Back Pain: Sran MM

Britnell SJ, Cole JV, Isherwood L, Sran MM, Britnell N, Burgi S, Candido G, Watson L, Anonymous00246, Anonymous00247. · No affiliation provided · J Obstet Gynaecol Can. · Pubmed #16100646 No free full text.

Abstract: OBJECTIVE: To advise obstetric and gynaecology care providers of the physical, psychological, and environmental factors that affect women's posture throughout their lifespan, from adolescence to menopause. To outline the physiotherapy management of obstetrics, osteoporosis, and urinary incontinence in women and to identify recommendations for referral to a physiotherapist. OUTCOMES: Knowledge of abnormal postures, contributing factors and recommendations for physiotherapy management. EVIDENCE: MEDLINE, PEDro, and Cochrane Library Search from 1992 to 2003 for English-language articles and references from current textbooks related to posture and women's health conditions that are managed by physiotherapists. VALUES: The evidence collected was reviewed by the authors and quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on the Periodic Health Exam. RECOMMENDATIONS: 1. Pelvic floor muscle training with a physiotherapist is recommended to prevent urinary incontinence during pregnancy and after delivery (I-A). 2. Core stability training with a physiotherapist is recommended to prevent and treat back and pelvic pain during and following pregnancy (I-B). 3. Physiotherapist-prescribed exercises are recommended for women to elicit positive changes in bone mass and to reduce fall and fracture risk (I-A). 4. Pelvic floor muscle training with a physiotherapist is recommended for women with stress urinary incontinence (I-A). The Canadian Physiotherapy Association and Society of Obstetricians and Gynaecologists of Canada have developed this joint policy statement regarding posture in women's health that highlights the physical, psychological, and environmental factors that affect women's posture throughout their lifespan, from adolescence to menopause. This statement outlines the role of physiotherapy in the assessment and treatment of women's posture; outlines the physiotherapy management of obstetrics, osteoporosis, and urinary incontinence; and identifies recommendations for referral to a physiotherapist. The quality of evidence and classification of recommendations have been adapted from the Report of the Canadian Task Force on the Periodic Health Exam (Table 1).1.

Sran MM. · Division of Orthopaedic Engineering Research, Department of Orthopaedics, Faculty of Medicine, University of British Columbia, VGH Research Pavilion, Room 500, 828 W 10th Ave, Vancouver, BC V5Z 1L8 Canada. · Br J Sports Med. · Pubmed #15388530 links to  free full text

This publication has no abstract.

Sran MM, Boyd SK, Cooper DM, Khan KM, Zernicke RF, Oxland TR. · Division of Orthopaedic Engineering Research, University of British Columbia, Vancouver, Canada. · Bone. · Pubmed #17134950 No free full text.

Abstract: INTRODUCTION: Spinal mobilization is commonly used in the treatment of patients with back pain, including individuals with osteoporosis. Previous data indicated that traditional predictors of skeletal failure-lateral or anteroposterior bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA) or geometry of the spinous process or vertebral body-do not predict failure load during posteroanterior spinal mobilization. Morphological differences and inhomogeneities in BMD may have important effects on vertebral strength but integral BMD values by DXA cannot reflect these potentially important differences. We investigated the determinants of spinal fracture using muCT. MATERIALS AND METHODS: We measured failure load and failure site in 11 T5-8 cadaveric specimens (mean age 78 years) when a posteroanterior load was applied at the spinous process of T6 using a servohydraulic material testing machine. Radiography and CT scan were used to verify failure site. We observed no damage to the adjacent T7 vertebrae following the T6 posteroanterior failure test. The T7 vertebrae were sectioned to produce regional samples of the spinous process, the lamina and a vertebral body core. Each sample was scanned with muCT to measure bone microarchitectural parameters. We segmented and analysed four trabecular regions (spinous process base and middle, central lamina and central vertebral body). We used one-way repeated measures ANOVA to compare regions and computed Pearson correlations to assess the relation between PA failure load of T6 and the morphological parameters of T7. RESULTS: The BV/TV at the base or middle of the T7 spinous process (fracture sites), Tb.N and Tb.Th at the base were significantly correlated with posteroanterior failure load of T6 (BV/TV base: r=0.74, p=0.01; BV/TV middle: r=0.73, p=0.01; Tb.N base: r=0.64, p=0.03; Tb.Th base: r=0.65, p=0.03). The Tb.Th of the lamina was significantly greater than Tb.Th of the spinous process base (p=0.002). CONCLUSIONS: Whereas previous data indicated that BMD by DXA was not a good predictor of posteroanterior failure load, regional BV/TV of the spinous process base and middle regions, the sites of fracture, are correlated with posteroanterior failure load. Trabecular thickness differed significantly between the base of the spinous process and the lamina, and may have influenced the site of fracture.

Sran MM, Khan KM, Zhu Q, Oxland TR. · Division of Orthopaedic Engineering Research, Faculty of Medicine, University of British Columbia and the Vancouver Coastal Health Research Institute, Vancouver, Canada. · Clin Biomech (Bristol, Avon). · Pubmed #15993525 No free full text.

Abstract: BACKGROUND. Spinal joint mobilization is a mainstay of clinical assessment of individuals with back pain. The clinician manually assesses stiffness and joint motion relative to segments above and below. Although clinical theory suggests that manually performed techniques can predict or detect intervertebral motion, this hypothesis remains untested. METHODS. Using a precision opto-electronic camera system and a custom spine testing machine, we measured intervertebral range of motion, neutral zone motion and three-dimensional flexibility in eight T5-T8 cadaveric specimens (mean age=81 years). We then measured stiffness when a cyclic posteroanterior load was applied at the spinous process of T6 using a servohydraulic material testing machine (Instron 8874), simulating the posteroanterior spinal mobilization technique. FINDINGs. There was a strong significant inverse relationship between stiffness during cyclic posteroanterior loading of T6 and flexion or extension range of motion of T6 relative to T7 (r=-0.88, P<0.01, extension; r=-0.81, P=0.01, flexion), and T6-T7 flexibility in all six directions. INTERPRETATION. Stiffness during simulated central cyclic posteroanterior mobilization in the cadaveric midthoracic spine is inversely correlated with flexion and extension range of motion and three-dimensional flexibility at the level at which the technique is applied. These findings provide biomechanical support for the inclusion of specific joint mobilization in the assessment of older adults with back pain.

Sran MM, Khan KM, Zhu Q, McKay HA, Oxland TR. · Division of Orthopaedic Engineering Research, BC Women's Health Centre, Vancouver, Canada. · Spine (Phila Pa 1976). · Pubmed #15507799 No free full text.

Abstract: STUDY DESIGN: In vitro biomechanical study of human cadaveric thoracic spine segments and one intact cadaver and applied load measurements in human volunteers. OBJECTIVES: To quantify failure load and pattern of midthoracic vertebrae under a posteroanterior load and to compare failure load in vitro with applied load in vivo. SUMMARY OF BACKGROUND DATA: Osteoporosis and back pain are common alone and in combination among older adults. Spinal mobilization techniques have been shown to relieve back pain and improve function in various clinical settings. However, whether controlled spinal mobilization can cause vertebral fracture in individuals with osteoporosis is not known. METHODS: Twelve T5-T8 cadaveric specimens (mean age, 77 years) were scanned using bone densitometry, radiographed, and measured for bone size. The authors measured failure load, failure site, and intervertebral motion (using a precision optoelectronic camera system) when a posteroanterior load was applied at the spinous process of T6 using a servohydraulic material testing machine. Post-test radiography and CT scan were used to verify failure site. These tests were repeated in an intact cadaver using a Tekscan I-Scan sensor to measure applied loads. The authors also quantified in vivo applied loads during posteroanterior mobilization during seven trials by two experienced physiotherapists. RESULTS: Mean (SD) in vitro failure load of 479 N (162 N) was significantly higher than the mean (SD) in vivo applied load of 145 N (38 N) (P = 0.0004). Macroscopic observation revealed a fracture at the T6 spinous process in 11 specimens and one at the T7 spinous process. These fractures were detected by plain radiography in three of 12 cases and by CT scan in six of 12 cases. CONCLUSIONS: The results suggest a reasonable margin between failure load in vitro and applied mobilization load in vivo.