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Lundblad M. SYMPTOM INSTABILITY AND A PROPOSED CLASSIFICATION SYSTEM FOR THE PHYSICAL THERAPY MANAGEMENT OF SPORTS-RELATED CONCUSSION. Int J Sports Phys Ther 2019; 14:835-844. [PMID: 31598420 PMCID: PMC6769268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Individuals can experience headaches, dizziness, cervical dysfunction, balance disturbances, fatigue, and oculomotor impairments following a concussion. Patients with sports-related concussions are not a homogenous group but rather heterogenous groups with mixed clinical findings. PURPOSE The purpose of this clinical commentary is to propose a classification system developed specifically for the physical therapy management of sports-related concussions. DESCRIPTION The concept of "symptom instability" was introduced to assist with classifying patients. The time period post-concussion, symptom instability, and the ability to identify symptom triggers were used as defining criteria. The end result was a classification system with five clinical subgroups. RELATIONSHIP TO CLINICAL PRACTICE The classification system assists in forming homogeneous groups. The grouping of patients into these subgroups can allow for improved efficiency of organizing treatment plans. LEVEL OF EVIDENCE 5.
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Nowotny AH, Calderon MG, de Souza PA, Aguiar AF, Léonard G, Alves BMO, Amorim CF, da Silva RA. Lumbar stabilisation exercises versus back endurance-resistance exercise training in athletes with chronic low back pain: protocol of a randomised controlled trial. BMJ Open Sport Exerc Med 2018; 4:e000452. [PMID: 30555717 PMCID: PMC6267311 DOI: 10.1136/bmjsem-2018-000452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/14/2018] [Accepted: 10/03/2018] [Indexed: 02/07/2023] Open
Abstract
Background Chronic low back pain (CLBP) is an important disorder in athletes that may negatively affect their performance in competitions. The literature usually recommends physiotherapy based on exercises for back pain management in athletes. Recent evidence suggests that interventions based on lumbar muscle stabilisation exercises (LMSE) and back endurance-resistance exercises (BERE) may improve back pain and function performance. However, it is still unclear which type of exercise is more effective for the treatment of CLBP in athletes. Objective To compare the efficacy of LMSE versus BERE in athletes with CLBP. Design The study is a 2-arm, prospectively registered, randomised controlled trial. Setting The physical therapy clinical and biomechanics laboratory of the UNOPAR University. Participants 32 male athletes with CLBP, age between 18 and 40 years old, recruited from the local community. Intervention An 8-week intervention programme will be carried out with LMSE s versus BERE. Measurements Trunk neuromuscular patterns during balance tasks (unipodal and over a ball) using electromyography and force platform parameters, pain, disability, fear and avoidance will be assessed by a blinded assessor at baseline and at follow-up after 8 weeks of intervention period. Limitations The absence of blinding intervention and the exclusion of female athletes, seated sports and swimmers will affect the internal and external validity of the study. Conclusions The results of this study will elucidate which of these two interventions promote better results in trunk neuromuscular pattern, back pain and function in male athletes with CLBP.
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Affiliation(s)
| | | | | | - Andreo Fernando Aguiar
- Doctoral and Masters Programs in Rehabilitation Sciences UEL/UNOPAR, LAFUP-UNOPAR, Londrina-PR, Brazil
| | - Guillaume Léonard
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Research Center on Aging, Institute of Geriatrics, Université de Sherbrooke, Québec, Canada
| | - Bruno Mazziotti Oliveira Alves
- Master and Doctoral Program in Physical Therapy, University of City of São Paulo, UNICID, São Paulo, Brazil.,Paris Saint-Germain Departament of Physical Therapy and Biomechanics, Paris Saint-Germain Football Club, Paris, France
| | - Cesar Ferreira Amorim
- Master and Doctoral Program in Physical Therapy, University of City of São Paulo, UNICID, São Paulo, Brazil.,Département des Sciences de la Santé, Programme de physiothérapie de l'université McGill offert en extension à l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada.,Physical Therapy and Neuroscience Departments, Wertheims' Colleges of Nursing and Health Sciences and Medicine, Florida International University (FIU), Miami, Florida, United States
| | - Rubens Alexandre da Silva
- Doctoral and Masters Programs in Rehabilitation Sciences UEL/UNOPAR, LAFUP-UNOPAR, Londrina-PR, Brazil.,Département des Sciences de la Santé, Programme de physiothérapie de l'université McGill offert en extension à l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
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Ganesh GS, Sahu PK, Das SP, Mishra C, Dhiman S. A subgroup analysis to compare patients with acute low back pain classified as per treatment-based classification. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 24:e1747. [PMID: 30226651 DOI: 10.1002/pri.1747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/17/2018] [Accepted: 08/15/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The evidence for the effectiveness of interventions targeting acute low back pain (LBP) is suboptimal. It is difficult to identify those patients who are more likely to develop chronic pain and disability after an acute episode of LBP. These shortcomings may be attributed to considering LBP as one homogenous condition. METHODS In this quasi-experimental study, we examined and analysed a prospective cohort of 267 patients with first-onset LBP and classified them into one of the groups based on treatment-based classification: direction-specified exercises (Group 2), manipulation (Group 3), stabilization exercises (Group 4), traction (Group 5), and a physician care group (Group 1). Disability and pain were assessed at baseline, after treatment, and at 6 months using the Oswestry Disability Index and the Numerical Rating Scale, respectively. Comparisons were made between the groups, and we predicted measures of disability and pain intensity at 6 months with age, gender, fear avoidance behaviour, centralization phenomenon (CP), expectations about recovery, CP, group classification, baseline pain, and disability. RESULTS Analysis showed that all the heterogeneous groups of LBP improved their outcomes with the respective treatment provided. However, when the entire sample was considered as one homogenous group of LBP, the results showed improvement with time (p < 0.05) only and no difference was found between groups (p > 0.05). None of the studied factors, except baseline pain (R = 0.227, R2 = 0.051, p < 0.05), were able to accurately predict the development of chronic pain in our study sample. CONCLUSION Though our results showed no differences between the subgroups in the reduction of pain and disability, we conclude that classifying and treating patients with LBP into subgroups based on signs and symptoms produce better outcomes. Baseline pain alone may predict a small percentage of people who may develop chronic pain.
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Affiliation(s)
- G Shankar Ganesh
- Department of Physiotherapy, Composite Regional Centre for Persons with Disabilities, Lucknow, India
| | - Pradeep Kumar Sahu
- Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sakti Prasad Das
- Department of Physical Medicine and Rehabilitation, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, India
| | - Chittaranjan Mishra
- Department of Physiotherapy, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, India
| | - Sapna Dhiman
- Department of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
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Patel VD, Eapen C, Ceepee Z, Kamath R. Effect of muscle energy technique with and without strain-counterstrain technique in acute low back pain - A randomized clinical trial. Hong Kong Physiother J 2018; 38:41-51. [PMID: 30930578 PMCID: PMC6385547 DOI: 10.1142/s1013702518500051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 05/14/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Muscle energy technique (MET) and strain-counterstrain (SCS) technique are found to be effective as a sole treatment of acute low back pain (LBP), but the combined effect of these two techniques has not been evaluated. OBJECTIVE The purpose of this randomized clinical trial was to evaluate the added effect of SCS to MET in acute LBP patients. METHODS In this trial, 50 patients were randomly allocated to MET or MET-SCS group to receive the assigned two treatment sessions for two consecutive days. Oswestry disability index (ODI) and Roland Morris disability questionnaire (RMDQ), visual analogue scale (VAS), lumbar range of motion (ROM) were recorded at baseline, after first and second session. RESULTS All the outcome measures showed statistically significant ( p < 0.05 ) improvement in both the groups after second session. Between the groups, analysis showed no statistically significant difference ( p > 0.05 ) after the first or second session. CONCLUSIONS The improvement after second treatment sessions was noted in pain, ROM, and disability in both the groups, but immediate effect was seen only on pain intensity after first treatment session. When compared between the groups, no added effect of SCS to MET was found in reducing pain and disability and increasing lumbar ROM in acute LBP patients.
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Affiliation(s)
- Vivek Dineshbhai Patel
- Department of Physiotherapy, Kasturba Medical College Hospital Attavar, KMC Mangalore, MAHE (Manipal Academy of Higher Education), Mangalore 575001, Karnataka, India
| | - Charu Eapen
- Department of Physiotherapy, Kasturba Medical College Hospital Attavar, KMC Mangalore, MAHE (Manipal Academy of Higher Education), Mangalore 575001, Karnataka, India
| | - Zulfeequer Ceepee
- Department of Physiotherapy, Kasturba Medical College Hospital Attavar, KMC Mangalore, MAHE (Manipal Academy of Higher Education), Mangalore 575001, Karnataka, India
| | - Ramachandra Kamath
- Department of Orthopaedics, Wenlock Government Hospital, Hampankatta, KMC Mangalore, MAHE (Manipal Academy of Higher Education), Mangalore 575001, Karnataka, India
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The Effectiveness of Classification-Specific Physical Therapy for People with Low Back pain Within Dominant Movement-Based Schemes: A Systematic Review. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016. [DOI: 10.5812/ircmj.41959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Gnat R, Spoor K, Pool-Goudzwaard A. The influence of simulated transversus abdominis muscle force on sacroiliac joint flexibility during asymmetric moment application to the pelvis. Clin Biomech (Bristol, Avon) 2015; 30:827-31. [PMID: 26094778 DOI: 10.1016/j.clinbiomech.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/08/2015] [Accepted: 06/08/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of so-called local muscle system in motor control of the lower back and pelvis is a subject of ongoing debate. Prevailing beliefs in stabilizing function of this system were recently challenged. This study investigated the impact of in vitro simulated force of transversely oriented fibres of the transversus abdominis muscle (a part of the local system) on flexibility of the sacroiliac joint during asymmetric moment application to the pelvis. METHODS In 8 embalmed specimens an incremental moment was applied in the sagittal plane to one innominate with respect to the fixed contralateral innominate. Ranges of motion of the sacroiliac joint were recorded using the Vicon Motion Capture System. Load-deformation curves were plotted and flexibility of the sacroiliac joint was calculated separately for anterior and posterior rotations of the innominate, with and without simulated muscle force. FINDINGS Flexibility of the sacroiliac joint was significantly bigger during anterior rotation of the innominate, as compared to posterior rotation (Anova P<0.05). After application of simulated force of transversus abdominis, flexibility of the joint did not change both during anterior and posterior rotations of the innominate. INTERPRETATION A lack of a stiffening effect of simulated transversus abdominis force on the sacroiliac joint was demonstrated. Earlier hypotheses suggesting a stiffening influence of this muscle on the pelvis cannot be confirmed. Consistent with previous findings smaller flexibility of the joint recorded during posterior rotation of the innominate may be of clinical importance for physio- and manual therapists. However, major limitations of the study should be acknowledged: in vitro conditions and simulation of only solitary muscle force.
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Affiliation(s)
- Rafael Gnat
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; Motion Analysis Laboratory, Faculty of Physiotherapy, University of Physical Education, ul. Mikolowska 72, 40-065 Katowice, Poland; Faculty of Physiotherapy, Academy of Business, ul. Cieplaka 1c, 41-300 DąbrowaGórnicza, Poland.
| | - Kees Spoor
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Annelies Pool-Goudzwaard
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat, 9, 1081 BT Amsterdam, The Netherlands
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Expanding Panjabi's stability model to express movement: a theoretical model. Med Hypotheses 2013; 80:692-7. [PMID: 23561576 DOI: 10.1016/j.mehy.2013.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 01/24/2013] [Accepted: 02/07/2013] [Indexed: 12/28/2022]
Abstract
Novel theoretical models of movement have historically inspired the creation of new methods for the application of human movement. The landmark theoretical model of spinal stability by Panjabi in 1992 led to the creation of an exercise approach to spinal stability. This approach however was later challenged, most significantly due to a lack of favourable clinical effect. The concepts explored in this paper address and consider the deficiencies of Panjabi's model then propose an evolution and expansion from a special model of stability to a general one of movement. It is proposed that two body-wide symbiotic elements are present within all movement systems, stability and mobility. The justification for this is derived from the observable clinical environment. It is clinically recognised that these two elements are present and identifiable throughout the body in different joints and muscles, and the neural conduction system. In order to generalise the Panjabi model of stability to include and illustrate movement, a matching parallel mobility system with the same subsystems was conceptually created. In this expanded theoretical model, the new mobility system is placed beside the existing stability system and subsystems. The ability of both stability and mobility systems to work in harmony will subsequently determine the quality of movement. Conversely, malfunction of either system, or their subsystems, will deleteriously affect all other subsystems and consequently overall movement quality. For this reason, in the rehabilitation exercise environment, focus should be placed on the simultaneous involvement of both the stability and mobility systems. It is suggested that the individual's relevant functional harmonious movements should be challenged at the highest possible level without pain or discomfort. It is anticipated that this conceptual expansion of the theoretical model of stability to one with the symbiotic inclusion of mobility, will provide new understandings on human movement. The use of this model may provide a universal system for body movement analysis and understanding musculoskeletal disorders. In turn, this may lead to a simple categorisation system alluding to the functional face-value of a wide range of commonly used passive, active or combined musculoskeletal interventions. Further research is required to investigate the mechanisms that enable or interfere with harmonious body movements. Such work may then potentially lead to new and evolved evidence based interventions.
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Kordi R, Rostami M, Noormohammadpour P. Letter to the editor: other interventions in approach to lumbar disorders. Sports Health 2012; 4:14-5. [PMID: 23016062 PMCID: PMC3435899 DOI: 10.1177/1941738111431062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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