the role of lumbotrain

The Role of LumboTrain® in the
Management of Low Back Pain
®
LumboTrain is a lumbar support designed to treat muscular imbalance as a major cause
of low back pain and of spinal instability. A viscoelastic nobbed pad is centred on the third
lumbar vertebra and positioned on the crossing point of the myotensive dorsal muscular
chains. By deforming the pad, muscular contraction allows for both massage and
enhanced proprioceptive effects. The elastic tension does not limit the range of motion but
generates sufficient compression on the pad which, consistent with the “gate control
mechanism, generates tactile stimulations interfering (with) and reducing pain perception.
Stiffness can be easily adjusted by overlapping the abdominal fixing system with hand
straps.
®
LumboTrain does not generate muscle atrophy. On the contrary, by allowing pain free
mouvement lumbar supports increase muscular recruitement and spine stability.
Lumbar supports represent the most efficient tool available today capable of reducing the
socio-economical burden of low back pain.
During the last twenty years it has become
increasingly clear that structural aberrations of the
aging spine account only for a small portion of low
back pain (LBP).
MRI studies have shown that people with LBP have
just as many disc degenerations, annular tears and
disc protrusions as healthy people of the same age
[ 1 ].
with no back pain
LBP is mainly caused by mechanical derangement
of the spine leading to segmental instability.
In healthy people specific muscles are activated to
stabilize the vertebrae of the lumbar spine as well
as the sacro-iliac joint. In LBP patients, as well as
in people who are prone to develop LBP, these
muscles have become weak or their “orchestration”
is out of phase (i.e., they fire too late or not strongly
enough when needed).
These muscles constitute the "inner unit" and
include the transversus abdominis, multifidus, pelvic
floor, and diaphragm and possibly the lower part of
the obliquus abdominis internus. Together they
form a "deep musculo-fascial corset" able to support
segmental stability from the inside and to allow
[2]
outer and more global muscles to work less .
Lumbar supports can generate biomechanical
effects which are also interfering in the synchronism
[ 3, 4, 5, 6, 7, 8 ]
of muscle activation pattern
.
They can reduce LBP intensity and duration
stabilizing the spine by alternative muscular
[ 9 ],
synergies
adapted to the effect of the external
forces.
In spite of this biomechanical evidence, the
Cochrane library
[ 21 ]
report that:
1°) No evidence was found on the effectiveness of
lumbar supports for secondary prevention.
The systematic review of therapeutic trials showed
that there is limited evidence that lumbar supports
are more effective than no treatment, while it is still
unclear if lumbar supports are more effective than
other interventions for treatment of low back pain.
2°) Overall the methodological quality of the studi es
included in our review was rather low...
It is mandatory to consider that lack of evidence and
lack of benefit express two different concepts not
necessarily inter-related or involving each other.
They should therefore not be confused.
The above statements are mainly justified by our
methodological limits to generate supporting
evidence, not only for lumbar supports but, for any
other therapeutic approach to LBP as well.
In order to perform a clinical study, clinicians and
researchers need first to identify a homogeneous
group of patients to be treated with the therapeutic
device (or method) under evaluation.
Homogeneity is extremely difficult to assess in LBP
patients (even if it may exists). Moreover pain is a
very subjective parameter (depending on resilience,
tolerance or psychological factors, etc.) generated
by multiple combinations of co-existing causes and
[11 ]
risk factors
.
Frequently cited data show that 80% to 90% of
patients with acute LBP recover within 12 weeks,
[12regardless of the type of administered treatment
13 ].
Less than 50% of patients with acute LBP are
[14-16]
pain-free after 1 month,
and after 3 months
[16-17].
more than 40% are still having discomfort.
However 1 year after injury, more than 60% of
[17-18]
patients will have had a relapse of pain
, 15%
to 20% will have at least 1 episode of moderate to
®
1
The Role of LumboTrain in the Management of Low Back Pain.
[email protected]
03.11.2009
1
[16]
severe activity limitation due to pain,
and 29%
[15 ]
will report a poor recovery outcome.
When followed up for 10 years after initial injury,
more than 80% of patients will report recurrent LBP,
[19]
and a lifetime recurrence rate of 85% has also
[12]
been reported.
Viewed together, the data on recovery would
indicate that the majority of patients with acute LBP
return to work within 3 months but that a substantial
number of these individuals continue to have
persistent or intermittent pain.
Most probably lumbar supports would not exist if
empirical experience (shared by generations all over
the world since thousands of years) could not
confirm their efficiency to reduces the self-limiting
condition caused by LBP consistently.
Product Features
®
®
Lumbo Train and Lumbo Train Lady are active supports for muscular stabilization of the lumbar spine.
®
®
Lumbo Train and Lumbo Train Lady
feature anatomically contoured, individually
adjustable knitting, with different dorsal heights,
allowing for specific adaptations to man and women’s pelvis.
®
The main feature of Lumbo Train is the
viscoelastic pad featuring a paravertebral pressure
at lumbar level by 26 semi-spherical dots.
This pressure causes a change in lumbar lordosis and
a modification of the role of the extensor muscles.
(McGill- Clin Biomech 2000).
The pad is positioned on “L3” at the centre of
the lumbar lordosis where the myotensive chains
of gluteus major and latissimus dorsi cross the spine.
Their contraction causes pressure and deformation of
the viscoelastic dots. Further, the perception of movement and
massage of these muscles chains improves proprioception and
decreases muscular imbalance. This is particularly important since
fatigue has been shown to impair spine proprioception
(Taimela et al., 1999) and the ability to regulate force
(Parnianpour et al., 1988; Sparto et al., 1997).
Moreover, consistent with the “gate control mechanism
” the skin contact with the support generates tactile stimulations interfering (with) and reducing pain
perception.(Pain Mechanism: A New Theory –Melzack R.; Wall P.; - Science: 150, 171-9, 1965).
Practical hand straps allow the lumbar support to be easily fitted, positioning correctly the dorsal insert without
effort.
2
®
2
The Role of LumboTrain in the Management of Low Back Pain.
[email protected]
03.11.2009
Indications
The risk of muscle atrophy may exist when patients
are obliged to avoid movement because of LBP.
When lumbar supports (interfering in the cocontraction balance of lumbar muscles) allow pain
free movement of LBP patients they prevent this
condition. Considering lumbar supports responsible
of muscle atrophy is a groundless prejudice
causing some physicians to ignore useful and safe
[20]
devices. A recent study
unmistakably confirms
this observation.
The development of lumbar supports with different
specific features (stiffness, etc.) is explained by the
need of achieving different biomechanical effects
with maximal treatment compliance and comfort.
Lumbar supports are often prescribed for the same
indications but their specific features allow for the
treatment of different severity levels.
Degenerations of spinal ligaments and/or discs,
combined with different levels of myostatic
insufficiency and facet joint’s syndromes, are
examples of common, often coexisting, indications.
The biomechanical effects of lumbar supports will
target all coexisting conditions globally but,
obviously, not selectively.
Education is an important component in the
treatment of LBP patients with lumbar supports.
[ 25 ].
The study of Jellema et al.
confirmed by
Multiple Logistic Analysis- shows that the best
predictor for compliance is the extent to which
subjects consider they can influence their own
health status.
Education should focus on the benefits of
movement avoiding end-range movements.
This condition is specifically encouraged by the use
[ 24 ]
of lumbar supports.
Lumbo Train® and LumboTrain® Lady
Indications
☺
Muscular imbalance:
☺
Muscular insufficiency:
Degenerative Changes:
Facets-Discs-Ligament-Syndromes;
Osteochondritis;
Spondylarthritis;
Osteoporosis;
Authors & Year : Valle-Jones, et al., 1992
Class : I
216 patient w/ LBP of all duration w/o any bone injury or any intervertebral disc pathology.
Randomized to lumbar brace or activity modification.- Patients then measured pain & disability on a
VAS & paracetamol intake. Also completed a subjective assessment of their condition.
Study duration was 3 wks. 100% of patients completed trial.
Comment
Significantly more improvement in pain at rest, activity, & night in bracing group after Day 7.
Fewer analgesics in brace group. Both groups improved over time; the brace group improved faster.
3
®
3
The Role of LumboTrain in the Management of Low Back Pain.
[email protected]
03.11.2009
Conclusion
Lumbar supports can be regarded as the best available tool capable of reducing the socioeconomic burden
of LBP, because:
Serial prefabricated products are available on the shelf allowing pain relief at quite moderate costs.
When compared with back school, manipulation (massage) and physical treatment they allow
patients a faster self medication approach.
Lumbar supports have fewer contra-indications and no addiction problems compared with
analgesic drugs.
They require an higher involvement of patients to the treatment and they allow physicians a better
educational approach pointing out the importance of movement in the management of LBP.
They are less frightful, safer (and definitively less expensive) than any invasive procedures.
The effectiveness of lumbar support for treatment and prevention has been (22) assessed in several
studies confirming that their contribution increases mainly depending on the risk exposure.
The right interpretation of the remarks (23) of the COCHRANE REVIEW- should lead to a much better
use of lumbar support more than to their avoidance.
Certainly a more efficient multidisciplinary way to attack the problem of LBP would support this conclusion.
References
(1) The value of MRI of the lumbar spine to predict LBP in
asymptomatic subjects: a seven-year follow-up study.
(Borenstein DG; O’Mara JW Jr; Boden SD – J Bone Joint
Surg Am 2001 Sept;83-A(9): 1306 11.)
(7) The effects of a lumbar support on repositioning error in
subjects with low back pain. Arch Phys Med Rehabil. 2001
Jul; 82(7): 906-10. Newcomer K, Laskowski ER, Yu B,
Johnson JC, An KN.
(2) Richardson C, et al.: Therapeutic exercises for spinal
segmental stabilization in low back pain. (Churchill
Livingstone, Edinburgh 1999.)
(8) Effet comparé de l'activité des muscles abdominaux
avec et sans ceinture lombaire souple chez des
lombalgiques. Etude préliminaire sur 480 myogrammes.
Hamonet c., Meziere c Rhumatologie, 1993, 45, 7, pp. 65170.
(9) A biomechanical assessment of disc pressures in the
lumbosacral spine in response to external unloading
forces. – ( Ferrara l, Triano jj, Sohn mj, Song e, Lee dd. Spine j. 2005 sep-oct;5(5):548-53.)
(3) Lumbar spine stability can be augmented with an
abdominal belt and/or increased intra- abdominal pressure.
(Cholewicki J, Juluru K, Radebold A, Panjabi MM, McGill
SM. - Eur.Spine J.1999; 8(5))
(4) Belts limit the range of motion of the trunk with respect
to flexion and extension. (Lüssenhop et al., 1996; McGorry
& Hsiang, 1999).
(5) Effects of lumbar support on spine posture and motion
assessed by electrogoniometer and continuous recording
Thoumie P; Drape JL; Aymard C; Bedoiseau M.
Clin.Biomechanics - Clin. Biomec. (Bristol Avon) 1998
Jan.13 (1): 18-26.
(6) Trunk proprioception: enhancement through lumbar
bracing. (McNair PJ, Heine PJ. Arch Phys Med Rehabil.
1999 Jan; 80(1): 96-9.)
(10) The stabilizing system of the spine, part I & II: neutral
zone and instability hypothesis. - Panjabi MM.- J Spinal
Disord. 1992; 5:390–396).
(11) The use of a classification approach to identify
subgroups of patients with acute low back pain. Interrater
reliability and short-term treatment outcomes.- Fritz JM,
George S.- Spine. 2000 Jan; 25(1):106-14.)
(12) Epidemiological features of chronic low-back pain.
Andersson GB: -Lancet 1999; 354:581-585.
4
®
4
The Role of LumboTrain in the Management of Low Back Pain.
[email protected]
03.11.2009
(13) Clinical course and prognostic factors in acute low
back pain: an inception cohort study in primary care
practice. -Coste J, Delecoeuillerie G, Cohen de Lara A, et
al: BMJ 1994; 308:577-580.
(14) Chavannes AW, Gubbels J, Post D, et al: Acute low
back pain: patients' perceptions of pain four weeks after
initial diagnosis and treatment in general practice. J R Coll
Gen Pract 1986; 36:271-273.
(15) Cherkin DC, Deyo RA, Street JH, et al: Predicting
poor outcomes for back pain seen in primary care using
patients' own criteria. Spine 1996; 21:2900-2907.
(16) The course of back pain in primary care
Von Korff M, Saunders K:. Spine 1996; 21:2833-2839.
(17) Outcome of low back pain in general practice: a
prospective study. Croft PR, Macfarlane GJ, Papageorgiou
AC, et al: BMJ 1998; 316:1356-1359.
(18) Studying the natural history of back pain. Von Korff M:
Spine 1994; 19(18 suppl):2041S-2046S.
(19) Back pain in primary care . Von Korff M, Deyo RA,
Cherkin D, et al:: outcomes at 1 year. Spine 1993; 18:855862.
(20) Effect of wearing a lumbar orthosis on trunk muscles:
study of the muscle strength after 21days of use on
healthy subjects. Fayolle-Minon I, Calmels P. Joint Bone
Spine. 2008 Jan;75(1):58-63. Epub 2007 Aug 30.
(21)a The effect of preventive belt on the incidence of lowback pain (part 2): investigation in rice-carrying work. - Udo
H., Seo A., Koda S. et coll. - Journal of Science of Labour,
1992, 68, 10, pp. 503-519 ).
(21)b The effect of a preventive belt on the incidence of
low-back pain (part 3) : investigation in crane work.
Udo h.,yoshinaga f.,tanida h., umino h.,yoshioka m.
Journal of Science of Labour,1993, 69, 1, pp. 10-21.
(22) Efficacy of lumbar support for workers wit low back
pain – Pepijin DDM Roelofs et al. Occup Med (Lond). 2002
Sep; 52(6): 317-23.)
(23) Lumbar supports for prevention and treatment of lowback pain (cochrane review) Chichester, UK: John Wiley &
Sons, Ltd. van Tulder MW, Jellema P, van Poppel MNM,
Nachemson AL, Bouter LM - From The Cochrane Library,
Issue 2, 2005.
(24) Compliance and subjective relief by corset treatment
in chronic low back pain. alaranta h., hurri h. scandinavian journal of rehabiliation medicine, 1988, 20,
pp. 133-136.].
(25) Feasibility of lumbar supports for home care workers
with low back pain . P. Jellema*, s.m. a. Biermazeinstra*,m. N.m. van poppel†,r. M. D. Bernsen* and b.w.
koes* -318 occup. Med. Vol. 52, 2002.)-
5
®
5
The Role of LumboTrain in the Management of Low Back Pain.
[email protected]
03.11.2009