(Research
article)
Low back pain relief
Most people with an acute episode of low back pain
or leg pain find significant pain relief within a
few weeks, but for some, the pain and inability to
tolerate upright, weight bearing postures persists
or recurs based on activity. As many as 62% of people
who have experienced an acute low back pain incident
have persistent pain episodes at 1 to 2 years after
onset (1). Many who have returned to normal
activities suffer relapses when they do certain activities
of daily living (2). These painful flare-ups can
occur in intervals as frequent as 6 to 7 weeks.
The reason that the pain can occur appears to be a
conspiracy of four factors:
While there is little that can be done to offset aging
and any effects from prior damage or injury, some people
with low back pain and leg pain can influence the other
two factors through exercise and, where necessary,
the use of other non-surgical treatments that reduce
weight-bearing strain on the tissues. This article
provides a review of recent information presented at
the 2005 North American Spine Society conference about
the effectiveness of one product designed to reduce
weight-bearing strain on the tissues—the Orthotrac
pneumatic vest (4).
Weight bearing intolerance
The term “weight bearing intolerance” is
used to describe pain that is aggravated by activities
or tasks in the upright positions of sitting, standing,
walking, lifting and bending. People who experience
this find significant and reliable low back pain relief
by getting off their feet and lying down or sitting
in a reclining position for 30 minutes or more. For
these individuals, the need to rest for low back pain
relief is not only restricting to life style but can
also promote a downward spiral of inactivity that promotes
further disability.
Weight bearing intolerance arises from the fact that
the strain of upright postures can result in a narrowing
of the disc space, increasing the pressure on the facet
joints and reducing the space for the spinal nerve
roots (Figure
1).
Aging and injury are associated with tearing and bulging
of the disc material and arthritic changes in the joints
that, by themselves, are often not painful. Under increased
strain, they may become symptomatic causing local low
back pain or radiating pain down the leg.
This situation can arise in patients with a variety
of common low back problems, including:
New research on the pneumatic vest
The vest reviewed in this article is a pneumatic vest
made by Orthofix (Figure
2).
It is a custom vest that uses pneumatic lifters to “unload” some
of the weight from the patient’s lumbar spine
onto the iliac crests (the pelvic bone). The
patient wears the vest when symptoms are experienced
during activity, usually during walking or standing
for some period of time. While there is no
required minimum wear time and the patient decides
when and for how long to use the vest for best individual
results, the suggested minimum to help provide low
back pain relief is 20-60 minutes three times per
day. The vest is not to be worn during heavy
lifting. Side effects can include occasional
local tenderness, or soreness when touched at bony
prominences of the spine, and rarely, temporarily
increased symptoms when the vest is fully inflated.
A recent biomechanical study reported in The Spine
Journal (3) demonstrates that the use of the vest results
in a decrease in low back disc pressure by as much
as 25% of normal body weight.
According to a randomized clinical trial presented
at the recent North American Spine Society (4) meeting
in September 2005, patients using the Orthotrac pneumatic
vest had up to twice the low back pain relief versus
those who did not, even when both groups had similar
improvement in activity levels and continued prescribed
medication or treatment.
Study background
62 patients were enrolled in the study and were randomly
assigned to either the Orthotrac Pneumatic Vest or
the Orthofix EZ Brace. The EZ Brace (also made
by Orthofix) is designed to protect the patient from
improper posture and movements that can cause additional
injury, while helping the initial soft tissue injury
to heal. Each enrolled patient had to meet
the following selection criteria:
Inclusion criteria summary
- Age 21-55
- Low back pain and/or leg pain greater than 4.0
on the Visual Analog Scale
- Confirmed disc problems on MRI scan
- Able to stand upright
- Consistent low back pain relief and/or leg pain
relief when recumbent (lying down or reclining)
- Inadequate low back pain relief and/or leg pain
relief after 4 weeks of conservative therapy
Exclusion criteria summary
- Prior surgery
- Neurologic deficit
- Leg pain and/or low back pain for less than 4
weeks
This research was funded by Orthofix, Inc, manufacturer
of both the Orthotrac Pneumatic Vest and the Orthofix
EZ Brace.
Study results
The patients were followed for one year. Those
patients using the Orthotrac Pneumatic Vest were found
to have significantly greater low back pain relief
(30% more on the Visual Analog Scale) as compared to
the patients using the EZ Form Brace, when combined
with other conservative therapy (e.g., exercise/physical
therapy, medication). While self-reported functionality
was not significantly different between the two groups
(as measured by the Oswestry scale), the study shows
a trend favoring the pneumatic vest. Specifically,
patients who seemed to get the most low back pain relief
(and/or leg pain relief) from unloading the disc while
weight bearing were those who did not have significant
emotional distress and tended to lead more active life
styles (10 point better energy/fatigue and mental health
profiles as measured on the SF-36).
Prior research showed that patients most likely to
get pain relief from the Orthotrac pneumatic vest typically
have had discogenic pain, mechanical low back pain
or radicular pain for more than 8 weeks, and experience:
-
Increased low back pain and/or leg pain when standing
or walking
-
Significant decrease of low back pain or leg pain
after lying down for 20 to 30 minutes
-
Ability to stand up straight
-
Approximately 24 inches to 57 inches waist measurement
By: John
J. Triano, DC, PhD
February 14, 2006
References:
-
VonKorff
M, Saunders K. The course of back pain in primary
care. Spine 1996; 21:2833-2837.
-
Carey TS, Garrett J, Jackman
A. The Outcomes and Costs of Care for Acute Low
Back Pain Among Patients Seen by Primary Care Practitioners
Chiropractors, and Orthopedic Surgeons. New
Engl J Med 1995; 333(14):913-917.
-
Ferrara L, Triano JJ, Sohn
M, Song E, Lee DD. A Biomechanical Assessment of
Disc Pressures in the Lumbosacral Spine in Response
to External Unloading Forces. The
Spine Journal 2005;
5(5):548-553.
-
Triano JJ, Roger C, Diederich, J, Gonzalez
C, Hochschuler S. Discopathy with leg pain: An
RCT of Orthotrac vest unloading vs. EZ brace—one
year outcomes. Proceedings of the North American
Spine Society annual meeting, Philadelphia, September,
2005. This research was funded by Orthofix,
Inc.
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