Search Results (28)

Lower back pain (LBP) is highly prevalent, and while non-pharmacological treatments exist such as heat or massage, they are rarely combined in a convenient manner. We examined the impact of two different heated massage protocols delivered from an automotive seat on LBP within typical commute times. Seventeen adults (eight females) with chronic, non-specific LBP (~6/10 initial back pain) evaluated a heated effleurage or heated tapotement massage—in a randomized order—applied to the lower back, upper thighs, and gluteal region while seated. Each visit included a 20 min control followed by a 20 min heated massage (30 min rest between), with thermal and subjective measurements assessed throughout. Before and after each 20 min session, viscoelastic properties of participants’ lower back muscles were assessed with a myotonometer. Heated massage increased skin temperature, thermal sensation and comfort vs. control (p ≤ 0.039). Both heated massage conditions reduced LBP at 10- and 20 min and reduced subjective tightness at 20 min (p ≤ 0.023). Tapotement produced an earlier reduction in tightness at 10 min and had a greater reduction than effleurage at 20 min (p ≤ 0.026). Increased tissue elasticity was observed in the heated tapotement condition (p ≤ 0.031). Seat-based heated massage offers a convenient method to alleviate LBP, potentially from changes to posterior chain tissue properties. Full article

Background and Objectives: Chronic low back pain (CLBP) is a prevalent condition that impairs quality of life, functionality, and work productivity. While most acute episodes of back pain resolve, 4–25% become chronic due to factors such as high pain intensity, psychological distress, and maladaptive behaviors. Nonspecific CLBP is best understood through the biopsychosocial model, encompassing biological, psychological, and social influences, including kinesiophobia. Management relies on physical activity, pain education, and psychological interventions, with therapist knowledge and attitudes affecting outcomes. This study aimed to assess the prevalence of CLBP among healthcare workers, examine their knowledge of pain neurophysiology, evaluate kinesiophobia, and explore how personal experience with CLBP influences their beliefs, attitudes, and interactions with patients. Materials and Methods: A cross-sectional observational study was conducted from January to May 2025 among healthcare professionals. A total of 50 participants completed an online questionnaire, of which 42 were valid and included in the analysis. The questionnaire collected demographic and professional data, determined the presence of CLBP, and included three standardized instruments: the Revised Neurophysiology of Pain Questionnaire (rNPQ) to assess knowledge of pain mechanisms, the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) to evaluate beliefs about pain and disability, and the Tampa Scale of Kinesiophobia (TSK-11) to measure fear of movement. Data were analyzed using SPSS and Microsoft Excel. Results: Among the 42 participants, 11 demonstrated low, 28 moderate, and 3 high knowledge of pain neurophysiology (rNPQ), with a mean score of 5.66. On the HC-PAIRS, the majority (30 participants) scored above 60, indicating beliefs that pain leads to disability, while 12 scored below 60, reflecting a biopsychosocial perspective; gender did not significantly affect HC-PAIRS scores (p = 0.213). As for kinesiophobia (TSK-11), 24 participants had low, 17 moderate, and 1 clinically significant fear of movement. Correlation analysis revealed that younger participants had higher rNPQ scores (r = −0.358, p = 0.020) and lower TSK-11 scores (r = −0.389, p = 0.011). TSK-11 scores increased with age (r = 0.432, p = 0.004), while HC-PAIRS scores showed no significant correlations. Conclusions: Healthcare professionals, particularly physiotherapists, show gaps in knowledge of pain neurophysiology and a tendency toward biomedical beliefs regarding chronic low back pain. This cross-sectional study indicates that a greater understanding of pain mechanisms is associated with lower kinesiophobia, emphasizing the importance of education. Integrating the biopsychosocial model into undergraduate and continuing professional training, through interdisciplinary and practical modules, may improve knowledge, reduce maladaptive fear-avoidance behaviors, and enhance patient care. Future studies should include larger, more diverse samples and assess the long-term impact of educational interventions on clinical practice. Full article

Background and Objectives: Chronic low back pain (CLBP) is associated with altered neuromuscular control. Dynamic Neuromuscular Stabilization (DNS) targets core–limb coordination; however, its specific impact on lower-limb electromyographic (EMG) activity during gait remains unclear. Materials and Methods: Fifty-five young adults with non-specific CLBP (pain ≥ 3 months with no identifiable specific pathology) completed the trial (overall mean age 23.7 ± 1.3 years). Participants were randomized to an 8-week DNS program or a control. Pre-/Post-intervention surface EMG during gait and clinical outcomes (VAS, ODI) were assessed. Results: Compared with control, DNS showed lower adjusted Post-test VAS (3.08 ± 0.25 vs. 6.13 ± 0.24; ηp² = 0.596) and ODI (15.73 ± 1.55% vs. 34.36 ± 1.52%; ηp² = 0.579). Directionally, DNS was associated with phase-specific EMG modulation: tibialis anterior during mid-stance was lower (ηp² = 0.137), rectus femoris during push-off was lower (ηp² = 0.119), biceps femoris during push-off was lower (ηp² = 0.168), and vastus medialis at heel-strike was higher (ηp² = 0.077) relative to control. Other muscle–phase pairs showed no adjusted between-group differences. Conclusions: An 8-week DNS program was associated with clinically meaningful reductions in pain and disability and with phase-specific changes in lower-limb EMG during gait. These findings support DNS as a promising rehabilitation option for young adults with CLBP; confirmation in larger trials with active comparators is warranted. Full article

Chronic musculoskeletal pain negatively affects patients’ quality of life, and pain perceptions may significantly influence rehabilitation outcomes. This study investigated the relationships among pain intensity, pain perceptions, and kinesiophobia in individuals with chronic musculoskeletal pain. No previous studies have examined these variables in combination. A cross-sectional observational study was conducted with 37 participants with non-specific chronic musculoskeletal pain for at least 6 months, affecting the neck (n = 8), lower back (n = 18), upper limbs (n = 5), lower limbs (n = 5), or shoulder (n = 1). The following validated tools were used: (a) Pain Beliefs and Perceptions Inventory (PBPI), (b) the Tampa Scale for Kinesiophobia (TSK), and (c) the Short-Form McGill Pain Questionnaire (SF-MPQ). Spearman r correlation analyses were performed. Total kinesiophobia scores were positively correlated with (a) total pain intensity (McGill score) (r = 0.37, p = 0.022), (b) present pain intensity (PPI) (r = 0.52, p = 0.001), (c) pain duration (r = 0.51, p = 0.001), (d) the “mystery” factor of pain perception (r = 0.41, p = 0.013), and (e) the Visual Analogue Scale (VAS) (r = 0.42, p = 0.009). The total pain perception scores were positively associated with the “fear of injury” factor of kinesiophobia (r = 0.36, p = 0.028). The McGill pain scores were strongly correlated with both PPI (r = 0.63, p = 0.001) and VAS (r = 0.51, p = 0.001). There is a significant relationship between pain perception and kinesiophobia levels in patients with chronic musculoskeletal pain. Limitations of the study include a small and heterogeneous sample regarding pain localization. Further research is required using larger, more homogeneous populations to confirm the present findings. Full article

Background/Objectives: Manual therapy techniques, including mobilization and manipulation, are commonly used for chronic low back pain (CLBP), with clinical guidelines recommending their use. This study aimed to compare the immediate hypoalgesic effects of mobilization and manipulation in patients with non-specific CLBP, evaluating their impact on pain sensitivity and range of motion. Methods: A cross-over randomized controlled trial was conducted with 27 participants with non-specific CLBP. Participants received either mobilization or manipulation on two different intervention days. Outcome measures included pressure pain thresholds (PPTs) assessed with a digital algometer, pain intensity using a numeric rating scale, and lumbar range of motion (ROM) measured with a digital inclinometer. Results: The results indicated no statistically significant differences between mobilization and manipulation for any outcome measures (all p > 0.05). However, significant within-intervention improvements were observed, including pain reduction, increased PPTs, and enhanced ROM of the lower back. Conclusions: Our findings suggest that both mobilization and manipulation provide similar immediate benefits for patients with CLBP. The choice between these techniques should be based on therapists’ clinical reasoning and individualized risk stratification, considering the potential benefits and risks of each approach for a specific patient. Full article

Background: The phenomenon of fear of movement is called kinesiophobia. Kinesiophobia is a significant factor that complicates the treatment process. Fear of movement and physical activity is a risk factor for the transformation of acute pain into chronic pain. Therefore, the assessment of the level of kinesiophobia is a prognostic factor for disability and mental stress, thus having a significant impact on the quality of life of people with lower back pain. One of the psychometric diagnostic tools for assessing the level of kinesiophobia is the Kinesiophobia Causes Scale (KCS). The aim of the study was to assess the reliability of the KCS test used in people suffering from chronic nonspecific lower back pain (nsLBP). Methods: The study included a group of 112 people suffering from chronic nsLBP. The subjects completed the same Polish version of the KCS questionnaire 4 weeks apart. Results: Good internal consistency was recorded for both domains—the biological and psychological one—as well as the general KCS index (Cronbach’s alpha index α from 0.8 to 0.9). Reliability was excellent for both domains (95% CI of ICC_3.1 biological domain: 0.86–0.93 and for psychological domain: 0.92–0.96) and for the total score of the Kinesiophobia Causes Scale (95% CI of ICC_3.1: 0.91–0.93). Conclusions: These results indicate very good measurement reliability of the Polish version of the KCS questionnaire among people suffering from chronic nsLBP. Full article

Background/Objectives: The assessment of relationships between trunk muscle activity and thoraco-lumbar movements during sagittal bending has demonstrated that low back pain (LBP) subgroups (flexion pattern and active extension pattern motor control impairment) reveal distinct relationships that differentiate these subgroups from control groups. The study objective was to establish whether such relationships exist during various daily activities. Methods: Fifty participants with non-specific chronic low back pain (NSCLBP) (27 flexion pattern (FP), 23 active extension pattern (AEP)) and 28 healthy controls were recruited. Spinal kinematics were analysed using 3D motion analysis (Vicon™, Oxford, UK) and the muscle activity recorded via surface electromyography during a range of activities (box lift, box replace, reach up, step up, step down, stand-to-sit, and sit-to-stand). The mean sagittal angles for upper and lower thoracic and lumbar regions were correlated with normalised mean amplitude electromyography of bilateral transversus abdominis/internal oblique (IO), external oblique (EO), superficial lumbar multifidus (LM), and erector spinae (ES). Relationships were assessed via Pearson correlations (significance p < 0.01). Results: In the AEP group, increased spinal extension was associated with altered LM activity during box-replace, reach-up, step-up, and step-down tasks. In the FP group, increased lower lumbar spinal flexion was associated with reduced muscle activation, while increased lower thoracic flexion was associated with increased muscle activation. The control group elicited no significant associations. Correlations ranged between −0.812 and 0.754. Conclusions: Differential relationships between muscle activity and spinal kinematics exist in AEP, FP, and pain-free control groups, reinforcing previous observations that flexion or extension-related LBP involves distinct motor control strategies during different activities. These insights could inform targeted intervention approaches, such as movement-based interventions and wearable technologies, for these groups. Full article

Background/Objectives: Non-specific low back pain represents a high number of primary care consultations, generating a great social and economic cost. There is a higher prevalence in women, and it may be associated with multiple factors. One of the most innovative tools in rehabilitation is virtual reality-based therapy. Virtual reality positively affects the motivation of participants and generates greater adherence to treatment, so this factor could lead to long-term functional improvement. The objective of this review is to update the effectiveness of virtual reality programs on pain, disability, kinesiophobia, and changes in the thoracoabdominal musculature in patients with chronic nonspecific low back pain. Methodology: PubMed, PEDro, SCOPUS, Web of Science, and the Cochrane Library were used in this systematic review. The research question was formulated using PICOS. The Physiotherapy Evidence Database (PEDro) scale was used. Inclusion criteria were randomized clinical trials, participants were men and/or women over 18 years of age who were diagnosed with chronic non-specific low back pain, and articles that included virtual reality as a treatment. Articles with a level of evidence lower than 5/10 on the PEDro scale were excluded. Results: A total of 14 studies were included with sample sizes between 34 and 188 participants. Studies showed significant improvements in pain reduction, kinesiophobia, and disability (inflammation and motor control). Some studies showed long-term benefits, with effects maintained up to 18 months post-intervention, especially in the reduction in pain and its interference with daily activities. Conclusions: The findings of this systematic review support the efficacy of virtual reality as an effective and safe therapeutic option for the treatment of chronic non-specific low back pain. Full article

Background and Objective: This study aimed to compare functional and clinical outcomes between patients with chronic non-specific lower back pain (NSLBP) with restricted hip extension mobility who performed spinal stabilization exercises with hip mobilization either with or without additional hip exercises. Methods: A total of 42 patients with chronic NSLBP with restricted hip extension mobility were enrolled (21 with and 21 without additional hip exercises). Functional and clinical outcomes were assessed based on hip joint mobility, back extensor endurance, postural stability, and patient-reported outcomes, including visual analog scale (VAS) and Oswestry disability index (ODI) scores. Results: A significant group–time interaction was identified for postural stability (Rt: p < 0.001, Lt: p = 0.002) and the ODI (p = 0.004). After the intervention, the group with additional hip exercises demonstrated significantly greater improvements in postural stability (Rt: p < 0.001; Lt: p = 0.01) and ODI scores (p < 0.001) compared with the group without additional hip exercises. However, no significant main group effect or group–time interaction was observed for the hip joint mobility, back extensor endurance, or VAS scores (all p > 0.05). Furthermore, the ODI score (r² = 0.123, p = 0.023) was an independent predictor of hip joint mobility but not the VAS score (p > 0.05). Conclusions: Hip exercises may improve postural stability and function in patients with chronic NSLBP with restricted hip extension mobility. Notably, clinicians and therapists must recognize the importance of hip exercises during rehabilitation of patients with chronic NSLBP with restricted hip extension mobility. Full article

Chronic nonspecific low back pain (CNSLBP) might be associated with increased pain sensitivity and inflammation. High-intensity interval training (HIIT) has been suggested to reduce pain outcomes and inflammatory markers, but its effects compared to moderate-intensity continuous training (MICT) remain unclear. This study aimed to evaluate the acute effects of HIIT on pain sensitivity and inflammatory markers in persons with CNSLBP compared to healthy controls (HCs) and to determine how these effects differ from MICT. Twenty persons with CNSLBP and twenty HCs were assessed before (PRE) and after (POST) a single HIIT and MICT protocol for pain sensitivity (cuff pressure pain threshold (cPPT), temporal summation of pain (TS), conditioned pain modulation (CPM)), and inflammatory markers (IL-6, TNF-α). Data were analyzed using one-way ANOVAs, paired t-tests, and correlation analyses. At PRE, persons with CNSLBP exhibited lower cPPT (28.2 ± 7.1, Δ = −5.5, p = 0.040), higher TS (1.11 ± 0.89, Δ = 0.79, p = 0.042), and lower CPM (36.2 ± 11.6, Δ = −10.0, p = 0.023) compared to HCs. HIIT resulted in PRE–POST improvements in cPPT (38.9 ± 12.6, Δ = 5.2, p = 0.019) in HCs. No PRE–POST differences were observed in pain processing in those with CLBP. No PRE or PRE–POST differences were observed in the inflammatory markers in either group. The current exploratory study suggests that a single HIIT session might have a beneficial effect on pain sensitivity in HCs but does not alter acute pain sensitivity or inflammatory markers in persons with CNSLBP. Further research is needed to clarify the involved mechanisms and explore the (relation with the) long-term effects of HIIT. Full article

Background and Objectives: Chronic low back pain is a widespread condition, particularly in older populations, contributing to physical, mental, and social burdens. Traditional treatments, such as medications and surgery, carry long-term risks, including dependency, side-effects, and complications from invasive procedures. Additionally, healthcare accessibility is limited due to high costs, long waiting times, and geographic disparities in healthcare services, particularly in rural areas. For these reasons, non-pharmacological approaches that address both physical and psychological aspects are increasingly recognized as effective. This study aimed to evaluate the effectiveness of a marine resource-based healing program in Taean, South Korea, in improving pain, physical function, and mental health in patients with non-specific chronic low back pain. Materials and Methods: This randomized controlled trial involved 46 participants with non-specific chronic low back pain (mean age, 68.7 ± 5.1 years), randomly allocated to either an experimental group (marine healing program) or a control group (core exercises). The experimental group participated in a 4-night, 5-day intervention comprising heated peat pack therapy, mindfulness meditation, core exercises, and local tourism. The control group performed core exercises without additional interventions. Key outcomes included pain, muscle properties, functional disability, lower extremity function, balance, gait, and depression. Results: The experimental group demonstrated significant reductions in resting pain (p < 0.001), improved pressure pain threshold at L3 (p < 0.001), decreased L3 muscle tone (p = 0.015), and improved functional disability scores (p < 0.001). Functional gains were observed in lower extremity function scores (p < 0.001), balance (sway area: p = 0.046), gait velocity (p < 0.001), and depression levels (p < 0.001). Conclusions: The marine healing program significantly improved pain, functional abilities, and mental well-being in patients with non-specific chronic low back pain, highlighting its potential as an integrative approach to chronic low back pain management. Further studies are recommended to explore long-term and generalized effects. Full article

Study Design: This is an observational study. Objectives: In general practice, it is noted that some people can deal more easily with a prominent belly than others. Recent use of spinopelvic parameters in the analysis of the spine might explain this observation. This study aimed to determine the correlation between pelvic incidence (PI), waist circumference (WC), and body mass index (BMI) in patients with non-specific chronic low back pain. We hypothesized that people with a low PI (non-pronounced lumbar lordosis) have significantly lower WC values than those with a high PI (pronounced lumbar lordosis). Methods: Adult patients presenting to the outpatient neurosurgery clinic with non-specific chronic low back pain who had undergone full spine radiography were included. The PI, BMI, and WC were measured in all cases. Results: We included 272 patients (male–female ratio, 1.08) with a mean age of 54 years. There was a statistically significant difference (p < 0.05) in the mean PI according to BMI group. The mean PI in our population was 57.8° (range 28.4–97.2°, SD 12.1°). A significant correlation coefficient of 0.271 (p < 0.001; 95%CI 0.157–0.377) was found between BMI and PI and 0.410 (p-value < 0.001; 95%CI 0.262–0.539). Conclusions: We found a significant correlation between PI, BMI, and WC. This finding is the first step in confirming our hypothesis that a patient with a high PI might be able to tolerate being overweight and a high WC better than patients with a low PI, possibly because of their ability to retrovert the pelvis to a greater extent. Further research is warranted to investigate whether people with a high pelvic PI can better cope with obesity, especially those with a higher waist circumference and abdominal weight. Full article

This study examined the erector spinae contractile properties, trunk isokinetic strength, and differences in acute muscle fatigue response after exercise in young females with and without non-specific chronic low back pain (NSCLBP). This study evaluated participants using tensiomyography and isokinetic trunk strength tests. An independent t-test compared the control group and the NSCLBP group, while a two-way mixed ANOVA analyzed differences in the erector spinae’s acute muscle fatigue response before and after exercise within and between groups. The results of the tensiomyography indicated that the NSCLBP group exhibited significantly lower Dm and Vc (p < 0.05) compared to the control group, while Tc showed no significant difference between groups. Significant differences in all variables were observed between the groups in the isokinetic trunk strength test (p < 0.05). Furthermore, the two-way mixed ANOVA revealed significant group main effects in Dm and Vc of the erector spinae (p < 0.05). This study found that non-specific chronic low back pain is linked to a decrease in Dm, Vc, and trunk isokinetic strength in both extensor and flexor muscles. It suggests that future research should further investigate the acute muscle fatigue response in individuals with and without NSCLBP. Full article

Lower back pain (LBP) has been the leading cause of disability since 1990. Objectives: The main objective of this observational case–control study was to evaluate, using ultrasound, whether there were differences in the onset and ratio of core muscle contraction between subjects with non-specific chronic lower back pain and healthy subjects. Methods: A total of 60 participants (52% women), split between those with non-specific chronic lower back pain (n = 26) and healthy (n = 34) subjects, were recruited. Initial muscle contraction of the lateral abdominal wall, pelvic floor, lumbar multifidus, and respiratory diaphragm was measured using ultrasound. The abdominal drawing-in maneuver, contralateral arm elevation, the Valsalva maneuver, and voluntary contraction of the pelvic floor in seated and standing positions were performed. The muscle thickness of the lateral abdominal wall and lumbar multifidus and excursion of the pelvic floor and diaphragm at rest and during testing were also analyzed. Results: No differences were found between the groups in the initial contraction. Statistically significant differences were found in the following variables: diaphragm excursion (p = 0.032, r = 0.277) and lumbar multifidus ratio (p = 0.010, r = 0.333) in the standing–abdominal retraction maneuver; pelvic floor excursion (p = 0.012, r = 0.325) in the standing–contralateral arm raise; and transverse abdominis ratio (p = 0.033, r = 0.275) in the sitting–contralateral arm raise. A statistically significant interaction between the groups and body mass index was observed in resting diaphragm excursion (p = 0.018, partial eta squared = 0.096) during sitting–voluntary pelvic floor contraction. Conclusions: It cannot be concluded that there is a specific pattern of core activation in any of the groups. However, statistically significant differences were found in the contraction indexes of the lumbopelvic musculature. Full article

Background and Aims: Low back pain is a prevalent condition affecting 60–85% of individuals during their lifetime. Despite various proposed mechanisms, the etiology of low back pain remains unclear. This study aims to evaluate the effectiveness of combining ultrasound-guided infiltrations with early rehabilitation in reducing pain and improving functional limitations in patients with chronic nonspecific low back pain. Methods: A retrospective observational study was conducted, reviewing data from January to April 2024 involving 40 patients with chronic nonspecific low back pain. Each patient received two cycles of ultrasound-guided lidocaine and corticosteroid infiltrations at the level of the posterior lower iliac spine, followed by 10 rehabilitation sessions. Patients were assessed at baseline (T0), after the first treatment cycle (T1), and after the second cycle (T2) using the Oswestry Disability Index, Quebec Back Pain Disability Scale, Roland Disability Questionnaire, and Numeric Rating Scale. Results: Significant improvements were observed across all assessment scales. The ODI scores decreased from 33.5 at baseline to 3.5 after treatment (p < 0.001). Similar reductions were noted in the QBPDS (from 61.5 to 10.3), RDQ (from 18 to 3.4), and NRS (from 7.4 to 1.3). The combination of ultrasound-guided infiltrations and early rehabilitation resulted in a significant reduction in pain and disability, with the most notable improvements occurring after the second treatment cycle. Conclusions: The integration of ultrasound-guided infiltrations with early rehabilitation is highly effective in managing chronic nonspecific low back pain, significantly reducing both pain and functional limitations. Full article