and offices, the questionnaires were completed and the data was collected. Questionnaire included two sections asking about demographic characteristics and some risk factors such as position of desk, chair, keyboard, mouse, monitor, working time of the day, duration of working year in each, break time, body posture, musculoskeletal pain such as cervical pain, shoulder, arm, elbow, wrist, hand and fingers pain, absence of computer user due to job diseases, performed treatment and daily exercise (1-5, 19-20). Exclusion criteria included the history of rheumatoid arthritis, osteoarthritis connective tissue lesions, surgery, fractures of spine and upper extremity. Inclusion criteria included working with the computer more than 1 year, and working more than 4 hours on a day. Proper working station (desk and chair) was considered in a way that posture of human body is without deviation to sides and kyphosis. Distance of monitor from eye must be 50 centimeters. The keyboard should be at elbow level and 15 centimeters bellow desk. Computer users must have rest time for 10 minutes after 50 minutes working. Also at this time computer users should have exercise of neck, shoulder, elbow, wrist, fingers, low back, knees and ankles (18-22). The data were kept confidential, anonymous and were analyzed using SPSS version 15 th .
The present study was done to see the effect of proprioceptive neuromuscular facilitation on back muscle strength, pain and QOL in subjects with Chronic Low BackPain. The main findings of the present study are that 4 weeks of PNF exercises significantly decreases the pain and increases spinal muscle strength in people with CLBP, without showing any improvement in QOL. Comparing VAS score measures taken after 4 weeks, the value of U = 39.500 for p < 0.0001 between Group A and Group B showed that the results were extremely significant at 5% level of significance.
The highest risk factors that contribute LBP was bending with 35% in the pre-test, this percentage was decreased to be 10.6% after having back physiotherapy and using back belts during the studied research period, this result is standby a study that revealed exercising applied in using body mechanism correctly strengthen the low back (Tosunoz and Oztune, 2017). Rest and sleep may also alleviate LBP as showed in the results, psychosocial factors and the presence of psychosomatic symptoms have been found to increase risk of backpain among nurses (Dawson et al., 2007). The radiation of LBP to left leg decreased, to the right leg increased, and for both legs increased after using the interventional methods, this result is consistence with a study that reported lumber support that used to prevent back injuries among nurses is limited evidence (Dawson et al., 2007). The findings also showed that 75% (n=15) of participants under went back physiotherapy and using belt while they are working at operation room, but 25% (n=5) of participants used only back belt while they are working at operation room. Preventing LBP among nurses by exercise should beunder healthy and safe environment is recommended, nurses who are responsible for health they Table 3. Frequencies of participants nurse responses to the questions regarding to backpain (N=20)
When the spine is involved, LCH most frequently presents with local backpain; the thoracic vertebrae is the most com- monly affected region (54%), followed by the lumbar spine (35%) and cervical spine (11%). There may be associated leu- kocytosis and fever. On conventional radiography, LCH can present as a lytic nonsclerotic destructive vertebral lesion; as a vertebra plana (with preserved adjacent disks and posterior elements rarely involved); or as scoliosis, which is far less com- mon. On CT, the nonsclerotic destructive osseous lesion can present with a paraspinal enhancing soft-tissue mass. Epidural extension may occur. A collapsed vertebra plana is a typical form of presentation (Fig 10A).
Backpain is one of the most costly conditions for which an economic analysis has been carried out in the UK, according to the NHS Pathfinder project (2014), a finding in line with the situation in other countries. Employers and the work force in general carry a great burden related to low backpain and other work-related musculoskeletal disorders (WRMSD, which include back, upper and lower body limb disorders) (Buckley 2015). Only the common cold exceeds backpain as a reason people seek medical health in the UK: almost 7 million GP visits are due to backpain annually (Johnson 2012).
Despite being told not to play sports the patient contin- ued to be active especially with hockey, golf, martial arts, roller blading, and horse back riding. Before participating in these activities he often wore a back brace around his torso. At 21 years of age the patient began massage thera- py school. The patient recalled that whenever other stu- dents massaged his back deeply he would suffer more pain for several weeks after.
We also found associations between cholesterol levels and CBP. Of note, whereas elevated LDL cholesterol was associated with CBP, elevated HDL was negatively associated with this outcome, sug- gesting that a favorable cholesterol profile may reduce the risk of CBP in patients with diabetes. These associations were present even after controlling for age, A1C level, and BMI. A link between serum lipid levels and backpain is controversial (16), although several epidemiological studies have found increased HDL cholesterol to be negatively associated with CBP (17,18). It is possible that advanced atherosclerosis also contrib- utes to the microvessel disease that leads to disc degeneration (7). More work is needed to determine whether TABLE 4. Results of Multivariable Logistic Regression Analysis
Although the general practitioner, and if applicable the occupational physician, will be informed about the treat- ment and progress of the patient, the intervention is mono-disciplinary. A multidisciplinary intervention in a primary care setting has major practical implications and would increase the costs of the intervention considerably. The intensive group training protocol itself probably gen- erates higher costs than physiotherapy guideline care but we expect reduction in health care utilization and produc- tivity losses in the long term, compensating for the increase in treatment cost. This trial will provide physio- therapists with more knowledge and experience in behav- ioural treatment for low backpain patients and may increase the efficiency of physiotherapeutic care for this complex and expensive patient group. If the intensive group training protocol appears to be more cost-effective than physiotherapy guideline care, a future update of the national physiotherapy guideline will include more spe- cific recommendations in line with this protocol. In that case the protocol will be implemented throughout the Netherlands.
Backpain is the most common reason for people in Denmark visiting general practitioners (GPs)  and it is responsible for more years lived with disability worldwide than any other condition [16, 17]. The societal, health care and economic burden associated with backpain is high and comparable to conditions such as cardiovascular dis- ease, cancer, mental health, and autoimmune diseases . In Denmark, every tenth visit to a GP and every third visit to a chiropractor or physiotherapist is due to backpain . Almost one in five patients consulting a Danish GP for backpain has severe persistent pain . Single episodes of backpain usually resolve quickly but recurrent episodes are very common [20–23]. Patients with persist- ent backpain describe the condition as negatively affect- ing their lives, leaving them disempowered, and that the outcomes of consultations with health care professionals are often inadequate . Further, half of the patients attending a GP due to backpain believe that they need imaging . There is an obvious need to reduce the burden of backpain both in terms of the disability and poor quality of life experienced by people who live with severe backpain and in terms of the substantial costs to society.
The specific etiology of LBP is still unidentified in most of the patients presenting to healthcare but listening to the patient gives the physician the best opportunity to identify the causes of LBP . A full history and physical examination is essential in developing a diagnostic plan to identify the cause(s) of symptoms and administering a therapeutic regimen to relieve the pain. A focused history and physical examination are essential in evaluating patients presenting with LBP to assess them for serious symptoms of neurologic compromise, inflammatory, or medical conditions. Most of the patients can be evaluated by history and physical examination alone if the dura- tion of backpain is less than one month  but a through history and physical exam can guide clinicians for further indicated diagnostic studies in serious underlying conditions (see Figure 1). In the majority of cases, the pain is self-limited so no specific treatment is required.
Aim:Low backpain is a common disease, and it is observed at least once in 70-85% of the population during their lifetime.Chronic low backpain (CLBP)interferes with the physical ability and mobility of high number of people. This study will determine if there is a relationship between mental disorders including depression, hypochondriasis and anxiety, and the functional status of patients suffering from chronic low back pain.Subjects and methods: The study was performed on a sample of 200 agreed to participate in this cross-sectional study. The patients were divided equally into two separate groups: first group consisted patients with chronic low backpain with clear organic lesion and validated radiologically.The second group consisted of patients with chronic low backpain in which no clinical and radiological confirmation for an organic lesion, or called functional group. Every patient has undergone to the following procedures: A) Medical evaluation including (Neurological evaluation, systemic examination mainly gynecological examination in all female patients and radiological examination mainly Plain x-ray of lumbosacral spine and Magnetic Resonence Imaging(MRI) lumbosacral spine. B) The psychological evaluation used to measure anxiety, depression and hypochondriasis by adopting the MMPI Questionnaire Results: This study sample has included 53% males and 47% females in organic group while 30% males and 70% females in functional group. In Organic group, age and LBPwere found to be significantly associated. Radiation was absent in 9% of patients in organic group and in 60% of patients in functional group. Parathesia present in 85% of organic group, while functional group 20%. 70% of those in organic group and 25% of those in functional group reported severe pain.Depressionwas observed in 15% oforganic group
Gary is a full-time shop owner. The role involves prolonged sitting and standing and also involves moving and sorting heavy deliveries. He has a history of lower backpain but 6 weeks ago his symptoms altered fol- lowing an incident at work lifting heavy boxes. Previously he com- plained of a constant, but variable, ache across the lumbar region and buttocks, affecting daily activities. Since the recent injury he reports unre- mitting pain in the lower back (Gary indicates this to be in the L4–L5 region). He also complains that he has a ‘numb bum’ with pins and needles in the right leg.
at follow-up was reported; the association between QST responses at baseline and LBP outcomes at follow-up was reported; and the follow-up duration was a minimum of 1 week. No restrictions were placed on the setting or recruit- ment source of participants. We excluded LBP due to serious pathology (eg, fracture, neoplasm, and infection) or a spe- cific condition (eg, rheumatoid arthritis, failed back surgery syndrome, pregnancy, postpartum backpain, and chronic widespread pain such as in fibromyalgia, irritable bowel syndrome) or after back surgery. Studies that investigated LBP together with other musculoskeletal pain disorders (eg, neck pain and thoracic pain) were also included if at least > 75% of the sample had LBP , or if data for LBP could be extracted separately.
One of the most frequent mechanisms suggested is associated with the mechanical factors, due to weight gaining during pregnancy, to the increase of the abdominal sagittal diameter and the consequent shifting of the body gravity center anteriorly, increasing the stress on the lower back. [3,8,9,11] Studies suggest that an anterior shift is associated with pubic symphysis problems.  Postural changes may be implemented to balance this anterior shift, causing lordosis and increasing stress on the lower back.  The connection between LBP and PFD (Pelvic Floor dysfunction) has been suggested. A negative Active Straight Leg Raise test (ASLR) in combination with a positive PPPT may be interpreted as an increased activity of the pelvic floor muscles, in order to compensate for the impaired pelvic stability. 
This study aimed to elucidate patterns uniquely associated with acute or chronic backpain. Differentiating between the two is challenging in clinical practice. Identifying risk factors associated with the pattern may help clinicians dif- ferentiate between the two conditions, manage them more appropriately and ultimately help to improve patient out- comes. In addition this could enable targeting of those at greatest risk for prevention through e.g. workplace modifi- cation strategies.
by stressors such as heavy lifting, contact stress (repeated or constant contact between soft body tissue and a hard or sharp object), vibration, repetitive motion, and awkward posture. Using ergonomically designed furniture and equipment to protect the body from injury at home and in the workplace may reduce the risk of back injury. In this module, authors have provided background, etiology, risk factors and prevention of backpain. Adopting correct postures is ated correct postures with the help of eleven colour
Low backpain is a common musculoskeletal problem af- fecting the population both in developing and developed world. It is the major cause of work absenteeism and mus- culoskeletal disability . Chronicity of low backpain leads to significant expenses causing strain on the health care system. Eighty percent of the population is expected to suffer from low backpain at one time or other during their life. In developed countries like the UK, the point prevalence of low backpain is estimated to be close to 50% [2, 3]. In the USA, the point prevalence ranges from 8 to 56% . Various studies of low backpain epidemi- ology done in India give the prevalence of low backpain (LBP) between 6.2 and as high as 92% depending on the population studied . In the majority of people, backpain is self-limiting. However, a significant percentage of these patients develop to have chronicity of their symptoms.
We previously developed and tested a simulated acupunc- ture technique using a toothpick in a guidetube and deter- mined that the technique was considered a credible acupuncture treatment by participants with low backpain  The acupuncturist will simulate insertion of needles, using the toothpick and guidetube technique, at the same eight acupoints used in the standardized treatment (Du3, UB23-bilateral, low back ashi, UB40-bilateral, Ki3-bilat- eral). Simulating insertion involves holding the skin taut around each acupoint and placing a standard acupuncture needle guidetube that contains a toothpick against the skin. The acupuncturist then taps the toothpick gently, twisting it slightly so that it feels to the participant like an acupuncture needle grabbing the skin, and then quickly withdraws both the toothpick and guidetube while keep- ing his or her fingers against the skin for a few additional seconds to imitate the process of inserting the needle to the proper depth. All acupoints will be "stimulated" with toothpicks at 10 minutes (i.e., the acupuncturist will touch each acupoint with the tip of a toothpick without the guidetube, rotate the toothpick clockwise and then counterclockwise less than 30 degrees) and again at 20 minutes just before they are "removed." Location of the correct acupoints for initial and subsequent stimulation will be facilitated by having marked all the acupoints with non-toxic ink prior to initiation of treatment. To simulate withdrawal of the needle, the acupuncturist tightly stretches the skin around each acupoint, presses a cotton ball firmly on the stretched skin, then momentarily touches the skin with a toothpick (without the guidetube) and quickly pulls the toothpick away using the same hand movements as in regular needle withdrawal. For verisimil- itude, the Therapists will crinkle an empty needle wrapper to simulate the sound of unwrapping needles before treat-
Abstract: Low backpain (LBP) is a musculoskeletal disorder, affecting humans from adolescent to adult age. It is a health and socio-economic problem worldwide. The cause and contributing factors to LBP are multifactorial resulting in different approaches for its management. The attitudes and beliefs of patient with LBP, play an important role in the whole process of pain management. Negative attitudes and beliefs may lead to fear -avoidance behaviour, resulting into pain chronicity and disability. Thus, this study aimed to identify the attitudes and beliefs among patients with LBP, attending physiotherapy treatment in Malawi. Queen Elizabeth and Kamuzu Central hospitals were selected as study settings. A quantitative cross-sectional survey was done, using a self-administered questionnaire, employing a convenience sampling method. Twelve statements about attitudes and beliefs on LBP were adopted from the Back Beliefs Questionnaire (BBQ) and from the Survey of Pain Attitudes (SOPA). The SPSS (version 19.0) was used for data capturing and analysis. Descriptive and inferential statistics were used to summarize data. The Chi-square test was used to determine any association between variables and the Alpha level of significance was set at 0.05. All ethical issues were sought and adhered to throughout the study period. The results showed that out of 205 participants, with mean age of 47.74 years, (SD=13.29), female constituted 53.2% of the sample. More than half (67%) of all participants portrayed negative attitudes and beliefs about their LBP. We concluded that, majority of patients with LBP in Malawi hold negative attitudes and beliefs about their pain. Therefore, patient health education is needed to change these attitudes and beliefs if recovery and treatment goal are to be achieved.
A systematic literature search was conducted in Pubmed (www.pubmed.org) for a number of musculoskeletal dis- eases  published between January 1 st 2000 and July 1 st 2011. Search terms included both free text and MeSH terms and were combined by Boolean terms (AND, OR, NOT) (see Additional file 1). The following MESH terms included in this review were “neck pain”, “backpain”, and “low backpain” and were limited to include only studies containing “epidemiology”, “etiology”, or “diagno- sis”. The search was restricted to English language only. No additional hand search was conducted. The retrieval of potentially relevant articles was conducted in two steps by one examiner. The first step focused on identifying relevant studies through the title and abstract. This was followed by retrieval of all full-text articles for further eligibility (see below).