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Yodchaisarn W, Puntumetakul R, Emasithi A, Boucaut R, Chatchawan U. Altered postural sway during quiet standing in women with clinical lumbar instability. J Phys Ther Sci 2018; 30:1099-1102. [PMID: 30154608 PMCID: PMC6110202 DOI: 10.1589/jpts.30.1099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/30/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The current study aimed to investigate the center of pressure, as an indicator
of postural sway, to determine any differences between women with clinical lumbar
instability and asymptomatic low back pain. [Participants and Methods] Thirty healthy and
fifteen clinical lumbar instability participants were measured for their postural sway in
the anterior-posterior and medial-lateral directions. The women were tested for postural
sway on a force plate in quiet standing and eyes closed. Center of pressure path length
and mean velocity in the anterior-posterior and medial-lateral directions and total area
of excursion were measured and analyzed for 30 seconds. [Results] Clinical lumbar
instability participants showed a significantly increase when compared with healthy
participants, in path length and mean velocity in both directions and total area of
excursion. [Conclusion] The findings suggest that chronic low back pain patients with
clinical lumbar instability have increased postural sway when vision is deprived. The
clinical significance of this has not yet been determined but may provide an opportunity
for therapy directed at improving balance control in this patient group.
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Affiliation(s)
| | - Rungthip Puntumetakul
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University: Khon Kaen, Thailand
| | - Alongkot Emasithi
- Department of Otolaryngology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Rose Boucaut
- School of Health Sciences (Physiotherapy), iCAHE (International Centre for Allied Health Evidence), Sansom Institute for Health Research, University of South Australia, Australia
| | - Uraiwan Chatchawan
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University: Khon Kaen, Thailand
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Ozcan Kahraman B, Kahraman T, Kalemci O, Salik Sengul Y. Gender differences in postural control in people with nonspecific chronic low back pain. Gait Posture 2018; 64:147-151. [PMID: 29909228 DOI: 10.1016/j.gaitpost.2018.06.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 02/09/2018] [Accepted: 06/11/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many studies have reported that there are several differences between genders which may result in altered neuromuscular control. Although the existing evidence suggests that low back pain (LBP) affects the ability to control posture, there is little evidence the gender differences in postural control in people with nonspecific chronic LBP. RESEARCH QUESTION Are there any gender differences in postural control and correlations between postural control, pain, disability, and fear of movement in people with nonspecific chronic LBP? METHODS Static and dynamic postural control were evaluated using a computerized postural control assessment tool including assessments for limits of stability (LOS), unilateral stance, and modified clinical test of sensory interaction on balance. Pain intensity and fear of movement were assessed using a visual analogue scale and the Tampa Scale of Kinesiophobia, respectively. RESULTS This cross-sectional study included 51 people (25 females and 26 males) with nonspecific chronic LBP. Mean reaction time in the LOS test was significantly less in male participants compared with females when adjusted for pain intensity and disability level, F(1,45) = 4.596, p = .037, ηp2 = 0.093. There was no significant difference in the remaining LOS variables as well as unilateral stance, and modified clinical test of sensory interaction on balance variables between the genders (p > .05). Many correlations were observed between the LOS variables, pain intensity, and Tampa Scale of Kinesiophobia score in female participants (p < .05). The Tampa Scale of Kinesiophobia score was also correlated with the movement velocity and endpoint excursion in the LOS test in the male participants (p < .05). SIGNIFICANCE This study suggests that there is no difference in most of the static and dynamic postural control variables between females and males; however, higher fear of movement, and pain intensity during activity are more associated with impaired dynamic balance in females with nonspecific chronic LBP.
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Affiliation(s)
- Buse Ozcan Kahraman
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey.
| | - Orhan Kalemci
- Department of Neurosurgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Yesim Salik Sengul
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
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Performance on Balance Evaluation Systems Test (BESTest) Impacts Health-Related Quality of Life in Adult Spinal Deformity Patients. Spine (Phila Pa 1976) 2018; 43:637-646. [PMID: 28858190 DOI: 10.1097/brs.0000000000002390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective single-center study. OBJECTIVE Study investigates how dynamic balance performance complements 2D static radiographic measurements and demographics in terms of understanding health-related quality of life in adult spinal deformity (ASD) patients. SUMMARY OF BACKGROUND DATA Recent insights suggest that demographic variables have a stronger impact on health-related quality of life than 2D radiographic spinopelvic parameters in ASD patients. METHODS Nine healthy volunteers and 36 ASD patients following inclusion criteria were recruited. Demographics, Scoliosis Research Society Score-22r (SRS-22r), Oswestry Disability Index (ODI), Core Outcome Measures Index (COMI), 2D radiographic spinopelvic measurements, and performance on Balance Evaluation Systems Test (BESTest), and Trunk Control Measurement Scale (TCMS) were determined for each subject. Nonparametric tests, Spearman correlations, univariate, and stepwise-like linear multivariate regression analysis were performed. RESULTS BESTest and TCMS had significant lower values in the ASD group versus the control group (P = 0.000). In the ASD group, Cumulative Illness Rating Scale (CIRS) correlated fair to ODI, COMI (0.441 ≥ r ≥ 0.383, P < 0.021) and to SRS-22-r (r = -0.335, P = 0.046), Mini Mental State Examination correlated fair to COMI (r = -0.352, P = 0.035), "Pelvic Incidence minus Lumbar Lordosis" correlated fair to ODI (r = 0.361, P = 0.031), BESTest correlated moderate to ODI and COMI (r ≤ -0.505; P ≤ 0.002), TCMS correlated fair to ODI (r = -0.356; P = 0.033). CIRS and BESTest were significant predictive variables for COMI based on univariate analysis in ASD patients. Multivariate regression analysis including demographics, 2D static radiographic parameters, and dynamic balance scales identified BESTest as single independent variable (P = 0.000) to predict COMI (adjusted R = 0.285) in ASD patients. CONCLUSION BESTest has a higher potential than demographic and 2D radiographic spinopelvic parameters to predict quality of life in ASD patients. Further research is necessary to identify the impact of ASD on quality of life. LEVEL OF EVIDENCE 3.
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McCaskey MA, Wirth B, Schuster-Amft C, de Bruin ED. Dynamic multi-segmental postural control in patients with chronic non-specific low back pain compared to pain-free controls: A cross-sectional study. PLoS One 2018; 13:e0194512. [PMID: 29634749 PMCID: PMC5892895 DOI: 10.1371/journal.pone.0194512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 03/02/2018] [Indexed: 11/18/2022] Open
Abstract
Reduced postural control is thought to contribute to the development and persistence of chronic non-specific low back pain (CNLBP). It is therefore frequently assessed in affected patients and commonly reported as the average amount of postural sway while standing upright under a variety of sensory conditions. These averaged linear outcomes, such as mean centre of pressure (CP) displacement or mean CP surface areas, may not reflect the true postural status. Adding nonlinear outcomes and multi-segmental kinematic analysis has been reported to better reflect the complexity of postural control and may detect subtler postural differences. In this cross-sectional study, a combination of linear and nonlinear postural parameters were assessed in patients with CNLBP (n = 24, 24-75 years, 9 females) and compared to symptom-free controls (CG, n = 34, 22-67 years, 11 females). Primary outcome was postural control measured by variance of joint configurations (uncontrolled manifold index, UI), confidence ellipse surface areas (CEA) and approximate entropy (ApEn) of CP dispersion during the response phase of a perturbed postural control task on a swaying platform. Secondary outcomes were segment excursions and clinical outcome correlates for pain and function. Non-parametric tests for group comparison with P-adjustment for multiple comparisons were conducted. Principal component analysis was applied to identify patterns of segmental contribution in both groups. CNLBP and CG performed similarly with respect to the primary outcomes. Comparison of joint kinematics revealed significant differences of hip (P < .001) and neck (P < .025) angular excursion, representing medium to large group effects (r′s = .36 − .51). Significant (P′s < .05), but moderate correlations of ApEn (r = -.42) and UI (r = -.46) with the health-related outcomes were observed. These findings lend further support to the notion that averaged linear outcomes do not suffice to describe subtle postural differences in CNLBP patients with low to moderate pain status.
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Affiliation(s)
- Michael A. McCaskey
- Department of Health Sciences and Technology, Institute for Human Movement Sciences, ETH Zurich, Zurich, Switzerland
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- * E-mail:
| | - Brigitte Wirth
- Department of Chiropractic Medicine, University of Zurich, Balgrist University Hospital, Zurich, Switzerland
| | - Corina Schuster-Amft
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Institute of Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
| | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute for Human Movement Sciences, ETH Zurich, Zurich, Switzerland
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
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Cramer H, Mehling WE, Saha FJ, Dobos G, Lauche R. Postural awareness and its relation to pain: validation of an innovative instrument measuring awareness of body posture in patients with chronic pain. BMC Musculoskelet Disord 2018; 19:109. [PMID: 29625603 PMCID: PMC5889545 DOI: 10.1186/s12891-018-2031-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/28/2018] [Indexed: 01/05/2023] Open
Abstract
Background Habitual postural patterns are associated with musculoskeletal pain, and improving a maladaptive posture requires postural awareness in order to lead to clinical improvements. This study aimed to develop and evaluate the psychometric properties of an innovative postural awareness scale. Methods A 12-item Postural Awareness Scale (PAS) was developed and administered to 512 chronic pain patients (50.3 ± 11.4 years, 91.6% female, 37.1% spinal/shoulder pain) to assess its factor structure and reliability. To determine convergent validity, measures of body awareness, body responsiveness, body image, and mindfulness were correlated with the PAS, as were clinical measures of pain intensity, disability, and mental health. Sensitivity to change was assessed in 202 outpatients participating in a 10-week multimodal mind-body program. Results Factor analysis revealed two factors (Ease/Familiarity with Postural Awareness and Need for Attention Regulation with Postural Awareness) that explained 50.8% of the variance. Cronbach’s alpha for the complete scale was 0.80; Spearman-Brown coefficient of split-half reliability was 0.67; and intra-class correlation was ICC2,1 = 0.75 (95% confidence interval = 0.71, 0.78). Significant positive correlations were found for body awareness (r = 0.23), body responsiveness (r = 0.41), body image (r = 0.22–0.32), and mindfulness (r = 0.38); negative correlations for pain intensity (r = − 0.14), disability (r = − 0.12), depression (r = − 0.23), and stress (r = − 0.29). Postural awareness scores increased with a mind-body program (p < 0.001); changes in the PAS were negatively correlated with changes in pain intensity (r = − 0.35) in patients with spinal/shoulder pain. Conclusion Self-reported postural awareness is associated with clinical symptoms in chronic pain patients; improvements in postural awareness are longitudinally associated with reduced pain in patients with spinal/shoulder pain.
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Affiliation(s)
- Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany. .,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, Australia.
| | - Wolf E Mehling
- Department of Family and Community Medicine, Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California, USA
| | - Felix J Saha
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Romy Lauche
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, Australia
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Altered trunk muscle recruitment patterns during lifting in individuals in remission from recurrent low back pain. J Electromyogr Kinesiol 2018; 39:128-133. [DOI: 10.1016/j.jelekin.2018.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 02/07/2018] [Accepted: 02/19/2018] [Indexed: 11/24/2022] Open
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Abbasi S, Rojhani-Shirazi Z, Shokri E, García-Muro San José F. The effect of Kinesio Taping on postural control in subjects with non-specific chronic low back pain. J Bodyw Mov Ther 2018; 22:487-492. [DOI: 10.1016/j.jbmt.2017.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Behennah J, Conway R, Fisher J, Osborne N, Steele J. The relationship between balance performance, lumbar extension strength, trunk extension endurance, and pain in participants with chronic low back pain, and those without. Clin Biomech (Bristol, Avon) 2018; 53:22-30. [PMID: 29407352 DOI: 10.1016/j.clinbiomech.2018.01.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/25/2018] [Accepted: 01/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic low back pain is associated with lumbar extensor deconditioning. This may contribute to decreased neuromuscular control and balance. However, balance is also influenced by the hip musculature. Thus, the purpose of this study was to examine balance in both asymptomatic participants and those with chronic low back pain, and to examine the relationships among balance, lumbar extension strength, trunk extension endurance, and pain. METHODS Forty three asymptomatic participants and 21 participants with non-specific chronic low back pain underwent balance testing using the Star Excursion Balance Test, lumbar extension strength, trunk extension endurance, and pain using a visual analogue scale. FINDINGS Significant correlations were found between lumbar extension strength and Star Excursion Balance Test scores in the chronic low back pain group (r = 0.439-0.615) and in the asymptomatic group (r = 0.309-0.411). Correlations in the chronic low back pain group were consistently found in posterior directions. Lumbar extension strength explained ~19.3% to ~37.8% of the variance in Star Excursion Balance Test scores for the chronic low back pain group and ~9.5% to ~16.9% for the asymptomatic group. INTERPRETATION These results suggest that the lumbar extensors may be an important factor in determining the motor control dysfunctions, such as limited balance, that arise in chronic low back pain. As such, specific strengthening of this musculature may be an approach to aid in reversing these dysfunctions.
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Affiliation(s)
- Jessica Behennah
- School of Sport, Health, and Social Sciences, Southampton Solent University, Southampton, UK
| | - Rebecca Conway
- School of Sport, Health, and Social Sciences, Southampton Solent University, Southampton, UK
| | - James Fisher
- School of Sport, Health, and Social Sciences, Southampton Solent University, Southampton, UK
| | - Neil Osborne
- AECC Clinic, Anglo European College of Chiropractic, Bournemouth, UK
| | - James Steele
- School of Sport, Health, and Social Sciences, Southampton Solent University, Southampton, UK.
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Azadinia F, Ebrahimi-Takamjani I, Kamyab M, Parnianpour M, Asgari M. A RCT comparing lumbosacral orthosis to routine physical therapy on postural stability in patients with chronic low back pain. Med J Islam Repub Iran 2018; 31:26. [PMID: 29445655 PMCID: PMC5804426 DOI: 10.18869/mjiri.31.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Indexed: 12/27/2022] Open
Abstract
Background: Poor balance performance and impaired postural control have been frequently reported in patients with low back pain.
However, postural control is rarely monitored during the course of treatment even though poor postural control may contribute to
chronicity and recurrence of symptoms. Therefore, the present study aimed at investigating the effect of a nonextensible lumbosacral
orthosis (LSO) versus routine physical therapy on postural stability of patients with nonspecific chronic low back pain.
Methods: This was a randomized controlled trial conducted between November 2015 and May 2016 at the outpatient physical therapy
clinic of the School of Rehabilitation Sciences. Patients with nonspecific chronic low back pain aged 20 to 55 years were randomly
allocated to the intervention and control groups. Both groups received 8 sessions of physical therapy twice weekly for 4 weeks. The
intervention group received nonextensible LSO in addition to routine physical therapy. Pain intensity, functional disability, fear of
movement/ (re)injury, and postural stability in 3 levels of postural difficulty were measured before and after 4 weeks of intervention. A
2×2×3 mixed model of analysis of variance (ANOVA) was used to determine the main and interactive effects of the 3 factors including
group, time, and postural difficulty conditions for each variable of postural stability.
Results: The LSO and control groups displayed significant improvement in postural stability at the most difficult postural task conditions
(P-value for 95% area ellipse was 0.003; and for phase plane, the mean total velocity and standard deviation of velocity was
<0.001). Both groups exhibited a decrease in pain intensity, Oswestry Disability Index, and Tampa Scale of Kinesiophobia after 4
weeks of intervention. A significant difference between groups was found only for functional disability, with greater improvement in
the orthosis group (t = 3.60, P<0.001).
Conclusion: Both routine physical therapy and LSO significantly improved clinical and postural stability outcomes immediately after
4 weeks of intervention. The orthosis group did not display superior outcomes, except for functional disability.
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Affiliation(s)
- Fatemeh Azadinia
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ismail Ebrahimi-Takamjani
- Department of Physical therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Kamyab
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamad Parnianpour
- Biomechanics Laboratory, Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Morteza Asgari
- Department of Mechanical Engineering, Sharif University of technology, Tehran, Iran
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Mohan V, Paungmali A, Sitilerpisan P, Hashim UF, Mazlan MB, Nasuha TN. Respiratory characteristics of individuals with non-specific low back pain: A cross-sectional study. Nurs Health Sci 2018; 20:224-230. [PMID: 29421851 DOI: 10.1111/nhs.12406] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/17/2017] [Accepted: 11/29/2017] [Indexed: 11/27/2022]
Abstract
Non-specific low back pain (NS-LBP) is known to cause respiratory dysfunction. In this study, we investigated alterations in breathing, respiratory strength and endurance, core stability, diaphragm mobility, and chest expansion among patients with NS-LBP and healthy individuals. The specific aim of the study was to correlate between respiratory function and other variables among NS-LBP patients. Thirty four patients with NS-LBP were matched with 34 healthy participants before undergoing total faulty breathing scale, spirometer, respiratory pressure meter, chest expansion, ultrasound, and pressure biofeedback measurements. There were signs of faulty breathing in the NS-LBP patients when compared to the healthy participants. Diaphragmatic mobility and respiratory muscle endurance were lower in the NS-LBP group. Chest expansion exhibited a significant decrease at the level of the fourth intercostal space in the NS-LBP group, but respiratory muscle strength and core stability were not significant between the two groups. Positive correlations were found to be fairly significant regarding respiratory muscle strength. The findings of this study indicated altered respiratory characteristics in the NS-LBP patients, and suggested that they would improve through respiratory exercises.
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Affiliation(s)
- Vikram Mohan
- Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand.,Centre of Physiotherapy, Universiti Teknologi MARA Selangor, Bandar Puncak Alam, Puncak Alam, Malaysia
| | - Aatit Paungmali
- Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
| | | | - Ummi F Hashim
- Centre of Medical Imaging, Universiti Teknologi MARA Selangor, Bandar Puncak Alam, Puncak Alam, Malaysia
| | - Munifa B Mazlan
- Centre of Physiotherapy, Universiti Teknologi MARA Selangor, Bandar Puncak Alam, Puncak Alam, Malaysia
| | - Tuan N Nasuha
- Centre of Physiotherapy, Universiti Teknologi MARA Selangor, Bandar Puncak Alam, Puncak Alam, Malaysia
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Sung PS, Danial P. Trunk sway response to consecutive slip perturbations between subjects with and without recurrent low back pain. Musculoskelet Sci Pract 2018; 33:84-89. [PMID: 29274629 DOI: 10.1016/j.msksp.2017.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/24/2017] [Accepted: 12/13/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Trunk sway responses following perturbations are critical to develop adequate prevention strategies. It is unclear how postural responses with a handheld task can validly be transferred to treadmill-induced slip perturbations in subjects with recurrent low back pain (LBP). OBJECTIVE To compare trunk sway angle, velocity, and reaction time following treadmill-induced perturbations while subjects with and without LBP held a tray. DESIGN Cross-sectional study. METHODS There were 30 subjects with LBP and 50 control subjects who participated in the study. Each participant stood on the treadmill while he/she held a tray to produce a functional task. Three levels of consecutive slips were introduced based on the specific duration, velocity, and displacement. RESULTS The trunk extension angle was significantly different (F = 4.22, p = 0.04) and demonstrated a significant interaction with groups and levels of perturbation (F = 6.83, p = 0.01). However, the reaction time was not significantly different based on the levels of perturbation (F = 0.43, p = 0.51). The LBP group increased trunk extension only at level 1 slip perturbation (t = 2.86, p = 0.005). CONCLUSION The increased trunk extension following the first perturbation indicated a delay in adjusting trunk stability in the LBP group. However, there was no group difference with higher magnitudes of perturbations. These results indicated that the LBP group was able to minimize trunk sway with higher perturbations following the first perturbation.
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Affiliation(s)
- Paul S Sung
- Doctoral Program in Physical Therapy/ Motion Analysis Center, Central Michigan University, USA.
| | - Pamela Danial
- Doctoral Program in Physical Therapy/ Motion Analysis Center, Central Michigan University, USA
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Berenshteyn Y, Gibson K, Hackett GC, Trem AB, Wilhelm M. Is standing balance altered in individuals with chronic low back pain? A systematic review. Disabil Rehabil 2018; 41:1514-1523. [PMID: 29382241 DOI: 10.1080/09638288.2018.1433240] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To examine the static standing balance of individuals with chronic low back pain when compared to a healthy control group. METHODS A search of available literature was done using PubMed, SPORTDiscus, CINAHL, and Scopus databases. Studies were included if they contained the following: (1) individuals with chronic low back pain 3 months or longer; (2) healthy control group; (3) quantified pain measurement; and (4) center of pressure measurement using a force plate. Two authors independently reviewed articles for inclusion, and assessed for quality using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies. Cohen's d effect size was calculated to demonstrate the magnitude of differences between groups. RESULTS Nine articles were included in this review. Quality scores ranged from 5/8 to 8/8. Although center of pressure measures were nonhomogeneous, subjects with chronic low back pain had poorer performance overall compared to healthy controls. Despite inconsistencies in statistical significance, effect sizes were frequently large, indicating a lack of sufficient power in the included studies. Data were insufficiently reported among certain studies, limiting the ability of direct study comparison. CONCLUSIONS Results suggest that balance is impaired in individuals with chronic low back pain when compared to healthy individuals. Implications for rehabilitation Static balance is affected in individuals with chronic low back pain. Balance assessments should be completed for individuals with chronic low back pain. Results from balance assessments should be used to indicate areas of improvement and help guide the course of treatment, as well as reassess as treatment progresses.
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Affiliation(s)
| | - Kelsey Gibson
- a Department of Physical Therapy , Walsh University , North Canton , OH , USA
| | - Gavin C Hackett
- a Department of Physical Therapy , Walsh University , North Canton , OH , USA
| | - Andrew B Trem
- a Department of Physical Therapy , Walsh University , North Canton , OH , USA
| | - Mark Wilhelm
- a Department of Physical Therapy , Walsh University , North Canton , OH , USA
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Sung PS, Danial P. Trunk Reaction Time and Kinematic Changes Following Slip Perturbations in Subjects with Recurrent Low Back Pain. Ann Biomed Eng 2018; 46:488-497. [PMID: 29372435 DOI: 10.1007/s10439-017-1972-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022]
Abstract
Postural responses following slip perturbations are critical to fall prevention strategies. It is unclear how postural reactions with a handheld task can validly be transferred to treadmill-induced slip perturbations in subjects with recurrent low back pain (LBP). The purpose of this study was to investigate trunk reaction times and trunk flexion angle as well as velocity following the slips between subjects with and without LBP. There were 29 subjects with LBP and 40 control subjects who participated in the study. Three levels of consecutive treadmill-induced slip perturbations were introduced at level 1 (duration: 0.10 s, velocity: 0.24 m/s, displacement: 1.20 cm), level 2 (0.12 s, 0.72 m/s, 4.32 cm), and level 3 (0.12 s, 1.37 m/s, 8.22 cm). The trunk reaction time, swing/step times, and trunk flexion angle as well as velocity at heel strike/toe-off were compared between the groups. There were significantly longer trunk reaction times (t = - 2.03, p = 0.04), swing times (t = - 2.63, p = 0.01), and step times (t = - 2.53, p = 0.01) in the LBP group at the level 1 slip perturbation. The groups demonstrated a significant interaction between the levels and trunk flexion angles (F = 4.72, p = 0.03), but there was no interaction between the levels and trunk flexion velocities (F = 0.07, p = 0.79). The LBP group demonstrated longer reaction times at the level 1 perturbation due to a possible pain recurrence. However, this compensatory tolerance was limited at the level 3 perturbation due to increased trunk flexion angle at heel strike and toe-off in the LBP group. Clinicians may consider a compensatory strategy to improve reaction time and minimize trunk flexion following slip perturbations in patients with LBP.
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Affiliation(s)
- Paul S Sung
- Doctoral Program in Physical Therapy/Motion Analysis Center, Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Health Professions Building 1220, Mt. Pleasant, MI, 48859, USA.
| | - Pamela Danial
- Doctoral Program in Physical Therapy/Motion Analysis Center, Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Health Professions Building 1220, Mt. Pleasant, MI, 48859, USA
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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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Comparison of the Therapeutic Effects of a Sling Exercise and a Traditional Stabilizing Exercise for Clinical Lumbar Spinal Instability. J Sport Rehabil 2018; 27:47-54. [DOI: 10.1123/jsr.2016-0083] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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66
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Sung PS, Danial P, Lee DC. Reliability of the Kinematic Steadiness Index during one-leg standing in subjects with recurrent low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:171-179. [PMID: 28980075 DOI: 10.1007/s00586-017-5314-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/29/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the reliability of standing time and the Kinematic Steadiness Index (KSI) in one-leg standing compared with the Timed Up and Go (TUG) test while considering anthropometric factors in subjects with recurrent low back pain (LBP). METHODS Sixty-six individuals participated in the study. The data were collected on two different days, 1 week apart. The KSI of the core spine, using video motion-capture techniques, was based on the relative standing time and relative standstill time. The intraclass correlation coefficient (ICC2,1) was compared for the reliability between measures. The covariates, such as age, Body Mass Index, and the Oswestry Disability Index (ODI), were analyzed for any interactions based on these measures. RESULTS The standing time (t = - 1.01, p = 0.32) and the KSI (t = - 1.70, p = 0.09) were not significantly different between measures. The TUG results were not different between measures (t = 1.01, p = 0.32). The Cronbach's alpha for the standing time was 0.84, for KSI was 0.89, and for TUG was 0.76. The standing time and KSI demonstrated an interaction with age, while the TUG demonstrated an interaction with the ODI score. CONCLUSIONS The KSI during one-leg standing could help to develop a practical tool to justify quantity and quality of balance outcome measures, which identify balance deficits and core spine rehabilitation strategies in subjects with recurrent LBP.
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Affiliation(s)
- Paul S Sung
- Department of Physical Therapy/Motion Analysis Center, Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Health Professions Building 1220, Mt. Pleasant, MI, 48859, USA.
| | - Pamela Danial
- Department of Physical Therapy/Motion Analysis Center, Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Health Professions Building 1220, Mt. Pleasant, MI, 48859, USA
| | - Dongchul C Lee
- Theoretical Research in Nevro Corp., Redwood City, CA, USA
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Mohammadi V, Letafatkar A, Sadeghi H, Jafarnezhadgero A, Hilfiker R. The effect of motor control training on kinetics variables of patients with non-specific low back pain and movement control impairment: Prospective observational study. J Bodyw Mov Ther 2017; 21:1009-1016. [DOI: 10.1016/j.jbmt.2016.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/12/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
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Soliman ES, Shousha TM, Alayat MS. The effect of pain severity on postural stability and dynamic limits of stability in chronic low back pain. J Back Musculoskelet Rehabil 2017; 30:1023-1029. [PMID: 28800302 DOI: 10.3233/bmr-169588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Deficits of dynamic balance in chronic low back pain patients have been reported by different studies in terms of impaired postural control. However, they excluded the degree of pain as a determinant affecting dynamic balance. OBJECTIVE To evaluate the effect of pain intensity on dynamic balance control in terms of postural stability indices (PSIs) and limits of stability (LOS) in chronic LBP patients. METHODS Sixty subjects (38 men, 22 women) participated in the current study, 45 patients with chronic LBP were selected randomly and served as the chronic LBP group while 15 healthy subjects served as the asymptomatic group (AS). The chronic LBP group was further classified in terms of pain intensity into 3 subgroups; low pain (LP), moderate pain (MP) and severe pain (SP) subgroups. The Biodex Balance System was used to measure the dynamic balance control (PSIs and LOS). RESULTS Statistical significant differences were found among AS group and chronic LBP subgroups in PSIs and LOS. CONCLUSIONS The intensity of pain has shown to be one of the determinants affecting dynamic balance in chronic LBP patients who showed differences in the impairment of PSIs and LOS with different degrees of pain.
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Affiliation(s)
- Elsadat Saad Soliman
- Department of Physical Therapy for Musculoskeletal Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Tamer Mohamed Shousha
- Department of Physical Therapy for Musculoskeletal Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.,Physiotherapy Department, College of Health Sciences, University of Sharjah, Sharjah, UAE
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Tsigkanos C, Gaskell L, Smirniotou A, Tsigkanos G. Static and dynamic balance deficiencies in chronic low back pain. J Back Musculoskelet Rehabil 2016; 29:887-893. [PMID: 27341640 DOI: 10.3233/bmr-160721] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND According to previously conducted studies, people with Low Back Pain (LBP) present with static balance deficiencies. OBJECTIVE The aim of the present study was to compare static, as well as dynamic balance ability between Chronic Low Back Pain (CLBP) and healthy subjects. METHODS The CLBP group comprised 17 subjects and the control group of 16 subjects, matched for age, BMI and gender. The protocol applied compared the balance ability when performing the Star Excursion Balance Test (SEBT) and the static 1-leg stance position. The innovation introduced in the protocol was that the participants performed not only the static 1-leg stance, but also the dynamic SEBT on a force plate which recorded the target sway (TS), i.e. the Center of Pressure (CoP) excursion. RESULTS The CLBP group had significantly reduced performance in SEBT, coupled with greater static and dynamic TS values. Age and especially BMI also bear a significant effect on SEBT execution. The inclusion of SEBT and TS derived scores in a stepwise logistic regression equation lead to the correct classification of 85% of the subjects. CONCLUSIONS Dynamic and static balance ability provide supplementary information for the identification of the presence of CLBP, with dynamic balance being more instrumental.
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Affiliation(s)
- Christos Tsigkanos
- Physiotherapy Department, School of Health Sciences, University of Salford, Manchester, UK
| | - Lynne Gaskell
- Physiotherapy Department, School of Health Sciences, University of Salford, Manchester, UK
| | | | - Georgios Tsigkanos
- Faculty of Physical Education and Sport Sciences, University of Athens, Greece
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Dynamic balance as measured by the Y-Balance Test is reduced in individuals with low back pain: A cross-sectional comparative study. Phys Ther Sport 2016; 22:29-34. [DOI: 10.1016/j.ptsp.2016.04.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 12/26/2022]
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Abstract
STUDY DESIGN A cross-sectional comparative study between chronic low back pain (CLBP) patients and healthy control subjects. OBJECTIVE The aim of this study was to investigate reorganization in the sensory cortex by comparing cortical activity due to mechanosensory stimulation of the lumbar spine in CLBP patients versus a control group by using functional magnetic resonance imaging (fMRI). SUMMARY OF BACKGROUND DATA LBP is now the number 1 condition across the world in terms of years living with a disability. There is growing evidence that maladaptive changes in the processing of sensory input by the central nervous system are central to understanding chronic (back) pain. METHODS Nonpainful, posterior-anterior (PA) movement pressure was applied manually to lumbar vertebrae at L1, L3, and L5 in 13 healthy subjects and 13 CLBP patients. The manual pressure (30 N) was monitored and controlled using sensors. A randomized stimulation protocol was used consisting of 51 pressure stimuli of 5 seconds duration. fMRI data analysis was performed for the group activation within the primary and secondary sensory cortices (S1 and S2, respectively) and the representation of the individual vertebrae was extracted and statistically analyzed. RESULTS Nonpainful PA pressure revealed no cortical reorganization in S1. In contrast, the extent of S2 activation in the CLBP group was significantly reduced in both hemispheres. In the control group, a somatotopy was identified for the lumbar vertebrae between L1 and L3, respectively, and L5 in S2 of the right hemisphere. Most importantly, a blurring of the somatotopic representation of the lumbar spine in S2 was observed in the patient group. CONCLUSION Together, these maladaptive changes suggest a reorganization of higher-order processing for sensory information in CLBP patients that might have implications for a decreased sensory acuity, also related to body perception and subsequent altered functioning of the lumbar spine. LEVEL OF EVIDENCE 2.
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Janssens L, McConnell AK, Pijnenburg M, Claeys K, Goossens N, Lysens R, Troosters T, Brumagne S. Inspiratory muscle training affects proprioceptive use and low back pain. Med Sci Sports Exerc 2016; 47:12-9. [PMID: 24870567 DOI: 10.1249/mss.0000000000000385] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE We have shown that individuals with recurrent nonspecific low back pain (LBP) and healthy individuals breathing against an inspiratory load decrease their reliance on back proprioceptive signals in upright standing. Because individuals with LBP show greater susceptibility to diaphragm fatigue, it is reasonable to hypothesize that LBP, diaphragm dysfunction, and proprioceptive use may be interrelated. The purpose of this study was to investigate whether inspiratory muscle training (IMT) affects proprioceptive use during postural control in individuals with LBP. METHODS Twenty-eight individuals with LBP were assigned randomly into a high-intensity IMT group (high IMT) and low-intensity IMT group (low IMT). The use of proprioception in upright standing was evaluated by measuring center of pressure displacement during local muscle vibration (ankle, back, and ankle-back). Secondary outcomes were inspiratory muscle strength, severity of LBP, and disability. RESULTS After high IMT, individuals showed smaller responses to ankle muscle vibration, larger responses to back muscle vibration, higher inspiratory muscle strength, and reduced LBP severity (P < 0.05). These changes were not seen after low IMT (P > 0.05). No changes in disability were observed in either group (P > 0.05). CONCLUSIONS After 8 wk of high IMT, individuals with LBP showed an increased reliance on back proprioceptive signals during postural control and improved inspiratory muscle strength and severity of LBP, not seen after low IMT. Hence, IMT may facilitate the proprioceptive involvement of the trunk in postural control in individuals with LBP and thus might be a useful rehabilitation tool for these patients.
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Affiliation(s)
- Lotte Janssens
- 1KU Leuven Department of Rehabilitation Sciences, University of Leuven, Leuven, BELGIUM; 2Centre for Sports Medicine and Human Performance, Brunel University, Uxbridge, UNITED KINGDOM; 3KU Leuven Department of Rehabilitation Sciences, University of Leuven, Kulab, Bruges, BELGIUM; 4Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, BELGIUM; 5Respiratory Rehabilitation and Respiratory Division, University Hospitals Leuven, Leuven, BELGIUM
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Huber J, Lisiński P, Ciesielska J, Kulczyk A, Lipiec J, Bandosz A. Surface electromyography studies in standing position confirm that ankle strategy remains disturbed even following successful treatment of patients with a history of sciatica. J Phys Ther Sci 2016; 28:563-8. [PMID: 27065544 PMCID: PMC4793011 DOI: 10.1589/jpts.28.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/17/2015] [Indexed: 11/27/2022] Open
Abstract
[Purpose] It is hypothesized that ankle strategy can be changed in patients with a
history of sciatica. The aim of this study was to detect residual disturbances following
successful treatment. [Subjects and Methods] In patients with a history of sciatica (N=11)
and pseudo-sciatica (N=9), differences in muscle activity were recorded with bilateral
surface polyelectromyography and stability measurements (center of foot pressure sway and
center of spectrum) in normal standing and tandem positions. Results were compared with
recordings in healthy people (N=9) to identify abnormalities in electromyographic and
postural studies. [Results] Increased amplitude of electromyographic recordings from the
gastrocnemius and extensor digiti muscles on the affected side was detected more in
patients with a history of sciatica than pseudo-sciatica syndromes in tandem position.
Fewer amplitude fluctuations were observed in both positions preferably in patients
following sciatica. Changes in center of foot pressure sway and center of spectrum during
balance platform studies were detected in normal standing position in this group of
patients. No similar abnormalities in electromyographic and postural studies were detected
in healthy people. [Conclusion] Sciatica and pseudo-sciatica evoke persistent disturbances
in activity of muscles responsible for ankle strategy. Electromyography differentiates the
two groups of patients better than postural studies.
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Affiliation(s)
- Juliusz Huber
- Department of Pathophysiology of Locomotor Organs, University of Medical Sciences in Poznań, Wiktor Dega Clinical Orthopaedic and Rehabilitation Hospital: 28 Czerwca 1956r. No 135/147, 61-545, Poznań, Poland
| | - Przemysław Lisiński
- Department of Rheumatology and Rehabilitation, University of Medical Sciences in Poznań, Poland
| | - Jagoda Ciesielska
- Department of Rheumatology and Rehabilitation, University of Medical Sciences in Poznań, Poland
| | - Aleksandra Kulczyk
- Department of Pathophysiology of Locomotor Organs, University of Medical Sciences in Poznań, Wiktor Dega Clinical Orthopaedic and Rehabilitation Hospital: 28 Czerwca 1956r. No 135/147, 61-545, Poznań, Poland
| | - Joanna Lipiec
- Department of Pathophysiology of Locomotor Organs, University of Medical Sciences in Poznań, Wiktor Dega Clinical Orthopaedic and Rehabilitation Hospital: 28 Czerwca 1956r. No 135/147, 61-545, Poznań, Poland
| | - Agata Bandosz
- Department of Rheumatology and Rehabilitation, University of Medical Sciences in Poznań, Poland
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Trunk Postural Muscle Timing Is Not Compromised In Low Back Pain Patients Clinically Diagnosed With Movement Coordination Impairments. Motor Control 2015; 21:133-157. [PMID: 26623551 DOI: 10.1123/mc.2015-0049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Trunk muscle timing impairment has been associated with nonspecific low back pain (NSLBP), but this finding has not been consistent. This study investigated trunk muscle timing in a subgroup of patients with NSLBP attributed to movement coordination impairment (MCI) and matched asymptomatic controls in response to a rapid arm-raising task. Twenty-one NSLBP subjects and 21 matched controls had arm motion and surface EMG data collected from seven bilateral trunk muscles. Muscle onset and offset relative to deltoid muscle activation and arm motion, duration of muscle burst and abdominal-extensor co-contraction time were derived. Trunk muscle onset and offset latencies, and burst and co-contraction durations were not different (p > .05) between groups. Patterns of trunk muscle activation and deactivation relative to arm motion were not different. Task performance was similar between groups. Trunk muscle timing does not appear to be an underlying impairment in the subgroup of NSLBP with MCI.
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Vrana A, Hotz-Boendermaker S, Stämpfli P, Hänggi J, Seifritz E, Humphreys BK, Meier ML. Differential Neural Processing during Motor Imagery of Daily Activities in Chronic Low Back Pain Patients. PLoS One 2015; 10:e0142391. [PMID: 26569602 PMCID: PMC4646462 DOI: 10.1371/journal.pone.0142391] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/21/2015] [Indexed: 11/18/2022] Open
Abstract
Chronic low back pain (chronic LBP) is both debilitating for patients but also a major burden on the health care system. Previous studies reported various maladaptive structural and functional changes among chronic LBP patients on spine- and supraspinal levels including behavioral alterations. However, evidence for cortical reorganization in the sensorimotor system of chronic LBP patients is scarce. Motor Imagery (MI) is suitable for investigating the cortical sensorimotor network as it serves as a proxy for motor execution. Our aim was to investigate differential MI-driven cortical processing in chronic LBP compared to healthy controls (HC) by means of functional magnetic resonance imaging (fMRI). Twenty-nine subjects (15 chronic LBP patients, 14 HC) were included in the current study. MI stimuli consisted of randomly presented video clips showing every-day activities involving different whole-body movements as well as walking on even ground and walking downstairs and upstairs. Guided by the video clips, subjects had to perform MI of these activities, subsequently rating the vividness of their MI performance. Brain activity analysis revealed that chronic LBP patients exhibited significantly reduced activity compared to HC subjects in MI-related brain regions, namely the left supplementary motor area and right superior temporal sulcus. Furthermore, psycho-physiological-interaction analysis yielded significantly enhanced functional connectivity (FC) between various MI-associated brain regions in chronic LBP patients indicating diffuse and non-specific changes in FC. Current results demonstrate initial findings about differences in MI-driven cortical processing in chronic LBP pointing towards reorganization processes in the sensorimotor network.
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Affiliation(s)
- Andrea Vrana
- University Hospital of Balgrist, Zurich, Switzerland
- Department of Health Sciences and Technology, Human Movement Sciences, ETH Zurich, Switzerland
| | | | - Philipp Stämpfli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- MR-Center of the Psychiatric Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Jürgen Hänggi
- Division Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | | | - Michael L. Meier
- University Hospital of Balgrist, Zurich, Switzerland
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Carvalho AR, Ribeiro Bertor WR, Briani RV, Zanini GM, Silva LI, Andrade A, Peyré-Tartaruga LA. Effect of Nonspecific Chronic Low Back Pain on Walking Economy: An Observational Study. J Mot Behav 2015; 48:218-26. [PMID: 26403060 DOI: 10.1080/00222895.2015.1079162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The authors investigated the effects of chronic low back pain (LBP) and walking speed (WS) on metabolic power and cost of transport (CT). Subjects with chronic nonspecific LBP (LBP group [LG]; n = 9) and healthy (control group [CG]; n = 9) were included. The test battery was divided into 3 blocks according to WS as follows: preferred self-selected speed (PS), and lower and higher than the PS. In each block, the volunteers walked 5 min, during which oxygen consumption was measured. Although without differences between groups, the LG had CT lower in slower speeds than in faster speeds. Walking speed affected CT only in the LG, which the group had the greatest walking economy at slower speeds.
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Affiliation(s)
- Alberito Rodrigo Carvalho
- a Fisioterapia, Clínica de Fisioterapia (Unioeste), Universidade Estadual do Oeste do Paraná , Cascavel , Brazil.,d Educação Física, Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil
| | - Welds Rodrigo Ribeiro Bertor
- a Fisioterapia, Clínica de Fisioterapia (Unioeste), Universidade Estadual do Oeste do Paraná , Cascavel , Brazil
| | | | - Gabriela Matté Zanini
- a Fisioterapia, Clínica de Fisioterapia (Unioeste), Universidade Estadual do Oeste do Paraná , Cascavel , Brazil
| | - Lígia Inez Silva
- a Fisioterapia, Clínica de Fisioterapia (Unioeste), Universidade Estadual do Oeste do Paraná , Cascavel , Brazil
| | - Alexandro Andrade
- c Educação Física, Universidade Estadual de Santa Catarina , Florianópolis , Brazil
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Sung W, Abraham M, Plastaras C, Silfies SP. Trunk motor control deficits in acute and subacute low back pain are not associated with pain or fear of movement. Spine J 2015; 15:1772-82. [PMID: 25862508 PMCID: PMC4516579 DOI: 10.1016/j.spinee.2015.04.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 02/23/2015] [Accepted: 04/02/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A subgroup of patients with acute to subacute low back pain (LBP) presenting with trunk movement control deficits, pain provocation with segmental testing, and segmental hypermobility have been clinically identified as having movement coordination impairments (MCIs) of the trunk. It is hypothesized that these patients have proprioceptive, postural, and movement control impairments of the trunk associated with LBP. Although trunk control impairments have been identified in patients with chronic LBP, they have not been investigated in this subgroup or closer to symptom onset. PURPOSE The purpose of the study was to identify trunk motor control (postural control and movement precision) impairments in a subgroup of patients with acute to subacute LBP who have been clinically identified to have MCIs and determine association of these impairments with pain and fear of movement. STUDY DESIGN/SETTING The study design includes observational design, university biomechanics laboratory, and clinical practice. PATIENT SAMPLE Thirty-three patients with acute to subacute LBP presenting with trunk MCIs and 33 healthy controls matched with gender, age, and body mass index were identified. OUTCOME MEASURES Self-report measures included Numeric Pain Rating Scale, Oswestry Disability Index Questionnaire, and Fear-Avoidance Beliefs Questionnaire and physiologic measures included postural control and movement precision. METHODS Center-of-pressure movement was measured while subjects attempted to volitionally control trunk posture and movement while sitting on a platform with a hemisphere mounted underneath. This created an unstable surface that required coordinated trunk control to maintain an upright seated posture. Postural control was tested using eyes-open and -closed balance protocols. Movement precision was tested with a dynamic control test requiring movement of the center of pressure along a discrete path. Group trunk motor control performance was compared with analysis of variance and t test. Performance association with pain and fear of movement were assessed with Pearson correlations. RESULTS Patients' postural control in the eyes-closed condition (p=.02) and movement precision (p=.04) were significantly impaired compared with healthy controls, with moderate-to-large group difference effect sizes. These trunk motor control impairments were not significantly associated with the patients self-reported pain characteristics and fear of movement. CONCLUSIONS Patients with clinical identification of trunk MCIs demonstrated decreased trunk motor control, suggesting that impairments in proprioception, motor output, or central processing occur early in the back pain episode. This information may help to guide interventions to address these specific limitations, improving delivery of care.
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Affiliation(s)
- Won Sung
- Rehabilitation Sciences Spine Research Laboratory, Drexel University, Three Parkway, Mail Stop 7-502, Philadelphia, PA 19102-1192, USA; Good Shepherd Penn Partners, Penn Therapy and Fitness, 3737 Market St, Philadelphia, PA 19146, USA
| | - Mathew Abraham
- Penn Spine Center, 1800 Lombard St, Philadelphia, PA 19146, USA
| | - Christopher Plastaras
- Penn Spine Center, 1800 Lombard St, Philadelphia, PA 19146, USA; Pearlman School of Medicine, University of Pennsylvania, 415 Curie Blvd, Philadelphia, PA 19146, USA
| | - Sheri P Silfies
- Rehabilitation Sciences Spine Research Laboratory, Drexel University, Three Parkway, Mail Stop 7-502, Philadelphia, PA 19102-1192, USA.
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78
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Sung PS, Leininger PM. A kinematic and kinetic analysis of spinal region in subjects with and without recurrent low back pain during one leg standing. Clin Biomech (Bristol, Avon) 2015; 30:696-702. [PMID: 26021880 DOI: 10.1016/j.clinbiomech.2015.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the relationship between normalized kinematic and kinetic stability indices for spinal regions with eyes-open and eyes-closed conditions during non-dominant leg standing between subjects with recurrent low back pain and control subjects. METHODS The kinematic stability index for the spinal regions (core spine model, lumbar spine, lower and upper thorax) and the kinetic stability index from force plate were measured. All participants were asked to maintain non-dominant leg standing with the dominant hip and knee flexed approximately 90 degrees for 25 seconds. Forty-two participants enrolled in the study, including 22 subjects with low back pain (12 male, 10 female) and 20 control subjects (12 male, 8 female). FINDINGS For the kinematic index for stability, the visual condition (F=30.06, p=0.0001) and spinal region (F=10.82, p=0.002) were statistically significant. The post hoc test results indicated a significant difference in the lumbar spine compared with the upper and lower thorax and the core spine model. The kinetic stability (average [standard deviation]) during the eyes-closed condition significantly decreased in the low back pain group (t=-3.24, p=0.002). INTERPRETATION The subjects with recurrent low back pain demonstrated higher lumbar spine stability in eyes-open condition. This higher stability of the lumbar spine might be due to a possible pain avoiding strategy from the standing limb. The low back pain group also significantly decreased kinetic stability during the eyes-closed condition. Clinicians need to consider both kinetic and kinematic indices while considering visual condition for lumbar spine stability in subjects with recurrent low back pain.
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Affiliation(s)
- Paul S Sung
- Department of Physical Therapy, The University of Scranton, Scranton, PA 18510, United States.
| | - Peter M Leininger
- Department of Physical Therapy, The University of Scranton, Scranton, PA 18510, United States
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Ito T, Sakai Y, Nakamura E, Yamazaki K, Yamada A, Sato N, Morita Y. Relationship between paraspinal muscle cross-sectional area and relative proprioceptive weighting ratio of older persons with lumbar spondylosis. J Phys Ther Sci 2015; 27:2247-51. [PMID: 26311962 PMCID: PMC4540857 DOI: 10.1589/jpts.27.2247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/13/2015] [Indexed: 01/27/2023] Open
Abstract
[Purpose] The purpose of this study was to examine the relationship between the
paraspinal muscle cross-sectional area and the relative proprioceptive weighting ratio
during local vibratory stimulation of older persons with lumbar spondylosis in an upright
position. [Subjects] In all, 74 older persons hospitalized for lumbar spondylosis were
included. [Methods] We measured the relative proprioceptive weighting ratio of postural
sway using a Wii board while vibratory stimulations of 30, 60, or 240 Hz were applied to
the subjects’ paraspinal or gastrocnemius muscles. Back strength, abdominal muscle
strength, and erector spinae muscle (L1/L2, L4/L5) and lumbar multifidus (L1/L2, L4/L5)
cross-sectional areas were evaluated. [Results] The erector spinae muscle (L1/L2)
cross-sectional area was associated with the relative proprioceptive weighting ratio
during 60Hz stimulation. [Conclusion] These findings show that the relative proprioceptive
weighting ratio compared to the erector spinae muscle (L1/L2) cross-sectional area under
60Hz proprioceptive stimulation might be a good indicator of trunk proprioceptive
sensitivity.
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Affiliation(s)
- Tadashi Ito
- Division of Physical Therapy, Department of Health Science, Graduate School of International University of Health and Welfare, Japan ; National Center for Geriatrics and Gerontology, Japan
| | | | | | - Kazunori Yamazaki
- Faculty of Clinical Engineering, School of Health Sciences, Fujita Health University, Japan
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80
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Schelldorfer S, Ernst MJ, Rast FM, Bauer CM, Meichtry A, Kool J. Low back pain and postural control, effects of task difficulty on centre of pressure and spinal kinematics. Gait Posture 2015; 41:112-8. [PMID: 25270326 DOI: 10.1016/j.gaitpost.2014.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 07/22/2014] [Accepted: 09/14/2014] [Indexed: 02/02/2023]
Abstract
Association of low back pain and standing postural control (PC) deficits are reported inconsistently. Demands on PC adaptation strategies are increased by restraining the input of visual or somatosensory senses. The objectives of the current study are, to investigate whether PC adaptations of the spine, hip and the centre of pressure (COP) differ between patients reporting non-specific low back pain (NSLBP) and asymptomatic controls. The PC adaption strategies of the thoracic and lumbar spine, the hip and the COP were measured in fifty-seven NSLBP patients and 22 asymptomatic controls. We tested three "feet together" conditions with increasing demands on PC strategies, using inertial measurement units (IMUs) on the spine and a Wii balance board for centre of pressure (COP) parameters. The differences between NSLBP patients and controls were most apparent when the participants were blindfolded, but remaining on a firm surface. While NSLBP patients had larger thoracic and lumbar spine mean absolute deviations of position (MADpos) in the frontal plane, the same parameters decreased in control subjects (relative change (RC): 0.23, 95% confidence interval: 0.03 to 0.45 and 0.03 to 0.48). The Mean absolute deviation of velocity (MADvel) of the thoracic spine in the frontal plane showed a similar and significant effect (RC: 0.12 95% CI: 0.01 to 0.25). Gender, age and pain during the measurements affected some parameters significantly. PC adaptions differ between NSLBP patients and asymptomatic controls. The differences are most apparent for the thoracic and lumbar parameters of MADpos, in the frontal plane and while the visual condition was removed.
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Affiliation(s)
- Sarah Schelldorfer
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Research and Development, Technikumstrasse 71, 8401 Winterthur, Switzerland.
| | - Markus Josef Ernst
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Research and Development, Technikumstrasse 71, 8401 Winterthur, Switzerland.
| | - Fabian Marcel Rast
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Research and Development, Technikumstrasse 71, 8401 Winterthur, Switzerland.
| | - Christoph Michael Bauer
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Research and Development, Technikumstrasse 71, 8401 Winterthur, Switzerland.
| | - André Meichtry
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Research and Development, Technikumstrasse 71, 8401 Winterthur, Switzerland.
| | - Jan Kool
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Research and Development, Technikumstrasse 71, 8401 Winterthur, Switzerland.
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81
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Carvalho ARD, Andrade A, Peyré-Tartaruga LA. Possible changes in energy-minimizer mechanisms of locomotion due to chronic low back pain - a literature review. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rbre.2014.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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82
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Fisher AR, Bacon CJ, Mannion JVH. The effect of cervical spine manipulation on postural sway in patients with nonspecific neck pain. J Manipulative Physiol Ther 2014; 38:65-73. [PMID: 25467613 DOI: 10.1016/j.jmpt.2014.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 08/25/2014] [Accepted: 09/01/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This crossover study aimed to determine whether a single high-velocity, low-amplitude manipulation of the cervical spine would affect postural sway in adults with nonspecific neck pain. METHODS Ten participants received, in random order, 7 days apart, a high-velocity, low-amplitude manipulation applied to a dysfunctional spinal segment and a passive head-movement control. Four parameters of postural sway were measured before, immediately after, and at 5 and 10 minutes after each procedure. RESULTS Results showed no differences between interventions in change in any of the parameters. When changes before and immediately after each procedure were analyzed separately, only the control showed a significant change in the length of center of pressure path (an increase from median, 118 mm; interquartlie range, 93-137 mm to an increase to 132 mm; 112-147; P = .02). CONCLUSION This study failed to show evidence that single manipulation of the cervical spine influenced postural sway. Given the ability of the postural control system to reweight the hierarchy of sensory information to compensate for inadequacies in any 1 component, it is possible that any improvements in the mechanisms controlling postural sway elicited by the manipulative intervention may have been concealed.
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Affiliation(s)
- Alison R Fisher
- Osteopath, Department of Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
| | - Catherine J Bacon
- Research Supervisor, Department of Osteopathy, Unitec Institute of Technology, Auckland, New Zealand; Postdoctoral Research Fellow, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Jamie V H Mannion
- Lecturer, Department of Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
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83
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Bowering KJ, Butler DS, Fulton IJ, Moseley GL. Motor Imagery in People With a History of Back Pain, Current Back Pain, Both, or Neither. Clin J Pain 2014; 30:1070-5. [DOI: 10.1097/ajp.0000000000000066] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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84
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de Carvalho AR, Andrade A, Peyré-Tartaruga LA. [Possible changes in energy-minimizer mechanisms of locomotion due to chronic low back pain - a literature review]. REVISTA BRASILEIRA DE REUMATOLOGIA 2014; 55:55-61. [PMID: 25440708 DOI: 10.1016/j.rbr.2014.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 01/28/2014] [Indexed: 01/31/2023] Open
Abstract
One goal of the locomotion is to move the body in the space at the most economical way possible. However, little is known about the mechanical and energetic aspects of locomotion that are affected by low back pain. And in case of occurring some damage, little is known about how the mechanical and energetic characteristics of the locomotion are manifested in functional activities, especially with respect to the energy-minimizer mechanisms during locomotion. This study aimed: a) to describe the main energy-minimizer mechanisms of locomotion; b) to check if there are signs of damage on the mechanical and energetic characteristics of the locomotion due to chronic low back pain (CLBP) which may endanger the energy-minimizer mechanisms. This study is characterized as a narrative literature review. The main theory that explains the minimization of energy expenditure during the locomotion is the inverted pendulum mechanism, by which the energy-minimizer mechanism converts kinetic energy into potential energy of the center of mass and vice-versa during the step. This mechanism is strongly influenced by spatio-temporal gait (locomotion) parameters such as step length and preferred walking speed, which, in turn, may be severely altered in patients with chronic low back pain. However, much remains to be understood about the effects of chronic low back pain on the individual's ability to practice an economic locomotion, because functional impairment may compromise the mechanical and energetic characteristics of this type of gait, making it more costly. Thus, there are indications that such changes may compromise the functional energy-minimizer mechanisms.
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Affiliation(s)
- Alberito Rodrigo de Carvalho
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil; Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brasil.
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85
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A cognitive dual task affects gait variability in patients suffering from chronic low back pain. Exp Brain Res 2014; 232:3509-13. [PMID: 25059910 DOI: 10.1007/s00221-014-4039-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 07/08/2014] [Indexed: 01/16/2023]
Abstract
Chronic pain and gait variability in a dual-task situation are both associated with higher risk of falling. Executive functions regulate (dual-task) gait variability. A possible cause explaining why chronic pain increases risk of falling in an everyday dual-task situation might be that pain interferes with executive functions and results in a diminished dual-task capability with performance decrements on the secondary task. The main goal of this experiment was to evaluate the specific effects of a cognitive dual task on gait variability in chronic low back pain (CLBP) patients. Twelve healthy participants and twelve patients suffering from CLBP were included. The subjects were asked to perform a cognitive single task, a walking single task and a motor-cognitive dual task. Stride variability of trunk movements was calculated. A two-way ANOVA was performed to compare single-task walking with dual-task walking and the single cognitive task performance with the motor-cognitive dual-task performance. We did not find any differences in both of the single-task performances between groups. However, regarding single-task walking and dual-task walking, we observed an interaction effect indicating that low back pain patients show significantly higher gait variability in the dual-task condition as compared to controls. Our data suggest that chronic pain reduces motor-cognitive dual-task performance capability. We postulate that the detrimental effects are caused by central mechanisms where pain interferes with executive functions which, in turn, might contribute to increased risk of falling.
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86
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Bourigua I, Simoneau EM, Leteneur S, Gillet C, Ido G, Barbier F. Chronic low back pain sufferers exhibit freezing-like behaviors when asked to move their trunk as fast as possible. Spine J 2014; 14:1291-9. [PMID: 24333457 DOI: 10.1016/j.spinee.2013.11.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 11/14/2013] [Accepted: 11/26/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The effect of chronic low back pain (CLBP) on the kinematic parameters of trunk motion has received much more interest in this last decade. However, there are no descriptions of the motor strategies that occur when patients perform trunk movements in the three anatomical planes at different pace conditions. PURPOSE To investigate motor strategies used by CLBP patients and asymptomatic people while performing different go and back trunk movements in an upright standing position. STUDY DESIGN A comparative study. PATIENT SAMPLE The control group (CG, n=33) included 14 men and 19 women with no history of low back pain, and the chronic low back pain group (CLBPG, n=49) included 21 men and 28 women. OUTCOME MEASURES Kinematic data were analyzed during six trunk movements: flexion, extension, left and right lateral bendings, and rotations under two pace conditions (preferred and fast paces). METHODS A three-dimensional optoelectronic motion analysis system was used to assess static (trunk inclinations and base of support) and dynamic (range of motion [ROM] and mean angular velocity of the trunk) parameters during the go and back phases of trunk movements. RESULTS In the initial position, CLBPG showed a more forward-tilted trunk inclination (2.1°±1.1°, p=.013) compared with CG. The base of support was significantly higher in CG (+22.7 cm2, p=.009) during the fast pace when compared with the preferred pace. Regardless of the pace condition, ROM and mean angular velocity of the trunk were significantly lower in CLBPG for all examined movements and the pace condition did not significantly alter ROM. At the preferred pace, both groups displayed the same motor strategy: they all went faster during the second phase of movement than during the first phase. However, at the fast pace, while CG was going faster during the first phase than during the second, CLBPG maintained the same motor strategy as at the preferred pace. CONCLUSIONS Contrary to CG who changed its motor behavior from a preferred pace to a fast pace, CLBPG exhibited freezing-like behaviors. This original result highlights the importance of studying the velocity. The use of this parameter may improve the diagnosis of CLBP patients and could be a key indicator for treatment progress and long-term monitoring.
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Affiliation(s)
- Imen Bourigua
- Univ Lille Nord de France, F-59000 Lille, France; UVHC, LAMIH, F-59313 Valenciennes, France; CNRS, UMR 8201, F-59313 Valenciennes, France; Centre de Rééducation Fonctionnelle La Rougeville, 59880 Saint-Saulve, France.
| | - Emilie M Simoneau
- Univ Lille Nord de France, F-59000 Lille, France; UVHC, LAMIH, F-59313 Valenciennes, France; CNRS, UMR 8201, F-59313 Valenciennes, France
| | - Sébastien Leteneur
- Univ Lille Nord de France, F-59000 Lille, France; UVHC, LAMIH, F-59313 Valenciennes, France; CNRS, UMR 8201, F-59313 Valenciennes, France; Centre de Rééducation Fonctionnelle La Rougeville, 59880 Saint-Saulve, France
| | - Christophe Gillet
- Univ Lille Nord de France, F-59000 Lille, France; UVHC, LAMIH, F-59313 Valenciennes, France; CNRS, UMR 8201, F-59313 Valenciennes, France
| | - Ghassan Ido
- Centre de Rééducation Fonctionnelle La Rougeville, 59880 Saint-Saulve, France
| | - Franck Barbier
- Univ Lille Nord de France, F-59000 Lille, France; UVHC, LAMIH, F-59313 Valenciennes, France; CNRS, UMR 8201, F-59313 Valenciennes, France
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87
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Janssens L, Pijnenburg M, Claeys K, McConnell AK, Troosters T, Brumagne S. Postural strategy and back muscle oxygenation during inspiratory muscle loading. Med Sci Sports Exerc 2014; 45:1355-62. [PMID: 23470314 DOI: 10.1249/mss.0b013e3182853d27] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Most healthy individuals show a multisegmental control strategy during challenging standing conditions, whereas others show a rigid ankle-steered strategy, which is assumed as suboptimal. Respiratory-demanding tasks exert a perturbing effect on balance, although the underlying mechanisms remain poorly understood. The purpose of this study was to investigate whether inspiratory resistive loading (IRL) affects postural strategy, back muscle oxygenation, and blood volume during postural control. METHODS We assessed the acute effects of increased respiratory effort by measuring the center of pressure displacement in 12 healthy individuals during upright standing on an unstable support surface while breathing against an IRL. Simultaneous ankle and back muscle vibration was used to evaluate the proprioceptive strategy (multisegmental vs ankle-steered) during postural control. Back muscles oxygenation and blood volume were assessed using near-infrared spectroscopy (tissue oxygenation index, deoxyhemoglobin, oxyhemoglobin, and combined hemoglobin). RESULTS An increased proprioceptive gain at the ankles and an decreased gain at the back were observed after approximately 7 min of IRL. Retrospectively, the group was subdivided on the basis of the participants' dominant proprioceptive use during a baseline postural control. During IRL, the ankle-steered group showed an increased reliance on ankle proprioception compared with a multisegmental group (-5.9 ± 3.1 and 1.0 ± 1.9 cm, respectively, P < 0.05). Tissue oxygenation index, deoxyhemoglobin, oxyhemoglobin, and combined hemoglobin declined progressively in the ankle-steered group during the IRL (from baseline (100%) to -1%, -1%, -45%, and -18%, respectively, P < 0.05), whereas no decline was found in the multisegmental group (from baseline (100%) to 134%, 82%, 129%, and 153%, respectively, P > 0.05). CONCLUSION Individuals who adopted an ankle-steered strategy during IRL showed a progressive decline in back muscle oxygenation and blood volume. In contrast, IRL did not affect back muscle oxygenation and blood volume in individuals who showed a multisegmental strategy in upright standing.
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Affiliation(s)
- Lotte Janssens
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.
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88
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Compressive preload reduces segmental flexion instability after progressive destabilization of the lumbar spine. Spine (Phila Pa 1976) 2014; 39:E74-81. [PMID: 24153162 DOI: 10.1097/brs.0000000000000093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Biomechanical human cadaveric study. OBJECTIVE We hypothesized that increasing compressive preload will reduce the segmental instability after nucleotomy, posterior ligament resection, and decompressive surgery. SUMMARY OF BACKGROUND DATA The human spine experiences significant compressive preloads in vivo due to spinal musculature and gravity. Although the effect of destabilization procedures on spinal motion has been studied, the effect of compressive preload on the motion response of destabilized, multisegment lumbar spines has not been reported. METHODS Eight human cadaveric spines (L1-sacrum, 51.4 ± 14.1 yr) were tested intact, after L4-L5 nucleotomy, after interspinous and supraspinous ligaments transection, and after midline decompression (bilateral laminotomy, partial medial facetectomy, and foraminotomy). Specimens were loaded in flexion (8 Nm) and extension (6 Nm) under 0-N, 200-N, and 400-N compressive follower preload. L4-L5 range of motion (ROM) and flexion stiffness in the high-flexibility zone were analyzed using repeated-measures analysis of variance and multiple comparisons with the Bonferroni correction. RESULTS With a fixed set of loading conditions, a progressive increase in segmental ROM along with expansion of the high-flexibility zone (decrease of flexion stiffness) was noted with serial destabilizations. Application of increasing compressive preload did not substantially change segmental ROM, but did significantly increase the segmental stiffness in the high-flexibility zone. In the most destabilized condition, 400-N preload did not return the segmental stiffness to intact levels. CONCLUSION Anatomical alterations representing degenerative and iatrogenic instabilities are associated with significant increases in segmental ROM and decreased segmental stiffness. Although application of compressive preload, mimicking the effect of increased axial muscular activity, significantly increased the segmental stiffness, it was not restored to intact levels; thereby suggesting that core strengthening alone may not compensate for the loss of structural stability associated with midline surgical decompression. This suggests that there may be a role for surgical implants or interventions that specifically increase flexion stiffness and limit flexion ROM to counteract the iatrogenic instability resulting from surgical decompression. LEVEL OF EVIDENCE N/A.
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89
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Bae SH, Lee JH, Oh KA, Kim KY. The effects of kinesio taping on potential in chronic low back pain patients anticipatory postural control and cerebral cortex. J Phys Ther Sci 2013; 25:1367-71. [PMID: 24396190 PMCID: PMC3881457 DOI: 10.1589/jpts.25.1367] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 05/31/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to examine the effects of kinesio tape applied to chronic low
back pain (CLBP) patients on anticipatory postural control and cerebral cortex potential.
[Subjects and Methods] Twenty patients whose low back pain had continued for more than 12
weeks were selected and assigned to a control group (n=10) to which ordinary physical
therapy was applied and an experimental group (n=10) to which kinesio tape was applied.
Anticipatory postural control was evaluated using electromyography, and movement-related
cortical potential (MRCP) was assessed using electroencephalography. Clinical evaluation
was performed using a visual analogue scale and the Oswestry disability index. [Results]
According to the analysis results for anticipatory postural control, there were
significant decreases in the transversus abdominis (TrA) muscle and the external oblique
muscle in both groups. Among them, the TrA of the experimental group exhibited the
greatest differences. According to the results of a between-group comparison, there was
significant difference in the TrA between the two groups. There was also a significant
decrease in the MRCP of both groups. In particular, changes in the movement monitoring
potential (MMP) of the experimental group were greatest at Fz, C3, Cz, and C4. According
to the between-group comparison, there were significant differences in MMP at F3, C3, and
Cz. Both groups saw VAS and ODI significantly decrease. Among them, the ODI of the
experimental group underwent the greatest change. [Conclusion] Kinesio tape applied to
CLBP patients reduced their pain and positively affected their anticipatory postural
control and MRCP.
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Affiliation(s)
- Sea Hyun Bae
- Department of Physical Therapy, Cheongam College, Republic of Korea
| | - Jeong Hun Lee
- Department of Occupational Therapy, Hanyoung College, Republic of Korea
| | - Kyeong Ae Oh
- Department of Health Science Graduate School of Chosun University, Republic of Korea
| | - Kyung Yoon Kim
- Department of Physical Therapy, College of Health and Welfare, Dongshin University, Republic of Korea
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90
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Sipko T, Kuczyński M. The Effect of Chronic Pain Intensity on the Stability Limits in Patients With Low Back Pain. J Manipulative Physiol Ther 2013; 36:612-8. [DOI: 10.1016/j.jmpt.2013.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 08/27/2013] [Accepted: 08/27/2013] [Indexed: 11/16/2022]
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91
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Dupeyron A, Demattei C, Kouyoumdjian P, Missenard O, Micallef JP, Perrey S. Neuromuscular adaptations after a rehabilitation program in patients with chronic low back pain: case series (uncontrolled longitudinal study). BMC Musculoskelet Disord 2013; 14:277. [PMID: 24063646 PMCID: PMC3849067 DOI: 10.1186/1471-2474-14-277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 09/18/2013] [Indexed: 11/27/2022] Open
Abstract
Background To investigate the impact of a short-term multimodal rehabilitation program for patients with low back pain (LBP) on trunk muscle reflex responses and feedforward activation induced by postural perturbations. Methods Case series (uncontrolled longitudinal study). Thirty chronic patients with LBP (21 women and 19 men, mean age 42.6 ± 8.6 years, mean weight 73 ± 14 kg, mean height 174 ± 10 cm) were included. The intervention consisted in a 5-day program including therapeutic education sessions (360 min), supervised abdominal and back muscle strength exercises (240 min), general aerobic training (150 min), stretching (150 min), postural education (150 min) and aqua therapy (150 min). Feedforward activation level and reflex amplitude determined by surface electromyographic activity triggered by postural perturbations were recorded from abdominal and paraspinal muscles in unexpected and expected conditions. Subjects were tested before, just after and again one month after the rehabilitation program. Results No main intervention effect was found on feedforward activation levels and reflex amplitudes underlining the absence of changes in the way patients with LBP reacted across perturbation conditions. However, we observed a shift in the behavioral strategy between conditions, in fact feedforward activation (similar in both conditions before the program) decreased in the unexpected condition after the program, whereas reflex amplitudes became similar in both conditions. Conclusions The results suggest that a short-term rehabilitation program modifies trunk behavioral strategies during postural perturbations. These results can be useful to clinicians for explaining to patients how to adapt to daily life activities before and after rehabilitation.
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Affiliation(s)
- Arnaud Dupeyron
- Movement to Health (M2H), Montpellier-1 University, Euromov, 700, Avenue du Pic Saint-Loup, 34090, Montpellier, France.
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92
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Kim JH, Kim YE, Bae SH, Kim KY. The effect of the neurac sling exercise on postural balance adjustment and muscular response patterns in chronic low back pain patients. J Phys Ther Sci 2013; 25:1015-9. [PMID: 24259906 PMCID: PMC3820226 DOI: 10.1589/jpts.25.1015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/08/2013] [Indexed: 12/23/2022] Open
Abstract
[Purpose] This study aimed to examine the effects of the Neurac sling exercise on postural balance adjustment and muscular response patterns in chronic low back pain (CLBP) patients. [Subjects and Methods] Sixteen CLBP patients participated in this study. They were randomly and equally assigned to group I, whose members received ordinary physical therapy (40 minutes per time, four times per week), and group II, whose members performed a lumbar stabilization exercise using the Neurac sling after ordinary physical therapy (40 minutes per time, four times per week). The visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate exercise effects. BioRescue and electromyography were utilized for the measurement of changes in postural balance adjustment and muscular response patterns, respectively. [Results] Both groups saw their VAS and ODI decrease significantly. There were significant decreases in both groups in posturography as well, but group II recorded a greater decrease. There were significant increases in the flexion-relaxation ratio in both groups, and there were significant increases in the extension-flexion ratio in the left L1-2 of group I and in all elements of group II. [Conclusion] Lumbar stabilization exercise using the Neurac sling is effective in decreasing pain, improving damaged postural balance adjustment, and normalizing muscle response patterns of CLBP patients.
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Affiliation(s)
- Ji Hae Kim
- Department of Physical Therapy, Dongshin University Oriental Hospital
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93
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Willigenburg NW, Kingma I, van Dieën JH. Center of pressure trajectories, trunk kinematics and trunk muscle activation during unstable sitting in low back pain patients. Gait Posture 2013; 38:625-30. [PMID: 23473809 DOI: 10.1016/j.gaitpost.2013.02.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 06/25/2012] [Accepted: 02/04/2013] [Indexed: 02/02/2023]
Abstract
Trunk motor behavior has been reported to be altered in low-back pain. This may be associated with impaired lumbar proprioception, which could be compensated by trunk stiffening. We assessed trunk control by measuring center-of-pressure, lumbar kinematics and trunk muscle electromyography in 20 low-back pain patients and 11 healthy individuals during a seated balancing task, in conditions with and without disturbance of lumbar proprioception and occlusion of vision. We hypothesized that low-back pain patients show larger postural sway, but smaller thoraco-lumbar movements than healthy individuals. Repeated measures analyses of variance indicated that the effects of proprioception disturbance and vision occlusion were similar between groups. Interestingly, low-back pain patients grabbed the safety rail more often, while differences between groups in sway measures were rather subtle. This suggests that low-back pain patients were more cautious. Furthermore, low-back pain patients had an about 20 degrees less flexed lumbar posture than healthy individuals, and, in contrast to our hypothesis, made larger thoraco-lumbar movements in the sagittal plane, as indicated by higher SDs of thoraco-lumbar flexion and lower (more negative) correlations between pelvis and thorax movements. Activation of the intersegmental longissimus relative to the iliocostalis muscle, which spans all lumbar segments, was lower in low-back pain patients compared to healthy individuals. This difference in muscle activation may be causal for larger thoraco-lumbar movements, and may be causative of reduced control over segmental lumbar movement, but may also reflect the need for larger corrective movements to compensate balance impairments.
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Affiliation(s)
- Nienke W Willigenburg
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
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94
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Hwang JH, Lee CH, Chang HJ, Park DS. Sequential analysis of postural control resource allocation during a dual task test. Ann Rehabil Med 2013; 37:347-54. [PMID: 23869332 PMCID: PMC3713291 DOI: 10.5535/arm.2013.37.3.347] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 08/21/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the postural control factors influencing the automatic (reflex-controlled) and attentional (high cortical) factors on dual task. METHODS We used a dual task model to examine the attentional factors affecting the control of posture, subjecting test subjects to vibration stimulation, one-leg standing and verbal or nonverbal task trials. Twenty-three young, healthy participants were asked to stand on force plates and their centers of pressure were measured during dual task trials. We acquired 15 seconds of data for each volunteer during six dual task trials involving varying task combinations. RESULTS We observed significantly different sway patterns between the early and late phases of dual task trials, which probably reflect the attentional demands. Vibration stimulation perturbed sway more during the early than the late phases; with or without vibration stimulation, the addition of secondary tasks decreased sway in all phases, and greater decreases in sway were observed in the late phases, when subjects were assigned nonverbal tasks. Less sway was observed during the nonverbal task in a sequential study. CONCLUSION The attentional and automatic factors were analyzed during a sequential study. By controlling the postural control factors, optimal parameters and training methods might be used in clinical applications.
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Affiliation(s)
- Ji Hye Hwang
- Department of Physical Medicine and Rehabilitation, Center for Clinical Research, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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95
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Janssens L, Brumagne S, McConnell AK, Claeys K, Pijnenburg M, Burtin C, Janssens W, Decramer M, Troosters T. Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease. PLoS One 2013; 8:e57949. [PMID: 23469255 PMCID: PMC3585868 DOI: 10.1371/journal.pone.0057949] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 01/27/2013] [Indexed: 12/11/2022] Open
Abstract
Introduction Balance deficits are identified as important risk factors for falling in individuals with chronic obstructive pulmonary disease (COPD). However, the specific use of proprioception, which is of primary importance during balance control, has not been studied in individuals with COPD. The objective was to determine the specific proprioceptive control strategy during postural balance in individuals with COPD and healthy controls, and to assess whether this was related to inspiratory muscle weakness. Methods Center of pressure displacement was determined in 20 individuals with COPD and 20 age/gender-matched controls during upright stance on an unstable support surface without vision. Ankle and back muscle vibration were applied to evaluate the relative contribution of different proprioceptive signals used in postural control. Results Individuals with COPD showed an increased anterior-posterior body sway during upright stance (p = 0.037). Compared to controls, individuals with COPD showed an increased posterior body sway during ankle muscle vibration (p = 0.047), decreased anterior body sway during back muscle vibration (p = 0.025), and increased posterior body sway during simultaneous ankle-muscle vibration (p = 0.002). Individuals with COPD with the weakest inspiratory muscles showed the greatest reliance on ankle muscle input when compared to the stronger individuals with COPD (p = 0.037). Conclusions Individuals with COPD, especially those with inspiratory muscle weakness, increased their reliance on ankle muscle proprioceptive signals and decreased their reliance on back muscle proprioceptive signals during balance control, resulting in a decreased postural stability compared to healthy controls. These proprioceptive changes may be due to an impaired postural contribution of the inspiratory muscles to trunk stability. Further research is required to determine whether interventions such as proprioceptive training and inspiratory muscle training improve postural balance and reduce the fall risk in individuals with COPD.
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Affiliation(s)
- Lotte Janssens
- Department of Rehabilitation Sciences, University of Leuven, KU Leuven, Leuven, Belgium.
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96
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Sherafat S, Salavati M, Ebrahimi Takamjani I, Akhbari B, Mohammadirad S, Mazaheri M, Negahban H. Intrasession and Intersession Reliability of Postural Control in Participants With and Without Nonspecific Low Back Pain Using the Biodex Balance System. J Manipulative Physiol Ther 2013; 36:111-8. [DOI: 10.1016/j.jmpt.2012.12.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 11/04/2012] [Accepted: 11/05/2012] [Indexed: 11/29/2022]
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97
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Mazaheri M, Coenen P, Parnianpour M, Kiers H, van Dieën JH. Low back pain and postural sway during quiet standing with and without sensory manipulation: a systematic review. Gait Posture 2013; 37:12-22. [PMID: 22796243 DOI: 10.1016/j.gaitpost.2012.06.013] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 05/08/2012] [Accepted: 06/17/2012] [Indexed: 02/02/2023]
Abstract
A previous review concluded that postural sway is increased in patients with low back pain (LBP). However, more detailed analysis of the literature shows that postural deficit may be dependent on experimental conditions in which patients with LBP have been assessed. The research question to be answered in this review was: "Is there any difference in postural sway between subjects with and without LBP across several sensory manipulation conditions?". A literature search in Pubmed, Scopus, Embase and PsychInfo was performed followed by hand search and contact with authors. Studies investigating postural sway during bipedal stance without applying external forces in patients with specific and non-specific LBP compared to healthy controls were included. Twenty three articles fulfilled the eligibility criteria. Most studies reported an increased postural sway in LBP, or no effect of LBP on postural sway. In a minority of studies, a decreased sway was found in LBP patients. There were no systematic differences between studies finding an effect and those reporting no effect of LBP. The proportion of studies finding between-group differences did not increase with increased complexity of sensory manipulations. Potential factors that may have caused inconsistencies in the literature are discussed in this systematic review.
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Affiliation(s)
- Masood Mazaheri
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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98
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Ung H, Brown JE, Johnson KA, Younger J, Hush J, Mackey S. Multivariate classification of structural MRI data detects chronic low back pain. ACTA ACUST UNITED AC 2012; 24:1037-44. [PMID: 23246778 DOI: 10.1093/cercor/bhs378] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic low back pain (cLBP) has a tremendous personal and socioeconomic impact, yet the underlying pathology remains a mystery in the majority of cases. An objective measure of this condition, that augments self-report of pain, could have profound implications for diagnostic characterization and therapeutic development. Contemporary research indicates that cLBP is associated with abnormal brain structure and function. Multivariate analyses have shown potential to detect a number of neurological diseases based on structural neuroimaging. Therefore, we aimed to empirically evaluate such an approach in the detection of cLBP, with a goal to also explore the relevant neuroanatomy. We extracted brain gray matter (GM) density from magnetic resonance imaging scans of 47 patients with cLBP and 47 healthy controls. cLBP was classified with an accuracy of 76% by support vector machine analysis. Primary drivers of the classification included areas of the somatosensory, motor, and prefrontal cortices--all areas implicated in the pain experience. Differences in areas of the temporal lobe, including bordering the amygdala, medial orbital gyrus, cerebellum, and visual cortex, were also useful for the classification. Our findings suggest that cLBP is characterized by a pattern of GM changes that can have discriminative power and reflect relevant pathological brain morphology.
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Affiliation(s)
- Hoameng Ung
- Division of Pain Medicine, Department of Anesthesia
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99
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Claeys K, Dankaerts W, Janssens L, Brumagne S. Altered preparatory pelvic control during the sit-to-stance-to-sit movement in people with non-specific low back pain. J Electromyogr Kinesiol 2012; 22:821-8. [DOI: 10.1016/j.jelekin.2012.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 02/21/2012] [Accepted: 04/09/2012] [Indexed: 12/01/2022] Open
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Nelson-Wong E, Alex B, Csepe D, Lancaster D, Callaghan JP. Altered muscle recruitment during extension from trunk flexion in low back pain developers. Clin Biomech (Bristol, Avon) 2012; 27:994-8. [PMID: 22877831 DOI: 10.1016/j.clinbiomech.2012.07.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 07/09/2012] [Accepted: 07/10/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND A functionally induced, transient low back pain model consisting of exposure to prolonged standing has been used to elucidate baseline neuromuscular differences between previously asymptomatic individuals classified as pain developers and non-pain developers based on their pain response during a standing exposure. Previous findings have included differences in frontal plane lumbopelvic control and altered movement strategies that are present prior to pain development. Control strategies during sagittal plane movement have not been previously investigated in this sample. The purpose of this research was to investigate neuromuscular control differences during the extension phase from trunk flexion between pain developers and non-pain developers. METHODS Continuous electromyography and kinematic data were collected during standing trunk flexion and extension on 43 participants (22 male) with an age range of 18-33 years, prior to entering into the prolonged standing exposure. Participants were classified as pain developer/non-pain developer by their pain response (≥ 10 mm increase on a 100 mm visual analog scale) during standing. Relative timing and sequencing data between muscle pairs were calculated through cross-correlation analyses, and evaluated by group and gender. FINDINGS Pain developers demonstrated a 'top-down' muscle recruitment strategy with lumbar extensors activated prior to gluteus maximus, while non-pain developers demonstrated a typical 'bottom-up' muscle recruitment strategy with gluteus maximus activated prior to lumbar extensors. INTERPRETATION Individuals predisposed to low back pain development during standing exhibited altered neuromuscular strategies prior to pain development. These findings may help to characterize biomechanical movement profiles that could be important for early identification of people at risk for low back pain.
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Affiliation(s)
- Erika Nelson-Wong
- Regis University School of Physical Therapy, 3333 Regis Blvd, G4, Denver, CO 80221, USA.
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