REFERENCES:

EXERCISE PRESCRIPTION 

1.Acute low back pain: systematic review of its prognosis

https://www.bmj.com/content/327/7410/323.full

People with acute low back pain and associated disability usually improve rapidly within weeks. None the less, pain and disability are typically ongoing, and recurrences are common.

 

2. Exercise Program Guidelines for Persons With Chronic Nonspecific Low Back Pain

https://journals.lww.com/nsca-scj/fulltext/2013/02000/Exercise_Program_Guidelines_for_Persons_With.4.aspx

Persons with CNSLBP derive the same physical health and quality of life benefits from individualized exercise programs as apparently healthy participants without CNSLBP. Comprehensive, individualized, progressive exercise programs consisting of AT, RT, flexibility, and neuromotor training have been proven effective in enhancing physical activity tolerance and function and well tolerated in persons with CNSLBP.

 

3. Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain

https://journals.lww.com/spinejournal/Abstract/2001/06010/Long_Term_Effects_of_Specific_Stabilizing.4.aspx

Long-term results suggest that specific exercise therapy in addition to medical management and resumption of normal activity may be more effective in reducing low back pain recurrences than medical management and normal activity alone.

 

4. Evaluation of Specific Stabilizing Exercise in the Treatment of Chronic Low Back Pain With Radiologic Diagnosis of Spondylolysis or Spondylolisthesis

https://journals.lww.com/spinejournal/Abstract/1997/12150/Evaluation_of_Specific_Stabilizing_Exercise_in_the.20.aspx

A “specific exercise” treatment approach appears more effective than other commonly prescribed conservative treatment programs in patients with chronically symptomatic spondylolysis or spondylolisthesis.

 

5. The Relation Between the Transversus Abdominis Muscles, Sacroiliac Joint Mechanics, and Low Back Pain

https://journals.lww.com/spinejournal/Abstract/2002/02150/The_Relation_Between_the_Transversus_Abdominis.15.aspx

Contraction of the transversus abdominis significantly decreases the laxity of the sacroiliac joint. This decrease in laxity is larger than that caused by a bracing action using all the lateral abdominal muscles. These findings are in line with the authors’ biomechanical model predictions and support the use of independent transversus abdominis contractions for the treatment of low back pain.

 

6. The Role of Paraspinal Muscle Spindles in Lumbosacral Position Sense in Individuals With and Without Low Back Pain

https://journals.lww.com/spinejournal/Abstract/2000/04150/The_Role_of_Paraspinal_Muscle_Spindles_in.15.aspx

Patients with low back pain have a less refined position sense than healthy individuals, possibly because of an altered paraspinal muscle spindle afference and central processing of this sensory input. Furthermore, muscle vibration can be an interesting expedient for improving proprioception and enhancing local muscle control.

 

BRAIN PROOF POINTS

 

7. Extensive reorganization of primary somatosensory cortex in chronic back pain patients

https://www.sciencedirect.com/science/article/abs/pii/S0304394097134413

These data suggest that chronic pain is accompanied by cortical reorganization and may serve an important function in the persistence of the pain experience.

 

8. Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density

http://www.jneurosci.org/content/24/46/10410.short

Our results imply that CBP is accompanied by brain atrophy and suggest that the pathophysiology of chronic pain includes thalamocortical processes.

 

  1. Psychiatric illness and chronic low-back pain. The mind and the spine–which goes first?

http://europepmc.org/abstract/med/8434327

https://www.sciencedirect.com/science/article/pii/S0304395998002292

 

Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability

 

10. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds

https://www.archives-pmr.org/article/S0003-9993(99)90052-7/abstract

Early activation of transversus abdominis (TrA) and obliquus internus abdominis (OI) occurred in the majority of trials, with movement at both the fast and intermediate speeds for the control group. In contrast, subjects with low back pain failed to recruit TrA or OI in advance of limb movement with fast movement, and no activity of the abdominal muscles was recorded in the majority of intermediate speed trials.

 

The results indicate that the mechanism of preparatory spinal control is altered in people with lower back pain for movement at a variety of speeds.

 

11. Effects of Muscular Stretching and Segmental Stabilization on Functional Disability and Pain in Patients with Chronic Low Back Pain: A Randomized, Controlled Trial

https://www.jmptonline.org/article/S0161-4754(12)00066-8/abstract

Both techniques improved pain and reduced disability. In this study, SS was superior to muscular stretching for the measured variables associated with chronic low back pain.

 

12. Dysfunction of the Neuro-Muscular System in the Presence of Low Back Pain—Implications for Physical Therapy Management

https://www.tandfonline.com/doi/abs/10.1179/jmt.1997.5.1.20

LBP is commonly associated with varied and complex patterns of neuro-muscular dysfunction both between and within trunk muscle synergies. This results in disrupted patterns of co-contraction and co-ordination between and within trunk synergists and appears to reflect altered patterns of neuro-motor control. There is also evidence that the muscles commonly affected are those whose primary role is to provide segmental control and dynamic stability to the spine.

 

BACK PAIN STATISTICS

 

13. The course of low back pain in a general population. results from a 5-year prospective study

https://www.jmptonline.org/article/S0161-4754(03)00006-X/fulltext

Low back pain should not be considered transient and therefore neglected, since the condition rarely seems to be self-limiting but merely presents with periodic attacks and temporary remissions.

 

14. Non-specific low back pain

https://www.sciencedirect.com/science/article/pii/S0140673611606107

Generally self-management, with appropriate support, is recommended and surgery and overtreatment should be avoided.

 

  1. Biomechanics of back pain

http://aim.bmj.com/content/22/4/178

http://aim.bmj.com/content/acupmed/22/4/178.full.pdf

It is widely suspected that many transient episodes of back pain arise from the back muscles

 

16. Self-reported pain and disability outcomes from an endogenous model of muscular back pain

https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-12-35#Bib1

Musculoskeletal pain is the most common form of chronic or recurrent pain

 

STRESS;

 

17. Pain and ‘hassles’ in the United States: findings of the Nuprin pain report.

https://www.ncbi.nlm.nih.gov/pubmed/3785965?dopt=Abstract

There was a very strong association between stress and pain and hassles and pain. The greater the stress and hassles, the greater the incidence, frequency and severity of all pains reported.

 

  1. Assessment of stress-related psychophysiological reactions in chronic back pain patients.

http://psycnet.apa.org/buy/1985-25818-001

Results indicate that CBP Ss displayed elevations and delayed return to baseline only in their paravertebral musculature and only when discussing personally relevant stress. Neither of the other groups displayed similar response patterns.

 

ROLE OF TA & MULTIFIDUS IN LBP:

 

19. Inefficient Muscular Stabilization of the Lumbar Spine Associated With Low Back Pain: A Motor Control Evaluation of Transversus Abdominis

 

https://journals.lww.com/spinejournal/Abstract/1996/11150/Inefficient_Muscular_Stabilization_of_the_Lumbar.14.aspx

Contraction of transversus abdominis was significantly delayed in patients with low back pain with all movements. Isolated differences were noted in the other muscles.

Conclusions The delayed onset of contraction of transversus abdominis indicates a deficit of motor control and is hypothesized to result in inefficient muscular stabilization of the spine.

 

  1. Lumbar muscle fatigue and chronic lower back pain.

http://europepmc.org/abstract/med/2528828

Results indicated: significant differences between lower back pain patients and control subjects for specific combinations of contractile force level and muscle site tested;

 

21. Multifidus Muscle Recovery Is Not Automatic After Resolution of Acute, First-Episode Low Back Pain

https://journals.lww.com/spinejournal/Abstract/1996/12010/Multifidus_Muscle_Recovery_Is_Not_Automatic_After.11.aspx

Multifidus muscle recovery is not spontaneous on remission of painful symptoms. Lack of localized, muscle support may be one reason for the high recurrence rate of low back pain following the initial episode.

 

22. Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb.

http://europepmc.org/abstract/med/9493770

The EMG onset of transversus abdominis was delayed in the LBP subjects. This result provides evidence of a change in the postural control of the trunk in people with LBP.

 

  1. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain.

http://europepmc.org/abstract/med/8153825

The site of wasting in patients corresponded to the clinically determined level of symptoms

 

24. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds

https://www.archives-pmr.org/article/S0003-9993(99)90052-7/abstract

To compare trunk muscle coordination in people with and without low back pain.

Subjects with low back pain failed to recruit TrA or OI in advance of limb movement

The results indicate that the mechanism of preparatory spinal control is altered in people with lower back pain for movement at a variety of speeds.

 

NEUROLOGICAL;

 

25. Associative memory for movement-evoked chronic back pain and its extinction with musculoskeletal physiotherapy

https://www.tandfonline.com/doi/abs/10.1179/174328808X251948

mechanically evoked symptoms and signs of chronic non-specific low back pain are the product of a sustained associatively learned memory for pain and its behavioural responses. With susceptible individuals, this memory is being inappropriately reinforced by both cognitive emotional factors, and pain-associated proprioceptive (not inflammatory nociceptive) afferent input continually generated in the periphery. Together, the verbal and physical strategies employed by musculoskeletal physiotherapy are proposed to be capable of extinguishing the associatively learned pain memory. They do so by effectively changing ‘top-down’ (cognitive-emotional) and ‘bottom-up’ (afferent input) sources of reinforcement. Extinction is, therefore, likely to be a neurological mechanism underlying the clinical efficacy of this type of intervention.

 

26. Consequences of Laughter Upon Trunk Compression and Cortical Activation: Linear and Polynomial Relations

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991051/

The results in Study 1 supported the idea of an inhibitory brain mechanism that may be triggered to protect the trunk in general, and the thorax cavity in particular, from excessive compression due to enduring laughter

 

27. Does anticipation of back pain predispose to back trouble?

https://academic.oup.com/brain/article/127/10/2339/404472

The strategy by which the CNS controls anticipatory postural adjustments of the trunk muscles during limb movement is altered during acute back pain and in people with recurrent back pain, even when they are pain free. The altered postural strategy probably serves to protect the spine in the short term, but it is associated with a cost and is thought to predispose spinal structures to injury in the long term. It is not known why this protective strategy might occur even when people are pain free, but one possibility is that it is caused by the anticipation of back pain

During anticipated experimental back pain, for single arm movements there was delayed activation of the deep trunk muscles and augmentation of at least one superficial trunk muscle. For repetitive arm movements, there was decreased activity and a shift from biphasic to monophasic activation of the deep trunk muscles and increased activity of superficial trunk muscles during anticipation of back pain. In both instances, the changes were consistent with adoption of an altered strategy for postural control and were similar to those observed in patients with recurrent back pain. We conclude that anticipation of experimental back pain evokes a protective postural strategy that stiffens the spine. This protective strategy is associated with compressive cost and is thought to predispose to spinal injury if maintained long term

 

“Prior to limb movement, the brain prepares the trunk for the impending perturbation by preparatory activation of the trunk muscles, so-called anticipatory postural adjustments (Belen’kii et al., 1967).

 

The normal strategy by which postural adjustments are controlled during limb movements involves differential activation of the deep and superficial trunk muscles (Hodges and Richardson, 1997, 1999; Moseley et al., 2002a,b). Anticipatory postural activation of the superficial trunk muscles involves evaluation of the direction and magnitude of the perturbation caused by movement. In contrast, anticipatory postural activation of the deep trunk muscles does not require evaluation of the spatial characteristics of the perturbation. This latter component of spinal control requires limited cortical resources and is not affected by competitive demands on attention (Moseley et al., 2004), or by altering the predictability of the required movement (Hodges and Richardson, 1999).”

 

29. ON THE CONTROL ELEMENTS OF VOLUNTARY MOVEMENTS.

http://psycnet.apa.org/record/1967-08445-001

Prior to limb movement, the brain prepares the trunk for the impending perturbation by preparatory activation of the trunk muscles, so-called anticipatory postural adjustments (Belen’kii et al., 1967).

 

30. Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement

https://link.springer.com/article/10.1007/PL00005644

 

The normal strategy by which postural adjustments are controlled during limb movements involves differential activation of the deep and superficial trunk muscles (Hodges and Richardson, 1997, 1999; Moseley et al., 2002a,b).

 

31. Pain differs from non-painful attention-demanding or stressful tasks in its effect on postural control patterns of trunk muscles

https://link.springer.com/article/10.1007/s00221-003-1766-0

 

Pain changes postural activation of the trunk muscles. The cause of these changes is not known but one possibility relates to the information processing requirements and the stressful nature of pain. although postural activation of the deep trunk muscles is not affected when central nervous system resources are limited, it is delayed when the individual is also under stress.

 

In contrast, anticipatory postural activation of the deep trunk muscles does not require evaluation of the spatial characteristics of the perturbation. This latter component of spinal control requires limited cortical resources and is not affected by competitive demands on attention (Moseley et al., 2004), or by altering the predictability of the required movement (Hodges and Richardson, 1999).

 

YOGA RESEARCH

 

  1. Yoga for reducing perceived stress and back pain at work

https://www.researchgate.net/publication/231212043_Yoga_for_reducing_perceived_stress_and_back_pain_at_work

 

  1. The effectiveness of yoga for the improvement of well-being and resilience to stress in the workplace.

Hartfiel N1, Havenhand J, Khalsa SB, Clarke G, Krayer A.

https://www.ncbi.nlm.nih.gov/pubmed/20369218

 

  1. Cost-effectiveness of yoga for managing musculoskeletal conditions in the workplace
  2. Hartfiel,1 G. Clarke,2 J. Havenhand,3 C. Phillips4 and R. T. Edwards5

https://watermark.silverchair.com/kqx161.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAaYwggGiBgkqhkiG9w0BBwagggGTMIIBjwIBADCCAYgGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM7ROf6h5tM8ZQ8jlAAgEQgIIBWTGIA-sk9SwFZmBLoHlSM8obUB1ki6mkRogZoZI_H9NHvuFTUhjrFpSMFG2tqpWZ12VU7xPdk5X3Vq7bnJVtqSKcPM-XaWSsQLJpeqUn3MiYFOiTZ-Fh4IKq9IoSth9s9lZpBHSVO2fBcMBGyTMdHN74zRYyH7KWHA7X9qCZpXNmWvSflo8sB0w8urC-cRUczXpieF17PYs8GQR9JioBp899Q038NIpkVn_EN_EALJ-B0GC56c0fmmMJVTVQDQ9l04P2CyfawAuPDHjNfkKlJ_f1eHF0XoUrIob9Au-dUOHi6vTszHhgxSB6AmC22jKedfepk4IHNMD4JfyWuo0pqlzBEuMzqoiI9k67mSgZspsQgoyNA7j4n6kWGtb0qnYIWZDMkdMaJ0T9syGTGMyU6v074y-JfeEmzW9jjxwGYRuZDF4sNhg9qBD_M8nfEypImWMmkqtYNa0DFg

 

36.Extensive reorganization of primary somatosensory cortex in chronic back pain patients

https://www.sciencedirect.com/science/article/abs/pii/S0304394097134413

These data suggest that chronic pain is accompanied by cortical reorganization and may serve an important function in the persistence of the pain experience.

 

37. Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density

https://www.sciencedirect.com/science/article/abs/pii/S0304394097134413

Our results imply that CBP is accompanied by brain atrophy and suggest that the pathophysiology of chronic pain includes thalamocortical processes.

 

38. Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density

https://www.sciencedirect.com/science/article/abs/pii/S0304394097134413

Our results imply that CBP is accompanied by brain atrophy and suggest that the pathophysiology of chronic pain includes thalamocortical processes.

 

39.Influence of paravertebral muscles training on brain plasticity and postural control in chronic low back pain.

https://www.sciencedirect.com/science/article/abs/pii/S0304394097134413

This original study presents how motor control exercises can influence brain plasticity and postural control in chronic low back pain. This knowledge will impact on the decision of clinicians to prescribe specific exercises with a view of improving motor control in this musculoskeletal condition.