Increased incidence and severity of somatic dysfunction in subjects with chronic low back pain

Department of Osteopathic Manipulative Medicine, Kirksville College of Osteopathic Medicine-A.T. Still University, 800 W Jefferson St, Kirksville, MO 63501-1443, USA.
The Journal of the American Osteopathic Association 09/2008; 108(8):372-8.
Source: PubMed

ABSTRACT Patients with back pain make more than 14 million office visits per year to US physicians. Many of these patients have chronic low back pain (LBP) and are assumed to have more somatic dysfunction than those without chronic LBP.
To investigate incidence and severity of somatic dysfunction of four lumbar vertebral segments (L1-L4).
Sixteen subjects with chronic LBP and 47 subjects without chronic LBP were each evaluated by two blinded examiners using reliable osteopathic palpatory tests. The incidence and severity of somatic dysfunction for each test were then analyzed within and between the study groups. Results: Resistance to anterior springing (P<.001) and tenderness (P=.002) were found at significantly greater incidence in the chronic LBP group than in the non-LBP group, but there were no significant differences between groups for incidence of tissue texture changes or static rotational asymmetry. Significantly greater severity of tissue texture changes (P=.006), static rotational asymmetry (P=.008), resistance to anterior springing (P<.001), and tenderness (P=.001) were observed in the chronic LBP group than in the non-LBP group.
When compared with non-LBP subjects, chronic LBP subjects had overall greater severity for each of the four elements of somatic dysfunction evaluated, as well as greater incidence of resistance to anterior springing and tenderness. Somatic dysfunction is more severe in individuals with chronic LBP than in individuals without chronic LBP.

Download full-text


Available from: Jane C Johnson, Aug 26, 2015
  • Source
    • "This concept has caused the profession to lose part of its monistic vision (Lee, 2005), by implying a direct link between SD and symptoms and diseases, which in reality corresponds to a biomedical model (Leigh, 1994) The concept of SD is clinically relevant, particularly in its association with LBP and its prevalence in a clinical setting (Licciardone et al, 2005b) but a clear distinction should be made between clinical evidence and scientific evidence for the concept of SD. SD is more prevalent in subjects with chronic LBP than in subjects without chronic LBP (Snider et al, 2008), and specific OMT is provided on a test-dependent basis for each patient. Patient agreement should also be obtained, and patient values and expectations for the outcome of the OMT should be acknowledged. "
    Evidence Based Medicine - Closer to Patients or Scientists?, 04/2012; , ISBN: 978-953-51-0504-6
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this article is to review current research investigating the reliability of bony anatomical landmark positional asymmetry assessment in the lumbar spine and pelvis, to determine the agreement on findings between authors, and to explore future directions in the area to address the significant issues. The databases MEDLINE, CINAHL, AMED, MANTIS, Academic Search Complete, and Web of Knowledge were searched. A total of 23 articles were identified and reviewed, 10 of which met the inclusion criteria. For these 10 articles, the average interexaminer reliability for bony anatomical landmark positional asymmetry assessment was slightly above chance for all landmarks except medial malleolus, which had fair reliability. Interexaminer reliability on average was less than intraexaminer reliability (anterior superior iliac spine, k = 0.128/0.414; posterior superior iliac spine, k = 0.092/0.371). All interexaminer reliability averages were below values of clinical significance. From the current literature review, bony anatomical landmark positional asymmetry assessment in the lumbar spine and pelvis has not been demonstrated to be a reliable assessment method. However, there are unexplored factors that, after standardization, may improve reliability and further the understanding of musculoskeletal palpatory examination.
    PM&R 01/2010; 2(1):48-56. DOI:10.1016/j.pmrj.2009.11.001 · 1.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare fear of movement between obese and non-obese individuals seeking therapy for chronic low back pain and to examine whether fear of movement predicted disability due to back pain, self-reported walking disability, and flexibility. This was a cross-sectional study. Outpatient physical therapy clinic associated with a tertiary care hospital. Patients with chronic low back pain (N=192; 48.2±18.8 years) were stratified into obese (average body mass index [BMI] 36.9±7.1 kg/m(2) ) or non-obese status (average BMI 24.5±3.4 kg/m(2) ). The Tampa Scale of Kinesiophobia (TSK), Short-Form 8 (SF-8), and Oswestry Disability Survey results were main outcome measures. Retrospective review of medical charts was performed. Hierarchical regression modeling determined the contribution of TSK scores to the variance of self-reported disability with walking, overall Oswestry score, and flexibility. TSK scores were higher in obese than non-obese patients (26.2±7.5 vs 23.9±6.8 points; P=0.032). The SF-8 physical and mental subscores were 6-10% lower in the obese than non-obese patients. Oswestry survey scores were higher in the obese patients (40.6 vs 31.6 points; P<0.001). TSK scores contributed to self-reported disability with walking and Oswestry disability score (both P<0.001), but not flexibility. Among obese patients with chronic lumbar pain, pain-related fear of movement enhanced prediction of self-reported disability with walking and overall Oswestry scores. The TSK might be a useful clinical assessment to identify obese patients at higher risk for future low back disability.
    Pain Medicine 11/2010; 12(1):154-64. DOI:10.1111/j.1526-4637.2010.01011.x · 2.24 Impact Factor
Show more