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groups. Neither patients’ motivation nor their anticipatory emotions corre-lated with the individual coefficients of variation of the trunk musclemoment measurements. Conclusion: Isometric maximum trunk musclemoment measurements derived from chronic low back pain patients olderthan 50 years are as reliable as those derived from younger patients of thecondition. These measurements enable an acceptable level of detection ofexpected muscle torque changes in these patients. Reprinted with permis-sion.

No. 247 Patient-Tailored Multimodal RehabilitationIntervention Is Necessary When Treating CervicalNeuromuscular Syndrome After Traffic Accidents.Yoichiro Kikuchi; Hideki Yumikake; Shiro Hanakawa;Naoya Kobayashi.

Objective: Cervical neuromuscular syndrome (CNMS) is an autonomicimbalance caused by neck muscle abnormalities. Cervical sprain (whiplash-associated disorders) following traffic accidents is a major cause of CNMS.So-called general malaise is a major somatic symptom and psychiatricsymptoms such as depression may develop with disease progression.We aimed to demonstrate that multimodal rehabilitation interventionis extremely effective for treating CNMS. Design: Case-control study.Setting: Therapeutic interventions were provided at a rehabilitationcenter of the 119-bed general hospital in Japan from June 2012 toNovember 2013. Okayama City (population: 701,629) had 8709 trafficaccident-related casualties with 33 deaths in 2012. Participants: Fromamong the 2585 individuals who underwent rehabilitation intervention,557 patients who had sustained traffic accidents were included in thisstudy. Of these 557 patients, 92 were diagnosed with CNMS and under-went therapeutic intervention and 386 underwent therapeutic interventionby physicians who were unaware of CNMS in other departments. Inter-ventions: Symptomatic treatments included oral medications, fluidreplacement, intravenous injections, and Botox injections along with phys-ical therapy including low-frequency electrotherapy and hot packs. We alsoconducted systemic adjustment training centered on muscle relaxationusing a combination of physical and occupational therapies. MainOutcome Measures: A questionnaire with 30 yes/no questionswas used for indefinite complaints. The presence of more than 5 symptomsrequired treatment. Assessments were performed before and after treatment.Treatment was considered effective if more than 1 symptom improved.Results: Sufficient effects were achieved with drugs and physiotherapyapparatus alone in 57.6% of patients and effects were seen in >90% ofpatients by the combination of physical and occupational therapies. Somepatients markedly responded to Botox therapy and some returned to labor-intensive work after temporary leave. Conclusions: Patient-tailored andappropriately-timed rehabilitation intervention is effective for treating CNMSand could reduce unnecessary tests drugs and medical expenses.

No. 248 Relationship Between the Type and Amount ofPhysical Activity and Low Back Pain in Koreans Aged 50Years And Over.Won Kim.

Objectives: To examine the association between the type and amount ofPA and LBP in people aged 50 years and over. Design: Cross-sectionalstudy. Setting: A nationwide survey. Participants: Data were obtainedfrom the fifth Korea National Health and Nutrition Examination Surveywhich was conducted in 2010 and 2011. Overall 1796 men and 2198women aged 50 years and over were included. Interventions: PA wascategorized as vigorous moderate walking, strength exercises, or flexibilityexercises. The total amount of PA was presented as quartiles of the totalmetabolic equivalent (MET)-min/week based on the PA questionnaire.Multivariate logistic regression analysis was performed to examine associa-tions between LBP and the type and amount of PA. Main OutcomeMeasurements: Odd ratio for low back pain according to the type ofphysical activity and the quartiles of the total MET-min/week. Level ofEvidence: Level 1 evidence. Results: After adjusting for age and body

mass index, vigorous and moderate PA were associated with an increasedrisk of LBP in both men and women, whereas strength exercises wereassociated with a reduced risk of LBP. These associations were maintainedafter adjusting for all potential confounders. Subgroup analysis according toage revealed that these trends were most significantly demonstrated inwomen aged 65 years and over. The PA quartiles for total MET-min/weekfor men showed a U-shaped association with LBP, whereas only the fourthPA quartile for women showed an increased risk of LBP compared with thesecond quartile. Conclusions: These results suggest that both the typeand amount of PA affect the development of LBP in people aged 50 yearsand over. Thus activity modification might be helpful for prevention andmanagement of LBP.

No. 249 Diagnostic Effectiveness of Electrodiagnostic Studyand Ultrasound in Sural Neuroma.Joon-Sung Kim; Hye Young Han, MD; Seong Hoon Lim;Bo Young Hong.

Disclosure: None. Setting: University Hospital. Patient: A 52-year oldman with numbness of leg. Case Description: A 52-year-old manreferred for electrodiagnostic evaluation to rule out lumbosacral radiculop-athy. He complained of lower back pain and numbness of left posterolateralcalf and lateral aspect of the foot. He underwent surgical tendon repair due totraumatic car accident in 1991. He had impaired light touch and pinpricksensation over the left posterolateral calf area from 14cm proximal of thelateral malleolus to the lateral aspect of the foot including fifth toe. Elec-trodiagnostic studies were performed. The left sural nerve was stimulated14cm proximal to the lateral malleolus; recording was made in just posteriorto the lateral malleolus. Recognizable response was not recorded followingstimulation at 14cm, 12cm, and 8cm proximal to the lateral malleolus. Theright sural nerve was not obtainable due to amputated state. An ultrasono-graphic study (US) was performed using a linear electronic 10-13 MHz probeat 14cm proximal to the lateral malleolus through transverse and longitu-dinal scans. US findings showed regular oval and hypoechoic mass at the site.Magnetic resonance imaging (MRI) showed a segmental thickening withperineural fibrosis of sural nerve and focal muscle herniation in soleus. Thepatient had surgical exploration and a fusiform like sural neuroma was foundat the site of surgical wound. After excision of neuroma his symptom dis-appeared. Conclusion: We report this case owing to its rarity and toemphasize the diagnostic effectiveness of the combination of electro-diagnostic study and US when sensory nerve action potential is not evoked.

No. 251 Effectiveness of Teriparatide Treatment on BackPain and Quality of Life in Patients With SevereOsteoporosis.Hikmet Kocyigit; Bengi Ozoglu Oz, MD Assoc. Prof.;Guzide Gonca Oruk.

Disclosure: None. Objective: Patients suffering from osteoporoticvertebral fractures often have impaired physical function and limited dailyliving activities due to back pain. We aimed to evaluate the effectiveness ofteriparatide treatment on the back pain and quality of life in severe cases ofosteoporosis. Participants: We retrospectively reviewed 12 osteoporosispatients treated with teriparatide. All the patients had at least two vertebralfractures and T score of>-4.0 at total hip or lumbar spine (L1-L4). MainOutcome Measures: Assessment of back pain was based on the visualanalog scale (VAS). For quality of life measurements we used the QUAL-EFFO and the SF-36. Patients were clinically assessed at baseline and at 6,12, and 18 months after teriparatide initiation as were weight, height,clinical complications, pain, and quality of life evolution. Results: Meanage of the patients (n¼12) was 71.1�5.1 years and all of them were women.At all follow-up visits statistically significant improvements were observed inthe pain domains of both QUALEFFO and SF-36 and also severity of backpain evaluated by VAS (p<0.05). At the 6-month follow-up visit meanQUALEFFO physical function and total QUALEFFO scores were signifi-cantly lower compared with the baseline scores. Additionally general healthperception subscale score was also improved compared to baseline at 12 and