Articles: low-back-pain.
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J. Occup. Environ. Med. · Dec 2000
Clinical management and the duration of disability for work-related low back pain.
Clinical practice guidelines recommend a conservative approach to management of acute low back pain (LBP). The present study sought to determine whether health care utilization and the physician's initial management of work-related LBP were associated with disability duration. Clinical management information was obtained for 98 randomly selected, workers' compensation claimants with acute, uncomplicated, disabling work-related LBP. ⋯ Effects of early diagnostic imaging (first 30 days of care) on length of disability were observed (P = 0.001). Patients whose treatment course did not involve extended opioid use and early diagnostic testing were 3.78 times more likely (95% confidence interval, 1.6 to 8.9) to have gone off disability status by the end of the study. The nature of the association between these initial clinical management aspects and LBP disability duration merits further exploration.
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Chronic low back pain (CHLBP) occupies first place among factors restricting people's life activity under the age of 45. Frequency of CHLBP occurrence oscillates between 60 and 80%. Dysfunction of the erector trunci is a fundamental cause of CHLBP. ⋯ At the L4 level, mean amplitude, mean density, background amplitude, background density and upper amplitude were significantly higher in control group. The findings of this study show that (1) dysfunction of the erector spinae plays a significant role in CHLBP, and (2) this process applies to small and large motor units, but the character of these changes is different in particular muscles. Surface EMG is an objective, non-invasive method of examining function of the erector spinae in the author's opinion.
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Int. J. Clin. Pract. · Dec 2000
A cross-sectional survey of the clinical and psychological features of low back pain and consequent work handicap: use of the Quebec Task Force classification.
A hospital-based cross-sectional study examined 657 consecutive referrals with low back pain over two years to a district rheumatology service serving a population of about 250,000 people. Five hundred and thirty-eight had mechanical/degenerative low back pain. The mean age was 48.6 (range 18-80 SD 15.3) years; 64% were women. ⋯ Women were more impaired (p = 0.02) than men but had similar disabilities (mean Roland score 11.7, range 0-24 SD 6.5). Fifty-three per cent of patients were receiving benefits and were significantly more likely to have musculoskeletal comorbidities than those in work (p < 0.025). It is concluded that the Quebec Task Force classification of low back pain impairment is a helpful descriptor and related to both physical and psychological disability and handicap in employment.
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Loss of muscle mass and central obesity progress with aging, but the effect of muscle loss on chronic low back pain has not been precisely evaluated. ⋯ Trunk and lower extremity loss of muscle mass and central obesity may be risk factors for chronic low back pain without a positive straight leg raise test result in women aged 45 to 69 years. Arch Intern Med. 2000;160:3265-3269.