Tactile cues can change movement: An example using tape to redistribute flexion from the lumbar spine to the hips and knees during lifting

Can training to dissociate trunk and pelvic motion influence thorax-pelvis coordination and lumbar spine dynamic stability?

BACKGROUND

The large number of articulating joints within the spinal column provides an abundance of options to control its movement. However, the ability of individuals to consciously manipulate these movement options is poorly understood.

OBJECTIVES

To determine if short-term training can improve the ability to consciously dissociate motion between the pelvis and thorax during repetitive pelvic tilting movements.

DESIGN

Cross-over design with young healthy individuals.

METHOD

Seventeen participants performed trials consisting of 35 continuous lift/lowers followed by 35 continuous anterior/posterior pelvic tilts while spine kinematics were recorded. Participants then underwent a 20-min training protocol designed to improve the control of pelvic motion and in particular the dissociation of pelvic and trunk motion. Post-training, the continuous pelvic tilt and lift/lower trials were repeated. Thorax-pelvis movement coordination was analyzed via vector coding and lumbar spine local dynamic stability was analyzed via Lyapunov exponents. Participants were grouped as being either high or low skill movers based on their ability to perform the pre-training pelvic tilt movements.

RESULTS

The low skill movement group demonstrated statistically significant increases in the time spent using in-phase pelvic dominant (p = 0.028) and anti-phase pelvic dominant (p = 0.043) coordination patterns during the pelvic tilt movements after the completion of the training protocol. The high skill movement group showed no differences in their movement patterns post-training.

CONCLUSIONS

Short-term training, targeted to improve the ability to dissociate pelvic from thorax motion, had a beneficial effect on the group of individuals who initially lacked skill performing the pelvic tilting task.

Real-time visual feedback can cue changes in grip force during electric hand tool operation

Objectives. Grip force applied during repetitive hand tool use varies amongst individuals and some apply more force than necessary. Augmented feedback may help modify grip force to reduce the risk of developing cumulative trauma disorders but has been scarcely investigated during electric hand tool operation. This study evaluated the feasibility of using real-time visual feedback to modify grip force and forearm electromyography (EMG) during electric hand tool operation. A secondary objective was to evaluate the effect of hand and tool orientation on any effects of visual feedback. Methods. Grip force and forearm muscle EMG were recorded as participants fastened bolts at three locations (low, high and overhead) using an electric pistol-grip nut-runner, without and with visual feedback. Results. Feedback decreased grip force (36.1% decrease; p < 0.001) and EMG of three wrist flexor muscles (22.8-33.0%; p < 0.008). Grip force and EMG also differed between fastening locations, but there were no interactions with condition (baseline and feedback; p > 0.266), suggesting that visual feedback can modify grip force across varying hand and tool orientations. Conclusion. Visual feedback can successfully modify grip force during hand tool operation. However, further investigation is needed to understand how to appropriately implement visual feedback during hand tool operation.

Influence of taping on joint proprioception: a systematic review with between and within group meta-analysis

Taping is increasingly used to manage proprioceptive deficits, but existing reviews on its impact have shortcomings. To accurately assess the effects of taping, a separate meta-analyses for different population groups and tape types is needed. Therefore, both between- and within-group meta-analyses are needed to evaluate the influence of taping on proprioception. According to PRISMA guidelines, a literature search was conducted across seven databases (Web of Science, PEDro, Pubmed, EBSCO, Scopus, ERIC, SportDiscus, Psychinfo) and one register (CENTRAL) using the keywords "tape" and "proprioception". Out of 1372 records, 91 studies, involving 2718 individuals, met the inclusion criteria outlined in the systematic review. The meta-analyses revealed a significant between and within-group reduction in repositioning errors with taping compared to no tape (Hedge's g: -0.39, p < 0.001) and placebo taping (Hedge's g: -1.20, p < 0.001). Subgroup and sensitivity analyses further confirmed the reliability of the overall between and within-group analyses. The between-group results further demonstrated that both elastic tape and rigid tape had similar efficacy to improve repositioning errors in both healthy and fatigued populations. Additional analyses on the threshold to detection of passive motion and active movement extent discrimination apparatus revealed no significant influence of taping. In conclusion, the findings highlight the potential of taping to enhance joint repositioning accuracy compared to no tape or placebo taping. Further research needs to uncover underlying mechanisms and refine the application of taping for diverse populations with proprioceptive deficits.

The acute effects of kinesio-taping on movement kinematics and muscle co-activation in rowing athletes

BACKGROUND

Rowing-related low back disorders may occur from inconsistent technique, high trunk flexion and training volumes, overactivation of paraspinal muscles, and fatigue.

OBJECTIVE

To examine if kinesiology tape (KT) affixed to the trunk dorsum affects muscular co-activation and neuromuscular control to limit dangerous rowing movements and associated injuries.

METHODS

Participants (n= 18) completed two 2000 m rowing trials under BASELINE and KT conditions. KT was applied to the skin superficial to the paraspinals bilaterally with 60% pre-strain. Participants were instructed to minimize any sensation of tension. Whole body kinematics were obtained using inertial measurement units (IMUs), and surface electromyograms (EMGs) were recorded from trunk and lower extremity. Changes in joint range-of-motion (ROM) and co-activation indices (CAIs) were analyzed for shoulder, lumbar, hip, and knee.

RESULTS

Responding participants (n= 5) were identified by reduced maximum lumbar flexion during the KT condition. As expected, significant differences occurred in maximum and minimum lumbar flexion/extension between responders and non-responders to KT. Additionally, there was significant reduction in mean trunk muscle co-activation in both those who did and did not respond to KT through reductions in maximum lumbar flexion.

CONCLUSION

KT can be an effective at reducing mean trunk co-activation during a rowing trial in the flexed catch position. Variable responses suggest that further work is necessary to optimize the efficacy of sensory cues derived from KT during rowing movements.

Effects of trunk extensor muscle fatigue on repetitive lift (re)training using an augmented tactile feedback approach

Augmented tactile and performance feedback has been used to (re)train a modified lifting technique to reduce lumbar spine flexion, which has been associated with low back disorder development during occupational repetitive lifting tasks. However, it remains unknown if the presence of trunk extensor neuromuscular fatigue influences learning of this modified lifting technique. Therefore, we compared the effectiveness of using augmented tactile and performance feedback to reduce lumbar spine flexion during a repetitive lifting task, in both unfatigued and fatigued states. Participants completed repetitive lifting tests immediately before and after training, and 1-week later, with half of the participants completing training after fatiguing their trunk extensor muscles. Both groups demonstrated learning of the modified lifting technique as demonstrated by increased thorax-pelvis coordination variability and reduced lumbar range of motion variability; however, experiencing trunk extensor neuromuscular fatigue during lift (re)training may have slight negative influences on learning the modified lifting technique. Practitioner summary: An augmented lift (re)training paradigm using tactile cueing and performance feedback regarding key movement features (i.e. lumbar spine flexion) can effectively (re)train a modified lifting technique to reduce lumbar flexion and redistribute motion to the hips and knees. However, performing (re)training while fatigued could slightly hinder learning this lifting technique.

Influence of taping on force sense accuracy: a systematic review with between and within group meta-analysis

Taping is a common technique used to address proprioceptive deficits in both healthy and patient population groups. Although there is increasing interest in taping to address proprioceptive deficits, little is known about its effects on the kinetic aspects of proprioception as measured by force sense accuracy. To address this gap in the literature, the present systematic review and meta-analysis was conducted to evaluate the impact of taping on force sense accuracy. A search for relevant literature was conducted following PRISMA guidelines across seven databases and one register. Eleven studies with 279 participants were included in the review out of 7362 records. In the between-group analyses, we found a significant improvement in absolute (p < 0.01) and relative (p = 0.01) force sense accuracy with taping compared to no comparator. Likewise, a significant improvement in absolute (p = 0.01) force sense accuracy was also observed with taping compared to placebo tape. In the within group analysis, this reduction in the absolute (p = 0.11) force sense accuracy was not significant. Additional exploratory subgroup analyses revealed between group improvement in force sense accuracy in both healthy individuals and individuals affected by medial epicondylitis. The findings of this meta-analysis should be interpreted with caution due to the limited number of studies and a lack of blinded randomized controlled trials, which may impact the generalizability of the results. More high-quality research is needed to confirm the overall effect of taping on force sense accuracy.

Feedback for the prevention and rehabilitation of work-related musculoskeletal disorders: A systematic review

BACKGROUND

Work-related musculoskeletal disorders (WRMSDs) remain a challenge despite research aimed at improving their prevention and treatment. Extrinsic feedback has been suggested for the prevention and rehabilitation of WRMSDs to improve sensorimotor control, and ultimately to reduce pain and disability. However, there are few systematic reviews on the effectiveness of extrinsic feedback for WRMSDs.

OBJECTIVE

To perform a systematic review investigating the effect of extrinsic feedback for the prevention and rehabilitation of WRMSDs.

METHODS

Five databases (CINAHL, Embase, Ergonomics Abstract, PsycInfo, PubMed) were searched. Studies of various designs assessing the effects of extrinsic feedback during work tasks on three outcomes (function, symptoms, sensorimotor control) in the context of prevention and rehabilitation of WRMSDs were included.

RESULTS

Forty-nine studies were included, for a total sample of 3387 participants (including 925 injured) who performed work-related tasks in the workplace (27 studies) or in controlled environments (22 studies). The use of extrinsic feedback was shown to be effective in controlled environments for short-term prevention of functional limitations and sensorimotor alterations (very limited to moderate evidence) and for improving, in injured participants, function, symptoms and sensorimotor control (moderate evidence). In the workplace, it was shown to be effective for short-term prevention of functional limitations (limited evidence). There was conflicting evidence regarding its effect for WRMSD rehabilitation in the workplace.

CONCLUSION

Extrinsic feedback is an interesting complementary tool for the prevention and rehabilitation of WRMSDs in controlled environments. More evidence is needed regarding its effect for the prevention and rehabilitation of WRMSDs in the workplace.

Influence of Spine-Focused Verbal Instruction on Spine Flexion During Lifting

Lifting with a flexed spine, especially near the end range of motion, has been identified as a potential risk factor for low back injury/pain. Therefore, individuals who develop discomfort from repetitive, prolonged and/or loaded flexed or slouched postures may benefit from a greater awareness of how to control and/or modify their spinal posture to avoid irritating their backs in these situations. This study was therefore designed to test the ability of spine-oriented verbal instructions to reduce intersegmental spine flexion during three lifting tasks. The lifts were first performed without any instructions on lifting technique. An audio recording was then played with instructions to limit bending in the lower back before repeating the lifts. Following the verbal instructions, maximum spine flexion angles significantly (p < 0.05) decreased at intersegmental levels in the lower thoracic and upper lumbar (T8/T9 to L2/L3) regions, but no significant changes were observed at the lower lumbar levels (L3/L4 to L5/S1). Thus, it is concluded that spine-oriented verbal instructions can decrease spine flexion during lifting; however, other cues/instructions may be required to target lower lumbar levels which have been identified as the most prone to injury/pain.

A comparison of augmented feedback and didactic training approaches to reduce spine motion during occupational lifting tasks

Manual handling training may be improved if it relied on the provision of individualized, augmented feedback about key movement features. The purpose of this study was to compare the reduction in sagittal spine motion during manual lifting tasks following two training approaches: didactic (DID) and augmented feedback (AUG). Untrained participants (n = 26) completed lifting tests (box, medication bag, and paramedic backboard) and a randomly-assigned intervention involving 50 practice box lifts. Lifting tests were performed immediately before and after training, and one-week after interventions. Both groups exhibited reductions in spine motions immediately and one-week after the interventions. However, the AUG intervention group elicited significantly greater reductions in 5 of 12 between-group comparisons (3 tasks × 4 spine motion variables). The results of the current study support the use of augmented feedback-based approaches to manual handling training over education-based approaches.

Deliberate Practice and Motor Learning Principles to Underpin the Design of Training Interventions for Improving Lifting Movement in the Occupational Sector: A Perspective and a Pilot Study on the Role of Augmented Feedback

Spine posture during repetitive lifting is one of the main risk factors for low-back injuries in the occupational sector. It is thus critical to design appropriate intervention strategies for training workers to improve their posture, reducing load on the spine during lifting. The main approach to train safe lifting to workers has been educational; however, systematic reviews and meta-analyses have shown that this approach does not improve lifting movement nor reduces the risk of low back injury. One of the main limitations of this approach lies in the amount, quality and context of practice of the lifting movement. In this article, first we argue for integrating psychologically-grounded perspectives of practice design in the development of training interventions for safe lifting. Principles from deliberate practice and motor learning are combined and integrated. Given the complexity of lifting, a training intervention should occur in the workplace and invite workers to repeatedly practice/perform the lifting movement with the clear goal of improving their lifting-related body posture. Augmented feedback has a central role in creating the suitable condition for achieving such intervention. Second, we focus on spine bending as risk factor and present a pilot study examining the benefits and boundary conditions of different feedback modalities for reducing bending during lifting. The results showed how feedback modalities meet differently key requirements of deliberate practice conditions, i.e., feedback has to be informative, individualized and actionable. Following the proposed approach, psychology will gain an active role in the development of training interventions, contributing to finding solutions for a reduction of risk factors for workers.

Valgus Control Feedback and Taping Improves the Effects of Plyometric Exercises in Women With Dynamic Knee Valgus

BACKGROUND

Female athletes are more predisposed to anterior cruciate ligament (ACL) injuries in comparison with their male counterparts. Research on ACL injury prevention strategies has demonstrated beneficial effects of plyometric exercises and feedback (FB) during the exercises. FB has resulted in reductions in vertical ground-reaction force and kinematic risk factors associated with ACL injury. Furthermore, taping (TP) may draw attention to the restriction created by the tape and serve as real-time biofeedback. The additional influence of FB and TP on plyometric exercises has not been determined.

HYPOTHESIS

FB and TP interventions delivered during plyometric exercises would result in positive changes in biomechanics and muscle onset in female athletes displaying dynamic knee valgus.

DESIGN

Controlled trial.

SETTING

University research laboratory.

LEVEL OF EVIDENCE

Level 2.

METHODS

Forty-eight active female athletes were divided into 3 groups: control (n = 16), plyometric training with FB (n = 16), and plyometric training with TP (n = 16). The 2 experimental groups performed a 6-week exercise program with either FB or TP. The control group continued its regular team schedule. Knee joint position sense, landing error scoring system (LESS), and the onset of muscle activation (the point at which muscle activation exceeds 3 standard deviations over baseline and continued above this threshold for at least 25 ms) before landing for the rectus femoris, vastus medialis, vastus lateralis, gluteus medius, semitendinosus, and biceps femoris during pre- and posttests were measured.

RESULTS

The vastus lateralis onset later in the TP group compared with the FB group (d [95% CI] = 0.64 [0.35-0.82], P = 0.01). Joint position sense accuracy improved only in the TP group (d = -0.63, P = 0.001). Both the FB (d = -0.85, P = 0.001), and TP (d = -0.82, P = 0.001) groups improved in LESS scores.

CONCLUSION

The results of the present study showed that plyometric exercises with FB or TP affect LESS and the onset of the vastus lateralis in active uninjured women with dynamic knee valgus, while TP improves joint position sense. Therefore, when more accurate joint position sense is desired, practitioners may use plyometric with TP. If an improved LESS score is desired, plyometrics with either TP or FB are acceptable.

CLINICAL RELEVANCE

Our findings indicate that female athletes may benefit more when completing a plyometric training program with a TP versus an FB. Trainers, coaches, and clinicians should consider utilizing instructions that promote an external focus when implementing plyometric training programs with male athletes.