Exercise treatment for sacroiliac pain.

The reciprocal relationship of the latissimus dorsi on one side and the gluteus maximus on the other side has been demonstrated anatomically. To demonstrate this relationship by muscle action, electromyographic studies were performed in 15 healthy individuals. This formed the baseline for evaluation of 5 symptomatic patients with sacroiliac dysfunction. Abnormal hyperactivity of the gluteus muscle on the involved side and increased activity of the latissimus on the contralateral side was contrasted with the normal function of the healthy individuals. All patients in the rotary strengthening exercise program improved in strength and return of myoelectric activity to more normal patterns.

A preliminary report on the effect of measured strength training in adolescent idiopathic scoliosis.

The authors studied 12 adolescent patients with scoliosis (10 girls and 2 boys) who were 11 to 16 years old and had curvatures ranging from 20 degrees to 60 degrees. Seven were right thoracic curves and five were thoracolumbar with double curves. When tested on the MedX Torso Rotation Machine, both sides were unequal in their torso rotation strength all patients. Myoelectric activity was asymmetric in both sides and in abdominal and paraspinal muscles of all patients. These asymmetries were corrected completely with torso rotation, which was associated with significant strength gains. Strength gains ranged from 12% to 40%. A 16-year-old girl with a 60 degree lumbar curve progressed and had surgery. None of the remaining patients progressed, and 4 of the 12 had decreases in their curvatures from 20 degrees to 28 degrees. None of the patients used braces during this study.

Effects of smoking and maturation on long-term maintenance of lumbar spinal fusion success.

This is a follow-up study of a multicenter, randomized, placebo-controlled clinical trial conducted in accordance with the condition for Food and Drug Administration approval for pulsed electromagnetic fields. The purpose of this study was to evaluate the long-term efficacy and safety of pulsed electromagnetic fields for spinal fusion. An earlier clinical trial study was conducted to evaluate the efficacy of Pulsed Electromagnetic Fields to enhance fusion success at one year follow-up. In the original study, 195 patients undergoing interbody fusion were enrolled. Of the 195 patients, 98 were in the active group and 97 were in the placebo group. Study results showed a 92% successful fusion rate in the active group compared to 68% in the placebo group. For this long-term follow-up study, all patients who had healed in the original study were recalled for a follow-up radiograph. Radiographs were assessed by the attending surgeon for fusion assessment, when possible. The results of this long-term follow-up study showed that there was a reduction in maintenance of the fusion over time by 25%, but that the reduction was unrelated to treatment group and correlated statistically with whether the patient was a smoker.

Restorative exercise for clinical low back pain. A prospective two-center study with 1-year follow-up.

STUDY DESIGN: A comparison of treatment of 412 patients with chronic back pain at two separate centers using the same treatment protocols and outcome measures. Outcome was defined by specific strength testing; Short Form-36 scores at intake, discharge, and 1-year follow-up; self-appraisal of improvement at discharge and in a 1-year follow-up; and reuse of health care services after discharge. OBJECTIVES: To investigate the efficacy of standardized treatment methods using isolated lumbar strength testing and strengthening based on progressive protocols using specific equipment. Comparison of results should clarify the effect of the treatment center versus the efficacy of standardized protocols. SUMMARY OF BACKGROUND DATA: There has been little support in the scientific literature for exercise programs based on standardized protocols. The use of specialized equipment to achieve intense specific exercise also has been poorly supported. Overall health benefit has not often been related to specific improvement in strength. METHODS: More than 400 individuals with chronic back pain were evaluated at the initiation of treatment, discharge, and 1 year after discharge. Measures of efficacy were based on Short Form-36 scores, self-appraisal of improvement, and reuse of health care services after discharge. Study participants were patients with chronic back pain consecutively referred to each treatment site and underwritten by a variety of payers, including workers' compensation, Medicare, and private insurance. RESULTS: Overall response during the course of the program and at 1-year follow-up was similar between the two centers. Similar proportions of participants at each site demonstrated improvement in SF-36 scores, self-appraisal of improvement, and reuse of health care services. CONCLUSIONS: Standardized protocols using specific strength and measurement equipment can achieve similar benefits at different sites.

Comparison of hydroxyapatite granules to autogenous bone graft in fusion cages in a goat model.

BACKGROUND: With the increased use of fusion cages to achieve lumbar intervertebral fusion, the question arises as to the potential for bone ingrowth from the host bone through the entire cage. Is it even necessary to have an autogenous graft to achieve total bone incorporation? METHODS: Nine adult male goats had fusion cages implanted into three vertebral bodies. The design was Surgical Dynamics/Ray Fusion Cage, measuring 21 mm x 14 mm. In each animal, one fusion cage was filled with autogenous graft, one with hydroxyapatite, porous granules, and the other with nonporous granules. Amount of new bone formation was determined by backscatter electron microscopy at 3 months post implantation in all animals. RESULTS: The histologic section shows that there was total incorporation in all specimens at 3 months. There was slightly more new bone (43%) with the nonporous granules compared with the porous granules (35%). The amount of residual void space was about the same in all specimens, indicating that the amount of new bone formation was similar and not statistically different in cages filled with hydroxyapatite granules versus granules of autogenous bone. CONCLUSION: This study confirms that total incorporation by ingrowth of new bone can be expected in fusion cages. The amount of ingrowth is about the same for autogenous graft versus hydroxyapatite granules. Apparently, it is not necessary to use bone graft to achieve successful bone incorporation if an acceptable biocompatable lattice, such as hydroxyapatite granules, is used.

Physical measurements of the lumbar spine.

This article describes measurement of lumbar function. The simplest range of motion devices are compared with the progressive, more complex computerized devices for range and strength testing. The author presents his own opinion as to the place of these devices in both research and clinical practices. The economics of accurate physical testing is compared to the clinical realities of current payment systems.

Relationships between myoelectric activity, strength, and MRI of lumbar extensor muscles in back pain patients and normal subjects.

Eight normal individuals and eight patients with chronic back pain were evaluated. They undertook a treatment program lasting 8 weeks, with two exercise sessions each week. Myoelectric activity, lumbar extensor strength, and cross-sectional magnetic resonance imaging appearance of the lumbar paraspinal extensor muscles was assessed at the beginning and end of the program. Initial baseline and final extensor strength measurements were done isometrically at seven points through full range. Surface myoelectric activity was monitored during both flexion and extension exercise. Subsequently, electromyographic (EMG) signals were analyzed for mean frequency (MPF) and amplitude (RMS). An average functional improvement of 65% and reduction of pain complaint of 41% occurred in the eight patients with chronic low back pain. Extensor strength improved an average of 48% contrasted to 6% for the normal subjects. Four patients who showed severe fatty infiltration in the extensors had a decrease in the degree of infiltration and no change in muscle mass. Changes in fatty infiltration did not correlate with strength changes. The dynamic EMG changes documented a decrease in amplitude (RMS) and a smaller decrease in frequency (MPF) for the same resistance when used at the beginning and end of the program. Structural changes in the muscles are not always needed to achieve strength gains or symptomatic improvement.

Relationship of lumbar strength in shipyard workers to workplace injury claims.

STUDY DESIGN: Strength testing of lumbar extensors of shipyard workers without back injury claims was accomplished to compare isolated lumbar strength with the severity of their workplace physical demands and the incidence of workplace back injury during a 2-year period. OBJECTIVES: To determine if strength is a predictor of workplace injury and if there is a relationship between the physical demands of the job and strength. SUMMARY OF BACKGROUND DATA: The role of preplacement strength testing has not been clarified as a potential means for predicting workplace injury. It has not been clarified whether work activity affects the strength of the worker. METHODS: One hundred fifty-two shipyard workers were strength tested for isometric lumbar extensor strength. They had been classified as to the severity of their job demands according to the Physical Demand Characteristics. All workers at this industry were likewise classified. Those workers who were tested were followed for 2 years to evaluate for claims of back injury. RESULTS: There was a higher incidence of low back injuries in the heavy and very heavy classification. There was, however, no difference in strength among those workers classified in medium, heavy, and very heavy work. Nine percent of those workers tested had back pains during the following 2 years. All but two had higher-than-average strength. CONCLUSIONS: There is no evidence that preplacement back strength testing would predict workplace claims of injury.

Comparison of female geriatric lumbar-extension strength: asymptotic versus chronic low back pain patients and their response to active rehabilitation.

We compared lumbar-extension strength between healthy asymptomatic geriatric females (HEAL) and symptomatic geriatric females (INJ) seeking medical attention for chronic low back pain. The INJ group used the MedX lumbar-extension machine to perform isotonic exercises two times per week and were eventually reduced to one time per week. Range of motion (ROM) and strength were significantly different between groups before beginning the program. After the program, ROM and strength improved significantly and were not different from those of the HEAL group. The average length of treatment was 97 days and 20 visits. Subjective pain ratings were significantly reduced (60%) and exercise weights significantly increased (71%). This reconfirms the notion that many back pain sufferers have weaker lumbar-extension strength and that some symptomatic geriatric women can increase strength with progressive resistance exercise, which leads to a decrease in low back pain.