At Dynamic Disc Designs, we believe research to be the foundation of our spine models so practitioners in musculoskeletal health feel confident in the use of an accurate model while they educate patients about their findings.  Historically, models have been inaccurate and most critically, static, making it very difficult for the doctor to be convincing to the patient in the accuracy of diagnosis.

Research is at the roots of any practice. It fuels practice guidelines and directs both the patient and practitioner down the best path of care. Our models help support that voyage. We have worked hard to bring the best to practitioners of musculoskeletal science by scouring databases of spine science, to arrive at the most accurate model for teaching possible.

With over 1000 papers read in full text, Dr. Jerome Fryer leads the way by making sure our models are keeping up to the standards of best evidence. Weekly literature searches on keywords that surround musculoskeletal health are at the core roots of Dynamic Disc Designs.

LBP and Disability

A cross-section study 1, in Spine, was conducted to investigate the link low back pain (LBP) and disability had with the structural features of the thoracolumbar fascia. The results shared that a relationship existed between these factors.

The Context

While the Global Burden of Disease Study has researched LBP to be the leading cause of disability in humans, a lot of work needs to be done to fully understand the etiology associated with LBP. More research needs to be done to address all of the factors linked to LBP. Such understanding is crucial because it will help with creating targeted prevention strategies to help millions around the globe.

Previous research has analyzed LBP and disability to be associated with structural abnormalities of the lumbar spine. Furthermore, MRI has shown LBP to be linked to disc protrusion, disc degeneration, nerve root displacement or compression, and high-intensity zone. While more research is still needed, the present results do suggest that the issues of LBP and disability can be addressed by targeting structural factors. Take note, there’s evidence that suggests the thoracolumbar fascia may be linked to LBP. However, few MRI studies have examined such a link.

hypermobility-spine

The Study

The current study had an aim to examine the link present between the lumbar fascia’s length and LBP as well as disability. The study used MRI.

A total of 72 participants (49 females and 23 males) were recruited. They weren’t required to have any history of LBP or current LBP to participate. The MRI was performed, in this study, using a 3.0-T magnetic resonance unit (with the participants in supine position). The study administered the Chronic Pain Grade Questionnaire (CPG) at the time of the MRI.

The study used the Logistic regression analyses for examining any likely associations between fascial length and high pain intensity (or disability).

What did the Results Conclude?

The results of the study concluded that there was a significant association between a shorter length of fascia and high-intensity LBP and/or disability. Such association was after adjusting gender, age, and the body mass index. The association was strengthened after adjustment for the cross-section area (in the paraspinal compartment).

While more studies are required, the current results do suggest that fascia’s structural features likely play a role in disability and LBP.

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.

Does the Human Body Hold Potential for Improved Regeneration

A recent study 1 from the journal Science Advances analyzed protein turnover that occurs in articular cartilage from lower limb joints in humans. The results showed a potential for regeneration that could likely be exploited to improve joint repair.

What was the Context?

While regeneration exists in certain animal species, humans are believed not to have the ability to counter cumulative damage. In this context, the said type of damage is caused by repetitive joint use as well as certain injuries due to which cartilage breaks down and gives rise to osteoarthritis (OA). According to previous research, the turnover of insoluble collagen in human adult cartilage has been suggested to be quite limited. However, take note, humans do have the limited regenerative capacity. For example, during childhood, the regrowth of distal portions of amputated digits has been observed.

miRNA has been observed to play a significant role in regeneration; however, miRNA’s regenerative role is low in humans. The current study set out to explore the articular cartilage’s protein turnover (in the human lower limb joints).

The Design

The current study collected articular cartilage (as waste surgical specimens) from Duke University Hospital. The full-thickness cartilage was collected from the hip, knee, and ankle joints from patients that had end-stage OA who had undergone total arthroplasty surgery. Take note; the cartilage was from the perilesional regions of the hip, knee, and ankle joint’s load-bearing area.

A total of 18 samples were collected. The samples included three types of joints (hip, knee, and ankle), two types of disease state (healthy as well as OA), and three biological replicates of each type with matched age range. The mean age of healthy non-OA patients was 58.8 years. Their age range was 30 to 82 years. Also, the mean age of the patients with OA was 59.8 years (with the range being 42 and 87 years).

The analysis was performed on a quadrupole Orbitrap benchtop mass spectrometer (Q Exactive) equipped with an EASY-nLC 1000 system. Furthermore, protein identification was performed using the Homo sapiens taxonomy) setting of the Swiss-Prot database with Proteome Discoverer 2.1.

Also, miRNA quantification was done by a real-time polymerase chain reaction. The Deamidation rate was analyzed using the Swiss-PdbViewer.

What were the Results?

The study demonstrated a position-dependent gradient (distal high, proximal low) of protein turnover in human lower limb cartilage. The findings of this study have helped reveal a dynamic anabolic effect in human limbs that showcase a potential (limited) natural regenerative capacity in human cartilage.

According to these results, increased expression of matrix proteins is seen in OA knee cartilage. Also, the higher prevalence of hip and knee OA (compared to ankle OA), might explain the lack of repair in proximal joints.

What was Concluded?

The results suggested the role of regenerative miRNA present in cartilage homeostasis, intrinsic repair capacity, and turnover. Also, the limited regenerative capacity in humans is proposed to be primarily controlled by location rather than the shape of the joint or loading. The use of in vivo protein deamidation molecular clocks helped find a distal-proximal gradient of protein turnover.

The current data also suggested that anabolic treatments may be required in addition to anticatabolic treatments, especially for human hip joints, to prevent or, at least, slow OA’s rate of progression.

The study concluded that more functional studies on the effects of these associated miRNAs would be required to further reveal their regulatory role in cartilage repair and to help prevent certain ailments (including Low Back Pain).

Interestingly, the study suggested that injection of key regenerative miRNA in a joint (either singly or in combination) might have the potential to improve endogenous repair and help resist the degeneration of joint tissues in all types of arthritis.

 

Defining The Term ‘Flare’ in Low Back Pain (LBP)

It turns out, there isn’t much of a consensus when it comes to the definition of Low Back Pain Flare. A study 1 from The Journal of Pain set out to change that to possibly help LBP patients, clinicians, and researchers around the globe.

Why Focus on LBP Flare?

Low back pain tends to vary over time. Numerous terms are used by medical professionals and researchers to describe the fluctuations. The term “Flare” is used for describing symptom fluctuation. However, the definition of the said term isn’t the same for everyone.

With LBP being a common musculoskeletal condition around the globe, the current study deemed it necessary to bring consensus to the term “Flare” or “Flare up” with regards to LBP. According to research, most people tend to experience LBP at least once. For many others, such a condition lasts throughout their lifespan (with fluctuating trajectories).

The Study

This was a mixed-method study. It consisted of four steps.

  1. Deriving the definition of LBP flare from the perspectives of individuals with LBP.
  2. Using the perspectives of experts.
  3. Undergoing a Delphi process with experts to polish the definition of LBP flare and reach an expert consensus.
  4. Applying qualitative testing to the definition with individuals with LBP.

Flare Low Back Pain

For the first step, five authors met on 3 different occasions for considering the perspective of individuals with LBP. They discussed the terminology to cover the features that separate other symptom fluctuations from flare. The initial definition was refined (involving consultation from an expert consumer writer).

For the second step, a workshop was held at the International Forum for Back and Neck Pain Research in Primary Care (Buxton UK, June 2016) with a group of 19 experts in LBP.

In the third step, a two-round Delphi process was conducted. The goal was to gather feedback from a diverse group of international experts, and to present a definition (from the collected feedback) to the participants for evaluating acceptability.

Take note, the Delphi process was implemented online via a web-based system (Google Drive).

A total of sixty-two experts were invited to participate. This included 19 participants of the Step 2 workshop, 19 members of the organizing committee of the International Forum for Back and Neck Pain Research in Primary Care, and a total of 24 other individuals with expertise in LBP flare or related conditions (or having international recognition in the field of musculoskeletal research).

Testing, during the fourth step, involved scenarios and follow-up questions. The participants were invited via social media, local community, and health centers. One of the eligibility criteria was the individual’s self-identification of previous or current LBP.

Defining The Term ‘Flare’ in Low Back Pain LBP

What did the Results Show?

The results of the study displayed how flare (connected to LBP) is multifaceted. The findings aligned with the research team’s expectations about how not every individual with LBP flare will experience all of the factors mentioned in the definition. However, the definition will be broad enough for many to relate to.

Where There Any Limitations?

The research team does share the current study might not have been able to accommodate every expert opinion because of the utilized selection criteria. Furthermore, the sample was biased toward people with long-term recurring or persistent/chronic symptoms.

What’s the Take-Away?

LBP flare is multifaceted and thus, needs an appropriate definition. The current study was able to propose a definition that might work well in a clinical or research context. The said definition is likely to have a beneficial use in epidemiologic studies as well as have clinical implications in terms of measuring treatment efficacy.

Sacroiliac Joint

According to research, at least 10 to 30% of LBP or low back pain is linked to the sacroiliac joints. A review 1 in the journal of Best Practice & Research Clinical Rheumatology decided to give the said link a more in-depth look.

The Context
As mentioned, studies have shown an approximate 10-30% of all LBP being attributed to sacroiliac joints SIJ. While almost 44% of SIJ pain is associated with trauma onset, the etiology is still unclear. So, even today, there are numerous challenges when it comes to diagnosing as well as treating sacroiliac joints. One of the biggest challenges is determining whether or not pain or dysfunction in the human body is primarily due to the sacroiliac joint. SIJ being a causative factor, while theorized, doesn’t have a lot of evidence for support.

The Purpose of This Review

The current content aimed to cover the available data regarding the anatomy of SIJ along with its examination, etiology, and treatment to assist clinical approaches. One of the major questions dealt with: when pain is experienced at the SIJ, is it better to direct treatment at local tissues, or should it focus on factors that are remote to the joint?

Furthermore, the review also wanted to analyze if the pain in a region was primarily due to SIJ or were other factors in place (on and around the said joint)?

The review went over the anatomy and function of the Sacroiliac joints, the etiology of Sacroiliac joint dysfunction, the clinical assessment of the SIJ, and managing SIJ pain.

The review tried its best to consider all of the complexities associated with SIJ’s diagnosis and management (including sport and exercise-related SIJ pain). It took a bio-psycho-social perspective.

What did the Review Find?

The review summarized that clinicians and researchers shouldn’t conflate sacroiliac pain, stability, and dysfunction (as all three are separate). Furthermore, trauma and repeated training might be associated with SIJ pain in athletes.

Clinical evaluations should administer clustered pain provocation testing. Such a suggestion was made after determining that palpation and mobility test didn’t offer any proven value. When addressing persistent pain, taking a bio-psycho-social approach is crucial. Treatments (backed by evidence) included pelvic compression belts, surgery, manipulation, exercise, and corticosteroid injections.

Also, further research is required for understanding SIJ pain better.

 

A review article 1 in Spine Surgery and Related Research presented an interesting overview of the molecular mechanisms involved in the degeneration of intervertebral discs. The review also described certain molecular targets and therapies that may help with intervertebral regeneration and repair.

Why do such a Review?

Even though life expectancy has increased over the past century, it isn’t without a share of medical issues. According to research, neck pain and low back pain (LBP) tends to increase with age. They’re also the 1st and 4th leading causes of disability in humans, respectively. Furthermore, intervertebral disc degeneration (IDD) plays a significant role in generating back pain. That’s why it’s important to understand the degeneration of healthy joints (especially intervertebral discs or IVDs) with age to improve quality of life.

One of the first tissues that experience degeneration in adults is the IVD. While there’s still a lot to learn, the current review was conducted to share some of the molecular pathways and cellular changes that tend to lead to IDD.

molecular mechanisms

What Did the Review Cover?

The objective of the current review was to offer an overview of the known molecular mechanisms leading to IDD. The review was sure to address the complex interactions of endogenous and exogenous stressors. It focused on the degeneration of the extracellular matrix (of the nucleus pulposus and the annulus fibrosus).

Furthermore, the review also went over the supporting role played by the DNA and intracellular damage, oxidative stress, cellular senescence’s catabolic effects, as well as the inappropriate response by the cells to damage. All of the data can prove to be beneficial in understanding how physical and chemical changes can increase the spine’s degeneration. The review also shared certain therapies for spinal regeneration and repair.

What was Concluded?

The review shared that there’s potential to discover novel disc degeneration mechanisms by focusing on disc functions that help maintain stability as well as motion of a mechanically loaded structure in a nutrient-poor, acidic, and hypoxic environment.

It was important to note that disc degeneration is influenced by the degeneration of adjacent spinal structures and systemic factors. That’s why researching the entire spine is essential for the progress in the spine’s degeneration and regeneration therapies. Also, early intervention (before the functional failure of the spinal disc) is crucial.

sitting, pain. sedentary

A recent study (accepted July 2019) 1 set out to analyze the relationship between Low Back Pain (LBP) and the sitting behavior among sedentary office workers. The results displayed a higher association between a person’s sitting behavior and chronic LBP compared to acute pain or disability. Such association was deemed plausible due to individuals with chronic pain being more aware of pain-free sitting positions.

Why Focus on LBP?

Due to current lifestyles, sedentary working hours are everywhere. Furthermore, many people, after spending hours in a seated position (in professional settings) also remain seated during leisure times, too.

According to research, in general, rates of LBP has increased in office workers. This is especially true for professionals such as call-center employees. They’re said to spend up to 95% of their working hours in a seated position. Call-center employees also have to deal with high levels of stress when dealing with aggressive callers. Furthermore, such employees have reported higher levels of musculoskeletal symptoms compared to other office-setting workers.

Take note, LBP is the third leading cause of self-perceived disability and serves as an indicator for a significant economic burden to society. Being able to identify possible risk factors can prove helpful for creating and implementing preventive measures in office settings to aid employees and improving office culture.

The Study

A total of 70 office workers from a professional call-center were recruited for the current study. The call-center selected (specifically) dealt with challenging client situations; thus, the assumption that the participants were exposed to considerable levels of mental stress burden. The study was conducted within 2 weeks (at two different worksites of the same call-center company). Each participant was assessed during one complete working shift.

The measurement system involved a textile pressure mat “sensomative science” consisting of a 196 sensor matrix. Using Bluetooth Low Energy, the collected data was transferred from the textile pressure mat to a connected mobile phone (Nexus 5X, Google, LG, Seoul, Korea). The information was then stored in a corresponding mobile application.

To collect data about short and long-term pain status, the study used the Chronic Pain Grade Questionnaire and the German brief pain inventory.

Four pain variables (CPI, DISS, BPISeverity, BPIInterfere) were used to allocate participants into either subgroup A: no pain; no functional disability, or into subgroup B: with pain; with functional disability.

Data management and statistical analysis were carried out through the software suite IBM SPSS Statistics (v24, SPSS Inc., Chicago, USA).

Results

While the study included 70 participants, six were excluded because of participation withdrawal or incomplete data sets. From a total of 64, two more participants weren’t included in the CPI and BPISeverity analysis due to inconsistent and (or) missing entries. However, a total of 64 participants were available to be considered for the DISS and BPIInterfere grouping variable.

It was indicated, through the Mean values of the four sitting behavior parameters, that participants with pain and pain-related disability displayed a comparatively static sitting behavior to their pain-free counterparts.

What does it all mean?

The study concluded that there is a possible trend toward more static sitting behavior among call-center workers who have chronic LBP pain and pain-related disability. Furthermore, a higher association was found between sitting behavior and chronic LBP compared to acute pain or disability.

This could be a possible result of the fact that participants with chronic pain have a higher level of awareness to pain-free sitting positions and pain provoking movements compared to individuals affected by acute pain.