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Chronic low back pain (cLBP) is the most frequently reported cause of years lived with disability. Identifying the anatomical structures or dysfunction contributing to patients' symptoms is critical to guiding treatment. The etiology of back pain and differential diagnosis is often broad, ranging from non-degenerative cLBP (trauma, tumor, inflammation, infection, etc.) to degenerative (also described as nonspecific) cLBP. After eliminating suspicion for more insidious causes of cLBP, a thorough investigation can be conducted in an attempt to identify a source of degenerative cLBP. Degenerative cLBP can originate from many sources, and a detailed understanding of the structures potentially involved is invaluable for an accurate diagnosis. This review article aims to provide a broad overview of the utility of clinical history, physical exam findings, imaging findings, and diagnostic procedures in identifying the cause of patients' cLBP. We provide a framework to help guide clinicians by dividing the structures into groups as follows: anterior vertebral column, posterior vertebral column, and extra-vertebral pain. For each condition listed, we touch on the treatment options that can be considered. [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) is one of the most common conditions in industrialized modern societies. Low back pain is usually nonspecific or mechanical. People with LBP have previously been found to have poor endurance and delayed Gluteus Maximus muscle firing. Anterior pelvic tilt was also believed to cause pelvic girdle discomfort and generalized LBP. Purpose: To evaluate the effectiveness of Gluteus Maximus Activation in correcting anterior pelvic tilt, reducing pain and improving the Functional Outcome among Mechanical Low back pain subjects. Materials and Methods: About 250 participants were selected from Thiraviam Orthopaedic Hospital by using Kinovea software based on inclusion and exclusion criteria. They were divided into 2 groups, Experimental Group (n=125), Control Group (n=125). Both groups were given stretching exercises then Experimental group was given Gluteus Maximus activation exercise with IFT and Control group was given spinal stabilization exercise with IFT. Interventions were given 5 times a week for 6 weeks. Study period : October 2022 to July 2023. Results: Pre-test and post-test values were analyzed and the result suggests that GM Activation Group has significant improvement when compared with Spinal stabilization Group with P<0.0001. Conclusion: According to this study, Gluteus Maximus activation exercises are more effective in correcting anterior pelvic tilt and reducing pain and improving functional outcome among Mechanical Low back pain subjects. [ABSTRACT FROM AUTHOR]

Background: Desk job workers are spending 75% of work hours in high levels of sitting and improper posture causing pain over the low back region.1 Physical exercise is recommended for reducing low back pain and it promotes a healthy lifestyle and quality of life for the workers.2 Purpose: The aim of the study was to determine the effect of Interferential therapy with ergonomic changes versus core strengthening exercises on low back pain among desk job workers. Materials and Methods: This was an Experimental study and the subjects were chosen from the KH shoe company, Ranipet. A total of (N=166) subjects participated in this study based on inclusion and exclusion criteria. The level of disability was assessed by using the Oswestry low back disability questionnaire and range of motion by modified Schober test and finger to floor test. The strengthening exercise was received by group B for 30 minutes and rest for 30 seconds. The entire study period was from September 2022 to July2023. Result: This study showed clinically significant reduction of low back pain using interferential therapy. Hence, by the conventional criteria, this difference is considered to be statistically significant P<0.0001. Conclusion: This study concluded that comparatively the interferential therapy with core strengthening exercise was more effective than the Interferential therapy with ergonomic changes. [ABSTRACT FROM AUTHOR]

Background: Mechanical low back pain (LBP) is one of the most prevalent musculoskeletal conditions, affecting a significant portion of the global population at some point in their lives. It is characterized by pain in the lumbar region without an obvious inflammatory or infectious origin, typically exacerbated by movement, posture, or mechanical load. LBP, whether acute, subacute, or chronic, is a leading cause of temporary and permanent disability, with significant economic repercussions due to lost workdays and healthcare costs. Recent clinical guidelines, such as those from the American College of Physicians (ACP) and the National Institute for Health and Care Excellence (NICE), emphasize the importance of non-invasive interventions for managing mechanical LBP, particularly in acute and chronic cases. In this context, this systematic review aims to consolidate current evidence on available therapeutic interventions, focusing on non-invasive treatments. Objective: To evaluate the available evidence on non-invasive therapeutic interventions for the treatment of mechanical low back pain. The review aims to synthesize international clinical guideline recommendations and identify the most effective practices for reducing pain and improving functional outcomes. Methods: This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Randomized controlled trials, systematic reviews, and clinical guidelines published up to 2023 addressing the management of mechanical low back pain in adults were included. Databases such as PubMed, Cochrane Library, and grey literature sources, including guidelines from medical societies, were searched. The study selection process followed strict eligibility criteria, including publications in English and Portuguese focused on non-invasive treatments for LBP. The methodological quality of the studies was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool. A total of 15 studies met the inclusion criteria, covering a range of non-invasive interventions such as physical therapy, exercise, acupuncture, manual therapy, and pharmacological approaches. Results: Evidence suggests that exercise-based interventions, particularly programs focused on muscle strengthening and stretching, are effective in reducing pain and improving functional outcomes in patients with mechanical LBP. Manual therapies and acupuncture also demonstrated benefits, albeit with less robust evidence. Reviewed guidelines recommend caution in the use of pharmacological interventions, such as nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in chronic cases. Conclusion: This review highlights that non-invasive therapies, especially supervised exercise programs, represent the most effective and safe treatment for mechanical low back pain. The revised international guidelines reinforce the importance of avoiding early invasive interventions, except in cases of persistent or refractory pain. Appropriate management of mechanical LBP should be individualized, integrating evidence-based interventions to promote functional rehabilitation and minimize the impact of pain on patients' quality of life. [ABSTRACT FROM AUTHOR]

Introduction. The primary purpose was to compare the effect of conventional program, instrument assisted soft tissue mobilization (IASTM) and kinesiotape (KT) in patients with chronic mechanical low back pain (CMLBP). Methods. 51 participants were randomly enrolled into three equal groups. Group A (n = 17) received conventional program, Group B (n = 17) received conventional program plus IASTM, and Group C (n = 17) received conventional program plus KT. The participants were evaluated before and after eight sessions using the Visual Analogue Scale (VAS), pressure algometer, dual inclinometer, and Oswestry Disability Index (ODI). Results. Between pre-treatment and post-treatment, the three groups demonstrated a significant pain reduction (57.2%, 61.2%, and 57.77%; p < 0.0001), a significant increase in pain pressure threshold (PPT) [right (Rt): 56%, 53.2%, and 35.6%; left (Lt): 49%, 50.55%, and 41.36%; p < 0.0001], a significant improvement in the range of motion (ROM) (flexion: 38.59%, 43.55%, and 35.7%; extension: 72.4%, 88.73%, and 65.56%; Rt lateral flexion: 79.05%, 78.03%, and 55.42%; Lt lateral flexion: 85.33%, 96.37%, and 64.66%; Rt rotation 135%, 116.5%, and 188.48%; Lt rotation: 203%, 140.48%, and 224.24%; p < 0.0001), and a significant improvement in the functional disability index (56.8%, 49.55%, and 46.99%; p < 0.0001). No significant difference in pain, PPT, ROM and function was found among the three groups. Conclusions. Conventional program, IASTM and KT are effective methods for improving pain, ROM and function on CMLBP. [ABSTRACT FROM AUTHOR]

Background: Mechanical low back pain is caused by the overuse of an anatomical or Functional structure (muscle strain), as well as pain caused by trauma or anatomic Structural deformity (herniated nucleus pulpous). Mechanical low back pain is a primary contributor to disability. Mechanical low back pain is associated with neck and trunk musculoskeletal weakness. Objective: To determine the effectiveness of lower back strengthening exercises combined with neck and upper trunk activities in alleviating low back pain. Methodology: A total 30 subjects with mechanical low back pain were chosen using convenient sampling technique based on inclusion and exclusion criteria. Patients were split into two groups (Conventional group-15, Intervention group-15). The Conventional group received Interferential therapy (IFT) and strengthening exercise for lower back. The Intervention group received Interferential therapy (IFT) and strengthening exercise for lower back along with the neck and upper trunk exercise. For a period of four weeks, three sets of 15 repetitions were completed during each of the interventions. The Oswestry disability index was used as an outcome measure to assess how much pain and disability each participant was experiencing. Results: The mean value of pre-test was 44.87 and the post-test was 38.60 for conventional group and the mean value of pretest was 45.60 and the post test was 26.07 for intervention group. Conclusion: From the study it has been concluded that neck and upper trunk Exercises combined with conventional protocol were shown to be more successful than Conventional protocol alone in the recovery of patients with mechanical low back pain. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The current study aimed at determining the difference in hamstring tightness between dominant and non-dominant legs and to detect the correlation between LBP and hamstring tightness. PATIENTS AND METHODS: One hundred females with hamstring tightness of at least 15 degrees have been included in the study. Hamstring shortening was examined by the Active Knee Extension test (AKE) and Straight Leg Raising test (SLR), whilst the functional disability' degree was measured by Oswestry Disability Index (ODI). RESULTS: The straight leg raising and the AKE of the dominant leg were significantly more flexible than the non-dominant ones. There was a weak positive non-significant correlation between ODI and AKE of the dominant side (r = 0.162, p = 0.1) and the non-dominant side (r = 0.071, p = 0.48). There was a weak negative non-significant correlation between ODI and SLR of the dominant side (r = - 0.29, p = 0.77) and the non-dominant side (r = - 0.53, p = 0.6). CONCLUSIONS: There was no relation between the degree of hamstring tightness and LBP in female students at Jouf University. [ABSTRACT FROM AUTHOR]

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Background: A slouched lumbar posture during sitting is risk factor for the low back pain (LBP). Various chairs have been used to maintain sagittal lumbar lordosis and sacral alignment during sitting. We aimed to demonstrate the effect of a pelvic-support chair on the lumbar lordosis and sacral tilt in patients with LBP. Methods: We recruited 29 patients with non-specific LBP and 11 healthy subjects in South Korea from Apr 2017 to Mar 2018. The sagittal lumbosacral alignment was examined radiographically in three sitting postures: usual, erect, and sitting in a pelvic-support chair. Five angles [the lumbar lordosis, upper lumbar (ULA), lower lumbar (LLA), lumbosacral (LSA), and sacral slope (SS) angles] were compared between the subjects with LBP and healthy subjects in the three sitting conditions. Results: There were significant differences in the lumbar lordosis, ULA, LLA, LSA, and SS according to sitting condition (P

BACKGROUND: Abnormal foot mechanics in foot over-pronation has an identified relationship with mechanical low back pain (MLBP). OBJECTIVE: To explore the use of short foot exercises (SFEs) as a standalone treatment for MLBP with foot over-pronation. METHODS: Forty-six patients with MLBP (PwMLBP) presenting with and foot over-pronation were analyzed. They were randomized into the SFE (short foot exercise), SFE plus traditional physical therapy treatment (SFE + TPT), and control (CG) groups. Functional disability and pain level were measured using the Oswestry Disability Index (ODI) and visual analog scale (VAS), respectively. Ultrasonography measured the cross-sectional area (CSA) of the abductor hallucis (AbdH) muscle. The foot posture and navicular drop (ND) were investigated using the foot posture index-6 (FPI) score and ND test, respectively. RESULTS: The CSA of the AbdH and VAS scores improved significantly (p < 0.001) between the groups, more in the SFE + TPT group than in the SFE group (p < 0.001). The ND, FPI, and ODI measures improved significantly among the groups (p < 0.001), with no significant difference (p > 0.002) between the SFE and SFE + TPT groups. The CG did not show significant differences in the outcome measures (p > 0.002). Based on the effect size, SFEs significantly improved all the variables of interest (d > 1). CONCLUSION: SFEs, with or without TPT may offer an effective treatment for PwMLBP with foot over-pronation. [ABSTRACT FROM AUTHOR]

Introduction: Prolonged sitting with awkward posture and long working hours are the predisposing factors for developing Mechanical Low Back Pain (LBP) in IT professionals. Poor dynamic trunk extension performance is associated with back-related permanent work disability and recurrence of LBP. The purpose of this study was to find and analyze the effect of spinal Extension exercises on Mechanical Low Back Pain in work from home IT professionals. Methods: In this comparative study, 50 work from home IT professionals from various companies were approached through emails. Subjects were randomized into two groups: Group A (n=25) was study group, and Group B (n=25) was control group. Subjects from both groups exercised three times per week for 4 months and followed the ergonomics. Pain intensity, functional disability, and strength of back extensor muscle were assessed at baseline and at the end of week 4. Results: Group A had lower pain intensity (3.24 ± 1.45 vs 4.76 ± 1.53) and functional disability (4.24 ± 2.14 vs 11.44 ± 1.75) and significantly higher back extensor strength (25.44 ± 4.3 vs 22.24 ± 4.58; P

Degenerative lumbar disease is a common condition in which progressive deterioration of the structures in the spine causes severely incapacitating pain and disability. Conservative management, including passive or active physical therapy, activity modification, and medications (eg, anti‐inflammatory medications, oral and injectable steroids, opioids), may provide relief. However, when conservative management is unsuccessful or patients experience symptoms for an extended period of time, they may require spine surgery. Surgeons use a variety of techniques to perform lumbar fusion procedures with instrumentation, including open, percutaneous, minimally invasive, and robotic‐assisted with navigation. The accuracy of pedicle‐screw placement varies according to the technique used, and accuracy rates are high after robotic‐assisted with navigation procedures. In addition, robotic‐assisted spine procedures result in fewer infections than non–robotic‐assisted spine procedures (P =.04). Perioperative nurses should understand basic lumbar spine anatomy, steps completed during robotic‐assisted lumbar spine surgery, and the nursing considerations for patients undergoing this type of procedure. [ABSTRACT FROM AUTHOR]

Introduction. Electrotherapy is a non-pharmacologic, non-invasive and simple method of back pain treatment that is also applied using interferential (IF) therapy. The objective of the study was to investigate the effect of IF on pain, range of motion, and quality of life in patients with chronic non-specific low back pain (CNLBP). Materials and methods. 61 patients suffering from CNLBP were randomly assigned to IF group (n=30) and placebo IF (n=31). All patients received supervised exercises 3 times per week for 4 weeks. The outcome measures were visual analogue scale (VAS), lumbar range of motion (ROM) in terms of flexion& extension and the Short Form-36 (SF-36) health questionnaire to evaluate the quality of life (QOL). Results. There were no significant differences between groups in terms of baseline and demographic characteristics (p > 0.05). There were significant differences between pre and post intervention in IF group in all measured parameters (VAS at rest, VAS during activity, Flexion, extension range of motion and QOL in term of physical and mental components) (p

Objective  To compare the effect of supervised physical therapy versus video-assisted technique in patients with chronic mechanical low back pain. Materials and Methods  This is a comparative study. Forty-two patients were recruited in the study where they were randomized by simple random sampling. Group A (n  = 21) received supervised physical therapy, and Group B (n  = 21) received the video-assisted technique. The intervention was given 45 minutes per day for 15 days. The measures of visual analog scale (VAS) and Roland–Morris Disability Questionnaire (RMQ) were taken both at baseline and after 15 days of intervention. Results  Comparison between the two groups using Mann–Whitney U test, supervised physiotherapy group showed significant improvement in VAS on activity, RMQ, and RMQ percentage (p  < 0.005). However, Group A, VAS on rest was not significant (p  > 0.005). Conclusion  Supervised physical therapy is effective in reducing pain on activity and improved the disability of patients with chronic mechanical low back pain than the video-assisted technique. [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) has been found to profoundly increase in athletes in the last decade. There are numerous treatment options available for LBP of which retrowalking seems to be a promising option for these patients; however, its potential utility in athletes is not known yet. Aim: To investigate the effect of addition of retrowalking to conventional exercises on pain, range of motion, muscle fatigability, and balance in collegiate athletes with chronic mechanical LBP. Methods: Subjects were screened using Oswestry Disability Index (ODI) and those having mild-to-moderate disability were included in the study. A sample of 30 athletes were randomly assigned into two groups, retrowalking + conventional exercise (n = 15) and conventional exercise (n = 15). Pain, flexion range of motion, balance, and muscle fatigability were examined before and after 4 weeks of the intervention. Retrowalking group performed retrowalk on a treadmill at self-paced speed for 15 min/day for 3 days per week for 4 weeks along with the conventional exercises for back pain, whereas participants in the control group performed conventional exercises alone for the same duration. Results: Significant differences were observed in pain (p = 0.003) and balance (p = 0.003) between the groups after the intervention period, signifying greater improvement in the retrowalking group. No significant group differences were observed for flexion range of motion (p = 0.97) and muscle fatigability (p > 0.05). Conclusions: Main findings of the present study suggest that retrowalking when added to conventional exercises may be helpful in reducing chronic mechanical LBP and improving dynamic balance. Whereas retrowalking when combined with conventional exercises has no additional effect in improving the flexion range of motion and reducing muscle fatigability. [ABSTRACT FROM AUTHOR]

Background: Spondylolysis and undiagnosed mechanical low back pain (UMLBP) are the main causes of low back pain (LBP) in adolescent athletes. No studies have evaluated the difference in clinical and radiographic factors between these 2 conditions. Furthermore, it remains unclear which adolescent athletes with LBP should undergo advanced imaging examination for spondylolysis. Purpose: To compare the clinical and radiographic factors of adolescent athletes with spondylolysis and UMLBP who did not have neurological symptoms or findings before magnetic resonance imaging (MRI) evaluation and to determine the predictors of spondylolysis findings on MRI. Study Design: Cohort study, Level of evidence, 3. Methods: The study population included 122 adolescent athletes aged 11 to 18 years who had LBP without neurological symptoms or findings and who underwent MRI. Of these participants, 75 were ultimately diagnosed with spondylolysis, and 47 were diagnosed with UMLBP. Clinical factors and the following radiographic parameters were compared between the 2 groups: spina bifida occulta, lumbar lordosis (LL) angle, and the ratio of the interfacet distance of L1 to that of L5 (L1:L5 ratio, %). A logistic regression analysis was performed to evaluate independent predictors of spondylolysis on MRI scans. Results: Significantly more athletes with spondylolysis were male (82.7% vs 48.9%; P < .001), had a greater LL angle (22.8> ± 8.1> vs 19.3 > ± 8.5>; P ¼ .02), and had a higher L1:L5 ratio (67.4% ± 6.3% vs 63.4% ± 6.6%; P ¼ .001) versus athletes with UMLBP. A multivariate analysis revealed that male sex (odds ratio [OR], 4.66; P < .001) and an L1:L5 ratio of >65% (OR, 3.48; P ¼ .003) were independent predictors of positive findings of spondylolysis on MRI scans. Conclusion: The study findings indicated that sex and the L1:L5 ratio are important indicators for whether to perform MRI as an advanced imaging examination for adolescent athletes with LBP who have no neurological symptoms and findings. [ABSTRACT FROM AUTHOR]

Oswestry disability Index(ODI) is the commonest patient reported outcome for assessment of disability due to low back pain. Its application to non-English speaking Punjabi population is limited as a validated and cross culturally adapted Punjabi version of ODI is not available. The purpose of the study was to analyse the psychometric properties of Punjabi version of Oswestry disability index (ODI-P) in patients with mechanical low back pain. The translation and cross-cultural adaptation of Punjabi version of ODI was done according to well recommended guidelines. The prefinal version was tested on a set of 15 patients and suitable modifications were made. The final version was administered to 113 patients with mechanical low back pain of more than two weeks duration. Psychometric properties comprising of internal consistency, test retest reliability, floor and ceiling effect, construct validity and factorial structure of the questionnaire were determined. ODI-P showed excellent internal consistency (Chronbach alpha of ODI-P is 0.72), test retest reliability (ICC 0.891) and construct validity (Spearman correlation coefficient with VAS 0.424). Factor analysis proved the questionnaire to be having a 1-factor structure with a total variance of 48.61%. ODI (P) is a reliable and valid instrument for measurement of disability related to mechanical low back pain in Punjabi population. It can be used both in research and clinical care settings in future. Image 1 [ABSTRACT FROM AUTHOR]

Background: Now-a-days it is seen that busy work schedule and unhealthy environment leads to discontinuity in exercising despite of awareness and knowledge of its effectiveness on problems like low back pain. There are many factors including improper posture, over loading, immobility, trunk muscles weakness leads to mechanical low back pain in adults. Exercises of various types have been used in managing low back pain. Hence there is a need to find out a single functional and effective exercise for such problems so that they can be done anytime during work and without any equipment which is also economical. Methodology: Thirty adults aged between 20-30 years participated in this comparative experimental study. After underwent physical screening for selection criteria mechanical low back pain followed by simple randomization participants were divided into group A and group B. Group A and group B received dynamic sitting and spinal extension exercise respectively for thrice a week for six weeks. Pre and post values were assessed using outcome measures Visual Analog Scale for pain, MMST used for lumbar mobility and Short Form-36 Health Survey Questionnaire for quality of life. Results: In comparison of post test scores of outcome measures evidenced that the reduction of pain score, improvement in lumbar mobility and quality of life scores. There were significantly improvement among the adults with mechanical low back pain treated with Dynamic sitting exercise (DSE) than treated with Spinal extension exercise (SEE). Conclusion: 6 weeks of dynamic sitting and spinal extension exercise can prevent in pain and improvement in lumbar mobility and quality of life in adults with mechanical low back pain. [ABSTRACT FROM AUTHOR]

The sacroiliac joint is a major cause of chronic low back pain. Radiofrequency (RF) ablation is a promising treatment for this problem, but strong evidence for the use of radiofrequency in management of sacroiliac joint arthropathy is lacking. Objective of this study is to detect and confirm the effects of radiofrequency ablation in managing pain from chronic sacroiliac joint arthropathy with identification of the proper technique for its application if feasible. Methods: After diagnostic sacroiliac joint injection, three groups with twenty subjects in each were subjected to radiofrequency ablation by one of three techniques: bipolar RF at six points, monopolar RF at six and three points. Evaluation was done after 2 weeks, one month, three months and six months for pain score using the visual analogue pain scale. Overall patient satisfaction was also evaluated by patient satisfaction score. Results: The VAS scores differed significantly [p < 0.001] pre and post RF, denoting statestically significant therapeutic effect of percutaneous radiofrequency in the management of pain ensuing from chronic sacroiliac joint arthropathy. However, the VAS did not differ significantly [P = 0.531] across the three techniques of applying RF. It was found that all the groups had similar satisfaction levels [p = 0.266]. Conclusions: Simple procedures may be as effective as more complex ones with less potential side effects during and after the procedure. [ABSTRACT FROM AUTHOR]

Background: Mechanical low back pain is one of the most common causes of discomfort amongst people all over. There are various exercises to reduce low back pain. Swiss ball exercises are one of the dynamic exercises which increase muscle strength, endurance, balance, and flexibility of the trunk while the individual leans on a swiss ball. Therefore the purpose of this study was to check the effects of lumbar stabilization exercises on a swiss ball in patients with mechanical low back pain. Methods: Forty participants out of which 30 were females and 10 were males who were suffering from mechanical low back pain between the age group of 20 to 60 years were included. They were divided into two groups, with each group having 20 subjects. One group was taught floor exercises, and the other was taught swiss ball exercises for two weeks thrice a week,i.e., six days. The pain and disability were checked with the Numeric Rating Scale, and Roland Morris Questionnaire scores respectively pre and post-intervention. Results: On comparison of the difference between both the groups the mean difference in the NRS and RMQ scores for floor group was one ± 1 and 0.75 ± 1.6(p

Abstract Aim of the work To assess the frequency and severity of peripheral enthesitis in spondyloarthritis (SpA) patients using musculoskeletal ultrasound (MSKUS) in B mode associated with power Doppler (PD) compared to a group of patients with mechanical low back pain (M-LBP). Patients and methods The study included 40 SpA patients and 20 M-LBP patients as a control group. Ultrasound (US) in B mode and PD was performed at Achilles tendon (AT) and plantar fascia (PF). Results The mean age of SpA patients was 41.9 ± 14.3 years and disease duration 8.4 ± 5.8 years. Axial form was found in 36 cases (90%) and peripheral form in 4 (10%). The mean ESR was 28.3 ± 23.2 mm/1sth and the CRP was 22.9 ± 31.2 mg/l. In SpA patients 109/160 (68.1%) of the assessed entheseal sites were significantly abnormal compared to 27/80 (33.8%) in M-LBP patients (AT p <.0001 and PF p =.02). Compared to the M-LBP patients, a significant difference was found in AT for hypoechogenicity (p =.006) and bone erosion (p =.005) and at both entheses for cortical hypervascularisation (AT: p <.0001 and PF: p =.03). Otherwise, in SpA patients, 60.2% (53/88) of non tender entheses showed at least one ultrasound abnormality compared to 77.8% (56/72) of tender entheses. A significant correlation was identified between clinical and ultrasound assessment (r = 0.4, p =.01). Conclusion The frequency of enthesitis was high among SpA compared with M-LBP patients and AT was the most affected enthesis. Abnormal vascularization in the cortical bone insertion of entheses was detected especially in SpA patients, and there was great evidence of subclinical enthesitis. [ABSTRACT FROM AUTHOR]

Background Lumbopelvic stabilization training ( LPST) may provide therapeutic benefits on pain modulation in chronic nonspecific low back pain conditions. This study aimed to examine the effects of LPST on pain threshold and pain intensity in comparison with the passive automated cycling intervention and control intervention among patients with chronic nonspecific low back pain. Methods A within-subject, repeated-measures, crossover randomized controlled design was conducted among 25 participants (7 males and 18 females) with chronic nonspecific low back pain. All the participants received 3 different types of experimental interventions, which included LPST, the passive automated cycling intervention, and the control intervention randomly, with 48 hours between the sessions. The pressure pain threshold ( PPT), hot-cold pain threshold, and pain intensity were estimated before and after the interventions. Results Repeated-measures analysis of variance showed that LPST provided therapeutic effects as it improved the PPT beyond the placebo and control interventions ( P < 0.01). The pain intensity under the LPST condition was significantly better than that under the passive automated cycling intervention and controlled intervention ( P < 0.001). Heat pain threshold under the LPST condition also showed a significant trend of improvement beyond the control ( P < 0.05), but no significant effects on cold pain threshold were evident. Conclusions Lumbopelvic stabilization training may provide therapeutic effects by inducing pain modulation through an improvement in the pain threshold and reduction in pain intensity. LPST may be considered as part of the management programs for treatment of chronic low back pain. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of the study was to gain information about the incidence of mechanical Low Back Pain (MLBP) injuries etiology in elite track and field athletes and to assess the recurrence rate. BACKGROUND: The prevalence and the etiology of Low Back Pain (LBP) in athletic populations at the elite level of competition lack of longitudinal studies focused on certain sport fields. The present study evaluates MLBP incidents in elite track and field athletes visiting National Track and Field Centre in Thessaloniki, Greece and classifies MLBP according to etiology. METHODS: One hundred and thirty Elite Track and Field Athletes with MLBP injuries were included in a 20-year observational cohort study recording the initial MLBP etiology according to a classification system based on mechanical diagnosis. It was examined if age, gender and sport category predispose the incidence of the initial MLBP etiology and if they consist risk factors for MLBP recurrence. RESULTS: Discogenic MLBP in elite track and field athletes was significantly higher at 46.9% (α = 0.05) compared with the other MLBP etiologies under consideration. Secondary findings of the present study regarding the incidence of MLBP etiology categories did not reveal significant associations with gender, age and contest categories (α = 0.05). Additionally, recurrence pathophysiology showed that discogenic MLBP obtained high recurrence rates at 0.48 (14 athletes from 29 athletes recurred) compared with other etiologies, followed by back elements injury recurrence rate at 0.24 (7 athletes out of 29). CONCLUSIONS: The study provided us with evidence of higher incidence of discogenic etiology of MLBP in elite track and field athletes. Further research is suggested in the use of etiology related LBP classification system in order to evaluate causes, prevalence and epidemiology of MLBP in athletic populations of specific sport categories. [ABSTRACT FROM AUTHOR]

Objective: To evaluate differences in measurements of the lateral recesses and foramina in degenerative lumbar segments on MR images in symptomatic patients obtained with the patient standing versus lying down and to analyze the relationship between possible differences and patients' symptoms., Material and Methods: We studied 207 disc levels in 175 patients aged between 17 and 75 years (median: 47 years) with low back pain. All patients underwent MRI in the decubitus position with their legs extended, followed by MRI in the standing position. We calculated the difference in the measurements of the lateral recesses (in mm) and in the foramina (area in mm 2 and smallest diameter in mm) obtained in the two positions. To eliminate the effects of possible errors in measurement, we selected cases in which the difference between the measurements obtained in the two positions was ≥10%; we used Student's t-tests for paired samples to analyze the entire group and subgroups of patients according to age, sex, grade of disc degeneration, and postural predominance of symptoms., Results: Overall, the measurements of the spaces were lower when patients were standing. For the lateral recesses, we observed differences ≥10% in 68 (33%) right recesses and in 65 (31.5%) left recesses; when patients were standing, decreases were much more common than increases (26% vs. 7%, respectively, on the right side and 24% vs. 7.5%, respectively, on the left side; p < 0.005). For the foramina, decreases in both the area and in the smallest diameter were also more common than increases when patients were standing: on the right side, areas decreased in 23% and increased in 4%, and smallest diameters decreased in 20% and increased 6%; on the left side, areas decreased in 24% and increased in 4%, and smallest diameters decreased in 17% and increased in 8% (p < 0.005). Considering the group of patients in whom the postural predominance of symptoms was known, we found significant differences in patients whose symptoms occurred predominantly or exclusively when standing, but not in the small group of patients whose symptoms occurred predominantly while lying. We found no differences between sexes in the changes in measurements of the recesses or foramina with standing. The differences between the measurements obtained in different positions were significant in patients aged >40 years, but not in younger groups of patients. Differences in relation to the grade of disc degeneration were significant only in intermediate grades (groups 3-6 in the Griffith classification system)., Conclusion: MRI obtained with patients standing can show decreases in the lateral recesses and foramina related to the predominance of symptoms while standing, especially in patients aged >40 years with Griffith disc degeneration grade 3-6, thus providing additional information in the study of patients who have low back pain when standing in whom the findings on conventional studies are inconclusive or discrepant with their symptoms. Further studies are necessary to help better define the value of upright MRI studies for degenerative lumbar disease., (Copyright © 2021 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Aim: Mechanical problems are frequently encountered and may cause low back pain (LBP) and leg pain by pressure on nerve roots. Neurologic findings like decreased deep tendon reflexes may be found during the physical examination. There are many etiologic factors in the pathogenesis of LBP and metabolic bone diseases like osteoporosis and osteomalacia also may cause mecanical LBP. Materials and Methods: In this study, 25 patients between 30-65 years were evaluated. In the patients, sensorial changes, deep tendon reflexes and muscle strength were correlated with dual x-ray absorbsiometry (DXA) results. Demographic findings (age, sex, occupation, education) and clinical results (pain duration, pain severity, height, weight) were evaluated. In DXA evaluation, L1-L4 total, femur neck and femur total bone mineral density (BMD) and T-scores were reported. Results: Pain severity, according to visual analog scale (VAS) was higher than six. Muscle strength, sensation and deep tendon reflex averages were found to be normal. DXA results were found to be osteopenic in femoral neck region of our patients. DXA results and clinical findings showed a weak and negative statistically significant correlation only between BMD at L1-L4 and pain severity. Conclusion: This study should be performed comparatively, multicenter, in a larger number of patients with LBP, for a longer period of follow-up. (Turkish Journal of Osteoporosis 2012;18:19-23)

Background: Conservative treatment remains the standard of care for treating nonspecific mechanical low back pain which is very common problem all around the world. In Pakistan, physiotherapists encounter this problem frequently in clinical practice. Despite a wide variety of treatments, 100 percent results have been unachievable. The purpose of this study was to establish a Standard and Uniform Physiotherapy Protocol for mechanical low back pain. Methods: To achieve the objective of this study, a questionnaire with structured and open ended questions were designed and distributed to hospitals and private clinics. 139 questionnaires were distributed from 1st March 2009 to 30th May 2009. By the end of July 5, 2009, 101 were filled and returned. The data was analyzed using descriptive statistics. Results: Results have shown that McKenzie (25%), combination of McKenzie and Maitland (9%) were among the preferred techniques. However, 14% did not use a specific technique. The preferred physical agents were hot packs (22%), combination of hot packs, ultrasound, TENS (22%). However, 4% did not prefer any physical agent. Out of 101 subjects per week, 20 subjects were treated for 7 days, 11 were treated for 5 days, 53 were treated for 3 days, 6 were treated for 2 days and 11 were treated for 1 day. The recurrence rate was 32.14% for those who were treated for six days, 34.75% for those treated for 5 days, 33.55% for those who were treated for 3 days, 31.25% for those who were treated for 2 days, and 37.55% for those who were treated for one day. 39% did not consider ergonomical issues while 27% did not advice regarding the patient nutritional facts. Average depression among patients was 24.7%. Conclusion: This study shows that the results for mechanical low back pain were not as effective with combination of techniques and modalities. If the physiotherapists had taken the psychological factors, ergonomical approach and nutrition into consideration, the results would have improved to a significant level.

Background: Mechanical Low back pain is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance. Both male and female populations are affected; however, there is a tendency towards a higher incidence in male patients. Mechanical low back pain is associated with pain and clinical instability in lumbar motion segments. Exercises play an important part in the rehabilitation of low back pain. The aim of this study was to compare the effectiveness between Core stabilization vs McKenzie exercises in the treatment of patients with mechanical low back pain. Methods: 30 patients were selected between the age groups of 20 yrs to 50 yrs and having a past history of low back pain for one month. 15 patients were allotted to each group of experiment. Group I was given Core stabilization exercises and Group II with McKenzie exercises. Interferential therapy was a common treatment for both the groups. Evaluations of the subjects were done using the Revised Oswestry Disability Index and Dynamic Endurance tests. Results: Data analysis revealed statistically significant difference between both the groups (p