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Ein systematisches Abfragen der Beschwerden bei Rückenschmerzen in Bezug auf auslösendes Ereignis und Beginn, Schmerzcharakter und Beeinflussbarkeit der Schmerzdynamik (im Liegen oder Stehen, unter Belastung, nächtliche Schmerzen, lokaler Klopfschmerz, B‑Symptomatik etc.) ergänzt durch eine strukturierte klinische Untersuchung (Segmenthöhe, Ausstrahlung, Projektion, Reflexstatus, Sensibilität und Motorik) erlaubt eine erste und somit wegweisende Einordnung der Rückenschmerzen als nichtspezifisch oder spezifisch. In der hausärztlichen Versorgung kann hierdurch vielen Patienten sehr effektiv und unter Kostenaspekt wirtschaftlich geholfen werden. Je präziser der Ausgangsbefund erhoben wurde, umso effektiver sind im Allgemeinen die eingeleiteten Maßnahmen. Neben einer möglichst zügigen Schmerzlinderung ist die Abwendung eines gefährlichen Verlaufs wichtig, ebenso die Vermeidung einer Chronifizierung. Neben nichtpharmakologischen Maßnahmen (initiale Schonung und früher Beginn mit Eigenübungen, Förderung von Alltagsbeweglichkeit, Physiotherapie, manuelle Therapie etc.) steht ein breit gefächertes Spektrum an pharmakologischen Therapiealternativen zur Verfügung. Im weiteren Heilverlauf kann es notwendig sein, fachärztliche Expertise aus den Fachgebieten der Radiologie, Orthopädie, Neurologie, Neurochirurgie, Rheumatologie, Psychotherapie, Psychiatrie usw. hinzuzuziehen. Die Behandlungsfallsteuerung erfolgt über den Hausarzt, hier sollten im Krankheitsverlauf auch alle Befunde einlaufen und reevaluiert werden.

Background Until recently, non-specific low back pain (NSLBP) in adolescents was considered a rare phenomenon unlike in adults. The last two decades has shown an increasing amount of research highlighting the prevalence in this age group. Recent studies estimate lifetime prevalence at 7%-80%, point prevalence at 10%-15%, and prevalence of recurrent NSLBP at 13%-36%. In Zimbabwe, there is dearth of literature on the magnitude of the problem in adolescents. Therefore, the aims of the study were to determine the prevalence (lifetime, point, recurrent) and the nature of recurrent NSLBP reported by adolescents in secondary schools. Methods A cross-sectional study was conducted using a questionnaire. A cluster sample of 544 adolescents (age 13–19 years) randomly derived from government schools participated in the study. Lifetime prevalence, point prevalence and prevalence of recurrent NSLBP were presented as percentages of the total population. Exact 95% confidence intervals were given. Chi-square test was used to evaluate the effect of gender and age on prevalence. Results The students’ response rate was 97.8%. The lifetime prevalence was 42.9% [95% confidence interval = 40.8-44.6] with no significant difference between sexes [ χ 2 (1) =0.006 , p  = 0.94]. However, NSLBP peaked earlier in female students (13.9 years) than in male students (15 years) [ t (226) = 4.21, p < 0.001]. About 10% of the adolescents reported having an episode of NSLBP on the day of the survey. However, female students (14.2%) were more affected on the day [ χ 2 (1) = 11.2 , p <  0.001]. Twenty-nine percent of the adolescents experienced recurrent NSLBP with 78% experiencing at least three episodes in the last 12 months. On average, recurrent NSLBP reported was mild in intensity (4.8 ± 1.9) on the visual analogue scale (VAS) and short in duration. Recurrent NSLBP was associated with sciatica in 20.9% of adolescents. Conclusions NSLBP is a common occurrence among Zimbabwean adolescents in secondary schools. It increases with chronological age and is recurrent in the minority of adolescents. Although much of the symptomatology may be considered benign, the existence of recurrent NSLBP in adolescents before their work-life begins should be a concern to health professionals, teachers and parents.

Background Low back pain (LBP) is one of the greatest contributors to disability in the world and there is growing interest on the role of biomarkers in LBP. To purpose of this review was to analyze available evidence on the relationship between inflammatory biomarkers, clinical presentation, and outcomes in patients with acute, subacute and chronic non-specific low back pain (NSLBP). Methods A search was performed in Medline, Embase, Cinahl and Amed databases. Studies which measured levels of inflammatory biomarkers in participants with NSLBP were included. Two reviewers independently screened titles and abstracts, full-texts, and extracted data from included studies. Methodological quality was assessed using the Newcastle Ottawa Quality Assessment Scale. Level of evidence was assessed using the modified GRADE approach for prognostic studies. Results Seven primary studies were included in this review. All results assessed using the modified GRADE demonstrated low to very low quality evidence given the small number of studies and small sample. Three studies examined C-reactive protein (CRP), one of which found significantly higher CRP levels in an acute NSLBP group than in controls and an association between high pain intensity and elevated CRP. Three studies examined tumor necrosis factor alpha (TNF-α), two of which found elevated TNF-α in chronic NSLBP participants compared to controls. Two studies examined interleukin 6 (IL-6), none of which found a significant difference in IL-6 levels between NSLBP groups and controls. Two studies examined interleukin 1 beta (IL-β), none of which found a significant difference in IL-β levels between NSLBP groups and controls. Conclusions This review found evidence of elevated CRP in individuals with acute NSLBP and elevated TNF-Α in individuals with chronic NSLBP. There are a limited number of high-quality studies evaluating similar patient groups and similar biomarkers, which limits the conclusion of this review.

Purpose Inconsistent reporting of outcomes in clinical trials of patients with non-specific low back pain (NSLBP) hinders comparison of findings and the reliability of systematic reviews. A core outcome set (COS) can address this issue as it defines a minimum set of outcomes that should be reported in all clinical trials. In 1998, Deyo et al. recommended a standardized set of outcomes for LBP clinical research. The aim of this study was to update these recommendations by determining which outcome domains should be included in a COS for clinical trials in NSLBP. Methods An International Steering Committee established the methodology to develop this COS. The OMERACT Filter 2.0 framework was used to draw a list of potential core domains that were presented in a Delphi study. Researchers, care providers and patients were invited to participate in three Delphi rounds and were asked to judge which domains were core. A priori criteria for consensus were established before each round and were analysed together with arguments provided by panellists on importance, overlap, aggregation and/or addition of potential core domains. The Steering Committee discussed the final results and made final decisions. Results A set of 280 experts was invited to participate in the Delphi; response rates in the three rounds were 52, 50 and 45 %. Of 41 potential core domains presented in the first round, 13 had sufficient support to be presented for rating in the third round. Overall consensus was reached for the inclusion of three domains in this COS: ‘physical functioning’, ‘pain intensity’ and ‘health-related quality of life’. Consensus on ‘physical functioning’ and ‘pain intensity’ was consistent across all stakeholders, ‘health-related quality of life’ was not supported by the patients, and all the other domains were not supported by two or more groups of stakeholders. Weighting all possible argumentations, the Steering Committee decided to include in the COS the three domains that reached overall consensus and the domain ‘number of deaths’. Conclusions The following outcome domains were included in this updated COS: ‘physical functioning’, ‘pain intensity’, ‘health-related quality of life’ and ‘number of deaths’. The next step for the development of this COS will be to determine which measurement instruments best measure these domains.

Background Non-specific neck (NNP) and low back pain (NLBP) pose significant global health challenges. Current treatment options often result in insufficient outcomes, either due to limited efficacy or adverse side effects. This two-center, randomized, sham-controlled trial utilized functional near-infrared spectroscopy (fNIRS) to explore the immediate analgesic effects and underlying cortical mechanisms of repetitive peripheral magnetic stimulation (rPMS), a non-invasive physiotherapy technique, in patients with NNP and NLBP. Methods A total of 181 patients (75 NNP, 106 NLBP) were randomized to receive either a single session of active or sham rPMS (10 Hz, 100% RMT, 1200 pulses) targeted at the most painful neck or lower back area. The primary outcome measured was the change in pain intensity on the numerical rating scale (NRS), while secondary outcomes included the pressure pain threshold (PPT). Cortical hemodynamic activity was assessed using fNIRS over the dorsolateral prefrontal cortex (DLPFC) and other pre-defined pain-processing regions. Results Active rPMS resulted in significantly greater analgesia compared to sham stimulation, as indicated by a notable decrease in NRS scores and an increase in PPT (both P  < 0.001). fNIRS revealed differential neuromodulatory effects: active rPMS significantly reduced pain-evoked activation in the left DLPFC (L-DLPFC) in NNP patients and bilaterally in NLBP patients. Pooled analysis revealed robust bilateral prefrontal inhibition (L-DLPFC, P  = 0.003; R-DLPFC, P  = 0.033). There was a significant pre-to-post reduction in DLPFC activation only in the active rPMS group. Interestingly, in the NNP group, ΔNRS were correlated with ΔL-DLPFC ( r  = 0.313, P  = 0.006), and the NLBP group showed bilateral correlations, with ΔNRS associated with both ΔL-DLPFC ( r  = 0.226, P  = 0.020) and ΔR-DLPFC ( r  = 0.298, P  = 0.002). Furthermore, the pooled analysis of all subjects demonstrated a significant bilateral relationship between ΔNRS and ΔDLPFC (ΔL-DLPFC: r  = 0.257, P  < 0.001; ΔR-DLPFC: r  = 0.244, P  = 0.001). Conclusion A single session of rPMS offers rapid and effective analgesia for both NNP and NLBP by modulating DLPFC activity. Our findings underscore a central neuromodulatory mechanism and suggest that the DLPFC may serve as a promising target for non-invasive brain stimulation therapies in the management of NNP and NLBP. Trial registration The Ethics Review Committee of the Xijing Hospital Affiliated to Air Force Medical University, No. KY-20222009-F-1; www.chictr.org.cn , ChiCTR2200060844, Date of Registration: 12 June 2022.

Study Design Randomized Controlled Trial. Objective Chronic low back pain (CLBP) is a major public health concern that will continue to grow with the expected aging of the population. The purpose of this study was to examine the clinical effect of a personalized, home-based biomechanical intervention compared to traditional physical therapy in patients with CLBP. Methods This was a randomized controlled trial. One-hundred and sixty-two patients were randomized in a 2:1 ratio to a home-based biomechanical intervention (HBBI, AposHealth) or traditional physical therapy (TPT), respectively. Patients were assessed at baseline and after 12 weeks and 52 weeks. The primary outcome measure was pain at 52 weeks, using a standard Numeric Rating Scale (NRS). Secondary outcomes included pain and function metrics, quality of life and objective spatio-temporal gait test. A Linear Mixed Model assessed changes over time across all study visits. Results A significant reduction in NRS was found after 52 weeks with a superiority effect of the HBBI arm compared to TPT (F = 13.82, P < 0.001). Patients in the HBBI arm demonstrated a marginal mean reduction of 3.5 points, from 6.2 to 2.7 (a 56% reduction), while patients in the TPT arm reported a mean decrease of 1.8 points from 6.9 to 5.1 (a 26% reduction). Conclusions A new foot-worn, home-based, biomechanical intervention for patients with chronic non-specific back pain was found to be clinically effective. Given the lack of non-surgical, non-pharmacological interventions for this populations, this treatment might serve as an adjunct to the current standard of care.

According to the current recommendations on the management of chronic non-specific low back pain (CNLBP), the intervention in this group of patients should include a programme of exercises. Pilates is a system of exercises widely used in patients with low back pain. The practices based on this method have promoted the restoration of the function of muscles involved in lumbopelvic stabilisation, that is, transversus abdominis, multifidus, diaphragm and pelvic floor muscles. During each exercise, specific principles of this method should be followed to restore or sustain the motor control of the lumbar spine and proper body posture. The aim of this study is to present the current state of knowledge concerning the application of Pilates method in the management of CNLBP as well as to define factors (eg, duration, frequency, exercises performed on a mat or specific equipment) influencing the effectiveness of Pilates in these individuals.

To evaluate the effects of Myofascial Release Technique (MRT) with a roller massager combined with core stabilization exercises (CSE) in elderly with non-specific low back pain (NSLBP). A total of forty-five participants were randomly divided into two groups (CSE and CSE+MRT). A core stabilization exercise program was applied for the participants in the CSE group for 3 days per week for a total of 6 weeks. In addition to the core stabilization exercises, myofascial relaxation technique with a roller massager was performed for 3 days per week for 6 weeks for the participants in the CSE+MRT group. Participants were assessed in terms of pain, low back disability, lower body flexibility, kinesiophobia, core stability endurance, spinal mobility, gait characteristics and quality of life both pre- and post-treatment. It was found that the improvement in core stability endurance (p=0.031) and spinal mobility (in the sagittal plane) (p=0.022) was greater in the CSE+MRT group compared to the CSE group. There was no significant difference between the two groups in terms of pain, low back disability, lower body flexibility, kinesiophobia, gait characteristics and quality of life (p>0.05). The current study suggests that myofascial release technique with a roller massager combined with core stabilization exercises can be a better choice in the treatment of NSLBP in elderly. NCT03898089.

Inertial measurement units (IMUs) offer a portable and quantitative solution for clinical movement analysis. However, their application in non-specific low back pain (NSLBP) remains underexplored. This study compared the spine and pelvis kinematics obtained from IMUs between individuals with and without NSLBP and across clinical subgroups of NSLBP. A total of 81 participants with NSLBP with flexion (FP; n = 38) and extension (EP; n = 43) motor control impairment and 26 controls (No-NSLBP) completed 10 repetitions of spine movements (flexion, extension, lateral flexion). IMUs were placed on the sacrum, fourth and second lumbar vertebrae, and seventh cervical vertebra to measure inclination at the pelvis, lower (LLx) and upper (ULx) lumbar spine, and lower cervical spine (LCx), respectively. At each location, the range of movement (ROM) was quantified as the range of IMU orientation in the primary plane of movement. The ROM was compared between NSLBP and No-NSLBP using unpaired t-tests and across FP-NSLBP, EP-NSLBP, and No-NSLBP subgroups using one-way ANOVA. Individuals with NSLBP exhibited a smaller ROM at the ULx (p = 0.005), LLx (p = 0.003) and LCx (p = 0.01) during forward flexion, smaller ROM at the LLx during extension (p = 0.03), and a smaller ROM at the pelvis during lateral flexion (p = 0.003). Those in the EP-NSLBP group had smaller ROM than those in the No-NSLBP group at LLx during forward flexion (Bonferroni-corrected p = 0.005), extension (p = 0.013), and lateral flexion (p = 0.038), and a smaller ROM at the pelvis during lateral flexion (p = 0.005). Those in the FP-NSLBP subgroup had smaller ROM than those in the No-NSLBP group at the ULx during forward flexion (p = 0.024). IMUs detected variations in kinematics at the trunk, lumbar spine, and pelvis among individuals with and without NSLBP and across clinical NSLBP subgroups during flexion, extension, and lateral flexion. These findings consistently point to reduced ROM in NSLBP. The identified subgroup differences highlight the potential of IMU for assessing spinal and pelvic kinematics in these clinically verified subgroups of NSLBP.

Chronic non-specific low back pain (cNLBP) is a pervasive and debilitating condition with significant personal, societal, and economic burdens. Despite its prevalence, effective and sustainable non-pharmacological treatment options remain limited. Here, we compared the efficacy of Tuina versus non-Tuina interventions in adults with cNLBP. PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, CBM, WanFang, and VIP were searched from inception to April 2025. The Cochrane Risk of Bias tool and the GRADE approach were applied to assess risk of bias and certainty of evidence. Twenty-one trials (1612 participants) were included. Compared with control interventions, Tuina showed greater pain reduction (SMD = −1.06, 95% CI: [−1.37, −0.76], p < 0.00001, GRADE: low), better functional improvement (SMD = −1.17, 95% CI: [−1.62, −0.72], p < 0.00001, GRADE: low), and superior clinical effectiveness (OR = 3.84, 95% CI: [2.42, 6.11], p < 0.00001, GRADE: low). No significant differences were found in muscle fitness (SMD = 1.42, 95% CI: [-0.00, 2.83], p = 0.05, GRADE: very low) or incidence of serious adverse events. Tuina effectively treats cNLBP, offering substantial pain relief and functional improvements, though it has no significant impact on muscle fitness. Future work should consider standardized protocols and more rigorously designed trials to support clinical recommendations. This study has been registered with the PROSPERO platform (registration no. CRD420251051014).