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A Controlled Randomized Study of the Effect of Training With Orthoses on the Incidence of Weight Bearing Induced Back Pain Among Infantry Recruits.
Spine. 2005 Feb 1;30(3):272-275.
Milgrom C, Finestone A, Lubovsky O, Zin D, Lahad A.
STUDY DESIGN.: Randomized controlled trial.
OBJECTIVES.: To determine if the use of custom shoe orthoses can lessen the incidence of weight bearing-induced back pain.
SUMMARY OF BACKGROUND DATA.: The scientific basis for the use of orthoses to prevent back pain is based principally on studies that show that shoe orthoses can attenuate the shock wave generated at heel strike. The repetitive impulsive loading that occurs because of this shock wave can cause wear of the mechanical structures of the back. Previous randomized studies showed mixed results in preventing back pain, were not blinded, and used orthoses for only short periods of time.
METHODS.: A total of 404 eligible new infantry recruits without a history of prior back pain were randomly assigned to received either custom soft, semirigid biomechanical, or simple shoe inserts without supportive or shock absorbing qualities. Recruits were reviewed biweekly by an orthopaedist for back signs and symptoms during the course of 14 weeks of basic training
RESULTS.: The overall incidence of back pain was 14%. By intention-to treat and per-protocol analyses, there was no statistically significant difference between the incidence of either subjective or objective back pain among the 3 treatment groups. Significantly more recruits who received soft custom orthoses finished training in their assigned orthoses (67.5%) than those who received semirigid biomechanical orthoses (45.5%) or simple shoe inserts (48.6%), P = 0.001.
CONCLUSIONS.: The results of this study do not support the use of orthoses, either custom soft or semirigid biomechanical, as prophylactic treatment for weight bearing-induced back pain. Custom soft orthoses had a higher utilization rate than the semirigid biomechanical or simple shoe inserts. The pretraining physical fitness and sports participation of recruits were not related to the incidence of weight bearing-induced back pain.
On the basis of the above summation, the authors should be congratulated, for at least specifying (and including)a particular type of back pain; in this case weight-bearing induced.
Too many studies across many professions don't bother to do this, and thus their research is relatively meaningless.
"Non-specific back-pain" is an unnecessary overused term. It has emerged because we are either too lazy or incapable of obtaining quality information from the patient and/or from our clinical examination.
I am presuming that weight-bearing induced back pain is eased by non-weightbearing and bedrest; while it is exacerbated by standing/walking, definitely carrying, and perhaps sitting. These are the backs that predictably don't get better after their practitioner advises ('best practice') to walk and exercise.
I seem to remember reading a synopsis of a similar study in 'Gait and Posture', must be five years or so ago. The research was performed by Salford University Podiatry Dep't I believe, and also used a sample group of non - symptomatic, fit adults, to prove that they did not subsequently suffer back pain as measured against a non - orthotised control group who also did not go on to develop back pain. If someone remembers this study more accurately and I have mis- remembered please correct me. Personally, most Patients that I fit with orthotics come to me after developing symptoms and often have factors such as limb - length inequality, hyperpronation and internal tibial rotation, anterior / lateral pelvic tilts Etc Etc Etc that do IMHO seem to generally respond to orthotic intervention. Would not a study of subjective pain perception from symptomatic individuals +/- orthotic intervention be an interesting comparison?
Last edited by martinharvey : 16th February 2006 at 02:17 AM.
PURPOSE: This study reports the responsiveness of the Short-Form 36 (SF-36) and Oswestry Disability Questionnaire (ODQ) to treatment with customized foot orthotics.
METHODS: Thirty consecutive patients presenting to a primary care clinic with chronic (>3 months), nonspecific, low back pain and/or soft tissue lower limb disorders completed the SF-36 and ODQ before and 6 weeks after prescription of customized foot orthotics. Locations of any pain in the lower half of the body (including the low back), age, sex, and duration of the most chronic pain were recorded. Responsiveness statistics of the ODQ and SF-36 physical and mental summary scores were calculated, as was correlation among these scores and the self-reported pain improvement scores.
RESULTS: All subjects completed the baseline and 6-week questionnaires. The mean age of the sample was 53.9 +/- 12.9 years, with 57% men and 43% women. The mean duration of the most chronic pain symptom was 14 +/- 14 months (range, 3-60 months). The mean ODQ score at baseline was 42.8% +/- 14. 8% and at 6 weeks was 16.6% +/- 5.0%. The physical component score of the SF-36 was 39.8 +/- 5.0 at baseline and at 6 weeks was 47.3 +/- 3.8. The mental component score of the SF-36 at baseline was 45.7 +/- 6.1 and at 6 weeks was 47.9 +/- 5.0. The responsiveness of the ODQ was calculated to be 9.40, the responsiveness being 1.77 for the physical component score of the SF-36 and 0.24 for the mental component score of the SF-36.
CONCLUSIONS: In this cohort, the ODQ and the physical component of the SF-36 appear to be responsive to treatment effects, with the ODQ having the highest responsiveness. The ODQ may be a useful outcome measure in trials of the effectiveness of customized foot orthotics in patients with nonspecific, chronic low back and/or soft tissue lower limb pain.