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Pain is a complex phenomenon, the experience of which varies widely across individuals. At worst, chronic pain can lead to anxiety and depression. Cost-effective strategies are urgently needed to improve the treatment of pain, and thus we propose a novel home-based pain measurement system for the longitudinal monitoring of pain experience and variation in different patients with chronic low back pain. The autonomous nervous system and audio-visual features are analyzed from heart rate signals, voice characteristics and facial expressions using a unique measurement protocol. Self-reporting is utilized for the follow-up of changes in pain intensity, induced by well-designed physical maneuvers, and for studying the consecutive trends in pain. We describe the study protocol, including hospital measurements and questionnaires and the implementation of the home measurement devices. We also present different methods for analyzing the multimodal data: electroencephalography, audio, video and heart rate. Our intention is to provide new insights using technical methodologies that will be beneficial in the future not only for patients with low back pain but also patients suffering from any chronic pain.

Objectives The aim of this study was to investigate the association between pelvic kinematics during the standing knee lift (SKL) test and low back pain (LBP) in youth floorball and basketball players. Design A prospective cohort study. Setting Finnish elite youth floorball and basketball players. Participants Finnish elite youth female and male floorball and basketball players (n = 258, mean age 15.7 ± 1.8). Main outcome measures LBP resulting in time loss from practice and games was recorded over a 12-month period and verified by a study physician. Associations between LBP and sagittal plane pelvic tilt and frontal plane pelvic obliquity during the SKL test as measured at baseline were investigated. Individual training and game hours were recorded, and Cox’s proportional hazard models with mixed effects were used for the analysis. Results Cox analyses revealed that sagittal plane pelvic tilt and frontal plane pelvic obliquity were not associated with LBP in floorball and basketball players during the follow-up. The hazard ratios for pelvic tilt and pelvic obliquity ranged between 0.93 and 1.08 (95% CIs between 0.91 and 1.07 and 0.83 and 1.29), respectively. Conclusions Pelvic movement during the SKL test is not associated with future LBP in youth floorball and basketball players.

OBJECTIVE: This study investigates the association between depressive symptoms and multisite pain and health-related quality of life and work ability in currently employed health care workers with recurrent low back pain (LBP). METHODS: Multisite pain, depressive symptoms, quality of life, and work ability were assessed by validated questionnaires. A generalized linear model was used for statistical analysis. RESULTS: Notably, 28% of female health care workers with LBP had at least moderate levels of depressive symptoms. Depressive symptoms were significantly associated with decreased health-related quality of life and work ability. Multisite pain was not significantly associated with work ability. CONCLUSIONS: Depressive symptoms are relatively common in female health care workers with LBP, and treatment of these symptoms may be crucial to improve their work ability. publishedVersion

Objectives: To evaluate the association of thoracic spine (TS) posture and mobility with TS pain. Methods: Participants with TS pain reported maximum, average, and night pain in TS area, and pain summary score was calculated. Upright and sitting TS postures were evaluated by inspection. TS posture and mobility (flexion and extension) were recorded using an inclinometer and a tape measure, respectively. Correlations between posture and mobility assessments were calculated using Spearman rank correlation, the association of TS posture and mobility with TS pain by logistic regression analysis. Results: The participants’ (n = 73, 52 females, age range 22–56) TS pain duration was 12 weeks on average. The correlations for measurements of TS posture and flexion mobility were higher than correlations of other TS measurements being between 0.53 and 0.82. Decreased extension mobility of the upper (from 1st to 6th TS segments; Th1–Th6) TS was associated with higher worst pain (OR 1.04, 95% CI 1.00–1.07) and whole TS with pain sum score (OR 1.05, 95% CI 1.01– 1.08). Less kyphotic whole TS was associated with lower pain sum score (OR 0.96, 95% CI 0.92– 1.00). Greater flexion mobility of upper and lower (Th6–Th12) TS were associated with lower pain sum score (OR 0.96, 95% CI 0.91–1.00, and OR 0.96, 95% CI 0.91–1.00, respectively). Conclusions: Reduced thoracic extension mobility was associated with higher pain scores and the greater flexion mobility with lower pain scores. Future research is warranted to evaluate if treatments geared toward TS extension mobility improvements would result in lower TS pain. peerReviewed

Background: A small cross sectional area (CSA) of the paraspinal muscles may be related to low back pain among military aviators but previous studies have mainly concentrated on spinal disc degeneration. Therefore, the primary aim of the study was to investigate the changes in muscle CSA and composition of the psoas and paraspinal muscles during a 5-year follow up among Finnish Air Force (FINAF) fighter pilots. Methods: Study population consisted of 26 volunteered FINAF male fighter pilots (age: 20.6 (±0.6) at the baseline). The magnetic resonance imaging (MRI) examinations were collected at baseline and after 5 years of follow-up. CSA and composition of the paraspinal and psoas muscles were obtained at the levels of 3-4 and 4-5 lumbar spine. Maximal isometric strength tests were only performed on one occasion at baseline. Results: The follow-up comparisons indicated that the mean CSA of the paraspinal muscles increased (p

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

Background Prospective studies investigating risk factors for low back pain (LBP) in youth athletes are limited. The aim of this prospective study was to investigate the association between hip-pelvic kinematics and vertical ground reaction force (vGRF) during landing tasks and LBP in youth floorball and basketball players. Methods Three-hundred-and-eighty-three Finnish youth female and male floorball and basketball players (mean age 15.7 ± 1.8) participated and were followed up on for 3 years. At the beginning of every study year the players were tested with a single-leg vertical drop jump (SLVDJ) and a vertical drop jump (VDJ). Hip-pelvic kinematics, measured as femur-pelvic angle (FPA) during SLVDJ landing, and peak vGRF and side-to-side asymmetry of vGRF during VDJ landing were the investigated risk factors. Individual exposure time and LBP resulting in time-loss were recorded during the follow-up. Cox’s proportional hazard models with mixed effects and time-varying risk factors were used for analysis. Results We found an increase in the risk for LBP in players with decreased FPA during SLVDJ landing. There was a small increase in risk for LBP with a one-degree decrease in right leg FPA during SLVDJ landing (HR 1.09, 95% CI 1.02 to 1.17, per one-degree decrease of FPA). Our results showed no significant relationship between risk for LBP and left leg FPA (HR 1.04, 95% CI 0.97 to 1.11, per one-degree decrease of FPA), vGRF (HR 1.83, 95% CI 0.95 to 3.51) or vGRF side-to-side difference (HR 1.22, 95% CI 0.65 to 2.27) during landing tasks. Conclusions Our results suggest that there is an association between hip-pelvic kinematics and future LBP. However, we did not find an association between LBP and vGRF. In the future, the association between hip-pelvic kinematics and LBP occurrence should be investigated further with cohort and intervention studies to verify the results from this investigation. Level of evidence Prognosis, level 1b.

The aim of this study was to investigate the incidence of back pain in young basketball and floorball players under 21 years of age. The secondary aim was to examine risk factors especially for low back pain (LBP). Nine basketball and nine floorball teams (n = 396) participated in this prospective follow‐up study (2011‐2014). Young athletes (mean age 15.8 ± 1.9) performed physical tests and completed a questionnaire at baseline. The follow‐up lasted 1‐3 years per player. During the follow‐up, back pain reported by the players was registered on a weekly basis and verified by a study physician. The exposure time (AE) on team practices and games was recorded by the coach. Altogether back pain was reported 61 times by 51 players. The incidence of back pain was 87 per 1000 athlete‐years and 0.4 per 1000 hours of AE. Hamstrings, quadriceps and iliopsoas extensibility and general joint hypermobility were not associated with LBP. Furthermore, no association between LBP and leg extension strength or isometric hip abduction strength asymmetry was found in these young basketball and floorball players. In conclusion, back pain can lead to a considerable time‐loss from training and competition among young basketball and floorball players and the pain tends to reoccur. Lower extremity muscle extensibility, general joint hypermobility or investigated lower extremity strength measures were not associated with the risk of LBP. peerReviewed

Leisure-time physical activity has a complex relationship with low back pain (LBP). Thus, we aimed to investigate whether the diversity of sport activities is associated with the type of LBP. In the FinnTwin16 study, 4246 (55% females) Finnish twins at mean age 34.1 years replied to a health behaviour survey in 2010-2012. Based on the participation in different sport activities, we created two measures of diversity: quantity (i.e. the number of sport activities: 1, 2, 3, 4 and >= 5) and quality (i.e. the type of sport activity: endurance, strength, body care, etc.). Based on the frequency, duration and type of LBP, we created three groups: no history of LBP lasting more than one day, radiating LBP and non-radiating LBP. The associations between the quantity and quality of sport activities and the type of LBP were investigated with logistic regression analyses. Participation in >= 5 sport activities associated with less radiating and non-radiating LBP in analyses pooled across sex (odds ratio 0.46, 95% CI 0.30-0.69 and 0.66, 0.44-0.99, respectively). However, the associations attenuated after adjusting for several confounders. Participation in endurance sports was associated with less radiating (0.58, 0.43-0.76) and non-radiating (0.60, 0.44-0.81) LBP, whereas strength sports and body care only with less radiating LBP (0.76, 0.58-1.00 and 0.26, 0.09-0.74, respectively) adjusted for all sport types. On a sport-specific level, running and cycling were associated with less radiating and non-radiating LBP. In adulthood, the diversity of sport activities, particularly participation in endurance sports, may be associated with less radiating and non-radiating LBP.

nonPeerReviewed

Exercise and spinal manipulative therapy are commonly used for the treatment of chronic low back pain (CLBP) in Australia. Reduction in pain intensity is a common outcome, however, it is only one measure of intervention efficacy in clinical practice. Therefore, we evaluated the effectiveness of two common clinical interventions on physical and self-report measures in CLBP. Participants were randomized to a 6‑month intervention of general strength and conditioning (GSC, n = 20, up to 52 sessions) or motor control exercise plus manual therapy (MCMT, n =20, up to 12 sessions). Pain intensity was measured at baseline and fortnightly throughout the intervention. Trunk extension and flexion endurance, leg muscle strength and endurance, paraspinal muscle volume, cardio‑respiratory fitness and self-report measures of kinesiophobia, disability and quality of life were assessed at baseline and 3- and 6-month follow-up. Pain intensity differed favoring MCMT between-groups at week 14 and 16 of treatment (both, p = 0.003), but not at 6-month follow‑up. Both GSC (mean change (95%CI): &minus, 10.7 (&minus, 18.7, &minus, 2.8) mm, p = 0.008) and MCMT (&minus, 19.2 (&minus, 28.1, &minus, 10.3) mm, p &lt, 0.001) had within-group reductions in pain intensity at six months, but did not achieve clinically meaningful thresholds (20mm) within- or between‑group. At 6-month follow-up, GSC increased trunk extension (mean difference (95% CI): 81.8 (34.8, 128.8) s, p = 0.004) and flexion endurance (51.5 (20.5, 82.6) s, p = 0.004), as well as leg muscle strength (24.7 (3.4, 46.0) kg, p = 0.001) and endurance (9.1 (1.7, 16.4) reps, p = 0.015) compared to MCMT. GSC reduced disability (&minus, 5.7 (‑11.2, &minus, 0.2) pts, p = 0.041) and kinesiophobia (&minus, 6.6 (&minus, 9.9, &minus, 3.2) pts, 0.001) compared to MCMT at 6‑month follow-up. Multifidus volume increased within-group for GSC (p = 0.003), but not MCMT or between-groups. No other between-group changes were observed at six months. Overall, GSC improved trunk endurance, leg muscle strength and endurance, self-report disability and kinesiophobia compared to MCMT at six months. These results show that GSC may provide a more diverse range of treatment effects compared to MCMT.

Background Low back pain (LBP) is the number one cause of disability globally. LBP is a symptom associated with biological, psychological and social factors, and serious causes for pain are very rare. Unhelpful beliefs about LBP and inappropriate imaging are common. Practitioners report pressure from patients to provide inappropriate imaging. A recently developed patient education and management booklet, ‘Understanding low back pain’, was designed to target previously identified barriers for reducing inappropriate imaging. The booklet includes evidence-based information on LBP and supports communication between patients and practitioners. Our aim was to 1) describe the translation process into Finnish and 2) study patients’ and practitioners’ attitudes to the booklet and to evaluate if it improved patients’ understanding of LBP and practitioners’ ability to follow imaging guidelines. Methods We translated the booklet from English to Finnish. Preliminary evaluation of the booklet was obtained from LBP patients (n = 136) and practitioners (n = 32) using web-based questionnaires. Open-ended questions were analysed using thematic analysis. Results Approximately half of the patients reported that reading the booklet helped them to understand LBP, while a third thought it encouraged them to perform physical activity and decreased LBP-related fear. Eighty percent of practitioners reported that the booklet helped them to follow imaging guidelines. In addition, practitioners reported that they found the booklet helpful and that it decreased the need for imaging. Conclusions The booklet seemed to be helpful in LBP management and in decreasing the need for LBP imaging according to patients and practitioners. Further research on the clinical effectiveness of the booklet in controlled study settings is needed. Trial registration ISRCTN, ISRCTN14389368, Registered 4 April 2019 - Retrospectively registered; ISRCTN11875357, Registered 22 April 2019 - Retrospectively registered.

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

This study investigates cross-sectional and longitudinal associations between the diversity of leisure-time sport activities and the frequencies of low back pain (LBP) and neck-shoulder region pain (NSP) in twins, including a cross-sectional within-pair design to adjust for potential familial confounding. Finnish twins born in 1975–79 (FinnTwin16 study) reported participation in leisure-time sport activities at the mean ages of 17 (1992–96) (n = 5096, 54% females) and 34 years (2010−12) (n = 3731, 57% females). Diversity assessed as the number of sport activities was categorized as 1, 2, 3, 4, and ≥ 5, excluding inactive individuals. The frequencies of LBP (n = 3201) and NSP (n = 3207), reported at age 34, were categorized as never/seldom, monthly, or weekly pain. Cross-sectional and longitudinal individual-based associations between the number of sport activities and the frequency of LBP and NSP were investigated with multinomial logistic regression analyses, adjusting for multiple confounders. Cross-sectionally, participation in ≥5 sport activities, compared to 1 sport, was associated with significantly less weekly LBP (OR = 0.63, 95%CI = 0.43–0.90), but not with NSP. Longitudinally, participation in several sport activities in adolescence had no significant association with LBP or NSP in adulthood. Cross-sectional within-pair analyses were conducted among twin pairs discordant for LBP (n = 507) and NSP (n = 579). The associations between monozygotic and dizygotic twin pairs were similar in LBP-discordant pairs but differed within NSP-discordant pairs. Participation in ≥5 sport activities in adulthood may be associated with less weekly LBP, but not with monthly LBP or the frequency of NSP. However, within-pair analyses for NSP suggest confounding due to shared familial factors., Highlights • Participation in more sport activities is associated with less low back pain (LBP). • More sport activities is not associated with neck-shoulder pain (NSP). • Shared familial factors may confound the association between sport activities and NSP. • Number of sport activities in adolescence did not predict LBP or NSP in adulthood.

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

Mikkonen, T. 2018. Fyysisen aktiivisuuden ja istumisen yhteys niskahartiaseudun ja alaselän kipujen esiintyvyyteen työikäisillä. Liikuntatieteellinen tiedekunta, Jyväskylän yliopisto, Liikuntalääketieteen pro gradu -tutkielma, 62 s, 1 liite. Niskahartiaseudun ja alaselän kivut ovat Suomessa ja maailmanlaajuisesti suurin työikäisten sairaslomapäiviä aiheuttava syy. Samaan aikaan fyysisen aktiivisuuden tiedetään vähentyneen ja päivittäisen istumisen ja muun paikallaanolon lisääntyneen. Viime vuosikymmeninä useat tutkimukset ovat osoittaneet, että fyysisellä aktiivisuudella voidaan parantaa terveyttä. Istumisen taas tiedetään olevan itsenäisenä tekijänä yhteydessä huonompaan terveyteen. Fyysisen aktiivisuuden ja istumisen yhteys niskahartiaseudun ja alaselän kipujen esiintyvyyteen ei ole täysin selvä. Tämän tutkimuksen tarkoituksena on selvittää, onko vapaa-ajalla, työmatkalla tai työajalla mitattu fyysinen aktiivisuus ja vapaa-ajalla tai työajalla mitattu istuminen yhteydessä niskahartiaseudun tai alaselän kipujen esiintyvyyteen Tampereen alueen työikäisillä. Tutkimusaineisto, jota tässä tutkimuksessa käytettiin, on saatu kokonaisuudessaan UKK- instituutilta. Aineisto on osa KÄPY- hankkeessa (Kävelyn- ja pyöräilyn edistämishanke) kerättyä aineistoa. Tässä tutkimuksessa käytetty aineisto on kerätty vuosien 2014–2015 välillä. Aineisto koostui sekä kyselylomakkeella kerätystä datasta että objektiivisesti HookieAM20 liikemittarilla mitatusta datasta. 1117 henkilöä täytti kyselylomakkeen ja 422 käytti liikemittaria. Kyselylomakkeesta saatiin tutkittavien niskahartiaseudun ja alaselän kipua sekä työmatkaliikuntaa kuvaavat arvot. Liikemittarista saatiin vapaa-ajan ja työajan fyysistä aktiivisuutta ja istumista kuvaavat arvot. Tilastollisista menetelmistä käytettiin Khiin neliö (χ2) -testiä, Kruskal-Wallis-testiä, Spearmanin korrelaatiokerrointa ja binääristä logistista regressioanalyysia. Kyselylomakkeella mitattu työmatkoilla tapahtunut fyysinen aktiivisuus oli tilastollisesti merkitsevästi yhteydessä niskahartiaseudun kipujen esiintyvyyteen, silloin kun työmatkalla käytettiin pyörää. Kävellen kuljetun työmatkan ja niskahartiaseudun kipujen välillä ei havaittu tilastollisesti merkitsevää yhteyttä. Harvemmin 1–2 kertaa viikossa kuljettu työmatka lisäsi kipujen esiintyvyyttä, kun usein 3–5 viikossa kuljettu työmatka vähensi kipujen esiintymistä. Monimuuttuja-analyysissa niskahartiaseudun kipujen esiintyvyyttä selitti työmatkapyöräilyn lisäksi naissukupuoli, nuorempi ikä ja koettu huonompi terveydentila. Työmatkalla tapahtunut fyysinen aktiivisuus ei ollut yhteydessä alaselän kipujen esiintyvyyteen. Objektiivisesti mitattu vapaa-ajan ja työajan fyysinen aktiivisuus tai istuminen ei ollut tilastollisesti merkitsevästi yhteydessä niskahartiaseudun tai alaselän kipuihin. Heikko korrelaatio havaittiin niskahartiaseudun kipujen ja työaikaisen istumisen välillä. Tämä tutkimus antaa viitteitä siitä, että 3-5 kertaa viikossa pyörällä kuljettu työmatka saattaisi vähentää niskahartiaseudun kipujen esiintyvyyttä työikäisillä, kun 1-2 kertaa viikossa kuljettu työmatka pyörällä saattaa lisätä kipuja. Aikaisempia tutkimuksia työmatkapyöräilyn ja niskahartiaseudun kivun esiintyvyyden yhteydestä ei juurikaan ole. Työmatkapyöräilyllä on kuitenkin havaittu olevan muita terveyttä edistäviä vaikutuksia. Erityisesti työnantajien kannattaa panostaa työmatkaliikuntaan, koska parempi terveys on yhteydessä vähentyneisiin sairaspoissaoloihin. Jatkossa on tärkeää, että aihetta tutkitaan lisää. Avainsanat: Niskahartiaseudun kipu, alaselän kipu, fyysinen aktiivisuus, istuminen, vapaa-aika, työaika ja työmatkaliikunta. Mikkonen T. 2018. Association of physical activity and sedentary behavior with neck shoulder and low back pain in sample of working aged population. Department of Health Sciences, University of Jyväskylä, Sports and Exercise Medicine, Master’s thesis, 62 pp, 1 appendix. Neck and shoulder pain as well as low back pain are major health problems among working age population. At the same time, we know that physical activity has decreased and that daily sedentary behavior has increased. In recent decades researchers have published several studies with evidence that physical activity can improve health. Recently studies have also found that sedentary behavior is associated with poorer health status as an independent factor. However, associations between physical activity and sedentary behavior to the neck shoulder pain and low back pain are not completely clear. The aim of this study is to investigate the associations between physical activity, sedentary behavior (leisure time, occupational or commute periods), neck shoulder pain and low back pain among working age population in the Tampere region. The data for this study was provided by UKK Institute and it was part of the study Socio-Ecological Intervention to Promote Active Commuting to Work. The data in this study was collected by using questionnaires and the objective data was collected with the triaxle accelerometer HookieAM20 in 2014 and 2015. 1117 participants filled the questionnaire and 422 wore accelerometers. The questionnaire included questions about neck shoulder pain, low back pain and active commuting by using a bicycle or walking. The accelerometer included data about leisure time, occupational physical activity and sedentary behavior. The associations between variables were then analyzed by using Chi-square (χ²)-test, Kruskall-Wallis test, Spearman correlation coefficients and multinomial logistic regression analysis. Active commuting measured by the questionnaire was associated to the incidence of neck shoulder pain when a bicycle was used. Commuting by walking was not associated to the neck shoulder pain. Participants using a bicycle 1-2 times per week for commuting seemed to have more neck shoulder pain than those using it 3-5 times per week. Multinomial regression analysis showed that also female gender, younger age and poorer health status were associated to the incidence of neck shoulder pain. Active commuting was not associated to the low back pain. Objective measured physical activity or sedentary behavior were not associated to the neck shoulder pain or low back pain. Weak correlation was noticed between the occupational sedentary behavior and neck shoulder pain. This study shows that active commuting by using a bicycle 3-5 times per week may decrease the incidence of neck shoulder pain; correspondingly using it 1-2 per week for commuting may increase the incidence of neck shoulder pain. There is a relatively small amount of recent studies on the association between commuting by using a bicycle and the incidence of neck shoulder pain though they have shown that commuting by using a bicycle has other health promoting factors. Because better health is associated with reduced sick leave employers should promote active commuting. In the future this topic needs to be further researched. Keywords: Neck shoulder pain, low back pain, physical activity, sedentary behavior, leisure time, occupational time and active commuting.

Low back pain is a considerable health problem which affects people around the world, causing major healthcare costs. The use of qualitative research methods enables us to describe and understand patients' experience of, and attitudes to, healthcare. The aim of the present phenomenographic study was to identify and describe the contextual nature of the conceptions of patients with low back pain of their encounters in the HCS. Seventeen patients with chronic or episodic low back pain classified as "high risk" were interviewed in open recall interviews, using videos of patients' initial physiotherapy sessions that had been recorded previously. The data were analysed using the phenomenographic method. Patients' conceptions of their clinical journey were formulated by a variety of themes: convincing care, lifestyle change, participation, reciprocality and ethicality of encounters. The themes varied in four categories: "non-encounters", seeking support, empowering collaboration and autonomic agency. The results showed a range of clinical interactions - from very negative and disempowering, to empowering and life changing. The key differences between the first and second categories were professionals "being present" and patients starting to understand their low back pain. Between the second and third category, the key aspects were strong therapeutic alliance and the active participation of the patient. Finally, the key differences between the third and fourth categories were the patient being in charge and taking responsibility while knowing that help was available if required. The results may help in improving the care of patients with low back pain.

Aim: The aim of this study was to deepen the current understanding of physiotherapists’ decision-making process and more specifically, to investigate their reflections on their clinical reasoning when examining low back pain patients. Method: Data were collected in interviews with six physiotherapists, were the stimulated recall method was used. Interviews were audio-recorded and transcribed and then analysed by content analysis. Results: Physiotherapists critically analysed and reflected their choices and decisions in clinical reasoning with patient’s symptoms, onset of pain, clinical test choices and results. They stopped to consider the adequacy of tests for drawing conclusions and their own manual skills as physiotherapists and also the classification of LBP being used. At critical reflection levels, based on King and Kitchener, physiotherapists’ judgements were at levels four to seven. Conclusions: The results showed that physiotherapists critically justified their clinical reasoning by systemically using a hypothetico-deductive reasoning model and reflected on their decisions in all phases of low back pain patient’s examination, from the history to the physiotherapy diagnosis and also on the classification of non-specific low back pain. peerReviewed

Undoubtedly, modern sedentary lifestyle is a severe threat factor for various health-related concerns. Engagement in regular physical activity is requisite to achieve physiological and psychological health benefits and to alleviate the risk for many undesirable health outcomes including musculoskeletal, cardiovascular disease, obesity, hypertension, and diabetes. Staying physically active is recommended in the deterrence and management of low back pain. Lately, an alternative guideline about physical activity has been introduced, which is more realistic than the 30 minutes/day recommendation. This guideline says that attaining 10,000 steps/day improves health. Therefore, pedometers have become popular tool to measure ambulatory activities objectively throughout the day in the form of steps count. Moreover, they provide a valid and accurate measure of activities in free-living condition. Furthermore, pedometers are simple to utilize, relatively inexpensive and good tools to use in large population based studies. The aim of the current study is to find the relation between pedometer-determined physical activity in the form of daily steps count and low back pain in middle aged Finnish population (30-45 year old participants). The data has drawn from the latest follow up in 2007 of an extensive interdisciplinary longitudinal research project “The Young Finns Study”. All the same subjects who participated first time in this study in 1980 and had a permanent address in Finland (n=3596) were invited to participate in the latest follow up in 2007. Among those, 2204 (65%) individuals filled out the questionnaire. From 2204 participants, 1874 completed the pedometer study. Complete date was received from 1866 (Female=1067, Men=799) participants. Women were more physically active than men. Chi square test revealed that there were no differences in back pain between different physical activity groups either in females or in males. In female, association between back pain and BMI was weak whereas in men, some association was seen between back pain and occupation. Regression analyses showed that physical activity did not increase the risk of having back pain, however, adding factor such as body mass index slightly increased the risk in women. On the other hand, active men were having risk for low back pain twice when it was compared with low active men. Adding factor like body mass index, education, and occupation did not show any risk for low back pain in men. In conclusion, this study did not support the idea of U-shaped relation (i.e. both inactivity and excessive activities) between different levels of physical activity and low back pain in males and females. Active males were at higher risk of having back pain than non-active ones.

Lamminen, Liisa 2016. Venyttelyn vaikutus tärinäaltistuksen ja kiertyneen ajoasennon aiheuttamaan selän ja niskan kuormitukseen. Biomekaniikan pro gradu -tutkielma, Liikuntabiologian laitos, Jyväskylän yliopisto, 56s. Tärinälle altistutaan lähes kaikilla ajoneuvoilla ajettaessa, mutta erityisesti työkoneiden kuljettajiin kohdistuu kehotärinää ja samanaikaisesti ajoasento voi poiketa normaalista suorasta ajoasennosta. Pitkäaikaisen kehotärinäaltistuksen tiedetään aiheuttavan terveyshaittoja kuten alaselän ja niskan kiputiloja. Jatkuva altistus epänormaalissa ajoasennossa aiheuttaa myös lihasväsymystä ja keskittymiskyvyn heikkenemistä. Tämän tutkimuksen tarkoituksena oli selvittää, aiheuttaako tärinäaltistus muutoksia isometriseen voimantuottoon. Lisäksi tutkittiin, miten tärinäaltistuksen keskeyttävä venyttely vaikuttaa kuljettajien toimintakykyyn, ja väheneekö kuormittuneisuuden tunne niskassa, hartioissa ja alaselässä, kun tärinäaltistuksen välillä on tehty venyttelyliikkeitä. Tutkimuksessa käytettiin liikelaitetta, jolla voidaan simuloida epätasaisella alustalla ajoneuvoon kohdistuvaa tärinää. Laitteeseen kiinnitettiin simuloitavan ajoneuvon istuin, ohjauspyörä sekä polkimet, jolloin altistus voitiin antaa autenttisessa ajoasennossa. Tärinän vaikutuksia kuljettajan väsymiseen ja voimantuottoon voitiin näin mitata laboratorio-olosuhteissa. Testattavina oli 10 tervettä miestä, iältään 29 ± 11 -vuotiaita, joilla ei ollut aiempia niskan, hartioiden tai alaselän vaivoja. Tärinäaltistus simuloi traktorilla tehtävää äestystä ja testattava oli kiertyneessä ajoasennossa 2 x 45 minuutin tärinäaltistuksen ajan, jonka aikana hän sai kääntyä suoraan ajoasentoon 15 sekunnin ajaksi 15 minuutin välein. Testattavilta mitattiin tärinäaltistusta ennen ja sen jälkeen isometriset maksimivoimantuotot käsien pystypunnerruksessa ja selän ojennuksessa sekä lihasaktiivisuudet vasemmasta hartialihaksesta, epäkäslihaksista ja oikeanpuoleisesta selän ojentajalihaksesta 100 %, 75 %, 50 % ja 25 % voimantuoton aikana. Lisäksi mitattiin testattavien pituus sekä reaktioaika auditiiviseen ja visuaaliseen ärsykkeeseen. Tärinäaltistuksen aikana testattavilta kirjattiin kuormittuneisuuden tuntemus niskan, hartioiden ja alaselän alueelta 15 minuutin välein. Voimantuottoon tärinäaltistuksella ei ollut vaikutusta. Kuormittuneisuuden tuntemus kasvoi 90 minuutin tauottoman altistuksen vaikutuksesta tilastollisesti merkitsevästi (p

Emmi Nissinen (2015). Fyysinen aktiivisuus, ruutuaika sekä tuki- ja liikuntaelimistön kipuoi-reet 7. ja 8. luokkalaisilla. Terveystieteiden laitos, Jyväskylän yliopisto, liikuntalääketieteen pro gradu-tutkielma, 77 s., 3 liitettä. Fyysisen aktiivisuuden vähentyminen ja vastaavasti inaktiivisten elämäntapojen lisääntyminen ovat nykyajan huolenaiheita niin lasten, nuorten kuin aikuistenkin kohdalla. Lapsista ja nuorista vain noin viidesosa liikkuu suositusten mukaisesti vähintään tunnin joka päivä. Sen sijaan ruutuaikaa kerääntyy runsaasti. Liian vähäisellä liikunnalla sekä liiallisella ruutuajalla on useita terveydelle haitallisia vaikutuksia ja etenkin tuki-ja liikuntaelimistön oireet ovat yleistyneet lasten ja nuorten keskuudessa. Työn tarkoituksena on selvittää, ovatko fyysinen aktiivisuus sekä ruutuaika yhteydessä 7. ja 8.luokkalaisten niska-hartia- ja alaselkäkipuihin. Työssä myös selvitetään, muuttuvatko liikunta- ja ruutuaikatottumukset sekä niska-hartia- ja alaselkäkivut vuoden seurannan aikana. Tutkimusaineistona oli Liikkuva koulu-hankkeen aikana, keväällä 2013 ja 2014, kyselylo-makkeilla kerätty aineisto. Kyseessä oli toistomittausasetelma. Tutkittavat olivat 7. ja 8. luok-kalaisia tyttöjä ja poikia (n=409). Muuttujien välisiä yhteyksiä tarkasteltiin ristiintaulukoinnilla ja χ²-testillä, Spearmanin korrelaatiokertoimella ja logistisella regressiolla. Muuttujien vuoden aikaista muutosta testattiin yhden otoksen t-testillä (One-Sample t-test) sekä parittaisten otosten t-testillä (Paired Samples t-test). Muutoksen suuruutta ja suuntaa testattiin toisto-mittausten varianssianalyysillä. Oppilaiden niska-hartiakipuihin olivat yhteydessä runsas viikoittainen ruutuaika, tietokone- ja konsolipelien pelaaminen, sosiaalisen median käyttö, naissukupuoli, vähäinen ripeä liikunta sekä organisoituun liikuntaan osallistuminen. Vastaavasti alaselkäkipuihin vaikuttivat runsas viikoittainen ruutuaika ja sosiaalisen median käyttö, organisoituun liikuntaan osallistuminen ja vähäinen ripeän liikunnan harrastaminen. Oppilaiden välituntiaktiivisuus, organisoituun liikuntaan osallistuminen, tietokone- ja konsolipelien pelaaminen sekä elektronisen aineiston lukeminen vähentyivät vuoden seurannan aikana. Poikien osalta myös niska-hartiakivut vä-hentyivät. Sen sijaan kotitehtävien tekeminen elektronisilla laitteilla ja etenkin sosiaalisen median käyttö lisääntyivät. Tulosten mukaan liian vähäinen tai runsas liikunnan harrastaminen ja liiallinen ruutuaika ovat yhteydessä niska-hartia- ja alaselkäkipuihin, joten liikuntaa tulisi lisätä maltillisesti sekä ruu-tuaikaa tulisi vähentää sekä kouluissa että kotona. Erityistä huomiota tulisi kiinnittää älypuhe-limien ja tablettien runsaaseen käyttöön ja niiden nopeaan lisääntymiseen. Emmi Nissinen (2015). Physical activity, screen time and musculoskeletal complaint among seventh and eighth graders. Department of Health Sciences, University of Jyväskylä, (Sport and Exercise Medicine), Master`s thesis, 77 pp., 3 appendices. Physical activity has decreased and respectively sedentary behavior has been increasing in recent years among children, adolescents and adults. Only a fifth of children and adolescents exercises at least one to two hours a day according to Finnish recommendations. Instead chil-dren and adolescent have plenty of screen time. Physical inactivity and excessive screen time have numerous harmful effects on health and especially musculoskeletal symptoms are com-mon in children and adolescents. The purpose of this study was to investigate significant as-sociations between seventh and eighth graders’ physical activity, screen time and neck and low back pain. The aim was also to investigate changes in adolescents’ physical activity and screen time habits and neck and low back pain during one year follow-up. This study was a part of the Finnish Schools on the Move -program. The data was collected with the questionnaire in the spring of 2013 and 2014. The subjects were 7. and -8. graders (n=409). The associations between variables were analyzed using cross tabulation, Chi-square tests (χ²-test), Spearman correlation coefficients and logistic regression. Changes which oc-curred in variables during one year follow-up were analyzed using One-Sample t-test, Paired Samples t-test and Repeated measures analysis of variance (rANOVA). Adolescents’ neck pain was associated with female gender, excessive screen time, computer- or videogames and social media use, low physical activity and participation in organized sports. Furthermore low back pain was associated with adolescents’ excessive screen time, social media use, participation in organized sports and low physical activity. Adolescent`s physical activity at recess, participation in organized sports, playing computer- or videogames and reading electronic documents, as well as boys neck pain reduced during one year follow-up. Additionally doing homework with electronic devices and using social media increased during one year. According to the results, too low or excessive physical activity and excessive screen time are associated with adolescents neck and low back pain, thus physical activity should be increased moderately, as well as screen time should be reduced both in school and at home. It is particularly important to pay attention to the intensive use of smartphones and tablets.

Eerika Saarijärvi (2015). Pystyvyyskäsityksiä selittävät tekijät alaselkäkipuisilla naishoitajilla, Terveystieteiden laitos, Jyväskylän yliopisto, Liikuntalääketieteen pro gradu -tutkielma, 56 s., 4 liitettä. Minäpystyvyydellä tiedetään olevan merkittävä rooli alaselkäoireiden vähentymisen ja kuntoutumisen kannalta. Alaselkäkipuisten naishoitajien pystyvyyskäsityksiä ei ole juuri tutkittu, vaikka epäspesifi alaselkäkipu on alalla hyvin yleistä ja siitä aiheutuvat kustannukset ovat merkittäviä. Tämän tutkimuksen tarkoituksena oli tutkia millaiset ovat alaselkäkipuisten naishoitajien pystyvyyskäsitykset, onko heidän terveyskunnon osatekijöillä yhteyttä pystyvyyskäsityksiin ja mitkä tekijät selittävät naishoitajien pystyvyyskäsityksiä. Aineisto oli osa UKK-instituutissa vuosina 2011–2015 toteutetun Prevention of Chronic Low Back Pain in Female Nurses (NURSE-RCT) -tutkimuksen 12 kuukauden seurantamittausaineistoa. Yhteensä 117 subakuuttia tai jaksottaista alaselkäkipua kokevaa naishoitajaa oli satunnaistettu neljään eri interventioryhmään (verrokki-, neuvonta-, harjoittelu-, neuvonta + harjoitteluryhmät). Päätulosmuuttujana käytettiin modifioitua The Low Back Activity Confidence Scalea (LoBACS). Seitsemäntoista kysymyksen pystyvyyskysely täytettiin terveyskuntomittausten yhteydessä 12 kuukauden seurannan kohdalla. Terveyskuntomuuttujien lisäksi selittävinä muuttujina tarkasteltiin numeerisella (0-10) asteikolla (Numeric Rating Scale, NRS) mitattua selkäkipua, koettua työkykyä, työviihtyvyyttä sekä vapaa-ajan viikoittaista fyysistä aktiivisuutta. Aineisto analysoitiin IBM SPSS Statistics 22-ohjelmalla. Tilastollisina testeinä käytettiin ristiintaulukointia, yksisuuntaista varianssianalyysiä (ANOVA), Kruskal-Wallisin testiä, Mann Whitney U-testiä, Spearmanin osittaiskorrelaatiota sekä yleistettyä lineaarista mallia (generalized linear models, GLMs). Alaselkäkipuiset naishoitajat olivat hyvin varmoja pystyvyydestään 12 kuukauden seurantamittausten kohdalla. Lihaskunto oli merkitsevä terveyskunnon osatekijä pystyvyyskäsitysten kannalta. Pystyvyyden eri osa-alueita selittivät vahvimmin koettu työkyky, vapaa-ajan fyysisen aktiivisuuden luokka ja terveyskuntomittauksista muunneltu punnerrus. Pystyvyyskäsitykset olivat vahvat kaikissa interventioryhmissä. Harjoitteluryhmässä liikuntaan liittyvät pystyvyyskäsitykset (p=0,048) ja kokonaispystyvyys (p=0,027) olivat neuvontaryhmää paremmat. Pystyvyyttä selittävien tekijöiden osuus vaihteli ryhmittäin. Tarkastellut muuttujat selittivät pystyvyyttä voimakkaammin neuvonta- ja neuvonta + harjoitteluryhmissä kuin verrokki- ja harjoitteluryhmissä. Koettu työkyky, vapaa-ajan fyysinen aktiivisuus ja lihaskunto olivat naishoitajien koetun pystyvyyden kannalta tärkeämpiä kuin työviihtyvyys tai kivun kokeminen. Alaselkäkipuiset naishoitajat voivat pystyvyyskäsitystensä kannalta hyötyä oikeinkohdistetusta neuvonnasta ja harjoittelusta. Pystyvyysuskomuksia olisi tärkeää selvittää koko intervention ajan, jolloin mahdolliset interventiojakson aikana tapahtuneet muutokset ilmenisivät. Käyttökelpoisia arviointi- ja seurantamenetelmiä ja päteviä pystyvyyskäsitysmittareita tarvitaan jatkossakin. Näin voitaisiin jo akuutissa ja subakuutissa vaiheessa vahvistaa alaselkäkipuisten aktiivista itsesäätelyä kipunsa suhteen, edistää heidän kuntoutumistaan ja ehkäistä kivun pitkittymistä ja uusiutumista. Eerika Saarijärvi (2015). Factors explaining Self-efficacy in Female Nurses with Low Back Pain. Department of Health Sciences, University of Jyväskylä, (Sport and Exercise Medicine), Master’s thesis, 56 pp, 4 appendices. Self-efficacy is an important predictor of functional recovery in nonspecific low back pain. The role of self-efficacy beliefs among female nurses have not been widely investigated although low back pain is very common musculoskeletal problem among nursing staff and it causes significant economic costs. The purpose of this study was to determine self-efficacy beliefs among female nurses, investigate the association between health-related fitness tests and self-efficacy and describe factors explaining nurses’ confidence in their ability to perform tasks successfully. The data is part of the UKK-institute Prevention of Chronic Low Back Pain in Female Nurses (NURSE-RCT) 12 months follow-up data collected during 2011–2015. Female nurses (n=117) with subacute or recurrent low back pain were randomized to one of the four intervention groups (control-, counselling-, exercise- and counselling + exercise). The primary outcome was the modified version of The Low Back Activity Confidence Scale (LoBACS). The questionnaire was filled while subjects participated in the health-related fitness tests after six months intervention had finished. In addition to five health-related fitness test, Numeric Rating Scale (NRS) for pain, work ability, job satisfaction, and overall level of physical activity were analysed. The analyses were carried out using IBM SPSS Statistics 22 software. Descriptive statistics were calculated and differences between intervention groups were examined using cross-tabulation, one-way analysis of variance (ANOVA) and Kruskal Wallis Test. A comparison between age groups was done using Mann-Whitney U test. Correlations between self-efficacy beliefs and health-related fitness test were examined using Spearman partial correlation coefficients and explanatory factors using generalized linear models (GLMs). According to the results at 12 months follow-up, nurses with low back pain were very confident in their capability to perform requested tasks successfully. Muscle strength was significantly associated with subjects’ self-efficacy beliefs. Work ability, overall level of physical activity and modified push-up explained best beliefs in whole sample. Subjects within different intervention groups were also confident. Subjects in exercise group had better beliefs concerning exercise (p=.048) and total self-efficacy (p=.027) compared to counselling group. The explanatory factors varied between intervention groups. Factors investigated in this thesis explained nurses’ self-efficacy beliefs better among counselling- and counselling + exercise group than control- or exercise group. Self-reported work ability, overall level of physical activity and muscle strength were more important to nurses’ self-efficacy beliefs than job satisfaction or pain. Nurses with subacute or recurrent low back pain might benefit from functional counselling and physical training. In order to detect changes occurred during interventions, self-efficacy beliefs should be measured from the beginning of interventions. Although several instruments assessing self-efficacy have been developed in the context of low back pain there still is need for reliable and valid method of assessment of in acute and subacute stage. It would enhance subjects’ active self-regulation in early stages, promote their rehabilitation process and prevent poor long-term outcome.

The aim of the present study was to assess associations between physician diagnosed unspecified low back pain (LBP) during compulsory military service and self-reported LBP and physical fitness measured on average four years after military service. From a total of 1155 persons who had been pass medical examination for military service and who had completed physically demanding military training between 1997 and 2007, 778 men participated in a refresher military training course and physical tests. In this study, the association between LBP during military service and LBP in later life in addition to the association between LBP and physical fitness were examined. A total of 219 out of 778 participants (28%) had visited a physician due to some musculoskeletal symptom (ICD-10 M-diagnosis) during their military service. Seventy-four participants (9.5%) had visited a physician due to unspecified LBP during their service, and 41 (5.3%) had temporarily been absent from duty due to LBP. At the follow-up examination, 122 (15.7%) had reported LBP during the past month. LBP during military service was associated with self-reported LBP in the follow-up (p = 0.004). Of those who had been absent from duty due to LBP during their military service, 13 (31.7%) reported LBP during the past month. In risk factor analysis, no initial health behaviour and physical performance variables were associated with baseline LBP in the follow-up. The main finding of the present study was that unspecified LBP during military service predicts LBP in later life. On the basis of previous literature, it is also known that LBP is a common symptom and thus, one cannot expect to be symptomless the entire life. Interestingly, none of the health behaviours nor the physical performance studied in the follow-up were associated with baseline LBP. It appears that individuals prone to LBP have symptoms during physically demanding military service and also later in their life. peerReviewed

The objectives were 1) to determine the reliability of the measures of back function related factors, 2) to investigate the possibilities to detect changes in paraspinal muscles, and 3) to study the relative effects of heredity, constitutional and behavioral factors on three back function tests. Paraspinal muscle cross-sectional areas were obtained by magnetic resonance imaging from a sample of 210 men; anthropometric measures, isokinetic and psychophysical lifting capacity, and isometric back extension endurance tests were performed and current and past physical activity during leisure-time and at work were ascertained from a structured interview from a total sample of 600 men who were 35 to 70 years old. The reliability of the lifetime physical activity interview and also the measures of paraspinal muscles CSAs was acceptable. The back function tests measure very different attributes with different determinants, emphasizing the importance of careful test selection. The isokinetic lifting test performance was mainly influenced by heredity i.e. it assesses the physical capacity for lifting, which means that it may prove difficult to alter isokinetic lifting capacity by interventions. Heredity and behavioral factors contributed equally to the psychophysical lifting ability. Anthropometric measures and physical activity parameters exhibited only a weak association with psychophysical lifting capacity, indicating that behavioral factors other than those considered in this study may play more influential roles. The isometric back extension endurance test reflected back health and performance in pain-free subjects, but this test may measure back pain in individuals with a history of LBP. The predictive association of isometric back extension endurance time for future LBP episodes could be enhanced by understanding in greater detail the reasons for test termination Erilaiset selän toimintakykytestit mittaavat eri ominaisuuksia ja niihin vaikuttavat monet tekijät. Oikean testin valinta on tärkeää, kun selän toimintakykytestejä käytetään esimerkiksi kuntoutuksen tai hoidon vaikutusten arviointiin, kertoo Annina Ropponen.Ropponen tutki 35-70 -vuotiaita identtisiä ja epäidenttisiä mieskaksosia. Laajaan tutkimukseen osallistui 600 miestä, joiden selkälihasten poikkipinta-alat tutkittiin magneettikuvauksella, kehon mittasuhteet ja koostumus mitattiin sekä selän toimintakyky testattiin. Tutkittavilta selvitettiin kyselyn avulla liikuntaharrastukset ja työkuormitus. Selän toimintakykytesteistä, joita tässä tutkimuksessa oli kolme: isokineettinen ja psykofyysinen nostotesti ja isometrinen selän kestävyystesti, Ropponen kartoitti perimän sekä synnynnäisten ja käyttäytymistekijöiden selittävää osuutta.Ropponen selvitti myös selän toimintakykytesteihin vaikuttavien tekijöiden, kuten liikuntaharrastusten ja selkälihasten koon, mittaamisen luotettavuutta. Selkälihasten koolla ja liikunnan harrastamisella on aiemmissa tutkimuksissa havaittu olevan merkitystä selän toimintakyvyn kannalta, mutta niiden mittaamisen luotettavuutta ei ole täysin tunnettu.Ropponen totesi, että selkälihasten poikkipinta-alojen mittaukset ovat hyvin toistettavia, joten niiden avulla on mahdollista selvittää selkälihasten kokoa ja laatua rutiinimagneettikuvista, joita tänä päivänä otetaan monilta selkäpotilailta. Myös elämänaikainen liikuntakysely osoittautui kohtuullisen hyvin toistettavaksi, joten se on käyttökelpoinen menetelmä arvioitaessa elämänaikaista liikunnan harrastamista ja esimerkiksi sen yhteyttä selän toimintakykytestituloksiin.

Kaksi kolmasosaa yli 30-vuotiaista suomalaisista on kokenut ainakin yhdenselkäkipuepisodin elämänsä aikana. Suurimmalla osalla kipu kuitenkin häviää kuuden viikon kuluessa, mutta vaivan jatkuessa tai uusiutuessa ihmisen toimintakyvyssä tapahtuu muutoksia. - Pitkittyneestä tai toistuvasta selkävaivasta kärsivän pitäisi aktivoitua liikkumaan, sillä terapeuttisen harjoittelun avulla voidaan vaikuttaa selkävaivan aiheuttamiin haittoihin, väittelijä Tiina Kuukkanen sanoo. Selkäkipu merkitsee usein mm. heikentynyttä lihastoimintaa, alentunutta liikkuvuutta, muutoksia psykomotorisissa toiminnoissa ja tasapainossa. Se vaikeuttaa päivittäisten toimintojen suorittamista työssä ja kotona, on eräs suurimmista syistä sairauspoissaoloihin ja saattaa haitata myös vapaa-ajan harrastuksia.- Positiivisia muutoksia selkäkivuista kärsivän tilanteessa voidaan siis saavuttaa myös kontrolloidulla kotiharjoittelulla, joka saattaa olla taloudellisempi ja yksilön kannalta joustavampikin ratkaisu kuin harjoittelusalilla käynti, Kuukkanen painottaa. Intensiivisen harjoittelun ryhmä suoritti noin tunnin kestävän harjoitusohjelman kolme kertaa viikossa harjoitussalilla ja kotiharjoitusryhmä teki ohjelmaansa kerran päivässä kotona. Muutoksia tarkasteltiin välittömästi kolmen kuukauden harjoittelun jälkeen sekä kolmen ja kuuden kuukauden kuluttua harjoittelun päättymisestä. The purpose of this prospective, clinical trial of twelve months was to investigate the changes in impairments, activity and participation among subacute and chronic low back pain population after a three months therapeutic exercise program using a controlled study design. Initially, 49 male and 41 female attended their local occupational health care services because of low back pain. Finally, the 29 subjects were placed into the three months intensive training group and the 57 subjects were randomly allocated into a home exercise and a control group. Measurements at different levels of ICIDH-2 classification were made at the baseline and after the three months interventions. Follow-up measurements were performed three and nine months after the completion of the interventions. Measurements of low back pain, muscular performance, spinal and muscle flexibility, psychomotor performance, postural sway, activity and participation were included.