Adaptive Patterns of Movement during Downward Reach and Pick-up Movements in Knee Osteoarthritis Patients with Mild Low Back Pain

[Purpose] Patients with severe bilateral knee osteoarthritis (KOA) often suffer from low back pain (LBP). However, few studies have examined the relationship between LBP and KOA in downward reach and pick-up movements. [Subjects] Eight KOA patients with LBP (LBP group), 8 KOA patients without LBP (NLBP group), and 7 healthy participants (Control group), without osteoarthritis or low back pain, were recruited for this study. [Methods] All subjects were asked to pick up a bottle with one hand, placed at the diagonal on the opposite side of the body. A 3D motion analysis system was used to record trunk and lower limb movements. [Results] The knee flexion angle on the side ipsilateral to the bottle was significantly smaller in both KOA groups than in the controls in the downward reach and pick-up movements. KOA patients showed a significantly lower trunk flexion angle and greater pelvis anterior tilt angle than the controls. In addition, no significant differences were found between the LBP and NLBP group. [Conclusion] We suspect that severe knee pain due to OA determines the priority of movement in strategic planning for the execution of pick-up movements. The knee strategy was abandoned by our severe knee OA patients, even when they had mild LBP.Key words: Knee osteoarthritis, Low back pain, Pick-up movement     

成年人体重指数、脂肪分布、脂肪含量的监测及分析

目的调查成人超重、肥胖的发生率，探讨体重指数（BMI）、体脂百分比（PBF）、腰臀比（WHR）与超重、肥胖之间的关系。方法对111名成人用InBody3．0人体成分分析仪随机进行人体成分测试，分析他们体重指数、体脂分布、体脂百分比情况。结果男女超重率63．06％，肥胖率19．82％。男女腰臀比及体脂肪比率超标分别占70．27％、72．07％。不同BMI和不同年龄的男性和女性腰臀比都有显著性差异（P〈0．01）。不同BMI男性体脂百分比有显著差异（P〈0．05），女性有显著性差异（P〈0．01）。不同年龄男性和女性体脂百分比有差异（P〈0．05）。结论体重指数的增加主要是脂肪增加造成的，而体内的脂肪又主要堆积在腹部。超重、肥胖情况较严重、体脂分布不合理、体内脂肪含量过高需引起重视，应采取各种措施以减少由超重带来的一系列问题。     

Effect of Togu-exercise on Lumbar Back Strength of Women with Chronic Low Back Pain

[Purpose] The present study analyzed the effect of the Togu exercise program on the lumbar back strength of middle-aged women who did not perform regular exercise, and presents an effective exercise method for middle-aged women with chronic low back pain symptom. [Subjects] The subjects were 16 women with chronic low back pain attending N University, Chungcheong-do, Korea. [Methods] Height, weight, body fat, and body mass index (BMI) were measured using a body composition analyzer (Inbody 720, Biospace, Korea), which utilizes bioelectrical impedance analysis. Using isokinetic lumbar muscle strength measurement equipment [Isomed 2000, Back system, (Germany)], peak torque/body weight, total work and average power of flexion and extension of the lumbar region were measured. For lumbar stabilization exercises, an air cushion (Germany), jumper (Germany), and aero step (Germany) were employed. First, warm-up exercise was conducted for 10 minutes, followed by 10 sets of the 3 main exercises using the above tools with 10-second rest intervals. The main exercise was done for 40 minutes in total. [Results] The paired sample t-test showed significant in the Togu exercise group peak torque of flexion, peak torque of extension, total work of flexion, total work of extension, average power of flexion, average power of extension, after the exercise showed a significant difference in the Togu exercise group. [Conclusion] The trunk muscle actiation program for middle-aged women had a significant effect on muscle strength and low back pain. Therefore the trunk muscle activation program is effective at increasing muscular strength of middle-aged women, and the results suggest improve muscle strength is effectively stabilizaties the lumbar region.Key words: Isokinetic, Lumbar stabilization, Togu     

Effects of the Ball-backrest Chair Combined with an Accelerometer on the Pain and Trunk Muscle Endurance of a Computer Worker with LBP

[Purpose] This study examined the effects of a ball-backrest chair combined with an accelerometer on the pain and trunk muscle endurance of a computer worker with low-back pain (LBP). [Subject and Methods] A 36-year-old male with a flat back who complained of LBP at the L3–5 level was the subject. He used the ball-backrest chair when working at a computer for 1 week. [Results] After using the ball backrest, the trunk extensor and flexor muscle endurance times had increased compared with the baseline and the VAS score had decreased from 7 to 4. [Conclusion] Combining exercises with information on motion is a useful common treatment approach for improving trunk muscle endurance in LBP.Key words: Ball-backrest chair, Biofeedback, Trunk muscle endurance     

Association of low back pain with muscle stiffness and muscle mass of the lumbar back muscles,and sagittal spinal alignment in young and middle-aged medical workers

BackgroundMuscle stiffness of the lumbar back muscles in low back pain (LBP) patients has not been clearly elucidated because quantitative assessment of the stiffness of individual muscles was conventionally difficult. This study aimed to examine the association of LBP with muscle stiffness assessed using ultrasonic shear wave elastography (SWE) and muscle mass of the lumbar back muscle, and spinal alignment in young and middle-aged medical workers.MethodsThe study comprised 23 asymptomatic medical workers [control (CTR) group] and 9 medical workers with LBP (LBP group). Muscle stiffness and mass of the lumbar back muscles (lumbar erector spinae, multifidus, and quadratus lumborum) in the prone position were measured using ultrasonic SWE. Sagittal spinal alignment in the standing and prone positions was measured using a Spinal Mouse. The association with LBP was investigated by multiple logistic regression analysis with a forward selection method. The analysis was conducted using the shear elastic modulus and muscle thickness of the lumbar back muscles, and spinal alignment, age, body height, body weight, and sex as independent variables.FindingsMultiple logistic regression analysis showed that muscle stiffness of the lumbar multifidus muscle and body height were significant and independent determinants of LBP, but that muscle mass and spinal alignment were not. Muscle stiffness of the lumbar multifidus muscle in the LBP group was significantly higher than that in the CTR group.InterpretationThe results of this study suggest that LBP is associated with muscle stiffness of the lumbar multifidus muscle in young and middle-aged medical workers.     

Comparison of the Hamstring Muscle Activity and Flexion-Relaxation Ratio between Asymptomatic Persons and Computer Work-related Low Back Pain Sufferers

[Purpose] The purpose of this study was to compare the hamstring muscle (HAM) activities and flexion-relaxation ratios of an asymptomatic group and a computer work-related low back pain (LBP) group. [Subjects] For this study, we recruited 10 asymptomatic computer workers and 10 computer workers with work-related LBP. [Methods] We measured the RMS activity of each phase (flexion, full-flexion, and re-extension phase) of trunk flexion and calculated the flexion-relaxation (FR) ratio of the muscle activities of the flexion and full-flexion phases. [Results] In the computer work-related LBP group, the HAM muscle activity increased during the full-flexion phase compared to the asymptomatic group, and the FR ration was also significantly higher. [Conclusion] We thought that prolonged sitting of computer workers might cause the change in their HAM muscle activity pattern.Key words: Computer work-related LBP, Flexion-Relaxation ratio, Hamstring     

The effect of six weeks of sling exercise training on trunk muscular strength and endurance for clients with low back pain

[Purpose] The purpose of this study was to investigate the effects of 6 weeks sling exercise training for clients with low back pain on the levels of pain, disability, muscular strength and endurance. [Subjects and Methods] Twelve chronic LBP subjects participated in this study. Subjects were randomly divided into a control group and a training group. Subjects in the training group performed sling exercise training for six weeks, and participants in the control group did not perform any exercise. [Results] Pain, disability levels and muscular strength significantly improved in the training group, but not in the control group. The left multifidus showed a significant improvement in muscular endurance, measured as the slope of the median frequency after training. [Conclusion] Six weeks of sling exercise training was effective at reducing pain intensity, and improving the disability level and trunk muscular strength of subjects with low back pain.Key words: Chronic low back pain, Sling exercise training, Slope of median frequency     

老年2型糖尿病与非酒精性脂肪性肝病相关性研究

[目的]探讨老年2型糖尿病（T2DM）合并非酒精性脂肪肝的临床相关因素.[方法]对老年T2DM合并非酒精性脂肪性肝病（NAFLD）或无NAFLD患者及健康对照志愿者进行血脂水平、空腹血糖（FBG）及空腹胰岛素（FINS）的测定,并计算体质量指数（BMI）,腰臀比值（WHR）及胰岛素敏感指数（HOMA-IR）,并进行分析.[结果]与对照组（n=35）、不合并NAFLD组比较（n=40）,合并NAFLD的T2DM患者（n=42）的BMI、WHR、血甘油三酯（TG）、收缩压（SBP）、HOMA-IR显著增高,HOMA-β降低（P〈0.05或P〈0.01）.[结论]T2DM患者合并NAFLD,与肥胖（主要是腹型肥胖）、血脂紊乱、血压增高相关;导致糖尿病合并NAFLD的最主要原因为胰岛素抵抗及其所包含的脂代谢紊乱.     

Adiposity assessed by anthropometric measures has a similar or greater predictive ability than dual-energy X-ray absorptiometry measures for abdominal aortic calcification in community-dwelling older adults

To determine whether adiposity assessed by dual-energy X-ray absorptiometry (DXA) compared to simple anthropometric assessments, are more predictive of abdominal aortic calcification (AAC), a risk factor for atherosclerosis. A cross-sectional study of 312 participants (60.3?% female) aged 70.6?±?5.6 years was conducted in 2010–2011. AAC was assessed by radiography. Adiposity was estimated for whole body, trunk, android, gynoid and visceral regions using DXA in addition to body mass index (BMI), waist circumference (WC) and waist to hip ratio (WHR). WHR [tertile 1 as reference, OR (95?% CI) for tertile 3: 3.62 (1.35–9.72)] and android to gynoid fat ratio [tertile 3: 2.87 (1.03–8.01)] were independent predictors of AAC severity among men. Positive associations with AAC severity were observed for WC [tertile 1 as reference, OR for tertile 3: 2.46 (1.12–5.41)], % trunk fat mass [tertile 2: 3.26 (1.52–7.03)], % android fat mass [tertile 2: 2.42 (1.13–5.18), tertile 3: 2.20 (1.02–4.73)] and visceral fat area [tertile 2: 2.28 (1.06–4.87), tertile 3: 2.32 (1.01–5.34)] among women. Indices of total body composition, BMI and % body fat mass were not associated with AAC severity in either men or women. Simple anthropometric measures, WHR and WC were the best predictors of AAC severity in men and women respectively, although higher android to gynoid fat ratio and central fat, assessed by DXA, were also predictive of higher risks of AAC severity in men and women respectively. Our findings add to existing evidence that relatively inexpensive and easily obtained anthropometric measures can be clinically useful indicators of atherosclerosis risk.     

The Association Among Overweight,Obesity, and Low Back Pain in U.S. Adults: A Cross-Sectional Study of the 2015 National Health Interview Survey

Objective

The purpose of this study was to explore the association between obesity (via body mass index [BMI]) and presence of low back pain (LBP) in a representative sample of US adults, aged ≥18 years.

男性人体测量指标与体脂含量相关性分析

[目的]探讨男性人体测量指标与体脂含量的相关性.[方法]选取 20～50岁男性 89例为研究对象,根据体重指数分为 3组.应用双能X线进行体脂含量测定.[结果]超重组和肥胖组体脂含量,总体脂肪质量和躯干脂肪质量均高于对照组（P〈0.05）.体脂含量与体重指数（r =0.765）,腰围（r =0.798）,腰围身高比（r =0.809）和腰臀比（r =0.665）均呈正相关（P〈0.01）.以体脂含量为因变量,行多元线性回归显示,腰围身高比（β=93.983,P=0.000,R2=0.654）被引入方程.[结论]男性人体测量指标与体脂含量密切相关,利用简单的人体测量指标推算体脂含量是可行的,但有待流行病学研究进一步证实.     

Impact of age, anthropometric data and body composition on calcaneal bone characteristics, as measured by quantitative ultrasound (QUS) in an older German population

The impact of fat-free mass (FFM), fat mass (FM), body mass index (BMI), body mass and body height on calcaneal bone characteristics as measured with quantitative ultrasound (QUS) was investigated in 137 women and 85 men aged 62-92 years, considering age, smoking, waist-to-hip ratio (WHR) and physical activity level (PAL). In regression analyses using various models, in women, age was a negative predictor of speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness index (SI) and smoking was a negative predictor of SOS; positive predictors of SOS, BUA, and SI were BMI, body mass and FFM. In men, smoking was a negative predictor and BMI, body mass and FFM were positive predictors of BUA and SI. In both sexes, PAL, body height, WHR and FM had no effect on QUS parameters. The influence of BMI on calcaneal bone characteristics in elderly people depends on FFM rather than on FM.     

Effects of Thoracic Mobilization and Manipulation on Function and Mental State in Chronic Lower Back Pain

[Purpose] The aim of this study was to evaluate the changes in function and mental state after thoracic mobilization and manipulation in patients with chronic lower back pain (LBP). [Subjects and Methods] Thirty-six subjects were randomly divided into mobilization group (group A), manipulation group (group B) and control group (group C). The Oswestry disability index (ODI) was used to measure the functional impairment of patients with LBP. A multiple spinal diagnosis was used to measure the range of motion (ROM) of vertebra segments. The Fear-avoidance beliefs questionnaire (FABQ) was used to investigate the mental state of LBP patients. [Results] Group A and group B were significantly different from group C in terms of the ODI. Between groups, there was no difference in ROM during trunk flexion. Group A and group B were also significantly different from the control group in extension ROM. The FABQ of group B was significantly different from that of group A. [Conclusion] Application of mobilization or manipulation to thoracic lumbar vertebrae has a positive effect on function, mental state, and ROM in patients with lower back pain.Key words: LBP, Mobilization, Manipulation     

Trunk Control Ability after Minimally Invasive Lumbar Fusion Surgery during the Early Postoperative Phase

[Purpose] Lumbar fusion has been used for spinal disorders when conservative treatment fails. The minimally invasive approach causes minimal damage to the back muscles and shortens the postoperative recovery time. However, evidence regarding functional recovery in patients after minimally invasive lumbar spinal fusion is limited. The purpose of this study was to investigate how trunk control ability is affected after minimally invasive lumbar fusion surgery during the early postoperative phase. [Subjects and Methods] Sixteen patients and 16 age- and sex-matched healthy participants were recruited. Participants were asked to perform a maximum forward reaching task and were evaluated 1 day before and again 1 month after the lumbar fusion surgery. Center of pressure (COP) displacement, back muscle strength, and scores for the Visual Analog Scale, and Chinese version of the modified Oswestry Disability Index (ODI) were recorded. [Results] The healthy control group exhibited more favorable outcomes than the patient group both before and after surgery in back strength, reaching distance, reaching velocity, and COP displacement. The patient group improved significantly after surgery in all clinical outcome measurements. However, reaching distance decreased, and the reaching velocity as well as COP displacement did not differ before and after surgery. [Conclusion] The LBP patients with lumbar fusion surgery showed improvement in pain intensity 1 month after surgery but no improvement in trunk control during forward reaching. The results provide evidence that the back muscle strength was not fully recovered in patients 1 month after surgery and limited their ability to move their trunk forward.Key words: Biomechanics, Postural balance, Low back pain     

Motor Training of the Lumbar Paraspinal Muscles Induces Immediate Changes in Motor Coordination in Patients With Recurrent Low Back Pain

Recurrent low back pain (LBP) is associated with altered motor coordination of the lumbar paraspinal muscles. Whether these changes can be modified with motor training remains unclear. Twenty volunteers with unilateral LBP were randomly assigned to cognitively activate the lumbar multifidus independently from other back muscles (skilled training) or to activate all paraspinal muscles with no attention to any specific muscles (extension training). Electromyographic (EMG) activity of deep (DM) and superficial multifidus (SM) muscles were recorded bilaterally using intramuscular fine-wire electrodes and that of superficial abdominal and back muscles using surface electrodes. Motor coordination was assessed before and immediately after training as onsets of trunk muscle EMG during rapid arm movements, and as EMG amplitude at the mid-point of slow trunk flexion-extension movements. Despite different intentions of the training tasks, the pattern of activity was similar for both. After both training tasks, activation of the DM and SM muscles was earlier during rapid arm movements. However, during slow trunk movements, DM and SM activity was increased, and EMG activity of the superficial trunk muscles was reduced only after skilled training. These findings show the potential to alter motor coordination with motor training of the lumbar paraspinal muscles in recurrent LBP.     

The effects of prone bridge exercise on trunk muscle thickness in chronic low back pain patients

[Purpose] This study aimed to investigate the effects of prone bridge exercise on trunk muscle thickness. [Subjects and Methods] Thirty-seven chronic low back pain patients participated in this study. Each participant was randomly assigned to one of three exercise groups, namely, a prone bridge exercise group, supine bridge exercise on a Swiss ball group, and supine bridge exercise group. The thicknesses of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) were measured using ultrasound. [Results] After eight weeks of training, the three groups showed significant increases in the thicknesses of the TrA, IO, and EO. Among the groups, TrA and IO showed significantly different muscle thicknesses. [Conclusion] The prone bridge exercise significantly affected the thicknesses of the TrA, IO, and EO unlike the supine bridge exercises. Based on the results of this study, the prone bridge exercise is a more effective method to improve trunk stability than conventional supine bridge exercises.Key words: Bridge exercise, Muscle thickness, Chronic low back pain     

Relationship between cardiovascular risk indicators and types of obesity in overweight and obese women

We aimed to evaluate the relationship between different types of obesity and cardiovascular risk indicators. A total of 623 overweight (body mass index [BMI] > 25 kg/m2), and 2559 obese (BMI > 30 kg/m2) women were divided into four groups according to their BMI and waist-to-hip ratio (WHR): simple overweight (BMI 25-30 kg/m2 and WHR < 0.8, n = 371), abdominal adiposity (BMI 25-30 kg/m2 and WHR > 0.8, n = 252), peripheral (pure) obesity (BMI > 30 kg/m2 and WHR < 0.8, n = 918) and central obesity (BMI > 30 kg/m2 and WHR > 0.8, n = 1641). The levels of the risk indicators measured (clinical, anthropometric and laboratory) were significantly higher in the central obesity group. Total body fat and abdominal fat accumulation seems to result in more serious hyperinsulinaemia and insulin resistance in central obesity. Measuring BMI and WHR in obese patients may reveal their risk for coronary heart disease.     

Effects of two 4-week proprioceptive neuromuscular facilitation programs on muscle endurance, flexibility, and functional performance in women with chronic low back pain

BACKGROUND AND PURPOSE: Improving functional performance in patients with chronic low back pain is of primary importance. The purpose of this study was to examine the effects of 2 proprioceptive neuromuscular facilitation (PNF) programs on trunk muscle endurance, flexibility, and functional performance in subjects with chronic low back pain (CLBP). SUBJECTS: Eighty-six women (40.2+/-11.9 [mean+/-SD] years of age) who had complaints of CLBP were randomly assigned to 3 groups: rhythmic stabilization training, combination of isotonic exercises, and control. METHODS: Subjects trained with each program for 4 weeks with the aim of improving trunk stability and strength. Static and dynamic trunk muscle endurance and lumbar mobility were measured before, at the end of, and 4 and 8 weeks after training. Disability and back pain intensity also were measured with the Oswestry Index. RESULTS: Multivariate analysis of variance indicated that both training groups demonstrated significant improvements in lumbar mobility (8.6%-24.1%), static and dynamic muscle endurance (23.6%-81%), and Oswestry Index (29.3%-31.8%) measurements. DISCUSSION AND CONCLUSION: Static and dynamic PNF programs may be appropriate for improving short-term trunk muscle endurance and trunk mobility in people with CLBP.     

Impaired trunk muscle function in sub-acute neck pain: etiologic in the subsequent development of low back pain?

Low back pain (LBP) and neck pain are associated with dysfunction of the trunk and neck muscles, respectively, and may involve common or similar mechanisms. In both cases, dysfunction may compromise spinal control. Anecdotally, neck pain patients commonly develop LBP. This study investigated the possibility that trunk muscle function is compromised in neck pain patients and that compromised trunk muscle function is associated with increased risk of LBP. Fifty-four neck pain patients and 52 controls were assessed on an abdominal drawing-in task (ADIT) and on self-report tests. Performance on the ADIT was able to detect neck pain patients with 85% sensitivity and 73% specificity. Catastrophizing and McGill pain questionnaire (affective) scores were higher in patients with an abnormal task response than in patients with an uncertain or normal response, although the self-report data did not predict task performance. Fifty subjects from each group were contactable by telephone at 2 years. They were asked whether they had experienced persistent or recurrent LBP since the assessment. Subjects (patients and controls) who obtained an abnormal response on the ADIT were 3 to 6 times more likely to develop persistent or recurrent LBP than those who obtained an uncertain or normal response. ADIT performance was the main predictor of development of LBP in patients. The results suggest that reduced voluntary trunk muscle control in neck pain patients is associated with an increased risk of developing LBP.     

The immediate effects of neuromuscular joint facilitation on chronic low back pain in young and elderly people

[Purpose] This study aimed to investigate the changes in the pain severity and muscle hardness of the multifidus and longissimus muscles of young and elderly patients with low back pain after neuromuscular joint facilitation treatment. [Participants and Methods] The participants were 13 young patients and 11 elderly patients with chronic low back pain. The neuromuscular joint facilitation lumbar approach was used in all participants. The muscle hardness of the multifidus and longissimus muscles was assessed at the L4 and L5 levels of the lumbar spine. The changes in pain severity of low back pain were assessed using a visual analogue scale before and after treatment. [Results] Visual analogue scale scores significantly decreased in both groups after treatment. The young group showed significant differences in muscle hardness pre- and post-intervention. In addition, except for the muscle hardness of the multifidus muscle before intervention, on the side with pain at the L5 level, longissimus muscle hardness was higher in the elderly, as compared to the young patient group. [Conclusion] Interventions with neuromuscular joint facilitation have an immediate effect on pain relief in young and elderly people with chronic low back pain and on muscle spasms in young people with chronic low back pain.