Physical activity and low back pain: A critical narrative review

BackgroundNon-specific low back pain (LBP) is the leading cause of years lived with disability worldwide. Physical activity is an integral part of LBP treatment.ObjectiveTo critically review available evidence regarding the efficacy of physical activity for people with LBP.MethodsUp to date critical narrative review of the efficacy of physical activity for the managment LBP. The process of article selection was unsystematic; articles were selected based on authors’ expertise, self-knowledge and reflective practice.ResultsTherapeutic physical activity for LBP includes a wide range of non-specific and specific activities. The efficacy of physical activity on pain and activity limitations has been widely assessed. In acute and subacute LBP, exercise did not reduce pain compared to no exercise. In chronic low back pain (CLBP), exercise reduced pain at the earliest follow-up compared with no exercise. In a recent systematic review, exercise improved function both at the end of treatment and in the long-term compared with usual care. Exercice also reduced work disability in the long-term. We were unable to establish a clear hierarchy between different exercise modalities. Multidisciplinary functional programs consistently improved pain and function in the short- and long-term compared with usual care and physiotherapy and improved the long-term likelihood of returning to work compared to non-multidisciplinary programs.ConclusionPhysical activity of all types is an effective treatment for CLBP.     

Mind-Body Exercise Performed by Physical Therapists for Reducing Pain and Disability in Low Back Pain: A Systematic Review With Meta-analysis

ObjectiveTo assess the effectiveness of mind-body (MB) exercise interventions provided by physical therapists for reducing pain and disability in people with low back pain (LBP).Data SourcesMEDLINE, Embase, CINAHL, and the Cochrane Library were searched for articles published in English between December 2010 and June 2020.Study SelectionRandomized controlled trials evaluating the effects of Pilates, yoga, and tai chi interventions performed by physical therapists on pain or disability outcomes in adults with musculoskeletal LBP were included.Data ExtractionData were extracted by 2 independent reviewers. Quality of evidence and risk of bias were assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework and Cochrane risk of bias tools, respectively.Data Synthesis21,230 exercise trials were identified; 161 progressed to full-text review. Eight trials, 7 reporting on Pilates and 1 reporting on yoga, were included. Short-term outcomes for pain (SMD: -0.93; 95% confidence interval [CI]: -1.65 to -0.021) and disability (SMD: -0.74 95% CI: -1.36 to -0.012) indicated MB exercise was more effective than control intervention. Tests for subgroup differences between studies with exercise vs non-exercise control groups revealed a moderating effect on short-term outcomes where larger effects were observed in studies with non-exercise comparators. Long-term outcomes for pain (SMD: -0.60; 95% CI:-1.43 to 0.23) and disability (SMD: -1.05; 95% CI:-3.51 to 1.41) suggested that MB exercise is not more effective than control interventions for pain or disability. Quality of the evidence ranged from very low to low.ConclusionsPhysical therapist-delivered MB exercise interventions, which overwhelmingly consisted of Pilates, were more effective than control in the short and long-term for pain and in the short-term for disability, with differences in the short-term effects lessened when compared with an active intervention. Pilates interventions delivered by physical therapists represent a viable tool for the clinical management of chronic LBP.     

The treatment of depression in chronic low back pain: review and recommendations.

The prevalence of major depression in patients with chronic low back pain (CLBP) is approximately three to four times greater than that reported in the general population. In spite of these high prevalence rates, there have been few systematic attempts to investigate the efficacy of treatment for major depression in patients with CLBP. While several studies have examined the efficacy of antidepressant medication and psychological treatment in patients with chronic pain, most of these studies have focused on treating chronic pain rather than depression. The few studies that have specifically addressed the treatment of depression in CLBP indicate that tricyclic antidepressants and cognitive-behavioral approaches may be effective means of treating depressed chronic pain patients. Clinical issues related to diagnostic confounds, rehabilitation outcome, and conceptualizations of the relation between pain and depression are discussed. It is argued that, in patients with clinical levels of depression, treatment modalities specifically targeting depressive symptomatology deserve serious consideration as an integral component of pain management programs.     

Hypnosis Treatment for Chronic Low Back Pain

Chronic low back pain (CLBP) is a significant healthcare problem, and many individuals with CLBP remain unresponsive to available interventions. Previous research suggests that hypnosis is effective for many chronic pain conditions; however, data to support its efficacy for CLBP are outdated and have been limited primarily to case studies. This pilot study indicated that a brief, 4-session standardized self-hypnosis protocol, combined with psycho-education, significantly and substantially reduced pain intensity and pain interference. Significant session-to-session improvements were also noted on pain ratings and mood states; however, follow-up data suggest that these benefits may not have been maintained across time in this sample. These findings need to be replicated and confirmed in a larger clinical trial, which could also assess the long-term effects of this treatment.     

Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism

Low back pain (LBP) is a very common but largely self-limiting condition. The problem arises however, when LBP disorders do not resolve beyond normal expected tissue healing time and become chronic. Eighty five percent of chronic low back pain (CLBP) disorders have no known diagnosis leading to a classification of 'non-specific CLBP' that leaves a diagnostic and management vacuum. Even when a specific radiological diagnosis is reached the underlying pain mechanism cannot always be assumed. It is now widely accepted that CLBP disorders are multi-factorial in nature. However the presence and dominance of the patho-anatomical, physical, neuro-physiological, psychological and social factors that can influence the disorder is different for each individual. Classification of CLBP pain disorders into sub-groups, based on the mechanism underlying the disorder, is considered critical to ensure appropriate management. It is proposed that three broad sub-groups of CLBP disorders exist. The first group of disorders present where underlying pathological processes drive the pain, and the patients' motor responses in the disorder are adaptive. A second group of disorders present where psychological and/or social factors represent the primary mechanism underlying the disorder that centrally drives pain, and where the patient's coping and motor control strategies are mal-adaptive in nature. Finally it is proposed that there is a large group of CLBP disorders where patients present with either movement impairments (characterized by pain avoidance behaviour) or control impairments (characterized by pain provocation behaviour). These pain disorders are predominantly mechanically induced and patients typically present with mal-adaptive primary physical and secondary cognitive compensations for their disorders that become a mechanism for ongoing pain. These subjects present either with an excess or deficit in spinal stability, which underlies their pain disorder. For this group, physiotherapy interventions that are specifically directed and classification based, have the potential to impact on both the physical and cognitive drivers of pain leading to resolution of the disorder. Two case studies highlight the different mechanisms involved in patients with movement and control impairment disorder outlining distinct treatment approaches involved for management. Although growing evidence exists to support this approach, further research is required to fully validate it.     

Definitions of Chronic Low Back Pain From a Scoping Review,and Analyses of Narratives and Self-Reported Health of Adults With Low Back Pain

Among those with low back pain (LBP), individuals with chronic LBP (CLBP) face different treatment recommendations and incur the majority of suffering and costs. However, the way CLBP has been defined varies greatly. This study used a scoping review and qualitative and quantitative analyses of data from LBP patients to explore this variation. CLBP in most recent randomized controlled trials (RCTs) was defined by duration of pain, most commonly ≥3 months. However, individuals with LBP most often define CLBP by frequency. CLBP has also been defined using a combination of duration and frequency (16% of RCTs and 20% of individuals), including 6% of recent RCTs that followed the NIH Pain Consortium research task force (RTF) definition. Although not a defining characteristic of CLBP for individuals, almost 15% of recent RCTs required CLBP to have a healthcare provider diagnosis. In our LBP sample moving from ≥3 months to the RTF definition reduced the CLBP group size by 25% and resulted in a group that used more pain management options and reported worse health across all outcome measures. A pain duration definition offers ease of application. However, refinements to this definition (eg, RTF) can identify those who may be better intervention targets.PerspectiveThis article presents the definitions used for CLBP by researchers and individuals, and the impact of these definitions on pain management and health outcomes. This information may help researchers choose better study inclusion criteria and clinicians to better understand their patients’ beliefs about CLBP.     

Clinical Perspective: How Do Clinical Test Results Differentiate Chronic and Subacute Low Back Pain Patients from “Non-Patients”?

Our limited understanding of underlying conditions for back pain is reflected in the common use of pain-duration-based groupings. The aim of this paper was to investigate typical clinical tests used in examining low back pain (LBP) patients in order to discover how tests distinguish between chronic low back pain patients (CLBP) and subacute low back pain patients (SLBP) and if they distinguish these groups from those with no “patient status.” CLBP patients in this study were from a university hospital and SLBP patients were from five occupational health care centers. Control subjects were recruited from a university. Determination of the best predictors between CLBP and SLBP patients and between CLBP and SLBP patients and non-patients was made by a forward stepwise logistic model. A total of 157 subjects were included in the study. Of all the clinical tests, several tests in each category had high odds ratio, differentiating CLBP patients from controls. Only a few tests differentiated between CLBP and SLBP patients. The only clinical differences between SLBP patients and controls were in the mobility test and in one test of muscle tightness. The best predictor for CLBP was the lumbar spine flexion test. SLBP patients seemed to differ from the control group in lumbar flexion, in a specific anterior-posterior mobility test, and in tightness of hip flexor muscles. CLBP patients differed from SLBP patients in functional tests, in the presence of sensation in the feet, and in different pain provocation tests. Whether these tests are sufficiently sensitive to classify a more specific diagnostic or clinical subgroup remains untested, and further studies with clinical tests to differentiate among pathological conditions are necessary.KEYWORDS: Clinical Tests, Low Back Pain, Odds Ratios, Orthopedic Manipulative Therapy, Sensitivity, SpecificityLow back pain (LBP) is one of the most common reasons for people to seek medical treatment in Western societies, with the majority of LBP sufferers having non-specific low back pain. This definition includes any type of back pain or referred leg pain or both that does not fall into the category of nerve root pain or serious spinal pathology¹. Our limited understanding of underlying conditions for back pain is reflected in the common use of pain-durationbased groupings: LBP lasting for 6 weeks or less has been defined as acute, from 7 to 12 weeks as subacute, and for 12 weeks or more as chronic back pain2,3. Still, classification according to LBP duration is questionable, because of evidence that new, acute LBP is rare among adults and that most experiences of all LBP will reoccur⁴.There is a consensus about the duration of the symptoms approach toward the standardization of back pain definitions for use in prevalence studies⁵. Although inter-country differences also exist in the management of LBP sufferers from differing cultural backgrounds, clinical guidelines in different countries are mostly based on the pain-duration classification (acute, subacute, and chronic), or a classification into a diagnostic triage: serious pathology or sciatic syndrome or non-specific LBP⁶.Several physical characteristics have been associated with LBP development. Physiologic changes such as muscle dysfunction occur in the lumbar spine at the same time as do initial episodes of pain: changes that remain after the pain has subsided^7,8. Knowing the degree of relationship between each of these factors and LBP will guide prevention treatment strategies⁹. Pengel et al¹⁰ suggested placing more emphasis on change in pain and disability scores than on physical impairment. Substantial evidence also exists that psychosocial variables are strongly linked to the transition from acute to chronic LBP disability¹¹.To date, there is only marginal literature that describes variations in clinical findings between duration-based classifications. Subsequently, the purpose of this study was to investigate typical clinical tests used in examining LBP patients in order to discover which tests distinguish between chronic low back pain patients (CLBP) and subacute low back pain patients (SLBP), and how clinical findings distinguish these groups from those with no “patient status”.     

Effects of eight-week water versus mat pilates on female patients with chronic nonspecific low back pain: Double-blind randomized clinical trial

ObjectiveTo evaluate the effects of water and mat Pilates on pain, disability, and static and dynamic balance in patients with chronic nonspecific low back pain (CNLBP).MethodsTwenty-four participants with CNLBP were randomly allocated into two groups (n = 12) that perform water and mat Pilates exercises for 24 sessions (8-week, 3 sessions per week). The value for pain, disability and balance were measured before and after the exercise program using the Visual Analogue Scale, Oswestry Disability Questionnaire and Biodex Balance System respectively.ResultsA paired t-test revealed significant differences in pain severity and disability in both groups after they performed the Pilates program (P ≤ 0.05). Mat Pilates improved static balance as the participants performed the tests with their eyes open and closed (P = 0.02, P = 0.04). Its effect on dynamic balance, however, was not statistically significant (ES = 0/33, P = 0/34). The same Pilates program performed in water did not show significant effects on balance despite a decline in body sway (P˃0/05). There was no difference between the two groups (P˃0/05).ConclusionThe results suggest that both mat and water Pilates exercise program have beneficial effects on the treatment of LBP. Nevertheless, the low impact of the mat and water Pilates program on balance improvement suggests more investigation on Pilates training or complementary exercises to improve balance in patients with CNLBP.     

Opioids Versus Physical Therapy for Management of Chronic Back Pain

Chronic low back pain (CLBP) is a common disabling disorder managed by a variety of interventions. The purpose of this article was to review the literature and critique the evidence to determine if opioid analgesics improved patient outcomes compared with physical therapy. No research was found that directly compared the efficacy of opioid analgesics with physical therapy. Although the evidence supports the use of physical therapy in chronic back pain, the study results are conflicting regarding the usefulness of opioid analgesics in CLBP management. More research involving the efficacy of opioid analgesic in treating CLBP is needed.     

Health literacy and beliefs among a community cohort with and without chronic low back pain

Health literacy, the ability to seek, understand and utilise health information, is important for good health. Suboptimal health literacy has been associated with poorer health outcomes in many chronic conditions although this has not been studied in chronic low back pain (CLBP). We examined the health literacy of individuals with CLBP using a mixed methods approach. One-hundred and seventeen adults, comprising 61 with no history of CLBP and 56 with CLBP (28 with low and high disability, respectively, as determined by a median split in Oswestry scores) participated. Data regarding severity of pain, LBP-related disability, fear avoidance, beliefs about LBP and pain catastrophizing were collected using questionnaires. Health literacy was measured using the Short-form Test of Functional Health Literacy in Adults (S-TOFHLA). A sub-sample of 36 participants with CLBP also participated in in-depth interviews to qualitatively explore their beliefs about LBP and experiences in seeking, understanding and using information related to LBP. LBP-related beliefs and behaviours, rather than pain intensity and health literacy skills, were found to be important correlates of disability related to LBP. Individuals with CLBP-high disability had poorer back pain beliefs and increased fear avoidance behaviours relating to physical activity. Health literacy (S-TOFHLA) was not related to LBP beliefs and attitudes. Qualitatively, individuals with CLBP-high disability adopted a more passive coping style and had a pathoanatomic view of their disorder compared to individuals with CLBP-low disability. While all participants with CLBP had adequate health literacy scores (S-TOFHLA), qualitative data highlighted difficulties in seeking, understanding and utilising LBP information.     

Pilates-based core exercise improves health-related quality of life in people living with chronic low back pain: A pilot study

PurposeTo investigate the effects of Pilates exercise on improving health-related quality of life in people living with chronic low back pain.MethodsThis was a single-blind, randomised clinical trial. Thirty-nine physically active subjects aged between 30 and 70 years with nonspecific chronic low back pain for more than three months were recruited. The study employed a pretest-posttest design, with a 4 -, 8 -, and 26-week follow-up. For eight weeks, the intervention group participated in a group-supervised, mat-based Pilates program, while the control group received the usual pharmacologic and rehabilitation standard of care, including patient education on chronic low back pain. The primary outcome was self-perceived health status measured using the EQ-5D questionnaire in a structured form and a visual analogue scale. Secondary outcomes included intensity of pain and degree of disability.ResultsBy the end of the 8-week Pilates program, the intervention group achieved a better health-related quality of life on the EQ-5D visual analogue score than the control group. In assessing the trends in each individual group regarding pain, the intervention group demonstrated an earlier pain reduction than the control group that lasted until the end of the trial.ConclusionsAn 8-week supervised Pilates-based core exercise program is an effective therapeutic modality for improving self-perceived health status in patients with chronic low back pain. This finding could inform clinicians of better alternatives when they suggest exercise interventions for chronic low back pain.     

Efficacy of the Pilates method for pain and disability in patients with chronic nonspecific low back pain: a systematic review with meta-analysis

Objective

To systematically review the available evidence on the efficacy of the Pilates method in patients with chronic nonspecific low back pain.

Method

Searches were performed in MEDLINE, EMBASE, PEDro, SciELO, LILACS, CINAHL and CENTRAL in March 2013. Randomized controlled trials that tested the effectiveness of the Pilates method (against a nontreatment group, minimal intervention or other types of interventions) in adults with chronic low back pain were included regardless the language of publication. The outcome data were extracted from the eligible studies and were combined using a meta-analysis approach.

Results

The searches identified a total of 1,545 articles. From these, eight trials were considered eligible, and seven trials were combined in the meta-analysis. The comparison groups were as follows: Pilates versus other types of exercises (n=2 trials), and Pilates versus no treatment group or minimal intervention (n=4 trials) for short term pain; Pilates versus minimal intervention for short-term disability (n=4).We determined that Pilates was not better than other types of exercises for reducing pain intensity. However, Pilates was better than a minimal intervention for reducing short-term pain and disability (pain: pooled mean difference=1.6 points; 95% CI 1.4 to 1.8; disability: pooled mean difference=5.2 points; 95% CI 4.3 to 6.1).

Conclusions

Pilates was better than a minimal intervention for reducing pain and disability in patients with chronic low back pain. Pilates was not better than other types of exercise for short-term pain reduction.     

Comparative effects of 12 weeks of equipment based and mat Pilates in patients with Chronic Low Back Pain on pain,function and transversus abdominis activation. A randomized controlled trial

BackgroundPilates method has been recommended for patients with chronic low back pain (CLBP) and the activation of transversus abdominis has been deemed to play an important role in the improvement of these patients. Nevertheless, the evidence of the activation of TrA in Pilates practitioners remains unclear.ObjectiveTo assess the effectiveness of 12 weeks of Pilates practice in disability, pain, kinesiophobia and transversus abdominis activation in patients with chronic nonspecific Low Back Pain.DesignA randomized controlled trial was carried out.MethodsA single-blind randomized controlled trial with repeated measures at 6 and 12 weeks was carried out. A total of ninety eight patients with low back pain were included and randomly allocated to a Pilates Mat group (PMG) equipment based with apparatus Pilates (PAG) or control group (CG). Roland Morris Disability Questionnaire (RMDQ), visual analog scale (VAS) Tampa Scale of Kinesiophobia (TSK), and transversus abdominis (TrA) activation assessed by real time ultrasound measurement (US) were assessed as outcome measures.ResultsImprovement were observed in both intervention groups in all the included variables at 6 and 12 weeks (p < 0.001). Faster enhancement was observed in the equipment based Pilates group (p = 0.007).ConclusionsEquipment based and mat Pilates modalities are both effective in the improvement of TaA activation in patients with CLBP with associate improvement on pain, function and kinesiophobia. Significant differences were observed after 12 weeks of intervention in PMG and PAG with faster improvement in PAG suggesting that, feedback provided by equipment could help in the interiorization of Pilates principles.     

Treating non-specific chronic low back pain through the Pilates Method

The goal of this study is to review and analyze scientific articles where the Pilates Method was used as treatment for non-specific chronic low back pain (CLBP). Articles were searched using the Medline, EMBASE, PEDro, CINAHL, and SPORTDICUS databases. The criteria used for inclusion were randomized controlled trials (RCT) and clinical controlled trials (CCT) published in English where therapeutic treatment was based on the Pilates Method. The analysis was carried out by two independent reviewers using the PEDro and Jadad Scales. Two RCTs and one CCT were selected for a retrospective analysis. The results of the studies analyzed all demonstrate positive effects, such as improved general function and reduction in pain when applying the Pilates Method in treating non-specific CLBP in adults. However, further research is required to determine which specific parameters are to be applied when prescribing exercises based on the Pilates Method with patients suffering from non-specific CLBP. Finally, we believe that more studies must be carried out where the samples are more widespread so as to give a larger representation and more reliable results.     

Exercise therapy for low back pain: a small-scale exploratory survey of current physiotherapy practice in the Republic of Ireland acute hospital setting

A small-scale exploratory cross-sectional survey investigated the current use of a range of exercise therapy approaches for low back pain (LBP) by outpatient physiotherapists in the acute hospital setting in the Republic of Ireland, where the majority of publicly funded treatment is delivered. Of the 120 postal questionnaires distributed to 24 physiotherapy departments, 87 were returned (72.5% response rate). The results showed specific spinal stabilization exercises were the most popular exercise therapy for acute (39%; n = 35) and chronic (51%; n = 48) LBP, followed by the McKenzie approach (acute LBP (ALBP) 35.6%; n = 32: chronic LBP (CLBP) 17%; n = 16), and abdominal exercise (ALBP 11.1%; n = 10: CLBP 9.6%; n = 9). The most popular forms of exercise therapy used by outpatient physiotherapists in acute hospital settings in Ireland lack support from evidence-based clinical guidelines, and further large-scale high quality randomized controlled trials of these approaches are warranted. Further research should also establish the use of exercise therapy and attitudes to clinical guidelines of physiotherapists in other countries and healthcare settings.     

A Randomised Controlled Study of the Outcome of Hydrotherapy for Subjects with Low Back or Back and Leg Pain

Background and purpose:

Exercise is frequently selected by physiotherapists to treat patients with low back pain (LBP) or with back and leg pain. Anecdotally a particular form of exercise, group hydrotherapy, is widely accepted as a beneficial and cost-effective method of management. This study was designed to investigate the claimed benefits of group hydrotherapy for subjects with chronic low back pain (CLBP) and back and leg pain.

Subjects:

A total of 109 adults with LBP or back and leg pain of more than three months duration were randomly assigned to either a hydrotherapy (experimental) or control (delayed hydrotherapy) group; 95 subjects completed the study.

Methods:

Before and after the four-week‘intervention period’ the following measures were recorded for all subjects in both groups: the ranges of active lumbar flexion and extension and of passive straight leg raise; the levels of lower limb strength, reflex responses, light touch sensation, functional disability using the Oswestry Low Back Pain Disability Questionnaire, and pain using the McGill Pain Questionnaire. All measurements were made and recorded by an experienced physiotherapist unaware of the group assignment of subjects.

Results:

Analysis with chi-square showed a statistically significant greater number of subjects in the experimental group improved in their function and fewer deteriorated. Subjects whose condition improved on the other measures were typically in the experimental group, while those whose condition deteriorated were typically in the control group.

Conclusion and discussion:

The findings offer qualified support to anecdotal evidence that group hydrotherapy can benefit subjects with CLBP or back and leg pain.     

Short- and long-term effects of a six-week clinical Pilates program in addition to physical therapy on postmenopausal women with chronic low back pain: a randomized controlled trial

Purpose: To determine the short- and long-term effectiveness of the application of Clinical Pilates in addition to physical therapy versus a physical therapy treatment alone in a population of postmenopausal women with chronic low back pain (CLBP). Methods: A single-blind randomized controlled trial with repeated measures and a follow-up period. One hundred and one patients were randomly allocated to a Pilates?+?physical therapy (PPT) group or to a physical therapy (PT) only group for six weeks. Pain and disability were measured by visual analog scale (VAS) and the Oswestry disability index respectively preintervention, after 6 weeks of treatment and after 1-year follow-up. Results: There were significant differences between groups in pain and disability after 6 weeks of treatment, with better results in the PPT group with an effect size of d?=?3.14 and d?=?2.33 for pain and disability. After 1-year follow-up, only PPT group showed better results compared with baseline with an effect size of d?=?2.49 and d?=?4.98 for pain and disability. Conclusion: The results suggest that using Clinical Pilates in addition to physical therapy provides improved results on pain management and functional status for postmenopausal woman with CLBP and that its benefits still linger after one year.

• Implications for Rehabilitation

• Chronic Low Back Pain could benefit from the Pilates practice in postmenopausal women.

• Improvement in pain and disability derived from CLBP seem to be maintained over time due to Pilates practice.

• Pilates constitutes a safe tool to be applied in older population with CLBP due to its ability to be adapted to every performance and physical level.

     

L’hypnose médicale dans la gestion de la douleur chronique

Interest in hypnosis for chronic pain management has increased in recent years and several studies have indicated that hypnosis interventions produce a significant decrease in chronic pain. However, there are a number of basic research weaknesses throughout most of these reports. First, there was a lack of standardization of the hypnotic interventions. Second, no data were available to determine precisely a clinical profile of responders to hypnosis. Third, the efficacy of self-hypnosis benefits has poorly been investigated. However, there are few data about the positive effects of hypnosis beyond pain reduction and so continuous research will be needed to fully evaluate the efficacy of hypnosis in chronic pain management.     

Low back pain: state of art

Diagnosis of low back pain (LBP) is made by exclusion of secondary spinal diseases, identifiable in the first month of pain (acute LBP – ALBP) through the so-called “reds flags”, and only if pain persists over 4 weeks (sub-acute LBP – SALBP) using diagnostic exams. LBP classification is actually based on the localization (LBP and sciatica) and duration of pain: ALBP, SALBP, and chronic (CLBP) when it lasts over 6 months. ALBP prognosis is very good because it is auto-resolving in most of the cases; on the contrary, CLBP has a bad prognosis (very low rate of resolution even with treatment). The stage of most interest is SALBP, in which it is possible to identify risk factors (“yellow flags”) of chronicity and to avoid the development of a series of vicious cycles that, according to a bio-psycho-social model of illness, can lead the patient to CLBP. In CLBP it's mandatory to make the patient able to manage his problem, so to increase his quality of life and decrease disability and pain. Treatment approach to ALBP consist of reassuring the patient and providing accurate preventive information, recommendations to remain as active as possible, to avoid bed rest. In SALBP and CLBP, a multidisciplinary team rehabilitation approach is the most important one, combining educational, cognitive-behavioural and physical exercise treatments according to the individual needs. Pain killer therapies can be proposed, but bearing in mind their short-term effects.     

Correlation between change in pain,disability, and surface electromyography topographic parameters after interferential current treatment in patients with chronic low back pain

[Purpose] Surface electromyography (SEMG) topography is used to objectively assess patients with low back pain (LBP). This study aimed to investigate the correlation between SEMG topographic variables, pain, and disability in patients with chronic LBP (CLBP) after interferential current (IFC) treatment, and to evaluate IFC treatment efficacy using SEMG topography. [Participants and Methods] Twenty nine patients with CLBP were recruited for a 6-week IFC treatment. Pain and disability scores, and the root-mean-square difference (RMSD) of SEMG topographic variables (relative areas [RAs] at flexion and extension) were compared before and after the intervention by repeated measures ANOVA; the correlation between variables was also explored and p-value was set at 0.001. [Results] Significant positive correlations between changes in pain score and the RMSD of RA at flexion (r(29)=0.593), and between changes in pain and disability scores (r(29)=0.426) were observed. All participants showed statistically significant improvements in the RMSD of RA at flexion, pain score, and disability score after IFC treatment. [Conclusion] SEMG topographic variables are closely associated with changes in pain score in patients with CLBP after IFC treatment. The RMSD of RA at flexion can be used as an objective marker in IFC treatment efficacy evaluation.