Neil Osborne

Incidence of ponticulus posterior of the atlas in migraine and cervicogenic headache.

BACKGROUND The clinical significance of the ponticulus posticus is far from clear. It has been associated with headaches, Barré-Lieou syndrome, photophobia, and migraine. However, little epidemiologic evidence for this exists. OBJECTIVE This study investigated the relationship of ponticulus posticus on x-ray studies and headache symptoms in a series of chiropractic patients. METHODS Eight hundred ninety-five patients who visited a chiropractic clinic for the first time and whose conditions required cervical spine x-ray examinations were studied. Complaints were categorized as migraine with aura, migraine without aura, cervicogenic headache, neck pain only, and other conditions. The presence or absence of the ponticulus posticus (whether partial or complete) was determined by means of a lateral cervical film and noted as a positive or negative finding. The data were analyzed by frequency analysis and Pearsons chi 2 test. RESULTS Forty-six percent of the sample were men and the predominant complaint was neck pain (33%). Most patients were in the fourth decade of life. The frequencies of the other complaints were migraine with aura (7%), migraine without aura (4%), cervicogenic headache (22%), other conditions (33%). An 18% prevalence of ponticulus posticus was found. This finding was significantly associated with migraine without aura (chi 2 = 4.97; P = .03) and not with any other conditions. CONCLUSION In a chiropractic patient population that required cervical x-ray examinations, a significant association was found between ponticulus posticus and migraine without aura, with an odds ratio of 2.19:1 in favor of this complaint being present with the osseous anomaly. The mechanism for this remains obscure but may be related to ischemic compression of the vertebral artery or by dural tension at the craniocervical junction.

A randomized controlled trial of limited range of motion lumbar extension exercise in chronic low back pain.

Study Design. Randomized controlled trial. Objective. To compare the effects of full range of motion (ROM) and limited ROM isolated lumbar extension exercise upon full ROM lumbar extension strength, ROM, perceived pain, and disability. Summary of Background Data. Limited ROM is common in chronic low back pain as is lumbar extensor deconditioning. Limited ROM exercise is a common prescription but is yet to be empirically tested. Methods. Males (n = 21) and females (n = 17) with nonspecific chronic low back pain were initially recruited. Participants were randomized to either a full ROM (FullROM) or limited ROM (LimROM) training group or a control group. A total of 24 participants (males: n = 14, females: n = 10) completed the study and were included in analysis. The intervention lasted 12 weeks. FullROM and LimROM groups completed isolated lumbar extension resistance training once per week, performing one set of exercise at 80% of their maximal tested functional torque to failure. FullROM group trained through a full ROM. LimROM group trained through the mid 50% of their full ROM. Full ROM isolated lumbar extension strength, lumbar and standing ROM (Schobers test), perceived pain (visual analogue scale), and disability (Revised Oswestry Disability Index) were measured pre- and postintervention. Results. FullROM and LimROM significantly improved in full ROM lumbar extension strength, perceived pain, and disability compared with the control group. No changes occurred in lumbar or standing ROM. No significant differences were found between either FullROM or LimROM for any outcome measure. Changes in perceived pain and disability met minimal clinically important change values for FullROM (visual analogue scale, −30.3 + 25.76 mm and Oswestry Disability Index, −18.2 + 6.63 patients) and LimROM (visual analogue scale, −16.29 + 10.97 mm and Oswestry Disability Index, −12 + 5.16 patients). Conclusion. The results suggest that both FullROM and LimROM are equally effective in increasing full ROM lumbar extension strength and producing clinically meaningful improvement in perceived pain and disability. Level of Evidence: 2

Lumbar kinematic variability during gait in chronic low back pain and associations with pain, disability and isolated lumbar extension strength

BACKGROUND Chronic low back pain is a multifactorial condition with many dysfunctions including gait variability. The lumbar spine and its musculature are involved during gait and in chronic low back pain the lumbar extensors are often deconditioned. It was therefore of interest to examine relationships between lumbar kinematic variability during gait, with pain, disability and isolated lumbar extension strength in participants with chronic low back pain. METHODS Twenty four participants with chronic low back pain were assessed for lumbar kinematics during gait, isolated lumbar extension strength, pain, and disability. Angular displacement and kinematic waveform pattern and offset variability were examined. FINDINGS Angular displacement and kinematic waveform pattern and offset variability differed across movement planes; displacement was highest and similar in frontal and transverse planes, and pattern variability and offset variability higher in the sagittal plane compared to frontal and transverse planes which were similar. Spearmans correlations showed significant correlations between transverse plane pattern variability and isolated lumbar extension strength (r=-.411) and disability (r=.401). However, pain was not correlated with pattern variability in any plane. The r(2) values suggested 80.5% to 86.3% of variance was accounted for by other variables. INTERPRETATION Considering the lumbar extensors role in gait, the relationship between both isolated lumbar extension strength and disability with transverse plane pattern variability suggests that gait variability may result in consequence of lumbar extensor deconditioning or disability accompanying chronic low back pain. However, further study should examine the temporality of these relationships and other variables might account for the unexplained variance.

A Randomized Controlled Trial of the Effects of Isolated Lumbar Extension Exercise on Lumbar Kinematic Pattern Variability During Gait in Chronic Low Back Pain

Chronic low back pain (CLBP) is a multifactorial condition with a variety of symptoms, one of which is abnormal gait. The lumbar spine and its musculature are important in controlling gait, and in CLBP the lumbar extensors are often deconditioned. Because of this specific isolated lumbar extension, exercise often is recommended. It was therefore of interest to examine its effects of upon gait variability.

Associations between Trunk Extension Endurance and Isolated Lumbar Extension Strength in Both Asymptomatic Participants and Those with Chronic Low Back Pain

Background: Strength and endurance tests are important for both clinical practice and research due to the key role they play in musculoskeletal function. In particular, deconditioning of the lumbar extensor musculature has been associated with low back pain (LBP). Due to the relationship between strength and absolute endurance, it is possible that trunk extension (TEX) endurance tests could provide a proxy measure of isolated lumbar extension (ILEX) strength and thus represent a simple, practical alternative to ILEX measurements. Though, the comparability of TEX endurance and ILEX strength is presently unclear and so the aim of the present study was to examine this relationship. Methods: Thirty eight healthy participants and nineteen participants with non-specific chronic LBP and no previous lumbar surgery participated in this cross-sectional study design. TEX endurance was measured using the Biering–Sorensen test. A maximal ILEX strength test was performed on the MedX lumbar-extension machine. Results: A Pearson’s correlation revealed no relationship between TEX endurance and ILEX strength in the combined group (r = 0.035, p = 0.793), the chronic LBP group (r = 0.120, p = 0.623) or the asymptomatic group (r = −0.060, p = 0.720). Conclusions: The results suggest that TEX is not a good indicator of ILEX and cannot be used to infer results regarding ILEX strength. However, a combination of TEX and ILEX interpreted together likely offers the greatest and most comprehensive information regarding lumbo-pelvic function during extension.

Attainment rate as a surrogate indicator of the intervertebral neutral zone length in lateral bending: an in vitro proof of concept study

BackgroundLumbar segmental instability is often considered to be a cause of chronic low back pain. However, defining its measurement has been largely limited to laboratory studies. These have characterised segmental stability as the intrinsic resistance of spine specimens to initial bending moments by quantifying the dynamic neutral zone. However these measurements have been impossible to obtain in vivo without invasive procedures, preventing the assessment of intervertebral stability in patients. Quantitative fluoroscopy (QF), measures the initial velocity of the attainment of intervertebral rotational motion in patients, which may to some extent be representative of the dynamic neutral zone. This study sought to explore the possible relationship between the dynamic neutral zone and intervertebral rotational attainment rate as measured with (QF) in an in vitro preparation. The purpose was to find out if further work into this concept is worth pursuing.MethodThis study used passive recumbent QF in a multi-segmental porcine model. This assessed the intrinsic intervertebral responses to a minimal coronal plane bending moment as measured with a digital force guage. Bending moments about each intervertebral joint were calculated and correlated with the rate at which global motion was attained at each intervertebral segment in the first 10° of global motion where the intervertebral joint was rotating.ResultsUnlike previous studies of single segment specimens, a neutral zone was found to exist during lateral bending. The initial attainment rates for left and right lateral flexion were comparable to previously published in vivo values for healthy controls. Substantial and highly significant levels of correlation between initial attainment rate and neutral zone were found for left (Rho = 0.75, P = 0.0002) and combined left-right bending (Rho = 0.72, P = 0.0001) and moderate ones for right alone (Rho = 0.55, P = 0.0012).ConclusionsThis study found good correlation between the initial intervertebral attainment rate and the dynamic neutral zone, thereby opening the possibility to detect segmental instability from clinical studies. However the results must be treated with caution. Further studies with multiple specimens and adding sagittal plane motion are warranted.

Isolated Lumbar Extension Resistance Training Improves Strength, Pain, and Disability, but Not Spinal Height or Shrinkage (“Creep”) in Participants with Chronic Low Back Pain

Objective. Loss of disc height is commonly associated with chronic low back pain (CLBP). Isolated lumbar extension (ILEX) exercise for the lumbar extensors is recommended to treat CLBP and is suggested such exercise might promote disc healing and regeneration. This study examined a 12-week ILEX intervention on indirect determination of disc height and shrinkage through seated stadiometry, strength, pain, and disability. Design. A quasi-experimental wait-list controlled design was used. Nine participants underwent pretesting (T1), a 12-week control period, retesting (T2), a 12-week intervention period, and finally posttesting (T3). Seated stadiometry, ILEX strength, pain, and disability were measured at each time point. Results. No significant repeated-measures effects for any seated stadiometry variables occurred. Significant improvement across the intervention period (T2 to T3) was found for strength (P <0.0001; effect size [ES] = 2.42). Change in pain was not significant for repeated effects (P = 0.064); however, ES for the intervention period (T2 to T3) was moderate (ES = −0.77). Change in disability was significant between time point T1 and T3 (P = 0.037) and ES for the intervention period (T2 to T3) was large (ES = −0.92). Pain and disability achieved minimal clinically important changes. Conclusions. This is apparently the first study to examine disc change in vivo after exercise in CLBP. Results of the present study, though supporting ILEX resistance training to improve strength, pain, and disability, did not find any effect on spinal height.

Variability in Strength, Pain, and Disability Changes in Response to an Isolated Lumbar Extension Resistance Training Intervention in Participants with Chronic Low Back Pain

Strengthening the lumbar extensor musculature is a common recommendation for chronic low back pain (CLBP). Although reported as effective, variability in response in CLBP populations is not well investigated. This study investigated variability in responsiveness to isolated lumbar extension (ILEX) resistance training in CLBP participants by retrospective analysis of three previous randomized controlled trials. Data from 77 participants were available for the intervention arms (males = 43, females = 34) 37 participants data (males = 20, females = 17) from the control arms. Intervention participants had all undergone 12 weeks of ILEX resistance training and changes in ILEX strength, pain (visual analogue scale; VAS), and disability (Oswestry disability index; ODI) measured. True inter-individual (i.e., between participants) variability in response was examined through calculation of difference in the standard deviation of change scores for both control and intervention arms. Intervention participants were classified into responder status using k-means cluster analysis for ILEX strength changes and using minimal clinically important change cut-offs for VAS and ODI. Change in average ILEX strength ranged 7.6 Nm (1.9%) to 192.1 Nm (335.7%). Change in peak ILEX strength ranged −12.2 Nm (−17.5%) to 276.6 Nm (169.6%). Participants were classified for strength changes as low (n = 31), medium (n = 36), and high responders (n = 10). Change in VAS ranged 12.0 mm to −84.0 mm. Participants were classified for VAS changes as negative (n = 3), non-responders (n = 34), responders (n = 15), and high responders (n = 19). Change in ODI ranged 18 pts to −45 pts. Participants were classified for ODI changes as negative (n = 2), non-responders (n = 21), responders (n = 29), and high responders (n = 25). Considerable variation exists in response to ILEX resistance training in CLBP. Clinicians should be aware of this and future work should identify factors prognostic of successful outcomes.

The relationship between balance performance, lumbar extension strength, trunk extension endurance, and pain in participants with chronic low back pain, and those without

Background Chronic low back pain is associated with lumbar extensor deconditioning. This may contribute to decreased neuromuscular control and balance. However, balance is also influenced by the hip musculature. Thus, the purpose of this study was to examine balance in both asymptomatic participants and those with chronic low back pain, and to examine the relationships among balance, lumbar extension strength, trunk extension endurance, and pain. Methods Forty three asymptomatic participants and 21 participants with non‐specific chronic low back pain underwent balance testing using the Star Excursion Balance Test, lumbar extension strength, trunk extension endurance, and pain using a visual analogue scale. Findings Significant correlations were found between lumbar extension strength and Star Excursion Balance Test scores in the chronic low back pain group (r = 0.439–0.615) and in the asymptomatic group (r = 0.309–0.411). Correlations in the chronic low back pain group were consistently found in posterior directions. Lumbar extension strength explained ˜19.3% to ˜37.8% of the variance in Star Excursion Balance Test scores for the chronic low back pain group and ˜9.5% to ˜16.9% for the asymptomatic group. Interpretation These results suggest that the lumbar extensors may be an important factor in determining the motor control dysfunctions, such as limited balance, that arise in chronic low back pain. As such, specific strengthening of this musculature may be an approach to aid in reversing these dysfunctions. HighlightsChronic low back pain is associated with lumbar extensor deconditioning.This may affect balance ability in this population.We investigated the relationship between these two variables.Lumbar extension strength may contribute to balance ability.Lumbar extensor strengthening should be examined to improve balance.

A pilot study to compare passive lumbar spine re-positioning error in those with chronic low back pain with healthy volunteers

Abstract Study design Cross-sectional laboratory study. Objective To compare the difference in passive re-positioning accuracy in the frontal plane, as a measure of lumbar kinaesthesis, between participants with chronic non-specific low back pain (CNSLBP) and healthy volunteers. Background Evidence suggests that spinal kinaesthesis impacting on spinal stability might be compromised in those with CNSLBP. It is suggested that in those with CNSLBP, there may be changes in ligamentous patho-physiology which lead to altered kinaesthetic perception. Methods Fourteen female participants, representing two groups, took part in the study. Participants in group one (n = 7) were those with CNSLBP (mean age 47.1 ± 15.41) and participants in group two (n = 7) were healthy volunteers (mean age 45.6 ± 10.63). There were no significant differences between the groups with regards to age, education, height, weight, hip, and waist circumference and all were right handed. Passive lumbar re-positioning accuracy was measured in the frontal plane using a motorized plinth with the Zebris® ultrasound-based motion analyser and the target positions were 10° left and right lumbar side flexion and neutral. Results The mean reporting error for the neutral position for participants with CNSLBP vs. healthy volunteers was <2.4° and <2.2° on both occasions (P > 0.05), respectively. The mean reporting error in left-side flexion for participants with CNSLBP vs. healthy volunteers was <1.5° and <2.0° on both occasions (P < 0.01; P < 0.05). The mean reporting error in right-side flexion for participants with CNSLBP vs. healthy volunteers was <2.1° and <1.1° on both occasions (P > 0.05). Conclusion There was a statistically significant difference in passive re-positioning accuracy to the left side only between participants with CNSLBP and healthy volunteers. This may represent an important finding in relation to structures that provide sensory information and the integration of that information in those with CNSLBP.