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European Spine Journal : Official... Jun 2011With aging of society, clarification of the relationship between QOL and abnormal posture in the elderly may allow improvement of QOL through any preventive methods and...
With aging of society, clarification of the relationship between QOL and abnormal posture in the elderly may allow improvement of QOL through any preventive methods and training. However, sagittal balance has not been studied widely and most studies have focused on postmenopausal patients with osteoporosis. In this report, we provide the first evaluation of the simultaneous effects of degenerative changes on radiograph, spinal range of motion (ROM), sagittal balance, and back muscle strength, and examine the influence of these effects on QOL of the middle-aged and elderly male subjects. The subjects were 100 Japanese males who underwent a basic health checkup. Lumbar lateral radiograph, sagittal balance and spinal mobility determined with SpinalMouse(®) and back muscle strength were measured. The thoracic/lumbar angle ratio (T/L ratio) was used as an index of sagittal balance. SF-36 physical component summary (PCS) scores showed a significant negative correlation with age (r = -0.377), osteophyte score (r = -0.246) and T/L ratio (r = -0.214), and a significant positive correlation with lumbar lordosis angle (r = 0.271), thoracic ROM (r = 0.282), and back muscle strength (r = 0.549). Multiple regression analysis indicated that thoracic spinal ROM (r = 0.254, p < 0.01) and back muscle strength (r = 0.488, p < 0.0001) were significantly associated with SF-36 PCS (R (2) = 0.403). In conclusion, QOL of the middle-aged and elderly male subjects was related to sagittal balance, lumbar lordosis angle, spinal ROM, and back muscle strength. Exercise including muscle strength and spinal ROM may be able to influence these primary factors related to QOL. Back muscle strength and thoracic ROM impact on improvement of QOL in the middle-aged and the elderly.
Topics: Aged; Aged, 80 and over; Back; Humans; Male; Middle Aged; Muscle Strength; Postural Balance; Quality of Life; Radiography; Range of Motion, Articular; Spine
PubMed: 21072545
DOI: 10.1007/s00586-010-1606-4 -
Clinical Biomechanics (Bristol, Avon) Nov 2017Muscle stiffness of the lumbar back muscles in low back pain (LBP) patients has not been clearly elucidated because quantitative assessment of the stiffness of...
BACKGROUND
Muscle stiffness of the lumbar back muscles in low back pain (LBP) patients has not been clearly elucidated because quantitative assessment of the stiffness of individual muscles was conventionally difficult. This study aimed to examine the association of LBP with muscle stiffness assessed using ultrasonic shear wave elastography (SWE) and muscle mass of the lumbar back muscle, and spinal alignment in young and middle-aged medical workers.
METHODS
The study comprised 23 asymptomatic medical workers [control (CTR) group] and 9 medical workers with LBP (LBP group). Muscle stiffness and mass of the lumbar back muscles (lumbar erector spinae, multifidus, and quadratus lumborum) in the prone position were measured using ultrasonic SWE. Sagittal spinal alignment in the standing and prone positions was measured using a Spinal Mouse. The association with LBP was investigated by multiple logistic regression analysis with a forward selection method. The analysis was conducted using the shear elastic modulus and muscle thickness of the lumbar back muscles, and spinal alignment, age, body height, body weight, and sex as independent variables.
FINDINGS
Multiple logistic regression analysis showed that muscle stiffness of the lumbar multifidus muscle and body height were significant and independent determinants of LBP, but that muscle mass and spinal alignment were not. Muscle stiffness of the lumbar multifidus muscle in the LBP group was significantly higher than that in the CTR group.
INTERPRETATION
The results of this study suggest that LBP is associated with muscle stiffness of the lumbar multifidus muscle in young and middle-aged medical workers.
Topics: Adult; Elasticity; Elasticity Imaging Techniques; Female; Humans; Low Back Pain; Lumbosacral Region; Male; Middle Aged; Muscle Strength; Paraspinal Muscles; Posture
PubMed: 28934633
DOI: 10.1016/j.clinbiomech.2017.09.008 -
Dermatology Online Journal Oct 2003Segmental neurofibromatosis is a rare variant of neurofibromatosis in which skin lesions are confined to a circumscribed body segment. A case of a 72-year-old woman with...
Segmental neurofibromatosis is a rare variant of neurofibromatosis in which skin lesions are confined to a circumscribed body segment. A case of a 72-year-old woman with this condition is presented. Clinical features and genetic evidence are reviewed.
Topics: Aged; Back; Female; Humans; Neurofibromatoses
PubMed: 14594599
DOI: No ID Found -
Brazilian Journal of Physical Therapy 2021There is considerable overlap between pain referral patterns from the lumbar disc, lumbar facets, the sacroiliac joint (SIJ), and the hip. Additionally, sciatic like... (Review)
Review
BACKGROUND
There is considerable overlap between pain referral patterns from the lumbar disc, lumbar facets, the sacroiliac joint (SIJ), and the hip. Additionally, sciatic like symptoms may originate from the lumbar spine or secondary to extra-spinal sources such as deep gluteal syndrome (GPS). Given that there are several overlapping potential anatomic sources of symptoms that may be synchronous in patients who have low back pain (LBP), it may not be realistic that a linear deductive approach can be used to establish a diagnosis and direct treatment in this group of patients.
OBJECTIVE
The objective of this theoretical clinical reasoning model is to provide a framework to help clinicians integrate linear and non-linear clinical reasoning approaches to minimize clinical reasoning errors related to logically fallacious thinking and cognitive biases.
METHODS
This masterclass proposes a hypothesis-driven and probabilistic approach that uses clinical reasoning for managing LBP that seeks to eliminate the challenges related to using any single diagnostic paradigm.
CONCLUSIONS
This model integrates the why (mechanism of primary symptoms), where (location of the primary driver of symptoms), and how (impact of mechanical input and how it may or may not modulate the patient's primary complaint). The integration of these components individually, in serial, or simultaneously may help to develop clinical reasoning through reflection on and in action. A better understanding of what these concepts are and how they are related through the proposed model may help to improve the clinical conversation, academic application of clinical reasoning, and clinical outcomes.
Topics: Clinical Reasoning; Humans; Low Back Pain; Lumbosacral Region; Sacroiliac Joint
PubMed: 33371952
DOI: 10.1016/j.bjpt.2020.12.001 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Apr 2017To summarize the application progress of surface electromyography (sEMG) and surface electromygraphic biofeedback (sEMGBF) in low back pain (LBP). (Review)
Review
OBJECTIVE
To summarize the application progress of surface electromyography (sEMG) and surface electromygraphic biofeedback (sEMGBF) in low back pain (LBP).
METHODS
The related literature about the application of sEMG and sEMGBF in diagnosis and therapy of LBP was summarized and analyzed.
RESULTS
As a auxiliary diagnostic technique, lumbar muscle fatigue, lumbar muscle activity disorder, flexion-relaxation phenomenon, and asymmetry of the paravertebral muscle electromygraphic activity were found in patients with LBP by sEMG. For treatment, sEMG combined with sEMGBF technology to form sEMGBF training. sEMGBF training include sEMGBF training and sEMGBF stretching exercise. sEMGBF training can improve lumbar muscle activity disorder, recover muscle function, and relieve back pain.
CONCLUSION
sEMG can monitor the electromyographic signal and sEMGBF biofeedback information can relax or strengthen the muscle. It is very meaningful for diagnosis and therapy of LBP.
Topics: Biofeedback, Psychology; Electromyography; Humans; Low Back Pain; Lumbosacral Region; Muscle, Skeletal
PubMed: 29798619
DOI: 10.7507/1002-1892.201609078 -
BMC Musculoskeletal Disorders Sep 2016MRI is considered to be the diagnostic tool of choice in diagnosing nerve root compromise among patients presenting with clinical suspicion of lumbo-sacral... (Review)
Review
BACKGROUND
MRI is considered to be the diagnostic tool of choice in diagnosing nerve root compromise among patients presenting with clinical suspicion of lumbo-sacral radiculopathy. There exists controversy among researchers and clinicians regarding the diagnostic utility and accuracy of MRI in detecting nerve root compromise and radiculopathy. This review evaluated 4 primary diagnostic accuracy studies that specifically assessed the accuracy of MRI in detecting nerve root compromise, as established in the current literature.
METHODS
Eight electronic data bases were searched for relevant articles from inception until January 2014. All primary diagnostic studies which investigated the accuracy of MRI in diagnosing nerve root compromise among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the 'Quality Assessment of Diagnostic tests Accuracy Studies' criteria.
RESULTS
Four studies qualified for inclusion in this review. The sensitivity of MRI in detecting lumbar nerve root compromise was very low at 0.25 (95 % CI) while the specificity was relatively high at 0.92 (95 % CI).
CONCLUSIONS
There is lack of sufficient high quality scientific evidence in support or against the use of MRI in diagnosing nerve root compression and radiculopathy. Therefore, clinicians should always correlate the findings of MRI with the patients' medical history and clinical presentation in clinical decision making.
Topics: Diffusion Tensor Imaging; Humans; Lumbosacral Region; Magnetic Resonance Imaging; Radiculopathy; Sensitivity and Specificity; Spinal Nerve Roots
PubMed: 27600883
DOI: 10.1186/s12891-016-1236-z -
International Journal of Environmental... Aug 2020The study assessed the proportion of time in risky postures for the main joints of the upper limbs in a truck assembly plant and explored the association with...
The study assessed the proportion of time in risky postures for the main joints of the upper limbs in a truck assembly plant and explored the association with musculoskeletal symptoms. Fourteen workstations (13 individuals) of a truck assembly plant were selected, and seven sensors were placed on the body segments of the participants. The sensors included tri-axial accelerometers for the arms and back, inclinometers for the neck and electro-goniometry for quantifying flexion/extension of the right and left hands. The proportions of time in moderate awkward postures were high at all workstations. Neck and wrist excessive awkward postures were observed for most workstations. The average values of the 91st percentile for back flexion and right/left arm elevation were 25°, 62°, and 57°, respectively. The 91st and 9th percentile averages for neck flexion/extension were 35.9° and -4.7°, respectively. An insignificant relationship was found between the percentage of time spent in awkward upper limb posture and musculoskeletal symptoms. The findings provide objective and quantitative data about time exposure, variability, and potential risk factors in the real workplace. Quantitative measurements in the field provide objective data of the body postures and movements of tasks that can be helpful in the musculoskeletal disorders (MSDs) prevention program.
Topics: Arm; Back; Ergonomics; Humans; Manufacturing Industry; Motor Vehicles; Musculoskeletal Diseases; Occupational Diseases; Posture; Wrist
PubMed: 32825386
DOI: 10.3390/ijerph17176062 -
The Spine Journal : Official Journal of... Mar 2022The lumbar sinuvertebral nerve (SVN) innervates the outer posterior intervertebral disc (IVD); it is thought to mediate discogenic low-back pain (LBP). Controversy,...
BACKGROUND CONTEXT
The lumbar sinuvertebral nerve (SVN) innervates the outer posterior intervertebral disc (IVD); it is thought to mediate discogenic low-back pain (LBP). Controversy, however, exists on its origins at higher (L1-L2) versus lower (L3-L5) lumbar levels. Additionally, lack of knowledge regarding its foraminal and intraspinal branching patterns and extensions may lead to iatrogenic damage.
PURPOSE
To systematically describe the origins of the L2 and L5 SVNs, their morphological variation in the intervertebral foramen (IVF) and intraspinal distribution.
STUDY DESIGN
Dissection-based study of 20 SVNs with histological confirmation in five embalmed human cadavers.
METHODS
The origin, branching pattern and distribution of the L2 and L5 SVNs was investigated bilaterally in five human cadavers using dorsal and anterolateral dissection approaches. Parameters studied included somatic and/or autonomic SVN root contributions, foraminal SVN morphology and course, diameter, branching point, intraspinal distribution and IVD innervation pattern. Nerve tissue was confirmed by immunostaining for neurofilament and S100 proteins.
RESULTS
The SVN and its origins was identified in all except one IVF at L2 and in all foramina at L5. At L2, the SVN arose in nearly 90% of sides from both somatic and autonomic roots and at L5 in 40% of sides. The remaining SVNs were formed by purely autonomic roots. The SVN arose from significantly more roots at L2 than L5 (3.1 ± 0.3 vs. 1.9 ± 0.3, respectively; p=.022). Four different SVN morphologies could be discerned in the L2 IVF: single filament (22%), multiple (parallel or diverging) filament (33%), immediate splitting (22%) and plexiform (22%) types, whereas the L5 SVN consisted of single (90%) and multiple (10%) filament types. SVN filaments were significantly thicker at L2 than L5 (0.48 ± 0.06 mm vs. 0.33 ± 0.02 mm, respectively; p=.043). Ascending SVN filaments coursed roughly parallel to the exiting spinal nerve root trajectory at L2 and L5. Branching of the SVN into ascending and descending branches occurred mostly intraspinal both at L2 and L5. Spinal canal distribution was also similar for L2 and L5 SVNs. Lumbar posterior IVDs were innervated by the descending branch of the parent SVN and ascending branch of the subjacent SVN.
CONCLUSIONS
The SVN at L2 originates from both somatic and autonomic roots in 90% of cases and at L5 in 40% of cases. The remaining SVNs are purely autonomic. In the IVF, the L2 SVN is morphologically heterogeneous, but generally consists of numerous filaments, whereas at L5 90% contains a single SVN filament. The L2 SVN is formed by more roots and is thicker than the L5 SVN. Intraspinal SVN distribution is confined to its level of origin; lumbar posterior IVDs are innervated by corresponding and subjacent SVNs (ie, two spinal levels).
CLINICAL SIGNIFICANCE
Our findings indicate that L5 discogenic LBP may be mediated both segmentally and nonsegmentally in 40% of cases and nonsegmentally in 60% of cases. Failure of lower lumbar discogenic pain treatment may be the result of only interrupting the nonsegmental pathway, but not the segmental one as well. Relating SVN anatomy to microsurgical spinal approaches may prevent iatrogenic damage to the SVN and the formation of postsurgical back pain.
Topics: Humans; Intervertebral Disc; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Spinal Nerves
PubMed: 34737065
DOI: 10.1016/j.spinee.2021.10.021 -
Journal of Biomechanics May 2013Motor control deficits have been suggested as potential cause and/or effect of a-specific chronic low-back pain and its recurrent behavior. Therefore, the goal of this...
Motor control deficits have been suggested as potential cause and/or effect of a-specific chronic low-back pain and its recurrent behavior. Therefore, the goal of this study is to identify motor control in low-back stabilization by simultaneously quantifying the intrinsic and reflexive contributions. Upper body sway was evoked using continuous force perturbations at the trunk, while subjects performed a resist or relax task. Frequency response functions (FRFs) and coherences of the admittance (kinematics) and reflexes (sEMG) were obtained. In comparison with the relax task, the resist task resulted in a 61% decrease in admittance and a 73% increase in reflex gain below 1.1Hz. Intrinsic and reflexive contributions were captured by a physiologically-based, neuromuscular model, including proprioceptive feedback from muscle spindles (position and velocity) and Golgi tendon organs (force). This model described on average 90% of the variance in kinematics and 39% of the variance in sEMG, while resulting parameter values were consistent over subjects.
Topics: Adult; Back; Biomechanical Phenomena; Electromyography; Humans; Low Back Pain; Middle Aged; Muscle, Skeletal; Posture; Reflex, Stretch
PubMed: 23578438
DOI: 10.1016/j.jbiomech.2013.03.007 -
BMC Musculoskeletal Disorders Oct 2020Among the paraspinal muscles, the structure and function of the lumbar multifidus (LM) has become of great interest to researchers and clinicians involved in lower back...
BACKGROUND
Among the paraspinal muscles, the structure and function of the lumbar multifidus (LM) has become of great interest to researchers and clinicians involved in lower back pain and muscle rehabilitation. Ultrasound (US) imaging of the LM muscle is a useful clinical tool which can be used in the assessment of muscle morphology and function. US is widely used due to its portability, cost-effectiveness, and ease-of-use. In order to assess muscle function, quantitative information of the LM must be extracted from the US image by means of manual segmentation. However, manual segmentation requires a higher level of training and experience and is characterized by a level of difficulty and subjectivity associated with image interpretation. Thus, the development of automated segmentation methods is warranted and would strongly benefit clinicians and researchers. The aim of this study is to provide a database which will contribute to the development of automated segmentation algorithms of the LM.
CONSTRUCTION AND CONTENT
This database provides the US ground truth of the left and right LM muscles at the L5 level (in prone and standing positions) of 109 young athletic adults involved in Concordia University's varsity teams. The LUMINOUS database contains the US images with their corresponding manually segmented binary masks, serving as the ground truth. The purpose of the database is to enable development and validation of deep learning algorithms used for automatic segmentation tasks related to the assessment of the LM cross-sectional area (CSA) and echo intensity (EI). The LUMINOUS database is publicly available at http://data.sonography.ai .
CONCLUSION
The development of automated segmentation algorithms based on this database will promote the standardization of LM measurements and facilitate comparison among studies. Moreover, it can accelerate the clinical implementation of quantitative muscle assessment in clinical and research settings.
Topics: Adult; Humans; Low Back Pain; Lumbosacral Region; Musculoskeletal System; Paraspinal Muscles; Ultrasonography
PubMed: 33097024
DOI: 10.1186/s12891-020-03679-3