Changes in sagittal lumbar configuration with a new method of extension traction: nonrandomized clinical controlled trial.
To determine if a new method of lumbar extension traction can increase lordosis in chronic low back pain (LBP) subjects with decreased lordosis.
Nonrandomized controlled trial with follow-up at 3 months and 1(1/2) years.
Primary care spine clinic in Nevada.
Beginning in mid-1998, the first 48 consecutive patients, who met the inclusion criteria of chronic LBP with decreased lordosis and who completed the treatment program were matched for sex, age, height, weight, and pain scores to 30 control subjects with chronic LBP, who received no treatment.
A new form of 3-point bending lumbar extension traction was provided in-office 3 to 4 times a week for 12+/-4 weeks. Per session, traction duration was started at 3 minutes and was increased to a maximum of 20 minutes. For short-term pain relief, torsion lumbar spinal manipulation was provided in the initial 3 weeks.
Pain as measured on a visual analog scale (VAS) and standing lateral lumbar radiographic measurements.
Pain scales and radiographic measurements did not change in the control subjects. In the traction group, VAS ratings decreased from mean +/- standard deviation of 4.4+/-1.9 pretreatment to 0.6+/-0.9 posttreatment (P<.001), and radiographic angles (except at T12-L1) showed statistically significant changes. Mean changes were 5.7 degrees at L4-5 (P<.001), 11.3 degrees between posterior tangents on L1 and L5 (P<.001), 9.1 degrees in Cobb angle at T12-S1 (P<.001), 4.6 degrees in pelvic tilt (P<.001), and 4.7 degrees in Ferguson's sacral base angle (P<.001). At long-term follow-up (17(1/2)mo), 34 of the 48 (71%) subjects returned. Improvements in lordosis were maintained in all 34.
This new method of lumbar extension traction is the first nonsurgical rehabilitative procedure to show increases in lumbar lordosis in chronic LBP subjects with hypolordosis. The fact that there was no change in control subjects' lumbar lordosis indicates the stability of the lumbar lordosis and the repeatability of x-ray procedures. Because, on average, chronic LBP patients have hypolordosis, additional randomized trials should be performed to evaluate the clinical significance of restoration of the lumbar lordosis in chronic LBP subjects.
Harrison DE
，Cailliet R
，Harrison DD
，Janik TJ
，Holland B
... -
《ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION》
Exploring Factors Influencing Low Back Pain in People With Nondysvascular Lower Limb Amputation: A National Survey.
Chronic low back pain (LBP) is a common musculoskeletal impairment in people with lower limb amputation. Given the multifactorial nature of LBP, exploring the factors influencing the presence and intensity of LBP is warranted.
To investigate which physical, personal, and amputee-specific factors predicted the presence and intensity of LBP in persons with nondysvascular transfemoral amputation (TFA) and transtibial amputation (TTA).
A retrospective cross-sectional survey.
A national random sample of people with nondysvascular TFA and TTA.
Participants (N = 526) with unilateral TFA and TTA due to nondysvascular etiology (ie, trauma, tumors, and congenital causes) and a minimum prosthesis use of 1 year since amputation were invited to participate in the survey. The data from 208 participants (43.4% response rate) were used for multivariate regression analysis.
Personal (ie, age, body mass, gender, work status, and presence of comorbid conditions), amputee-specific (ie, level of amputation, years of prosthesis use, presence of phantom-limb pain, residual-limb problems, and nonamputated limb pain), and physical factors (ie, pain-provoking postures including standing, bending, lifting, walking, sitting, sit-to-stand, and climbing stairs).
LBP presence and intensity.
A multivariate logistic regression model showed that the presence of 2 or more comorbid conditions (prevalence odds ratio [POR] = 4.34, P = .01), residual-limb problems (POR = 3.76, P < .01), and phantom-limb pain (POR = 2.46, P = .01) influenced the presence of LBP. Given the high LBP prevalence (63%) in the study, there is a tendency for overestimation of POR, and the results must be interpreted with caution. In those with LBP, the presence of residual-limb problems (β = 0.21, P = .01) and experiencing LBP symptoms during sit-to-stand task (β = 0.22, P = .03) were positively associated with LBP intensity, whereas being employed demonstrated a negative association (β = -0.18, P = .03) in the multivariate linear regression model.
Rehabilitation professionals should be cognizant of the influence that comorbid conditions, residual-limb problems, and phantom pain have on the presence of LBP in people with nondysvascular lower limb amputation. Further prospective studies could investigate the underlying causal mechanisms of LBP.
II.
Devan H
，Hendrick P
，Hale L
，Carman A
，Dillon MP
，Ribeiro DC
... -
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