Biomechanical comparison of isokinetic lifting and free lifting when applied to chronic low back pain rehabilitation

Isokinetic trunk training on pain, disability, and strength in non-specific low back pain patients: A systematic review and meta-analysis

BACKGROUND

Low back pain is one of the leading causes of disability globally, with a high economic and social burden. A decrease or imbalance in trunk strength has been associated with the occurrence of low back pain and its severity. Trunk strength training is helpful in the treatment of Non-specific low back pain (NSLBP) patients. However, we do not know the effects of trunk isokinetic training (IKT) on pain intensity, disability, and trunk strength.

OBJECTIVE

This systematic review aimed to determine the effects of trunk IKT in NSLBP patients on pain intensity, disability, and trunk flexor and extensor isokinetic strength.

METHODS

We searched PubMed, Web of Science, Scopus, CENTRAL, and PEDro, from January 2001 until March 2021 and updated to November 2022. Randomized controlled trials (RCTs) that investigated the effect of IKT in adult participants with NSLBP on pain intensity, disability, or isokinetic trunk strength were included. Mean difference (MD) and 95% confidence intervals (95% CI) were calculated for pain. Bias was assessed using the Cochrane risk of bias (RoB) tool and evidence certainty via Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

Among 1750 retrieved articles, eight were included in this review. Meta-analysis comparing IKT (trunk isokinetic training, n= 134) with control groups (conventional exercises, n= 133) revealed that IKT decreases pain intensity (MD -1.50 (95% CI: -2.60; -0.39)) immediately post-intervention, and one month (MD -1.97 (95% CI: -2.92; -1.03)) and at six months follow-up (MD -2.48 (95% CI: -2.77; -2.19)), although with a very low to low quality according to the GRADE rating. Besides, IKT decreases disability and increases isokinetic trunk strength, but with scant evidence.

CONCLUSIONS

Trunk IKT could be a novel clinical tool for pain management in patients with NSLBP, although evidence is scarce. In addition, few RCTs exist for IKT on disability or trunk isokinetic strength in patients with NSLBP. Therefore, further research on this topic is needed.

Reliability of trunk strength measurements with an isokinetic dynamometer in non-specific low back pain patients: A systematic review

BACKGROUND

Imbalance or decreased trunk strength has been associated with non-specific low back pain (NSLBP).

OBJECTIVE

This systematic review aimed (I) to evaluate the quality of evidence of studies evaluating the reliability of trunk strength assessment with an isokinetic dynamometer in NSLBP patients, (II) to examine the reliability of trunk strength assessment using an isokinetic dynamometer in NSLBP patients and (III) to determine the most reliable protocol for trunk strength assessment in NSLBP patients.

METHOD

PRISMA guidelines were followed. Three databases were used: PubMed, Scopus, and Web of Science with the following keywords: Isokinetic, Dynamometer, Trunk strength testing, Muscle testing, Isokinetic measurement, CORE, Abdominal muscles, Abdominal wall, Torso, Trunk, Spine, Reliability and, Reproducibility. We included only test-retest studies, focused on the reliability of isometric and isokinetic strength assessed with an isokinetic dynamometer in NSLBP adults' patients, published in English and from inception to March 30, 2021. The methodological quality was evaluated with the CAT scale and QAREL checklist.

RESULTS

Five hundred and seventy-seven articles were retrieved, of which five are included in this review. Three articles provide good quality of evidence, the reliability of trunk strength assessment in NSLBP patients is excellent, and the most reliable protocol for isometric assessment is in a seated position (ICC = 0.94-0.98) and for isokinetic strength in standing position, at 60∘/s and 120∘/s (ICC = 0.98).

CONCLUSION

There is good quality evidence regarding the trunk strength assessment's reliability. Reliability is excellent in NSLBP patients; however, a familiarization process should be considered to obtain clinically reliable data. The most reliable protocol is in a seated position for isometric strength and a standing position for isokinetic strength.

Isokinetic Trunk Strength in Acute Low Back Pain Patients Compared to Healthy Subjects: A Systematic Review

BACKGROUND

The purpose of this systematic review was to: (I) determine the quality of evidence from studies assessing trunk isokinetic strength in subjects with acute low back pain (ALBP) compared to healthy subjects and (II) establish reference values of isokinetic trunk strength in subjects with ALBP.

METHODOLOGY

Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statements were followed using keywords associated with trunk, strength and low back pain. Four databases were used: PubMed, Web of Science, Scopus and SPORTDiscus. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS).

RESULTS

A total of 1604 articles were retrieved, four included in this review. All were evaluated as high risk of bias (Rob). Due to the high Rob and the diversity of protocols, instruments and variables used, it was not possible to determine reference values for subjects with ALBP, we can only establish a range of flexion peak torque (PT) between 175.1 and 89.7 Nm at 60°/s and between 185 and 81.5 Nm at 120°/s, and for extension PT between 240.0 and 91.5 Nm at 60°/s and between 217.5 and 69.2 Nm at 120°/s in subjects with ALBP.

CONCLUSIONS

Due to the low quality of the evidence and the diversity of protocols used when measuring trunk isokinetic strength, it is necessary to carry out new high-quality research to establish reference values of trunk strength in subjects with ALBP.

Multiple-Joint Isokinetic Dynamometry: A Critical Review

Dvir, Z and Müller, S. Multiple-joint isokinetic dynamometry: a critical review. J Strength Cond Res 34(2): 587-601, 2020-Angular isokinetic dynamometry (AID) is widely regarded as the gold standard for dynamic muscle performance testing. Based on the rotational movement of its actuator, AID targets "single-joint" (knee, shoulder, hip, etc.) configurations namely measurement of muscle potential while it moves the lever arm-limb assembly ostensibly around a single fixed axis. On the other hand, the application of multiple-joint isokinetic dynamometry (MID) is relatively narrow, both in research and in practice. This situation is due, possibly, to the fact that these dynamometers are generally more limited in scope namely to testing/conditioning of combined hip, knee, ankle motion (leg press), combined shoulder, elbow motion, and lifting motion patterns, despite the fact that all 3 are associated with higher functionality. However, with the emerging importance of MID, this critical review takes a fresh look at its various aspects including the terminology and classification of multiple-joint isokinetic dynamometers; the problem of scaling namely the need to adjust the range of motion and linear velocities to subjective anthropometric measures; specific technical and methodological issues that underlie the valid application of these dynamometers; available reference values; and the reproducibility of MID-based test findings. Analysis of these topics indicates that MID may validly and effectively be applied for the assessment and conditioning of specific muscle action patterns. However, there is a clear need for standardization of tests and for conditioning protocols alongside research into the use of this method in various clinical cohorts.

Gait disorder rehabilitation using vision and non-vision based sensors: a systematic review

Even though the amount of rehabilitation guidelines has never been greater, uncertainty continues to arise regarding the efficiency and effectiveness of the rehabilitation of gait disorders. This question has been hindered by the lack of information on accurate measurements of gait disorders. Thus, this article reviews the rehabilitation systems for gait disorder using vision and non-vision sensor technologies, as well as the combination of these. All papers published in the English language between 1990 and June, 2012 that had the phrases "gait disorder", "rehabilitation", "vision sensor", or "non vision sensor" in the title, abstract, or keywords were identified from the SpringerLink, ELSEVIER, PubMed, and IEEE databases. Some synonyms of these phrases and the logical words "and", "or", and "not" were also used in the article searching procedure. Out of the 91 published articles found, this review identified 84 articles that described the rehabilitation of gait disorders using different types of sensor technologies. This literature set presented strong evidence for the development of rehabilitation systems using a markerless vision-based sensor technology. We therefore believe that the information contained in this review paper will assist the progress of the development of rehabilitation systems for human gait disorders.