Diaphragm Fatigue And Lower Pack Pain

A thought-provoking study, abstract:

The diaphragm plays an important role in spinal control. Increased respiratory demand compromises spinal control, especially in individuals with low back pain (LBP). The objective was to determine whether individuals with LBP exhibit greater diaphragm fatigability compared to healthy controls. Transdiaphragmatic twitch pressures (TwPdi) were recorded in 10 LBP patients and 10 controls, before and 20 and 45 min after inspiratory muscle loading (IML). Individuals with LBP showed a significantly decreased potentiated TwPdi, 20 min (-20%) (p=0.002) and 45 min (-17%) (p=0.006) after IML. No significant decline was observed in healthy individuals, 20 min (-9%) (p=0.662) and 45 min (-5%) (p=0.972) after IML. Diaphragm fatigue (TwPdi fall ≥ 10%) was present in 80% (20 min after IML) and 70% (45 min after IML) of the LBP patients compared to 40% (p=0.010) and 30% (p=0.005) of the controls, respectively. Individuals with LBP exhibit propensity for diaphragm fatigue, which was not observed in controls. An association with reduced spinal control warrants further study.

Further study can, among other things, look at cause and effect.  Does diaphragm fatigue lead to spinal problems and lower back pain?  Or is it the reverse?  Or is spinal problems and back pain not directly related, but that one leads to the other through the intermediate step of diaphragm  fatigue?  Is there some way to make the diaphragm less "fatigable" - perhaps by increasing ease of breathing through weight loss of conditioning through exercise?

Wool Underwear For Lower Back Pain

Public Domain, https://commons.wikimedia.org/w/index.php?curid=16818

Lower back pain is a common complaint; here we see a study suggesting that the use of wool underwear leads to "significant improvements in pain intensity, disability, and lower back flexibility." Temperature-related mechanism? Abstract:

The aim was to assess the effect of wool underwear use in patients with chronic non specific low back pain. The study employed two-group, experimental design. A total of 48 patients with chronic non specific low back pain were selected for the study. They were distributed into two groups: a control group and a treatment group. The 24 patients in each group were randomly selected and the compositions of the two groups. The patients in the treatment group wore woolen underwear during the experimental period of 2 month. All patients were assessed at the beginning the trial (pre-test) and the end of 8th (post-test) week. Data were collected using the visual analogue pain scale, Oswestry Disability Index and Schober test measurements. Patients in the treatment group reported significant improvements in their conditions including a reduction in pain levels and Oswestry Disability Index, and Schober test measurements increased (p<0.001). Patients with chronic non-specific low back pain who wore wool underwear experienced significant improvements in pain intensity, disability, and lower back flexibility.

Caveat emptor.  

Chronic Back Pain: Surgery Or Conservative Treatment?

By http://en.wikipedia.org/wiki/user:Vsion - Originally Vsion's work, CC0, https://commons.wikimedia.org/w/index.php?curid=16090144

Should you have surgery or nonsurgical treatment for chronic lower back pain? This paper suggests nonsurgical treatment can be “effective, feasible, and safe” although more studies, properly conducted, are required to give more definitive results (a caveat one often reads with respect to such studies and reviews). Conclusions from the abstract:

CONCLUSIONS: For chronic low back pain, nonsurgical treatment was shown to be effective, feasible, and safe during the follow-up period. More randomized controlled trials are needed to compare surgical and nonsurgical treatment of chronic low back pain.

Here is a paper on lumbar spinal stenosis treatment, conclusions of the abstract:

AUTHORS' CONCLUSIONS: We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis, and we can provide no new recommendations to guide clinical practice. However, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservative treatment. No clear benefits were observed with surgery versus non-surgical treatment. These findings suggest that clinicians should be very careful in informing patients about possible treatment options, especially given that conservative treatment options have resulted in no reported side effects. High-quality research is needed to compare surgical versus conservative care for individuals with lumbar spinal stenosis.

Essentially, these authors state that there is no clear evidence of whether surgery or more conservative treatment is best for lumbar spinal stenosis; however, given that there is a significant risk of side effects for surgery and no side effects reported for conservative treatments, clinicians need to take care in how they inform patients of treatment options. Everyone must make their own decisions on these matters with the consultation of their physician. Speaking strictly for myself (as someone who has had some moderate flare-ups of lower back pain), I would always first choose the conservative treatments and have surgery as a “last resort’ back-up plan. But, that’s me. Others may be in a condition where conservative treatment does not help and then they and their physician need to review more aggressive treatment options.