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Background: Age-related differences in the limited range of motion of the lower extremities and their relationship with low back pain in juvenile athletes have not been well assessed. This study investigated the relationship between low back pain and limited range of motion of the hip and knee in young baseball players during the baseball season. Results: Participants comprised 1215 baseball players (216 pitchers, 999 fielders) aged 6–16 years who underwent medical checkups (self-completed questionnaire and physical examination). Of the 1215 players, 255 (21.0%) experienced seasonal low back pain requiring rest during the previous year. The prevalence of low back pain and a positive Thomas test, straight-leg-raising test, and heel-to-buttock test increased with age. Univariate analysis revealed that a positive heel-to-buttock test in both the throwing and non-throwing arm sides in the 11–12 age group and a positive Thomas test in the throwing arm side in the 13–14 age group were associated with seasonal low back pain (P = 0.0051, P = 0.021, and P = 0.048, respectively). Multivariate analysis, adjusted for factors associated with low back pain, showed significant associations between the positive heel-to-buttock test (odds ratio 1.75, 95% confidence interval 1.11–2.79; P = 0.016) and low back pain in players aged 11–14 years. Conclusions: A positive heel-to-buttock test is potentially associated with low back pain among juvenile baseball players. Particular attention should be paid to the limited range of motion of the knee joint and tightness of the quadriceps femoris muscle among baseball players with low back pain aged 11–14 years. [ABSTRACT FROM AUTHOR]

Purpose: Nocturnal leg cramps are considered to be a symptom of lumbar spinal stenosis (LSS). However, the relationship between LSS and nocturnal leg cramps in the general population remains unclear. The purpose of this study was to investigate the prevalence and characteristics of nocturnal leg cramps in LSS in the community. Patients and Methods: 328 voluntary participants were enrolled in this study. The presence of LSS was assessed by a validated and self-administered diagnostic support tool. The presence of nocturnal leg cramps and neurological findings were evaluated by one experienced spine surgeon. To investigate the relationship between leg cramps and anatomical factors, the participants underwent an MRI scan, and the dural sac cross-sectional area (DCSA) at each lumbar intervertebral disc level was measured. Results: A total of 214 participants (65.2%) had nocturnal leg cramps, and 94 of 328 participants (28.7%) showed typical LSS symptoms. In the typical LSS symptom group, 31 participants (33.0%) had nocturnal leg cramps. In the atypical LSS symptom group, 83 participants (35.5%) had nocturnal leg cramps. There was no statistically significant difference in the prevalence of nocturnal leg cramps between the two groups. The narrowest DCSA (< 25 mm2 and 25– 49.4mm2) was statistically related to the presence of nocturnal leg cramp. Statistically significant differences in sensory disturbance and motor weakness were not observed between the subjects with and those without nocturnal leg cramps. Moreover, impaired PTR was statistically related to the presence of nocturnal leg cramp. Conclusion: The prevalence of nocturnal leg cramps did not differ with or without typical LSS symptoms in the community. The degree of dural tube compression that is determined by DCSA had a direct effect on the presence of nocturnal leg cramps. Neurological impairment, such as PTR abnormalities, was associated with the presence of nocturnal leg cramps. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal pain could represent a psychological stressor in adolescent athletes. However, few epidemiological studies have investigated this association. Purpose: To assess the relationship between musculoskeletal pain (shoulder, elbow, wrist, and low back) and psychological stress responses in high school baseball players. Study Design: Cross-sectional study. Methods: Participants comprised male Japanese high school baseball players who had completed a questionnaire as part of their annual medical evaluation in 2016. Experiences of shoulder, elbow, wrist, and low back pain during the previous season were investigated. Pain severity was graded as 1 (mild, playing without interference), 2 (moderate, playing with interference), or 3 (severe, could not play because of pain). The Stress Response Scale–18 was used to measure stress response: low, medium, rather high, and high. Prevalence rates of shoulder, elbow, wrist, and low back pain and their association with psychological stress responses were investigated using univariate and multivariable analyses. Results: A total of 944 players (223 pitchers and 721 fielders) were included in this study. Their mean age was 16.1 ± 0.6 years, and 66% were high school juniors, while 33.6% were seniors. In pitchers, the prevalence rates during the previous year of severe (grade 3) interference with playing because of elbow, shoulder, wrist, and low back pain were 21.5% (n = 48), 19.3% (n = 43), 3.6% (n = 8), and 18.4% (n = 41), respectively, whereas in fielders, the respective prevalence rates were 17.1% (n = 123), 17.9% (n = 129), 6.7% (n = 48), and 19.3% (n = 139). After adjusting for confounding factors (playing on a top-performing team, high school grade level, and all other sites of musculoskeletal pain), the authors found significant associations in pitchers between severe experiences of elbow pain and low back pain and medium to high psychological stress responses (odds ratio, 2.64 [95% CI, 1.32-5.39], P =.006 and odds ratio, 2.32 [95% CI, 1.12-4.89], P =.024, respectively). No significant associations were seen between musculoskeletal pain and psychological stress responses in fielders. Conclusion: In the current study, elbow and low back pain were associated with stronger psychological stress responses compared with other musculoskeletal pain in high school baseball pitchers. [ABSTRACT FROM AUTHOR]

Introduction: Lumbar spinal stenosis (LSS) is a lumbar spinal disorder that causes leg symptoms and intermittent claudication. It is reported that the risk factors for low back pain include age, family history, smoking, obesity, work-related physical load, exercise, and depression. This was a multicenter, cross-sectional survey, and the aim of this study was to investigate the prevalence of LSS by age and the relationships between LSS and psychosocial factors and job satisfaction.Methods: This study enrolled subjects aged 50 years and over from a survey of LSS in 2177 hospitals and general practices nationwide. The clinical characteristics of the LSS and non-LSS groups were compared using the χ2 test, and the multivariate logistic regression analysis was performed to examine associations between exercise, perceived stress, strenuous use of the low back or legs, job satisfaction, and LSS.Results: In total, 18,642 patients (8338 males, 10,267 females) were analyzed. The rate of LSS was 38.3% and it increased with age. Regular exercise was less common among those in the LSS group than those in the non-LSS group (p<0.001). Satisfaction in all job-related items was less in the LSS group than in the non-LSS group (p<0.001). The odds for having LSS were higher in subjects having perceived stress and strenuous use of the low back or legs (p=0.001). The odds ratios of heart diseases and hypertension (p<0.001) were higher in the LSS group.Conclusion: This study investigated factors associated with LSS. The prevalence of LSS increased with age. Perceived stress and strenuous use of the low back or legs might be associated with LSS, and job satisfaction was lower with LSS. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to clarify pain, quality of life and activity in the aged evacuees living in temporary housing after the Great East Japan Earthquake on 11 March 2011.Methods: The study was a cross-sectional study performed in Minamisoma City, Fukushima Prefecture 1 year and 6 months after the disaster. Inclusion criteria were the ability to walk independently and consent to answer questionnaires. Seventy-one evacuees who met the inclusion criteria were included in this study. There were 16 men and 55 women with a mean age of 75.9 years. Sixty evacuees were surveyed when they gathered at the assembly hall in the temporary housing (Assembled group) and 11 evacuees were surveyed through individual visits to their residences (Individual group). Evacuees in the Individual group agreed to participate in this study, but refused to visit the assembly hall to engage in exercise and recreation. Pain, quality of life (QOL) and level of activity were assessed with the Numeric Rating Scale (NRS), the MOS Short-Form 36 item Health Survey (SF-36) and a pedometer, respectively. Student's t-test, Mann-Whitney U test, and Fisher's exact test were used for statistical analysis.Results: Forty-four (62.0 %) residents had chronic pain with a mean NRS of 2.74. Twenty-one (29.6 %) of these residents had relatively severe pain rated 5 or above on the NRS. QOL was significantly lower for the subscales of "physical functioning," "role physical", "general health", "social functioning", "role emotional" and "mental health", when compared with the national standard values. Values were also visibly lower for "physical component summary" in the summary score. On comparing the Assembled group and the Individual group, "physical function", "role physical", "social functioning" and "physical component summary" were found to be significantly lower in the Individual group. The mean daily number of steps was 1,892 in the Individual group and 4,579 in the Assembled group. The Individual group thus significantly took less mean daily number of steps compared with the Assembled group.Conclusions: This study quantified the state of pain, QOL and activity of aged evacuees living in temporary housing after the Great East Japan Earthquake. The evacuees frequently had chronic pain and lower physical and mental QOL scores compared to the national standard values. [ABSTRACT FROM AUTHOR]

Background: Reduced core stability is a potential risk factor for low back pain in athletes. However, the association between core stability and low back pain in high school baseball players has not been thoroughly studied. The purpose of this study was to investigate the relationship between core stability and low back pain and its clinical characteristics in high school baseball players.Methods: Participants comprised 812 high school baseball players who had undergone annual medical evaluations, comprising a self-completed questionnaire and a physical examination. We investigated the relationships between low back pain during the season and on the day of medical evaluations and core stability using a cross-sectional study design. Core stability was assessed using the Sahrmann core stability test.Results: Reduced core stability was confirmed in 358 (44.1%) of all players, 98 (49.5%) pitchers, and 260 (42.3%) fielders. In total, 352 players (43.3%) reported incidents of seasonal low back pain during the previous year. Thirty-five pitchers (17.7%) and 153 fielders (24.9%) reported low back pain on the day of the medical evaluations. No significant associations were seen between low back pain throughout the season and reduced core stability. After adjusting for confounding factors (total amount of practice per week, hamstring tightness and quadriceps tightness) using logistic regression modeling, a significant association between presence of low back pain during lumbar extension movement and reduced core stability was found (odds ratio, 2.57; 95% confidence interval, 1.08-6.62; P = 0.033) in pitchers.Conclusions: High school baseball pitchers with reduced core stability showed a higher probability of reporting low back pain during lumbar extension movement. Evaluation of core stability should be considered in high school baseball players, especially in pitchers. [ABSTRACT FROM AUTHOR]

Background: Numbness in the soles of both feet at rest or bowel/bladder dysfunction can occur in patients with lumbar spinal stenosis (LSS), especially in patients with cauda equina lesions. The purpose of this study was to clarify the relationship between cauda equina symptoms at rest and quality of life (QOL) in LSS patients using standardized questionnaires developed for the Japanese population.Methods: A survey was conducted in 564 hospitals and general practice clinics nationwide from December 1, 2011 to December 31, 2012. All patients who visited hospital or clinic because of low back pain were included. Patients were diagnosed with LSS using the LSS-Diagnostic Support Tool (LSS-DST), and the severity of the disease was measured using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) for quality of life. Presence of both sole numbness and/or bowel/bladder dysfunction were determined by medical interview. 3647 patients were diagnosed with LSS according to the results of the LSS-DST. 1294 of these patients (35.5%) had symptoms at rest. Of these patients, 359 patients with sole numbness, 135 patients with bowel/bladder dysfunction, and 52 patients with both numbness and bowel/bladder dysfunction were compared to the patients without rest symptoms (n = 2182). Comparisons between groups with or without sole numbness and bowel/bladder dysfunction were performed using statistical analysis of JOABPEQ responses in the categories of pain-related disorder, lumbar spine disorder, gait disturbance, social life disturbance, and psychological disorder.Results: All groups with sole numbness and/or bowel/bladder dysfunction had statistically lower (worse) scores in all categories of the JOABPEQ compared to the group without these symptoms at rest.Conclusion: LSS patients having numbness in the soles of both feet at rest or bowel/bladder dysfunction had lower measurements of QOL and activities of daily living than those patients without symptoms at rest. These symptoms appear to be related to QOL of LSS patients. [ABSTRACT FROM AUTHOR]

Study Design: A cross-sectional study.Objective: The aim of this study was to evaluate activity of the nucleus accumbens (NAc) in response to lumbar mechanical stimulation in patients with chronic low back pain (cLBP) using functional magnetic resonance imaging (fMRI).Summary Of Background Data: Although a modified activity of the NAc was characterized in cLBP patients, its pathological significance has yet to be determined. We hypothesized that NAc activation in response to pain might differ depending on the extent of psychiatric problems, which might be associated with the affective/motivational background of chronic pain.Methods: Twenty-one patients with cLBP (four men, 17 women) were recruited. Subjects were divided into two groups on the basis of scores on the patient version of the Brief Scale for Psychiatric problems in Orthopaedic Patients (BS-POP) scores: ≥17 (High Score, HiS group) and <17 (non-High Score, non-HiS group). Each subject was placed in the prone position on a 3-Tesla magnetic resonance imaging (MRI) scanner and stimulated by mechanical stimulation on the left lower back. Three blocks of 30-second pain stimulus calibrated at either 3 or 5 on an 11-grade numerical rating scale (NRS) were applied with intervening 30-second rest conditions during whole-brain echo-planar imaging. Functional images were analyzed using a multisubject general linear model with Bonferroni multiple comparisons.Results: Subjects in the HiS group had more intense daily pain and lower quality of life than those in the non-HiS group (P < 0.05). Catastrophic thinking in relation to pain experience did not differ between the groups. Activation at the NAc was smaller in the HiS group than in the non-HiS group (P < 0.001).Conclusion: The presence of psychiatric problems was associated with attenuated activity of the NAc in cLBP patients. Dysfunction of the NAc might potentially be involved in the affective/motivational factors in the chronification of LBP.Level Of Evidence: N/A. [ABSTRACT FROM AUTHOR]

Background: Diagnostic support tools for lumbar spinal stenosis such as the Self-administered, Self-reported History Questionnaire have been developed in Japan, but no report has demonstrated the diagnostic accuracy of this questionnaire in Japanese primary care settings. This multicenter, cross-sectional survey was performed to evaluate and improve the diagnostic accuracy of this questionnaire for lumbar spinal stenosis patients in Japanese primary care settings.Methods: The lumbar spinal stenosis diagnosis support tool project was conducted in 1657 hospitals to evaluate the diagnostic accuracy of the Self-administered, Self-reported History Questionnaire in Japan from 2011 to 2012. Consecutive adults (≥50 years old) from physicians, including non-orthopedic general practitioners and orthopedic general practitioners, were considered for enrollment. Consecutive adults (≥50 years old) with low back pain from hospital-based orthopedic surgeons were also considered for enrollment. The diagnostic accuracy of the Self-administered, Self-reported History Questionnaire with initial and several new cutoff points in classifying patients according to the presence of lumbar spinal stenosis was assessed in terms of sensitivity, specificity and negative predictive values.Results: Among the 33,545 patients, 10,199 (30.4 %) were diagnosed with lumbar spinal stenosis by the physicians. The Self-administered, Self-reported History Questionnaire version 1.1 with a new cutoff point was more sensitive than the Self-administered, Self-reported History Questionnaire version 1.0 with the initial cutoff point (79.8 vs. 68.3 %) and less specific (68.8 vs. 75.1 %) for lumbar spinal stenosis diagnosis. The respective negative predictive values were 88.5 and 84.3 %.Conclusions: The Self-administered, Self-reported History Questionnaire version 1.1 with the new cutoff was more sensitive and had higher negative predictive value than version 1.0 with the initial cutoff. Therefore, the improved Self-administered, Self-reported History Questionnaire version 1.1 can be used for lumbar spinal stenosis screening, and its use may improve the quality of lumbar spinal stenosis diagnostic practice in Japanese primary care settings. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: While several studies have cited a potential association between testosterone deficiency and risk of falls among community-dwelling older men, evidence for such an association is conflicting. Depressive symptoms, which occasionally accompany testosterone deficiency but which are often neglected as associated symptoms, may actually provoke falls independent of or jointly with testosterone deficiency. We examined the association between testosterone levels, depressive symptoms, and falls, and assessed the joint effect of testosterone levels and depressive symptoms on falls among older men. Design, Setting, and Participants: Data for this cross-sectional study were obtained from 869 men aged over 60 years who participated in health check-ups conducted in 2010 from 2 Japanese municipalities. Salivary testosterone (sT) levels were measured using an enzyme-linked immunosorbent assay, and depressive symptoms were assessed via the short form of the Center for Epidemiologic Studies Depression Scale. Main outcome measures: Self-reported “any fall” over the 1-month period. Results: Among the total of 482 participants analyzed (median age, 70 years), 10.8% reported any fall. On comparison between 90th percentile sT levels and lower levels, our logistic regression model with restricted cubic splines showed that lower sT levels were associated with an increased likelihood of suffering any fall after adjustment for sociodemographic characteristics, comorbidities, and mobility function. For example, 5th percentile sT was associated with any fall [adjusted odds ratio (OR), 4.23; 95% confidence interval (CI), 1.66–10.8]. Depressive symptoms were also strongly associated with any fall [adjusted OR, 3.49 (95% CI, 1.52–8.04)]. We noted no apparent interaction of sT and depressive symptoms with falls (P = .079), suggesting that the joint effect of testosterone deficiency and depressive symptoms on falls was multiplicative. Indeed, compared with a combination of 90th percentile sT values and no depressive symptoms, adjusted OR for any fall in a combination involving 5th percentile sT and depressive symptoms was 14.8-fold (95% CI, 3.76–58.0). Conclusions: Our findings indicated that both relatively low testosterone levels and presence of depressive symptoms were independently associated with falls among older men. Causality of these associations should be confirmed in future prospective studies. [Copyright &y& Elsevier]

Objectives Findings from several experimental studies in animals have suggested a protective action of testosterone on kidney function, but hard evidence for such an association in humans is scarce. We examined the association between testosterone levels and kidney function among adult men living in super-aged communities. Design, setting, participants, and measurements We conducted cross-sectional study involving residents aged 40–80 years who participated in annual health check-ups in 2 communities. A total of 1031 men were recruited in 2010. Main exposure was salivary testosterone (sT) levels measured using an enzyme-linked immunosorbent assay. Main outcome was estimated glomerular filtration rate (eGFR) determined by age, gender, and serum creatinine levels. Results For the 848 participants analyzed, median age and eGFR were 69 years and 69.1 mL/min/1.73 m 2 , respectively. On comparison of 90th-percentile sT levels with lower levels, our general linear model with restricted cubic splines showed that lower sT levels were associated with decreased eGFR after adjustment for sociodemographic characteristics, comorbidities, and blood pressure. For example, fifth percentile sT was associated with decreased eGFR, with a difference in eGFR [−3.43 mL/min/1.73 m 2 (95% confidence interval, CI −6.02 to −0.84)] comparable in magnitude to the reduction in eGFR observed for a 6-year increase in age in our population. The association between low testosterone levels and decreased eGFR remained similar even when analyses were restricted to participants aged over 60 years (734 participants, median age 71 years). Conclusions Results from our study indicated that having low testosterone levels was independently associated with reduced eGFR in adult men. Our finding of this association between low testosterone levels and reduced kidney function needs to be corroborated among persons with chronic kidney disease or in a longitudinal study. [ABSTRACT FROM AUTHOR]