Sensitivity, specificity and predictive value of the clinical trunk muscle endurance tests in low back pain

Testing the Posterior Chain: Diagnostic Accuracy of the Bunkie Test versus the Isokinetic Hamstrings/Quadriceps Measurement in Patients with Self-Reported Knee Pain and Healthy Controls

(1) Background: The isokinetic measurement (IM) of the leg muscles is well established but costly, whereas the Bunkie Test (BT) is a rarely investigated but easy-to-conduct functional test to evaluate the total posterior chain. Although the tests differ in aim and test structures, both have their justification in the assessment process. Therefore, this study evaluated the diagnostic accuracy of the BT and the IM. (2) Methods: 21 participants (9 female, 12 male; age, 26.2 ± 5.26 years; weight 73.8 ± 14.6 kg; height 176.0 ± 9.91 cm) and 21 patients (9 female, 12 male; age, 26.5 ± 5.56 years; weight, 72.6 ± 16.9 kg; height 177.0 ± 10.1 cm) with self-reported pain in the knee performed the IM and the BT. For IM, we calculated the ratio of the knee mean flexor/extensor peak torque (H/Q ratio) for 60°/s and 120°/s, and BT performance was measured in seconds. We classified the IM (<0.6 H/Q ratio) and the BT (leg difference ≥4 s) as binary results according to the literature. We calculated the sensitivity and specificity, which we compared with the Chi-Square test, and the 95% confidence intervals (CI). A p-value of ≤0.05 is considered significant. (3) Results: The sensitivity for the BT was 0.89, 95% CI [0.67, 0.99], and the specificity was 0.52 [0.30, 0.74]. For the IM, the sensitivity was 0.14 [0.03, 0.36] for 60°/s and 0.05 [0.00, 0.24] for 120°/s, and the specificity was 0.70 [0.46, 0.88] for 60°/s and 0.90 [0.68, 0.99] for 120°/s. The results of the Chi-Square tests were significant for the BT (χ2 (1) = 6.17, p = 0.01) but not for the IM (60°/s: χ2 (1) = 0.70, p = 0.40; 120°/s: χ2 (1) = 0.00, p = 0.97). (4) Conclusions: Patients were more likely to obtain a positive test result for the BT but not for the IM.

Lumbar Kinematics Assessment of Patients with Chronic Low Back Pain in Three Bridge Tests Using Miniaturized Sensors

Lumbar muscle atrophy, diminished strength, stamina, and increased fatigability have been associated with chronic nonspecific low back pain (LBP). When evaluating patients with LBP, trunk or core stability, provided by the performance and coordination of trunk muscles, appears to be essential. Several clinical tests have been developed to identify deficiencies in trunk performance, demonstrating high levels of validity and reproducibility. The most frequently prescribed tests for assessing the core body muscles are the prone plank bridge test (PBT), the side bridge test (SBT), and the supine bridge test (SUBT). However, quantitative assessments of the kinematics of the lumbar spine during their execution have not yet been conducted. The purpose of our study was to provide objective biomechanical data for the assessment of LBP patients. The lumbar spine ranges of motion of 22 healthy subjects (Group A) and 25 patients diagnosed with chronic LBP (Group B) were measured using two inertial measurement units during the execution of the PBT, SUBT, and SBT. Statistically significant differences between the two groups were found in all three tests' kinematic patterns. This quantitative assessment of lumbar spine motion transforms the three bridge tests into an objective biomechanical diagnostic tool for LPBs that may be used to assess the efficacy of applied rehabilitation programs.

Comparison of supervised exercise therapy with or without biopsychosocial approach for chronic nonspecific low back pain: a randomized controlled trial

Background

A biopsychosocial rehabilitation is recommended for chronic nonspecific low back pain (CNLBP); however, its effectiveness compared to the traditional supervised exercise therapy of CNLBP treatment is still unclear.

Methods

This was a parallel-group randomized controlled clinical trial. The sample consisted of 180 participants of both sexes, aged ≥18 years, with CNLBP for ≥3 months. Using web randomization and concealed allocation, they were assigned to three groups; graded activity receiving cognitive-behavioral therapy, group-based combined exercise therapy and education (GA; n = 59), supervised group-based combined exercise therapy and education (SET; n = 63), and a control group receiving usual care (n = 58). Interventions were administered for 4 weeks (8 sessions). The primary outcome was pain intensity. Outcome measures were collected baseline, after interventions (4 weeks), and during two follow-up periods (3 and 6 months).

Results

After the intervention, GA had a significant large effect on pain reduction compared to the control group (MD of 22.64 points; 95% CI = 16.10 to 29.19; p < 0.0001; Cohen’s d = 1.70), as well as SET compared with the control group (MD of 21.08 points; 95% CI = 14.64 to 27.52; p < 0.0001; Cohen’s d = 1.39), without significant difference between two intervention groups. At 3 and 6 months of follow-up, GA had a statistically significantly better effect in reducing pain, disability and fear-avoidance beliefs, and improving spinal extensor endurance, range of extension and quality of life compared to SET and the control group. A statistically significantly better effect of SET compared with the control group was found in reducing pain, disability, fear-avoidance beliefs, and improving the physical component of quality of life. Harms were not reported.

Conclusion

This study suggests that graded activity and group-based supervised exercise therapy have beneficial effects over the control group in the treatment of CNLBP. The graded activity was more beneficial than supervised group-based exercise therapy only during the follow-up.

Trial registration

Clinicaltrials.gov (NCT04023162; registration date: 17/07/2019).

GLA:D® Back Australia: a mixed methods feasibility study for implementation

Background

Practice-based guidelines recommend patient education and exercise as first-line care for low back pain (LBP); however, these recommendations are not routinely delivered in practice. GLA:D® Back, developed in Denmark to assist clinicians to implement guideline recommendations, offers a structured education and supervised exercise program for people with LBP in addition to a clinical registry to evaluate patient outcomes. In this study we evaluated the feasibility of implementing the GLA:D® Back program in Australia. We considered clinician and patient recruitment and retention, program fidelity, exploring clinicians’ and patients’ experiences with the program, and participant outcome data collection.

Methods

Clinicians (chiropractors and physiotherapists) were recruited and participated in a 2-day GLA:D® Back training course. Patients were eligible to participate if they had persistent or recurrent LBP. Feasibility domains included the ability to: (1) recruit clinicians to undergo training; (2) recruit and retain patients in the program; (3) observe program fidelity; and (4) perceive barriers and facilitators for GLA:D® Back implementation. We also collected data related to: (5) clinician confidence, attitudes, and behaviour; and (6) patient self-reported outcomes related to pain, disability, and performance tests.

Results

Twenty clinicians (8 chiropractors, 12 physiotherapists) participated in the training, with 55% (11/20) offering GLA:D® Back to their patients. Fifty-seven patients were enrolled in the program, with 67% (38/57) attending the final follow-up assessment. Loss to follow up was mainly due to the effects of the COVID-19 pandemic. We observed program fidelity, with clinicians generally delivering the program as intended. Interviews revealed two clinician themes related to: (i) intervention acceptability; and (ii) barriers and facilitators to implementation. Patient interviews revealed themes related to: (i) intervention acceptability; and (ii) program efficacy. At 3 months follow-up, clinicians demonstrated high treatment confidence and biomedical orientation. Patient outcomes trended towards improvement.

Conclusion

GLA:D® Back implementation in Australia appears feasible based on clinician recruitment, program acceptability and potential benefits for patient outcomes from the small sample of participating clinicians and patients. However, COVID-19 impacted patient recruitment, retention, and data collection. To scale-up GLA:D® Back in private and public settings, further work is warranted to address associated barriers, and to leverage facilitators.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12998-022-00427-3.

Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial

Background

Lumbar radiculopathy is an extensively common complaint reported by patients of low back pain (LBP), resulting in several impairments. A comparatively novel technique, non-surgical spinal decompression (NSD), is introduced, which uses a sensitive computerized feedback mechanism and decompresses the spinal nerve roots through segmental distraction. The objective of this study was to determine the effects of NSD therapy in addition to routine physical therapy on pain, lumbar range of motion (ROM), functional disability, back muscle endurance (BME), and quality of life (QOL) in patients with lumbar radiculopathy.

Methods

A total of sixty patients with lumbar radiculopathy were randomly allocated into two groups, an experimental (n = 30) and a control (n = 30) group, through a computer-generated random number table. Baseline values were recorded before providing any treatment by using a visual analogue scale (VAS), Urdu version of Oswestry disability index (ODI-U), modified-modified Schober’s test (MMST), prone isometric chest raise test, and Short Form 36-Item Survey (SF-36) for measuring the pain at rest, functional disability, lumbar ROM, BME, and QOL, respectively. All patients received twelve treatment sessions over 4 weeks, and then all outcome measures were again recorded.

Results

By using the ANCOVA test, a statistically significant (p < 0.05) between-group improvement was observed in VAS, ODI-U, BME, lumbar ROM, role physical (RP), and bodily pain (BP) domains of SF-36, which was in favour of NSD therapy group. The between-group difference was 1.07 ± 0.32 cm (p < .001) for VAS, 5.65 ± 1.48 points (p < .001) for ODI-U, 13.93 ± 5.85 s (p = 0.002) for BME, 2.62 ± 0.27 cm (p < .001) for lumbar flexion, 0.96 ± 0.28 (p < .001) for lumbar extension, 5.77 ± 2.39 (p = 0.019) for RP and 6.33 ± 2.52 (p = 0.016) for BP domain of SF-36. For these outcomes, a medium to large effect size (d = 0.61–2.47, 95% CI: 0.09–3.14) was observed.

Conclusion

It was concluded that a combination of non-surgical spinal decompression therapy with routine physical therapy is more effective, statistically and clinically, than routine physical therapy alone in terms of improving pain, lumbar range of motion, back muscle endurance, functional disability, and physical role domain of quality of life, in patients with lumbar radiculopathy, following 4 weeks of treatment.

Trial registration

WHO Iranian registry of clinical trials (IRCT20190717044238N1) Dated: 23.12.2019.

Criterion-Related Validity of Field-Based Fitness Tests in Adults: A Systematic Review

We comprehensively assessed the criterion-related validity of existing field-based fitness tests used to indicate adult health (19–64 years, with no known pathologies). The medical electronic databases MEDLINE (via PubMed) and Web of Science (all databases) were screened for studies published up to July 2020. Each original study’s methodological quality was classified as high, low and very low, according to the number of participants, the description of the study population, statistical analysis and systematic reviews which were appraised via the AMSTAR rating scale. Three evidence levels were constructed (strong, moderate and limited evidence) according to the number of studies and the consistency of the findings. We identified 101 original studies (50 of high quality) and five systematic reviews examining the criterion-related validity of field-based fitness tests in adults. Strong evidence indicated that the 20 m shuttle run, 1.5-mile, 12 min run/walk, YMCA step, 2 km walk and 6 min walk test are valid for estimating cardiorespiratory fitness; the handgrip strength test is valid for assessing hand maximal isometric strength; and the Biering–Sørensen test to evaluate the endurance strength of hip and back muscles; however, the sit-and reach test, and its different versions, and the toe-to-touch test are not valid for assessing hamstring and lower back flexibility. We found moderate evidence supporting that the 20 m square shuttle run test is a valid test for estimating cardiorespiratory fitness. Other field-based fitness tests presented limited evidence, mainly due to few studies. We developed an evidence-based proposal of the most valid field-based fitness tests in healthy adults aged 19–64 years old.

Novel lateral whole-body dual-energy X-ray absorptiometry of lumbar paraspinal muscle mass: results from the SarcoSpine study

BACKGROUND

Here, we aimed to propose novel lateral whole-body dual-energy X-ray absorptiometry (lateral DXA) as a simple tool for measuring spinal muscle mass and investigate the feasibility of lateral DXA to measure lumbar paraspinal muscle (LPM) mass compared with lumbosacral spine three-dimensional magnetic resonance imaging (3D MRI).

METHODS

Twenty consecutive participants were enrolled from a prospective observational cohort (SarcoSpine study). Lateral DXA was scanned with each participant in the lateral decubitus position. The region of interest was defined to analyse the LPM mass. LPM total volume, LPM cross-sectional area at the L3 mid-vertebra and L4/5 mid-disc levels and each signal intensity were measured by 3D MRI. Isokinetic and isometric back extensor muscle strengths as well as back extensor endurance were examined. The correlation between lateral DXA-based mass (weight) and 3D MRI-based LPM volume was analysed.

RESULTS

The mean age of the 20 participants (15 women, 5 men) was 72.2 ± 4.9 years. LPM mass by lateral DXA was positively correlated with LPM volume by 3D MRI (β = 0.333, r = 0.692, p < 0.001) and negatively correlated with signal intensity of the total LPM (β = -0.263, r = -0.530, p = 0.016). LPM mass was also correlated with appendicular limb muscle mass, handgrip strength and gait speed as well as back extensor endurance (r = 0.620, p = 0.004).

CONCLUSIONS

Our data suggest that LPM mass assessed by lateral DXA was positively correlated with LPM volume by 3D MRI in older adults. Lateral DXA may be a potential substitute for the cross-sectional area measurement of LPM mass. Further studies are required to validate this lateral DXA technique.

The influence of Kinesio Taping on muscle fatigue in individuals with low back pain: A randomised controlled trial

OBJECTIVE

To evaluate the effect of different taping techniques on back muscle fatigue in people with low back pain.

METHODS

Sixty women with chronic non-specific low back pain were randomly assigned to four groups of 15 participants each: control (CG), Kinesio Taping (KT) with tension (KTT), KT no tension (KTNT) and Micropore® (MP), which were applied over the erector spinae muscles. The median frequency (MF) fatigue slopes of the longissimus muscle and sustained contraction time during a trunk fatigue test (Ito test), and pain using the numerical pain rating scale (NPRS) were collected at three time points: pre-treatment, three and ten days after intervention at a university laboratory.

RESULTS

Significant differences were seen in the MF slopes between groups (p= 0.01, η2= 0.20), with the KTT showing a mean difference (MD = 0.31, p= 0.04) and KTNT (MD = 0.28, p= 0.04) compared with CG. Significant reductions in NPRS were seen between time points (p< 0.001, η2= 0.28), with a reduction between pre and 3 days (MD = 1.87, p< 0.001), and pre and 10 days (MD = 1.38, p< 0.001), with KTT and KTNT both showing clinically important changes.

CONCLUSION

KT, with or without tension, has a tendency to reduce back muscle fatigue and reduce pain in individuals with chronic non-specific low back pain.

Adherence and characteristics of participants enrolled in a standardised programme of patient education and exercises for low back pain, GLA:D® Back - a prospective observational study

BACKGROUND

Low back pain is often long-lasting, and implementation of low-cost interventions to improve care and minimise its burden is needed. GLA:D® Back is an evidence-based programme consisting of patient education and supervised exercises for people with low back pain, which was implemented nationwide in primary care clinics in Denmark. To assess how the intervention was received and factors influencing adherence to the program, we aimed to evaluate participants' adherence to the intervention and identified characteristics related to the completion of GLA:D® Back. Specifically, we investigated: 1) level of attendance of participants enrolled in the programme, and 2) participant-related factors associated with low attendance.

METHODS

Primary care clinicians delivered GLA:D® Back, a standardised 10-week programme of 2 educational and 16 supervised exercise sessions, to patients with low back pain. Attendance was defined as low, medium or high based on self-reported number of attended sessions. Additional participant-reported data included demographic characteristics, pain, prognostic risk profiles, self-efficacy, illness-beliefs, function and clinician-reported physical performance tests. Results for high, medium, low, and unknown attendance were reported descriptively. Odds ratios for low attendance compared to medium/high attendance were calculated by including all baseline factors in a mixed-model logistic regression model.

RESULTS

Of 1730 participants, 52% had high, 23% medium, and 25% low levels of attendance. Level of attendance was not strongly associated with participants' individual factors, but in combination, prediction of low attendance was fair (AUC 0.77; 95% CI 0.74-0.79). The strongest indicator of low attendance was not completing the baseline questionnaire.

CONCLUSIONS

Most participants of a 10-week low back pain programme attended almost all session. Non-response to the baseline questionnaire was strongly associated with low attendance, whereas individual patient characteristics were weakly related to attendance. Not completing baseline questionnaires might be an early indicator of poor adherence in programs for people with persistent low back pain.

TRIAL REGISTRATION

The Health Research Ethics for Southern Denmark decided there was no need for ethical approval (S-20172000-93). The Danish data collection has obtained authorisation from the Danish Data Protection Agency as part of the University of Southern Denmark's institutional authorisation (DPA no. 2015-57-0008 SDU no. 17/30591). The trial was registred at ClinicalTrials.gov NCT03570463 .

A Novel Rehabilitation Program Using Neuromuscular Electrical Stimulation (NMES) and Taping for Shoulder Pain in Swimmers: A Protocol and Case Example

In-pool return to swim protocols have been described for swimmers returning from being deactivated from swimming due to a shoulder injury who have full shoulder strength. Many swimmers actively participate in swim practice and competition with shoulder pain and experience deficits in performance. There are multiple reported risk factors associated with shoulder pain among swimmers, including training errors and physical impairments. These include pool and dry-land training errors, weakness in the scapular stabilizers and rotator cuff, and muscle tightness. A need exists for dry-land rehabilitation programs for impairments common to swimmers that can be performed in a traditional outpatient physical therapy setting. The purpose of this clinical commentary is to present a protocol using neuromuscular electrical stimulation (NMES), taping, strengthening, and stretching to address impairments that are common among swimmers while allowing continued active participation in practice and competition.

LEVEL OF EVIDENCE

Level 5.

The feasibility of implementing an English language version of GLA:D Back

BACKGROUND

Evidenced-based clinical guidelines for the treatment of low back pain (LBP) consistently suggest educating patients about their back pain, its natural course, and providing advice to keep active and continue working. Despite this evidence, clinicians routinely do not follow these recommendations resulting in ineffective and fragmented care. GLA:D® Back, a standardized care package, was originally developed in Denmark to assist clinicians in implementing evidence-based care. This study will evaluate the feasibility of implementing the English version of the Danish GLA:D® Back program in Alberta, Canada.

METHODS

Thirty-five clinicians from nineteen clinics in Alberta, Canada, participated. Feasibility of program implementation, our primary objective, was evaluated within 3 months. Feasibility success was defined as 50% clinician/clinic adoption in addition to 66-88 enrolled participants registered in the database. Our secondary objectives included collecting data pertaining to clinician confidence, attitudes and behaviour of treating patients, perceived barriers and facilitators of program in addition to collecting patient-data regarding pain, function, general health and self-efficacy.

RESULTS

The majority of the clinics (15/19, 79%) offered GLA:D® Back to their patients within the study period. Of the participating clinicians, GLA:D® Back was delivered by (25/35, 71%) of clinicians. In total, 78 patients were enrolled in the program and (69/78, 88%) participants attended the final assessment. Secondarily, clinicians demonstrated a biomedical and behavioural orientation along with high confidence when treating LBP patients while patient outcomes trended toward improvement.

CONCLUSION

The English translation of the Danish GLA:D Back program was feasible for Albertan clinicians to implement into practice in both urban and rural settings.

Identifying Fatigue Indicators Using Gait Variability Measures: A Longitudinal Study on Elderly Brisk Walking

Real-time detection of fatigue in the elderly during physical exercises can help identify the stability and thus falling risks which are commonly achieved by the investigation of kinematic parameters. In this study, we aimed to identify the change in gait variability parameters from inertial measurement units (IMU) during a course of 60 min brisk walking which could lay the foundation for the development of fatigue-detecting wearable sensors. Eighteen elderly people were invited to participate in the brisk walking trials for 60 min with a single IMU attached to the posterior heel region of the dominant side. Nine sets of signals, including the accelerations, angular velocities, and rotation angles of the heel in three anatomical axes, were measured and extracted at the three walking times (baseline, 30th min, and 60th min) of the trial for analysis. Sixteen of eighteen participants reported fatigue after walking, and there were significant differences in the median acceleration (p = 0.001), variability of angular velocity (p = 0.025), and range of angle rotation (p = 0.0011), in the medial–lateral direction. In addition, there were also significant differences in the heel pronation angle (p = 0.005) and variability and energy consumption of the angles in the anterior–posterior axis (p = 0.028, p = 0.028), medial–lateral axis (p = 0.014, p = 0.014), and vertical axis (p = 0.002, p < 0.001). Our study demonstrated that a single IMU on the posterior heel of the dominant side can address the variability of kinematics parameters for elderly performing prolonged brisk walking and could serve as an indicator for walking instability, and thus fatigue.

A Meta-Analysis of the Reliability of Four Field-Based Trunk Extension Endurance Tests

This meta-analysis aimed to estimate the inter- and intra-tester reliability of endurance measures obtained through trunk extension field-based tests and to explore the influence of the moderators on the reliability estimates. The reliability induction rate of trunk extension endurance measures was also calculated. A systematic search was conducted using various databases, and subsequently 28 studies were selected that reported intraclass correlation coefficients for trunk extension endurance measures. Separate meta-analyses were conducted using a random-effects model. When possible, analyses of potential moderator variables were carried out. The inter-tester average reliability of the endurance measure obtained from the Biering-Sorensen test was intraclass correlation coefficient (ICC) = 0.94. The intra-session reliability estimates of the endurance measures recorded using the Biering-Sorensen test, the prone isometric chest raise test, and the prone double straight-leg test were ICC = 0.88, 0.90, and 0.86, respectively. The inter-session average reliability of the endurance measures from the Biering-Sorensen test, the prone isometric chest raise test, and the dynamic extensor endurance test were ICC = 0.88, 0.95, and 0.99, respectively. However, due to the limited evidence available, the reliability estimates of the measures obtained through the prone isometric chest raise, prone double straight-leg, and dynamic extensor endurance tests should be considered with a degree of caution. Position control instruments, tools, and familiarization session demonstrated a statistical association with the inter-session reliability of the Biering-Sorensen test. The reliability induction rate was 72.8%. Only the trunk extension endurance measure obtained through the Biering-Sorensen test presented sufficient scientific evidence in terms of reliability to justify its use for research and practical purposes.

Trunk-Pelvis Kinematics Variability During Gait and Its Association With Trunk Muscle Endurance in Patients With Chronic Low Back Pain

The first purpose was to investigate the trunk muscle endurance, the second aim was to evaluate the trunk-pelvis kinematics during gait, and the third was to evaluate the relationship between trunk-pelvis kinematics and the trunk muscle endurance. Thirty participants (15 nonspecific chronic low back pain [NCLBP] and 15 healthy) were included. The authors first assessed trunk muscle endurance on endurance testing protocols. The authors next measured the trunk-pelvis kinematics during gait using a 3-dimensional motion capture system. Angular displacement, waveform pattern (CVp), and offset variability (CVo) were also examined. Statistical analysis revealed a significant difference in (1) the trunk muscle endurance and (2) sagittal, frontal, and transverse planes CVp between groups (P < .05). A significant moderate correlation was found between supine double straight-leg raise and frontal CVp (r = .521, P = .03) and transverse planes CVp (r = .442, P = .05). However, a significant moderate correlation was observed between prone double straight-leg raise and sagittal plane CVp (r = .528, P = .03) and transverse plane CVp (r = .678, P = .001). The relationship between (1) lower trunk extensor endurance with transverse and sagittal planes CVp and (2) lower abdominal muscle endurance with transverse and frontal planes CVp suggests that gait variability in these planes may result because of trunk muscle deconditioning accompanying NCLBP.

GLA:D® Back: group-based patient education integrated with exercises to support self-management of persistent back pain - feasibility of implementing standardised care by a course for clinicians

BACKGROUND

Clinical guidelines for management of low back pain (LBP) are not routinely implemented in practice, and guidelines rarely offer tools for implementation. Therefore, we developed GLA:D® Back, a standardised intervention of patient education and supervised exercises. This pilot study tested the feasibility of implementing GLA:D Back in clinical practice in Denmark by delivering a course for physiotherapists and chiropractors. It should further inform the planning of an implementation-effectiveness study using a pre-post group design alongside nation-wide implementation.

METHODS

Thirty-one clinicians from nine clinics participated. Feasibility of implementation was evaluated in terms of adoption and through focus group interviews and a feedback meeting. Patient-level data, including pain, disability, and pain enablement, were collected from (1) LBP patients visiting the clinics during a pre-specified 2-week period 2 months prior to clinicians attending the GLA:D Back course (n = 84), (2) LBP patients consulting during a 2-week period 2 months after the course (n = 77), and (3) those enrolled in GLA:D Back during 4 months after implementation (n = 89). Patient data were collected at baseline and at 4 months.

RESULTS

Clinicians' evaluations of the course were positive and resulted in several modifications. The clinical intervention was adopted by all test sites. Most patient characteristics were similar across groups. Patients mainly had persistent LBP (73% > 3 months) and most had been treated for more than 4 weeks at inclusion. Patients in GLA:D Back were more often retired (30% vs. 16% before implementation) and at high risk of poor prognosis (25% vs. 13%). Procedures for data collection were feasible, and outcomes after implementation, especially with GLA:D Back, were as good as or better than before implementation. Recruiting patients and achieving comparable pre- and post-groups was difficult.

CONCLUSIONS

Implementation of the GLA:D Back clinical intervention in Danish primary care physiotherapy and chiropractic clinics was feasible through a 2-day clinician course. Both clinicians and patients were satisfied with the programme, and patient-reported outcomes were slightly better than outcomes in patients registered before implementation. It was not deemed possible to conduct an implementation-effectiveness trial as part of a nation-wide implementation.

GLA:D® Back: implementation of group-based patient education integrated with exercises to support self-management of back pain - protocol for a hybrid effectiveness-implementation study

BACKGROUND

Reassuring patient education and exercise therapy are widely recommended interventions for back pain in clinical guidelines. However, many patients are offered non-guideline endorsed options, and strategies for effective implementation of guideline-based care have not yet been developed. This protocol outlines the evaluation of a strategy for nationwide implementation of standardised patient education and exercise therapy for people with persistent or recurrent back pain in a hybrid implementation-effectiveness design. The strategy and the evaluation were planned using the framework of the Behaviour Change Wheel.

METHODS

The main activity of the implementation strategy is a two-days course for physiotherapists and chiropractors in delivering patient education and exercise therapy that is aimed at supporting patient self-management. This comes with ready-to-use patient education materials and exercise programs. The clinical intervention is a group-based program consisting of two sessions of patient education and 8 weeks of supervised exercises. The program uses a cognitive-behavioural approach and the aim of the exercise component is to restore the patient's ability and confidence to move freely. The implementation process is evaluated in a dynamic process monitoring the penetration, adoption and fidelity of the clinical intervention. The clinical intervention and potential effect mechanisms will be evaluated at the patient-level using measures of knowledge, skills, beliefs, performance, self-efficacy and success in self-management. The education of clinicians will be evaluated via clinician-level outcomes, including the Pain Attitudes and Beliefs Scale, the Practitioner Confidence Scale, and the Determinants of Implementation Behaviour Questionnaire. Effects at a national level will be investigated via data from national registries of health care utilisation and sick-leave.

DISCUSSION

This implementation-effectiveness study is designed to evaluate the process of implementing an evidence-based intervention for back pain. It will inform the development of strategies for implementing evidence-based care for musculoskeletal pain conditions, it will enhance the understanding of mechanisms for developing patient self-management skills, and it will demonstrate the outcomes that are achievable in everyday clinical practice.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03570463 . Registered 27 June 2018.

GLA:D® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence

BACKGROUND

Clinical guidelines recommend that people with back pain be given information and education about their back pain, advice to remain active and at work, and exercises to improve mobility and physical activity. Guidelines, however, rarely describe how this is best delivered. The aim of this paper is to present the development, theories, and underlying evidence for 'GLA:D Back' - a group education and exercise program that translates guideline recommendations into a clinician-delivered program for the promotion of self-management in people with persistent/recurrent back pain.

METHODS

GLA:D Back, which included a rationale and objectives for the program, theory and evidence for the interventions, and program materials, was developed using an iterative process. The content of patient education and exercise programs tested in randomised trials was extracted and a multidisciplinary team of expert researchers and clinicians prioritised common elements hypothesised to improve back pain beliefs and management skills. The program was tested on eight people with persistent back pain in a university clinic and 152 patients from nine primary care physiotherapy and chiropractic clinics. Following feedback from the clinicians and patients involved, the working version of the program was created.

RESULTS

Educational components included pain mechanisms, pain modulation, active coping strategies, imaging, physical activity, and exercise that emphasised a balance between the sum of demands and the individual's capacity. These were operationalised in PowerPoint presentations with supporting text to aid clinicians in delivering two one-hour patient education lectures. The exercise program included 16 supervised one-hour sessions over 8 weeks, each comprising a warm-up section and eight types of exercises for general flexibility and strengthening of six different muscle groups at four levels of difficulty. The aims of the exercises were to improve overall back fitness and, at the same time, encourage patients to explore variations in movement by incorporating education content into the exercise sessions.

CONCLUSION

From current best evidence about prognostic factors in back pain and effective treatments for back pain, research and clinical experts developed a ready-to-use structured program - GLA:D® Back - to support self-management for people with persistent/recurrent back pain.

Collegiate baseball players with more optimal functional movement patterns demonstrate better athletic performance in speed and agility

Sports injuries are common among baseball players and may result in abnormal movement patterns, increased risks of future injury, and unsatisfactory performance. The Functional Movement Screen (FMS™) has been developed to detect abnormal functional movement patterns and can be used for predicting risks of sports injury. However, whether FMS™ scores are associated with athletic performance remains unclear. The goal of this study was to determine the association between functional movements and athletic performance in elite baseball players. Core stability, muscular strength and flexibility of the lower extremities, and FMS™, as well as athletic performance in sprinting, agility, and balance tests were assessed in 52 male collegiate Division I baseball players placed into two groups based on FMS™ scores. The high-scoring group demonstrated better athletic performance than the low-scoring group, with a shorter duration of the agility test. No group differences were found in core stability, muscular strength, or muscle flexibility, except for rectus femoris flexibility. Thus, the FMS™ score is associated with sprinting and agility performance in elite baseball players. These findings indicate that the FMS™ may have a role in predicting athletic performance and thereby help determine the goals of training regimens or return-to-play strategies.

l-Arginine supplementation does not improve muscle function during recovery from resistance exercise

The purpose of this study was to investigate the effects of l-arginine supplementation on muscle recovery after a single session of high-intensity resistance exercise (RE). Twenty healthy young adult participants (22.8 ± 3.4 years old) were assigned to 1 of 2 groups (N = 10 per group): a placebo-supplement group or an l-arginine-supplement group. The groups completed a session of high-intensity RE (0 h) and 3 subsequent fatigue test sessions (at 24, 48, and 72 h postexercise) to assess the time course of muscle recovery. During the test sessions, we assessed the following dependent variables: number of maximum repetitions, electromyographic signal (i.e., root mean square (RMS) and median frequency (MF) slope), muscle soreness, perceived exertion, blood levels of creatine kinase (CK) and lactate, and testosterone:cortisol ratio. Number of maximum repetitions increased at 48 and 72 h postexercise in both groups (time, P < 0.05). CK levels and muscle soreness increased at 24 h postexercise and then progressively returned to baseline at 72 h post exercise in both groups (time, P < 0.05). Lactate levels increased immediately postexercise but were reduced at 24 h postexercise in both groups (time, P < 0.05). Testosterone:cortisol ratio, RMS, and MF slope remained unchanged during the recovery period in both groups (time, P > 0.05). No significant (P > 0.05) group × time interaction was found for all dependent variables during the recovery period. In conclusion, our data indicate that l-arginine supplementation does not improve muscle recovery following a high-intensity RE session in young adults.

Effect of Elastic Therapeutic Taping on Abdominal Muscle Endurance in Patients With Chronic Nonspecific Low Back Pain: A Randomized, Controlled, Single-Blind, Crossover Trial

OBJECTIVE

The purpose of this study was to determine the immediate effect of elastic therapeutic taping and sham taping of the abdominal musculature on maximum hold time of endurance tests in patients with chronic nonspecific low back pain (CNLBP).

METHODS

Twenty-six people with CNLBP and 26 asymptomatic individuals were included in this study. The CNLBP participants were allocated to an elastic therapeutic tape group or a sham tape group. Standard adhesive elastic therapeutic tape was utilized for facilitatory application in the elastic therapeutic tape group. The elastic therapeutic tape group received real elastic therapeutic taping on the transversus abdominis and internal obliques, and the sham tape group received sham elastic therapeutic taping application. For the sham group, the elastic therapeutic tape was positioned horizontally above the navel and applied without tension. After a wash-out period, each CNLBP participant was switched to the other group. Outcome measures included maximum hold time of supine isometric chest raise, supine double straight-leg raise, and abdominal drawing in maneuver.

RESULTS

The CNLBP participants had lower maximum hold time compared to the asymptomatic individuals (P ≤ .01). Following taping, both groups showed an increase in the maximum hold time (mean difference = 4.43 - 50.69 seconds; P ≤ .02). Although there was no difference between the results of both groups (P ≥ .12), effect sizes were large for the elastic therapeutic tape group (Cohen's d = -1.93 to -1.00).

CONCLUSIONS

The results suggest that the maximum hold time of endurance tests was decreased in CNLBP patients compared to healthy participants. The application of both elastic therapeutic tape and sham tape to the transversus abdominis and internal obliques produced short-term improvement in abdominal endurance. There was no statistically significant difference between the results of elastic therapeutic tape and sham tape.

Lumbar extensor muscle profile of rural milk production workers

Background

Milk production is a work system that comprises several tasks from cattle handling, feeding and milking to product consumption. Isometric lumbar extension dynamometry is considered a satisfactory instrument for occupational evaluation and monitoring, especially for populations of workers whose activities demand high levels of strength.

Objective

To investigate isometric lumbar extension strength among rural milk production workers.

Methods

The sample comprised 47 rural milk production workers affiliated with the Technical Assistance and Rural Outreach Company/Southern Credit and Rural Assistance Company (Empresa de Assistência Técnica e Extensão Rural/Associação Sulina de Crédito e Assistência Rural - EMATER/ASCAR), Rio Grande do Sul, Brazil. The participants were analyzed based on a sociodemographic questionnaire and lumbar extensor muscle strength testing by means of an isometric dynamometry system.

Results

Participants were 20 men with average age 50.45±9.44 years old and 27 women with average age 46.15±7.56 years old. The isometric lumbar extension strength was 1,169±289.96 N for the men and 571.34±190.36 N for the women.

Conclusion

The lumbar extensor muscle profile of rural milk production workers was characterized by higher values for the men, which might be attributed to the fact that men exhibit higher body mass levels, and consequently produce greater force.

Influence of Manual Labor at Work on Muscular Fitness and Its Relationship With Work Performance

OBJECTIVE

The present study examined the influence of workplace manual labor on measures of muscular fitness, with a secondary aim to investigate the relationship between muscular fitness and work performance in blue-collar (BC) workers.

METHODS

Leg extension isokinetic strength at slow and fast velocities, hamstring and hip-flexor flexibility, and low back muscular endurance were examined in young and older BC workers and white-collar (WC) controls, while work performance was examined in the BC cohort.

RESULTS

There were no differences in muscular fitness variables between BC and WC groups; however, the older men had lower low back muscular endurance (-43.0%) and strength at slow (-9.4%) and fast (-12.7%) velocities. Work performance was associated with strength at fast velocities (r = 0.633) in the older BC workers.

CONCLUSIONS

Leg strength may influence work performance, with higher velocities becoming more important in older workers.

Citrulline Malate Does Not Improve Muscle Recovery after Resistance Exercise in Untrained Young Adult Men

The effects of citrulline malate (CM) on muscle recovery from resistance exercise remains unknown. We aimed to determine if citrulline malate supplementation improves muscle recovery after a single session of high-intensity resistance exercise (RE) in untrained young adult men. Nine young adult men (24.0 ± 3.3 years) participated in a double-blind crossover study in which they received 6 g of CM and placebo (PL) on two occasions, separated by a seven-day washout period. Each occasion consisted of a single session of high-intensity RE (0 h) and three subsequent fatigue tests sessions (at 24, 48, and 72 h) to assess the time course of muscle recovery. During the tests sessions, we assessed the following variables: number of maximum repetitions, electromyographic signal (i.e., root mean square (RMS) and median frequency (MF)), muscle soreness and perceived exertion, as well as blood levels of creatine kinase (CK), lactate, insulin, and testosterone:cortisol ratio. CK levels increased at 24 h post-exercise and remained elevate at 48 and 72 h, with no difference between CM and PL conditions. Muscle soreness increased at 24 h post-exercise, which progressively returned to baseline at 72 h in both conditions. Lactate levels increased immediately post-exercise and remained elevated at 24, 48, and 72 h in both conditions. No significant treatment × time interaction was found for all dependents variables (maximum repetitions, perceived exertion, CK, lactate, RMS, MF, and testosterone:cortisol ratio) during the recovery period. In conclusion, our data indicate that CM supplementation (single 6 g dose pre-workout) does not improve the muscle recovery process following a high-intensity RE session in untrained young adult men.

Responsiveness of the bridge maneuvers in subjects with symptomatic lumbar spondylolisthesis: A prospective cohort study

BACKGROUND AND PURPOSE

To date no study was made on the responsiveness of Bridge tests (BTs) in subjects with low back pain and spondylolisthesis (SPL) submitted to a physical therapy program. The objective of this study is to examine the responsiveness of the BTs in subjects with symptomatic lumbar SPL.

METHODS

One hundred twenty patients with symptomatic SPL received physical therapy treatments for a number of sessions depending on the individual patient's needs. Each session included supervised exercises and the teaching of home exercises aiming to improve the lumbar stability, for about 1 hr in total. At the beginning and immediately after the last session of treatment, participants completed the Oswestry Disability Index - Italian version and the Pain Numerical Rating Scale, and performed the supine bridging (SBT) and the prone bridging (PBT). The global perception of effectiveness was measured with a seven-point Likert scale Global Perceived Effect questionnaire.

RESULTS

The mean post-treatment change score (95% confidence interval [CI]) was 18.2 s (14.5; 21.9) for the PBT and 43.9 s (35.1; 52.8) for the SBT, all p < .001. The area under the receiver operating characteristic curve for the PBT was 0.83 (95% CI 0.74-0.91) and for the SBT was 0.703 (95% CI 0.61-0.80). The optimal cutoff points were 19.5 s for the PBT and 62.5 s for the SBT. Logistic regression revealed that PBT (odds ratio = 0.952) was associated with the type of SPL. The final regression model explained 36.4% (R²  = 0.36; p = .001) of the variability.

DISCUSSION

Bridge maneuvers proved to be responsive, because their results were significantly related to pain and disability changes. BTs may be suggested to detect clinical changes after physical therapy treatment in symptomatic SPL. Copyright © 2017 John Wiley & Sons, Ltd.

Relationship between flexion-rotation test and ultrasound thickness measurement of the abdominal muscles

OBJECTIVE

The purpose of this study was to investigate the relationship between flexion-rotation test and ultrasound (US) thickness measurement of the antero-lateral abdominal muscles.

DESIGN

Following ethical approval, a convenience sample of 55 subjects between the ages of 20 and 30 years participated in this study. Endurance of the abdominal muscles was measured using the flexion-rotation test in all subjects. US thickness measurement for the transversus abdominis (TrA), internal oblique (IO) and external oblique (EO) muscles was performed on the right side at rest in a supine position.

RESULTS

Pearson correlation coefficient between the variables of the study showed no significant relationship between the flexion-rotation test and US thickness measurements of the TrA (r = -0.03, P = 0.80), IO (r = -0.13, P = 0.32), and EO (r = -0.14, P = 0.31) muscles. The significance level of 0.05 was chosen.

CONCLUSION

It seems that there is no significant relationship between the flexion-rotation test and US measurement of abdominal muscles thickness.

The Effect of Sitting on Stability Balls on Nonspecific Lower Back Pain, Disability, and Core Endurance: A Randomized Controlled Crossover Study

STUDY DESIGN

Experimental randomized crossover.

OBJECTIVE

The aim of the study was to determine whether sitting on a ball for 90 min/d instead of a chair has an effect on low back pain (LBP), low back disability, and/or core muscle endurance.

SUMMARY OF BACKGROUND DATA

LBP may result from prolonged sitting. It has been proposed that replacing chairs with stability balls can diminish LBP in those who sit for prolonged periods. Research on the topic is sparse and inconclusive.

METHODS

A total of 90 subjects (university students, staff, and faculty, ages 18-65, who sit ≥4 hr/d) were randomly assigned to the intervention or control group for the first part of the study. Baseline data were collected: Oswestry Disability Index, a numerical pain rating scale for LBP, and four core muscle endurance tests. For 8 weeks, the control group sat on their usual chair. The intervention group sat on stability balls 5 d/wk, increasing up to 90 min/d. Baseline measurements were repeated postintervention. After a washout period, subjects switched groups, and the procedures were repeated-70 completed participation in control group and 76 in intervention group.

RESULTS

There were no statistically significant differences for pain or disability in either group (P > 0.05). Changes in isometric trunk flexion (P = 0.001), nondominant side plank (P = 0.008), and Sorensen (P = 0.006) endurance scores were significant within the intervention group but not the control group. Between-group comparisons revealed a significant difference for isometric trunk flexion (P = 0.005) and Sorensen endurance times (P = 0.010). Analysis also showed that ball-sitting did not prevent an increase in LBP over the 8-week period.

CONCLUSION

Ball-sitting had no significant effects on LBP or associated disability, but did improve core endurance in the sagittal plane. Although ball-sitting may be useful as an adjunct treatment for LBP when core muscles are involved, clinicians should rely on other, evidence-based treatments for LBP.

ACURÁCIA DE TESTES FUNCIONAIS NA IDENTIFICAÇÃO DA PRÉ-ATIVAÇÃO DE MÚSCULOS LOMBOPÉLVICOS

RESUMO Introdução: Ajustes antecipatórios (pré-ativação) dos músculos profundos do tronco aumentam a estabilidade lombopélvica. Estudos prévios demonstram que indivíduos assintomáticos podem apresentar atrasos no início de ativação muscular e alterações físico-funcionais. No entanto, não foram encontrados estudos que tenham verificado se testes físico-funcionais (TFF) são capazes de identificar alteração no início de ativação dos músculos estabilizadores lombopélvicos. Objetivo : Verificar os níveis de sensibilidade, especificidade e acurácia de um conjunto de testes de avaliação da capacidade física funcional para detectar alterações na pré-ativação dos músculos transverso do abdome/oblíquo interno (TrA/OI) e multífido lombar (ML) durante o teste de movimento rápido de flexão do ombro (TMRFO). Método : Participaram do estudo 27 voluntários assintomáticos para dor lombar, com média de idade de 23,8 anos (desvio padrão: 2,2), e que foram submetidos aos TFF e TMRFO para determinação do início da ativação dos músculos profundos do tronco por meio da eletromiografia de superfície. Foi verificada sensibilidade e especificidade e análise da acurácia através da curva ROC (Receiver Operating Characteristic) e teste de qui-quadrado para comparações entre porcentagens (p < 0,05) . Resultados : A "pré-ativação" foi a condição que ocorreu com maior frequência no grupo como um todo, bem como em ambos os gêneros, com exceção do TrA/OI no gênero feminino (χ2 = 0,28/P = 0,58). Entre todos os TFF aplicados, o de enrolamento repetitivo do tronco apresentou maior valor de sensibilidade, especificidade e área sob a curva ROC (0,75; 0,73; 0,74, respectivamente) . Conclusão : Entre os TFF avaliados, o de enrolamento repetitivo do tronco mostrou níveis aceitáveis de acurácia para identificar alterações na ativação da musculatura estabilizadora lombopélvica em voluntários assintomáticos para dor lombar. Assim, o teste de enrolamento repetitivo do tronco pode ser utilizado na clínica para predizer alterações na ativação dos músculos profundos do tronco.

Spinal Stabilization Exercise Effectiveness for Low Back Pain in Adolescent Idiopathic Scoliosis: A Randomized Trial

PURPOSE

To compare 8 weeks of weekly supervised spinal stabilization exercises with 1-time treatment in participants with low back pain and adolescent idiopathic scoliosis.

METHODS

Participants were randomly assigned to the supervised or unsupervised group. Seventeen participants in the supervised group received weekly physical therapy, and 17 participants in the unsupervised group received a 1-time treatment followed by home exercises.

RESULTS

Significant between-group differences were found in the Numeric Pain Rating Scale and the Patient-Specific Functional Scale scores after 8 weeks (P < .01), indicating the supervised group had significantly more pain reduction and functional improvements than the unsupervised group. However, no between-group differences were found in back muscle endurance, the revised Oswestry Back Pain Disability Questionnaire scores, or the Global Rating of Change scores.

CONCLUSIONS

Supervised physical therapy may be more effective than 1-time treatment in reducing pain and improving function in patients with adolescent idiopathic scoliosis and low back pain.

VIDEO ABSTRACT

For more insights from the authors, access Supplemental Digital Content 1, at http://links.lww.com/PPT/A85.

Musculoskeletal fitness and health-related quality of life characteristics among sedentary office workers affected by sub-acute, non-specific low back pain: a cross-sectional study

OBJECTIVES

To establish the level of musculoskeletal fitness and health-related quality of life (HRQoL) in sedentary office workers with sub-acute, non-specific low back pain, and compare the results with reference data for healthy sedentary office workers.

DESIGN

Cross-sectional study.

SETTING

Occupational secondary prevention setting.

PARTICIPANTS

One-hundred and ninety sedentary office workers: 118 suffering from sub-acute, non-specific low back pain (47 men and 71 women) and 72 age-matched healthy controls (30 men and 42 women).

MAIN OUTCOME MEASURES

Participants were assessed using a musculoskeletal fitness battery (sit-and-reach test, hand grip strength, lumbar and abdominal trunk muscle endurance, and back scratch test), the EuroQol-5D-3L, Oswestry Disability Questionnaire, and Roland Morris Disability Questionnaire. Data for both genders and conditions were compared.

RESULTS

Subjects with low back pain achieved lower scores in most of the fitness tests compared with healthy, age-matched controls. Trunk flexor and extensor endurance demonstrated the greatest difference in both men {flexion: median difference 59 [95% confidence interval (CI) 26 to 90]seconds; extension: median difference 24 [95% CI 20 to 68]} and women [flexion: median difference 59 (95% CI 5 to 85.50)seconds; extension: median difference 41 (95% CI 30 to 55)seconds]. Differences in HRQoL were also demonstrated between groups for both men and women, with the exception of the pain/discomfort dimension in women.

CONCLUSIONS

Sedentary office workers with sub-acute, non-specific low back pain had lower musculoskeletal fitness than healthy, age-matched controls, with the main difference found in endurance of the trunk muscles. HRQoL was also lower in workers with low back pain.

A web-based intervention to improve and prevent low back pain among office workers: a randomized controlled trial

STUDY DESIGN

Randomized controlled trial.

OBJECTIVES

To test the feasibility, safety, and efficacy of a web-based multidisciplinary intervention for office workers with subacute, nonspecific low back pain.

BACKGROUND

Low back pain is one of the most frequent ailments seen in primary care consultations.

METHODS

The trial included 100 office workers with subacute low back pain. The intervention group had access to both the study intervention and standard care. The control group had access to standard care only. Standard care was defined as all existing non-web-based interventions offered by the University of Extremadura's Preventive Medicine Service. The web-based program was offered via the Preventive Medicine Service website. The participants in the intervention group were asked to engage in the web-based program at their work site for 11 minutes each day, 5 days a week. Primary outcomes were functional disability, as measured by the Roland-Morris Disability Questionnaire, and health-related quality of life, as measured by the European Quality of Life-5 Dimensions-3 Levels. Secondary outcomes were the number of episodes of low back pain and trunk muscle endurance. Outcomes were measured before and after the 9-month intervention period.

RESULTS

Over the 9-month study, the score on the Roland-Morris Disability Questionnaire for the participants in the web-based intervention group improved by a mean of -7.36 points (95% confidence interval [CI]: -8.41, -6.31) compared to a worsening of 1.89 points (95% CI: 0.71, 2.65) in the control group. The between-group difference in change on the Roland-Morris Disability Questionnaire over the study period was -9.25 points (95% CI: -10.57, -7.89). Similarly, over the 9-month study, the intervention group had a significant improvement in quality of life of 0.24 points (95% CI: 0.20, 0.29) compared to the control group.

CONCLUSION

A 9-month web-based intervention is feasible and effective to improve function and health-related quality of life and to decrease episodes of low back pain among office workers with a history of subacute, nonspecific low back pain.

Effect of core strength on the measure of power in the extremities

The purpose of this study was to (a) develop a functional field test to assess the role of the core musculature and its impact on sport performance in an athletic population and (b) develop a functional field test to determine how well the core can transfer forces from the lower to the upper extremities. Twenty-five DI collegiate football players performed medicine ball throws (forward, reverse, right, and left) in static and dynamic positions. The results of the medicine ball throws were compared with several athletic performance measurements: 1 repetition maximum (1RM) squat, squat kg/bw, 1RM bench press, bench kg/bw, countermovement vertical jump (CMJ), 40-yd dash (40 yd), and proagility (PrA). Push press power (PWR) was used to measure the transfer of forces through the body. Several correlations were found in both the static and dynamic medicine ball throws when compared with the performance measures. Static reverse correlated with CMJ (r = 0.44), 40 yd (r = 0.5), and PrA (r = 0.46). Static left correlated with bench kg/bw (0.42), CMJ (0.44), 40 yd (0.62), and PrA (0.59). Static right also correlated with bench kg/bw (0.41), 40 yd (0.44), and PrA (0.65). Dynamic forward (DyFw) correlated with the 1RM squat (r = 0.45) and 1RM bench (0.41). Dynamic left and Dynamic right correlated with CMJ, r = 0.48 and r = 0.40, respectively. Push press power correlated with bench kg/bw (0.50), CMJ (0.48), and PrA (0.48). A stepwise regression for PWR prediction identified 1RM squat as the best predictor. The results indicate that core strength does have a significant effect on an athlete's ability to create and transfer forces to the extremities. Currently, plank exercises are considered an adequate method of training the core for athletes to improve core strength and stability. This is a problem because it puts the athletes in a nonfunctional static position that is very rarely replicated in the demands of sport-related activities. The core is the center of most kinetic chains in the body and should be trained accordingly.

Low back pain

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF). The purpose of these low back pain clinical practice guidelines, in particular, is to describe the peer-reviewed literature and make recommendations related to (1) treatment matched to low back pain subgroup responder categories, (2) treatments that have evidence to prevent recurrence of low back pain, and (3) treatments that have evidence to influence the progression from acute to chronic low back pain and disability.

Biering-Sorensen test performance of Japanese young males: comparison with other ethnicities and relationship to electromyography, near-infrared spectroscopy and exertion ratings

Back muscle endurance is a predictor of future low back pain and is commonly assessed using the Biering-Sorensen Test (BST). Differences exist between ethnic groups that may affect the performance and interpretation of the BST and should be investigated. This study's aim was to explore objective and subjective measures of the BST in a Japanese group in comparison with previous studies in other ethnic groups. A total of 27 young male Japanese students performed the BST while measures of muscle fatigue were collected. The mean BST time (152.7 (32.5) s) was greater than the median of the reported mean times in other ethnic groups over the previous decade (128.6 s). Objective measures indicated that the Japanese subjects' lumbar muscles were as fatigued as those of previous studies, while subjective measures appear to indicate that subjects under-reported exertion. The better performance of the Japanese subjects in the BST may reflect physical, psychosocial and lifestyle differences related to ethnicity. STATEMENT OF RELEVANCE: Ergonomics research and practice needs to be applicable to different ethnic groups. Despite the substantial body of evidence on back muscle endurance and indications of potential ethnicity related differences, this had not been previously investigated. These results help ergonomists to interpret physical ergonomics evidence in a multi-ethnic world.

Reliability of alternative trunk endurance testing procedures using clinician stabilization vs. traditional methods

The purpose of this study was to determine if a modified (MOD) testing method for previously established trunk endurance testing for flexion and extension is a reliable alternative. Fifty subjects were tested with the standard (ST) testing procedure and an MOD testing procedure on separate testing occasions 1 week apart. The testing procedure order and method of assessments were randomly selected and implemented. The MOD testing procedure used a clinician to provide stabilization as opposed to the ST method of belt stabilization. Interrater reliability for MOD procedures was 0.97 for extension and 0.93 for flexion. Correlation of the MOD procedure to the ST procedure was found to be 0.90 and 0.84 for extension and flexion, respectively. From this testing, it can be concluded in a sample of normal college-aged subjects that an MOD testing method for trunk flexion and extension endurance can reliably be used as compared with the previously accepted ST testing methods. From a practical application standpoint, this allows the use of an MOD testing procedure to be implemented in athletic training rooms and weight rooms that may not have appropriate tables for the ST testing and the fact that the MOD testing procedure will most likely require less time commitment and greater efficiency with testing of large groups of subjects.

Comparison between elderly and young males' lumbopelvic extensor muscle endurance assessed during a clinical isometric back extension test

OBJECTIVE

Endurance of the back extensor muscles has become important for clinical decisions that guide interventions, particularly for chronic low back pain patients. Very little information is available regarding back muscle endurance in the elderly. The aim of this study was to investigate back extensor muscle endurance in healthy elderly subjects during a modified Sorensen test.

METHODS

Sixteen elderly and 20 young male adults participated in our cross-sectional study. The subjects performed a modified Sorensen test (on a 45 degrees Roman chair) to quantify lumbopelvic extensor muscle endurance. Pre and postfatigue back extension maximal voluntary force was assessed according to an isometric lift test in a semicrouched position. Endurance time, perceived exertion (Borg CR10 scale), and postfatigue reduction of lifting force were recorded and compared among groups.

RESULTS

Elderly subjects showed a trend toward decreased endurance time compared to young adults, but the difference was not significant. Similar perceived exertion and diminished maximal force after the fatiguing protocol were observed in both young and elderly subjects. Maximal isometric lift force was significantly associated with endurance time in young but not in elderly subjects.

CONCLUSIONS

Lumbopelvic extensor muscle endurance and perceived exertion do not differ between young and healthy elderly individuals. However, back muscle endurance seems to be modulated by different neurophysiologic factors in the elderly. Normative data on young adults should be interpreted with caution in assessing back fitness in elderly subjects.

Dynamic trunk stabilization: a conceptual back injury prevention program for volleyball athletes

The sport of volleyball creates considerable dynamic trunk stability demands. Back injury occurs all too frequently in volleyball, particularly among female athletes. The purpose of this clinical commentary is to review functional anatomy, muscle coactivation strategies, assessment of trunk muscle performance, and the characteristics of effective exercises for the trunk or core. From this information, a conceptual progressive 3-phase volleyball-specific training program is presented to improve dynamic trunk stability and to potentially reduce the incidence of back injury among volleyball athletes. Phase 1 addresses low-velocity motor control, kinesthetic awareness, and endurance, with the clinician providing cues to teach achievement of biomechanically neutral spine alignment. Phase 2 focuses on progressively higher velocity dynamic multiplanar endurance, coordination, and strength-power challenges integrating upper and lower extremity movements, while maintaining neutral spine alignment. Phase 3 integrates volleyball-specific skill simulations by breaking down composite movement patterns into their component parts, with differing dynamic trunk stability requirements, while maintaining neutral spine alignment. Prospective research is needed to validate the efficacy of this program.