Posts Tagged ‘Low back pain’
Mechanical or inflammatory low back pain. What are the potential signs and symptoms?
Tuesday, August 4th, 2009Non-specific low back pain (NS-LBP) is commonly conceptualised, categorised and treated as inflammatory and/or mechanical in nature. There is no universally accepted definition for mechanical or inflammatory LBP, however, there is evidence to support the involvement of both mechanical and inflammatory factors in its generation. Following from this nosological separation, there are two distinct approaches to treatment for LBP: treatment involving “mechanical” intervention, such as mobilisation, manipulation, traction and exercise are contrasted with ‘‘anti-inflammatory’’ treatments like non-steroidal anti-inflammatory medications and corticosteroid injections.
In an effort to identify common symptoms or signs that may allow discrimination between inflammatory low back pain (ILBP) and mechanical low back pain (MLBP), Walker and Williamson recently surveyed experienced health professionals from five professions using a questionnaire listing 27 signs/symptoms. Of 129 surveyed, 105 responded (81%). According to their results, constant pain, pain that wakes, and stiffness after resting were generally considered as moderate indicators of inflammatory LBP. Intermittent pain during the day, pain that develops later in the day, pain on standing for a while, pain bending forward a little, pain on trunk flexion or extension, pain doing a sit up, pain when driving long distances, pain getting out of a chair, and pain on repetitive bending, running, coughing or sneezing were all generally considered as moderate indicators of MLBP. There was, however, no consistency of agreement either between or within professional groups.
While the general absence of agreement regarding signs and symptoms of ILBP and MLBP does not invalidate the pathophysiological paradigms of mechanical and inflammatory pains, it does, however, signal the need for further research. This research should be aimed at testing the indicators identified in this study for their ability to predict the outcome of mechanical and anti-inflammatory treatments of LBP.
Physical activity and low back pain: a U-shaped relationship?
Monday, August 3rd, 2009Heneweer H, Vanhees L, Picavet HS. Physical activity and low back pain: a U-shaped relation. Pain. 2009 May;143(1-2):21-5. Epub 2009 Feb 12.
Physical activity is often suggested to be important in the prevention and management of low back pain. However, when viewed simply such advice does not take into account the possibility of U-shaped relation between the level of activity and back pain – i.e. both inactivity and excessive activities present an increased risk for back pain.
Heneweer et al. have analyzed cross-sectional data from the Dutch population-based Musculoskeletal Complaints and Consequences Cohort study (DMC(3), 1998) of a sex-age stratified sample of 25 years and older (n=3364). The type of activity (daily routine, leisure time and sport activity), intensity of and time spent on these activities, and back exertion of sport activities were all taken into account. Physical activity was not associated with chronic low back pain (CLBP) when studied by the dimension of activity, by the intensity or by the duration of physical activity. Only engaging in sport activity was associated with less CLBP. The extremes of the total physical activity pattern were associated with CLBP: a moderate increased risk for CLBP was found for both participants with a sedentary lifestyle and for those being involved in physical strenuous activities. This was especially true for women.
This study provides some evidence that the relationship between physical activity and CLBP is U-shaped. Total physical activity appeared to be more significant than individual dimensions of low back exertion.
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