Tai chi exercise for treatment of pain and disability in people with persistent low back pain: A randomized controlled trial.
Arthritis Care Res (Hoboken). 2011 Nov;63(11):1576-83
To determine the effect of tai chi exercise on persistent low back pain, the authors performed a randomized controlled trial in a general community setting in Sydney, New South Wales, Australia. Participants consisted of 160 volunteers between ages 18 and 70 years with persistent nonspecific low back pain. The tai chi group (n = 80) consisted of 18 40-minute sessions over a 10-week period delivered in a group format by a qualified instructor. The waitlist control group continued with their usual health care. Bothersomeness of back symptoms was the primary outcome. Secondary outcomes included pain intensity and pain-related disability. Data were collected at pre- and postintervention and analyzed by intent-to-treat.
Tai chi exercise reduced bothersomeness of back symptoms by 1.7 points on a 0-10 scale, reduced pain intensity by 1.3 points on a 0-10 scale, and improved self-report disability by 2.6 points on the 0-24 Roland-Morris Disability Questionnaire scale. The followup rate was >90% for all outcomes. These results were considered a worthwhile treatment effect by researchers and participants.
This is the first pragmatic randomized controlled trial of tai chi exercise for people with low back pain. It showed that a 10-week tai chi program improved pain and disability outcomes and can be considered a safe and effective intervention for those experiencing long-term low back pain symptoms.
A randomized, comparative trial: does pillow type alter cervico-thoracic spinal posture when side lying
Journal of Multidisciplinary Healthcare 2011:4 321–327
Many patients present with symptoms related to the cervico-thoracic spine, such as pain, stiffness, headache, and scapular pain. Changing pillows can significantly alter waking cervical pain and stiffness, headache, and scapular pain reports.
Many people appear to have made poor pillow choices, as low sleep quality, low pillow comfort, and waking cervico-thoracic symptoms are commonly reported. Hence they often ask their health practitioner for advice regarding pillow selection. While it is widely believed that a pillow which holds the cervical spine in a neutral position prevents cervical waking symptoms, by minimizing end-range positioning of spinal segments, no information is available about how to achieve such a position. A range of subjective recommendations regarding pillow choice have been provided. These include use of pillows of malleable consistency such as feathers, kapok, or foam chip which provide support for the head but avoid pushing the head into flexion or lateral flexion and alter shape to the contours of the individual.
People have been advised not to use molded foam or latex pillows, which resist comfortable indentation of body contours, to use a cervical roll in the pillow, or to use a contour pillow.
The range of advice is confusing for consumers and health professionals and is not underpinned by published scientific evidence. There has been very limited research to understand or assess the effect of different pillow types on cervical spine posture, and appropriate recommendations cannot be made unless the manner in which the spine responds to specific pillow content and shape are better understood.
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Does Radiating Spinal Pain Determine Future Work Disability? A Retrospective Cohort Study of 22,952 Danish Twins
From: Spine (Phila Pa 1976). 2011 Oct 21. [Epub ahead of print]
This was a population-based, retrospective cohort study to determine if radiating spinal pain from the low back, mid back, and neck is associated with future use of health-related benefits and their duration as compared to those with non-radiating spinal pain. Studies on the socioeconomic consequences of radiating pain have primarily focused on the low back and to a lesser extent on the neck and mid back. Additionally, few studies report on the incidence of health-related benefit use after any radiating spinal pain.
A cohort of 22,952 subjects was formed from the 2002 survey of the Danish Twin Registry. The survey contained information on spinal pain and important confounding factors. Work disability over an 8-year period was determined through data linkage with the Danish DREAM register of government transfer payments. The authors determined the incidence rate ratio for receipt of sickness benefit and the mean duration of the first and total sickness benefit periods by radiating and non-radiating spinal pain. Relative risks for the occurrence and number of sickness benefit episodes were calculated by radiating spinal pain status.
The incidence of sickness benefit was greater for those with radiating spinal pain than those with non-radiating spinal pain. However, the duration of time off work, conditional on one day or more off work, was the same between those with and without radiating spinal pain. Radiating spinal pain is an important risk factor for future sickness benefit. Radiating spinal pain was not associated with the duration of sickness benefit. These findings were independent of the effects of pain duration at baseline. The results highlight the need for interventions to prevent the onset of work disability, especially for those with radiating pain.
On cervical Zygapophysial Joint Pain After Whiplash
From: Spine (Phila Pa 1976). 2011 Oct 20. [Epub ahead of print]
This was a narrative review to summarise the evidence that implicates the cervical zygapophysial joints as the leading source of chronic neck pain after whiplash. Reputedly a patho-anatomic basis for neck pain after whiplash has been elusive. However, studies conducted in a variety of disparate disciplines indicate that this is not necessarily the case. Data were retrieved from studies that addressed the post-mortem features and biomechanics of injury to the cervical zygapophysial joints, and from clinical studies of the diagnosis and treatment of zygapophysial joint pain, to illustrate convergent validity.
Post-mortem studies show that a spectrum of injuries can befall the zygapophysial joints in motor vehicle accidents. Biomechanics studies of normal volunteers and of cadavers reveal the mechanisms by which such injuries can be sustained. Studies in cadavers and in laboratory animals have produced these injuries. Clinical studies have shown that zygapophysial joint pain is very common amongst patients with chronic neck pain after whiplash, and that this pain can be successfully eliminated by radiofrequency neurotomy.
The fact that multiple lines of evidence, using independent techniques, consistently implicate the cervical zygapophysial joints as a site of injury and source of pain, strongly implicates injury to these joints as a common basis for chronic neck pain after whiplash.
Transforaminal ligament may play a role in lumbar nerve root compression of foraminal stenosis
From: Med Hypotheses. 2011 Oct 17. [Epub ahead of print]
Lumbar foraminal stenosis is a common pathological change, and lumbar nerve root compression in stenotic foramina was recently considered as one of the main causes of low back pain and leg pain. However, the exact mechanism of lumbar nerve root compression in foramina is still not clear. Previous studies indicated that loss of the intervertebral disc height could reduce the cross-sectional area of lumbar foramina, while lumbar nerve root compression by boundaries of foramina has not been observed in experimental reduction of the intervertebral disc height.
Given the close anatomic relationship between transforaminal ligaments and lumbar nerve roots, the authors hypothesize that transforaminal ligament can be the leading cause of lumbar nerve root compression in foraminal stenosis. They also propose that there are two possible mechanisms of lumbar nerve root compression by transforaminal ligaments:
- nerve roots are compressed by the transforaminal ligament which moves downward with the loss of the intervertebral disc height
- pathological transforaminal ligaments increase the risk of nerve root compression in foramina
Reality about migration of the nucleus pulposus within the intervertebral disc with changing postures
From: Clin Biomech (Bristol, Avon). 2011 Oct 18. [Epub ahead of print]
Previous studies reported that, in non-degenerate discs, the nucleus pulposus migrates posteriorly during flexion and anteriorly during extension within the intervertebral disc. However, in these studies the differences between anterior and posterior distances have been regarded as an indicator of nucleus pulposus migration. This study investigated the reality of migration of the nucleus pulposus within the intervertebral disc with changing postures.
Magnetic resonance images were obtained of the lumbar spines of 25 asymptomatic volunteers in sitting, standing and supine postures. The anterior and posterior height of the intervertebral disc, the anterior-posterior length of the intervertebral disc and nucleus pulposus, and the positions of the anterior and posterior margins of the nucleus were measured from mid-line sagittal images.
Changing postures altered the anterior and posterior height of the disc and three types of morphological changes, including changes in the anterior-posterior lengths of the intervertebral disc and nucleus pulposus, together with the position of the nucleus in the disc were found. The length of the intervertebral disc and nucleus pulposus changed under the variations in spinal loading caused by posture.
The results of this study indicated that the apparent nucleus pulposus migration within intervertebral disc is actually deformation of the nucleus pulposus length which depends on posture and the magnitude of the load. In other words, adopting different postures deforms the nucleus pulposus and therefore, changes the position of the nucleus pulposus but there is no apparent nucleus pulposus migration within the intervertebral disc.
3D Finite Element Analysis of Nutrient Distributions and Cell Viability in the Intervertebral Disc: Effects of Deformation and Degeneration
From: J Biomech Eng. 2011 Sep;133(9):091006
The intervertebral disc receives important nutrients, such as glucose, from surrounding blood vessels. Poor nutritional supply is believed to play a key role in disc degeneration. Several investigators have presented finite element models of the intervertebral disc to investigate disc nutrition; however, none has predicted nutrient levels and cell viability in the disc with a realistic 3D geometry and tissue properties coupled to mechanical deformation. Understanding how degeneration and loading affect nutrition and cell viability is necessary for elucidating the mechanisms of disc degeneration and low back pain.
The objective of this study was to analyze the effects of disc degeneration and static deformation on glucose distributions and cell viability in the intervertebral disc using finite element analysis. A realistic 3D finite element model of the intervertebral disc was developed based on mechano-electrochemical mixture theory. In the model, the cellular metabolic activities and viability were related to nutrient concentrations, and transport properties of nutrients were dependent on tissue deformation. The effects of disc degeneration and mechanical compression on glucose concentrations and cell density distributions in the intervertebral disc were investigated. To examine effects of disc degeneration, tissue properties were altered to reflect those of degenerated tissue, including reduced water content, fixed charge density, height, and endplate permeability. Two mechanical loading conditions were also investigated: a reference (undeformed) case and a 10% static deformation case. In general, nutrient levels decreased moving away from the nutritional supply at the disc periphery. Minimum glucose levels were at the interface between the nucleus and annulus regions of the disc. Deformation caused a 6.2% decrease in the minimum glucose concentration in the normal intervertebral disc, while degeneration resulted in an 80% decrease. Although cell density was not affected in the undeformed normal disc, there was a decrease in cell viability in the degenerated case, in which averaged cell density fell 11% compared with the normal case. This effect was further exacerbated by deformation of the degenerated intervertebral disc.
Both deformation and disc degeneration altered the glucose distribution in the intervertebral disc. For the degenerated case, glucose levels fell below levels necessary for maintaining cell viability, and cell density decreased. This study provides important insight into nutrition-related mechanisms of disc degeneration. Moreover, this model may serve as a powerful tool in the development of new treatments for low back pain.
Poor sitting posture and a heavy schoolbag as contributors to musculoskeletal pain in children: an ergonomic school education intervention program
From: J Pain Res. 2011;4:287-96.
The purpose of this study was to evaluate a multidisciplinary, interventional, ergonomic education program designed to reduce the risk of musculoskeletal problems by reducing schoolbag weight and correcting poor sitting posture.
Data were collected twice before and twice following intervention using the Standardized Nordic Body Map Questionnaire, a rapid upper limb assessment for posture evaluation, and schoolbag weight measurement in children aged 8 and 11 years attending two schools within the central region of Malaysia.
Students who received the ergonomic intervention reported significant improvements in their sitting posture in a classroom environment and reduction of schoolbag weight as compared with the controls.
A single-session, early intervention, group ergonomics education program for children aged 8 and 11 years is appropriate and effective, and should be considered as a strategy to reduce musculoskeletal pain among schoolchildren in this age group.
Intervertebral disc changes after 1 h of running: a study on athletes.
From: J Int Med Res. 2011;39(2):569-79
The vertebral column is a strong yet flexible shaft which provides support of body weight, a basis for locomotion, and protection of the spinal cord and its nerve roots. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 fused sacral vertebrae, and 4 coccygeal vertebrae. The intervertebral discs are interposed between adjacent surfaces of the vertebral bodies and provide the strongest attachment between the vertebrae. The principal functions of the intervertebral discs are to allow movement between vertebral bodies, transmit forces evenly from one vertebral body to the next, and absorb and store energy.
Throughout the day the vertebral column is subjected to compressive as well as other types of loading by gravity, changes in position, muscle activity, external forces, and external work. The fluid pressure within the nucleus pulposus is related to the axial compression applied to the disc. When the compressive load exceeds the interstitial osmotic pressure of the tissues of the disc, water is extruded through the disc wall. The result is a loss in disc height, and thus, a loss in total body height. The gelatinous nature of the nucleus allows it to imbibe fluid and regain its original size when the axial compression is minimized. During the day, when a person is usually under the constant force of gravity and muscular activity, the intervertebral discs lose as much as an inch in height. However, at night, while a person is recumbent, that height is restored.
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An increased response to experimental muscle pain is related to psychological status in women with chronic non-traumatic neck-shoulder pain
From: BMC Musculoskelet Disord. 2011 Oct 12;12(1):230
Neck shoulder pain remains a major problem in work tasks with high exposure to awkward working positions, repetitive movements and movements with high precision demands. The trapezius muscle is considered particularly affected. The prevalence of chronic neck shoulder pain appears to be higher in women than in men. It causes high socioeconomic costs and significant loss of quality of life for the individual. Because of limited knowledge of the mechanisms involved in transition from acute to chronic pain, attempts to develop effective treatments have had limited success. The clinical manifestations of chronic pain conditions include both somatic (e.g., sensory disturbances, facilitated pain responses in association with movements, tense muscles with hyperalgesia for mechanical pressure/manual palpation) and psychological symptoms (e.g., sleeping problems, anxiety, and depressive symptoms).
Sensory hypersensitivity (central sensitization is sometimes used as a synonym while others use central sensitization as a term for specific mechanisms in the central nervous system (CNS)) is a common feature of several chronic neck shoulder pain conditions, particularly those with higher levels of pain intensity and disability. At the clinical examination, this can be manifested as increased sensitivity to manual palpation (i.e., pressure), but increased sensitivity to other sensory modalities, e.g., heat or cold, have also been described. Hypersensitivity to mechanical pressure or thermal pain is sometimes confined to the neck shoulder area but may also be present in remote pain-free areas, even though the clinical routine examination does not reveal clinical anatomical widespread pain and/or generalized hyperalgesia for different types of stimuli. Widespread deep tissue hyperalgesia has been found in patients with fibromyalgia, tension–type headache, whiplash associated disorders, idiopathic neck pain, epicondylalgia, low back pain, pelvic pain syndrome, and osteoarthritis.
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