Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial Impact of a Sit-Stand Workstation on Chronic Low Back Pain: Results of a Randomized Trial Sitting and low back pain: the positive effect of rotatory dynamic stimuli during prolonged sitting Energy transfer across the lumbosacral and lower-extremity joints in patients with low back pain during sit-to-stand. Efficacy of two multimodal treatments on physical strength of occupationally subgrouped male with low back pain. Relationship Between Low Back Pain and Lumbar Multifidus Size at Different Postures A multifaceted workplace intervention for low back pain in nurses' aides: a pragmatic stepped wedge cluster randomised controlled trial A Prospective Study of Incidence and Risk Factors for the Onset and Persistence of Low Back Pain in Thai University Students Postural sway in low back pain: Effects of dual tasks. Control of the Lumbar Neutral Zone Decreases Low Back Pain and Improves Self-Evaluated Work Ability: A 12-Month Randomized Controlled Study Occupational, Personal and Psychosocial Resources for Preventing Persistent Low Back Pain Effect of Dual-Tasking on Postural Control in Subjects With Nonspecific Low Back Pain Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. A randomized controlled trial to determine the effect of spinal stabilization exercise intervention based on pain level and standing balance differences in patients with low back pain Effect of a multidisciplinary program for the prevention of low back pain in hospital employees: a randomized controlled trial. Manipulation does not add to the effect of extension exercises in chronic low-back pain (LBP). A randomized, controlled, double blind study. The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: a preliminary report.
Objective The St and Back study evaluated the feasibility and effects of a multicomponent intervention targeting reduced prolonged sitting and pain self-management in desk workers with chronic low back pain ( LBP ) . Methods This r and omised controlled trial recruited 27 individuals with chronic LBP , Oswestry Disability Index ( ODI ) > 10 % and desk jobs ( sitting ≥20 hours/week ) . Participants were r and omised within strata of ODI ( > 10%–<20 % , ≥20 % ) to receive bimonthly behavioural counselling ( in-person and telephone ) , a sit-st and desk attachment , a wrist-worn activity-prompting device and cognitive behavioural therapy for LBP self-management or control . Self-reported work sitting time , visual analogue scales ( VAS ) for LBP and the ODI were assessed by monthly , online question naires and compared across intervention groups using linear mixed models . Results Baseline mean ( SD ) age was 52 ( 11 ) years , 78 % were women , and ODI was 24.1 (10.5)% . Across the 6-month follow-up in models adjusted for baseline value , work sitting time was 1.5 hour/day ( P<0.001 ) lower comparing intervention to controls . Also across follow-up , ODI was on average 8 points lower in intervention versus control ( P=0.001 ) . At 6 months , the relative decrease in ODI from baseline was 50 % in intervention and 14 % in control ( P=0.042 ) . LBP from VAS was not significantly reduced in intervention versus control , though small-to-moderate effect sizes favouring the intervention were observed ( Cohen ’s d ranged from 0.22 to 0.42 ) . Conclusion An intervention coupling behavioural counselling targeting reduced sedentary behaviour and pain self-management is a translatable treatment strategy that shows promise for treating chronic LBP in desk-bound employees . Trial registration number NCT0224687 ; Pre- results Objective : The aim of the study was to determine whether  chronic low back pain ( LBP ) might be attenuated through the introduction of a sit-st and workstation ( SSW ) in office employees . Methods : Participants were r and omized to receive a SSW at the beginning or at the end of a 3-month study period . Participants responded to a short survey at the end of each workday and a comprehensive survey at weeks 1 , 6 , and 12 . Surveys consisted of a modified brief pain inventory and the Rol and Morris Disability Question naire . Results : Forty-six university employees with self-reported chronic LBP were enrolled . Participants who were given access to a SSW reported a significant reduction in current ( P = 0.02 ) and worst ( P = 0.04 ) LBP over time . Conclusions : Our findings support the hypothesis that chronic LBP might be improved by the introduction of a SSW in an office environment Abstract In this study the effect of dynamic stimuli on  low back pain during prolonged sitting was investigated . The pain experience of two groups of 60 subjects with aspecific low back pain was recorded . All subjects were investigated on pain behaviour by the Multidimensional Pain Inventory ( MPI ) and pain was measured on an open visual analogue scale ( VAS ) . During sitting , one group received dynamic stimuli that were generated by alternating rotations in the horizontal plane of the seat of the chair , with back and arm rests in fixed position . Two different frequencies of rotation were applied in subgroups . The authors concluded that such stimuli , especially of the lower frequency , reduced pain in prolonged sitting OBJECTIVE To examine the transfer of energy through the pelvis and the lower limb during sit-to-st and ( STS ) in low back pain ( LBP ) subjects with or without a straight-leg raise sign . DESIGN Cross-sectional . SETTING Biomechanics laboratory . PARTICIPANTS Three groups , each of 20 subjects , participated . The first group consisted of asymptomatic subjects , and the other 2 groups of consisted of LBP subjects ( duration between 7 days and 12 weeks ) with and without a straight-leg raise sign .  INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The work done and the power of the pelvis , thigh , and leg segments during STS  were determined . RESULTS Energy was transferred from the pelvis to the thigh segment and then to the leg segment , and this was achieved mainly by passive mechanisms . The power flow of the pelvis segment was significantly decreased in subjects with LBP . Although the power of the lower-limb segments was decreased , the total work done of these segments was increased . CONCLUSIONS STS is a more energy-dem and ing and less efficient task for subjects with LBP , either with or without a positive straight-leg raise sign . Such increases in energy dem and may further exacerbate back pain , and treatment should be developed to restore a more efficient energy transfer pattern OBJECTIVES Some occupations are more prone to low back pain ( LBP ) due to their static work postures and work place design . Multidisciplinary pain programs have shown their effectiveness in the management of LBP in general population but which treatment and which segment of the population will be benefited more was not investigated yet . This study determines the effect of two treatment protocol s on five occupationally subgrouped male LBP patients . METHODS A total of 102 occupational male , 20 - 40 yrs of age , with sub-acute or chronic nonspecific LBP were r and omized and treated either with conventional treatment a combination of two electrotherapy ( ultrasound and short wave diathermy ) and one exercise therapy ( lumbar strengthening exercises ) or dynamic muscular stabilization techniques ( DMST ) an active approach of stabilizing training . At the end of the treatment , subjects of both the groups were further stratified in five subgroups on the basis of their occupation . The pain was the primary outcome measure while physical strength [ back pressure changes ( BPC ) and abdominal pressure changes ( APC ) ] the secondary . RESULTS The Pain , BPC and APC of all subgroups improved significantly ( P < 0.01 ) in the both treatments but more in DMST . For each variable , improvement in subgroups differed within and between the treatments . Overall improvement in all assessed variables were evident on Desk workers followed by Shop keepers the most while BPC of Movement job , APC of Others and Pain of Sedentary and Shop keepers improved the least . CONCLUSIONS Study concluded that for the management of occupational LBP , DMST is more effective than conventional treatment . The Pain of Sedentary and Shopkeepers and physical strength of Movement job and Others may need more clinical attention . Findings of this study may be helpful in the management of occupational LBP Study Design . A prospect i ve study of multifidus images . Objective . To compare the change of the cross-sectional area ( CSA ) of multifidus in subjects with and without chronic low back pain ( LBP ) at different postures . Summary of Background Data . Ultrasound imaging was shown to be useful in assessing acute LBP patients at rest only . Methods and Measures . Thirty-five male adults participated , including 19 normal and 16 chronic LBP patients . The CSAs of multifidus were assessed on ultrasound images acquired on both sides of the L4 and L5 levels with the subjects in prone lying , upright st and ing , and 25 ° and 45 ° forward stooping . Results . In the control group , the CSA of multifidus increased from prone lying to upright st and ing and then gradually decreased from 25 ° to 45 ° forward stooping . However , a reverse pattern of the CSA changes was identified in patients with chronic LBP . Conclusion . Multifidus contracts maximally at upright st and ing in the normal group , while maximum contraction of the muscle occurs at 25 ° forward stooping in the patient group . The role of multifidus may be altered in the stabilization of the lumbar spine of chronic LBP patients . Assessment of the change in muscle size reacting to different postures is found to be helpful Abstract This study established the effectiveness of a workplace multifaceted intervention consisting of participatory ergonomics , physical training , and cognitive – behavioural training ( CBT ) for  low back pain ( LBP ) . Between November 2012 and May 2014 , we conducted a pragmatic stepped wedge cluster r and omised controlled trial with 594 workers from eldercare workplaces ( nursing homes and home care ) r and omised to 4 successive time periods , 3 months apart . The intervention lasted 12 weeks and consisted of 19 sessions in total ( physical training [ 12 sessions ] , CBT [ 2 sessions ] , and participatory ergonomics [ 5 sessions ] ) . Low back pain was the outcome and was measured as days , intensity ( worst pain on a 0 - 10 numeric rank scale ) , and bothersomeness ( days ) by monthly text messages . Linear mixed models were used to estimate the intervention effect . Analyses were performed according to intention to treat , including all eligible r and omised participants , and were adjusted for baseline values of the outcome . The linear mixed models yielded significant effects on LBP days of −0.8 ( 95 % confidence interval [ CI ] , −1.19 to −0.38 ) , LBP intensity of −0.4 ( 95 % CI , −0.60 to −0.26 ) , and bothersomeness days of −0.5 ( 95 % CI , −0.85 to −0.13 ) after the intervention compared with the control group . This study shows that a multifaceted intervention consisting of participatory ergonomics , physical training , and CBT can reduce LBP among workers in eldercare . Thus , multifaceted interventions may be relevant for improving LBP in a working population This study aim ed to examine the 12-month incidence and risk factors for the onset and persistence of low back pain ( LBP ) in undergraduate students . A 1-year prospect i ve study was carried out among 684 healthy students in a large public university in Thail and . Data were collected using a self-administered question naire and a physical examination . Follow-up data were collected every 3 months . A total of 524 ( 77 % ) students were followed for 1 year . A total of 31 % reported a new onset of LBP , of whom 31 % reported persistent LBP . Having no low back support during computer work was a significant predictor for the onset and persistence of LBP . The onset of LBP was also associated with quadriceps muscle tightness . LBP is common among undergraduate students , and many of them may have persistent symptoms . Physical risk factor plays a significant role for the onset and persistence of LBP among the study population Recurrence quantification analysis ( RQA ) , a nonlinear method of postural analysis , was used to explore the effects of dual-tasking on postural performance in people with nonspecific low back pain ( LBP ) compared with healthy participants .  Postural performance was quantified by RQA % recurrence , % determinism , entropy and trend .  People with nonspecific LBP ( n=22 ) and unimpaired individuals ( n=22 ) r and omly performed quiet st and ing tasks with three levels of difficulty ( rigid-surface eyes open , rigid-surface eyes closed and foam-surface eyes closed ) . These tasks were performed in isolation or concurrently with an easy or difficult cognitive task . Increasing postural difficulty was associated with higher % determinism , higher entropy and lower trend in anteroposterior ( AP ) and mediolateral ( ML ) directions in people with LBP and healthy participants .  All RQA variables in the ML direction decreased as cognitive conditions became more difficult . Significant interactions between group and cognitive difficulty were shown for % recurrence , % determinism and trend in the AP direction . While healthy participants decreased % recurrence and trend by increasing the level of cognitive difficulty , the LBP patients did not . This preliminary study suggests that LBP may be one factor that modulates the posture-cognition interaction Study Design . A r and omized controlled study with 12 months intervention . Objective . To study the effectiveness of a training intervention with emphases on the control of lumbar neutral zone ( NZ ) and behavior modeling as secondary prevention of  low back pain ( LBP ) and disability .  Summary of Background Data . Improving the control of lumbar NZ and enhancing muscle activation patterns ensuring spinal stability have been proposed as means for secondary prevention of LBP and disability . In addition , cognitive behavior interventions have been shown to lower the risk of recurrence of LBP and long-term disability . Methods . Middle-aged working men with recent LBP but without severe disability were r and omly allocated to either a training ( TG , n = 52 ) or control group ( CG , n = 54 ) . The aim was to exercise twice a week for 12 months , once guided and once independently . The outcome measures were the changes in intensity of LBP , disability , self-evaluated future work ability , and neuromuscular fitness . Results . The intensity of LBP decreased significantly more ( 39 % ) in the TG than in CG at 12 months . The proportion of subjects with negative expectations about their future work ability decreased in both groups at 6 and 12 months ; however , the proportion was significantly bigger in TG compared with CG ( P = 0.028 ) . There effects on disability indexes and fitness were not statistically significant . Conclusions . Controlling lumbar NZ is a specific form of exercise and daily self-care with potential for prevention of recurrent nonspecific LBP and disability among middle aged working men The aim of this prospect i ve cohort study was to identify modifiable protective factors of the progression of acute/subacute low back pain ( LBP ) to the persistent state at an early stage to reduce the socioeconomic burden of persistent LBP .  Patients attending a health practitioner for acute/subacute LBP were assessed at baseline addressing occupational , personal and psychosocial factors , and followed up over 12 weeks . Pearson correlations were calculated between these baseline factors and the presence of nonpersistent LBP at 12-week follow-up . For those factors found to be significant , multivariate logistic regression analyses were performed . The final 3-predictor model included job satisfaction , mental health and social support . The accuracy of the model was 72 % , with 81 % of nonpersistent and 60 % of persistent LBP patients correctly identified . Further research is necessary to confirm the role of different types of social support regarding their prognostic influence on the development of persistent LBP Study Design . Three factors mixed- design with 1 between-subject and 2 within-subject factors . Objective . To compare the main effects and interactions of postural and cognitive difficulty on quiet stance between subjects with and without nonspecific low back pain ( LBP ) . Summary of Background Data . The interference between postural control and cognitive tasks depends on factors such as sensorimotor/cognitive integrity . Changes in peripheral sensory and muscular systems as well as cognitive processes have been observed in LBP patients . It was hypothesized that the effect of cognitive task on postural performance might be different in subjects with nonspecific LBP as compared with healthy individuals . To the authors ’ knowledge this has not been investigated before . Methods . Postural stability was measured by center of pressure parameters while nonspecific LBP ( n = 22 ) and healthy ( n = 22 ) subjects r and omly performed quiet st and ing task with 3 levels of difficulty ( rigid-surface eyes open , rigid-surface eyes-closed , and foam-surface eyes-closed ) in isolation or concurrently with an easy or difficult digits backward cognitive task . Results . Subjects with nonspecific LBP had less postural sway than healthy subjects , while postural sway decreased with increase in the level of cognitive difficulty . Nonspecific LBP and healthy subjects had larger postural sway at more difficult sensory conditions such as rigid-surface eyes-closed and foam-surface eyes-closed . The response to dual-tasking was not significantly different between the 2 groups . Conclusion . The dual-tasking did not change the postural performance of nonspecific LBP subjects with low level of pain and disability differently compared to healthy subjects OBJECTIVE To develop a clinical prediction rule to predict treatment response to a stabilization exercise program for patients with low back pain ( LBP ) . DESIGN A prospect i ve , cohort study of patients with nonradicular LBP referred to physical therapy ( PT ) . SETTING Outpatient PT clinics . PARTICIPANTS Fifty-four patients with nonradicular LBP . INTERVENTION A st and ardized stabilization exercise program . MAIN OUTCOME MEASURE Treatment response ( success or failure ) was categorized based on changes in the Oswestry Disability Question naire scores after 8 weeks . RESULTS Eighteen subjects were categorized as treatment successes , 15 as treatment failures , and 21 as somewhat improved . After using regression analyses to determine the association between st and ardized examination variables and treatment response status , preliminary clinical prediction rules were developed for predicting success ( positive likelihood ratio [ LR ] , 4.0 ) and failure ( negative LR , .18 ) . The most important variables were age , straight-leg raise , prone instability test , aberrant motions , lumbar hypermobility , and fear-avoidance beliefs . CONCLUSIONS It appears that the response to a stabilization exercise program in patients with LBP can be predicted from variables collected from the clinical examination . The prediction rules could be used to determine whether patients with LBP are likely to benefit from stabilization exercises Summary Background A number of studies have evaluated exercise interventions compared with other treatment strategies for subjects with recurrent low back pain ( LBP ) ; however , subject pain level and balance were not carefully considered . The purpose of this study was to investigate the effectiveness of spinal stabilization exercises ( SSE ) for managing pain and increasing balance strategy changes following unexpected perturbations in patients diagnosed with recurrent LBP . Material / Methods Twenty-one age- and gender-matched patients participated in a supervised SSE or control exercise program 5 times a week over a 4-week period . The Million Visual Analogue Scale ( MVAS ) and Oswestry Disability Index ( ODI ) were used to measure each patient ’s level of pain and disability . Balance measurements were derived from recordings of the anterior-posterior ( A/P ) and medio-lateral ( M/L ) center of pressure ( COP ) displacements during 3 consecutive , unexpected r and om perturbations . Results The level of reported pain and disability significantly decreased following treatment for both groups . Although the M/L sway was not significantly different in either group ( p=0.86 ) , there was a significant difference between group and measurement time during A/P sway ( p=0.04 ) . The A/P displacement of the SSE group significantly decreased compared with the control group . The decreased A/P displacement can be linked to the SSE intervention , which helps prevent further injury by limiting an individual ’s response rate to external perturbations . Conclusions Clinicians might consider SSE for LBP patients as a possible rehabilitation strategy to reduce A/P displacement BACKGROUND Hospital workers with physically dem and ing jobs are at risk for developing recurrent LBP . There is a lack of studies evaluating multidisciplinary prevention of  low back pain ( LBP ) in hospital workers . OBJECTIVE This r and omized controlled trial evaluates the effect of a multidisciplinary prevention program , focusing on a client-centred approach , on hospital workers at risk for developing LBP . METHODS Caregiving hospital workers were allocated to an experimental ( 12-week lasting multidisciplinary prevention program ) or control group ( no intervention ) . They were evaluated prior to the intervention and after a 6 months follow-up period . Primary outcome measures included incidence of LBP , work absenteeism and general health . Secondary outcomes included daily physical activity , job satisfaction and coping strategies . RESULTS A significant improvement was seen for passive coping after 6 months follow-up , but no significant differences were observed between groups in primary or other secondary outcome measures ( p > 0.05 ) . CONCLUSIONS A multidisciplinary prevention program fitting into a bio-psychosocial context may not have been intensive enough to promote a change in daily habitudes , and had no effect on work absenteeism , incidence of LBP or general health . Further research should determine whether prevention of LBP is possible in caregiving personnel OBJECTIVES Both exercises and manipulation are recommended as basic therapy in back diseases , while a possible synergistic effect of these treatments have not been clarified . This study was conducted to test a possible further effect of manipulation as adjunct to extension exercises for unspecific LBP . METHODS 72 patients with chronic LBP ( mean 12 months ) were examined by a specialist in manual medicine , who detected localized binding between the lumbar segments . All patients were instructed in extension exercises , while r and omized to either pretreatment with specific manipulation or control . The patients were blinded to the manipulation , which was performed at the end of the manual examination , and repeated after two and four weeks . The manipulator only knew the group of the particular patient just before manipulation by the end of the examination . The primary end point was pain , measured by a visual analogue scale . RESULTS Pain in both back and leg decreased without differences between groups . Segmental binding of the low-back was associated with persisting clinical symptoms at four weeks . CONCLUSION No additional effect was demonstrated of manipulation , when extension exercises were used as basic therapy OBJECTIVE To examine the effect on symptoms of modifying  patient-preferred movements and alignments of the lumbar spine during patient examination . DESIGN Repeated- measures study in which patients with low back pain ( LBP ) participated in a st and ardized examination that included tests of symptoms with various movements and positions . SETTING Six university-affiliated outpatient physical therapy clinics and the local community . PARTICIPANTS Five trained physical therapists examined a total of 185 patients ( 102 women , 83 men ; mean age , 41.89+/-13.29 y ) with LBP . The majority of patients had multiepisode , chronic LBP . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The examination included tests of symptoms with various alignments and movements in several different positions . Seven tests were design ated as primary tests . Tests that increased symptoms were followed immediately by a secondary test in which ( 1 ) patient-preferred lumbar spine movement was modified or ( 2 ) the lumbar spine was positioned in a neutral alignment . Patients reported the effect of the secondary test on symptoms relative to their symptoms with the primary test . Three responses were possible : symptoms increased , remained the same , or decreased . RESULTS Eighty-three percent of the patients reported an increase in symptoms with 1 or more of the 7 primary tests . Ninety-five percent who reported an increase in symptoms with at least 1 of the primary tests reported a decrease in symptoms with 1 or more of the 7 secondary tests . The majority of patients reported a decrease in symptoms when the spinal movement or alignment was modified for 6 of the 7 secondary tests . CONCLUSIONS Modifying the symptom-provoking movements and alignments of the spine during symptom testing result ed in a decrease in symptoms for the majority of patients . Information about specific modifications that provide relief of LBP symptoms is important because it can be used to design a treatment program that focuses on training a patient to modify the same movements and alignments in their everyday activities
The results suggest there is currently no evidence to support the use of dynamic sitting as a st and -alone approach in the management of LBP .
Overall , the evidence suggests that dynamic sitting approaches are not effective as a st and -alone management approach for LBP
Dynamic sitting has been proposed to reduce  low back pain ( LBP ) and /or low back discomfort ( LBD ) while sitting .
This is supported by studies suggesting that subjects with LBP assume more static , sustained postures while sitting .
This systematic review investigated the effect of dynamic sitting on LBP among subjects with LBP and the development of LBD among pain-free subjects .
Practitioner Summary : This systematic review investigated the effect of dynamic sitting on LBP or LBD .