Christopher J. Sorensen

Is lumbar lordosis related to low back pain development during prolonged standing

BACKGROUND An induced-pain paradigm has been used in back-healthy people to understand risk factors for developing low back pain during prolonged standing. OBJECTIVES The purposes of this study were to (1) compare baseline lumbar lordosis in back-healthy participants who do (Pain Developers) and do not (Non-Pain Developers) develop low back pain during 2 h of standing, and (2) examine the relationship between lumbar lordosis and low back pain intensity. DESIGN Cross-sectional. METHOD First, participants stood while positions of markers placed superficial to the lumbar vertebrae were recorded using a motion capture system. Following collection of marker positions, participants stood for 2 h while performing light work tasks. At baseline and every 15 min during standing, participants rated their low back pain intensity on a visual analog scale. Lumbar lordosis was calculated using marker positions collected prior to the 2 h standing period. Lumbar lordosis was compared between pain developers and non-pain developers. In pain developers, the relationship between lumbar lordosis and maximum pain was examined. RESULTS/FINDINGS There were 24 (42%) pain developers and 33 (58%) non-pain developers. Lumbar lordosis was significantly larger in pain developers compared to non-pain developers (Mean difference = 4.4°; 95% Confidence Interval = 0.9° to 7.8°, Cohens d = 0.7). The correlation coefficient between lumbar lordosis and maximum pain was 0.46 (P = 0.02). CONCLUSION The results suggest that standing in more lumbar lordosis may be a risk factor for low back pain development during prolonged periods of standing. Identifying risk factors for low back pain development can inform preventative and early intervention strategies.

Association between rotation-related impairments and activity type in people with and without low back pain.

OBJECTIVE To determine whether people with low back pain (LBP) who regularly participated in a rotation-related activity displayed more rotation-related impairments than people without LBP who did and did not participate in the activity. DESIGN Secondary analysis of data from a case-control study. SETTING Musculoskeletal analysis laboratory at an academic medical center. PARTICIPANTS A convenience sample of participants with LBP (n=55) who participated in a rotation-related sport, back-healthy controls (n=26) who participated in a rotation-related sport, and back-healthy controls (n=42) who did not participate in a rotation-related sport. Participants were matched based on age, sex, and activity level. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The total number of rotation-related impairments and asymmetrical rotation-related impairments identified during a standardized clinical examination. RESULTS Compared with the back-healthy controls who do not play a rotation-related sport group, both the LBP and back-healthy controls who play a rotation-related sport groups displayed significantly more (1) rotation-related impairments (LBP, P<.001; back-healthy controls who play a rotation-related sport, P=.015), (2) asymmetrical rotation-related impairments (LBP, P=.006; back-healthy controls who play a rotation-related sport, P=.020), and (3) rotation-related impairments with trunk movement tests (LBP, P=.002; back-healthy controls who play a rotation-related sport, P<.001). The LBP group had significantly more rotation-related impairments with extremity movement tests than both of the back-healthy groups (back-healthy controls who play a rotation-related sport, P=.011; back-healthy controls who do not play a rotation-related sport, P<.001). CONCLUSIONS The LBP and back-healthy controls who play a rotation-related sport groups demonstrated a similar number of total rotation-related impairments and asymmetrical rotation-related impairments, and these numbers were greater than those of the back-healthy controls who do not play a rotation-related sport group. Compared with people without LBP, people with LBP displayed more rotation-related impairments when moving an extremity. These findings suggest that impairments associated with extremity movements may be associated with having an LBP condition.

Validity of a Paradigm for Low Back Pain Symptom Development During Prolonged Standing.

Objectives:Examine the validity of an induced pain paradigm in which people stand while performing simulated light work tasks (standing paradigm). Materials and Methods:Initially, people with low back pain (LBP) reported the quality and location of their typical symptoms on a body pain diagram. Then, people with LBP and back-healthy people stood for 2 hours and reported the intensity, quality, and location of symptoms at baseline and every 15 minutes. Quality and location of typical symptoms of people with LBP were compared with their symptoms during standing. Back-healthy people were separated into pain developers (PDs) and nonpain developers. Symptom quality and location were compared between people with LBP and PDs. Results:There were no differences in the quality and location of typical symptoms and symptoms during standing in people with LBP (P>0.05). Three symptom descriptors were used by >30% of people with LBP to describe typical symptoms. Only 2 people with LBP used these descriptors to describe typical symptoms but not during standing. There were no differences in the quality and location of symptoms reported in standing between people with LBP and PDs (P>0.05). Four symptom descriptors were used by >30% of participants with LBP during standing. There were no symptoms reported by PDs that were not reported by people with LBP. Discussion:This study provides evidence that symptoms experienced during the standing paradigm are similar to symptoms experienced by people with LBP and, thus, provides support for the validity of the paradigm.

Psychological Factors Are Related to Pain Intensity in Back-Healthy People Who Develop Clinically Relevant Pain During Prolonged Standing: A Preliminary Study

An induced‐pain paradigm has been used to examine risk factors for the development of low back pain (LBP) during prolonged standing in back‐healthy people (standing paradigm). Previous studies that used induced‐pain methods suggest that pain intensity may be related to psychologic factors. It is not currently known, however, whether pain intensity reported during the standing paradigm is related to psychologic factors.

Relationship of shoulder activity and skin intrinsic fluorescence with low level shoulder pain and disability in people with type 2 diabetes

AIM People with type 2 diabetes (T2DM) have a high incidence of musculoskeletal disorders thought to be influenced by high non-enzymatic advanced glycated end-products (AGEs). The goals of this study were to determine differences in shoulder activity level and AGEs in people with T2DM compared to matched controls, and to determine factors associated with shoulder pain and disability. METHODS Eighty-one participants, T2DM (n=52) and controls (n=29), were examined for magnitude and duration of shoulder activity (measured using accelerometers), skin intrinsic florescence (SIF) as a surrogate measure of AGE level, and the Shoulder Pain and Disability Index (SPADI) as a self-report of shoulder pain and disability. RESULTS Compared with controls, T2DM participants had 23% less shoulder activity (p=0.01), greater SIF level (3.6±1.7 vs 2.7±0.6AU, p=0.01), less shoulder strength (p<0.05), and the duration of their shoulder activity was moderately associated (r=0.40; p<0.01) with reported shoulder pain and disability. Shoulder pain and disability were not related to SIF level. CONCLUSIONS Persons with T2DM have higher SIF levels and shoulder symptoms and disability indices than controls. Research is needed to determine if a shoulder mobility intervention to increase strength and mobility can help decrease shoulder pain and disability.

Asymmetry of lumbopelvic movement patterns during active hip abduction is a risk factor for low back pain development during standing

An induced-pain paradigm has been used in back-healthy people to understand risk factors for developing low back pain (LBP) during prolonged standing. We examined asymmetry of lumbopelvic movement timing during a clinical test of active hip abduction in back-healthy people who developed LBP symptoms during standing (Pain Developers; PDs) compared to back-healthy people who did not develop LBP symptoms during standing (Non Pain Developers, NPDs). Participants completed the hip abduction test while movement was recorded with a motion capture system. Difference in time between start of hip and lumbopelvic movement was calculated (startdiff). PDs moved the lumbopelvic region earlier during left hip abduction than right hip abduction. There was no difference between sides in NPDs. In PDs, the amount of asymmetry was related to average symptom intensity during standing. Asymmetric lumbopelvic movement patterns may be a risk factor for LBP development during prolonged standing.

Diffusion Tensor Imaging of the Calf Muscles in Subjects With and Without Diabetes Mellitus: Calf Muscle DTI in DM Subjects

Diffusion tensor imaging (DTI) has been used to characterize calf skeletal muscle architecture.