Search Results (448)

Low back pain (LBP) is the leading cause of disability worldwide. While studies often focus on the relationship between magnetic resonance imaging (MRI) findings and symptoms or the link between pain and disability, comprehensive assessments that incorporate both structural and functional impairments are lacking. This study prospectively includes standardized questionnaires, medical histories, clinical exams, and lumbar–pelvic MRI. Participants were grouped by pain status, physical activity, structural impairments (e.g., Pfirrmann, Krämer, Fujiwara, Meyerding), and posture/mobility deviations. Data were analyzed using the Kruskal–Wallis test. Of the 1262 participants, 392 (31%) reported chronic low back pain (cLBP), 226 (18%) had intermittent low back pain (iLBP), and 335 (27%) were pain-free. Significant differences were observed in high physical activity levels based on WHO criteria (cLBP: 79%, iLBP: 78%, no-BP(2): 86%, p = 0.020, η² = 0.008). Morphological impairments were more prevalent in cLBP (75%) and iLBP (76%) compared to no-BP(2) (55%) (p = 0.000, η² = 0.043). Functional impairments showed similar patterns (cLBP: 42%, iLBP: 51%, no-BP(2): 38%, p = 0.014, η² = 0.010). Participants with functional impairments tended to be younger. Consequently, the current classification system for diagnostics needs to incorporate alternative categories to more accurately differentiate types of back pain, which could enhance therapeutic outcomes. Full article

Low back pain (LBP) is a common chronic musculoskeletal disorder with significant interpersonal variability, so individual treatment strategies are difficult to implement. Prevention of recurrence, particularly through exercise and physical activity, appears to be necessary to avoid acute episodes. The present study aims to find whether some behavioral characteristics (particularly inter-girdle coordination) in the painless period in patients who had experienced LBP could be detected as relevant to prevent acute recurrences. Thirty-four young adults participated in the study. They were recruited from outpatient physiotherapy clinics. Sixteen subjects formed the Control group (CG), and eighteen subjects formed the patient group (LBPG), with no differences between groups in individual parameters. Moreover, the Duke Health Profile (General Health Score, Perceived Health Score, and Pain Score) was calculated and did not show differences between groups. Kinematic data, muscular activity, and inter-girdle coordination were captured. Our results show significant differences between groups only for inter-girdle coordination, which is less out-of-phase in the LBP group. The emergence of coordinative patterns (in the present work, the inter-girdle coordination) expresses behavior in an integrative way and allows the prevention of acute recurrences despite a lack of differences in usual gait parameters. Full article

Background: Fatigue can be a useful tool to understand the effects of physical activity (PA) and sedentary behavior on musculoskeletal health in university students. Methods: The aim of this cross-sectional study was to examine gender differences in the relationships between fatigue and specific types and levels of PA, posture, sleep quality (SQ), and non-specific low back pain (NS-LBP) in young adult university students aged 18–25 years. A total of 180 students completed all required tests. Results: Female students had higher total fatigue as they generally engaged in more PA in contrast to male students, who had higher total fatigue when they engaged in less moderate and less vigorous PA. With increasing sedentary behavior, overall fatigue was pronounced in both sexes, although female students spent significantly more time sitting. Poorer SQ correlated with NS-LBP and higher levels of sleep-related fatigue in female students. Males with pronounced hypekyphosis and females with pronounced lordosis were more fatigued. In addition, fatigue was more pronounced in female students with a higher extensor/flexor ratio, suggesting that trunk extensors are more fatigued due to the need to maintain lumbar spine stability. Conclusions: Our findings suggest that the choice of PA should be gender-specific to prevent chronic musculoskeletal disorders and fatigue in young adult university students. Full article

Background: This systematic review evaluates the efficacy of rehabilitation-focused exercise interventions for lumbar degenerative disc disease (DDD), a leading cause of chronic low back pain. Methods: Following PRISMA guidelines, a comprehensive search was conducted across international and regional databases (PubMed, Scopus, Web of Science, Magiran, SID, and Noormags) covering the period from January 2010 to January 2025. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420251088811. Using keywords such as “lumbar DDD,” “exercise therapy,” and “rehabilitation,” a total of 2495 records were identified. After screening, 20 studies—including clinical trials, quasi-experimental, and experimental designs—met the inclusion criteria and were assessed using the McMaster Critical Review Form for Quantitative Studies. Results: Interventions such as hydrotherapy, core stability training, Pilates, and suspension exercises were found to significantly reduce pain and improve functional outcomes. While multimodal approaches (e.g., aquatic exercise combined with acupuncture) showed positive effects, the comparative studies revealed no significant differences between modalities. Suspension training demonstrated superior efficacy in pain reduction compared to isolated core stability exercises. The methodological quality of included studies ranged from good to excellent, with the majority rated as very good or excellent (McMaster scores: 8 “excellent,” 7 “very good,” and 5 “good”). Common limitations among the studies included methodological heterogeneity, small sample sizes (n = 14–30), and insufficient long-term follow-up. Conclusions: Exercise-based rehabilitation is an effective strategy for managing lumbar DDD. Evidence particularly supports the use of suspension training and aquatic therapy for superior improvements in pain and functional outcomes. Future research should aim to adopt standardized protocols, recruit larger sample sizes, and include extended follow-up periods to produce more robust and generalizable findings. Full article

Degenerative disc disease (DDD) is a major cause of chronic low back pain (LBP), yet the molecular mechanisms driving disc degeneration and pain remain poorly understood. This study analyzed intervertebral disc (IVD) tissue from 36 young patients (median age = 36.00 [31.00, 42.50] years) with herniated discs and LBP, alongside healthy controls, to investigate changes in the extracellular matrix (ECM) and neurochemical alterations. Disc degeneration was assessed using MRI (Pfirrmann grading) and histology (Sive’s criteria). Histochemical and immunohistochemical methods were used to evaluate aggrecan content, calcification, and the expression of nerve growth factor (NGF), substance P (SP), and S-100 protein. MRI findings included Pfirrmann grades V (30.55%), IV (61.11%), III (5.56%), and II (2.78%). Severe histological degeneration (10–12 points) was observed in three patients. Aggrecan depletion correlated with longer pain duration (r = 0.449, p = 0.031). NGF expression was significantly elevated in degenerated discs (p = 0.0287) and strongly correlated with SP (r = 0.785, p = 5.268 × 10⁻⁹). Free nerve endings were identified in 5 cases. ECM calcification, present in 36.1% of patients, was significantly associated with radiculopathy (r = 0.664, p = 0.005). The observed co-localization of NGF and SP suggests a synergistic role in pain development. These results indicate that in young individuals, aggrecan loss, neurochemical imbalance, and ECM calcification are key contributors to DDD and chronic LBP. Full article

Background/Objectives: Left/right discrimination (LRD) training is increasingly being used in the treatment of chronic low back pain (CLBP). However, it is unclear whether trunk LRD-performance is impaired in CLBP patients and whether clinical parameters are related to LRD-performance. Therefore, this cross-sectional study aimed to examine (1) whether LRD-performance differs between CLBP patients and pain-free individuals; (2) whether these differences depend on the low back pain (LBP) history in pain-free individuals; (3) if clinical factors are related to LRD-performance; (4) whether LRD-task difficulty influences these results. Methods: Participants included 150 pain-free persons (107 with no LBP-history; 43 with past LBP) and 150 patients with CLBP. All participants performed the LRD-task in a simple and complex condition. Outcomes were reaction time and accuracy. Results: CLBP patients were significantly slower (Cohen’s d = 0.47 to 0.50, p < 0.001) and less accurate (Cohen’s d = 0.30 to 0.55, p < 0.001) than pain-free individuals without LBP-history, but not compared to those with past LBP (Cohen’s d reaction time = 0.07 to 0.15, p = 0.55; Cohen’s d accuracy = 0.03 to 0.28, p-value = 0.28). All participant groups were slower and less accurate in the complex condition, but between-groups differences were independent of task difficulty. Linear mixed models showed that older age and lower education were independently associated with less accuracy. When controlling for demographics, pain intensity, disability, fear of movement, pain-related worry and pain duration were not related to LRD-performance in patients with CLBP. Conclusions: Patients with CLBP showed impaired trunk LRD-performance compared to pain-free persons without LBP history, but not compared to those with past LBP. When controlling for demographics, clinical parameters were not related to LRD-performance in patients with CLBP. Our findings indicate that LRD-performance may remain impaired after recovering from LBP. 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: Bertolotti syndrome describes a painful lumbosacral transitional vertebra (LSTV) with a pseudoarticulation between an enlarged lateral process of the caudal lumbar vertebra (L5) and ilium or sacrum. It often presents with chronic lower back pain with or without radiculopathy. The current literature emphasizes Bertolotti as a differential diagnosis in young adults. However, it is presumably underdiagnosed in middle-aged and older patients. Treatment ranges from conservative treatment with physiotherapy, infiltration, and radiofrequency ablation to surgical interventions. Case Description: In this case illustration, we present the diagnostic and therapeutic challenges in a 48-year-old female triathlete with persistent left gluteal pain caused by Bertolotti syndrome. When conservative treatment with physiotherapy, infiltrations, thermocoagulation, and radiofrequency ablation of the pseudoarticulation failed, microsurgical reduction of the hypertrophic transverse process was performed. This minimally invasive intervention achieved satisfactory pain relief of at least 70% one year after surgery, allowing the patient to resume her athletic activities. Conclusions: Bertolotti syndrome should be considered a potential differential diagnosis in patients of all ages. Since many patients endure years of misdiagnosis, adequate treatment is crucial upon diagnosis. If conservative measures fail, surgical treatment such as “processectomy” or spinal fusion should be evaluated. This case follows the CARE reporting guidelines. Full article

Background: Chronic low back pain (CLBP) is the leading cause of disability both within the United States and globally. However, reliable diagnosis and treatment remains limited due to a lack of objective and image-based biomarkers. Modic changes (MCs) are visible vertebral endplate and bone marrow changes in signal intensity seen on MRI. MCs have emerged as promising correlates with degenerative disc disease and CLBP. Methods: This is a non-systematic literature review. Results: This review synthesizes current evidence on the classification, pathophysiology, and imaging of MCs, with a particular focus on their associations with patient-reported outcomes, including pain (Visual Analog Scale), functional status (Oswestry disability index and Roland-Morris Disability Questionnaire), and health-related quality of life (Short Form-36 and EuroQol 5-Dimension 5 Level). MC type 1 and 2 show significant correlations with symptom severity and predict positive response to basi-vertebral nerve (BVN) ablation, a minimally invasive intervention inhibiting the nerves’ ability to transmit pain signals. Conclusions: Across multiple trials, BVN ablation has shown significant sustained improvements in patient-reported outcomes among patients with MC, reinforcing their role as both a diagnostic and therapeutic biomarker. 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 and Objectives: In the present study, distinct subgroups of older adults with chronic low back pain (LBP) were identified using cluster analysis based on the five dimensions of the EQ-5D-5L. Using detailed profiles of how chronic LBP affects various facets of health-related quality of life (HRQoL), differences in frailty levels across these subgroups were investigated in this study. Materials and Methods: This retrospective study included patients ≥ 60 years of age who visited the pain clinic at a tertiary hospital between March 2022 and February 2023. HRQoL was assessed using the EQ-5D-5L, and frailty was evaluated via the Frailty Phenotype Questionnaire. Hierarchical cluster analysis using the WARD method with squared Euclidean distance was conducted on the EQ-5D-5L dimensions to identify subgroups. Differences in frailty, demographics, and clinical data across clusters were analyzed. Results: Among 837 older adults with chronic LBP, four distinct clusters were identified based on a cluster analysis of the EQ-5D-5L dimensions. Cluster 1 exhibited high levels of pain/discomfort and anxiety/depression, and cluster 2 had severe mobility limitations and pain/discomfort but low anxiety/depression. Cluster 3 showed balanced scores across all dimensions, and cluster 4 had severe pain/discomfort but good mobility. Significant differences were observed among the clusters in pain intensity, EQ Visual Analogue Scale (EQ-VAS) and EQ-5D-5L index scores, and frailty status. Cluster 1 had the highest pain scores and lowest EQ-VAS, and frailty was most prevalent in cluster 2 (28.5%) and least in cluster 4 (13.3%). Conclusions: The results of the present study emphasize the complexity of chronic LBP in older adults by identifying distinct clusters. Cluster analysis identified four unique profiles, with significant frailty differences across the clusters. These findings emphasize the importance of personalized management strategies tailored to specific patient profiles to enhance treatment effectiveness and improve frailty status. Full article

Background: Severe scoliosis can lead to chronic low back pain (cLBP) and may progress in adulthood. While day-time bracing is commonly used to alleviate pain and improve function, the role of night-time bracing remains unclear. This study aimed to assess the six-month effectiveness of a custom-made night-time brace in reducing pain in adults with scoliosis, compared to a prefabricated brace worn for 2–4 h during the day. Methods: A retrospective cohort study was conducted at a tertiary outpatient clinic specializing in spinal deformities. Adults with scoliosis (≥30° Cobb) and cLBP were divided into two groups: the study group used a custom-made night-time thoracolumbosacral orthosis (TLSO), while the control group wore a prefabricated brace (Peak) for 2–4 h daily. Pain and functional outcomes were assessed at baseline and after six months. Results: The study group included 25 women (mean age, 62.3 ± 9.5 years; Cobb angle, 60.4 ± 17.7°) who wore the night-time brace for an average of 7.2 ± 2.2 h per night. The control group comprised 20 women (mean age, 67.8 ± 10.5 years; Cobb angle, 61.9 ± 12.6°). At six months, the worst pain significantly improved in the TLSO group compared to the Peak group (F = 6.32, p = 0.0158). However, no statistically significant differences were observed between groups for back pain, leg pain, Core Outcome Measures Index (COMI), or Oswestry Disability Index (ODI). Conclusions: Night-time bracing shows interesting results on pain at six months in adults with severe scoliosis and back pain. These preliminary results open a new perspective that needs further verification and will help design more robust studies to verify what we found and identify the population more responsive to this approach. Full article

Background: The methodology of ultrasound (US)-guided percutaneous neuromodulation (PNM) remains unclear. Objective: To determine the optimal stimulation frequency (3 Hz vs. 10 Hz) during the short-term application of US-guided PNM on the sciatic nerve, we assessed the therapeutic benefits, including pain reduction, hip passive internal rotation range of motion (IR-ROM), balance, and functionality, in patients with chronic low back pain (LBP). Methods: Forty patients with LBP were randomly assigned to two groups, each receiving isolated percutaneous electrical stimulation of the sciatic nerve. One group received stimulation at 3 Hz, while the other received stimulation at 10 Hz. Pain intensity, hip passive IR-ROM, hip muscle strength, and the Oswestry Disability Index (ODI) were measured before and one week after the intervention. Results: Both interventions significantly reduced pain and improved ROM, balance, and functionality after one week (p = 0.001). However, significant between-group (treatment × time) differences were observed for pain intensity (p = 0.001) and flexion strength in the non-intervention limb (p = 0.01), though the effect size was small (η² = 0.1). Conclusions: US-guided PNM applied to the sciatic nerve was more effective at 3 Hz than at 10 Hz in relieving pain intensity in patients with LBP. 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

Apoptosis plays a crucial role in the progression of intervertebral disc degeneration (IVDD), a significant cause of chronic low back pain. This review explores disc cell apoptosis’s cellular and molecular mechanisms, focusing on nucleus pulposus, annulus fibrosus, and cartilage endplates cells. Apoptotic pathways—intrinsic (mitochondrial), extrinsic (death receptor-mediated), ER stress-mediated, and autophagy-related—are activated by oxidative stress, inflammation, mechanical load, and metabolic disturbances like hyperglycemia. Diabetes exacerbates disc cell apoptosis through AGE-RAGE signaling and mitochondrial dysfunction. Inflammation further amplifies apoptotic cascades via cytokine signaling and ROS generation. The review also examines emerging therapeutic strategies, including antioxidants (e.g., MitoQ, resveratrol), anti-inflammatory agents (e.g., cytokine inhibitors), autophagy modulators (e.g., rapamycin, metformin), and stem cell and gene therapies. While promising preclinical results exist, challenges such as poor bioavailability and clinical translation remain. Enhanced understanding of apoptosis pathways informs future cellular preservation and matrix integrity treatments. Based on a comprehensive literature search from 2000 to 2025, this narrative review synthesizes current knowledge, identifies knowledge gaps, and discusses translational potential. Our findings support a paradigm shift toward mechanism-based therapies that address the root cause of IVDD rather than symptomatic relief alone. Full article