Randomized controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol

Abstract Background Lumbar spine fusion (LSF) effectively decreases pain and disability in specific spinal disorders; however, the disability rate following surgery remains high. This, combined with the fact that in Western countries the number of LSF surgeries is increasing rapidly it is important to develop rehabilitation interventions that improve outcomes. Methods/design In the present RCT-study we aim to assess the effectiveness of a combined back-specific and aerobic exercise intervention for patients after LSF surgery. One hundred patients will be randomly allocated to a 12-month exercise intervention arm or a usual care arm. The exercise intervention will start three months after surgery and consist of six individual guidance sessions with a physiotherapist and a home-based exercise program. The primary outcome measures are low back pain, lower extremity pain, disability and quality of life. Secondary outcomes are back function and kinesiophobia. Exercise adherence will also be evaluated. The outcome measurements will be assessed at baseline (3 months postoperatively), at the end of the exercise intervention period (15 months postoperatively), and after a 1-year follow-up. Discussion The present RCT will evaluate the effectiveness of a long-term rehabilitation program after LSF. To our knowledge this will be the first study to evaluate a combination of strength training, control of the neutral lumbar spine position and aerobic training principles in rehabilitation after LSF. Trial registration ClinicalTrials.gov Identifier NCT00834015peerReviewe

Trainingsinduzierte Hypoalgesie : mit Bewegung gegen den Schmerz

Bei vielen muskuloskelettalen Beschwerden lindert Bewegung die Schmerzen und verbessert die Funktionsfähigkeit. Körperliche Aktivität zeigt aber auch systemische Effekte, die sich positiv auf die Psyche und mehrere Organsysteme auswirken können

Bursiitit:diagnostiikka ja hoito

Tiivistelmä Syvät limapussit ovat synnynnäisiä rakenteita, kun taas pinnalliset bursat kehittyvät kuormituksen ­seurauksena. Pinnallisten infektiivisten bursiittien hoitona on ripeä antibioottihoidon aloitus limapussin punktion ja ­bakteeriviljelyn jälkeen. Pinnallisten inflammatoristen bursiittien hoitona on punktio ja lepo. Kuormitusperäisiin syviin bursiitteihin käytetyt kortikosteroidi-injektiot voivat lievittää oireita, ­mutta niistä ei ole pitkävaikutteista hyötyä. Syvissä bursiiteissa tulee huomioida usein taustalla vaikuttava lisääntynyt tai poikkeava epäsuora ­mekaaninen kuormitus, tarvittaessa kuntoutuksen avulla.English summary Diagnosis and treatment of bursitis A bursa is a structure that reduces friction between soft tissues and bony structures. Bursitis can be either aseptic or septic. Aseptic bursitis is more frequent. Septic bursitis occurs mainly in superficial bursae. Infection in deep bursae is less frequent. The diagnosis of superficial bursitis is fairly straightforward based on clinical examination, but imaging can be useful in some cases. Treatment consists of aspiration of the bursa and relative rest. The diagnosis of deep bursitis is more challenging and ultrasound or magnetic resonance imaging can be helpful in reaching the diagnosis. Indirect mechanical loading is a common contributing factor in deep bursitis, and tendinopathy findings are frequent in adjacent tendons. The treatment in the acute phase consists of relative rest and medication. However, when aiming for long-term effects, improvement in the loading tolerance of the bursa and the loading capacity of the adjacent tendons should be targeted in rehabilitation. Corticosteroid injections can be useful in the short-term, but they do not have any long-term benefit and, thus, the use of injections should be considered carefully. Surgery is required infrequently

Effectiveness of postoperative home-exercise compared with usual care on kinesiophobia and physical activity in spondylolisthesis : A randomized controlled trial

Objective: To study the effectiveness of a 12-month exercise therapy on kinesiophobia and physical activity in patients with spondylolisthesis after lumbar spine fusion. Design: Randomized controlled trial. Subjects: Patients (n=98) with spondylolisthesis who had undergone lumbar spine fusion. Methods: All patients (mean age 59 years) had received lumbar spine fusion surgery and identical postoperative instructions. Three months postoperatively, they were randomized into an exercise group (n=48) or usual care group (n=50). The exercise group received 12-month progressive home-based training with regular booster sessions, and the usual care group a single session of physiotherapy instruction. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK) and physical activity by the International Physical Activity Questionnaire (IPAQ) preoperatively, 3 months after lumbar spine fusion, and at the end of the 12-month intervention. Results: Before the intervention, the median (first quartile; third quartile) of TSK was 32.5 (29.0; 37.0) in the exercise group and 30.0 (25.8; 36.0) in the usual care group, changing to 30.0 (25; 36) in the exercise group and to 30.5 (24; 36.3) in the usual care group (between-group p=0.17). IPAQ metabolic equivalent minutes per week increased from 1,863 (1,040; 3,042) to 3,190 (1,634; 6,485) in the exercise group and from 2,569 (1,501; 4,075) to 3,590 (1,634; 6,484) in the usual care group (between-group p=0.92). Conclusion: Progressive 12-month home-exercise starting 3 months postoperatively was not superior to usual care in decreasing kinesiophobia or increasing physical activity in spondylolisthesis.peerReviewe

Neutral spine control exercises in rehabilitation after lumbar spine fusion

Lumbar spine fusion (LSF) has been reported to change the biomechanics of the spine and therefore the rehabilitation after LSF is important. In this study, the effect of selected neutral spine control exercises on activation of trunk muscles after LSF was evaluated. Muscle activity was measured by surface electromyography of the rectus abdominis, external oblique, longissimus, and multifidus muscles during 6 exercises in 22 LSF patients (mean age = 59 years; age range = 25-84 years; 50% women). Muscle activity concurrent with trunk flexion and extension during maximal voluntary isometric contraction (MVIC) was used as a reference value. Pain during the effort was assessed with a visual analog scale (VAS). The highest activity in the rectus abdominis muscles was measured during bilateral shoulder extension (51% of MVIC), and in the external oblique, it occurred during unilateral shoulder horizontal adduction (48% of MVIC) and unilateral hip extension (46% of MVIC) exercises. The highest activation of the multifidus and longissimus muscles (60-104%) was measured during bilateral shoulder flexion and modified Roman chair exercises. The mean (SD) self-reported back pain VAS scores during exercises varied from 3 (7) to 16 (26). Neutral spine control exercises activate trunk muscles and cause minimal pain and are therefore feasible exercises for home-based training to improve muscle endurance and postural control after LSF. In addition, the level of muscle activity during bilateral shoulder flexion and modified Roman chair exercises was over 60%of MVIC, justifying their use in training for strength of the trunk extensor muscles

Trunk Muscle Strength After Lumbar Spine Fusion : A 12-Month Follow-up

Objective: The aim of this study was to investigate changes in trunk muscle strength 12 months after lumbar spine fusion (LSF) compared to preoperative strength. Methods: A total of 194 patients (mean ± standard deviation [SD] age, 61 ± 21 years) who underwent LSF participated in this prospective longitudinal study. Physical measurements of the participants were made before surgery and 12 months postoperatively. Isometric trunk extension and flexion strength was measured using a strain-gauge dynamometer in the standing position. Strength changes were calculated. Regression analysis was performed to explore which factors predicted strength levels at 12 months postoperatively. Results: The preoperative mean ± SD extension strength was 205 ± 144 N, which increased to 258 ± 142 N (p < 0.001) at the 12-month follow-up. Flexion strength increased from 295 ± 172 N to 364 ± 164 N (p < 0.001). The preoperative extension/flexion strength ratio was 0.75 ± 0.38 and remained similar (0.73 ± 0.26) at 12 months postoperatively (p = 0.39). Conclusion: Although trunk muscle strength increased by 26% for extension and 23% for flexion at the 12-month postoperative follow-up, both values remained objectively low. In addition, flexion strength remained higher than extension strength, which indicates an imbalance between those muscle groups. Age, severe back pain, and low trunk muscle strength before surgery predicted low trunk muscle strength at 1 year after spinal fusion.peerReviewe