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Segura-Jiménez V, Tsiarleston G, Donoso B, Gil-Gutiérrez YM, Delgado-Fernández M. Association of Muscle Strength, Psychological Factors, and Central Sensitization With Movement-Evoked Pain in Patients With Nonspecific Chronic Low Back Pain: The BACKFIT Project. Sports Health 2024:19417381241235152. [PMID: 38566303 DOI: 10.1177/19417381241235152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND People with chronic pain might evade certain movements to prevent their experience of pain. Movement-evoked pain (MEP) might induce lower functionality during daily activities. HYPOTHESIS (1) MEP after physical fitness tests would vary depending on the main musculature involved in the test; (2) physical and psychological factors would be associated with MEP in patients with NSCLBP. STUDY DESIGN Cross-sectional design. LEVEL OF EVIDENCE Level 3. METHODS A total of 104 (69 women) patients aged 51.0 ± 10.3 years with NSCLBP participated. MEP was measured with a visual analog scale (VAS) at baseline and immediately after performing each physical fitness test, that is, the Biering-Sørensen, prone bridging, handgrip, chair-stand, and 8-foot time-up-and-go tests, measuring back extensor, back flexor, upper- and lower-body muscle strength, and motor agility, respectively. Global muscle strength was calculated with normalized index (z-score) procedure. Depression, anxiety, pain catastrophizing, and central sensitization were assessed with the Beck Depression Inventory II, State Trait Anxiety Inventory I, Pain Catastrophizing Scale, and Central Sensitization Inventory (CSI), respectively. RESULTS Patients showed greater pain after completion of the Biering-Sørensen (mean difference 95% CI, 0.02, 1.11), prone bridging (0.15, 1.21), lower pain after handgrip (-1.46, -0.52), and the 8-foot time-up-and-go (-1.43, 0.46) tests (all P ≤ 0.04). Lower global muscular strength (β between -0.18 and -0.30), and greater pain catastrophizing (β = 0.16), and CSI scoring (β between 0.18 and 0.27) were associated with greater MEP (all P ≤ 0.04). CONCLUSION Greater MEP was observed after tests measuring core musculature strength than after tests measuring distal (limbs) strength and agility. Greater MEP was overall associated with lower muscle strength, greater pain catastrophizing, and central sensitization. CLINICAL RELEVANCE Fitness testing might be implemented as a complementary tool for the monitoring of NSCLBP in clinical settings.
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Affiliation(s)
- Víctor Segura-Jiménez
- UGC Neurotraumatología y Rehabilitación, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. Granada, Granada, Spain
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Gavriella Tsiarleston
- Physical Activity for Health Promotion (PA-HELP) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Belén Donoso
- Department of Psychology, Faculty of Education Sciences and Psychology, University of Córdoba, Córdoba, Spain
| | | | - Manuel Delgado-Fernández
- Physical Activity for Health Promotion (PA-HELP) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Sport and Health University Research Institute (iMUDS), Granada, Spain
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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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Patterson CS, Lohman E, Asavasopon S, Dudley R, Gharibvand L, Powers CM. The influence of hip flexion mobility and lumbar spine extensor strength on lumbar spine flexion during a squat lift. Musculoskelet Sci Pract 2022; 58:102501. [PMID: 35026497 DOI: 10.1016/j.msksp.2021.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 12/02/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
STUDY DESIGN Cross-sectional; Controlled laboratory study. OBJECTIVE To examine the associations among available hip flexion motion, lumbar extensor strength and peak lumbar flexion during a squat lift task. SUMMARY OF BACKGROUND DATA Lumbar spine flexion during lifting can result in increased strain on spinal structures. Although decreased available hip flexion motion and reduced strength of the lumbar extensor muscles has been proposed to contribute to greater lumbar flexion during lifting, direct relationships have not been explored. METHODS Fifty healthy young adults participated (23 males and 27 females). Strength of the lumbar extensors was measured using a motor-driven dynamometer. Available hip flexion was assessed using 3D motion capture. Peak lumbar spine flexion and hip flexion were quantified during the descent phase of the squat lifting task. RESULTS There was a significant negative association between available hip flexion and peak lumbar spine flexion during squat lifting in females (r = -0.407, p = 0.035) but not males (r = -0.341, p = 0.120). Similarly, peak lumbar spine flexion was negatively associated with lumbar extensor strength in females (r = -0.398, p = 0.040) but not males (r = -0.310, p = 0.161). During the squat lift, peak hip motion was positively associated with available hip flexion for both males and females combined (r = 0.774, p < 0.001). CONCLUSION Females with less available hip flexion and lower lumbar extensor strength exhibit greater lumbar flexion when performing a lifting task. Clinicians should be aware of the potential contributions of such impairments when instructing patients into various lifting strategies.
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Affiliation(s)
- Christopher S Patterson
- Loma Linda University Department of Physical Therapy, 24951, N. Circle Dr., A-620, Loma Linda, CA, 92350, USA; Azusa Pacific University, 901 E Alosta Ave. Azusa, CA, 91702, USA.
| | - Everett Lohman
- Loma Linda University Department of Physical Therapy, 24951, N. Circle Dr., A-620, Loma Linda, CA, 92350, USA.
| | - Skulpan Asavasopon
- University of Southern California Division of Biokinesiology and Physical Therapy, 1540 E. Alcazar St. CHP - 155, Los Angeles, CA, 90089, USA
| | - Robert Dudley
- Loma Linda University Department of Physical Therapy, 24951, N. Circle Dr., A-620, Loma Linda, CA, 92350, USA; Azusa Pacific University, 901 E Alosta Ave. Azusa, CA, 91702, USA.
| | - Lida Gharibvand
- Loma Linda University School of Allied Health Professions, 24951 N. Circle Dr., A-620, Loma Linda, CA, 92350, USA.
| | - Christopher M Powers
- University of Southern California Division of Biokinesiology and Physical Therapy, 1540 E. Alcazar St. CHP - 155, Los Angeles, CA, 90089, USA.
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Falla D, Devecchi V, Jiménez-Grande D, Rügamer D, Liew BXW. Machine learning approaches applied in spinal pain research. J Electromyogr Kinesiol 2021; 61:102599. [PMID: 34624604 DOI: 10.1016/j.jelekin.2021.102599] [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] [Received: 06/08/2021] [Revised: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 01/13/2023] Open
Abstract
The purpose of this narrative review is to provide a critical reflection of how analytical machine learning approaches could provide the platform to harness variability of patient presentation to enhance clinical prediction. The review includes a summary of current knowledge on the physiological adaptations present in people with spinal pain. We discuss how contemporary evidence highlights the importance of not relying on single features when characterizing patients given the variability of physiological adaptations present in people with spinal pain. The advantages and disadvantages of current analytical strategies in contemporary basic science and epidemiological research are reviewed and we consider how analytical machine learning approaches could provide the platform to harness the variability of patient presentations to enhance clinical prediction of pain persistence or recurrence. We propose that machine learning techniques can be leveraged to translate a potentially heterogeneous set of variables into clinically useful information with the potential to enhance patient management.
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Affiliation(s)
- Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK.
| | - Valter Devecchi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - David Jiménez-Grande
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - David Rügamer
- Department of Statistics, Ludwig-Maximilians-Universität München, Germany
| | - Bernard X W Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, UK
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Rummens S, Robben E, De Groef A, Van Wambeke P, Janssens L, Brumagne S, Desloovere K, Peers K. Factors Associated With the Ultrasound Characteristics of the Lumbar Multifidus: A Systematic Review. PM R 2019; 12:82-100. [PMID: 31264799 DOI: 10.1002/pmrj.12212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/21/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The first aim of this review was to investigate the association between age, sex, height, weight, physical activity level, posture, lumbar level and body side, and structural characteristics (cross-sectional area [CSA], thickness, linear dimensions, and echo intensity) of the lumbar multifidus (LM) measured by ultrasound. Second, differences between healthy individuals and patients with chronic low back pain (CLBP) were investigated. TYPE: Systematic review. LITERATURE SURVEY PubMed, Embase and Web of Science were searched until September 2018. METHODOLOGY Studies were included if (a) full text was available in English, Dutch, or French; (b) participants were older than 18 years of age and were asymptomatic or had nonspecific CLBP; and (c) the relation between structural characteristics of the LM, measured by ultrasound, and at least one of the above-mentioned factors was described, and/or a comparison between a CLBP and control group was made. Data were extracted independently by two reviewers. Quality of studies was assessed using an adapted version of the Downs and Black checklist. SYNTHESIS Twenty-seven studies were included. Thickness and CSA of the LM do not correlate with age. Males have a larger LM size than females. Thickness and CSA of left and right LM are highly correlated in healthy subjects. More significant side-to-side differences are present in subjects with CLBP than in those without. Muscle size increases from proximal to caudal lumbar levels. The presence of CLBP is associated with muscle size and function. CONCLUSIONS The association between the factors age, sex, height, weight, physical activity level, posture, lumbar level, body side, and presence of CLBP, and the ultrasound characteristics of the LM is discussed. These factors should be taken into account in future research on structural muscle characteristics, or when correlating with functional behavior or investigating the effect of a targeted intervention. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Sofie Rummens
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Elise Robben
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - An De Groef
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Peter Van Wambeke
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Lotte Janssens
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Simon Brumagne
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Koen Peers
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
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