Effects of Pelvic Asymmetry and Low Back Pain on Trunk Kinematics During Sitting: A Comparison With Standing Identification of Modifiable Personal Factors That Predict New-onset Low Back Pain: A Prospective Study of Female Nursing Students Energy transfer across the lumbosacral and lower-extremity joints in patients with low back pain during sit-to-stand. Persistence and Change in Nonspecific Low Back Pain Among Adolescents: A 3-Year Prospective Study Exploring Factors Influencing Low Back Pain in People With Nondysvascular Lower Limb Amputation: A National Survey. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial Impact of a Sit-Stand Workstation on Chronic Low Back Pain: Results of a Randomized Trial Reliability and Validity of a New Objective Tool for Low Back Pain Functional Assessment Sitting and low back pain: the positive effect of rotatory dynamic stimuli during prolonged sitting Immediate changes in feedforward postural adjustments following voluntary motor training Efficacy of two multimodal treatments on physical strength of occupationally subgrouped male with low back pain. The natural course of low back pain: a systematic critical literature review The Effectiveness of an Unstable Sandal on Low Back Pain and Golf Performance Low back joint loading and kinematics during standing and unsupported sitting 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 Immediate and Short-Term Effects of Kinesio Taping Tightness in Mechanical Low Back Pain: A Randomized Controlled Trial. Autonomic status and pain profile in patients of chronic low back pain and following electro acupuncture therapy: a randomized control trial. Effect of Dual-Tasking on Postural Control in Subjects With Nonspecific Low Back Pain Effect of Lumbar Stabilization and Dynamic Lumbar Strengthening Exercises in Patients With Chronic Low Back Pain Physical Therapy Treatment of Back Complaints on Children and Adolescents No effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy® Effectiveness of a Lumbar Support Continuous Passive Motion Device in the Prevention of Low Back Pain During Prolonged Sitting A review and proposal for a core set of factors for prospective cohorts in low back pain: a consensus statement.
Study Design . A prospect i ve study was conducted on a group of patients with unilateral nonspecific low back pain ( LBP ) and healthy controls . Objectives . To answer 3 questions : ( 1 ) Does pelvic asymmetry measured in st and ing affect the dynamics of motion performed in sitting ? ( 2 ) Do patients with LBP perform trunk motions differently from non-LBP participants in sitting position ? and ( 3 ) Do the kinematics of lateral flexion and axial rotation differ between sitting and st and ing positions ? Summary of Background Data . The effect of pelvic asymmetry on trunk motion while sitting remains unclear . LBP has been associated with altered trunk kinematics in st and ing ; however , there is limited information available describing trunk kinematics in sitting position in comparison to st and ing . Methods . Pelvic asymmetry was measured in 54 patients with unilateral nonspecific LBP and 59 control subjects .  A motion- analysis system was used to test the  range and symmetry of lateral flexion and axial rotation  in sitting and st and ing positions . Bivariate correlations , regression , multivariate analysis of variance , and paired sample t tests were used to test for associations between variables and differences between groups . Results . We found significant : ( 1 ) correlations between pelvic asymmetry and asymmetric trunk motion performed in sitting , ( 2 ) differences between the LBP and control groups in patterns of trunk motion performed in a sitting posture , and ( 3 ) differences between kinematics of motions performed in sitting versus st and ing postures . Conclusions . This study shows a link between pelvic asymmetry and altered trunk motion in sitting position . We suggest that people with LBP may have a distinct compensatory mechanism , secondary to pelvic asymmetry , which puts the lumbar spine under higher stress . Movement asymmetry , rather than range of motion , may be a better indicator of disturbed function for people with LBP . Structural and functional asymmetries are factors that may be considered in the seating design and work environment Objectives Prevention of occupational low back pain ( LBP ) in nurses is a research priority . Recent research suggests intervening before commencing nursing employment is ideal ; however , identification of modifiable risk factors is required . The objective of this study was to investigate modifiable personal characteristics that predicted new-onset LBP in nursing students . Methods This prospect i ve study was conducted on female nursing students ( n=117 ) without LBP at baseline to predict new-onset LBP ( an episode of significant LBP during the follow-up period ) . At the 12-month follow-up , participants with ( n=31 ) and without new-onset LBP ( n=76 ) were compared across baseline social or lifestyle , psychologic ( distress , back pain beliefs , coping strategies , and catastrophising ) , and physical ( spinal postures and spinal kinematics in functional tasks , leg and back muscle endurance , spinal repositioning error , and cardiovascular fitness ) characteristics . Results Participants response rate at follow-up was excellent ( 91 % ) . After controlling for earlier LBP , age , and BMI , regression analysis showed that modifiable social or lifestyle , psychologic and physical characteristics ( namely , smoking , increased physical activity , higher stress , reduced back muscle endurance , greater posterior pelvic rotation in slump sitting , and more accurate spinal repositioning in sitting ) were significant and independent predictors of new-onset LBP at follow-up . Inclusion of these factors in multivariate logistic regression analysis , with significant new-onset LBP as the outcome , result ed in a substantial model R2 of 0.45 . Discussion Modifiable personal characteristics across multiple domains are associated with new-onset LBP in female nursing students . These findings may have implication s for the development of prevention and management interventions for LBP in nurses OBJECTIVE To examine the transfer of energy through the pelvis and the lower limb during sit-to-st and ( STS ) in low back pain ( LBP ) subjects with or without a straight-leg raise sign . DESIGN Cross-sectional . SETTING Biomechanics laboratory . PARTICIPANTS Three groups , each of 20 subjects , participated . The first group consisted of asymptomatic subjects , and the other 2 groups of consisted of LBP subjects ( duration between 7 days and 12 weeks ) with and without a straight-leg raise sign .  INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The work done and the power of the pelvis , thigh , and leg segments during STS  were determined . RESULTS Energy was transferred from the pelvis to the thigh segment and then to the leg segment , and this was achieved mainly by passive mechanisms . The power flow of the pelvis segment was significantly decreased in subjects with LBP . Although the power of the lower-limb segments was decreased , the total work done of these segments was increased . CONCLUSIONS STS is a more energy-dem and ing and less efficient task for subjects with LBP , either with or without a positive straight-leg raise sign . Such increases in energy dem and may further exacerbate back pain , and treatment should be developed to restore a more efficient energy transfer pattern Study Design . This is a 3-year prospect i ve study of juvenile low back pain ( LBP ) . Objectives . To investigate persistence and change in LBP . Summary of Background Data . Earlier episodes of LBP are a strong risk factor for LBP in adults , while the persistence of LBP through adolescence is not known . Methods . The material comprised all pupils in eighth and ninth grade s ( N = 105 , mean age 14.7 years ) , living within two geographic areas in Eastern Norway in January 1997 . The analyses included 88 adolescents at baseline , and 85 at follow-up . The question naire , which identified LBP as pain or ache in the low back during the preceding year , was answered at baseline in the classroom and at follow-up by post . Results . LBP was reported by 58 % at baseline and by 39 % at follow-up , and LBP provoked by manual work by 40 % at baseline and 26 % at follow-up . Thirty-one percent reported LBP at both occasions . LBP more than 7 days was reported by 32 % at baseline , by 26 % at follow-up , and by 18 % at both occasions . Twenty-two percent of those reporting LBP at baseline rejected ever LBP at follow-up . Baseline reports of LBP predicted corresponding reports of LBP at follow-up : Odds ratio was 4.7 ( 95 % confidence interval 1.7–12.7 ) for LBP generally , 9.1 ( 3.0–27.2 ) for LBP more than 7 days , 9.2 ( 2.9–28.8 ) for LBP provoked by manual work , and 3.8 ( 1.3–11.3 ) for LBP provoked by sitting at school . Conclusion . The findings indicate a persistent , but changeable , trend in LBP from midadolescence until late adolescence . The consistency and the high rates of reports of LBP provoked by manual work and sitting imply needs for more research on the persistence of LBP , and on relevant interventions during school age BACKGROUND Chronic low back pain ( LBP ) is a common musculoskeletal impairment in people with lower limb amputation . Given the multifactorial nature of LBP , exploring the factors influencing the presence and intensity of LBP is warranted . OBJECTIVE To investigate which physical , personal , and amputee-specific factors predicted the presence and intensity of LBP in persons with nondysvascular transfemoral amputation ( TFA ) and transtibial amputation ( TTA ) . DESIGN A retrospective cross-sectional survey . SETTING A national r and om sample of people with nondysvascular TFA and TTA . PARTICIPANTS Participants ( N = 526 ) with unilateral TFA and TTA due to nondysvascular etiology ( ie , trauma , tumors , and congenital causes ) and a minimum prosthesis use of 1 year since amputation were invited to participate in the survey . The data from 208 participants ( 43.4 % response rate ) were used for multivariate regression analysis . METHODS ( INDEPENDENT VARIABLES ) Personal ( ie , age , body mass , gender , work status , and presence of comorbid conditions ) , amputee-specific ( ie , level of amputation , years of prosthesis use , presence of phantom-limb pain , residual-limb problems , and nonamputated limb pain ) , and physical factors ( ie , pain-provoking postures including st and ing , bending , lifting , walking , sitting , sit-to-st and , and climbing stairs ) . MAIN OUTCOME MEASURES ( DEPENDENT VARIABLES ) LBP presence and intensity . RESULTS A multivariate logistic regression model showed that the presence of 2 or more comorbid conditions ( prevalence odds ratio [ POR ] = 4.34 , P = .01 ) , residual-limb problems ( POR = 3.76 , P < .01 ) , and phantom-limb pain ( POR = 2.46 , P = .01 ) influenced the presence of LBP . Given the high LBP prevalence ( 63 % ) in the study , there is a tendency for overestimation of POR , and the results must be interpreted with caution . In those with LBP , the presence of residual-limb problems ( β = 0.21 , P = .01 ) and experiencing LBP symptoms during sit-to-st and task ( β = 0.22 , P = .03 ) were positively associated with LBP intensity , whereas being employed demonstrated a negative association ( β = -0.18 , P = .03 ) in the multivariate linear regression model . CONCLUSIONS Rehabilitation professionals should be cognizant of the influence that comorbid conditions , residual-limb problems , and phantom pain have on the presence of LBP in people with nondysvascular lower limb amputation .  Further prospect i ve studies could investigate the underlying causal mechanisms of LBP . LEVEL OF EVIDENCE II Objective The St and Back study evaluated the feasibility and effects of a multicomponent intervention targeting reduced prolonged sitting and pain self-management in desk workers with chronic low back pain ( LBP ) . Methods This r and omised controlled trial recruited 27 individuals with chronic LBP , Oswestry Disability Index ( ODI ) > 10 % and desk jobs ( sitting ≥20 hours/week ) . Participants were r and omised within strata of ODI ( > 10%–<20 % , ≥20 % ) to receive bimonthly behavioural counselling ( in-person and telephone ) , a sit-st and desk attachment , a wrist-worn activity-prompting device and cognitive behavioural therapy for LBP self-management or control . Self-reported work sitting time , visual analogue scales ( VAS ) for LBP and the ODI were assessed by monthly , online question naires and compared across intervention groups using linear mixed models . Results Baseline mean ( SD ) age was 52 ( 11 ) years , 78 % were women , and ODI was 24.1 (10.5)% . Across the 6-month follow-up in models adjusted for baseline value , work sitting time was 1.5 hour/day ( P<0.001 ) lower comparing intervention to controls . Also across follow-up , ODI was on average 8 points lower in intervention versus control ( P=0.001 ) . At 6 months , the relative decrease in ODI from baseline was 50 % in intervention and 14 % in control ( P=0.042 ) . LBP from VAS was not significantly reduced in intervention versus control , though small-to-moderate effect sizes favouring the intervention were observed ( Cohen ’s d ranged from 0.22 to 0.42 ) . Conclusion An intervention coupling behavioural counselling targeting reduced sedentary behaviour and pain self-management is a translatable treatment strategy that shows promise for treating chronic LBP in desk-bound employees . Trial registration number NCT0224687 ; Pre- results Objective : The aim of the study was to determine whether  chronic low back pain ( LBP ) might be attenuated through the introduction of a sit-st and workstation ( SSW ) in office employees . Methods : Participants were r and omized to receive a SSW at the beginning or at the end of a 3-month study period . Participants responded to a short survey at the end of each workday and a comprehensive survey at weeks 1 , 6 , and 12 . Surveys consisted of a modified brief pain inventory and the Rol and Morris Disability Question naire . Results : Forty-six university employees with self-reported chronic LBP were enrolled . Participants who were given access to a SSW reported a significant reduction in current ( P = 0.02 ) and worst ( P = 0.04 ) LBP over time . Conclusions : Our findings support the hypothesis that chronic LBP might be improved by the introduction of a SSW in an office environment Study Design . Classification and functional assessment model for nonspecific low back pain ( LBP ) patients and controls on the basis of kinematic analysis parameters . Objective . Develop a logistic regression model using kinematic analysis variables to ( 1 ) discriminate between LBP patients and controls and ( 2 ) obtain objective parameters for LBP functional assessment . Summary of Background Data . Functional assessment of spinal disorders has been carried out traditionally by means of subjective scales . Objective functional techniques have been developed , which usually involve the application of external loads or the analysis of highly st and ardized trunk flexion-extension maneuvers . Few studies have used everyday activities such as sit-to-st and or lifting an object from the ground . They have shown that the motion patterns of LBP patients differ from those of healthy subjects . Nevertheless , very few studies have tried to correlate objective findings to the results of subjective scales , and no previous study has developed a LBP classification and functional assessment model on the basis of kinematic analysis of everyday activities . Methods . Sixteen controls and 39 LBP patients performed a sit-to-st and task , and lifted three different weights from a st and ing position . The vertical forces exerted and the relative positions of the lower limb and the cervical , thoracic , lumbar , and sacroiliac regions were recorded . Reliability was determined from repetitions of the tests performed by the control group . Binary logistic regression analyses were computed . The results of the selected regression equation were correlated to the Oswestry Disability Index scale results , to check the validity of the procedure for the measurement of functional disability . Results . Reliability of the parameters was good . The selected regression model used two variables , and correctly classified 97.3 % of the patients . High correlations were found between the results of this regression equation and the Oswestry Disability Index scale . Conclusion . It is possible to distinguish LBP patients from healthy subjects by means of the biomechanical analysis of everyday tasks . This kind of analysis can produce objective and reliable indexes about the patients ' degree of functional impairment Abstract In this study the effect of dynamic stimuli on  low back pain during prolonged sitting was investigated . The pain experience of two groups of 60 subjects with aspecific low back pain was recorded . All subjects were investigated on pain behaviour by the Multidimensional Pain Inventory ( MPI ) and pain was measured on an open visual analogue scale ( VAS ) . During sitting , one group received dynamic stimuli that were generated by alternating rotations in the horizontal plane of the seat of the chair , with back and arm rests in fixed position . Two different frequencies of rotation were applied in subgroups . The authors concluded that such stimuli , especially of the lower frequency , reduced pain in prolonged sitting There is limited evidence that preprogrammed feedforward adjustments , which are modified in people with neurological and musculoskeletal conditions , can be trained and whether this depends on the type of training . As previous findings demonstrate consistent delays in feedforward activation of the deep abdominal muscle , transversus abdominis ( TrA ) , in people with recurrent low back pain ( LBP ) , we investigated whether training involving voluntary muscle activation can change feedforward mechanisms , and whether this depends on the manner in which the muscle is trained . Twenty-two volunteers with recurrent LBP were r and omly assigned to undertake either training of isolated voluntary activation of TrA or sit-up training to activate TrA in a non-isolated manner to identical amplitude . Subjects performed a trunk perturbation task involving arm movement prior to and after training , and surface and fine-wire electromyography ( EMG ) recordings were made from trunk and arm muscles . Following a single session of training of isolated voluntary activation of TrA , onset of TrA EMG was earlier during rapid arm flexion and extension , to more closely resemble the responses in pain-free individuals . The magnitude of change in TrA EMG onset was correlated with the quality of isolated training . In contrast , all of the abdominal muscles were recruited earlier during arm flexion after sit-up training , while onset of TrA EMG was further delayed during arm extension . The results provide evidence that training of isolated muscle activation leads to changes in feedforward postural strategies , and the magnitude of the effect is dependent on the type and quality of motor training OBJECTIVES Some occupations are more prone to low back pain ( LBP ) due to their static work postures and work place design . Multidisciplinary pain programs have shown their effectiveness in the management of LBP in general population but which treatment and which segment of the population will be benefited more was not investigated yet . This study determines the effect of two treatment protocol s on five occupationally subgrouped male LBP patients . METHODS A total of 102 occupational male , 20 - 40 yrs of age , with sub-acute or chronic nonspecific LBP were r and omized and treated either with conventional treatment a combination of two electrotherapy ( ultrasound and short wave diathermy ) and one exercise therapy ( lumbar strengthening exercises ) or dynamic muscular stabilization techniques ( DMST ) an active approach of stabilizing training . At the end of the treatment , subjects of both the groups were further stratified in five subgroups on the basis of their occupation . The pain was the primary outcome measure while physical strength [ back pressure changes ( BPC ) and abdominal pressure changes ( APC ) ] the secondary . RESULTS The Pain , BPC and APC of all subgroups improved significantly ( P < 0.01 ) in the both treatments but more in DMST . For each variable , improvement in subgroups differed within and between the treatments . Overall improvement in all assessed variables were evident on Desk workers followed by Shop keepers the most while BPC of Movement job , APC of Others and Pain of Sedentary and Shop keepers improved the least . CONCLUSIONS Study concluded that for the management of occupational LBP , DMST is more effective than conventional treatment . The Pain of Sedentary and Shopkeepers and physical strength of Movement job and Others may need more clinical attention . Findings of this study may be helpful in the management of occupational LBP Background Most patients in the secondary care sector consulting for low back pain ( LBP ) seem to have a more or less constant course of pain during the ensuing year . Fewer patients with LBP in the primary care sector report continual pain over a one-year period . However , not much is known about the long-term course of LBP in the general population . A systematic critical literature review was undertaken in order to study the natural course of LBP over time in the general population . Methods A search of articles was performed in Pubmed , Cinahl and Psychinfo using the search terms ‘ epidemiology ’ ; ‘ low back pain ’ or ‘ back pain ’ ; ‘ prospect i ve study ’ or ‘ longitudinal study ’ ; ‘ follow-up ’ , ‘ natural course ’ , ‘ course ’ or ‘ natural history ’ ; ‘ general population ’ or ‘ working population ’ . Inclusion criteria were that one of the objectives was to study the course of (L)BP in the adult population , that the period of follow-up was at least 3 months , and that there were three points of observation or more . The review was undertaken by two independent review ers using three checklists relating to description of studies , quality and outcomes . The course of LBP was established in relation to those who , at baseline , were reported not to have LBP or to have LBP . Would this course be stable , fluctuating , worsening , or improving over time ? A synthesis of results in relation to common patterns was presented in a table and interpreted in a narrative form . Results Eight articles were included . Articles were different on time span , the number of surveys , and the definition of LBP . In six of the seven relevant studies , for those with no LBP at baseline , relatively substantial stable subgroups of people who continued to be LBP free were identified . In six of the seven relevant studies , definite stable subgroups of continued LBP were noted and improvement ( becoming pain free ) was never reported to be a common finding . Conclusion The status of LBP in individuals of the general population appears to be relatively stable over time , perhaps particularly so for those without LBP at baseline Objective : The objectives of this study were to assess the effect of unstable s and als on ( 1 ) low back pain ( LBP ) in golfers with undiagnosed moderate LBP , ( 2 ) static and dynamic balance , and ( 3 ) golf performance . Design : This was a 6-week prospect i ve study where subjects were r and omized to a control group and an intervention group . Setting : Baseline measurements were recorded in the Human Performance Laboratory . Participants : Forty male golfers with nonspecific moderate LBP . Intervention : The intervention group wore unstable shoes for 6 weeks , and the control group wore their regular golf shoes . Main Outcome Measures : Low back pain , timed balance , and golf performance were assessed at baseline and at 6 weeks . Changes were compared through independent sample s t tests . Results : ( 1 ) There was a significant difference between groups in the change of perceived LBP scores in the laboratory ( test group : −17.5/100 mm , control : −3.6/100 mm ) and in the comparison of the first week entries to the last week entries recorded in logbooks ( test group : −10.7/100 mm , control group : + 2.6/100 mm ) . ( 2 ) There was no significant change in the static or dynamic balance times . ( 3 ) There was no significant change in golf performance between the intervention and control groups . Conclusion : The results indicate that unstable s and als can be used to reduce moderate lower back pain in this population of golfers without negatively affecting performance The aim was to examine lumbar spine kinematics , spinal joint loads and trunk muscle activation patterns during a prolonged ( 2 h ) period of sitting .  This information is necessary to assist the ergonomist in design ing work where posture variation is possible — particularly between st and ing and various styles of  sitting  . Joint loads were predicted with a highly detailed anatomical biomechanical model ( that incorporated 104 muscles , passive ligaments and intervertebral discs ) , which utilized biological signals of spine posture and muscle electromyograms ( EMG ) from each trial of each subject . Sitting result ed in significantly higher ( p < 0.001 ) low back compressive loads ( mean±SD 1698±467 N ) than those experienced by the lumbar spine during st and ing ( 1076±243 N ) . Subjects were equally divided into adopting one of two sitting strategies : a single ‘ static ’ or a ‘ dynamic ’ multiple posture approach . Within each individual , st and ing produced a distinctly diVerent spine posture compared with sitting , and st and ing spine postures did not overlap with flexion postures adopted in sitting when spine postures were averaged across all eight subjects . A rest component ( as noted in an amplitude probability distribution function from the EMG ) was present for all muscles monitored in both sitting and st and ing tasks . The upper and lower erector spinae muscle groups exhibited a shifting to higher levels of activation during sitting . There were no clear muscle activation level diVerences in the individuals who adopted diVerent sitting strategies . St and ing appears to be a good rest from sitting given the reduction in passive tissue forces . However , the constant loading with little dynamic movement which characterizes both st and ing and sitting would provide little rest/change for muscular activation levels or low back loading 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 There is controversy regarding the best technique for applying Kinesio Taping ( KT ) , and the theory supporting that skin convolutions may explain its efficacy has recently been challenged . OBJECTIVE To compare the immediate and short-term effectiveness of KT tightness on mechanosensitivity and spinal mobility in nonspecific low back pain ( LBP ) , and to observe the influence of gender in the outcome measures . DESIGN Double-blind , r and omized , controlled trial . SETTING University-based clinical research center . PARTICIPANTS A total of 75 individuals with a mean age of 33 years ( ±7.4 years ) , 60 % female and 40 % male , with nonspecific LBP were recruited and r and omly assigned to 1 of the following study groups : st and ard KT tension ( n = 26 ) , increased KT tension ( n = 25 ) , and no KT tension ( n = 24 ) . INTERVENTIONS All participants received a two I-strip taping over the paravertebral muscles for 24 hours . Paper-off tension ( 15%-25 % of the available stretch ) was used in the st and ard KT group , which was increased to 40 % in the increased KT tension group . The rest of participants received a taping procedure with no KT tension . Measurements were taken at baseline , immediately after the taping , 24 hours after the taping , and after KT removal . MAIN OUTCOME MEASURES The primary outcome included pressure pain thresholds over the erector spinae and gluteus medius muscles . The secondary outcome was lumbar mobility ( assessed with a digital inclinometer , and back-saver sit- and -reach , finger-to-floor , and sit- and -reach tests ) . RESULTS In the between-groups analysis of the mean score changes after baseline assessment , no significant differences were found for any of the outcome measures ( P > .05 ) except the left back-saver sit- and -reach test ( P = .03 ) . A statistically significant interaction group × gender × time was observed only for mechanosensitivity values ( P = .02 for the gluteus and P = .01 for the erector spinae ) . CONCLUSION KT tightness does not seem to influence pain sensitivity and lumbar mobility in chronic LBP in either the immediate or short term . LEVEL OF EVIDENCE II Pain is a syndrome characterized by several neurophysiological changes including that of the autonomic nervous system . Chronic low back pain ( LBP ) is a major health problem and is a frequent reason for using unconventional therapies especially acupuncture . This study was conducted to evaluate the autonomic status and pain profile in chronic LBP patients and to observe the effect of electro acupuncture therapy . Chronic LBP patients ( n=60 ) were recruited from the Department of Orthopaedics , GTB Hospital , Delhi . Age and sex matched healthy volunteers were selected as controls ( n=30 ) . Following a written consent , LBP patients were r and omly allocated into two study groups - Group A received 10 sittings of electro acupuncture , on alternate days , at GB and UB points selected for back pain , while the Group B received a conventional drug therapy in the form of oral Valdecoxib together with supervised physiotherapy . Controls were assessed once while the patients were assessed twice , before and after completion of the treatment program ( 3 weeks ) . The autonomic status was studied with non-invasive cardiovascular autonomic function tests which included E : I ratio , 30:15 ratio , postural challenge test and sustained h and grip test . Pain intensity was measured with the visual analogue scale ( VAS ) and the global perceived effect ( GPE ) . Statistical analysis was performed using repeated measure 's ANOVA with Tukey 's test . Pain patients showed a significantly reduced vagal tone and increased sympathetic activity as compared to the controls ( P<0.05 to P<0.001 in different variables ) . Following treatment , both the study groups showed a reduction in vagal tone together with a decrease in the sympathetic activity . There was also a considerable relief of pain in both groups , however , the acupuncture group showed a better response ( P<0.01 ) . We conclude that there is autonomic dysfunction in chronic LBP patients . Acupuncture effectively relieves the pain and improves the autonomic status and hence can be used as an alternative/additive treatment modality in these cases Study Design . Three factors mixed- design with 1 between-subject and 2 within-subject factors . Objective . To compare the main effects and interactions of postural and cognitive difficulty on quiet stance between subjects with and without nonspecific low back pain ( LBP ) . Summary of Background Data . The interference between postural control and cognitive tasks depends on factors such as sensorimotor/cognitive integrity . Changes in peripheral sensory and muscular systems as well as cognitive processes have been observed in LBP patients . It was hypothesized that the effect of cognitive task on postural performance might be different in subjects with nonspecific LBP as compared with healthy individuals . To the authors ’ knowledge this has not been investigated before . Methods . Postural stability was measured by center of pressure parameters while nonspecific LBP ( n = 22 ) and healthy ( n = 22 ) subjects r and omly performed quiet st and ing task with 3 levels of difficulty ( rigid-surface eyes open , rigid-surface eyes-closed , and foam-surface eyes-closed ) in isolation or concurrently with an easy or difficult digits backward cognitive task . Results . Subjects with nonspecific LBP had less postural sway than healthy subjects , while postural sway decreased with increase in the level of cognitive difficulty . Nonspecific LBP and healthy subjects had larger postural sway at more difficult sensory conditions such as rigid-surface eyes-closed and foam-surface eyes-closed . The response to dual-tasking was not significantly different between the 2 groups . Conclusion . The dual-tasking did not change the postural performance of nonspecific LBP subjects with low level of pain and disability differently compared to healthy subjects Objective To compare the effects of lumbar stabilization exercises and lumbar dynamic strengthening exercises on the maximal isometric strength of the lumbar extensors , pain severity and functional disability in patients with chronic low back pain ( LBP ) . Methods Patients suffering nonspecific LBP for more than 3 months were included prospect ively and r and omized into lumbar stabilization exercise group ( n=11 ) or lumbar dynamic strengthening exercise group ( n=10 ) . Exercises were performed for 1 hour , twice weekly , for 8 weeks . The strength of the lumbar extensors was measured at various angles ranging from 0 ° to 72 ° at intervals of 12 ° , using a MedX. The visual analog scale ( VAS ) and the Oswestry Low Back Pain Disability Question naire ( ODQ ) were used to measure the severity of LBP and functional disability before and after the exercise . Results Compared with the baseline , lumbar extension strength at all angles improved significantly in both groups after 8 weeks . The improvements were significantly greater in the lumbar stabilization exercise group at 0 ° and 12 ° of lumbar flexion . VAS decreased significantly after treatment ; however , the changes were not significantly different between the groups . ODQ scores improved significantly in the stabilization exercise group only . Conclusion Both lumbar stabilization and dynamic strengthening exercise strengthened the lumbar extensors and reduced LBP . However , the lumbar stabilization exercise was more effective in lumbar extensor strengthening and functional improvement in patients with nonspecific chronic LBP Study Design . A r and omized controlled trial was performed . Objectives . To evaluate how 2 different treatment options affect perception of health , pain , and physical functioning over time among children and adolescents with low back pain ( LBP ) . Summary of Background Data . LBP among children and adolescents has increased . The literature shows that children with LBP also suffer from this condition as adults . Thus , it is important to prevent and treat LBP in children and adolescents . Methods . Forty-five children and adolescents were consecutively r and omized into one of 2 treatment groups and were studied for 12 weeks . Group 1 was given individualized physical therapy and exercise and a st and ardized self-training program and back education . Group 2 was given self-training program and back education but no individualized therapy . The children and adolescents were tested before and after the treatment period .  Child Health Question naire Child Form 87 , Rol and & Morris Disability Question naire , Painometer , Back Saver Sit and Reach , and test of trunk muscle endurance  were used to evaluate the interventions . Results . Both groups improved statistically significant in most parameters over time . On comparison between the groups the physical function measured by Rol and & Morris Disability Question naire and the duration of pain measured by Painometer improved statistically significant in Group 1 . Conclusion . An individual assessment by a knowledgeable physiotherapist and an active treatment model improve how children and adolescents experience their back problems with respect to health and physical function , pain , strength , and mobility , regardless of whether treatment consists of a home exercise program with follow-up or home exercise combined with exercise and treatment supervised by a physiotherapist Low back pain ( LBP ) poses a significant problem to society . Although initial conservative therapy may be beneficial , persisting chronic LBP still frequently leads to expensive invasive intervention . A novel non-invasive therapy that focuses on discogenic LBP is Intervertebral Differential Dynamics Therapy ® ( IDD Therapy , North American Medical Corp. Reg U.S. ) . IDD Therapy consists of intermittent traction sessions in the Accu-SPINA device ( Steadfast Corporation Ltd , Essex , UK ) , an FDA approved , class II medical device . The intervertebral disc and facet joints are unloaded through axial distraction , positioning and relaxation cycles . The purpose of this study is to investigate the effect of IDD Therapy when added to a st and ard grade d activity program for chronic LBP patients . In a single blind , single centre , r and omized controlled trial ; 60 consecutive patients were assigned to either the SHAM or the IDD Therapy . All subjects received the st and ard conservative therapeutic care ( grade d activity ) and 20 sessions in the Accu-SPINA device . The traction weight in the IDD Therapy was systematic ally increased until 50 % of a person ’s body weight plus 4.45 kg ( 10 lb ) was reached . The SHAM group received a non-therapeutic traction weight of 4.45 kg in all sessions . The main outcome was assessed using a 100-mm visual analogue scale ( VAS ) for LBP . Secondary outcomes were VAS scores for leg pain , Oswestry Disability Index ( ODI ) , Short-Form 36 ( SF-36 ) . All parameters were measured before and 2 , 6 and 14 weeks after start of the treatment . Fear of (re)injury due to movement or activities ( Tampa Scale for Kinesiophobia ) , coping strategies ( Utrecht Coping List ) and use of pain medication were recorded before and at 14 weeks . A repeated measures analysis was performed . The two groups were comparable at baseline in terms of demographic , clinical and psychological characteristics , indicating that the r and om allocation had succeeded . VAS low back pain improved significantly from 61 ( ±25 ) to 32 ( ±27 ) with the IDD protocol and 53 ( ±26 ) to 36 ( ±27 ) in the SHAM protocol . Moreover , leg pain , ODI and SF-36 scores improved significantly but in both groups . The use of pain medication decreased significantly , whereas scores for kinesiophobia and coping remained at the same non-pathological level . None of the parameters showed a difference between both protocol s. Both treatment regimes had a significant beneficial effect on LBP , leg pain , functional status and quality of life after 14 weeks . The added axial , intermittent , mechanical traction of IDD Therapy to a st and ard grade d activity program has been shown not to be effective Study Design . Subjective ratings of discomfort were compared between a fixed lumbar support and lumbar support continuous passive motion ( CPM ) device . Objective . To compare a fixed lumbar support with a lumbar support CPM device during prolonged sitting . Summary of Background Data . To prevent low back pain during prolonged sitting , an inflatable lumbar support CPM has been developed . There are no studies that compare static lumbar support with lumbar CPM using the same pressure in the cushions . Methods . A total of 31 male volunteers without low back pain sat in the same chair for a 2-hour period on each of 3 consecutive days under 3 r and omized test methods : 1 , no lumbar support ; 2 , static lumbar support ; and 3 , lumbar support CPM . Each subject rated low back pain , stiffness , fatigue , and buttock numbness on a visual analog scale ( VAS ) .  Fixed lumbar support and CPM device were compared with a same inflation pressure in the cushion . For 10 subjects , the whole body posture and the pressure distribution changes of the human-seat interface during CPM were evaluated . Results . Compared with no lumbar support , a significant improvement in VAS scores for low back pain , stiffness , and fatigue was obtained with both static lumbar support and with lumbar support CPM ( P < 0.005 ) . A significant ( P < 0.005 ) improvement for buttock numbness was obtained only with lumbar support CPM . There were no statistical differences in all VAS scores between the fixed lumbar support and the CPM device . A forward rotation of the pelvic region was obtained during inflation of the cushion during CPM . Significant differences ( P < 0.05 ) were found between cushion inflation and deflation periods both in contact areas and in the peak pressures at the human-seat interface . Conclusion . There were no statistical differences in the subjective ratings of discomfort between the fixed lumbar support and the CPM device Introduction The Multinational Musculoskeletal Inception Cohort Study ( MMICS ) Statement is a consensus statement aim ed at improving the quality of prospect i ve investigations into the transition from early stages of low back pain ( LBP ) to persistent problems . The statement aims to help improve the quality of such studies by recommending an agreed minimal list of measures for inclusion in baseline data collection . The MMICS Statement is primarily aim ed at research ers who want to investigate prognosis in LBP , and this will allow data from cohorts to be pooled and will facilitate comparisons between different health care systems . One approach to preventing acute new episodes of LBP ( up to 3 weeks from onset ) from developing into persistent disabling pain is to identify those individuals with LBP who are most likely to progress to chronic disability . Targeting interventions at those at highest risk could reduce the population burden of chronic LBP . A wide range of baseline parameters have been associated with poor outcome in inception cohort studies ( 1–6 ) . Few existing studies have been of sufficient size and method ologic rigor to produce conclusive findings . Even in method ologically robust studies , baseline factors only account for a small proportion of the variance in outcome ( 7 ) , typically around 30 % . Systematic review s of the literature could not pool data because studies used different measurements ( 1–3 ) . Despite some information on physical , psychosocial , and work-related risk factors , it has not been possible to adequately estimate the comparative impact of individual psychosocial and societal factors on the transition from acute to persistent disabling LBP . How to address this problem was one focus of the VI International Forum for Primary Care Research in Low Back Pain held in April 2003 . A steering group for the collaboration was appointed , and 8 national team leaders volunteered to recruit teams of national experts . Three additional team leaders were recruited by the steering group ( Australia , France , and Germany ) . Independent experts were invited to advise on the quality of the MMICS process . The MMICS steering group , located in the UK , met regularly and included expert research ers in clinical and outcome factors in back pain ( AB ) , work-related issues in back pain ( AKB ) , psychosocial aspects of back pain ( TP and RS ) , and general practice aspects of back pain ( MU ) . The MMICS Statement set out to include 1 ) a minimal but comprehensive number of predictor factors based on current evidence and theory ; 2 ) appropriate measurement instruments for agreed predictor factors based on their clinometric properties , availability , and practical characteristics ; and 3 ) a minimum set of followup measures , including recommendations about measurement and timing
The results suggest there is currently no evidence to support the use of dynamic sitting as a st and -alone approach in the management of LBP .
Overall , the evidence suggests that dynamic sitting approaches are not effective as a st and -alone management approach for LBP
Dynamic sitting has been proposed to reduce  low back pain ( LBP ) and /or low back discomfort ( LBD ) while sitting .
This is supported by studies suggesting that subjects with LBP assume more static , sustained postures while sitting .
This systematic review investigated the effect of dynamic sitting on LBP among subjects with LBP and the development of LBD among pain-free subjects .
Practitioner Summary : This systematic review investigated the effect of dynamic sitting on LBP or LBD .