Low back pain and everyday activities : the influence of axial rotation on low back pain

Low back pain (LBP) is a major problem in the industrialized world. The aetiology of LBP is multicausal: heavy physical workload, sedentary work, whole body vibration, smoking, as well as minimal influence over work conditions, poor social relations and psychological factors all play a dominant role (Thorbjornsson et al. 2000). Heavy physical workload is often cited as a primary factor, and is mostly related to an overload and high intradiscal pressure of the intervertebral discs. After Nachemson measured intervertebral disc pressure in vivo in 1964 and found higher disc pressure in sitting, lifting and bending than in standing and lying down, most physicians concluded that high intradiscal pressure, e.g. from heavy workload, should be avoided. Because of low intradiscal pressure during lying down, bed rest was the first choice in case of LBP, and recommendations for activities were restrictive. It is now evident that bed rest for longer than two days is ineffective in case of LBP (Deyo et al. 1986) and even leads to chronicity and disuse (Waddell 1993; Bortz 1984); there is now worldwide consensus about the value of maintaining or resuming normal activities and doing exercises of any kind (Koes et al. 2001). However, even today, it is common in routine medical practice, that physicians still tend to restrict rather than encourage physical activity and work for patients with LBP (Rainville et al. 2000). It is also remarkable that in daily practice it is not the extent of spinal load that may be most painful, but the lack of spinal motion. Most LBP patients say that: "I can easily do sports, cycling and walking, but sauntering, sitting and even lying down is painful". The controversy between the "spinal load" axiom and this clinical information from patients was the main incentive for the work presented in this thesis.

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