Clinical spinal instability and low back pain

Panjabi, Manohar M.

doi:10.1016/s1050-6411(03)00044-0

Cited by 757 publications

(538 citation statements)

References 41 publications

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“…This was suggested to contribute to increased strain on the spinal tissues, potentially causing further damage and injury [6,70] and also to influence the trunk muscle activity role in spinal control and stability [2,5], which may perpetuate the spinal pain disorder and contribute to more disability [2,[4][5][6]. Establishing an accurate measure of a baseline posture that patients report to be painful may be invaluable with respect to evaluating the efficacy of postural re-education interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Although the link between posture and back pain is largely unknown, it has been speculated that end-of-range sitting and standing postures, that were shown to be associated with altered muscle activation patterns [1][2][3][4][5], may result in excessive loading of the passive spinal structures, eventual trauma and injury and could potentially pose a risk to the development of back pain [4,6]. Postural re-education is performed on the premise of optimizing spinal alignment to minimize stresses on the spinal structures and to improve trunk muscle efficiency in protecting the spine [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Preliminary study: reliability of the spinal wheel. A novel device to measure spinal postures applied to sitting and standing

et al. 2009

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Postural re-education is an integral part of physiotherapy management in patients with back pain. Although the link between posture and back pain is largely unknown, postural re-education is performed on the premise of optimizing spinal alignment to minimize stresses on the passive structures of the spine, to facilitate optimal muscular support and thus to prevent possible damage and further pain. A reliable and clinically meaningful measurement of spinal postures to monitor such interventions remains challenging. This study evaluated within-day (intra-tester, inter-tester) and between-day (test-retest) reliability of a novel spinal wheel device measuring thoracic and lumbar postures during sitting and standing. 17 healthy volunteers (age 39.5 ± 5.4, BMI 25 ± 9.2; 9 males) were measured three times, by three testers, on two separate occasions (1 week apart). The angular change between C7 and T12 and between T12 and S1 provided thoracic and lumbar curvatures, respectively. Intra-class correlation coefficient (ICC) with 95% confidence intervals and typical error were calculated. Excellent reliability was demonstrated with intra-tester ICCs between 0.947 and 0.980 and typical error between 1.7°and 3.7°and intertester ICCs between 0.949 and 0.986 and typical error between 2.0°and 4.7°. Test-retest reliability was high with ICCs 0.719-0.908 and typical error between 4.0°and 7.4°. In conclusion, the spinal wheel demonstrated excellent within-day and high between-day reliability. The device may be used in conjunction with 2D camcorder to provide clinically useful visual evaluation of postures for assessment, intervention monitoring, and feedback during postural re-education.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preliminary study: reliability of the spinal wheel. A novel device to measure spinal postures applied to sitting and standing

et al. 2009

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“…Injury to the spine structures (e.g., joints, ligaments, disc) can disrupt one or more of the spine stability sub‐systems 19, 63, 64, 65. Induced pain studies in humans confirm that local pain of the spinal column leads to reduction of neural drive to the adjacent MF, apparent on functional MRI 66 and ultrasound 67, 68.…”

Section: Introductionmentioning

confidence: 99%

Muscle Control and Non-specific Chronic Low Back Pain

Russo¹,

Deckers

Eldabe

et al. 2018

Neuromodulation: Technology at the Neural Interface

129

116

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ObjectivesChronic low back pain (CLBP) is the most prevalent of the painful musculoskeletal conditions. CLBP is a heterogeneous condition with many causes and diagnoses, but there are few established therapies with strong evidence of effectiveness (or cost effectiveness). CLBP for which it is not possible to identify any specific cause is often referred to as non‐specific chronic LBP (NSCLBP). One type of NSCLBP is continuing and recurrent primarily nociceptive CLBP due to vertebral joint overload subsequent to functional instability of the lumbar spine. This condition may occur due to disruption of the motor control system to the key stabilizing muscles in the lumbar spine, particularly the lumbar multifidus muscle (MF).MethodsThis review presents the evidence for MF involvement in CLBP, mechanisms of action of disruption of control of the MF, and options for restoring control of the MF as a treatment for NSCLBP.ResultsImaging assessment of motor control dysfunction of the MF in individual patients is fraught with difficulty. MRI or ultrasound imaging techniques, while reliable, have limited diagnostic or predictive utility. For some patients, restoration of motor control to the MF with specific exercises can be effective, but population results are not persuasive since most patients are unable to voluntarily contract the MF and may be inhibited from doing so due to arthrogenic muscle inhibition.ConclusionsTargeting MF control with restorative neurostimulation promises a new treatment option.

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“…For the assessment of mechanical destabilisation of the spine caused by injury, the intervertebral neutral zone is thought to be the most sensitive measure [6]. Although its measurement has been generally confined to cadaveric studies, the advancing sophistication of quantitative fluoroscopic systems (QF) is beginning to provide a surrogate in vivo measure in the form of slope of the intervertebral rotation-time curve (also known as the attainment rate) [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Uneven intervertebral motion sharing is related to disc degeneration and is greater in patients with chronic, non-specific low back pain: an in vivo, cross-sectional cohort comparison of intervertebral dynamics using quantitative fluoroscopy

Breen

2017

Eur Spine J

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Clinical spinal instability and low back pain

Cited by 757 publications

References 41 publications

Preliminary study: reliability of the spinal wheel. A novel device to measure spinal postures applied to sitting and standing

Preliminary study: reliability of the spinal wheel. A novel device to measure spinal postures applied to sitting and standing

Muscle Control and Non-specific Chronic Low Back Pain

Uneven intervertebral motion sharing is related to disc degeneration and is greater in patients with chronic, non-specific low back pain: an in vivo, cross-sectional cohort comparison of intervertebral dynamics using quantitative fluoroscopy

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