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Chen Z, Tirosh O, Han J, Adams R, El-Ansary D, Pranata A. Kinematic changes of the trunk and lower limbs during voluntary lateral sway postural control in adults with low back pain. Front Bioeng Biotechnol 2024; 12:1351913. [PMID: 38476964 PMCID: PMC10927732 DOI: 10.3389/fbioe.2024.1351913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction: Voluntary lateral weight shifting is essential for gait initiation. However, kinematic changes during voluntary lateral weight shifting remain unknown in people with low back pain (LBP). This study aims to explore the differences in kinematics and muscle activation when performing a voluntary lateral weight shifting task between patients with LBP and asymptomatic controls without pain. Methods: Twenty-eight participants volunteered in this study (14 in both the LBP group and the control group). The Sway Discrimination Apparatus (SwayDA) was used to generate a postural sway control task, mimicking lateral weight shifting movements when initiating gait. Kinematic parameters, including range of motion (ROM) and standard deviation of ROM (Std-ROM) of the lumbar spine, pelvis, and lower limb joints, were recorded using a motion capture system during lateral weight shifting. The electroactivity of the trunk and lower limb muscles was measured through surface electromyography using root mean square (RMS). The significant level was 0.05. An independent t-test was employed to compare kinematic parameters, and muscle activation between the LBP group and the control group. A paired-sample t-test, adjusted with Bonferroni correction (significant level of 0.025), was utilized to examine differences between the ipsilateral weight shifting towards side (dominant side) and the contralateral side. Results: The results of kinematic parameters showed significantly decreased ROM and std-ROM of the ipsilateral hip in the transverse plane (tROM = -2.059, p = 0.050; tstd-ROM = -2.670, p = 0.013), as well as decreased ROM of the ipsilateral knee in the coronal plane (t = -2.148, p = 0.042), in the LBP group compared to the control group. For the asymptomatic controls, significantly larger ROM and ROM-std were observed in the hip and knee joints on the ipsilateral side in contrast to the contralateral side (3.287 ≤ t ≤ 4.500, 0.001 ≤ p≤ 0.006), but no significant differences were found between the two sides in the LBP group. In addition, the LBP group showed significantly lower RMS of the biceps femoris than the control group (tRMS = -2.186, p = 0.044). Discussion: Patients with LBP showed a conservative postural control pattern, characterized by reduced ROM of ipsilateral joints and diminished activation of the biceps femoris. These findings suggested the importance of voluntary postural control assessment and intervention to maximize recovery.
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Affiliation(s)
- Zhengquan Chen
- Shanghai Yangpu District Mental Health Center, Shanghai University of Medicine and Health Sciences, Shanghai, China
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Oren Tirosh
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Jia Han
- Shanghai Yangpu District Mental Health Center, Shanghai University of Medicine and Health Sciences, Shanghai, China
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Roger Adams
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Doa El-Ansary
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
- Department of Surgery, Melbourne Medical School, Melbourne, VIC, Australia
| | - Adrian Pranata
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
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Shaw J, Jacobs JV, Van Dillen LR, Beneck GJ, Smith JA. Understanding the Biering-Sørensen test: Contributors to extensor endurance in young adults with and without a history of low back pain. J Electromyogr Kinesiol 2024; 74:102854. [PMID: 38171249 PMCID: PMC10842485 DOI: 10.1016/j.jelekin.2023.102854] [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: 07/31/2023] [Revised: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
The Biering-Sørensen test is commonly used to assess paraspinal muscle endurance. Research using a single repetition of the test has provided conflicting evidence for the contribution of impaired paraspinal muscle endurance to low back pain (LBP). This study investigated how Sørensen test duration, muscle activation, and muscle fatigability are affected by multiple repetitions of the test and determined predictors of Sørensen test duration in young adults with and without a history of LBP. Sixty-four young individuals performed three repetitions of the Sørensen test. Amplitude of activation and median frequency slope (fatigability) were calculated for the lumbar and thoracic paraspinals and hamstrings. Duration of the test was significantly less for the 3rd repetition in individuals with LBP. In individuals without LBP, test duration was predicted by fatigability of the lumbar paraspinals. In individuals with LBP, Sørensen test duration was predicted by fatigability of the hamstrings and amplitude of activation of the thoracic and lumbar paraspinals. Our findings demonstrate that it is necessary to amplify the difficulty of the Sørensen test to reveal impairments in young, active adults with LBP. Training programs aiming to improve lumbar paraspinal performance should monitor performance of other synergist muscles during endurance exercise.
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Affiliation(s)
- Jonathan Shaw
- Crean College of Health and Behavioral Sciences, Chapman University, CA, USA
| | - Jesse V Jacobs
- Rehabilitation and Movement Science, University of Vermont, VT, USA
| | - Linda R Van Dillen
- Program in Physical Therapy, Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, WA, USA
| | - George J Beneck
- Department of Physical Therapy, California State University, Long Beach, CA, USA
| | - Jo Armour Smith
- Crean College of Health and Behavioral Sciences, Chapman University, CA, USA.
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Matheve T, Hodges P, Danneels L. The Role of Back Muscle Dysfunctions in Chronic Low Back Pain: State-of-the-Art and Clinical Implications. J Clin Med 2023; 12:5510. [PMID: 37685576 PMCID: PMC10487902 DOI: 10.3390/jcm12175510] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Changes in back muscle function and structure are highly prevalent in patients with chronic low back pain (CLBP). Since large heterogeneity in clinical presentation and back muscle dysfunctions exists within this population, the potential role of back muscle dysfunctions in the persistence of low back pain differs between individuals. Consequently, interventions should be tailored to the individual patient and be based on a thorough clinical examination taking into account the multidimensional nature of CLBP. Considering the complexity of this process, we will provide a state-of-the-art update on back muscle dysfunctions in patients with CLBP and their implications for treatment. To this end, we will first give an overview of (1) dysfunctions in back muscle structure and function, (2) the potential of exercise therapy to address these dysfunctions, and (3) the relationship between changes in back muscle dysfunctions and clinical parameters. In a second part, we will describe a framework for an individualised approach for back muscle training in patients with CLBP.
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Affiliation(s)
- Thomas Matheve
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Ghent University, 9000 Gent, Belgium;
- REVAL—Rehabilitation Research Center, Faculty of Rehabilitation Sciences, UHasselt, 3500 Diepenbeek, Belgium
| | - Paul Hodges
- NHMRC—Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia;
| | - Lieven Danneels
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Ghent University, 9000 Gent, Belgium;
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Shaw J, Jacobs JV, Van Dillen LR, Beneck GJ, Smith JA. Understanding the Biering-Sørensen test: contributors to extensor endurance in young adults with and without low back pain. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.11.23284452. [PMID: 36712062 PMCID: PMC9882630 DOI: 10.1101/2023.01.11.23284452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Impaired paraspinal muscle endurance may contribute to persistent low back pain (LBP) and is frequently assessed using a single repetition of the Biering-Sørensen test. This study investigated how Sørensen test duration, muscle activation, and muscle fatigability are affected by multiple repetitions of the test, and determined predictors of Sørensen test duration in young, active adults with and without a history of LBP. Sixty-four individuals with and without persistent LBP performed 3 repetitions of the Sørensen test. Amplitude of activation and median frequency slope (fatigability) were calculated for the lumbar and thoracic paraspinals and the hamstrings. Duration of the test was significantly less for the 2nd and 3rd repetitions in individuals with LBP. In individuals without LBP, fatigability of the lumbar paraspinals was the best predictor of test duration. In individuals with LBP, Sørensen test duration was predicted by fatigability of the hamstrings and amplitude of activation of the thoracic and lumbar paraspinals. Our findings demonstrate that it is necessary to amplify the difficulty of the Sørensen test to elucidate impairments in young, active adults with LBP. Training programs aiming to improve lumbar paraspinal performance in individuals with LBP should monitor performance of other synergist muscles during endurance exercise.
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Effect of Progressive Postural Control Exercise Versus Core Stability Exercise in Young Adults with Chronic Low Back Pain: A Randomized Controlled Trial. Pain Ther 2023; 12:293-308. [PMID: 36454387 PMCID: PMC9845492 DOI: 10.1007/s40122-022-00458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/03/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION This study aimed to investigate the effects of progressive postural control exercise (PPCE) vs core stability exercise (CSE) in patients with chronic low back pain (CLBP). METHODS A total of 34 young-adult participants with CLBP were randomly assigned to two groups (the PPCE group and the CSE group). They received instructions for two different exercise training regimens persisting over 8 weeks. Before, after, and at 6 months after the intervention, the participants were evaluated on the basis of pain intensity (VAS), degree of dysfunction (ODI and RMDQ), contractility of transversus abdominis (TrA) and lumbar multifidus (MF), as well as the ability to control static posture. RESULTS There was no significant difference between the results of the PPCE group and the CSE group. At the 6-month follow-up after the 8-week treatment, the scores of VAS, ODI, and RMDQ in the two groups decreased significantly compared to before (p < 0.05). The percentage change in thickness of bilateral TrA and left MF (p < 0.05) was elevated and the sway area of center of pressure during static stance tasks with eyes opened (p < 0.05) was decreased in both groups. CONCLUSION In the short term, PPCE provides positive effects similar to those of core stability exercise in patients with CLBP. The effective mechanism of PPCE might be the consequence of neuromuscular plasticity and adaptation adjustments. PPCE enriches the choices of treatment for CLBP. CLINICAL TRIAL REGISTRATION The trial was registered at www.chictr.org.cn , identifier ChiCTR2100043113.
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Association of non-chronic low back pain with physical function, endurance, fatigability, and quality of life in middle- and older-aged adults: Findings from Baltimore Longitudinal Study of Aging. PLoS One 2022; 17:e0277083. [DOI: 10.1371/journal.pone.0277083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/19/2022] [Indexed: 11/12/2022] Open
Abstract
Low back pain (LBP) is an important condition associated with high healthcare burden. However, the relationship of this condition with physical function (PF) and health-related quality of life (HRQoL) remains unclear. This is a cross-sectional study that aims to investigate the association between presence and intensity of non-chronic LBP with PF and HRQoL in middle-and older-aged adults. Participants answered questions about presence and intensity of LBP in the previous year, self-reported their PF and HRQoL (SF-12), and underwent objective measures of PF ([ExSPPB] including usual gait speed, narrow walk, chair stands, and standing balance), endurance performance ([EP] long-distance corridor walk) and fatigability. Generalized linear models and logistic regression models were performed. A total of 1500 participants (52.5% women, 70.3% white) aged 69.0 (SD 13.1) years were included. Of those, 642 (42.8%) reported LBP and the mean pain intensity was 4.1 (SD 2.2). After adjustments for potential confounders, presence of LBP was associated with lower self-reported PF (OR 1.73, 95% CI 1.27 to 2.37), lower physical component of HRQoL (β -0.03, 95% CI -0.04 to -0.02) and poorer chair stand performance (β -0.05, 95% CI -0.09 to -0.008). Higher intensity of LBP was associated with lower physical component of HRQoL (β -0.01, 95% CI -0.02 to -0.007), poorer ExSPPB performance (β -0.01, 95% CI -0.02 to -0.004), slower usual gait speed (β -0.01, 95% CI -0.02 to -0.004), lower total standing balance time (β -0.01, 95% CI -0.02 to -0.001) and higher fatigability (OR 1.13, 95% CI 1.01 to 1.25). The presence of non-chronic LBP was more consistently associated with lower self-reported PF, while higher intensity non-chronic LBP was associated with poorer objectively measured PF and fatigability. Collectively, this evidence suggests that although presence of pain may affect perception of function, greater pain intensity appears more strongly associated with unfavorable functional performance in mid-to-late life.
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Boutellier A, Nüesch C, Suter P, Perrot G, Mündermann A. Trunk muscle function and its association with functional limitations in sedentary occupation workers with and without chronic nonspecific low back pain. J Back Musculoskelet Rehabil 2022; 35:783-791. [PMID: 34744065 DOI: 10.3233/bmr-200269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The function of trunk muscles in chronic nonspecific low back pain (CNLBP) is controversially discussed, and trunk muscle function in sedentary occupation workers is poorly understood. OBJECTIVE To investigate whether muscle function differs between sedentary occupation workers with and without CNLBP and to determine the association between functional limitations and muscle function. METHODS This study included 32 sedentary occupation workers (16 workers with CNLBP and 16 age- and sex-matched workers without CNLBP). Group differences in isokinetic trunk flexion-extension strength, muscle cocontraction, endurance time (Biering-Sorensen test) and electromyographic muscle fatigue were assessed. The association of these parameters and Oswestry Disability Index (ODI) score were examined in the CNLBP group. RESULTS Participants with CNLBP had lower trunk extensor (-20%) and flexor (-18%) strength and less cocontraction (-22%) than participants without CNLBP, but due to large variability in both groups these differences were not statistically significant. Trunk muscle endurance and fatigue were comparable between groups. Variance in endurance time explained 28% of variance in the ODI-score in the CNLBP group (R2= 0.277). CONCLUSIONS In patients with CNLBP, greater functional disability was associated with lower endurance. Further evidence is necessary to elucidate whether specifically training endurance performance may be beneficial for sedentary occupation workers.
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Affiliation(s)
- Angela Boutellier
- School of Health Professions, Zurich University of Applied Sciences Winterthur, Winterthur, Switzerland.,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Peter Suter
- Institute for Physiotherapy, University Hospital Basel, Basel, Switzerland
| | - Guido Perrot
- Institute for Physiotherapy, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
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Tajali S, Roozbehfar N, Mehravar M, Goharpey S, Gayem K. Effects of back extensor and hip abductor fatigue on dynamic postural stability in patients with nonspecific chronic low back pain: A case-control study. Physiother Theory Pract 2021; 38:1987-1995. [PMID: 33881376 DOI: 10.1080/09593985.2021.1913775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Patients with nonspecific chronic low back pain (NSCLBP) complain of pain and fatigue during functional activities. Poor back muscle endurance has been associated with recurrent pain and long-term disability. However, the relationship between proximal muscle fatigue and postural stability is not well understood. PURPOSE To investigate the effects of lumbar extensor and hip abductor fatigue on postural stability in NSCLBPs. METHODS To induce isolated fatigue, participants (24 LBPs, 24 controls) were asked to perform multiple back extension and hip abduction in the separate sessions until the muscle force reached 60% of pre-fatigued force. The overall (OSI), anteroposterior (APSI), and mediolateral (MLSI) stability indices were measured during single-leg stance using the Biodex dynamic platform. RESULTS The results revealed higher postural instability (APSI and OSI) following fatiguing lumbar extensor and hip abductor muscles (greater effect size for APSI than OSI) in LBPs than controls. Furthermore, significant and inverse relationships were found between the level of physical activity, pain, and post-fatigue postural instability (OSI) in NSCLBPs. CONCLUSION Fatigue of proximal muscles could differentiate postural stability primarily in the sagittal plane between NSCLBPs and controls. Therefore, reducing the fatigability of these muscles by endurance training in addition to balance training may improve physical activity.
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Affiliation(s)
- Shirin Tajali
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
| | - Narges Roozbehfar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
| | | | - Khadije Gayem
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
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