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There is evidence in animal populations that loading and exercise can positively impact the intervertebral disc (IVD). However, there is a paucity of information in humans. We examined the lumbar IVDs in 308 young athletes across six sporting groups (baseball, swimming, basketball, kendo, soccer and running; mean age 19yrs) and 71 non‐athletic controls. IVD status was quantified via the ratio of IVD to vertebral body height (IVD hypertrophy) and ratio of signal intensity in the nucleus to that in the annulus signal (IVD nucleus hydration) on sagittal T2‐weighted MRI. P‐values were adjusted via the false discovery rate method to mitigate false positives. In examining the whole collective, compared to referents, there was evidence of IVD hypertrophy in basketball (P≤0.029), swimming (P≤0.010), soccer (P=0.036) and baseball (P=0.011) with greater IVD nucleus hydration in soccer (P=0.007). After matching participants based on back‐pain status and body height, basketball players showed evidence of IVD hypertrophy (P≤0.043) and soccer players greater IVD nucleus hydration (P=0.001) than referents. Greater career duration and training volume correlated with less (i.e. worse) IVD nucleus hydration, but explained less than 1% of the variance in this parameter. In this young collective, increasing age was associated with increased IVD height. The findings suggest that basketball and soccer may be associated with beneficial adaptations in the IVDs in young athletes. In line with evidence on other tissues, such as muscle and bone, the current study adds to evidence that specific loading types may beneficially modulate lumbar IVD properties. peerReviewed

(1) Background: Assessments of intervertebral disc (IVD) changes, and IVD tissue adaptations due to physical activity, for example, remains challenging. Newer magnetic resonance imaging techniques can quantify detailed features of the IVD, where T2-mapping and T2-weighted (T2w) and Dixon imaging are potential candidates. Yet, their relative utility has not been examined. The performances of these techniques were investigated to characterize IVD differences in asymptomatic individuals with distinct physical activity histories. (2) Methods: In total, 101 participants (54 women) aged 25&ndash, 35 years with distinct physical activity histories but without histories of spinal disease were included. T11/12 to L5/S1 IVDs were examined with sagittal T2-mapping, T2w and Dixon imaging. (3) Results: T2-mapping differentiated Pfirrmann grade-1 from all other grades (p &lt, 0.001). Most importantly, T2-mapping was able to characterize IVD differences in individuals with different training histories (p &lt, 0.005). Dixon displayed weak correlations with the Pfirrmann scale, but presented significantly higher water content in the IVDs of the long-distance runners (p &lt, 0.005). (4) Conclusions: Findings suggested that T2-mapping best reflects IVD differences in asymptomatic individuals with distinct physical activity histories changes. Dixon characterized new aspects of IVD, probably associated with IVD hypertrophy. This complementary information may help us to better understand the biological function of the disc.

Background context Muscle, bone and tendon respond anabolically to mechanical forces. Whether the intervertebral disc (IVD) can benefit from exercise is unclear. Purpose To examine whether exercise can beneficially affect IVD characteristics. Study design/setting This is a single-blinded 6-month randomised controlled trial (ACTRN12615001270505) in an exercise and physiotherapy clinic. Patient sample Forty patients with chronic non-specific low back pain (NSCLBP) are included in this study. Outcome measures The primary outcome was lumbar IVD T2 time (MRI). Secondary outcomes included IVD diffusion coefficient and IVD expansion with short-duration lying. Methods Twenty patients progressively loaded their lumbar IVDs (exercise) via an exercise programme involving progressive upright aerobic and resistance exercises targeting the trunk and major muscle groups and were compared to twenty patients who performed motor control training and manual therapy (control). Testing occurred at baseline, 3 months and 6 months. Results Seventeen exercise and fifteen control patients completed the interventions. There were no group-by-time differences in T2 time of the entire IVD (exercise 94.1 ± 10.0 ms vs. control 96.5 ± 9.3 ms, p = 0.549). Exercise patients had shorter T2 time in the posterior annulus at 6 months (82.7 ± 6.8 ms vs. 85.1 ± 8.0 ms, p = 0.028). Exercise patients showed higher L5/S1 apparent diffusion coefficients and decreased IVD height at 3 months (both p ≤ 0.050). After adjustments for multiple comparisons, differences lost statistical significance. Per-protocol and intent-to-treat analyses yielded similar findings. Conclusions This trial found that 6 months of exercise did not benefit the IVD of people with NSCLBP. Based on this index study, future studies could investigate the effect of exercise on IVD in different populations, with different types, durations and/or intensities of exercise, and using different IVD markers. peerReviewed

PURPOSE: Cycling is widely practiced as a mode of transportation, a leisurely pursuit and a competitive sport. Approximately half of cyclists experience low back pain. Yet, there has been limited study of spine tissue adaptations due to cycling. METHODS: To investigate potential risk factors for spinal pain, we compared 18 high-volume cyclists (>150 km per week for ³5 years) to 18 height-matched non-sporting referents. Participants had no history of spinal pathology. Magnetic resonance imaging was used to quantify intervertebral disc (IVD) morphology and hydration; and psoas, erector spinae, quadratus lumborum and multifidus muscle size and fat content. Endurance of trunk muscles (flexors and extensors) were measured and physical activity levels assessed objectively using accelerometry. RESULTS: Cyclists IVD showed prolonged T2-time (+10.0(17.3)%; p=0.021), implying better IVD hydration and glycosaminoglycan content, compared to referents. Lower thoracic and upper lumbar IVD T2 time were longer in cyclists (p≤0.029) but not at the lower lumbar spine. T2-time differences were larger in the nucleus pulposus compared to the annulus fibrosus. Cyclists showed larger psoas muscles with less fat content compared to referents. Cyclists also exhibited longer isometric trunk endurance times (p≤0.036) and higher physical activity levels (osteogenic index, p=0.038). CONCLUSION: Despite previous studies reporting higher than average prevalence of back pain in cyclists, the high-volume road cyclists in our cohort showed no anatomical or functional deficiency in spinal structures. In contrast, we found evidence for beneficial adaptations to the intervertebral discs and psoas muscles in high-volume cyclists compared to referents. These data support the notion that cycling is not detrimental to the spine; rather, in contrast, may be associated with beneficial changes at the spine. peerReviewed

Purpose Cycling is widely practiced as a mode of transportation, a leisurely pursuit, and a competitive sport. Approximately half of cyclists experience low back pain. Yet, there has been limited study of spine tissue adaptations due to cycling.Methods To investigate potential risk factors for spinal pain, we compared 18 high-volume cyclists (>150 kmwk(-1) for 5 yr) to 18 height-matched nonsporting referents. Participants had no history of spinal pathology. Magnetic resonance imaging was used to quantify intervertebral disc (IVD) morphology and hydration, and psoas, erector spinae, quadratus lumborum, and multifidus muscle size and fat content. Endurance of trunk muscles (flexors and extensors) was measured, and physical activity levels were assessed objectively using accelerometry.Results Cyclists' IVD showed prolonged T2 time (+10.0% 17.3%; P = 0.021), implying better IVD hydration and glycosaminoglycan content, compared with referents. Lower thoracic and upper lumbar IVD T2 time were longer in cyclists (P 0.029) but not at the lower lumbar spine. T2 time differences were larger in the nucleus pulposus compared with the annulus fibrosus. Cyclists showed larger psoas muscles with less fat content compared with referents. Cyclists also exhibited longer isometric trunk endurance times (P 0.036) and higher physical activity levels (osteogenic index, P = 0.038).Conclusion Despite previous studies reporting higher than average prevalence of back pain in cyclists, the high-volume road cyclists in our cohort showed no anatomical or functional deficiency in spinal structures. By contrast, we found evidence for beneficial adaptations to the IVD and psoas muscles in high-volume cyclists compared with referents. These data support the notion that cycling is not detrimental to the spine, rather, by contrast, may be associated with beneficial changes at the spine. Refereed/Peer-reviewed

Low back pain is a remarkably large part of the national health problems. Prolongation of the symptoms causes incapacity to work as well as economic burdens for the individual person and society. Traction has a long history of being used as a form of rehabilitation. The aim of traction is to decrease the pressure on different structures of the lumbar spine, i.e. discus and nervous tissues. Traction is especially used as a treatment for the lower back pain patients with sciatica. Most commonly traction treatment is combined with other forms of physiotherapy. However, research evidence of the impact of traction treatment, on the lower back pain is conflicting and insufficient. Therefore the national instructions for treatment have a reserved attitude to traction. Because only part of the low back pain patients benefit from the traction treatment, the optimal patient group has been tried to define. In the policlinic of physiatrics of Central Finland´s Health Care District, the Bac Trac – traction treatment is offered as one of the alternative treatment possibilities in home rehabilitation. The aim of this B.Sc. –thesis is to study the use of the Bac Trac – device of low back pain patients from the policlinic. In this study, the time used, the amount of and changes in the pain levels of patients has been studied from years 2003 to 2005. The background information concerning the low back pain symptoms is then used to find out what kind of patients benefit most from traction. The data was collected from the patient files as well as the use- and pain diaries, kept by the patients. The Bac Trac users were classified in to three categories: 1. discus prolaps, 2. lumbago 3.others. The changes in pain levels were monitored by the VAS – scale (visual analogues scale). The statistical analysis was conducted by the SPSS - programme. During the study the Bac Trac – device was used by 267 persons. Of these, 229 had returned diaries. On average the Bac Trac – device was used twice a day for 3.5 months. VAS- analogue scale information was found from 219 users. According to the VAS – scale the pain was relieved on average by 7 mm. In all categories there were patients who benefited from the traction as well as those who did not. However, in the comparison between these two groups there was not statistical difference. In the pain relief and longterm usage of the device there was a slight (r=0,30, p < 0,001) statistical correlation . Change in levels of pain and other background information showed no connection. Based on this study, it´s not possible to define users who benefit from traction. In the future the background information of patients should be charted in more detail and the experiences of long term traction users studied. In addition the follow up of the usage of the device, documentation and recording methods should be further developed in the policlinic. Alaselkäkivut ovat merkittävä kansanterveydellinen haaste. Oireiden pitkittyessä niistä aiheutuu työ- ja toimintakyvyttömyyttä sekä taloudellisia rasitteita yksilöille itselleen ja yhteiskunnalle. Traktio- eli vetohoidoilla on pitkä historia selkäkivun kuntoutuksessa. Traktiolla pyritään vähentämään kompressiota lannerangan eri rakenteissa, mm. välilevyissä ja hermokudoksissa. Alaselkäkipupotilailla traktiota käytetään etenkin välilevyperäisen iskiaskivun hoidossa usein yhdistettynä muuhun fysioterapiaan. Tutkimusnäyttö traktion vaikutuksesta selkäkipuun on kuitenkin ristiriitaista ja puutteellista. Hoitosuositukset suhtautuvat traktioon varautuneesti. Osa selkäkipupotilasta kokee hyötyvän vetohoidoista ja optimaalisen käyttäjäryhmän tunnuspiirteitä onkin pyritty selvittämään. Keski-Suomen keskussairaalan fysiatrian poliklinikan alaselkäkipupotilaille on tarjottu yhtenä lääkkeettömänä hoitovaihtoehtona Bac Trac -painovoima-avusteista traktiota kotikuntoutuksessa. Opinnäytetyön tavoitteena oli selvittää Keski-Suomen keskussairaalan fysiatrian poliklinikan selkäkipupotilaiden Bac Trac -laitetta käyttäneiden käyttöaikoja, -määriä ja kipumuutoksia vuosien 2003–2005 ajalta. Käyttäjien selkäoireeseen liittyvien taustatietojen avulla pyrittiin saamaan tietoa siitä millaiset potilaat hyötyvät traktiosta. Tiedot kerättiin potilaspapereista sekä potilaiden palauttamista käyttö- ja kipupäiväkirjoista. Käyttäjät luokiteltiin kolmeen diagnoosiryhmään. 1. välilevytyrä 2. lumbago 3. muut. Bac Trac – käytön aikaista kivun muutosta seurattiin VAS – kipujanalla. Tilastoanalyysi tehtiin SPSS -ohjelmalla. Bac Trac -laitteen oli saanut lainaan tutkimusvuosien aikana yhteensä 267 henkilöä. Heistä 229 oli palauttanut käyttöpäiväkirjat. Keskimäärin Bac Trac -laitetta käytettiin 3,5 kuukautta kahdesti päivässä. 219 käyttäjältä löytyi kattava kipuseuranta. Tulosten perusteella kipu lievittyi VAS - janalla keskimäärin 7 mm. Kaikissa diagnoosiryhmissä oli traktiosta hyötyneitä sekä niitä joille siitä ei ollut apua, mutta ryhmien välisissä vertailuissa ei ilmennyt tilastollisia eroja. Kivun lievittymisen ja laitteen pitkän käyttöajan välillä oli lievä (r=0,30, p < 0,001) tilastollinen yhteys. Kipumuutoksen ja muiden taustatietojen välisissä vertailuissa ei löytynyt yhteyttä, joiden avulla olisi saatu tietoa käytöstä hyötyvien yhteisiä tunnuspiirteistä. Jatkossa tulisi kartoittaa selkäpotilaiden taustatiedot vielä tarkemmin ja selvittää pitkäaikaiskäyttäjien käyttökokemuksia. Lisäksi apuvälineen käytön seurantaa, dokumentointia ja tallennusjärjestelmää olisi syytä kehittää työyksikössä.