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  • 1.
    Aasa, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundell, Sara
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Aasa, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Norrlandskliniken, Umeå, Sweden.
    Westerståhl, Maria
    Institutionen för laboratoriemedicin, Karolinska institutet.
    Physical Activity Might Be of Greater Importance for Good Spinal Control Than If You Have Had Pain or Not: A Longitudinal Study2015In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, no 24, p. 1926-1933Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Longitudinal design. A cohort followed in 3 waves of data collection.

    OBJECTIVE: The aim of the study was to describe the relationships between the performance of 2 tests of spinal control at the age of 52 years and low back pain, physical activity level, and fitness earlier in life, as well as to describe the cross-sectional relationships between these measures.

    SUMMARY OF BACKGROUND DATA: Altered spinal control has been linked to pain; however, other stimuli may also lead to inability to control the movements of the spine.

    METHODS: Participants answered questions about physical activity and low back pain, and performed physical fitness tests at the age of 16, 34, and 52 years. The fitness test battery included tests of endurance in the back and abdominal muscles, a submaximal bicycle ergometer test to estimate maximal oxygen uptake, and measurements of hip flexion, thoracic spine flexibility, and anthropometrics. Two tests were aggregated to a physical fitness index. At the age of 52, also 2 tests of spinal control, the standing Waiter's bow (WB) and the supine double leg lower (LL) were performed.

    RESULTS: Logistic regression analyses showed that higher back muscle endurance at the age of 34 years could positively predict WB performance at 52 years and higher physical fitness at the age of 34 could positively predict LL performance at 52 years. Regarding cross-sectional relationships, an inability to perform the WB correctly was associated with lower physical fitness, flexibility and physical activity, and larger waist circumference. An inability to correctly perform the LL was associated with lower physical fitness. One-year prevalence of pain was not significantly associated with WB or LL test performance.

    CONCLUSION: An active life resulting in higher physical fitness is related to better spinal control in middle-aged men and women. This further strengthens the importance of physical activity throughout the life span.

    LEVEL OF EVIDENCE: 3.

  • 2.
    Berglund, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Aasa, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Norrlandskliniken Hlth Care Ctr, Umea, Sweden.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi .
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Effects of Low-Load Motor Control Exercises and a High-Load Lifting Exercise on Lumbar Multifidus Thickness: A Randomized Controlled Trial2017In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 42, no 15, p. E876-E882Article in journal (Refereed)
    Abstract [en]

    Study Design. Randomized controlled trial.Objective. The aim of this study was to compare the effects of low-load motor control (LMC) exercises and a high-load lifting (HLL) exercise, on lumbar multifidus (LM) thickness on either side of the spine and whether the effects were affected by pain intensity or change in pain intensity. Summary of Background Data. There is evidence that patients with low back pain (LBP) may have a decreased size of the LM muscles with an asymmetry between sides in the lower back. It has also been shown that LMC training can affect this asymmetry. It is, however, not known whether a high-load exercise has the same effect. Methods. Sixty-five participants diagnosed with nociceptive mechanical LBP were included and randomized into LMC exercises or a HLL exercise, the deadlift. The LM thickness was measured using rehabilitative ultrasound imaging (RUSI), at baseline and after a 2-month training period. Results. There were no differences between interventions regarding effect on LM muscle thickness. However, the analysis showed a significant effect for asymmetry. The thickness of the LM muscle on the small side increased significantly compared with the large side in both intervention groups, without influence of pain at baseline, or change in pain intensity.Conclusion. At baseline, there was a difference in thickness of the LM muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the LM muscles on the small side, irrespective of exercise load. The increase in LM thickness does not appear to be mediated by either current pain intensity or the magnitude of change in pain intensity.

  • 3. Bergmann, Annekatrin
    et al.
    Bolm-Audorff, Ulrich
    Ditchen, Dirk
    Ellegast, Rolf
    Grifka, Joachim
    Haerting, Johannes
    Hofmann, Friedrich
    Jäger, Matthias
    Linhardt, Oliver
    Luttmann, Alwin
    Meisel, Hans Jörg
    Michaelis, Martina
    Petereit-Haack, Gabriela
    Schumann, Barbara
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Seidler, Andreas
    Do occupational risks for low back pain differ from risks for specific lumbar disc diseases?: Results of the German Lumbar Spine Study (EPILIFT)2017In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 42, no 20, p. E1204-E1211Article in journal (Refereed)
    Abstract [en]

    Study design: A multicenter, population based, case-control study.

    Objective: The aim of the present analysis is to clarify potential differences in the "occupational risk profiles" of structural lumbar disc diseases on the one hand, and low back pain (LBP) on the other hand.

    Summary of background data: Physical workplace factors seem to play an important etiological role.

    Methods: We recruited 901 patients with structural lumbar disc diseases (disc herniation or severe disc space narrowing) and 233 control subjects with "low-back-pain." Both groups were compared with 422 "low-back pain free" control subjects. Case history, pain data, neurological deficits, and movement restrictions were documented. LBP was recorded by the Nordic questionnaire on musculoskeletal symptoms. All magnetic resonance imaging, computed tomography, and X-rays were inspected by an independent study radiologist. The calculation of cumulative physical workload was based on a computer-assisted interview and a biomechanical analysis by 3-D-dynamic simulation tool. Occupational exposures were documented for the whole working life.

    Results: We found a positive dose-response relationship between cumulative lumbar load and LBP among men, but not among women. Physical occupational risks for structural lumbar disc diseases [odds ratio (OR) 3.7; 95% confidence interval (95% CI) 2.3-6.0] are higher than for LBP (OR 1.9; 95% CI 1.0-3.5).

    Conclusion: Our finding points to potentially different etiological pathways in the heterogeneous disease group of LBP. Results suggest that not all of the structural disc damage arising from physical workload leads to LBP.

  • 4.
    Crnalic, Sead
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Löfvenberg, Richard
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Bergh, Anders
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Widmark, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Hildingsson, Christer
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Predicting survival for surgery of metastatic spinal cord compression in prostate cancer: a new score2012In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 37, no 26, p. 2168-2176Article in journal (Other academic)
    Abstract [en]

    Study design. We retrospectively analyzed prognostic factors for survival in prostate cancer patients operated for metastatic spinal cord compression.

    Objective. The aim was to obtain a clinical score for prediction of survival after surgery.

    Summary of background data. Survival prognosis is important when deciding about treatment of patients with metastatic spinal cord compression. The criteria for identifying prostate cancer patients who may benefit from surgical treatment are unclear.

    Patients and methods The study comprised 68 consecutive patients with prostate cancer operated for metastatic spinal cord compression at Umeå University Hospital, Sweden. The indication for surgery was neurological deficit; 53 patients had hormone-refractory prostate cancer, and 15 patients had previously untreated, hormone-naïve prostate cancer. In 42 patients posterior decompression was performed and 26 patients were operated with posterior decompression and stabilization.

    Results A new score for prediction of survival was developed based on the results of survival analyses. The score includes: hormone status of prostate cancer, Karnofsky performance status, evidence of visceral metastasis, and preoperative serum PSA. The total scores ranged from 0 to 6. Three prognostic groups were formulated: group A (n = 32) with scores 0-1; group B (n = 23) with scores 2-4, and group C (n = 12) with scores 5-6. The median overall survival was 3 (0.3 - 20) months in group A, 16 (1.8 - 59) months in group B, and in group C more than half (7 of 12) of patients were still alive.

    Conclusion We present a new prognostic score for predicting survival of prostate cancer patients after surgery for metastatic spinal cord compression. The score is easy to apply in clinical practice and may be used as additional support when making decision about treatment.

  • 5.
    Karppinen, Jaro
    et al.
    Department of Physical Medicine and Rehabilitation, University of Oulu, Oulu, Finland.
    Inkinen, Ritva
    Department of Anatomy, University of Kuopio, Kuopio, Finland.
    Kääpä, Eeva
    Department of Physical Medicine and Rehabilitation, University of Oulu, Oulu, Finland.
    Lammi, Mikko
    Department of Anatomy, University of Kuopio, Kuopio, Finland.
    Tammi, Markku
    Department of Anatomy, University of Kuopio, Kuopio, Finland.
    Holm, Sten
    Department of Orthopaedics, Sahlgren Hospital, University of Göteborg, Göteborg, Sweden.
    Vanharanta, Hannu
    Department of Physical Medicine and Rehabilitation, University of Oulu, Oulu, Finland.
    Effects of tiaprofenic acid and indomethacin on proteoglycans in the degenerating porcine intervertebral disc.1995In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 20, no 10, p. 1170-1177, article id 7638661Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Eighteen pigs were stabbed with a scalpel in the anterior part of the anulus fibrosus of a lumbar disc. After surgery, the pigs received either tiaprofenic acid or indomethacin daily, and a third group did not receive any medication.

    OBJECTIVES: Nonsteroidal anti-inflammatory agents are widely used in the treatment of low back patients, but their long-term effects on the matrix molecules in the degenerate disc are unknown.

    SUMMARY OF BACKGROUND DATA: Several in vitro and in vivo studies on articular cartilage have suggested that tiaprofenic acid may not have adverse effects on matrix metabolism, whereas indomethacin probably does.

    METHODS: Uronic acid, DNA, and water contents were determined from five different locations in each injured disc. Transport and incorporation of sulfate were examined by in vivo radioactive tracer analysis, and proteoglycan structures were analyzed by gel electrophoresis.

    RESULTS: Morphologically, there were no differences between the treatments. Tiaprofenic acid maintained a higher uronic acid content in the nucleus pulposus and outer anulus compared with that of the nonmedicated animals. Tiaprofenic acid decreased the incorporation of sulfate in the injured area and the water content at most sites. Indomethacin had no adverse effects compared with the nonmedicated group, and it increased water content in the posterior anulus fibrosus.

    CONCLUSIONS: Long-term administration of tiaprofenic acid and indomethacin did not have harmful effects on matrix metabolism after disc injury. On the contrary, tiaprofenic acid may slightly protect proteoglycans in the degenerating disc.

  • 6. Knutsson, Björn
    et al.
    Sandén, Bengt
    Sjödén, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Michaëlsson, Karl
    Body mass index and risk for clinical lumbar spinal stenosis: a cohort study2015In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, no 18, p. 1451-1456Article in journal (Refereed)
    Abstract [en]

    STRUCTURED ABSTRACT: Study Design. A prospective cohort study that used a Swedish nationwide occupational surveillance program for construction workers (period of registration from 1971-1992). In all, 364 467 participants (mean age at baseline 34 years) were included in the study.

    OBJECTIVE: To determine whether overweight and obesity are associated with a higher risk of lumbar spinal stenosis (LSS).

    SUMMARY OF BACKGROUND DATA: During recent decades, LSS has become the most common indication for spine surgery, a change that coincides with a higher prevalence of obesity.

    METHODS: A diagnosis of LSS was collected through individual linkage to the Swedish National Patient Register through December 31, 2011. Poisson regression models were employed to estimate multivariable-adjusted incidence rate ratios (IRRs) for LSS.

    RESULTS: At baseline, 65% had normal weight (BMI 18.5 to 24.99 kg/m), 29% were overweight (BMI 25 to 29.99 kg/m), 5% were obese (BMI≥30 kg/m) and 2% were underweight (BMI<18.5 kg/m). During 11,190,944 person-years of follow-up, with a mean of 31 years, 2381 participants were diagnosed with LSS. Compared with normal weight individuals, obese workers had an IRR of 2.18 (95% confidence interval (CI), 1.87 to 2.53) for LSS and overweight workers had an IRR of 1.68 (95% CI, 1.54 to 1.83). Workers who were underweight halved their risk of LSS (IRR 0.52, 95% CI 0.30 to 0.90).

    CONCLUSION: Obese and overweight persons are at a higher risk of developing LSS. Further, our results indicate that obesity might be a novel explanation for the increased number of patients with clinical LSS.

  • 7.
    Lampa, Ewa
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nordh, Erik
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Häggman-Henrikson, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial pain and Jaw function, Malmö University, Malmö, Sweden.
    The Course of Orofacial Pain and Jaw Disability after Whiplash Trauma: A 2-year Prospective Study2019In: Spine, ISSN 0362-2436, E-ISSN 1528-1159Article in journal (Refereed)
    Abstract [en]

    Study Design: Prospective cohort study.

    Objective: To evaluate the course of orofacial pain and jaw disability in relation to neck pain, neck disability and psychosocial factors at the acute stage and the chronic stage after whiplash trauma.

    Summary of Background Data: Many individuals report chronic pain in the orofacial region after whiplash trauma. The possible association between whiplash trauma and orofacial pain is debated. Prospective studies are therefore needed to evaluate the development of orofacial pain after whiplash trauma.

    Methods: Within one month following a whiplash trauma, 176 cases were examined and compared to 116 controls with questionnaires concerning neck and jaw pain and related disability, non-specific physical symptoms and depression. At the 2-year follow-up, 119 cases (68%) and 104 controls (90%) were re-examined.

    Results: Compared to controls, cases reported more jaw and neck pain, both at baseline and follow-up. A majority (68%) of cases with pain in the jaw region in the acute stage also reported jaw pain at the follow-up. The intensity of jaw and neck pain was correlated both at baseline and follow-up. Both neck pain and jaw pain was correlated to non-specific physical symptoms and to depression.

    Conclusion: Orofacial pain and jaw disability related to neck pain is often present already at the acute stage after whiplash trauma and persist into the chronic stage for most individuals. Assessment following whiplash trauma should therefore include both the neck and the orofacial regions. More studies are needed to further evaluate risk factors for development of orofacial pain after whiplash trauma.

    Level of Evidence: 3

  • 8. Leijon, Ola
    et al.
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Mulder, Marie
    Prevalence of self-reported neck-shoulder-arm pain and concurrent low back pain or psychological distress: time-trends in a general population, 1990-2006.2009In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 34, no 17, p. 1863-1868Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Analysis of repeated cross-sectional surveys. OBJECTIVE: To investigate the prevalence of neck-shoulder-arm pain and concurrent low back pain and psychological distress in a geographical area over a 16-year period. SUMMARY OF BACKGROUND DATA: A large number of studies have shown that nonspecific neck, shoulder, and arm pain is a very common symptom in the general population. However, few studies have followed the prevalence of neck-shoulder-arm pain within a geographical area, in order to investigate time-trends. METHODS: This study provides an analysis of questionnaire data collected every 4 years between 1990 and 2006 on the prevalence of neck-shoulder-arm pain and concurrent low back pain or psychological distress in the County of Stockholm, Sweden (response rate: 61%-69%). All individuals aged 21 to 64 years (n = 1976-26,611) were included in the study. RESULTS: Over the 16-year period, the prevalence of self-reported neck-shoulder-arm pain rose slightly, from 22.8% to 25.0% among females (prevalence rate ratio [PRR]: 1.10) and from 12.8% to 15.4% among males (PRR: 1.21). The prevalence of neck-shoulder-arm pain with concurrent low back pain also rose slightly, from 8.4% to 10.8% among females (PRR: 1.28) and from 5.3% to 6.6% among males (PRR: 1.24). In contrast, the prevalence of neck-shoulder-arm pain with concurrent psychological distress rose more substantially, from 4.4% to 8.5% among females (PRR: 1.91) and from 2.0% to 4.3% among males (PRR: 2.18). All prevalence rates rose between 1990 and 2002, and decreased in 2006 compared to 2002. The gender gap in prevalence did not change over time. CONCLUSION: Although the prevalence of neck-shoulder-arm pain and concurrent symptoms decreased in 2006 compared to 2002, it is still too early to conclude that we have reached and passed the peak of the "epidemic" of neck-shoulder-arm pain.

  • 9.
    Sahlman, Janne
    et al.
    Department of Anatomy, University of Kuopio, Kuopio, Finland.
    Inkinen, Ritva
    Department of Anatomy, University of Kuopio, Kuopio, Finland.
    Hirvonen, Teemu
    Department of Anatomy, University of Kuopio, Kuopio, Finland.
    Lammi, Mikko
    Department of Anatomy, University of Kuopio, Kuopio, Finland.
    Lammi, Pirkko
    Department of Anatomy, University of Kuopio, Kuopio, Finland.
    Nieminen, Jyrki
    Department of Surgery, Tampere University Hospital, Tampere, Finland.
    Lapveteläinen, Tuomo
    Department of Anatomy, University of Kuopio, Kuopio, Finland.
    Prockop, Darwin
    Center for Gene Therapy, School of Medicine, MCP Hahnemann University, Philadelphia, Pennsylvania, USA.
    Arita, Machiko
    Center for Gene Therapy, School of Medicine, MCP Hahnemann University, Philadelphia, Pennsylvania, USA.
    Li, Shi-Wu
    Center for Gene Therapy, School of Medicine, MCP Hahnemann University, Philadelphia, Pennsylvania, USA.
    Hyttinen, Mika
    Department of Anatomy, University of Kuopio, Kuopio, Finland.
    Helminen, Heikki
    Department of Anatomy, University of Kuopio, Kuopio, Finland.
    Puustjärvi, Kaija
    Department of Physical Medicine and Rehabilitation, Kuopio University Hospital, Kuopio, Finland.
    Premature vertebral endplate ossification and mild disc degeneration in mice after inactivation of one allele belonging to the Col2a1 gene for Type II collagen.2001In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 26, no 23, p. 2558-2565, article id 11725236Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Skeletal tissues of mice with an inactivated allele of the Col2a1 gene for Type II collagen ("heterozygous knockout") were studied.

    OBJECTIVE: To determine whether a heterozygous inactivation of the Col2a1 gene has a role in the etiology of spine disorders such as disc degeneration.

    SUMMARY OF BACKGROUND DATA: Mutations in the COL2A1, COL11A1, COL11A2, and COL9A2 genes have been linked to spine disorders. However, the mechanism by which genetic factors lead to disc degeneration still are largely unknown.

    METHODS: Spine tissues were studied using radiograph analyses; conventional, quantitative, and polarized light microscopy; immunohistochemistry for the major extracellular components, and in situ hybridization for procollagens alpha1(I) and alpha1(II). Voluntary running activity also was monitored in half of the mice.

    RESULTS: As the findings showed, 1-month-old heterozygous knockout mice had shorter limb bones, skulls, and spines, as well as thicker and more irregular vertebral endplates, which calcified earlier than in the control mice. They also had a lower concentration of glycosaminoglycans in the anulus fibrosus, in the endplates, and in the vertebral bone than the controls. These features in the heterozygous knockout mice were compensated by the age of 15 months. However, the long bones and skulls of the mature heterozygous mice remained shorter than those of the controls. Gene-deficient mice used the running wheel less. However, physical exercise did not induce any marked structural changes in the skeleton.

    CONCLUSION: Mice with heterozygous knockout of Col2a1 show subtle early skeletal manifestations that bear some resemblance to those of human spine disorders.

  • 10.
    Stenlund, Tobias
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Öhberg, Fredrik
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Lindroos, Ola
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Neely, Gregory
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Rehn, Börje
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Double-sided Mechanical Shocks Provoke Larger Seated Postural Reactions Compared to Single-Sided Mechanical Shocks2018In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 43, no 8, p. E482-E487Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Human volunteers were exposed experimentally to single-sided mechanical shocks (SSMS) and double-sided mechanical shocks (DSMS) while seated.

    OBJECTIVE: To describe and contrast seated postural reactions due to SSMS or DSMS in healthy male adults.

    SUMMARY OF BACKGROUND DATA: Mechanical shocks to the body, caused when driving on irregular terrain, are suggested to be hazardous to the spine and may be associated with the reported musculoskeletal pain of the back and neck among professional drivers. However, very little is known about the characteristics of seated postural reactions and the biomechanical effects caused by mechanical shocks.

    METHODS: Twenty healthy male subjects (18-43 years old) were exposed while seated to 5 SSMS and 15 DSMS in lateral directions. The second acceleration in the DSMS was in the opposite direction to the first acceleration and was either fast, medium or slow depending on the speed of direction change. Surface electromyography (EMG) was recorded in muscles of the upper neck, trapezius, erector spinae and external oblique while kinematics were recorded with inertial sensors placed at the neck, trunk and pelvis. Muscle activity was normalized to maximum voluntary contractions (MVC).

    RESULTS: The EMG amplitudes were significantly higher (0.6-1%; p < 0.001) for the fast DSMS compared to all other shocks. Range of motion (ROM) of the neck and trunk was greater during the DSMS compared to the SSMS. Evoked muscle activity was less than 2% MVC in the trapezius, less than 10% MVC in the erector spinae and upper neck while the activity exceeded 10% MVC in the external oblique muscles.

    CONCLUSION: Fast DSMS in lateral directions appear more demanding compared to SSMS, demonstrating augmented seated postural reactions. However, the present mechanical shocks employed did not seem to induce postural reactions with regard to ROM or muscle activity of a magnitude likely to cause musculoskeletal overload.

    LEVEL OF EVIDENCE: 4.

  • 11. Torstensson, Thomas
    et al.
    Lindgren, Anne
    Kristiansson, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Corticosteroid injection treatment to the ischiadic spine reduced pain in women with long-lasting sacral low back pain with onset during pregnancy: a randomized, double blind, controlled trial2009In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 34, no 21, p. 2254-2258Article in journal (Refereed)
    Abstract [en]

    Study Design. Randomized double blind controlled clinical trial.

    Objective. To evaluate the pain relief effect of locally injected corticosteroid treatment in women with long-lasting sacral low back pain with onset during pregnancy.

    Summary of Background Data. Pregnancy-related low back pain is a global problem. Almost 1 of 10 women still experienced disabling daily back pain 2 years after childbirth with high impact on the individual, family, and society. On spite of this, the sources of pain and effective treatment are uncertain.

    Methods. Thirty-six women were allocated to injection treatment, with slow-release triamcinolone and lidocaine or saline and lidocaine, given at the sacrospinous ligament insertion on the ischiadic spine bilaterally with 4 weeks follow-up time. Primary outcome measure was reported pain intensity on visual analogue scale and secondary outcome measures number of pain-drawing locations and pain-provoking test results.

    Results. The triamcinolone treatment group had significantly reduced pain intensity, number of pain locations, and pain-provoking test results between baseline and follow-up as compared with the saline treatment group. The absolute median change of visual analogue scale score in the triamcinolone treatment group was -24 mm and in the saline group +4.5 mm (P < 0.05). A reduced number of pain drawing locations was reported by 16 of 18 women in the triamcinolone group as compared with 10 of 18 in the saline group (P < 0.05). In the triamcinolone treatment group, 17 of 18 women had an improved pain provocation test result as compared with 9 of 18 in the saline treatment group (P < 0.01).

    Conclusion. The anatomic region around the sacrospinous ligament insertion on the ischial spine is suggested to be one source of long-lasting sacral low back pain with onset during pregnancy. The pain was relieved by slow-release corticosteroid injection treatment to the ischial spine.

  • 12.
    Wahlström, Jens
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Risk factors for hospitalization due to lumbar disc disease2012In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 37, no 15, p. 1334-1339Article in journal (Refereed)
    Abstract [en]

    Study Design. Prospective cohort study

    Objective. To study biomechanical factors in relation to symptomatic lumbar disc disease

    Summary of Background Data. The importance of biomechanical factors in lumbar disc disease have been questioned the past decade and knowledge from large prospective studies is lacking.

    Methods. The study basis is a cohort of 263 529 Swedish construction workers who participated in a national occupational health surveillance programme from 1971 until 1992. The workers' job title, smoking habits, body weight, height and age were registered at the examinations. The occurrence of hospitalization due to lumbar disc disease from January 1 1987 until December 31 2003 was collected from a linkage with the Swedish Hospital Discharge Register.

    Results. There was an increased risk for hospitalization due to lumbar disc disease for several occupational groups compared to white-collar workers and foremen. Occupational groups with high biomechanical loads had the highest risks, e.g the relative risk for concrete workers was 1.55 (95% CI 1.29-1.87). A taller stature was consistently associated with an increased risk. The relative risk for a man of 190-199 cm height was 1.55 (95% CI 1.30-1.86) compared to a man being 170-179 cm. Body weight and smoking were also risk factors, but weaker than height. Workers in the age span of 30-39 had the highest relative risk (RR = 1.87; 95% CI 1.58-2.23) compared to those 20-29, while men 60-65 years old had a lower risk (RR = 0.86; 95%CI 0.68-1.09).

    Conclusions. This study indicates that factors increasing the load on the lumbar spine are associated with hospitalization for lumbar disc disease. Occupational biomechanical factors seem to be important, and a taller stature was consistently associated with an increased risk.

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