Spine
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Does it matter which exercise? A randomized control trial of exercise for low back pain.
Multicentered randomized controlled trial. ⋯ Consistent with prior evidence, a standardized mechanical assessment identified a large subgroup of LBP patients with a DP. Regardless of subjects' direction of preference, the response to contrasting exercise prescriptions was significantly different: exercises matching subjects' DP significantly and rapidly decreased pain and medication use and improved in all other outcomes. If repeatable, such subgroup validation has important implications for LBP management.
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A review of the literature on macromechanical factors that accelerate disc degeneration with particular focus on distinguishing the roles of immobilization and overloading. ⋯ It is concluded that probably any abnormal loading conditions (including overload and immobilization) can produce tissue trauma and/or adaptive changes that may result in disc degeneration. Adverse mechanical conditions can be due to external forces, or may result from impaired neuromuscular control of the paraspinal and abdominal muscles. Future studies will need to evaluate additional unquantified interactions between biomechanics and factors such as genetics and behavioral responses to pain and disability.
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Review of the most recent advances in the development of poro-elastic analytical models that include physiologic parameters used for understanding lumbar disc degeneration due to repetitive loading. ⋯ A number of different approaches have been used to address the issue of disc degeneration. Poro-elastic finite element model including strain-dependent permeability and osmotic pressure is the most popular analytical tool currently available that can be used to understand how cyclic loading affects the biomechanical characteristics of a degenerated lumbar disc. However, it is important to note that a complete understanding of the behavior of the intervertebral disc will ultimately be arrived using a combination of analytical models, such as the models presented here, in addition to in vitro and in vivo experimental methods.
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A review of the literature on disc nutrition. ⋯ Loss of nutrient supply can lead to cell death, loss of matrix production, and increase in matrix degradation and hence to disc degeneration.
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The occurrence of anular tears and general disc degeneration of the lumbar spine was studied in relation to the lifetime frequency of back pain. ⋯ Anular degeneration of the lumbar discs appear earlier and are more clearly related to back pain than previously thought, most probably due to the better sensitivity of the BaSO4 discography method to detect tears.