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The natural history of idiopathic low back pain
Abstracts
group included 200 age-matched subjects with similar occupation. The first group consisted of men claiming no previous back-pain history who underwent spinal X-ray as a part of a preemployment examination. The second group consisted of men who had a spinal X-ray examination after claiming their first low-back injury, but not preemployment screening. The third group consisted of X-ray examination of men evaluated for chronic low back disability. The findings thus indicated that the distribution and range of lordosis as viewed by clinicians and radiologists does not vary in the acute or with chronic low-back pain, more than in men without back pain of the same age. Hansson T, Bigos S, Beecher P, Wortley M. Spine 1985; 10: 154-5
The natural history of idiopathic low back pain During a three-year follow-up study of 31 chronic idiopathic low back pain patients significant spontaneous improvements of pain and disability scores were found, while range of motion of the lumbar spine decreased. It is argued that increasing stiffness of the low back may be the clinical manifestation of the process of stabilization, that takes place in previously painful instable motion segments. The present findings have also implications for the interpretation of changes of spinal motion. Restriction of range of motion seems to be a normal long-term development in low back pain patients and is accompanied by a diminution of pain and disabi!ity. Lankhorst G, Van de Stadt RJ, Van der Korst JK. Stand J. Rehab Med 1985; 17: l-4
SPORTS MEDICINE A comparison of muscular tightness in runners and nonrunners and the relation of muscular tightness to low back pain in runners The focus of this experimental study was to compare muscular tightness at the hip between runners and nonrunners, and to determine if there is a relation between muscular tightness and low back pain in runners. Goniometric range of motion measurements of three hip movements, abduction, Rexion with the knee extended, and extension, were taken on two subject populations, runners (N=45), and nonrunners (n=43), in order to determine tightness of the hip adductor, extensor, and flexor muscles, respectively. The mean score values obtained for each of the three measurements for both the right and left sides were compared for differences between the running and nonrunning populations and between male and female subjects. Runners were found to be significantly limited in the movement of hip flexion with the knee extended. The mean score values obtained for all male subjects for this movement were lower than those for all female subjects. The incidence of low back pain in runners was examined; however, no correlation could be drawn between muscular tightness in these subjects and low back pain. Bach DK, Green DS, Jensen GM, Savinar E. J Orthop Sports Phys Ther 1985; 6: 315-23
Outcome of sports injuries treated in a casualty department The present investigation analyses 2493 patients with a sports injury treated in a casualty department during a one-year period. Of the patients 73% were men, the age of the patients averaging 26 years and the mean follow-up time was 24 months. Soccer and indoor ball games caused 24% and 23%
55
of the injuries respectively, these being followed by injuries in ice hockey in 14%. Track and field injuries scored low with 2% out of all injuries. Injuries to the lower extremity predominated. At follow-up, ligamentous injuries of the lower extremity were the major cause of discomfort. Further, in the group of patients with persistent discomfort 36% had suffered a fracture or a dislocation, 13% a contusion and 10% a wound. The mean period of sports incapacity after a sustained injury was 3 weeks. In track and field events the injury seldom disturbed training for more than one week, but in soccer, indoor ball games, skiing and skating the mean sports incapacity period varied between 6 and 3 weeks. Out of the total injured, 2% had to give up their sports activity completely. An injury of the lower extremity demanded on average 4 weeks’ rest, an injury of the upper extremity and the trunk 2 weeks and injuries of the head and neck one week’s rest. According to the present investigation sports injuries were, in the majority of cases of a relatively benign nature and sick leave from work seldom exceeded 2 weeks. Sandelin J, Kiviluoto 0, Santavirta S, Honkanen Sports Med 1985; 19: 103-6
Sports injuries of the knee ligaments-a stress radiographic study
R. Br J
prospective
FOIty-six patients were entered into a prospective clinical and stress radiographic study done to assess the value of acute surgical treatment of injuries to the knee ligaments sustained during sports activities. After an average follow-up period of 5% years (range 4-6Yz years) medial instability was found only in two patients, both of whom were in the group with isolated rupture of the medial collateral ligament. Nine of the 29 patients in this group developed rotatory instability, but it was moderate and did not give rise to symptoms. Among the 17 patients with either injuries to the anterior cruciate ligament or combined injuries, anterior drawer instability persisted in seven, with an insufficient functional result in five. None of these 17 patients were able to resume competitive sport. Those patients who had not exercised physically just before the injury proved to have a significantly greater total instability than those who had. Therefore, routine limberingup is recommended before sports activities. Hede A, Hejgaard N, Sandberg H, Jacobsen K. Br J Sports Med 1985; 19: 8-10
MEDICAL SCIENCES Inter- and intra-examiner reliability of the upper cervical X-ray marking system This paper investigates the reliability of the upper cervical X-ray marking procedure. The measurement chosen to be examined was atlas laterality. Twenty X-rays were marked by three experienced upper cervical practitioners for the interexaminer reliability testing, and two of the doctors marked 10 of the films twice for intra-examiner testing. The average measurement for the 60 markings was 1.83”. The average difference between the 3 doctors was 1.05”. The range of error is 57% of the average measurement. With interval agreements, it is shown that at the point where all 3 doctors agree 80% of the time, the range of error is 2” this being over 100% of the average measurement. The range of error percentages for the 2 intra-examiner tests were 41% and 71%. It is concluded that with ranges of error of this magnitude any measured differences produced using this system will be just as likely to be from marking error as from actual atlas
group included 200 age-matched subjects with similar occupation. The first group consisted of men claiming no previous back-pain history who underwent spinal X-ray as a part of a preemployment examination. The second group consisted of men who had a spinal X-ray examination after claiming their first low-back injury, but not preemployment screening. The third group consisted of X-ray examination of men evaluated for chronic low back disability. The findings thus indicated that the distribution and range of lordosis as viewed by clinicians and radiologists does not vary in the acute or with chronic low-back pain, more than in men without back pain of the same age. Hansson T, Bigos S, Beecher P, Wortley M. Spine 1985; 10: 154-5
The natural history of idiopathic low back pain During a three-year follow-up study of 31 chronic idiopathic low back pain patients significant spontaneous improvements of pain and disability scores were found, while range of motion of the lumbar spine decreased. It is argued that increasing stiffness of the low back may be the clinical manifestation of the process of stabilization, that takes place in previously painful instable motion segments. The present findings have also implications for the interpretation of changes of spinal motion. Restriction of range of motion seems to be a normal long-term development in low back pain patients and is accompanied by a diminution of pain and disabi!ity. Lankhorst G, Van de Stadt RJ, Van der Korst JK. Stand J. Rehab Med 1985; 17: l-4
SPORTS MEDICINE A comparison of muscular tightness in runners and nonrunners and the relation of muscular tightness to low back pain in runners The focus of this experimental study was to compare muscular tightness at the hip between runners and nonrunners, and to determine if there is a relation between muscular tightness and low back pain in runners. Goniometric range of motion measurements of three hip movements, abduction, Rexion with the knee extended, and extension, were taken on two subject populations, runners (N=45), and nonrunners (n=43), in order to determine tightness of the hip adductor, extensor, and flexor muscles, respectively. The mean score values obtained for each of the three measurements for both the right and left sides were compared for differences between the running and nonrunning populations and between male and female subjects. Runners were found to be significantly limited in the movement of hip flexion with the knee extended. The mean score values obtained for all male subjects for this movement were lower than those for all female subjects. The incidence of low back pain in runners was examined; however, no correlation could be drawn between muscular tightness in these subjects and low back pain. Bach DK, Green DS, Jensen GM, Savinar E. J Orthop Sports Phys Ther 1985; 6: 315-23
Outcome of sports injuries treated in a casualty department The present investigation analyses 2493 patients with a sports injury treated in a casualty department during a one-year period. Of the patients 73% were men, the age of the patients averaging 26 years and the mean follow-up time was 24 months. Soccer and indoor ball games caused 24% and 23%
55
of the injuries respectively, these being followed by injuries in ice hockey in 14%. Track and field injuries scored low with 2% out of all injuries. Injuries to the lower extremity predominated. At follow-up, ligamentous injuries of the lower extremity were the major cause of discomfort. Further, in the group of patients with persistent discomfort 36% had suffered a fracture or a dislocation, 13% a contusion and 10% a wound. The mean period of sports incapacity after a sustained injury was 3 weeks. In track and field events the injury seldom disturbed training for more than one week, but in soccer, indoor ball games, skiing and skating the mean sports incapacity period varied between 6 and 3 weeks. Out of the total injured, 2% had to give up their sports activity completely. An injury of the lower extremity demanded on average 4 weeks’ rest, an injury of the upper extremity and the trunk 2 weeks and injuries of the head and neck one week’s rest. According to the present investigation sports injuries were, in the majority of cases of a relatively benign nature and sick leave from work seldom exceeded 2 weeks. Sandelin J, Kiviluoto 0, Santavirta S, Honkanen Sports Med 1985; 19: 103-6
Sports injuries of the knee ligaments-a stress radiographic study
R. Br J
prospective
FOIty-six patients were entered into a prospective clinical and stress radiographic study done to assess the value of acute surgical treatment of injuries to the knee ligaments sustained during sports activities. After an average follow-up period of 5% years (range 4-6Yz years) medial instability was found only in two patients, both of whom were in the group with isolated rupture of the medial collateral ligament. Nine of the 29 patients in this group developed rotatory instability, but it was moderate and did not give rise to symptoms. Among the 17 patients with either injuries to the anterior cruciate ligament or combined injuries, anterior drawer instability persisted in seven, with an insufficient functional result in five. None of these 17 patients were able to resume competitive sport. Those patients who had not exercised physically just before the injury proved to have a significantly greater total instability than those who had. Therefore, routine limberingup is recommended before sports activities. Hede A, Hejgaard N, Sandberg H, Jacobsen K. Br J Sports Med 1985; 19: 8-10
MEDICAL SCIENCES Inter- and intra-examiner reliability of the upper cervical X-ray marking system This paper investigates the reliability of the upper cervical X-ray marking procedure. The measurement chosen to be examined was atlas laterality. Twenty X-rays were marked by three experienced upper cervical practitioners for the interexaminer reliability testing, and two of the doctors marked 10 of the films twice for intra-examiner testing. The average measurement for the 60 markings was 1.83”. The average difference between the 3 doctors was 1.05”. The range of error is 57% of the average measurement. With interval agreements, it is shown that at the point where all 3 doctors agree 80% of the time, the range of error is 2” this being over 100% of the average measurement. The range of error percentages for the 2 intra-examiner tests were 41% and 71%. It is concluded that with ranges of error of this magnitude any measured differences produced using this system will be just as likely to be from marking error as from actual atlas