Movement control exercise versus general exercise to reduce disability in patients with low back pain and movement control impairment. A randomised controlled trial How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists Does physical activity change predict functional recovery in low back pain? Protocol for a prospective cohort study Comparison between Kinesio Taping and a Traditional Physical Therapy Program in Treatment of Nonspecific Low Back Pain Effects of assisted sit-up exercise compared to core stabilization exercise on patients with non-specific low back pain: A randomized controlled trial. Recurrent non-specific low-back pain in adolescents: the role of exercise Inclusion and exclusion criteria used in non-specific low back pain trials: a review of randomised controlled trials published between 2006 and 2012 A tailored exercise program versus general exercise for a subgroup of patients with low back pain and movement control impairment: A randomised controlled trial with one-year follow-up. Implementation of a multidisciplinary program for active duty personnel seeking care for low back pain in a U.S. Navy Medical Center: a feasibility study. Are non-steroidal anti-inflammatory drugs effective for the management of neck pain and associated disorders, whiplash-associated disorders, or non-specific low back pain? A systematic review of systematic reviews by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration Improving the care for people with acute low-back pain by allied health professionals (the ALIGN trial): A cluster randomised trial protocol Individuals with low back pain: how do they view physical activity? Does a patient’s physical activity predict recovery from an episode of acute low back pain? A prospective cohort study Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain 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) Evaluation of perifacet injections and paraspinal muscle rehabilitation in treatment of low back pain. A randomised controlled trial. [Increase in strength after active therapy in chronic low back pain (CLBP) patients: muscular adaptations and clinical relevance]. Disc extrusions and bulges in nonspecific low back pain and sciatica: Exploratory randomised controlled trial comparing yoga therapy and normal medical treatment. Effects of recreational physical activity and back exercises on low back pain and psychological distress: findings from the UCLA Low Back Pain Study. Randomized Controlled Trial of Specific Spinal Stabilization Exercises and Conventional Physiotherapy for Recurrent Low Back Pain Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society Quality of life improved by multidisciplinary back school program in patıents with chronic non-specific low back pain: a single blind randomized controlled trial. Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature.
Background Non-specific low back pain ( NSLBP ) in subacute and chronic stages can be treated effectively with exercise therapy . Research guidelines recommend evaluating different treatments in defined subgroups of patients with NSLBP . A subgroup of patients with movement control impairment ( MCI ) improved significantly on patient specific function and disability in a previous case series after movement control exercises . Methods / Design In a r and omised controlled trial ( RCT ) we will compare the effectiveness of movement control and general exercise in patients with MCI . 106 participants aged 18 - 75 will be recruited in 5 outpatient hospital departments and 7 private practice s. Patients r and omly assigned to the movement control exercise group will be instructed to perform exercises according to their MCI . The general exercise group will follow an exercise protocol aim ed at improving endurance and flexibility . Patients in both groups will receive 9 - 18 treatments and will be instructed to do additional exercises at home . The primary outcome is the level of disability assessed using the patient specific functional scale ( PSFS ) which links the perceived pain to functional situations and is measured before treatment and at 6 and 12 months follow-up . Secondary outcomes concern low back pain related disability ( Rol and Morris question naire , RMQ ) , grade d chronic pain scale ( GCPS ) , range of motion and tactile acuity . Discussion To our knowledge this study will be the first to compare two exercise programs for a specific subgroup of patients with NSLBP and MCI . Results of this study will provide insight into the effectiveness of movement control exercise and contribute to our underst and ing of the mechanisms behind MCI and its relation to NSLBP.Trial registration Current Controlled Trials IS RCT & NA ; Guidelines for the management of low back pain ( LBP ) have existed for many years , but adherence to these by health care practitioners ( HCPs ) remains suboptimal . The aim of this study was to measure the attitudes , beliefs and reported clinical behaviour of UK physiotherapists ( PTs ) and general practitioners ( GPs ) about LBP and to explore the associations between these . A cross‐sectional postal survey of GPs ( n = 2000 ) and PTs ( n = 2000 ) was conducted that included the  Pain Attitudes and Beliefs Scale ( PABT.PT )  , and a vignette of a  patient with non‐specific LBP ( NSLBP )  with questions asking about recommendations for work , activity and bedrest . Data from 1022 respondents ( 442 GPs and 580 PTs ) who had recently treated patients with LBP were analysed . Although the majority of HCPs reported providing advice for the vignette patient that was broadly in line with guideline recommendations , 28 % reported they would advise this patient to remain off work . Work advice was significantly related to the PABS.PT scores with higher biomedical ( F1,986 = 77.5 , p < 0.0001 ) and lower behavioural ( F1,981 = 31.9 , p < 0.001 ) scores associated with advice to remain off work . We have demonstrated that the attitudes and reported practice behaviour of UK GPs and PTs for patients with NSLBP are diverse . Many HCPs held the belief that LBP necessitates some avoidance of activities and work . The attitudes and beliefs of these HCPs were associated with their self‐reported clinical behaviour regarding advice about work . Future studies need to investigate whether approaches aim ed at modifying these HCP factors can lead to improved patient outcomes Background Activity advice and prescription are commonly used in the management of low back pain ( LBP ) . Although there is evidence for advising patients with LBP to remain active , facilitating both recovery and return to work , to date no research has assessed whether objective measurements of free living physical activity ( PA ) can predict outcome , recovery and course of LBP . Methods An observational longitudinal study will investigate  PA  levels in a cohort of community-dwelling working age adults with acute and sub-acute LBP . Each participant 's  PA level , functional status , mood , fear avoidance behaviours , and levels of pain , psychological distress and occupational activity  will be measured on three occasions during for 1 week periods at baseline , 3 months , and 1 year .  Physical activity levels  will be measured by self report , RT3 triaxial accelerometer , and activity recall question naires . The primary outcome measure of functional recovery will be the Rol and Morris Disability Question naire ( RMDQ ) . Free living PA levels and changes in functional status will be quantified in order to look at predictive relationships between levels and changes in free living PA and functional recovery in a LBP population . Discussion This research will investigate levels and changes in activity levels of an acute LBP cohort and the predictive relationship to LBP recovery . The results will assess whether occupational , psychological and behavioural factors affect the relationship between free living PA and LBP recovery . Results from this research will help to determine the strength of evidence supporting international guidelines that recommend restoration of normal activity in managing LBP.Trial registration [ Clinical Trial Registration Number , ACTRN12609000282280 [ Purpose ] Nonspecific low back pain ( NSLBP ) is a very common but largely self-limiting condition . Several types of tape and their associated application methods are available for different conditions . The aim of the present study was to observe the effect of Kinesio taping ( KT ) compared with traditional management of NSLBP . [ Subjects and Methods ] Forty male and female patients with a mean age of 34.8±7.54 years were r and omly divided into two groups ; group 1 ( n=20 ) which underwent conventional physical therapy with KT , and group 2 ( n=20 ) , which underwent only conventional physical therapy . The intervention sessions for both groups were three times per week for four weeks . Outcomes were assessed for activities of daily living ( ADL ) using the Rol and -Morris Disability Question naire , pain severity using a visual analogue scale , and ranges of motion ( ROMs ) of trunk flexion and extension using the modified Schober ’s test . [ Results ] Significant differences in measures of pain , ADL , and trunk flexion and extension ROMs were observed post intervention within each group . In comparison , there were no significant differences in measures of pain , ADL , and trunk flexion and extension ROMs post intervention between groups . [ Conclusion ] A physical therapy program involving strengthening exercises for abdominal muscles and stretching exercises for back , hamstring , and iliopsoas muscles with or without Kinesio taping was beneficial in the treatment of chronic low back pain BACKGROUND Traditional sit-up exercise is a simple method to strengthen core muscles . However , it can increase the potential of lumbar spine injury during the bending process . OBJECTIVE To evaluate the effect of assisted sit-up exercise ( SUE ) using a new training device , HubEX-LEX ® , on strengthening core muscles and improving non-specific low back pain ( NSLBP )  compared to conventional core stabilization exercise ( CSE ) . METHODS Subjects with chronic NSLBP were r and omly divided into two groups : SUE ( n= 18 ) or CSE ( n= 18 ) . They participated in 12 sessions of the exercise program . Before and after the training , thickness and activity of core muscles were measured using ultrasonogram and surface electromyography respectively . Pain and disability were assessed using two question naires . RESULTS Thickness ratios ( contracted/rest ) of rectus abdominis and external oblique in the SUE group and those of transversus abdominis in the CSE group showed statistically significant difference between before and after exercise ( p < 0.05 ) . The ratio of activation of internal oblique relative to rectus abdominis and all measurements for pain and disability showed statistically significant improvement in both groups ( p < 0.05 ) . CONCLUSIONS Assisted SUE using new training device can be an effective therapeutic exercise to strengthen dynamic abdominal muscles and improve core muscle activation pattern in NSLBP patients This study evaluated the efficacy of an exercise programme as an intervention for  recurrent non-specific low-back pain ( NLSBP ) in adolescents . A r and omized controlled trial was conducted with an experimental group ( n = 27 , age 14.6 years ) who participated in an 8-week exercise programme and a matched control group ( n = 27 , age 14.6 years ) who continued normal daily activities . All participants suffered from recurrent NSLBP . Pre and post intervention measures of NSLBP status ( pain severity and consequences ) and daily inactivity ( time spent sitting , PC time , TV time ) were reported in one week diaries . Two-way mixed ANOVA ( independent variables : pre/post and experimental/control ) was conducted for each dependent variable , significance was set at P < 0.05 . Significant interaction effects were identified for the severity of pain , number of occasions missing sport due to NSLBP and amount of sport participated in . In each case the experimental group benefited from the exercise programme . In contrast , no significant interaction effects were observed for physical inactivity , both groups spent a similar amount of time sitting , watching TV and using a PC pre- and post- intervention . It was concluded that an exercise programme acted as an effective short-term treatment strategy for NSLBP in adolescents . Further evaluation is required to assess the long-term effectiveness Background Low back pain is a common health complaint result ing in substantial economic burden . Each year , upwards of 20 r and omised controlled trials ( RCTs ) evaluating interventions for non-specific low back pain are published . Use of the term non-specific low back pain has been criticised on the grounds of encouraging heterogeneity and hampering interpretation of findings due to possible heterogeneous causes , challenging meta-analyses . We explored selection criteria used in trials of treatments for nsLBP . Methods A systematic review of English- language reports of RCTs in nsLBP population sample s , published between 2006 and 2012 , identified from MEDLINE , EMBASE , and the Cochrane Library data bases , using a mixed- methods approach to analysis . Study inclusion and exclusion criteria were extracted , thematically categorised , and then descriptive statistics were used to summarise the prevalence by emerging category . Results We included 168 studies . Two inclusion themes ( anatomical area , and symptoms and signs ) were identified . Anatomical area was most reported as between costal margins and gluteal folds ( n = 8 , 5 % ) , while low back pain ( n = 150 , 89 % ) with or without referred leg pain ( n = 27 , 16 % ) was the most reported symptom . Exclusion criteria comprised 21 themes . Previous or scheduled surgery ( n = 84 , 50 % ) , pregnancy ( n = 81 , 48 % ) , malignancy ( n = 78 , 46 % ) , trauma ( n = 63 , 37 % ) and psychological conditions ( n = 58 , 34 % ) were the most common . Sub-themes of exclusion criteria mostly related to neurological signs and symptoms : nerve root compromise ( n = 44 , 26 % ) , neurological signs ( n = 34 , 20 % ) or disc herniation ( n = 30 , 18 % ) . Specific conditions that were most often exclusion criteria were spondylolisthesis ( n = 35 , 21 % ) , spinal stenosis ( n = 31 , 18 % ) or osteoporosis ( n = 27 , 16 % ) . Conclusion RCTs of interventions for non-specific low back pain have incorporated diverse inclusion and exclusion criteria . Guidance on st and ardisation of inclusion and exclusion criteria for nsLBP trials will increase clinical homogeneity , facilitating greater interpretation of between-trial comparisons and meta-analyses . We propose a template for reporting inclusion and exclusion criteria BACKGROUND Exercise is an effective treatment for patients with sub-acute and chronic non-specific low back pain ( NSLBP ) . Previous studies have shown that a subgroup of patients with NSLBP and movement control impairment ( MCI ) can be diagnosed with substantial reliability . However , which type of exercises are most beneficial to this subgroup is still unknown . OBJECTIVES The effectiveness of a specific exercise treatment to improve movement control was tested in this study . METHODS Using a multicentre r and omised controlled trial ( RCT ) , we compared exercises that targeted MCI ( MC ) with a general exercise ( GE ) treatment . After r and omisation , patients in both groups n(MC = 52 ; GE = 54 ) were treated in eight private physiotherapy practice s and five hospital outpatient physiotherapy centres . Follow-up measurements were taken at post-treatment , six months and 12 months . The primary outcome measurement was the Patient Specific Function Scale ( PSFS ) . RESULTS PSFS showed no difference between groups after treatment , or at six months and 12 months . Secondary outcome analysis for pain and disability , measured with the Grade d Chronic Pain scale and the Rol and Morris Disability Question naire respectively , showed that a small improvement post-treatment levelled off over the long term . Both groups improved significantly ( p < 0.001 ) over the course of one year . CONCLUSION This study found no additional benefit of specific exercises targeting MCI The aim of the pilot study was to evaluate a multidisciplinary program for nonspecific low back pain ( NSLBP ) at a major U.S. Navy base . In this single blinded r and omized clinical trial , subjects were drawn from a larger , prospect i ve cohort of active duty service members seeking care for NSLBP pain at a U.S. Navy Branch Medical Clinic . Outcome measures included return to work , self-reported pain , function , and psychological distress . Subjects were r and omly allocated to one of two study arms : a multidisciplinary reconditioning program or the current st and ard of care for low back pain . The intervention lasted 4 weeks with a 12-week follow-up . Thirty-three subjects were enrolled . Subjects allocated to multidisciplinary care reported significantly lower perceived disability ( p = 0.014 ) and less pain than those allocated to usual care at the end of the intervention period . All subjects returned to their usual duty following the conclusion of the intervention . The implementation of the intervention program was successful . Subjects in the multidisciplinary program showed a clinical ly significant improvement in the perception of disability compared to the usual care group . This is an important finding since perception of disability is associated with long-term functional outcome Abstract Purpose To evaluate the effectiveness of non-steroidal anti-inflammatory drugs ( NSAIDs ) for the management of neck pain and associated disorders ( NAD ) , whiplash-associated disorders , and non-specific low back pain ( LBP ) with or without radiculopathy . Methods We systematic ally search ed six data bases from 2000 to 2014 . R and om pairs of independent review ers critically appraised eligible systematic review s using the Scottish Intercollegiate Guidelines Network criteria . We included systematic review s with a low risk of bias in our best evidence synthesis . Results We screened 706 citations and 14 systematic review s were eligible for critical appraisal . Eight systematic review s had a low risk of bias . For recent-onset NAD , evidence suggests that intramuscular NSAIDs lead to similar outcomes as combined manipulation and soft tissue therapy . For NAD ( duration not specified ) , oral NSAIDs may be more effective than placebo . For recent-onset LBP , evidence suggests that : ( 1 ) oral NSAIDs lead to similar outcomes to placebo or a muscle relaxant ; and ( 2 ) oral NSAIDs with bed rest lead to similar outcomes as placebo with bed rest . For persistent LBP , evidence suggests that : ( 1 ) oral NSAIDs are more effective than placebo ; and ( 2 ) oral NSAIDs may be more effective than acetaminophen . For recent-onset LBP with radiculopathy , there is inconsistent evidence on the effectiveness of oral NSAIDs versus placebo . Finally , different oral NSAIDs lead to similar outcomes for neck and LBP with or without radiculopathy . Conclusions For NAD , oral NSAIDs may be more effective than placebo . Oral NSAIDs are more effective than placebo for persistent LBP , but not for recent-onset LBP . Different oral NSAIDs lead to similar outcomes for neck pain and LBP Background Variability between clinical practice guideline recommendations and actual clinical practice exists in many areas of health care . A 2004 systematic review examining the effectiveness of guideline implementation interventions concluded there was a lack of evidence to support decisions about effective interventions to promote the uptake of guidelines . Further , the review recommended the use of theory in the development of implementation interventions . A clinical practice guideline for the management of acute low-back pain has been developed in Australia ( 2003 ) . Acute low-back pain is a common condition , has a high burden , and there is some indication of an evidence - practice gap in the allied health setting . This provides an opportunity to develop and test a theory-based implementation intervention which , if effective , may provide benefits for patients with this condition . Aims This study aims to estimate the effectiveness of a theory-based intervention  to increase allied health practitioners ' ( physiotherapists and chiropractors in Victoria , Australia ) compliance with a clinical practice guideline for acute non-specific low back pain ( LBP ) , compared with providing practitioners with a printed copy of the guideline . Specifically , our primary objectives are to establish if the intervention is effective in reducing the percentage of acute non-specific LBP patients who are either referred for or receive an x-ray  , and improving mean level of disability for patients three months post-onset of acute LBP . Methods The design of the study is a cluster r and omised trial . Restricted r and omisation was used to r and omise 210 practice s ( clusters ) to an intervention or control group . Practitioners in the control group received a printed copy of the guideline . Practitioners in the intervention group received a theory-based intervention developed to address prospect ively identified barriers to practitioner compliance with the guideline . The intervention primarily consisted of an educational symposium .  Patients aged 18 years or older who visit a participating practitioner for acute non-specific LBP of less than three months duration over a two-week data collection period , three months post the intervention symposia , are eligible for inclusion . Sample size calculations are based on recruiting between 15 to 40 patients per practice . Outcome assessors will be blinded to group allocation . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12609001022257 ( date registered 25th November 2009 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 Background Advice to remain active and normalisation of activity are commonly prescribed in the management of low back pain ( LBP ) . However , no research has assessed whether objective measurements of physical activity predict outcome and recovery in acute low back pain . Method The aims of this study were to assess the predictive relationship between activity and disability at 3 months in a sub-acute LBP population . This prospect i ve cohort study recruited 101 consenting patients with sub-acute LBP ( < 6 weeks ) who completed the Rol and Morris Disability Question naire ( RMDQ ) , the Visual Analogue Scale , and resumption of full ‘ normal ’ activity question ( Y/N ) , at baseline and 3 months .  Physical activity  was measured for 7 days at both baseline and at 3 months with an RT3 accelerometer and a recall question naire . Results Observed and self-reported measures of physical activity at baseline and change in activity from baseline to 3 months were not independent predictors of RMDQ ( p > 0.05 ) or RMDQ change ( p > 0.05 ) over 3 months . A self-report of a return to full ‘ normal ’ activities was significantly associated with greater RMDQ change score at 3 months ( p < 0.001 ) . Paired t-tests found no significant change in activity levels measured with the RT3 ( p = 0.57 ) or the recall question naire ( p = 0.38 ) from baseline to 3 months . Conclusions These results question the predictive role of physical activity in LBP recovery , and the assumption that activity levels change as LBP symptoms resolve . The importance of a patient ’s perception of activity limitation in recovery from acute LBP was also highlighted . Trial registration Clinical Trial Registration Number , Study Design . A r and omized clinical trial with 1-year and 3-year telephone question naire follow-ups . Objective . To report a specific exercise intervention ’s long-term effects on recurrence rates in acute , first-episode low back pain patients . Summary of Background Data . The pain and disability associated with an initial episode of acute low back pain ( LBP ) is known to resolve spontaneously in the short-term in the majority of cases . However , the recurrence rate is high , and recurrent disabling episodes remain one of the most costly problems in LBP . A deficit in the multifidus muscle has been identified in acute LBP patients , and does not resolve spontaneously on resolution of painful symptoms and resumption of normal activity . Any relation between this deficit and recurrence rate was investigated in the long-term . Methods . Thirty-nine patients with acute , first-episode LBP were medically managed and r and omly allocated to either a control group or specific exercise group . Medical management included advice and use of medications . Intervention consisted of exercises aim ed at rehabilitating the multifidus in cocontraction with the transversus abdominis muscle . One year and three years after treatment , telephone question naires were conducted with patients . Results . Question naire results revealed that patients from the specific exercise group experienced fewer recurrences of LBP than patients from the control group . One year after treatment , specific exercise group recurrence was 30 % , and control group recurrence was 84 % ( P < 0.001 ) . Two to three years after treatment , specific exercise group recurrence was 35 % , and control group recurrence was 75 % ( P < 0.01 ) . Conclusion . Long-term results suggest that specific exercise therapy in addition to medical management and resumption of normal activity may be more effective in reducing low back pain recurrences than medical management and normal activity alone 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 BACKGROUND Lumbar paraspinal muscle dysfunction and Low Back Pain are strongly correlated . The best treatment for non-specific Low Back Pain is still controversial . OBJECTIVE To evaluate the efficacy of lumbar multifidus muscle retraining exercises and perifacet multifidus injections in the treatment of Low Back Pain . MATERIAL AND METHODS 63 patients with non-specific LBP , with or without leg pain , and magnetic resonance images of paraspinal muscle degeneration only , were r and omised to one of three treatment groups : A- Back education and st and ard physiotherapy for 10 weeks , B- Back education and gym ball exercise for 10 weeks or C- Perifacet injection into the lumbar multifidus muscle with methylprednisolone . The Oswestry Disability Index was used as the primary outcome measure and the SF-36 , modified Zung depression index , modified somatic perception and McGill pain question naires were used as secondary outcome measures . RESULTS 56 patients completed the trial . The Oswestry Disability Index improved in general from a mean of 29.9 to 25.9 , but there were no statistically significant differences between the groups . Low back pain improved most in group C ( P<0.02 ) , while physical activities and social functioning were improved the most in group B ( P<0.03 ) . CONCLUSION Perifacet injection and back education including a gym ball exercise program may be more effective than back education alone in relieving pain and improving physical capacity respectively . Back education including gym ball exercise could be used for non-specific Low Back Pain , as the ultimate goal should be to restore function INTRODUCTION Active treatments are advocated for the management of  non-specific chronic low back pain ( CLBP ) , although few studies have documented the relative efficacy of differing types of programme . A number of the available treatments comprise exercise routines on specially design ed training machines , which are ostensibly better disposed to reverse the compromised trunk muscle function displayed by these patients than are ' free exercise ' programmes . However , in using these muscle-training programmes , the physiological or anatomical adaptations that might account for the improved performance are rarely investigated , let alone identified . This is an important issue , because if the ' newly-acquired strength ' is mostly specific to performance on the devices on which the patient has trained and been tested , and reflects the skill in executing these particular tasks , this will not necessarily assist the patient during performance of his/her everyday activities . The aims of the present study were ( 1 ) to quantify the changes in back muscle performance in chronic LBP patients following 3 months active therapy , and ( 2 ) to analyse the corresponding changes in activation and cross-sectional area of the paraspinal muscles . METHODS 148 individuals ( 57 % women ) with CLBP ( age 45.0+/-10.0 years ; duration of LBP 10.9+/-9.5 years ) were r and omised to a treatment which they attended 2/week for 3 months : active physiotherapy , muscle reconditioning on training devices , or low-impact aerobics . Pre- and post-therapy , assessment s were made of isometric trunk muscle strength in each plane of movement and of erector spinae activation ( using surface electromyography ) during back extension . In a sub-group of 56 patients , the cross-sectional area of the paravertebral muscles was determined using magnetic resonance imaging ( MRI ) . In all patients , self-rated pain intensity , pain frequency and disability were assessed before and after therapy . RESULTS 132/148 patients completed the therapy .  Isometric strength in each movement plane increased significantly in all groups post-therapy . Apart from trunk extension , the changes were significantly greater in the devices group than in the other two groups ( Fig 1 ) . Activation of the paraspinal muscles during back extension also increased significantly in all groups ( Fig 2 ) and was weakly , but significantly ( r = 0.37 ; p = 0.0001 ) correlated with increased strength in back extension . Although , at baseline , highly significant correlations were observed between the size of the paraspinal muscles ( at L3/4 and at L4/5 ) and isometric back extension strength ( r=0.75 ; p < 0.0001 ) , post-training increases in strength were not accompanied by corresponding changes in muscle size . None of the improvements in strength showed any relationship with the clinical changes in pain and disability , regardless of whether the latter were examined on an individual basis or in relation to ' outcome groups ' . CONCLUSION The superior trunk strength shown by the devices group post-therapy was considered to be attributable , in part , to a ' learning effect ' , of the type often seen when training and testing are carried out on the same machines . These gains are considered to be mostly ' task-specific ' . However , part of the improvement in strength after active therapy ( in all groups ) also appeared to be due to an increased neural activation of the trunk muscles . These positive effects should be transferable to the performance of everyday activities for which the same muscles are employed , although the percentage improvement is probably not as high as the measured increase in strength might suggest . Possible roles for improved co-ordination and changes in motivation and /or pain tolerance after therapy can not be excluded . No differences in the clinical outcome were observed between the three therapy groups , and the changes in physical performance after therapy did not correlate with the clinical outcome . It is therefore question able whether strength measurements have any clinical significance in documenting the success of rehabilitation programmes , other than on a motivational basis . The results of the present study suggest that the value of supervised active therapy programmes does not reside in the reversal of specific muscular deficiencies , but rather in the provision of a source of confirmation/encouragement for the patient , that movement is not harmful , and a foundation upon which to further build . Whether the utilisation of specific training devices , or individual instruction , is necessary to elicit these particular effects is question able BACKGROUND Previous trials of yoga therapy for nonspecific low back pain ( nsLBP ) ( without sciatica ) showed beneficial effects . OBJECTIVE To test effects of yoga therapy on pain and disability associated with lumbar disc extrusions and bulges . METHODS Parallel-group , r and omised , controlled trial . Sixty-one adults from rural population , aged 20 - 45 , with nsLBP or sciatica , and disc extrusions or bulges . R and omised to yoga  ( n=30 ) and  control  ( n=31 ) . Yoga : 3-month yoga course of group classes and home practice , design ed to ensure safety for disc extrusions . CONTROL normal medical care . OUTCOME MEASURES ( 3 - 4 months ) Primary : Rol and Morris Disability Question naire ( RMDQ ) ; worst pain in past two weeks . Secondary : Aberdeen Low Back Pain Scale ; straight leg raise test ; structural changes . RESULTS Disc projections per case ranged from one bulge or one extrusion to three bulges plus two extrusions . Sixty-two percent had sciatica . Intention-to-treat analysis of the RMDQ data , adjusted for age , sex and baseline RMDQ scores , gave a Yoga Group score 3.29 points lower than Control Group ( 0.98 , 5.61 ; p=0.006 ) at 3 months . No other significant differences in the endpoints occurred . No adverse effects of yoga were reported . CONCLUSIONS Yoga therapy can be safe and beneficial for patients with nsLBP or sciatica , accompanied by disc extrusions and bulges OBJECTIVES We sought to estimate the effects of recreational physical activity and back exercises on  low back pain , related disability , and psychological distress among patients r and omized to chiropractic or medical care in a managed care setting . METHODS Low back pain patients ( n=681 ) were r and omized and followed for 18 months . Participation in recreational physical activities , use of back exercises , and low back pain , related disability , and psychological distress were measured at baseline , at 6 weeks , and at 6 , 12 , and 18 months . Multivariate logistic regression modeling was used to estimate adjusted associations of physical activity and back exercises with concurrent and subsequent pain , disability , and psychological distress . RESULTS Participation in recreational physical activities was inversely associated -- both cross-sectionally and longitudinally -- with low back pain , related disability , and psychological distress . By contrast , back exercise was positively associated -- both cross-sectionally and longitudinally -- with low back pain and related disability . CONCLUSIONS These results suggest that individuals with low back pain should refrain from specific back exercises and instead focus on nonspecific physical activities to reduce pain and improve psychological health Study Design . Pragmatic , multicentered r and omized controlled trial , with 12-month follow-up . Objective . To evaluate the effect of adding specific spinal stabilization exercises to conventional physiotherapy for patients with recurrent low back pain ( LBP ) in the United Kingdom . Summary of Background Data . Spinal stabilization exercises are a popular form of physiotherapy management for LBP , and previous small-scale studies on specific LBP subgroups have identified improvement in outcomes as a result . Methods . A total of 97 patients ( 18–60 years old ) with recurrent LBP were recruited . Stratified r and omization was undertaken into 2 groups : “ conventional , ” physiotherapy consisting of general active exercise and manual therapy ; and conventional physiotherapy plus specific spinal stabilization exercises . Stratifying variables used were laterality of symptoms , duration of symptoms , and Rol and Morris Disability Question naire score at baseline . Both groups received The Back Book , by Rol and et al. Back-specific functional disability ( Rol and Morris Disability Question naire ) at 12 months was the primary outcome . Pain , quality of life , and psychologic measures were also collected at 6 and 12 months . Analysis was by intention to treat . Results . A total of 68 patients ( 70 % ) provided 12-month follow-up data . Both groups showed improved physical functioning , reduced pain intensity , and an improvement in the physical component of quality of life . Mean change in physical functioning , measured by the Rol and Morris Disability Question naire , was −5.1 ( 95 % confidence interval −6.3 to −3.9 ) for the specific spinal stabilization exercises group and −5.4 ( 95 % confidence interval −6.5 to −4.2 ) for the conventional physiotherapy group . No statistically significant differences between the 2 groups were shown for any of the outcomes measured , at any time . Conclusions . Patients with LBP had improvement with both treatment packages to a similar degree . There was no additional benefit of adding specific spinal stabilization exercises to a conventional physiotherapy package for patients with recurrent LBP Low back pain is the fifth most common reason for all physician visits in the United States ( 1 , 2 ) . Approximately one quarter of U.S. adults reported having low back pain lasting at least 1 whole day in the past 3 months ( 2 ) , and 7.6 % reported at least 1 episode of severe acute low back pain ( see Glossary ) within a 1-year period ( 3 ) . Low back pain is also very costly : Total incremental direct health care costs attributable to low back pain in the U.S. were estimated at $ 26.3 billion in 1998 ( 4 ) . In addition , indirect costs related to days lost from work are substantial , with approximately 2 % of the U.S. work force compensated for back injuries each year ( 5 ) . Many patients have self-limited episodes of acute low back pain and do not seek medical care ( 3 ) . Among those who do seek medical care , pain , disability , and return to work typically improve rapidly in the first month ( 6 ) . However , up to one third of patients report persistent back pain of at least moderate intensity 1 year after an acute episode , and 1 in 5 report substantial limitations in activity ( 7 ) . Approximately 5 % of the people with back pain disability account for 75 % of the costs associated with low back pain ( 8) . Many options are available for evaluation and management of low back pain . However , there has been little consensus , either within or between specialties , on appropriate clinical evaluation ( 9 ) and management ( 10 ) of low back pain . Numerous studies show unexplained , large variations in use of diagnostic tests and treatments ( 11 , 12 ) . Despite wide variations in practice , patients seem to experience broadly similar outcomes , although costs of care can differ substantially among and within specialties ( 13 , 14 ) . The purpose of this guideline is to present the available evidence for evaluation and management of acute and chronic low back pain ( see Glossary ) in primary care setting s. The target audience for this guideline is all clinicians caring for patients with low ( lumbar ) back pain of any duration , either with or without leg pain . The target patient population is adults with acute and chronic low back pain not associated with major trauma . Children or adolescents with low back pain ; pregnant women ; and patients with low back pain from sources outside the back ( nonspinal low back pain ) , fibromyalgia or other myofascial pain syndromes , and thoracic or cervical back pain are not included . These recommendations are based on a systematic evidence review summarized in 2 background papers by Chou and colleagues in this issue ( 15 , 16 ) from an evidence report by the American Pain Society ( 17 ) . The evidence report ( 17 ) discusses the evidence for the evaluation , and the 2 background papers ( 15 , 16 ) summarize the evidence for management . Methods The literature search for this guideline included studies from MEDLINE ( 1966 through November 2006 ) , the Cochrane Data base of Systematic Review s , the Cochrane Central Register of Controlled Trials , and EMBASE . The literature search included all English- language articles reporting on r and omized , controlled trials of nonpregnant adults ( age > 18 years ) with low back pain ( alone or with leg pain ) of any duration that evaluated a target medication and reported at least 1 of the following outcomes : back-specific function , generic health status , pain , work disability , or patient satisfaction .  The American College of Physicians ( ACP ) and the American Pain Society ( APS ) convened a multidisciplinary panel of experts to develop the key questions and scope used to guide the evidence report , review its results , and formulate recommendations . The background papers by Chou and colleagues ( 15 , 16 ) provide details about the methods used for the systematic evidence review . This guideline grade s its recommendations by using the ACP 's clinical practice guidelines grading system , adapted from the classification developed by the Grading of Recommendations , Assessment , Development , and Evaluation ( GRADE ) work group ( Appendix Table 1 ) ( 18 ) . The evidence in this guideline was first evaluated by the ACP/APS panel by using a system adopted from the U.S. Preventive Services Task Force for grading strength of evidence , estimating magnitude of benefits , and assigning summary ratings ( Appendix Tables 2 , 3 , and 4 ) ( 19 ) . The evidence was independently review ed by the ACP 's Clinical Efficacy Assessment Subcommittee . The ratings for individual low back pain interventions discussed in this guideline are summarized in Appendix Table 5 for acute low back pain ( < 4 weeks ' duration ) and in Appendix Table 6 for chronic/subacute low back pain ( > 4 weeks ' duration ) . This guideline considered interventions to have proven benefits only when they were supported by at least fair- quality evidence and were associated with at least moderate benefits ( or small benefits but no significant harms , costs , or burdens ) . Figures 1 and 2 present an accompanying algorithm . Appendix Table 1 . The American College of Physicians Clinical Practice Guidelines Grading System Appendix Table 2 . Methods for Grading the Strength of the Overall Evidence for an Intervention Appendix Table 3 . Definitions for Estimating Magnitude of Effects Appendix Table 4 . Recommendations and Summary Ratings Appendix Table 5 . Level of Evidence and Summary Grade s for Noninvasive Interventions in Patients with Acute Low Back Pain Appendix Table 6 . Level of Evidence and Summary Grade s for Noninvasive Interventions in Patients with Chronic or Subacute Low Back Pain Figure 1 . Initial evaluation of low back pain ( LBP Figure 2 . Management of low back pain ( LBP Recommendations : Evaluation of Low Back Pain Recommendation 1 : Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories : nonspecific low back pain , back pain potentially associated with radiculopathy or spinal stenosis , or back pain potentially associated with another specific spinal cause . The history should include assessment of psychosocial risk factors , which predict risk for chronic disabling back pain ( strong recommendation , moderate- quality evidence ) . More than 85 % of patients who present to primary care have low back pain that can not reliably be attributed to a specific disease or spinal abnormality ( nonspecific low back pain [ see Glossary ] ) ( 20 ) . Attempts to identify specific anatomical sources of low back pain in such patients have not been vali date d in rigorous studies , and classification schemes frequently conflict with one another ( 21 ) . Moreover , no evidence suggests that labeling most patients with low back pain by using specific anatomical diagnoses improves outcomes . In a minority of patients presenting for initial evaluation in a primary care setting , low back pain is caused by a specific disorder , such as cancer ( approximately 0.7 % of cases ) , compression fracture ( 4 % ) , or spinal infection ( 0.01 % ) ( 22 ) . Estimates for prevalence of ankylosing spondylitis in primary care patients range from 0.3 % ( 22 ) to 5 % ( 23 ) . Spinal stenosis ( see Glossary ) and symptomatic herniated disc ( see Glossary ) are present in about 3 % and 4 % of patients , respectively . The cauda equina syndrome ( see Glossary ) is most commonly associated with massive midline disc herniation but is rare , with an estimated prevalence of 0.04 % among patients with low back pain ( 24 ) . A practical approach to assessment is to do a focused history and physical examination to determine the likelihood of specific underlying conditions and measure the presence and level of neurologic involvement ( 24 , 25 ) . Such an approach facilitates classification of patients into 1 of 3 broad categories : nonspecific low back pain , back pain potentially associated with radiculopathy ( see Glossary ) or spinal stenosis ( suggested by the presence of sciatica [ see Glossary ] or pseudoclaudication ) , and back pain potentially associated with another specific spinal cause . The latter category includes the small proportion of patients with serious or progressive neurologic deficits or underlying conditions requiring prompt evaluation ( such as tumor , infection , or the cauda equina syndrome ) , as well as patients with other conditions that may respond to specific treatments ( such as ankylosing spondylitis or vertebral compression fracture ) . Diagnostic triage into 1 of these 3 categories helps guide subsequent decision making . Clinicians should inquire about the location of pain , frequency of symptoms , and duration of pain , as well as any history of previous symptoms , treatment , and response to treatment . The possibility of low back pain due to problems outside the back , such as pancreatitis , nephrolithiasis , or aortic aneurysm , or systemic illnesses , such as endocarditis or viral syndromes , should be considered . All patients should be evaluated for the presence of rapidly progressive or severe neurologic deficits , including motor deficits at more than 1 level , fecal incontinence , and bladder dysfunction . The most frequent finding in the cauda equina syndrome is urinary retention ( 90 % sensitivity ) ( 24 ) . In patients without urinary retention , the probability of the cauda equina syndrome is approximately 1 in 10000 . Clinicians should also ask about risk factors for cancer and infection . In a large , prospect i ve study from a primary care setting , a history of cancer ( positive likelihood ratio , 14.7 ) , unexplained weight loss ( positive likelihood ratio , 2.7 ) , failure to improve after 1 month ( positive likelihood ratio , 3.0 ) , and age older than 50 years ( positive likelihood ratio , 2.7 ) were each associated with a higher likelihood for cancer ( 26 ) . The posttest probability of cancer in patients presenting with back pain increases from approximately 0.7 % to 9 % in patients with a history of cancer ( not including nonmelanoma skin cancer ) . In patients with any 1 of the other 3 risk factors , the likelihood of cancer only increases to approximately 1.2 % ( 26 ) . Features predicting the presence of vertebral infection have not been well studied STUDY DESIGN A three and six months follow-up in a r and omized controlled trial . BACKGROUND Back School has become a widespread exercise program for low back pain ( LBP ) , since its introduction in 1969 . Back School could improve quality of life ( QoL ) , but there are controversial data regarding its effectiveness . AIM To evaluate the effects of the Back School program on quality of life ( primary outcome ) , disability and pain perceptions ( secondary outcomes ) in patients with chronic and non-specific low back pain . SETTING Rehabilitative specialized centre . POPULATION Seventy four patients with chronic non-specific LBP . METHODS Patients were r and omly placed in a 3:2 form and were allocated into 2 groups ( treated-control ) . Treatment group participated in a intensive multidisciplinary Back School program including brief education and active back exercises ( BSG , N.=41 ) , while the control group received medical assistance ( CG , N.=29 ) . Medication was the same in both groups . The Short Form 36 Health Status Survey , Waddel Index , Oswestry Disability Index and Visual Analogue Scale were collected at baseline , at the end of treatment , and at the three and six month follow-up . RESULTS Quality of life significantly improved along time more in BSG , both in Physical and Mental Composite Score ( repeated measure Anova : interaction time per group : P<0.001 and P=0.002 , respectively ) . We also observed a significant improvement in disability scores along time ( P<0.001 ) in BSG with significant differences between groups at three and at six months for Waddell Index ( P=0.006 and P=0.009 respectively ) and for Oswestry Disability Index ( P=0.018 and 0.011 respectively ) . Moreover , pain perception score VAS showed a reduction in both groups , but it was significantly lower in BSG at end of treatment and both follow-ups ( P<0.001 ) . CONCLUSION Our Back School program can be considered an effective treatment in people with chronıc non-specıfıc LBP 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
These data suggest that the activity levels of patients with NSLBP are neither associated with , nor predictive of , disability or pain levels .
Although clinical guidelines advocate exercise and activity in the management of non-specific low back pain ( NSLBP ) , the link between levels of physical activity and outcomes is unclear .
This systematic review investigated the relationships between free living activity levels  after onset of low back pain ( LBP ) and measures of pain , and disability in patients with NSLBP .