What is mechanical back pain and how best to treat it?

Effectiveness of gluteal control training in chronic low back pain patients with functional leg length inequality

Chronic low back pain (LBP) is a common musculoskeletal disorder and is often accompanied by functional leg length inequality (FLLI). However, little was known about the effects of gluteal muscle control training in patients with LBP and FLLI. This study was designed to investigate the effects of gluteal control training in patients with LBP and FLLI. This is a double-blinded, randomized controlled study design. Forty-eight LBP patients with FLLI were randomized to the gluteal control training (GT) (47.58 ± 9.42 years) or the regular training (RT) (47.38 ± 11.31 years) group and received allocated training for six weeks. The outcome measures were pelvic inclination (PI), ilium anterior tilt difference (IATD), FLLI, visual analogue scale (VAS), patient specific-functional scale (PSFS), Oswestry disability index (ODI), hip control ability, global rating of change scale (GRoC), and lower extremity strength and flexibility. The intervention effects were compared using two-way repeated measures analysis of variance and chi-square tests with α = 0.05. The results indicated that the GT group showed greater improvement (P < 0.01) in PI (1.03 ± 0.38∘ vs. 1.57 ± 0.51∘), IATD (0.68 ± 0.66∘ vs. 2.31 ± 0.66∘), FLLI (0.3 ± 0.22 vs. 0.59 ± 0.13 cm), VAS (1.41 ± 1.32 vs. 3.38 ± 1.51), hip control ability (2.20 ± 0.45 vs. 0.89 ± 0.74), GRoC at 3rd and 6th week as compared to the RT group. Hip strength and flexibility also improved more in the GT group (P < 0.05). In conclusion, gluteal control training was more effective in improving low back pain and dysfunctions, and should be integrated in the management plan in patients with LBP and FLLI.

Use of the Oswestry Disability Index in ankylosing spondylitis

OBJECTIVE

The Oswestry Disability Index is considered the gold standard in the evaluation of disability in patients with chronic mechanical back pain. The aim of this study was to assess the applicability of Oswestry Disability Index in patients with ankylosing spondylitis and its relationship with disease assessment parameters for ankylosing spondylitis.

METHODS

A total of 100 patients diagnosed with ankylosing spondylitis were included in the study group. The control group consisted of 50 individuals with nonspecific low back pain. The Oswestry Disability Index and Bath Ankylosing Spondylitis Disease Activity Index were applied to both groups. In addition, the Visual Analog Scale, the Ankylosing Spondylitis Disease Activity Score C-Reactive Protein, the Ankylosing Spondylitis Disease Activity Score-the Erythrocyte Sedimentation Rate, the Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, and the Ankylosing Spondylitis Quality of Life scales were applied in the study group. the Erythrocyte Sedimentation Rate, C-Reactive Protein levels, and HLA-B27 analysis were noted as laboratory markers in ankylosing spondylitis patients.

RESULTS

The scores of Oswestry Disability Index had a significant correlation with scores of Bath Ankylosing Spondylitis Disease Activity Index in ankylosing spondylitis patients (r=0.543) and in the control group (r=0.401). There was a significant correlation between the scores of Oswestry Disability Index and the Bath Ankylosing Spondylitis Functional Index (r=0.544), Bath Ankylosing Spondylitis Metrology Index (r=0.317), the Ankylosing Spondylitis Quality of Life (r=0.723), the Ankylosing Spondylitis Disease Activity Score-the Erythrocyte Sedimentation Rate (r=0.501), the Ankylosing Spondylitis Disease Activity Score C-Reactive Protein (r=0.530), Visual Analog Scale-Rest (r=0.476), and Visual Analog Scale-Activity (r=0.441) values in patients with ankylosing spondylitis.

CONCLUSION

Evaluation of Oswestry Disability Index in conjunction with Bath Ankylosing Spondylitis Disease Activity Index may warn the physician to interpret high Bath Ankylosing Spondylitis Disease Activity Index scores in the context of mechanical pain. Therefore, the use of Oswestry Disability Index in patients with ankylosing spondylitis will be beneficial.

Burden of disease and impact on quality of life in chronic back pain - a comparative cross-sectional study of 150 axial spondyloarthritis and 150 orthopedic back pain patients

Objective

Chronic back pain (CBP) constitutes one of the most common complaints in primary care and a leading cause of disability worldwide. CBP may be of mechanical or inflammatory character and may lead to functional impairment and reduced quality of life. In this study, we aimed to assess and compare burden of disease, functional capacity, quality of life and depressive symptoms in axial spondyloarthritis (axSpA) patients with orthopedic chronic back pain patients (OBP). We further aimed to identify factors associated with quality of life.

Methods

Cross-sectional survey of a cohort of 300 CBP patients including 150 patients from a University Hospital Orthopedic Back Pain Outpatient Clinic with OBP and 150 patients with confirmed axSpA from a University Hospital Rheumatology Outpatient Clinic. Questionnaire-based assessment of pain character (Inflammatory Back Pain, MAIL-Scale), functional status (FFbH, BASFI), quality of life (WHOQOL-Bref) and depressive symptoms (Phq9) and retrospective medical chart analysis.

Results

Both, OBP and axSpA patients reported on average intermediate pain levels of mostly mixed pain character. Both groups demonstrated a reduced health-related quality of life and the presence of depressive symptoms. However, axSpA patients reported a significantly better subjective quality of life, more satisfaction with their health status and better functional capacity compared to OBP patients (all p < 0.001). In a multivariate regression model, depressive symptoms, mechanical back pain, pain level and age were negative predictors of subjective quality of life, whereas functional capacity was a positive predictor.

Conclusion

Chronic back pain was associated with a high morbidity and reduced quality of life regardless of pain character. We identified multiple factors associated with reduced quality of life. Awareness and addressing of these factors may help to overcome unmet needs and improve quality of life for these patients.

Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation

BACKGROUND

To better understand biomechanical factors that affect intervertebral alignment throughout active therapeutic exercise, it is necessary to determine spinal kinematics when subjects perform spinal exercises. This study aims to investigate the outcomes of active cervical therapeutic exercise on intervertebral foramen changes in neck pain patients with disc herniation.

METHODS

Thirty diagnosed C4/5 and/or C5/6 disc-herniated patients receiving an 8-week cervical therapeutic exercise program were followed up with videofluoroscopic images. The dynamic changes in the foramen were computed at different timepoints, including the neutral position, end-range positions in cervical flexion-extension, protrusion-retraction, and lateral flexion movements.

RESULTS

The results showed that the active cervical flexion, retraction, and lateral flexion away from the affected side movements increased the area of the patients' intervertebral foramen; while the active extension, protrusion, and lateral flexion toward the affected side reduced the areas of intervertebral foramen before treatment. After the treatment, the active cervical flexion significantly increased the C2/3, C3/4, and C6/7 foramen area by 5.02-8.67% (p = 0.001 ~ 0.029), and the extension exercise significantly reduced the C2/3 and C4/5 area by 5.12-9.18% (p = 0.001 ~ 0.006) compared to the baseline. Active retraction movement significantly increased the foramen area from C2/3 to C6/7 by 3.82-8.66% (p = 0.002 ~ 0.036 with exception of C5/6). Active lateral flexion away from the affected side significantly increased the foramen by 3.71-6.78% (p = 0.007 ~ 0.046 with exception of C6/7).

CONCLUSIONS

The 8-week therapeutic exercises including repeated cervical retraction, extension, and lateral flexion movements to the lesion led to significant changes and improvements in intervertebral foramen areas of the patients with disc herniation.

TRIAL REGISTRATION

ISRCTN61539024.

Guidance to trigger point injection for treating myofascial pain syndrome: Intramuscular neural distribution of the quadratus lumborum

Postural habits and repetitive motion contribute toward the progress of myofascial pain by affecting overload on specific muscles, the quadratus lumborum (QL) muscle being the most frequently involved. The therapy of myofascial pain syndrome includes the release of myofascial pain syndrome using injective agents such as botulinum neurotoxin, lidocaine, steroids, and normal saline. However, an optimal injection point has not been established for the QL muscle. This study aimed to propose an optimal injection point for this muscle by studying its intramuscular neural distribution using the whole mount staining method. A modified Sihler's procedure was completed on 15 QL muscles to visualize the intramuscular arborization areas in terms of the inferior border of the 12th rib, the transverse processes of L1-L4, and the iliac crest. The intramuscular neural distribution of the QL had the densely arborized areas in the three lateral portions of L3-L4 and L4-L5 and the medial portion between L4 and L5.

Prevalence and Risk Factors Associated with Low Back Pain in the Saudi Adult Community: A Cross-Sectional Study

Worldwide, low back pain is common and linked with many risk factors. There is a lack of studies in the Saudi Arabian community on low back pain prevalence and risk factors. Therefore, the present research will investigate the prevalence of low back pain in the middle-aged and elderly community population and examine the risk factors contributing to low back pain in Saudi Arabia. The present paper is a cross-sectional study of the community living in Riyadh and the surrounding areas in Saudi Arabia. Data were collected between October 2019 and April 2020 via trained research assistants. A total of 276 participants were included in the analysis. The prevalence of low back pain was 27.9% (n = 77) among the participants included in this study. All participants reported low back pain severity with a mean of 4.35 ± 2.19 on the pain rating scale. Older age, arthritis, hypertension, anemia, osteoporosis, and a history of fractures were all associated with having LBP. Low back pain is highly prevalent in the Saudi community adult population living in Riyadh and its surrounding areas. More than a fourth of the sample reported experiencing back pain. The study outlines several modifiable risk factors (BMI, education, employment status, marital status, and smoking status) and unmodifiable risk factors (arthritis, hypertension, anemia, osteoporosis, and a history of fractures) associated with low back pain in the study sample.

Paravertebral Muscle Mechanical Properties in Patients with Axial Spondyloarthritis or Low Back Pain: A Case-Control Study

Different musculoskeletal disorders are a source of pain in the spinal region; most of them can be divided into mechanical, such as low back pain (LBP), or inflammatory origins, as is the case of axial spondyloarthritis (axSpA). Nevertheless, insufficient information is available about the muscle negative consequences of these conditions. Thus, the objective of this study was to identify whether mechanical muscle properties (MMPs) of cervical and lumbar muscles are different between patients with axSpA, subacute LBP (sLBP), and healthy controls. Furthermore, we aimed identify whether MMPs were related to sociodemographic and clinical variables in various study groups. The MMPs, sociodemographic, and clinical variables were obtained in 43 patients with axSpA, 43 subjects with sLBP, and 43 healthy controls. One-way ANOVAs and ROC curves were applied to identify whether the MMPs could differentiate between the study groups. Intra-group Pearson r coefficients to test the associations between MMPs and the rest of the variables were calculated. The results showed that axSpA subjects have a higher tone and stiffness and a lower relaxation and creep than sLBP and healthy ones (p < 0.05). All lumbar and cervical MMPs, except for decrement, could correctly classify axSpA and healthy subjects and axSpA and sLBP patients (in both cases, Area Under the Curve > 0.8). However, no MMP could differentiate between sLBP and healthy subjects. Each group had a different pattern of bivariate correlations between MMPs and sociodemographic and clinical data, with a worse state and progression of the axSpA group associated with a higher tone and stiffness in both spinal regions. This study supports that MMPs are different and show different patterns of correlations depending on the type of spinal pain.

Evaluating Inflammatory Versus Mechanical Back Pain in Individuals with Psoriatic Arthritis: A Review of the Literature

Psoriatic arthritis (PsA) is a chronic immune-mediated disease characterized by psoriatic skin and nail changes, peripheral joint inflammation, enthesitis, dactylitis, and/or axial involvement, either alone or in combination with each other. The presence of axial involvement has been shown to be a marker of PsA severity; however, there is no widely accepted definition of axial involvement in PsA (axPsA) or consensus on how or when to screen and treat patients with suspected axPsA. Chronic back pain is a prominent feature of axPsA and is thought to have a relevant role in early identification of disease. Chronic back pain can be caused by inflammatory back pain (IBP) or mechanical back pain (MBP). However, MBP can complicate recognition of IBP and delay diagnosis of axPsA. While MBP can also be associated with chronic back pain of ≥ 3 months in duration that is typical of IBP, IBP is characterized by inflammation of the sacroiliac joint and lower spine that is differentiated from MBP by key characteristic features, including insidious onset at age < 40 years, improvement with exercise but not with rest, and nighttime pain. This review discusses the differences in identification and management of IBP and MBP in patients with PsA with axPsA. The summary of available evidence highlights the importance of appropriate and timely screening, difficulties and limitations of differential diagnoses and treatment, and unmet needs in axPsA.

Comorbid pain in axial spondyloarthritis, including fibromyalgia

The main symptom in patients with axial spondyloarthritis (axSpA) is inflammatory back pain, caused principally by inflammation of the sacroiliac joints and the spine. However, not all back pain in patients with axSpA is related to active inflammation: other types of pain can occur in these patients, and may be related to structural damage (e.g. ankylosis), degenerative changes, vertebral fractures or comorbid fibromyalgia, which are not uncommon in these patients. Structural damage and ankylosis may lead to a biomechanical stress, which can lead to chronic mechanical pain; and degenerative changes of the spine may also exist in patients with axSpA also leading to mechanical pain. Osteoporosis is more prevalent in axSpA patients than in the general population, and vertebral fractures may result in acute bone pain, which can persist for several months. Fibromyalgia, which is also more prevalent in patients with chronic inflammatory diseases (including axSpA), presents with widespread pain which can mimic entheseal pain. A correct diagnosis of the origin of the pain is crucial, since treatments and management may differ considerably. Recognizing these causes of pain may be a challenge in clinical practice, especially for fibromyalgia, which can coexist with axSpA and may have a significant impact on biologic drug response.

In this review, we provide an update of the most common causes of pain other than inflammatory back pain in axSpA patients, and we discuss the latest management options for such causes.

Comparison of muscle activation imbalance following core stability or general exercises in nonspecific low back pain: a quasi-randomized controlled trial

Background

Low back pain causes changes in muscle activation patterns. Knowing how different exercises may improve altered muscle activation is useful in the treatment of patients. The aim of the study was to investigate whether there was a difference in the pattern of muscle activation in chronic nonspecific low back pain sufferers following core stability exercise (CSE) and general exercise (GE).

Methods

Fifty-six non-specific chronic LBP subjects were randomly assigned to either groups (28 participants in CSE and 28 in GE group). Both groups performed 16 sessions of an exercise program for about 5 weeks. Pain, disability and trunk muscle activation patterns (using surface electromyography) were measured at baseline and post-training.

Results

After the intervention period, antagonist coactivation ratio did not change in either groups. Though all compensated imbalance ratios (residual unequal muscular activity after cancellation of directionality) decreased towards negative (imbalance to left side) only this change for total muscles ratio in GE was significant (mean difference in GE group, 0.15; 95% CI: 0.02 to 0.28; p-value of paired t-test: 0.022); (mean difference in CSE, 0.02; 95% CI: − 0.07 to 0.11; p-value of paired t-test: 0.614).. No overall significantly decrease in uncompensated imbalance ratio (absolute imbalance values without cancellation directionality) was observed. Pain and disability decreased significantly in both groups. However, there was no difference between two groups in either of the variables after the intervention.

Conclusions

Both exercise programs reduced pain and disability and made or kept trunk muscle activation imbalance to the left side. The effects of two exercises on pain, disability and antagonist coactivation or imbalance ratios were not different.

Trial registration

This study was registered in the Iranian Clinical Trial Center with the code IRCT201111098035N1, Registered Jan 21, 2013.

Effects of pulse ultrasound and kneading massage in managing individual with incessant pain at lower region of back using random allocation

The study examined the effect of pulsed therapeutic ultrasound in management of patients with incessant pain at lower region of the back (PWIPLB) in comparison with kneading massage (KM). Fifty PWIPLB recruited purposively were randomly assigned into ultrasound group (USG) and KM group (KMG) equally. Subjects received back extension exercises as baseline treatment. USG received pulse ultrasound (PUS) while KMG was treated using KM. The treatments were administered 2 times weekly for a 6-week period. Severity of pain (SP) and inability of patient (IoP) were evaluated at baseline, 3rd week and 6th week of treatment. Values of the variables obtained were classified and the implications were summarised. A significant change was observed in precompared with posttreatment SP (F=32.6, P=0.000) and IoP (F=2.5, P<0.021) in USG. A significant change was observed in precompared with posttreatment IoP (F=4.1, P<0.05) but not in SP (F=2.9, P<0.086). In the 6th week, there was a significant reduction of SP in the USG relative to SP in the KMG (F=11.98, P=0.000), and there was improvement significantly in the IoP in the KMG relative to that in the USG (F=2.58, P=0.05). PUS may be better than KM in management of SP but KM is better than PUS in IoP with PWCPLB.

Qigong and a Tale of Two Back Complaints

Background: Chronic back pain is one of the leading causes of disability and decreased quality of life for people in both their personal and professional lives. In addition to modern medical intervention, many individuals seek relief through complementary and alternative therapies. Design: This study was designed as a retrospective descriptive review presented as two case studies. Methods: Data were collected through face-to-face interviews with two volunteer subjects of convenience who each had a medical diagnosis of chronic back pain. Intervention: Both individuals practiced a daily, standardized regimen of 24-Posture Qigong. Results: Both individuals experienced clinically significant symptomatic relief and functional benefit from their practice of qigong. Conclusion: Positive outcomes are theoretically attributed to relief of inflammation systemically and locally, reversal of sensitization and structural restorative reparation. These results provide justification for further prospective, controlled, long-term investigations.

Effect of spinal manipulative treatment on cardiovascular autonomic control in patients with acute low back pain

Background

This study aimed to quantify the effect of spinal manipulative treatment (SMT) from an analysis of baroreflex, systolic blood pressure and heart rate variability (HRV) on patients with acute back pain. It was hypothesized that SMT would increase the parasympathetic cardiovascular autonomic control.

Methods

Twenty-two patients with acute back pain were randomly divided into two groups: one receiving sham treatment (Sham) and the other receiving SMT. Recordings were completed during the first day and the seventh day, immediately before and after treatment on both days. ECG and systolic blood pressure were continuously recorded to compute cardiovascular variability and baroreflex sensitivity components. The perceived level of pain was measured with the numeric pain scale (NPS) 48 h before, just before and just after each treatment. The NPS ranged from 0 to 100% (peak of pain before treatment). ECG and systolic blood pressure recordings were analyzed in time frequency domain using the Smoothed pseudo Wigner-Ville distribution.

Results

Root mean square of the successive differences, high frequency power of the heart rate variability, and high frequency baroreflex sensitivity differences between post and pre tests were higher in the SMT group than in the Sham group (p < 0.01), whereas no differences were observed with the other heart rate variability components. Also, no differences were observed with the systolic blood pressure components. Although the estimated pain scale values decreased over time, no difference was observed between the SMT and Sham groups.

Conclusions

This seems to be the first study to assess the effect of SMT on both heart rate variability and baroreflex sensitivity in patients with acute back pain. SMT can be seen to provoke an increase in parasympathetic control known to relate to a person's healthy state. Thus, cardiovascular variability analysis may be a useful tool for clinicians to quantify and objectify the beneficial effects of spinal manipulation treatment.

Impact of Needle Diameter on Long-Term Dry Needling Treatment of Chronic Lumbar Myofascial Pain Syndrome

Supplemental digital content is available in the text.

Objective

To investigate the impact of diameter of needles on the effect of dry needling treatment of chronic lumbar myofascial pain syndrome.

Design

Forty-eight patients with chronic lumbar myofascial pain syndrome were randomly allocated to 3 groups. They received dry needling with needles of diameter 0.25 (group A), 0.5 (group B), and 0.9 mm (group C). Visual analog scale evaluation and health survey were conducted at baseline and 3 months after the treatment.

Results

Visual analog scale scores were significantly different in all groups from baseline to 3 months. Visual analog scale scores at 3 months showed differences between group C and the other 2 groups. When baseline and 3 months after treatment (0 day and 3 months) in each of the 3 groups was compared, there was a difference between group C and group B. The Short Form (36) Health Survey scores from baseline to 3 months were different within the treatment groups.

Conclusions

Visual analog scale score evaluations at 3 months showed efficacy in all groups. Results of 3 months showed that efficacy of treatment with larger needles (0.9-mm diameter) was better than that of smaller ones (0.5-mm diameter). The Short Form (36) Health Survey scores at 3 months indicated that treatments with needles of varying diameters were all effective, and when the results of 3 months were compared, there was no difference between the 3 groups.

Participation in physical activity and back pain among an elderly population in South Asia

Introduction

Globally, chronic back pain is one of the most commonly encountered medical conditions among an elderly population with significant bearings on health, functional mobility and general well-being.

Objective

To estimate the burden of chronic back pain and its association with physical activity (PA) among population aged 50 years and above in Bangladesh, India, Nepal, Pakistan and Sri Lanka.

Methods

Cross-sectional data on 8502 men and women aged 50 years and above were collected from the World Health Survey (2002). Three forms of PA were considered – vigorous physical activity (VPA), moderate physical activity (MPA) and walking. Odds ratios (ORs) of the association between self-reported back pain and VPA, MPA and walking were calculated by using generalized estimating equations.

Results

The prevalence of back pain was, respectively, 64.8%, 19.8%, 69.5%, 40.6% and 36.2% in Bangladesh, India, Nepal, Pakistan and Sri Lanka. No significant association between back pain and VPA was observed among men in any of the countries. In India, Pakistan and Sri Lanka, the odds of suffering from back pain were, respectively, 29%, 2.5 times and 59% higher among women who almost never took MPA. In India, taking MPA for few days a week and almost never was associated with, respectively, 38% (OR=1.38; 95% confidence interval [CI]=1.017–1.876) and 56% (OR=1.564; 95% CI=1.003–2.438) higher odds of reporting back pain. Walking almost never was also associated with, respectively, 83% (OR=1.829; 95% CI=1.14–2.934) and 2.9 times (OR=2.854; 95% CI=1.419–5.738) higher odds of reporting back pain among men in Nepal and Pakistan, respectively.

Conclusion

Though the relationship was not consistent across sex and countries, results indicate that inadequate or nonparticipation can substantially increase the likelihood of suffering from back pain among an elderly population in this region. Further research is needed to better understand this relationship and the potential of exercised-based strategies to prevent and treat back pain among elderly persons.

Therapeutic efficacy of Lofnac Gel via phonophoresis in the management of chronic nonspecific low back pain: A randomised controlled trial

BACKGROUND

The prevalence of nonspecific low back pain is very high among Nigerians and in Africa. Lofnac Gel is a nonsteroidal anti-inflammatory gel that has been used to treat musculoskeletal pain, but its efficacy on nonspecific low back pain is inconclusive.

OBJECTIVE

The objective of this study was to examine the therapeutic efficacy of Lofnac Gel in the management of nonspecific low back pain.

METHODS

Seventy patients diagnosed with mechanical low back pain of 3 months' duration were divided into two groups: experimental group (n = 35) and control group (n = 35). Participants in both groups were placed on supervised strengthening exercises for multifidus muscles of the low back. The experimental group was placed on ultrasound phonophoresis therapy with Lofnac Gel (with diclofenac and methyl salicylate as active ingredients), whereas the control group was placed on ultrasound with water as coupling medium. The treatment was applied twice per week for 6 weeks. Present pain intensity and disability were measured before treatment, and in the 3rd week and 6th week of treatment. Data were analysed using descriptive and inferential statistics, and post hoc analysis was carried out when necessary.

RESULTS

There was a significant difference between the pre- and posttreatment pain intensity and disability index for both the experimental (F = 17.947, p < 0.001; F = 20.712, p < 0.001) and control (F = 14.791, p < 0.001; F = 10.418, p < 0.001) groups. There was also a significant difference between the experimental and control group data in terms of pain intensity (F = 28.76, p < 0.001) and disability index (F = 39.817, p < 0.001) in the 6th week.

CONCLUSION

Exercise combined with Lofnac phonophoresis was more effective in the management of patients with chronic low back pain than exercise and ultrasound alone.

Myofascial low back pain

Low back pain is a common condition that is encountered by both primary care physicians as well as various specialists, which include: orthopedic surgeons, physical medicine and rehabilitation specialists, neurologists, rheumatologists, and pain management specialists. Associated muscular pain is very common and often a reactive response from nociception from other structures. Myofascial pain may arise, which is characterized by the presence of myofascial trigger points (MTrPs) that are located in fascia, tendons, and/or muscle. This article reviews the current evidence regarding the pathophysiology, assessment, and recommended treatment options for myofascial low back pain.

Spine injuries in dancers

Care of a dancer calls for a unique balance between athlete and artist. The physician must familiarize himself or herself with dance terminology, common moves, correct technique, and dancer's mentality. The goal is to work intimately with the dancer to care for the injury and, if possible, continue to participate in portions of dance class to limit anxiety and increase compliance to treatment. The spine is the second most injured area of the body in dancers, and many issues stem from poor technique and muscle imbalance. This often leads to hyperlordosis, spondylolysis, spondylolisthesis, lumbar facet sprain, discogenic back pain, and muscle spasm and piriformis syndrome. This article reviews these causes of low back pain with a focus on dance-related presentation and treatment issues.

Myofascial low back pain: a review

Myofascial pain syndrome is a common nonarticular local musculoskeletal pain syndrome caused by myofascial trigger points located at muscle, fascia, or tendinous insertions, affecting up to 95% of people with chronic pain disorders. Clinically, myofascial pain syndrome can present as painful restricted range of motion, stiffness, referred pain patterns, and autonomic dysfunction. The underlying cause is often related to muscular imbalances, and following a thorough physical examination the condition should be treated with a comprehensive rehabilitation program. Additional treatment options include pharmacologic, needling with or without anesthetic agents or nerve stimulation, and alternative medicine treatments such as massage or herbal medicines. Repeated trigger point injections should be avoided, and corticosteroids should not be injected into trigger points.