BACKGROUND: Education and encouragement to remain active are considered first-line treatments for acute non-specific low back pain (NSLBP). Aim: to assess the effectiveness of an early physiotherapy education intervention-including also a posture exercise - combined with standard medical care, compared to standard medical care alone, in patients presenting with acute NSLBP in the emergency department (ED). METHODS: Adults with acute NSLBP were randomized to receive either standard care plus a physiotherapy session involving education, reassurance, pain neuroscience, and a guided lumbar exercise or standard medical care. Participants were assessed at three timepoints: before treatment (baseline), at 1 month, and at 3 months post-treatment. Outcome measures included the 0-10 Numerical Rating Scale (NRS), the Roland-Morris Disability Questionnaire (RMDQ), and the 5-level EuroQol-5D (EQ-5D-5L) for assessing quality of life (QoL). Linear mixed model analyses for repeated measures were performed for each outcome (P<0.01). RESULTS: Significant time effects were observed for NRS, RMDQ, and EQ-5D-5L (P<0.001) in both groups across all timepoints. No significant group effects or time-by-group interactions were found at any timepoint. CONCLUSIONS: An early, single-session physiotherapy education program added to standard ED care resulted in equal clinical outcomes compared to standard care alone in patients with acute NSLBP. Future studies should investigate more structured models of care to improve outcomes in this population.
BACKGROUND: Proximal hamstring tendon avulsions represent severe injuries that often require surgical repair. Postoperative failure and prolonged immobilization remain clinical challenges. Botulinum toxin A (BoNT-A) has been proposed as a chemoprotective adjunct to reduce muscle tension and protect tendon repairs. Evidence in adult populations remains limited. The aim of this article is to describe the feasibility, safety profile, and preliminary functional outcomes of BoNT-A administration as an adjunct to surgical repair of complete proximal hamstring tendon avulsions in adults. METHODS: In this retrospective case series, five adult patients with complete proximal hamstring tendon avulsions underwent surgical repair between 2019 and 2021. All patients received three ultrasound-guided intramuscular injections of BoNT-A (3 IU/kg) prior to surgery. Demographic and clinical data were retrospectively collected. At final follow-up, functional outcomes were assessed using the Perth Hamstring Assessment Tool (PHAT), and return-to-sport status was recorded. Complications were documented descriptively. RESULTS: At a mean follow-up of two years, all patients achieved full range of motion and reported no subjective weakness. The mean PHAT score was 91.2 +/- 8.3. All patients returned to their pre-injury level of activity at a mean of four months postoperatively. One patient reported partial sciatic nerve hypoesthesia, which resolved without intervention. No re-ruptures were observed. CONCLUSIONS: In this small retrospective case series, good outcomes were observed with the adjunctive use of BoNT-A in proximal hamstring tendon repair. These preliminary findings support further prospective controlled studies to evaluate the potential role of chemoprotection in proximal hamstring repair.
