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The Reduction of Chronic, Nonspecific Low Back Pain Through the Control of Early Morning Lumbar Flexion: 3-Year Follow-Up


Three years ago, an 18-month randomized controlled trial of chronic, nonspecific low back pain investigated the effectiveness of instructing subjects to restrict bending activities in the early morning, when the fluid content in the disc is increased. Pain days (as recorded by daily diaries) were reduced 23% in the treatment group, compared to a 2% reduction in the control (sham treatment) group. The purpose of the current follow-up study was to determine whether the results of that trial were maintained during the 3 years following completion of the trial. A questionnaire was mailed to the 60 subjects who completed the original trial. Fifty subjects completed the questionnaire for a response rate of 83%. Thirty-one subjects (62%) continued to restrict bending activities in the early morning, and experienced a further reduction of 10.1 pain days per month (51%) since the completion of the experiment. However, some of the subjects who did not continue to comply also improved. Several possible explanations for the improvement of noncompliant subjects are offered.

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  1. Race A, Broom ND, Robertson P. Effect of loading rate and hydration on the mechanical properties of the disc. Spine 2000; 25: 662-669.

    Google Scholar 

  2. Simunic DI, Broom ND, Robertson PA. Biomechanical factors influencing nuclear disruption of the intervertebral disc. Spine 2001; 26: 1223-1230.

    Google Scholar 

  3. Adams MA, Dolan P, Hutton WC. Diurnal variations in the stresses on the lumbar spine. Spine 1987; 12: 130-137.

    Google Scholar 

  4. Adams MA, Dolan P, Hutton WC, Porter RW. Diurnal changes in spinal mechanics and their clinical significance. J Bone Joint Surg Br 1990; 72B: 266-270.

    Google Scholar 

  5. Snook SH, Webster BS, McGorry RW, Fogleman MT, McCann KB. The reduction of chronic nonspecific low back pain through the control of early morning lumbar flexion: A randomized controlled trial. Spine 1998; 23: 2601-2607.

    Google Scholar 

  6. Faas A, Chavannes AW, van Eijk JThM, Gubbels JW. A randomized, placebo-controlled trial of exercise therapy in patients with acute low back pain. Spine 1993; 18: 1388-1395.

    Google Scholar 

  7. McGorry RW, Webster BS, Snook SH. Accuracy of pain recall in chronic and recurrent low back pain. J Occup Rehabil 1999; 9: 169-178.

    Google Scholar 

  8. Von Korff M, Deyo RA, Cherkin D, Barlow W. Back pain in primary care: Outcomes at 1 year. Spine 1993; 18: 855-862.

    Google Scholar 

  9. Weinstein JN. Letters: Clinical crossroads: A 45-year old man with low back pain. JAMA 1999; 281: 893-895.

    Google Scholar 

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Correspondence to Stover H. Snook.

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Snook, S.H., Webster, B.S. & McGorry, R.W. The Reduction of Chronic, Nonspecific Low Back Pain Through the Control of Early Morning Lumbar Flexion: 3-Year Follow-Up. J Occup Rehabil 12, 13–19 (2002).

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  • low back pain
  • intervertebral disc
  • disc hydration
  • self-care