Back Pain: Airaksinen O

Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G, Anonymous00003. · No affiliation provided · Eur Spine J. · Pubmed #16550448 No free full text.

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Malmivaara A, Airaksinen O. · Työterveyslaitos, työlääketieteen osasto 00250 Helsinki. · Duodecim. · Pubmed #11912766 No free full text.

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Airaksinen O, Lindgren KA. · KYS:n fysiatrian klinikka, 70210 Kuopio. · Duodecim. · Pubmed #11912764 No free full text.

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Leinonen V, Kankaanpää M, Luukkonen M, Kansanen M, Hänninen O, Airaksinen O, Taimela S. · Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland. · Spine (Phila Pa 1976). · Pubmed #12698130 No free full text.

Abstract: STUDY DESIGN: A follow-up study evaluating postural control, lumbar movement perception, and paraspinal muscle reflexes in disc herniation-related chronic low back pain (LBP) before and after discectomy. OBJECTIVES: To assess the effect of discectomy on postural control, lumbar perception, and reflex activation of paraspinal muscles during sudden upper limb loading. SUMMARY OF BACKGROUND DATA: Impaired muscle function, postural control, and lumbar proprioception have been observed in LBP. However, they have not been studied in sciatica patients after surgery. METHODS: The study included 20 patients selected for an operation for chronic LBP caused by disc herniation and 15 controls without chronic LBP. The paraspinal muscle responses for upper limb loading during unexpected and expected conditions were measured by surface electromyography. The ability to sense lumbar rotation was assessed in a previously validated motorized trunk rotation unit in the seated position. The postural control was measured with a vertical force platform. Pain, disability, and depression scores were recorded. RESULTS: Patients had poorer lumbar perception (P = 0.012) and postural control (P < 0.05) than did healthy controls. The postural control remained unchanged, but lumbar perception (P = 0.054) and the lumbar feed-forward control (P = 0.043) improved after the surgery. CONCLUSIONS: The results demonstrate impaired lumbar proprioception and postural control in sciatica patients. During short-term follow-up after operative treatment, postural control does not seem to change, but impaired lumbar proprioception and feed-forward control of paraspinal muscles seem to recover.

Leinonen V, Määttä S, Taimela S, Herno A, Kankaanpää M, Partanen J, Kansanen M, Hänninen O, Airaksinen O. · Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, University of Kuopio, Kuopio, Finland. · Spine (Phila Pa 1976). · Pubmed #11979174 No free full text.

Abstract: STUDY DESIGN: A descriptive study of the associations between different neurophysiologic findings in patients with lumbar spinal stenosis. OBJECTIVES: To evaluate the ability to sense a change in lumbar position and the associations between lumbar movement perception, postural stability, and motor-evoked potentials and somatosensory-evoked potentials. SUMMARY OF BACKGROUND DATA: Patients with low back pain have impaired postural control and impaired lumbar proprioception. Altered motor-evoked potentials and somatosensory-evoked potentials have been often observed in lumbar spinal stenosis. METHODS: The study included 26 patients with clinically and radiologically diagnosed lumbar spinal stenosis. Their ability to sense lumbar rotation was assessed in a previously validated motorized trunk rotation unit in the seated position. The abilities to indicate the movement direction and the movement magnitude were used as indexes of the ability to sense the lumbar rotatory movement. The postural stability was measured with a vertical force platform. The motor-evoked potentials were elicited by transcranial and lumbar stimulation and recorded from anterior tibialis muscles. The somatosensory-evoked potentials were elicited by transcutaneous electrical stimulation of the tibial nerve at the ankle. RESULTS: Twenty patients (76.9%; P = 0.006) reported the wrong movement direction. Furthermore, the patients consistently localized the movement sensation in their shoulders instead of the lumbar region. The altered motor-evoked potentials and somatosensory-evoked potentials were observed in 11 and 16 patients, respectively. Abnormal motor-evoked potentials had inconsistent associations with impaired movement perception and postural stability and abnormal somatosensory-evoked potentials had no associations with other findings. CONCLUSIONS: Many patients with lumbar spinal stenosis have difficulties in sensing the lumbar rotational movement, which may indicate impaired proprioceptive abilities. Abnormal motor-evoked potentials and somatosensory-evoked potentials are also frequent in lumbar spinal stenosis but do not necessarily occur in the same patients as the abnormal ability to sense trunk movement. These new findings add to our understanding of the pathophysiology of lumbar spinal stenosis.

Kilpikoski S, Airaksinen O, Kankaanpää M, Leminen P, Videman T, Alen M. · Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland. · Spine (Phila Pa 1976). · Pubmed #11935120 No free full text.

Abstract: STUDY DESIGN: A test-retest design was used. OBJECTIVE: To assess interexaminer reliability of the McKenzie method for performing clinical tests and classifying patients with low back pain. SUMMARY OF BACKGROUND DATA: Clinical methods and tests classifying patients with nonspecific low back pain have been based mainly on symptom duration or extent of pain referral. The McKenzie mechanical diagnostic and classification approach is a widely used noninvasive, low-technology method of assessing patients with low back pain. However, little is known about the interexaminer reliability of the method, previous studies having yielded conflicting results. METHODS: For this study, 39 volunteers with low back pain, mean age 40 years (range, 24-55 years), were blindly assessed by two physical therapists trained in the McKenzie method. The variability of two examiners for binary decisions was expressed by the kappa coefficient, and by the proportion of observed agreement, as calculated from a 2 x 2 contingency table of concordance. RESULTS: On the basis of pure observation alone, agreement among clinical tests on the presence and direction of lateral shift was 77% (kappa = 0.2; P < 0.248) and 79% (kappa = 0.4; P < 0.003), respectively. Agreement on the relevance of lateral shift and the lateral component according to symptom responses was 85% (kappa = 0.7; P < 0.000) and 92% (kappa= 0.4; P < 0.021), respectively. Using the repeated movements and static end-range loading strategy to define the centralization phenomenon and directional preference, agreement was 95% (kappa = 0.7; P < 0.002) and 90% (kappa = 0.9; P < 0.000), respectively. When patients with low back pain were classified into the McKenzie main syndromes and into specific subgroups, agreement was 95% (kappa = 0.6; P < 0.000) and 74% (kappa = 0.7; P < 0.000), respectively. CONCLUSIONS: Interexaminer reliability of the McKenzie lumbar spine assessment in performing clinical tests and classifying patients with low back pain into syndromes were good and statistically significant when the examiners had been trained in the McKenzie method.

Penttinen J, Nevala-Puranen N, Airaksinen O, Jääskeläinen M, Sintonen H, Takala J. · Kuopio Regional Institute of Occupational Health, P.O. Box 93, FIN-70701 Kuopio, Finland. · J Occup Rehabil. · Pubmed #11837056 No free full text.

Abstract: The aim of this trial was to determine whether social interaction between patients with long-lasting nonspecific back pain reduces subjective or objective disability. The participants were selected from persons visiting an occupational health care unit because of back pain. After a clinical examination in a university clinic, subjects without a specific diagnosis and having no disabilities preventing active rehabilitation were selected for study. The subjects (n = 108) were randomized into treatment (n = 54) and control groups (n = 54). Altogether 18 study groups, 9 treatment groups and 9 groups for controls, were formed. Before starting the back schools altogether 15 subjects dropped out. Both the treatment groups (n = 47) and the controls (n = 46) attended a back school consisting of 10 lessons and demonstrations supervised by a physiotherapist. The participants in treatment groups, but not the controls, had physical exercise and social intercourse with other members within the group. The clinical examination was repeated after 6 and 12 months. Both the treatment groups and the controls showed improvement in perceived functional capacity (assessed with Oswestry disability questionnaire) and in perceived life quality (assessed with 15D score). At the 6-month follow-up life quality had improved statistically significantly more among the participants in treatment groups than among the controls, and at the 12-month follow-up the Oswestry index showed corresponding improvement. Among subjects suffering from nonspecific back pain, social support improves the results of active rehabilitation.

Arokoski JP, Valta T, Airaksinen O, Kankaanpää M. · Departments of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland. · Arch Phys Med Rehabil. · Pubmed #11494189 No free full text.

Abstract: OBJECTIVES: To assess the paraspinal and abdominal muscle activities during different therapeutic exercises and to study how load increment produced by varying limb movements and trunk positions could affect these muscle activities. DESIGN: A cross-sectional study comparing muscle activities between men and women. SETTING: Rehabilitation clinic in university hospital. PARTICIPANTS: Twenty-four healthy volunteers (14 women, 10 men) aged 21 to 39 years. INTERVENTIONS: Subjects performed 16 different therapeutic exercises commonly used to treat low back pain. MAIN OUTCOME MEASURES: Surface electromyography was recorded from the paraspinal (T9, L5) and abdominal (rectus abdominis, obliquus externus) muscles during these exercises. Average electromyographic amplitudes obtained during the exercises were normalized to the amplitude in maximal voluntary contraction (% MVC) to produce interindividually comparable muscle activity assessments. RESULTS: Mean average normalized electromyographic amplitudes (% MVC) of the exercises were below 50% MVC. At L5 level, the multifidus muscle activities were significantly higher (p <.05) in women than in men, whereas no significant difference was found at T9 level. Similarly, rectus abdominis and obliquus externus activities were significantly higher (p <.001, p <.05) in women than in men. Load increment in hands or unbalanced trunk and limb movements produced higher paraspinal and abdominal muscle activities (p <.05). CONCLUSIONS: Simple therapeutic exercises are effective in activating both abdominal and paraspinal muscles. By changing limb and trunk positions or unbalancing trunk movements, it is possible to increase trunk muscle activities. Women were better able to activate their stabilizing trunk muscles than men; but it is also possible that men, having a much higher degree of strength on maximal contraction, only need to activate a smaller amount of that maximum to perform a similar activity.

Kankaanpää M, Taimela S, Airaksinen O, Hänninen O. · Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Finland. · Spine (Phila Pa 1976). · Pubmed #10332798 No free full text.

Abstract: STUDY DESIGN: A randomized study comparing the results of active rehabilitation and passive control treatment in patients with chronic low back pain with follow-up at 6 months and 1 year. OBJECTIVES: To study the efficacy of active rehabilitation on pain, self-experienced disability, and lumbar fatigability. SUMMARY OF BACKGROUND DATA: Exercises in an outpatient setting are widely used for the treatment of chronic low back pain. The efficacy of the active rehabilitation approach has been documented in randomized control studies, but these studies have seldom been focused on lumbar fatigability, which is now recognized as a frequent problem among patients with chronic low back pain. METHODS: Fifty-nine middle-aged patients (37 men and 22 women) with nonspecific chronic low back pain were randomly assigned to 12 weeks' active rehabilitation or to a passive control treatment (massage, thermal therapy). Pain and disability index, low back pain intensity (visual analog scale, 100 mm), and the objectively assessed lumbar muscle fatigability (spectral electromyogram, mean power frequency slope [MPFSLOPE]) in a new 90-second submaximal isoinertial back endurance test were recorded before and after the interventions and at 6-month and 1-year follow-up visits. RESULTS: Results of repeated measures multivariate analysis of variance indicated that back pain intensity (visual analog scale) and functional disability (pain and disability index score) decreased, and lumbar endurance (MPFSLOPE) improved significantly more (P < 0.05) in the active rehabilitation group than in the passive control treatment group, when measured at a 1-year follow-up examination. The group difference in visual analog scale and pain and disability index changes became even more significant at the end of 1 year. The change in lumbar endurance was significantly greater in the active rehabilitation group than in the passive control treatment group at the 6-month follow-up, but not at the 1-year follow-up. CONCLUSIONS: The active progressive treatment program was more successful in reducing pain and self-experienced disability and also in improving lumbar endurance than was the passive control treatment. However, the group difference in lumbar endurance tended to diminish at the 1-year follow-up.

Zaproudina N, Hietikko T, Hänninen OO, Airaksinen O. · Department of Biomedicine, Physiology, University of Kuopio, PO Box 1627, FIN-70211, Finland. · Complement Ther Med. · Pubmed #19114225 No free full text.

Abstract: OBJECTIVES: The aim of this trial was to establish the effectiveness of traditional bone setting (TBS) compared with conventional physical and exercise therapy (PhT) in treating chronic low back pain (cLBP). DESIGN: Randomised clinical trial. SETTING: Working-aged cLBP patients (n=131, age range 29-51 years) were randomised into two treatment groups: TBS and PhT. Follow-up assessments took place 1, 6 and 12 months after treatment. INTERVENTIONS: TBS is a popular traditional manual mobilisation therapy for musculoskeletal disorders in Finland. Conventional PhT was used as the reference treatment. MAIN OUTCOME MEASURES: LBP intensity (Visual Analog Scale 0-100, VAS), the Oswestry Disability Index (ODI), the global assessment score (scale -1 to +10), a health-related quality of life (HRQoL) assessment and spine mobility measurements were used as measures. RESULTS: 118 patients (95.9%, 59 men and 59 women) completed the treatment program. Both treatments reduced the VAS and ODI levels after 1 month. Changes in VAS did not differ between the two treatment groups (mean -0.2, CI -11.3 to 10.9). The improvement in ODI (mean 2.4, CI -1.2 to 6.0, p=0.069, repeated measurements ANOVA) and quality of life scores (mean -0.03, CI -0.06 to 0, p=0.056) tended to be greater after TBS. Additionally, global assessment scores were better for TBS-treated patients (Mann-Whitney test, p=0.001). There were no differences between the spine mobility test results of the two groups. Changes in both VAS (mean -2.4, CI -15.5 to 10.6) and ODI (mean 1.0, CI -3.0 to 5.1) measures did not, however, differ between the groups at the 1-year follow-up stage. CONCLUSIONS: Most cLBP patients found the treatments to be beneficial. Although the long-term dynamics of pain and disability did not differ between the groups, the subjective benefits appeared to be more significant after TBS.

Luomajoki H, Kool J, de Bruin ED, Airaksinen O. · Physiotherapie Reinach, 5734 Reinach, Switzerland. · BMC Musculoskelet Disord. · Pubmed #19108735 links to  free full text

Abstract: BACKGROUND: To determine whether there is a difference between patients with low back pain and healthy controls in a test battery score for movement control of the lumbar spine. METHODS: This was a case control study, carried out in five outpatient physiotherapy practices in the German-speaking part of Switzerland. Twelve physiotherapists tested the ability of 210 subjects (108 patients with non-specific low back pain and 102 control subjects without back pain) to control their movements in the lumbar spine using a set of six tests. We observed the number of positive tests out of six (mean, standard deviation and 95% confidence interval of the mean). The significance of the differences between the groups was calculated with Mann-Whitney U test and p was set on <0.05. The effect size (d) between the groups was calculated and d>0.8 was considered a large difference. RESULTS: On average, patients with low back pain had 2.21(95%CI 1.94-2.48) positive tests and the healthy controls 0.75 (95%CI 0.55-0.95). The effect size was d = 1.18 (p < 0.001). There was a significant difference between acute and chronic (p < 0.01), as well as between subacute and chronic patient groups (p < 0.03), but not between acute and subacute patient groups (p > 0.7). CONCLUSION: This is the first study demonstrating a significant difference between patients with low back pain and subjects without back pain regarding their ability to actively control the movements of the low back. The effect size between patients with low back pain and healthy controls in movement control is large.

Luomajoki H, Kool J, de Bruin ED, Airaksinen O. · Physiotherapie Reinach, 5734 Reinach, Switzerland. · BMC Musculoskelet Disord. · Pubmed #17850669 links to  free full text

Abstract: BACKGROUND: Movement control dysfunction [MCD] reduces active control of movements. Patients with MCD might form an important subgroup among patients with non specific low back pain. The diagnosis is based on the observation of active movements. Although widely used clinically, only a few studies have been performed to determine the test reliability. The aim of this study was to determine the inter- and intra-observer reliability of movement control dysfunction tests of the lumbar spine. METHODS: We videoed patients performing a standardized test battery consisting of 10 active movement tests for motor control in 27 patients with non specific low back pain and 13 patients with other diagnoses but without back pain. Four physiotherapists independently rated test performances as correct or incorrect per observation, blinded to all other patient information and to each other. The study was conducted in a private physiotherapy outpatient practice in Reinach, Switzerland. Kappa coefficients, percentage agreements and confidence intervals for inter- and intra-rater results were calculated. RESULTS: The kappa values for inter-tester reliability ranged between 0.24 - 0.71. Six tests out of ten showed a substantial reliability [k > 0.6]. Intra-tester reliability was between 0.51 - 0.96, all tests but one showed substantial reliability [k > 0.6]. CONCLUSION: Physiotherapists were able to reliably rate most of the tests in this series of motor control tasks as being performed correctly or not, by viewing films of patients with and without back pain performing the task.

Leinonen V, Airaksinen M, Taimela S, Kankaanpää M, Kukka A, Koivisto T, Airaksinen O. · Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland. · Spine (Phila Pa 1976). · Pubmed #17334276 No free full text.

Abstract: STUDY DESIGN: A cross-sectional comparative study between healthy controls and patients with chronic low back pain (LBP). OBJECTIVE: To assess the effect of chronic LBP on biceps brachii muscle activation during sudden upper-limb loading. SUMMARY OF BACKGROUND DATA: Chronic LBP is related to altered trunk muscle function. However, it is not known if these changes are also found in upper-limb function, indicating a general effect. METHODS: Surface electromyographic recordings were made from the biceps brachii bilaterally from 22 control subjects without chronic LBP and 29 patients with chronic LBP. Electromyography was recorded during expected and unexpected limb loading, with the activation pattern recorded for analysis at 150 milliseconds before loading, and 3 consecutive 50 milliseconds periods following loading. RESULTS.: Chronic LBP patients had decreased biceps brachii activation before expected perturbation (P = 0.035) and during the third 50-millisecond period (from 100 to 150 milliseconds) after unexpected perturbation (P = 0.010). During the first 2, 50-millisecond periods (from 0 to 100 milliseconds) after the perturbation, the activation was similar. CONCLUSIONS: Chronic LBP did not affect reflex activation of biceps brachii muscles but decreased preparatory and triggered reactions. The finding indicates that back pain may disturb higher level information processing in motor control.

Leinonen V, Kankaanpää M, Vanharanta H, Airaksinen O, Hänninen O. · Department of Physiology, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland. · Pathophysiology. · Pubmed #16223576 No free full text.

Abstract: This study assessed low back and trapezius muscle activity in bus drivers, with or without recurrent low back pain (LBP), during the long term driving. In addition, low back and neck-shoulder pain intensities and fatigue were measured and the effect of low back support was observed. Also the possible source of LBP was attempted to assess by vibration pain provocation test and lumbar MRI. Forty bus drivers (recurrent LBP n = 25) participated in this study. Low back and neck-shoulder pain and subjective fatigue intensity was assessed by visual analogue scales (VAS) before and after driving. Lumbar paraspinal and trapezius muscle activation during driving was measured by surface EMG. Vibration pain provocation test was applied for all subjects. Average paraspinal myoelectric activity during driving was approximately 1% of MVC in both groups. Average trapezius myoelectric activity during driving was from 2 to 4% of MVC. Trapezius muscle activity was higher in back healthy drivers than in those with LBP. The low back support had no effect either on paraspinal or trapezius EMG activity. Low back and neck-shoulder fatigue increased during driving in both groups especially in those subjects with positive vibration pain provocation. The neck-shoulder pain and fatigue were more severe in drivers suffering from LBP. Low back support had no effect on low back and neck-shoulder subjective fatigue and neck-shoulder pain but tended to limit the LBP increase during driving. Paraspinal muscle loading in urban bus drivers was very limited and either LBP or ergonomic low back support had no effect on it. Trapezius muscle seemed to be less active in drivers suffering from recurrent LBP. Internal disc disruptions may expose to pain and fatigability during driving.

Arokoski JP, Valta T, Kankaanpää M, Airaksinen O. · Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland. · Arch Phys Med Rehabil. · Pubmed #15129408 No free full text.

Abstract: OBJECTIVES: To assess the activities of paraspinal and abdominal muscles during therapeutic exercises for the treatment of patients with nonspecific chronic low back pain (CLBP), and to study the effects of active physical rehabilitation on these activities. DESIGN: A cross-sectional study comparing muscle activities during 18 stabilization exercises, and a prospective follow-up of patients with CLBP during rehabilitation. SETTING: Rehabilitation clinic in university hospital in Finland. PARTICIPANTS: Nine volunteers (5 men, 4 women) aged 27 to 58 years. INTERVENTION: Three months of active outpatient rehabilitation (4 to 6 times in a rehabilitation clinic, supplemented with self-motivated exercise at home) supervised by a physiotherapist. MAIN OUTCOME MEASURES: Surface electromyography was recorded bilaterally from L5 level paraspinal, rectus abdominis, and obliquus externus abdominis muscles. The recorded signal was averaged and normalized to the maximal electromyographic amplitude obtained during the maximal voluntary contraction. The measurements were taken before and after the exercise treatment period. RESULTS: CLBP patients showed variable trunk muscle activity patterns during the different therapeutic exercises, similar to those that we reported earlier in healthy subjects. The maximal trunk isometric extension (pre, 147.3+/-75.9Nm; post, 170.1+/-72.3Nm) and flexion (pre, 72.0+/-37.9Nm; post, 93.5+/-42.5Nm) torques did not show a significant changes during the exercise period. However, trunk rotation-flexion torque (pre, 52.9+/-26.5Nm; post, 82.4+/-65.8Nm) increased significantly (35.8%) after the exercise period (P<.05). The corresponding maximal electromyographic amplitudes of back and abdominal muscles remained unchanged. Disability, as assessed by visual analog scale and Oswestry Disability Index, did not change. CONCLUSIONS: The CLBP patients performed therapeutic exercises with similar abdominal and back extensor muscle activities in the same way as the healthy subjects in our earlier studies. In this study, active physical rehabilitation had no effect on the abdominal and back muscle activities or on pain and functional disability indices.

Miettinen T, Leino E, Airaksinen O, Lindgren KA. · Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland. · Spine (Phila Pa 1976). · Pubmed #14752363 No free full text.

Abstract: STUDY DESIGN: A prospective follow-up study. OBJECTIVES: To evaluate the relation of the state of health before the accident and the significance of the symptoms reported soon after the injury to the situation 3 years after the injury. To evaluate the possibility of using simple validated questionnaires to predict long-term health problems after the injury. SUMMARY OF BACKGROUND DATA: A whiplash injury is generally benign in its natural course. However, some of the patients have diverse and prolonged symptoms. Although several prognostic factors have been suggested for the poor recovery, in most cases the factors leading to prolonged disability remain unclear. METHODS: In collaboration with traffic insurance companies, we gathered information of neck injuries that occurred in traffic accidents in Finland in 1998. After the insurance company received a notification of a neck injury and consent from the injured party to participate in the study, they sent the information to the research team. The first inquiry was sent to the patients as soon as possible. One- and three-year follow-up questionnaires were posted to those who responded to the first inquiry. A total of 144 persons returned the 3-year follow-up questionnaires and form the material of this study.RESULTS A poor state of health or frequent neck pain or headache before the accident did not have any significant relation to the poor outcome 3 years after the accident. The extent of neck pain and lower back pain reported soon after the accident was significantly associated to a poor outcome in the follow-up. The Neck Disability Index questionnaire was significantly related to the poor outcome after 3 years. CONCLUSIONS: The subjective experience of a notably decreased level of activity because of the neck pain when supplemented by the enhanced score of Neck Disability Index questionnaire predicts well poor outcome in long-term follow-up and can be used as a tool to identify persons who are at risk to suffer long-term health problems after whiplash injury.

Häkkinen A, Ylinen J, Kautiainen H, Airaksinen O, Herno A, Tarvainen U, Kiviranta I. · Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Jyväskylä, Finland. · J Rehabil Med. · Pubmed #14582556 No free full text.

Abstract: OBJECTIVE: To study associations between pain, trunk muscle strength, flexibility and disability in patients with lumbar disc herniation 2 months after surgery. DESIGN: Clinical cross-sectional survey. PARTICIPANTS: 172 operated lumbar disc herniation patients. METHODS: Back and leg pain on Visual Analogue Scale, Oswestry Disability Index and Brief Depression Scale were applied to assess the subjectively perceived outcome. Isometric and dynamic strength of trunk muscles and mobility of the lumbar spine were measured to mirror physical impairment. RESULTS: Two months after the operation median leg pain had decreased by 87% and back pain by 81%, respectively. However, moderate or severe leg pain was still reported by 25% and back pain by 20% of the patients. Approximately 30% of the patients perceived moderate or severe disability measured by the Oswestry index. Decreased muscle strength and spine mobility caused functional disability, especially in older patients and patients with postoperative pain. Furthermore, the ratio of trunk extension/flexion strength had changed in favour of the flexion muscles, being 0.98. Greater age and depression were associated with poorer postoperative recovery. CONCLUSION: Pain, decreased trunk muscle strength and decreased mobility still remained in a considerable proportion of patients with lumbar disc herniation 2 months after surgery. Early identification of those patients with restrictions is essential in order to commence rehabilitation.

Hakkinen A, Ylinen J, Kautiainen H, Airaksinen O, Herno A, Kiviranta I. · Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Jyväskylä, Finland. · Disabil Rehabil. · Pubmed #12851085 No free full text.

Abstract: PURPOSE: To assess the prognostic value of some preoperative and early post-operative indicators in the prediction of disability 14 months after lumbar disc surgery. METHODS: Of 173 patients, who had participated in baseline measurements, 145 (84%) attended the 14-month follow-up. Before surgery the duration and intensity of pain was assessed. Follow-up questionnaires were completed during check-ups and included items on pain (VAS), Oswestry and Million disability indices, depression (BDS) and work status. RESULTS: Two months after surgery average back pain was 67% lower and leg pain 70% lower than pre-operatively. The median Oswestry and Million disability indices were 14 and 15 at 2-months and remained low also at 14-months check-up. Further, the post-operative Oswestry and Million disability indices and BDS were highly associated with 14-month back and leg pain. Although the outcome of the patients was mostly good, 5% and 8% of them, respectively, reported severe pain at 2- and 14-month check-ups. CONCLUSIONS: As recovery following lumbar disc surgery occurred to a great extent during the first 2 months, the early post-operative outcome appears to be quite a reliable indicator of the postoperative outcome in 1-year follow-up. The strong association between pain and the disability indices allows us to conclude that both the Million and Oswestry indices are clinically useful instruments in the evaluation of outcome in these cases.

Leinonen V, Määttä S, Taimela S, Herno A, Kankaanpää M, Partanen J, Hänninen O, Airaksinen O. · Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland. · Spine (Phila Pa 1976). · Pubmed #12590204 No free full text.

Abstract: STUDY DESIGN: A descriptive study was conducted to investigate the paraspinal muscle function in patients with lumbar spinal stenosis. OBJECTIVE: To evaluate paraspinal muscle innervation and endurance in lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: Abnormal lumbar paraspinal muscle function is associated with chronic low back pain. Abnormal neurophysiologic findings of the lower limbs often are observed in lumbar spinal stenosis, and abnormal lumbar function also can be expected. However, paraspinal muscle function and innervation have not been studied in lumbar spinal stenosis. METHODS: The study evaluated 25 patients with clinically and radiologically diagnosed lumbar spinal stenosis. Electromyography of the paraspinal muscles was performed from L3 to S1 bilaterally using a concentric needle. At least 20 insertions were analyzed from each muscle. The aim of the examination was to detect abnormal spontaneous activity associated with axonal damage (fibrillation potentials, positive sharp waves, and complex repetitive discharges). Paraspinal muscle activity during trunk flexion-extension movement and muscle endurance during the dynamic isoinertial back endurance test were assessed by surface electromyography. Muscle fatigue was calculated using mean power frequency analysis. RESULTS: Abnormal findings in needle electromyography of the paraspinal muscles were observed in 18 of the 22 (81.8%) examined patients. Abnormal flexion-extension activation of the paraspinal muscles was observed in all the examined patients. The change in mean power frequency was significantly smaller than in previously evaluated healthy subjects and patients with nonspecific chronic low back pain (P < 0.001) who were not experiencing symptoms of lumbar spinal stenosis. Paraspinal muscle fatigability was not associated with the denervation of the muscles. CONCLUSIONS Denervation and abnormal activation of lumbar paraspinal muscles are frequent findings in patients with lumbar spinal stenosis who have not undergone surgery. The paraspinal muscle endurance of the patients was unexpectedly good.

Pitkänen MT, Manninen HI, Lindgren KA, Sihvonen TA, Airaksinen O, Soimakallio S. · Departments of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland. · Clin Radiol. · Pubmed #12096864 No free full text.

Abstract: AIM: To identify plain radiographic findings that predict segmental lumbar spine instability as shown by functional flexion-extension radiography. MATERIALS AND METHODS: Plain radiographs and flexion-extension radiographs of 215 patients with clinically suspected lumbar spine instability were analysed. Instability was classified into anterior or posterior sliding instability. The registered plain radiographic findings were traction spur, spondylarthrosis, arthrosis of facet joints, disc degeneration, retrolisthesis, degenerative spondylolisthesis, spondylolytic spondylolisthesis and vacuum phenomena. Factors reaching statistical significance in univariate analyses (P < 0.05) were included in stepwise multiple logistic regression analysis. RESULTS: Degenerative spondylolisthesis (P = 0.004 at L3-4 level and P = 0.017 at L4-5 level in univariate analysis and odds ratio 16.92 at L4-5 level in multiple logistic regression analyses) and spondylolytic spondylolisthesis (P = 0.003 at L5-S1 level in univariate analyses) were the strongest independent determinants of anterior sliding instability. Retrolisthesis (odds ratio 10.97), traction spur (odds ratio 4.45) and spondylarthrosis (odds ratio 3.20) at L3-4 level were statistically significant determinants of posterior sliding instability in multivariate analysis. CONCLUSION: Sliding instability is strongly associated with various plain radiographic findings. In mechanical back pain, functional flexion-extension radiographs should be limited to situations when symptoms are not explained by findings of plain radiographs and/or when they are likely to alter therapy.

Arokoski JP, Valta T, Kankaanpää M, Airaksinen O. · Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland. · Am J Phys Med Rehabil. · Pubmed #11964572 No free full text.

Abstract: OBJECTIVE: To assess the activities of the paraspinal and abdominal muscles during manually assisted therapeutic exercises (MATEs) and nonassisted therapeutic exercises (NATEs) that are used in the initial phases of the progressive exercise programs designed for the treatment of low back pain. DESIGN: Thirteen healthy subjects volunteered in the study. Surface electromyography (EMG) was recorded. The recorded EMG signal was averaged and normalized to the maximal EMG amplitude obtained during the maximal voluntary contraction (%EMGmax). RESULTS: In general, the %EMGmax values were higher during NATEs than during MATEs. Sitting seemed to activate lumbar L5 level paraspinal muscles to the same extent as MATEs. CONCLUSION: MATEs require only minimal trunk muscle activities, and thus, they may not be sufficiently intense to improve the trunk muscle performance. NATEs require high trunk muscle activities that are adequate for improving the trunk muscle performance, but they may cause high compressive loading of the lumbar spine, and if unchecked, this can aggravate low back pain.

Leinonen V, Kankaanpää M, Luukkonen M, Hänninen O, Airaksinen O, Taimela S. · Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Finland. · Spine (Phila Pa 1976). · Pubmed #11493866 No free full text.

Abstract: STUDY DESIGN: A comparative study of lumbar paraspinal muscle reflexes during sudden upper limb loading in healthy control subjects and patients with sciatica. OBJECTIVES: To assess reflex activation of paraspinal muscles during sudden upper limb loading. SUMMARY OF BACKGROUND DATA: Sudden upper limb loading and upper limb voluntary movements cause reflex activation of trunk muscles. A short latency response of approximately 50 msec of lumbar muscles has been observed before, but the reflexes have not been studied in patients with sciatica. METHODS: The paraspinal muscle responses for upper limb loading during unexpected and expected conditions were measured by surface EMG from 20 patients selected for an operation as a result of disc herniation-related chronic low back pain and 15 back-healthy controls. Pain, disability, and depression scores were recorded. RESULTS: Short latency response of paraspinal muscles for unexpected upper limb loading was similar in healthy controls and patients with sciatica in supported standing. During normal standing anticipation shortened the lumbar reflex latency in healthy controls but not among the patients. CONCLUSIONS: The results provide evidence for impaired feed-forward control of lumbar muscles in patients with sciatica.

Leinonen V, Kankaanpää M, Airaksinen O, Hänninen O. · Department of Physiology, Kuopio University, Finland. · Arch Phys Med Rehabil. · Pubmed #10638873 No free full text.

Abstract: OBJECTIVE: To compare lumbar paraspinal, gluteus maximus, and biceps femoris muscle function during sagittal trunk flexion and extension in patients with chronic low back pain and healthy control subjects, and to assess the influence of rehabilitation in the back pain patients. DESIGN: A cross-sectional study comparing chronic low back pain patients and healthy controls, and a prospective follow-up in back pain patients during rehabilitation. SETTING: Physical medicine and rehabilitation clinic. SUBJECTS: Nineteen women with chronic low back pain, and 19 women without pain (controls). INTERVENTION: Five-week active outpatient rehabilitation (1 hour three times a week) guided by a physiotherapist, followed by 5-week self-motivated exercise at home. OUTCOME MEASURES: Subjects performed sagittal trunk flexion and extension while surface electromyogram was bilaterally recorded of paraspinal (L1-L2 level), gluteus maximus, and biceps femoris muscles. The muscle activity was assessed from the average electromyogram and the relative muscle activation onsets and their duration were calculated. RESULTS: During early flexion, lumbar paraspinal and biceps femoris were activated simultaneously before gluteus maximus. At the end of flexion and during extension all investigated muscles were activated and relaxed in order. Lumbar paraspinal and biceps femoris muscles were activated in a similar order in low back pain patients and healthy controls during flexion and extension. However, the duration of gluteus maximus activity was shorter in the back pain patients than in controls during the trunk flexion (p<.05), and it ended earlier during extension. Active rehabilitation did not change the muscle activities of lumbar paraspinal and biceps femoris in the back pain patients, but in the measurements after rehabilitation the onset of gluteus maximus activity occurred later in flexion and earlier in extension. CONCLUSIONS: The activity of the gluteus maximus muscle during the flexion-extension cycle was reduced in patients with chronic low back pain. The gluteal muscles should be taken into consideration in the rehabilitation of these patients.

Herno A, Partanen K, Talaslahti T, Kaukanen E, Turunen V, Suomalainen O, Airaksinen O. · Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Finland. · Spine (Phila Pa 1976). · Pubmed #10457572 No free full text.

Abstract: STUDY DESIGN: A cross-sectional retrospective study to observe the correlation between postoperation findings shown on magnetic resonance imaging and clinical observations of 56 patients 10 years after laminectomy for lumbar spinal stenosis. OBJECTIVE: To evaluate the relation between postoperation findings on magnetic resonance imaging and surgical outcome in patients surgically treated for lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: Surgical management of lumbar spinal stenosis is based on the compression seen in radiologic imaging of neurovascular structures in the vertebral canal, but the success of surgical decompression and its correlation with clinical observations very seldom have been monitored by postoperation radiologic imaging. METHODS: In this study, 56 patients surgically treated for lumbar spinal stenosis were re-examined clinically by use of the Oswestry disability questionnaire. Their walking capacity was evaluated by the treadmill test. Severity of pain before and after the treadmill test was investigated using a visual analog scale. Patients' perception of improvement measured as the change in their condition during the preceding 5 years was elicited by a questionnaire. On the basis of the stenotic findings on magnetic resonance imaging, the patients were classified into no stenosis (NoSten, n = 15) and stenosis (Sten, n = 41) groups, and a summative degenerative scale also was constructed with the findings categorized as follows: disc degeneration, disc herniation, facet joint arthrosis, and degenerative spondylolisthesis. RESULTS: Whereas the patients' perception of improvement correlated very strongly with the Oswestry score and walking capacity, there was no statistical difference between the NoSten and Sten groups in the Oswestry score, walking capacity, perception of improvement, or severity of pain. The effect of the summative degenerative scale on the patients' walking capacity was 13 times greater than the effect of the minimum area of the dural sac. CONCLUSIONS: Patients' perception of improvement had a much stronger correlation with long-term surgical outcome than structural findings seen on postoperation magnetic resonance imaging. Moreover, degenerative findings had a greater effect on patients' walking capacity than stenotic findings.

Arokoski JP, Kankaanpää M, Valta T, Juvonen I, Partanen J, Taimela S, Lindgren KA, Airaksinen O. · Department of Physical and Rehabilitation Medicine, Rehabilitation Clinic, Kuopio University Hospital, Finland. · Arch Phys Med Rehabil. · Pubmed #10414772 No free full text.

Abstract: BACKGROUND: Therapeutic exercises are widely used in the treatment of low back problems. Clinical knowledge about targeting the load in these exercises, however, is insufficient. This study assessed the L2 and L5 level paraspinal and gluteus maximus muscle activities in different therapeutic exercises. Intramuscular and surface electromyography (EMG) measurements were obtained to study whether surface EMG measurements can be used in the assessment of multifidus muscle function. METHODS: Eleven healthy subjects (5 men, 6 women) 21 to 38 years of age volunteered for the study. The subjects performed 18 different therapeutic exercises. During the exercises paraspinal EMG was recorded using fine wire and surface electrodes. The normalized peak and average muscle EMG activities (percentage of amplitude in maximal voluntary contraction [MVC]) during each task were determined. RESULTS: The correlations between the average intramuscular and surface activities of the normalized EMG (% of MVC) at the L2 and L5 levels were .928 and .950, respectively. The peak and average EMG amplitudes of the exercises were below 50% and 25% of MVC, respectively. At the L5 level, the multifidus peak and average EMG amplitudes (% MVC) were higher in women than in men, whereas no significant difference was found at the L2 level. In women, the normalized multifidus EMG amplitude was higher at the L5 level than at the L2 level, whereas no significant difference was found in men. In both sexes, the normalized EMG amplitude was higher in the multifidus than in the longissimus muscle. CONCLUSION: Surface EMG measurements may be used in the assessment of multifidus muscle function. Simple therapeutic exercises are effective in activating the lumbar paraspinal muscles.