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The majority of non-specific low back pain has a favourable evolution within a short period of time but in some cases the pain becomes persistent or recurrent. These chronic forms are responsible for most of the social and economic burden of low back pain. The crucial role of psycho-social factors in the chronicisation of low back pain justifies a thorough bio-psycho-social assessment. An active semi-intensive ambulatory multidisciplinary programme (Spine Unit Center) that complies with international and national recommendations (KCE and INAMI) has demonstrated its effectiveness in chronic low back pain in terms of algo-functional, physical and psycho-social components. In contrast to intensive programmes requiring hospitalisation, this outpatient treatment allows the patient to remain in his/her social and professional network. The active participation and motivation of the patient are essential for the success of the treatment. The multidisciplinary team will help the patient to define his/her functional objectives and to manage, via the psychologist, emotional aspects. The programme includes therapeutic education and physical reconditioning sessions including progressive aerobic training, group exercises, and individualised and progressive strengthening of the trunk muscles. The introduction of physical activity at home will be encouraged in order to sustain the changes in the patient's behaviour.

Background: Resisted training of the trunk muscles improves outcomes in chronic low back pain (CLBP). The Itensic b-effect machine was designed to provide resisted training through posterior translation of the pelvis in a seated, forward-tilted position, in contrast with traditional machines that involve extension of the trunk., Objective: To study the effectiveness of lumbopelvic training on the Itensic b-effect machine in individuals with CLBP., Methods: Participants were allocated to 4 weeks of either progressive Itensic (I) training in addition to an education/exercise (EE) program (I+EE group, n= 23) or the education/exercise program alone (EE group, n= 22)., Primary Outcome: Roland Morris Disability Questionnaire (RMDQ)., Secondary Outcomes: pain (0-10 numeric rating scale), trunk extensor endurance (Sorensen test), motor control (thoraco-lumbar dissociation test) and mobility (finger-to-floor test)., Results: RMDQ score improved more in the I+EE group than in the EE group (with a between-group difference at the pos-test). Pain and mobility improved in the I+EE group only, motor control improved in both groups with no between-group difference and the Sorensen test did not improve significantly in either group., Conclusions: Resisted posterior pelvic translation using the Itensic machine in addition to an education/exercise program improved disability, pain and mobility more than the education/exercise program alone.

Objectives: to investigate the questionnaires used in French-speaking Belgian spine multidisciplinary rehabilitation centers for patients with low back pain and to propose a minimal core set of questionnaires based on the results of our survey and on the (inter)national guidelines., Methods: the spine centers offering the 36 two-hour sessions defined by the Belgian national Institute for Health and disability insurance were invited to provide their battery of questionnaires., Results: among the 37 identified and contacted centers, 21 participated in our survey. Results pointed out the use of questionnaires assessing pain intensity, disability, anxiety/depression and kinesiophobia in most centers as well as a huge heterogeneity regarding the questionnaires (and even the version of the questionnaire) reported and the non-systematic use of questionnaires recommended by the guidelines., Conclusion: taking into account the results of this survey, the present article proposes a minimal core set of questionnaires meeting the guidelines, which would make it possible to harmonize the assessments in the different centers and would facilitate the realization of multicenter studies.

This study aimed to investigate the relationship between the history of low back pain and quality of lumbopelvic motor control in soccer players. Forty-three male elite soccer players (mean age, 18.2 ± 1.4 years) filled in questionnaires related to low back pain and attended a session to assess lumbopelvic motor control by means of five tests (the bent knee fall out test, the knee lift abdominal test, the sitting knee extension test, the waiter's bow and the transversus abdominis test). A physiotherapist, blinded to the medical history of the participants, scored (0 = failed, 1 = correct) the performance of the players for each of the tests resulting in a lumbopelvic motor control score ranging from 0 to 5. Forty-seven per cent of the soccer players reported a disabling low back pain episode lasting at least two consecutive days in the previous year. These players scored worse lumbopelvic motor control than players without a history of low back pain (lumbopelvic motor control score of 1.8 vs. 3.3, P < 0.01). The between-groups difference was particularly marked for the bent knee fall out test, the knee lift abdominal test and the transversus abdominis test (P < 0.01). In conclusion, most soccer players with a history of low back pain had an altered lumbopelvic motor control. Further research should examine whether lumbopelvic motor control is etiologically involved in low back pain episodes in soccer players.

Aim: The aim of this study was to compare tennis players with and without low back pain (LBP) and healthy sedentary participants regarding the trunk muscle strength and flexibility., Methods: Thirty-eight male elite tennis players and 22 healthy sedentary male students (24.8±4.0 years) participated in this investigation. Tennis players were divided into two groups: 11 players (27.8±5.5 years) with current LBP and 27 players (24.3±5.9 years) without LBP. Maximal isometric strength of trunk extensor, rotator, flexor and lateralflexor muscles was assessed by means of specific trunk dynamometers. Pelvic and lumbar flexion mobility were measured by means of inclinometer technique., Results: Comparison of tennis players with and without LBP revealed no significant difference regarding trunk muscle strength and ratio or lumbar spine flexibility (all P>0.05). In comparison with sedentary participants, the tennis players showed a sport-specific profile determined by a non-dominant trunk lateralflexors (P=0.02, F=4.05) and rotators (P=0.03, F=3.62) strength significantly higher than the dominant side., Conclusion: In the current study, comparison of tennis players with and without LBP showed no significant difference regarding trunk strength and spine flexibility. Trunk profile of tennis players showed selective unilateral strength increase of the non-dominant trunk lateralflexors and rotators. This finding could result from the forehand and the service action which involves simultaneously left trunk rotators and lateralflexors, in right-handed players, to generate power. In order to confirm that trunk muscle imbalance has no influence on LBP, further studies should study the effectiveness of a programme aiming to normalize strength ratios in tennis players with LBP.

Background Context: It has been controversially stated that pain-related fear is a more important determining factor for disability in chronic low back pain (CLBP) than pain or physical impairment in itself. So far, the relationship between psychological and physiological determinants of chronic pain, that is, pain-related fear and physiological abilities, remains unclear., Purpose: To evaluate whether pain-related fear assessed by different tools (both task specific and non task specific) is related to physical capacity measured by specific spine tests and, secondarily, to explore the relationship between different pain-related fear assessment tools., Study Design/setting: Cross-sectional study., Patient Sample: Fifty patients with CLBP (50% women; meanage [standard deviationage]: 44.2 [9.5 years])., Outcome Measures: Physical capacity by means of three specific spine tests, that is, the finger-floor distance test (flexibility), a maximal isometric strength test of trunk extensor muscles (strength), and the Sorensen test (endurance). Pain-related fear by means of self-report measures, that is, the Tampa Scale for Kinesiophobia (TSK), the Photograph Series of Daily Activities (PHODA), and a fear visual analog scale (FVAS) tailored to the spine tests., Methods: Participants were asked to complete the TSK and PHODA and to perform the three spine tests. Right before performing each of the spine tests, an FVAS was filled out. Linear regression analyses controlling for gender and age were performed to study the association between the pain-related fear measurements and the results of the spine tests. To investigate the relationship between the pain-related fear measurements, correlation tests were performed., Results: The linear regression analyses revealed that neither the TSK and PHODA scores nor the FVAS scores were significantly related to the physical capacity measurements. The correlational tests showed no significant correlation between the PHODA, TSK, and FVAS scores., Conclusions: The present study shows that neither the task-specific tool (FVAS) nor the non task-specific questionnaires (TSK and PHODA) were significantly correlated to the spine tests in patients with CLBP. This is contrary to earlier evidence according to which physical capacity is inversely related to the level of pain-related fear, and it suggests that one should not draw conclusions about physical capacity based on pain-related fear scores. Furthermore, the different assessment tools for pain-related fear were surprisingly not correlated with each other., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objectives: To evaluate the efficacy of a semi-intensive multidisciplinary outpatient program complying with the requirements of the Belgian National Institute for Health and Disability Insurance and intended for patients with chronic low back pain., Methods: We included 262 patients with nonspecific chronic low back pain, among whom 136 (73 women and 63 men) with a mean pain duration of 11.3 years completed the outpatient program (36 sessions each lasting 2h). The program consisted of education about back-sparing techniques, interventions by an occupational therapist and psychologist, and physical reconditioning. Three sessions (sessions 1, 18, and 36) were used to evaluate pain intensity, functional impairment, kinesiophobia, cognitive knowledge, knowledge of appropriate spinal movement technique, and physical performance (trunk muscle strength and endurance, mobility of the pelvis and lumbar spine, and aerobic capacity)., Results: All study variables were significantly improved at study completion compared to baseline: pain intensity was decreased by 44%, functional impairment by 40%, and kinesiophobia by 11% whereas knowledge was improved by 59%, back-sparing technique by 95%, trunk muscle strength by 40% on average, trunk extensor muscle endurance by 90%, mobility by 8%, and aerobic capacity by 18%., Conclusions: A semi-intensive multidisciplinary outpatient program was beneficial in patients with chronic low back pain. Careful patient selection and increased patient involvement in the program may help to improve adherence., (Copyright 2009 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.)

The purpose of this cross-sectional study is to investigate the prevalence of impaired lumbopelvic motor control in elite tennis players with disabling episode of low back pain in the previous year. Thirty-five elite tennis players (9 males and 26 females, mean age 17.4 ± 2.6 years) from two Belgian Tennis Academies were asked to fill in questionnaires related to low back pain and to perform five lumbopelvic motor control tests (bent knee fall out test, knee lift abdominal test, sitting knee extension test, waiters bow and transversus abdominis test). A physiotherapist, blinded to the medical history of the participants, scored the performance of the players for each of the tests (0 = failed, 1 = correct) resulting in a total lumbopelvic motor control score ranging from 0 to 5. Forty percent of players reported at least one past disabling episode of low back pain lasting more than five consecutive days in the previous year. Significant more altered lumbopelvic motor control tests were observed in players with a history of low back pain (score of 1.7 vs. 3.3 in those without a history of low back pain, P < 0.001). The between-group difference was particularly marked for the bent knee fall out test, the knee lift abdominal test and the transversus abdominis test (P ≤ 0.05). The current study confirms that low back pain is common in tennis players and has pointed out an impaired motor control of the lumbopelvic region in most tennis players with a history of low back pain. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the inter-session, inter-tester and inter-site reproducibility of trunk muscle strength scores in flexion, extension, lateral flexion and rotation. Ten healthy students were tested on four apparatus with a 7–10 day break between sessions. The first two sessions were identical while the other two differed either by the tester or by the site. Furthermore, 10 patients with chronic low back dysfunction (CLBD) were assessed with the four apparatus, once only. For all tests, CV ranged from 3.4% to 7.6% and from 3.9% to 8.1% in the inter-session and inter-tester studies, respectively (p>0.05 except for inter-session reproducibility of trunk flexor strength). Peak torque (PT) was more variable from site to site with a CV ranging from 4.2% to 12.7%, particularly in extension and left lateral flexion (p< 0.05). No statistically significant difference in the strength ratios (flexion/extension, right/left lateral-flexion and right/left rotation) were found between sessions or testers (4.9% < CV < 9.7%. The inter-site reproducibility of ratios was lower. Comparison between the CLBD patients and the healthy subjects with regard to PT normalized to body weight indicated significantly decreased performance for the former except for flexion and rotation scores in males. We conclude that in the case of healthy subjects, inter-session and inter-tester trunk strength measurements derived from these devices are reproducible. The low inter-site reproducibility suggests that caution should be exercised when interpreting findings originating from different sites. The lower extension strength scores in CLBD patients test lends some validity to the system. However, further studies focusing on reproducibility and validity of this system in CLBD patients are critical before any conclusion regarding their clinical viability may be drawn. [ABSTRACT FROM AUTHOR]