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Brandt M, Danneels L, Meirezonne H, Van Oosterwijck J, Willems T, Matheve T. Clinically assessed lumbopelvic sensorimotor control tests in low back pain: are they actually valid? A systematic review according to COSMIN guidelines. Musculoskelet Sci Pract 2024; 71:102953. [PMID: 38604022 DOI: 10.1016/j.msksp.2024.102953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Impairments in lumbopelvic sensorimotor control (SMC) are thought to be one of the underlying mechanisms for the recurrence and persistence of low back pain (LBP). As such, lumbopelvic SMC tests are frequently included in the clinical examination of patients with LBP. OBJECTIVE To evaluate convergent and known-groups validity of clinically assessed lumbopelvic SMC tests in patients with LBP according to COSMIN guidelines. DESIGN Systematic review METHODS: Five electronic databases were searched until December 2023. Studies examining convergent or known-groups validity of lumbopelvic SMC tests assessed via inspection or palpation in patients with LBP were included. Known-groups validity had to be assessed between patients with LBP and pain-free persons. Two independent researchers appraised risk of bias and quality of evidence (QoE) using the COSMIN Risk of Bias checklist and modified GRADE approach, respectively. Results for known-groups validity were reported separately for single tests and test-clusters. RESULTS Twelve studies (946 participants) were included. Three studies investigated convergent validity of three single tests. Regarding known-groups validity, six studies evaluated six single tests and four studies investigated two test-clusters. For only one test, both convergent and known-groups were assessed. The QoE for tests showing sufficient convergent or known-groups validity was (very) low, whereas QoE was moderate for single tests or test-clusters with insufficient known-groups validity. CONCLUSION All clinically assessed lumbopelvic SMC tests with sufficient convergent or known-groups validity had (very) low QoE. Therefore, test outcomes should be interpreted cautiously and strong reliance on these outcomes for clinical decision-making can currently not be recommended.
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Affiliation(s)
- Michiel Brandt
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium.
| | - Lieven Danneels
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium. https://twitter.com/DanneelsLieven
| | - Hannes Meirezonne
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium. https://twitter.com/Hmeirezo
| | - Jessica Van Oosterwijck
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium; Pain in Motion International Research Group, Belgium. https://twitter.com/Jessica_V_O
| | - Tine Willems
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium
| | - Thomas Matheve
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, UHasselt, 3590, Diepenbeek, Belgium. https://twitter.com/ThomasMatheve
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Folkins E, Nelson-Wong E, Ebaugh D, Silfies S. Clinical tests predictive of temporary low back pain development during the prolonged standing test in physical therapy students. ERGONOMICS 2024:1-14. [PMID: 38440991 DOI: 10.1080/00140139.2024.2323998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024]
Abstract
Low back pain among physical therapists is a common musculoskeletal disorder that first occurs early in their career or as a student. This observational prospective study assessed the ability of hip and lumbopelvic neuromuscular control, endurance and hip range of motion tests to predict the development of transient low back pain development during a standing task. Seventy-two physical therapy students without low back pain completed nine performance tests and a 2-hour standing test on two separate days. Participants were classified as transient pain developers (PD) if they reported a ≥ 10mm increase in low back pain on a visual analog scale. Transient back pain was reported by 37.5% of students during the standing test. A cluster of three positive tests, self-rated active hip abduction (somewhat difficult or more), bilateral total hip internal rotation greater than 81 degrees, and non-dominant limb single-leg squat (moderate deviations), demonstrated an increased probability (94.9%) of identifying PDs. Negative findings on the same three tests decreased the probability to 10.7%. Overall, the classification accuracy for the three-test model was 72.2%. The sensitivity for the model was 63% and the specificity was 77.8%.
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Affiliation(s)
- Eric Folkins
- Physical Therapy, Saint Joseph's University, Philadelphia, PA, USA
- Drexel University, Philadelphia, PA, USA
| | | | - David Ebaugh
- Physical Therapy, University of Delaware, Newark, DE, USA
| | - Sheri Silfies
- Drexel University, Philadelphia, PA, USA
- Exercise Science/Physical Therapy, University of South Carolina, Columbia, SC, USA
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Othman IK, Raj NB, Siew Kuan C, Sidek S, Wong LS, Djearamane S, Loganathan A, Selvaraj S. Association of Piriformis Thickness, Hip Muscle Strength, and Low Back Pain Patients with and without Piriformis Syndrome in Malaysia. Life (Basel) 2023; 13:life13051208. [PMID: 37240853 DOI: 10.3390/life13051208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/29/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Low back pain is a serious threat to human health and the illness jeopardizes the human workforce and pressurizes the health system in the community. Low back pain might be related to piriformis syndrome (PS), which is a disorder presented as muscular spasm and hypertrophy that is strongly associated with piriformis thickness. Nevertheless, the relationship between piriformis thickness and morphological and functional changes of the gluteal muscles in PS remains unclear. This study aimed to investigate the association between the thickness, strength, and activation of piriformis and gluteus muscles (maximus and medius) among low back pain (LBP) patients with and without PS. This is a case-control study conducted at HSNZ and UiTM from 2019-2020. A total number of 91 participants (LBP + PS (n = 36), LBP - PS (n = 24), and healthy (n = 31)) were recruited in this study. Negative radiography, specific symptoms, and a positive PS test were applied for PS diagnoses. The thickness, strength, and activation of piriformis and gluteus muscles were measured using ultrasonography (USG) and a surface electromyogram, respectively. Resultantly, the one-way ANOVA test demonstrated no significant difference in piriformis thickness between LBP + PS and LBP - PS (p > 0.01). Piriformis thickness was inversely correlated with gluteus maximus strength (r = -0.4, p < 0.05) and positively correlated with gluteus medius activation (r = 0.48, p < 0.01) in LBP + PS. Stepwise linear regression for LBP + PS revealed a significant association between piriformis thickness and gluteus maximus strength (R = -0.34, accounted for 11% of the variance) and gluteus medius activation in prone lying with the hip in an externally rotated, abducted, and extended (ERABEX) position (R = 0.43, accounted for 23% of the variance). With the adjustment of age and gender, piriformis thickness, gluteus maximus strength, and gluteus medius activation in prone lying with hip ERABEX demonstrated a significant association, but no independent effect of age and gender was detected within the range. Meanwhile, a significant association between piriformis thickness and gluteus maximus thickness was observed (R = 0.44, accounted for 19% of the variance) in the LBP - PS group. These findings may assist to elucidate the actions and functions of piriformis and gluteus muscle in LBP with and without PS.
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Affiliation(s)
- Ida Kartini Othman
- Centre of Physiotherapy, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam 42300, Malaysia
- Physiotherapy Unit, Hospital Sultanah Nur Zahirah, Jalan Sultan Mahmud, Kuala Terengganu 20400, Malaysia
| | - Naresh Bhaskar Raj
- School of Rehabilitation Science, Faculty of Health Sciences, University Sultan Zainal Abidin (UniSZA), Kuala Nerus 21300, Malaysia
| | - Chua Siew Kuan
- Centre of Physiotherapy, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam 42300, Malaysia
- Faculty of Applied Science, Lincoln University College, Petaling Jaya 47301, Malaysia
| | - Sabrilhakim Sidek
- Centre of Physiotherapy, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam 42300, Malaysia
- Department of Radiology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia
| | - Ling Shing Wong
- Faculty of Health and Life Sciences, INTI International University, Nilai 71800, Malaysia
| | - Sinouvassane Djearamane
- Biomedical Research Unit and Lab Animal Research Centre, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 602105, India
- Department of Allied Health Sciences, Faculty of Science, Universiti Tunku Abdul Rahman, Jalan Universiti, Bandar Barat, Kampar 31900, Malaysia
| | - Annaletchumy Loganathan
- Department of Allied Health Sciences, Faculty of Science, Universiti Tunku Abdul Rahman, Jalan Universiti, Bandar Barat, Kampar 31900, Malaysia
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Suehiro T, Ishida H, Kobara K, Osaka H, Kurozumi C. Trunk muscle activation patterns during active hip abduction test during remission from recurrent low back pain: an observational study. BMC Musculoskelet Disord 2021; 22:671. [PMID: 34372821 PMCID: PMC8353751 DOI: 10.1186/s12891-021-04538-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/20/2021] [Indexed: 11/12/2022] Open
Abstract
Background The active hip abduction test (AHAbd) is widely used to evaluate lumbopelvic stability, but the onset of trunk muscle activation during the test in individuals with recurrent low back pain (rLBP) has not been investigated so far. It is important to investigate the pattern of trunk muscle activation during the AHAbd test to provide insight into the interpretation of observation-based assessment results; this may help to create exercise therapy interventions, from a movement control perspective, for people seeking treatment for rLBP. The purpose of this study was to compare the timing of trunk muscle activation between individuals with and without rLBP and to assess potential differences. Methods Seventeen subjects in remission from rLBP and 17 subjects without rLBP were recruited. We performed surface electromyography of the transversus abdominis/internal abdominal oblique, external oblique, erector spinae, and gluteus medius muscles during the AHAbd test on both sides. The onset of trunk muscle activation was calculated relative to the prime mover gluteus medius. The independent-samples t- and Mann-Whitney U tests were used to compare the onset of trunk muscle activation between the two groups. Results The onset of transversus abdominis/internal abdominal oblique activation on the ipsilateral (right AHAbd: −3.0 ± 16.2 vs. 36.3 ± 20.0 msec, left AHAbd: −7.2 ± 18.6 vs. 29.6 ± 44.3 ms) and contralateral sides (right AHAbd: −11.5 ± 13.9 vs. 24.4 ± 32.3 ms, left AHAbd: −10.1 ± 12.5 vs. 23.3 ± 17.2 ms) and erector spinae on the contralateral side (right AHAbd: 76.1 ± 84.9 vs. 183.9 ± 114.6 ms, left AHAbd: 60.7 ± 70.5 vs. 133.9 ± 98.6 ms) occurred significantly later in individuals with rLBP than in individuals without rLBP (p < 0.01). During the left AHAbd test, the ipsilateral erector spinae was also activated significantly later in individuals with rLBP than in individuals without rLBP (71.1 ± 80.1 vs. 163.8 ± 120.1 ms, p < 0.05). No significant difference was observed in the onset of the external oblique activation on the right and left AHAbd tests (p > 0.05). Conclusions Our results suggest that individuals with rLBP possess a trunk muscle activation pattern that is different from that of individuals without rLBP. These findings provide an insight into the underlying muscle activation patterns during the AHAbd test for people with rLBP and may support aggressive early intervention for neuromuscular control.
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Affiliation(s)
- Tadanobu Suehiro
- Department of Physical Therapy, Kawasaki University of Medical Welfare, 288, 701-0193, Matsushima, Kurashiki City, Japan.
| | - Hiroshi Ishida
- Department of Physical Therapy, Kawasaki University of Medical Welfare, 288, 701-0193, Matsushima, Kurashiki City, Japan
| | - Kenichi Kobara
- Department of Physical Therapy, Kawasaki University of Medical Welfare, 288, 701-0193, Matsushima, Kurashiki City, Japan
| | - Hiroshi Osaka
- Department of Physical Therapy, Kawasaki University of Medical Welfare, 288, 701-0193, Matsushima, Kurashiki City, Japan
| | - Chiharu Kurozumi
- Department of Occupational Therapy, Kawasaki University of Medical Welfare, 288, 701-0193, Matsushima, Kurashiki City, Japan
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Crasto C, Montes AM, Carvalho P, Carral JC. Abdominal muscle activity and pelvic motion according to active straight leg raising test results in adults with and without chronic low back pain. Musculoskelet Sci Pract 2020; 50:102245. [PMID: 32919292 DOI: 10.1016/j.msksp.2020.102245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/29/2020] [Accepted: 08/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Active Straight Leg Raise (ASLR) is a clinical test that challenges lumbopelvic stability and have been used in low back pain patients. There are reports of positive tests in asymptomatic individuals, however, it is not clear if they are false positives or a consequence of performing the test differently. OBJECTIVES To compare abdominal muscles activity and pelvic motion during an ASLR between adults with chronic low back pain and asymptomatic participants with a positive and negative ASLR test. DESIGN Cross-sectional study design. METHOD Nineteen volunteers with chronic nonspecific low back pain (LBP) and 19 asymptomatic, 12 with a negative ASLR (AG-) and 7 with a positive ASLR test (AG+) were assessed while performing an ASLR (dynamic postural challenge). Pelvic rotation and medio-lateral center of pressure displacement (COPml), as well as bilateral EMG abdominal muscles activity were assessed. Muscles asymmetry index were also analyzed. Kruskal-wallis test was used to compare groups (α = 0.05). RESULTS Both LBP and AG + displayed significantly less contralateral internal oblique/transversus abdominis (IO/TrA) muscle activation than AG- (p = 0.003 and p = 0.005, respectively) and also more asymmetry between sides in the IO/TrA than AG- (p = 0.022 and p = 0.004, respectively). No significant differences between LBP and AG+ were found (p > 0.05). CONCLUSION A positive ASLR test in an asymptomatic person could be more than a false positive, since IO/TrA muscle activation appears to be lower and more asymmetrical in people with a positive ASLR test, both with and without low back pain. Future studies may consider removing asymptomatic individuals with a positive ASLR.
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Affiliation(s)
- Carlos Crasto
- Department of Physiotherapy and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of Porto, Portugal; Department of Physiotherapy, Santa Maria Health School, Porto, Portugal.
| | - António Mesquita Montes
- Department of Physiotherapy and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of Porto, Portugal; Department of Physiotherapy, Santa Maria Health School, Porto, Portugal.
| | - Paulo Carvalho
- Department of Physiotherapy and Activity and Human Movement Study Center (CEMAH), School of Allied Health Technologies, Polytechnic Institute of Porto, Portugal.
| | - Jm Cancela Carral
- Faculty of Education and Sports Science, University of Vigo, Pontevedra, Spain.
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Ingerson E, Renfrow C, Aragon E, Ferger N, Olson B, Sachs A, Nelson-Wong E. Individuals with low back pain improve in standing tolerance and sagittal plane muscle activation following exercise intervention. J Back Musculoskelet Rehabil 2020; 32:885-895. [PMID: 30958331 DOI: 10.3233/bmr-171053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Healthy individuals who develop low back pain (LBP) during standing (standing intolerant) respond favorably to stabilization-based exercise interventions. People with clinical LBP meeting clinical prediction rules for stabilization-based exercise share characteristics with standing intolerant individuals. OBJECTIVE To investigate the impact of stabilization-based exercise on standing tolerance, muscle activation and clinical measures in individuals with LBP meeting clinical prediction rules for stabilization-based exercise. METHODS Participants with and without LBP completed testing pre- and post-6 weeks of progressive home exercise intervention. Testing included clinical examination and electromyography during sagittal and frontal plane movements. LBP was also assessed by visual analogue scale (VAS) during standing. Outcomes included clinical findings, muscle sequencing, and VAS in standing. RESULTS The LBP group had non-significant decreases in Oswestry Disability Index (-2.1%, p= 0.22), baseline VAS (-7.1 mm, p= 0.11), lumbopelvic reversal (p= 0.06) and positive active hip abduction test (p= 0.06). Significant improvements were seen in standing VAS (-5.6 mm, p< 0.001). The LBP group had beneficial changes in activation strategies in standing flexion (p< 0.05) following intervention, with no changes during frontal plane movement strategies. CONCLUSIONS Individuals with LBP meeting clinical prediction rules for stabilization-based exercise demonstrated increased standing tolerance and sagittal plane muscle sequencing following a 6-week intervention.
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Flores-León A, Redenz G, Valencia OD, Guzmán-Venegas R, Araneda OF, Berral de la Rosa F. Coordination of the rotational movement of the pelvis and the hip in men without low back pain, with control impairment of the lumbopelvic region in the sagittal plane. Physiother Theory Pract 2018; 36:810-817. [PMID: 30130429 DOI: 10.1080/09593985.2018.1510451] [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: 10/28/2022]
Abstract
Purpose To assess the presence of control impairment (CI) of the lumbopelvic region in the axial plane in men without low back pain (LBP) with CI in the sagittal plane. Methods : Twenty-four males, between 18 and 23 of age, BMI = normal, who did not report episodes of LBP in the 12 months prior to the study, were studied. Assessment of the sagittal control of the lumbopelvic region was performed during stand to sit. Nine participants demonstrated CI in sagittal plane and 15 did not. An active hip lateral rotation (HLR) test was performed, in which lumbopelvic rotation during HLR was assessed using a three-dimensional motion analysis system. Results : Patients with CI in sagittal plane had a greater percentage of their total lumbopelvic pelvic rotation at 60% of HLR range compared to those without CI (p < 0.05; d = 0.93). No significant differences in the total lumbopelvic and HLR range of motion were found between the groups. Conclusion : Men without LBP who experience CI of the lumbopelvic region in the sagittal plane also show CI in the axial plane. The control deficiencies were not related to the total range of lumbopelvic or HLR range of motion.
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Affiliation(s)
- Andres Flores-León
- Integrative Laboratory of Biomechanics and Physiology of Physical Effort, Kinesiology School, Faculty of Medicine, Universidad de Los Andes , Santiago, Chile
| | - Gunther Redenz
- Integrative Laboratory of Biomechanics and Physiology of Physical Effort, Kinesiology School, Faculty of Medicine, Universidad de Los Andes , Santiago, Chile
| | - Oscar David Valencia
- Integrative Laboratory of Biomechanics and Physiology of Physical Effort, Kinesiology School, Faculty of Medicine, Universidad de Los Andes , Santiago, Chile
| | - Rodrigo Guzmán-Venegas
- Integrative Laboratory of Biomechanics and Physiology of Physical Effort, Kinesiology School, Faculty of Medicine, Universidad de Los Andes , Santiago, Chile
| | - Oscar Florencio Araneda
- Integrative Laboratory of Biomechanics and Physiology of Physical Effort, Kinesiology School, Faculty of Medicine, Universidad de Los Andes , Santiago, Chile
| | - Francisco Berral de la Rosa
- Department of Sport and informatics. Biomechanics, Kinesiology and Kinanthropometry Laboratory, Universidad Pablo de Olavide , Sevilla, Spain
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