• The Korean Journal of Pain
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• v.28 no.2
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• pp.137-143
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• 2015

Background: Insomnia is becoming increasingly recognized as a clinically important symptom in patients with chronic low back pain (CLBP). In this retrospective study, we have determined risk factors associated with clinical insomnia in CLBP patients in a university hospital in Korea. Methods: Data from four-hundred and eighty one CLBP patients was analyzed in this study. The Insomnia Severity Index (ISI) was used to determine the presence of clinical insomnia (ISI score ${\geq}15$). Patients' demographics and pain-related factors were evaluated by logistic regression analysis to identify risk factors of clinical insomnia in CLBP. Results: It was found that 43% of patients reported mild to severe insomnia after the development of back pain. In addition, 20% of patients met the criteria for clinically significant insomnia (ISI score ${\geq}15$). In a stepwise multivariate analysis, high pain intensity, the presence of comorbid musculoskeletal pain and neuropathic pain components, and high level of depression were strongly associated with clinical insomnia in CLBP. Among these factors, the presence of comorbid musculoskeletal pain other than back pain was the strongest determinant, with the highest odds ratio of 8.074 (95% CI 4.250 to 15.339) for predicting clinical insomnia. Conclusions: Insomnia should be addressed as an integral part of pain management in CLBP patients with these risk factors, especially in patients suffering from CLBP with comorbid musculoskeletal pain.

• Journal of Physiology & Pathology in Korean Medicine
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• v.26 no.4
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• pp.557-565
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• 2012

The purpose of this study was to examine the effect of acupuncture on trunk flexors compared with trunk extensors in patients with chronic low back pain. The experimental group was treated with acupuncture on trunk flexors. The control group was treated with acupuncture on trunk extensors. Acupuncture treatment was performed 12 sessions over the course of 6 weeks. Volunteers who satisfied the requirements were enrolled in the study. Chronic low back pain was evaluated based on the VAS for bothersomeness, VAS for pain intensity at every treatment and 8, 12 and 24 weeks after starting the treatments, and ODI, SF-36 and BDI before and after treatments and 8, 12 and 24 weeks after starting the treatments. The VAS score for bothersomeness significantly decreased after treatment for up to 24 weeks after starting the treatments in both group (p<0.05). The VAS score for bothersomeness in the experimental group decreased more rapidly than that of the control group with statistical significance (p<0.05). The VAS score for pain intensity, ODI, SF-36 and BDI significantly improved after treatment for up to 24 weeks after starting the treatments in both group (p<0.05). The VAS score for pain intensity, ODI, SF-36 and BDI in the experimental group showed more rapid improvement than those of the control group. But, there were no statistical significances. Treating trunk flexors using acupuncture was more effective in decreasing the degree of bothersomeness caused by chronic low back pain than treating trunk extensors with acupuncture. There is a need to perform further studies.

• The Korean Journal of Pain
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• v.31 no.2
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• pp.109-115
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• 2018

Background: Patients with lumbar disc herniation are treated with physiotherapy/medication and some with surgery. However, even after technically successful surgery some develop a failed back syndrome with persistent pain. Our aim was to evaluate the efficacy of epiduroscopy in patients who suffer chronic low back pain and/or radicular pain with or without surgery and the gender difference in outcome. Methods: A total of 88 patients were included with a mean age of 52 years (27-82), 54 women and 34 men. 66 of them were operated previously and 22 were non-operated. They all had persistent chronic back pain and radicular pain despite of medication and physical rehabilitation. Visual Analog Scale (VAS) for pain and Oswestry Disability Index (ODI) were evaluated preoperatively, after one month, six months and one-year after the epiduroscopy. Results: All patients, and also the subgroups (gender and operated/non-operated) improved significantly in pain (VAS) and disability (ODI) at one month. A significant improvement was also seen at one year. No differences were found between men and woman at the different follow-up times. A slight worsening in VAS and ODI was noticed over time except for the non-operated group. Conclusions: Epiduroscopy helps to improve the back and leg pain due to lumbar disc herniation in the early stage. At one year an improvement still exists, and the non-operated group seems to benefit most of the procedure.

• Annals of Clinical Neurophysiology
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• v.12 no.1
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• pp.7-10
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• 2010

Chronic low back pain (CLBP) is a distinct disease entity in that its clinical course and response to the treatment are quite different from acute low back pain (ALBP). CLBP is also closely related with systemic or preexisting psychosocial factors rather than focal or localized factors. Since there has been little consensus in practice regarding the proper management of CLBP, clinicians tend to approach and manage patients with CLBP in an empirical manner rather than an evidence-based one. In this article, I will review the difficulties of therapeutic choice in CLBP and provide superior aspects of medical treatment over invasive interventional treatments.

• Journal of Korean Medicine Rehabilitation
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• v.20 no.4
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• pp.171-183
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• 2010

Objectives : The biomechanical relationship of leg length discrepancy(LLD), Lumbar lordosis, pelvic variance and degenerative scoliosis is one of the most important parameters when treat musculoskeletal disorders, however the reports are still controversial. The purpose of this study was to compare the relationships between the parameters and bothersomeness in subject with chronic ow back pain. Methods : Sixty female and eight male adults with non specific low back pain over 3 months were recruited. LLD was measured by tape measure method. Lumbar lordosis, lumbosacral angle and related pelvic parameters were measured using simple radiologic films of lumbosacral view. Results : Lumbar lordosis was significantly correlated to the lumbosacral angle, pelvic incidence and difference of the both iliac widths. Pelvic incidence had significant correlation with difference of the both iliac widths. And difference of both iliac widths was related with LLD by radiologic film. There was also significant correlation between the LLD by radiologic film and tape measurement. Visual analogue scale(chronic low back pain) of normal lordosis group was greater than hyperlordosis group. Conclusions : There were close biomechanical relationships between lumbar, pelvis, and lower extremity. But in order to determine the effect of structure on the chronic low back pain, global balance of musculoskeletal structure seems to be worth further researching.

• Journal of the Korean Society of Physical Medicine
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• v.16 no.2
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• pp.71-79
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• 2021

PURPOSE: Chronic low back pain is one of the main factors that affect the quality of life and cause problems of gait and balance in elderly people. This study investigated the correlation between the Oswestry disability index (ODI), Berg balance scale (BBS), and kinematic data measured while analyzing the gait of elderly people with chronic back pain. METHODS: A total of 29 subjects participated in this study. The ODI, BBS, and kinematic data of lower extremities were measured while walking. All data were analyzed using Pearson's correlation coefficients and the significance was measured at .05. RESULTS: ODI had a significant correlation with 1, 13, and 14 items of BBS (p < .05), and left hip external rotation and right ankle abduction respectively in the stance and swing phase of gait (p < .01). 13 items of BBS had a significant correlation with the right ankle abduction in the stance phase of gait (p < .01). In addition, 14 items of BBS had a significant correlation with right and left ankle abduction in the stance and swing phase of gait (p < .01). CONCLUSION: While attempting to predict chronic low back pain and balance issues, it may be useful to check the right ankle abduction in the stance and swing phase of gait. In the future, it would be helpful if some simple tests could be designed to assess balance in elderly people with chronic low back pain.

• Physical Therapy Korea
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• v.22 no.3
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• pp.1-11
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• 2015

The purpose of this study was to investigate the effect of lumbar stabilization training and additional thoracic mobilization on pain, proprioception and static balance in patients with chronic low back pain. The subjects of this study were 48 chronic low back pain patients who were randomly allocated to an experimental group 1 ($n_1=16$, lumbar stabilization and thoracic mobilization, thoracic hypomobility), experimental group 2 ($n_2=16$, lumbar stabilization and thoracic mobilization, thoracic normal mobility), and a control group ($n_3=16$, lumbar stabilization, thoracic hypomobility) after a thoracic mobility test. Both experimental groups underwent lumbar stabilization training and additional thoracic mobilization. The control group underwent only lumbar stabilization training. The intervention was performed 3 times per week, 30 minutes each time, for a total of 6 weeks. Thoraco-lumbar joint reposition error was measured using an electrogoniometer and static balance ability was measured using the Tetrax posture analysis system. Subjects' pain level was measured using a 100 mm visual analogue scale. Statistical analyses were performed using a one-way analysis of variance and a paired t-test. Post-hoc testing was carried out with a Bonferroni test. The pain level was significantly lower in both experimental groups compared to the control group. Both experimental groups showed significant reductions in joint reposition error angle (flexion, extension, and side bending) compared to the control group. The static balance level was significantly lower in both experimental groups than in the control group. In summary, lumbar stabilization exercises and additional thoracic mobilization significantly improved the pain level, proprioception, and static balance in patients with chronic low back pain.

• Physical Therapy Korea
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• v.17 no.3
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• pp.31-39
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• 2010

The purpose of this study was to determine the effect of sciatic nerve mobilization technique on perceived pain, straight leg raise test (SLR), and strength of knee extensor, location of symptoms (LOS) in patients with chronic low back pain. 22 patients with chronic low back pain were recruited for this study. The subjects were randomly assigned to either the experimental group (EG) or the control group (CG), with 11 patients in each group. All patients received a routine physical therapy (hot pack and transcutaneous electrical nerve stimulation). The mobilization technique of the sciatic nerve was performed for 10 min in the case of the EG subjects. Outcome measurements included the level of the perceived pain, SLR, and strength of the knee extensor, LOS. The measurements were recorded 3 times: before the intervention, after the intervention, and at 1 hour of follow up. The two groups did not significantly differ with regard to the level of perceived pain, SLR, and strength of the knee extensor, LOS before the test (p>.05). In the case of the EG subjects, all the variables measured after the intervention significantly differed from those measured before the intervention (p<.05). However, in the case of the CG subjects, a significant difference was noted only with regard to the level of perceived pain (p<.05). The findings indicate that sciatic nerve mobilization technique exerts a positive effect on the control of subjective symptoms and knee strength in patients with chronic low back pain. Further studies are required to generalize the result of this study.

• Journal of the Korean Society of Physical Medicine
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• v.16 no.2
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• pp.115-123
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• 2021

PURPOSE: This study aimed to investigate the benefits of thoracic manipulation and the trunk stability exercises on spine trunk flexibility and the pain index of chronic low back pain patients. METHODS: The study included 44 patients suffering from chronic low back pain. The participants were divided into two groups: the first group was assigned for trunk stability exercises (TSE), and the second group was randomly assigned TSE and thoracic manipulation at the same time (TSE+TM). Both groups carried out each assigned treatment thrice a week for 8 weeks. The study outcome was based on assessment of spine trunk flexibility and the pain index. Spine trunk flexibility was measured by spine flexion and extension through a range of motion and thoracic cage circumference. The pain index was measured using a visual analog scale (VAS). RESULTS: Spine flexion and extension range of motion showed a significant difference within each group and between the groups before and after the treatment. The measurement of the thoracic cage circumference also showed a notable difference within each group and between the groups before and after the treatment. There was no change in the pain index. CONCLUSION: These results indicate that thoracic manipulation with the trunk stability exercises is an efficient treatment for improving the spine trunk flexibility and soothing pain for chronic low back pain patients.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.28 no.2
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• pp.45-55
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• 2022

Background: This study compared the effects of trunk stabilization exercise and hip joint exercises on the range of motion of the lumbar spine, pain severity, and severity of disability in patients with chronic lower back pain. Methods: A total of 30 participants were enrolled and divided into group 1 (n=10), group 2 (n=10), and group 3 (n=10) were performed by each group thrice a week for a total of 8 weeks. Group 1 performed warm-up exercise (15 min), trunk stabilization exercise (25 min), finish-up exercise (15mins). Group 2 performed warm-up exercise (15 min), hip exercise (25 mins, finish-up exercise (15mins). Group 3 warm-up exercise (15 min), trunk stabilization and hip exercise (25 min), Finish-up exercise (15 min). Participants were assessed for the range of motion of the lumbar spine, pain severity (visual analog scale score; VAS), and severity of disability (Oswestry disability index score; ODI) before and after the interventions. Results: All three groups showed a significant increase in the range of motion of the lumbar spine, but there was no significant difference among the groups. Moreover, the severity of pain and ODI were significantly decreased in all groups; however, the intergroup differences were non-significant. Conclusion: The results from this study confirmed the effectiveness of trunk stabilization and hip joint exercise in improving the lumbar range of motion, pain severity, and chronic lower back pain in patients. Thus, trunk and pelvic stabilization exercises and hip joint exercise can be used as clinical practices to treat and prevent chronic lower back pain.