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Showing 8 results for Back Pain
Low Level Laser Therapy And Exercise Therapy In Treatment Of Chronic Low Back Pain: A Double-Blind Randomized Clinical Trial
Mehrdad R, Esmaeili Javid G, Hasan Zadeh H, Sotoodeh Manesh A, Ghasemi M,
Volume 63, Issue 4 (7-2005)
Abstract
Background: This study was designed to compare low-level laser therapy (LLLT) + exercise therapy with LLLT alone and exercise therapy alone, and to determine whether laser therapy is a useful treatment modality for chronic low back pain (LBP).
Materials and Methods: This study was a double-blind placebo-controlled randomized clinical trial. Patients with chronic LBP for at least 12 weeks were included. Visual analogue scale (VAS), Modified Oswestry Disability Questionnaire (MODQ), Schober test, flexion, extension and lateral bending were used to evaluate back pain, disability score and lumbar range of motion. Irradiation was performed with GaAlAs (=810 nm, power density=226 mW/cm2) laser, two times a week, over a period of 6 weeks. Subjects were evaluated before the first treatment, at week 6 and 12 follow-up.
Results: The reduction in pain related to motion was significantly greater in the exercise + LLLT group compared with the exercise alone group (P = 0.004) but was not significant, compared with LLLT alone (P = 0.982). Disability score in LLLT + exercise therapy reduced more than the other two groups, and the difference with exercise alone group was significant (p = 0.03). Comparison of reduction of disability between LLLT alone and exercise therapy alone was not statistically significant. Improvement of lumbar range of motion in patients treated with LLLT + exercise therapy was better than the other two groups significantly, especially by Schober test and Flexion and lateral bending.
Conclusion: This study clearly shows that LLLT alone and especially LLLT combined with exercise can lead to better improvement in chronic LBP.
Postural deviations from chronic low back pain and correction through exercise therapy
Farahpour N, Marvi Esfahani M,
Volume 65, Issue 2 (3-2008)
Abstract
Background: It has been shown that five deficits of the proprioceptive system and poor motor skills are associated with chronic low back pain (CLBP). However, the exact mechanism is unknown. The objectives of this study were to assess the dynamic postural balance behavior of CLBP patients, as well as the effects of a specific exercise therapy for the treatment of CLBP and related postural imbalances.
Methods: Sixteen females with CLBP and 30 healthy females all between 20 and 40 years of age, of similar height and weight, voluntarily participated in this study. Patients underwent a three-month therapeutic exercise program. The disability and back pain of the patients were measured using the Oswestry and Quebec questionnaires, respectively. A dynamic stability platform system (Biodex) was used to evaluate the postural imbalances in both groups. All measurements of the experimental group were repeated after the therapy.
Results: Overall deviation of center of gravity (COG) from COBOS in patients and controls were 3 (±0.3) and 1.3 (±0.2), respectively. Thus, postural imbalances were 2.3 times greater in the patients than those of the controls. After the treatment, the disability and pain of the patients were diminished by 53% and 58%, respectively. Furthermore, with the improvement of the patients COG deviation, both groups had similar posture.
Conclusions: The postural orientation of CLBP patients was significantly improved by the therapeutic exercise program. The applied exercise therapy significantly reduced both the pain and the disability of the patients. Based on these conclusions, we recommend that postural correction be included in regular therapeutic exercise programs.
The accommodation of EMG and MRI findings in patients with radicular low back pain
Koushan A, Sadat Mm, Golbakhsh Mr, Siavashi B, Mehran S, Tajik A,
Volume 68, Issue 5 (8-2010)
Abstract

Background: There are multiple diagnostic methods for evaluation of patients with low back pain with a radicular pattern, each one has it's own accuracy and diagnostic ability and so comparing them with each other would help the clinicians to find the best diagnostic method. The main objective of our study was to compare the diagnostic accommodation of electromyography (EMG) and Magnetic Resonance Imaging (MRI) findings in patients with low back pain and radiculopathy.

Methods: In this descriptive cross-sectional study, 101 patients with low back pain and radiculopathy attending to Sina Hospital in Tehran, Iran from 2007 to 2009 that had indication for both EMG and MRI were evaluated for their demographic characteristics and disease-related factors.

Results: Totally, 90 out of 101 patients (89%) had abnormal EMG findings and 94 out of 101 subjects (93%) had abnormal MRI results. The concordance rate was 88% (89 patients) with no significant difference (p> 0.05). The sensitivity and specificity of MRI were 95.6% and 27.3%, respectively, and the sensitivity and specificity of EMG were 91.5% and 60%, respectively.

Conclusion: According to the results of this study and in comparison with other studies it may be concluded that MRI and EMG are both accurate and use of them in a concomitant manner would result in increased diagnostic ability in patients with low back pain and radiculopathy.
Is lumbosacral MRI in complemetary health insured patients, requested based on scientific guidelines?
Mojtaba Sedaghat , Arash Rashidian , Seyed Davood Hosseini ,
Volume 71, Issue 6 (9-2013)
Abstract
Background: The request for lumbosacral MRI in Iran  based on previous studies is high (almost half of all MRI cases), so, our study is concerned with investigating the necessity of lumbosacral MRI request in patients with low back pain that is covered by  complementary health insurance in Tehran through comparing  MRI practice with valid guidelines.
Methods: Information of 274 complementary insured patients at Dana Insurance Company in Tehran, who had undergone low back MRI was studied. A portion of information in the questionnaire including age, sex, the physician’s field of specialty, and MRI report, was derived from the medical records. Other information based on guidelines indications, including duration of the prolonged back pain, record of associated infection, malignancy or trauma, saddle anesthesia, lower limb motor deficit and incontinence of urine or feces, was elicited from patients orally.
Results: Males represented 35% and females 65% of patients. Also, males were on average 10 years younger than females. Over 90% of MRI scans were requested by three fields of specialty (orthopedic, neurosurgery and neurology). Considering the indications of lumbar spine MRI request (prolonged back pain of more than one month duration, incontinence of urine or feces, lower limb motor deficit, saddle anesthesia, recent related trauma, infection and malignancy), approximately 20% of lumbar spine MRI scans were prescribed in accordance with guidelines.
Conclusion: Out of every five cases of lumbar spine MRI, four cases were not requested based on guidelines, suggesting needs for local guideline design and revising the manner in which MRI scans are prescribed for low back pain in complementary health insured patients in Tehran.

The correlation between the duration of sciatica and clinical outcome after lumbar discectomy
Hossein Mashhadinezhad , Babak Ganjeifar ,
Volume 73, Issue 3 (6-2015)
Abstract
Background: Sciatic pain in association with lumbar disc herniation may require surgical intervention in the form of lumbar discectomy. Yet, the optimal time for this operation has not been specified in medical literature. Methods: In a Cross-sectional study, 147 patients (100 men and 47 women) with radiological and clinical signs of L4-L5 or L5-S1 disc herniation were entered to our registry prior to March 2009. They were all examined, diagnosed and operated on (lumbar discectomy) in Ghaem General Hospital, Mashhad, Iran. Patients were all subsequently followed for one year. The follow-up continued in a number of 126 cases, whose satisfaction was rated via phone interview for an extra year. The patients’ assessments were implemented employing three scaling systems, both before and following lumbar discectomy, to name the Modified Oswestry Disability Index (MODI), Visual Analogue Scale (VAS) and Prolo Functional Economic Outcome Rating Scale (PORS). The former two were used for pre-operative and post-operative assessments whereas the latter was applied during the first year of follow-up. The focus of the investigation during second year was on patients’ satisfaction. Results: Mean age of our cases were 34±7.4 years. According to the duration of the sciatica, patients were divided into 4 groups. <3 months, 3 to <6 month, 6 to <12 months and >12 months. Statistical analysis revealed a significant difference between patients having undergone lumber discectomy with a history of sciatica for less and more than three month before the operation in terms of pre-and post-operative visual Analogue Scale (P= 0.022). However, there could be found no such disparity in other clinical scores (P= 0.63 for MODI, P= 0.85 for Prolo scale and P= 0.73 for satisfaction). Conclusion: Patients with less than three months of sciatica may seem to enjoy a better clinical outcome after one year, there could be found no correlation between the duration of sciatica and the satisfaction after two years.
Association between lumbar Modic changes and MRI finding of degenerative disc in patients with low back pain
Seyed Reza Saadat Mostafavi , Kaveh Samimi , Fatemeh Parvin Ashtiani , Soheil Fateh ,
Volume 73, Issue 10 (1-2016)
Abstract

Background: Recent studies have indicated the relation of vertebral endplate lesions (Modic changes) to low back pain (LBP). The aim of this study was to investigate the Modic changes in magnetic resonance imaging (MRI) of patients with low back pain, and its correlation with age, sex, type of changes, number of involved segments and location of changes. Additionally, association of degenerative disc changes and disc herniation was assessed.

Methods: In this retrospective study, MRI records of 229 patients with LBP referring to Medical Center of Hazrat-e-Rasoul Hospital, Tehran, Iran, from August to February 2014, were assessed and Modic changes and degenerative and herniated disc changes were recorded.

Results: Based on our observations, a significant association between Modic type and age (P= 0.003) existed in patients with LBP. The highest prevalence in Modic location were observed in anterior part of vertebral endplate (48.8%, P= 0.001). Although, observation of the Modic changes in superior vertebral endplate was higher than inferior parts, but this differences was not statistically significant. The highest prevalence in degenerative disc disease was disc dehydration which was observed in 18.1% of patients (P= 0.04). The relationship between the degenerative changes and Modic type was significant (P= 0.04), while the most prevalent change of disc contour was disc bulging which occurred in 23.7% of patients (P= 0.01). The highest frequency of abnormal disc contour were observed in Modic type 2 which was statistically significant (P= 0.01). Modic surface involvement above 25% was significantly associated with disc herniation (P= 0.04). There was no significant association between Modic height involvement above 25% and disc herniation.

Conclusion: Considering significant association between Modic changes and degenerative and herniated disc changes, reporting of Modic changes is necessary.


The methodology of validating movement system based classification of low back pain: narrative review article
Amin Behdarvandan, Hossein Negahban,
Volume 79, Issue 4 (7-2021)
Abstract
Classifying patients with low back pain into homogeneous and distinct categories by organizing similar manifestations among individuals can be helpful to attain better results for treatments. Providing homogenous categories of patients with low back pain would improve benefits produced by treatments. To gain a greater understanding of the proposed multi-stage process and validate diagnostic categories, the current research was designed to conduct a review about this process. We aimed to validate movement system impairment (MSI) based categories of people with chronic low back pain. MSI-based classification uses a standardized approach for classifying people with low back pain into 1 of 5 subgroups. For the present narrative review, computerized databases of EMBASE, Google Scholar, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed and Science Direct were searched for articles published between January 1990 and December 2018. For electronic searches, keywords and terms used were: “Reliability”, “Validity”, “Classification”, “low back pain" and “Human Movement System”. Fourteen full-text research reports that have been undertaken to add clinical, laboratory and outcome validity to MSI-based classification of low back pain were included in the review. Five studies were categorized as clinical validity studies which investigated the accuracy of examinations for patients with low back pain, 5 studies categorized as laboratory validity studies and 4 studies categorized as outcome validity studies which included randomized control trials. The results of this review revealed that novice users can learn the diagnosis algorithm of MSI-based categories of low back pain and by practicing, their inter-tester reliability and precision in applying the classification algorithm would be comparable to that of described for experienced expert raters. The laboratory-based tests, including 3D motion analysis, indicated that there are differences in movement patterns of the lumbar spine between low back pain subgroups. Also, for people with low back pain, classification-specific treatments based on the MSI model resulted in better outcomes. In conclusion, this review indicated the validity of the MSI classification system in people with chronic low back pain.
 

Evaluation of pelvic, spine and sagittal spine parameters in people without chronic low back pain
Sajad Ataei, Masoud Zeinali, Azim Motamedfar, Maryam Moradi, Hossein Jafari Marandi ,
Volume 80, Issue 9 (12-2022)
Abstract
Background: Chronic low back pain (CLBP) is one of the most common spine disorders, which is seen in 65-80% of people. Knowing the normal patterns of spine and pelvic parameters is very helpful in determining the susceptible subjects for CLBP.
Methods: This study was conducted in healthy people during April 2017 until April 2018 in Golestan hospital of Ahvaz. Inclusion criteria include; Age group 20-65 years, no history of surgery, spine disorders, and having normal radiographs were performed. People who have complained of back pain in the last three months, neuromuscular disease, lumbosacral anomalies, kyphosis and obvious scoliosis, history of spine surgery and vertebral fracture, were excluded. A 36-inch radiology stereotype was prepared in the standing position. Pelvic and spine parameters that were investigated in this research included the following, Pelvic incidence, Pelvic tilt, Sagittal Vertical Axis, T9 Sagittal Angle, Thoracic Kyphosis, Lumbar Lordosis, and Sacral Slope. All data were analyzed with SPSS software, version 24 (SPSS Inc., Chicago, IL, USA).
Results: 50 participants including 27(54%) men and 23(46%) women with an average age of 33±12.5 years and BMI of 25±5.5 kg/m2 were examined. After examining the vertebral and pelvic parameters, it was found that PI is significantly higher in women than in men (P=0.02). It was also found that with increasing age, the amount of Pelvic incidence also increases (P=0.043), so that in people over 60 years of age, the amount of pelvic incidence is significantly higher than other people (P<0.05). Further analyzes showed that BMI has a direct effect on the amount of Thoracic Kyphosis (P=0.03) and Lumbar Lordosis (P=0.04). Thus, the highest amount of Lumbar Lordosis and Thoracic Kyphosis was seen in people with BMI 30-34.9 Kg/m2.
Conclusion: The findings of the present study showed that spine and pelvis indices have an important effect on the occurrence of CLBP. Hence, it is highly recommended to check these parameters in asymptomatic people, especially in older people.

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