A prospective study of lumbo-pelvic coordination in patients with non-chronic low back pain.

Despite the current knowledge about abnormalities in the lumbo-pelvic coordination of patients with non-specific low back pain (LBP), it is unclear how such abnormalities change with time. Timing and magnitude aspects of lumbo-pelvic coordination during a trunk forward bending and backward return task along with subjective measures of pain and disability were collected at three-time points over a six-month period from 29 patients who had non-chronic LBP at the time of enrollment in the study. To enable investigation of abnormalities in lumbo-pelvic coordination of patients, we also included lumbo-pelvic coordination data of age and gender-matched back healthy individuals from an earlier study of our group. Finally, differences in lumbo-pelvic coordination between patients with moderate-severe LBP (i.e., those whose level of pain was ≥ 4 (out of 10) at all three data collection sessions; n = 8) and patients with low-moderate LBP (n = 21) were investigated. There were clear distinctions in measures of lumbo-pelvic coordination between patients with low-moderate and moderate-severe LBP. Contrary to our expectation, however, the abnormalities in magnitude aspects of lumbo-pelvic coordination were larger (F > 4.84, P < 0.012) in patients with low-moderate LBP. These abnormalities in patients with low-moderate LBP, compared to controls, included larger (>12°) pelvic and thoracic rotations as well as smaller (>10°) lumbar flexion. The abnormal lumbo-pelvic coordination of patients with non-specific LBP, observed at baseline, persisted (F < 1.96, P > 0.156) or worsen (F > 3.48, P < 0.04) over the course of study period despite significant improvement in their pain (18% decrease; F = 12.10, P < 0.001) and disability (10% decrease; F = 4.39, P = 0.017). Distinct but lingering abnormalities in lumbo-pelvic coordination, observed in patients with low-moderate and moderate-severe LBP, might have a role in persistence and/or relapse of symptoms in patients with non-specific LBP. Such inferences, however, should further be studied in future via investigation of the relationship between abnormalities in lumbo-pelvic coordination and clinical presentation of LBP.

Mechanical demands on the lower back in patients with non-chronic low back pain during a symmetric lowering and lifting task.

There is limited information in the literature related to the lower back loading in patients with LBP, particularly those with non-chronic LBP. Toward addressing such a research gap, a case-control study was conducted to explore the differences in lower back mechanical loads between a group of females (n=19) with non-chronic, non-specific LBP and a group of asymptomatic females (n=19). The differences in lower back mechanical loads were determined when participants completed one symmetric lowering and lifting of a 4.5kg load at their preferred cadence. The axial, shearing, and moment components of task demand at the time of peak moment component as well as measures of peak trunk kinematics were analyzed. Patient vs. asymptomatic group performed the task with smaller peak thoracic rotation and peak lumbar flexion. While no differences in the moment component of task demand on the lower back between the patients and controls were found, the shearing (40-50 age group) and axial components of task demand were, respectively, larger and smaller in patients vs. CONTROLS: Whether alterations in lower back loads in patients with non-chronic LBP are in response to pain or preceded the pain, the long-term exposure to abnormal lower back mechanics may adversely affect spinal structure and increase the likelihood of further injury or pain. Therefore, the underlying reason(s) as well as the potential consequence(s) of such altered lower back mechanics in patients with non-chronic LBP should to be further investigated.

Timing and magnitude of lumbar spine contribution to trunk forward bending and backward return in patients with acute low back pain.

Alterations in the lumbo-pelvic coordination denote changes in neuromuscular control of trunk motion as well as load sharing between passive and active tissues in the lower back. Differences in timing and magnitude aspects of lumbo-pelvic coordination between patients with chronic low back pain (LBP) and asymptomatic individuals have been reported; yet, the literature on lumbo-pelvic coordination in patients with acute LBP is scant. A case-control study was conducted to explore the differences in timing and magnitude aspects of lumbo-pelvic coordination between females with (n=19) and without (n=19) acute LBP. Participants in each group completed one experimental session wherein they performed trunk forward bending and backward return at preferred and fast paces. The amount of lumbar contribution to trunk motion (as the magnitude aspect) as well as the mean absolute relative phase (MARP) and deviation phase (DP) between thoracic and pelvic rotations (as the timing aspect) of lumbo-pelvic coordination were calculated. The lumbar contribution to trunk motion in the 2nd and the 3rd quarters of both forward bending and backward return phases was significantly smaller in the patient than the control group. The MARP and the DP were smaller in the patient vs. the control group during entire motion. The reduced lumbar contribution to trunk motion as well as the more in-phase and less variable lumbo-pelvic coordination in patients with acute LBP compared to the asymptomatic controls is likely the result of a neuromuscular adaptation to reduce painful deformation and to protect injured lower back tissues.

Factors affecting well-being in adults recently diagnosed with rheumatoid arthritis.

This article examines role stress, key psychosocial variables, and well-being in adults recently diagnosed with rheumatoid arthritis. Patients recently diagnosed with rheumatoid arthritis must often learn to balance disease and role-related responsibilities. This was cross-sectional, descriptive study ( N = 80). Data were analyzed using correlation coefficients and linear regression models. Participants were predominantly female (78%), married, and employed. Mean age and disease duration were 54.2 years and 24.2 months, respectively. The findings suggest that well-being is influenced by feelings of being self-efficacious and having balance in their roles and less to do with social support received from others.

Comparison of lumbo-pelvic kinematics during trunk forward bending and backward return between patients with acute low back pain and asymptomatic controls.

BACKGROUND: Prior studies have reported differences in lumbo-pelvic kinematics during a trunk forward bending and backward return task between individuals with and without chronic low back pain; yet, the literature on lumbo-pelvic kinematics of patients with acute low back pain is scant. Therefore, the purpose of this study was set to investigate lumbo-pelvic kinematics in this cohort. METHODS: A case-control study was conducted to investigate the differences in pelvic and thoracic rotation along with lumbar flexion as well as their first and second time derivatives between females with and without acute low back pain. Participants in each group completed one experimental session wherein they performed trunk forward bending and backward return at self-selected and fast paces. FINDINGS: Compared to controls, individuals with acute low back pain had larger pelvic range of rotations and smaller lumbar range of flexions. Patients with acute low back pain also adopted a slower pace compared to asymptomatic controls which was reflected in smaller maximum values for angular velocity, deceleration and acceleration of lumbar flexion. Irrespective of participant group, smaller pelvic range of rotation and larger lumbar range of flexion were observed in younger vs. older participants. INTERPRETATION: Reduced lumbar range of flexion and slower task pace, observed in patients with acute low back pain, may be the result of a neuromuscular adaptation to reduce the forces and deformation in the lower back tissues and avoid pain aggravation.