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Assessing the efficacy of a specific physiotherapy intervention for the prevention of low back pain in female adolescent rowers: a field study
Abstract
Objectives: To determine the efficacy of a specific physiotherapy intervention administered to adolescent female rowers with the aim to decrease the prevalence of low back pain (LBP) and associated levels of pain and disability. A secondary aim of the study was to determine whether changes in lower limb endurance and flexibility were evident in an experimental group. Design: A non randomized controlled trial in adolescent female rowers with and without LBP. Setting: Curtin University of Technology, Western Australia and the participating private school boatshed, Perth, Western Australia. Participants: Participants were 82 adolescent female rowers, with and without LBP. These participants attended the same school and were aged between 13-17 years [experimental group 13.9(0.9) years, control group 13.8(1.0) years] Main Outcome Measures: Primary outcome measures in this study included; LBP point prevalence, pain intensity (utilizing a visual analogue scale) and disability level (utilizing a modified Oswestry questionnaire). These measures were taken at four time points over the rowing season. Secondary outcome measures of lower limb flexibility (sit and reach test) and lower limb endurance (timed squat test) were taken in the experimental group only. Results: The experimental group demonstrated a significant reduction in the prevalence of LBP across the rowing season 48% to 19% pre-season to midseason and from 48% to 24% pre-season to end-season. The prevalence of LBP in the control group slightly increased from 22% to 25% pre-season to mid-IV season and was unchanged at 22% pre-season to end-season. A significant increase in the proportion of subjects pain-free was shown in the experimental group at mid-season compared with pre-season (p=0.007), but no change thereafter (p>0.05). In the control group the proportion pain-free remained relatively stable across the four time points (p>O.2 for changes between consecutive times). The experimental group rowers demonstrated reduced pain intensity over the course of the rowing season compared with the control group [mean pre-end season exp 6.4(21.0), control -2.7(17.6) Z= -2.283, P = 0.022]. Levels of disability did not differ between the groups across the rowing season. Significant improvements in lower limb endurance and flexibility were observed in the experimental group (p=<0.05). Conclusions: A specific physiotherapy exercise intervention was effective in reducing the prevalence of LBP in a population of adolescent female rowers and reducing pain intensity levels in subjects who complained of LBP at the commencement of the rowing season. A randomized trial to test the intervention under more rigorous scientific conditions is recommended.
... Eight articles met the selection criteria2930314748495051, which made a total of 16 independent analysis units, or groups, of which 11 were treatment groups and 5 control groups. (Additional file 2).Table 1 shows the individual characteristics of each of the integrated studies. ...
... In two articles (three treatment groups) subjects were randomly assigned to groups [30,31] and in one article the groups were randomly assigned but the subjects were not [29]. Only one study [48] used an active control group, in comparison with an inactive control group. The sample size in the treatment group at the posttest was more than fifteen subjects in seven articles [ ...
Background
Low back pain (LBP) in adolescents is associated with LBP in later years. In recent years treatments have been administered to adolescents for LBP, but it is not known which physical therapy treatment is the most efficacious. By means of a meta-analysis, the current study investigated the effectiveness of the physical therapy treatments for LBP in children and adolescents.
Methods
Studies in English, Spanish, French, Italian and Portuguese, and carried out by March 2011, were selected by electronic and manual search. Two independent researchers coded the moderator variables of the studies, and performed the effect size calculations. The mean effect size index used was the standardized mean change between the pretest and posttest, and it was applied separately for each combination of outcome measures, (pain, disability, flexibility, endurance and mental health) and measurement type (self-reports, and clinician assessments).
Results
Eight articles that met the selection criteria enabled us to define 11 treatment groups and 5 control groups using the group as the unit of analysis. The 16 groups involved a total sample of 334 subjects at the posttest (221 in the treatment groups and 113 in the control groups). For all outcome measures, the average effect size of the treatment groups was statistically and clinically significant, whereas the control groups had negative average effect sizes that were not statistically significant.
Conclusions
Of all the physical therapy treatments for LBP in children and adolescents, the combination of therapeutic physical conditioning and manual therapy is the most effective. The low number of studies and control groups, and the methodological limitations in this meta-analysis prevent us from drawing definitive conclusions in relation to the efficacy of physical therapy treatments in LBP.
Objectives
Rowing, when practiced as a sport, is currently typically conducted on sliding-seat boats which permit efficient lower limb use. Nevertheless, traditional fixed-seat rowing, with its own particular technique, is experiencing a revival and competitions utilizing this technique are held on a regular basis around the world. This paper investigated injuries sustained by competitive fixed-seat rowers when compared to rowers using the more widely studied sliding-seat technique.
Method
Two cohorts of male rowers, who train and compete on fixed-seat and sliding seat boats at national levels were asked to fill in a questionnaire looking into musculoskeletal injuries sustained as a result of their particular rowing style. Portuguese sliding-seat rowers rowed standard World Rowing (FISA) approved boats whilst fixed-seat rowers from Malta used traditional wooden boats and oars. Injury probabilities between the two cohorts were compared.
Results
Statistically significant diminution, P = 0.022, of knee injuries in the fixed-seat group was observed when compared to standard sliding-seat rowing, something which may be explained from the biomechanics of the stroke. Also, pelvic, other lower limb, neck and rib injuries were absent in the fixed-seat cohort. The incidence of back, shoulder, forearm and wrist injuries was comparable in both groups despite the increased reliance on the upper body, in the fixed-seat stroke. This means that contrary to common perception, fixed-seat rowing is a safe sport to practice. Furthermore, with its reduced risk of lower limb injuries, this technique could potentially form part of rehabilitation programs for rowers with such injuries.
The primary objective of this study was to determine the lifetime and point prevalence of low back pain, the related pain intensity and the rowing-related aggravating factors for low back pain in adolescent rowers who participated in school-level competitions. The secondary objective was to determine whether between-gender differences existed in these data.
Retrospective cross-sectional survey METHOD: 130 adolescent male and 235 adolescent female rowers aged between 14 and 16 years were recruited in this study. Participants completed a questionnaire to determine their lifetime and point prevalence of low back pain, their pain intensity and rowing-related factors that aggravated their low back pain.
A high lifetime and point prevalence of low back pain were found in both adolescent male (93.8% and 64.6%, respectively) and female (77.9% and 52.8%, respectively) rowers. A significant between-gender difference was reported for both statistics (p<0.001). A significantly lower (p=0.003) level of pain intensity via a visual analog scale was found for males (4.1/10) when compared to females (5.0/10). Similar rowing-related aggravating factors were reported by males and females although fewer males reported that lifting the rowing shell aggravated their low back pain.
A high lifetime and point prevalence of low back pain was reported by the adolescent rowers recruited in this study. While a greater proportion of adolescent male rowers reported low back pain, they reported a lower intensity of pain when compared to their female counterparts. Coaches, clinicians and rowers should be made aware of these findings such that future research and development can focus on promoting pain management strategies in this sport.
The measurement of subjective pain intensity continues to be important to both researchers and clinicians. Although several scales are currently used to assess the intensity construct, it remains unclear which of these provides the most precise, replicable, and predictively valid measure. Five criteria for judging intensity scales have been considered in previous research: (a) ease of administration of scoring; (b) relative rates of incorrect responding; (c) sensitivity as defined by the number of available response categories; (d) sensitivity as defined by statistical power; and (e) the magnitude of the relationship between each scale and a linear combination of pain intensity indices. In order to judge commonly used pain intensity measures, 75 chronic pain patients were asked to rate 4 kinds of pain (present, least, most, and average) using 6 scales. The utility and validity of the scales was judged using the criteria listed above. The results indicate that, for the present sample, the scales yield similar results in terms of the number of subjects who respond correctly to them and their predictive validity. However, when considering the remaining 3 criteria, the 101-point numerical rating scale appears to be the most practical index.
The aim of this study was to determine whether adolescent rowers with and without low back pain (LBP) displayed differences in spino-pelvic kinematics and trunk muscle activation during prolonged ergometer rowing. Ten rowers with LBP and twelve rowers without LBP performed a 20 minute ergometer trial with kinematics, muscle activation and self reported perception of pain data (VAS) collected during the trial. Results of this study show that rowers with LBP postured their lumbar spine in flexion for a greater proportion of the drive phase and nearer to their end range of flexion when compared to those without LBP. This study highlights potential mechanisms for the ramping of back pain in adolescent rowers.
The aim of the study was to compare the temporal kinematics of a stroke, spino-pelvic kinematics, trunk and quadriceps muscle activation in prolonged rgometer rowing between males and female rowers. Twelve adolescent rowers performed a 20 minute rowing ergometer trial at a high self perceived rate of exertion. Spino-pelvic kinematics, muscle activity and temporal kinematics data were compared in the 1st, 10th and 20th minute. The results from this study indicate there is a difference in temporal kinematics of a rowing stroke between adolescent males and females. Furthermore, males row with a more flexed thoracic spine and a posteriorly rotated sacrum compared to females at the catch and the finish positions.
Muscle fatigue and lack of endurance are complaints of persons with chronic low back pain, but there are no standard ways to assess endurance in this population. The purposes of this study were to examine three measures of endurance; to determine relationships of these measures to each other; and to describe effects of gender, obesity, smoking, and self-reported fitness on the clinical measures. The measures of endurance selected were not dependent on maximal voluntary muscular contractions. They were the Sorensen test, median frequency decline of selected muscles, and a submaximal bicycle ergometer test. Thirty-five consenting individuals who were referred for treatment answered questions about their daily exercise prior to being tested. Repeatability of the Sorensen test holding time and of the slope measure of decline in the median frequencies was acceptable for subjects who reported a higher activity level. The decline of the median frequency in the biceps femoris muscles correlated with holding time of the Sorensen test. Smoking, gender, or obesity level did not affect test results on any of the endurance measures. Subjects who reportedly were more active achieved significantly higher scores on the Sorensen test. The importance of controlling for self-perception of activity in physical testing is discussed.
We asked 78 chronic low back pain patients to report on their usual pain intensity, and on the lifestyle changes caused by their pain, on a horizontally-oriented visual analogue scale (VAS). Also, the usual and the current pain intensities were examined on a vertical VAS. Statistical analysis showed normal distribution of data in the measurement of usual pain on the horizontal VAS, but no homogeneous distribution on the vertical VAS. Therefore, in the measurement of chronic low back pain VAS should be used horizontally rather than vertically, because of higher sensitivity. The intensity of usual pain was significantly correlated with the degree of lifestyle change. No correlation was found between current and usual pain. There was no significant difference in the failure rate between the vertical and horizontal VAS. Also, there was no reduction of the failure rate by giving additional oral explanations in the use of the scale to the patient. Owing to a negative influence in distribution of rates and an increase in the failure rate, complex questions should be avoided. A short written introduction to the scale is sufficient, and oral explanations are not essential.
Competitive rowing is a highly aerobic sport requiring technical skills, motor coordination, adequate strength, and endurance.1,2 A number of authors13–6 have reported a significant incidence of low back pain among the rowing population. This paper identifies the factors that may influence the onset of low back pain.
During the rowing stroke, the magnitude of the forces on the lumbar spine is high. Hosea et al 7 reported average compressive loads of 3919 N for men and 3330 N for women, while anterior shear forces were found to be 848 N and 717 N for men and women respectively. Peak compressive loads during the stroke were 6066 N and 5031 N for men and women respectively. Furthermore, for 70% of the stroke cycle, rowers are in a flexed posture.7 Hosea et al 7 recorded flexion ranges averaging 28–30° which equates to 55% of maximum range of spinal flexion. Tensile stresses on the outer annulus of the intervertebral disc have been found to increase considerably above 50% flexion.8 The combination of flexion with compressive loading has been identified as a mechanism for injury to the lumbar spine structures.9 In addition to flexion and compression, sweep rowers also rotate their trunks. This combination can place considerably more stress through the facet joint capsules and ligaments and may facilitate damage to discs, although the evidence for the latter is inconclusive.9 For rowers, the time of day will also influence the magnitude of the forces on their lumbar spines. In order to have calm …
To investigate the trunk strength of elite rowers and the impact of low back pain on these measures in order to determine if asymmetries or weakness were present.
Twenty two elite rowers were recruited: 13 reported previous low back pain, five current low back pain, and the remainder had no history of low back pain. All subjects were scanned during simulated rowing in an interventional open magnetic resonance imaging scanner. In each simulated rowing position, axial scans were obtained at the level of the L4-5 and L5-S1 disc interspace to determine the cross sectional area of the posterior trunk muscles.
Considerable differences were observed between the three groups of rowers. In contrast with expectations and previous literature, the trunk muscles of rowers with low back pain had significantly larger cross sectional areas (p<0.001). No left/right asymmetries were observed and no differences between oarside and non-oarside in terms of muscle cross sectional area.
These findings suggest that low back pain in rowers does not arise as a result of muscle weakness.
Prospective study with 8-year follow-up.
To describe the evolution of low back pain from adolescence into adulthood.
High prevalence rates of low back pain among children and adolescents have been demonstrated in several studies, and it has been theorized that low back pain in childhood may have important consequences for future low back pain. It is important to understand the nature of such a link if effective preventive programs are to be established.
Almost 10,000 Danish twins born between 1972 and 1982 were surveyed by means of postal questionnaires in 1994 and again in 2002. The questionnaires dealt with various aspects of general health, including the prevalence of low back pain, classified according to number of days affected (0, 1-7, 8-30, >30).
Low back pain in adolescence was found to be a significant risk factor for low back pain in adulthood with odds ratios as high as four. We also demonstrated a dose-response association: the more days with low back pain at baseline, the higher the risk of future low back pain. Twenty-six percent of those with low back pain for more than 30 days during the baseline year also had more than 30 days with low back pain during the follow-up year. This was true for only 9% of the rest of the sample.
Our study clearly demonstrates correlations between low back pain in childhood/adolescence and low back pain in adulthood. This should lead to a change in focus from the adult to the young population in relation to research, prevention, and treatment.
There currently is a clinical need for an objective technique to assess muscle dysfunction associated with chronic lower back pain. A Back Analysis System for objectively measuring local fatigue in the back extensor muscles is presented. The reliability and validity of this technique was evaluated by testing chronic low-back pain patients and control subjects without back pain. Concurrent surface electromyograms (EMG) were detected from multiple back muscles during sustained isometric contractions at different force levels of trunk extension. Median frequency parameters of the EMG power density spectrum were monitored to quantify localized muscle fatigue. Results indicated: 1) high reliability estimates for repeated trials; 2) significant differences (P less than 0.05) in median frequency parameters between lower back pain patients and control subjects for specific combinations of contractile force level and muscle site tested; 3) Median Frequency parameters correctly classified lower back pain and control subjects using a two-group discriminant analysis procedure. The applicability of this technique as a treatment outcome measure and diagnostic screening method for lower back pain patients is discussed.
Earlier studies have investigated the biomechanics of rowing during step testing with a focus on lumbo-pelvic kinematics and force output and noted that these parameters change with work intensity. The aim of this study was to investigate how the biomechanics of the rowing stroke changes over time as a result of coaching and training and to see if these change were related to a change in physiological performance. An electromagnetic motion measuring device in conjunction with a load cell was used to determine the ergometer rowing kinematics of 7 elite international oarswomen during routine step tests over a two year period. Force output was observed to improve over the two year time period, with peak force significantly rising by 40-80 N. This was associated with significant increases in stroke length of between 15 and 19 cm. Both of these are indicative of improvement in performance. Kinematic variables were also observed to change, with greater pelvic rotation and associated lumbar spine motion at the later time point. The findings of this study demonstrate that rowing technique changes with time, and suggest that kinematics measures of rowing technique may be important tools to monitor athletes. Key pointsKinematics of rowing technique change with time and reflect improvements in performanceImproved kinematics appear to be associated with improved rowing efficiencyImprovement in stroke length linked in part to improvements in lumbo-pelvic technique
Earlier studies have investigated the biomechanics of rowing during step testing with a focus on lumbo-pelvic kinematics and force output and noted that these parameters change with work intensity. The aim of this study was to investigate how the biomechanics of the rowing stroke changes over time as a result of coaching and training and to see if these change were related to a change in physiological performance. An electromagnetic motion measuring device in conjunction with a load cell was used to determine the ergometer rowing kinematics of 7 elite international oarswomen during routine step tests over a two year period. Force output was observed to improve over the two year time period, with peak force significantly rising by 40-80 N. This was associated with significant increases in stroke length of between 15 and 19 cm. Both of these are indicative of improvement in performance. Kinematic variables were also observed to change, with greater pelvic rotation and associated lumbar spine motion at the later time point. The findings of this study demonstrate that rowing technique changes with time, and suggest that kinematics measures of rowing technique may be important tools to monitor athletes. Key pointsKinematics of rowing technique change with time and reflect improvements in performanceImproved kinematics appear to be associated with improved rowing efficiencyImprovement in stroke length linked in part to improvements in lumbo-pelvic technique.
Fitness, Health, and Work Capacity: International Standards for Assessment. International Committee for the Standardization of Physical Fitness Test, L A Larson, Ed. New York: Macmillan Pub Co, 1974, 562 pp, $14.95 clothbound.
In this study, we examined the relationships between low back pain, hamstring flexibility, and lumbar flexion in rowers. Twenty-six male university rowers participated. Hamstring flexibility was assessed using an adjusted straight leg raise technique, and lumbar flexion was assessed via a distraction of skin marks protocol while long sitting. A questionnaire ascertained rowing details and low back pain characteristics. Low back pain was highly prevalent. No association was observed between low back pain and hamstring flexibility, or between hamstring flexibility and lumbar flexion. Sufferers of low back pain showed reduced lumbar flexion (P=0.03; 95% confidence interval = − 3.7 to −0.2). Results obtained using the adjusted straight leg raise technique suggested that low back pain was not associated with hamstring inflexibility, which suggests that increasing hamstring flexibility for rehabilitation or prevention of low back pain in rowers might not be necessary.
Sports such as rowing, gymnastics, cycling and fast bowling in cricket that combine rotation with spine flexion and extension are known to carry greater risk of low back pain (LBP). Few studies have investigated the capacity of the lumbar spine to rotate in various sagittal positions, and further, these studies have generated disparate conclusions. The purpose of this study was to determine whether the range of lower lumbar axial rotation (L3-S2) is decreased in end-range flexion and extension postures when compared to the neutral spine posture. Eighteen adolescent female rowers (mean age=14.9 years) with no history of LBP were recruited for this study. Lower lumbar axial rotation was measured by an electromagnetic tracking system (3-Space Fastrak) in end-range flexion, extension and neutral postures, in sitting and standing positions. There was a reduction in the range of lower lumbar axial rotation in both end-range extension and flexion (p<0.001) postures when compared to neutral. Further, the range of lower lumbar axial rotation measurements in flexion when sitting was reduced when compared to standing (p=0.013). These findings are likely due to the anatomical limitations of the passive structures in end-range sagittal postures.
There were two aims of the current study; firstly, to determine the incidence of low back pain in adolescent female rowers and secondly, to determine the differences between LBP and no-LBP groups for a range of physical tests and psycho-social variables. The point prevalence of LBP was 47.5% for rowers and 15.5% for controls indicating that LBP is common in this group of rowers. When no-LBP and LBP groups were compared for the data collected in this study, LBP subjects showed significantly decreased lower limb endurance and back muscle endurance and sitting with more erect postures. Although this study cannot determine causation, it has the potential to direct interventions to decrease the incidence of LBP in this group.
The aim of this study was to determine whether a multi-dimensional intervention programme was effective in reducing the incidence of low back pain (LBP) and the associated levels of pain and disability in schoolgirl rowers. This non-randomised controlled trial involved an intervention (INT) group consisting of 90 schoolgirl rowers from one school and a control (CTRL) group consisting of 131 participants from three other schools. All participants in the INT group underwent a multi-dimensional programme that consisted of an individualised exercise programme based on an individual musculoskeletal screening (Week 1) and a LBP education session conducted by a physiotherapist (Week 2) and performed an off-water-conditioning programme conducted by a Physical Education teacher. All exercises were undertaken during the season. Primary outcome variables collected at Start-season, Mid-season, End-season and Post-season included the incidence of LBP and related levels of pain and disability. Secondary outcome variables from the bio-psycho-social domain were measured at Start-season and End-season in the INT group only. The INT group had a lower incidence of LBP at Mid-season and End-season and displayed significantly better results than the CTRL group for improvers and non-improvers with respect to the levels of pain and disability. The INT group following the intervention also displayed improved physical fitness levels, sat with significantly less anterior tilt of the pelvis and lumbar kyphosis when in their usual sitting posture and demonstrated positive changes in their behaviour. The multi-dimensional approach to reducing the incidence of LBP, pain and disability in schoolgirl rowers in this study was effective. Several secondary outcome variables measured in the INT group considered to be of importance in LBP significantly improved. These included physical fitness (aerobic conditioning, lower limb and back muscle endurance and sit and reach flexibility) and seated posture (usual and slump sitting).
There currently is a clinical need for an objective technique to assess muscle dysfunction associated with chronic lower back pain. A Back Analysis System for objectively measuring local fatigue in the back extensor muscles is presented. The reliability and validity of this technique was evaluated by testing chronic low-back pain patients and control subjects without back pain. Concurrent surface electromyograms (EMG) were detected from multiple back muscles during sustained isometric contractions at different force levels of trunk extension. Median frequency parameters of the EMG power density spectrum were monitored to quantify localized muscle fatigue. Results indicated: 1) high reliability estimates for repeated trials; 2) significant differences (P less than 0.05) in median frequency parameters between lower back pain patients and control subjects for specific combinations of contractile force level and muscle site tested; 3) Median Frequency parameters correctly classified lower back pain and control subjects using a two-group discriminant analysis procedure. The applicability of this technique as a treatment outcome measure and diagnostic screening method for lower back pain patients is discussed.
Of all 30-, 40-, 50-, and 60-year-old inhabitants of Glostrup, a suburb of Copenhagen, 82% (449 men and 479 women) participated in a general health survey, which included a thorough physical examination relating to the lower back. The examination was constituted of anthropometric measurements, flexibility/elasticity measurements of the back and hamstrings, as well as tests for trunk muscle strength and endurance. The reproducibility of the tests was found to be satisfactory. Twelve months after the physical examination 99% of the participants completed a questionnaire sent by mail concerning low back trouble (LBT) in the intervening period. The prognostic value of the physical measurements was evaluated for first-time experience and for recurrence or persistence of LBT by analyses of the separate measurements and discriminant analyses. The main findings were that good isometric endurance of the back muscles may prevent first-time occurrence of LBT in men and that men with hypermobile backs are more liable to contract LBT. Recurrence or persistence of LBT was correlated primarily to the interval since last LBT-episode: the more LBT, the shorter the intervals had been. Weak trunk muscles and reduced flexibility/elasticity of the back and hamstrings were found as residual signs, in particular, among those with recurrence or persistence of LBT in the follow-up year.
There is a lack of information dealing with the muscu loskeletal profile of common injuries in women rowers.
Strength and flexibility of trunk/pelvic muscles were qualitatively described in 17 elite lightweight women rowers. Questionnaires regarding incidence of muscu loskeletal injuries in this population were completed. Correlations between musculoskeletal profiles and in cidence of injury were determined.
Results indicate elite lightweight women rowers have a high incidence of low back pain and discomfort. Seventy-five percent of the sample demonstrated hy perflexion of the lumbar spine. There was a high posi tive correlation between hyperflexion motion of the lumbar spine and incidence of low back pain. There was a high negative correlation between adherence to a regular stretching program and incidence of low back pain.
The questionnaire is divided into ten sections selected from a series of experimental questionnaires designed to assess limitations of various activities of daily living. The chosen sections were those found to be most relevant to the problems suffered by people with low back pain. Each section contains six statements. A study of 25 patients with primary low back pain has already been mentioned. Their symptoms tended to resolve quickly and changes in their mean disability score can be seen over the first three weeks after referral to the spinal disorders department. The disability score was also used to demonstrate that there was no difference in the severity of symptoms in two sub-groups of patients in the same study. All new patients referred to the department complete the questionnaire when they first attend. The disability score is used as a guide to a patient's treatment programme. It cannot be used in isolation since it makes no allowance for the demands of a patient's job, his age or psychological make-up. However, it does ensure that important aspects of disability which are often forgotten are recorded in the patient's notes. Later, changes in the score may be used in monitoring the subsequent progress of the patient through treatment.
Hamstring muscle length may be associated with specific pelvic and trunk postures, but the influence of hamstring length on trunk postures is not well documented. The purposes of this study were to examine the influence of hamstring length on 1) the pelvic angle, lumbar angle, and thoracic angle in standing; and 2) the flexion ranges of motion of the pelvic angle, lumbar angle, and thoracic angle during the toe-touch test. Surface platform pointers over bony landmarks and photography were used to examine the pelvic and trunk angles and ranges of motion of 10 men with short hamstrings, 10 men with medium hamstrings, and 10 men with long hamstrings while standing and after assuming the toe-touch position. Separate one-way analyses of variance detected no significant differences among groups for the three angles in standing. Significant differences were detected among groups for the three angles in the toe-touch position and the flexion ranges of motion during the toe-touch test (p < 0.05). Short hamstrings were associated with decreased flexion range of motion of the pelvic angle and lumbar angle and increased flexion range of motion of the thoracic angle. Therapeutic interventions should be considered in light of the influences of hamstring length on the flexion range of motion of the pelvic angle, lumbar angle, and thoracic. angle.
Low back pain (LBP) among children and adolescents has become the subject of an increasing amount of literature over the last 15 years. This topic, which was considered almost insignificant less than two decades ago, was the focus of a recent international meeting organised in Grenoble (France) in March 1999. This review paper is the result of an literature update search performed by members of three groups which have been active in this field for many years. Current epidemiological data on LBP is summarized as well as the role of the major risk factors according to studies published in the principal peer reviewed journals interested in the topic.
The RDQ is a short and simple method of a self-rated assessment of physical function in patients with back pain. Its ease of use makes it suitable for following up on the progress of individual patients in clinical settings and for combining with other measures of function (e.g., psychological or work disability) in research settings. The ODI is likewise an effective method of measuring disability in patients with back pain with a wide degree of severity and causes. Both instruments have stood the test of time and have been used in a wide variety of clinical situations, in the United Kingdom, the United States, and many other countries. Both instruments perform as well as most other currently available instruments and better than some. The RDQ may be better suited to settings in which patients have mild to moderate disability and the ODI to situations in which patients may have persistent severe disability. The availability of the two instruments in a wide range of languages permits comparison between studies performed in numerous countries.
A very specific type of exercise has been devised which is proving to provide effective pain relief for chronic and recurrent back pain sufferers. The exercise approach focuses on retraining a precise co-contraction pattern of the deep trunk muscles, the transversus abdominis and lumbar multifidus. The approach is based on the knowledge of how muscles provide stability for the spine in normal situations. It has been further developed according to research evidence which has demonstrated dysfunction in the deep trunk muscles in patients with back pain. The mechanism for pain relief with this specific exercise approach is believed to be through enhanced stability of the lumbar spine segments.
Of the many problems associated with low back pain, those which are most amenable to biomechanical investigation are identified. Recent advances in lumbar spinal mechanics are then reviewed in five sections dealing with mechanical function, mechanisms of failure, movements in vivo, loading in vivo, and the biological consequences of mechanical loading. The discussion suggests that mechanical fatigue damage may frequently be the underlying cause of low back pain, even when degenerative changes are evident in the tissues, and the review ends by suggesting some priority areas for future research.
The influence of a core-strengthening program on low back pain (LBP) occurrence and hip strength differences were studied in NCAA Division I collegiate athletes.
In 1998, 1999, and 2000, hip strength was measured during preparticipation physical examinations and occurrence of LBP was monitored throughout the year. Following the 1999-2000 preparticipation physicals, all athletes began participation in a structured core-strengthening program, which emphasized abdominal, paraspinal, and hip extensor strengthening. Incidence of LBP and the relationship with hip muscle imbalance were compared between consecutive academic years.
After incorporation of core strengthening, there was no statistically significant change in LBP occurrence. Side-to-side extensor strength between athletes participating in both the 1998-1999 and 1999-2000 physicals were no different. After core strengthening, the right hip extensor was, on average, stronger than that of the left hip extensor (P = 0.0001). More specific gender differences were noted after core strengthening. Using logistic regression, female athletes with weaker left hip abductors had a more significant probability of requiring treatment for LBP (P = 0.009)
The impact of core strengthening on collegiate athletes has not been previously examined. These results indicated no significant advantage of core strengthening in reducing LBP occurrence, though this may be more a reflection of the small numbers of subjects who actually required treatment. The core program, however, seems to have had a role in modifying hip extensor strength balance. The association between hip strength and future LBP occurrence, observed only in females, may indicate the need for more gender-specific core programs. The need for a larger scale study to examine the impact of core strengthening in collegiate athletes is demonstrated.
To evaluate the measurement properties of the Revised Oswestry Disability Questionnaire (RODQ) by using rating scale analyses.
Calibration of item responses by using a data set.
Four outpatient therapy clinics in the northeastern United States.
Convenience sample of 95 community-dwelling adults exhibiting mild to severe low back pain-related disability (LBP-D).
Not applicable.
The RODQ.
Several Rasch analyses were performed, with 1 item deleted and 2 response categories collapsed, creating a better test without increased error. A schema for item administration and evaluation was also developed.
By using the abbreviated scale, suggested item order, and predicted responses, abbreviated versions of the instrument can be applied to measure LBP-D more efficiently.
A cross-sectional observational design study was conducted to determine lumbar repositioning error in 15 subjects who had chronic low back pain with a clinical diagnosis of lumbar segmental instability and 15 asymptomatic participants.
To determine whether individuals with lumbar segmental instability have a decreased ability to reposition their lumbar spine into a neutral spinal position.
Proprioception of the lumbar spine has been investigated in individuals who have low back pain with variable results. The testing procedure's lack of sensitivity and the nonhomogeneity of groups may be responsible for the conflicting findings.
Repositioning accuracy of the lumbar spine was assessed using the 3Space Fastrak to determine error in 15 participants with lumbar segmental instability and 15 asymptomatic subjects. The participants were assisted into a neutral spinal sitting posture and then asked to reproduce this position independently over five trials separated by periods of relaxed full lumbar flexion.
Lumbosacral repositioning error was significantly greater in participants with lumbar segmental instability than in the asymptomatic group (t[28] = 2.48; P = 0.02. There also was a significant difference between the groups at each individual sensor.
The results of this study indicate that individuals with a clinical diagnosis of lumbar segmental instability demonstrate an inability to reposition the lumbar spine accurately into a neutral spinal posture while seated. This finding provides evidence of a deficiency in lumbar proprioceptive awareness among this population.
The purpose of this study was to investigate changes in lumbar flexion together with the pattern and level of muscle activity of selected erector spinae during a rowing trial.Design. Cross-sectional repeated measures design.
Low back pain is a common problem in rowers. The amount of lumbar flexion occurring during rowing might influence the possibility of injury.
Sixteen young adult school rowers participated in the study. Changes in lumbar flexion and muscle activity were recorded across the drive phase, at three stages of an ergometer based rowing trial. Lumbar flexion was calculated by computerised motion analysis of surface markers attached to the spinous processes of L1 and S1. Surface electromyography techniques were used to examine the magnitude of activity from three erector spinae muscles. The median frequency of the electromyographic signal was examined to quantify fatigue in the erector spinae muscles during isometric maximal effort muscle activation prior to and after the rowing trial.
Lumbar flexion increased significantly (P<0.05) during the rowing trial, as did the magnitude of electromyographic activity from sites over the lumbar multifidus, iliocostalis lumborum and longissimus thoracis muscles. The median frequency decreased significantly (P<0.05) in each muscle examined.
The findings showed that rowers attain relatively high levels of lumbar flexion during the rowing stroke, and these levels are increased during the course of the rowing trial. Indirect evidence of muscle fatigue in erector spinae muscles was also apparent, and this observation may in part be responsible for the increased levels of lumbar flexion observed.
Excessive lumbar flexion may influence the potential for injury to spinal structures. An awareness of increased lumbar flexion and muscle fatigue in the erector spinae muscles may be important for injury prevention programs for rowers.
Relationships between adolescent physical fitness and adult health-related fitness were investigated. Forty-five subjects (20 males, 25 females) participated in physical fitness tests in 1976 and again in 2001. The adolescent physical fitness tests were distance running (2,000 m for boys or 1,500 m for girls), 50 m run, pull-ups (boys) or flexed arm hangs (girls), shuttle run, a 30-sec sit-up test, standing broad jump, hand grip-test, and sit-and-reach test. The adult health-related physical fitness index (APFI), stratified by sex, was formed by summing the z-scores of a bicycle ergometer test, sit-up test, hand-grip test, and sit-and-reach test. Height- and weight-adjusted correlations between adolescence and adulthood for exactly similar tests for men and women were, respectively, 0.74 (95% CI, 0.44-0.89) and 0.53 (95% CI, 0.17-0.76) in sit-and-reach tests, 0.41 (95% CI, -0.04 to 0.72) and 0.55 (95% CI, 0.20-0.78) in sit-up tests, and 0.53 (95% CI, 0.11-0.44) and 0.44 (95% CI, 0.05-0.71) in hand-grip tests. When all adolescent tests were put in regression analysis together with BMI in 2001, the significant explanatory factors for APFI were distance running ability and the sit-and-reach test for men and sit-up test, flexed arm hang, and BMI in 2001 for women.
A normative within-subjects single-group study.
To compare spinal-pelvic curvature and trunk muscle activation in 2 upright sitting postures ("thoracic" and "lumbo-pelvic") and slump sitting in a pain-free population.
Clinical observations suggest that both upright and slump sitting postures can exacerbate low back pain. Little research has investigated the effects of different upright sitting postures on trunk muscle activation.
Spinal-pelvic curvature and surface electromyography of 6 trunk muscles were measured bilaterally in 2 upright (thoracic and lumbo-pelvic) sitting postures and slump sitting in 22 subjects.
Thoracic, compared to lumbo-pelvic, upright sitting showed significantly greater thoracic extension (P < 0.001), with significantly less lumbar extension (P < 0.001) and anterior pelvic tilt (P = 0.03). Furthermore, there was significantly less superficial lumbar multifidus (P < 0.001) and internal oblique (P = 0.03) activity, with significantly higher thoracic erector spinae (P < 0.001) and external oblique (P = 0.04) activity in thoracic upright sitting. There was no significant difference in superficial lumbar multifidus activity between thoracic upright and slump sitting.
Different upright sitting postures resulted in altered trunk muscle activation. Thoracic when compared to lumbo-pelvic upright sitting involved less coactivation of the local spinal muscles, with greater coactivation of the global muscles. These results highlight the importance of postural training specificity when the aim is to activate the lumbo-pelvic stabilizing muscles in subjects with back pain.
Prospective controlled intervention study. To evaluate a specific segmental muscle training program of the lumbar spine in order to prevent and reduce low back pain in young female teamgym gymnasts. Teamgym is a team sport comprising three events: trampette, tumbling and floor programme. In a recent study, it was found that teamgym gymnasts practice and compete despite suffering from back pain. Specific muscle control exercises of the lumbar spine have shown good results in reducing pain intensity and functional disability levels in patients with low back pain. To our knowledge, this type of training has not been studied in an adolescent athletic population before. Fifty-one gymnasts, with and without LBP, 11-16 years old, from three top-level gymnastics team participated in the study comprising 12 weeks. Every day the gymnasts answered a questionnaire regarding low back pain. After baseline (4 weeks) the intervention group performed a specific segmental muscle training program. Twenty-four gymnasts (47%) reported low back pain during baseline. Nine gymnasts failed to answer the questionnaire every day and the following results are based on 42 gymnasts (intervention group, n = 30, and control group, n=12). Gymnasts in the intervention group reported significantly less number of days with low back pain at completion compared to baseline (P=0.02). Gymnasts in the control group showed no difference in terms of days with low back pain or intensity of low back pain between baseline and completion. Eight gymnasts (out of 15) with LBP in the intervention group became pain free. Specific segmental muscle control exercises of the lumbar spine may be of value in preventing and reducing low back pain in young teamgym gymnasts.
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Evaluation of specific stabilizing exercises in the treatment of chronic LBP with the radiological diagnosis of spondylosis and spondylolisthesis
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