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Bornhöft L, Arvidsson D, Bergenheim A, Börjesson M, Fridolfsson J, Hellgren M, Nordeman L, Larsson ME. Development and feasibility of a function-based preventive intervention for lifestyle-related disorders. BMC Public Health 2024; 24:681. [PMID: 38438859 PMCID: PMC10910714 DOI: 10.1186/s12889-024-18017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/06/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The enormous effect of lifestyle-related disorders on health of the global population warrants the development of preventive interventions. Focusing on musculoskeletal health and physical activity may be a way to encourage necessary lifestyle changes by making them more concrete and understandable. The aims of the current study were to develop a function-based preventive intervention aimed at lifestyle-related disorders in physically inactive 40-year-old people and to investigate the feasibility of the intervention. The feasibility study aimed to solve practical and logistical challenges and to develop the intervention based on the experiences of participants and involved clinical personnel according to defined criteria. METHODS Development of the standardised functional examination was based on literature-validated tests and clinical reasoning. Development of a risk profile was based on the functional examination and similar profiles which have already proved feasible. The feasibility of the functional examination and risk profile, together with function-based lifestyle counselling was tested on 27 participants in a pilot study with two physiotherapist examinations over a four-month period. Practical results and feedback from participants and collaborating personnel were examined. RESULTS The functional examination consists of 20 established tests not requiring specialised equipment or training which were deemed relevant for a middle-aged population and a sub-maximal ergometer test. The risk profile consists of seven functional dimensions: cardiovascular fitness, strength in upper extremity, lower extremity and trunk, mobility, balance and posture, and three non-functional dimensions: weight, self-assessed physical activity and pain. Each dimension contains at least two measures. The participants appreciated the intervention and found it motivating for making lifestyle changes. They found the tests and risk profile understandable and could see them as tools to help achieve concrete goals. The examination required 60-75 min for one physiotherapist. The recruitment rate was low and recruited participants were highly motivated to making lifestyle changes. CONCLUSION This project developed a functional test battery and risk profile aimed at inactive 40-year-olds which fulfilled our feasibility criteria. Functional screening and lifestyle counselling were found to be of value to a sub-group of inactive 40-year-olds who were already motivated to improve their health situations. TRIAL REGISTRATION ClinicalTrials.gov: NCT05535296 first posted on 10/09/2022.
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Affiliation(s)
- Lena Bornhöft
- Research, Education, Development, Innovation and Implementation, Primary Health Care, .
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
- Primary Care Rehabilitation, Närhälsan Torslanda Rehabilitation Clinic, Gothenburg, Region Västra Götaland, Sweden.
| | - Daniel Arvidsson
- Center for Health and Performance, Department of Food and Nutrition and Sport Science, Faculty of Education, University of Gothenburg, Gothenburg, Sweden
| | - Anna Bergenheim
- Research, Education, Development, Innovation and Implementation, Primary Health Care
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Center for Lifestyle Intervention, Department of MGAÖ, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Jonatan Fridolfsson
- Center for Health and Performance, Department of Food and Nutrition and Sport Science, Faculty of Education, University of Gothenburg, Gothenburg, Sweden
| | - Margareta Hellgren
- General practice - Family medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Skaraborg Institute, Skövde, Sweden
| | - Lena Nordeman
- Research, Education, Development, Innovation and Implementation, Primary Health Care
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Maria Eh Larsson
- Research, Education, Development, Innovation and Implementation, Primary Health Care
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Chang R, Smith A, Kent P, O'Sullivan P, Hancock M, Campbell A. How Movement Is Assessed Matters. Changes in Forward Bending During Cognitive Functional Therapy Treatment for People With Chronic Low Back Pain. J Orthop Sports Phys Ther 2024; 54:209-221. [PMID: 38113376 DOI: 10.2519/jospt.2023.12023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE: To investigate forward bending range of motion (ROM) and velocity in patients with low back pain who were receiving Cognitive Functional Therapy and determine (1) the amount and timing of change occurring at the trunk and pelvis (global angles), and lumbar spine (intersensor angle), and (2a) differences in changes between participants with and without sensor biofeedback, and (2b) participants with and without baseline movement limitation. DESIGN: Observational study. METHODS: Two hundred sixty-one participants attended Cognitive Functional Therapy treatment and wore sensors at the T12 and S2 spine levels while performing forward bending. Measures included ROM and velocity from both sensors, and the intersensor angle. Regression models estimated changes over time. Time-group interactions tested participants who were subgrouped by treatment and baseline movement. RESULTS: During the 90-day evaluation period, most change occurred in the first 21 days. Changes in ROM observed at T12 (3.3°, 95% CI: 1.0°, 5.5°; P = .001) and S2 (3.3°, 95% CI: 1.2°, 5.4°; P = .002) were similar. Intersensor angle remained similar (0.2°, 95% CI: -2.0°, -1.6°; P = .81). Velocity measured at T12 and S2, and the intersensor angle increased 8.5°/s (95% CI: 6.7°/s, 10.3°/s; P<.0001), 5.3°/s (95% CI: 4.0°/s, 6.5°/s; P<.0001), and 3.4°/s (95% CI: 2.4°/s, 4.5°/s; P<.0001), respectively, for 0 to 21 days. There were minimal differences in participants who received biofeedback. Larger increases occurred in participants with restricted ROM and slower velocity at baseline. CONCLUSION: During 0 to 21 days, we observed changes at the trunk and pelvis (especially in people with reduced ROM), and velocity changes across all measures (especially in people with baseline movement limitations). Biofeedback did not augment the changes. When targeting forward bending in people with low back pain, clinicians should monitor changes in velocity and global ROM. J Orthop Sports Phys Ther 2024;54(3):1-13. Epub 19 December 2023. doi:10.2519/jospt.2023.12023.
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Wood L, Booth V, Dean S, Foster NE, Hayden JA, Booth A. Understanding how therapeutic exercise prescription changes outcomes important to patients with persistent non-specific low back pain: a realist review protocol. Syst Rev 2024; 13:63. [PMID: 38331838 PMCID: PMC10854159 DOI: 10.1186/s13643-024-02466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/20/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Persistent low back pain (LBP) is the leading cause of disability worldwide, and therapeutic exercise is recommended as a first-line treatment in international guidelines. The effects of exercise on clinical outcomes of pain and physical function are small to moderate, despite broader impacts on cardiovascular systems, biological health, mood, and emotional well-being. Therapeutic exercise prescription is defined as exercise that is prescribed by a clinician for a health-related treatment. It is unknown how therapeutic exercise prescription creates effects on outcomes of importance. Realist reviews explore how underlying mechanisms (M) may be active in the context (C) of certain situations, settings, or populations to create an intended or unintended outcome (O). Our objective is to explore and understand the mechanisms by which therapeutic exercise prescription changes outcomes for people with persistent LBP. METHODS We will develop initial programme theories based on preliminary data from a previous systematic review and consensus workshop. These theories will be modified with input from a steering group (experts), a stakeholder group (people with lived experience of exercise for persistent LBP and clinicians), and a scoping search of the published literature. An information specialist will design and undertake an iterative search strategy. These will be used to create CMO configurations, which will be refined and tested using the literature. The realist review will be reported following RAMESES guidance. DISCUSSION Realist reviews are uncommon in LBP research to date, yet those offer an opportunity to contrast with traditional methods of randomised controlled trials and systematic reviews and provide additional information regarding the contexts and mechanisms that may trigger certain outcomes. This can aid our understanding of the contextual features that may influence exercise prescription, such as for whom they are most effective, in what setting, how they are implemented and why. This realist synthesis will enhance our understanding of therapeutic exercise prescription to improve adherence and engagement and ultimately will provide clinically relevant recommendations regarding exercise prescription for those with persistent LBP. SYSTEMATIC REVIEW REGISTRATION The review has been registered with PROSPERO (CRD42017072023).
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Affiliation(s)
- Lianne Wood
- Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences University of Exeter, Exeter, UK.
- Faculty of Medicine, University of Keele, Newcastle Under Lyme, UK.
- Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
| | - Sarah Dean
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Nadine E Foster
- Faculty of Medicine, University of Keele, Newcastle Under Lyme, UK
- Surgical, Treatment And Rehabilitation Service (STARS) Education and Research Alliance, Metro North Health and The University of Queensland, Brisbane, QLD, Australia
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Nzamba J, Van Damme S, Favre J, Christe G. The relationships between spinal amplitude of movement, pain and disability in low back pain: A systematic review and meta-analysis. Eur J Pain 2024; 28:37-53. [PMID: 37475698 DOI: 10.1002/ejp.2162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND AND OBJECTIVES The role of spinal movement alterations in low back pain (LBP) remains unclear. This systematic review and meta-analyses examined the relationships between spinal amplitude of movement, disability and pain intensity in patients with LBP. DATABASES AND DATA TREATMENT We searched PubMed, CINAHL, Embase, Pedro and Web of Science for relevant articles until 14th March 2023. Risk of bias was assessed with the Quality in Prognostic Studies Tool. We analysed the relationships between amplitude of movement, disability and pain intensity with standard correlational meta-analyses and meta-analytic structural equation modelling (MASEM) in cross-sectional and longitudinal data. RESULTS A total of 106 studies (9001 participants) were included. In cross-sectional data, larger amplitude of movement was associated with lower disability (pooled coefficient: -0.25, 95% confidence interval: [-0.29 to -0.21]; 69/5899 studies/participants) and pain intensity (-0.13, [-0.17 to -0.09]; 74/5806). An increase in amplitude of movement was associated with a decrease in disability (-0.23, [-0.31 to -0.15]; 33/2437) and pain intensity (-0.25, [-0.33 to -0.17]; 38/2172) in longitudinal data. MASEM revealed similar results and, in addition, showed that amplitude of movement had a very small influence on the pain intensity-disability relationship. CONCLUSIONS These results showed a significant but small association between amplitude of movement and disability or pain intensity. Moreover, they demonstrated a direct association between an increase in amplitude of movement and a decrease in pain intensity or disability, supporting interventions aiming to reduce protective spinal movements in patients with LBP. SIGNIFICANCE The large meta-analyses performed in this work revealed an association between reductions in spinal amplitude of movement and increased levels of disability and pain intensity in people with LBP. Moreover, it highlighted that LBP recovery is associated with a reduction in protective motor behaviour (increased amplitude of movement), supporting the inclusion of spinal movement in the biopsychosocial understanding and management of LBP.
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Affiliation(s)
- J Nzamba
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - S Van Damme
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - J Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - G Christe
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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Jain S, Shetty GM, Linjhara S, Chutani N, Ram CS. Do Improved Trunk Mobility and Isometric Strength Correlate with Improved Pain and Disability after Multimodal Rehabilitation for Low Back Pain? Rev Bras Ortop 2023; 58:e698-e705. [PMID: 37908535 PMCID: PMC10615606 DOI: 10.1055/s-0043-1768625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/18/2022] [Indexed: 11/02/2023] Open
Abstract
Objective To determine the correlation between posttreatment trunk range of motion (ROM) and isometric strength (TIS) and pain and disability in patients who underwent multimodal rehabilitation for low back pain (LBP). Methods In this prospective cohort study, 122 patients undergoing multimodal rehabilitation for LBP were analyzed. The pre- and posttreatment numerical pain rating scale (NPRS) and the Oswestry disability index (ODI) scores, as well as trunk ROM and TIS were compared. The Pearson correlation was used to determine correlation between posttreatment clinical outcomes and ROM and TIS. Results At the end of treatment, the mean NPRS ( p < 0.0001) and ODI ( p < 0.0001) scores, mean trunk extension ( p < 0.0001), and flexion ( p < 0.0001) ROMs improved significantly. Similarly, posttreatment, the mean extension ( p < 0.0001) and flexion ( p < 0.0001) TISs improved significantly. There was a weak correlation between the NPRS score and ROM extension (r = -0.24, p = 0.006) and flexion strength (r = -0.28, p = 0.001), as well as between the ODI score and TIS extension (r = -0.30, p = 0.0007) and flexion (r = -0.28, p = 0.001). Conclusion Despite significant improvement in pain, disability, trunk ROM, and TIS with multimodal treatment, there was a weak correlation between posttreatment pain and function and trunk ROM and TIS. Improvement in pain and function with physical rehabilitation treatment for LBP is a complex phenomenon and needs further investigation.
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Affiliation(s)
- Shikha Jain
- Fisioterapeuta sênior, QI Spine Clinic, Delhi, Índia
| | - Gautam M. Shetty
- Cirurgião ortopédico, chefe de Pesquisa e Excelência Clínica, QI Spine Clinic, Mumbai, Maharashtra, Índia
| | | | - Neha Chutani
- Fisioterapeuta sênior, QI Spine Clinic, Delhi, Índia
| | - C. S. Ram
- Professor, Faculdade de Fisioterapia I.T.S, Ghaziabad, Índia
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Vaz DV, Stilwell P, Coninx S, Low M, Liebenson C. Affordance-based practice: An ecological-enactive approach to chronic musculoskeletal pain management. Braz J Phys Ther 2023; 27:100554. [PMID: 37925996 PMCID: PMC10632936 DOI: 10.1016/j.bjpt.2023.100554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 08/16/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The biomedical understanding of chronic musculoskeletal pain endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. Although the biopsychosocial approach is an important advancement, it has a limited theoretical foundation. As such, it tends to be misinterpreted in manners that lead to artificial boundaries between the biological, psychological, and social, with fragmented and polarized clinical applications. OBJECTIVE We present an ecological-enactive approach to complement the biopsychosocial model. In this approach, the disabling aspect of chronic pain is characterized as an embodied, embedded, and enactive process of experiencing a closed-off field of affordances (i.e., shutting down of action possibilities). Pain is considered as a multi-dimensional, multicausal, and dynamic process, not locatable in any of the biopsychosocial component domains. Based on a person-centered reasoning approach and a dispositional view of causation, we present tools to reason about complex clinical problems in face of uncertainty and the absence of 'root causes' for pain. Interventions to open up the field of affordances include building ability and confidence, encouraging movement variability, carefully controlling contextual factors, and changing perceptions through action according to each patient's self-identified goals. A clinical case illustrates how reasoning based on an ecological-enactive approach leads to an expanded, multi-pronged, affordance-based intervention. CONCLUSIONS The ecological-enactive perspective can provide an overarching conceptual and practical framework for clinical practice, guiding and constraining clinicians to choose, combine, and integrate tools that are consistent with each other and with a true biopsychosocial approach.
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Affiliation(s)
- Daniela Virgínia Vaz
- Faculty of Physical Therapy Department and Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
| | - Peter Stilwell
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Sabrina Coninx
- Department of Philosophy, VU Amsterdam, Amsterdam, The Netherlands
| | - Matthew Low
- Christchurch Hospital, Fairmile Road, Dorset, United Kingdom; Visiting Fellow, Orthopaedic Research Institute, Bournemouth University, United Kingdom; Consultant Physical Therapist, University Hospitals NHS Foundation Trust, England
| | - Craig Liebenson
- Founder of First Principles of Movement, Director of L.A. Sports & Spine, Los Angeles, and Continuing Education faculty with Parker University, Dallas, United States
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Chen KK, Hutchinson MR, Rolan P, de Zoete RMJ. Effect of exercise on chronic neck pain and central sensitization: A protocol for a randomized crossover trial. Exp Physiol 2023; 108:672-682. [PMID: 36989062 PMCID: PMC10988480 DOI: 10.1113/ep091065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
Abstract
Exercise-induced hypoalgesia (EIH) has been found to vary widely within individuals with chronic neck pain (NP). Research has suggested that the presence of central sensitization within a subgroup of individuals with chronic NP might be a mediating factor to explain the relationship between exercise and improvements in patient-reported outcomes. Furthermore, recent work has found that lactate might play a role in the development and maintenance of chronic pain. The immediate effect of a single bout of physical exercise on central sensitization in individuals with chronic NP and the relationship between lactate concentration, central sensitization and pain sensitivity are to be investigated. Eighty adult participants with chronic NP will be recruited for this randomized crossover trial. Outcome measures, including temporal summation, conditioned pain modulation, EIH and lactate concentration, will be assessed before and after low- and high-intensity bicycling exercise. The outcomes of this study will provide new insights into the mechanistic effect of exercise on central sensitization in individuals with chronic NP and have the potential to add important information to the current exercise prescription guidelines for individuals with chronic NP. This study has been approved by the Human Research Ethics Committee, The University of Adelaide (H-2022-082) and registered in the Australian New Zealand Clinical Trials Registry (ACTRN12622000642785p).
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Affiliation(s)
- Kexun Kenneth Chen
- School of Allied Health Science and Practice, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Mark Rowland Hutchinson
- Adelaide Medical School, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
- Australian Research Council Centre of Excellence for Nanoscale BiophotonicsThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Paul Rolan
- Adelaide Medical School, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Rutger Marinus Johannes de Zoete
- School of Allied Health Science and Practice, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
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Liew BXW, Hartvigsen J, Scutari M, Kongsted A. Data-driven network analysis identified subgroup-specific low back pain pathways: a cross-sectional GLA:D Back study. J Clin Epidemiol 2023; 153:66-77. [PMID: 36396075 DOI: 10.1016/j.jclinepi.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To understand the physical, activity, pain, and psychological pathways contributing to low back pain (LBP) -related disability, and if these differ between subgroups. METHODS Data came from the baseline observations (n = 3849) of the "GLA:D Back" intervention program for long-lasting nonspecific LBP. 15 variables comprising demographic, pain, psychological, physical, activity, and disability characteristics were measured. Clustering was used for subgrouping, Bayesian networks (BN) were used for structural learning, and structural equation model (SEM) was used for statistical inference. RESULTS Two clinical subgroups were identified with those in subgroup 1 having worse symptoms than those in subgroup 2. Psychological factors were directly associated with disability in both subgroups. For subgroup 1, psychological factors were most strongly associated with disability (β = 0.363). Physical factors were directly associated with disability (β = -0.077), and indirectly via psychological factors. For subgroup 2, pain was most strongly associated with disability (β = 0.408). Psychological factors were common predictors of physical factors (β = 0.078), pain (β = 0.518), activity (β = -0.101), and disability (β = 0.382). CONCLUSIONS The importance of psychological factors in both subgroups suggests their importance for treatment. Differences in the interaction between physical, pain, and psychological factors and their contribution to disability in different subgroups may open the doors toward more optimal LBP treatments.
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Affiliation(s)
- Bernard X W Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, UK.
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Chiropractic Knowledge Hub, Odense, Denmark
| | - Marco Scutari
- Istituto Dalle Molle di Studi sull'Intelligenza Artificiale (IDSIA), Lugano, Switzerland
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Chiropractic Knowledge Hub, Odense, Denmark
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Mueller S, Mueller J, Stoll J, Mayer F. Effect of Six-Week Resistance and Sensorimotor Training on Trunk Strength and Stability in Elite Adolescent Athletes: A Randomized Controlled Pilot Trial. Front Physiol 2022; 13:802315. [PMID: 35370766 PMCID: PMC8969222 DOI: 10.3389/fphys.2022.802315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/08/2022] [Indexed: 12/29/2022] Open
Abstract
Intervention in the form of core-specific stability exercises is evident to improve trunk stability. The purpose was to assess the effect of an additional 6 weeks sensorimotor or resistance training on maximum isokinetic trunk strength and response to sudden dynamic trunk loading (STL) in highly trained adolescent athletes. The study was conducted as a single-blind, 3-armed randomized controlled trial. Twenty-four adolescent athletes (14f/10 m, 16 ± 1 yrs.;178 ± 10 cm; 67 ± 11 kg; training sessions/week 15 ± 5; training h/week 22 ± 8) were randomized into resistance training (RT; n = 7), sensorimotor training (SMT; n = 10), and control group (CG; n = 7). Athletes were instructed to perform standardized, center-based training for 6 weeks, two times per week, with a duration of 1 h each session. SMT consisted of four different core-specific sensorimotor exercises using instable surfaces. RT consisted of four trunk strength exercises using strength training machines, as well as an isokinetic dynamometer. All participants in the CG received an unspecific heart frequency controlled, ergometer-based endurance training (50 min at max. heart frequency of 130HF). For each athlete, each training session was documented in an individual training diary (e.g., level of SMT exercise; 1RM for strength exercise, pain). At baseline (M1) and after 6 weeks of intervention (M2), participants’ maximum strength in trunk rotation (ROM:63°) and flexion/extension (ROM:55°) was tested on an isokinetic dynamometer (concentric/eccentric 30°/s). STL was assessed in eccentric (30°/s) mode with additional dynamometer-induced perturbation as a marker of core stability. Peak torque [Nm] was calculated as the main outcome. The primary outcome measurements (trunk rotation/extension peak torque: con, ecc, STL) were statistically analyzed by means of the two-factor repeated measures analysis of variance (α = 0.05). Out of 12 possible sessions, athletes participated between 8 and 9 sessions (SMT: 9 ± 3; RT: 8 ± 3; CG: 8 ± 4). Regarding main outcomes of trunk performance, experimental groups showed no significant pre–post difference for maximum trunk strength testing as well as for perturbation compensation (p > 0.05). It is concluded, that future interventions should exceed 6 weeks duration with at least 2 sessions per week to induce enhanced trunk strength or compensatory response to sudden, high-intensity trunk loading in already highly trained adolescent athletes, regardless of training regime.
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Affiliation(s)
- Steffen Mueller
- Physiotherapy, Exercise Science and Applied Biomechanics, Department Computer Science – Therapy Sciences, Trier University of Applied Sciences, Trier, Germany
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of Potsdam, Potsdam, Germany
- *Correspondence: Steffen Mueller,
| | - Juliane Mueller
- Physiotherapy, Exercise Science and Applied Biomechanics, Department Computer Science – Therapy Sciences, Trier University of Applied Sciences, Trier, Germany
| | - Josefine Stoll
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Frank Mayer
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of Potsdam, Potsdam, Germany
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Christe G, Darlow B, Pichonnaz C. Changes in physiotherapy students' beliefs and attitudes about low back pain through pre-registration training. Arch Physiother 2021; 11:13. [PMID: 33993879 PMCID: PMC8126429 DOI: 10.1186/s40945-021-00106-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Implementation of best-practice care for patients with low back pain (LBP) is an important issue. Physiotherapists' who hold unhelpful beliefs are less likely to adhere to guidelines and may negatively influence their patients' beliefs. Pre-registration education is critical in moving towards a biopsychosocial model of care. This study aimed to investigate the changes in 2nd year physiotherapy students' beliefs about LBP after a module on spinal pain management and determine whether these changes were maintained at the end of academic training. METHODS During three consecutive calendar years, this longitudinal cohort study assessed physiotherapy students' beliefs with the Back Pain Attitudes Questionnaires (Back-PAQ) in their 1st year, before and after their 2nd year spinal management learning module, and at the end of academic training (3rd year). Unpaired t-tests were conducted to explore changes in Back-PAQ score. RESULTS The mean response rate after the spinal management module was 90% (128/143 students). The mean (± SD) Back-PAQ score was 87.73 (± 14.21) before and 60.79 (± 11.44) after the module, representing a mean difference of - 26.95 (95%CI - 30.09 to - 23.80, p < 0.001). Beliefs were further improved at the end of 3rd year (- 7.16, 95%CI - 10.50 to - 3.81, p < 0.001). CONCLUSIONS A spinal management learning module considerably improved physiotherapy students' beliefs about back pain. Specifically, unhelpful beliefs about the back being vulnerable and in need of protection were substantially decreased after the module. Improvements were maintained at the end of academic training one-year later. Future research should investigate whether modifying students' beliefs leads to improved clinical practice in their first years of practice.
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Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Claude Pichonnaz
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Department of Musculoskeletal Medicine, University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
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Kostadinović S, Milovanović N, Jovanović J, Tomašević-Todorović S. Efficacy of the lumbar stabilization and thoracic mobilization exercise program on pain intensity and functional disability reduction in chronic low back pain patients with lumbar radiculopathy: A randomized controlled trial. J Back Musculoskelet Rehabil 2021; 33:897-907. [PMID: 32675390 DOI: 10.3233/bmr-201843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Exercise programs in the treatment of chronic lumbar pain are quite diverse, but it has been proven that stabilization exercises are the most effective. OBJECTIVE We compared the lumbar stabilization exercise program in a closed and open kinetic chain (LSCO) and lumbar stabilization exercises and thoracic mobilization program in a closed kinetic chain (LSTMC), and evaluated the clinical effectiveness of each program. METHODS Prospective, randomized, controlled trial in 80 chronic low back pain (CLBP) patients with lumbar radiculopathy of both sexes (35 male, 45 female), average age (48.45 ± 10.22 years), divided in two groups that performed different sets of exercises. Participants were given laser therapy, transcutaneous electro-nerve stimulation and an eight-week kinesiotherapy that included exercises to strengthen the deep lumbar spine stabilizers. Retesting was done after four and eight weeks. RESULTS Statistically significant (p< 0.05) superior recovery of the LSTMC group subjects compared to the LSCO group was achieved at all measurement intervals in the pain intensity and functional disability parameters. CONCLUSION Patients who performed the lumbar stabilization and thoracic mobilization exercise program in a closed kinetic chain had the most effective reduction of pain intensity and functional disability.
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Affiliation(s)
- Stefan Kostadinović
- Medical Faculty, University of Novi Sad, Clinical Research, Novi Sad, Serbia
| | - Nenad Milovanović
- Rehabilitation Clinic "Dr. Miroslav Zotović" Belgrade, University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Jelena Jovanović
- Rehabilitation Clinic "Dr. Miroslav Zotović" Belgrade, University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Snežana Tomašević-Todorović
- Medical Faculty, University of Novi Sad, Medical Rehabilitation Clinic, Clinical Centre of Vojvodina, Novi Sad, Serbia
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12
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Johnson AW, Adams L, Kho JB, Green DM, Pace NB, Mitchell UH. Extended field-of-view ultrasound imaging is reliable for measuring Transversus Abdominis muscle size at rest and during contraction. BMC Musculoskelet Disord 2021; 22:282. [PMID: 33731070 PMCID: PMC7968206 DOI: 10.1186/s12891-021-04157-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/08/2021] [Indexed: 01/04/2023] Open
Abstract
Background The strength and size of core muscles, including the abdominal muscles, are crucial to proper function in most activities. Therefore, it is important to reliably assess these characteristics. Our primary objective was to determine if the length, thickness and cross-sectional area of the transversus abdominis (TrA) can be visualized independently from the internal and external abdominal oblique muscles using extended field of view ultrasound imaging at rest and with contraction and to establish its intra- and inter-tester reliability. Methods Twenty-six individuals were recruited to participate in the study (20 F, 6 M), average age 24.0 years (SD 9.4), height 170.7 cm (SD 8.6) and weight 63.9 kg (SD 9.0). From this total number of participants, two groups of 16 randomly selected participants were assessed to determine intra- and inter-tester reliability respectively. Extended field of view ultrasound images were obtained at three vertebral levels during rest and contraction in the side lying position for both the right and left sides of the trunk. Results Excellent intra-tester and inter-tester reliability was seen (ICC range of 0.972 to 0.984). The overall average percent standard error of the measurement for all measurements and locations was approximately 4%. The overall average minimal difference for the thickness measurement for the resting and contraction conditions combined were as follows: intratester 0.056 (0.014) cm and intertester 0.054 (0.017) cm, for area intratester 0.287 (0.086) cm2 and intertester 0.289 (0.101) cm2 and for length intratester 0.519 (0.097) cm and intertester 0.507 (0.085) cm. Conclusions Extended field of view ultrasound imaging is an effective method of reliably capturing clear images of the TrA during rest and contraction. It provides an efficient mechanism for the analysis of muscle morphology by being able to measure the cross-sectional area, thickness, and length on one image. This methodology is recommended for studies investigating TrA function and training.
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Affiliation(s)
- A Wayne Johnson
- Department of Exercise Sciences, Brigham Young University, 106 Smith Fieldhouse, Provo, UT, 84602, USA.
| | - Lauren Adams
- Department of Exercise Sciences, Brigham Young University, 106 Smith Fieldhouse, Provo, UT, 84602, USA
| | - Jade B Kho
- Department of Exercise Sciences, Brigham Young University, 106 Smith Fieldhouse, Provo, UT, 84602, USA
| | - Daniel M Green
- Department of Exercise Sciences, Brigham Young University, 106 Smith Fieldhouse, Provo, UT, 84602, USA
| | - Nicolas B Pace
- Department of Exercise Sciences, Brigham Young University, 106 Smith Fieldhouse, Provo, UT, 84602, USA
| | - Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, 106 Smith Fieldhouse, Provo, UT, 84602, USA
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Abstract
OBJECTIVE To investigate the relationship between changes in volitional spinal movement (including muscle activity) and changes in pain or activity limitation at the individual level in people with nonspecific low back pain. DESIGN Etiology systematic review. LITERATURE SEARCH MEDLINE, Embase, CINAHL, and AMED were searched from inception to January 2020. STUDY SELECTION CRITERIA The study included peer-reviewed articles that reported the relationship between changes in volitional spinal movement and changes in pain or activity limitation at the individual level in people with nonspecific low back pain. DATA SYNTHESIS The data were descriptively synthesized to identify a relationship between change in movement and improved pain or activity limitation. RESULTS We included 27 studies involving 2739 participants. There was low-quality evidence of a relationship between change in movement and change in pain or activity limitation at the individual level 31% of the time (20 of the 65 times investigated within the 27 studies). Increases in spinal range of motion, velocity, and flexion relaxation of the back extensors were consistently related to improved pain or activity limitation (93%, 18.5/20 relationships observed). CONCLUSION A relationship between changes in movement and changes in pain or activity limitation was infrequently observed at the individual level; however, a paucity of high-quality evidence precludes a definitive understanding of this relationship. J Orthop Sports Phys Ther 2020;50(12):664-680. Epub 28 Oct 2020. doi:10.2519/jospt.2020.9635.
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Cho JH, Lee KH, Lim ST. Aged Lumbar Extension Strength of Chronic Low Back Pain in Korean Population of 10-80 Years. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1894-1901. [PMID: 33346210 PMCID: PMC7719641 DOI: 10.18502/ijph.v49i10.4692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: The purpose of this study was to find the basic data of medical and exercise therapy by indexing lumbar extension muscle strength of low back pain (LBP) patients. Methods: In this cross-sectional study, 3078 chronic LBP participants from The J hospital, Seoul, Republic of Korea, from 2003 to 2010 were enrolled. Maximum muscle strength was measured at maximum flexion angle and maximum extension angle according to range of motion (ROM) results. For each isometric test, participants were seated and secured in the MEDX (medx lumbar extension machine, Ocala, FL, USA) machine. Results: The relative ROM (P=0.012) differed significantly among the aged groups in all participants. In addition, mean of strength (P<0.001), maximal of strength (P<0.001), mean of strength %BW (P<0.001) and maximal of strength %BW (P<0.001) are significant differences in all participants. The results of multiple regression analysis was the ‘model A’, maximal of strength for 32.1% of the variance in weigh, body mass index and range of motion. In addition, ‘model B’ was 30.4%, ‘model C’ was 28.8%, ‘model D’ was 28.5%, ‘model E’ was 21.7%, and ‘model F’ was 23.5% of the variance in weigh, body mass index and range of motion. Conclusion: We found the three predictor (weight, BMI, and ROM) variables accounted for 32.1% of the variance in maximal of strength %BW, the highest in < 29 yr groups. Our data indicate the basic data of medical and exercise therapy by indexing lumbar extension muscle strength of LBP patients.
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Affiliation(s)
- Ji-Hoon Cho
- Department of Sport and Leisure Studies, Shingyeong University, Hwaseong, Republic of Korea
| | - Ki-Hyuk Lee
- Department of Sport Culture, Dongguk University, Seoul, Republic of Korea
| | - Seung-Taek Lim
- Institute of Sport Science, Kangwon National University, Gangwon-do, Republic of Korea.,Nasaret International Hospital, Incheon, Republic of Korea.,Waseda Institute for Sport Sciences, Waseda University, Saitama, Japan
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15
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Clinical Assessment and Thickness Changes of the Oblique and Multifidus Muscles Using a Novel Screening Tool and Exercise Program: A Randomized Controlled Trial. J Sport Rehabil 2020; 30:384-394. [PMID: 32723925 DOI: 10.1123/jsr.2019-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 01/02/2020] [Accepted: 04/26/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Training and assessment of the abdominal and trunk muscles are widely used in the clinical setting. However, it is unknown what types of exercises are most effective in activation of both the global and local stabilizers in these regions. OBJECTIVE The purpose of this study was to establish the reliability of a novel clinical screening tool (sling screen) to assess the muscles of the abdomen and trunk. The second aim was to use the clinical screening tool and musculoskeletal ultrasound to compare the effects of a rotary-based exercise program that targets both the global and local muscles to the effects of a traditional exercise program on the activation of the abdominal and trunk muscles. DESIGN Double-blind, randomized controlled trial. SETTING Sports medicine facility. PARTICIPANTS AND INTERVENTIONS Thirty-one healthy participants were randomly allocated to receive a single-session rotary-based or traditional "core" exercise program. MAIN OUTCOME MEASURES The participants were assessed at the baseline and immediately postintervention. The primary outcome measures were muscle thickness examined by musculoskeletal ultrasound and clinical examination of muscle activation using a screening tool. The data were collected by blind assessors. Reliability and validity of a clinical screening tool (sling screen) were also assessed. RESULTS The analysis of the covariance tests showed a significant increase in oblique thickness for the rotary exercise group. All participants displayed a significant increase in multifidus thickness. The Wilcoxon signed-rank tests revealed a significant increase in clinical assessment scores in the rotary exercise group but not the traditional exercise group. Reliability of the sling screen ranged from moderate to good. CONCLUSION This clinical trial provides evidence that a rotary-based exercise program may be more effective in producing increases in oblique muscle thickness than traditional "core" exercises in young, healthy adults. The sling screen tool was able to identify these muscle thickness changes. Future studies should investigate how these results correlate to injury risk, other populations, and also how to implement the sling screen into clinical practice.
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Wernli K, O'Sullivan P, Smith A, Campbell A, Kent P. Movement, posture and low back pain. How do they relate? A replicated single-case design in 12 people with persistent, disabling low back pain. Eur J Pain 2020; 24:1831-1849. [PMID: 32621351 DOI: 10.1002/ejp.1631] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/11/2020] [Accepted: 06/28/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Movement and posture are commonly believed to relate to non-specific low back pain (NSLBP). While people with NSLBP appear to move and posture themselves differently from those without NSLBP, changes in movement and posture infrequently relate to improvements in NSLBP when analysed at a group-level. Additionally, little is known about how movement or posture change when clinical outcome improves. METHODS Within-person relationships were investigated using a replicated, repeated measures, single-case design in 12 people with persistent, disabling NSLBP. Individually relevant movement and posture were captured using wearable sensors on up to 20 occasions over a 22-week period (5-week baseline, 12-week physiotherapy-led intervention, 5-week follow-up), while pain and activity limitation were collected concomitantly. A series of cross-correlation analyses estimated the presence, strength, and direction of relationships. RESULTS Many participants (n = 10/12) had strong (e.g. r = 0.91, p = <0.001) relationships between changes in movement or posture and changes in pain and activity limitation, while some showed no strong association. Where relationships were observed, clinical improvement predominantly (93% or 57/61 relationships) related to increased spinal movement range and velocity during forward bending and lifting, reduced lumbar muscle EMG activity at maximum voluntary flexion, and increased posterior-pelvic-tilt during sitting and standing. CONCLUSION Within-person changes to individually relevant movement and posture appear to often relate to clinical outcome, but not always. When changes were related, movement and posture appear to return towards being 'less protective', however causal directions remain unknown. Important activities, movements, and postural parameters varied across the participants, highlighting the potential importance of individualized management. SIGNIFICANCE Changes to individually relevant movement and posture appear to often relate to clinical outcome, but not always. Patient-specific activities, and movement or postural parameters that related to improved pain and activity limitation, varied across the 12 participants, highlighting the potential importance of individualised management. Where clinical improvements were related to changes in movement or posture, participants consistently returned towards being 'less protective' (increased range and speed of movement, increased posterior-pelvic-tilt during sitting and standing). Mechanisms and generalizability remain unclear.
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Affiliation(s)
- Kevin Wernli
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
- Body Logic Physiotherapy, Perth, Western Australia, Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
- Body Logic Physiotherapy, Perth, Western Australia, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Amity Campbell
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Peter Kent
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Development of the "Core Yellow Flags Index" (CYFI) as a brief instrument for the assessment of key psychological factors in patients undergoing spine surgery. 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 2020; 29:1935-1952. [DOI: 10.1007/s00586-020-06462-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/10/2020] [Indexed: 12/21/2022]
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18
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Jung SH, Hwang UJ, Ahn SH, Kim HA, Kim JH, Kwon OY. Lumbopelvic motor control function between patients with chronic low back pain and healthy controls: a useful distinguishing tool: The STROBE study. Medicine (Baltimore) 2020; 99:e19621. [PMID: 32282709 PMCID: PMC7440336 DOI: 10.1097/md.0000000000019621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/28/2022] Open
Abstract
Although lumbopelvic stability exercise improves lumbopelvic motor control function in patients with chronic low back pain (CLBP), the difference in lumbopelvic motor control function between the patients with CLBP and the healthy controls is unclear. The purpose of this study was to compare lumbopelvic motor control function between patients with CLBP and healthy controls and to determine the prevalence of CLBP according to core stability function.For this study, 278 participants were recruited, including patients with CLBP (n = 137) and healthy controls (n = 141). The participants performed a core stability function test and were classified to either the low or high core stability function group according to their core stability function for CLBP prevalence analysis.Lumbopelvic motor control was significantly higher in the healthy controls than in patients with CLBP. Of the patients in the low lumbopelvic motor control function group, 65.9% had CLBP, whereas 36.8% of the patients in the high lumbopelvic motor control function group had CLBP. Lumbopelvic motor control function demonstrated a significant difference between the patients with CLBP and the healthy controls. The lumbopelvic motor control function test was demonstrated to be an effective diagnostic tool for distinguishing CLBP. This information can be applied in assessments and interventions for CLBP in clinical settings.
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Affiliation(s)
- Sung-hoon Jung
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea
| | - Ui-jae Hwang
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea
| | - Sun-hee Ahn
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - Hyun-a Kim
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - Jun-hee Kim
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - Oh-yun Kwon
- Department of Physical Therapy, Kinetic Ergocise Based on Movement Analysis Laboratory, College of Health Science, Yonsei University, Wonju, South Korea
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Augeard N, Carroll SP. Core stability and low-back pain: a causal fallacy. J Exerc Rehabil 2019; 15:493-495. [PMID: 31316947 PMCID: PMC6614774 DOI: 10.12965/jer.1938198.099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/19/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Nathan Augeard
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sean Paul Carroll
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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van Dieën JH, Reeves NP, Kawchuk G, van Dillen LR, Hodges PW. Analysis of Motor Control in Patients With Low Back Pain: A Key to Personalized Care? J Orthop Sports Phys Ther 2019; 49:380-388. [PMID: 29895232 PMCID: PMC7393666 DOI: 10.2519/jospt.2019.7916] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SYNOPSIS Motor control exercise has been shown to be effective in the management of low back pain (LBP). However, the effect sizes for motor control exercise are modest, possibly because studies have used a one-size-fits-all approach, while the literature suggests that patients may differ in presence or type of motor control issues. In this commentary, we address the question of whether consideration of such variation in motor control issues might contribute to more personalized motor control exercise for patients with LBP. Such an approach is plausible, because motor control changes may play a role in persistence of pain through effects on tissue loading that may cause nociceptive afference, particularly in the case of peripheral sensitization. Subgrouping systems used in clinical practice, which comprise motor control aspects, allow reliable classification that is, in part, aligned with findings in studies on motor control in patients with LBP. Motor control issues may have heuristic value for treatment allocation, as the different presentations observed suggest different targets for motor control exercise, but this remains to be proven. Finally, clinical assessment of patients with LBP should take into account more aspects than motor control alone, including pain mechanisms, musculoskeletal health, and psychosocial factors, and may need to be embedded in a stratification approach based on prognosis to avoid undue diagnostic procedures. J Orthop Sports Phys Ther 2019;49(6):380-388. Epub 12 Jun 2018. doi:10.2519/jospt.2019.7916.
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Ehsani F, Sahebi N, Shanbehzadeh S, Arab AM, ShahAli S. Stabilization exercise affects function of transverse abdominis and pelvic floor muscles in women with postpartum lumbo-pelvic pain: a double-blinded randomized clinical trial study. Int Urogynecol J 2019; 31:197-204. [DOI: 10.1007/s00192-019-03877-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/10/2019] [Indexed: 01/13/2023]
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Larivière C, Henry SM, Gagnon DH, Preuss R, Dumas J. Ultrasound Measures of the Abdominal Wall in Patients with Low Back Pain Before and After an 8‐week Lumbar Stabilization Exercise Program, and Their Association With Clinical Outcomes. PM R 2019; 11:710-721. [DOI: 10.1002/pmrj.12000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Christian Larivière
- Institut de recherche Robert‐Sauvé en santé et en sécurité du travail (IRSST), 505, boul. De Maisonneuve Ouest Montréal Québec H3A 3C2 Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM)Centre intégré universitaire de santé et de services sociaux du Centre‐Sud‐de‐l'Ile‐de‐Montréal (CCSMTL)MontréalQuébecCanada
| | - Sharon M. Henry
- Department of Rehabilitation TherapyThe University of Vermont Medical Center Burlington VT
| | - Dany H. Gagnon
- School of Rehabilitation, Faculty of MedicineUniversité de Montréal Montréal Québec Canada
| | - Richard Preuss
- School of Physical & Occupational TherapyMcGill University Montréal Québec Canada
| | - Jean‐Pierre Dumas
- School of Rehabilitation, Faculty of MedicineUniversité de Sherbrooke Sherbrooke Québec Canada
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Knox MF, Chipchase LS, Schabrun SM, Romero RJ, Marshall PWM. Anticipatory and compensatory postural adjustments in people with low back pain: a systematic review and meta-analysis. Spine J 2018; 18:1934-1949. [PMID: 29906616 DOI: 10.1016/j.spinee.2018.06.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT Despite altered anticipatory (APAs) and compensatory postural adjustments (CPAs) being hypothesized to contribute to the onset and persistence of low back pain (LBP), results from studies comparing people with and without LBP are conflicting. PURPOSE This systematic review aimed to determine whether APAs or CPAs are altered in the presence of acute and chronic LBP. STUDY DESIGN A systematic review of studies was carried out. PATIENT SAMPLE No patient sample was required. OUTCOME MEASURES Between group standardized mean differences and 95% confidence intervals for APAs ad CPAs METHODS: A comprehensive search was conducted for articles comparing people with LBP (acute or chronic) to healthy controls for the onset or amplitude of muscle activity, center of pressure (COP), or kinematic responses to expected or unexpected perturbations. Two independent reviewers extracted data and assessed the methodological quality of relevant studies. Differences between people with and without LBP were calculated as standardized mean differences, and included in a meta-analysis if outcomes were homogeneous. Otherwise, a narrative synthesis was conducted. RESULTS Twenty-seven studies were included, of which the majority examined muscle onsets in response to expected and unexpected perturbations. Only two studies compared people with and without acute LBP, and results for these studies were conflicting. The results show delayed muscle onsets in response to expected and unexpected perturbations for people with chronic LBP when compared with healthy controls. No conclusive evidence for differences between people with and without chronic LBP for COP or kinematic responses. CONCLUSIONS There is currently no convincing evidence of differences between people with and without acute LBP for APAs or CPAs. Conversely, delayed muscle onsets in people with chronic LBP suggest APAs and CPAs are altered in this population. However, the functional relevance of these delayed muscle onsets (eg, COP and kinematics) is unknown.
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Affiliation(s)
- Michael F Knox
- School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia.
| | - Lucy S Chipchase
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Siobhan M Schabrun
- School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Rick J Romero
- School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Paul W M Marshall
- School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia
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Mueller J, Stoll J, Mueller S, Mayer F. Dose-response relationship of core-specific sensorimotor interventions in healthy, well-trained participants: study protocol for a (MiSpEx) randomized controlled trial. Trials 2018; 19:424. [PMID: 30081948 PMCID: PMC6090836 DOI: 10.1186/s13063-018-2799-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 07/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Core-specific sensorimotor exercises are proven to enhance neuromuscular activity of the trunk, improve athletic performance and prevent back pain. However, the dose-response relationship and, therefore, the dose required to improve trunk function is still under debate. The purpose of the present trial will be to compare four different intervention strategies of sensorimotor exercises that will result in improved trunk function. METHODS/DESIGN A single-blind, four-armed, randomized controlled trial with a 3-week (home-based) intervention phase and two measurement days pre and post intervention (M1/M2) is designed. Experimental procedures on both measurement days will include evaluation of maximum isokinetic and isometric trunk strength (extension/flexion, rotation) including perturbations, as well as neuromuscular trunk activity while performing strength testing. The primary outcome is trunk strength (peak torque). Neuromuscular activity (amplitude, latencies as a response to perturbation) serves as secondary outcome. The control group will perform a standardized exercise program of four sensorimotor exercises (three sets of 10 repetitions) in each of six training sessions (30 min duration) over 3 weeks. The intervention groups' programs differ in the number of exercises, sets per exercise and, therefore, overall training amount (group I: six sessions, three exercises, two sets; group II: six sessions, two exercises, two sets; group III: six sessions, one exercise, three sets). The intervention programs of groups I, II and III include additional perturbations for all exercises to increase both the difficulty and the efficacy of the exercises performed. Statistical analysis will be performed after examining the underlying assumptions for parametric and non-parametric testing. DISCUSSION The results of the study will be clinically relevant, not only for researchers but also for (sports) therapists, physicians, coaches, athletes and the general population who have the aim of improving trunk function. TRIAL REGISTRATION German Clinical Trials Register, ID: DRKS00012917 . Registered on 22 August 2017.
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Affiliation(s)
- Juliane Mueller
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of Potsdam, Am Neuen Palais 10, House 12, 14469, Potsdam, Germany.
| | - Josefine Stoll
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of Potsdam, Am Neuen Palais 10, House 12, 14469, Potsdam, Germany
| | - Steffen Mueller
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of Potsdam, Am Neuen Palais 10, House 12, 14469, Potsdam, Germany.,Professorship for Physiotherapy: Exercise Science and Applied Biomechanics, Trier University of Applied Sciences, Trier, Germany
| | - Frank Mayer
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of Potsdam, Am Neuen Palais 10, House 12, 14469, Potsdam, Germany
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Abstract
PURPOSE OF REVIEW Physical activity is increasingly recommended for chronic pain. In this review, we briefly survey recent, high-quality meta-analyses on the effects of exercise in human chronic pain populations, followed by a critical discussion of the rodent literature. RECENT FINDINGS Most meta-analytical studies on the effects of exercise in human chronic pain populations describe moderate improvements in various types of chronic pain, despite substantial variability in the outcomes reported in the primary literature. The most consistent findings suggest that while greater adherence to exercise programs produces better outcomes, there is minimal support for the superiority of one type of exercise over another. The rodent literature similarly suggests that while regular exercise reduces hypersensitivity in rodent models of chronic pain, exercise benefits do not appear to relate to either the type of injury or any particular facet of the exercise paradigm. Potential factors underlying these results are discussed, including the putative involvement of stress-induced analgesic effects associated with certain types of exercise paradigms. Exercise research using rodent models of chronic pain would benefit from increased attention to the role of stress in exercise-induced analgesia, as well as the incorporation of more clinically relevant exercise paradigms.
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Affiliation(s)
- Mark Henry Pitcher
- Pain and Integrative Neuroscience Laboratory, National Center for Complementary and Integrative Health, National Institutes of Health, Room 1E-420, 35A Convent Drive, Bethesda, MD, 20892, USA.
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Trunk postural adjustments: Medium-term reliability and correlation with changes of clinical outcomes following an 8-week lumbar stabilization exercise program. J Electromyogr Kinesiol 2018; 41:66-76. [DOI: 10.1016/j.jelekin.2018.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/09/2018] [Accepted: 04/20/2018] [Indexed: 12/25/2022] Open
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Palsson TS, Caneiro JP, Hirata RP, Griffin D, Gibson W, Travers MJ. Commentary: Trunk Muscle Activity during Drop Jump Performance in Adolescent Athletes with Back Pain. Front Physiol 2018; 9:298. [PMID: 29755359 PMCID: PMC5932380 DOI: 10.3389/fphys.2018.00298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/13/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Thorvaldur S. Palsson
- Department of Health Science and Technology, Sanse-Motorisk Interaktion (SMI), Aalborg University, Aalborg, Denmark
- *Correspondence: Thorvaldur S. Palsson
| | - J. P. Caneiro
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
- Body Logic Physiotherapy Clinic, Perth, WA, Australia
| | - Rogerio Pessoto Hirata
- Department of Health Science and Technology, Sanse-Motorisk Interaktion (SMI), Aalborg University, Aalborg, Denmark
| | | | - William Gibson
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Mervyn J. Travers
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
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Mueller J, Hadzic M, Mugele H, Stoll J, Mueller S, Mayer F. Effect of high-intensity perturbations during core-specific sensorimotor exercises on trunk muscle activation. J Biomech 2018; 70:212-218. [DOI: 10.1016/j.jbiomech.2017.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 11/14/2017] [Accepted: 12/07/2017] [Indexed: 10/18/2022]
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Steele J, Fisher J, Perrin C, Conway R, Bruce-Low S, Smith D. Does change in isolated lumbar extensor muscle function correlate with good clinical outcome? A secondary analysis of data on change in isolated lumbar extension strength, pain, and disability in chronic low back pain. Disabil Rehabil 2018; 41:1287-1295. [DOI: 10.1080/09638288.2018.1424952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- James Steele
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - James Fisher
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - Craig Perrin
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - Rebecca Conway
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - Stewart Bruce-Low
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - Dave Smith
- Department of Exercise and Sport Science, Manchester Metropolitan University, Manchester, UK
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Knox MF, Chipchase LS, Schabrun SM, Marshall PWM. Improved compensatory postural adjustments of the deep abdominals following exercise in people with chronic low back pain. J Electromyogr Kinesiol 2017; 37:117-124. [PMID: 29080466 DOI: 10.1016/j.jelekin.2017.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to determine if 8 weeks of exercise affects motor control in people with chronic low back pain (CLBP), measured by anticipatory (APAs) and compensatory postural adjustments (CPAs). APAs and CPAs were measured prior to and following 8 weeks in two groups of people with CLBP: an exercise group (n=12) who attended three exercise sessions per week for 8 weeks; and a non-exercise control group (n=12) who were advised to continue their usual activities for the duration of the study. APAs and CPAs were recorded during unilateral arm flexion, bilaterally from rectus abdominis (RA), transverse abdominis/internal oblique (TA/IO), and erector spinae (ES) via surface electromyography. Analysis of muscle onsets and APA amplitudes suggests APAs did not change for either group. Ipsi-lateral TA/IO CPAs increased for the exercise group and ipsi-lateral TA/IO CPAs decreased for the control group. Only exercise promoted a pattern of TA/IO activity during CPAs similar to healthy individuals, suggesting improved control of rotational torques. These results show motor control improvement following exercise in people with CLBP, highlighted by improved side specific control of TA/IO.
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Affiliation(s)
- Michael F Knox
- Western Sydney University, School of Science and Health, Campbelltown, New South Wales 2751, Australia.
| | - Lucy S Chipchase
- Western Sydney University, School of Science and Health, Campbelltown, New South Wales 2751, Australia.
| | - Siobhan M Schabrun
- Western Sydney University, School of Science and Health, Campbelltown, New South Wales 2751, Australia.
| | - Paul W M Marshall
- Western Sydney University, School of Science and Health, Campbelltown, New South Wales 2751, Australia.
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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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Fryer G. Integrating osteopathic approaches based on biopsychosocial therapeutic mechanisms. Part 1: The mechanisms. INT J OSTEOPATH MED 2017. [DOI: 10.1016/j.ijosm.2017.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Letafatkar A, Nazarzadeh M, Hadadnezhad M, Farivar N. The efficacy of a HUBER exercise system mediated sensorimotor training protocol on proprioceptive system, lumbar movement control and quality of life in patients with chronic non-specific low back pain. J Back Musculoskelet Rehabil 2017; 30:767-778. [PMID: 28453452 DOI: 10.3233/bmr-150404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is a relation between deficits of the proprioceptive system and movement control dysfunction in patients with chronic low back pain (LBP) but, the exact mechanism of this relation is unknown. Exercise therapy has been recognized as an effective method for low back pain treatment. In spite of this, it is not clear which of the various exercise therapy programs lead to better results. OBJECTIVE Therefore, the present analyze the efficacy of a HUBER study aims to exercise system mediated sensorimotor training protocol on proprioceptive system, lumbar movement control (LMC) and quality of life (QOL) in patients with chronic non-specific LBP. DESIGN Quasi-experimental study. METHODS 53 patients with chronic non-specific LBP (mean age 37.55 ± 6.67 years,and Body Mass Index (BMI) 22.4 ± 3.33) were selected by using Roland-Morris Disability Questionnaire (RMQ) and were assigned into two experimental (N= 27) and control groups (N= 26) The experimental group underwent a five-week (10 sessions) Sensorimotor training by using the Human Body Equalizer (HUBER) spine force under the supervision of an investigator. The movement control battery tests, the HUBER machine testing option, goniometer and visual analogue scale used for movement control, neuromuscular coordination, proprioception and LBP assessment respectively. The assessments were completed in pre-test and after five weeks. The paired and sample T tests were used for data analysis in SPSS program version 18 (Significance level were set at a P value < 0.05). RESULTS The HUBER system mediated sensorimotor training demonstrated significant improvement in the proprioceptive system, LMC and QOL (P= 0.001). Also There was a significant reduction in the pain scores of subjects with chronic non-specific LBP in the sensorimotor group (P= 0.001). LIMITATIONS In this study, only the short term effects of the sensorimotor training were examined. CONCLUSIONS The results suggest that a sensorimotor training program causes significant improvement in patients with chronic non-specific LBP. Future research should be carried out with a larger sample size to examine the long term effects of the sensorimotor training program on treatment of patients with chronic non-specific LBP. Considering the efficacy of the sensorimotor training, it is recommended that this intervention should be applied to treatment of patients with chronic non-specific LBP in the future.
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Affiliation(s)
- Amir Letafatkar
- Department of Biomechanics and Sport injuries, Faculty of Physical Education and Sport Science, Kharazmi University, Tehran, Iran
| | - Maryam Nazarzadeh
- Faculty of Physical Education and Sport Science, Department of health and Sport Medicine, Broujed University, Tehran, Iran
| | - Malihe Hadadnezhad
- Department of Biomechanics and Sport injuries, Faculty of Physical Education and Sport Science, Kharazmi University, Tehran, Iran
| | - Niloufar Farivar
- Department of Biomechanics and Sport injuries, Faculty of Physical Education and Sport Science, Kharazmi University, Tehran, Iran
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Marshall PWM, Schabrun S, Knox MF. Physical activity and the mediating effect of fear, depression, anxiety, and catastrophizing on pain related disability in people with chronic low back pain. PLoS One 2017; 12:e0180788. [PMID: 28686644 PMCID: PMC5501599 DOI: 10.1371/journal.pone.0180788] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 06/21/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic low back pain is a worldwide burden that is not being abated with our current knowledge and treatment of the condition. The fear-avoidance model is used to explain the relationship between pain and disability in patients with chronic low back pain. However there are gaps in empirical support for pathways proposed within this model, and no evidence exists as to whether physical activity moderates these pathways. METHODS This was a cross-sectional study of 218 people with chronic low back pain. Multiple mediation analyses were conducted to determine the role of fear, catastrophizing, depression, and anxiety in the relationship between pain and disability. Separate analyses were performed with physical activity as the moderator. Individuals were classified as performing regular structured physical activity if they described on average once per week for > 30-minutes an activity classified at least moderate intensity (≥ 4-6 METs), activity prescribed by an allied health professional for their back pain, leisure time sport or recreation, or self-directed physical activity such as resistance exercise. RESULTS Fear, catastrophizing, and depression significantly mediated the relationship between pain and disability (p<0.001). However the mediating effect of catastrophizing was conditional upon weekly physical activity. That is, the indirect effect for catastrophizing mediating the relationship between pain and disability was only significant for individuals reporting weekly physical activity (B = 1.31, 95% CI 0.44 to 2.23), compared to individuals reporting no weekly physical activity (B = 0.21, 95% CI -0.50 to 0.97). Catastrophizing also mediated the relationship between pain and fear (B = 0.37, 95% CI 0.15 to 0.62), with higher scores explaining 53% of the total effect of pain on fear. CONCLUSIONS These results support previous findings about the importance of fear and depression as factors that should be targeted in low back pain patients to reduce back pain related disability. We have also extended understanding for the mediating effect of catastrophizing on back pain related disability. Back pain patients engaged with regular physical activity may require counselling with regards to negative pain perceptions.
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Affiliation(s)
- Paul W. M. Marshall
- School of Science and Health, Western Sydney University, Penrith South, New South Wales, AUSTRALIA
| | - Siobhan Schabrun
- School of Science and Health, Western Sydney University, Penrith South, New South Wales, AUSTRALIA
| | - Michael F. Knox
- School of Science and Health, Western Sydney University, Penrith South, New South Wales, AUSTRALIA
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Psychometric Properties of the Deep Muscle Contraction Scale for Assessment of the Drawing-in Maneuver in Patients With Chronic Nonspecific Low Back Pain. J Orthop Sports Phys Ther 2017; 47:432-441. [PMID: 28504068 DOI: 10.2519/jospt.2017.7140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design A prospective cohort study. Background Motor control dysfunctions have been commonly reported in patients with chronic nonspecific low back pain (LBP). Physical therapists need clinical tools with adequate psychometric properties to assess such patients in clinical practice. The deep muscle contraction (DMC) scale is a clinical rating scale for assessing patients' ability to voluntarily contract deep abdominal muscles. Objectives To investigate the intrarater reliability, floor and ceiling effects, internal and external responsiveness, and correlation analysis (with ultrasound measures) of the DMC scale in patients with chronic nonspecific LBP undergoing a lumbar stabilization exercise program. Methods Sixty-two patients with chronic nonspecific LBP were included. At baseline, self-report questionnaires were administered to patients and a trained assessor evaluated abdominal muscle recruitment with the DMC scale and ultrasound imaging. Four ratios of the change in abdominal muscle thickness between the resting and contracted states were calculated through the ultrasound measures. After 1 week, the same ultrasound measures and DMC scale were collected again for the reliability analysis. The proportions of patients with the lowest and highest scores on the DMC scale were calculated to investigate floor and ceiling effects. All patients underwent a lumbar stabilization program, administered twice a week for 8 weeks. After the treatment period, all measures were collected again, with the addition of the global perceived effect scale, to assess the internal and external responsiveness of the measures. Correlation coefficients between ultrasound ratios and DMC scale total and subscale scores were also calculated. Results The intrarater reliability of the DMC scale and the 4 ratios of abdominal muscle thickness varied from moderate to excellent. The DMC scale showed no floor or ceiling effects. Results for internal responsiveness of the DMC scale showed large effect sizes (2.26; 84% confidence interval [CI]: 2.06, 2.45), whereas the external responsiveness was below the proposed threshold (area under the curve = 0.54; 95% CI: 0.39, 0.68). Fair and significant correlations between some ultrasound ratios and DMC subscales were found. Conclusion The DMC scale was demonstrated to be a reliable tool, with no ceiling and floor effects, and to detect change in the ability to contract the deep abdominal muscles after a lumbar stabilization exercise program, but with low accuracy for estimating patient-perceived clinical outcome. J Orthop Sports Phys Ther 2017;47(6):432-441. doi:10.2519/jospt.2017.7140.
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Rahmani N, Kiani A, Mohseni-Bandpei MA, Abdollahi I. Multifidus muscle size in adolescents with and without back pain using ultrasonography. J Bodyw Mov Ther 2017; 22:147-151. [PMID: 29332739 DOI: 10.1016/j.jbmt.2017.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purposes of this study were; a) to compare multifidus muscle cross sectional area (CSA) in male adolescents suffering from low back pain (LBP) with healthy male adolescents using ultrasonography (US), and b) to assess the correlation between multifidus muscle size and demographic variables. METHODS A random sample of 40 healthy boys (as a control group) and 40 boys with LBP (as an experimental group) at the age range of 15-18 years was recruited in the present cohort study. Multifidus muscle dimensions including CSA, antero-posterior and medio-lateral dimensions were measured at level of L5 in both groups using US. RESULTS The results of an independent t-test to compare multifidus muscle size between the experimental and control groups showed a significant difference between the two groups in terms of CSA, antro-posterior and medio-lateral dimensions so that the experimental group had smaller muscle size than the control group. A significant correlation was found between height, weight and body mass index (BMI) and multifidus muscle size, but no significant correlation was observed between age and muscle size. Pain intensity and functional disability index was significantly correlated with muscle size in the experimental group. CONCLUSIONS According to the results, multifidus muscle size was decreased in 15-18 years old male adolescents suffering from LBP compared with their healthy counterparts. Further studies are needed to support the findings of the present study.
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Affiliation(s)
- Nahid Rahmani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Ali Kiani
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Mohammad Ali Mohseni-Bandpei
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
| | - Iraj Abdollahi
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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Caneiro JP, Smith A, O'Sullivan K, O'Keeffe M, Dankaerts W, Fersum K, Gibson W, Wand BM, O'Sullivan P. RE: "Low back pain misdiagnosis or missed diagnosis: Core principles" (Monie AP, Fazey PJ, Singer KP. Manual Therapy 22 (2016) 68-71). Musculoskelet Sci Pract 2017; 28:e1-e2. [PMID: 27720322 DOI: 10.1016/j.math.2016.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Affiliation(s)
- J P Caneiro
- School of Physiotherapy & Exercise Science, Curtin University, Perth, Australia; Body Logic Physiotherapy Clinic, Perth, Australia.
| | - Anne Smith
- School of Physiotherapy & Exercise Science, Curtin University, Perth, Australia
| | - Kieran O'Sullivan
- Sports Spine Centre, Qatar Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar
| | - Mary O'Keeffe
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Wim Dankaerts
- Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven, Belgium
| | - Kjartan Fersum
- Physiotherapy Research Group, Department of Public Health and Primary Health Care, University of Bergen, Norway
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Peter O'Sullivan
- School of Physiotherapy & Exercise Science, Curtin University, Perth, Australia; Body Logic Physiotherapy Clinic, Perth, Australia
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Mueller J, Engel T, Mueller S, Stoll J, Baur H, Mayer F. Effects of sudden walking perturbations on neuromuscular reflex activity and three-dimensional motion of the trunk in healthy controls and back pain symptomatic subjects. PLoS One 2017; 12:e0174034. [PMID: 28319133 PMCID: PMC5358879 DOI: 10.1371/journal.pone.0174034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/02/2017] [Indexed: 12/19/2022] Open
Abstract
Background Back pain patients (BPP) show delayed muscle onset, increased co-contractions, and variability as response to quasi-static sudden trunk loading in comparison to healthy controls (H). However, it is unclear whether these results can validly be transferred to suddenly applied walking perturbations, an automated but more functional and complex movement pattern. There is an evident need to develop research-based strategies for the rehabilitation of back pain. Therefore, the investigation of differences in trunk stability between H and BPP in functional movements is of primary interest in order to define suitable intervention regimes. The purpose of this study was to analyse neuromuscular reflex activity as well as three-dimensional trunk kinematics between H and BPP during walking perturbations. Methods Eighty H (31m/49f;29±9yrs;174±10cm;71±13kg) and 14 BPP (6m/8f;30±8yrs;171±10cm;67±14kg) walked (1m/s) on a split-belt treadmill while 15 right-sided perturbations (belt decelerating, 40m/s2, 50ms duration; 200ms after heel contact) were randomly applied. Trunk muscle activity was assessed using a 12-lead EMG set-up. Trunk kinematics were measured using a 3-segment-model consisting of 12 markers (upper thoracic (UTA), lower thoracic (LTA), lumbar area (LA)). EMG-RMS ([%],0-200ms after perturbation) was calculated and normalized to the RMS of unperturbed gait. Latency (TON;ms) and time to maximum activity (TMAX;ms) were analysed. Total motion amplitude (ROM;[°]) and mean angle (Amean;[°]) for extension-flexion, lateral flexion and rotation were calculated (whole stride cycle; 0-200ms after perturbation) for each of the three segments during unperturbed and perturbed gait. For ROM only, perturbed was normalized to unperturbed step [%] for the whole stride as well as the 200ms after perturbation. Data were analysed descriptively followed by a student´s t-test to account for group differences. Co-contraction was analyzed between ventral and dorsal muscles (V:R) as well as side right:side left ratio (Sright:Sleft). The coefficient of variation (CV;%) was calculated (EMG-RMS;ROM) to evaluate variability between the 15 perturbations for all groups. With respect to unequal distribution of participants to groups, an additional matched-group analysis was conducted. Fourteen healthy controls out of group H were sex-, age- and anthropometrically matched (group Hmatched) to the BPP. Results No group differences were observed for EMG-RMS or CV analysis (EMG/ROM) (p>0.025). Co-contraction analysis revealed no differences for V:R and Srigth:Sleft between the groups (p>0.025). BPP showed an increased TON and TMAX, being significant for Mm. rectus abdominus (p = 0.019) and erector spinae T9/L3 (p = 0.005/p = 0.015). ROM analysis over the unperturbed stride cycle revealed no differences between groups (p>0.025). Normalization of perturbed to unperturbed step lead to significant differences for the lumbar segment (LA) in lateral flexion with BPP showing higher normalized ROM compared to Hmatched (p = 0.02). BPP showed a significant higher flexed posture (UTA (p = 0.02); LTA (p = 0.004)) during normal walking (Amean). Trunk posture (Amean) during perturbation showed higher trunk extension values in LTA segments for H/Hmatched compared to BPP (p = 0.003). Matched group (BPP vs. Hmatched) analysis did not show any systematic changes of all results between groups. Conclusion BPP present impaired muscle response times and trunk posture, especially in the sagittal and transversal planes, compared to H. This could indicate reduced trunk stability and higher loading during gait perturbations.
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Affiliation(s)
- Juliane Mueller
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Germany
- * E-mail:
| | - Tilman Engel
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Germany
| | - Steffen Mueller
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Germany
| | - Josefine Stoll
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Germany
| | - Heiner Baur
- Bern University of Applied Sciences, Health, Physiotherapy, Bern, Switzerland
| | - Frank Mayer
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Germany
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Whittle CJ, Flavell CA, Gordon SJ. Methodological consistency and measurement reliability of transversus abdominis real time ultrasound imaging in chronic low back pain populations: a systematic review. PHYSICAL THERAPY REVIEWS 2017. [DOI: 10.1080/10833196.2017.1287151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Connie Jean Whittle
- College of Healthcare Sciences, James Cook University, Douglas Campus , Townsville, Australia
| | - Carol Ann Flavell
- College of Healthcare Sciences, James Cook University, Douglas Campus , Townsville, Australia
| | - Susan Jayne Gordon
- College of Healthcare Sciences, James Cook University, Douglas Campus , Townsville, Australia
- School of Health Sciences, Flinders University , Bedford Park, Australia
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Mueller J, Engel T, Kopinski S, Mayer F, Mueller S. Neuromuscular trunk activation patterns in back pain patients during one-handed lifting. World J Orthop 2017; 8:142-148. [PMID: 28251064 PMCID: PMC5314143 DOI: 10.5312/wjo.v8.i2.142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/01/2016] [Accepted: 11/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze neuromuscular activity patterns of the trunk in healthy controls (H) and back pain patients (BPP) during one-handed lifting of light to heavy loads.
METHODS After assessment of back pain (graded chronic pain scale according to von Korff) all subjects (n = 43) performed a warm-up (treadmill walking). Next, subjects were instructed to lift 3 × a 20 kg weight placed in front of them (with both hand) onto a table (height: 0.75 m). Subsequently, all subjects lifted with one hand (left-side, 3 repetitions) a weight of 1 kg (light), 10 kg (middle) and 20 kg (heavy) in random order from the ground up onto the table left of them. Trunk muscle activity was assessed with a 12-lead EMG (6 ventral/6 dorsal muscles; 4000 Hz). EMG-RMS (%) was averaged over the 3 repetitions and analyzed for the whole one-handed lifting cycle, then normalized to RMS of the two-handed lifting. Additionally, the mean (normalized) EMG-RMS of four trunk areas [right/left ventral area (VR/VL); right/left dorsal area (DR/DL)] was calculated. Data were analyzed descriptively (mean ± SD) followed by student’s t-test comparing H and BPP (α = 0.05). With respect to the unequal distribution of subjects in H and BPP, a matched-group analysis was conducted. Seven healthy controls were gender- and age-matched (group Hmatched) to the 7 BPP. In addition, task failure was calculated and compared between H/Hmatchedvs BPP using χ2.
RESULTS Seven subjects (3m/4f; 32 ± 7 years; 171 ± 7 cm; 65 ± 11 kg) were assigned to BPP (pain grade ≥ 2) and 36 (13m/23f; 28 ± 8 years; 174 ± 10 cm; 71 ± 12 kg) to H (pain grade ≤ 1). H and BPP did not differ significantly in anthropometrics (P > 0.05). All subjects were able to lift the light and middle loads, but 57% of BPP and 22% of H were not able to lift the heavy load (all women). χ2 analysis revealed statistically significant differences in task failure between H vs BPP (P = 0.03). EMG-RMS ranged from 33% ± 10%/30% ± 9% (DL, 1 kg) to 356% ± 148%/283% ± 80% (VR, 20 kg) in H/BPP with no statistical difference between groups regardless of load (P > 0.05). However, the EMG-RMS of the VR was greatest in all lifting tasks for both groups and increased with heavier loads.
CONCLUSION Heavier loading leads to an increase (2- to 3-fold) in trunk muscle activity with comparable patterns. Heavy loading (20 kg) leads to task failure, especially in women with back pain.
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Ghaderi F, Mohammadi K, Amir Sasan R, Niko Kheslat S, Oskouei AE. Effects of Stabilization Exercises Focusing on Pelvic Floor Muscles on Low Back Pain and Urinary Incontinence in Women. Urology 2016; 93:50-4. [DOI: 10.1016/j.urology.2016.03.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/08/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
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A Randomized Controlled Trial Comparing the McKenzie Method to Motor Control Exercises in People With Chronic Low Back Pain and a Directional Preference. J Orthop Sports Phys Ther 2016; 46:514-22. [PMID: 27170524 DOI: 10.2519/jospt.2016.6379] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Randomized clinical trial. Background Motor control exercises are believed to improve coordination of the trunk muscles. It is unclear whether increases in trunk muscle thickness can be facilitated by approaches such as the McKenzie method. Furthermore, it is unclear which approach may have superior clinical outcomes. Objectives The primary aim was to compare the effects of the McKenzie method and motor control exercises on trunk muscle recruitment in people with chronic low back pain classified with a directional preference. The secondary aim was to conduct a between-group comparison of outcomes for pain, function, and global perceived effect. Methods Seventy people with chronic low back pain who demonstrated a directional preference using the McKenzie assessment were randomized to receive 12 treatments over 8 weeks with the McKenzie method or with motor control approaches. All outcomes were collected at baseline and at 8-week follow-up by blinded assessors. Results No significant between-group difference was found for trunk muscle thickness of the transversus abdominis (-5.8%; 95% confidence interval [CI]: -15.2%, 3.7%), obliquus internus (-0.7%; 95% CI: -6.6%, 5.2%), and obliquus externus (1.2%; 95% CI: -4.3%, 6.8%). Perceived recovery was slightly superior in the McKenzie group (-0.8; 95% CI: -1.5, -0.1) on a -5 to +5 scale. No significant between-group differences were found for pain or function (P = .99 and P = .26, respectively). Conclusion We found no significant effect of treatment group for trunk muscle thickness. Participants reported a slightly greater sense of perceived recovery with the McKenzie method than with the motor control approach. Level of Evidence Therapy, level 1b-. Registered September 7, 2011 at www.anzctr.org.au (ACTRN12611000971932). J Orthop Sports Phys Ther 2016;46(7):514-522. Epub 12 May 2016. doi:10.2519/jospt.2016.6379.
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Kliziene I, Sipaviciene S, Vilkiene J, Astrauskiene A, Cibulskas G, Klizas S, Cizauskas G. Effects of a 16-week Pilates exercises training program for isometric trunk extension and flexion strength. J Bodyw Mov Ther 2016; 21:124-132. [PMID: 28167168 DOI: 10.1016/j.jbmt.2016.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/03/2016] [Accepted: 05/25/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the effects of Pilates exercises designed to improve isometric trunk extension and flexion strength of muscles in women with chronic low back pain (cLBP). PARTICIPANTS Female volunteers with cLBP were divided into an experimental group (EG; n = 27) and a control group (CG; n = 27). INTERVENTION Pilates exercises were performed twice per week by the EG; the duration of each session was 60 min. The program lasted for 16 weeks; thus patients underwent a total of 32 exercise sessions. RESULTS The maximum isometric waist bending strength of the EG had improved significantly (p = 0.001) after 16 weeks of the Pilates program. The results of trunk flexion muscle endurance tests significantly depended on the trunk extension muscle endurance before the intervention, and at 1 month (r = 0.723, p < 0.001) and 2 months (r = 0.779, p < 0.001) after the Pilates exercise program. At the end of the 16-week exercise program, cLBP intensity decreased by 2.01 ± 0.8 (p < 0.05) in the EG, and this reduction persisted for 1 month after completion of the program. CONCLUSIONS At 1 and 2 months after cessation of the Pilates exercise program the pain intensified and the functional state deteriorated much faster than the maximum trunk muscle strength. Therefore, it can be concluded that, to decrease pain and improve functional condition, regular exercise (and not only improved strength and endurance) is required. We established that, although the 16-week lumbar stabilization exercise program increased isometric trunk extension and flexion strength and this increase in strength persisted for 2 months, decreased LBP and improved functional condition endured for only 1 month.
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Affiliation(s)
- Irina Kliziene
- Department of Education Science, Kaunas University of Technology, Kaunas, Lithuania.
| | - Saule Sipaviciene
- Department of Applied Biology and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania.
| | - Jovita Vilkiene
- Department of Education Science, Kaunas University of Technology, Kaunas, Lithuania.
| | - Audrone Astrauskiene
- Department of Education Science, Kaunas University of Technology, Kaunas, Lithuania.
| | - Gintautas Cibulskas
- Department of Education Science, Kaunas University of Technology, Kaunas, Lithuania.
| | - Sarunas Klizas
- Department of Health Psychology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Ginas Cizauskas
- Department of Mechanical Engineering, Kaunas University of Technology, Kaunas, Lithuania.
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Widerström B, Olofsson N, Boström C, Rasmussen-Barr E. Feasibility of the subgroup criteria included in the treatment-strategy-based (TREST) classification system (CS) for patients with non-specific low back pain (NSLBP). ACTA ACUST UNITED AC 2016; 23:90-7. [DOI: 10.1016/j.math.2016.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/14/2015] [Accepted: 01/03/2016] [Indexed: 02/06/2023]
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Ferreira LCM, Araujo AC, Oliveira CBSD, Jassi FJ, Oliveira VC, Negrão Filho RDF. Associação entre recrutamento de músculos abdominais com desfechos clínicos e risco prognóstico em indivíduos com dor lombar crônica não específica: estudo preliminar. FISIOTERAPIA E PESQUISA 2016. [DOI: 10.1590/1809-2950/14560723012016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Este estudo investigou a associação entre testes clínicos, desfechos clínicos e risco prognóstico de pacientes com dor lombar crônica não específica. Para esta pesquisa, 20 pacientes, maiores de 18 anos, foram selecionados por conveniência e submetidos à avaliação dos desfechos clínicos por meio de Escala numérica de dor e Questionário de incapacidade. Para classificação de risco prognóstico utilizou-se o questionário STarT Back, e para avaliar o recrutamento do músculo transverso do abdome foram utilizados os seguintes testes clínicos: Escala de classificação clínica (ECC); e medida da espessura dos músculos do abdome por meio de imagens ultrassonográficas (MEM-US). Os testes foram realizados em um único dia por avaliador treinado, e a ordem dos testes foi aleatória. Os coeficientes de correlação de Pearson (r) e Spearman (rS) foram utilizados para investigar a associação. Os resultados mostraram que as associações entre o risco prognóstico de dor lombar com os desfechos clínicos, dor e incapacidade foram moderadas (r=0,68 e r=0,57, respectivamente). Para ECC, as associações com incapacidade e risco prognóstico foram consideradas razoáveis (r=-0,34 e r=-0,36, respectivamente). Não houve associações com a MEM-US. Na amostra de baixo risco prognóstico, a relação do ECC com a incapacidade foi considerada moderada para boa, enquanto para dor a correlação foi razoável (rS=-0,62 e rS=-0,24, respectivamente). Concluímos que existe associação entre ECC com desfechos clínicos e risco prognóstico, e a estratificação, segundo o risco prognóstico, aumenta a relação observada. Futuros estudos devem ser conduzidos com novas medidas para avaliação do recrutamento muscular abdominal com amostras maiores.
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Macedo LG, Saragiotto BT, Yamato TP, Costa LOP, Menezes Costa LC, Ostelo RWJG, Maher CG. Motor control exercise for acute non-specific low back pain. Cochrane Database Syst Rev 2016; 2:CD012085. [PMID: 26863390 PMCID: PMC8734597 DOI: 10.1002/14651858.cd012085] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Motor control exercise (MCE) is used by healthcare professionals worldwide as a common treatment for low back pain (LBP). However, the effectiveness of this intervention for acute LBP remains unclear. OBJECTIVES To evaluate the effectiveness of MCE for patients with acute non-specific LBP. SEARCH METHODS We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), four other databases and two trial registers from their inception to April 2015, tracked citations and searched reference lists. We placed no limitations on language nor on publication status. SELECTION CRITERIA We included only randomised controlled trials (RCTs) examining the effectiveness of MCE for patients with acute non-specific LBP. We considered trials comparing MCE versus no treatment, versus another type of treatment or added as a supplement to other interventions. Primary outcomes were pain intensity and disability. Secondary outcomes were function, quality of life and recurrence. DATA COLLECTION AND ANALYSIS Two review authors screened for potentially eligible studies, assessed risk of bias and extracted data. A third independent review author resolved disagreements. We examined MCE in the following comparisons: (1) MCE versus spinal manipulative therapy; (2) MCE versus other exercises; and (3) MCE as a supplement to medical management. We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess the quality of evidence. For missing or unclear information, we contacted study authors. We considered the following follow-up intervals: short term (less than three months after randomisation); intermediate term (at least three months but within 12 months after randomisation); and long term (12 months or longer after randomisation). MAIN RESULTS We included three trials in this review (n = 197 participants). Study sample sizes ranged from 33 to 123 participants. Low-quality evidence indicates no clinically important differences between MCE and spinal manipulative therapy for pain at short term and for disability at short term and long term. Low-quality evidence also suggests no clinically important differences between MCE and other forms of exercise for pain at short or intermediate term and for disability at intermediate term or long term follow-up. Moderate-quality evidence shows no clinically important differences between MCE and other forms of exercise for disability at short term follow-up. Finally, very low-quality evidence indicates that addition of MCE to medical management does not provide clinically important improvement for pain or disability at short term follow-up. For recurrence at one year, very low-quality evidence suggests that MCE and medical management decrease the risk of recurrence by 64% compared with medical management alone. AUTHORS' CONCLUSIONS We identified only three small trials that also evaluated different comparisons; therefore, no firm conclusions can be drawn on the effectiveness of MCE for acute LBP. Evidence of very low to moderate quality indicates that MCE showed no benefit over spinal manipulative therapy, other forms of exercise or medical treatment in decreasing pain and disability among patients with acute and subacute low back pain. Whether MCE can prevent recurrences of LBP remains uncertain.
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Affiliation(s)
- Luciana G Macedo
- University of AlbertaGlen Sather Sports Medicine Clinic, Faculty of Rehabilitation Medicine2C/2D Kaye Edmonton ClinicEdmontonABCanadaT6G 1Z1
| | - Bruno T Saragiotto
- Sydney Medical School, The University of SydneyMusculoskeletal Division, The George Institute for Global HealthSydneyAustralia
| | - Tiê P Yamato
- Sydney Medical School, The University of SydneyMusculoskeletal Division, The George Institute for Global HealthSydneyAustralia
| | - Leonardo OP Costa
- Universidade Cidade de São PauloMasters and Doctoral Programs in Physical TherapyRua Cesário Galeno 448São PauloBrazil03071‐000
| | - Luciola C Menezes Costa
- Universidade Cidade de São PauloMasters and Doctoral Programs in Physical TherapyRua Cesário Galeno 448São PauloBrazil03071‐000
| | - Raymond WJG Ostelo
- VU University AmsterdamDepartment of Health Sciences, EMGO+ Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | - Christopher G Maher
- Sydney Medical School, The University of SydneyMusculoskeletal Division, The George Institute for Global HealthSydneyAustralia
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Saragiotto BT, Maher CG, Yamato TP, Costa LOP, Menezes Costa LC, Ostelo RWJG, Macedo LG. Motor control exercise for chronic non-specific low-back pain. Cochrane Database Syst Rev 2016; 2016:CD012004. [PMID: 26742533 PMCID: PMC8761501 DOI: 10.1002/14651858.cd012004] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Non-specific low back pain (LBP) is a common condition. It is reported to be a major health and socioeconomic problem associated with work absenteeism, disability and high costs for patients and society. Exercise is a modestly effective treatment for chronic LBP. However, current evidence suggests that no single form of exercise is superior to another. Among the most commonly used exercise interventions is motor control exercise (MCE). MCE intervention focuses on the activation of the deep trunk muscles and targets the restoration of control and co-ordination of these muscles, progressing to more complex and functional tasks integrating the activation of deep and global trunk muscles. While there are previous systematic reviews of the effectiveness of MCE, recently published trials justify an updated systematic review. OBJECTIVES To evaluate the effectiveness of MCE in patients with chronic non-specific LBP. SEARCH METHODS We conducted electronic searches in CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers from their inception up to April 2015. We also performed citation tracking and searched the reference lists of reviews and eligible trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) that examined the effectiveness of MCE in patients with chronic non-specific LBP. We included trials comparing MCE with no treatment, another treatment or that added MCE as a supplement to other interventions. Primary outcomes were pain intensity and disability. We considered function, quality of life, return to work or recurrence as secondary outcomes. All outcomes must have been measured with a valid and reliable instrument. DATA COLLECTION AND ANALYSIS Two independent review authors screened the search results, assessed risk of bias and extracted the data. A third independent review author resolved any disagreement. We assessed risk of bias using the Cochrane Back and Neck (CBN) Review Group expanded 12-item criteria (Furlan 2009). We extracted mean scores, standard deviations and sample sizes from the included trials, and if this information was not provided we calculated or estimated them using methods recommended in the Cochrane Handbook. We also contacted the authors of the trials for any missing or unclear information. We considered the following time points: short-term (less than three months after randomisation); intermediate (at least three months but less than 12 months after randomisation); and long-term (12 months or more after randomisation) follow-up. We assessed heterogeneity by visual inspection of the forest plots, and by calculating the Chi(2) test and the I(2) statistic. We combined results in a meta-analysis expressed as mean difference (MD) and 95% confidence interval (CI). We assessed the overall quality of the evidence using the GRADE approach. MAIN RESULTS We included 29 trials (n = 2431) in this review. The study sample sizes ranged from 20 to 323 participants. We considered a total of 76.6% of the included trials to have a low risk of bias, representing 86% of all participants. There is low to high quality evidence that MCE is not clinically more effective than other exercises for all follow-up periods and outcomes tested. When compared with minimal intervention, there is low to moderate quality evidence that MCE is effective for improving pain at short, intermediate and long-term follow-up with medium effect sizes (long-term, MD -12.97; 95% CI -18.51 to -7.42). There was also a clinically important difference for the outcomes function and global impression of recovery compared with minimal intervention. There is moderate to high quality evidence that there is no clinically important difference between MCE and manual therapy for all follow-up periods and outcomes tested. Finally, there is very low to low quality evidence that MCE is clinically more effective than exercise and electrophysical agents (EPA) for pain, disability, global impression of recovery and quality of life with medium to large effect sizes (pain at short term, MD -30.18; 95% CI -35.32 to -25.05). Minor or no adverse events were reported in the included trials. AUTHORS' CONCLUSIONS There is very low to moderate quality evidence that MCE has a clinically important effect compared with a minimal intervention for chronic low back pain. There is very low to low quality evidence that MCE has a clinically important effect compared with exercise plus EPA. There is moderate to high quality evidence that MCE provides similar outcomes to manual therapies and low to moderate quality evidence that it provides similar outcomes to other forms of exercises. Given the evidence that MCE is not superior to other forms of exercise, the choice of exercise for chronic LBP should probably depend on patient or therapist preferences, therapist training, costs and safety.
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Affiliation(s)
- Bruno T Saragiotto
- Sydney Medical School, The University of SydneyMusculoskeletal Division, The George Institute for Global HealthSydneyAustralia
| | - Christopher G Maher
- Sydney Medical School, The University of SydneyThe George Institute for Global HealthPO Box M201Missenden RoadSydneyNSWAustralia2050
| | - Tiê P Yamato
- Sydney Medical School, The University of SydneyMusculoskeletal Division, The George Institute for Global HealthSydneyAustralia
| | - Leonardo OP Costa
- Universidade Cidade de São PauloMasters and Doctoral Programs in Physical TherapyRua Cesário Galeno 448São PauloBrazil03071‐000
| | - Luciola C Menezes Costa
- Universidade Cidade de São PauloMasters and Doctoral Programs in Physical TherapyRua Cesário Galeno 448São PauloBrazil03071‐000
| | - Raymond WJG Ostelo
- VU University AmsterdamDepartment of Health Sciences, EMGO+ Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | - Luciana G Macedo
- University of AlbertaGlen Sather Sports Medicine Clinic, Faculty of Rehabilitation Medicine2C/2D Kaye Edmonton ClinicEdmontonABCanadaT6G 1Z1
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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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Vieira S, Dibai-Filho AV, Brandino HE, Ferreira VTK, Scheicher ME. Abdominal muscle strength is related to the quality of life among older adults with lumbar osteoarthritis. J Bodyw Mov Ther 2015; 19:273-7. [PMID: 25892383 DOI: 10.1016/j.jbmt.2014.05.002] [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: 01/29/2014] [Revised: 04/27/2014] [Accepted: 05/07/2014] [Indexed: 01/13/2023]
Abstract
The aim of the present study was to determine the association between abdominal muscle strength and quality of life among older adults with lumbar osteoarthritis. A blind, cross-sectional study was conducted involving 40 older adults: 20 with lumbar osteoarthritis (12 women and 8 men, mean age of 65.90 ± 4.80 years) and 20 controls (14 women and 6 men, mean age of 67.90 ± 4.60 years). The volunteers were submitted to an abdominal muscle strength test. Quality of life was evaluated using the SF-36 questionnaire. Both abdominal muscle strength and quality of life scores were significantly lower in the group with lumbar osteoarthritis in comparison to the controls (p < 0.05). Moreover, significant and positive associations were found between abdominal muscle strength and the subscales of the SF-36 questionnaire (p < 0.05, 0.421 ≥ rs ≤ 0.694). Based on the present findings, older adults with lumbar osteoarthritis with greater abdominal muscle strength have a better quality of life.
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Affiliation(s)
- Suenimeire Vieira
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Almir Vieira Dibai-Filho
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Hugo Evangelista Brandino
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Vânia Tie Koga Ferreira
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcos Eduardo Scheicher
- Department of Physiotherapy and Occupational Therapy, São Paulo State University, Marília, SP, Brazil
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Pillastrini P, Ferrari S, Rattin S, Cupello A, Villafañe JH, Vanti C. Exercise and tropism of the multifidus muscle in low back pain: a short review. J Phys Ther Sci 2015; 27:943-5. [PMID: 25931765 PMCID: PMC4395749 DOI: 10.1589/jpts.27.943] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 10/24/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this review was to investigate the types of exercises that can
improve the tropism of the multifidus muscles, based on clinical evidence. [Methods]
Following to the PICO (Problem, Intervention, Comparison, Outcome) model, we considered
studies of subjects with specific or non-specific LBP that used exercises aimed at
activating the lumbar multifidus muscle and measured its cross-sectional area or thickness
with ultrasound, computed tomography or magnetic resonance imaging. [Results] This review
found that most studies compared different types of exercises for lumbar muscles, but
without specifically investigating the multifidus muscle. However, a few studies showed
that the cross-sectional area and thickness of the multifidus muscle can be increased by
activating this muscle, and they progressed from motor control to increased static and
dynamic loads. [Conclusion] A review of the literature revealed that specific supervised
and home exercises may improve the symmetry of the multifidus muscle.
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Affiliation(s)
- Paolo Pillastrini
- School of Physical Therapy, Alma Mater Studiorum, University of Bologna, Italy
| | - Silvano Ferrari
- Department of Biomedical Sciences, University of Padova, Italy
| | | | - Andrea Cupello
- School of Physical Therapy, Alma Mater Studiorum, University of Bologna, Italy
| | | | - Carla Vanti
- School of Physical Therapy, Alma Mater Studiorum, University of Bologna, Italy
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