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To Seija Rautiainen I extend special thanks for help in recruiting the patients and scheduling the measurements diabetes symptoms hands discount glipizide 10 mg online. I gratefully acknowledge the financial support I have received from the following foundations and organizations: the Academy of Finland diabetes type 1 during pregnancy order glipizide uk, the Finnish Cultural Foundation metabolic disease of muscle proven 10mg glipizide, the Pirkanmaa Regional Fund diabete 2 sintomi discount glipizide express, the Competitive State Re search Financing of the Expert Responsibility Area of Tampere University Hos pital, the Finnish Association of Physiotherapists, and the Finnish Association of Orthopaedic Manual Therapy. I would like to thank the staff of the clinic for their support and all the doctor jokes. I want to thank Jari Inkinen and Vesa Linna for offer ing me the opportunity to continue clinical work alongside my PhD studies. Petteri, the wager we made also helped me to stay physically fit during my PhD project. Although, unfortunately, we failed to achieve our train ing aims, we nevertheless proved that finishing a PhD thesis is easier than per forming 20 pull-ups. In addition, I would like to thank Teemu Asikainen for many interesting, inspiring, and refreshing conversations on physiotherapy, the theory of evolution, restaurants, and red wines. Your ad vice has been very valuable to me from the very outset of my doctoral studies. Sharing thoughts and feelings with fellow PhD students was also important during this project. I warmly thank my parents Eeva and Pentti; you have always supported me whatever projects I have started. You have helped me see life from the right perspective by reminding me what the most important things in life are. The early changes in trunk muscle strength and disability following lumbar spine fusion. Effect of isometric upper-extremity exercises on the ac tivation of core stabilizing muscles. Randomized controlled trial of postop erative exercise rehabilitation program after lumbar spine fusion: study protocol. The natural course of low back pain is benign, since most low back pain episodes are mild and rarely very disabling, and therefore only a small propor tion of patients seek care. However, there is no real evidence to support the general belief that 80-90% of low back pain patients become pain-free within a month (Airaksinen et al. Low back pain symptoms fluctuate over time with frequent recurrences or exacerbations. According to another systematic review, 73% of patients had at least one recurrence within 12 months (Pengel et al. Due to the high prevalence and costs of low back pain, effective treatment for this condition is extremely important (Airaksinen et al. However, there is no consensus as to what kinds of ex ercises should be performed or what constitutes proper exercise dose. If con servative treatments fail to reduce severe low back pain and lower extremity symptoms, and if there are structural problems in the lumbar spine, spinal sur gery is considered (Malmivaara et al. In specific disorders, the early outcome of fusion surgery has been report ed to be good (Moller & Hedlund 2000, Weinstein et al. In addition, patients undergoing fusion operation have usually suffered low back pain for years, and hence functional and structural changes may have tak en place in their trunk muscles (Danneels et al. The aim of the rehabilitation after fusion is to improve the functional ca pacity of trunk muscles and control of the neutral spine position to diminish loading of adjacent segments. More broadly, rehabilitation aims at activating patients and thus improving their health-related quality of life and long-term maintenance of the surgical results. In addition to back surgery operation tech nique used and the healing processes of tissues, the effect of exercises on trunk muscles function has to be known to optimize the effectiveness of postoperative rehabilitation. The present study focuses on evaluating changes in trunk muscle function after lumbar spine fusion and assessing the feasibility of neutral spine control exercises for rehabilitation purposes. On the basis of the findings, an evidence-based post-operative exercise program was developed. Further, the lumbar spine comprises the vertebral bodies and the three-joint complex of the intervertebral disc and the two posterior facet joints (Willson et al.
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