Paraspinal strength and electromyographic fatigue in patients with sub-acute back pain and controls: Reliability, clinical applicability and between-group differences

INTRODUÇÃO: O diafragma é o principal músculo respiratório e desempenha um papel importante na respiração e na regulação fisiológica. Uma terapia que visa melhorar essas condições referentes ao diafragma, é a técnica de liberação manual diafragmática. OBJETIVO: O objetivo deste estudo foi verificar a aplicabilidade clínica das técnicas manuais de liberação diafragmática e identificar as principais técnicas, populações investigadas, variáveis avaliadas e seus desfechos. MÉTODOS: Foram pesquisadas as seguintes bases de dados: PubMed, Scielo e Science Direct, com os descritores “Diaphragm [Mesh]” e “Musculoskeletal Manipulations [Mesh]” com seus correspondentes no mesmo idioma. Foram incluídos ensaios clínicos randomizados, não randomizados, estudos semi, quase-experimentais e estudos pilotos ou de caso, que abordaram técnicas de liberação manuais diafragmáticas.RESULTADOS: Há variadas técnicas de liberação diafragmática, sendo as mais mencionadas: normalização dos pilares do diafragma, alongamento e estiramento do diafragma, relaxamento dos pilares do diafragma. Além disso, as técnicas de liberação diafragmática vêm sendo associadas a protocolos de terapia manipulativa osteopática (TMO). As principais populações estudadas foram de pacientes saudáveis, com lombalgia, cervicalgia, osteoartrite, asmáticos, doença pulmonar obstrutiva crônica, constipados, cardiopatas e com refluxo gastroesofágico. Os principais desfechos avaliados são variáveis musculoesqueléticas (dor, flexibilidade, amplitude, espessura diafragmática), variáveis cardiorrespiratórias (pressão inspiratória/expiratória máxima (PImax e Pemax), mobilidade torácica, frequência cardíaca e respiratória), qualidade de vida e disfunções gastrointestinais/gastroesofágicas. CONCLUSÃO: A aplicabilidade clínica das técnicas de liberação diagramática está sendo investigada associado com outras técnicas osteopáticas, em protocolos de TMO em pacientes saudáveis, pneumopatas, cardiopatas, gestantes, em cicatriz pós-cirúrgica, constipados, com refluxo gastroesofágico, osteoartrite, cervicalgia e com lombalgia. Evidencia-se: diminuição ou eliminação das dores musculoesqueléticas, aumento da flexibilidade, ADM, Pimáx e Pemáx, aumento da mobilidade torácica, aumento da qualidade de vida, diminuição do inchaço e dor abdominal e sem efeito em cardiopatas.ABSTRACT. Clinical applicability of manual diaphragmatic release techniques: a systematic review.BACKGROUND: The diaphragm is the main respiratory muscle and plays an important role in breathing and physiological regulation. A therapy that aims to improve these conditions regarding the diaphragm, is the manual diaphragmatic release technique.OBJECTIVE: The aim of this study was to verify the clinical applicability of manual diaphragmatic release techniques and searching the main techniques, population, evaluated variables, and outcomes. METHODS: The following electronic databases were searched: PubMed, Scielo, and Science Direct, with the descriptors “Diaphragm [Mesh]” and “Musculoskeletal Manipulations [Mesh]” with their correspondents in the same language. There were included randomized clinical trial, non-randomized clinical trials, semi, and quasi-experimental studies, and pilot or case studies, which addressed manual diaphragmatic release techniques.RESULTS: There are various diaphragmatic release techniques, the most mentioned are: normalization of the diaphragm pillars, stretching of the diaphragm, relaxation of the diaphragm pillars, and protocols for osteopathic manipulative therapy (OMT) for the diaphragm. The main populations studied were healthy patients, with low back pain, asthmatics, chronic pulmonary obstructive disease, constipated, cardiac patients, and gastroesophageal reflux. The main outcomes assessed are musculoskeletal variables (pain, flexibility, range of motion, diaphragmatic thickness), cardiorespiratory variables (maximal inspiratory/expiratory pressure (MIP and MEP), chest mobility, heart, and respiratory rate), quality of life, and gastrointestinal/ gastroesophageal disorders.CONCLUSION: The clinical applicability of diagrammatic release techniques is being investigated in association with other osteopathic techniques, in protocols of OMT in healthy subjects, patients with lung diseases, heart disease, pregnant women, scar tissue, constipated, with gastroesophageal reflux, osteoarthritis, cervicalgia and with low back pain. There is evidence of reduction and elimination of musculoskeletal pain, increased MIP, increased chest mobility, an increase in health quality, a decrease of bloating and abdominal pain related to constipation, and a decrease of reflux symptoms.

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Vertebral sarcoidosis with associated Darier-Roussy disease manifesting as acute back pain

Interdisciplinary Neurosurgery ◽

10.1016/j.inat.2021.101330 ◽

2021 ◽

pp. 101330

Author(s):

Mohamad Syafeeq Faeez ◽

Naveen Rajadurai ◽

Thajunnisa Hassan ◽

Alias Mardziah ◽

Robert Penafort ◽

...

Keyword(s):

Back Pain ◽

Acute Back Pain

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Federal Acute Back Pain Guideline Recommends Medication, Spinal Manipulation, and Exercise Most Patients Can Safely Defer Specialized Diagnostic Testing

The Back Letter ◽

10.1097/00130561-199501000-00001 ◽

1995 ◽

Vol 10 (1) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

&NA;

Keyword(s):

Back Pain ◽

Spinal Manipulation ◽

Diagnostic Testing ◽

Acute Back Pain

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Acute Back Pain in a Child

Orthopedics ◽

10.3928/0147-7447-20010101-07 ◽

2001 ◽

Vol 24 (1) ◽

pp. 20-20

Author(s):

Charles Sorbie

Keyword(s):

Back Pain ◽

Acute Back Pain

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Acute Back Pain and Sciatica

Principles of Pain Management for Anaesthetists ◽

10.1201/b13530-16 ◽

2005 ◽

pp. 150-154

Keyword(s):

Back Pain ◽

Acute Back Pain

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Osteopathic correction in the treatment of pain in the lower back

Russian Osteopathic Journal ◽

10.32885/2220-0975-2020-1-2-140-146 ◽

2020 ◽

pp. 140-146

Author(s):

V. O. Belash ◽

Yu. O. Novikov

Keyword(s):

Back Pain ◽

Developed Countries ◽

Economic Problem ◽

World Health ◽

Randomized Controlled ◽

Lower Back ◽

The World ◽

Working Age ◽

Acute Back Pain ◽

Health Organization

According to experts of the World Health Organization the lower back pain (LBP) prevalence in developed countries reaches the pandemic size, and it is a serious medical and socio-economic problem. Acute back pain is transformed into chronic in 10–20 % of working age patients′ cases; this causes serious psychological disorders appearing, forms painful behavior and persists even when the initial pain trigger is eliminated. Data from metaanalyses of randomized controlled trials indicate the effectiveness of the osteopathic approach in the treatment of LBP patients. At the same time the osteopathic correction is effective not only for acute pain, but also for chronic pain. A case from clinical practice is described demonstrating the possibility of osteopathic correction of a LBP patient.

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Effects of weekly pain monitoring on back pain outcomes: a non-randomised controlled study

Chiropractic & Manual Therapies ◽

10.1186/s12998-021-00393-2 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Alice Kongsted ◽

Tue Secher Jensen ◽

Klaus Doktor ◽

Lise Hestbæk

Keyword(s):

Back Pain ◽

Pain Intensity ◽

Activity Limitation ◽

Controlled Study ◽

Group Differences ◽

Control Group ◽

Negative Effects ◽

Randomised Controlled Study ◽

Pain Outcomes ◽

Randomised Controlled

Abstract Background Disease monitoring is an important element of self-management of several chronic diseases. Pain monitoring has become very easily available, but the role in musculoskeletal pain conditions is not clear. Awareness of pain might be helpful for people to understand pain, but focusing on pain may on the contrary negatively affect pain experience and behaviours. The objective of this study was to investigate the potential impact of pain monitoring on low back pain (LBP), specifically to determine if pain intensity, activity limitation and pain control, differed between patients with weekly pain monitoring over 12 months and patients with follow-ups at 2 weeks, 3 months and 12 months. Methods This was a non-randomised controlled study embedded in a cohort study with data collection November 1st 2016 to December 21st 2018. Adults seeking care for LBP were enrolled at the first visit to a chiropractor and followed with surveys after 2 weeks, 3 months and 12 months. Those enrolled first, n = 1,623, furthermore received weekly SMS-questions about pain frequency and pain intensity, whereas those enrolled next was the control group, n = 1,269 followed only by surveys. Outcomes at 12-months were compared, adjusting for group differences on baseline parameters. Results LBP intensity (0–10) was slightly lower at 12-months follow-up in the SMS group than the control group (adjusted beta − 0.40 (95% CI: − 0.62; − 0.19)). No relevant between-group differences were observed for activity limitation (0–100) (1.51 (95% CI: − 0.83; 3.85)) or ability to control pain (0–10) (− 0.08 (95% CI − 0.31; 0.15)). Conclusions Frequent pain monitoring did not demonstrate any negative effects of weekly pain monitoring, and it was perhaps even helpful. The role of self-monitoring as part of self-managing LBP should be explored further including optimal frequencies, formats, and methods for feedback. Trial registration The study was not registered as a clinical trial.

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Watchful Waiting as a Strategy to Reduce Low-Value Spinal Imaging: Study Protocol for a Randomized Trial

10.21203/rs.3.rs-142884/v2 ◽

2021 ◽

Author(s):

Joshua Fenton ◽

Anthony Jerant ◽

Peter Franks ◽

Melissa Gosdin ◽

Ilona Fridman ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Watchful Waiting ◽

Standardized Patient ◽

Low Back ◽

Patient Trust ◽

Post Intervention ◽

Acute Low Back Pain ◽

Spinal Imaging ◽

Acute Back Pain

Abstract Background: Patients with acute low back pain frequently request diagnostic imaging, and clinicians feel pressure to acquiesce to such requests to sustain patient trust and satisfaction. Spinal imaging in patients with acute low back pain poses risks from diagnostic evaluation of false-positive findings, patient labeling and anxiety, and unnecessary treatment (including spinal surgery). Watchful waiting advice has been an effective strategy to reduce some low-value treatments, and some evidence suggests a watchful waiting approach would be acceptable to many patients requesting diagnostic tests. Methods: We will use key informant interviews of clinicians and focus groups with primary care patients to refine a theory-informed standardized patient-based intervention designed to teach clinicians how to advise watchful waiting when patients request low-value spinal imaging for low back pain. We will test the effectiveness of the intervention in a cluster randomized clinical trial. We will recruit 8-10 primary care and urgent care clinics (~55 clinicians) in Sacramento, CA; clinicians will be randomized 1:1 to intervention and control groups. Over a 3 to 6 month period, clinicians in the intervention group will receive 3 visits with standardized patient instructors (SPIs) portraying patients with acute back pain; SPIs will instruct clinicians in a three-step model emphasizing establishing trust, empathic communication, and negotiation of a watchful waiting approach. Control physicians will receive no intervention. The primary outcome is the post-intervention rate of spinal imaging among actual patients with acute back pain seen by the clinicians adjusted for rate of imaging during a baseline period. Secondary outcomes are: use of targeted communication techniques during a follow-up visit with an SP; clinician self-reported use of watchful waiting with actual low back pain patients; post-intervention rates of diagnostic imaging for other musculoskeletal pain syndromes (to test for generalization of intervention effects beyond back pain); and patient trust and satisfaction with physicians. Discussion: This trial will determine whether standardized patient instructors can help clinicians develop skill in negotiating a watchful waiting approach with patients with acute low back pain, thereby reducing rates of low-value spinal imaging. The trial will also examine the possibility that intervention effects generalize to other diagnostic tests. Trial registration: NCT 04255199, ClinicalTrials.gov (January 20, 2020)

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