Online ISSN: 2515-8260

Keywords : Low Back Pain

Analysis of Lumbar Spine Stress Injuries in Adolescent Cricket Fast Bowlers

Jujhar Singh, Shikhar Dogra

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 351-357

Background: Fast bowling in cricket is associated with a high prevalence of lumbar spine stress injuries, especially in adolescents. This cannot be correlated with risk factors identified in adult players. This study aimed to examine the incidence of lumbar spine stress injuries in adolescent fast bowlers as a prospective study so as to predict risk factors.
Methodology: 32 asymptomatic male fast bowlers (aged 14–17 years) received baseline & annual lumbar dual-energy X-ray absorptiometry (DEXA), magnetic resonance imaging (MRI) scans, musculoskeletal and bowling workload assessment. These were followed up after one year to calculate the prevalence at baseline and annual incidence. Potential risk factors were compared between the injured and uninjured groups using T-tests with Hedges’ g effect sizes.
Results: At baseline, 7 cricketers (21.8%) had evidence of lumbar spine stress injury. Subsequent incidence was 27.3 ± 18.6 injuries per 100 players per year (mean ± 95% CI). Injured bowlers were older on average at the beginning of the season preceding injury (16.7 versus 15.5 years, g = 1.396, P = 0.047)
Conclusion: Risk of lumbar spine stress injury coincides with increases in bowling & cricketing workload as well as intensity as bowlers step up playing levels to more senior teams during late adolescence whilst the lumbar spine is immature and less robust.

A prospective clinical assessment of the role of caudal epidural steroid injections in the management of chronic low backache

Dr. Suneet Rajshekhar, Dr. Anurag Chandrakar Dr. Madhuri Gadela

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 281-286

Aims: The aim of this study was to find Role of caudal epidural steroid injections in the management of chronic low backache.
Materials and Methods: A prospective study was conducted in the Department of Orthopaedics, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, India for the period of 1 year. Total 80 Patients with chronic low back pain and sensory symptoms not responding to conservative management were include in this study. They were evaluated clinically before and after epidural steroid on the basis of pain, unrestricted activities of day to day life and work performance on the basis of visual analogue scale and oswestry disability index.
Results: Total 120 ESI were given to 80 patients. 50 patients were given single injection, while 20 had two and 10 received three ESI doses. We included total 80 cases in this study, 35 were males and 45 females with chronic LBP.Out of 80 cases of LBP, Lumbar disc herniation was seen in 26, lumbar canal stenosis in 8 and degenerative disc disease in 14 cases while 32 cases had non-specific LBP. Follow up was done at one week, one month and then every three months up to twelve months of treatment (post third ESI 9 months).Mean pre ESI, VAS was 7.06 while it was 4.75 at one year of treatment. Mean pre ESI, ODI score was 58.88 while after twelve months of treatment with ESI it was 44.74 at one year. We obtained excellent results in 26.75 percent, good in 37.5 percent, fair in 22.5 percent while poor in 13.75 percent patients.
Conclusion: ESIs are very effective and significantly reduce pain in patients with chronic function-limiting LBP.


Dr. Vipin Garg, Dr. Parul Trichal, Dr. Vijerdra Damor, Dr. Pradeep Dubey, Dr. Roma Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 656-663

Background: Low backache (LBA) in females is a major public health problem world-wide and treating this condition is also challenging due to its vast differential diagnosis. Pelvic inflammatory disease (PID) is the most frequently encountered condition in females for LBA and if diagnosed and treated early can lead to significant improvement in symptoms of LBA.       Aim: The present study is conducted to determine the incidence of Pelvic inflammatory disease (PID) and its associated risk factors in women with complaints of low back pain (LBP).      Material and Methods: A prospective epidemiological study was done in the department of orthopedics in GRMC Gwalior, M.P. 400 female patients attending OPD with the presenting complaint of LBP were enrolled in our study. Detailed history was taken and thorough examination was done.      Results: Out of 400 patients with LBA, PID was found in 324 (81%) patients. Maximum number (32%) of patients was from the age group of 41- 50 years. Majority of patients (60.7%) were of low socio-economic status, 51.7% females were illiterate, 69% females were overweight  31.8% of patients complained of vaginal discharge were age group of 41-50 years. 37.4% women used oral contraceptive pills and 58.1% females had an intrauterine contraceptive device inserted. Majority of the PID patients (53.4%) showed inflammatory cell on Pap smear
Conclusion: The present study suggests that PID is a major contributing factor in LBP in middle age females.

Evaluation of clinico-radiological outcomes in patients with lumbar degenerative disc diseases treated with intradiscal PRP versus steroids: A prospective double blinded randomized controlled trial

Dr. Bhupinder Singh Brar, Dr. Vivek Jha, Dr. Guncha Kalia, Dr. Bhandari Vaibhav, Dr. Neelam Gupta, Dr. Mandeep Kaur Nanda, Dr. Monika Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1079-1088

Context: To evaluate clinico-radiological outcomes in patients with lumbar degenerative disc
diseases treated with intradiscal PRP versus steroids.
Design: Prospective double blinded randomized controlled trial.
Aims: The aim of the study was to compare and assess radiological changes and clinical
outcome in patients with degenerative disc diseases when treated with intradiscal platelet rich
plasma and intradiscal steroid.
Objectives: To compare clinical outcome in PRP and steroid treated patients, to compare
radiological changes in PRP and steroid treated patients, to assess clinical outcome in PRP
and steroid treated patients at subsequent follow ups, to assess radiological changes in PRP
and steroid treated patients at subsequent follow up.
Settings and Design: Prospective double blinded randomized controlled trial.
Methods and Material: Adults (18-50 years) with chronic low back ache (> 6 months) nonradiating
who were unresponsive to conservative treatment. A total 40 patients were
randomized to receive intradiscal PRP (Group A) or steroid (Group B) after provocative
discography in the department of Orthopaedics in Maharishi Markandeshwar Medical
College and Hospital, Solan between the time period of November 2019 to September 2021
based on inclusion and exclusion criteria were enrolled for platelet rich plasma and steroid
infiltration in a randomized manner. Pain relief as assessed by change in VAS score,
functional assessment using change in Modified oswestry disability index (MODI). Pfirrman
and MSU grades as assessed by MRI.


Parama Nanda Taye, Dhrubajyoti Borpatra Gohain, Mary Hazarika Bhuyan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 12189-12195

Background: Back pain is a common clinical condition and is a frequent cause of referral for lumbar spine MRI. The use of radiological imaging is crucial for helping to confirm or exclude pathology and, more crucially, for influencing the treatment decision-making process.The purpose of the current study was to assess the use of MRI in individuals with lower back pain.
Material and Methods: The current study involved individuals who had been sent for an MRI and had low back pain as their predominant complaint, either with or without radiculopathy.
Results: 234 patients of low back pain were considered for study. Mean Age was 46.85 ± 16.35 years. Majority cases were from 46-60 (62.39 %) years age group, were Female (53.42 %), had BMI 25–30 kg/m2 (47.86 %). Majority cases had radiating pain (sciatica) (71.37 %), pain since >2 Years (44.87 %), Moderate (63.68 %) severity of pain. Associated symptoms were tingling (19.66 %), numbness (25.21 %), pain exaggerated by: lifting heavy objects (38.03 %) & pain exaggerated by walking (26.07 %). Common MRI findings were degenerative changes (56.41 %), neural foraminal narrowing (43.16 %), degenerative spondylolisthesis (28.63 %), disc bulge (23.08 %), abnormal alignment (19.23 %), spondylosis (18.38 %), disc protrusion (12.82 %) & canal stenosis (10.26 %). Conclusion: Disc degeneration and other degenerative changes are the most common abnormalities found in MRI examination.


Dr. Manoj Kumar HV,Dr. SomashekarDoddabhadre Gowda Dr. Abhijit Patil, Dr. AnkithNV

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1777-1783

Context: Treatment for lumbar disc prolapse includes conservative, interventional and operative treatment. Controversies exist regarding most effective type of conservative treatment.
Aim: To assess the efficacy of different types of conservative management in low back pain due to lumbar inter vertebral disc prolapse.
Study design: Prospective study
Methods and Materials: 160Adult patients of either sex with low back pain due to lumbar disc prolapse with or without mild neurological deficits visiting or admitted in our hospital were included in the study. 40 patients were treated with bed rest, 40 patients were allowed to continue routine daily activities, 40 patients were treated with back school exercises and 40 patients were treated with McKenzie exercises. The patients were followed for a period of three months with serial neurological examination and outcome measures.
Statistical analysis used: ANOVA and Chi square test.
Results: Back school group and McKenzie group had more favorable scores with respect to VAS, ODI and JOA score which is statistically significant(P=<0.001). Among back school group and McKenzie group, latter had better results with respect to VAS, ODI and JOA score but statistically not significant. JOA post intervention improvement is maximally seen in McKenzie group. Majority of patients from McKenzie group returned to work at the end of 12 weeks.
Conclusions: Back school exercises and McKenzie exercises have better results for low back pain due to lumbar disc prolapse compared to other types of conservative management.

The Effectiveness of Dry Cupping and Hot Pack in Pain Relief and Reduce Functional Disability on Non-specific Low Back Pain

Azira Iqlima Razali, Bsc; Lee Ai Choo, PhD

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 2796-2810

The objective of this study was to identify the effectiveness of dry cupping and hot pack on pain relief and reduce functional disability for patients with non-specific low back pain. A total of 39 patients with non-specific low back pain from Sultan Idris Education University, Malaysia who fulfilled the inclusion criteria were chosen as participants using purposive sampling methods. The participants were randomly assigned equally (N=13) into dry cupping group, hot pack group and control group. Dry cupping group received a session of treatment in a week, hot pack group received twice a week of treatment session and control group had no treatment, but the participants were allowed to continue their previous treatment. Numerical Pain Rating Scale (NPRS) was used to measure pain intensity and Oswestry Disability Index (ODI) was used to measure functional disability before and after the intervention for all three groups. Data was analyzed using one-way ANOVA with significant level was predetermined at p<0.025 prior to study. The study findings indicated that both dry cupping group and hot pack group showed significant improvement on pain relief (p=0.001) and functional disability (p=0.001) after completing the interventions when compared to control group. Therefore, both dry cupping and hot pack were found to be effective interventions for pain relief and reduce functional disability among patients with non-specific low back pain. Health professional practice are suggested to include dry cupping therapy as another choice of treatment in treating patients with non-specific low back pain.

Working position and low back pain complaint of Dental Therapist in Pati, Indonesia

Ayun Q; Fatmasari D; Suparmi .

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 10, Pages 1206-1212

Working position is the posture formed naturally of bodywhich interact with facility workers and work habits in a clinical job. The effectiveness of a treatment is influenced by work posture. Ergonomic work posture produces good output, and vice versa. In addition, an ergonomic work position needs to be considered to prevent complaints from work-related diseases. Low back pain is a condition with discomfort or acute pain in the fifth and sacral lumbar region (L5-S1). The purpose of this study was to determine the relationship between demographic characteristic and work position with complaints of low back pain in dental therapists in Pati, Central Java Indonesia. Design research is an obeservasional studywithcross sectional approach. Population is all dental therapist, and sample is 37 of those who selected purposively. Respondent characteristic, complaint of low back pain was collected by questionnaire and determined of work position was by Rapid Entire Body Assesment(REBA). Relation of variables was analyzed by Chi Square test. Research study found no relationship of age, gender, and body mass index with complain of low back pain (p= 0.122 ;0.816; 0.761 and 0.208 respectively), in addition variable length of workingand working position were significantly has relation (p = 0.01and 0.02). Dental therapist need to concern with their working position to prevent of their complaint of LBP.

Swiss Ball Exercises As An Alternative To Mckenzie Exercises In Treating Chronic Low Back Pain Among Poultry Workers

Regen R. Villarin; Patricia Nina R. Marasigan; Wellvert A. Cabatay; Vanessa Oarga; Maria Simplicia E. Flores

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 2, Pages 4197-4207

Low back pain (LBP) extension-biased, is the most common leading cause of disability among poultry workers who frequently perform repetitive trunk motions such as bending, twisting, and lifting. The incidence of LBP among the poultry worker’s has been reported to be 17.2% and it affects the workers capacity in doing functional activities of daily living. Men have higher risk of developing LBP due to the design of their work which involves repetitive trunk bending, twisting and rotation. The common interventions for LBP extension-biased include traction, acupuncture, stabilization, manipulation and Mckenzie exercises. Mckenzie exercises centralize pain, decrease functional disability, and improve spinal mobility. However, Swiss ball exercises are for stabilization exercises that strengthen core muscles, decrease pain perception, increase trunk mobility, decrease functional, and disability, The purpose of the study is to determine the effectiveness of Swiss ball exercises as an alternative to McKenzie exercises in treating Chronic Low Back Pain (CLBP) among poultry workers in terms of the following: relief of low back pain, increasing muscle strength, trunk flexibility, and improving functional ability and performance. The study utilized pre-test and post-test using paired T-test and independent T-test, and Wilcoxon signed ranked test. Sixty poultry workers were randomly grouped into controlled group and intervention group. Results show that there is no significant difference between the two exercises. Therefore, Swiss Ball can be used as an alternative to McKenzie in treating CLBP.

Clinical Effectiveness Of “Transforaminal Epidural Block”by Subpedicular Approach In Lumbar Radiculopathy

Dr.Santosh Kumar Sahu; Dr.Deepak Verma; Dr.Binod Chandra Raulo

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 6, Pages 963-971

Introduction :TFEB(Transforaminal Epidural Block) involves delivery of drugs through the epidural space and along the nerve root.’’This procedure can be both diagnostic (to know whether the given nerve root is the cause of pain) and therapeutic (to lessen pain by deceasing irritation around the nerve root) purposes’’. The subpedicular approach is a very commonly used procedure at present. This technique involves placement of the spinal needle in‘’the secure triangle under the inferior exterior of the pedicle to reach the superolateral spinal nerve responsible for pain generation’’.‘’Transforaminal area is the favoured location,as the drugs can be directly ‘’delivered into the anterior extradural space, i.e. area stuck between the back of the protruded disc and the anterior nerve root dural sleeve,thus reducing the risk of injuy to dura mater’’. Transforaminal Epidural Block injections reduces the inflammation andstabilizes the nociceptive neural activity thus relieving the pain.
Materials and methods :We conducted aProspective Cohort Study at IMS&SUM hospital,Bhubaneswar from Mach 2017 to December 2019.Our study includes 100 patients with lower back ache with radiculopathy due to disc herniation or lumbar canal stenosis managed conservatively for at least six weeks.All the patients have been diagnosed with transforaminal epidural block(TFEB). A complete clinical examination was done to rule out other causes of lowbachache with radiculopathy. Patient having predominant unilateral symptoms were given transforaminal block.
Results :. In our study 78 patients (78 %) had significant pain relief,which common in 48 patients(48%) till the go behind up period of more than 12 months,78 patients(78%)till the follow up period of 6months .The current study also provides evidence that, LTFEB provides significant respite of pain in majority of patients for three months following the block’’. Reduction in pain was assessed by‘’restoration of activities of daily life without the need for other treatment modalities’’.48% of patients who were administered LTFEB had relief that persists for more than 12 months, without need for any other treatment.
Conclusion : From our study we conclude that, LTFEBs are reliable and cost effective procedures, without major adverse effects. Irrespective of become old, gender, stage of injection, symptom period and harshness of pain, TFEBs can provide significant relief of pain in majority of patients.