No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Active Visceral Manipulation Associated With Conventional Physiotherapy in People With Chronic Low Back Pain and Visceral Dysfunction: A Preliminary, Randomized, Controlled, Double-Blind Clinical Trial
Abstract
Objective:
The purpose of this study was to generate data for conduction of a power analysis to investigate short-term effects of visceral manipulation associated with conventional physical therapy on pain intensity, lumbar mobility, and functionality of people with chronic low back pain and visceral dysfunctions.
Methods:
This was a double-blinded, randomized, controlled, clinical trial preliminary study. A blinded evaluation was conducted involving 20 people with chronic low back pain with visceral dysfunction. Pain perception, lumbar mobility, and functionality were assessed in 3 moments: evaluation 1 (1 week before the intervention), evaluation 2 (immediately after the last intervention), and evaluation 3 (1 week after the last intervention). The protocol consisted of 50-minute session of conventional physical therapy and visceral manipulation. The participants were randomly allocated to 2 groups: 10 for the experimental group (conventional physical therapy and visceral manipulation) and 10 for the control group (conventional physical therapy and placebo visceral manipulation).
Results:
Significant reductions were found in the experimental group for lumbar mobility and specific functionality in comparison with the control group (P < .05). There were no significant differences for pain perception and global functionality.
Conclusion:
The combination of visceral manipulation and conventional physical therapy program demonstrated significant between-groups differences over time for lumbar spine mobility and specific functionality. These gains occurred after 5 sessions, once a week, and were maintained 1 week after the end of the treatment. This study generated data for conduction of a power analysis to inform the design for future clinical research in this line of inquiry.
... Two out of five studies assessing disability reported improvements in disability in favor to the VO group [1,6]. One out of four studies reported improvements in spinal range of motion in favor to the VO group [42]. Two out of two studies reported an improvement in kidney mobility after VO [26,39] (Table 1). ...
... On the other hand, two studies classified as high risk of bias but with less domains classified as high risk of bias presented no statistically significant differences in any outcome variable (A. C. D. O. [35,37]. The three studies classified as some concerns did not present statistically significant differences in the primary outcome measure [6,30,42], and the only study that was classified as low risk of bias [12] showed no statistically significant differences between the VO and the control group. ...
... In musculoskeletal conditions, more than half of the included studies failed to show statistically significant improvements in the variables evaluated in patients low back pain, neck pain and urinary incontinence due to pelvic floor muscle dysfunction. Five studies showed some improvements after the application of VO in pain intensity, disability, range of motion and/or kidney mobility [1,6,26,39,42]. Three of them were classified as high risk of bias [1,26,39] and two as some concerns [6,42]. The quantitative synthesis corroborated these results for all the outcome variables. ...
Objective
the aim of this systematic review with meta-analysis aims to evaluate the clinical effectiveness of visceral osteopathy (VO) in musculoskeletal and non-musculoskeletal disorders.
Methods
two independent reviewers searched in PubMed, Physiotherapy Evidence Database, Cochrane Library, Scopus, and Web of Science databases in November 2023 and extracted data for randomized controlled trials evaluating the clinical effectiveness of VO. The risk of bias and the certainty of evidence were assessed using the Risk-of-Bias tool 2 and the GRADE Profile, respectively. Meta-analyses were conducted using random effect models using RevMan 5.4. software.
Results
Fifteen studies were included in the qualitative and seven in the quantitative synthesis. For musculoskeletal disorders, the qualitative and quantitative synthesis suggested that VO produces no statistically significant changes in any outcome variable for patients with low back pain, neck pain or urinary incontinence. For non-musculoskeletal conditions, the qualitative synthesis showed that VO was not effective for the treatment of irritable bowel syndrome, breast cancer, and very low weight preterm infants. Most of the studies were classified as high risk of bias and the certainty of evidence downgraded to low or very low.
Conclusion
VO did not show any benefit in any musculoskeletal or non-musculoskeletal condition.
... [6] Several studies have shown that visceral dysfunction may be implicated in the etiology of LBP and contribute to the increased severity of pain. [7][8][9] Surgical interventions, adhesions, or inflammatory processes that affect the visceral connective tissue mobility, such as the fascia, may lead to visceral dysfunction. [8,9] Visceral dysfunction is altered mobility of visceral organs and their fascial, neural, skeletal, vascular, and lymphatic components. ...
... [7][8][9] Surgical interventions, adhesions, or inflammatory processes that affect the visceral connective tissue mobility, such as the fascia, may lead to visceral dysfunction. [8,9] Visceral dysfunction is altered mobility of visceral organs and their fascial, neural, skeletal, vascular, and lymphatic components. [10] These restrictions may adversely affect the spinal nerve innervation related to dysfunctional viscera. ...
... [10] These restrictions may adversely affect the spinal nerve innervation related to dysfunctional viscera. As the visceral innervation arises from the thoracic and lumbar regions via the sympathetic nervous system, the state of the abdominal and pelvic viscera may segmentally restrict the mobility of structures in the distant parts of the body, contributing to the development or continuation of chronic LBP in some cases [8,9] or increased severity of symptoms or widespread and localized pain. [11] Currently, three mechanisms have been proposed by which the altered movement relationship between organs and supporting connective tissues can potentially manifest as LBP: visceral, central sensitization, and local fascial alterations. ...
Objectives
In this study, we aimed to evaluate the effectiveness of osteopathic visceral manipulation (OVM) combined with physical therapy in pain, depression, and functional impairment in patients with chronic mechanical low back pain (LBP).
Patients and methods
A total of 118 patients with chronic mechanical LBP were assessed, and 86 who met the inclusion criteria were included in the randomized-controlled study between January 2021 and August 2022. The patients were randomized to either Group 1 (n=43), which underwent physical therapy (5 days/week, for a total of 15 sessions) combined with OVM (2 days/week with three-day intervals), or Group 2 (n=43), which underwent physical therapy (5 days/week, for a total of 15 sessions) combined with sham OVM (2 days/week with three-day intervals). Both groups were assessed before and after treatment and at the fourth week post-treatment.
Results
Seven patients were lost to follow-up, and the study was completed with 79 patients (25 males, 54 females; mean age: 46.87±14.12 years; range, 19 to 75 years). Pain, depression, and functional impairment scores were all improved in both groups (p=0.001 for all). This improvement was sustained at week four after the end of treatment. However, improvement in the pain, depression, and functional impairment scores was significantly higher in Group 1 than in Group 2 (p=0.001 for all).
Conclusion
The results suggest that OVM combined with physical therapy is useful to improve pain, depression, and functional impairment in patients with chronic mechanical low back pain. We believe that OVM techniques should be combined with other physical therapy modalities in this patient population.
... Two out of five studies assessing disability reported improvements in disability in favor to the VO group [1,6]. One out of four studies reported improvements in spinal range of motion in favor to the VO group [42]. Two out of two studies reported an improvement in kidney mobility after VO [26,39] (Table 1). ...
... On the other hand, two studies classified as high risk of bias but with less domains classified as high risk of bias presented no statistically significant differences in any outcome variable (A. C. D. O. [35,37]. The three studies classified as some concerns did not present statistically significant differences in the primary outcome measure [6,30,42], and the only study that was classified as low risk of bias [12] showed no statistically significant differences between the VO and the control group. ...
... In musculoskeletal conditions, more than half of the included studies failed to show statistically significant improvements in the variables evaluated in patients low back pain, neck pain and urinary incontinence due to pelvic floor muscle dysfunction. Five studies showed some improvements after the application of VO in pain intensity, disability, range of motion and/or kidney mobility [1,6,26,39,42]. Three of them were classified as high risk of bias [1,26,39] and two as some concerns [6,42]. The quantitative synthesis corroborated these results for all the outcome variables. ...
Objectives
To analyze the effectiveness of craniosacral therapy in improving pain and disability among patients with headache disorders.
Design
Systematic review and meta-analysis.
Data sources
PubMed, Physiotherapy Evidence Database, Scopus, Cochrane Library, Web of Science, and Osteopathic Medicine Digital Library databases were searched in March 2023.
Review methods
Two independent reviewers searched the databases and extracted data from randomized controlled trials comparing craniosacral therapy with control or sham interventions. The same reviewers assessed the methodological quality and the risk of bias using the PEDro scale and the Cochrane Collaboration tool, respectively. Grading of recommendations, assessment, development, and evaluations was used to rate the certainty of the evidence. Meta-analyses were conducted using random effects models using RevMan 5.4 software.
Results
The searches retrieved 735 studies, and four studies were finally included. The craniosacral therapy provided statistically significant but clinically unimportant change on pain intensity (Mean difference = –1.10; 95% CI: –1.85, –0.35; I2: 44%), and no change on disability or headache effect (Standardized Mean Difference = –0.34; 95% CI –0.70, 0.01; I2: 26%). The certainty of the evidence was downgraded to very low.
Conclusion
Very low certainty of evidence suggests that craniosacral therapy produces clinically unimportant effects on pain intensity, whereas no significant effects were observed in disability or headache effect.
... Zwei Arbeiten (Panagopoulos et al., 2015;Villalta Santos et al., 2019) benutzten physiotherapeutische Übungen begleitend zur VOM (Tabelle 4). ...
... Der primäre Parameter Schmerz wurde mit der "VAS" ('Visuelle Analogskala', 2021) in drei Studien (Tamer et al., 2017;Salinas Sanmartí et al., 2019;Villalta Santos et al., 2019), dem "DSF" (Deutscher Schmerzfragebogen, 2022) in einer Studie (Birkner, 2020), dem "SF-MPQ" (Melzack, 1987) in zwei Studien und der "Numeric Pain Rating Scale" (Numeric Pain Rating Scale, 2022) in einer Studie (Panagopoulos et al., 2015) gemessen. ...
... Der sekundäre Parameter LWS-Mobilität wurde mit dem "Schober Test" (Schober-Zeichen, 2022) bei einer Studie (Villalta Santos et al., 2019) gemessen. Gernerelle Funktionalität und Einschränkungen wurden mit dem "RMDQ" (RMDQ, 2022) bei zwei Studien (Panagopoulos et al., 2015;Villalta Santos et al., 2019) und mit der "ODI" ('Oswestry Disability Index', 2021) bei einer Studie (Tamer et al., 2017) erfasst. Spezifische Funktionalität wurde anhand der "PSFS" (Patient Specific Functional Scale, 2022) erfasst. ...
Es wurden durch ein Suchverfahren verschiedene “randomisierte-Kontroll-Studien” aus sieben Datenbanken ausgewählt, die anschließend mit der PEDro Skala auf ihre Validität bewertet wurden.
Inhaltlich wurden die Studien dann tabellarisch auf ihre Methodik, technische Ausführung sowie ihre Resultate im zeitlichen Zusammenhang ausgewertet und dargestellt. Es wurde zwischen kurz-, mittel- und langfristigen Ergebnissen unterschieden. Die Parameter, deren Ergebnisse gemessen wurden, waren Schmerz und Schmerzschwellenwert (primär) sowie Lebensqualität, Nieren-/Blasenmobilität, Funktion/Einschränkung, LWS-Beweglichkeit und Wohlergehen (sekundäre Parameter).
Processing a search method, regarding seven databases, different RCT’s (randomised-controll-trials) were chosen and validated through the PEDro scale. The content was then illustrated in charts regarding methodology, techniqueal execution and results related to time. Results were then distinguished between short term, middle term and long term results. The parameters measured were pain and pressure pain thresholds (primary parameters) as well as quality of life, kidney and bladder mobility, function/restriction, lumbar mobility and well- beeing (secondary parameters).
... Finally, 10 studies [35][36][37][38][39][40][41][42][43][44] were included both in the qualitative and in the quantitative analysis (Fig. 1). The aggregate number of subjects in the included studies is 1160, even if great differences among trials were detected (sample size range: 20-455). ...
... All the included studies (n = 10) were RCTs, nine [35][36][37][38][39][41][42][43][44] (90%) with a parallel design, and one 40 (10%) had a "2 × 2 factorial" design. Five trials 35,37,40,42,44 (50%) had no active treatment as comparison (sham therapy or no intervention), and the other five 36,38,39,41,43 (50%) had an active control group (standard exercise, classic massage). ...
... All the included studies (n = 10) were RCTs, nine [35][36][37][38][39][41][42][43][44] (90%) with a parallel design, and one 40 (10%) had a "2 × 2 factorial" design. Five trials 35,37,40,42,44 (50%) had no active treatment as comparison (sham therapy or no intervention), and the other five 36,38,39,41,43 (50%) had an active control group (standard exercise, classic massage). Six trials 35,36,[39][40][41][42] (60%), including 983 subjects, reported a follow-up assessment, varying from 4 to 24 weeks depending on the study. ...
Objective
The aim of this systematic review and meta-analysis is to evaluate whether osteopathic manipulative interventions can reduce pain levels and enhance the functional status in patients with non-specific neck pain (NS-NP).
Methods
A systematic review and meta-analysis was conducted following the 2020 PRISMA statement. Randomized controlled trials (RCTs) were searched in five databases, assessed through a standardized form, and evaluated using the “13 items Cochrane risk of bias (RoB) tool”. Effect sizes (ES) were calculated post-treatment, and the quality of evidence was assessed through GRADE criteria.
Results
Five articles were included in the review, and none of these was completely judged at low RoB. Four of these were included in the meta-analysis. Osteopathic interventions compared to no intervention/sham treatment showed statistically significant results for pain levels (ES = −1.57 [-2.50, −0.65]; P = 0.0008) and functional status (ES = −1.71 [-3.12, −0.31]; P = 0.02). The quality of evidence was “very low” for all the assessed outcomes. Other results were presented in a qualitative synthesis.
Conclusions
Osteopathic interventions could be effective for pain levels and functional status improvements in adults with NS-NP. However, these findings are affected by a very low quality of evidence. Therefore, further high-quality RCTs are necessary to improve the quality of evidence and generalize the results.
... Finally, 10 studies [35][36][37][38][39][40][41][42][43][44] were included both in the qualitative and in the quantitative analysis (Fig. 1). The aggregate number of subjects in the included studies is 1160, even if great differences among trials were detected (sample size range: 20-455). ...
... All the included studies (n = 10) were RCTs, nine [35][36][37][38][39][41][42][43][44] (90%) with a parallel design, and one 40 (10%) had a "2 × 2 factorial" design. Five trials 35,37,40,42,44 (50%) had no active treatment as comparison (sham therapy or no intervention), and the other five 36,38,39,41,43 (50%) had an active control group (standard exercise, classic massage). ...
... All the included studies (n = 10) were RCTs, nine [35][36][37][38][39][41][42][43][44] (90%) with a parallel design, and one 40 (10%) had a "2 × 2 factorial" design. Five trials 35,37,40,42,44 (50%) had no active treatment as comparison (sham therapy or no intervention), and the other five 36,38,39,41,43 (50%) had an active control group (standard exercise, classic massage). Six trials 35,36,[39][40][41][42] (60%), including 983 subjects, reported a follow-up assessment, varying from 4 to 24 weeks depending on the study. ...
Background
Chronic low back pain (CLBP) is a frequent cause of disability and it represents a medical, social and economic burden globally. Therefore, we assessed effectiveness of osteopathic interventions in the management of NS-CLBP for pain and functional status.
Methods
A systematic review and meta-analysis were conducted. Findings were reported following the PRISMA statement. Six databases were searched for RCTs. Studies were independently assessed using a standardized form. Each article was assessed using the Cochrane risk of bias (RoB) tool. Effect size (ES) were calculated at post-treatment and at 12 weeks’ follow up. We used GRADE to assess quality of evidence.
Results
10 articles were included. Studies investigated osteopathic manipulative treatment (OMT, n = 6), myofascial release (MFR, n = 2), craniosacral treatment (CST, n = 1) and osteopathic visceral manipulation (OVM, n = 1). None of the study was completely judged at low RoB. Osteopathy revealed to be more effective than control interventions in pain reduction (ES: -0.59; 95% CI: -0.81, -0.36; P < 0.00,001) and in improving functional status (ES: -0.42; 95% 95% CI: -0.68, -0.15; P = 0.002). Moderate-quality evidence suggested that MFR is more effective than control treatments in pain reduction (ES: -0.69; 95% CI: -1.05, -0.33; P = 0.0002), even at follow-up (ES: -0.73; 95% CI: -1.09, -0.37; P < 0.0001). Low-quality evidence suggested superiority of OMT in pain reduction (ES: -0.57; 95% CI: -0.90, -0.25; P = 0.001) and in changing functional status (ES: -0.34; 95% CI: -0.65, -0.03; P = 0.001). Very low-quality evidence suggested that MFR is more effective than control interventions in functional improvements (ES: -0.73; 95% CI: -1.25, -0.21; P = 0.006).
Conclusion
Results strengthen evidence that osteopathy is effective in pain levels and functional status improvements in NS-CLBP patients. MFR reported better level of evidence for pain reduction if compared to other interventions. Further high-quality RCTs, comparing different osteopathic modalities, are recommended to produce better-quality evidence.
... Physical activity as a preparation for delivery and rehabilitation in the postpartum period are recommended in order to improve quality of life and prevent pain [69][70][71]. A less common non-invasive and non-pharmacological method to reduce pain and tension in soft tissues is osteopathic visceral treatment. ...
... A less common non-invasive and non-pharmacological method to reduce pain and tension in soft tissues is osteopathic visceral treatment. Santos et al. showed that visceral manipulations combined with a physiotherapeutic program improved mobility in the lumbar spine [71]. Visceral techniques can successfully be used for non-specific pain in the cervical spine. ...
Movement is a physiological phenomenon and a fundamental aspect of the living human body in a global context (e.g., musculoskeletal system function) and local one (e.g., visceral system function). The local activity of the body is expressed in the rhythm of pulsations, peristalsis and vibrations. Visceral therapy supports movement, articulation and tissue rhythm. The use of visceral treatment for pain is complementary and is relevant for pregnant women. Maintaining the mobility and motility of internal organs by means of visceral techniques can regulate anatomical relations and physiological processes within the urogenital diaphragm. The role of physical activity is also important. A scoping review was conducted to analyze the relevant literature on pain in pregnant women, the role of visceral therapy in pregnant women and oxidative stress. Eligible articles presented aspects of the occurrence of pain in locomotive organs in pregnant women, the use of visceral therapy in pain management, and the reduction of oxidative stress. The use of visceral therapy and physical activity in the treatment of pain is complementary and also important for pregnant women, and so may have an effect on reducing oxidative stress in pregnant women.
... Del conjunto de los artículos relativos a la osteopatía, todos los estudios excepto uno (Tamer et al., 2017), detallaron la formación de los terapeutas que aplicaron los tratamientos, todos los estudios fueron a simple ciego, pero sólo cuatro compararon el grupo intervención con un tratamiento placebo Martí-Salvador et al., 2018;Villalta Santos et al., 2019). Todos los seleccionaron a pacientes refiriendo síntomas de más de tres meses de duración. ...
... Dos estudios se centraron en la movilidad raquídea utilizando respectivamente la prueba Fingertip to Floor y un sistema optoelectrónico (Castro-Sánchez et al., 2016;Vismara et al., 2012). En cambio, los otros dos estudios se enfocaron específicamente en el rango de movimiento lumbar con la prueba de Schober (Mohseni-Bandpei et al., 2006;Villalta Santos et al., 2019). Los cuatro estudios concluyeron que la osteopatía mejoró significativamente la movilidad. ...
... which is believed to be affected following a previous inflammation or surgery. 9 Evidence supports the effectiveness of OMT in alleviating persistent pain, and improving the short-and longterm pain-related psychological outcomes while showing cost efficiency. 10 The literature on the effect of osteopathic treatment with CRPS patients is limited; however, it has demonstrated a reduction in cortisol levels, which can decrease inflammation levels and lead to a reduction in sympathetic tone, positively altering the pain response. ...
Complex regional pain syndrome (CRPS) is a debilitating condition that typically affects one limb, often triggered by acute trauma. Symptoms include persistent pain, skin sensitivity, swelling, and mobility issues. While various therapeutic approaches exist, evidence for the effectiveness of multimodal treatments is limited. A 25-year-old female presented with CRPS following a sciatic nerve injury due to an intramuscular injection. She experienced severe pain, swelling, and limited mobility in her left ankle. Physical therapy assessment revealed significant weakness and limitations in both active and passive range of motion due to pain and swelling. The patient underwent a holistic treatment consisting of osteopathy and rehabilitation exercises over 36 sessions spanning 9 months. Significant improvements were observed after treatment, including reduced pain, increased mobility, and improved nerve conduction. These findings suggest that a multimodal therapeutic approach may be beneficial in managing CRPS and improving patients’ quality of life.
... Visceral dysfunction is considered as mobility and/or motility restriction in the viscera and its related structures include fascial, neural, skeletal, vascular, and lymphatic components (11,12) . VM is a gentle, specifically placed manual technique that aims to correct mechanical (mobility and motility), vascular, and neurological dysfunction in viscera (11,13) . ...
– Background – Functional constipation (FC) is a common
global high prevalence issue in children. Objective – The purpose of the
present study is to evaluate the effect of visceral manipulation (VM) on
children with chronic interacble FC unresponsive to the standard treat�ment. Methods – This study was conducted as a randomized, single-blind
controlled trial. Fifty-two children with refractory chronic functional con�stipation unresponsive to the standard medical treatment were randomly
allocated to two groups of 26 control (standard medical care (SMC)) and
26 intervention (SMC with VM) for 4 weeks. Abdominal pain, painful
defecation, stool consistency, defecation frequency, and the dose of oral
laxative were evaluated before and after the treatment period using the
Pain Rating Scale, Bristol stool form scale, and patient/parents report.
Results – At the end of treatment, except for the dose of oral laxative
in the control group, all of the results showed a significant difference in
both groups (P<0.05). The dose of oral laxative in the intervention group
decreased significantly (P<0.05), however, no significant change was ob�served in the control group (P>0.05). In the intervention group compari�son, statistically significant differences were found in all variables except
the Bristol stool form scale (P<0.05). The Bristol stool form scale after
treatments was not different when the groups were compared (P=0.32),
but the number of subjects who had normal stool consistency was significantly increased in the intervention group than in the control group
(P<0.05). Conclusion – VM can be considered as a possible treatment
without side effects besides SMC for the management of chronic FC. Further studies are needed to investigate the long-term effect of VM.
... However, the study was a quasiexperimental study, and the participants were only violin players. In contrast, Villalta Santos et al. (2019) 6 showed that the application of VM alone or VM with exercise had the same effect on reducing the pain sensation. This conflict might be due to the small sample size (N=20), most of them were females (19 females,1male), sampling method(convenience),and different population(LBP with Dyspepsia) of that study. ...
... Pain in the pelvic area that radiates to the lumbar spine can also cause inflammation of the female reproductive organs; this condition in pregnant women can be treated non-pharmacologically by means of balneoclimatology treatments 43 . Visceral manipulation combined with a personal physiotherapy program can be an effective way to reduce pain sensations and improve mobility of the lumbar spine 44 . Visceral therapy is also effective in treating non-specific back pain [45][46][47] . ...
Pregnancy affects a woman’s physiological and psychological state. One of the most important aspects that requires attention is the quality of life of pregnant women. The quality of life of women during this period is influenced by a number of factors, such as back and pelvic pain, physiotherapy and physical activity, and also sexual satisfaction. Eighty-five women aged 21–40 years (30.80 ± 5.05) in pregnancy trimesters participated in the study: 17 women were in the first trimester, 32 women were in the second, and 36 women in the third trimester. The World Health Organisation Quality of Life (WHOQOL-BREF), Oswestry Disability Index (ODI) and the Sexual Satisfaction Scale for Women SSS-W-R15 were used to answer the research hypotheses. Respondents also provided information on questions regarding physiotherapy treatments and physical activity. Quality of life (WHOQOL-BREF) and disability due to back pain (ODI) showed a statistical association and relationship (p-value = 0.045, rho = − 0.22). Quality of life (WHOQOL-BREF) has an association with sexual satisfaction in pregnant women (SSS-W-R15) (p-value = 0.003, rho = 0.32). The trimester of pregnancy has an effect on ODI (p-value = 0.027). A significant effect occurred in a detailed comparison between the first and third trimesters of pregnancy (p-value = 0.026). The trimester also has an impact on quality of life (WHOQOL-BREF) (p-value = 0.002). In a detailed analysis, a significant effect occurred between the first and third trimesters of pregnancy (p-value = 0.001). Moreover, the trimester of pregnancy has an impact on sexual satisfaction (SSS-W-R15) (p-value = 0.027). After detailed statistical analysis, a significant effect occurred between trimesters one and three of pregnancy (p-value = 0.046). On the other hand, the number of days of physical activity performed by pregnant women per month and the type of physical activity had no effect on the ODI (p-value = 0.071). The type of physical activity performed by pregnant women also has no effect on ODI (p-value = 0.023). The number of physiotherapy treatments used has no effect on the ODI (p-value = 0.156). Type of physiotherapy treatment has no effect on ODI (p-value = 0.620). Normal pregnancy quality of life (WHOQOL) is related to ODI and sexual satisfaction (SSS-W-R15), while the trimester of pregnancy also has an impact on quality of life, disability due to back pain and sexual satisfaction.
... Relationships based on cross-sectional data between spinal amplitude and pain intensity were available for 74 studies with 5806 participants (Alschuler et al., 2009;Alves et al., 2020;Anderson et al., 2013;Ansari et al., 2014;Aure & Kvåle, 2022;Bazzaz-Yamchi et al., 2021;Carpino et al., 2020 Demoulin et al., 2013;Du et al., 2017;Dubois et al., 2016;Duray et al., 2018;Fehrmann et al., 2017;Garcia et al., 2013;Geller et al., 2016;Grosdent et al., 2023;Grotle et al., 2004;Hidalgo et al., 2015;Hofste et al., 2021;Hrkać et al., 2022;Ibrahim et al., 2019;Jensen et al., 2010;Jette et al., 2016;Joshi et al., 2021;Kernan & Rainville, 2007;Kienbacher et al., 2017;Kiran et al., 2017;Larivière et al., 2022;Lenoir dit Caron et al., 2022;Louw et al., 2015;Louw, Farrell, et al., 2017;Louw, Zimney, et al., 2017;Mannion et al., 2001;Marich et al., 2017;Matheve et al., 2019;McCracken et al., 2002;Melikoglu et al., 2009;Mieritz et al., 2014;Miyachi et al., 2021;Neblett et al., 2013;Nemcić et al., 2013;Nordstoga et al., 2019;Olaogun et al., 2004;Ostelo et al., 2003;Osumi et al., 2019;Ozkaraoglu et al., 2020;Pagé et al., 2015;Papciak & Feuerstein, 1991;Peng et al., 2016;Preyde, 2000;Sakulsriprasert et al., 2011;Sasani et al., 2008;Satpute et al., 2019;Shahvarpour et al., 2017;Shin, 2020;Shum et al., 2013;Silveira et al., 2021;Steele et al., 2013;Sturion et al., 2020;Takinacı et al., 2019;Taşpınar et al., 2023;Taulaniemi et al., 2017;Teixeira da Cunha-Filho et al., 2010;Thomas & France, 2008;van Wingerden et al., 2008;Villalta Santos et al., 2019;Vowles et al., 2004Vowles et al., , 2007Yuen et al., 2017). The meta-analysis resulted in a pooled coefficient of −0.13 [95%CI −0.20 to −0.12], F I G U R E 2 Forest plot of the associations between spinal amplitude and disability for cross-sectional data. ...
Background and objectives:
The role of spinal movement alterations in low back pain (LBP) remains unclear. This systematic review and meta-analyses examined the relationships between spinal amplitude of movement, disability and pain intensity in patients with LBP.
Databases and data treatment:
We searched PubMed, CINAHL, Embase, Pedro and Web of Science for relevant articles until 14th March 2023. Risk of bias was assessed with the Quality in Prognostic Studies Tool. We analysed the relationships between amplitude of movement, disability and pain intensity with standard correlational meta-analyses and meta-analytic structural equation modelling (MASEM) in cross-sectional and longitudinal data.
Results:
A total of 106 studies (9001 participants) were included. In cross-sectional data, larger amplitude of movement was associated with lower disability (pooled coefficient: -0.25, 95% confidence interval: [-0.29 to -0.21]; 69/5899 studies/participants) and pain intensity (-0.13, [-0.17 to -0.09]; 74/5806). An increase in amplitude of movement was associated with a decrease in disability (-0.23, [-0.31 to -0.15]; 33/2437) and pain intensity (-0.25, [-0.33 to -0.17]; 38/2172) in longitudinal data. MASEM revealed similar results and, in addition, showed that amplitude of movement had a very small influence on the pain intensity-disability relationship.
Conclusions:
These results showed a significant but small association between amplitude of movement and disability or pain intensity. Moreover, they demonstrated a direct association between an increase in amplitude of movement and a decrease in pain intensity or disability, supporting interventions aiming to reduce protective spinal movements in patients with LBP.
Significance:
The large meta-analyses performed in this work revealed an association between reductions in spinal amplitude of movement and increased levels of disability and pain intensity in people with LBP. Moreover, it highlighted that LBP recovery is associated with a reduction in protective motor behaviour (increased amplitude of movement), supporting the inclusion of spinal movement in the biopsychosocial understanding and management of LBP.
... If the respiratory diaphragm is moved upwards, the expiratory reserve volume and the lung backflow volume reduce [22,23]. Performing visceral manipulation in combination with a physiotherapy programme improves mobility in the lumbar spine [24]. ...
Proper diet and physical activity are a form of prevention of female genital prolapse disorders. The causal substrate of pelvic floor dysfunction is multifactorial. Fifty percent of women over the age of 50 have pelvic organ prolapse, often accompanied by urinary incontinence. It is a complicated social and medical (urogynecological and sexological) problem. The authors conducted a literature review on the role of visceral therapy, Kegel and core stability exercises and diet in pelvic support disorders and urinary incontinence. The eligible articles provided insights into sexological factors, as well as the role of osteopathy and physiotherapy. These results provide new insights into the relevance of clinical practice. In addition to standard treatment methods used in gynaecology, sexology, physiotherapy and osteopathy (e.g., visceral therapy), Kegel muscle and core stability exercises are becoming increasingly important. The aim of visceral therapy is to restore the mobility of the organs while reducing increased tension and improving blood and lymph circulation. This has the effect of reducing pain sensations, thereby influencing the function of the uterus and ovaries.
... Pain in the lower spine, pelvis, sacrum and sacroiliac joint may also be caused by sexual abuse or incestuous intercourse [24]. Santos et al. showed that visceral manipulations combined with a physiotherapeutic programme improve mobility in the lumbar spine [28]. Visceral therapy can successfully be used for non-specific pain in the cervical spine. ...
Dyspareunia is genital pain during sexual intercourse without constriction of the vulva or vagina. This is one of the most
significant issues that lies at the border of gynaecology and sexology. Dyspareunia can be caused by endometriosis. Many
women can also experience premenstrual syndrome, which can occur as a separate problem. All three of these can result
from an imbalance between the female genital organs and their surrounding tissues with other structures of the skeletal
or visceral system, with impaired mobility and motility of organs, intra-organ movement, vascular drainage, a pressure
gradient between the urogenital and diaphragmatic cylinders, dysfunctions in the area of the broad ligament of the
uterus, and fascial bonding. Apart from standard treatment methods used in gynaecology and sexology, physiotherapy
(e.g., visceral therapy) is of great value. Visceral therapy aims at restoring intra-organ movement, reducing tension,
focusing on the area of the two cylinders of the trunk, and supporting the functioning of the vascular system in the
vicinity of the uterus. All these activities reduce pain and substantially change the functioning of the uterus and ovaries.
Key words: visceral therapy; woman; reproductive organ
... 4,38,39,109 Furthermore, our review demonstrates that high-similarity control interventions are feasible, 70,90,153 likely providing more insight into treatment efficacy and mechanism than unmatched active comparator treatments such as education, relaxation, or exercise. 165 In addition, many manual therapy 2,15,17,25,28,37,63,73,74,89,100,106,120,136,140,142,151,167,170 and some exercise trials 69,84 found promising solutions to the sham control problem, creating largely similar control interventions through the consideration of mechanistic treatment rationales and the mimicking of main contextual treatment aspects. This approach may in turn inspire development in other therapy fields, including psychological interventions. ...
Blinding is challenging in randomised controlled trials of physical, psychological, and self-management therapies for pain, mainly because of their complex and participatory nature. To develop standards for the design, implementation, and reporting of control interventions in efficacy and mechanistic trials, a systematic overview of currently used sham interventions and other blinding methods was required. Twelve databases were searched for placebo or sham-controlled randomised clinical trials of physical, psychological, and self-management treatments in a clinical pain population. Screening and data extraction were performed in duplicate, and trial features, description of control methods, and their similarity to the active intervention under investigation were extracted (protocol registration ID: CRD42020206590). The review included 198 unique control interventions, published between 2008 and December 2021. Most trials studied people with chronic pain, and more than half were manual therapy trials. The described control interventions ranged from clearly modelled based on the active treatment to largely dissimilar control interventions. Similarity between control and active interventions was more frequent for certain aspects (eg, duration and frequency of treatments) than others (eg, physical treatment procedures and patient sensory experiences). We also provide an overview of additional, potentially useful methods to enhance blinding, as well as the reporting of processes involved in developing control interventions. A comprehensive picture of prevalent blinding methods is provided, including a detailed assessment of the resemblance between active and control interventions. These findings can inform future developments of control interventions in efficacy and mechanistic trials and best-practice recommendations.
... Pain in the lower spine, pelvis, sacrum and sacroiliac joint may also be caused by sexual abuse or incestuous intercourse [24]. Santos et al. showed that visceral manipulations combined with a physiotherapeutic programme improve mobility in the lumbar spine [28]. Visceral therapy can successfully be used for non-specific pain in the cervical spine. ...
ABSTRACT
Dyspareunia is genital pain during sexual intercourse without constriction of the vulva or vagina. This is one of the most
significant issues that lies at the border of gynaecology and sexology. Dyspareunia can be caused by endometriosis. Many
women can also experience premenstrual syndrome, which can occur as a separate problem. All three of these can result
from an imbalance between the female genital organs and their surrounding tissues with other structures of the skeletal
or visceral system, with impaired mobility and motility of organs, intra-organ movement, vascular drainage, a pressure
gradient between the urogenital and diaphragmatic cylinders, dysfunctions in the area of the broad ligament of the
uterus, and fascial bonding. Apart from standard treatment methods used in gynaecology and sexology, physiotherapy
(e.g., visceral therapy) is of great value. Visceral therapy aims at restoring intra-organ movement, reducing tension,
focusing on the area of the two cylinders of the trunk, and supporting the functioning of the vascular system in the
vicinity of the uterus. All these activities reduce pain and substantially change the functioning of the uterus and ovaries.
Key words: visceral therapy; woman; reproductive organ
... The gallbladder derives from the mesoderm and is richly covered with smooth muscle (muscularis propria), as well as the bile duct (muscularis mucosae); thanks to the muscular elasticity, both structures are able to correctly manage the mechanical tensions they feel and adapt their structure [41]. A visceral manual treatment is able to improve digestive functions in patients undergoing chemotherapy for breast cancer, as well as improve function parameters in the area of lumbar pain, after a visceral abdominal treatment with a manual approach [42,43]. The manual approach has the same principles for a myofascial type treatment, and one could speak of viscerofascial [44]. ...
The fascial continuum is a topic for which all clinicians and other healthcare professionals come into contact on a daily basis, both consciously and without having the idea that the tissues they deal with can fall within the concept of fascia. The Foundation of Osteopathic Research and Clinical Endorsement (FORCE) organization includes many clinicians and health professionals, as well as researchers in different scientific disciplines. The goal is to dissect some concepts related to daily practice, such as fascial tissue, from a scientific point of view and impartially. Proof of the impartiality of FORCE is the fact that it does not sell any fascial products, no tools, and, above all, all the fascial terminology used has no copyright: research and knowledge are the right of anyone who wishes improvement for the good of the patient. The article aims to review the themes that could add new elements for a broader view of the meaning and nomenclature of the fascial system.
... The treatment protocol consisted of applying myofascial release techniques and immediately afterwards they were reassessed by VAS and the modified Shober test. The study of Villalta Santos et al. (18) evaluated 20 people with chronic LBP with visceral dysfunction, the protocol consisted of a 50-minute session of conventional physiotherapy and osteopathic visceral manipulations. Pain perception, lumbar mobility and functionality were assessed in three stages. ...
Introduction: Low back pain is one of the most frequent causes of disability, with several associated etiologies. Osteopathic manipulative treatment is widely used to evaluate and manage musculoskeletal disorders. The aim of the study was to evaluate the immediate and late effects of 3 sessions of myofascial osteopathic techniques on pain intensity, posterior chain flexibility, lumbar mobility and level of disability in patients with chronic low back pain. Methods: 60 subjects of both genders, randomly divided into 3 experimental groups: healthy control (HC n = 20), low back pain control group (CG, n = 20) and treated low back pain group (TG, n = 20). Initially, the 3 groups were evaluated using the Visual Analogue Scale (VAS), Oswestry questionnaire, Wells bench and measurement of lateral spine tilt and fingertip-to-floor test. The TG was submitted to 3 sessions of myofascial techniques (lasting 40 minutes), 1x / week. The session consisted of the application of 6 myofascial techniques (thoracolumbar fascia, quadratus lumborum fascia, iliopsoas muscle stretching, quadratus lumborum stretching and iliolumbar ligaments). Subjects were reevaluated immediately after the first session, 7 days after the last session and one month after treatment completion (follow up). Results: There was an improvement in posterior chain flexibility (20.3 ± 7.4 cm pre to 26.3 ± 8 cm after 3 sessions), spinal mobility (fingertip-to-floor: 13.3 ± 11.33 cm pre to 4.8 ± 10.5 cm after 3 sessions), as well as pain intensity reduction (3.3 ± 1.9 cm pre to 1 ± 1.7 after 3 sessions) and reduction in the level of lumbar disability (15.8 ± 7.3 in the pre to 9.2 ± 8.6 after 3 sessions) for TG. In HC and CG there was no change in any of the variables. The results shown for TG remained even one month after the intervention. Conclusion: The osteopathic treatment protocol with myofascial techniques was effective for the treatment of low back pain.
Introduction: Functional chronic bowel constipation is a motility disorder of great relevance and prevalence worldwide. Objective: Analyze the efficiency of visceral manipulation technique in individuals with bowel constipation diagnose according to Roma III criteria. Methods: This is a crossover clinical study that included individuals of both genders aged between 20 and 40 years who had had bowel constipation symptoms for over one year. Individuals were randomized into two groups: the intervention (IG) and control (CG) groups. A four weeks washout period was given. Each volunteer underwent 24 individual osteopathic sessions, twice a week that lasted up to 30 minutes. Three intervention techniques were performed: two for the large intestine and one for the small intestine. Results: Thirty four patients were recruited but nine were excluded. Our sample consisted in 25 participants, 13 were allocated in the IG and 12 in the CG. No significant difference was found between groups for anthropometric, educational, marital status, proportion of smokers and alcoholics, and VAS for lumbar spine pain measures. Lumbar spine flexibility, was significant increased for the IG (p<0.0001). A higher proportion of patients in the IG presented reduced hard stools, effort to evacuate, incomplete evacuation feeling, anorectal obstruction sensation and manual maneuvers to facilitate evacuation after treatment (p<0.0001). A significant correlation was found between pain (VAS) and the Schober test (r=-0.41). Conclusion: This study was successful in showing that there seems to be a positive effect of the osteopathic treatment for chronic bowel constipation at short and long terms.
Background: Lower back pain the most prevalent conditions that leads to a visit to a pain specialist. Individuals
with lower back pain or traumatic back / spine injury compliant triage compliance will first discuss patient
presentations and patient attributes.
Methods/Deign:An comparative study was conducted in Cuttack from September 2020 to January 2022.The
total sample size was 30 and we used convenient sampling in which 10 in each group were recruited. Then the
patient was screened according to inclusion and exclusion criteria with which informed consent was given if
the patient agrees to give the consent. Then the patient was selected by convenient sampling based on eligibility
criteria. Procedure of study was explained to all the patients and written consent was taken from them. Patients
with low back pain were allocated for the study. Amongst this, group1 was given conventional physical therapy,
Group 2 was given osteopathy techniques and group 3 was given combined both physical therapy and osteopathy
techniques for 6 days a week for 6 weeks.
Results: Significant difference(p<0.001) were seen in group 3 in both outcome measures from 2nd week.
Conclusion: The combination of both conventional physical therapy and osteopathy manipulative techniques will
help in better way in patients with lower back pain.
Background: Lower back pain the most prevalent conditions that leads to a visit to a pain specialist. Individuals
with lower back pain or traumatic back / spine injury compliant triage compliance will first discuss patient
presentations and patient attributes.
Methods/Deign:An comparative study was conducted in Cuttack from September 2020 to January 2022.The
total sample size was 30 and we used convenient sampling in which 10 in each group were recruited. Then the
patient was screened according to inclusion and exclusion criteria with which informed consent was given if
the patient agrees to give the consent. Then the patient was selected by convenient sampling based on eligibility
criteria. Procedure of study was explained to all the patients and written consent was taken from them. Patients
with low back pain were allocated for the study. Amongst this, group1 was given conventional physical therapy,
Group 2 was given osteopathy techniques and group 3 was given combined both physical therapy and osteopathy
techniques for 6 days a week for 6 weeks.
Results: Significant difference(p<0.001) were seen in group 3 in both outcome measures from 2nd week.
Conclusion: The combination of both conventional physical therapy and osteopathy manipulative techniques will
help in better way in patients with lower back pain.
Abstract
Background and purpose: Systematic review and meta-analysis to assess the
effectiveness of visceral osteopathy in improving pain intensity, disability and physical
function in patients with low-back pain (LBP).
Materials and methods: MEDLINE (Pubmed), PEDro, SCOPUS, Cochrane Library and
Web of Science databases were searched from inception to February 2022. PICO search
strategy was used to identify randomized controlled trials applying visceral techniques in
patients with LBP. Eligible studies and data extraction were conducted independently by
two reviewers. Quality of the studies was assessed with the Physiotherapy Evidence
Database scale, and the risk of bias with Cochrane Collaboration tool. Meta-analyses were
conducted using fixed or random effects models according to heterogeneity assessed with
I2 coefficient. Data on outcomes of interest were extracted by a researcher using RevMan
5.4 software.
Results: Five studies were included in the systematic review involving 268 patients with
LBP. The methodological quality of the included ranged from high to low and the risk of
bias was high. Visceral osteopathy techniques have shown no improvements in pain
intensity (Standardized mean difference (SMD) = -0.53; 95% CI; -1.09, 0.03; I2: 78%),
disability (SMD = -0.08; 95% CI; -0.44, 0.27; I2: 0%) and physical function (SMD = -
0.26; 95% CI; -0.62, 0.10; I2: 0%) in patients with LBP.
Conclusions: This systematic review and meta-analysis showed a lack of high-quality
studies showing the effectiveness of visceral osteopathy in pain, disability, and physical
function in patients with LBP.
Objective
The purpose of this study was to assess abdominal and diaphragmatic mobility in adults with chronic gastritis compared with healthy individuals and to analyze the impact of chronic gastritis on musculoskeletal signs and symptoms of the cervical and thoracic spine.
Methods
This was a cross-sectional study conducted by the physiotherapy department at the Universidade Federal de Pernambuco in Brazil. Fifty-seven individuals participated, 28 with chronic gastritis (gastritis group [GG]) and 29 healthy individuals (control group [CG]). We assessed the following: restricted abdominal mobility in the transverse, coronal, and sagittal planes; diaphragmatic mobility; restricted cervical vertebral segmental mobility; restricted thoracic vertebral segmental mobility; and pain on palpation, asymmetry, and density and texture of the soft tissues on the cervical and thoracic spine. The measure of diaphragmatic mobility was assessed with ultrasound imaging. The Fisher exact and χ² tests were applied to compare the groups (GG and CG) in relation to the restricted mobility of the abdominal tissues near the stomach on all planes and diaphragm, and the independent samples t test to compare the mobility measurements of the diaphragm. A significance level of 5% was considered for all tests.
Results
Restricted abdominal mobility in all directions (P < .05) was greater in GG when compared with CG except for the counterclockwise direction (P = .09). In GG, 93% of the individuals presented restricted diaphragmatic mobility, with a mean mobility of 3.1 ± 1.9 cm, and in the CG, 36.8% with a mean of 6.9 + 1.7 cm (P < .001). The GG presented a higher occurrence of restricted rotation and lateral glide mobility of the cervical vertebrae, pain to palpation, and density and texture dysfunction of the adjacent tissues when compared with CG (P < .05). In the thoracic region, there was no difference between GG and CG regarding musculoskeletal signs and symptoms.
Conclusion
Individuals with chronic gastritis presented greater abdominal restriction and lower diaphragmatic mobility, in addition to a higher occurrence of musculoskeletal dysfunction in the cervical spine when compared with healthy individuals.
Objective: To discuss the professional identify of chiropractic as evident in the profession's literature. Methods: Structured literature review followed by a pragmatic historical narrative of found artefacts. Results: The literature appears vague regarding chiropractic's identity. Discussion: The literature does allow a broad determination that the identity of chiropractic is uni-modal gathered around the founding premise of DD Palmer with an informed prediction of a left-skewed, negative distribution of concessional chiropractors representing no more than 30% of all. It appears this minority becomes more dogmatic as it concedes elements of conventional identity and adopts extreme evidence-based musculoskeletal medicine to become a sect of about 0.2% of all. About 70% of chiropractors identify with subluxation in an evidence-informed context and I call this representation the conventional chiropractic identity. Conclusion: The identity of chiropractic may now be described as conventional when its practitioners adhere to the profession's founding precepts, or concessional when it modifies or ignores these. The majority of the profession can be considered conventional. (J Contemporary Chiropr 2020;3:111-126)
OBJECTIVE
This systematic review is to evaluate the impact of visceral mobilization or manipulation in improving low back pain via standard protocols.MATERIALS AND METHODS
Literature was searched electronically on various databases such as PEDro, PubMed Central, Google Scholar, BioMed Central, MEDLINE, EMBASE and Science Direct considering duration of 2011 to 2019. Randomized Controlled Trials investigating effectiveness of visceral manipulation or mobilization, either, in the comparison with differentmodalities or with sham/placebo were included. Data was extracted and studies were reviewed on standardized qualitative assessment criteria. Cochrane guidelines were followed to find out the risk of bias among the included studies.RESULTSAll the studies provided moderate to high quality evidence in favor of visceral mobilization or manipulation being effective on low back pain in terms of risk of bias and quality assessment with significant results (p-value <0.05).CONCLUSION
The available studies provided the significant and strong effectiveness of visceral manipulation and mobilization. However, scarcity of literature in domain raises an inevitable need for further studies to be conducted in future.
Nociceptor inputs can trigger a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways, the phenomenon of central sensitization. Central sensitization manifests as pain hypersensitivity, particularly dynamic tactile allodynia, secondary punctate or pressure hyperalgesia, aftersensations, and enhanced temporal summation. It can be readily and rapidly elicited in human volunteers by diverse experimental noxious conditioning stimuli to skin, muscles or viscera, and in addition to producing pain hypersensitivity, results in secondary changes in brain activity that can be detected by electrophysiological or imaging techniques. Studies in clinical cohorts reveal changes in pain sensitivity that have been interpreted as revealing an important contribution of central sensitization to the pain phenotype in patients with fibromyalgia, osteoarthritis, musculoskeletal disorders with generalized pain hypersensitivity, headache, temporomandibular joint disorders, dental pain, neuropathic pain, visceral pain hypersensitivity disorders and post-surgical pain. The comorbidity of those pain hypersensitivity syndromes that present in the absence of inflammation or a neural lesion, their similar pattern of clinical presentation and response to centrally acting analgesics, may reflect a commonality of central sensitization to their pathophysiology. An important question that still needs to be determined is whether there are individuals with a higher inherited propensity for developing central sensitization than others, and if so, whether this conveys an increased risk in both developing conditions with pain hypersensitivity, and their chronification. Diagnostic criteria to establish the presence of central sensitization in patients will greatly assist the phenotyping of patients for choosing treatments that produce analgesia by normalizing hyperexcitable central neural activity. We have certainly come a long way since the first discovery of activity-dependent synaptic plasticity in the spinal cord and the revelation that it occurs and produces pain hypersensitivity in patients. Nevertheless, discovering the genetic and environmental contributors to and objective biomarkers of central sensitization will be highly beneficial, as will additional treatment options to prevent or reduce this prevalent and promiscuous form of pain plasticity.
The aim of this study was to present and compare the content of (inter)national clinical guidelines for the management of low back pain. To rationalise the management of low back pain, evidence-based clinical guidelines have been issued in many countries. Given that the available scientific evidence is the same, irrespective of the country, one would expect these guidelines to include more or less similar recommendations regarding diagnosis and treatment. We updated a previous review that included clinical guidelines published up to and including the year 2000. Guidelines were included that met the following criteria: the target group consisted mainly of primary health care professionals, and the guideline was published in English, German, Finnish, Spanish, Norwegian, or Dutch. Only one guideline per country was included: the one most recently published. This updated review includes national clinical guidelines from 13 countries and 2 international clinical guidelines from Europe published from 2000 until 2008. The content of the guidelines appeared to be quite similar regarding the diagnostic classification (diagnostic triage) and the use of diagnostic and therapeutic interventions. Consistent features for acute low back pain were the early and gradual activation of patients, the discouragement of prescribed bed rest and the recognition of psychosocial factors as risk factors for chronicity. For chronic low back pain, consistent features included supervised exercises, cognitive behavioural therapy and multidisciplinary treatment. However, there are some discrepancies for recommendations regarding spinal manipulation and drug treatment for acute and chronic low back pain. The comparison of international clinical guidelines for the management of low back pain showed that diagnostic and therapeutic recommendations are generally similar. There are also some differences which may be due to a lack of strong evidence regarding these topics or due to differences in local health care systems. The implementation of these clinical guidelines remains a challenge for clinical practice and research.
Although the connective tissues forming the fascial planes of the back have been hypothesized to play a role in the pathogenesis of chronic low back pain (LBP), there have been no previous studies quantitatively evaluating connective tissue structure in this condition. The goal of this study was to perform an ultrasound-based comparison of perimuscular connective tissue structure in the lumbar region in a group of human subjects with chronic or recurrent LBP for more than 12 months, compared with a group of subjects without LBP.
In each of 107 human subjects (60 with LBP and 47 without LBP), parasagittal ultrasound images were acquired bilaterally centered on a point 2 cm lateral to the midpoint of the L2-3 interspinous ligament. The outcome measures based on these images were subcutaneous and perimuscular connective tissue thickness and echogenicity measured by ultrasound.
There were no significant differences in age, sex, body mass index (BMI) or activity levels between LBP and No-LBP groups. Perimuscular thickness and echogenicity were not correlated with age but were positively correlated with BMI. The LBP group had approximately 25% greater perimuscular thickness and echogenicity compared with the No-LBP group (ANCOVA adjusted for BMI, p<0.01 and p<0.001 respectively).
This is the first report of abnormal connective tissue structure in the lumbar region in a group of subjects with chronic or recurrent LBP. This finding was not attributable to differences in age, sex, BMI or activity level between groups. Possible causes include genetic factors, abnormal movement patterns and chronic inflammation.
The purpose of the present study was to translate the Roland-Morris (RM) questionnaire into Brazilian-Portuguese and adapt and validate it. First 3 English teachers independently translated the original questionnaire into Brazilian-Portuguese and a consensus version was generated. Later, 3 other translators, blind to the original questionnaire, performed a back translation. This version was then compared with the original English questionnaire. Discrepancies were discussed and solved by a panel of 3 rheumatologists and the final Brazilian version was established (Brazil-RM). This version was then pretested on 30 chronic low back pain patients consecutively selected from the spine disorders outpatient clinic. In addition to the traditional clinical outcome measures, the Brazil-RM, a 6-point pain scale (from no pain to unbearable pain), and its numerical pain rating scale (PS) (0 to 5) and a visual analog scale (VAS) (0 to 10) were administered twice by one interviewer (1 week apart) and once by one independent interviewer. Spearman's correlation coefficient (SCC) and intraclass correlation coefficient (ICC) were computed to assess test-retest and interobserver reliability. Cross-sectional construct validity was evaluated using the SCC. In the pretesting session, all questions were well understood by the patients. The mean time of questionnaire administration was 4 min and 53 s. The SCC and ICC were 0.88 (P<0.01) and 0.94, respectively, for the test-retest reliability and 0.86 (P<0.01) and 0.95, respectively, for interobserver reliability. The correlation coefficient was 0.80 (P<0.01) between the PS and Brazil-RM score and 0.79 (P<0.01) between the VAS and Brazil-RM score. We conclude that the Brazil-RM was successfully translated and adapted for application to Brazilian patients, with satisfactory reliability and cross-sectional construct validity.
The objective was to estimate the psychometric properties of the Modified-Modified Schober Test (MMST).
This study compared range of motion measurements of lumbar flexion in low back pain (LBP) patients using the MMST with measurements calculated on X-rays as the gold standard, and compared the measurements taken by two independent examiners.
This study was conducted at the main hospital in the Outaouais area, Quebéc, Canada. Thirty-one subjects with LBP from private and public clinics participated in the study. After a warm-up session, measurements with the MMST were taken in neutral position and an X-ray technician took an exposure in the same position.
Pearson's correlation test (r) between measurements made with the MMST and the gold standard, intra-class correlation coefficient (ICC), minimum metrically detectable change (MMDC) and confidence interval (CI) were used to analyze the data. The MMST demonstrated moderate validity (r=0.67; 95%CI 0.44-0.84), excellent reliability (intra: ICC=0.95; 95%CI 0.89-0.97; inter: ICC=0.91; 95%CI 0.83-0.96) and a MMDC of 1 cm.
In our sample of LBP patients, the MMST showed moderate validity but excellent reliability and MMDC.
The economic burden of low back pain (LBP) is very large and appears to be growing. It is not possible to impact this burden without understanding the strengths and weaknesses of the research on which these costs are calculated.
To conduct a systematic review of LBP cost of illness studies in the United States and internationally.
Systematic review of the literature.
Medline was searched to uncover studies about the direct or indirect costs of LBP published in English from 1997 to 2007. Data extracted for each eligible study included study design, population, definition of LBP, methods of estimating costs, year of data, and estimates of direct, indirect, or total costs. Results were synthesized descriptively.
The search yielded 147 studies, of which 21 were deemed relevant; 4 other studies and 2 additional abstracts were found by searching reference lists, bringing the total to 27 relevant studies. The studies reported on data from Australia, Belgium, Japan, Korea, the Netherlands, Sweden, the UK, and the United States. Nine studies estimated direct costs only, nine indirect costs only, and nine both direct and indirect costs, from a societal (n=18) or private insurer (n=9) perspective. Methodology used to derive both direct and indirect cost estimates differed markedly among the studies. Among studies providing a breakdown on direct costs, the largest proportion of direct medical costs for LBP was spent on physical therapy (17%) and inpatient services (17%), followed by pharmacy (13%) and primary care (13%). Among studies providing estimates of total costs, indirect costs resulting from lost work productivity represented a majority of overall costs associated with LBP. Three studies reported that estimates with the friction period approach were 56% lower than with the human capital approach.
Several studies have attempted to estimate the direct, indirect, or total costs associated with LBP in various countries using heterogeneous methodology. Estimates of the economic costs in different countries vary greatly depending on study methodology but by any standards must be considered a substantial burden on society. This review did not identify any studies estimating the total costs of LBP in the United States from a societal perspective. Such studies may be helpful in determining appropriate allocation of health-care resources devoted to this condition.
Incomplete and inadequate reporting is an avoidable waste that reduces the usefulness of research. The CONSORT (Consolidated Standards of Reporting Trials) Statement is an evidence-based reporting guideline that aims to improve research transparency and reduce waste. In 2008, the CONSORT Group developed an extension to the original statement that addressed methodological issues specific to trials of nonpharmacologic treatments (NPTs), such as surgery, rehabilitation, or psychotherapy. This article describes an update of that extension and presents an extension for reporting abstracts of NPT trials. To develop these materials, the authors reviewed pertinent literature published up to July 2016; surveyed authors of NPT trials; and conducted a consensus meeting with editors, trialists, and methodologists. Changes to the CONSORT Statement extension for NPT trials include wording modifications to improve readers' understanding and the addition of 3 new items. These items address whether and how adherence of participants to interventions is assessed or enhanced, description of attempts to limit bias if blinding is not possible, and specification of the delay between randomization and initiation of the intervention. The CONSORT extension for abstracts of NPT trials includes 2 new items that were not specified in the original CONSORT Statement for abstracts. The first addresses reporting of eligibility criteria for centers where the intervention is performed and for care providers. The second addresses reporting of important changes to the intervention versus what was planned. Both the updated CONSORT extension for NPT trials and the CONSORT extension for NPT trial abstracts should help authors, editors, and peer reviewers improve the transparency of NPT trial reports.
Background
This study aimed to investigate whether the addition of visceral manipulation, to a standard physiotherapy algorithm, improved outcomes in patients with low back pain.Methods
Sixty-four patients with low back pain who presented for treatment at a private physiotherapy clinic were randomized to one of two groups: standard physiotherapy plus visceral manipulation (n = 32) or standard physiotherapy plus placebo visceral manipulation (n = 32). The primary outcome was pain (measured with the 0–10 Numerical Pain Rating Scale) at 6 weeks. Secondary outcomes were pain at 2 and 52 weeks, disability (measured with the Roland-Morris Disability Questionnaire) at 2, 6 and 52 weeks and function (measured with the Patient-Specific Functional Scale) at 2, 6 and 52 weeks. This trial was registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12611000757910).ResultsThe addition of visceral manipulation did not affect the primary outcome of pain at 6 weeks (−0.12, 95% CI = −1.45 to 1.21). There were no significant between-group differences for the secondary outcomes of pain at 2 weeks or disability and function at 2, 6 or 52 weeks. The group receiving addition of visceral manipulation had less pain than the placebo group at 52 weeks (mean 1.57, 95% CI = 0.32 to 2.82). Participants were adequately blinded to group status and there were no adverse effects reported in either group.Conclusions
Our study suggests that visceral manipulation in addition to standard care is not effective in changing short-term outcomes but may produce clinically worthwhile improvements in pain at 1 year.
Even though nociceptive pathology has often long subsided, the brain of patients with chronic musculoskeletal pain has typically acquired a protective (movement-related) pain memory. Exercise therapy for patients with chronic musculoskeletal pain is often hampered by such pain memories. Here the authors explain how musculoskeletal therapists can alter pain memories in patients with chronic musculoskeletal pain, by integrating pain neuroscience education with exercise interventions. The latter includes applying graded exposure in vivo principles during exercise therapy, for targeting the brain circuitries orchestrated by the amygdala (the memory of fear centre in the brain).
Before initiating exercise therapy, a preparatory phase of intensive pain neuroscience education is required. Next, exercise therapy can address movement-related pain memories by applying the ‘exposure without danger’ principle. By addressing patients’ perceptions about exercises, therapists should try to decrease the anticipated danger (threat level) of the exercises by challenging the nature of, and reasoning behind their fears, assuring the safety of the exercises, and increasing confidence in a successful accomplishment of the exercise. This way, exercise therapy accounts for the current understanding of pain neuroscience, including the mechanisms of central sensitization.
The purpose of this preliminary study was demonstrate if it was feasible to evaluate variations in acceleration of trunk movement, pain, and disability during an episode of acute nonspecific low back pain comparing regular trunk exercises to regular exercises in addition to core stability exercises.
A pilot randomized controlled trial was used to evaluate 33 participants recruited from a National Health Service physiotherapy musculoskeletal provider in the London district of Hillingdon. Participants were allocated to 2 groups; a regular exercise group (male, 2; female, 15) with a mean (SD) age of 35.8 (9.1) years and intervention group (male, 3; female, 13) with a mean (SD) age of 36.2 (9.8) years. The regular exercise group received exercise that consisted of a core stability class including both specific and global trunk exercises. The intervention group, in addition to these core exercises, received further instruction on 8 specific stabilization muscles involving the transversus abdominis and the lumbar multifidus. Trunk sagittal acceleration, pain, and disability were measured using a Lumbar Motion Monitor, pain visual analog scale, and Roland Morris Disability Questionnaire, respectively. Measures were taken at baseline, 3 and 6 weeks, and a 3-month follow-up. Multiple regression with adjustment for baseline value was used to analyze each outcome. All outcomes were log transformed to correct skewness and so presented as ratio of geometric means with 95% confidence interval.
Differences in mean trunk sagittal acceleration between the regular exercise and intervention groups was not statistically significant at any time point (ratio of means [95% confidence interval]: 3 weeks 1.2 [0.9-1.6], P = .2; 6 weeks 1.1 [0.8-1.5], P = .7; 3 months: 1.2 [0.8-1.9], P = .9). Similarly, the effects on neither pain score nor disability score were significant (pain score: 3 weeks 1.3 [0.8-2.2], P = .3); 6 weeks 1.2 [0.7-2.0], P = .6; 3 months 1.0 [0.5-1.9], P = 1.0); disability score: 6 weeks 1.0 [0.7-1.5], P = 1.0; 3 months 1.3 [0.8-1.9], P = .3). Outcome measures for both groups improved over time.
This pilot study demonstrated that a study of this nature is feasible. Both the regular exercise and the intervention groups demonstrated improvements in mean trunk sagittal acceleration at 3, 6, and 12 weeks. The preliminary findings showed that evidence was inconclusive for the beneficial effect of adding specific core stability exercises for acute low back pain. The results of this study demonstrated an increase in acceleration accompanied by a reduction in pain, which may suggest that acute nonspecific low back pain may induce the pain-spasm-pain model rather than the pain adaptation model.
Background: Conventional medical treatment for constipation typically consists of dietary modification, increased fluid intake and exercise frequency, but many people do not respond to these interventions. Osteopathic treatment is claimed to restore normal function to the digestive system and related somatic structures and may provide an effective treatment for constipation. Objective: To examine the effect of osteopathic manipulative treatment for people with chronic constipation over a four week period. Methods: Six participants (mean age 48.5 ± 14.1 years) with chronic constipation were treated utilising a semi-standardised osteopathic treatment. Each participant was examined and treated six times over four weeks. Treatment outcomes were measured pre-treatment, during and one week following the treatment period using validated outcome measures specific to bowel function. Results: Following treatment there was a significant improvement in the severity of their constipation (p < 0.01), overall symptom improvement (p < 0.01), improved colonic transit times (p < 0.01) and overall quality of life (p < 0.01). Conclusion: Participants reported an improvement in the overall severity of constipation, symptoms and quality of life. Further investigation of osteopathic treatment of constipation is recommended using larger sample sizes and a randomized controlled design. Crown
a) To calculate and compare a Kidney Mobility Score (KMS) in asymptomatic and Low Back Pain (LBP) individuals through real-time Ultrasound (US) investigation. b) To assess the effect of Osteopathic Fascial Manipulation (OFM), consisting of Still Technique (ST) and Fascial Unwinding (FU), on renal mobility in people with non-specific LBP. c) To evaluate 'if' and 'to what degree' pain perception may vary in patients with LBP, after OFM is applied.
101 asymptomatic people (F 30; M 71; mean age 38.9 ± 8) were evaluated by abdominal US screening. The distance between the superior renal pole of the right kidney and the ipsilateral diaphragmatic pillar was calculated in both maximal expiration (RdE) and maximal inspiration (RdI). The mean of the RdE-RdI ratios provided a Kidney Mobility Score (KMS) in the cohort of asymptomatic people. The same procedure was applied to 140 participants (F 66; M 74; mean age 39.3 ± 8) complaining of non-specific LBP: 109 of whom were randomly assigned to the Experimental group and 31 to the Control group. For both groups, a difference of RdE and RdI values was calculated (RD = RdE-RdI), before (RD-T0) and after (RD-T1) treatment was delivered, to assess the effective range of right kidney mobility.
A blind assessment of each patient was carried using US screening. Both groups completed a Short-Form McGill Pain Assessment Questionnaire (SF-MPQ) on the day of recruitment (SF-MPQ T0) as well as on the third day following treatment (SF-MPQ T1). An Osteopathic assessment of the thoraco-lumbo-pelvic region to all the Experimental participants was performed, in order to identify specific areas of major myofascial tension.
Each individual of the Experimental group received OFM by the same Osteopath who had previously assessed them. A sham-treatment was applied to the Control group for the equivalent amount of time.
a) The factorial ANOVA test showed a significant difference (p-value < 0.05) between KMS in asymptomatic individuals (1.92 mm, Std. Dev. 1.14) compared with the findings in patients with LBP (1.52 mm, Std. Dev. 0.79). b) The ANOVA test at repeated measures showed a significant difference (p-value < 0.0001) between pre- to post-RD values of the Experimental group compared with those found in the Control. c) A significant difference (p-value < 0.0001) between pre- to post-SF-MPQ results was found in the Experimental cohort compared with those obtained in the Control.
People with non-specific LBP present with a reduced range of kidney mobility compared to the findings in asymptomatic individuals. Osteopathic manipulation is shown to be an effective manual approach towards improvement of kidney mobility and reduction of pain perception over the short-term, in individuals with non-specific LBP.
To perform a systematic review of the global prevalence of low back pain, and to examine the influence that case definition, prevalence period, and other variables have on prevalence.
We conducted a new systematic review of the global prevalence of low back pain that included general population studies published between 1980 and 2009. A total of 165 studies from 54 countries were identified. Of these, 64% had been published since the last comparable review.
Low back pain was shown to be a major problem throughout the world, with the highest prevalence among female individuals and those aged 40-80 years. After adjusting for methodologic variation, the mean ± SEM point prevalence was estimated to be 11.9 ± 2.0%, and the 1-month prevalence was estimated to be 23.2 ± 2.9%.
As the population ages, the global number of individuals with low back pain is likely to increase substantially over the coming decades. Investigators are encouraged to adopt recent recommendations for a standard definition of low back pain and to consult a recently developed tool for assessing the risk of bias of prevalence studies.
Peritoneal adhesions are almost ubiquitous following surgery. Peritoneal adhesions can lead to bowel obstruction, digestive problems, infertility, and pain, resulting in many hospital readmissions. Many approaches have been used to prevent or treat adhesions, but none offer reliable results. A method that consistently prevented or treated adhesions would benefit many patients. We hypothesized that an anatomically-based visceral mobilization, designed to promote normal mobility of the abdominal contents, could manually lyse and prevent surgically-induced adhesions.
Cecal and abdominal wall abrasion was used to induce adhesions in 3 groups of 10 rats (Control, Lysis, and Preventive). All rats were evaluated 7 days following surgery. On postoperative day 7, unsedated rats in the Lysis group were treated using visceral mobilization, consisting of digital palpation, efforts to manually lyse restrictions, and mobilization of their abdominal walls and viscera. This was followed by immediate post-mortem adhesion evaluation. The rats in the Preventive group were treated daily in a similar fashion, starting the day after surgery. Adhesions in the Control rats were evaluated 7 days after surgery without any visceral mobilization.
The therapist could palpate adhesions between the cecum and other viscera or the abdominal wall. Adhesion severity and number of adhesions were significantly lower in the Preventive group compared to other groups. In the Lysis and Preventive groups there were clear signs of disrupted adhesions.
These initial observations support visceral mobilization may have a role in the prevention and treatment of post-operative adhesions.
Systematic review of the literature.
To summarize peer-reviewed literature on the reliability, validity, and responsiveness of the Patient-Specific Functional Scale (PSFS), and to identify its use as an outcome measure.
Searches were performed of several electronic databases from 1995 to May 2010. Studies included were published articles containing (1) primary research investigating the psychometric and clinimetrics of the PSFS or (2) the implementation of the PSFS as an outcome measure. We assessed the methodological quality of studies included in the first category.
Two hundred forty-two articles published from 1994 to May 2010 were identified. Of these, 66 met the inclusion criteria for this review, with 13 reporting the measurement properties of the PSFS, 55 implementing the PSFS as an outcome measure, and 2 doing both of the above. The PSFS was reported to be valid, reliable, and responsive in populations with knee dysfunction, cervical radiculopathy, acute low back pain, mechanical low back pain, and neck dysfunction. The PSFS was found to be reliable and responsive in populations with chronic low back pain. The PSFS was also reported to be valid, reliable, or responsive in individuals with a limited number of acute, subacute, and chronic conditions. This review found that the PSFS is also being used as an outcome measure in many other conditions, despite a lack of published evidence supporting its validity in these conditions.
Although the use of the PSFS as an outcome measure is increasing in physiotherapy practice, there are gaps in the research literature regarding its validity, reliability, and responsiveness in many health conditions.
Translation, cross-cultural adaptation, and clinimetric testing of self-report outcome measures.
The aims of this investigation were to perform the translation and cross-cultural adaptation of the Patient-Specific Functional Scale (PSFS) into Brazilian-Portuguese and to perform a head-to-head comparison of the clinimetric properties of the Brazilian-Portuguese versions of the PSFS, the Roland-Morris Disability Questionnaire (RMDQ) and the Functional Rating Index (FRI).
To date, there is no Brazilian-Portuguese version of the PSFS available and no head-to-head comparison of the Brazilian-Portuguese versions of the PSFS, RMDQ, and FRI has been undertaken.
The PSFS was translated and adapted into Brazilian-Portuguese. The PSFS, the RMDQ, and the FRI were administered to 99 patients with low back pain to evaluate internal consistency, reproducibility, ceiling and floor effects, construct validity, internal and external responsiveness. To fully test the construct validity and external responsiveness of these measures, it was necessary to cross-culturally adapt the Pain Numerical Rating Scale and the Global Perceived Effect Scale.
All measures demonstrated high levels of internal consistency (Cronbach's alpha range = 0.88-0.90) and reproducibility (Intraclass Correlation Coefficient 2,1 range = 0.85-0.94). High correlations among the disability-related measures were observed (Pearson's r ranging from 0.51 to 0.71). No ceiling or floor effects were detected. The PSFS was consistently more responsive than the other measures in both the internal responsiveness and external responsiveness analyses.
The results from this study demonstrate that the Brazilian-Portuguese versions of the RMDQ, the FRI and the PSFS have similar clinimetric properties to each other and to the original English versions. Of allthe measures tested in this study the PSFS seems the most responsive. These measures will enable international comparisons to be performed, and encourage researchers to include Portuguese speakers in their clinical trials.
Objective:
For many individuals with chronic low back pain (CLBP), there is no identifiable cause. In other idiopathic chronic pain conditions, sensory testing and functional magnetic resonance imaging (fMRI) have identified the occurrence of generalized increased pain sensitivity, hyperalgesia, and altered brain processing, suggesting central augmentation of pain processing in such conditions. We compared the results of both of these methods as applied to patients with idiopathic CLBP (n = 11), patients with widespread pain (fibromyalgia; n = 16), and healthy control subjects (n = 11).
Methods:
Patients with CLBP had low back pain persisting for at least 12 months that was unexplained by MRI/radiographic changes. Experimental pain testing was performed at a neutral site (thumbnail) to assess the pressure-pain threshold in all subjects. For fMRI studies, stimuli of equal pressure (2 kg) and of equal subjective pain intensity (slightly intense pain) were applied to this same site.
Results:
Despite low numbers of tender points in the CLBP group, experimental pain testing revealed hyperalgesia in this group as well as in the fibromyalgia group; the pressure required to produce slightly intense pain was significantly higher in the controls (5.6 kg) than in the patients with CLBP (3.9 kg) (P = 0.03) or the patients with fibromyalgia (3.5 kg) (P = 0.006). When equal amounts of pressure were applied to the 3 groups, fMRI detected 5 common regions of neuronal activation in pain-related cortical areas in the CLBP and fibromyalgia groups (in the contralateral primary and secondary [S2] somatosensory cortices, inferior parietal lobule, cerebellum, and ipsilateral S2). This same stimulus resulted in only a single activation in controls (in the contralateral S2 somatosensory cortex). When subjects in the 3 groups received stimuli that evoked subjectively equal pain, fMRI revealed common neuronal activations in all 3 groups.
Conclusion:
At equal levels of pressure, patients with CLBP or fibromyalgia experienced significantly more pain and showed more extensive, common patterns of neuronal activation in pain-related cortical areas. When stimuli that elicited equally painful responses were applied (requiring significantly lower pressure in both patient groups as compared with the control group), neuronal activations were similar among the 3 groups. These findings are consistent with the occurrence of augmented central pain processing in patients with idiopathic CLBP.
Cohort study of patients with low back pain (LBP) receiving physical therapy.
To examine the responsiveness characteristics of the numerical pain rating scale (NPRS) in patients with LBP using a variety of methods.
Although several studies have assessed the reliability and validity of the NPRS, few studies have characterized its responsiveness in patients with LBP.
Determination of change on the NPRS during 1 and 4 weeks was examined by calculating mean change, standardized effect size, Guyatt Responsiveness Index, area under a receiver operating characteristic curve, minimum clinically important difference, and minimum detectable change. Change in the NPRS from baseline to the 1 and 4-week follow-up was compared to the average of the patient and therapist's perceived improvement using the 15-point Global Rating of Change scale.
The majority of patients had clinically meaningful improvement after both 1 and 4 weeks of rehabilitation. The standard error of measure was equal to 1.02, corresponding to a minimum detectable change of 2 points. The area under the curve at the 1 and 4-week follow-up was 0.72 (0.62, 0.81) and 0.92 (0.86, 0.97), respectively. The minimum clinically important difference at the 1 and 4-week follow-up corresponded to a change of 2.2 and 1.5 points, respectively.
Clinicians can be confident that a 2-point change on the NPRS represents clinically meaningful change that exceeds the bounds of measurement error.
Although obesity and physical activity have been argued to predict back pain, these factors are also related to incontinence and breathing difficulties. Breathing and continence mechanisms may interfere with the physiology of spinal control, and may provide a link to back pain. The aim of this study was to establish the association between back pain and disorders of continence and respiration in women. We conducted a cross-sectional analysis of self-report, postal survey data from the Australian Longitudinal Study on Women's Health. We used multinomial logistic regression to model four levels of back pain in relation to both the traditional risk factors of body mass index and activity level, and the potential risk factors of incontinence, breathing difficulties, and allergy. A total of 38,050 women were included from three age-cohorts. When incontinence and breathing difficulties were considered, obesity and physical activity were not consistently associated with back pain. In contrast, odds ratios (OR) for often having back pain were higher for women often having incontinence compared to women without incontinence (OR were 2.5, 2.3 and 2.3 for young, mid-age and older women, respectively). Similarly, mid-aged and older women had higher odds of having back pain often when they experienced breathing difficulties often compared to women with no breathing problems (OR of 2.0 and 1.9, respectively). Unlike obesity and physical activity, disorders of continence and respiration were strongly related to frequent back pain. This relationship may be explained by physiological limitations of co-ordination of postural, respiratory and continence functions of trunk muscles.
This study examined the relationship between back pain and gastrointestinal (GI) symptoms in a large scale population study with consideration of possible confounding factors.
Cross-sectional analysis of survey data from the Australian Longitudinal Study on Women's Health was conducted using multinomial logistic regression to model 4 frequencies of back pain in relation to number of GI symptoms (including constipation, hemorrhoids, and other bowel problems). A total of 38,050 women from 3 age cohorts were included in analysis.
After adjustment for confounding factors, the number of GI symptoms was significantly associated with back pain among all age cohorts. Odds ratios for experiencing back pain "rarely," "sometimes," and "often" increased with the number of GI symptoms. Young, mid-age, and older women who experience 2 or 3 GI symptoms had adjusted odds ratios of 3.3 (2.5 to 4.4), 3.0 (2.5 to 3.7) and 2.8 (2.3 to 3.4), respectively, for "often" having back pain.
This study has identified a strong association between back pain and GI symptoms in women. Possible factors that may account for this relationship include referred pain through viscerosomatic convergence, altered pain perception, increased spinal loading when straining during defecation, or reduced support of the abdominal contents and spine secondary to changes in function of the abdominal muscles.
Motor control exercise for chronic non-specific low-back pain
- B Saragiotto
- C Maher
- T Ymato
Saragiotto B, Maher C, Ymato T, et al. Motor control exercise
for chronic non-specific low-back pain. Cochrane Database
Syst Rev. 2016;1:CD012004.
Clinically Oriented Anatomy
- K L Moore
- A F Dalley
- Amr Agur
Moore KL, Dalley AF, Agur AMR. Clinically Oriented
Anatomy. Philadelphia, PA: Wolters Kluwer Health/Lippincott
Williams & Wilkins; 2013.
An updated overview of clinical guidelines for the management of non-specific low back pain in primary care
- B W Koes
- M Van Tulder
- C-Wc Lin
- L G Macedo
- J Mcauley
- C Maher
Koes BW, van Tulder M, Lin C-WC, Macedo LG,
McAuley J, Maher C. An updated overview of clinical
guidelines for the management of non-specific low
back pain in primary care. Eur Spine J. 2010;19(12):
2075-2094.
The patient-specific functional scale: psychometrics, clinimetrics, and application as a clinical outcome measure
- K Kowalchuk-Horn
- Jennings S Richardson
- G Vanvliet
- D Hefford
- C Abbott
Kowalchuk-Horn K, Jennings S, Richardson G, VanVliet D,
Hefford C, Abbott JH. The patient-specific functional scale:
psychometrics, clinimetrics, and application as a clinical
outcome measure. J Orthop Sports Phys Ther. 2011;42(1):
30-40.
Clinimetric testing of three self-report outcome measures for low back pain patients in Brazil: which one is the best? Spine (Phila Pa 1976)
- L Oliveira
- P Costa
- C G Maher
Oliveira L, Costa P, Maher CG, et al. Clinimetric testing of
three self-report outcome measures for low back pain patients
in Brazil: which one is the best? Spine (Phila Pa 1976). 2008;
33(22):2459-2463.