with hip problems had more severe symptoms
than the patients without
hip problems. The
symptoms in both the patients with and without hip problems reduced after
treatment.