Biomechanical Response of a Functional Spine Unit Under Various Loading Conditions: A Viscoelastic Finite Element Approach

2004 ◽  
Author(s):  
Volkan Esat ◽  
Memis Acar
Keyword(s):  
Finite Element ◽  
Low Back Pain ◽  
Back Pain ◽  
Experimental Studies ◽  
Intervertebral Discs ◽  
Computational Method ◽  
Industrial Safety ◽  
Low Back ◽  
Loading Conditions

Biomechanical and epidemiologic studies state that recreational activity and industrial work, embodying static work postures, physically heavy tasks, frequent bending, and twisting motions, lifting and sudden loading incidents are highly related to low back pain disorders. In order to provide a comprehensive understanding of the low back pain under severe and traumatic static and dynamic loading conditions, the finite element (FE) technique is widely used as a computational method to model, simulate and analyse the behaviour of the spinal segments in the lumbar spine, which are much more difficult with in vitro and in vivo experimental studies. Intervertebral discs, having many other functions, support a huge extent of the compressive loadings the trunk is subjected to. The results of the FE analyses can be employed to understand the injury mechanisms occurring in and about the intervertebral discs, providing stress and strain distributions, and to aid the therapists in selecting the type of treatment for low back pain, and in developing guidelines for industrial safety.

Aplicabilidade clínica das técnicas de liberação manual diafragmática: uma revisão sistemática

2020 ◽  
Vol 18 (3) ◽  
pp. 111-116
Author(s):  
Dulce Marieli Danieli ◽  
Fabíola De Almeida Gomes ◽  
Bruna Eibel ◽  
William Dhein
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Gastroesophageal Reflux ◽  
Randomized Clinical Trials ◽  
Experimental Studies ◽  
Scar Tissue ◽  
Low Back ◽  
Musculoskeletal Manipulations ◽  
Clinical Applicability ◽  
Quasi Experimental

INTRODUÇÃO: O diafragma é o principal músculo respiratório e desempenha um papel importante na respiração e na regulação fisiológica. Uma terapia que visa melhorar essas condições referentes ao diafragma, é a técnica de liberação manual diafragmática. OBJETIVO: O objetivo deste estudo foi verificar a aplicabilidade clínica das técnicas manuais de liberação diafragmática e identificar as principais técnicas, populações investigadas, variáveis avaliadas e seus desfechos. MÉTODOS: Foram pesquisadas as seguintes bases de dados: PubMed, Scielo e Science Direct, com os descritores “Diaphragm [Mesh]” e “Musculoskeletal Manipulations [Mesh]” com seus correspondentes no mesmo idioma. Foram incluídos ensaios clínicos randomizados, não randomizados, estudos semi, quase-experimentais e estudos pilotos ou de caso, que abordaram técnicas de liberação manuais diafragmáticas.RESULTADOS: Há variadas técnicas de liberação diafragmática, sendo as mais mencionadas: normalização dos pilares do diafragma, alongamento e estiramento do diafragma, relaxamento dos pilares do diafragma. Além disso, as técnicas de liberação diafragmática vêm sendo associadas a protocolos de terapia manipulativa osteopática (TMO). As principais populações estudadas foram de pacientes saudáveis, com lombalgia, cervicalgia, osteoartrite, asmáticos, doença pulmonar obstrutiva crônica, constipados, cardiopatas e com refluxo gastroesofágico. Os principais desfechos avaliados são variáveis musculoesqueléticas (dor, flexibilidade, amplitude, espessura diafragmática), variáveis cardiorrespiratórias (pressão inspiratória/expiratória máxima (PImax e Pemax), mobilidade torácica, frequência cardíaca e respiratória), qualidade de vida e disfunções gastrointestinais/gastroesofágicas. CONCLUSÃO: A aplicabilidade clínica das técnicas de liberação diagramática está sendo investigada associado com outras técnicas osteopáticas, em protocolos de TMO em pacientes saudáveis, pneumopatas, cardiopatas, gestantes, em cicatriz pós-cirúrgica, constipados, com refluxo gastroesofágico, osteoartrite, cervicalgia e com lombalgia. Evidencia-se: diminuição ou eliminação das dores musculoesqueléticas, aumento da flexibilidade, ADM, Pimáx e Pemáx, aumento da mobilidade torácica, aumento da qualidade de vida, diminuição do inchaço e dor abdominal e sem efeito em cardiopatas.ABSTRACT. Clinical applicability of manual diaphragmatic release techniques: a systematic review.BACKGROUND: The diaphragm is the main respiratory muscle and plays an important role in breathing and physiological regulation. A therapy that aims to improve these conditions regarding the diaphragm, is the manual diaphragmatic release technique.OBJECTIVE: The aim of this study was to verify the clinical applicability of manual diaphragmatic release techniques and searching the main techniques, population, evaluated variables, and outcomes. METHODS: The following electronic databases were searched: PubMed, Scielo, and Science Direct, with the descriptors “Diaphragm [Mesh]” and “Musculoskeletal Manipulations [Mesh]” with their correspondents in the same language. There were included randomized clinical trial, non-randomized clinical trials, semi, and quasi-experimental studies, and pilot or case studies, which addressed manual diaphragmatic release techniques.RESULTS: There are various diaphragmatic release techniques, the most mentioned are: normalization of the diaphragm pillars, stretching of the diaphragm, relaxation of the diaphragm pillars, and protocols for osteopathic manipulative therapy (OMT) for the diaphragm. The main populations studied were healthy patients, with low back pain, asthmatics, chronic pulmonary obstructive disease, constipated, cardiac patients, and gastroesophageal reflux. The main outcomes assessed are musculoskeletal variables (pain, flexibility, range of motion, diaphragmatic thickness), cardiorespiratory variables (maximal inspiratory/expiratory pressure (MIP and MEP), chest mobility, heart, and respiratory rate), quality of life, and gastrointestinal/ gastroesophageal disorders.CONCLUSION: The clinical applicability of diagrammatic release techniques is being investigated in association with other osteopathic techniques, in protocols of OMT in healthy subjects, patients with lung diseases, heart disease, pregnant women, scar tissue, constipated, with gastroesophageal reflux, osteoarthritis, cervicalgia and with low back pain. There is evidence of reduction and elimination of musculoskeletal pain, increased MIP, increased chest mobility, an increase in health quality, a decrease of bloating and abdominal pain related to constipation, and a decrease of reflux symptoms.

scholarly journals Low Back Pain: The Potential Contribution of Supraspinal Motor Control and Proprioception

2018 ◽  
Vol 25 (6) ◽  
pp. 583-596 ◽  
Author(s):  
Michael Lukas Meier ◽  
Andrea Vrana ◽  
Petra Schweinhardt
Keyword(s):  
Low Back Pain ◽  
Motor Control ◽  
Back Pain ◽  
Control Strategies ◽  
Intervertebral Discs ◽  
Cortical Reorganization ◽  
Potential Contribution ◽  
Low Back ◽  
Output Side

Motor control, which relies on constant communication between motor and sensory systems, is crucial for spine posture, stability and movement. Adaptions of motor control occur in low back pain (LBP) while different motor adaption strategies exist across individuals, probably to reduce LBP and risk of injury. However, in some individuals with LBP, adapted motor control strategies might have long-term consequences, such as increased spinal loading that has been linked with degeneration of intervertebral discs and other tissues, potentially maintaining recurrent or chronic LBP. Factors contributing to motor control adaptations in LBP have been extensively studied on the motor output side, but less attention has been paid to changes in sensory input, specifically proprioception. Furthermore, motor cortex reorganization has been linked with chronic and recurrent LBP, but underlying factors are poorly understood. Here, we review current research on behavioral and neural effects of motor control adaptions in LBP. We conclude that back pain-induced disrupted or reduced proprioceptive signaling likely plays a pivotal role in driving long-term changes in the top-down control of the motor system via motor and sensory cortical reorganization. In the outlook of this review, we explore whether motor control adaptations are also important for other (musculoskeletal) pain conditions.

Low back pain – literature review

Ból ◽  
2020 ◽  
Vol 20 (3) ◽  
pp. 51-59
Author(s):  
Marcin Kopka
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Discs ◽  
Prior History ◽  
Low Back ◽  
Red Flags ◽  
Recurrence Rates ◽  
Reduction Of Pain ◽  
History Of ◽  
Optimal Visualization

Low back pain (LBP) is the third most common disorder presenting in the neurology outpatient clinic. It is usually defined as acute (less than 4 weeks), subacute (4–8 weeks) and chronic (more than 12 weeks). It is estimated that lifetime prevalence of up to 84 %. LBP is the most common cause of disability. LBP is divided into musculoskeletal and neurologic low back pain. In 90% of patients under the age of 65 the cause of pain is nerve root compression caused by disk herniation. Although serious spinal pathology is rare (less than 1%), the identification of red flags remains key in the evaluation of patients with LBP. A prior history of cancer, even in the absence of other red flags, has the highest predictive value for detection of malignancy. In conjunction with the history, a careful neurologic examination can help establish the presence and localize the lesion. According to guidelines imaging studies should not be obtained in patients with LBP of less than 6 weeks duration in the absence of red flags. Magnetic resonance imaging is the study of choice in patients with LBP. It allows for optimal visualization of the spinal cord, nerve roots and intervertebral discs. The results of MRI should be interpreted with caution because incidental degenerative spine changes unrelated to the pain are commonly seen in MRI. The main goals of treatment the patients presenting with acute LBP are reduction of pain and preservation of sensory and motor function. In the absence of red flags, for most cases conservative management will be appropriate. Prognosis are favorable, although recurrence rates range from 23% to 80%.

scholarly journals Discogenic low back pain: interventional treatment

Pain medicine ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 16-26
Author(s):  
V I Smolanka ◽  
V M Fedurtsya ◽  
B B Pavlov
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Adult Population ◽  
Intervertebral Discs ◽  
Interventional Treatment ◽  
Therapeutic Effects ◽  
Low Back ◽  
Discogenic Pain ◽  
Discogenic Low Back Pain ◽  
Common Causes

Low back pain (LBP) is one of the most common causes of disability in the adult population. A significant place in its genesis is occupied by a degenerative-dystrophic diseases of intervertebral discs. The article highlights the classification and mechanism of discogenic pain origin. Various types of interventions aredescribed for this pathology: indications, specificities of carrying out manipulations and therapeutic effects, efficiency and possible complications of procedures.

DIAGNOSTIC RADIOLOGY METHODS OF DEGENERATIVE CHANGES IN LUMBAR INTERVERTEBRAL DISCS IN YOUNG PEOPLE

2020 ◽  
pp. 93-96
Author(s):  
Ilhar Halyb ohly Mammadov
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Symptoms ◽  
Intervertebral Discs ◽  
Information Value ◽  
Diagnostic Radiology ◽  
Degenerative Changes ◽  
Low Back ◽  
Disc Disease ◽  
Disc Protrusion

In recent years, the number of scientific studies investigating the prevalence of low back pain among schoolchildren has been significantly increased. Degenerative disease of the discs is often accompanied by a low back pain with irradiation into the legs in representatives of different age groups, in particular, in older children. The main factors of its development are genetic predisposition, trauma, obesity, lack of exercise. Most of the components of the vertebral motor segment have the nerve endings and reflex influences, accompanied by inflammation, microcirculatory disorders, and their combination contributes to an appearance of back pain. Diagnosis of degenerative disc disease includes the study of the patient's medical history, analysis of clinical symptoms, use of functional tests and various types of imaging to clarify the degree of macrostructural changes in disks, among which the main place is taken by the magnetic resonance imaging. The development of degenerative changes in intervertebral discs as early as childhood, which requires a further study using non−invasive, accessible and informative methods, especially ultrasound ones. The results of ultrasonography of lumbar intervertebral discs were analyzed in 36 adolescents aged 16−18 years, diagnosed for the protrusion when the MRI was applied. Paramedian protrusion was found to be significantly more frequent than posterolateral, median, and circular ones. Due to its non−invasiveness, low price and information value, the ultrasound can be the most popular method not only as a screening one but also for the expert evaluation of lumbar intervertebral disc protrusion in schoolchildren. Key words: diagnostic radiology, lumbar intervertebral discs, adolescents.

scholarly journals Current insights on use of growth factors as therapy for Intervertebral Disc Degeneration

2018 ◽  
Vol 9 (1) ◽  
pp. 43-52 ◽  
Author(s):  
Justin C. Kennon ◽  
Mohamed E. Awad ◽  
Norman Chutkan ◽  
John DeVine ◽  
Sadanand Fulzele
Keyword(s):  
Tissue Engineering ◽  
Low Back Pain ◽  
Back Pain ◽  
Growth Factors ◽  
Growth Factor ◽  
Intervertebral Disc ◽  
Transforming Growth Factor ◽  
Low Back

AbstractChronic low back pain is a critical health problem and a leading cause of disability in aging populations. A major cause of low back pain is considered to be the degeneration of the intervertebral disc (IVD). Recent advances in therapeutics, particularly cell and tissue engineering, offer potential methods for inhibiting or reversing IVD degeneration, which have previously been impossible. The use of growth factors is under serious consideration as a potential therapy to enhance IVD tissue regeneration. We reviewed the role of chosen prototypical growth factors and growth factor combinations that have the capacity to improve IVD restoration. A number of growth factors have demonstrated potential to modulate the anabolic and anticatabolic effects in both in vitro and animal studies of IVD tissue engineering. Members of the transforming growth factor-β superfamily, IGF-1, GDF-5, BMP-2, BMP-7, and platelet-derived growth factor have all been investigated as possible therapeutic options for IVD regeneration. The role of growth factors in IVD tissue engineering appears promising; however, further extensive research is needed at both basic science and clinical levels before its application is appropriate for clinical use.

scholarly journals Treatment of Naturally Degenerated Canine Lumbosacral Intervertebral Discs with Autologous Mesenchymal Stromal Cells and Collagen Microcarriers: A Prospective Clinical Study

2018 ◽  
Vol 28 (2) ◽  
pp. 201-211 ◽  
Author(s):  
Frank Steffen ◽  
Alessandro Bertolo ◽  
Remo Affentranger ◽  
Stephen J. Ferguson ◽  
Jivko Stoyanov
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Mesenchymal Stromal Cells ◽  
Stromal Cells ◽  
Large Animal ◽  
Low Back ◽  
Schmorl’S Nodes ◽  
Ivd Degeneration ◽  
Tgf Β1

Intervertebral disc (IVD) degeneration is a frequent disease in modern societies and at its later stages is likely to cause chronic low back pain. Although many studies have been published, the available treatments for IVD degeneration fail to promote regeneration or even marginal repair of the IVD structure. In this study, we aimed to establish veterinary canine patients as a translational large animal model that recapitulates IVD degeneration that occurs in humans, and to investigate the suitability of intradiscal application of mesenchymal stromal cells (MSC). Twenty client-owned dogs diagnosed with spontaneous degenerative lumbosacral IVD and low back pain were included in the study. Autologous MSC were isolated from bone marrow and cultured for 2 weeks. Prior to injection, MSC were attached on collagen microcarriers for delivery, with or without TGF-β1 crosslinking. After decompressive spinal surgery, dogs received an intradiscal injection of MSC-microcarriers ( n = 11), MSC-TGF-β1-microcarriers ( n = 6) or microcarriers only (control, n = 3). MSC-microcarriers were initially evaluated in vitro and ex vivo, to test cell chondrogenic potential and biomechanical properties of the microcarriers, respectively. Clinical performance and Pfirrmann grading were evaluated at 10 months after the injection by magnetic resonance imaging. MSC differentiated successfully in vitro towards chondrogenic phenotype and biomechanical tests showed no significant differences of IVD stiffness after microcarrier injection. In vivo injection was successful in all dogs, without any visible leakage, and clinical functioning was restored back to normality. However, postoperative Pfirrmann grade remained identical in all dogs, and formation of Schmorl’s nodes was detected in 45% of dogs. This side effect was reduced by halving the injection volume, which was then observed only in 11% of dogs. In conclusion, we observed marked clinical improvement in all groups, despite the formation of Schmorl’s nodes, but microcarriers and MSC failed to regenerate the structure of degenerated IVD.

Syndromes associated with protrusion of upper lumbar intervertebral discs

1973 ◽  
Vol 38 (4) ◽  
pp. 499-503 ◽  
Author(s):  
Paul Gutterman ◽  
Henry A. Shenkin
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Discs ◽  
Thigh Pain ◽  
Low Back ◽  
Good Recovery ◽  
Content Type ◽  
Anterior Thigh ◽  
Acute Paraplegia ◽  
Fine Print

✓ This report reviews a series of 69 patients operated on for herniations of upper lumbar intervertebral discs and identifies four syndromes related to the principal complaint. These are, in order of frequency, anterior thigh pain, low-back pain only, sciatica, and acute paraplegia. Overall, 78% had satisfactory relief of pain and 93% were improved following laminectomy. Satisfactory results were more common with protrusions at L3–4 than at L2–3. Patients in whom the onset was sciatica had a higher percentage of satisfactory results (94%) than those with anterior thigh pain (70%) or low-back pain alone (80%). Neither of the patients with a paraplegic onset had a good recovery even after removal of the extruded disc.

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