[Posterior iliac crest low back pain]. / Lombalgie localisée au niveau de la crête iliaque postérieure.

In the context of low back pain of the posterior iliac crest, various etiologies can be evoked, in particular Maigne's syndrome in D12/L1, ilio-lumbar ligament syndrome or L5/S1 facet syndrome. Maigne's syndrome is a painful segmental vertebral dysfunction leading to a cellulo-periosto-myalgic syndrome. Propedeutic is essential to the diagnosis and is based on a rigorous segmental spinal examination and on the remote search for palpable changes in the texture of the skin, muscle and teno-periosteal tissues. The iliolumbar ligament is a powerful fibrous stabilising element of the lumbosacral hinge. Its tensioning by repeated movements of anteflexion and contralateral lateroflexion-rotation contributes to the expression of a painful symptomatology of the posteromedial iliac crest. Pain in the posterior inter-apophyseal joint L5-S1 is characterised by a more medial lumbosacral pain, accentuated on facet palpation and reproduced on combined heterolateral extension-rotation of the spine. Manual therapy centred on the dorsolumbar or lumbosacral hinge is recommended as a first-line treatment to control these different diagnoses. Rehabilitation of the motor control of the deep stabilising muscles of the dorsolumbar spine is essential. Various local infiltrations often complete the physiotherapy approach.

Dans le cadre d'une lombalgie de la crête iliaque postérieure, diverses étiologies peuvent être évoquées, notamment le syndrome de Maigne en D12/L1, le syndrome du ligament ilio-lombaire ou encore le syndrome facettaire L5/S1. Le syndrome de Maigne traduit une dysfonction vertébrale segmentaire douloureuse entraînant un syndrome cellulo-périosto-myalgique. La propédeutique est essentielle au diagnostic et repose sur un examen vertébral segmentaire rigoureux et sur la recherche à distance des modifications palpables de la texture des tissus cutané, musculaire et téno-périosté. Le ligament ilio-lombaire est un puissant élément fibreux stabilisateur de la charnière lombo-sacrée. Sa mise en tension par des mouvements répétés d'antéflexion et de latéroflexion-rotation controlatérale contribue à l'expression d'une symptomatologie douloureuse de la crête iliaque postéro-médiale. La souffrance de l'articulaire inter-apophysaire postérieure L5-S1 se caractérise par une douleur lombo-sacrée plus médiane, accentuée à la palpation facettaire et reproduite lors de la combinaison d'un mouvement d'extension-rotation hétérolatérale du rachis. Une thérapie manuelle centrée sur la charnière dorso-lombaire ou lombo-sacrée est préconisée en première intention pour maîtriser ces différents diagnostics. La rééducation du contrôle moteur des muscles stabilisateurs profonds du rachis dorso-lombaire s'avère primordiale. Diverses infiltrations locales complètent souvent l'approche rééducative.

[Recommendations for functional evaluation and rehabilitation of chronic low back pain]. / Recommandations pour l'évaluation et la rééducation fonctionnelles du patient souffrant d'une lombalgie chronique.

The majority of non-specific low back pain has a favourable evolution within a short period of time but in some cases the pain becomes persistent or recurrent. These chronic forms are responsible for most of the social and economic burden of low back pain. The crucial role of psycho-social factors in the chronicisation of low back pain justifies a thorough bio-psycho-social assessment. An active semi-intensive ambulatory multidisciplinary programme (Spine Unit Center) that complies with international and national recommendations (KCE and INAMI) has demonstrated its effectiveness in chronic low back pain in terms of algo-functional, physical and psycho-social components. In contrast to intensive programmes requiring hospitalisation, this outpatient treatment allows the patient to remain in his/her social and professional network. The active participation and motivation of the patient are essential for the success of the treatment. The multidisciplinary team will help the patient to define his/her functional objectives and to manage, via the psychologist, emotional aspects. The programme includes therapeutic education and physical reconditioning sessions including progressive aerobic training, group exercises, and individualised and progressive strengthening of the trunk muscles. The introduction of physical activity at home will be encouraged in order to sustain the changes in the patient's behaviour.

La majorité des lombalgies non spécifiques présente une évolution favorable dans un délai assez court, mais, dans certains cas, les douleurs deviennent persistantes ou récurrentes. Ces formes chroniques sont responsables de l'essentiel du poids social et économique des lombalgies. Le rôle crucial des facteurs psycho-sociaux dans la chronicisation de la lombalgie justifie une évaluation bio-psycho-sociale approfondie. Un programme pluridisciplinaire ambulatoire actif semi-intensif («Clinique du Dos¼) répondant aux recommandations internationales et nationales (KCE et INAMI) a démontré une efficacité sur les composantes algo-fonctionnelles, physiques et psycho-sociales du patient lombalgique chronique. Contrairement aux programmes intensifs imposant une hospitalisation, cette prise en charge ambulatoire permet au patient de rester dans son réseau social et professionnel. La participation active et la motivation du patient constituent les éléments essentiels pour la réussite du traitement. L'équipe pluridisciplinaire l'aidera à définir ses objectifs fonctionnels et à gérer, via le psychologue, certains aspects émotionnels en lien avec la douleur. Le programme comprend des séances d'éducation thérapeutique et de reconditionnement physique, incluant un entraînement aérobie progressif, une gymnastique collective de tonification et un renforcement individualisé et graduel des muscles du tronc. L'instauration d'une activité physique à domicile sera encouragée de manière à pérenniser les changements de comportement du patient.

Complementary treatment comparison for chronic pain management: A randomized longitudinal study.

BACKGROUND: In chronic pain, it seems that the effect of cognitive-behavioral therapy (CBT) is boosted when it is combined with hypnosis. The aim of this study was to assess the efficacy of self-hypnosis combined with self-care (i.e., a type of CBT) compared to music/self-care, self-care and psychoeducation/CBT and to evaluate their long-term effects. METHODS: An open label randomized clinical trial enrolled patients with chronic pain and was carried out at the University Hospital of Liège (Belgium). Patients were randomized into four groups: self-hypnosis/self-care, music/self-care, self-care, psychoeducation/CBT (7 monthly sessions of 2 hours). Two follow-up sessions were delivered at 6- and 12-month. Levels of pain, fatigue intensity, anxiety, depression, insomnia severity, disability, health locus of control, mental and physical quality of life and attitudes (control, disability, harm, emotion, medical cure, medication, solicitude) towards pain were assessed before and after the treatments, and at follow-up. RESULTS: 203 patients were randomized: 52 in self-hypnosis/self-care, 59 in music/self-care, 47 in self-care, and 45 in psychoeducation/CBT. No group effect was found. A significant time effect was showed. Directly after the treatment, all groups decreased in pain attitudes and physical quality of life. Perceived control increased. At 6-month, all patients kept their levels of physical quality of life and perceived control, and showed decrease in pain intensity, harm, emotion and medical cure. At 12-month, scores that had change previously remained ameliorated, a decrease in insomnia severity and an increase in internal locus of control were observed. CONCLUSIONS: The present findings are encouraging as they display long-term beneficial effects of complementary biopsychosocial-based treatments in chronic pain. It seems that patients continued to apply the learnt strategies as improvements were observed one year after the treatments had ended.

Multidisciplinary rehabilitation program after breast cancer: benefits on physical function, anthropometry and quality of life.

BACKGROUND: Different clinical trials show beneficial effects of physical training offered during and/or after breast cancer treatment. However, given the variety of side effects that may be encountered, physical training could be combined with psychological, relational and social guidance. This kind of multidisciplinary program has been little studied so far. AIM: The aim of this study was to determine the benefits of a three-month multidisciplinary rehabilitation program among women after breast cancer treatment. DESIGN: Controlled no-randomized trial. SETTING: University for outcomes, University Hospital Center for interventions. POPULATION: Two hundred and nine outpatients who have been treated for a primary breast carcinoma. METHODS: Patients were divided into a control group (N.=106) and an experimental group (N.=103) which has benefited from a rehabilitation program of three months including physical training and psycho-educational sessions. The assessments, performed before and after the program, included functional assessments ("Sit and Reach Test", maximal incremental exercise test and "Six-Minute Walk Test"), body composition measurements (Body Mass Index [BMI] and body fat percentage) and a questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30). RESULTS: After three months, flexibility, walking distance and all parameters measured during the maximal incremental exercise, except maximal heart rate, were significantly improved in the experimental group. The body fat percentage was significantly decreased and a significant improvement was observed for perceived health status (quality of life), functional role, emotional state, physical, cognitive and social functions and for most symptoms. In the control group, most of these improvements didn't appear and a significant increase in BMI and body fat percentage was observed. CONCLUSIONS: This trial identifies the benefits of a well detailed multidisciplinary rehabilitation program, including physical re-conditioning and psycho-educational sessions, with important improvements in functional capacity, body composition and the majority of functions and symptoms among women after breast cancer treatment. CLINICAL REHABILITATION IMPACT: Through its results, this study could contribute to the development of hospital quality standards for oncologic rehabilitation. Physiotherapists can efficiently propose this kind of multidisciplinary rehabilitation program.

Lumbopelvic motor control and low back pain in elite soccer players: a cross-sectional study.

This study aimed to investigate the relationship between the history of low back pain and quality of lumbopelvic motor control in soccer players. Forty-three male elite soccer players (mean age, 18.2 ± 1.4 years) filled in questionnaires related to low back pain and attended a session to assess lumbopelvic motor control by means of five tests (the bent knee fall out test, the knee lift abdominal test, the sitting knee extension test, the waiter's bow and the transversus abdominis test). A physiotherapist, blinded to the medical history of the participants, scored (0 = failed, 1 = correct) the performance of the players for each of the tests resulting in a lumbopelvic motor control score ranging from 0 to 5. Forty-seven per cent of the soccer players reported a disabling low back pain episode lasting at least two consecutive days in the previous year. These players scored worse lumbopelvic motor control than players without a history of low back pain (lumbopelvic motor control score of 1.8 vs. 3.3, P < 0.01). The between-groups difference was particularly marked for the bent knee fall out test, the knee lift abdominal test and the transversus abdominis test (P < 0.01). In conclusion, most soccer players with a history of low back pain had an altered lumbopelvic motor control. Further research should examine whether lumbopelvic motor control is etiologically involved in low back pain episodes in soccer players.

Effectiveness of a semi-intensive multidisciplinary outpatient rehabilitation program in chronic low back pain.

OBJECTIVES: To evaluate the efficacy of a semi-intensive multidisciplinary outpatient program complying with the requirements of the Belgian National Institute for Health and Disability Insurance and intended for patients with chronic low back pain. METHODS: We included 262 patients with nonspecific chronic low back pain, among whom 136 (73 women and 63 men) with a mean pain duration of 11.3 years completed the outpatient program (36 sessions each lasting 2h). The program consisted of education about back-sparing techniques, interventions by an occupational therapist and psychologist, and physical reconditioning. Three sessions (sessions 1, 18, and 36) were used to evaluate pain intensity, functional impairment, kinesiophobia, cognitive knowledge, knowledge of appropriate spinal movement technique, and physical performance (trunk muscle strength and endurance, mobility of the pelvis and lumbar spine, and aerobic capacity). RESULTS: All study variables were significantly improved at study completion compared to baseline: pain intensity was decreased by 44%, functional impairment by 40%, and kinesiophobia by 11% whereas knowledge was improved by 59%, back-sparing technique by 95%, trunk muscle strength by 40% on average, trunk extensor muscle endurance by 90%, mobility by 8%, and aerobic capacity by 18%. CONCLUSIONS: A semi-intensive multidisciplinary outpatient program was beneficial in patients with chronic low back pain. Careful patient selection and increased patient involvement in the program may help to improve adherence.

[Dorsal and lumbar paraspinal electromyographic study. Multi-MUP analysis and drawing up normal values in a reference population]. / Etude électromyographique paravertébrale dorso-lombaire. Analyse en mode multi-MUP et établissement de normes au sein d'une population de référence.

OBJECTIVE: The aim of this study was to contribute to draw up reference values relating to electromyographic (EMG) parameters in dorsal and lumbar paraspinal muscles. MATERIALS AND METHODS: 75 healthy subjects without back pain underwent electromyography of multifidus bundles, which are innervated uni-segmentally by the dorsal ram of the spinal nerve. T8, L3, L4, L5 and S1 myotomes were systematically explored. Output variables were spontaneous denervation activity and quantitative EMG data obtained by multi-MUP (Motor Unit action Potential) analysis. RESULTS: No abnormal insertional or spontaneous activity (such as fibrillation, positive sharp waves or fasciculation) was recorded at rest. Neither sex nor age influenced motor unit action potential features in our series. Reference values were drawn up for T8 and L5 segmental levels using the mean values of 20 motor unit potentials in each patient studied, the reference interval being defined by the lower and the upper outlier limits on individual values. CONCLUSION: This study offers reference data to electromyographers to help better identifying possible myogenic or neurogenic pathological changes, especially in lumbosacral radiculopathies.