Our lumbar models are identical in size and geometry to a real cadaveric specimen. With careful construction of the soft tissues including a flexible intervertebral disc including an annulus fibrosus and a nucleus puplosus,  each model is meticulously hand-crafted to provide the most accurate modeling to help the musculoskeletal practitioner to engage with patients in a convincing way.

Lumbar models have historically been static and immobile, but at Dynamic Disc Designs, we have developed flexible lumbar models to help relay essential movements to the patient related to their pain triggers. Having a patient genuinely understand their body mechanics empowers the patient and improves outcomes.

Patient-centered care must include translational strategies to help a pain sufferer understand their origins. A dynamic lumbar model helps execute efficient and accurate patient education.

Static Flexion

A study 1 in the journal of Clinical Biomechanics shared results pointing toward the relationship between the muscular flexion-relaxation response in humans and period of static flexion. The aim was to further understand the phenomenon and its link to muscular modification (including low back pain).

Understanding Static Lumbar Flexion

Research has shown that workers are at risk of static lumbar flexion. However, not a lot of data is present that experimentally addresses the physiological biochemical and histological processes that are active in the evolutionary progression of the resulting low back disorder. Studies, involving animals, have shared that static lumbar flexion is responsible for the development of creep in associated viscoelastic tissues. This leads to elicit spasms and even modifies muscle function.

The current study set out to investigate neuromuscular changes while assessing normal (health-wise) human participates through the flexion-relaxation phenomenon.

The Study

The current research included male and female participants. There were 24 males and 25 female participants. The males ranged from 22 to 40 in age (the mean being 23.7 years old). The females were 19 to 30 in age (with the mean being 23.3 years). None of the participants reported issues in their spinal functions. Take note, six additional participants served as a control group.

They were asked to perform three bouts of lumbar flexion-extension before as well as after a 10 minutes long period of static flexion. The researchers recorded the surface electromyographic from the erector spinae muscles along with the flexion angle.

ANOVA was utilized on the angle in which electromyographic was reduced during flexion and initiated during the extension stage.

The Results

The study saw that the human erector spinae were active through a significantly larger angle during the flexion stage and were able to initiate activity significantly earlier during the extension stage (after static flexion). More pronounced changes were seen in the female participants (compared to the male participants). Furthermore, spasms were recorded by the researchers in more than 50% of the participants during the static flexion period.

What does it all mean?

According to the study, it was concluded that creep which was developed during a short static lumbar flexion was able to elicit a significant change in the flexion-relaxation phenomenon’s muscular activity pattern (in humans). It was observed that due to the loss of tension in the lumbar viscoelastic tissues, the muscles offered some compensation. The recorded spasms suggested minor micro-damage due to the viscoelastic tissues. The data was helpful in understanding why static lumbar flexion was an activity that was a risk factor for the development of the low back disorder in humans.

What are the Risk Factors Associated with Recurrent Lumbar Disc Herniation After Discectomy

Not many reports address whether LSTV (Lumbosacral transitional vertebrae) has a link with LDH (Lumbar disc herniation). A study 1, in the journal International Orthopedics, was conducted to rectify that. The results showed that LSTV and a hypermobile disc in flexion-extension radiography were risk factors for recurrent LDH.

What was the Context?

Reports show that LDH is a common complication following discectomy. The reported frequency has been observed to be up to 21%. The previous operation site was where the recurrence was the most frequent. Patients were likely to experience pain in the legs and back. They might even require revision surgery.

There’s still controversy present with regards to the risk factors associated with recurrent LDH. There are a lot of conflicting results. While gender, age, obesity, and smoking status are considered risks, radiological factors might be risk factors, too. These factors include disc degeneration, larger sagittal range of motion (SROM) in flexion-extension radiography, and larger disc height.

The Study

The current study investigated numerous risk factors for LDH following discectomy. The study involved a total of 119 participants. All of them had undergone a discectomy for L4-5 disc herniation. The minimum follow-up was of two years.

The study evaluated a range of risk factors. The clinical parameters involved body mass index, smoking status, and gender. The radiological parameters were LSTV, degree of disc degeneration, SROM, and type of herniated disc.

Disc Herniation

What were the Results?

The results showed that 21 of the participants had recurrent disc herniation at L4-5. From the 21 patients, 11 had LSTV. Seven patients had LSTV in the 98 patients from the non-recurrent group. The study shared that it had confirmed LSTV and a larger SROM being significant risk factors at L4-5 (for recurrent disc herniation).

What does it Mean?

The current study, deemed to be the first of its kind, concluded that LSTV and a hypermobile disc in flexion-extension radiography were indeed risk factors for recurrent LDH. The current data can offer beneficial knowledge for future research.

 

A study 1 in the Frontiers in Bioengineering and Biotechnology investigated the in vitro glucose consumption as well as gene expression by NP cells (over time) while under varying oxygen tensions. The study’s objective was to gain data for understanding disc pathophysiology and to determine the therapeutic potential of notochordal NP cells.

Why such a Focus?

Low back pain or LBP is a common condition affecting millions of people around the globe. According to research, LBP has a relationship with the degeneration of the spine’s intervertebral discs. Furthermore, an imbalance in the catabolic and anabolic activity by disc cells is known to result in such degeneration. Due to intervertebral discs being avascular (in their nature), there may be an oxygen deficiency in the central NP or nucleus pulposus. While the mechanisms require further understanding, the matrix regulation and energy metabolism of the disc cells can be affected by the resulting hypoxia. Monitoring such affects might help with better LBP treatments down the line (including treatment and preventive strategies for degenerative intervertebral discs).

The Study

The current study cultured notochordal procine NP cells in agarose discs. The cultures were at 21, 5, or 1% oxygen tension for 1, 5, or 10 days. An RT-PCR was used to analyze the expression of 10 key matric genes, as well as Brachyury (T), by the said NP cells. A two-point method was used to measure the consumption of glucose.

Spinal bone

What were the significant Results?

The study’s results revealed that glucose consumption rates (by NP cells) were significantly affected by oxygen tension and culture time. Furthermore, significant changes were seen in T expression based on the culture time and oxygen level. Take note, better maintenance of the notochordal phenotype may be indicated due to how the T expression was significantly higher in the 1% oxygen tension on day 10 (compared to the other two groups).

What does it mean?

The study shared that (when it comes to agarose disc culture) a vital role is played by oxygen tensions level in maintaining the proper expression levels of matrix regulation genes of notochordal NP cells. The study offered data regarding the role of nutritional environment to support healthy NP cell expression. Better treatment strategies for disc regeneration might be helped by using the quantitative information gathered by this study. The data can also prove helpful to understand disc pathophysiology.

Can Verbal Suggestions Manage Musculoskeletal Pain A Review

How much of an impact do verbal suggestions have on managing pain? We can’t be entirely sure. There has been a lot of controversy surrounding the power of suggestion and pain management. A review 1, in the journal of Physical Therapy Reviews, was conducted to find some answers. While there is potential in such a field, more research is required to see any clinical significance associated with pain management and verbal suggestions.

What’s the Context?

Numerous studies prove that pain has socioeconomic and health implications. This includes disability and functional limitation. Chronic lumbar pain has been observed to have the greatest prevalence. Low Back Pain or LBP is an economically draining ailment for individuals around the globe. Furthermore, reduction in pain due to surgeries and other LBP treatments isn’t always accompanied by improvement. Due to LBP being multi-faceted (including psychological factors), a person’s psyche has been suggested to help with recovery. So, verbal suggestions might have a role to play in the treatment of LBP.

Musculoskeletal lower back pain

The Purpose of This Review

The aim of the current review was to describe as well as explore the neurobiological mechanisms associated with verbal suggestions when it came to managing musculoskeletal pain in patients.

The literature search was conducted by two independent reviewers. The databases included were PEDro databases, Medline, Cochrane Library, Lilacs. Systematic reviews, randomized clinical trials, and literature reviews were included in this review.

After the study’s exclusion criteria, a total of 13 studies were involved in the current review. The total included four randomized controlled trials and nine reviews. The current review covered the neurobiology of verbal suggestion, and the effects of verbal suggestion in pain sufferers.

What did the Review Conclude?

The review concluded that there’s potential in positive verbal suggestion to improve the effectiveness of LBP management in patients. The review pointed out that such suggestions could generate hypoalgesia via the placebo effect. However, more research is required to fully determine the clinical significance of verbal suggestions for pain management in patients.

Can Hypersensitivity Be Decreased in Patients of Chronic Whiplash after a Medial Branch Block Procedure

A study 1, in the BMC Musculoskeletal Disorders, was conducted to determine if there was any change in sensory hypersensitivity in patients of chronic whiplash disorders after a medial branch block procedure in the cervical spine. The results showed a decrease in the patient’s pain.

What’s the Context?

It’s common for motor vehicle collision (MVC) to result in cervical spine pain and dysfunction. While many are able to recover (significantly) from neck pain and disability in about six months or even a year, reports show that 32% to 56% of patients continue to suffer.

According to studies, the cervical zygapophyseal joints are known to be a primary source of pain in as many as 60% of people who experience WAD or whiplash associated disorders. Such joints may also be playing a role in peripheral and centrally mediated pain (sensory hypersensitivity).

The Study

The current study was conducted to determine any change in sensory hypersensitivity in WAD grade II patients after a medial brank block (or MBB) procedure in their cervical spine.

This exploratory study utilized a pretest-posttest design. Eighteen participants (3 males, and 15 females) with whiplash associated disorders grade II, and 18 healthy (matches gender breakdown) participants were involved in this study. Take note, patients with chronic WAD and aged 18 to 60 years, who reported neck pain for more than 6 months, and who experienced a minimum of 80% decrease in the said neck pain after an intra-articular zygapophyseal joint block procedure were included.

zygapophyseal joints

The study used a single item Numeric Pain Rating Scale (0-10) for measuring the cervical spine pain intensity of patients before as well as after the MBB procedure.

Quantitative sensory testing (QST), which considered pressure pain thresholds (PPTs’) and cold pain thresholds (CPT’s), was used to measure sensory hypersensitivity. In patients dealing with WAD, the measures were taken at three sites bilaterally, pre and post-MBB. The study used an independent and dependent t-test to determine differences between thresholds.

The Results

The study revealed that, at baseline, the PPT’s were decreased at all three sites in the WAD group. The cervical spine had an increase of cold pain thresholds in the WAD group. Significant increases in PPT’s at all sites was observed in the WAD group (post-MBB), along with a substantial decrease in CPT’s at the cervical spine.

What was Concluded?

The study concluded that chronic WAD patients showed evidence of widespread sensory hypersensitivity in the presence of thermal or mechanical stimuli. Decreased levels of sensory hypersensitivity were observed in the WAD group after the decrease in the primary source of pain caused by the cervical zygapophyseal joints.

However, the study did note that large clinical trials, addressing long-term follow-up interventions targeted at eliminating or reducing the source of cervical pain in WAD patients, were required.

Assessing the Relationship Between Biomechanical Instability and Degenerative Changes in the Lumbar Spine in CLBP Patients

There still seems to be some controversy when it comes to addressing the relationship between biomechanical instability and the degenerative changes in the lumbar spine in CLBP (chronic lower back pain) patients. A study 1 decided to gather more data about it.

Why such a focus?

Chronic low back pain or CLBP may be caused by the biomechanical instability following degenerative changes in the lumbar spine. Low back pain is experienced by millions of people around the globe. The course of clinical treatment for such an issue can be guided through radiographical assessment. Such an assessment would be of the bending motions of the lumbar spine as it might aid with the identification of the absence or presence of biomechanical instability in patients with CLBP.

Lumbar spine

Due to the said controversy, this study decided to look into the relationship between biomechanical instability and degree of degenerative changes in the lumbar spine in CLBP patients. Being a retrospective radiographical study, it focused on evaluating the changes in kinematics at various lumbar levels (the L5-S1 level, in particular) with progressive grades of disc degeneration as well as facet joint osteoarthritis in CLBP patients.

The Study

The current study involved 72 (51 males and 21 females) consecutive CLBP patients. The age range of the participants was kept 18 to 70 years.

It used standing neutral and dynamic flexion/extension (Fx/Ex) radiographs of the lumbar spine to evaluate the in vivo segmental kinematics at the L1-L2 through L5-L1. Changes in signal intensity and central disc height on mid-sagittal T2-weight MR (magnetic resonance) scans were used to quantify disc degeneration.

What were the Results?

The study shared that disc degeneration and facet joint osteoarthritis was able to occur independently of each other at the L5-L1 level. However, an association was observed at the L4-L5 as well as the L3-L4 levels. A greater range of motion in Ex and a smaller range of motion in Fx was observed in the absence of facet joint osteoarthritis (when compared to the upper lumbar levels). No change in the L5-L1 kinematics was observed with progressive disc degeneration in the absence of facet joint osteoarthritis. However, in the presence of such osteoarthritis, re-stabilization of the L5-L1 segment was observed between the severe and mild disc degeneration states.

 

Assessing the Relationship Between Biomechanical Instability and Degenerative Changes

The Conclusion

The study concluded that unique degenerative and kinematic characteristics were exhibited by the L5-S1 motion segment compared with the upper lumbar motion segments. Furthermore, at the L5-S1 level, facet joint osteoarthritis and disc degeneration occurred independently of each other. The L5-S1 motion segment was biomechanically re-stabilized by severe disc degeneration if facet joint osteoarthritis was present.

What does it mean?

The study shared that the L5-S1 level, due to having unique anatomical features, may play a significant role in re-stabilizing the level with severe degeneration of the disc and facet joints. The data will prove beneficial in understanding more about CLBP and its clinical treatments.

 

Do Concepts of Stability and Instability Matter for Back Pain

A clinical commentary 1 in the Journal of Orthopaedic & Sports Physical Therapy was conducted to see if the concepts of stability and instability had any value when talking about Back Pain. The commentary’s argument was that the view of stability needed to be broadened and should also integrate interdisciplinary knowledge. Such a change was deemed necessary due to the complex nature of back pain.

What did it set out to do?

The current clinical commentary had the objective of providing a broad definition of stability. It showed how a unifying framework could be used to integrate different interpretations of spine stability. Furthermore, basic and clinical studies were examined to determine the link of spine stability to back pain. Recent scientific, as well as technological advancements, were also considered. The commentary also speculated on how to evolve the concept of stability (in a manner that also addresses non-mechanical issues lined to experiencing pain).

The main goal of the commentary was to display critical knowledge gathered from studying the concepts of stability and to share the potential present in understanding the etiology concerned with back pain.

Disc Herniation

 

Did it reach the intended goal?

While lumbar spine stability was the focus of this commentary, it was determined that similar concepts could still be used when covering different forms of back pain.

It shared that stability is linked to the central nervous system and how neural and mechanical coupling can help reduce the risk of instability connected to a healthy spine.

The commentary talked about how the messaging surrounding the human spine and its susceptibility should be made better for the general public’s understanding. A better understanding can also help reduce the likelihood of maladaptive strategies. A systems-based framework can also prove beneficial for interdisciplinary integration of knowledge; something this commentary stated needed improvement in the spine community.

The basic conclusion was that we still have a lot to learn about back pain. However, using a framework and using the potential that still exists, we can make the spine community efficient to help others.