News Category: Lumbar Spine

Can children and teenagers have back pain from a “slipped disc”? Yes. Although rare in children nine to 12 years old (only three cases on record), this condition is more common between ages 12 and 16.

A spongy pad called an intervertebral disc separates the bones of the spine. When the disc bulges out and pushes against the spinal nerves inside the spinal canal, low back pain with or without leg pain can occur. Though commonly called a “slipped disc,” the medical term for this condition is disc herniation.

Back pain from a disc herniation can occur in adults and teenagers, usually from direct injury to the back, sports activities, or lifting heavy objects. Researchers looking at cases of children and teens from nine to 18 years of age also discovered a large number (31 percent) who had changes in their bone structure. Curvature of the spine (scoliosis), narrowing of the space for the spinal cord (stenosis), and differences in the normal shape of the bones were the most common changes observed. Researchers think these defects most likely result in discs that herniate at an early age.

Treatment for a herniated disc in the low back begins with medication. Other treatment includes physical therapy, bracing, and surgery. Surgery to remove a small covering of the vertebral column over the injured disc is called laminectomy. When the disc is also removed, the procedure is called discectomy.

Some doctors have questioned the success of surgery for this problem. By studying 129 cases of children ages nine to 18 years, doctors were able to see that right after surgery, pain was decreased or eliminated. Three-quarters of these children could continue their previous activities.

However, when these children and teenagers were contacted years later, more than half had back or leg pain causing them to avoid some activities. Until better treatment choices are available, doctors recommend close follow-up for anyone under the age of 18 who has surgery for this kind of back problem.

If your doctor said you should exercise to get rid of your back pain, would you follow that advice? Would you be more likely to exercise if your doctor gave you a booklet with ways to help take care of your back pain?

Doctors often tell their patients to exercise more often after a bout with back pain. But they don’t know if their advice is taken. More important, doctors aren’t sure if their patients improve after following instructions to exercise.

To find out the answers to these questions, doctors made up their own test. Eight doctors from six clinics divided 311 patients into four groups. Each patient had a new episode of back pain. One group received a detailed self-help booklet. Another group was given advice to take regular exercise. A third group received both the booklet and the advice. The last group did not get either.

Everyone was contacted by phone one week after the first appointment with the doctor and again after three weeks. A survey was also mailed to each patient. The doctors were interested in patients’ pain, ability to carry out daily activities, satisfaction with results, and how much patients had learned.

What did the doctors find out?

• Advice to exercise or a booklet with information increases patient satisfaction.


• With either advice or a booklet (but not both), patients improved more than if they were told to exercise and use medication for pain.


• A booklet increases knowledge and doesn’t cost much.


• When told to exercise regularly, people usually do it!


• Advice and a booklet given together are not helpful, especially if the information in each one is different.

To doctors: Give simple advice and a booklet with the same information to patients with new back pain. Even slightly different information is not effective.

To patients: When you have new back pain, take your doctor’s advice. Read and follow the self-care tips offered in booklets. Exercise regularly and keep exercising all your life. Research proves that exercise and activity will help protect your back in the long run.

We tend to think of the spine as rigid and unmoving. But in fact the spine is moving whenever we’re up and about. Though we stand upright while walking, the parts of the spine are still in motion. Walking is actually a product of thousands of small spinal movements. These authors wanted to see whether low back pain changed the pattern of these spinal movements.

Thirty-four patients with low back pain participated in the study. These patients had experienced low back pain on at least half the days of the past 12 months. On a scale of one to 10, their average pain rating was a four. They had moderate limitations in their daily activities due to low back pain.

The patients walked on a treadmill for several minutes at 4.5 km/hour. During this time, movement in the upper and lower areas of their low backs was recorded by ultrasound. Three kinds of spinal movements were recorded: forward to back, side to side, and rotation. Twenty-two hospital personnel who didn’t have low back pain were also monitored on the treadmill, to act as a comparison group.

Patients with low back pain took shorter steps than the other group. The authors think that people with back problems may develop more rigid or cautious walking styles to avoid pain.

Overall, there were no major differences between the two groups in kinds of movement while walking. The size, pattern, and timing of spinal movements were basically the same for both groups.

However, patients with low back pain showed an inconsistent stride. For these patients, one step could be very different from the next. This variability reflected actual fluctuations in amount of spinal movement.

The authors think that low back pain reduces patients’ control over movement. Low back pain may actually impair the sensory information systems that regulate movement. With more variation during their strides, patients with low back pain expended more energy. This makes it hard to maintain a consistent, effective gait.

The authors feel that studies of movement offer important information about low back pain. Variations in how people with low back pain walk should be considered by those treating patients with back problems.

Low back pain affects millions of people in the United States every year. Billions of dollars are spent in lost wages and medical bills for this problem. It is expected that eight out of every 10 Americans will suffer back pain sometime during their lives.

Given those numbers, doctors and physical therapists are working hard to find ways to prevent and treat back injuries. One of the most popular ways to treat back pain is exercise to strengthen muscles. Different exercises are used to strengthen different muscles of the back, trunk, stomach, and buttocks.

Physical therapists know that some muscles move the back or upper body while others hold the back in place. Knowing how these muscles work and which exercises really make a difference is important. Previous research has shown that muscles that move the back or trunk can be strengthened and measured. So far, similar studies of exercises for the holding or stabilizing muscles have not been done.

A group of physical therapists looked at two of the stabilization exercises commonly used in back programs. Muscle activity during these exercises was measured. Twelve healthy adults (ages 25 to 39) who had no previous back problems did the exercises. The therapists placed electrodes on the skin over different muscles of the back, stomach, trunk, and buttocks. While doing one of two different exercises, the activity level of the muscles was measured through these electrodes.

What did the researchers find? One exercise used the stomach or abdominal muscles while the other exercise required more trunk and buttock muscles. However, in healthy adults there wasn’t enough muscle activity to actually strengthen the muscles during these exercises. What does this mean? It’s back to the drawing board for physical therapists! A future study is planned to measure the effects of these exercises on people who have injured their backs. It may be that weak muscles can be strengthened by these two exercises.

It’s nice to know that physical therapists are able to train patients with low back injuries in safer and more effective ways. Finding out which exercises work the best to strengthen the back will benefit those who have low back pain.

People whose work or sport requires them to bend their lower backs forward a lot risk low back pain and injury. After periods of bending, the multifidus–the deep muscles that run along each side of the spine –may not adequately support the spine. Also, the other supportive tissues in the low back relax. When the multifidus muscles tire and other supportive tissues relax, the spine is left unprotected and prone to injury.

These tissues need a chance to recover after the spine is bent forward for long periods. But how much rest do they need in order to keep the spine safe? The purpose of this study was to describe the recovery in the spine after periods of bending. Specifically, the authors wanted to know how long it took for the muscles and other supportive tissues to recover. They also wanted to learn the extent of the recovery.

Seven cats were anesthetized and kept with their spines in a forward bent position for 20 minutes. They were then put in a normal resting position for seven hours. During the rest period, the cats were again bent forward in nine, six-second tests. The activity of the multifidus muscles was recorded. Low back tension was also measured.

Twenty minutes of bending resulted in considerable fatigue of the multifidus muscles. This was followed by erratic spasm within the muscles. The tension of the low back tissues also decreased. Some signs of back strain lasted after the 20 minutes were up.

Prolonged use may deactivate the multifidus muscles to the point that they can’t give the spine the stability it needs. The normal level of supportive tension in the back is also reduced. This leaves the spine unprotected and prone to injury. In fact, the spasms observed in these models suggest that some damage had already occurred during the test period.

In addition, the tissues in the low back did not completely recover in the seven hours of rest. Tension reached a low of 32 percent after 20 minutes of bending. After seven hours of rest, the tension was only 79 percent, a total improvement of 47 percent. Most of the recovery happened within the first 10 minutes of rest. However, recovery was slow after that. Using this model, the authors suspect that 24 hours may be needed for the muscles and elastic tissues to recover fully–much more than a simple cat nap.

Clearly, long periods of forward bending threaten the stability of the spine and can cause strain and muscle spasm. Long periods of rest may be necessary to restore optimal back function after the spine has been kept in a forward-bent position.

Ideally, there should be a balance between what is demanded of us in our daily lives and what we can physically handle. For patients with low back pain, this balance has often been thrown out of whack. These patients may attempt more activities than they can tolerate. Or they may have less physical ability than they need to get through their days.

The authors believe that low back pain isn’t just physical–it has to do with mental and social factors as well. In this view, treatment of back pain needs to address all these parts in order to help the patient achieve a healthy, balanced lifestyle. A back “school” in the Netherlands seemed to provide exactly this kind of treatment, addressing the whole person rather than the low back alone.

The goal of the back school was to help patients toward their ideal load of activities and level of performance. Generally, patients went to the school 12 times over about four months. During this time, they did physical activities such as circuit training and aqua jogging to improve their aerobic performance, range of movement, and strength. They also learned about the mental and social components of back pain. They were trained in body awareness so they better understood their limits.

Fourteen patients went to back school. Ten other patients were put on a waiting list. Both groups had an equal number of men and women. Patients in both groups had experienced low back pain for more than three months. Before and after back school (or after one month’s time, in the case of the waiting list group), patients completed a series of physical tests and questionnaires.

The back school seemed to improve patients’ physical abilities and in many cases to give them an edge over patients who didn’t do the program. Patients in back school improved their aerobic performance, range of movement, and strength. Compared to patients on the waiting list, back school patients had more strength and achieved a higher heart rate while lifting. They also felt they were able to work harder during lifting tasks.

Back school patients showed improved mental health and social functioning after treatment. However, waiting list patients started out showing better mental health and social functioning and came out ahead in these areas.

Patients who went to back school improved their physical functioning, health, and ability to do daily tasks. By the end of the study, they far surpassed the waiting list group in these areas.

From these results, the authors conclude that back school helped patients toward better health and functioning. The authors don’t think this was due to the physical training alone, though. The back school seemed to improve patients’ responses to signals that they might be doing too much or that they could safely do a little more. The authors believe that this program helped patients to understand the need for balance. By doing so, patients might be better able to control back pain.

Lumbar spinal stenosis (LSS) is a common condition for people over 60. It comes from compression of the nerve roots that exit the spinal column or of the cauda equina, a bundle of nerves in the base of the spinal canal. The condition can result in low back pain, pain in the legs and feet, numbness or tingling, and difficulty walking.

LSS tends to get worse over time and may even get in the way of patients’ ability to do daily activities. Doctors make certain assumptions about symptoms that go along with LSS, but few studies have given a full medical profile of patients who have it. These authors wanted to do just that. Their study was designed to identify symptoms that go with LSS and find out which of them relate to difficulty walking.

Patients were recruited from three specialty clinics: a center for spine disorders, a pain treatment unit, and an orthopedic spine practice. There were 43 patients in all, about half of them from the orthopedic practice. Sixty-five percent of the patients were women. Almost all of them were Caucasian. Patients’ ages ranged from 46 to 90; 74 was the average age. Patients had experienced low back pain for about two years. A few of them (16 percent) had even had back surgery.

After patients were diagnosed with LSS, they filled out questionnaires about their pain and difficulty walking. They then underwent a full physical examination. The exam included assessments of posture, balance, range of spinal movement, muscle strength, and reflexes.

One-third of the patients said they had problems with balance. The same percentage had trouble standing with their feet close together and eyes closed without swaying. Nearly half of the patients walked with their legs in a wide stance–a common way of making up for balance problems.

Patients with LSS generally find it comfortable to stoop forward to relieve the pressure in their low backs. This held true for patients in this study. Eighty-one percent either had a stooped posture or were missing the slight inward curve normally found in the low back.

As expected, patients’ range of spinal movement was limited. Two-thirds of the patients had trouble bending backward from the waist and reported pain in this position. This supports the belief that this position shrinks the size of the openings where the nerve roots come out of the spinal column. It also narrows the spinal canal, potentially putting more pressure on the cauda equina. Yet thirty-seven percent of the patients also had a hard time bending forward.

The majority of the patients (63 percent) had some numbness or tingling in their thighs, calves, or feet. These symptoms were sometimes severe and often happened a few times a day.

Most of the patients either did not respond or had poor responses to sensation tests (for example, vibration or pinpricks) of their legs and feet. They also showed weakness in some of the muscles of their lower limbs, which matched reports of muscle weakness in the questionnaires. One-third of them said they had severe lower-body weakness; another third said they had mild to moderate lower-body weakness. This could be attributed to the fact that patients in pain are less active, leading to even greater muscle weakness.

Most patients (65 percent) said they had low back pain at the time of the exam. They also felt pain in the buttocks (81 percent), thighs (84 percent), calves (51 percent), and feet (35 percent). About one-third of the subjects said they had back pain all of the time. Roughly three-quarters said the pain got worse with walking. During the exam, patients’ pain often flared up when they bent forward or backward.

Sixty-three percent of the patients said they had severe or very severe problems walking. About the same number of patients were unable to walk two or more blocks. Surprisingly, women were more likely to have difficulty walking than men. So were patients with balance problems and those whose pain worsened as they walked. Age didn’t seem to affect patients’ balance or walking. The authors conclude that pain and balance problems are the tell-tale features that limit walking in patients with LSS.

Surgery to join vertebrae in the spine doesn’t always work. In some cases, the bone graft placed between the vertebrae may not unite, or the graft simply may not be strong enough. Doctors use the term “nonunion” to describe a failed fusion.
 
Certain risk factors, like being overweight or smoking, can make fusion less likely. So can taking anti-inflammatory drugs or steroids right after surgery. Still, doctors want to get good results for all their patients. In this article, the authors review techniques that may help the spine heal after surgery.

Whether or not the fusion takes has a lot to do with what happens during surgery. Implanting metal hardware such as screws, plates, or rods to reduce spinal movement after surgery has improved the success of spinal fusion. Also, the greater the blood supply, the better the healing. Surgeons can improve blood supply by clearing damaged tissues out of the way and by taking extra care around healthy tissues. With an improved blood supply, the fusion site gets more of the oxygen and infection-fighting cells that promote healing.

After surgery, electrical stimulation may also help improve fusion success. A version of this technique was first used in the 1950s to promote bone growth. Surgeons implant an electrode that gives a mild current directly to the fusion site. Or electricity can come from wearing a pulsing device on the skin up to 24 hours a day.

Electrical stimulation has worked wonders on fusion rates. High-risk patients have better chances of spinal fusion with this technique. (These patients include those who smoke or are overweight, and those who have surgery at multiple levels of the spine.)

Ultrasound therapy is another possibility for improving fusion rates. This technique has recently been tested on rabbits. A low-intensity ultrasound wave may help spinal fusion. Like electrical techniques, this one can be done at home, and it may take only 20 minutes a day.

Scientists have begun using gene therapy to develop growth factors. These are natural proteins found in the body that encourage the growth of healthy bone. Doctors are excited about the recently discovered bone morphogenic proteins (BMPs). These proteins have shown promising results in growing and fusing bone tissue.

Most of the techniques mentioned here are new to spinal fusion. There is still a lot of research to be done. But in general, these methods promise better results for spinal fusion surgery.

Back injuries among workers continue to escalate. As people work later in their lives, the number of injuries may go even higher. Are people less likely to recover from back pain as they get older? What are their chances of returning to work?

This study involved 1,052 patients with back injuries from work. The patients ranged in age from 22 to 59. They were divided into five groups based on age. None of the patients was working full-time at the beginning of the study.

The patients took part in a treatment program that included counseling for stress, pain management, and physical exercise. Patients were contacted a year after treatment to see how they were doing and whether they had returned to work. The authors wanted to know whether patients of different ages had different results from the treatment. 

Before treatment, younger patients generally hadn’t been in pain as long as older patients. Younger patients were also less likely to have had back surgery. Even so, patients of all ages went into treatment with basically the same level of functioning. After treatment, however, younger patients tended to have much better functioning. Compared to older patients, younger patients showed better physical abilities both before and after treatment, and they were better able to shake depression.

Younger patients were also much more likely to go back to work after treatment. All of the patients under age 25 returned to work, but only 69 percent of patients 55 and older got back on the job. Once back on the job, younger patients were more likely to stick with it. Ninety-eight percent of them were still working one year after treatment, versus 63 percent of the 55 and older group.

Younger patients were more likely to get a different job than the one they’d had at the time of injury. Older patients often went back to the same employer to do the same job, or they became self employed. The authors consider that perhaps older workers feel they have fewer options in the workforce.

The authors conclude that patients have a harder time getting over back injuries as they get older. Older patients face other challenges that can hamper their return to work: worker burnout, easier access to Social Security Disability Income, and greater difficulty healing after injury. This study bolsters the notion that older backs have a harder time bouncing back.

Patients who seek medical help for low back pain often get mixed advice on how the problem should be treated. Some treatments help; others don’t. Which ones are best, and which of them are potentially harmful for patients? 

Some doctors recommend bed rest for acute low back pain and sciatic pain in the leg. But is this the best advice? A recent review of scientific studies on bed rest may put this heated issue to rest.

Two independent researchers did a complete review of scientific studies dealing with bed rest for patients with acute low back pain. Only high-quality studies were included for the final analysis. In this way, health experts could know whether bed rest is helpful–or harmful.

Nine studies were included in the final review. Four studies showed a comparison between patients who were told to stay in bed and those who were advised to stay active. Four other studies matched up how well people did on bed rest compared to other treatments like exercise, joint stretching, spine education, and medication. Two additional studies measured the difference between staying in bed for up to three days versus seven days.

Pain, function, and sick leave were used as bench marks to test whether bed rest was more helpful than staying active. No differences were found. Staying in bed seven days was no better than resting for three days. And no differences were seen between people who were advised to rest in bed and those who stayed active with other types of treatment.

According to the authors, “Bed rest is not effective in the treatment of low back pain.” 

Patients treated with bed rest didn’t show any side effects. But the authors caution those who recommend bed rest to consider the harmful effects that are known to happen as a result of limiting movement and activity.

In conclusion, the authors put the issue to rest by stating: “No further research on the role of bed rest in the treatment of low back pain is needed.”

What causes low back pain? In a society plagued by back problems, that’s a million dollar question. So far, research has shown different risk factors for low back pain based on work, lifestyle, and health. In this study, the authors followed a group of factory workers for two years to see whether they developed low back pain. A comparison was also made of the workers who ended up with back pain, to try to identify possible causes of low back pain.

One hundred forty-nine workers from a factory in Canada participated in this study. The participants were mostly men who worked as spinning operators. This job involves running machines that prepare fibers for weaving into fabric. The workers also had to lift more than 5,000 kilograms of nylon bobbins per shift, with each bobbin weighing between 4.5 and 12.7 kilograms. About half of the participants said they had felt low back pain at least one time in the two years before the study.

The participants did a series of physical tests that measured the strength of their backs, legs, and abdominals. Special sensors were used to record how fast participants could bend down and straighten up at the waist and to measure the strength of their spine muscles. Participants also filled out a questionnaire about their work, health, and lifestyle.

Every six months for the next two years, participants were asked whether they had any low back pain. Of the 149 participants, 82 (55 percent) said they had low back pain at some point over the two years. However, they usually said their pain wasn’t serious.

Based on the initial tests, the authors identified characteristics that seemed to lead to low back pain. Younger workers and those who were not physically active were more likely to develop low back pain. Workers who took more medications were more likely to have low back pain, as were those who didn’t have someone close to talk to. Workers with weaker quadriceps (front thigh muscles) and spine muscles were more likely to have pain, as were those who couldn’t move their trunks up and down very quickly.

Research has shown that people with a history of low back pain are more likely to have low back pain in the future, but this did not hold true in this study. Job stress and job satisfaction were not related to low back pain, and neither were lifting techniques.

The authors conclude that many factors can lead to low back problems. Given the results of this study, physical fitness may be factory workers’ best defense against low back pain.

Healthy trunk muscles activate to hold the spine stable and safe during movement. Though small in size, the multifidus muscles that lay deep within the low back have become the focus of attention as a key contributor to spine stability. These important muscles lie on the back surface of the spinal column. The shortest ones cross from one vertebra to another. Others cross several vertebrae. They coordinate their actions with key muscles of the abdomen, the transverse abdominal muscles. Working together, the multifidus and transverse abdominal muscles control and protect the spine during movement.

A weak or injured multifidus muscle may make a person prone to low back pain. Even when a first episode of low back pain gets better, the multifidus muscle may not heal completely. This leaves the low back prone to reinjury. Could this be a reason why almost 90 percent of patients who’ve had low back pain once end up having it again–and again? These authors tested whether training patients’ multifidus and transverse abdominal muscles after a first episode of low back pain would make patients less vulnerable to low back pain in the future.

Thirty-nine patients ages 18 to 45 participated in the study. All of the patients were experiencing their first episodes of low back pain, which lasted less than three weeks.

The patients were divided into two groups. Nineteen of them got advice on bed rest, pain medication, and time off work. They were advised to do their normal activities to the extent that their pain allowed. The other 20 patients got the same treatment plus specific exercises twice a week to activate and train their multifidus and transverse abdominal muscles.

The treatment lasted four weeks. The authors followed up one and three years later to see whether patients had additional episodes of low back pain. 

Patients who did exercises to train their trunk muscles had less low back pain later. In the year after treatment, only 30 percent of them had low back pain. Meanwhile, 84 percent of patients who didn’t do special exercises had low back pain again in the first year. That means patients who didn’t do exercises were 12 times more likely to have low back pain.

Most of the patients who did the exercises said the second round of pain wasn’t as severe as the first. However, more than half (56 percent) of the patients who didn’t do exercises said the pain was just as severe as the first time.

In the second and third years after treatment, patients who did the trunk exercises still fared better. Only 35 percent of them had back pain. Seventy-five percent of patients who didn’t do exercises had low back pain in the second and third year, though the severity of their pain had subsided somewhat from the first episode.

The study shows that an exercise program targeting the multifidus muscles combined with basic medical treatments and resuming normal activities lowers the chances of having future episodes of low back pain. To confirm this theory, the authors would like to see this program repeated for a larger group of patients.

The authors conclude that “In terms of prevention of recurrences [of low back pain], this study might represent one step forward in the optimal management of the acute low back pain patient.”

A natural response to low back pain is to stop using the sore muscles in your back. But after a while, the pain and inactivity can make these muscles shrink. Can exercise therapy get the muscles back in good shape?

This study was part of a series to examine the effects of exercise therapy on low back pain. In the first part of the series, researchers found that exercise therapy improved the muscular strength and endurance of patients with low back pain. In this segment, researchers looked at the muscles themselves, to see if improvements in strength were related to actual changes in the muscle tissue.

Fifty-nine patients participated in the study. Twenty-nine were men; 30 were women. They each took part in one of three exercise programs: physical therapy, muscle training with special devices, or low-impact aerobics. Patients did exercise therapy twice a week for three months.

Before and after treatment, the authors took an MRI scan of each patient’s torso. This gave a computerized image of patients’ back muscle tissues. The authors also took muscle samples from each patient’s back, to study under a microscope.

Before exercise therapy, the size of patients’ back muscles was directly related to their strength. That is, the bigger the muscle, the stronger it was. The presence of certain muscle fibers was important to keeping muscles from wearing out during physical tests.

The authors expected that patients’ muscles would get bigger during exercise therapy, to explain their increased strength after treatment. Yet exercise therapy didn’t seem to make much difference in the size of patients’ muscles. Trunk muscles tended to get slightly bigger for patients in the physical therapy and aerobics groups, and slightly smaller in the group that used special training devices. But changes in muscle size weren’t related to improvements in muscle strength. And the actual fibers that made up the muscles didn’t change at all.

No changes occurred at the muscular level, suggesting that improvements were due to improved muscle action and coordination. However, this time span might not have been enough time to show changes within the muscle cells. Muscles may change more slowly, especially when they’ve stopped working due to back pain.

This study may have captured the beginning of a long process of muscular change. A longer study period and other specialized ways to explore the back muscles may show that more than three months is required to reverse the harmful effects of back pain on the health of these muscles.

A common response to low back pain is to become less active and to stop using the muscles in the back. It’s natural to want to avoid the pain that may come with movement, but not using back muscles can lead to more problems. The muscles quickly lose strength and start to tire easily–hardly a recipe for a healthy back. Exercise therapy can help. But what benefits can patients expect from exercise therapy, and is one kind better than another?

This study was the first of a three-part series to examine the effects of exercise therapy on low back pain. In particular, these authors wanted to know whether different exercise therapy programs would improve back muscle strength and endurance for patients with ongoing low back pain.

Participants included 148 patients who had been having pain off and on for an average of 11 years. More than half of them were women. The average age was 45.

Patients were placed in one of three treatment groups. The first group had one-on-one physical therapy treatments. They did strength exercises and learned about healthy ways to move. The second set of patients met in groups of two or three and used special training devices to improve back strength. The third group of patients met with a dozen others in an aerobics and stretching class, which included exercises for the trunk and legs. For all groups, treatment took place twice a week for three months.

Patients in each group did a series of physical tests before and after treatment to see whether their physical performance had changed. After treatment, patients in all of the groups showed better trunk strength (bending forward, stretching back and to the side, and twisting). They were better able to use their back muscles in trunk-bending exercises, suggesting improved strength. Patients’ back muscles also showed better endurance, though the authors suggest these improvements had more to do with patient motivation and pain tolerance than real physical changes in the muscles.

The specific type of treatment patients got didn’t seem to affect their physical performance, with one exception. Patients in the group that used special training devices did better on tests of trunk strength. This could be because they had practiced similar exercises during the treatments.

The authors conclude that exercise therapy encourages patients to use their back muscles again, with positive physical results. From this study, it doesn’t seem to matter what kind of exercise therapy patients do, as long as they follow through with it.

Patients with low back pain often find they’re unable to do the things they are used to doing. Simple daily tasks can be difficult, and work may seem next to impossible. Certainly the physical pain affects patients’ ability to function normally. But what other factors may be involved?

This study was part of a series that looked at the effects of exercise therapy on low back pain. In this last part of the series, the authors tried to pin down factors that prevent patients with low back pain from doing their daily activities. In particular, the authors wanted to know the extent that physical performance, feelings and beliefs, and pain affected patients’ ability to do their regular tasks.

Participants included 148 patients who had been having pain off and on for an average of 11 years. More than half of them were women. The average age was 45.

Patients did one of three exercise programs twice a week: physical therapy, muscle training with special devices, or low-impact aerobics. Before and after three months of exercise therapy, patients did a series of physical tests. They also filled out questionnaires about their low back pain, ability to do daily tasks, ways of coping, depression, and fears about their pain.

Before treatment, several factors seemed to affect whether patients felt able to do activities. Severity of pain was the most important. The greater their pain, the harder it was for patients to do their regular activities.

Depression and the belief that low back pain was “the end of the world” increased patients’ feelings of being unable function normally. So did believing that low back pain was inevitable and likely to worsen with work or physical activities. Not being able to use certain back muscles and having poor range of trunk movement prevented patients from going about their days as usual.

After treatment, patients said they were better able to do tasks, no matter which of the three exercise therapies they had. What caused this change? Contrary to what the authors expected, improvements in physical performance weren’t the key to reducing the patients’ sense of disability. Instead, changes in pain, depression, and fears about work and physical activity factored heavily in improving patients’ ability to do tasks.

Although the exercise therapies used in this study didn’t focus on patients’ feelings or beliefs, the treatments seemed to have positive effects in these areas. After three months of exercise therapy, patients were less likely to think their condition was “the end of the world.” They less often thought that work and physical activities would lead to low back pain. And they believed more strongly that they could control their own pain.

Exercise therapy seems to help patients in many ways. First, it gets them to use their back muscles again. But perhaps more important, it shows patients that they can safely do activities without hurting themselves. At its best, exercise therapy may give patients the confidence to return to the tasks of their daily lives.

Because their jobs often involve lifting and moving patients, health care workers are at serious risk for back injuries. Many nurses endure back pain without taking time off or even reporting their injuries. What’s the best way to keep nurses’ backs healthy?

Training and education aren’t enough. Special equipment to lift and move patients may help. But this kind of equipment can be expensive and slow patient transfers. In this study, the authors wanted to see whether having special equipment on hand actually reduced health care workers’ back problems. That way, hospitals could know whether the costs were worth it.

Three hundred forty-six nurses and nurses’ aides in three different types of hospital wards (medical, surgical, and rehabilitative) participated in the study. They were divided into three groups. The first group was told to go about their work as usual. They had limited access to patient handling equipment and no special training. The second group, the “safe lifting” group, had more access to manual equipment, such as transfer belts and sliding devices. The third group had a “no strenuous lifting” policy. This group had the most access to special equipment, including mechanical lifting machines and sliding devices. Both the “safe lifting” and “no strenuous lifting” groups also received three hours of intensive training on patient handling techniques.

Nurses and aides who had access to patient-handling equipment really did use it. In the “no strenuous lifting” group, health care workers reduced the amount of patient handling they did without assistance by nine tasks per shift. This change took effect within six months and lasted through the one-year follow-up. In contrast, changes in work habits made by the other groups did not last a year.

After a year of “no strenuous lifting,” nurses and aides weren’t as tired after their shifts. Both the “safe lifting” and “no strenuous lifting” groups had fewer complaints of back and shoulder pain. They also felt less physical discomfort from patient handling tasks and noted less physical fatigue. However, the “no strenuous lifting” group improved the most in these areas. A key finding is that they showed greater improvement in their comfort during patient handling tasks.

There were no differences in number of injuries between groups. But only about one-third of injuries in the “no strenuous lifting” group affected the back. Health care workers in this group more often injured their arms or necks. Notably, 75 percent of injuries involved the back among workers who didn’t use the equipment.

Nurses and aides in both the “safe lifting” and “no strenuous lifting” groups felt safer from injury at the end of the study. In general, having special equipment on hand made the workplace healthier for health care workers. The authors hope that using this kind of equipment on a regular basis may keep nurses’ backs safe from the heavy workloads required in the health care industry today.

Sciatica is commonly thought of as pain along the sciatic nerve. When sciatica comes from a ruptured disc in the low back, it often causes pain to spread from the low back into the backs of the thighs. Most patients with sciatica start to feel better after a few weeks. But if the pain is ongoing or very intense, doctors may suggest surgery. Does surgery really help patients in the long run?

This study looked at the treatment results of 402 patients with sciatica. The patients were mostly men in their forties who had sciatica for less than six months. Two hundred twenty of them had surgery to remove the vertebral disc that was putting pressure on the nerve. The other 182 who didn’t have surgery were treated with physical therapy, bed rest, steroids, and other nonsurgical treatments. Of the two groups, patients who chose surgery had more pain and worse functioning before treatment, though they rated themselves to be in better health overall. 

Doctors checked on the two groups for five years after treatment to see if the results changed. Patients who had surgery generally did better. Seventy percent of them had less low back or leg pain five years after treatment. Meanwhile, only 56 percent of patients who did not have surgery had less pain five years later. By comparison, patients who had surgery had better back functioning. These benefits leveled off after two years. However, surgery still showed better results at the five-year mark. 

Patients who had surgery were more satisfied with their treatment. Sixty-three percent of them were satisfied with their results versus 46 percent of those who didn’t have surgery. Among patients who had surgery, 82 percent said if they had to go back, they would choose surgery again.

Work outcomes were about the same for both groups after five years. Both groups had the same percentage of patients on disability compensation. Patients who had surgery were a little more likely to be working, but this difference was so small that it wasn’t felt to have much significance.

The benefits of surgery may depend on the patient’s amount of pain. In this study, patients with less pain seemed to do well whether they had surgery or not. However, for patients with severe pain, surgery was a faster, better solution. The authors believe that patients with sciatic pain from a herniated lumbar disc who don’t choose surgery will improve over time, but their recovery may be slower and less complete.

Sixty to 80 percent of people will have low back pain at some point in their lives. For some, this pain starts early in life. Ten percent of 9- and 10-year-olds have low back pain. And 13-year-olds are just as likely as adults to have low back pain. Even so, little attention has been paid to low back pain in young people–and how to prevent it.

As much as half of low back pain is thought to be caused by poor bending and lifting techniques. In many cases, teaching people to use their bodies in the right way may prevent low back pain. These authors created a program to teach kids good back health and habits, to help prevent low back problems.

The program took place during the school day and involved three different groups. Each group was made up of 35 third-grade (9-year-old) students. The first group had 11 classes that covered good posture and low back health. Students learned about the spine and respiratory system. They also practiced exercises to strengthen and protect the low back. The second group had the same number of classes about general health issues, which included but did not focus on the spine. This group did not do special back exercises. The third group had no special instruction and stuck to their regular classroom routine.

Students took a written test about back health both before and after the program. They were also “graded” on their technique for daily activities such as sitting down, getting up, and picking up and carrying objects.

Students who had the low back program learned more about back anatomy and movement than the other groups. They did better on the written test right after the program, and six and 12 weeks later. They also improved their posture and habits (bending and lifting) more than the other groups. The students in the general health program showed better back habits than those who didn’t have any health education, but this difference was small.

The habits students learned in the low back program seemed to carry over in gym class and at home. In some cases, these habits even continued four years later, with 61 percent of the students still showing good posture and good bending and lifting techniques.

Compared to students in the low back program, students who didn’t have health education during the test period were a little more likely to have back pain that required treatment four years later. Given that, the authors believe their low back program may have greater and lasting effects through motivation and practice, not just by giving kids information. They suggest having booster sessions a few years after the initial program to help kids keep good habits over time. They also recommend bringing in a variety of health care providers, including psychologists and pediatricians, to make a well-rounded program.

Scientists continue their search to discover the most important factors impacting back problems. Knowing the reasons back pain strikes can equip medical providers with new and effective ways to help people prevent back problems. 

Recommendations about back pain are like people; they come in all shapes in sizes. Overweight patients are frequently advised to lose weight. But is there scientific evidence that being overweight is truly a factor in low back pain? 

One method of finding out is to review and analyze scientific studies that deal with the topic. Author Charlotte Leboeuf-Yde reviewed 56 journal articles covering 65 studies relating to body weight and low back pain. Her objective was to determine if there is actually an association between body weight and back pain and to determine if being overweight causes back pain.

The relationship between body weight and low back pain was positive in 32 percent of the studies. However, the author acknowledged several factors that could have influenced this percentage. Studies that were designed differently showed different results. The association between body weight and back pain was higher in studies that had more than 3,000 participants. When using statistics, a large sampling has to be gathered in order to reach significance when the association between two items is weak.

Also, studies of the general population had different results than groups of working individuals. People on the job may not want anyone to know they’re having a problem and may have reported they were okay. The author calls this the “healthy worker” effect. Even with these results, the author determined that in large populations, the association between extra body weight and back pain was “weak.”

The author concludes that there is “insufficient evidence” linking body weight as a cause of low back pain. So until more is known, Charlotte Leboeuf-Yde insists that body weight carries little weight when it comes to back pain.

Chronic low back pain takes its toll on society, both in human suffering and cost of treatment. There are many remedies available, but only a few have proved effective so far. Injections with anesthetics, steroids, or both are one way to treat patients with chronic low back pain, but do they work?  

This article reviews 21 studies of injection therapy between 1966 and 1998. The authors reported on the results of three types of injection therapy. They also examined the methods each study used to get these results, to see whether the results could be trusted.

Each of the studies involved patients who had low back pain for more than one month. The patients had one of three types of injections. The first type, facet-joint injections, were injected into the small joints that link along the back of the spinal column. Epidural injections were given into the membrane around the spinal cord. Finally, local injections were applied to trigger points in the muscles of the back, ligaments, or other tissues around the spine.

The best way to determine if injection therapy works is to compare it to placebo–or “empty”–injections. Only 11 of the studies did this. Based on these studies, none of the injection therapies worked miracles for low back pain. Patients who had injection therapy tended to have more pain relief than patients who received placebos, but this tendency was slight.

The methods used in the studies were generally poor. On a scale of one to 100, only eight of the studies reviewed received scores of 50 or more. Clearly, better research on injection therapy is needed.

There is no strong evidence that injection therapy works. However, it seems to have some good short-term results with few side effects, so it shouldn’t be abandoned completely. The authors emphasize the need for more studies that compare injection therapy with placebos for long-term pain relief.