This study examined the effectiveness of computer-designed insoles in reducing low back pain among 58 employees whose jobs involved extensive walking. The employees were randomly assigned to use either the computer-designed insoles or placebo insoles for 5 weeks, then switched to the other insole for another 5 weeks. Those using the computer-designed insoles experienced a greater reduction in reported low back pain according to a standardized questionnaire, with average pain decreasing by 1.49 points compared to a decrease of 0.31 points for those using placebo insoles. 81% of employees preferred the computer-designed insoles as more effective and comfortable than the placebo insoles. The results suggest computer-designed insoles more effectively reduce low back pain in workers whose
1) Thirty 11-year-old girls participated in a study examining the effects of a 4-week Pilates intervention on body composition. Girls in the intervention group attended hourly Pilates classes 5 days a week while the control group engaged in normal after-school activities.
2) Results showed the intervention group had a significant reduction in BMI percentile compared to the control group. This effect was influenced by reductions in healthy girls with lower initial BMI values.
3) Girls enjoyed the Pilates classes and had high average attendance. The study suggests Pilates may be an effective way to increase physical activity and lower BMI in girls. However, larger and longer studies are still needed.
Adapted progressive isoinertial lifting evaluation for determining lifting ca...Premier Publishers
Weight of the load and its characteristics is considered to be the important risk factor for low back disorders (LBD) among manual materials handlers. Determining weight of the load and the amount of load a person can lift is important in minimizing the incidence of LBD. Among various methods like isometric, isoinertial and isokinetic, isoinertial approach of lifting evaluation is best as it is safe, inexpensive, simple and dynamically represents real world lifting. The objective of this study was to evaluate the feasibility of adapted progressive isoinertial lifting evaluation (PILE) for determining maximum acceptable weight of lift (MAWL). This experimental study was conducted among 30 adult male participants recruited from a university community. Adaptation was done to the box dimensions and the weights used for PILE. The subjects were instructed to perform the PILE protocol using adapted box and weights using free lifting technique at two vertical distances and lifting capacity was determined. Heart rate was monitored throughout the trial and the participants were asked to rate their discomfort in a six point likert scale. All the participants were comfortable in performing adapted PILE and no untoward incident was noticed during the procedure. It may be feasible to adapt PILE for determining lifting capacity.
Assessing the Relationship between Body Composition and Spinal Curvatures in ...peertechzpublication
This study investigated the relationship between body composition and spinal curvatures in young adults. Body composition analysis was performed on 67 participants to determine ratios of total fat, body fat, visceral fat, and total muscle. Spinal curvatures of the thoracic and lumbar regions were also measured. The results showed a significant positive correlation between total fat ratio and lumbar lordosis, as well as between visceral fat ratio and lumbar lordosis. Thoracic kyphosis was positively correlated with total fat ratio and visceral fat ratio. Total muscle ratio showed a negative correlation with lumbar lordosis and thoracic kyphosis. The study suggests that increased fat ratios and decreased muscle ratios can shift spinal alignment in a way that may negatively impact
Goodwin efetividade da fisio supervisionada num período precGustavo Resek Borges
This randomized controlled trial evaluated the effectiveness of supervised physical therapy plus a home program versus a home program alone for 84 patients who underwent arthroscopic partial meniscectomy. Patients were randomly assigned to receive either 6 weeks of supervised physical therapy plus a home program or just a home program. Outcome measures were collected at 5 and 50 days post-surgery and found no differences between the groups, indicating that the supervised physical therapy used in this study provided no additional benefits in the early period after uncomplicated arthroscopic partial meniscectomy compared to a home program alone.
This systematic review and meta-analysis evaluated the efficacy of patellar taping for patellofemoral pain (PFP) and identified potential biomechanical mechanisms. The review included 20 studies on the effects of various taping techniques on pain and lower limb biomechanics in individuals with PFP. The main findings were: 1) Tailored (customized) patellar taping provided immediate large reductions in pain, while untailored taping provided small reductions; 2) Tailored taping was associated with earlier onset of vastus medialis oblique muscle contraction; 3) Limited evidence suggested tailored taping combined with exercise provided superior pain relief compared to exercise alone at 4 weeks. The review concluded tailored taping application is important
This systematic review analyzed 12 controlled trials that compared the effects of different insoles on postural balance. The insoles studied included vibrating insoles, textured insoles, insoles with different densities, and insoles with wedges or sensors. Most studies found that the insoles improved postural balance and reduced sway, especially in the anteroposterior direction. Textured insoles and vibrating insoles showed benefits by increasing sensory input from the feet. While insole rigidity did not influence balance, soft gel insoles and insoles with spikes were found to improve postural control. The review concluded that insoles can provide benefits that favor better postural balance and control.
This study evaluated the effectiveness of a Global Postural Reeducation (GPR) program compared to a Stabilization Exercise (SE) program for patients with persistent low back pain. 100 patients were assigned to either the GPR group or SE group. Outcome measures including disability questionnaires and pain/mobility scales were measured at baseline and 3 and 6 month follow-ups. Results showed significantly greater improvements in all outcome measures in the GPR group compared to the SE group at both short-term and mid-term follow-ups. The GPR intervention was found to be more effective for reducing pain and disability in patients with persistent low back pain.
Objective: To assess the effect of a kinesitherapeutic
program of special exercises for treatment of pain intensity and
endurance of the extensor trunk muscles in patients with
chronic lumbalgy.
Methods: The study included 110 patients with chronic
lumbalgy, equally distributed in two treatment groups.
Participants in the experimental group performed the
recommended special exercises 3 times a week at home, while
those in the control group only followed the guidelines of a
physician. At the beginning of the study and 12 months later,
the pain intensity of all the participants was assessed by means
of Visual Analog Scale.
Results: In contrast to the participants in the control
group, those in the experimental group at the end of observation
were reported to experience a significant reduction in pain
intensity.
Conclusions: Treatment with specific exercises proved
more effective in terms of pain complaints in patients with
chronic lumbalgy.
Effects of Strength Training in Multiple sclerosis patientsDaniel Yazbek
1) A systematic review of 4 randomized controlled trials investigating the effects of progressive resistance training (PRT) in patients with multiple sclerosis found that PRT can improve muscle strength and size.
2) Meta-analysis of the 3 studies measuring leg strength showed a significant mean increase in strength for patients undergoing PRT compared to controls.
3) While the studies had some limitations, overall they provide evidence that PRT can provide health benefits for MS patients and help increase muscle strength and size. Larger and higher quality studies are still needed.
This study examined whether early improvement in neck function predicted overall response to a cervical strengthening program for chronic neck pain. 214 patients completed a 3-week strengthening program and were assessed for changes in neck disability index (NDI) scores. Patients with a positive change in NDI scores after 3 weeks had a 25 times greater odds of overall improvement. Early improvement likely reflects motor skill acquisition rather than muscle hypertrophy. While early responders saw small additional gains, continued strengthening may provide further benefits like reduced muscle co-activation.
Chronic administration of the novel hydrogel Gelesis100 at a dose of 2.25 g twice daily significantly decreased body weight in overweight and obese subjects over 12 weeks compared to placebo. Weight loss was especially pronounced in subjects with impaired fasting glucose at baseline. Gelesis100 was well tolerated with few gastrointestinal side effects. The hydrogel works by expanding in the stomach and intestines to increase feelings of fullness without calories. It has potential as a safe and effective weight loss treatment, especially for those with prediabetes.
This document summarizes a study that compares two surgical approaches for total hip arthroplasty - the conventional lateral Hardinge approach and an intermuscular Hardinge approach. The study evaluated 28 patients who underwent unilateral hip replacement via one of the two approaches. Outcomes were assessed using Trendelenburg sign, plantar pressure distribution via pedobarography, and Harris Hip Scores pre-and post-operatively. The study found that both approaches led to increased total contact time and contact areas on the operated side post-surgery compared to pre-surgery. Harris Hip scores also improved significantly for both groups following the operation. The document provides details on the study methodology, surgical procedures, and analysis of results.
The effect of hot intermittent cupping on pain, stiffness and disability of p...LucyPi1
Abstract Objective: The aim of this study was to investigate the effect of hot intermittent cupping on pain, stiffness and inability of patients with knee osteoarthritis (KO). Methods: The present study was a clinical trial, which was performed on 38 patients with KO referring to Gonabad Rheumatology Specialty Clinic. Based on permutation block method, the research units were divided into cupping therapy and control groups. For the cupping therapy group, four sessions of cupping therapy were performed every four days. To collect data, the form of demographic information, Visual Analogue Scale (VAS) and the Western Ontario and McMaster (WOMAC) osteoarthritis scale were used, and the data were analyzed by SPSS software v. 16 using descriptive statistics and independent t-test, paired t-test, Chi-square test and Fishers exact test with a significance level of P < 0.05. Results: Findings showed that there was no significant difference between the cupping therapy and control groups in terms of demographic characteristics and they were homogeneous. Findings indicated that, based on VAS, the mean pain intensity in the left (P < 0.001) and the right knees (P < 0.001), as well as based on WOMAC, stiffness (P = 0.006), pain intensity (P < 0.001) and disability (P < 0.001) in the cupping therapy group significantly decreased compared to the control group. Conclusion: Findings showed that hot intermittent cupping therapy reduced the pain intensity, stiffness and disability in patients with KO.
This document summarizes and compares different models of back schools for treating chronic low back pain. It discusses the original Swedish back school model and how various programs have modified the content, format, and length. Several recent randomized controlled trials that compared different back school models to other treatments are highlighted. The studies found that back schools based on biopsychosocial principles led to better long-term outcomes than traditional models. Spinal manipulation was also found to result in lower disability scores compared to back school or individual physiotherapy. Overall, back schools may be considered as part of multidisciplinary treatment, though more research is still needed.
Recent advances in Manipulative MedicineSoniya Lohana
What new techniques are been used in manipulative medicine and physical therapy that help the patients to recover better and address their condition by various approaches where surgery is not required.
Landmark guided high volume steroid injections combined with stretching exercises were found to be effective in treating frozen shoulder in a community-based musculoskeletal clinic. 90 patients diagnosed with frozen shoulder received injections of triamcinolone and marcaine into the glenohumeral joint using a posterior approach, along with instructions for home stretching exercises. Only 3.3% of patients required further orthopaedic management, indicating this treatment can be recommended before considering secondary care interventions for most frozen shoulder patients.
This document summarizes a network meta-analysis of randomized controlled trials examining the effectiveness of exercise interventions for lower limb osteoarthritis. The analysis included 60 RCTs with 8,218 patients. It found that exercise programs combining strengthening, flexibility, and aerobic exercises were most effective at improving pain and physical function outcomes. The analysis provides evidence that a structured exercise program targeting multiple domains is the best exercise option clinicians can recommend to patients for treating lower limb osteoarthritis.
Case study on lowback pain using Physioball, yoga And Dietry Measures.iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study evaluated the ability of rasterstereography to detect changes in posture induced by different neuromuscular stimulation techniques and proprioceptive insoles. 27 healthy volunteers underwent rasterstereography to measure 14 posture parameters under 6 test conditions: normal stance, foot elevation, foot exercises, loose jaw, biting, and wearing proprioceptive insoles. Rasterstereography measurements had low variability. Several posture parameters showed significant changes between test conditions, indicating that neuromuscular stimulation and insoles induce detectable postural shifts. Proprioceptive insoles specifically altered lateral spine deviation, demonstrating rasterstereography's sensitivity to subtle posture variations.
Este estudo comparou os efeitos do uso de palmilhas customizadas e pré-fabricadas em trabalhadoras que permaneciam em posição estática por longos períodos. Ambas as palmilhas reduziram os níveis de dor nos pés e coluna lombar após oito semanas, porém aumentaram a pressão máxima e média nos pés. Não houve diferença significativa entre os grupos nos dados de pressão plantar ou nos níveis de dor.
O documento discute os diferentes tipos de pés e suas implicações posturais. Resume os quatro tipos de pés: causativo, adaptativo, misto e duplo componente. Descreve como anomalias podais como pé plano valgo, pé cavo varo e pés assimétricos podem afetar a postura.
Este documento descreve diferentes tipos de palmilhas e seus usos. Ele lista palmilhas termo-moldáveis, esportivas e de conforto, bem como diferentes tipos de tamanhos de palmilha como inteira e infracapital. Também descreve vários elementos de palmilha como abdutores, barras, botões e talonetas e suas funções de estimulação muscular, rotação, alinhamento e conforto.
O documento descreve o Pé Torto Congênito, definindo-o como uma deformidade dos ossos, nervos, vasos sanguíneos e tendões que pode estar associada a síndromes congênitas. Apresenta as classificações, sintomas, diagnóstico e tratamentos possíveis, incluindo conservador com gesso seriado e cirúrgico.
Este documento trata sobre posturología. Explica que la posturología no se trata solo de férulas o plantillas, sino que es una filosofía diagnóstica basada en anatomía, fisiología y fisiopatología, con el objetivo de realizar un diagnóstico holístico del individuo. También describe algunos conceptos posturales como cifosis, lorosis y patología de los receptores, así como pruebas como el test de Fukuda y el test de cobertura. El autor explica que la posturología se enfoca en la
O documento fornece um resumo da história da podologia, desde os tempos antigos no Egito e Roma até os dias atuais. Aborda os principais conceitos da podologia como profissão e ciência, incluindo as funções do pé e os problemas tratados por podologistas. Também discute a importância da anamnese no diagnóstico médico.
Analysis of Spinal Decompression via Surgical Methods and Traction TherapyPaige Barrett
This document summarizes various surgical and non-surgical methods for spinal decompression to treat back pain. For surgical decompression of the cervical spine, early surgery (<24 hrs) after spinal cord injury produces better outcomes than delayed surgery. Circumferential decompression and fusion is effective for cervical myelopathy. In the thoracic spine, posterior decompression with instrumented fusion improves neurological functioning for thoracic myelopathy. Video-assisted thoracoscopic surgery and percutaneous laser disc decompression are suitable minimally invasive options for the thoracic spine. For the lumbar spine, indirect decompression using an interbody cage is effective for degenerative lumbar stenosis, while decompression without fusion significantly decreases leg pain and disability. Minimally invasive
This study compared the effects of a clinical physical therapy program versus a home-based physical therapy program for female patients with knee osteoarthritis. The clinical program included manual therapy, supervised exercises, and electroacupuncture, while the home program included only exercises. Both programs improved knee function and reduced pain and stiffness, but the clinical program produced greater improvements in range of motion, pain reduction, and physical function compared to the home program. The study concluded that both programs were effective for osteoarthritis, but a clinical program provided better outcomes while a home program could still provide benefits and reduce costs.
The document presents a study on the effectiveness of home-based exercise intervention on osteoarthritis among old age people. The objectives are to assess and compare joint pain levels before and after the intervention in experimental and control groups, and to examine the association between pain levels and demographic variables. The study will involve 60 subjects, 30 in the experimental group receiving home exercises and 30 controls. Outcomes will be measured using a pain scale. Results will be analyzed using t-tests, frequencies, percentages, and chi-square to evaluate the effectiveness of the home exercises in reducing joint pain for older adults with osteoarthritis.
This study examined determinants of intention to continue using a lumbar support among home care workers with recurrent low back pain. The strongest predictor of intention was positive attitude towards lumbar supports, explaining 41% of the variance. A positive attitude indicated that perceived benefits of lumbar supports, such as pain relief, outweighed discomfort of use. Social support and self-efficacy were less influential on intention. Overall, intention to continue lumbar support use was primarily driven by workers' positive evaluation of the device's ability to manage their low back pain.
The prevalence and correlates of low back pain in adultsYounis I Munshi
This study examined the prevalence and correlates of low back pain in adults in Southern India. A total of 804 adults (401 men and 403 women) aged 20 years and older participated in the study. The key findings were:
1. The overall prevalence of low back pain was 40.7%, with the prevalence being higher in women (52.9%) compared to men (28.4%).
2. Height, weight, waist circumference, waist-hip ratio, and BMI were not associated with low back pain in both men and women.
3. In women, those who had undergone caesarean sections or sterilization were more likely to experience low back pain.
4. Both men and women
This document provides a literature review on work overload and the development of low back pain among nurses. The review finds that the prevalence of low back pain among nurses, especially ICU nurses, is very high, ranging from 70-90%. Key risk factors identified include long standing hours, heavy workload, patient handling duties, and shift work. Several studies conclude that occupational bending, twisting, and patient handling tasks increase the risk of developing low back pain. Improving nurse staffing and reducing shift work may help decrease the prevalence of low back pain among nurses.
Effect of stretching with and without muscle strenghening exercise for the fo...JuanMa Cor San
This randomized controlled trial compared the effects of three treatment protocols for plantar fasciitis over eight weeks: 1) stretching alone, 2) foot muscle strengthening exercises, and 3) foot and hip muscle strengthening exercises. Outcomes included pain, function, and balance. All three groups experienced improvements in pain, function, and dynamic stability, with no significant differences between groups. The study found that stretching alone was as effective as adding muscle strengthening exercises for treating plantar fasciitis symptoms over the short term.
This document contains summaries of 4 research studies:
1. A randomized controlled trial that found suprascapular nerve blocks were no more effective than saline injections for treating subacute adhesive capsulitis.
2. A study that found intra-articular injections of hyaluronic acid plus dextrose for knee osteoarthritis resulted in greater improvements in physical function and pain reduction compared to hyaluronic acid plus saline.
3. A randomized controlled trial that demonstrated alendronate effectively prevented bone loss in the hip in men during the first year after a traumatic spinal cord injury.
4. A study that found patients with acquired brain injuries who had contractures required more intensive rehabilitation therapy, longer
paper regarding implementation of shakers exercise for impaired swallowing patients and compare pre , immediate and post implementation of the exercises
Prevalence of musculo skeletal disorders among nurses in osun state, nigeriaAlexander Decker
This study aimed to determine the prevalence of musculoskeletal disorders among nurses in two teaching hospitals in Osun State, Nigeria. A questionnaire was administered to 138 nurses. The results showed:
1) The most common musculoskeletal disorder was lower back pain, affecting 70.3% of nurses.
2) Musculoskeletal disorders were highly prevalent in nurses aged 26-31 years (100%) and those working in theaters (100%) and medical wards (100%).
3) More nurses experienced musculoskeletal disorders after working hours (45.7%) and those working more than 40 hours per week (90.4%).
1) Many physical factors are associated with increased risk of low back pain, including heavy physical strain, frequent lifting, whole-body vibration, prolonged sitting or standing, and bending and twisting.
2) Occupational factors like heavy physical labor, driving vehicles that experience vibration, and jobs requiring static postures are linked to higher prevalence of low back pain.
3) Psychosocial work factors such as low job satisfaction, poor employee relations, and high job demands may also contribute to increased risk and persistence of low back pain.
This document summarizes several sources on the use of kinesiology taping. The sources discuss research that has found kinesiology taping can reduce pain from contractions and lymphedema in breast cancer patients. Additional research discussed found that kinesiology taping can improve joint position sense after muscle fatigue and help recovery from occupational wrist disorders in physical therapists. One source discussed a study that found kinesiology taping decreased upper back pain in female sedentary workers with rounded shoulder posture. Another source described a randomized controlled trial that found a mixed kinesiology taping-compression technique reduced venous symptoms, pain, and clinical severity in postmenopausal women with chronic venous insufficiency.
This randomized controlled trial evaluated the effectiveness of Pilates for chronic low back pain. Sixty patients were randomly assigned to an experimental group that received Pilates twice a week for 90 days in addition to medication, or a control group that received only medication. Outcomes including pain, function, quality of life, medication use, and flexibility were measured at baseline and 45, 90, and 180 days. The Pilates group had significantly greater improvements in pain, function, and some quality of life domains compared to the control group. The Pilates group also used less pain medication. This study provides evidence that Pilates can improve pain and function for patients with chronic low back pain.
This randomized controlled trial investigated the effectiveness of pulsatile dry cupping therapy compared to no intervention for knee osteoarthritis. 40 patients were randomly assigned to receive either 8 cupping sessions over 4 weeks or no treatment. Outcome measures including pain, stiffness, physical function, and quality of life were assessed at 4 and 12 weeks. At 4 weeks, cupping resulted in significantly greater improvements in pain, physical function, and quality of life scores compared to the control group. Many benefits were still present at 12 weeks, though some scores were no longer significantly different. The study provides preliminary evidence that cupping may be an effective treatment for relieving symptoms of knee osteoarthritis.
This study examined pain, physical activity, and disability in 32 individuals with late effects of polio. The key findings were:
- More than 50% experienced pain every day, mostly during physical activity, with a mean daily pain intensity of 55mm on a 100mm visual analogue scale. Cramping pain was most common in the lower limbs.
- Degree of muscle weakness did not correlate with pain experience. Spontaneous and maximal walking speeds were similar, indicating a high level of pain.
- All six dimensions of the Nottingham Health Profile questionnaire (energy, pain, physical mobility, sleep, emotional reactions, and social isolation) were affected, with pain and physical mobility strongly correlating with low energy.
Long-Term Effect of Exercise Therapyand Patient Education on.docxwkyra78
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T.
Long-Term Effect of Exercise Therapyand Patient Education on.docxcroysierkathey
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T ...
Long-Term Effect of Exercise Therapyand Patient Education on.docx
Palmilhas e dor lombar
1. S. Shabat
T. Gefen
M. Nyska
Y. Folman
R. Gepstein
The effect of insoles on the incidence and
severity of low back pain among workers
whose job involves long-distance walking
Received: 26 June 2004
Accepted: 16 September 2004
Published online: 25 January 2005
Ó Springer-Verlag 2005
Abstract The prevalence and inci-
dence of low back pain in general
society is high. Workers whose job
involves walking long distances have
an even higher tendency to suffer
from low back pain. A positive effect
of insoles in reducing low back pain
was found in professional sports
players. This was not examined on
people whose job involves walking
long distances. In this double blind
prospective study we examined the
effectiveness of insoles constructed in
a computerized method to placebo
insoles in 58 employees whose work
entailed extensive walking and who
suffered from low back pain. The
evaluation was performed by the
MILLION questionnaire, which is
considered as a valid questionnaire
for evaluation of low back pain. We
calculated the differences of the pain
intensity before and after the inter-
vention, in the employees using the
insoles manufactured by computer in
comparison to the users of the pla-
cebo insoles. In each group, the
analysis was performed in compari-
son to the baseline. A total of 81% of
the employees preferred the real in-
soles as effective and comfortable in
comparison to 19% of the users of the
placebo insoles (P<0.05). The results
of this study indicate a substantial
improvement in the low back pain
after the use of the true insoles. The
average pain intensity according to
the MILLION questionnaire before
the use of the insoles was 5.46. How-
ever, after the use of the real insoles
and the placebo insoles, the average
pain intensity decreased to 3.96 and
5.11, respectively. The difference of
the average pain intensity at the start
of the study and after the use of the
real insoles was significant: )1.49
(P=0.0001), whereas this difference
after the use of the placebo insoles
was not significant: )0.31
(P=0.1189). The reported severity of
pain also decreased significantly: a
level 5 pain and above was reported
by 77% of the subjects at the start of
the study. After the use of the real
insoles only 37.9% of the subjects
reported a similar degree of pain
severity, and 50% of the subjects did
so after the use of the placebo insoles
(P< 0.05). We did not find a link
between low back pain and other
variables such as gender, age, number
of offspring, work seniority, smoking,
previous use of insoles and previous
medication. This study demonstrates
that the low back pain decreased sig-
nificantly after the use of real insoles
compared to placebo ones.
Keywords Low back pain Æ Work-
ers Æ Insoles Æ Long distance walking
Eur Spine J (2005) 14: 546–550
DOI 10.1007/s00586-004-0824-z ORIGINAL ARTICLE
S. Shabat Æ T. Gefen Æ M. Nyska
R. Gepstein
The Orthopaedic Surgery Department,
Spine Unit, Sapir Medical Center,
Tel-Aviv Sackler Medical School,
Kfar-Saba, Israel
Y. Folman
Department of Orthopaedic Surgery,
Hillel-Yafe Medical Center,
Hadera, Israel
S. Shabat (&)
The Orthopaedic Surgery Department,
Spine Unit, Sapir Medical Center,
Tel-Aviv Sackler Medical School, 48
Tchernichovsky Street,
Kfar-Saba, 44281, Israel
E-mail: drshabat@hotmail.com
Tel.: +972-9-7472549
Fax: +972-9-7410596
2. Introduction
The prevalence of low back pain in the general pop-
ulation is estimated to be between 60 and 80% [28].
Low back pain is considered to be the second com-
plaint of patients arriving to their primary care phy-
sician, only following upper respiratory tract infection
[7], and is one of the most common causes that every
occupational physician faces each day in his/her daily
practice [8]. The prevalence of low back pain is 25
times higher in the industrial countries [11], and it is
common during the second and fifth decades, which
means it creates a heavy financial burden on society
[28].
One of the common causes for low back pain is
walking long distances [5, 18]. This is common in some
professional workers such as post-office deliverers, nur-
ses, etc. It is assumed that there is a connection between
the anatomical shape of the foot and foot pain or low
back pain during walking. There is a physiological
connection between the feet and the back muscles. The
thoracolumbar fascia is a very important link between
these two structures, and it transmits the loads from
the upper extremities, to the back, and from the back to
the lower extremities and the ground [29]. Therefore, the
assumption is that unbalanced pressure over the feet will
cause low back pain due to a compensatory spasm on
the quadratus lumborum muscles. This assumption was
not validated so far.
Insoles have been used for many years. They make
the person feel more comfortable [2]. This phenomenon
is achieved by decrease in the point pressure by 30–50%
(depends on the material the insole is made of) [16]. It
was also proven by electromyographic studies that in-
soles decrease the fatigability in the back muscles [14, 19,
27].
Not many studies have looked into the agronomic
physiological aspects of insoles [4, 9, 12, 13, 20, 24].
Brown and co-workers concluded that more research is
needed to explain the clinical success in using insoles
[20].
The Foot Support Anterior Posterior (FSAP)
(TekScan, Inc., Boston, Mass., USA) is one of the
methods to make insoles. This is a computerized
method, which shows an individual map of the foot
with the various pressure points, and therefore enables
to make insoles with maximal support to the foot.
This method was used for searching pressure points in
diabetic patients in order to prevent chronic ulcers
[22]. After a comprehensive search in Medline, we
found only one study that examined the relation
between the use of insoles to low back pain during
long distance walking in military recruits [15]. The
purpose of this work was to examine if such a con-
nection exists.
Materials and methods
A total of 105 postmen whose job includes walking long
distances (walking for many hours a day) were asked if
they suffered from low back pain. Of these 105 persons,
75 (71.4%) answered that they did. Out of these 75
(80%), 60 persons agreed to participate in this pro-
spective double-blind study. The feet of these 60 subjects
were fitted before the beginning of this study for the
insoles, and after randomization they received, either a
true FSAP insole or a placebo insole for 5 weeks, and
then it was switched to the other insole for the next 5
weeks. Either the true or the placebo insoles were made
from a commercially available and widely used visco-
elastic polymeric material for shoe inserts (Sorbothane,
Sorbothane Inc., Kent, Ohio, USA). Both the caregiver
and the subjects were blinded and both shoe insoles
looked the same when used. The participants were per-
mitted to put the insoles during work time, or non-work
time (including home use).
Demographical parameters which included age, sex,
marital status, smoking habits, height and weight,
number of years at work and number of children were
recorded. Each patient filled a MILLION questionnaire
[21] to assess his/her back pain intensity before receiving
insoles and after each period of using either the true or
placebo insoles. The questionnaire was distributed and
collected by another person not connected with this
study. This questionnaire is widely used in the spine
literature for assessing the changes in the back pain after
a certain procedure or treatment and is considered as
valid [3, 21]. In addition, each patient filled a question-
naire after each period with questions regarding the use
of insoles, timing of pain in relation to walking distance,
feeling of being tired after work and if at all so and
preference for one of the insoles.
Statistical analysis was done using the SAS statistical
program. Due to a normal distribution we used the
Student’s t-test. A P value of less than 0.05 was con-
sidered as statistically significant.
Results
A total of 60 patients (25 men and 35 women) agreed to
participate in this study. In the first round, 41 patients
received the true insoles (FSAP) and 19 received the
placebo. After the first period of 5 weeks, two patients
(one from each group) dropped from the study. One
patient from the true insoles group was hospitalized for
a non-related reason, and another patient from the
placebo group refused to continue in the study because
the insoles were inconvenient for him. Therefore, in the
second round 40 patients received placebo insoles and 18
547
3. patients received true insoles. A comparison between the
groups in terms of the demographical parameters did
not reveal statistical difference in any of the examined
parameters (P>0.05) (Table 1).
A constant use with the insoles was reported by 49
patients (84.5%) from the true insole group and by 45
(77.6%) of the placebo group. Of these patients, four
(6.9%) and six (10.3%), respectively, reported that they
used it often, while five patients from each group (8.6%)
reported only part-time use. Two patients from the
placebo group (3.5%) did not use it at all.
The frequency of low back pain that was found in
relation to the type of insole is presented in Table 2. This
frequency was found to be lower after the use of true
insoles relative to placebo (P<0.05). A total of 54 pa-
tients (93.1%) from the true insoles group and 46
(79.3%) from the placebo group would have liked to
continue with the use of the insole (P>0.05). However,
47 patients out of the 58 (81%) would have preferred the
true insole (P<0.05). This shows that the patients were
satisfied with both insoles including the placebo (placebo
effect), but were much satisfied with the true insoles.
The average back pain according to MILLION was
5.46±1.8 before the study, 3.96±1.74 after the use of
the FSAP insoles and 5.11±1.85 after use with the
placebo insoles (P<0.05). This led us to examine if there
is an influence on the results according to the first insole
that was used by the patients. Such an influence was not
found (Table 3).
Discussion
The relation between insoles, feet pain and low back
pain was examined mainly on professional sports players
[4, 9, 12, 16, 20] and on people whose their job involves a
lot of standing [2, 19, 27]. In the latter, it was found that
74% of the examinees found the insoles to be comfort-
able and reported decrease in their feet and lower back
pain [2]. However, none of these papers examined the
relation between insoles and low back pain in patients
whose job includes walking long distances. Only one
study examined the relation between insoles and low
back pain in military conscripts who are supposed to
walk relatively long distances and found a positive
relation between the use of insoles to reduction of low
back pain [15].
There is evidence that the frequency and severity of
low back pain is related to heavy loading of the spine [1,
25, 26]. It was also shown that walking, a regular daily
activity produces heavier loads on the lumbar spine [6].
This increase in the loads is transferred from the foot
during heel strike to the lower extremity and then to the
spine.
The most crucial factor for the development of shock
wave related injuries is not the absolute value of the
force at heel strike but the loading rate [23]. Our study
group consisted of postmen who used to walk regularly
for long distances each day, which means a high loading
rate. In this group of examinees, we could have antici-
pated a high rate of low back pain. The fact that the
insoles reduced the low back pain rate proves its po-
tential to absorb some of the force, which is generated
by repetitive walking. Windle and co-workers have
shown that the insoles placed in shoes would attenuate
the peak pressure at heel strike during running and
marching compared to a ‘‘no insole’’ condition [30]. A
decrease in the shock-wave amplitude transferred to the
tibia in subjects who had insoles was reported by Light
et al. [17]. This decreased load, which in turn transfers
less energy towards the upper part of the lower extremity
and the lumbar spine, is probably the cause for the de-
crease in low back pain.
This study was designed as a double blind study. To
our knowledge, this is the only study reported in this
subject which utilizes a double-blind technique. This is
Table 1 Demographic data of
the 60 patients
a
Total—58
b
Eighteen subjects, 9 females, 9
males
c
Forty subjects, 24 females, 16
males
Parameters Mean±SDa
Mean±SDb
,
placebo first use
Mean±SDc
,
true first use
P-value
Age (years) 39.14 37.8± 9.07 39.7±7.67 0.415
Weight (Kg) 69.74 69.2±10.6 70.0±12.1 0.494
Height (cm) 167.98 166.8±7.7 168.5±8.9 0.821
BMI (kg/cm2
) 24.67 24.8±2.8 24.6±3.6 0.857
No. of children 2.21 1.66±1.8 2.45±1.8 0.123
No. of years at work 8.59 8.3±6.7 8.7±6.6 0.847
Shoe size 40.71 40.5±2.3 40.8±2.6 0.675
Table 2 Frequency of low back pain according to type of insole
(MILLION questionnaire). M0 ‘‘Basic’’ Million questionnaire
(before enrollment), M1 million questionnaire after use of true
insoles, M2 million questionnaire after use of placebo insoles
Frequency of LBP M0 M1 M2
Never 0 (0%) 6 (10.3%) 2 (3.4%)
Seldom 15 (25.9%) 34 (58.6%) 26 (44.8%)
Often 37 (63.8%) 15 (25.9%) 24 (41.4%)
Every day 6 (10.3%) 3 (5.2%) 6 (10.3%)
Total 58 (100%) 58 (100%) 58 (100%)
548
4. superior to other methodologies which do not use dou-
ble blind techniques.
In this study, it was shown that the patients reported a
greater reduction in their low pain when used the true
insoles, in comparison to the period that they used the
placebo insoles. It was found that the contribution of the
true insoles to the improvement in the low back pain, after
reducing the placebo effect, is 79.2%. We did not find any
correlation between improvement of low back pain to
other measured criteria such as age, sex and marital status.
Evaluation of back pain is a subjective evaluation.
For this evaluation we used the MILLION question-
naire that was proven to be valid in this subject [3, 21].
This work also contributes to the validity of this ques-
tionnaire as there was a good correlation between the
different times that the subjects filled out this question-
naire, in terms of their low back pain.
Reduction in pain intensity by about 2 points in a 10-
point scale, or more than 30%, has been reported to
represent a clinically important difference in pain be-
tween treatments [10]. In our study we found this
reduction in the patients when they used the true insoles
and not when they used the placebo.
In conclusion, it was proven that insoles causes
improvement of low back pain for subjects with repeti-
tive loading such as walking long distances every day.
Table 3 The efficiency of the insoles (according to MILLION questionnaire). P–T placebo insoles were used prior to the true, T–P true
insoles were used prior to the placebo
Questionnaire Delta D P–T (18 patients) P value T–P (40 patients) P value
M1–M2 Between true insoles and placebo )1.30 0.0008 )1.16 0.0001
M1–M0 Between use of true insoles to ‘‘basic’’ MILLION )1.91 0.0001 )1.31 0.0001
M2–M0 Between use of placebo insoles to ‘‘basic’’ MILLION 0.61 0.146 )0.17 0.4443
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