Lumbar supports for prevention and treatment of lower back pain
From: Cochrane Database Syst Rev. 2008 Apr 16;(2):CD001823
Back supports are used in the treatment of lower back pain patients, to prevent the onset of lower back pain (primary prevention) or to prevent recurrences of a lower back pain episode (secondary prevention). To assess the effects of back supports for prevention and treatment of non-specific lower back pain. It is not clear from the abstract if the samples include back support pillows and/or back support belts
Randomized controlled trials that reported on any type of back supports as preventive or therapeutic intervention for non-specific lower back pain. One review author generated the electronic search. Two review authors independently identified trials that met the inclusion criteria. One review author extracted data on the study population, interventions, and final results.
There was moderate evidence that back supports are not more effective than no intervention or training in preventing lower back pain, and conflicting evidence whether back supports are effective supplements to other preventive interventions. It is still unclear if back supports are more effective than no or other interventions for the treatment of lower back pain.
There is moderate evidence that back supports are not more effective than no intervention or training in preventing lower back pain, and conflicting evidence whether they are effective supplements to other preventive interventions. It remains unclear whether back supports are more effective than no or other interventions for treating lower back pain. There is still a need for high quality randomized trials on the effectiveness of back supports. One of the most essential issues to tackle in these future trials seems to be the realization of an adequate compliance. Special attention should be paid to different outcome measures, types of patients and types of back supports.
Neck pain and pillows - A blinded study of the effect of pillows on non-specific neck pain, headache and sleep
From: Advances in Physiotherapy, Volume 8, Number 3, September 2006 , pp. 122-127(6)
Neck support pillows are widely used in patients with neck pain to reduce pain and get better quality of sleep. To test whether specific neck pillows have any effect on neck pain, headache and quality of sleep in people with chronic non-specific neck pain and to find the optimal characteristics of such a pillow, 52 patients with chronic neck pain tested four different pillows (three specially designed neck pillows and one normal pillow) with different shapes and consistency randomly over 4-10 weeks. The patients graded them according to comfort and described the characteristics of an ideal pillow. The effects of the pillows on neck pain, sleep quality and headache were stated on a questionnaire. Forty of the 52 patients found a positive effect on the neck pain, 24 of 31 (77%) reported a positive effect on night’s sleep and 19 of 31 (61%) a positive effect on headache. There were no differences in graded comfort between two of the specially designed neck pillows and the “normal pillow” in the test. The opinion was that an ideal pillow should be soft and with good support for the neck lordosis. A specially selected and individually tested pillow with good shape, comfort and support to the neck lordosis can reduce neck pain and headache and give a better sleep quality.
Active Neck Muscle Training in the Treatment of Chronic Neck Pain in Women
From: JAMA Vol. 289 No. 19, May 21, 2003
Neck disorders remain a common problem in modern, industrialized countries. Neck pain has been the most common chief complaint among working-aged women visiting their physicians. In a Canadian study, 54% of the general population had experienced neck pain during the past 6 months, and approximately 5% were highly disabled by neck pain. The prevalence of chronic neck pain has been reported to be 7% in women and 5% in men in Finland. Patients with chronic neck pain used health care services twice as much as the population on average. Sick leave, therapy, and specialist care form the major part of the costs incurred by neck pain, whereas investigations at the primary health care level play a minor role.
The origin and exact pathophysiologic mechanisms of chronic neck pain often remain obscure because trauma or severe degenerative conditions at working age are found only in a few cases. The origin of neck pain is thought to be multifactorial. Excessive physical strain may cause microtrauma in connective tissues, and psychosocial stress may lead to increased muscular tension. Degenerative changes in cervical vertebrae and disks are common and increase with advanced age in asymptomatic people. Thus, examination using radiographs or magnetic resonance imaging does not elucidate the origin of pain in most cases.
Evidence for many of the standard treatment approaches to neck pain is lacking. Conservative management of neck disorders includes both passive and active therapies, neither of which have been shown to be effective. However, these treatments are widely prescribed by physicians. The aim of our study was to investigate the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles in rehabilitation of women with chronic, nonspecific neck pain.
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Are the determinants of vertebral endplate changes and severe disc degeneration in the lumbar spine the same? A magnetic resonance imaging study in middle-aged male workers.
From: BMC Musculoskelet Disord. 2008 Apr 16;9(1):51
Modic changes are bone marrow lesions visible in magnetic resonance imaging (MRI), and they are assumed to be associated with symptomatic intervertebral disc disease, especially changes located at L5-S1. Only limited information exists about the determinants of Modic changes. The objective of this study was to evaluate the determinants of vertebral endplate (Modic) changes, and whether they are similar for Modic changes and severe disc degeneration focusing on L5-S1 level.
228 middle-aged male workers (159 train engineers and 69 sedentary factory workers) from northern Finland underwent sagittal T1- and T2-weighted MRI. Modic changes and disc degeneration were analyzed from the scans. The participants responded to a questionnaire including items of occupational history and lifestyle factors. Logistic regression analysis was used to evaluate the associations between selected determinants (age, lifetime exercise, weight-related factors, fat percentage, smoking, alcohol use, lifetime whole-body vibration) and Modic type I and II changes, and severe disc degeneration.
The prevalences of the Modic changes and severe disc degeneration were similar in the occupational groups. Age was significantly associated with all degenerative changes. In the ageadjusted analyses, only weight-related determinants (BMI, waist circumference) were associated with type II changes. Exposure to whole-body vibration, besides age, was the only significant determinant for severe disc degeneration. In the multivariate model, BMI was associated with type II changes at L5-S1, and vibration exposure with severe disc degeneration at L5-S1 (OR 1.08 per one SD = 11-year increment in vibration exposure).
Besides age, weight-related factors seem important in the pathogenesis of Modic changes, whereas whole-body vibration was the only significant determinant of severe disc degeneration.
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Proposal of a Classification System for Patients With Neck Pain
From: J Orthop Sports Phys Ther • Volume 34 • Number 11 • November 2004
Approximately 54% of individuals have experienced neck pain within the last 6 months, and the incidence of neck pain may be increasing. The economic burden associated with the management of patients with neck pain is high, second only to low back pain (LBP) in annual workers’ compensation costs in the United States. Patients with neck pain are frequently encountered in outpatient physical therapy practice. Jette et al reported that patients with neck pain make up approximately 25% of all patients receiving outpatient physical therapy. The system proposed in this commentary primarily addresses the classification of patients with neck pain attributable to cervical and upper thoracic spine dysfunction. Patients with neck pain referred from other structures (eg, temporomandibular joint) are not considered. The classification system requires integration of data from a variety of information from the history and physical examination. Whenever possible, the system is based on evidence from the peer-reviewed literature, but also incorporates clinical experience and expert opinion in areas where evidence is insufficient. In these instances, we were intentionally vague to avoid propagating opinion that may or may not be supported by future research attempting to more specifically define characteristics of patients within each classification.
It is likely that patients with neck pain are not a homogeneous group, but, instead, consist of a variety of subgroups, each of which may benefit from a specific intervention matched to the patient’s signs and symptoms. Studies to date have largely failed to account for this possibility, which may compromise the statistical power of research and ultimately fail to provide guidance for clinical decision making. Classification provides a means of breaking down a larger entity into more homogeneous subgroups of patients, based on examination data. Classification can guide the determination of a patient’s prognosis, and the selection of the most appropriate intervention strategy. Classification has received considerable attention in the management of patients with low back pain, and evidence is emerging regarding its benefits. There has been considerably less effort made towards examining classification as it pertains to patients with neck pain. The purpose of this clinical commentary is to examine the current literature and to propose a classification system for patients with neck pain, based on the overall goal of treatment. The approach is based on published evidence when possible and is also informed by clinical experience and expert opinion. Classification decisions are based on the integration of data from a variety of information from the history and physical examination. The end result of the classification process is to determine the treatment approach believed to be most likely to maximize the clinical outcome for an individual patient with neck pain.
The classifications are: Mobility, Centralization, Conditioning and Increase Exercise Tolerance, Pain Control and Reduce Headache. Examinations and Intervention methods are outlined and discussed.
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Similarities in stress physiology among patients with chronic pain and headache disorders: evidence for a common pathophysiological mechanism?
From: The Journal of Headache and Pain. 2008 Apr 14 [Epub ahead of print]
One common feature of chronic musculoskeletal pain and headaches are that they are both influenced by stress. Among these, tension headache, fibromyalgia and chronic neck and shoulder pain appear to have several similarities, both with regard to pathophysiology, clinical features and demographics. The main hypothesis of the present study was that patients with chronic pain (tension headache, fibromyalgia and shoulder neck pain) had stress-induced features distinguishing them from migraine patients and healthy controls. We measured pain, blood pressure, heart rate (HR) and skin blood flow (BF) during (1 h) and after (30 min) controlled low-grade cognitive stressor in 22 migraine patients, 18 tension headache patients, 23 fibromyalgia patients, 29 shoulder neck pain patients and 44 healthy controls. fibromyalgia patients had a lower early HR response to stress than migraine patients, but no differences were found among fibromyalgia, tension headaches, shoulder and neck pain patients. Finger skin BF decreased more in fibromyalgia patients compared to migraine patients, both during and after the test. When comparing chronic pain patients (chronic tension headaches, fibromyalgia and shoulder neck pain) with those with episodic pain (episodic tension headache and migraine patients) or little or no pain (healthy controls), different adaptation profiles were found during the test for systolic and diastolic blood pressure, HR and skin BF in the chronic group. In conclusion, these results suggest that tension headache, fibromyalgia and shoulder neck pain patients may share common pathophysiological mechanisms regarding the physiological responses to and recovery from low-grade cognitive stress, differentiating them from episodic pain conditions such as migraine.
Neck Retractions, Cervical Root Decompression, and Radicular Pain
From: J Orthop Sports Phys Ther 2000;30: 4–12.
Evaluation of the changes in the flexor carpi radialis H reflex after reading and neck retraction exercises and to correlate reflex changes with the intensity of radicular pain. Repeated neck retraction movements have been routinely prescribed for patients with neck pain. Methods and Measures: Ten nonimpaired subjects (mean age, 27 ± 4 years) and 13 patients (mean age, 35 ± 9 years) with C7 radiculopathy volunteered for the study. The flexor carpi radialis H reflex was elicited by electrical stimulation of the median nerve at the cubital fossa before and after 20 minutes of reading and after 20 repetitive neck retractions. Subjective intensity of the radicular pain was reported before and after each condition using an analog scale.
For patients with radiculopathy, a repeated-measures analysis of variance showed a significant decrease in the H reflex amplitude, an increase in radicular symptoms after reading on the visual analog scale, an increase in the H reflex amplitude, and a decrease in pain intensity after repeated neck retractions. There was an association between cervical root compression (smaller H reflexes) and increased pain during reading and between cervical root decompression and reduced pain. Exacerbation of symptoms was found with a reading posture. There were no significant changes in the H reflex amplitude in the nonimpaired group. No changes were found in reflex latency for either group.
Neck retractions appeared to alter H reflex amplitude. These exercises might promote cervical root decompression and reduce radicular pain in patients with C7 radiculopathy. The opposite effect (an exacerbation of symptoms) was found with the reading posture.
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The Refractory Period of the Audible “Crack” After Lumbar Manipulation
From: Journal of Manipulative and Physiological Therapeutics Volume 31, Issue 3, March 2008, Pages 199-203
This study evaluates if side posture lumbar manipulation frequently used in chiropractic treatment of lower back pain is associated with a refractory period of the audible “crack” or popping sound of a joint and if so, to quantify this refractory period across subjects.
Three subjects were exposed to multiple “baseline” side posture manipulations until no further audible cracks or popping of the jointswere recorded. “Test-refractory period” manipulations were administered after a set time (ie, potential refractory period) at which point the number of audible cracks was recorded. The refractory period was declared when a minimum of 50% of the baseline audible “cracks” had recovered during the test lower back manipulations. The study design included 2 clinicians who performed side posture lumbar manipulation on asymptomatic subjects ranging from 38 to 49 years of age.
The refractory period was 40 minutes for subject A, 70 minutes for subject B, and 95 minutes for subject C. The average refractory period across subjects was 68.33 minutes. The audible “crack” recovery was maintained for the remaining test days once the refractory period had been met.
The audible “crack” heard during side posture lumbar manipulation is believed to originate from the zygapophyseal joints. This is supported by the presence of a refractory period and by the number of audible “cracks” found per manipulation.
