Muscle Control and Non-specific Chronic Low Back Pain

Abstract

ObjectivesChronic low back pain (CLBP) is the most prevalent of the painful musculoskeletal conditions. CLBP is a heterogeneous condition with many causes and diagnoses, but there are few established therapies with strong evidence of effectiveness (or cost effectiveness). CLBP for which it is not possible to identify any specific cause is often referred to as non‐specific chronic LBP (NSCLBP). One type of NSCLBP is continuing and recurrent primarily nociceptive CLBP due to vertebral joint overload subsequent to functional instability of the lumbar spine. This condition may occur due to disruption of the motor control system to the key stabilizing muscles in the lumbar spine, particularly the lumbar multifidus muscle (MF).MethodsThis review presents the evidence for MF involvement in CLBP, mechanisms of action of disruption of control of the MF, and options for restoring control of the MF as a treatment for NSCLBP.ResultsImaging assessment of motor control dysfunction of the MF in individual patients is fraught with difficulty. MRI or ultrasound imaging techniques, while reliable, have limited diagnostic or predictive utility. For some patients, restoration of motor control to the MF with specific exercises can be effective, but population results are not persuasive since most patients are unable to voluntarily contract the MF and may be inhibited from doing so due to arthrogenic muscle inhibition.ConclusionsTargeting MF control with restorative neurostimulation promises a new treatment option.

Association Between Absenteeism and Low Back Pain in an Automobile Factory

“…Among musculoskeletal disorders, low back pain (LBP) is one of the most common complaints of workers [1]. LBP not only is considered as the most common cause of the performance failure worldwide, but also it is estimated that it affects 90% of whole world population [2]. Abdulmujeeb (2017) who studied factors related to the backache in the health workers of a hospital in Uganda stated that 31% of personnel were out of work because of this problem [3] .The prevalence of LBP among adults is very high, and 70-80% of all adults experience LBP at least once in their lifetime [4].…”

“…Several studies have showed that backache is a common disease that results in a significant disability and absence from work worldwide, and it has been reported that it could increase the probability of LBP due to mental and physical stresses, poverty, and heavy workload. Its relationship with the absence from work is also reported [2,[5][6][7]. Basen (2017) evaluated the relationship between pain and work limitations and performance disability in a population of workers who had acute backache (241 patients).…”

The effect of chronic, non-specific low back pain on superficial lumbar muscle activity: a protocol for a systematic review and meta-analysis

“…This has the potential to change the load distribution on spinal structures, and thus contribute to the maintenance and/or perpetuation of pain 7. However, despite several investigations, the exact link between the level of muscle activity and CNSLBP remains unclear 7–10. The lumbar region is highly muscular, comprising subcutaneous contributions from the lumbar erector spinae ( iliocostalis, longissimus and spinalis ) and the superficial multifidus 11.…”

“…Previous reviews have attempted to synthesise these results to draw conclusions; however, these reviews have been focused on the investigation of activity within just one muscle, or during one task, for example, standing on unstable surfaces, or synthesising results drawn from one database 8 10 23 24. While these reviews do answer specific questions, there remains a gap in the literature to assess what the overall effect of CNSLBP is on lumbar paraspinal muscle activity.…”

GLA:D® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence -

“…Four systematic reviews have addressed therapeutic exercise as a prevention strategy, either as a post-treatment intervention or as a particular part of the intervention focusing on prevention of recurrence and duration of new episodes [ 95 , 103 – 105 ]. Positive effects have been reported for different types of exercise therapy spanning general strengthening [ 101 , 106 – 108 ], endurance training [ 109 ], direction-specific repeated movements and flexibility [ 99 , 100 , 110 , 111 ], yoga, Pilates [ 108 , 112 ], and motor control exercises [ 96 , 97 , 99 , 113 , 114 ] with a focus on specific muscles such as the transverse abdominal or multifidus muscles as compared with no treatment or ‘usual care’ [ 115 ]. No single form of exercise is clearly superior to any other, but exercise seems to be more effective in people with chronic and persistent back pain than in people with back pain of shorter duration [ 98 ].…”