Neuromuscular control of walking with chronic low-back pain. Efficacy of graded activity versus supervised exercises in patients with chronic non-specific low back pain: protocol of a randomised controlled trial A walking programme and a supervised exercise class versus usual physiotherapy for chronic low back pain: a single-blinded randomised controlled trial. (The Supervised Walking In comparison to Fitness Training for Back Pain (SWIFT) Trial) Deconditioning in Patients With Chronic Low Back Pain: Fact or Fiction? Individuals with low back pain: how do they view physical activity? [Psychological mechanisms in the transition from acute to chronic pain: over- or underrated?]. Influencing Factors on the Overestimation of Self-Reported Physical Activity: A Cross-Sectional Analysis of Low Back Pain Patients and Healthy Controls Evaluation of a specific home exercise program for low back pain. The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status Integrating Mobile health and Physical Activity to reduce the burden of Chronic low back pain Trial (IMPACT): a pilot trial protocol Low Synthesis Rate of Type I Procollagen Is Normalized During Active Back Rehabilitation The Back 2 Activity Trial: education and advice versus education and advice plus a structured walking programme for chronic low back pain TTM-based counselling in physiotherapy does not contribute to an increase of adherence to activity recommendations in older adults with chronic low back pain--a randomised controlled trial. Multidisciplinary Group Rehabilitation Versus Individual Physiotherapy for Chronic Nonspecific Low Back Pain: A Randomized Trial Physical deconditioning in chronic low back pain. Predictors for chronic neck and low back pain in office workers: a 1-year prospective cohort study. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Natural History of Individuals With Asymptomatic Disc Abnormalities in Magnetic Resonance Imaging: Predictors of Low Back Pain–Related Medical Consultation and Work Incapacity Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. Short-term effects of interferential current electro-massage in adults with chronic non-specific low back pain: a randomized controlled trial Stretching in the Rehabilitation of Low-Back Pain Patients Exercise, Manual Therapy, and Education with or Without High-Intensity Deep-Water Running for Nonspecific Chronic Low Back Pain: A Pragmatic Randomized Controlled Trial An educational approach based on a non-injury model compared with individual symptom-based physical training in chronic LBP. A pragmatic, randomised trial with a one-year follow-up
The reported association of low-back pain and musculoskeletal disorders contributed to the examination of the lumbar spine and hip extensor activation patterns in back pain sufferers during walking . Seventeen idiopathic low-back pain male subjects and 16 healthy volunteers participated in the study .  Hip joint ROMs in the sagittal plane and neuromuscular activities of erector spinae [ L3 , T12 ] , gluteus maximus and biceps femoris were recorded on one r and omly selected body side in each group . Analysis using the Student 's t-test revealed significant differences for hip joint range of motion , stride time and significantly earlier onsets of the lumbar spine and hip extensors of the back pain sufferers compared with the healthy controls . It is assumed , that low-back disorders are related to changes of the lumbar spine and hip extensor recruitment pattern Background Low back pain is a relevant public health problem , being an important cause of work absenteeism worldwide , as well as affecting the quality of life of sufferers and their individual functional performances . Supervised active physical routines and of cognitive-behavioral therapies are recommended for the treatment of chronic Low back pain , although evidence to support the effectiveness of different techniques is missing . Accordingly , the aim of this study is to contrast the effectiveness of two types of exercises , grade d activity or supervised , in decreasing symptoms of chronic low back pain . Methods / design Sample will consist of 66 patients , blindly allocated into one of two groups : 1 ) Grade d activity which , based on an operant approach , will use time-contingent methods aim ing to increase participants ’ activity levels ; 2 ) Supervised exercise , where participants will be trained for strengthening , stretching , and motor control targeting different muscle groups . Interventions will last one hour , and will happen twice a week for 6 weeks . Outcomes ( pain , disability , quality of life , global perceived effect , return to work , physical activity , physical capacity , and kinesiophobia ) will be assessed at baseline , at treatment end , and three and six months after treatment end . Data collection will be conducted by an investigator blinded to treatment allocation . Discussion This project describes the r and omisation method that will be used to compare the effectiveness of two different treatments for chronic low back pain : grade d activity and supervised exercises . Since optimal approach for patients with chronic back pain have yet not been defined based on evidence , good quality studies on the subject are necessary . Trial registration Background Chronic low back pain ( CLBP ) is a persistent disabling condition with rising significant healthcare , social and economic costs . Current research supports the use of exercise-based treatment approaches that encourage people with CLBP to assume a physically active role in their recovery . While international clinical guidelines and systematic review s for CLBP support supervised group exercise as an attractive first-line option for treating large numbers of CLBP patients at low cost , barriers to their delivery include space and time restrictions in healthcare setting s and poor patient attendance . The European Clinical Guidelines have identified the need for research in the use of brief/minimal contact self-activation interventions that encourage participation in physical activity for CLBP . Walking may be an ideally suited form of individualized exercise prescription as it is easy to do , requires no special skills or facilities , and is achievable by virtually all ages with little risk of injury , but its effectiveness for LBP is unproven . Methods and design This study will be an assessor-blinded r and omized controlled trial that will investigate the difference in clinical effectiveness and costs of an individualized walking programme and a supervised general exercise programme compared to usual physiotherapy , which will act as the control group , in people with chronic low back pain . A sample of 246 patients will be recruited in Dublin , Irel and through acute general hospital outpatient physiotherapy departments that provide treatment for people with CLBP . Patients will be r and omly allocated to one of the three groups in a concealed manner . The main outcomes will be functional disability , pain , quality of life , fear avoidance , back beliefs , physical activity , satisfaction and costs , which will be evaluated at baseline , and 3 , 6 and 12 months [ follow-up by pre-paid postage ] . Qualitative telephone interviews and focus groups will be embedded in the research design to obtain feedback about participants ' experiences of the interventions and trial participation , and to inform interpretation of the quantitative data . Planned analysis will be by intention to treat ( quantitative data ) and thematic analysis ( qualitative data ) Discussion The trial will evaluate the effectiveness of a walking programme and a supervised general exercise programme compared to usual physiotherapy in people with CLBP.Trial registration Current controlled trial IS RCT Study Design . Prospect i ve case series with historical controls ( normative data ) . Objectives . To compare aerobic fitness levels in patients with chronic low back pain with those published on a sample of 295 healthy subjects . Summary of Background Data . Clinical belief holds that patients with chronic low back pain have low fitness levels as a result of inactivity because of pain . Because few studies have investigated the level of aerobic fitness in these patients , however , it remains unclear how fitness levels in patients with chronic low back pain patients compare with those published a sample of the normative population . Methods . A sample of 50 patients with chronic low back pain with a mean pain duration of 40 months referred to an outpatient pain clinic performed a  symptom-limited modified treadmill test .  Aerobic fitness levels were determined by indirect calorimetry to measure oxygen consumption ( VO2 ) . Predicted maximum oxygen consumption ( VO2max ) levels were calculated for all subjects . Multiple regression analysis with adjustment for age and sex yielded prediction equations for men and women separately . Ninety-five percent confidence intervals were calculated for predicted mean oxygen consumption ( VO2 ) and the slope of the equations . These were compared to established prediction equations on healthy subjects . Results . Prediction equations for estimated maximum oxygen consumption ( VO2max ) in patients with chronic low back pain equal those in healthy sedentary men and active women . Conclusions . Levels of aerobic fitness in patients with chronic low back pain are comparable with those in healthy subjects BACKGROUND Recent guidelines for those with acute low back pain have advocated early resumption of normal activity and increased physical activity . Little is known about the relationship between low back pain and physical activity , and on the impact of that relationship on the promotion of increased levels of physical activity within a general practice population . OBJECTIVES We aim ed to explore associations between factors that influence changes in physical activity and the way individuals perceive and behave with their low back pain , and the impact of those perceptions and behaviour on physical activity . METHODS Twenty-seven informants were chosen using a purposive sample from a larger group of individuals who , because of their low back trouble , had been referred by their GPs to a community-based , single-blind , r and omized controlled trial ( RCT ) at the University of York , which is evaluating the effectiveness and cost-effectiveness of a progressive exercise programme . Fifty-four interviews were conducted with this subgroup of the RCT ; four informants were interviewed once , 19 twice and four of them three times . Interviews were transcribed and analysed using manual and computer-aided approaches . RESULTS Physical activity was perceived as ( i ) activities of daily living , ( ii ) activities causing breathlessness that they went out of the way to do and ( iii ) more competitive-type activity . The avoidance of physical activity and fear of pain returning were the two main factors directly associated with informants ' backs and changes in physical activity . These two factors hindered increases in physical activity , even though the majority of informants believed strongly that being physically active helped ease their low back pain . CONCLUSIONS When advocating that individuals with acute low back pain return to or increase physical activity , it is important that clinicians identify avoidance of physical activity and /or fear of pain at the earliest stage in order to tailor advice and reassurance appropriately . If avoidance of activity and fear of pain is identified and clinicians want to encourage patients to take up and sustain increased physical activity , they should explore issues of fear of pain , and avoidance of and confidence to do physical activities , in addition to other factors influencing physical activity INTRODUCTION During the last 20 years a great number of studies have emphasized the potential role of psychological factors as relevant predictors for the first onset of back pain as well as for the development of chronic pain . The formulation of a biopsychosocial perspective of the etiology and chronicity of back pain was a natural consequence . Actual questions concern the relative impact of psychological risk factors in the process of chronicity of back pain compared to biomedical , social and occupational factors . METHODS Whereas several review articles regarding the role of psychological risk factors are available up to now , a recently published review conducted by Steven Linton was the first systematic analysis of well controlled prospect i ve studies published since 1967 . Using a grading system similar to that recommended for guidelines the author defined a level A evidence when at least two good- quality prospect i ve studies supported the prospect i ve power of a variable . Level B evidence had support from one prospect i ve study . Level C represented inconclusive data and level D indicated that no studies met the criteria . Based on a literature search of more than 900 studies , 37 good- quality prospect i ve studies were analysed in detail . RESULTS The results indicated level A evidence for the following interrelations : ( 1 ) Psychosocial variables , especially chronic distress in daily life , depression and work dissatisfaction were clearly associated with the onset of back and neck pain ( 2 ) . Psychological variables , especially chronic stress in daily life , work dissatisfaction , depression and pain-related cognitions and coping behaviour were clearly linked to the transition from acute to chronic pain and disability ( 3 ) . Psychological variables generally had more prospect i ve power than biomedical , social or objective occupational variables . Among the pain-related cognitions , catastrophizing and fear-avoidance-beliefs yielded the most empirical support . Among coping behaviour passive coping stretegies such as avoiding behaviour was most important . At least level B evidence has been shown for the counterpart of an extreme suppressive coping behaviour . Patients who tended to suppress or ignore pain in order to finish all activities they started , who were unable to integrate phases of passive relaxation into the daily routine displayed a high risk of chronicity of pain 6 months after an acute phase of pain . One international and two German good- quality prospect i ve studies have shown the predictive power of a maladaptive suppressive behaviour pattern . Based on the avoidance-endurance-model of pain chronification , both extreme and one-sided passive pain coping as well as one-sided suppressive coping modes were conceptualized as maladaptive due to the process of chronicity . We assume that extreme passive behaviour will lead to immobility and muscular atrophy . Neurophysiological processes of sensitization will further lead to the development of chronic pain . On the other h and , extreme suppressive behaviour will lead to an overuse of muscles and joints with a repetitive combination of muscular hyperactivity and pain . These repetitive pain experiences will also elicit neurophysiological processes of sensitization . ( 4 ) Psychosocial variables displayed more predictive power than biomedical or biomechanical factors . ( 5 ) Psychosocial factors may be used as predictors of the risk for developing long-term pain and disability . Mixed empirical evidence has been shown for the role of personality factors ( level C evidence ) and no support has been found for the idea of a " pain prone " personality disorder or for the role of sexual and physical abuse . DISCUSSION 20 years of research , several qualitative review s and a recently published systematic review of 37 good- quality prospect i ve studies regarding the role of psychological , biomedical , social and objective occupational factors in the process of chronicity of back pain revealed that psychological factors are significantly related to the onset of back pain as well as to the development of chronic pain . Furthermore , the psychological factors displayed more predictive power than biomedical or biomechanical variables . As a consequence for clinical practice , these psychological risk factors have to be considered as " yellow flags " if a back pain problem wo n't respond to medical treatment for more than four weeks . As a further consequence , special risk factor - based psychosocial interventions should be offered in addition to the medical treatment to patients with high psychological risk factors for the development of chronic pain . The efficacy of such an interdisciplinary care in the very early phases of back pain in order to prevent chronicity of pain and disability has been published recently by our group Introduction . The aim of the present study was to determine the closeness of agreement between a self-reported and an objective measure of physical activity in low back pain patients and healthy controls . Beyond , influencing factors on overestimation were identified . Methods . 27 low back pain patients and 53 healthy controls wore an accelerometer ( objective measure ) for seven consecutive days and answered a question naire on physical activity ( self-report ) over the same period of time . Differences between self-reported and objective data were tested by Wilcoxon test . Bl and -Altman analysis was conducted for describing the closeness of agreement . Linear regression models were calculated to identify the influence of age , sex , and body mass index on the overestimation by self-report . Results . Participants overestimated self-reported moderate activity in average by 42 min/day ( p = 0.003 ) and vigorous activity by 39 min/day ( p < 0.001 ) . Self-reported sedentary time was underestimated by 122 min/day ( p < 0.001 ) . No individual-related variables influenced the overestimation of physical activity .  Low back pain patients were more likely to underestimate sedentary time compared to healthy controls . Discussion . In rehabilitation and health promotion , the application-oriented measurement of physical activity remains a challenge . The present results contradict other studies that had identified an influence of age , sex , and body mass index on the overestimation of physical activity BACKGROUND The prescription of exercise as a conservative treatment for lumbar pain is frequent and seems effective for the chronic cases of nonspecific low back pain . However , there is no evidence favoring one type of exercise over another . Often , exercise programs are prescribed without adequate evaluation of the individual characteristics like posture , muscular force , and extensibility . Patients with totally different causes of low back pain will often be given the same type of exercises . OBJECTIVE Our objective was to compare the effectiveness of 2 home exercise programs in decreasing disability and pain related to subacute and chronic nonspecific low back pain . To do so we compared a specific ( individualized ) exercise program with a program of commonly prescribed exercises for low back pain . METHOD In a control group study , 20 patients with chronic or subacute nonspecific low back pain participated after giving their informed consent . All subjects were evaluated ( physical evaluation of lumbar and pelvic muscles [ 1 ] force and [ 2 ] extensibility , [ 3 ] trunk range of motion ) and then divided in 2 groups : 10 patients received specific exercises ( experimental group ) based on their evaluation , and 10 patients received a commonly prescribed exercise program for low back pain ( control group ) . Six weeks later a second physical evaluation was conducted . Pain ( visual analog pain scale ) and disability ( modified Oswestry ) question naires were also completed by each subject at both evaluations . DESIGN This was a r and omized experimental study . RESULTS Both groups had similar age , weight , and sex characteristics . The experimental group showed significant improvements for some components targeted by the program . The control group significantly had improvement of some physical characteristics not related to their initial deficits . Even if both groups showed some improvements in muscular force and extensibility , only the members of the group who received specific exercises significantly reduced their level of pain and disability . Both groups showed a similar rate of participation in the program . CONCLUSION The results of this study suggest that applying a specific physical evaluation and exercise prescription is an appropriate treatment for people having subacute or chronic nonspecific pain . Thus clinicians should prescribe exercise programs based on individual muscular deficits rather than most commonly prescribed exercise programs & NA ; Fear‐avoidance beliefs have been identified as an important psychosocial variable in patients with chronic disability doe to low back pain . The importance of fear‐avoidance beliefs for individuals with acute low back pain has not been explored . Seventy‐eight subjects with work‐related low back pain of less than 3 weeks ' duration were studied .  Measurements of pain intensity , physical impairment , disability , nonorganic signs and symptoms , and depression were taken at the initial evaluation . Fear‐avoidance beliefs were measured with the  work and physical activity subscales of the Fear‐avoidance Beliefs Question naire .  Disability and work status were re‐assessed after 4 weeks of physical therapy . Patterns of correlation between fear‐avoidance beliefs and other concurrently‐measured variables were similar to those reported in patients with chronic low back pain . Fear‐avoidance beliefs did not explain a significant amount of the variability in initial disability levels after controlling for pain intensity and physical impairment . Fear‐avoidance beliefs about work were significant predictors of 4‐week disability and work status even after controlling for initial levels of pain intensity , physical impairment , and disability , and the type of therapy received . Fear‐avoidance beliefs are present in patients with acute low back pain , and may be an important factor in explaining the transition from acute to chronic conditions . Screening for fear‐avoidance beliefs may be useful for identifying patients at risk of prolonged disability and work absence Background It is well recognised that low back pain is a significant public health problem and engagement in moderate levels of physical activity is associated with positive outcomes .Conservative active care , such as exercise , is effective in reducing pain and disability associated with chronic low back pain . However , a rapid decline in clinical outcomes is commonly seen after discharge from treatment . Methods / Design We will conduct a r and omised controlled trial to investigate the effectiveness of a mobile health supported physical activity intervention ( compared to st and ard care ) in care-seeking , pain and disability in people with chronic low back pain after discharge from treatment . We will recruit 68 patients with chronic low back pain following discharge from an outpatient hospital program , who will be r and omly allocated to the physical activity intervention ( n = 34 ) or the st and ard care group ( n = 34 ) and monitored for 6 months . The physical activity intervention will involve a physical activity advice booklet , a face-to-face health coaching session and 12 fortnightly follow-up telephone-based health coaching sessions . This intervention will be supported by provision of a specifically design ed web app and a physical activity monitoring device ( FitBit ) . The st and ard care group will receive the physical activity advice booklet only . Discussion This pilot trial will investigate a new model to prevent clinical decline in people following conservative treatment for chronic low back pain . If proven to be effective , this approach will constitute a major advance in the management of low back pain . Chronic patients who experience recurrent pain and disability after treatment are prone to seek additional care in the form of physiotherapy , medication , emergency department attendance , specialist consultation or spinal surgery . This model aims to maintain functional levels and reduce care-seeking empowering patients to self-manage their low back pain by offering them a contemporary patient-centred physical activity program with the support of mobile health technology . The outcomes of this trial will have immediate implication s for clinical practice .Trial registration ACTRN12615000189527 ( 26 - 02 - 2015 ) Study Design . Open , prospect i ve trial with patients participating in an active back restoration program .  Objectives . To compare the concentrations of biochemical indicators of Type I and III collagen synthesis and Type I collagen degradation in the serum of patients with chronic low back pain and healthy control subjects and to evaluate the effect of active back rehabilitation based on vigorous exercise on collagen metabolism . Summary of Background Data . The aim of active back rehabilitation is to restore the physical function of low back pain patients falling into the so-called " deconditioning syndrome . " The changes in functional muscle strength measurements during the restoration rehabilitation program always depend on motivation , learning phenomena , and fear of pain and injury , so that even more objective ways of showing changes in physical activity are needed . Methods . Specific radioimmunoassays for the amino-terminal ( PINP ) and carboxy-terminal ( PICP ) propeptides of Type I procollagen , the amino-terminal propeptide of Type III procollagen ( PIIINP ) , and the cross-linked carboxy-terminal telopeptide of Type I collagen ( ICTP ) were used for serum sample s obtained from 41 patients before , during , and after an active back restoration program and from 16 age- and sex-matched healthy control subjects . Results . The circulating concentrations of PINP and PICP were initially lower in the patients ( [ mean ± SD ] 35.3 ± 12.5 μg/L and 119.0 ± 32.6 μg/L , respectively ) than in the control subjects ( 47.9 ± 18.0 μg/L and 136.7 ± 47.7 μg/L , respectively ; P < 0.05 for PINP ) . Toward the end of the active back rehabilitation program , both PINP and PICP increased in the patients ( P < 0.001 for the increase between the initial level and the end of rehabilitation ) . There was a significant difference in the time courses of these changes , with the circulating PICP concentration increasing earlier than that of PINP . In the intervention group , the PIIINP concentration also increased ( P < 0.01 ) , whereas the ICTP concentration remained unchanged , with a tendency to decrease . No changes occurred in the control subjects . Conclusions . Active back rehabilitation based on vigorous exercise increases Type I collagen synthesis in patients with chronic low back pain ; this may provide a means of objective ly verifying the effects of such rehabilitation Background Current evidence supports the use of exercise-based treatment for chronic low back pain that encourages the patient to assume an active role in their recovery . Walking has been shown it to be an acceptable type of exercise with a low risk of injury . However , it is not known whether structured physical activity programmes are any more effective than giving advice to remain active . Methods / Design The proposed study will test the feasibility of using a pedometer-driven walking programme , as an adjunct to a st and ard education and advice session in participants with chronic low back pain . Fifty adult participants will be recruited via a number of different sources . Baseline outcome measures including self reported function ; objective physical activity levels ; fear-avoidance beliefs and health-related quality of life will be recorded . Eligible participants will be r and omly allocated under strict , double blind conditions to one of two treatments groups . Participants in group A will receive a single education and advice session with a physiotherapist based on the content of the ' Back Book ' . Participants in group B will receive the same education and advice session . In addition , they will also receive a grade d pedometer-driven walking programme prescribed by the physiotherapist . Follow up outcomes will be recorded by the same research er , who will remain blinded to group allocation , at eight weeks and six months post r and omisation . A qualitative exploration of participants ' perception of walking will also be examined by use of focus groups at the end of the intervention . As a feasibility study , treatment effects will be represented by point estimates and confidence intervals . The assessment of participant satisfaction will be tabulated , as will adherence levels and any recorded difficulties or adverse events experienced by the participants or therapists . This information will be used to modify the planned interventions to be used in a larger r and omised controlled trial . Discussion This paper describes the rationale and design of a study which will test the feasibility of using a structured , pedometer-driven walking programme in participants with chronic low back pain . Trial Registration [ IS RCT N67030896 AIMS The present study examines the outcome of counselling in physiotherapy based on the Transtheoretical Model ( TTM ) in a sample of elderly individuals with chronic low back pain . METHODS In a prospect i ve r and omised trial with concealed assignment , elderly individuals with chronic low back pain were allocated to two treatment conditions . Both contained 10 sessions of physiotherapy , each of 20min duration . In addition , the experimental group ( EG ) received 10min counselling prior to every session based on the TTM , also provided by the physiotherapist , and the control group ( CG ) underwent a placebo ultrasound treatment with an inactivated device to control for the additional attention given to the EG . Assessment s took place prior to the treatment ( t1 ) , immediately after termination of the treatment ( t2 ) , and at a 6-months follow-up . Outcome measures were physical activity calculated from one-week activity diaries , self-reported functional capacity , and range of motion measured by ultrasound topometry . RESULTS A total of 170 individuals ( 64 % female ) with a mean age of 70.3 years ( SD=4.4 , range 65 - 84 ) participated in the study . The retention rate was 90 % . At t3 , both EG and CG showed increased physical activity and functional capacity , but no change in range of motion . Effect sizes were large . Contrary to our hypothesis , however , motivational training did not result in a better outcome compared with placebo treatment . CONCLUSION The study does not provide evidence that a short TTM-based motivation programme is superior to placebo treatment regarding adherence to activity recommendations Study Design . A r and omized trial . Objective . To evaluate the effectiveness of a semi-intensive multidisciplinary rehabilitation for patients with chronic low back pain in an outpatient setting . Summary and Background Data . Systematic review s have shown that there is strong evidence that intensive multidisciplinary treatment ( > 100 hours ) , which includes functional restoration , improves function among chronic patients with low back pain , and moderate evidence that it reduces pain but contradictory evidence regarding improvement of working ability . However , there is paucity of data whether semi-intensive outpatient multidisciplinary rehabilitation in groups is more effective than individual physiotherapy . Material s and Methods . A total of 120 women employed as healthcare and social care professionals with nonspecific chronic low back pain were recruited from two occupational healthcare centers . The patients were r and omized into two intervention programs . Multidisciplinary rehabilitation ( n = 59 ) was conducted in groups and comprised of physical training , workplace interventions , back school , relaxation training , and cognitive-behavioral stress management methods for 70 hours . The individual physiotherapy ( n = 61 ) included physical exercise and passive treatment methods administered for 10 hours . Main outcome measures were : back pain and sciatic pain intensity , disability , sick leaves , healthcare consumption , symptoms of depression , and beliefs of working ability after 2 years . Results . There were no statistically significant differences between the two treatment groups in main outcome measures just after rehabilitation , at 6- , at 12- , or 24-month follow-up . In both intervention arms , however , the before- and -after comparison showed favorable effects , and the effects were still maintained at 2 years follow-up . Conclusions . The results of this study indicate that semilight outpatient multidisciplinary rehabilitation program for female chronic low back pain patients does not offer incremental benefits when compared with rehabilitation carried out by a physiotherapist having a cognitive-behavioral way of administering the treatment OBJECTIVE To establish the level of cardiorespiratory fitness and the rate of decrease in maximal aerobic capacity according to age in patients with chronic low back pain and compare these with normative data . DESIGN Prospect i ve case series with historical controls . SUBJECTS/ PATIENTS Seventy patients with chronic low back pain . METHODS A maximal cycle ergometer protocol was used to measure VO2max , heart rate , respiratory exchange ratio and blood lactate levels .  RESULTS Seventy patients achieved absolute and normalized for weight VO2max values of 2.17 ( st and ard deviation ( SD ) 0.65 ) l/min and 30.79 ( SD 7.77 ) ml/kg/min , respectively . Absolute VO2max was poorly related to age in both men and women with chronic low back pain ( r = -0.22 and r = -0.28 , respectively ) . VO2max normalized for weight was also inversely related to age in both men and women ( r = -0.36 and r = -0.42 , respectively ) . The rate of VO2max decline between 20 and 59 years was -3.3 ml/kg/min/decade for the entire population and -1.2 and -5.4 ml/kg/min/decade in men and women , respectively . CONCLUSION The level of physical fitness of patients with chronic low back pain is comparable to the physical fitness of healthy , but poorly conditioned subjects . Patients with chronic low back pain show a VO2max decline with ageing that is slower than of active subjects OBJECTIVE All occupations expose workers to varied and unique conditions . The nature of work has been recognized as influencing the health of workers . Whether predictors for chronic neck and low back pain would be occupation-specific is unknown . This study aim ed to identify predictors for chronic neck and low back pain in a cohort of office workers . METHODS A prospect i ve study was carried out among 669 healthy office workers . At baseline , risk factors were assessed using a question naire and st and ardized physical examination . A symptomatic case was defined as an individual who reported pain greater than 30 mm on a 100-mm VAS , and chronic pain was defined as experiencing ongoing neck or low back pain for greater than 3 months over the past 6 months . Two regression models were built to analyze the risk factors for developing chronic neck and low back pain . RESULTS Of the sample , 17 and 27 % of office workers who reported a new onset of neck or low back pain developed chronicity , respectively . Predictors for chronic neck pain were high body mass index , frequent neck extension during the work day , high initial pain intensity , and high psychological job dem and s. The development of chronic low back pain was associated with history of low back pain and high initial pain intensity . CONCLUSIONS The findings suggest that predictors for chronic musculoskeletal pain in a sub population may be a subset of predictors identified in a general population or occupation specific . Successful management to prevent chronic musculoskeletal pain may also need to consider the patient 's occupation Description The American College of Physicians ( ACP ) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain . Methods Using the ACP grading system , the committee based these recommendations on a systematic review of r and omized , controlled trials and systematic review s published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain . Up date d search es were performed through November 2016 . Clinical outcomes evaluated included reduction or elimination of low back pain , improvement in back-specific and overall function , improvement in health-related quality of life , reduction in work disability and return to work , global improvement , number of back pain episodes or time between episodes , patient satisfaction , and adverse effects . Target Audience and Patient Population The target audience for this guideline includes all clinicians , and the target patient population includes adults with acute , subacute , or chronic low back pain . Recommendation 1 Given that most patients with acute or subacute low back pain improve over time regardless of treatment , clinicians and patients should select nonpharmacologic treatment with superficial heat ( moderate- quality evidence ) , massage , acupuncture , or spinal manipulation ( low- quality evidence ) . If pharmacologic treatment is desired , clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants ( moderate- quality evidence ) . ( Grade : strong recommendation ) . Recommendation 2 For patients with chronic low back pain , clinicians and patients should initially select nonpharmacologic treatment with exercise , multidisciplinary rehabilitation , acupuncture , mindfulness-based stress reduction ( moderate- quality evidence ) , tai chi , yoga , motor control exercise , progressive relaxation , electromyography biofeedback , low-level laser therapy , operant therapy , cognitive behavioral therapy , or spinal manipulation ( low- quality evidence ) . ( Grade : strong recommendation ) . Recommendation 3 In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy  , clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy , or tramadol or duloxetine as second-line therapy . Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients . ( Grade : weak recommendation , moderate- quality evidence ) Study Design . Prospect i ve study on individuals with asymptomatic lumbar disc abnormalities detected in magnetic resonance imaging .  Objectives . To determine the natural history of asymptomatic disc abnormalities in magnetic resonance imaging and to identify predictors of future low back pain – related medical consultation and work incapacity . Summary of Background Data . The natural history of individuals with asymptomatic disc herniations has not been well established , but the high rate of lumbar disc alterations recently detected in asymptomatic individuals by magnetic resonance imaging dem and s reconsideration of a pathomorphology-based explanation of low back pain and sciatica . Methods . Forty-six asymptomatic individuals who had a high rate of disc herniations ( 73 % ) were observed for an average of 5 years ( range , 54–72 months ) . Four classes of variables ( medical data including magnetic resonance imaging – identified disc abnormalities , general psychological factors , physical job characteristics , and psychosocial aspects of work ) were assessed at baseline and follow-up . Results . Disc herniations and neural compromise did not significantly worsen at follow-up , whereas disc degeneration progressed in 17 individuals ( 41.5 % ) . Minor episodes of low back pain occurred in 19 individuals ( 41.3 % ) , 6 of whom had to seek medical treatment and 5 of whom had to stop work temporarily . The requirement for low back pain – related medical consultation was predicted with high accuracy by listlessness , job satisfaction , and working in shifts ( P < 0.001 ) . Work incapacity was best predicted by physical job characteristics , job disaffection , and working in shifts ( P < 0.01 ) . Conclusion . Physical job characteristics and psychological aspects of work were more powerful than magnetic resonance imaging – identified disc abnormalities in predicting the need for low back pain – related medical consultation and the result ant work incapacity . However , the conclusions are still preliminary , and replication of the findings in larger and more representative study sample s is needed BACKGROUND CONTEXT Low back pain ( LBP ) is a prevalent disorder in society that has been associated with increased loss of work time and medical expenses . A common intervention for LBP is spinal manipulation , a technique that is not specific to one scope of practice or profession . PURPOSE The purpose of this systematic review was to examine the effectiveness of physical therapy spinal manipulations for the treatment of patients with low back pain . METHODS A search of the current literature was conducted using PubMed , CINAHL , SPORTD iscus , Pro Quest Nursing and Allied Health Source , Scopus , and Cochrane Controlled Trials Register . Studies were included if each involved : 1 ) individuals with LBP ; 2 ) spinal manipulations performed by physical therapists compared to any control group that did not receive manipulations ; 3 ) measurable clinical outcomes or efficiency of treatment measures , and 4 ) r and omized control trials . The quality of included articles was determined by two independent authors using the criteria developed and used by the Physiotherapy Evidence Data base ( PEDro ) . RESULTS Six r and omized control trials met the inclusion criteria of this systematic review . The most commonly used outcomes in these studies were some variation of pain rating scales and disability indexes . Notable results included varying degrees of effect sizes favoring physical therapy spinal manipulations and minimal adverse events result ing from this intervention . Additionally , the manipulation group in one study reported statistically significantly less medication use , health care utilization , and lost work time . CONCLUSION Based on the findings of this systematic review there is evidence to support the use of spinal manipulation by physical therapists in clinical practice . Physical therapy spinal manipulation appears to be a safe intervention that improves clinical outcomes for patients with low back pain Objectives : To analyse the effectiveness of a combined procedure of massage and electrotherapy with interferential current in individuals with chronic non-specific low back pain of mechanical aetiology . Design : A single blinded r and omized controlled trial . Setting : Clinical setting . Participants : Sixty-two individuals with chronic non-specific low back pain were r and omly assigned to an experimental or control group . For 10 weeks the experimental group underwent treatment comprising 20 sessions ( twice a week ) of massage with interferential current in the lumbar and dorsal – lumbar area , and the control group received superficial lower back massage ( effleurage , superficial pressure and skin rolling ) . Main outcome variables : Oswestry Disability Index , pain visual analogue scale , Tampa Scale for Kinesiophobia , Rol and Morris Disability Question naire , McQuade Test , Side Bridge Test , quality of life scores and the range of trunk anteflexion motion , which were all assessed before the treatment and immediately after the last treatment session . Results : The 2 × 2 mixed model ANOVA with repeated measurements showed statistically significant group * time interactions for the visual analogue scale ( F = 12.839 ; P = 0.001 ) , Oswestry Disability Index ( F = 5.850 ; P = 0.019 ) , Rol and Morris Disability Question naire ( F = 8.237 ; P = 0.006 ) and quality of life ( physical function ( F = 16.792 ; P = 0.001 ) , physical role ( F = 14.839 ; P = 0.001 ) and body pain ( F = 11.247 ; P = 0.001 ) ) . Conclusions : In individuals with chronic non-specific low back pain  , interferential current electro-massage achieved a significantly greater improvement in disability , pain and quality of life in comparison to superficial massage after 20 treatment sessions The major objective of this investigation was to study the effectiveness of the physical conditioning program used at the University of Miami Comprehensive Pain and Rehabilitation Center in restoring certain elements of the functional abilities of individuals suffering from chronic low-back pain and to evaluate the effectiveness of using a systematic ally applied , aggressive stretching maneuver as an add-on therapy in the treatment of chronic low-back pain patients . The effect(s ) of the proposed stretching maneuver was evaluated . Twenty-eight chronic low-back pain patients were r and omly assigned to one of two groups . The control group underwent a multimodal rehabilitation program , and the experimental group underwent the same rehabilitation program in addition to the systematic stretching maneuver under investigation . The results obtained showed that patients undergoing the multimodal rehabilitation program with and without the proposed systematic stretching maneuver showed a significant improvement in their functional abilities as seen from the significant increase in the static strength of the back extensors , with corresponding significant increase in back muscle myoelectric signals . Also , a significant decrease in their pain level was reported after 2 weeks of continuous treatment . The use of the systematic stretching maneuver enhanced the functional gains of chronic low-back pain patients compared to the control group Objectives : The aim of this study on persons with nonspecific chronic low back pain was to evaluate the effect of a multimodal physical therapy program with or without the addition of deep-water running on pain , physical disability , and general health . Design : A r and omized controlled trial involving 46 subjects with nonspecific chronic low back pain were treated three times a week for 15 wks . Each group received 60 mins of multimodal physical therapy program ( an individualized exercise program ; manual therapy ; and back care , pain education , and information on an active lifestyle ) , whereas one group performed additional 20-min sessions of deep-water running at an individual workload of the aerobic threshold . Results : Both interventions result ed in significant improvements in pain , disability , and physical health . The mean change in pain , disability , and physical health state were −36.1 ± 25.1 mm on the visual analog scale , −3.0 ± 4.8 points for the Rol and Morris Question naire , and 10.6 ± 12.9 points for the Short Form-12 for the physical therapy plus deep-water running group and −34.1 ± 26.0 mm on the visual analog scale , −1.6 ± 1.5 points for the Rol and Morris Question naire , and 8.9 ± 13.0 points for the Short Form-12 for the physical therapy alone group . Conclusions : Pain , disability , health status , muscle strength and endurance , and lumbar range of motion significantly improved in both groups . The addition of a deep-water running program at an individual workload of the aerobic threshold to the multimodal physical therapy program produced a significant improvement in pain in patients with nonspecific chronic low back pain , but this was not significantly different when compared with multimodal physical therapy program alone . Disability , health status , muscle strength and endurance , and lumbar range of motion significantly improved to a similar level in both intervention groups Background In the treatment of  chronic back pain  , cognitive methods are attracting increased attention due to evidence of effectiveness similar to that of traditional therapies . The purpose of this study was to compare the effectiveness of performing a cognitive intervention based on a non-injury model with that of a symptom-based physical training method on the outcomes of  low back pain ( LBP ) , activity limitation , LBP attitudes ( fear-avoidance beliefs and back beliefs ) , physical activity levels , sick leave , and quality of life , in chronic LBP patients . Methods The study was a pragmatic , single-blind , r and omised , parallel-group trial . Patients with chronic/recurrent LBP were r and omised to one of the following treatments : 1 . Educational programme : the emphasis was on creating confidence that the back is strong , that loads normally do not cause any damage despite occasional temporary pain , that reducing the focus on the pain might facilitate more natural and less painful movements , and that it is beneficial to stay physically active . 2 . Individual symptom-based physical training programme : directional-preference exercises for those central ising their pain with repetitive movements ; ' stabilising exercises ' for those deemed ' unstable ' based on specific tests ; or intensive dynamic exercises for the remaining patients . Follow-up question naires ( examiner-blinded ) were completed at 2 , 6 and 12 months . The main statistical test was an ANCOVA adjusted for baseline values . Results A total of 207 patients participated with the median age of 39 years ( IQR 33 - 47 ) ; 52 % were female , 105 were r and omised to the educational programme and 102 to the physical training programme .  The two groups were comparable at baseline . For the primary outcome measures , there was a non-significant trend towards activity limitation being reduced mostly in the educational programme group , although of doubtful clinical relevance . Regarding secondary outcomes , improvement in fear-avoidance beliefs was also better in the educational programme group . All other variables were about equally influenced by the two treatments . The median number of treatment sessions was 3 for the educational programme group and 6 for the physical training programme group . Conclusions An educational approach to treatment for chronic LBP result ed in at least as good outcomes as a symptom-based physical training method , despite fewer treatment sessions . Trial registration Clinical trials.gov : #
Pooled data revealed no significant difference in the overall activity level of adults or adolescents with CLBP , however there is evidence that older adults with chronic low back pain are less active than controls .
The results suggest that patients exhibit an altered pattern of physical activity over the course of a day compared to controls .
There is no conclusive evidence that patients with chronic low back pain are less active than healthy individuals .
Based on a limited number of studies , there is some evidence that the distribution of activities over the course of a day is different between patients with chronic low back pain and controls
BACKGROUND It is commonly assumed that patients with chronic low back pain are less active than healthy individuals .
There has been a recent increase in the number of studies published comparing the physical activity levels of patients with chronic low back pain and healthy individuals .
OBJECTIVES The aim of this systematic review was to determine , based on the current body of evidence , if patients with chronic low back pain have a lower level and /or altered pattern of physical activity compared with asymptomatic , healthy individuals .