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Golyski PR, Hendershot BD. Trunk and pelvic dynamics during transient turns among individuals with unilateral traumatic lower limb amputation. Hum Mov Sci 2018; 58:41-54. [DOI: 10.1016/j.humov.2018.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 01/06/2018] [Accepted: 01/09/2018] [Indexed: 11/28/2022]
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Lima M, Ferreira AS, Reis FJJ, Paes V, Meziat-Filho N. Chronic low back pain and back muscle activity during functional tasks. Gait Posture 2018; 61:250-256. [PMID: 29413793 DOI: 10.1016/j.gaitpost.2018.01.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/05/2018] [Accepted: 01/21/2018] [Indexed: 02/02/2023]
Abstract
There is evidence that patients with low back pain favor their trunk muscles when moving. However, it is unknown whether this maladaptive behavior is generalized across different functional tasks. This study analyzed the back muscle activity of patients with chronic low back pain compared to asymptomatic controls during five functional tasks. The secondary aim of this study was to test whether the electromyographic activity of patients' back muscles was correlated with either the TAMPA scale score or the Örebro Questionnaire. Forty patients with chronic, non-specific low back pain and 40 asymptomatic participants were assessed on the electromyographic activity of the lumbar longissimus, ilio-costal and multifidus while picking up and placing an object on the ground, sitting down and standing up, and climbing stairs. There was statistical evidence of two-way interactions involving group by task (F4,308 = 7.921, p < 0.001, η2 = 0.049) and task by muscle (F18,1386 = 2.912, p < 0.001, η2 = 0.004), but not group by muscle (F7,539 = 1.104, p = 0.359, η2 = 0.004). Patients with chronic low back pain showed an increase in back muscle activity regardless of the type of functional task, except the left side of multifidus muscle during the picking up of a ball on the ground task. There was no correlation between the measure of kinesiophobia or the Örebro questionnaire score and the level of electromyographic activity.
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Affiliation(s)
- Maicom Lima
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, UNISUAM,Praça das Nações 34, terceiro andar, Bonsucesso, Rio de Janeiro, RJ, 21041-010, Brazil; Research Laboratory of Exercise Science, CEFAN, Brazilian Navy, Brazil.
| | - Arthur Sá Ferreira
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, UNISUAM,Praça das Nações 34, terceiro andar, Bonsucesso, Rio de Janeiro, RJ, 21041-010, Brazil.
| | - Felipe José Jandre Reis
- Instituto Federal do Rio de Janeiro, Brazil; Department of Clinical Medicine, Universidade Federal do Rio de Janeiro, Brazil.
| | - Vanessa Paes
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, UNISUAM,Praça das Nações 34, terceiro andar, Bonsucesso, Rio de Janeiro, RJ, 21041-010, Brazil; Research Laboratory of Exercise Science, CEFAN, Brazilian Navy, Brazil.
| | - Ney Meziat-Filho
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, UNISUAM,Praça das Nações 34, terceiro andar, Bonsucesso, Rio de Janeiro, RJ, 21041-010, Brazil.
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53
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Spinal loads and trunk muscles forces during level walking – A combined in vivo and in silico study on six subjects. J Biomech 2018; 70:113-123. [DOI: 10.1016/j.jbiomech.2017.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 08/17/2017] [Accepted: 08/19/2017] [Indexed: 11/19/2022]
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Actis JA, Honegger JD, Gates DH, Petrella AJ, Nolasco LA, Silverman AK. Validation of lumbar spine loading from a musculoskeletal model including the lower limbs and lumbar spine. J Biomech 2018; 68:107-114. [DOI: 10.1016/j.jbiomech.2017.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 12/18/2022]
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Larsen LH, Hirata RP, Graven-Nielsen T. Experimental Low Back Pain Decreased Trunk Muscle Activity in Currently Asymptomatic Recurrent Low Back Pain Patients During Step Tasks. THE JOURNAL OF PAIN 2018; 19:542-551. [PMID: 29325884 DOI: 10.1016/j.jpain.2017.12.263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 11/28/2017] [Accepted: 12/22/2017] [Indexed: 11/16/2022]
Abstract
Low back pain (LBP) patients show reorganized trunk muscle activity but if similar changes are manifest in recurrent LBP (R-LBP) patients during asymptomatic periods remains unknown. In 26 healthy and 27 currently asymptomatic R-LBP participants electromyographic activity (EMG) was recorded from trunk and gluteal muscles during series of stepping up and down on a step bench before and during experimentally intramuscular induced unilateral and bilateral LBP. Pain intensity was assessed using numeric rating scale (NRS) scores. Root mean square EMG (RMS-EMG) normalized to maximal voluntary contraction EMG and pain-evoked differences from baseline (ΔRMS-EMG) were analyzed. Step task duration was calculated from foot sensors. R-LBP compared with controls showed higher baseline RMS-EMG and NRS scores of experimental pain (P < .05). In both groups, bilateral compared with unilateral experimental NRS scores were higher (P < .001) and patients compared with controls reported higher NRS scores during both pain conditions (P < .04). In patients, unilateral pain decreased ΔRMS-EMG in the Iliocostalis muscle and bilateral pain decreased ΔRMS-EMG in all back and gluteal muscles during step tasks (P < .05) compared with controls. In controls, bilateral versus unilateral experimental pain induced increased step task duration and trunk RMS-EMG whereas both pain conditions decreased step task duration and trunk RMS-EMG in R-LBP patients compared with controls (P < .05). PERSPECTIVE Task duration and trunk muscle activity increased in controls and decreased in R-LBP patients during experimental muscle LBP. These results indicate protective strategies in controls during acute pain whereas R-LBP patients showed higher pain intensity and altered strategies that may be caused by the higher pain intensity, but the long-term consequence remains unknown.
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Affiliation(s)
- Lars Henrik Larsen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark; University College North Denmark, Department of Physiotherapy, Aalborg, Denmark
| | - Rogerio Pessoto Hirata
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark.
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Kim SH, Park KN, Kwon OY. Pain intensity and abdominal muscle activation during walking in patients with low back pain: The STROBE study. Medicine (Baltimore) 2017; 96:e8250. [PMID: 29049215 PMCID: PMC5662381 DOI: 10.1097/md.0000000000008250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Nonspecific low back pain (LBP) is a common musculoskeletal problem that is intensified during physical activity. Patients with LBP have been reported to change their abdominal muscle activity during walking; however, the effects of pain intensity, disability level, and fear-avoidance belief on this relationship have not been evaluated. Thus, we compared abdominal muscle activity in patients with LBP and asymptomatic controls, and assessed the impact of pain intensity, disability level, and fear-avoidance belief.Thirty patients with LBP divided into groups reporting low (LLBP) and high-pain intensity low back pain (HLBP), and 15 participants without LBP were recruited. LBP patients' self-reported pain intensity, disability, and fear-avoidance belief were recorded. To examine abdominal muscle activity (rectus abdominis [RA], internal [IO], and external oblique [EO] muscles) during walking, all subjects walked at a self-selected speed. Abdominal muscle activity (RA, IO, and EO) was compared among groups (LLBP, HLBP, and controls) in different phases of walking (double support vs swing). Relationships between abdominal muscle activity and clinical measures (pain intensity, disability, fear-avoidance belief) were analyzed using partial correlation analysis.Right IO muscle activity during walking was significantly decreased in LLBP and HLBP compared with controls in certain walking phase. Partial correlation coefficients showed significant correlations between fear-avoidance belief and right EO activity (r = .377, P < .05) and between disability index and left IO activity (r = .377, P < .05) in patients with LBP. No significant difference was found in abdominal muscle activity in walking between patients with LLBP and HLBP (P > .05).This study demonstrated decreased IO muscle activity during certain walking phases in LLBP and HLBP compared with asymptomatic participants. Although altered IO muscle activity during walking was observed in patients with LBP, no changes were found with other abdominal muscles (EO, RA). Thus, these results provide useful information about abdominal muscle activity during walking in patients with LBP.
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Affiliation(s)
- Si-Hyun Kim
- Department of Physical Therapy, College of Health Science, Yonsei University, Maeji-ri, Heungeop-myeon, Wonju-si, Gangwon-do
| | - Kyue-Nam Park
- Department of Physical Therapy, College of Medical Science, Jeonju University
| | - Oh-Yun Kwon
- Laboratory of Kinetic Ergocise based on Movement Analysis, Department of Physical Therapy, College of Health Science, Yonsei University, Maeji-ri, Heungeop-myeon, Wonju-si, Gangwon-do, South Korea
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Drew M, Palsson T, Hirata R, Izumi M, Lovell G, Welvaert M, Chiarelli P, Osmotherly P, Graven-Nielsen T. Experimental pain in the groin may refer into the lower abdomen: Implications to clinical assessments. J Sci Med Sport 2017; 20:904-909. [DOI: 10.1016/j.jsams.2017.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/14/2017] [Accepted: 04/16/2017] [Indexed: 11/27/2022]
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58
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Wachi M, Suga T, Higuchi T, Misaki J, Tsuchikane R, Tanaka D, Miyake Y, Kanazawa N, Isaka T. Applicability of ultrasonography for evaluating trunk muscles size in athletes: a study focused on baseball batters. J Phys Ther Sci 2017; 29:1534-1538. [PMID: 28931982 PMCID: PMC5599815 DOI: 10.1589/jpts.29.1534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/05/2017] [Indexed: 11/27/2022] Open
Abstract
[Purpose] Recently, we demonstrated that the thicknesses of trunk muscles measured using
ultrasonography were correlated strongly with the cross-sectional areas measured using
magnetic resonance imaging in untrained subjects. To further explore the applicability of
ultrasonography in the clinical setting, the present study examined the correlation
between ultrasonography-measured thicknesses and magnetic resonance imaging-measured
cross-sectional areas of trunk muscles in athletes with trained trunk muscles. [Subjects
and Methods] The thicknesses and cross-sectional areas at total 10 sites of the bilateral
sides of the upper, central, and lower parts of the rectus abdominis, abdominal wall, and
multifidus lumborum in 30 male baseball batters were measured. [Results] Overall
thicknesses and cross-sectional areas of the trunk muscles in baseball batters were higher
than those in untrained subjects who participated in our previous study. The
ultrasonography-measured thicknesses at all 10 sites of the trunk muscles correlated
highly with the magnetic resonance imaging-measured cross-sectional areas in baseball
batters. [Conclusion] These results suggest that the thicknesses of the trunk muscles
measured using ultrasonography can be used as a surrogate marker for the cross-sectional
area measured using magnetic resonance imaging, in athletes who have larger trunk muscles
than that of untrained subjects.
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Affiliation(s)
- Michio Wachi
- Faculty of Sport and Health Science, Ritsumeikan University: 1-1-1 Nojihigashi, Kusatsu, Shiga 525-8577, Japan.,Kanazawa Orthopaedic & Sports Medicine Clinic, Japan
| | - Tadashi Suga
- Faculty of Sport and Health Science, Ritsumeikan University: 1-1-1 Nojihigashi, Kusatsu, Shiga 525-8577, Japan
| | - Takatoshi Higuchi
- Faculty of Socio-Environmental Studies, Fukuoka Institute of Technology, Japan
| | - Jun Misaki
- Faculty of Sport and Health Science, Ritsumeikan University: 1-1-1 Nojihigashi, Kusatsu, Shiga 525-8577, Japan
| | - Ryo Tsuchikane
- Faculty of Sport and Health Science, Ritsumeikan University: 1-1-1 Nojihigashi, Kusatsu, Shiga 525-8577, Japan
| | - Daichi Tanaka
- Faculty of Sport and Health Science, Ritsumeikan University: 1-1-1 Nojihigashi, Kusatsu, Shiga 525-8577, Japan
| | - Yuto Miyake
- Faculty of Sport and Health Science, Ritsumeikan University: 1-1-1 Nojihigashi, Kusatsu, Shiga 525-8577, Japan
| | - Nobuhiko Kanazawa
- Kanazawa Orthopaedic & Sports Medicine Clinic, Japan.,Faculty of Nursing and Rehabilitation, Aino University, Japan
| | - Tadao Isaka
- Faculty of Sport and Health Science, Ritsumeikan University: 1-1-1 Nojihigashi, Kusatsu, Shiga 525-8577, Japan
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Manickaraj N, Bisset LM, Devanaboyina VSPT, Kavanagh JJ. Chronic pain alters spatiotemporal activation patterns of forearm muscle synergies during the development of grip force. J Neurophysiol 2017; 118:2132-2141. [PMID: 28724779 DOI: 10.1152/jn.00210.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 02/04/2023] Open
Abstract
It is largely unknown how the CNS regulates multiple muscle systems in the presence of pain. This study used muscle synergy analysis to investigate multiple forearm muscles in individuals with chronic elbow pain during the development of grip force. Eleven individuals with chronic elbow pain and 11 healthy age-matched control subjects developed grip force to 15% and 30% of maximum voluntary contraction (MVC). Surface electromyography was obtained from six forearm muscles during force development before nonnegative matrix factorization was performed. The relationship between muscle synergies and standard clinical tests of elbow pain were examined by linear regression. During grip force development to 15% MVC the pain group had a lower number of forearm muscle synergies, increased similarity in spatial activation patterns, increased cocontraction of forearm flexors, and a greater magnitude of muscle weightings across the forearm when performing the task. During the 30% MVC grip the numbers of muscle synergies were the same for both groups; however, the pain group had lower activation and reduced variability in the timing of peak activation. The timing of peak activation was delayed in the pain group regardless of the task, and performing the grip in different wrist postures did not affect muscle synergy characteristics in either group. Although localized pain causes direct dysfunction of an affected muscle, this study provides evidence that the timing and amplitude of agonist and antagonist muscle activity are also affected with chronic pain.NEW & NOTEWORTHY Muscle activation patterns of individuals with chronic elbow pain are simplified compared with healthy individuals. This is apparent as individuals with pain exhibit fewer forearm muscle synergies, and increased similarity of activation patterns between forearm muscles, when performing pain-free isometric gripping. As such, even during pain-free tasks it is possible to observe changes in motor control in people with chronic pain.
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Affiliation(s)
- Nagarajan Manickaraj
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Leanne M Bisset
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | | | - Justin J Kavanagh
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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60
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Ross GB, Sheahan PJ, Mahoney B, Gurd BJ, Hodges PW, Graham RB. Pain catastrophizing moderates changes in spinal control in response to noxiously induced low back pain. J Biomech 2017; 58:64-70. [DOI: 10.1016/j.jbiomech.2017.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/23/2017] [Accepted: 04/10/2017] [Indexed: 11/16/2022]
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61
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Rosquist PG, Collins G, Merrell AJ, Tuttle NJ, Tracy JB, Bird ET, Seeley MK, Fullwood DT, Christensen WF, Bowden AE. Estimation of 3D Ground Reaction Force Using Nanocomposite Piezo-Responsive Foam Sensors During Walking. Ann Biomed Eng 2017; 45:2122-2134. [PMID: 28512701 DOI: 10.1007/s10439-017-1852-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/10/2017] [Indexed: 11/25/2022]
Abstract
This paper describes a method for the estimation of the 3D ground reaction force (GRF) during human walking using novel nanocomposite piezo-responsive foam (NCPF) sensors. Nine subjects (5 male, 4 female) walked on a force-instrumented treadmill at 1.34 m/s for 120 s each while wearing a shoe that was instrumented with four NCPF sensors. GRF data, measured via the treadmill, and sensor data, measured via the NCPF inserts, were used in a tenfold cross validation process to calibrate a separate model for each individual. The calibration model estimated average anterior-posterior, mediolateral and vertical GRF with mean average errors (MAE) of 6.52 N (2.14%), 4.79 N (6.34%), and 15.4 N (2.15%), respectively. Two additional models were created using the sensor data from all subjects and subject demographics. A tenfold cross validation process for this combined data set resulted in models that estimated average anterior-posterior, mediolateral and vertical GRF with less than 8.16 N (2.41%), 6.63 N (7.37%), and 19.4 N (2.31%) errors, respectively. Intra-subject estimates based on the model had a higher accuracy than inter-subject estimates, likely due to the relatively small subject cohort used in creating the model. The novel NCPF sensors demonstrate the ability to accurately estimate 3D GRF during human movement outside of the traditional biomechanics laboratory setting.
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Affiliation(s)
- Parker G Rosquist
- Department of Mechanical Engineering, Brigham Young University, 435B CTB, Provo, UT, 84602, USA
| | - Gavin Collins
- Department of Statistics, Brigham Young University, Provo, UT, 84602, USA
| | - A Jake Merrell
- Department of Mechanical Engineering, Brigham Young University, 435B CTB, Provo, UT, 84602, USA
| | - Noelle J Tuttle
- Department of Exercise Science, Brigham Young University, Provo, UT, 84602, USA
| | - James B Tracy
- Department of Exercise Science, Brigham Young University, Provo, UT, 84602, USA
| | - Evan T Bird
- Department of Mechanical Engineering, Brigham Young University, 435B CTB, Provo, UT, 84602, USA
| | - Matthew K Seeley
- Department of Exercise Science, Brigham Young University, Provo, UT, 84602, USA
| | - David T Fullwood
- Department of Mechanical Engineering, Brigham Young University, 435B CTB, Provo, UT, 84602, USA
| | | | - Anton E Bowden
- Department of Mechanical Engineering, Brigham Young University, 435B CTB, Provo, UT, 84602, USA.
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Abstract
Study Design Controlled laboratory study, case-control design. Objective To evaluate spine kinematics and gait characteristics in people with nonspecific chronic neck pain. Background People with chronic neck pain present with a number of sensorimotor and biomechanical alterations, yet little is known about the influence of neck pain on gait and motions of the spine during gait. Methods People with chronic nonspecific neck pain and age- and sex-matched asymptomatic controls walked on a treadmill at 3 different speeds (self-selected, 3 km/h, and 5 km/h), either with their head in a neutral position or rotated 30°. Tridimensional motion capture was employed to quantify body kinematics. Neck and trunk rotations were derived from the difference between the transverse plane component of the head and thorax and thorax and pelvis angles to provide an indication of neck and trunk rotation during gait. Results Overall, the patient group showed shorter stride length compared to the control group (P<.001). Moreover, the patients with neck pain showed smaller trunk rotations (P<.001), regardless of the condition or speed. The difference in the amount of trunk rotation between groups became larger for the conditions of walking with the head rotated. Conclusion People with chronic neck pain walk with reduced trunk rotation, especially when challenged by walking with their head positioned in rotation. Reduced rotation of the trunk during gait may have long-term consequences on spinal health. J Orthop Sports Phys Ther 2017;47(4):268-277. Epub 3 Feb 2017. doi:10.2519/jospt.2017.6768.
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63
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Massé-Alarie H, Beaulieu LD, Preuss R, Schneider C. Repetitive peripheral magnetic neurostimulation of multifidus muscles combined with motor training influences spine motor control and chronic low back pain. Clin Neurophysiol 2017; 128:442-453. [DOI: 10.1016/j.clinph.2016.12.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 12/15/2016] [Accepted: 12/21/2016] [Indexed: 12/15/2022]
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64
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Russell Esposito E, Choi HS, Darter BJ, Wilken JM. Can real-time visual feedback during gait retraining reduce metabolic demand for individuals with transtibial amputation? PLoS One 2017; 12:e0171786. [PMID: 28182797 PMCID: PMC5300156 DOI: 10.1371/journal.pone.0171786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/24/2017] [Indexed: 12/02/2022] Open
Abstract
The metabolic demand of walking generally increases following lower extremity amputation. This study used real-time visual feedback to modify biomechanical factors linked to an elevated metabolic demand of walking in individuals with transtibial amputation. Eight persons with unilateral, traumatic transtibial amputation and 8 uninjured controls participated. Two separate bouts of real-time visual feedback were provided during a single session of gait retraining to reduce 1) center of mass sway and 2) thigh muscle activation magnitudes and duration. Baseline and post-intervention data were collected. Metabolic rate, heart rate, frontal plane center of mass sway, quadriceps and hamstrings muscle activity, and co-contraction indices were evaluated during steady state walking at a standardized speed. Visual feedback successfully decreased center of mass sway 12% (p = 0.006) and quadriceps activity 12% (p = 0.041); however, thigh muscle co-contraction indices were unchanged. Neither condition significantly affected metabolic rate during walking and heart rate increased with center-of-mass feedback. Metabolic rate, center of mass sway, and integrated quadriceps muscle activity were all not significantly different from controls. Attempts to modify gait to decrease metabolic demand may actually adversely increase the physiological effort of walking in individuals with lower extremity amputation who are young, active and approximate metabolic rates of able-bodied adults.
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Affiliation(s)
- Elizabeth Russell Esposito
- Center for the Intrepid, Brooke Army Medical Center, JBSA, Ft. Sam Houston, Texas, United States of America
- Extremity Trauma and Amputation Center of Excellence, Ft. Sam Houston, Texas, United States of America
- * E-mail:
| | - Harmony S. Choi
- Center for the Intrepid, Brooke Army Medical Center, JBSA, Ft. Sam Houston, Texas, United States of America
- Extremity Trauma and Amputation Center of Excellence, Ft. Sam Houston, Texas, United States of America
| | - Benjamin J. Darter
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Jason M. Wilken
- Center for the Intrepid, Brooke Army Medical Center, JBSA, Ft. Sam Houston, Texas, United States of America
- Extremity Trauma and Amputation Center of Excellence, Ft. Sam Houston, Texas, United States of America
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65
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Comparison of the trunk-pelvis and lower extremities sagittal plane inter-segmental coordination and variability during walking in persons with and without chronic low back pain. Hum Mov Sci 2017; 52:55-66. [PMID: 28119210 DOI: 10.1016/j.humov.2017.01.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/31/2016] [Accepted: 01/05/2017] [Indexed: 11/21/2022]
Abstract
Inter-segmental coordination can be influenced by chronic low back pain (CLBP). The sagittal plane lower extremities inter-segmental coordination pattern and variability, in conjunction with the pelvis and trunk, were assessed in subjects with and without non-specific CLBP during free-speed walking. Kinematic data were collected from 10 non-specific CLBP and 10 non-CLBP control volunteers while the subjects were walking at their preferred speed. Sagittal plane time-normalized segmental angles and velocities were used to calculate continuous relative phase for each data point. Mean absolute relative phase (MARP) and deviation phase (DP) were derived to quantify the trunk-pelvis and bilateral pelvis-thigh, thigh-shank and shank-foot coordination pattern and variability over the stance and swing phases of gait. Mann-Whitney U test was employed to compare the means of DP and MARP values between two groups (same side comparison). Statistical analysis revealed more in-phase/less variable trunk-pelvis coordination in the CLBP group (P<0.05). CLBP group demonstrated less variable right or left pelvis-thigh coordination pattern (P<0.05). Moreover, the left thigh-shank and left shank-foot MARP values in the CLBP group, were more in-phase than left MARP values in the non-CLBP control group during the swing phase (P<0.05). In conclusion, the sagittal plane lower extremities, pelvis and trunk coordination pattern and variability could be generally affected by CLBP during walking. These changes can be possible compensatory strategies of the motor control system which can be considered in the CLBP subjects.
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66
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Edwards S, Austin AP, Bird SP. The Role of the Trunk Control in Athletic Performance of a Reactive Change-of-Direction Task. J Strength Cond Res 2017; 31:126-139. [DOI: 10.1519/jsc.0000000000001488] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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67
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Shojaei I, Nussbaum MA, Bazrgari B. Age-related differences in trunk muscle reflexive behaviors. J Biomech 2016; 49:3147-3152. [PMID: 27488545 DOI: 10.1016/j.jbiomech.2016.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/21/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
Reports of larger passive and similar intrinsic trunk stiffness in older vs. younger populations suggest a diminishing demand for reflexive contributions of trunk muscles to spinal stability with aging. It remains unclear, though, whether such diminishing demands result in deterioration of trunk muscle reflexive behaviors. A cross-sectional study was completed to assess age-related differences in the latency and likelihood of trunk muscle reflexive responses to sudden perturbations. Sixty healthy individuals, aged 20-70 years, were recruited to form five equal-sized and gender-balanced age groups. Using a displacement-control, sudden perturbation paradigm, the latency and likelihood of trunk muscle reflexive responses to sudden perturbations were estimated, and the influences of age, gender, and level of effort (20% versus 30% of maximum voluntary exertion-MVE) were evaluated. There were no consistent age-related differences found in any of the measures of trunk muscle reflexive behavior. However, the latency of muscle response to perturbation was generally higher among older individuals, and this difference was significant in the condition involving 30% MVE effort. With an increase in level of effort (from 20% to 30% of MVE), there was a ~7% increase in the latency of trunk muscle responses to anteriorly-directed perturbations as well as ~ 15% (21%) decrease (increase) in response likelihood during anteriorly (posteriorly) directed perturbations. Furthermore, the reflexive response likelihood of trunk muscles was 28% (58%) larger (smaller) in female vs. male participants during anteriorly (posteriorly) directed perturbations. Our results did not, in general, support the hypothesis of an age-related decay in reflexive trunk muscle behaviors. Larger reflexive responses were associated with lower trunk intrinsic stiffness among females and during a lower level of effort, suggesting a secondary role for reflexive responses in spinal stability. Such secondary compensatory responses appear, however, to be consistent over a wide age range.
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Affiliation(s)
- Iman Shojaei
- F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY 40506, USA
| | - Maury A Nussbaum
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Babak Bazrgari
- F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY 40506, USA.
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Toward a Transformed Understanding: From Pain and Movement to Pain With Movement. Phys Ther 2016; 96:1503-1507. [PMID: 27694519 PMCID: PMC5046190 DOI: 10.2522/ptj.20160211] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/05/2016] [Indexed: 12/15/2022]
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Pain catastrophizing and trunk muscle activation during walking in patients with chronic low back pain. Gait Posture 2016; 49:73-77. [PMID: 27388960 DOI: 10.1016/j.gaitpost.2016.06.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 06/09/2016] [Accepted: 06/20/2016] [Indexed: 02/02/2023]
Abstract
It has been hypothesized that individuals with low back pain (LBP) will have higher trunk muscle activity during gait, in an attempt to limit spine motion, and that this "guarding strategy" may be influenced by the person's psychological response to pain. This study investigated whether the amplitude of trunk muscle activation differs between persons with chronic LBP and healthy individuals during walking, and whether changes in muscle activation were related to pain catastrophizing. Thirty persons with chronic non-specific LBP, stratified into 2 groups of high (HLBP) and low (LLBP) pain catastrophizing, were contrasted with a control group of 15 healthy individuals during walking on a treadmill at a self-selected speed. Surface electromyographic (EMG) data were recorded from 10 trunk muscles. The effects of Group and gait Sub-phase on EMG activation amplitudes were assessed. The HLBP group exhibited higher activation of certain muscles throughout the gait cycle, and reduced variability of others at specific sub-phases of gait. A significant correlation was found between activation amplitude and pain catastrophizing in most muscles, when controlling for gait speed and pain intensity. These data indicate that altered trunk muscle activation is present in some patients with LBP during walking, but does not represent a universal increase in activation for all muscles. This altered neuromotor control is, however, more strongly associated with pain catastrophizing than with pain intensity, and appears to represent a non-functional, maladaptive behavior, as it alters the normal, phasic pattern of activation in certain trunk muscles.
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Massé-Alarie H, Beaulieu LD, Preuss R, Schneider C. Influence of paravertebral muscles training on brain plasticity and postural control in chronic low back pain. Scand J Pain 2016; 12:74-83. [PMID: 28850499 DOI: 10.1016/j.sjpain.2016.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/19/2016] [Accepted: 03/17/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Isometric activation (ISOM) of deep multifidi muscles (MF) can influence postural adjustments and primary motor cortex (M1) function in chronic low back pain (CLBP). In order to better understand how ISOM impacts on CLBP condition, the present study contrasted ISOM after-effects on M1 function, MF postural activation and pain with another training, the global activation of paravertebral muscles (GLOB, hip extension). The main objective of this study was to compare the effects of ISOM and GLOB (3-week training each) on MF postural activation and M1 function in a CLBP population. METHODS Twenty-four people with CLBP were randomly allocated to ISOM and GLOB groups for a 3-week daily practice. Pre/post-training after-effects were assessed by the onset of superficial MF (MF-S) activation during ballistic limb movements (bilateral shoulder flexion in standing; unilateral hip extension in prine lying), MF-S corticomotor control tested by transcranial magnetic stimulation of M1, and assessment of pain, kinesiophobia and disability by standardized questionnaires. RESULTS Both ISOM and GLOB improved pain and disability. However, only ISOM influenced M1 function (decreased corticospinal excitability and increased intracortical inhibition), fastened MF-S postural activation and decreased kinesiophobia. CONCLUSIONS Changes of corticospinal excitability and of MF-S postural adjustments suggest that ISOM better influenced brain plasticity. Future studies should further test whether our novel findings relate to an influence of the exercises on the lumbopelvic control of different muscles and on cognitive function. Clinically, individual's evaluation remains warranted before prescribing one or the other of these two conventional exercises for reducing pain. IMPLICATIONS This original study presents how motor control exercises can influence brain plasticity and postural control in chronic low back pain. This knowledge will impact on the decision of clinicians to prescribe specific exercises with a view of improving motor control in this musculoskeletal condition.
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Affiliation(s)
- Hugo Massé-Alarie
- Research Center of CHU de Québec, Neuroscience Division, Clinical Neuroscience and Neurostimulation Laboratory, Quebec City, QC, Canada.
| | - Louis-David Beaulieu
- Research Center of CHU de Québec, Neuroscience Division, Clinical Neuroscience and Neurostimulation Laboratory, Quebec City, QC, Canada
| | - Richard Preuss
- McGill University, Constance-Lethbridge Rehabilitation Center-CRIR, Montreal, QC, Canada
| | - Cyril Schneider
- Research Center of CHU de Québec, Neuroscience Division, Clinical Neuroscience and Neurostimulation Laboratory, Quebec City, QC, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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71
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Altered Multifidus Recruitment During Walking in Young Asymptomatic Individuals With a History of Low Back Pain. J Orthop Sports Phys Ther 2016; 46:365-74. [PMID: 26999410 DOI: 10.2519/jospt.2016.6230] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study, with a case-control, cross-sectional design. Background Individuals with low back pain have impaired activation of the multifidus during postural adjustments and increased activity of the erector spinae musculature during walking. However, it is unclear whether these alterations in muscle activity are evident during locomotion in individuals with a history of low back pain when they are between symptomatic episodes. Objectives To compare paraspinal muscle activity in young, healthy individuals and young individuals with a history of low back pain during walking turns. Methods Fourteen asymptomatic individuals with a history of low back pain and 14 controls performed 90° walking turns at both a self-selected speed and a fast speed. The duration and amplitude of activity in the deep fibers of the multifidus and the lumbar and thoracic longissimus were quantified using intramuscular electromyography. Results There was a significant speed-by-group interaction for the duration of multifidus activity (P = .013). Duration of activity increased from the self-selected speed to the fast locomotor speed in the controls, but decreased in the individuals with a history of low back pain (P = .003). Self-selected speed was the same in both groups (P = .719). There was a trend toward a significant association between group and the direction of change in the duration of deep multifidus activity (χ(2) = 0.058). Duration of thoracic longissimus activity and amplitude of multifidus and thoracic longissimus activity increased similarly in both groups from the self-selected to the faster speed. Conclusion Even between symptomatic episodes, young individuals with a history of low back pain demonstrated altered recruitment of the deep fibers of the lumbar multifidus in response to changing locomotor speed during walking turns. J Orthop Sports Phys Ther 2016;46(5):365-374. Epub 21 Mar 2016. doi:10.2519/jospt.2016.6230.
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Forearm Muscle Activity in Lateral Epicondylalgia: A Systematic Review with Quantitative Analysis. Sports Med 2016; 46:1833-1845. [DOI: 10.1007/s40279-016-0539-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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73
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Shojaei I, Vazirian M, Croft E, Nussbaum MA, Bazrgari B. Age related differences in mechanical demands imposed on the lower back by manual material handling tasks. J Biomech 2016; 49:896-903. [DOI: 10.1016/j.jbiomech.2015.10.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/14/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
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74
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Burns E, Chipchase LS, Schabrun SM. Reduced Short- and Long-Latency Afferent Inhibition Following Acute Muscle Pain: A Potential Role in the Recovery of Motor Output. PAIN MEDICINE 2016; 17:1343-1352. [PMID: 26874884 DOI: 10.1093/pm/pnv104] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/20/2015] [Accepted: 12/13/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Corticomotor output is reduced in response to acute muscle pain, yet the mechanisms that underpin this effect remain unclear. Here the authors investigate the effect of acute muscle pain on short-latency afferent inhibition, long-latency afferent inhibition, and long-interval intra-cortical inhibition to determine whether these mechanisms could plausibly contribute to reduced motor output in pain. DESIGN Observational same subject pre-post test design. SETTING Neurophysiology research laboratory. SUBJECTS Healthy, right-handed human volunteers (n = 22, 9 male; mean age ± standard deviation, 22.6 ± 7.8 years). METHODS Transcranial magnetic stimulation was used to assess corticomotor output, short-latency afferent inhibition, long-latency afferent inhibition, and long-interval intra-cortical inhibition before, during, immediately after, and 15 minutes after hypertonic saline infusion into right first dorsal interosseous muscle. Pain intensity and quality were recorded using an 11-point numerical rating scale and the McGill Pain Questionnaire. RESULTS Compared with baseline, corticomotor output was reduced at all time points (p = 0.001). Short-latency afferent inhibition was reduced immediately after (p = 0.039), and long-latency afferent inhibition 15 minutes after (p = 0.035), the resolution of pain. Long-interval intra-cortical inhibition was unchanged at any time point (p = 0.36). CONCLUSIONS These findings suggest short- and long-latency afferent inhibition, mechanisms thought to reflect the integration of sensory information with motor output at the cortex, are reduced following acute muscle pain. Although the functional relevance is unclear, the authors hypothesize a reduction in these mechanisms may contribute to the restoration of normal motor output after an episode of acute muscle pain.
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Affiliation(s)
- Emma Burns
- *Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
| | - Lucinda Sian Chipchase
- *Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
| | - Siobhan May Schabrun
- *Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
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75
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A Randomized Controlled Trial of the Effects of Isolated Lumbar Extension Exercise on Lumbar Kinematic Pattern Variability During Gait in Chronic Low Back Pain. PM R 2016; 8:105-14. [DOI: 10.1016/j.pmrj.2015.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 11/22/2022]
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76
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Danneels L, Cagnie B, D'hooge R, De Deene Y, Crombez G, Vanderstraeten G, Parlevliet T, Van Oosterwijck J. The effect of experimental low back pain on lumbar muscle activity in people with a history of clinical low back pain: a muscle functional MRI study. J Neurophysiol 2016; 115:851-7. [DOI: 10.1152/jn.00192.2015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 11/27/2015] [Indexed: 11/22/2022] Open
Abstract
In people with a history of low back pain (LBP), structural and functional alterations have been observed at several peripheral and central levels of the sensorimotor pathway. These existing alterations might interact with the way the sensorimotor system responds to pain. We examined this assumption by evaluating the lumbar motor responses to experimental nociceptive input of 15 participants during remission of unilateral recurrent LBP. Quantitative T2 images (muscle functional MRI) were taken bilaterally of multifidus, erector spinae, and psoas at several segmental levels (L3 upper and L4 upper and lower endplate) and during several conditions: 1) at rest, 2) upon trunk-extension exercise without pain, and 3) upon trunk-extension exercise with experimental induced pain at the clinical pain-side (1.5-ml intramuscular hypertonic saline injections in erector spinae). Following experimental pain induction, muscle activity levels similarly reduced for all three muscles, on both painful and nonpainful sides, and at multiple segmental levels ( P = 0.038). Pain intensity and localization from experimental LBP were similar as during recalled clinical LBP episodes. In conclusion, unilateral and unisegmental experimental LBP exerts a generalized and widespread decrease in lumbar muscle activity during remission of recurrent LBP. This muscle response is consistent with previous observed patterns in healthy people subjected to the same experimental pain paradigm. It is striking that similar inhibitory patterns in response to pain could be observed, despite the presence of preexisting alterations in the lumbar musculature during remission of recurrent LBP. These results suggest that motor output can modify along the course of recurrent LBP.
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Affiliation(s)
- Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Roseline D'hooge
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Yves De Deene
- Department of Radiotherapy and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Guy Vanderstraeten
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium; and
| | - Thierry Parlevliet
- Department of Physical Medicine and Orthopedic Surgery, Ghent University Hospital, Ghent, Belgium
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77
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Center of Pressure Displacement of Standing Posture during Rapid Movements Is Reorganised Due to Experimental Lower Extremity Muscle Pain. PLoS One 2015; 10:e0144933. [PMID: 26680777 PMCID: PMC4683030 DOI: 10.1371/journal.pone.0144933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Background Postural control during rapid movements may be impaired due to musculoskeletal pain. The purpose of this study was to investigate the effect of experimental knee-related muscle pain on the center of pressure (CoP) displacement in a reaction time task condition. Methods Nine healthy males performed two reaction time tasks (dominant side shoulder flexion and bilateral heel lift) before, during, and after experimental pain induced in the dominant side vastus medialis or the tibialis anterior muscles by hypertonic saline injections. The CoP displacement was extracted from the ipsilateral and contralateral side by two force plates and the net CoP displacement was calculated. Results Compared with non-painful sessions, tibialis anterior muscle pain during the peak and peak-to-peak displacement for the CoP during anticipatory postural adjustments (APAs) of the shoulder task reduced the peak-to-peak displacement of the net CoP in the medial-lateral direction (P<0.05). Tibialis anterior and vastus medialis muscle pain during shoulder flexion task reduced the anterior-posterior peak-to-peak displacement in the ipsilateral side (P<0.05). Conclusions The central nervous system in healthy individuals was sufficiently robust in maintaining the APA characteristics during pain, although the displacement of net and ipsilateral CoP in the medial-lateral and anterior-posterior directions during unilateral fast shoulder movement was altered.
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78
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Pecos-Martín D, de Melo Aroeira AE, Verás Silva RL, Martínez de Tejada Pozo G, Rodríguez Solano LM, Plaza-Manzano G, Gallego-Izquierdo T, Falla D. Immediate effects of thoracic spinal mobilisation on erector spinae muscle activity and pain in patients with thoracic spine pain: a preliminary randomised controlled trial. Physiotherapy 2015; 103:90-97. [PMID: 27012824 DOI: 10.1016/j.physio.2015.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 10/30/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the activity of the thoracic erector spinae muscles and perceived pain intensity immediately after central postero-anterior (PA) mobilisation of the thoracic spine. DESIGN Randomised, placebo-controlled, experimental design. PARTICIPANTS AND INTERVENTIONS Thirty-four participants with non-specific thoracic pain were randomised to the experimental group [grade III central PA mobilisation performed for 3minutes at the level of the seventh thoracic vertebra (T7)] or the placebo group (less than grade I central PA mobilisation performed for 3minutes at T7). MAIN OUTCOME MEASURES Before and immediately after PA mobilisation, surface electromyography (EMG) was recorded from the thoracic erector spinae muscles as the participants performed 10° spine extension from a prone position for 10seconds. Each participant rated their pain intensity as an investigator performed grade III central PA over the most symptomatic thoracic segment, and the pressure pain threshold (PPT) was evaluated bilaterally over the erector spinae muscles. RESULTS The EMG amplitude of thoracic erector spinae activity was reduced significantly after the intervention in the experimental group (P<0.05), but not in the placebo group. The difference between the groups was significant {pre-post change: placebo -14 [standard deviation (SD) 50]mV, experimental 28 (SD 48)mV; mean difference -42mV; 95% confidence interval of the difference -76 to 7; P<0.05} albeit small (Grissom=0.44). However, both groups showed a significant reduction in pain immediately after the intervention, and both groups showed a similar pre-post change in PPT. CONCLUSION These preliminary findings indicate that grade III central mobilisation over the most symptomatic thoracic segment reduces thoracic erector spinae activity during extension of the trunk in people with non-specific thoracic spine pain. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN47601528.
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Affiliation(s)
- D Pecos-Martín
- Department of Physical Therapy, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - A E de Melo Aroeira
- Department of Physical Therapy, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - R L Verás Silva
- Department of Physical Therapy, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | | | - L M Rodríguez Solano
- Department of Physical Therapy, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - G Plaza-Manzano
- Department of Medicine, University Complutense of Madrid, Madrid, Spain
| | - T Gallego-Izquierdo
- Department of Physical Therapy, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - D Falla
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK; Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany.
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79
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Larsen LH, Hirata RP, Graven-Nielsen T. Reorganized Trunk Muscle Activity During Multidirectional Floor Perturbations After Experimental Low Back Pain: A Comparison of Bilateral Versus Unilateral Pain. THE JOURNAL OF PAIN 2015; 17:223-35. [PMID: 26548972 DOI: 10.1016/j.jpain.2015.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 10/14/2015] [Accepted: 10/25/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Low back pain changes trunk muscle activity after external perturbations but the relationship between pain intensities and distributions and their effect on trunk muscle activity remains unclear. The effects of unilateral and bilateral experimental low back pain on trunk muscle activity were compared during unpredictable multidirectional surface perturbations in 19 healthy participants. Pain intensity and distribution were assessed using a visual analogue scale (VAS) and pain drawings. Root mean square (RMS) of the electromyographic (EMG) signals from 6 trunk muscles bilaterally after each perturbation was extracted and averaged across perturbations. The difference (ΔRMS-EMG) and absolute difference (absolute ΔRMS-EMG) RMS from baseline conditions were extracted for each muscle during pain conditions and averaged bilaterally for back and abdominal muscle groups. Bilateral compared with unilateral pain induced higher VAS scores (P < .005) and larger pain areas (P < .001). Significant correlation was present between VAS scores and muscle activity during unilateral (P < .001) and bilateral pain (P < .001). Compared with control injections ΔRMS-EMG increased in the back (P < .03) and abdominal (P < .05) muscles during bilateral and decreased in the back (P < .01) and abdominal (P < .01) muscles during unilateral pain. Bilateral pain caused greater absolute ΔRMS-EMG changes in the back (P < .01) and abdominal (P < .01) muscle groups than unilateral pain. PERSPECTIVE This study provided novel observations of differential trunk muscle activity in response to perturbations dependent on pain intensity and/or pain distribution. Because of complex and variable changes the relevance of clinical examination of muscle activity during postural tasks is challenged.
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Affiliation(s)
- Lars Henrik Larsen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Department of Physiotherapy, University College North Denmark, Aalborg, Denmark
| | - Rogerio Pessoto Hirata
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
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80
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Relationship Between Electromyographic Signal Amplitude and Thickness Change of the Trunk Muscles in Patients With and Without Low Back Pain. Clin J Pain 2015; 31:893-902. [DOI: 10.1097/ajp.0000000000000179] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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81
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Son SJ, Kim H, Seeley MK, Feland JB, Hopkins JT. Effects of transcutaneous electrical nerve stimulation on quadriceps function in individuals with experimental knee pain. Scand J Med Sci Sports 2015; 26:1080-90. [PMID: 26346597 DOI: 10.1111/sms.12539] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2015] [Indexed: 11/30/2022]
Abstract
Knee joint pain (KJP) is a cardinal symptom in knee pathologies, and quadriceps inhibition is commonly observed among KJP patients. Previously, KJP independently reduced quadriceps strength and activation. However, it remains unknown how disinhibitory transcutaneous electrical nerve stimulation (TENS) will affect inhibited quadriceps motor function. This study aimed at examining changes in quadriceps maximum voluntary contraction (MVC) and central activation ratio (CAR) before and after sensory TENS following experimental knee pain. Thirty healthy participants were assigned to either the TENS or placebo groups. All participants underwent three separate data collection sessions consisting of two saline infusions and one no infusion control in a crossover design. TENS or placebo treatment was administered to each group for 20 min. Quadriceps MVC and CAR were measured at baseline, infusion, treatment, and post-treatment. Perceived knee pain intensity was measured on a 100-mm visual analogue scale. Post-hoc analysis revealed that hypertonic saline infusion significantly reduced the quadriceps MVC and CAR compared with control sessions (P < 0.05). Sensory TENS, however, significantly restored inhibited quadriceps motor function compared with placebo treatment (P < 0.05). There was a negative correlation between changes in MVC and knee pain (r = 0.33, P < 0.001), and CAR and knee pain (r = 0.62, P < 0.001), respectively.
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Affiliation(s)
- S J Son
- Department of Exercise Sciences, Human Performance Research Center, Brigham Young University, Provo, Utah, USA
| | - H Kim
- Department of Kinesiology, West Chester University, West Chester, Pennsylvania, USA
| | - M K Seeley
- Department of Exercise Sciences, Human Performance Research Center, Brigham Young University, Provo, Utah, USA
| | - J B Feland
- Department of Exercise Sciences, Human Performance Research Center, Brigham Young University, Provo, Utah, USA
| | - J T Hopkins
- Department of Exercise Sciences, Human Performance Research Center, Brigham Young University, Provo, Utah, USA
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82
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Marinko LN, Christie RE, Lewis CL. Successful Rehabilitation of a Young Adult With Total Hip Arthroplasty a Decade After a Girdlestone Procedure: A Case Presentation. PM R 2015; 7:895-900. [PMID: 25857591 PMCID: PMC4555005 DOI: 10.1016/j.pmrj.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 03/28/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
This is a case presentation of a female patient who underwent a Girdlestone arthroplasty at age 10 years and a total hip arthroplasty at age 21. Despite early postoperative rehabilitation, the patient experienced increasing pain, progressive gait deviations, and functional limitations during the year after surgery. This course of care was initiated 1 year after surgery and focused on motor retraining to address pain and gait deviations. This case demonstrates that positive outcomes can be achieved after longstanding musculoskeletal dysfunction is corrected, but that prolonged rehabilitation may be necessary to produce changes in movement patterns at both the local (joint and muscle) and central (cortical) levels. Correction of both the structural problem and the learned movement patterns is necessary for a successful outcome.
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Affiliation(s)
- Lee N. Marinko
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, USA
| | - Renee E. Christie
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, USA
| | - Cara L. Lewis
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, USA
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83
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Experimental Pelvic Pain Impairs the Performance During the Active Straight Leg Raise Test and Causes Excessive Muscle Stabilization. Clin J Pain 2015; 31:642-51. [DOI: 10.1097/ajp.0000000000000139] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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84
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Toosizadeh N, Yen TC, Howe C, Dohm M, Mohler J, Najafi B. Gait behaviors as an objective surgical outcome in low back disorders: A systematic review. Clin Biomech (Bristol, Avon) 2015; 30:528-36. [PMID: 25921552 PMCID: PMC4714541 DOI: 10.1016/j.clinbiomech.2015.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Objective motor performance measures, especially gait assessment, could improve evaluation of low back disorder surgeries. However, no study has compared the relative effectiveness of gait parameters for assessing motor performance in low back disorders after surgery. The purpose of the current review was to determine the sensitive gait parameters that address physical improvements in each specific spinal disorder after surgical intervention. METHODS Articles were searched with the following inclusion criteria: 1) population studied consisted of individuals with low back disorders requiring surgery; 2) low back disorder was measured objectively using gait assessment tests pre- and post-surgery. The quality of the selected studies was assessed using Delphi consensus, and meta-analysis was performed to compare pre- and post-surgical changes. FINDINGS Thirteen articles met inclusion criteria, which, almost exclusively, addressed two types of spinal disorders/interventions: 1) scoliosis/spinal fusion; and 2) stenosis/decompression. For patients with scoliosis, improvements in hip and shoulder motion (effect size=0.32-1.58), energy expenditure (effect size=0.59-1.18), and activity symmetry of upper-body muscles during gait were present after spinal fusion. For patients with spinal stenosis, increases in gait speed, stride length, cadence, symmetry, walking smoothness, and walking endurance (effect size=0.60-2.50), and decrease in gait variability (effect size=1.45) were observed after decompression surgery. INTERPRETATION For patients with scoliosis, gait improvements can be better assessed by measuring upper-body motion and EMG rather than the lower extremities. For patients with spinal stenosis, motor performance improvements can be captured by measuring walking spatio-temporal parameters, gait patterns, and walking endurance.
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Affiliation(s)
- Nima Toosizadeh
- interdisciplinary Consortium on Advanced Motion Performance (iCAMP) and Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, College of Medicine
| | | | | | - Michael Dohm
- Department of Orthopaedic Surgery, College of Medicine
| | - Jane Mohler
- interdisciplinary Consortium on Advanced Motion Performance (iCAMP) and Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, College of Medicine,Arizona Center on Aging, University of Arizona, Tucson, USA
| | - Bijan Najafi
- interdisciplinary Consortium on Advanced Motion Performance (iCAMP) and Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, College of Medicine,Arizona Center on Aging, University of Arizona, Tucson, USA
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85
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Niemier K, Schindler M, Volk T, Baum K, Wolf B, Eberitsch J, Seidel W. [Efficacy of epidural steroid injections for chronic lumbar pain syndromes without neurological deficits. A randomized, double blind study as part of a multimodal treatment concept]. Schmerz 2015; 29:300-7. [PMID: 26099752 DOI: 10.1007/s00482-015-0020-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic lumbar pain syndromes without neurological deficits are generated by a multitude of causes. Functional, morphological and psychosocial factors are discussed. In many cases a diseased intervertebral disc is found on radiological examination but the clinical relevance of these findings is not clear. For this study it was postulated that a diseased disc results in a local inflammatory reaction therefore causing pain and impairing treatability of patients. An epidural injection of steroids can reduce inflammation and therefore improve treatability and ultimately treatment outcome. METHODS A double blind randomized prospective trial was carried out. Patients treated in hospital for a chronic lumbar pain syndrome without neurological deficits within a multimodal treatment program were screened for indications for an epidural steroid injection (e.g. diseased lumbar disc and intention to treat). Patients eligible for the study were randomized into two groups. The treatment group received an epidural injection of 80 mg triamcinolone and 8 ml bupivacaine 0.25 %. The control group received only an epidural injection of 8 ml bupivacaine 0.25 %. RESULTS In both groups pain intensity and treatability showed a statistically significant improvement after the epidural injection. The differences between the control and treatment groups were small and not clinically relevant. A small subgroup might profit from the steroid injection. In addition the treatability was dependent on psychometric values and the long-term outcome from a reduction of muscular skeletal dysfunctions. DISCUSSION After the epidural injection the decrease in pain and increase in treatability was statistically significant. The mechanism of the improvement is not clear and should be examined further. The epidural injection of a steroid in this subgroup of patients did not lead to a clinical improvement in the outcome.
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Affiliation(s)
- K Niemier
- Klinik für Manuelle Therapie Hamm, Ostenallee 83, 59071, Hamm, Deutschland,
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86
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Hodges PW, Tsao H, Sims K. Gain of postural responses increases in response to real and anticipated pain. Exp Brain Res 2015; 233:2745-52. [PMID: 26105752 DOI: 10.1007/s00221-015-4347-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 05/28/2015] [Indexed: 11/28/2022]
Abstract
This study tested two contrasting theories of adaptation of postural control to pain. One proposes alteration to the postural strategy including inhibition of muscles that produce painful movement; another proposes amplification of the postural adjustment to recruit strategies normally reserved for higher load. This study that aimed to determine which of these alternatives best explains pain-related adaptation of the hip muscle activity associated with stepping down from steps of increasing height adaptation of postural control to increasing load was evaluated from hip muscle electromyography (fine-wire and surface electrodes) as ten males stepped from steps of increasing height (i.e. increasing load). In one set of trials, participants stepped from a low step (5 cm) and pain was induced by noxious electrical stimulation over the sacrum triggered from foot contact with a force plate or was anticipated. Changes in EMG amplitude and onset timing were compared between conditions. Hip muscle activation was earlier and larger when stepping from higher steps. Although ground reaction forces (one of the determinants of joint load) were unchanged before, during and after pain, trials with real or anticipated noxious stimulation were accompanied by muscle activity indistinguishable from that normally reserved for higher steps (EMG amplitude increased from 9 to 17 % of peak). These data support the notion that muscle activation for postural control is augmented when challenged by real/anticipated noxious stimulation. Muscle activation was earlier and greater than that required for the task and is likely to create unnecessary joint loading. This could have long-term consequences if maintained.
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Affiliation(s)
- Paul W Hodges
- Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Science, The University of Queensland, Brisbane, QLD, 4072, Australia,
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87
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Kutch JJ, Yani MS, Asavasopon S, Kirages DJ, Rana M, Cosand L, Labus JS, Kilpatrick LA, Ashe-McNalley C, Farmer MA, Johnson KA, Ness TJ, Deutsch G, Harris RE, Apkarian AV, Clauw DJ, Mackey SC, Mullins C, Mayer EA. Altered resting state neuromotor connectivity in men with chronic prostatitis/chronic pelvic pain syndrome: A MAPP: Research Network Neuroimaging Study. NEUROIMAGE-CLINICAL 2015; 8:493-502. [PMID: 26106574 PMCID: PMC4474411 DOI: 10.1016/j.nicl.2015.05.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/25/2015] [Accepted: 05/29/2015] [Indexed: 01/27/2023]
Abstract
Brain network activity associated with altered motor control in individuals with chronic pain is not well understood. Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a debilitating condition in which previous studies have revealed altered resting pelvic floor muscle activity in men with CP/CPPS compared to healthy controls. We hypothesized that the brain networks controlling pelvic floor muscles would also show altered resting state function in men with CP/CPPS. Here we describe the results of the first test of this hypothesis focusing on the motor cortical regions, termed pelvic-motor, that can directly activate pelvic floor muscles. A group of men with CP/CPPS (N = 28), as well as group of age-matched healthy male controls (N = 27), had resting state functional magnetic resonance imaging scans as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network study. Brain maps of the functional connectivity of pelvic-motor were compared between groups. A significant group difference was observed in the functional connectivity between pelvic-motor and the right posterior insula. The effect size of this group difference was among the largest effect sizes in functional connectivity between all pairs of 165 anatomically-defined subregions of the brain. Interestingly, many of the atlas region pairs with large effect sizes also involved other subregions of the insular cortices. We conclude that functional connectivity between motor cortex and the posterior insula may be among the most important markers of altered brain function in men with CP/CPPS, and may represent changes in the integration of viscerosensory and motor processing. We studied men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). First resting state neuroimaging comparison CP/CPPS and healthy controls (HC) Motor cortex connectivity to insula distinguishes CP/CPPS from HC. Motor cortex connectivity to insula is among largest changes in CP/CPPS resting brain. Results provide additional evidence of motor network changes in chronic pain.
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Affiliation(s)
- Jason J Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Moheb S Yani
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | | | - Daniel J Kirages
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Manku Rana
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Louise Cosand
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Jennifer S Labus
- Oppenheimer Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lisa A Kilpatrick
- Oppenheimer Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Cody Ashe-McNalley
- Oppenheimer Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Melissa A Farmer
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin A Johnson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Division of Pain Medicine, Stanford, CA, USA
| | - Timothy J Ness
- Departments of Radiology and Anesthesiology, Birmingham Medical Center, University of Alabama, Birmingham, AL, USA
| | - Georg Deutsch
- Departments of Radiology and Anesthesiology, Birmingham Medical Center, University of Alabama, Birmingham, AL, USA
| | - Richard E Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - A Vania Apkarian
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Division of Pain Medicine, Stanford, CA, USA
| | - Chris Mullins
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, USA
| | - Emeran A Mayer
- Oppenheimer Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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88
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Hirata R, Salomoni S, Christensen S, Graven-Nielsen T. Reorganised motor control strategies of trunk muscles due to acute low back pain. Hum Mov Sci 2015; 41:282-94. [DOI: 10.1016/j.humov.2015.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 02/05/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
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89
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Müller R, Ertelt T, Blickhan R. Low back pain affects trunk as well as lower limb movements during walking and running. J Biomech 2015; 48:1009-14. [DOI: 10.1016/j.jbiomech.2015.01.042] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/28/2015] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
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90
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Wang TY, Pao JL, Yang RS, Jang JSR, Hsu WL. The adaptive changes in muscle coordination following lumbar spinal fusion. Hum Mov Sci 2015; 40:284-97. [DOI: 10.1016/j.humov.2015.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 12/03/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
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91
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Trulsson A, Miller M, Hansson GÅ, Gummesson C, Garwicz M. Altered movement patterns and muscular activity during single and double leg squats in individuals with anterior cruciate ligament injury. BMC Musculoskelet Disord 2015; 16:28. [PMID: 25887306 PMCID: PMC4333170 DOI: 10.1186/s12891-015-0472-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/16/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Individuals with Anterior Cruciate Ligament (ACL) injury often show altered movement patterns, suggested to be partly due to impaired sensorimotor control. Here, we therefore aimed to assess muscular activity during movements often used in ACL-rehabilitation and to characterize associations between deviations in muscular activity and specific altered movement patterns, using and further exploring the previously developed Test for substitution Patterns (TSP). METHODS Sixteen participants (10 women) with unilateral ACL rupture performed Single and Double Leg Squats (SLS; DLS). Altered movement patterns were scored according to TSP, and Surface Electromyography (SEMG) was recorded bilaterally in six hip, thigh and shank muscles. To quantify deviations in muscular activity, SEMG ratios were calculated between homonymous muscles on injured and non-injured sides, and between antagonistic muscles on the same side. Correlations between deviations of injured/non-injured side SEMG ratios and specific altered movement patterns were calculated. RESULTS Injured/non-injured ratios were low at transition from knee flexion to extension in quadriceps in SLS, and in quadriceps and hamstrings in DLS. On injured side, the quadriceps/hamstrings ratio prior to the beginning of DLS and end of DLS and SLS, and tibialis/gastrocnemius ratio at end of DLS were lower than on non-injured side. Correlations were found between specific altered movement patterns and deviating muscular activity at transition from knee flexion to extension in SLS, indicating that the more deviating the muscular activity on injured side, the more pronounced the altered movement pattern. "Knee medial to supporting foot" correlated to lower injured/non-injured ratios in gluteus medius (rs = -0.73, p = 0.001), "lateral displacement of hip-pelvis-region" to lower injured/non-injured ratios in quadriceps (rs = -0.54, p = 0.03) and "displacement of trunk" to higher injured/non-injured ratios in gluteus medius (rs = 0.62, p = 0.01). CONCLUSIONS Deviations in muscular activity between injured and non-injured sides and between antagonistic muscular activity within injured as compared to non-injured sides indicated specific alterations in sensorimotor control of the lower limb in individuals with ACL rupture. Also, correlations between deviating muscular activity and specific altered movement patterns were suggested as indications of altered sensorimotor control. We therefore advocate that quantitative assessments of altered movement patterns should be considered in ACL-rehabilitation.
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Affiliation(s)
- Anna Trulsson
- Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden. .,Department of Rehabilitation Medicine, Skane University Hospital, Lund, Sweden.
| | - Michael Miller
- Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden.
| | - Gert-Åke Hansson
- Occupational and Environmental Medicine, Lund University, and University and Regional Laboratories Region Scania, Lund, Sweden.
| | | | - Martin Garwicz
- Department of Experimental Medical Science, Neuronano Research Center, Lund University, Lund, Sweden.
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92
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Trunk Muscles Activation Pattern During Walking in Subjects With and Without Chronic Low Back Pain: A Systematic Review. PM R 2015; 7:519-26. [DOI: 10.1016/j.pmrj.2015.01.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 11/21/2022]
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93
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Does insertion of intramuscular electromyographic electrodes alter motor behavior during locomotion? J Electromyogr Kinesiol 2015; 25:431-7. [PMID: 25648579 DOI: 10.1016/j.jelekin.2015.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/01/2014] [Accepted: 01/06/2015] [Indexed: 11/23/2022] Open
Abstract
Intramuscular electromyography (EMG) is commonly used to quantify activity in the trunk musculature. However, it is unclear if the discomfort or fear of pain associated with insertion of intramuscular EMG electrodes results in altered motor behavior. This study examined whether intramuscular EMG affects locomotor speed and trunk motion, and examined the anticipated and actual pain associated with electrode insertion in healthy individuals and individuals with a history of low back pain (LBP). Before and after insertion of intramuscular electrodes into the lumbar and thoracic paraspinals, participants performed multiple repetitions of a walking turn at self-selected and controlled average speed. Low levels of anticipated and actual pain were reported in both groups. Self-selected locomotor speed was significantly increased following insertion of the electrodes. At the controlled speed, the amplitude of sagittal plane lumbo-pelvic motion decreased significantly post-insertion, but the extent of this change was the same in both groups. Lumbo-pelvic motion in the frontal and axial planes and thoraco-lumbar motion in all planes were not affected by the insertions. This study demonstrates that intramuscular EMG is an appropriate methodology to selectively quantify the activation patterns of the individual muscles in the paraspinal group, both in healthy individuals and individuals with a history of LBP.
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94
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van den Hoorn W, Hodges PW, van Dieën JH, Hug F. Effect of acute noxious stimulation to the leg or back on muscle synergies during walking. J Neurophysiol 2015; 113:244-54. [DOI: 10.1152/jn.00557.2014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
This study aimed to examine how acute muscle pain affects muscle coordination during gait with consideration of muscle synergies (i.e., group of muscles activated in synchrony), amplitude of muscle activity and kinematics. A secondary aim was to determine whether any adaptation was specific to pain location. Sixteen participants walked on a treadmill during 5 conditions [control, low back pain (LBP), washout LBP, calf pain (CalfP), and washout CalfP]. Five muscle synergies were identified for all of the conditions. Cross-validation analysis showed that muscle synergy vectors extracted for the control condition accounted for >81% of variance accounted for from the other conditions. Muscle synergies were altered very little in some participants ( n = 7 for LBP; n = 10 for CalfP), but were more affected in the others ( n = 9 for LBP; n = 6 for CalfP). No systematic differences between pain locations were observed. Considering all participants, synergies related to propulsion and weight acceptance were largely unaffected by pain, whereas synergies related to other functions (trunk control and leg deceleration) were more affected. Gastrocnemii activity was less during both CalfP and LBP than control. Soleus activity was further reduced during CalfP, and this was associated with reduced plantar flexion. Some lower leg muscles exhibited adaptations depending on pain location (e.g., greater vastus lateralis and rectus femoris activity during CalfP than LBP). Overall, these changes in muscle coordination involve a participant-specific strategy that is important to further explore, as it may explain why some people are more likely to develop persistence of a painful condition.
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Affiliation(s)
- Wolbert van den Hoorn
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitations Sciences, St. Lucia, Brisbane, Queensland, Australia
| | - Paul W. Hodges
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitations Sciences, St. Lucia, Brisbane, Queensland, Australia
| | - Jaap H. van Dieën
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- King Abdulaziz University, Jeddah, Saudi Arabia
| | - François Hug
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitations Sciences, St. Lucia, Brisbane, Queensland, Australia
- University of Nantes, Laboratory “Motricité, Interactions, Performance” (EA 4334), Nantes, France
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95
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Lumbar kinematic variability during gait in chronic low back pain and associations with pain, disability and isolated lumbar extension strength. Clin Biomech (Bristol, Avon) 2014; 29:1131-8. [PMID: 25451860 DOI: 10.1016/j.clinbiomech.2014.09.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 09/29/2014] [Accepted: 09/29/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic low back pain is a multifactorial condition with many dysfunctions including gait variability. The lumbar spine and its musculature are involved during gait and in chronic low back pain the lumbar extensors are often deconditioned. It was therefore of interest to examine relationships between lumbar kinematic variability during gait, with pain, disability and isolated lumbar extension strength in participants with chronic low back pain. METHODS Twenty four participants with chronic low back pain were assessed for lumbar kinematics during gait, isolated lumbar extension strength, pain, and disability. Angular displacement and kinematic waveform pattern and offset variability were examined. FINDINGS Angular displacement and kinematic waveform pattern and offset variability differed across movement planes; displacement was highest and similar in frontal and transverse planes, and pattern variability and offset variability higher in the sagittal plane compared to frontal and transverse planes which were similar. Spearman's correlations showed significant correlations between transverse plane pattern variability and isolated lumbar extension strength (r=-.411) and disability (r=.401). However, pain was not correlated with pattern variability in any plane. The r(2) values suggested 80.5% to 86.3% of variance was accounted for by other variables. INTERPRETATION Considering the lumbar extensors role in gait, the relationship between both isolated lumbar extension strength and disability with transverse plane pattern variability suggests that gait variability may result in consequence of lumbar extensor deconditioning or disability accompanying chronic low back pain. However, further study should examine the temporality of these relationships and other variables might account for the unexplained variance.
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96
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Williams JM, Haq I, Lee RY. An experimental study investigating the effect of pain relief from oral analgesia on lumbar range of motion, velocity, acceleration and movement irregularity. BMC Musculoskelet Disord 2014; 15:304. [PMID: 25228332 PMCID: PMC4171543 DOI: 10.1186/1471-2474-15-304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 09/11/2014] [Indexed: 11/11/2022] Open
Abstract
Background Movement alterations are often reported in individuals with back pain. However the mechanisms behind these movement alterations are not well understood. A commonly cited mechanism is pain. The aim of this study was to investigate the effect of pain reduction, from oral analgesia, on lumbar kinematics in individuals with acute and chronic low back pain. Methods A prospective, cross-sectional, experimental repeated-measures design was used. Twenty acute and 20 chronic individuals with low back pain were recruited from General Practitioner and self-referrals to therapy departments for low back pain. Participants complained of movement evoked low back pain. Inertial sensors were attached to the sacrum and lumbar spine and used to measure kinematics. Kinematic variables measured were range of motion, angular velocity and angular acceleration as well as a determining movement irregularity (a measure of deviation from smooth motion). Kinematics were investigated before and after administration of oral analgesia to instigate pain reduction. Results Pain was significantly reduced following oral analgesia. There were no significant effects on the kinematic variables before and after pain reduction from oral analgesia. There was no interaction between the variables group (acute and chronic) and time (pre and post pain reduction). Conclusion The results demonstrate that pain reduction did not alter lumbar range of motion, angular velocity, angular acceleration or movement irregularity questioning the role of pain in lumbar kinematics. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-304) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonathan M Williams
- Bournemouth University, School of Health and Social Care, Royal London House, Christchurch Road, Bournemouth, Dorset BH1 3LT, UK.
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97
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Russell Esposito E, Wilken JM. The relationship between pelvis-trunk coordination and low back pain in individuals with transfemoral amputations. Gait Posture 2014; 40:640-6. [PMID: 25155692 DOI: 10.1016/j.gaitpost.2014.07.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/14/2014] [Accepted: 07/17/2014] [Indexed: 02/02/2023]
Abstract
Low back pain (LBP) is common in individuals with transfemoral amputation and may result from altered gait mechanics associated with prosthetic use. Inter-segmental coordination, assessed through continuous relative phase (CRP), has been used to identify specific patterns as risk factors. The purpose of this study was to explore pelvis and trunk inter-segmental coordination across three walking speeds in individuals with transfemoral amputations with and without LBP. Nine individuals with transfemoral amputations with LBP and seven without pain were compared to twelve able-bodied subjects. Subjects underwent a gait analysis while walking at slow, moderate, and fast speeds. CRP and CRP variability were calculated from three-dimensional pelvis and trunk segment angles. A two-way ANOVA and post hoc tests assessed statistical significance. Individuals with transfemoral amputation demonstrated some coordination patterns that were different from able-bodied individuals, but consistent with previous reports on persons with LBP. The patient groups maintained transverse plane CRP consistent with able-bodied participants (p = 0.966), but not sagittal (p < 0.001) and frontal plane CRP (p = 0.001). Sagittal and frontal CRP may have been re-optimized based on new sets of constraints, such as protective rigidity of the segments, muscular strength limitations, or prosthesis limitations. Patients with amputations and without LBP exhibited few differences. Only frontal and transverse CRP shifted toward out-of-phase as speed increased in the patient group with LBP. Although a cause and effect relationship between CRP and future development of back pain has yet to be determined, these results add to the literature characterizing biomechanical parameters of back pain in high-risk populations.
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Affiliation(s)
- Elizabeth Russell Esposito
- Center for the Intrepid, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Ft. Sam Houston, TX, USA.
| | - Jason M Wilken
- Center for the Intrepid, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Ft. Sam Houston, TX, USA
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98
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Pao JL, Yang RS, Hsiao CH, Hsu WL. Trunk Control Ability after Minimally Invasive Lumbar Fusion Surgery during the Early Postoperative Phase. J Phys Ther Sci 2014; 26:1165-71. [PMID: 25202174 PMCID: PMC4155213 DOI: 10.1589/jpts.26.1165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/16/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Lumbar fusion has been used for spinal disorders when conservative treatment
fails. The minimally invasive approach causes minimal damage to the back muscles and
shortens the postoperative recovery time. However, evidence regarding functional recovery
in patients after minimally invasive lumbar spinal fusion is limited. The purpose of this
study was to investigate how trunk control ability is affected after minimally invasive
lumbar fusion surgery during the early postoperative phase. [Subjects and Methods] Sixteen
patients and 16 age- and sex-matched healthy participants were recruited. Participants
were asked to perform a maximum forward reaching task and were evaluated 1 day before and
again 1 month after the lumbar fusion surgery. Center of pressure (COP) displacement, back
muscle strength, and scores for the Visual Analog Scale, and Chinese version of the
modified Oswestry Disability Index (ODI) were recorded. [Results] The healthy control
group exhibited more favorable outcomes than the patient group both before and after
surgery in back strength, reaching distance, reaching velocity, and COP displacement. The
patient group improved significantly after surgery in all clinical outcome measurements.
However, reaching distance decreased, and the reaching velocity as well as COP
displacement did not differ before and after surgery. [Conclusion] The LBP patients with
lumbar fusion surgery showed improvement in pain intensity 1 month after surgery but no
improvement in trunk control during forward reaching. The results provide evidence that
the back muscle strength was not fully recovered in patients 1 month after surgery and
limited their ability to move their trunk forward.
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Affiliation(s)
- Jwo-Luen Pao
- Institute of Biomedical Engineering, National Taiwan University, Taiwan ; Division of Orthopedic Surgery, Department of Surgery, Far Eastern Memorial Hospital, Taiwan
| | - Rong-Sen Yang
- Department of Orthopedics, National Taiwan University Hospital, Taiwan ; Department of Orthopedics, College of Medicine, National Taiwan University, Taiwan
| | - Chen-Hsi Hsiao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan ; Physical Therapy Center, National Taiwan University Hospital, Taiwan
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Abstract
The involvement of the primary motor cortex (M1) in chronic low back pain (LBP) is a relatively new concept. Decreased M1 excitability and an analgesic effect after M1 stimulation have been recently reported. However, the neurochemical changes underlying these functional M1 changes are unknown. The current study investigated whether neurochemicals specific to neurons and glial cells in both right and left M1 are altered. N-Acetylaspartate (NAA) and myo-inositol (mI) were measured with proton magnetic resonance spectroscopy in 19 subjects with chronic LBP and 14 healthy controls. We also examined correlations among neurochemicals within and between M1 and relationships between neurochemical concentrations and clinical features of pain. Right M1 NAA was lower in subjects with LBP compared to controls (p = 0.008). Left M1 NAA and mI were not significantly different between LBP and control groups. Correlations between neurochemical concentrations across M1s were different between groups (p = 0.008). There were no significant correlations between M1 neurochemicals and pain characteristics. These findings provide preliminary evidence of neuronal depression and altered neuronal-glial interactions across M1 in chronic LBP.
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100
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Falla D, Gizzi L, Tschapek M, Erlenwein J, Petzke F. Reduced task-induced variations in the distribution of activity across back muscle regions in individuals with low back pain. Pain 2014; 155:944-953. [DOI: 10.1016/j.pain.2014.01.027] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 01/23/2014] [Accepted: 01/28/2014] [Indexed: 12/25/2022]
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