High-Force Versus Low-Force Lumbar Traction in Acute Lumbar Sciatica Due to Disc Herniation: A Preliminary Randomized Trial.

OBJECTIVE: This study compared the effects of high-force versus low-force lumbar traction in the treatment of acute lumbar sciatica secondary to disc herniation. METHODS: A randomized double blind trial was performed, and 17 subjects with acute lumbar sciatica secondary to disc herniation were assigned to high-force traction at 50% body weight (BW; LT50, n = 8) or low force traction at 10% BW (LT10, n = 9) for 10 sessions in 2 weeks. Radicular pain (visual analogue scale [VAS]), lumbo-pelvic-hip complex motion (finger-to-toe test), lumbar-spine mobility (Schöber-Macrae test), nerve root compression (straight-leg-raising test), disability (EIFEL score), drug consumption, and overall evaluation of each patient were measured at days 0, 7, 1, 4, and 28. RESULTS: Significant (P < .05) improvements were observed in the LT50 and LT10 groups, respectively, between day 0 and day 14 (end of treatment) for VAS (-44% and -36%), EIFEL score (-43% and -28%) and overall patient evaluation (+3.1 and +2.0 points). At that time, LT50 specifically improved in the finger-to-toe test (-42%), the straight-leg-raising test (+58), and drug consumption (-50%). No significant interaction effect (group-by-time) was revealed, and the effect of traction treatment was independent of the level of medication. During the 2-week follow-up at day 28, only the LT10 group improved (P < .05) in VAS (-52%) and EIFEL scores (-46%). During this period, no interaction effect (group-by-time) was identified, and the observed responses were independent of the level of medication. CONCLUSIONS: For this preliminary study, patients with acute lumbar sciatica secondary to disc herniation who received 2 weeks of lumbar traction reported reduced radicular pain and functional impairment and improved well-being regardless of the traction force group to which they were assigned. The effects of the traction treatment were independent of the initial level of medication and appeared to be maintained at the 2-week follow-up.

Mechanism of action of spinal manipulative therapy.

Spinal manipulative therapy (SMT) acts on the various components of the vertebral motion segment. SMT distracts the facet joints, with faster separation when a cracking sound is heard. Intradiscal pressure may decrease briefly. Forceful stretching of the paraspinal muscles occurs, which induces relaxation via mechanisms that remain to be fully elucidated. Finally, SMT probably has an inherent analgesic effect independent from effects on the spinal lesion. These changes induced by SMT are beneficial in the treatment of spinal pain but short-lived. To explain a long-term therapeutic effect, one must postulate a reflex mechanism, for instance the disruption of a pain-spasm-pain cycle or improvement of a specific manipulation-sensitive lesion, whose existence has not been established to date.

Sciatica, disk herniation, and neuroborreliosis. A report of four cases.

We report four cases of sciatica in patients with same-level disk herniation confirmed by computed tomography and a final diagnosis of acute radiculitis caused by Borrelia burgdorferi, with a favorable response to ceftriaxone therapy. The neurological manifestations of Lyme disease are protean, and a potential contribution of concomitant disk disease to sciatica can lead to diagnostic wanderings. Disk lesions and infectious conditions that can cause sciatica are discussed. Whether a favorable response to antibiotic therapy should be taken as proof of B. burgdorferi radiculitis deserves discussion. In practice, in a patient with clinical manifestations suggesting disk-related nerve root pain and residing or having traveled to an endemic area, B. burgdorferi infection should be looked for, as both etiologies can coexist.

Eccentric exercise training: modalities, applications and perspectives.

Eccentric (ECC) exercise is classically used to improve muscle strength and power in healthy subjects and athletes. Due to its specific physiological and mechanical properties, there is an increasing interest in employing ECC muscle work for rehabilitation and clinical purposes. Nowadays, ECC muscle actions can be generated using various exercise modalities that target small or large muscle masses with minimal or no muscle damage or pain. The most interesting feature of ECC muscle actions is to combine high muscle force with a low energy cost (typically 4- to 5-times lower than concentric muscle work) when measured during leg cycle ergometry at a similar mechanical power output. Therefore, if caution is taken to minimize the occurrence of muscle damage, ECC muscle exercise can be proposed not only to athletes and healthy subjects, but also to individuals with moderately to severely limited exercise capacity, with the ultimate goal being to improve their functional capacity and quality of life. The first part of this review article describes the available exercise modalities to generate ECC muscle work, including strength and conditioning exercises using the body's weight and/or additional external loads, classical isotonic or isokinetic exercises and, in addition, the oldest and newest specifically designed ECC ergometers. The second part highlights the physiological and mechanical properties of ECC muscle actions, such as the well-known higher muscle force-generating capacity and also the often overlooked specific cardiovascular and metabolic responses. This point is particularly emphasized by comparing ECC and concentric muscle work performed at similar mechanical (i.e., cycling mechanical power) or metabolic power (i.e., oxygen uptake, VO2). In particular, at a similar mechanical power, ECC muscle work induces lower metabolic and cardiovascular responses than concentric muscle work. However, when both exercise modes are performed at a similar level of VO2, a greater cardiovascular stress is observed during ECC muscle work. This observation underlines the need of cautious interpretation of the heart rate values for training load management because the same training heart rate actually elicits a lower VO2 in ECC muscle work than in concentric muscle work. The last part of this article reviews the documented applications of ECC exercise training and, when possible, presents information on single-joint movement training and cycling or running training programs, respectively. The available knowledge is then summarized according to the specific training objectives including performance improvement for healthy subjects and athletes, and prevention of and/or rehabilitation after injury. The final part of the article also details the current knowledge on the effects of ECC exercise training in elderly populations and in patients with chronic cardiac, respiratory, metabolic or neurological disease, as well as cancer. In conclusion, ECC exercise is a promising training modality with many different domains of application. However, more research work is needed to better understand how the neuromuscular system adapts to ECC exercise training in order to optimize and better individualize future ECC training strategies.

Muscle oxygenation and intramuscular pressure related to posture and load in back muscles.

BACKGROUND CONTEXT: There is little information about the simultaneous changes of intramuscular pressure (IMP) and oxygen saturation (StO(2)) of the paraspinal muscle under various conditions of posture and load. PURPOSE: To measure simultaneously and compare IMP and StO(2) across a range of static trunk postures commonly observed during normal work tasks. STUDY DESIGN: A prospective study using a repeated-measure design in clinical setting. PATIENT SAMPLE: Sixteen healthy young men with no history of back pain. OUTCOME MEASURES: Simultaneous measurements of IMP by a flexible slit catheter and StO(2) by near infrared spectroscopy of the multifidus muscle were performed. METHODS: The two measures were taken in six static posture tasks: standing upright and bending forward with and without load (20kg), bending backward and during a sustained isometric contraction (ie, Sorensen test). To compare the influence of the tasks on IMP and StO(2) variables, a one-way variance analysis with repeated measures was used. Spearman's rank correlation coefficient (rho) was determined between the two variables for each posture task. RESULTS: We observed only a moderate but significant correlation between IMP and StO(2) values in upright standing and a trend in bending forward positions with load (p<.05). IMP increased in the bending backward position and showed the greatest increase during the Sorensen test. StO(2) decreased significantly during the Sorensen test, in the bending forward position with and without load bearing but did not in bending backward. CONCLUSION: The simultaneous recording of IMP and StO(2) of the multifidus muscle allows a deeper insight of physiological events during various trunk postures. In the mutifidus muscle, there is no evident linear relationship between IMP and StO(2) values in various static postures of the trunk in young males. This preliminary study shows that IMP may play a role on StO(2) only in some circumstances, such as a prolonged endurance test or in a bending forward position with a significant load bearing.

[A rare cause of constipation: neurinoma of the fourth lumbar nerve. Case report and review of the literature ]. / Une cause rare de constipation: le neurinome du quatrième nerf lombaire. A propos d'un cas et revue de la littérature.

Constipation is a symptom not to be neglected, especially if the complaint is recent. We report a case where this symptom was the only clinical manifestation of a voluminous retroperitoneal tumor. The tumor was found to be a neurilemmoma of the fourth right lumbar roots, confirmed at pathological examination. Manifestations of extradural neurinomas generally result from compression of neighboring structures. The best preoperative diagnosis approach is magnetic resonance imaging but histology is required for confirmation. The close relations the tumor mass maintains with the unaffected nerve fibers makes resection difficult without postoperative functional consequences. Surgeons discuss the relevance of partial excision in order to preserve the nerve root in case of a benign slow-growing tumor. There does however appear to be a significant recovery of muscle strength even in case of total resection.