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Background Neuropathic-like pain, fatigue, cognitive difficulty, catastrophizing, anxiety, sleep disturbance, depression and widespread pain associate with a single factor in people with knee pain. We report the Central Aspects of Pain questionnaire (CAP) to characterize this across painful musculoskeletal conditions. Methods CAP was derived from the 8-item CAP-Knee questionnaire, and completed by participants with joint pain in the Investigating Musculoskeletal Health and Wellbeing survey. Subgroups had OA, back pain or FM. Acceptability was evaluated by feedback and data missingness. Correlation coefficients informed widespread pain scoring threshold in relation to the other items, and evaluated associations with pain. Factor analysis assessed CAP structure. Intraclass Correlation Coefficient (ICC) between paper and electronic administration assessed reliability. Friedman test assessed score stability over 4 years in people reporting knee OA. Results Data were from 3579 participants (58% female, median age 71 years), including subgroups with OA (n  = 1158), back pain (n  = 1292) or FM (n  = 177). Across the three subgroups, ≥10/26 painful sites on the manikin scored widespread pain. Reliability was high [ICC = 0.89 (95% CI 0.84–0.92)] and CAP scores fit to one- and two-factor model, with a total CAP score that was associated with pain severity and quality (r = 0.50–0.72). In people with knee pain, CAP scores were stable over 4 years at the group level, but displayed significant temporal heterogeneity within individual participants. Conclusions Central aspects of pain are reliably measured by the CAP questionnaire across a range of painful musculoskeletal conditions, and is a changeable state. [ABSTRACT FROM AUTHOR]

Sickle cell disease is a common hemoglobinopathy in Iraq, specifically in Basrah province. Sacroiliac joint involvement is rarely reported in the literature. Objectives: To find out how often the sacroiliac joint is involved in sickler patients and to describe its clinical and radiological features using plain radiographs and magnetic resonance imaging (MRI). Methods: A descriptive cross-sectional study was conducted at Basrah Teaching Hospital, Basrah arthroplasty center and Basrah Center for Hereditary Diseases from the 1st of October 2021 to the 1st of December 2022. A prepared questionnaire was used for data collection which focused on the history and clinical examination of all patients with sickle cell disease with or without lower backache. Radiological imaging was offered to all patients and MRI to selected patients. Results: A total of 217 patients with sickle cell disease were involved. 62 (28.6%) of patients with sickle cell disease have lower back pain, and it is mostly common in patients with moderate severity — 43 patients (19.8%) — according to VAS score. FABER test was positive in 43 (19.8%) of patients with sickle cell disease and lower backache. Plain radiography was positive in about one-fifth of the enrolled patients in the study 44/217 (20.3%). MRI was able to detect an abnormality in 19/31 (64.2%) of the examined cases, and the most common MRI finding is subchondral sclerosis. Conclusions: The sacroiliac joint is involved in sickle cell disease but the diagnosis is vague, requiring comprehensive history, clinical and specific radiological imaging. [ABSTRACT FROM AUTHOR]

Purpose: Cauda equina syndrome (CES) may have significant individual consequences if diagnostic delays occur. Our aim was to evaluate the presenting subjective and objective features of patients with suspected CES in comparison to those with radiologically confirmed cauda equina compression (CEC).. Methods: This was a retrospective analysis of all cases presenting with suspected CES to a tertiary emergency care unit over a two-year period. CEC was defined as radiological confirmation of CEC by Consultant Musculoskeletal (MSK) Radiologist report (MSK-CEC) and by measured canal occupancy due to an acute disc extrusion (> 75%)[measured by a Senior Spinal Surgeon (SP-CEC)]. Routine data collection was compared between categories. Chi square, multivariate regression analyses and ROC analysis of multiple predictors was performed. Results: 530 patients were included in this analysis, 60 (11.3%) had MSK-CEC, and 470 had NO- CEC. Only 43/60 (71.7%) had emergent surgery. Those with MSK-CEC and SP-CEC were statistically more likely to present with bilateral leg pain [(MSK-CEC OR 2.6, 95%CI 1.2, 5.8; p = 0.02)(SP-CEC OR 4.7, 95%CI 1.7, 12.8; p = 0.003)]; and absent bilateral ankle reflexes [(MSK-CEC OR 4.3; 95% CI 2.0, 9.6; p < 0.001)(SP CEC OR 2.5; 95%CI 1.0, 6.19; p = 0.05)] on multivariate analysis. The ROC curve analysis acceptable diagnostic utility of having SP-CEC when both are present [Area under the curve 0.72 (95%CI 0.61, 0.83); p < 0.0001]. Conclusion: This study suggests that in those presenting with CES symptoms, the presence of both bilateral leg pain and absent ankle reflexes pose an acceptable diagnostic tool to predict a large acute disc herniation on MRI scan.. Highlights: The most predictive features of radiological cauda equina compression were bilateral leg pain and absent bilateral ankle reflexes when patients present with other features of suspected CES (including any of urinary, bowel, sexual dysfunction and/or perineal sensory change). Radiological definitions of cauda equina compression vary across studies making comparisons difficult across existing evidence. In cases where there is progression of symptoms, in severity, distribution or laterality of symptoms, we would suggest a low threshold for same-day emergency imaging. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lumbar facet arthritis is one of the main causes of low back pain. At present, MRI is mainly used for preliminary diagnosis, and there is still a certain probability of missed diagnosis and misdiagnosis. Therefore, MR T2* mapping imaging technology is expected to become an important means of quantitative detection of cartilage damage in lumbar facet arthritis. OBJECTIVE: To investigate the application value of MR T2* mapping imaging technique in quantitative analysis of cartilage damage and degeneration of lumbar facet joint. METHODS: A total of 110 outpatient or inpatient patients with low back pain in Fourth Affiliated Hospital of Nanjing Medical University from April 2020 to March 2022 were collected and set as case group. At the same time, 80 asymptomatic volunteers were recruited as the control group. T2* mapping transectal images and T2WI images were obtained by 3.0T MR Scanning for the facet joints of all included subjects L1-S1. Weishaupt grading and T2* value measurement were performed for all facet joint cartilage, and the data were collected for parallel statistical analysis. The comparison of T2* values of facet joint cartilage between different articular Weishaupt grades was performed by one-way analysis of variance. RESULTS AND CONCLUSION: (1) Statistical analysis found that the T2* value of lumbar facet joint cartilage in the case group (17.6±1.5) ms was significantly lower than that in the control group (21.4±1.3) ms (P < 0.05). (2) In the case group, with the hierarchical increase of lumbar facet joint Weishaupt, the T2* value of facet joint cartilage also showed a gradual decreasing trend, and the difference was statistically significant (P < 0.05). (3) It is concluded that T2* mapping can better display the early pathological changes of lumbar facet joint cartilage injury, and T2* value of lumbar facet joint cartilage can quantitatively evaluate the degree of lumbar facet joint cartilage injury. T2* mapping imaging technique can provide a good theoretical basis for the imaging diagnosis of the early cartilage injury induced by lumbar facet arthritis and has important clinical application value. [ABSTRACT FROM AUTHOR]

Background/Objectives: Low back pain is thought to be caused by lumbar instability. To date, multiple definitions of radiological lumbar instability have been used without verifying the "normal range" of the lumbar segmental mobility. Ideally, normative data for lumbar mobility in healthy individuals are required to establish an acceptable threshold for lumbar instability. This study aims to elucidate (i) the prevalence of so-called radiological lumbar instability at each lumbar spine level in conventional criteria and (ii) a practical radiological threshold for lumbar instability in healthy individuals. Methods: Participants completed a questionnaire and underwent standard active dynamic radiography of the lumbar spine in the standing position. Intervertebral range of motion (IROM) and sagittal translation distance (ΔST) were measured at each intervertebral level. Nachemson's criteria of radiological lumbar instability were applied. Results: This study involved four hundred and twenty participants (249 males and 171 females); 76% (320/420) met the criteria for radiological lumbar instability. The definition of lumbar instability based on IROM and ΔST was achieved by 0.2% and 1.7% of participants at the L5–sacrum (L5–S) level, respectively. Conclusions: The normative data of lumbar mobility were obtained from a large number of participants who had less LBP-related ADL disability. The widely accepted criteria for lumbar instability were not applicable except for the L5–S level. Further studies of lumbar mobility, including patients with severe LBP, might prove the relationship between hypermobility of the lumbar spine and LBP. [ABSTRACT FROM AUTHOR]

Background: There is an urgent need to confirm biomarkers reflecting the pathogenesis and targeted drugs of lower back pain or/and sciatica in clinical practice. This study aimed to conduct a two sample bidirectional Mendelian randomization (MR) analysis to explore the causal link between 486 serum metabolites and lower back pain or/and sciatica. Methods: All data come from two public shared databases of European ancestry and single nucleotide polymorphisms (SNPs) for lower back pain or/and sciatica acted as instrumental variables. The traditional inverse variance weighting (IVW) method, weighted-median method, MR-Egger methodand other methods were used to estimate causality. The horizontal pleiotropy, heterogeneities were also verified through the MR-Egger intercept test, Cochran's Q test, MR-PRESSO test and the leave-one-out sensitivity analysis. Reverse MR analysis was employed to evaluate the direct impact of metabolites on lower back pain or/and sciatica. Additionally, we conducted the colocalization analysis to reflect the causality deeply. Furthermore, metabolic pathway analysis was performed. Results: 28 metabolites (18 known metabolites, 1 identified metabolites and 9 unknown metabolites) relevant to the risk of sciatica or/and lower back pain after using genetic variants as probes at PIVW < 0.05 were identifed. Among them, 8 serum metabolites decreased risk of sciatica or/and lower back pain significantly (P < 0.05), and 14 serum metabolites increased risk of sciatica or/and lower back pain significantly (P < 0.05). No reverse causal association was found between 28 metabolites and sciatica or/and lower back pain. Colocalization analysis results showed that the associations between sciatica or/and lower back pain and the 28 identified metabolites were not due to shared causal variant sites. Moreover, pathway enrichment analysis identifed 11 signifcant metabolic pathways, which are mainly involved in the pathological mechanism of sciatica or/and lower back pain (P < 0.05). There was no horizontal pleiotropy or heterogeneity in the other analyses. Conclusion: Our analyses provided robust evidence of causal associations between blood metabolites on sciatica or/and lower back pain. However, the underlying mechanisms remain to be further investigated. [ABSTRACT FROM AUTHOR]

Lower back pain (LBP) is one of the most prevalent health losses in adults worldwide. Historically, heat has been successfully used for treating pain and relieving tight muscles. Given the effective contact with the occupant's back and proximity to the heat source, coupled with increasing commute times, automotive seats offer an opportunity to intervene. Fifteen adults (nine female) who experienced acute, subacute, and chronic lower back pain were recruited to examine the effectiveness of heat delivered to the lower back in providing temporary pain relief. Participants sat in a car seat for 38 min on two days, which included a 5-min baseline followed by a 33-min intervention; control, or localized. For the control condition, participants sat for 33 min without any thermal devices on, while the localized condition heated and maintained the seat surface temperature of the lower seat back area to ~45 °C. Over the 33-min control condition, the back skin temperature increased by ~1–2 °C and did not impact the subjective LBP. Heating the lower back for 33 min to ~39 °C reduced the subjective LBP by 10%. We demonstrated that lower back pain can be alleviated from an automotive seat providing heat to the lower back within normal commute times in those with lower back pain. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of the Muscle Energy Technique (MET) and the Bowen Technique on hamstring muscle tightness in chronic low back pain (CLBP) patients. Method: A randomized clinical trial (RCT) designed study in which 62 participants were recruited through the purposive sampling technique were divided into two groups by the lottery method. Subjects who had pain for more than six months in the back and hamstring tightness were included. The duration of the study was four months from February to May 2023 conducted at Madinah Teaching Hospital Faisalabad. Subjects in Group-A were given the Bowen technique, whereas subjects in Group-B were given the MET. Numeric pain rating scale (NPRS), Oswestry disability index (ODI), and active knee extension (AKE) tests were used for measurements of outcomes. Results: Intra-group comparison by using Friedman test revealed that both Group-A & B subject’s pain were reduced (P<0.000), their tightness in back thigh muscles were significantly reduced (P<0.000) and functional activities of subjects were also improved (P<0.000). Mann Whitney test was used to determine the between group comparison. P-value ≤ 0.05 was considered as significant. Inter Group-Analysis revealed that there was no statistically significant difference between effects of Bowen technique & MET on pain, hamstring tightness and disability as both techniques improved pain, flexibility & disability. Conclusion: This study revealed that both groups treated by MET and Bowen Technique had significantly reduced pain, improved flexibility of back thigh muscle and reduced functional disability. [ABSTRACT FROM AUTHOR]

Musculoskeletal disorders occur frequently in industrial settings, and police officers in particular are at high risk of developing musculoskeletal disorders due to the nature of their work, but research on this is lacking. Therefore, the purpose of this study was to examine the prevalence and risk factors of musculoskeletal disorders according to the job functions of police officers. A survey was conducted, targeting active-duty police officers, and data were collected from 4268 respondents who answered all items on the questionnaire. As a control group, we used the general population dataset from the 2020 National Health and Nutrition Examination Survey conducted in Korea. The survey included general information such as gender, age, working hours, and type of work. It also investigated medical utilization, including the frequency of medical visits and hospitalizations. The assessment of musculoskeletal disorders was analyzed using pain NRS, VAS, SPADI, and ODI. The working characteristics of police officers were found to be more irregular in terms of working hours and involved a higher intensity of work activities compared with the general population. However, there was a lack of precise diagnoses and continuous treatment for these disorders. These results imply that police officers' occupational characteristics are related to musculoskeletal disorders. Considering the direct relationship between police officers' health and public safety, systematic evaluation and management of their musculoskeletal disorders are needed. [ABSTRACT FROM AUTHOR]

Introduction: Favorable short- and long-term outcomes have been reported for lumbar intervertebral total disc replacement (L-TDR). However, there is little evidence regarding the uptake of L-TDR in practice. The objective of this study was to analyze Australian-based population trends in L-TDR over the past 5 years. Methods: The 5-year incidence of L-TDR from 2019 to 2023 in adult patients was analyzed using the Medicare Benefits Schedule (MBS) database. Data were stratified by sex and year, with an offset term introduced using population data from the Australian Bureau of Statistics to account for population changes over the study period. Results: A total of 1558 L-TDRs were completed in Australia under the MBS in the 5 years of interest. The 5-year annual mean case volume was 311.6 cases per annum. A downtrend and plateau in the rate of L-TDR has been seen from 2021 onward. The distribution of L-TDR across ages showed a significantly higher concentration in the 35–44 and 45–54 age groups (P < 0.05). More operations were performed in males (n = 876, 56.2%) than females (n = 682, 43.8%). Conclusions: The uptake of L-TDR has declined throughout the 5-year study period in Australia. Despite modest use currently, the future of L-TDR will rely on more robust long-term outcome data.

Introduction: This study aimed to investigate the relationship between childbirth and lower back pain and determine the health-related quality of life of female patients with lower back pain. Methods: A total of 111 patients were divided into three groups: those who had given birth and developed lower back pain due to pregnancy, childbirth, or child-rearing movements (childbirth group, n=41), those who had given birth and developed lower back pain due to other causes (childbirth and other cause group, n=29), and those who were nulliparous (nulliparous group, n=41). A total of 22 physical therapists evaluated the patients during initial rehabilitation. Basic information and health-related quality of life were compared among the three groups using a one-way analysis of variance for the visual analog scale scores for lower back pain, summary scores (physical health [physical component summary] and mental health [mental component summary]), and subscales (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health) of the Short Form-8 Health Survey. These values were also compared with the national standard values for health-related quality of life. The chi-square test of independence was used to compare distributions, and Fisher's exact probability test was used for cells with an expected value of

Abstract Background Sometimes during breastfeeding women adopt positions that may cause problems with musculoskeletal system, resulting in back pain. The aim of this study was to determine the prevalence of lower back, upper back and neck pain in breastfeeding women and how this may be related to the act of breastfeeding. Methods An online survey within Poland was conducted among 395 breastfeeding women who were 1 to 48 months postpartum and were divided into two groups; “no back pain” and “back pain present”. The measurement tools used included an original questionnaire, the International Physical Activity Questionnaire (IPAQ), a Numerical Pain Rating Scale (0–10), and the Roland-Morris Disability Questionnaire. Pearson’s chi-squared tests, Mann-Whitney U tests, Student’s t-tests, and Kruskal-Wallis ANOVA tests were used to compare the groups. Results It was found that 84% of breastfeeding mothers suffered from back pain at least once a month. Pain was experienced at least once a week in the cervical, thoracic and lumbosacral regions in 48%, 36%, and 66% of the women, respectively. A dysfunctional state was present in 27.6% of breastfeeding mothers who suffered from back pain. Mothers experiencing back pain spent significantly more time on single breastfeeding episodes (p

Objective: The aim of this study was to investigate the effect of osteoporosis (OP) on the outcomes of facet medial branch radiofrequency thermocoagulation (RFT). Materials and Methods: Thirty-six patients with chronic lower back pain due to lumbar facet joint syndrome (LFJS) who underwent facet medial branch RFT were retrospectively reviewed. The patients were divided into two groups: Group I (without OP, n=19) and group II (with OP, n=16). Pre-intervention and post-intervention evaluations of the patients were assessed at 1, 6, and 12th months by visual analog scale (VAS). Results: In both groups, VAS scores 1st, 6th, and 12th months after intervention were lower than those at baseline (p=0.001). There were no significant difference between the groups in terms of VAS score improvement. Conclusion: Lumbar facet medial branch RFT is an effective and safe treatment method in both the short and long-term in patients with LFJS. OP therapy had no effect on RFT treatment results.

Introduction: Lumbar facet joint degeneration is a source of chronic low back pain, with an incidence of 15% to 45% among patients with low back pain. Pain arising from the lumbar facet joints is a common cause of axial back pain in adults. Radiofrequency ablation (RF) of the medial branches of the spinal dorsal rami has been used as a treatment option. Various therapeutic techniques in the treatment of facet-related pain have been described in the literature, including intraarticular lumbar facet joint steroid injections and radiofrequency denervation. Aim and Objective: To provide evidence based clinical practice guidelines for comparison of fluoroscopic guided facet joint radiofrequency ablation of medial branch and facet joint steroid injection for low back pain. Material and Methods: This was a prospective non-randomized study carried out in the Department of Anaesthesia at Maharaja Institute of Medical Sciences for a period of 1 year i.e, April 2023 to April 2024 on patients who were admitted from casualty and outpatient’s department with a diagnosis of chronic low back pain. All patients were assigned to LFJ intraarticular steroid infiltrations or RF denervation. All of the enrolled patients were suffering from LFJ-related pain at the L3/L4–L5/S1. Results: In the present study, there were 65 patients screened out of which 8 patients drop out. There were 57 patients of low back pain in which the mean age of Group A patients was (62.26 ± 11.56) years and Group B patients was(55.75±10.25)years. It was observed that Males were more commonly affected than females. Duration of back pain of Group A patients was (1.72±0.85) years while that of Group B patients was (2.26±0.92) years. Vas scoring before procedure was found to be not significant. But vas scoring at 6 months after procedure was found to be very highly significant. Rolland Morris questionnaire before procedure in both the groups was found to be insignificant. But at 6 months after procedure between both groups was found to be highly significant. Conclusion : Intraarticular steroid infiltration or radiofrequency denervation appear to be a managing option for chronic function-limiting low back pain of facet origin with favourable short- and midterm results in terms of pain relief and function improvement, but improvements were similar in both groups. [ABSTRACT FROM AUTHOR]

Lumbosacral intervertebral disc herniation (IVDH) is a common cause of lower back pain in dogs and humans. In humans, the vertebral endplate to annulus fibrosus (AF) attachment was implicated as an alternative failure site besides rupture through the dorsal AF (AFF). Endplate junction failure (EPJF) is characterized by IVDH, accompanied by endplate irregularities (type A), rim avulsions (type B), or larger bony avulsions on one (type C) or both endplates (type D), associated with an adjacent endplate defect. This retrospective study reports the CT prevalence of presumed EPJF in dogs and its associations with signalment and other lumbosacral CT abnormalities. CT scans, including the lumbosacral spine of dogs obtained at two institutions, were assessed, yielding 324 scans. Presumed EPJF was found in 69 dogs (21%) and AFF in 68 dogs (21%), commonly at the caudal endplate of the last lumbar vertebra (71%). The remaining 187 dogs did not show presumed EPJF or AFF. Presumed EPJF type A occurred in 49/69, type B in 19/69, and type C in 1/69 dogs. Univariable logistic regression showed that presumed EPJF was associated with significantly higher IVDH grades than AFF. In the multiple regression model, presumed EPJF and AFF remained associated with increasing age and spondylosis deformans. Presumed EPJF was associated with vertebral endplate sclerosis and AFF with zygapophyseal joint osteoarthritis. In conclusion, presumed EPJF was observed on CT in 21% of dogs with lumbosacral IVDH. Prospective studies correlating EPJF on CT with clinical, surgical, and histopathological findings are needed for a better understanding of the underlying pathology and clinical relevance. [ABSTRACT FROM AUTHOR]

Lower back pain is a common occurrence among mine workers due to the nature of their work. Globally, workplace (occupational) and ergonomic risk factors have been reported to influence the prevalence of lower back pain among workers. This study aimed to determine ergonomic risk factors associated with lower back pain and associated risk factors (workplace and ergonomics) among mineworkers in a nickel mine in Zimbabwe. A cross-sectional study design was employed, and participants were randomly selected to complete a questionnaire that included the Dutch Musculoskeletal Questionnaire (DMQ). A total of 420 mine workers were interviewed, with the majority being male (n = 259, 61.7%) and aged between 31 and 44 years old (n = 159, 37.9%). The study found that the prevalence of lower back pain was 41.43% (n = 174). Several risk factors were found to be associated with lower back pain, including working overtime (AOR = 1.13, p < 0.01; 95% CI: 0.07–0.22), performing repetitive tasks (AOR = 8.06, p < 0.01; 95% CI: 4.67–13.93), bending (AOR = 7.77, p < 0.01; 95% CI: 3.97–15.22), and twisting (AOR = 3.32, p < 0.01; 95% CI: 1.83–6.03). Based on these findings, it is recommended that an ergonomic risk assessment and prevention program be implemented, which should include educational awareness about lower back pain and its prevention among mine workers. [ABSTRACT FROM AUTHOR]

Lower back pain (LBP) is a widely prevalent global health issue, affecting over half a billion people and remaining the leading cause of years lived with disability (YLDs). LBP significantly impacts healthcare systems, with substantial costs related to surgical procedures and lost workdays. Vertebrogenic back pain (VBP), characterized by specific clinical symptoms and associated with Modic changes (MC) in vertebral endplates, best seen on MRI, is a significant subset of LBP. This paper explores the pathophysiology, diagnosis, and current reports and studies focusing on VBP and the role of basivertebral nerve (BVN) ablation as a therapeutic intervention. Multiple studies, including randomized controlled trials (RCTs) and meta-analyses, demonstrate the efficacy of BVN ablation in reducing pain and improving function in patients with chronic LBP associated with MC. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive surgical techniques for sacroiliac joint (SIJ) fixation have the potential to reduce risk and improve patient outcomes, but evidence remains limited. This interim analysis presents initial findings from an ongoing prospective study evaluating the safety and efficacy of the Catamaran System. Methods: The primary endpoint of success at 6 months was defined as a ≥20 mm improvement in SIJ pain (Visual Analog Scale, VAS), no neurologic worsening, absence of device-related serious adverse events (SAEs), and no surgical reintervention. Secondary endpoints included 6 month evaluation of the Oswestry Disability Index (ODI), patient satisfaction, and 12 month radiographic CT fusion, performed by an indpendent radiologist. Results: Thirty-three consecutive patients (mean age: 58.9 years; %-females: 76%; Body Mass Index: 30.5) were treated across six U.S. clinical sites. At the primary endpoint of 6 months, 80% of patients met the criteria for success, with no device-related SAEs and no surgical reintervention reported. VASSIJ-Pain significantly decreased from preoperative levels (mean: 80.9 mm) to 6 months postoperatively (31.1 mm; p < 0.001). Mean ODI scores also showed a significant improvement from preoperative values (51.9%) to 6 months postoperatively (29.6%, p < 0.01). Patients reported high satisfaction rates throughout all follow-ups, with 93.3% of patients being satisfied at 6 months. Conclusion: In patients diagnosed with chronic SIJ pain, minimally invasive inferior-posterior delivery of the Catamaran implant was safe and effective in relieving pain and reducing disability. [ABSTRACT FROM AUTHOR]

Background: Sometimes during breastfeeding women adopt positions that may cause problems with musculoskeletal system, resulting in back pain. The aim of this study was to determine the prevalence of lower back, upper back and neck pain in breastfeeding women and how this may be related to the act of breastfeeding. Methods: An online survey within Poland was conducted among 395 breastfeeding women who were 1 to 48 months postpartum and were divided into two groups; "no back pain" and "back pain present". The measurement tools used included an original questionnaire, the International Physical Activity Questionnaire (IPAQ), a Numerical Pain Rating Scale (0–10), and the Roland-Morris Disability Questionnaire. Pearson's chi-squared tests, Mann-Whitney U tests, Student's t-tests, and Kruskal-Wallis ANOVA tests were used to compare the groups. Results: It was found that 84% of breastfeeding mothers suffered from back pain at least once a month. Pain was experienced at least once a week in the cervical, thoracic and lumbosacral regions in 48%, 36%, and 66% of the women, respectively. A dysfunctional state was present in 27.6% of breastfeeding mothers who suffered from back pain. Mothers experiencing back pain spent significantly more time on single breastfeeding episodes (p < 0.05) and had an increased total time breastfeeding per day (p < 0.01) compared to mothers with no back pain. Neck pain was significantly less intense in mothers preferring to breastfeed in a lying position as compared to mothers preferring a sitting position in a chair or an armchair (p < 0.05). Conclusions: This survey of Polish breastfeeding mothers revealed a very high prevalence of lower back, upper back and neck pain. The amount of time spent on breastfeeding and the choice of body position for breastfeeding were important factors differentiating the prevalence and intensity of the pain. It is recommended that breastfeeding mothers do not extend the single-feeding time in the adopted position beyond the required time. It is of utmost importance to choose a breastfeeding position in which all parts of the mother's body are supported. To prevent neck pain, lying and semi-lying positions with head support are recommended. [ABSTRACT FROM AUTHOR]

Various nutritional supplements are available over the counter, yet few have been investigated in randomized controlled trials. The rationale for using the specific mix of nutritional substances including collagen type II, hyaluronic acid, n-acetyl-glucosamine, bamboo extract, L-lysine, and vitamin C is the assumption that combining naturally occurring ingredients of the intervertebral disc would maintain spine function. This double-blinded, placebo-controlled randomized trial aimed to evaluate the efficacy of a nutraceutical supplement mix in the management of lumbar osteochondrosis. Fifty patients were randomly assigned to either the supplement or placebo group in a 1:1 ratio. Patient-Reported Outcome Measures (PROMs) included the Oswestry Disability Index (ODI), the visual analogue scale for pain (pVAS), short form-12 (SF-12) physical and mental component summary subscale scores (PCS and MCS, respectively), and global physical activity questionnaire (GPAQ). Magnetic resonance imaging (MRI) was used to evaluate degenerative changes of intervertebral discs (IVD) including Pfirrmann grades as well as three-dimensional (3D) volume measurements. Data were collected at baseline and after the 3-month intervention. None of the PROMs were significantly different between the supplement and placebo groups. Disc degeneration according to Pfirrmann classifications remained stable during the 3-month intervention in both groups. Despite no significance regarding the distribution of Pfirrmann grade changes (improvement, no change, worsening; p = 0.259), in the supplement group, one patient achieved a three-grade improvement, and worsening of Pfirrmann grades were only detected in the placebo group (9.1%). Furthermore, in-depth evaluations of MRIs showed significantly higher 3D-measured volume changes (increase) in the supplement (+740.3 ± 796.1 mm3) compared to lower 3D-measured volume changes (decrease) in the placebo group (−417.2 ± 875.0 mm3; p < 0.001). In conclusion, this multi-nutrient supplement might not only stabilize the progression of lumbar osteochondrosis, but it might also potentially even increase IVD volumes as detected on MRIs. [ABSTRACT FROM AUTHOR]

Objectives: This project aimed to promote running as the best treatment for lower back pain (LBP) in an outpatient setting. Introduction: LBP is one of the most prevalent conditions worldwide. Sixty-two percent of all Germans experience episodes of non-specific back pain at least once a year, with one-fifth developing chronic conditions. Intervertebral disc (IVD) degeneration is a natural process, contributing to periods of acute LBP. However, the scientific literature and guidelines partially overlook the significance of water management in IVD. This implementation project sought to address this gap by educating patients about this process. Running and/or walking were chosen as general approaches for treatment rather than specific disease-related approaches. Methods: This implementation project was conducted in an outpatient physiotherapy clinic in Brandenburg, Germany, utilizing the JBI Evidence Implementation Framework. An evidence-informed clinical audit and feedback strategy was used to measure compliance with ten audit criteria. Five physiotherapists and 20 patients took part in the audits. Results: At baseline, only 20% of participating physiotherapists screened for yellow flags regarding psychological issues. However, after project implementation, this criterion scored 100% compliance. Some patients performed exercises independently, but confusion persisted regarding the choice of beneficial exercises. Patients continued running, but those who took a break due to pain expressed uncertainty about resuming. Conclusions: The project highlighted the effectiveness of collaborative efforts between patients and therapists to address the issue. The project team's conviction in action and solution strategies serves as the foundation for this collaboration. This implementation strategy provided "running" patients with the confidence to either resume or reintegrate running after an extended break. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the effect of osteoporosis (OP) on the outcomes of facet medial branch radiofrequency thermocoagulation (RFT). Materials and Methods: Thirty-six patients with chronic lower back pain due to lumbar facet joint syndrome (LFJS) who underwent facet medial branch RFT were retrospectively reviewed. The patients were divided into two groups: Group I (without OP, n=19) and group II (with OP, n=16). Pre-intervention and post-intervention evaluations of the patients were assessed at 1, 6, and 12th months by visual analog scale (VAS). Results: In both groups, VAS scores 1st, 6th, and 12th months after intervention were lower than those at baseline (p=0.001). There were no significant difference between the groups in terms of VAS score improvement. Conclusion: Lumbar facet medial branch RFT is an effective and safe treatment method in both the short and long-term in patients with LFJS. OP therapy had no effect on RFT treatment results. [ABSTRACT FROM AUTHOR]

Lower back pain is prevalent in equestrian athletes, but its prevalence and associated factors are unknown in the Portuguese equestrian population. A questionnaire regarding lower back pain and possible associated factors was answered by 347 respondents. Of the respondents, 214 (61.7%) stated having experienced lower back pain in the past 12 months and therefore completed the Roland Morris disability questionnaire. Among the latter, 63.1% stated that lower back pain impaired their performance. The probability of suffering from lower back pain was higher in individuals with higher weekly riding workloads, who reported equestrianism as their main occupation, and who performed daily stable duties. Considering a Roland Morris disability score of 4 as the cut-off value for dysfunction, this sample had an average score of 5.39 ± 4.42. Individuals who stated equestrianism was their main occupation showed a significantly higher risk (OR = 1.759, p = 0.041) of exhibiting a score ≥ 4 than those who stated equestrianism as a hobby. Age (p = 0.029), body mass index (p = 0.047), and daily performance of stable duties (p = 0.030) were also associated with a higher Roland Morris disability score. Further research is needed to understand the full impacts of lower back pain in Portuguese equestrian athletes. [ABSTRACT FROM AUTHOR]

Avascular necrosis (AVN) is linked to considerable morbidity, resulting in severe pain and functional impairment. Herein, for the first time, we reported an 18-year-old patient with Crohn's disease during the remission phase under Azathioprine therapy who presented with articular pain. Although no underlying risk factors, the patient was diagnosed with severe AVN of the bilateral femoral head and both knees simultaneously following pain in involved areas. This case highlights the importance of demand multidisciplinary approach to chronic disease. Moreover, clinicians should be aware of articular manifestations in IBD patients to diagnose and treat these conditions as soon as possible. Patients should be evaluated for their psychologic, gastrointestinal, and extra-gastrointestinal comorbidities during each follow-up visit. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to evaluate the efficacy of ultrasound‐guided erector spinae plane (ESP) block and compare with the conventional physical therapy in chronic low back pain (LBP). Materials and Methods: This prospective case‐controlled study included patients with chronic LBP. Their clinical and demographic data were obtained, and they were divided into two groups for conventional physical therapy and ESP blocks. Prior to treatment, on the first day, the second week, and the third month, the Oswestry Disability Index (ODI) and visual analog scale (VAS) pain score were evaluated. Results: The study included 43 patients, 21 in the ESP block group and 22 in the conventional physical therapy group. The VAS in movement was higher in the ESP block group at baseline (p = 0.047). On the first day after the treatments, the ESP block group showed lower resting (p < 0.001) and movement (p = 0.001) VAS values than the conventional physical therapy group. At the end of 3 months, both groups had improved VAS and ODI scores (all p < 0.001). Conclusion: US‐guided ESP block might be considered a successful, safe, and technically simple alternative treatment in patients with chronic LBP to control pain and reduce the cost of physical therapy and lost workdays. [ABSTRACT FROM AUTHOR]

Lower back pain (LBP) is a musculoskeletal condition that affects millions of people worldwide and significantly limits their mobility and daily activities. Appropriate ergonomics and exercise are crucial preventive measures that play a vital role in managing and reducing the risk of LBP. Individuals with LBP often exhibit spinal anomalies, which can serve as valuable indicators for early diagnosis. We propose an advanced machine learning methodology for LBP detection that incorporates data balancing and bootstrapping techniques. Leveraging the features associated with spinal anomalies, our method offers a promising approach for the early detection of LBP. Our study utilizes a standard dataset comprising 310 patient records, including spinal anomaly features. We propose an ensemble method called the random forest gradient boosting XGBoost Ensemble (RGXE), which integrates the combined power of the random forest, gradient boosting, and XGBoost methods for LBP detection. Experimental results demonstrate that the proposed ensemble method, RGXE Voting, outperforms state-of-the-art methods, achieving a high accuracy of 0.99. We fine-tuned each method and validated its performance using k-fold cross-validation in addition to determining the computational complexity of the methods. This innovative research holds significant potential to revolutionize the early detection of LBP, thereby improving the quality of life. [ABSTRACT FROM AUTHOR]

Introduction and purpose Non-specific and specific lower back pain syndrome is one of the leading causes of musculoskeletal disability and affects more than half of the population worldwide. The aim of this paper is to confront the problem of lumbar pain, possible diagnostic options, conservative and surgical opportunities with long term satisfactory rate. State of knowledge The paper reviews literature on lower back pain syndrome, sciatica, radiculopathy and lumbar disc herniation in regards to detection of the problem, classifying it and possible methods of resolvent. The WHO defines lower back pain as one of the leading causes of musculoskeletal dysfunction and it focuses on reducing the occurrence by programs like WHO Rehabilitation 2030 Initiative, UN Decade of Healthy Ageing and others. The paper also focuses on nonsurgical options of treatment. Material and method A review of the literature available in the "PubMed" and Google Schoolar was conducted. We focused on differential diagnosis depending on clinical presentation and possible treatment methods depending on symptoms, pathogenesis of the disorder and available procedures. Summary Our review managed to present the current state of development, possible differential diagnosis, prevalence of neural compressions, sciatica and radiculopathy in different diagnostic options. By receiving multiple studies we confront varied opinions of specialists regarding the approach to lower back pain syndrome and favorable forms of care. Additionally we came to the conclusion that the difference of patients' long term satisfactory rate in regards to nonoperative and operative treatment is not significant, and flattens over the years. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate whether combining fast acquisitions with deep-learning reconstruction can provide diagnostically useful images and quantitative assessment comparable to standard-of-care acquisitions for lumbar spine magnetic resonance imaging (MRI). METHODS: Eighteen patients were imaged with both standard protocol and fast protocol using reduced signal averages, each protocol including sagittal fat-suppressed T2-weighted, sagittal T1-weighted, and axial T2-weighted 2D fast spin-echo sequences. Fast-acquisition data was additionally reconstructed using vendor-supplied deep-learning reconstruction with three different noise reduction factors. For qualitative analysis, standard images as well as fast images with and without deep-learning reconstruction were graded by three radiologists on five different categories. For quantitative analysis, convolutional neural networks were applied to sagittal T1-weighted images to segment intervertebral discs and vertebral bodies, and disc heights and vertebral body volumes were derived. RESULTS: Based on noninferiority testing on qualitative scores, fast images without deep-learning reconstruction were inferior to standard images for most categories. However, deep-learning reconstruction improved the average scores, and noninferiority was observed over 24 out of 45 comparisons (all with sagittal T2-weighted images while 4/5 comparisons with sagittal T1-weighted and axial T2-weighted images). Interobserver variability increased with 50 and 75% noise reduction factors. Deep-learning reconstructed fast images with 50% and 75% noise reduction factors had comparable disc heights and vertebral body volumes to standard images (r2≥ 0.86 for disc heights and r2≥ 0.98 for vertebral body volumes). CONCLUSIONS: This study demonstrated that deep-learning-reconstructed fast-acquisition images have the potential to provide noninferior image quality and comparable quantitative assessment to standard clinical images.

OBJECTIVE: We applied natural language processing and inference methods to extract social determinants of health (SDoH) information from clinical notes of patients with chronic low back pain (cLBP) to enhance future analyses of the associations between SDoH disparities and cLBP outcomes. MATERIALS AND METHODS: Clinical notes for patients with cLBP were annotated for 7 SDoH domains, as well as depression, anxiety, and pain scores, resulting in 626 notes with at least one annotated entity for 364 patients. We used a 2-tier taxonomy with these 10 first-level classes (domains) and 52 second-level classes. We developed and validated named entity recognition (NER) systems based on both rule-based and machine learning approaches and validated an entailment model. RESULTS: Annotators achieved a high interrater agreement (Cohens kappa of 95.3% at document level). A rule-based system (cTAKES), RoBERTa NER, and a hybrid model (combining rules and logistic regression) achieved performance of F1 = 47.1%, 84.4%, and 80.3%, respectively, for first-level classes. DISCUSSION: While the hybrid model had a lower F1 performance, it matched or outperformed RoBERTa NER model in terms of recall and had lower computational requirements. Applying an untuned RoBERTa entailment model, we detected many challenging wordings missed by NER systems. Still, the entailment model may be sensitive to hypothesis wording. CONCLUSION: This study developed a corpus of annotated clinical notes covering a broad spectrum of SDoH classes. This corpus provides a basis for training machine learning models and serves as a benchmark for predictive models for NER for SDoH and knowledge extraction from clinical texts.

Introduction and Purpose This literature review endeavors to provide a current synthesis of the available literature regarding the relationship between road bike cycling and lower back pain (LBP). This review focuses on the aspects of bike fitting, riding position, preexisting LBP, cycling injuries and predisposing risk factors among others. Brief Description of the State of Knowledge Road bike cycling is a popular sport considered to be low-impact physically and easy to start with. So goes the proverb - „it’s as easy as riding a bike”. However the truth may be more complicated. There are many positive effects associated with this sport, such as overall health improvement and the ecological impact, and they are generally well-researched. However it is more difficult to find data regarding the dangers. Improper training program, incorrect bike fit or suboptimal riding position are all factors that can lead to lower back pain (LBP) connected with road bike cycling. Previous injuries and spine health should also be taken into account. Summary In consideration of the gathered evidence it is important to consider the above-mentioned interventions to prevent or stop lower back pain (LBP) from emerging. This literature review struggles to provide a starting point for both cyclists and physicians alike who encounter such a problem. The bike fit, adjusting the bike in accordance with the body of the cyclist, analyzing the cycling position and the training program should be principal points to provide for a pain-free road bike cycling. Further research is needed to determine the long-term effects of such actions and their ability to prevent or stop LBP while/after road bike cycling.

Back pain is the single leading cause of disability worldwide. Despite the prevalence and morbidity of lower back pain, we still lack a gold-standard treatment that restores the physiological function of degenerated intervertebral discs. Recently, stem cells have emerged as a promising strategy for regenerative therapy for degenerative disc disease. In this study, we review the etiology, pathogenesis, and developing treatment strategies for disc degeneration in low back pain with a focus on regenerative stem cell therapies. A systematic search of PubMed/MEDLINE/Embase/Clinical Trials.gov databases was conducted for all human subject abstracts or studies. There was a total of 10 abstracts and 11 clinical studies (1 RCT) that met the inclusion criteria. The molecular mechanism, approach, and progress of the different stem cell strategies in all studies are discussed, including allogenic bone marrow, allogenic discogenic cells, autologous bone marrow, adipose mesenchymal stem cells (MSCs), human umbilical cord MSC, adult juvenile chondrocytes, autologous disc derived chondrocytes, and withdrawn studies. Clinical success with animal model studies is promising; however, the clinical outcomes of stem cell regenerative therapy remain poorly understood. In this systematic review, we found no evidence to support its use in humans. Further studies on efficacy, safety, and optimal patient selection will establish whether this becomes a viable, non-invasive therapeutic option for back pain.

Xinyong Chen,1,2,&ast; Zhe Chen,3,&ast; Gongchang Ma,2 Jianjun Sha,2 Shan Zhao,2 Zuoqing Liu,2 Nong Chen,2 Huilin Yang1 1Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215000, People’s Republic of China; 2Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200025, People’s Republic of China; 3Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Nong Chen, Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200025, People’s Republic of China, Email chennong1975@126.com Huilin Yang, Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215000, People’s Republic of China, Email orthdoctor@126.comBackground: Dorsal root ganglia (DRGs) contain sensory neurons that innervate intervertebral discs (IVDs) and may play a critical role in mediating low-back pain (LBP), but the potential pathophysiological mechanism needs to be clarified.Methods: A discogenic LBP model in rats was established by penetration of a lumbar IVD. The severity of LBP was evaluated through behavioral analysis, and the gene and protein expression levels of pro-algesic peptide substance P (SP) and calcitonin gene–related peptide (CGRP) in DRGs were quantified. The level of reactive oxygen species (ROS) in bilateral lumbar DRGs was also quantified using dihydroethidium staining. Subsequently, hydrogen peroxide solution or N-acetyl-L-cysteine was injected into DRGs to evaluate the change in LBP, and gene and protein expression levels of transient receptor potential vanilloid-1 (TRPV1) in DRGs were analyzed. Finally, an inhibitor or activator of TRPV1 was injected into DRGs to observe the change in LBP.Results: The rats had remarkable LBP after disc puncture, manifesting as mechanical and cold allodynia and increased expression of the pro-algesic peptides SP and CGRP in DRGs. Furthermore, there was significant overexpression of ROS in bilateral lumbar DRGs, while manipulation of the level of ROS in DRGs attenuated or aggravated LBP in rats. In addition, excessive ROS in DRGs stimulated upregulation of TRPV1 in DRGs. Finally, activation or inhibition of TRPV1 in DRGs resulted in a significant increase or decrease of discogenic LBP, respectively, suggesting that ROS-induced TRPV1 has a strong correlation with discogenic LBP.Conclusion: Increased ROS in DRGs play a primary pathological role in puncture-induced discogenic LBP, and excessive ROS–induced upregulation of TRPV1 in DRGs may be the underlying pathophysiological mechanism to cause nerve sensitization and discogenic LBP. Therapeutic targeting of ROS or TRPV1 in DRGs may provide a promising method for the treatment of discogenic LBP.Keywords: lower back pain, reactive oxygen species, dorsal root ganglion, transient receptor potential vanilloid-1, substance p, calcitonin gene related peptide, intervertebral disc

BACKGROUND: Rowing-related low back disorders may occur from inconsistent technique, high trunk flexion and training volumes, overactivation of paraspinal muscles, and fatigue. OBJECTIVE: To examine if kinesiology tape (KT) affixed to the trunk dorsum affects muscular co-activation and neuromuscular control to limit dangerous rowing movements and associated injuries. METHODS: Participants (n = 18) completed two 2000 m rowing trials under BASELINE and KT conditions. KT was applied to the skin superficial to the paraspinals bilaterally with 60% pre-strain. Participants were instructed to minimize any sensation of tension. Whole body kinematics were obtained using inertial measurement units (IMUs), and surface electromyograms (EMGs) were recorded from trunk and lower extremity. Changes in joint range-of-motion (ROM) and co-activation indices (CAIs) were analyzed for shoulder, lumbar, hip, and knee. RESULTS: Responding participants (n = 5) were identified by reduced maximum lumbar flexion during the KT condition. As expected, significant differences occurred in maximum and minimum lumbar flexion/extension between responders and non-responders to KT. Additionally, there was significant reduction in mean trunk muscle co-activation in both those who did and did not respond to KT through reductions in maximum lumbar flexion. CONCLUSION: KT can be an effective at reducing mean trunk co-activation during a rowing trial in the flexed catch position. Variable responses suggest that further work is necessary to optimize the efficacy of sensory cues derived from KT during rowing movements. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Spinal subdural hematoma is uncommon but may become more prevalent with increasing anticoagulant use. Early diagnosis from symptoms like lower back pain and leg paralysis is crucial for timely intervention. [ABSTRACT FROM AUTHOR]

Lower back pain is a leading cause of global disability, affecting 12-33% of the population and stemming from various factors. One contributing factor is the entrapment of the superior cluneal nerves (SCN), which occurs in 1.6-14% of cases. This condition manifests as poorly localized lower back pain, often radiating to the gluteal and/or leg areas, without associated muscle weakness or sensory changes. The SCN are sensory nerves originating from the intermediate branches of the dorsal branches of the spinal nerves from T12-L3. They penetrate the thoracolumbar fascia, providing sensation to the skin of the lower back, upper buttocks, lateral thigh, and proximal thigh. This paper presents a clinical case of clunealgia with positive diagnostic tests involving ultrasound-guided infiltration of local anesthetic. Subsequently, an effective and viable therapeutic alternative for this syndrome is proposed. [ABSTRACT FROM AUTHOR]

Introduction: The lumbar erector spinae plane block is one of the interventional procedures for chronic low back pain. This study aimed to compare the efficacy of lumbar erector spinae plane block for chronic axial low back pain due to disc protrusion/bulging in geriatric and younger patients and to evaluate clinical, demographic, and radiological characteristics that may be associated with treatment success. Materials and Method: The clinical and demographic data of patients who underwent ultrasound-guided lumbar erector spinae plane block for chronic axial low back pain between November 2022 and July 2023 were retrospectively evaluated. Patients were divided into two groups, =65 and <65 years of age, and treatment efficacy at the third month after the procedure was evaluated and compared. Results: A total of 147 patients (75 patients aged <65 years and 72 patients aged =65 years) were included in the analysis, and a successful treatment response (at least 50% pain relief) was achieved in 44.4% of geriatric patients and 62.6% of younger patients (p=0.027). In addition BMI, comorbidity, opioid use, and lumbar paraspinal fatty infiltration were significantly higher in geriatric patients than in younger patients (p<0.05). Conclusion: The results of this study demonstrate that lumbar erector spinae plane block for chronic axial low back pain provides significantly less pain relief in geriatric patients than in younger patients at three-month follow-up. [ABSTRACT FROM AUTHOR]

Given there are no known studies which have examined multiple lower extremity muscles between different ankle positions during bridging activities, the objective was to assess how employing two different ankle positions (PF versus DF) while performing five common bridging exercises (three bipedal and two unipedal) used in rehabilitation and athletic performance affect core and select lower extremity muscle EMG recruitment. Twenty healthy subjects performed a 5 s isometric hold during five two- and one-leg bridge exercises: (1) on right leg with left knee to chest (1LB-LFlex); (2) on right leg with left knee extended (1LB-LExt); (3) standard two-leg bridge (2LB); (4) two-leg bridge with resistance band around knees (2LB-ABD); and (5) two-leg bridge with ball between knees (2LB-ADD). Surface electromyographic (EMG) data were collected using a Noraxon Telemyo Direct Transmission System from fourteen muscles: (1) three superficial quadriceps (VM, VL, and RF); (2) three hip abductors (TFL, GMED, and GMAX); (3) medial hamstrings (ST) and lateral hamstrings (BF); (4) hip adductors (ADD); (5) erector spinae (ES); (6) latissimus dorsi (LATS); (7) upper rectus abdominis (RA); and (8) external oblique (EO) and internal oblique (IO). EMG data were normalized by maximum voluntary isometric contractions (MVICs). A paired t-test (p < 0.01) was used to assess differences in normalized mean EMG activities between DF and PF for each exercise. EMG activities were significantly greater in DF than PF for the (a) VM, VL, and RF during 1LB-LFlex; (b) ADD during 1LB-LFlex, 1LB-LExt; (c) EO during 1LB-LFlex; and (d) IO during 1LB-LFex. In contrast, EMG activities were significantly greater in PF than DF for ST and BF during all five bridge exercises. Bridging with PF (feet flat) was most effective in recruiting the hamstrings, while bridging with DF (feet up) was most effective in recruiting the quadriceps, hip adductors, and internal and external obliques. [ABSTRACT FROM AUTHOR]

To explore the main risk factors for the occurrence of low back pain (LBP) and provide a theoretical basis for future prevention and intervention of LBP. Methods Using stratified cluster sampling, LBP patients treated in 11 hospitals nationwide were selected as the case group (n = 394), and patients with other diseases or healthy individuals from the same hospitals were selected as the control group (n = 413) from December 2021 to December 2022. Data on general personal information, occupational factors, lifestyle, and socio -psychological factors were collected through electronic questionnaires. R-language statistical software was used to analyze the data. Multifactorial logistic regression analysis was employed to explore the influencing factors of LBP, and multiplicative and additive interaction models were used to analyze the interaction effects of occupational and lifestyle factors. Results The average age of the case group was (47.65 ± 11.24) years; the control group's average age was (46.54 ± 11.31) years. Multifactorial logistic regression analysis showed that compared to those who were underweight, did not engage in repetitive work, did not use mobile phones during commuting, and were dissatisfied with their salary, those who were overweight or obese, engaged in repetitive work, used mobile phones during commuting, and were satisfied with their salary had an increased risk of LBP ranging from 1.759 to 3.713 times (P < 0.05). Compared to those with an educational level of primary school or below and administrative personnel, those with higher educational levels and professional technicians, office workers, military personnel, and equipment operators had a lower risk of LBP ranging from 0.144 to 0.571 times (P < 0.05). Interaction analysis showed a multiplicative interaction between repetitive work and mobile phone use during commuting (OR = 3.743, 95%CI: 2.181 - 6.424). Conclusions The occurrence of LBP was related to multiple individual, occupational, and lifestyle factors, and there may be a cumulative effect of work and lifestyle factors on the occurrence of LBP. Employers should take reasonable preventive measures to reduce the risk of LBP and ensure the occupational health of workers. [ABSTRACT FROM AUTHOR]

Introduction: Chronic low back pain presents a significant challenge in healthcare, affecting numerous individuals globally. Despite the availability of various treatment options, optimal management remains elusive. This study aims to explore different treatment strategies for chronic low back pain, including exercise, pharmacological interventions, and emerging techniques in neural management. Aim of the Study: The aim of this study is to provide healthcare professionals with comprehensive insights into managing chronic low back pain. By examining the effectiveness and potential side effects of different treatment modalities, the study seeks to enhance clinicians' understanding and decision-making in pain management. Brief Summary: Through a thorough review of literature and evidence-based analysis, this study discusses the role of exercise, medications, and neural management techniques in managing chronic low back pain. It evaluates the efficacy, safety, and potential benefits of each approach, offering valuable guidance for healthcare professionals in optimizing patient care. Conclusion: This study underscores the importance of adopting a multidisciplinary approach to managing chronic low back pain. By incorporating a range of treatment modalities, including exercise, pharmacological interventions, and emerging techniques, healthcare professionals can deliver personalized and effective care to patients. Enhanced knowledge and understanding of these strategies empower clinicians to address the complex challenges associated with chronic low back pain and improve patient outcomes.

Background. Globally, the LBP prevalence among the general population varies from 15-45%. Work-related LBP is estimated to cause 818,000 disability-adjusted life years lost (DALYs) annually. Aim of study. To determine the prevalence and factors associated with LBP among Iraqi Healthcare workers. Methodology. This is a cross-sectional study that included 220 participants and was conducted at Baghdad during the period from 5/7/2023 to 25/11/2023. Lower back pain was assessed using an Arabic version of the Standardized Nordic Musculoskeletal Questionnaire (NMQ). Results. The life, annual, and weekly prevalence of LBP were 92.7%, 90.9%, and 58.2%, respectively. A statistically significant associated was detected between weekly prevalence of LBP and each of female gender, long working hours, BMI, and occupation. Conclusion. LBP is a highly prevalent condition among Iraqi HCWs and it caused considerable reduction to the quality of life and work performance. Risk factors for weekly prevalence were female gender, longer working hours, obesity, and working as a dentist.

Lumbar facet interventions, including facet joint injections, medial nerve blocks, and radiofrequency ablation (RFA), are prevalent treatments for low back pain (LBP). Despite their widespread use, debates persist regarding various aspects of these procedures. The 2024 Consensus Working Group on Lumbar Facet Interventions, composed of practicing pain physicians from both China and the United States, conducted an extensive review of the literature on the use of lumbar facet interventions in chronic pain management. Following the U.S. Preventive Services Task Force grading guidelines, this consensus provides an evidence-based, patient-centered guideline tailored for pain physicians at all expertise levels for the management of chronic lower spinal pain. The guideline offers detailed recommendations on the identification of facetogenic pain, criteria for patient selection, the application of lumbar facet blocks and RFA techniques, and strategies for the prevention and management of intervention-related complications.

Abstract Introduction Persistent low back pain (LBP) is the leading cause of disability worldwide, and therapeutic exercise is recommended as a first-line treatment in international guidelines. The effects of exercise on clinical outcomes of pain and physical function are small to moderate, despite broader impacts on cardiovascular systems, biological health, mood, and emotional well-being. Therapeutic exercise prescription is defined as exercise that is prescribed by a clinician for a health-related treatment. It is unknown how therapeutic exercise prescription creates effects on outcomes of importance. Realist reviews explore how underlying mechanisms (M) may be active in the context (C) of certain situations, settings, or populations to create an intended or unintended outcome (O). Our objective is to explore and understand the mechanisms by which therapeutic exercise prescription changes outcomes for people with persistent LBP. Methods We will develop initial programme theories based on preliminary data from a previous systematic review and consensus workshop. These theories will be modified with input from a steering group (experts), a stakeholder group (people with lived experience of exercise for persistent LBP and clinicians), and a scoping search of the published literature. An information specialist will design and undertake an iterative search strategy. These will be used to create CMO configurations, which will be refined and tested using the literature. The realist review will be reported following RAMESES guidance. Discussion Realist reviews are uncommon in LBP research to date, yet those offer an opportunity to contrast with traditional methods of randomised controlled trials and systematic reviews and provide additional information regarding the contexts and mechanisms that may trigger certain outcomes. This can aid our understanding of the contextual features that may influence exercise prescription, such as for whom they are most effective, in what setting, how they are implemented and why. This realist synthesis will enhance our understanding of therapeutic exercise prescription to improve adherence and engagement and ultimately will provide clinically relevant recommendations regarding exercise prescription for those with persistent LBP. Systematic review registration The review has been registered with PROSPERO (CRD42017072023).

Abstract Purpose Lower back pain (LBP), mainly caused by intervertebral disk (IVD) degeneration (IDD), is widely prevalent worldwide and is a serious socioeconomic burden. Numerous factors may trigger this degenerative process, and microbial dysbiosis has recently been implicated as one of the likely causes. However, the exact relationship between IDD and the microbiome remains obscure. In this study, we investigated the gut microbiota composition and fecal metabolic phenotype and discussed the possible influences of microbiome dysbiosis on IDD. Methods Fecal DNA was extracted from 16 fecal samples (eight rabbit models with IDD and eight sex- and age-matched healthy controls) and analyzed by high-throughput 16S rDNA sequencing. The fecal samples were also analyzed by liquid chromatography–mass spectrometry-based metabolomics. Multivariate analyses were conducted for the relationship between the omics data and IDD, linear discriminant analysis effect size was employed for biomarker discovery. Moreover, the Kyoto Encyclopedia of Genes and Genomes (KEGG) database was used to annotate the differential metabolites. The potential correlation between differential gut microbiota and metabolites was then assessed. Results The 16S rDNA sequencing results showed that the β-diversity of the gut microbiota was significantly different between the IDD and control groups, with distinct abundance levels of dominant genera. Moreover, 59 metabolites were significantly upregulated and 91 were downregulated in IDD rabbits versus the controls. The KEGG enrichment analysis revealed that the top pathways remarkably impacted by IDD were tyrosine metabolism, amino sugar and nucleotide sugar metabolism, benzoate degradation, ABC transporters, ascorbate and aldarate metabolism, pantothenate and CoA biosynthesis, and pyrimidine metabolism. The correlation analysis revealed that DL-tyrosine and N-acetylmuramic acid were associated with multiple differential bacterial genera, including Helicobacter and Vibrio, which may play important roles in the process of IVD degeneration. Conclusion Our findings revealed that IDD altered gut microbiota and fecal metabolites in a rabbit model. The correlation analysis of microbiota and metabolome provides a deeper understanding of IDD and its possible etiopathogenesis. These results also provide a direction and theoretical basis for the clinical application of fecal transplantation, probiotics, and other methods to regulate gut microbiota in the treatment of LBP caused by IDD.

Lower back pain (LBP) is one of the most prevalent health losses in adults worldwide. Historically, heat has been successfully used for treating pain and relieving tight muscles. Given the effective contact with the occupant’s back and proximity to the heat source, coupled with increasing commute times, automotive seats offer an opportunity to intervene. Fifteen adults (nine female) who experienced acute, subacute, and chronic lower back pain were recruited to examine the effectiveness of heat delivered to the lower back in providing temporary pain relief. Participants sat in a car seat for 38 min on two days, which included a 5-min baseline followed by a 33-min intervention; control, or localized. For the control condition, participants sat for 33 min without any thermal devices on, while the localized condition heated and maintained the seat surface temperature of the lower seat back area to ~45 °C. Over the 33-min control condition, the back skin temperature increased by ~1–2 °C and did not impact the subjective LBP. Heating the lower back for 33 min to ~39 °C reduced the subjective LBP by 10%. We demonstrated that lower back pain can be alleviated from an automotive seat providing heat to the lower back within normal commute times in those with lower back pain.