Back extensor muscle oxygenation and fatigability in healthy subjects and low back pain patients during dynamic back extension exertion

The purpose of this study was to assess if chronic low back pain patients have impaired paraspinal muscle O₂ turnover and endurance capacity as compared to healthy control subjects during dynamic exercise. Middle-aged healthy male subjects (n = 12, control) and male patients with chronic low back pain (n = 17, CLBP) participated in the study. L4–L5 level paraspinal muscle fatigue was objectively assessed during earlier validated 90 s dynamic back endurance test (spectral EMG, MPF_slope). Also EMG amplitude (EMG_amplitude) and initial MPF (MPF_initial) were assessed from the initial 5 s of the endurance contraction. Simultaneously near infrared spectroscopy (NIRS) was used for quantitative measurement of local L4–L5 paraspinal muscle O₂ consumption. Subcutaneous tissue thickness (ATT) was measured from the EMG and NIRS recording sites. The results indicated that control and CLBP groups were compatible as regarding anthropometric variables, paraspinal muscle activation levels (EMG_amplitude), initial MPF (MPF_initial) and ATT. When the ATT was used as a covariate in the ANOVA analysis, CLBP group did not show significantly greater paraspinal muscle fatigability (right MPF_slope – 12.2 ± 10.7%/min, left right MPF_slope – 12.6 ± 13.3%/min) or O₂ consumption (right NIRS_slope – 52.8 ± 79.6 μM/l/s) as compared to healthy controls (right MPF_slope – 11.9 ± 7.6%/min, left MPF_slope – 12.7 ± 8.6%/min, right NIRS_slope – 53.7 ± 95.2 μM/l/s). As a conclusion, these CLBP male patients did not show any impaired rate of paraspinal muscle oxygen consumption or excessive paraspinal muscle fatigability during dynamic exercise as compared with healthy controls. Subcutaneous tissue thickness has a strong influence on the NIRS and EMG amplitude measurements and, if unchecked, it could result in the false interpretation of the results.     

下腰痛患者脑网络的动态功能连接

目的:探究下腰痛（LBP）患者脑网络功能连接的动态变化。方法:对20例LBP患者及20例健康志愿者进行静息态 脑功能核磁共振扫描,采用连接数目熵（CNE）比较LBP患者与健康志愿者大脑的动态功能连接变化,分析LBP患者各独立 脑区的功能灵活性与年龄和日本骨科协会（JOA）量表评分的相关性。结果:全脑水平,LBP患者CNE低于正常人（P＜0.05）, 显著改变的脑区集中在额叶皮层、颞叶皮层、皮质下核团及部分枕叶皮层。脑区水平,LBP 患者中AAL 15（r=-0.525 5, P=0.020 8）、AAL32（r=-0.529 2,P=0.019 8）、AAL41（r=-0.546 9,P=0.015 4）、AAL62（r=0.601 5,P=0.006 4）、AAL76（r=-0.513 3, P=0.024 6）、AAL89（r=0.461 9, P=0.046 5）和AAL90（r=0.508 5, P=0.026 2）与年龄有临床相关性。LBP患者AAL17（r=-0.499 1, P=0.029 6）、AAL 47（r=0.481 4, P=0.036 9）、AAL 82（r=-0.554 8, P=0.013 7）、AAL 90（r=-0.562 1, P=0.012 3）与临床JOA量 表评分有相关性。结论:LBP患者全脑功能网络的功能灵活性是降低的。CNE动态功能连接的测量不仅为量化大脑活动 的时间与空间行为提供了一个新的框架,而且可以探索LBP脑功能变化的机理。     

TTM-based motivational counselling does not increase physical activity of low back pain patients in a primary care setting--A cluster-randomized controlled trial

OBJECTIVE: To investigate the effectiveness of a TTM-based motivational counselling approach by trained practice nurses to promote physical activity of low back pain patients in a German primary care setting. METHODS: Data were collected in a cluster-randomized controlled trial with three study arms via questionnaires and patient interviews at baseline and after 6 and 12 months. We analysed total physical activity and self-efficacy by using random effect models to allow for clustering. RESULTS: A total of 1378 low back pain patients, many with acute symptoms, were included in the study. Nearly 40% of all patients reported sufficient physical activity at baseline. While there were significant improvements in patients' physical activity behaviour in all study arms, there was no evidence for an intervention effect. CONCLUSION: The outcome may be explained by insufficient performance of the practice nurses, implementation barriers caused by the German health care system and the heterogenous sample. PRACTICE IMPLICATIONS: Given the objective to incorporate practice nurses into patient education, there is a need for a better basic training of the nurses and for a change towards an organizational structure that facilitates patient-nurse communication. Counselling for low back pain patients has to consider more specificated aims for different subgroups.     

Predictors of disability in patients with chronic low back pain

IntroductionChronic low back pain (CLBP) is a common and disabling health problem. In this study, we aimed to assess the relationship between pain intensity, the components of catastrophizing, depression and disability in patients with chronic low back pain.Material and methodsSeventy-six patients diagnosed with CLBP (age range 25–77 years; 73.7% female) participated in the study. Participants’ socio-demographic data were collected: age, gender, height, weight, and work status (employed or retired). All participants were asked to complete the Pain Catastrophizing Scale (PCS), the visual analogue scale (VAS), the Oswestry Disability Questionnaire (ODQ), and the Beck Depression Inventory (BDI).ResultsThe mean group scores revealed moderate CLBP complaints (VAS – 4 [3–6]), mild depression (BDI – 10 [5–16]), a moderate level of catastrophizing (PCS total score 20.5 [10–34]) and moderate disability (Oswestry Disability Index [ODI] – 31 [14–38]). Positive significant correlations were found between ODI and age, residence, work status, VAS, PCS-rumination, PCS-magnification, PCS-helplessness and BDI, and also between PCS subscales and VAS. Our multivariate linear regression analysis showed that age, pain intensity, PCS-helplessness and depression can predict disability in patients with CLBP, explaining 84% of the variance of disability (R² = 0.851, adjusted R² = 0.843).ConclusionsA multidisciplinary approach is needed for patients with CLBP and should include physical, mental and social evaluation in order to offer an optimal treatment.     

Lumbar muscularity and its relationship with age,occupation and low back pain

Summary This paper considers an internal standard of lumbar muscularity. The cross-sectional areas (A _cs) of the intervertebral disc and paraspinal muscles were measured in 147 working men from an axial magnetic resonance image passing through the L3-4 disc. Lumbar muscularity was expressed by two ratios; the ratio between the A _cs of the right psoas and the A _cs of the intervertebral disc (P:disc), and the ratio between the combined A _cs values of the right erector spinae and quadratus lumborum and the A _cs of the disc (ESQL:disc). When the subjects were divided into two age groups (76 aged 20–30 years and 71 aged 31–58 years) lumbar muscularity was found to be significantly greater (P < 0.001) in the younger age group (P:disc=0.8, SD 0.2; ESQL:disc=2.0, SD 0.3) than in the older age group (P:disc =0.7, SD 0.2; ESQL:disc=1.8, SD 0.3). Lumbar muscularity was not significantly affected by occupation or by a history of low back pain.     

Self-management program for chronic low back pain: A systematic review and meta-analysis

ObjectiveTo determine the effectiveness of self-management programs (SMPs) on chronic low back pain (CLBP).MethodsA search of randomized controlled trials (RCTs) was performed in Pubmed, Cochrane Library, Web of Science, Elsevier, and CINAHL through June, 2015. Two reviewers selected trials, conducted critical appraisal, and extracted data. Meta analyses were performed.ResultsThirteen moderate-quality RCTs were included. There were 9 RCTs for immediate post intervention on pain intensity and disability, 5 RCTs for short term, 3 RCTs for intermediate and 4 RCTs for long term. Specifically, the effect sizes (ESs) of SMP on pain intensity were −0.29, −0.20, −0.23, and −0.25 at immediate post-intervention, short-term, intermediate-term, and long-term follow-ups, respectively. The ESs on disability were −0.28, −0.23, −0.19, and −0.19 at immediate post-intervention, short-term, intermediate-term, and long-term follow-ups, respectively.ConclusionFor CLBP patients, there is moderate-quality evidence that SMP has a moderate effect on pain intensity, and small to moderate effect on disability.Practice implicationsSMP can be regarded as an effective approach for CLBP management. In addition to face-to-face mode, internet-based strategy can also be considered as a useful option to deliver SMP. Theoretically driven programs are preferred.     

Prevalence and associated risk factors of low back pain among users of a primary health care clinic serving semi-urban and rural settlements in KwaZulu-Natal,South Africa

BackgroundLow back pain (LBP) is one of the most frequent musculoskeletal conditions and a common work-related health problem. In South Africa, people from lower socio-economic strata are involved in physical labour and also have unequal access to health services. There is minimal data on the prevalence of LBP in these communities. This study determined the prevalence and associated risk factors of LBP among public sector health care users in a semi-urban/rural area of KwaZulu-Natal, South Africa.MethodsThe study was conducted at a primary health care clinic in the Umdoni municipality, KwaZulu-Natal, South Africa. Convenience sequential sampling was used. An interviewer-administered questionnaire was utilized due to literacy constraints. Participants (n=400) answered the questionnaire in either English or isiZulu.ResultsThe lifetime prevalence of LBP was 79.3%. Female gender and lifting heavy objects were associated with LBP. The direct impact of LBP was faced in the work place resulting in absenteeism, often followed by unemployment.ConclusionIn this setting, where the prevalence of LBP was high, specialized treatments for LBP were not available at the primary health care facility. Incorporation of such treatments will be useful, for people in lower socio-economic strata, to overcome the burden of LBP.     

Ultrasound evidence of altered lumbar fascia in patients with low back pain

Different hypotheses have been proposed about the role of lumbar connective tissue in low back pain (LBP). However, none of the previous studies have examined the change in the elastic behavior of lumbar fascia in patients with LBP. The present study aimed to evaluate the changes in the elastic behavior of lumbar fascia in patients with chronic non-specific LBP based on ultrasound imaging. The sonographic strain imaging assessed the thoracolumbar fascia (TLF) of 131 human subjects (68 LBP and 63 non-LBP). Assessments were done at L2–L3 and L4–L5 levels bilaterally. The points were located 2 cm lateral to the midpoint of the interspinous ligament. There were no significant differences in age, sex, and BMI between LBP and healthy individuals. There is a strong inverse relationship between pain severity (r = −0.76, n = 68, p = 0.004) and the TLF elastic modulus coefficient. No significant relationship were observed between age (r = 0.053, n = 68, p = 0.600), BMI (r = −0.45, n = 68, p = 0.092), and gender (r = −0.09, n = 68, p = 0.231) with the TLF elasticity coefficient. The LBP group had a 25%–30% lower TLF elastic modulus coefficient than healthy individuals. The present study is the first to evaluate the elastic coefficient of TLF using the ultrasound imaging method. The study results showed that the TLF elastic coefficient in patients with LBP was reduced compared to healthy individuals and directly related to LBP severity.     

Experiences of chronic low back pain: a meta-ethnography of qualitative research

Chronic low back pain (CLBP) is associated with a number of costly disability-related outcomes. It has received increasing attention from qualitative researchers studying its consequences for personal, social, and health care experiences. As research questions and methods diversify, there is a growing need to integrate findings emerging from these studies. A meta-ethnography was carried out to synthesise the findings of 38 separate qualitative articles published on the subjective experience of CLBP between 1994 and 2011. Studies were identified following a literature search and quality appraisal. Four themes were proposed after a process of translating the meaning of text extracts from the findings sections across all the articles. The themes referred to the undermining influence of pain, its disempowering impact on all levels, unsatisfying relationships with health care professionals, and learning to live with the pain. The findings are dominated by wide-ranging distress and loss but also acknowledge self-determination and resilience. Implications of the meta-ethnography for clinicians and future qualitative research are outlined, including the need to study relatively unexamined facets of subjective experience such as illness trajectory and social identity.     

Effectiveness of a standardized back school program for patients with chronic low back pain after implementation in routine rehabilitation care

ObjectiveTo evaluate the effectiveness of a standardized, patient-oriented, biopsychosocial back school after implementation in inpatient orthopedic rehabilitation.MethodsA multi-center, quasi-experimental controlled study of patients with low back pain (n = 535) was conducted. Patients in the control group received the traditional back school before implementation of the new program (usual care); patients in the intervention group received the new standardized back school after implementation into routine care. Patients’ illness knowledge and conduct of back exercises (primary outcomes) and secondary self-management outcomes and treatment satisfaction were obtained at admission, discharge, and 6 and 12 months after rehabilitation.ResultsWe found a significant small between-group intervention effect on patients‘ illness knowledge in medium- to long term (6 months: η² = 0.015; 12 months: η² = 0.013). There were trends for effects on conduct of back exercises among men (6 and 12 months: η² = 0.008 both). Furthermore, significant small effects were observed for treatment satisfaction at discharge and physical activity after 6 months.ConclusionsThe standardized back school seems to be more effective in certain outcomes than a usual care program despite heterogeneous program implementation.Practice implicationsFurther dissemination within orthopedic rehabilitation may be encouraged to foster self-management outcomes.     

椎间盘源性腰痛的诊断及治疗进展

椎间盘源性腰痛是慢性腰痛的常见类型,是导致残疾的首要原因之一,给社会带来了巨大的经济负担。由于椎间盘解剖结构的特殊性,目前关于椎间盘源性腰痛的具体机制尚不清楚,其诊断及治疗尚未达成统一共识。国内外对于椎间盘源性腰痛的治疗主要包括保守治疗及外科手术治疗,治疗的目的是缓解临床症状,而不是从根本上逆转椎间盘退变。近年来生物治疗开始兴起,为椎间盘源性腰痛的治疗提供了新的方向,但国内关于生物治疗的相关研究报道较少。本文就椎间盘源性腰痛的诊断及治疗进展作一综述,以期为临床提供相关参考。     

Effectiveness of communicative and educative strategies in chronic low back pain patients: A systematic review

ObjectiveTo investigate the effectiveness of communicative and educative strategies on 1) patient’s low back pain awareness/knowledge, 2) maladaptive behavior modification and 3) compliance with exercise in patients with chronic low back pain.MethodsA systematic review was conducted. Searches were performed on 13 databases. Only randomized controlled trials enrolling patients ≥ 18 years of age were included. Risk of bias was assessed with the Cochrane Collaboration’s tool and interrater agreement between authors for full-texts selection was evaluated with Cohen’s Kappa. No meta-analysis was performed and qualitative analysis was conducted.Results24 randomized controlled trials which intervention included communicative and educative strategies were selected. Most of the studies were judged as low risk of bias and Cohen’s Kappa was excellent ( = 0.822). Interventions addressed were cognitive behavioral therapy as unique treatment or combined with other treatments (multimodal interventions), coaching, mindfulness, pain science education, self-management, graded activity and graded exposure.Conclusions, practice implicationPatient’s low back pain awareness/knowledge is still a grey area of literature. Pain science education, graded exposure and multimodal interventions are the most effective for behavior modification and compliance with exercise with benefits also in the long-term, while self-management, graded activity and coaching provide only short-term or no benefits.     

Effect of information format on intentions and beliefs regarding diagnostic imaging for non-specific low back pain: A randomised controlled trial in members of the public

ObjectiveTo evaluate the effects of information format on intentions to request diagnostic imaging for non-specific low back pain in members of the public.MethodsWe performed a three arm, 1:1:1, superiority randomised trial on members of the public. Participants were randomised to one of the three groups: a Standard Care Leaflet group (standard information on low back pain), a Neutral Leaflet group (balanced information on the benefits and harms of imaging) and a Nudge Leaflet group (with behavioural cues to emphasise the harms of unnecessary imaging). Our primary outcome was intention to request imaging for low back pain.Results418 participants were randomised. After reading the leaflet, intention to request imaging (measured on an 11-point scale (0 = definitely would not request to 10 = definitely would request) was lower in the Nudge Leaflet group (mean = 4.6, SD = 3.4) compared with the Standard Care Leaflet group (mean = 5.3, SD = 3.3) and the Neutral Leaflet group (mean = 5.3, SD = 3.0) (adjusted mean difference between Nudge and Neutral, ?1.0 points, 95%CI ?1.6 to ?0.4).ConclusionFraming information to emphasise potential harms from overdiagnosis reduced intention to request diagnostic imaging for low back pain.Practice implicationsNudge leaflets could help clinicians manage patient pressure for unnecessary tests.     

Indigenous healers’ explanations of low back pain and its relief

Significant number of Finns consults annually indigenous healers for their low back pain (LBP). Bone setting is the most vital traditional Finnish mobilization treatment of LBP. In the present study we have clarified healers’ believes on the pathophysiology of back pain and observed them at work to clarify the effectiveness of treatment by medical check-up and by interviewing the patients who also compared the benefits of this method with their previous other treatments such as drugs, exercise and physiotherapy.

Study design

Two of the oldest bone setters participated in the study. In the patient follow-up they treated 35 consecutive chronic LBP subjects. A medical check-up of the patients was done before and after their treatments. After 7 months mean follow-up time patients replied by using questionnaires and evaluated the effectiveness of the method.

Results

The indigenous bone setters told that they followed the hundreds of years old tradition. The healers explained that the back pain was due to difference in the leg lengths and this was reflected in the pelvic and spinal asymmetry as well as increased muscle tension. After the sessions the subjects reported relaxation and clear immediate pain alleviation. The patients reported in the follow-up questionnaires benefits from their LBP treatment in 28 cases out of 29 who replied after the treatment. According to physician's evaluation 27 patients (from 35 or 77%) got excellent or good result in their chronic LBP. There was no change in one case, and none got worse. Bone setting received in patients’ reports better evaluation than drug treatment and physical therapy.     

Neuroanatomical pathway of nociception originating in a low back muscle (multifidus) in the rat

The neural mechanisms of low back pain (LBP) are still enigmatic. Presently, low back muscles are being discussed as an important source of LBP. Here, the neuroanatomical pathway of the nociceptive information from the caudal multifidus muscle (MF) was studied. True blue was injected into the MF at the level L5 to visualize the dorsal root ganglion (DRG) cells that supply this muscle. The distribution of the stained cells had a maximum in the DRG L3, not in L5. Injection of 5% formalin into the MF at levels L4 and L5 induced a significant increase in the number of c-Fos-immunoreactive (-ir) nuclei in the dorsal horn in many lumbar segments. Cells expressing c-Fos were particularly numerous in the most lateral part of the ipsilateral laminae I–II. The number of c-Fos-ir nuclei in the dorsal horn of segment L3 was significantly higher than that in segment L5. To visualize supraspinal projections, fluorogold (FG) was injected into the contralateral ventrolateral periaqueductal gray (vlPAG) 6 days prior to formalin or saline injection into the MF. The number of double-labeled dorsal horn neurons (FG-positive plus c-Fos-ir) in all lumbar segments was significantly higher in the formalin group than in the saline group. These results show that (1) the origin of the sensory supply of the MF is shifted two segments cranially relative to the location of the muscle, (2) the spinal cells processing nociceptive input from the caudal MF are widely distributed, and (3) the vlPAG is a supraspinal center of nociception from the MF.     

Functional disability in nonspecific low back pain: The role of pain-related fear and problem-solving skills

Previous studies have shown that pain disability in chronic back pain patients is closely associated with pain-related fear and avoidance. This study was aimed at replicating this finding in a sample of low back pain (LBP) patients with a new episode of sick leave. In addition, the supplemental value of problem solving in predicting pain disability was examined. It was further hypothesized that problem solving would moderate the effects of daily stress on pain disability. The results were partly as predicted. Pain-related fear, pain intensity, pain catastrophizing, daily stress, and problem solving were found to be individually related to functional disability, of which pain intensity and pain catastrophizing were the strongest predictors. Problem solving neither added predictive value regarding pain disability, nor could the moderating role of problem solving be confirmed. Surprisingly, and in disagreement with previous findings, pain intensity was found to be closely related to disability in this sample of LBP patients. This study was supported by Grant No. 940-31-004 of the Council for Medical and Health Research of the Netherlands (MW-NWO).     

整骨疗法治疗非特异性下腰痛：解读2016年美国骨科协会的指南

文题释义：整骨疗法：文章中提及的整骨疗法是指美式整骨手法,指南中明确为由整骨医师或其他在整骨手法治疗方面受过培训和精通的医师(如欧洲接受过整骨培训项目的医师)提供的手法治疗。该方法强调徒手操作技巧,通过调整脊柱的结构紊乱,改善肌肉骨骼系统功能,能对其他神经肌肉骨骼组织与器官的功能障碍、组织病理条件或是复杂的症状产生积极影响。 非特异性下腰痛：美国骨科协会指南适用的范围为非特异性下腰痛患者,所有非特异性肌肉及骨骼源性下腰痛患者均符合指南建议。而有内脏疾病引起腰痛的患者应被排除在指南之外。其他应排除发生以下确定的下腰痛来源的情况：脊椎骨折;椎关节脱位;肌肉撕裂;脊柱或脊椎关节韧带断裂;椎间盘、脊柱关节突关节、肌肉或筋膜的炎症;皮肤撕裂伤;骶髂关节炎;强直性脊柱炎;肿块在或从背部下部引起疼痛的患者。但是指南特别指出,排除在指南之外并不意味着整骨手法在这些情况下是禁忌的。 背景：下腰痛是骨科常见疾病之一,非特异性下腰痛在临床中占到了非常大的比重。为更好的治疗该疾病,2016年美国骨科协会制定了整骨疗法治疗非特异性下腰痛患者的临床指南。 目的：通过解读指南让骨科医生以及其他医生、其他卫生专业人员和第三方付费者了解关于适当使用整骨手法治疗非特异性下腰痛患者的潜在建议的证据,帮助临床骨科医生在遇到非特异性下腰痛患者选择治疗方法时提供参考。同时科研工作者可借鉴、学习指南中科学严谨的设计思路与评价方法。 方法：指南是建立在先前指南和最新高质量荟萃分析的基础上进行的修订,确定了采用整骨手法治疗非特异性下腰痛为确实有效的治疗手段,明确其推荐等级。文章通过详细解读指南中的相关定义、循证医学的评价方法、具体内容和结果,并结合中国临床实际进行分析与讨论。 结果与结论：指南共纳入17项研究,系统评价了整骨手法在治疗急慢性非特异性下腰痛以及妊娠期及产后妇女非特异性下腰痛的治疗效果,结果证实患者在疼痛及功能状态等方面都有极大的改善,美国骨科协会的最终建议是建议骨科医生使用整骨手法治疗下腰痛患者。该治疗方法安全性及科学性较高,适合在国内进行推广。 ORCID: 0000-0001-6897-1581(谢瑞) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

Self-management of chronic low back pain: An exploration of the impact of a patient-centered website

Objective

This paper examines from a qualitative approach the role of a patient-centered website – named “Oneself” – on patients’ chronic low back pain self-management attitudes and behaviors in the Italian part of Switzerland.

Methods

In-depth interviews have been conducted with a purposive and convenient sample of 18 chronic low back pain sufferers who had used Oneself during 6 months. Data collection and analysis were driven by grounded theory.

Results

Reported positive effects of the use of Oneself on self-management attitudes and behaviors include self-comprehension, improvement of argumentative abilities, orientation, development of self-confidence and maintenance of a high level of attention. In some cases, participants affirm to have experienced negative effects such as confusion and discouragement. The individual's previous awareness of cLBP and level of self-management plays a main role in the way people use the website and in its impact. Based on this criterium, a typology of four patterns of use is drawn.

Conclusion

Patient-centered websites are useful for enhancing self-management of chronic low back pain. However, individuals take advantage of this means differently, based on their stage of advancement in the self-management process.

Practice implications

Information and supports provided online should be tailored according to people's stage of advancement.     

Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized,controlled, clinical trial

Intracutaneous sterile water injection (ISWI) is used for relief of low back painduring labor, acute attacks of urolithiasis, chronic neck and shoulder pain followingwhiplash injuries, and chronic myofascial pain syndrome. We conducted a randomized,double-blinded, placebo-controlled trial to evaluate the effect of ISWI for relief ofacute low back pain (aLBP). A total of 68 patients (41 females and 27 males) between18 and 55 years old experiencing aLBP with moderate to severe pain (scores ≥5 on an11-point visual analogue scale [VAS]) were recruited and randomly assigned to receiveeither ISWIs (n=34) or intracutaneous isotonic saline injections (placebo treatment;n=34). The primary outcome was improvement in pain intensity using the VAS at 10, 45,and 90 min and 1 day after treatment. The secondary outcome was functionalimprovement, which was assessed using the Patient-Specific Functional Scale (PSFS) 1day after treatment. The mean VAS score was significantly lower in the ISWI groupthan in the control group at 10, 45, and 90 min, and 1 day after injection(P<0.05, t-test). The mean increment in PSFS score of the ISWIgroup was 2.9±2.2 1 day after treatment, while that in the control group was 0.9±2.2.Our study showed that ISWI was effective for relieving pain and improving function inaLBP patients at short-term follow-up. ISWI might be an alternative treatment foraLBP patients, especially in areas where medications are not available, as well as inspecific patients (e.g., those who are pregnant or have asthma), who are unable toreceive medications or other forms of analgesia because of side effects.