Is recurrent low back trouble associated with increased lumbar sagittal mobility?

The hypothesis that increased lumbar sagittal mobility constitutes a risk factor for recurrent low back trouble was tested in respect of two specific groups of subjects thought likely to display this phenomenon: young females reporting recurrent back pain, and middle-aged adults reporting recurrent or persistent sciatic symptoms. Lumbar flexibility was estimated from back surface curvatures by a validated technique which uses a flexicurve to record mobility in upper (T12-L4) and lower (L4-S2) lumbar regions. Mean mobility for young females (<40 years) with recurrent back pain was less, though not significantly so, than those without back trouble. A loss of mobility was also found in young males with recurrent trouble. However, it was a proportionally greater loss than that found in the females and was statistically significant. The mean mobility for middle-age adults with recurrent sciatic symptoms was significantly reduced compared to those without a history of back trouble. Whilst these results failed to support the general hypothesis, it remains possible that aspects of increased mobility not studied here, such as localized segmental instability or abnormal coupled motions, may be associated with an increased frequency of recurrent low back trouble

Prediction of the Clinical Course of Low-Back Trouble Using Multivariable Models

The inability to predict outcome in patients with low-back pain seriously impedes clinical trials and leads to inappropriate or unnecessary treatment. This prospective study investigated the value of multivariable mathematical models to predict the 1-year clinical course of 109 patients with low-back trouble (LBT). Discriminant analysis was used to determine predictive models for outcome groups at 1 month, 3 months and 1 year. The variables selected in the analyses were subsets of 29 items from a clinical interview at presentation. These included anamnestic features of the first episode as well as symptomatic details and results from clinical tests for the current spell. The derived models successfully discriminated outcome groups with estimates of sensitivity and specificity ranging from 63 to 99%. When models from one set of patients were tested for predictive accuracy by the application of them to a different set, nonrecovery and satisfactory improvement were predicted with a 76-100% success rate. The results affirmed the importance of considering combinations of interrelated variables for prediction and discrimination in LBT. This work has demonstrated that outcome can be predicted successfully by the use of mathematic models based just on presentation data. The ability to determine homogenous groups in respect to outcome is seen as an important aid to therapeutic research; further work will enable refinement of these models for general clinical use and for incorporation into computer-based interview systems

Noninvasive Measurement of Lumbar Sagittal Mobility: An Assessment of the Flexicurve Technique

The use of flexicurves to measure lumbar sagittal mobility was subjected to a series of reliability and validation experiments. Appropriate statistical methods were described and used to quantify intraobserver and intrasubject variability and to determine limits of agreement with measurements from radiographs. It was shown that the traditional use of correlation coefficients can produce misleading or inadequate information. The flexicurve technique had an intraobserver variability of 3-4[degrees] of movement, was not significantly influenced by intrasubject variability, and provided measurements typically within 6[degrees] of radiographic measurements. The data suggest that the flexicurve technique is less biased than the inclinometric method. These results demonstrate the use of suitable statistical methods to assess the clinical usefulness, or level of interchangeability, of spinal measurement instruments

Does Leisure Sports Activity Influence Lumbar Mobility or the Risk of Low Back Trouble?

In order to look for relationships between leisure sports activity and both low back trouble and back flexibility, 958 people, aged 10-84 years, were examined. Their history of low back trouble and leisure sports participation was recorded, together with measurements of maximal lumbar sagittal mobility. No evidence was found to suggest that the extent of sports participation either during childhood or as an adult was related to the development, frequency, or onset-age of low back trouble. Although sports participation was not associated with flexibility in schoolchildren, adults who had continued leisure sports for >5 years showed relatively reduced lumbar mobility. On the basis of the results presented here, it is concluded that sporting pursuits at amateur/leisure level do not, in themselves, represent a major risk factor for low back trouble. On the contrary, it was found that adults typically continued leisure sports participation for some years after developing low back trouble. Sports participation, in general terms, is not con-traindicated for those who have experienced low back trouble, but regular exercise does not apparently result in increased lumbar flexibility

Reference values for ‘normal’ regional lumbar sagittal mobility

From a sample of 958 individuals, a group with no anamnestic recall of notable low back trouble (n=510) was selected to provide reference values for lumbar sagittal mobility. The measurement technique employed a flexicurve to give angular measures for maximal sagittal mobility in upper (T12-L4) and lower (L4-S2) regions. The results are presented in the form of reference ranges and modal values, stratified by age and sex. A wide variation in the 'normal' range of mobility at all ages is confirmed. Males had higher values for flexion, whilst females showed higher values for extension and for mobility in the lower region. Sagittal mobility declined with age at different rates in males and females for both flexion/extension and upper/lower measures. Generally speaking, mobility was reduced by some 50% in old age compared with childhood, the reduction being most marked for measures of flexion and upper lumbar mobility

Variation in Lumbar Sagittal Mobility with Low-Back Trouble

The influence of low-back trouble on lumbar sagittal mobility was explored in 958 individuals aged 10 to 84 years. Experience of low-back trouble was determined by questionnaire, and categorized as none, a previous history, or a current spell. Maximal mobility was estimated from flexicurve records of back surface curvature. The results for adults revealed that mean mobility values were reduced by both previous and current low-back trouble, particularly in the upper lumbar region, when compared with nonsufferers. Stepwise regression analyses showed that variation in mobility was best accounted for by the cumulative effects of age and sex. These variables accounted for approximately one-third of the variation in mobility: low-back trouble only accounted for an additional 1%. At the extremes of the range, both hypomobility and hypermobility were identified as risk indicators for low-back trouble. Relative hypermobility was not confined to subjects with no history of back trouble; some current sufferers had particularly high levels of mobility. Similarly hypomobility was found in nonsufferers as well as in those with back trouble. The data indicated that young adults (notably males) with previous low-back trouble may not recover their previous mobility on symptomatic resolution. The finding of hypermobility in current sufferers indicates that mobilization therapy may not be appropriate for such patients

Prediction of Low-Back Trouble Frequency in a Working Population

This study was performed to estimate the discriminatory power of multiple combinations of risk Indicators for the occurrence and recurrence of low-back trouble (LBT) in workers. Two categories of LBT provided groups for discrimination; 1) the presence or absence of LBT history, and 2) three patterns of recurrence characterized by the number of episodes (Isolated, periodic, chronic). The risk indicators comprised data reflecting occupational and leisure demands on the back, measures of lumbar sagittal mobility, and anamnestic features of the first episode. Discriminant analysis was the statistical procedure used. The results showed that it was possible to find linear combinations of the discriminating variables that successfully allocated around two-thirds of the sample to the correct group. The presence of a history of LBT was predicted by the combined effect of increasing age and adult sports participation, but only in females did a heavier job contribute to such prediction. A reduction in risk was associated with lumbar flexibility and sports participation at school. Chronic LBT was more accurately identified than the two other groups; increasing age, a long initial spell, and an onset early in life were associated with increased likelihood of chronicity, while a report of symptoms being relieved by sitting reduced this risk. It is concluded that the occurrence and recurrence of LBT are related to combinations of risk indicators, and that it is imperative to consider the interactive effect of a multiplicity of factors In epldemiologic studies

Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation

This single-blind randomised clinical trial compared osteopathic manipulative treatment with chemonucleolysis (used as a control of known efficacy) for symptomatic lumbar disc herniation. Forty patients with sciatica due to this diagnosis (confirmed by imaging) were treated either by chemonucleolysis or manipulation. Outcomes (leg pain, back pain and self-reported disability) were measured at 2 weeks, 6 weeks and 12 months. The mean values for all outcomes improved in both groups. By 12 months, there was no statistically significant difference in outcome between the treatments, but manipulation produced a statistically significant greater improvement for back pain and disability in the first few weeks. A similar number from both groups required additional orthopaedic intervention; there were no serious complications. Crude cost analysis suggested an overall financial advantage from manipulation. Because osteopathic manipulation produced a 12-month outcome that was equivalent to chemonucleolysis, it can be considered as an option for the treatment of symptomatic lumbar disc herniation, at least in the absence of clear indications for surgery. Further study into the value of manipulation at a more acute stage is warranted