1
|
Zhang T, Firouzabadi A, Yang D, Liu S, Schmidt H. Age-dependent flexion relaxation phenomenon in chronic low back pain patients. Front Bioeng Biotechnol 2024; 12:1388229. [PMID: 39295844 PMCID: PMC11408191 DOI: 10.3389/fbioe.2024.1388229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 08/26/2024] [Indexed: 09/21/2024] Open
Abstract
Background The flexion relaxation phenomenon (FRP) is characterized by suddenly reduced paraspinal muscle activity during full flexion. Previous studies showed significant differences in FRP and flexion angles in chronic low back pain (cLBP) patients compared to individuals without back pain (no-BP). However, the relationship between FRP and flexion angles remains insufficiently understood in older populations. Thus, this study investigated the relationship between FRP and flexion angles concerning to the age and presence of cLBP. Methods Forty no-BP subjects (20m/20f; mean age 41.5 years) and thirty-eight cLBP patients (19m/19f; mean age 43.52 years) performed maximum full upper body flexion task. Electromyographic (EMG) measurements were conducted to assess the activity of lumbar erector spinae (ESL), thoracic erector spinae (EST), and multifidus (MF). Lumbar, thoracic, and pelvic angles at the onset (OnsetL/T/P) and offset of the FRP (OffsetL/T/P) and maximum trunk inclination (MaxL/T/P) were calculated. The FRP was evaluated using a flexion relaxation ratio (FRR). Results cLBP patients showed smaller FRR in MF and right ESL compared to no-BP individuals (p < 0.05), while no differences were found in flexion angles between two groups. Subjects over 40 showed smaller FRR in MF and ESL, and smaller flexion angles on OffsetL and MaxL (p < 0.05). Age-related analysis in the cLBP group revealed that patients over 40, compared to younger ones, had smaller FRR in MF and ESL, and smaller values in all thoracic and lumbar flexion angles (p < 0.05). While in no-BP group, significant larger flexion angles in OnsetL and OffsetT (p < 0.05) were observed in participants over 40. Pain-related analysis in the older group revealed that the cLBP patients, compared to no-BP individuals, had smaller FRR in right MF and right ESL, and smaller values in all lumbar and thoracic flexion angles (p < 0.05), while in younger group, there were no significant pain-related differences in FRR, with larger values in all lumbar flexion angles (p < 0.05). Conclusion Our findings indicate a reduction or absence of FRP in cLBP patients compared to no-BP individuals, with age being a significant factor as those over 40 showed smaller FRP and flexion angles compared to younger individuals.
Collapse
Affiliation(s)
- Tianwei Zhang
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ali Firouzabadi
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Daishui Yang
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sihai Liu
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Hendrik Schmidt
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
2
|
Blanco-Giménez P, Vicente-Mampel J, Gargallo P, Maroto-Izquierdo S, Martín-Ruíz J, Jaenada-Carrilero E, Barrios C. Effect of exercise and manual therapy or kinesiotaping on sEMG and pain perception in chronic low back pain: a randomized trial. BMC Musculoskelet Disord 2024; 25:583. [PMID: 39054514 PMCID: PMC11270888 DOI: 10.1186/s12891-024-07667-9] [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: 01/23/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
The importance of incorporating lumbo-pelvic stability core and controlling motor exercises in patients with chronic low back pain (CLBP) reinforces the use of strategies to improve biopsychosocial beliefs by reducing biomedical postulations. However, clinical practice guidelines recommend multimodal approaches incorporating exercise and manual therapy (MT), and instead reject the application of kinesiotape (KT) in isolation. Therefore, the objectives of this study were to analyze the effects of 12 weeks of exercises combined with MT or KT on perceived low back pain using the visual analog scale (VAS) and muscle electric activity measured with electromyography (EMG) of the rectus abdominis and multifidus in CLBP (mild disability) and to explore the relationship between the rectus abdominis and multifidus ratios and pain perception after intervention. A blinded, 12-week randomized controlled trial (RCT) was carried out, involving three parallel groups of patients with CLBP. The study was registered at Clinicaltrial.gov and assigned the identification number NCT05544890 (19/09/22). The trial underwent an intention-to-treat analysis. The primary outcome revealed a multimodal treatment program supplemented by additional therapies such as MT and KT, resulting in significant reductions in perceived low back pain. The subjective assessment of individuals with CLBP indicated no discernible distinction between exclusive core stability exercises and control-motor training when combined with MT or KT. Notably, our findings demonstrated positive alterations in both the mean and peak EMG values of the right rectus abdominis in the exercise group, suggesting a beneficial impact on muscle activation. This study focused on assessing the activation levels of the trunk musculature, specifically the rectus abdominis (RA) and multifidus (MF), in individuals with CLBP exhibiting mild disability according to the Oswestry Disability Index. Importantly, improvements in the VAS values were observed independently of changes in muscle electrical activity.
Collapse
Affiliation(s)
- P Blanco-Giménez
- Doctoral School, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
- School of Medicine and Health Science, Department of Physiotherapy, Catholic University of Valencia, Torrent, Valencia, Spain
| | - J Vicente-Mampel
- School of Medicine and Health Science, Department of Physiotherapy, Catholic University of Valencia, Torrent, Valencia, Spain.
- Faculty of Medicine and Health Science, Department of Physiotherapy, Catholic University of Valencia, Torrent, Valencia, Spain.
| | - P Gargallo
- School of Medicine and Health Science, Department of Physiotherapy, Catholic University of Valencia, Torrent, Valencia, Spain
| | | | - J Martín-Ruíz
- Faculty of Sciences of Physical Activity and Sport, Department of Health and Functional Assessment, Catholic University of Valencia, Torrent, Valencia, Spain
| | - E Jaenada-Carrilero
- School of Medicine and Health Science, Department of Physiotherapy, Catholic University of Valencia, Torrent, Valencia, Spain
| | - C Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine and Health Sciences, Valencia Catholic University, Valencia, Spain
| |
Collapse
|
3
|
Rose-Dulcina K, Dubessy M, Armand S, Genevay S. Understanding the flexion-relaxation phenomenon in non-specific chronic low back pain patients throught immersive virtual reality feedback approach. Sci Rep 2024; 14:15936. [PMID: 38987311 PMCID: PMC11236989 DOI: 10.1038/s41598-024-65983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/26/2024] [Indexed: 07/12/2024] Open
Abstract
The flexion-relaxation phenomenon (FRP) is frequently absent among non-specific chronic low back pain (NSCLBP) patients. However, it is unknown whether this absence is intrinsic to their pathology or merely a consequence of reduced trunk flexion. Immersive virtual reality (IVR) can create a patient avatar whose range of motion can be modulated to differ from the real movement. The present study enrolled 15 NSCLBP patients and 15 asymptomatic participants with similar characteristics to disentangle the relationship between range of motion and the FRP in NSCLBP using IVR. Trunk kinematics and lumbar muscle electromyography were assessed. The IVR environment was combined with a motion capture system to create avatars that moved like each participant. The IVR display showed a closed room and a mirror reflecting the subject's avatar with a target line to be reached by trunk flexion. The avatar's trunk movements were modulated from reality, leading the participants to flex their trunk more than their voluntary maximum trunk flexion. Under IVR conditions, NSCLBP patients significantly increased their trunk flexion angle, which was coupled with a significant improvement in the FRP. The absence of the FRP among the NSCLBP population appeared to be primarily related to reduced trunk flexion.
Collapse
Affiliation(s)
- Kevin Rose-Dulcina
- Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | | | - Stéphane Armand
- Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stéphane Genevay
- Division of Rheumatology, Department of Medecine, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
4
|
Sun D, Liu YY, Luo D, Wu YQ, Yan ZQ, Liang YQ, Huang XY, Lin JL, Luo HS, Wang R. A multidimensional nomogram combining clinical factors and imaging features to predict 1-year recurrence of low back pain with or without radicular pain after spinal manipulation/mobilization. Chiropr Man Therap 2023; 31:27. [PMID: 37563732 PMCID: PMC10416529 DOI: 10.1186/s12998-023-00500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/18/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND In this retrospective study, we aimed to develop a nomogram to predict recurrence during a 1-year period of spinal manipulation/mobilization (SM/M) in patients with low back pain (LBP) with greater pain intensity, more severe comorbid conditions, or a neuropathic component. METHODS A total of 786 consecutive patients with LBP treated with SM/M as primary therapy were divided into training (n = 545) and validation (n = 241) sets. Cox regression analyses were used to assess the relative value of clinical factors and lumbar magnetic resonance imaging features associated with recurrence during the 1-year period. Predictors of recurrence with significant differences were used to construct a nomogram in the training set. We evaluated the performance of the model on the training and validation sets to determine its discriminative ability, calibration, and clinical utility. The prognostic value of the nomogram for predicting recurrence was assessed using Kaplan-Meier analysis and time-dependent receiver operating characteristic analyses. RESULTS A nomogram comprising hospitalization time, previous history of LBP, disease duration, lumbar range of motion, lower extremity tendon reflex, muscle strength, ratio of herniation to uncompressed dural sac area, and Pfirrmann classification was established for recurrence during a 1-year period after SM/M in patients with LBP. Favorable calibration and discrimination were observed in the nomogram training and validation sets (C-index 0.753 and 0.779, respectively). Decision curve analysis confirmed the clinical utility of the nomogram. Over a 1-year period, the nomogram showed satisfactory performance in predicting recurrence in LBP after SM/M. CONCLUSION We established and validated a novel nomogram that can accurately predict a patient's risk of LBP recurrence following SM/M. This realistic prognostic model may aid doctors and therapists in their decision-making process and strategy optimization for non-surgical treatment of LBP using SM/M.
Collapse
Affiliation(s)
- Dai Sun
- Department of Massage, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Yang-Yang Liu
- Department of Massage, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Dan Luo
- Department of Massage, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Ye-Qi Wu
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhi-Qiang Yan
- Department of Massage, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Yun-Qi Liang
- Department of Massage, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Xue-Yan Huang
- Department of Massage, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Jia-Long Lin
- Department of Massage, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Hua-Song Luo
- Department of Massage, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
| | - Rui Wang
- Department of Massage, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
| |
Collapse
|
5
|
Boas Fernandes WV, Politti F, Blanco CR, Garcia Lucareli PR, Gomes CAFDP, Corrêa FI, Corrêa JCF. Effect of osteopathic visceral manipulation for individuals with functional constipation and chronic nonspecific low back pain: Randomized controlled trial. J Bodyw Mov Ther 2023; 34:96-103. [PMID: 37301564 DOI: 10.1016/j.jbmt.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 12/14/2022] [Accepted: 04/05/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To investigate the effect of osteopathic visceral manipulation (OVM) on disability and pain intensity in individuals with functional constipation and chronic nonspecific low back pain. METHODS This study is a randomized controlled trial with a blinded assessor. Seventy-six volunteers with functional constipation and chronic nonspecific low back pain were randomized to two groups: OVM and sham OVM. The primary clinical outcome was pain intensity measured using a numeric rating scale (NRS) and disability measured using the Oswestry Disability Index (ODI). The secondary outcomes were electromyographic signals measured during the flexion-extension cycle, the finger-to-floor distance during complete flexion of the trunk and the Fear-Avoidance Beliefs Questionnaire (FABQ). All outcomes were determined after six weeks of treatment as well as three months after randomization. RESULTS The OVM group reported a reduction in pain intensity after six weeks of treatment and at the three-month evaluation (p < .0002) and the sham group reported a reduction in pain intensity after three-month evaluation (p < .007). For the ODI was also found in the OVM group six weeks after the end of treatment (treatment effect = -6.59, 95% CI: -12.01 to -1.17, p = .01) and at the three-month evaluation (treatment effect = -6.02, 95% CI: -11.55 to -0.49, p = .03). Significant differences were also found for paravertebral muscle activity during the dynamic phases (flexion and extension) six-week evaluations. CONCLUSIONS The OVM group demonstrated a reduction in pain intensity and improvement in disability after six-weeks and three-month follow-up while the sham group reduction in pain three-month follow-up.
Collapse
Affiliation(s)
- Walkyria Vilas Boas Fernandes
- Postgraduate Program in Rehabilition Sciences, Nove de Julho University, São Paulo, Brazil; Federal University of Mato Grosso, Rondonópolis, Brazil
| | - Fabiano Politti
- Postgraduate Program in Rehabilition Sciences, Nove de Julho University, São Paulo, Brazil
| | | | | | | | - Fernanda Ishida Corrêa
- Postgraduate Program in Rehabilition Sciences, Nove de Julho University, São Paulo, Brazil
| | | |
Collapse
|
6
|
Gouteron A, Tabard-Fougère A, Moissenet F, Bourredjem A, Rose-Dulcina K, Genevay S, Laroche D, Armand S. Sensitivity and specificity of the flexion and extension relaxation ratios to identify altered paraspinal muscles' flexion relaxation phenomenon in nonspecific chronic low back pain patients. J Electromyogr Kinesiol 2023; 68:102740. [PMID: 36549262 DOI: 10.1016/j.jelekin.2022.102740] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/10/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Among the main methods used to identify an altered flexion relaxation phenomenon (FRP) in nonspecific chronic low back pain (NSCLBP), it has been previously demonstrated that flexion relaxation ratio (FRR) and extension relaxation ratio (ERR) are more objective than the visual reference method. OBJECTIVE To determine the sensitivity and specificity of the different methods used to calculate the ratios in terms of their ability to identify an altered FRP in NSCLBP. METHODS Forty-four NSCLBP patients performed a standing maximal trunk flexion task. Surface electromyography (sEMG) was recorded along the erector spinae longissimus (ESL) and multifidus (MF) muscles. Altered FRP based on sEMG was visually identified by three experts (current standard). Six FRR methods and five ERR methods were used both for the ESL and MF muscles. ROC curves (with areas under the curve (AUC) and sensitivity/specificity) were generated for each ratio. RESULTS All methods used to calculate these ratios had an AUC higher than 0.9, excellent sensitivity (>90 %), and good specificity (80-100 %) for both ESL and MF muscles. CONCLUSION Both FRP ratios (FRR and ERR) for MF and ESL muscles, appear to be an objective, sensitive and specific method for identifying altered FRP in NSCLBP patients.
Collapse
Affiliation(s)
- Anaïs Gouteron
- INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, Faculty of Sport Sciences, Burgundy, Dijon, France; Department of Physical Medicine and Rehabilitation, University Hospital Dijon, Burgundy, Dijon, France; INSERM CIC 1432, Clinical Investigation Center P Module, Technological Investigation Platform University Hospital Dijon, Burgundy, Dijon, France; Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Anne Tabard-Fougère
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Florent Moissenet
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Abderrahmane Bourredjem
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon, Burgundy, Dijon, France
| | - Kévin Rose-Dulcina
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stéphane Genevay
- Division of Rheumatology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Davy Laroche
- INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, Faculty of Sport Sciences, Burgundy, Dijon, France; INSERM CIC 1432, Clinical Investigation Center P Module, Technological Investigation Platform University Hospital Dijon, Burgundy, Dijon, France
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| |
Collapse
|
7
|
Shamsi MB, Ahmadi A, Mirzaei M, Jaberzadeh S. Effects of static stretching and strengthening exercises on flexion relaxation ratio in patients with LBP: A randomized clinical trial. J Bodyw Mov Ther 2022; 30:196-202. [DOI: 10.1016/j.jbmt.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 10/10/2021] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
|
8
|
Zhang X, Yuan L, Zeng Y, Liu Y, Chen Z, Li W. Evaluation of lumbar stiffness after long-level fusion for degenerative lumbar scoliosis via a Chinese version of the lumbar stiffness disability index. Spine J 2021; 21:1881-1889. [PMID: 34174436 DOI: 10.1016/j.spinee.2021.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/17/2021] [Accepted: 06/18/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Long-level spinal fusion for degenerative lumbar scoliosis (DLS)seeks to eliminate spinal motion in an attempt to alleviate pain, improve deformity, and reduce disability. However, this surgery considerably impairs the performance of activities of daily living (ADL) due to the resulting stiffness. The lumbar stiffness disability index (LSDI) is a validated measure of the effect of lumbar stiffness on functional activity, but this index might not be fully applicable to the elderly Chinese population given several specific lifestyle characteristics. PURPOSE To evaluate lumbar stiffness in patients with DLS after long-level fusion by Chinese-LSDI (C-LSDI). STUDY DESIGN A retrospective study. PATIENT SAMPLE A total of 129 DLS patients who underwent long-level (≧4 levels) fusion surgery with at least one-year follow-up from June 2009 to September 2017 were retrospectively included. OUTCOME MEASURES The C-LSDI was designed by modifying LSDI and Korean-LSDI (K-LSDI) based on elderly Chinese lifestyles and the internal consistency and retest repeatability of the patient-reported outcome questionnaire in the measurement of the impact of lumbar stiffness on functional abilities was assessed. METHODS The radiographic parameters including Cobb angle, apical vertebral translation (AVT), coronal vertical axis (CVA), sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and PI-LL, and clinical symptoms including visual analogue scale (VAS) for back and low extremity pain; Oswestry disability index (ODI), Japanese Orthopedic Association-29 (JOA-29), Scoliosis Research Society⁃22 (SRS-22), 36⁃Item short form survey (SF-36), physical component scores (PCS) and mental component scores (MCS) were measured preoperatively and at the last follow-up. RESULTS Compared with LSDI and K-LSDI, the C-LSDI demonstrated higher internal consistency (Cronbach's alpha=0.902) and retest reliability (Internal consistency coefficients, ICC=0.904) in the elderly Chinese population. All patients showed increased lumbar stiffness and significant improvement in pain and deformity postoperatively. Regarding items, such as performing personal hygiene after toileting and getting out of a car, people reported more inconvenience with increasingly fixed levels. CONCLUSIONS This study demonstrated that the C-LSDI questionnaire was a reliable and valid instrument for assessing functional limitations due to lumbar stiffness among elderly Chinese patients with DLS after long-level fusion. Although the effects of stiffness did trend toward greater impacts among patients who underwent longer fusions, most patients were satisfied with trade-offs of function and pain relief in exchange for perceived increases in lumbar stiffness.
Collapse
Affiliation(s)
- Xinling Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China
| | - Lei Yuan
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China
| | - Yan Zeng
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China.
| | - Yinhao Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China
| | - Zhongqiang Chen
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China
| | - Weishi Li
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191China; Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China
| |
Collapse
|
9
|
Active, Targeted, and Measured Device-Based Therapy for Low Back Pain With the David Spine Concept. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Gouteron A, Tabard-Fougère A, Bourredjem A, Casillas JM, Armand S, Genevay S. The flexion relaxation phenomenon in nonspecific chronic low back pain: prevalence, reproducibility and flexion-extension ratios. A systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:136-151. [PMID: 34553264 DOI: 10.1007/s00586-021-06992-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The flexion relaxation phenomenon (FRP) is characterized by the reduction of paraspinal muscle activity at maximum trunk flexion. The FRP is reported to be altered (persistence of spinal muscle activity) in nonspecific chronic low back pain (NSCLBP) and is considered a promising biomarker. The aim of this systematic review was to synthetize current knowledge on FRP in the NSCLBP population regarding prevalence, the reliability of FRP measurement using surface electromyography (sEMG), the average value, and variation of the relaxation ratios (RR). METHODS Five databases were searched (PubMed, EMBASE, Web of Sciences, Cochrane Library, Pedro). A qualitative analysis was done for all included studies and meta-analysis studying prevalence, mean value of flexion relaxation ratio (FRR) and extension relaxation ratio (ERR), and difference between asymptomatic and NSCLBP FRR. RESULTS Twenty-seven studies were included for qualitative analysis and 21 studies for meta-analysis. The prevalence of the altered FRP was 55% (95%CI [32-79%]) in the NSCLBP population. The studies on reliability reported good within-session and between-session reproducibility. In the NSLBP population, the mean FRR was 2.96 (95%CI [2.02; 3.90]) and the mean ERR was 4.07 (95%CI [2.08; 6.07]). The difference between asymptomatic and NSCLBP FRR was - 1.19 (95%CI [- 1.92, - 0.45]). In all meta-analysis, the I2 index was > 80%. CONCLUSION An altered FRP is frequently found in NSCLBP population using sEMG and the test has a good reproducibility. The difference between asymptomatic and NSCLBP FRR was significant. Nevertheless, considering the high heterogeneity observed, additional research is required to confirm the value of RR.
Collapse
Affiliation(s)
- Anaïs Gouteron
- Inserm UMR 1093, Cognition, Action, Plasticité sensori-motrice, Dijon, France. .,University Hospital Dijon-Burgundy Franche-Comté, France, Pôle Rééducation-Réadaptation, CHU de Dijon, 23, Rue Gaffarel, 21078, Dijon, France.
| | - Anne Tabard-Fougère
- Geneva University Hospitals and University of Geneva, Willy Taillard Laboratory of Kinesiology, Geneva, Switzerland
| | - Abderrahmane Bourredjem
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon, Burgundy, Dijon, France
| | - Jean-Marie Casillas
- Inserm UMR 1093, Cognition, Action, Plasticité sensori-motrice, Dijon, France.,Inserm CIC 1432, Module P, Plateforme d'investigation Technologique, CHU de Dijon, Dijon, France.,University Hospital Dijon-Burgundy Franche-Comté, France, Pôle Rééducation-Réadaptation, CHU de Dijon, 23, Rue Gaffarel, 21078, Dijon, France
| | - Stéphane Armand
- Geneva University Hospitals and University of Geneva, Willy Taillard Laboratory of Kinesiology, Geneva, Switzerland
| | - Stéphane Genevay
- Division of Rheumatology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
11
|
Kang KW, Kwon YH, Son SM. Ultrasound Measurement of the Transverse Abdominis, Internal Oblique, and External Oblique Muscles Associated with Forward Head Posture and Reduced Cranio-Vertebral Angle. Med Sci Monit 2021; 27:e928987. [PMID: 34097670 PMCID: PMC8194289 DOI: 10.12659/msm.928987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Abnormal posture can affect the alignment of the cervical spine, which can lead to various physical problems. There are many ways to solve the problem by limiting the area around the neck to restore abnormal neck condition. However, there is a need to look at these problems from an enlarged perspective through the relationship between the cervical spine and trunk. This study aimed to investigate the significance of the thickness of the transverse abdominis, internal oblique, and external oblique muscles in patients with forward head posture and reduced cranio-vertebral angle. Material/Methods We included 24 healthy adult males in their 20s without lower back pain. The cranio-vertebral angle (CVA) in all the subjects was measured with the help of pictures taken in the sagittal plane using a digital camera. The thickness of muscles, including transverse abdominis (TrA), internal oblique (IO), and external oblique (EO), was measured using a diagnostic ultrasound device. Pearson’s correlation analysis was used to identify the correlation between the variables measured. Results CVA showed a statistically significant correlation with TrA thickness (r=0.506/p=0.012), and among the abdominal muscles, there was a significant correlation between IO and EO thickness (r=0.663/p=0.000). Conclusions A reduced CVA due to FHP was significantly associated with reduced TrA thickness. Therefore, increasing the bulk of the abdominal muscles with restoration of the abnormal CVA is a potential treatment approach and requires further study.
Collapse
Affiliation(s)
- Kyung Woo Kang
- Department of Physical Therapy, Yeungnam University College, Daegu, South Korea
| | - Yong Hyun Kwon
- Department of Physical Therapy, Yeungnam University College, Daegu, South Korea
| | - Sung Min Son
- Department of Physical Therapy, College of Health Science, Cheongju University, Chungbuk, South Korea
| |
Collapse
|
12
|
Stamenkovic A, Clark BC, Pidcoe PE, van der Veen SM, France CR, Russ DW, Kinser PA, Thomas JS. Distinguishing chronic low back pain in young adults with mild to moderate pain and disability using trunk compliance. Sci Rep 2021; 11:7592. [PMID: 33828171 PMCID: PMC8026630 DOI: 10.1038/s41598-021-87138-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/24/2021] [Indexed: 11/09/2022] Open
Abstract
Chronic low back pain (cLBP) rates among younger individuals are rising. Although pain and disability are often less severe, underlying changes in trunk behavior may be responsible for recurrence. We examine the biomarker capacity of a simple Trunk Compliance Index (TCI) to distinguish individuals with and without cLBP. A random subset (n = 49) of the RELIEF RCT were matched to healthy controls for sex, age, height and weight. We measured TCI (as displacement/ weight-normalized perturbation force) using anthropometrically-matched, suddenly-applied pulling perturbations to the trunk segment, randomized across three planes of motion (antero-posterior, medio-lateral, and rotational). Mean differences between cLBP, sex and perturbation direction were assessed with repeated-measures analysis of variance. Discriminatory accuracy of TCI was assessed using Receiver Operator Characteristic (ROC) analysis. Baseline characteristics between groups were equivalent (x̅ [range]): sex (57% female / group), age (23.0 [18-45], 22.8 [18-45]), height, cm (173.0 [156.5-205], 171.3 [121.2-197], weight, kg (71.8 [44.5-116.6], 71.7 [46.8-117.5]) with cLBP associated with significantly lower TCI for 5 of 6 directions (range mean difference, - 5.35: - 1.49, range 95% CI [- 6.46: - 2.18 to - 4.35: - 0.30]. Classification via ROC showed that composite TCI had high discriminatory potential (area under curve [95% CI], 0.90 [0.84-0.96]), driven by TCI from antero-posterior perturbations (area under curve [95% CI], 0.99 [0.97-1.00]). Consistent reductions in TCI suggests global changes in trunk mechanics that may go undetected in classic clinical examination. Evaluation of TCI in younger adults with mild pain and disability may serve as a biomarker for chronicity, leading to improved preventative measures in cLBP.Trial Registration and Funding RELIEF is registered with clinicaltrials.gov (NCT01854892) and funded by the NIH National Center for Complementary & Integrative Health (R01AT006978).
Collapse
Affiliation(s)
- Alexander Stamenkovic
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, 900 East Leigh St, 4th Floor, Richmond, VA, 23298, USA.
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, USA.,Department of Biomedical Sciences, Ohio University, Athens, USA
| | - Peter E Pidcoe
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, 900 East Leigh St, 4th Floor, Richmond, VA, 23298, USA
| | - Susanne M van der Veen
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, 900 East Leigh St, 4th Floor, Richmond, VA, 23298, USA.,Physical and Rehabilitation Medicine, Virginia Commonwealth University, Richmond, USA
| | - Christopher R France
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, USA.,Department of Psychology, Ohio University, Athens, USA
| | - David W Russ
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, USA
| | | | - James S Thomas
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, 900 East Leigh St, 4th Floor, Richmond, VA, 23298, USA.,Physical and Rehabilitation Medicine, Virginia Commonwealth University, Richmond, USA
| |
Collapse
|
13
|
Owens EF, Hosek RS, Russell BS. Mechanical properties of a thoracic spine mannequin with variable stiffness control. THE JOURNAL OF CHIROPRACTIC EDUCATION 2021; 35:1-7. [PMID: 32930327 PMCID: PMC7958670 DOI: 10.7899/jce-19-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/07/2019] [Accepted: 12/24/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To test the posterior-to-anterior stiffness (PAS) of a new thoracic spine training simulator under different conditions of "fixation." METHODS We constructed a thoracic spine model using plastic bones and ribs mounted in a wooden box, with skin and soft tissue simulated by layers of silicone and foam. The spine segment could be stiffened with tension applied to cords running through the vertebrae and ribs. We tested PAS at 2 tension levels using a custom-built device to apply repetitive loads at the T6 spinous process (SP) and over adjacent soft tissue (TP) while measuring load and displacement. Stiffness was the slope of the force-displacement curve from 55 to 75 N. RESULTS Stiffness in the unconstrained (zero tension) condition over the SP averaged 11.98 N/mm and 6.72 N/mm over the TP. With tension applied, SP stiffness increased to 14.56 N/mm, and TP decreased to 6.15 N/mm. CONCLUSION Thoracic model compliance was similar to that reported for humans. The tension control system increased stiffness by 21.3% only over the SP. Stiffness over the TP was dominated by the lower stiffness of the thicker foam layer and did not change. The mannequin with these properties may be suitable for use in manual training of adjusting or PAS testing skills.
Collapse
|
14
|
Christe G, Crombez G, Edd S, Opsommer E, Jolles BM, Favre J. Relationship between psychological factors and spinal motor behaviour in low back pain: a systematic review and meta-analysis. Pain 2021; 162:672-686. [PMID: 33591109 DOI: 10.1097/j.pain.0000000000002065] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
ABSTRACT This meta-analysis investigated whether more negative psychological factors are associated with less spinal amplitude of movement and higher trunk muscle activity in individuals with low back pain. Furthermore, it examined whether pain intensity was a confounding factor in this relationship. We included studies that provided at least 1 correlation coefficient between psychological (pain-related fear, catastrophizing, depression, anxiety, and self-efficacy) and spinal motor behaviour (spinal amplitude and trunk muscle activity) measures. In total, 52 studies (3949 participants) were included. The pooled correlation coefficients (95% confidence interval; number of participants) were -0.13 (-0.18 to -0.09; 2832) for pain-related fear, -0.16 (-0.23 to -0.09; 756) for catastrophizing, -0.08 (-0.13 to -0.03; 1570) for depression, -0.08 (-0.30 to 0.14; 336) for anxiety, and -0.06 (-0.46 to 0.36; 66) for self-efficacy. The results indicated that higher levels of pain-related fear, catastrophizing, and depression are significantly associated with reduced amplitudes of movement and larger muscle activity and were consistent across subgroup and moderation analyses. Pain intensity did not significantly affect the association between these psychological factors and spinal motor behaviour and had a very small independent association with spinal motor behaviour. In conclusion, the very small effect sizes found in the meta-analyses question the role of psychological factors as major causes of spinal movement avoidance in low back pain. Experimental studies with more specific and individualized measures of psychological factors, pain intensity, and spinal motor behaviour are recommended.
Collapse
Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Ghent University, Gent, Belgium
| | - Shannon Edd
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Emmanuelle Opsommer
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Brigitte M Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
15
|
Nim CG, Kawchuk GN, Schiøttz-Christensen B, O'Neill S. Changes in pain sensitivity and spinal stiffness in relation to responder status following spinal manipulative therapy in chronic low Back pain: a secondary explorative analysis of a randomized trial. BMC Musculoskelet Disord 2021; 22:23. [PMID: 33407345 PMCID: PMC7786943 DOI: 10.1186/s12891-020-03873-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022] Open
Abstract
Background In a prior randomized trial, we demonstrated that participants receiving spinal manipulative therapy at a pain-sensitive segment instead of a stiff segment experienced increased mechanical pressure pain thresholds. We hypothesized that the targeted segment mediated this increase through a segment-dependent neurophysiological reflective pathway. Presently, it is not known if this decrease in pain sensitivity is associated with clinical improvement. Therefore, we performed an explorative analysis to examine if changes in experimental pain sensitivity (mechanical and thermal) and lumbar stiffness were further dependent on clinical improvement in disability and patient-reported low back pain. Methods This study is a secondary explorative analysis of data from the randomized trial that compared 132 participants with chronic low back pain who received lumbar spinal manipulative therapy applied at either i) the stiffest segment or ii) the segment having the lowest pain threshold (i.e., the most pain-sensitive segment). We collected data at baseline, after the fourth session of spinal manipulation, and at 14-days follow-up. Participants were dichotomized into responders/non-responders using different clinical variables (disability and patient-reported low back pain) with varying threshold values (0, 30, and 50% improvement). Mixed models were used to assess changes in experimental outcomes (stiffness and pain sensitivity). The fixed interaction terms were time, segment allocation, and responder status. Results We observed a significant increase in mechanical pressure pain thresholds for the group, which received spinal manipulative therapy at the most pain-sensitive segment independent of whether they improved clinically or not. Those who received spinal manipulation at the stiffest segment also demonstrated increased mechanical pain sensitivity, but only in the subgroup with clinical improvement. We did not observe any changes in lumbar stiffness. Conclusion Our results suggest the existence of two different mechanistic pathways associated with the spinal manipulation target. i) A decrease of mechanical pain sensitivity independent of clinical outcome (neurophysiological) and ii) a decrease as a reflection of the clinical outcome. Together, these observations may provide a novel framework that improves our understanding of why some respond to spinal manipulative therapy while others do not. Trial registration ClinicalTrials.gov identifier: NCT04086667 registered retrospectively September 11th 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03873-3.
Collapse
Affiliation(s)
- Casper Glissmann Nim
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Østrehougvej 55, 5500, Middelfart, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Gregory Neil Kawchuk
- Department of Physical Therapy, University of Alberta, 8205 114St, 2-50 Corbett Hall, Edmonton, Alberta, T6G 2G4, Canada
| | - Berit Schiøttz-Christensen
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Søren O'Neill
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Østrehougvej 55, 5500, Middelfart, Denmark.,Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| |
Collapse
|
16
|
Shigetoh H, Nishi Y, Osumi M, Morioka S. Combined abnormal muscle activity and pain-related factors affect disability in patients with chronic low back pain: An association rule analysis. PLoS One 2020; 15:e0244111. [PMID: 33332431 PMCID: PMC7746291 DOI: 10.1371/journal.pone.0244111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 12/02/2020] [Indexed: 12/27/2022] Open
Abstract
Objectives In patients with chronic low back pain (CLBP), reduced lumbar flexion-relaxation and reduced variability of muscle activity distribution are reported as abnormal muscle activity. It is not known how abnormal muscle activity and pain-related factors are related to CLBP-based disability. Here, we performed an association rule analysis to investigated how CLBP disability, muscle activity, and pain-related factors in CLBP patients are related. Methods Surface electromyographic signals were recorded from over the bilateral lumbar erector spinae muscle with four-channel electrodes from 24 CLBP patients while they performed a trunk flexion re-extension task. We calculated the average value of muscle activities of all channels and then calculated the flexion relaxation ratio (FRR) and the spatial variability of muscle activities. We also assessed the pain-related factors and CLBP disability by a questionnaire method. A clustering association rules analysis was performed to determine the relationships among pain-related factors, the FRR, and the variability of muscle activity distribution. Results The association rules of severe CLBP disability were divisible into five classes, including ‘low FRR-related rules.’ The rules of the mild CLBP disability were divisible into four classes, including ‘high FRR-related rules’ and ‘high muscle variability-related rules.’ When we combined pain-related factors with the FRR and muscle variability, the relationship between abnormal FRR/muscle variability and CLBP disability became stronger. Discussion Our findings thus highlight the importance of focusing on not only the patients’ pain-related factors but also the abnormal motor control associated with CLBP, which causes CLBP disability.
Collapse
Affiliation(s)
- Hayato Shigetoh
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Koryo-cho, Nara, Japan
- Miura Internal Medicine Michiko Pediatrics Clinic, Marugame-shi, Kagawa, Japan
- * E-mail:
| | - Yuki Nishi
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Koryo-cho, Nara, Japan
| | - Michihiro Osumi
- Neuro Rehabilitation Research Center, Kio University, Koryo-cho, Nara, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Koryo-cho, Nara, Japan
- Neuro Rehabilitation Research Center, Kio University, Koryo-cho, Nara, Japan
| |
Collapse
|
17
|
Shigetoh H, Nishi Y, Osumi M, Morioka S. Temporal Associations Between Pain-Related Factors and Abnormal Muscle Activities in a Patient with Chronic Low Back Pain: A Cross-Lag Correlation Analysis of a Single Case. J Pain Res 2020; 13:3247-3256. [PMID: 33311998 PMCID: PMC7725073 DOI: 10.2147/jpr.s286280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/17/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose The cross-sectional and longitudinal associations between pain-related factors and muscle activity in patients with chronic low back pain (CLBP) are unclear. This study aimed to examine the temporal associations between them in a CLBP patient using a single-case analysis to account for an individual course. Patient and Methods A patient with a history of lower back pain lasting more than 3 months was studied from March 16, 2020 to May 30, 2020. Surface electromyographic signals were recorded from over the bilateral lumbar erector spinae in the patient while performing a standing trunk flexion and re-extension task. The average value for muscle activity during each movement phase was estimated, and the flexion relaxation ratio (FRR) of all channels was subsequently calculated. Pain-related factors and disability were assessed using questionnaires. All assessments were performed nine times, along with 2-3 months of intervention. Once or twice per week, the patient received physical therapy that consisted of soft tissue mobilization, joint mobilization, nerve mobilization, and patient education. A cross-lag correlation analysis of this single case was conducted. Results Pain-related factors showed a trend toward improvements in all variables when compared to those in the first assessment; however, there was no general change (increase) in FRR over time. The cross-lag correlation analysis revealed that improvements in FRR were associated with improvements in body perception disturbance (ρ = -0.78, p < 0.01), and that improvements in muscle activity during the extension phase were associated with improvements in pain (ρ = 0.75), psychological factors (ρ = 0.57), and disability (ρ = 0.67) (p < 0.05). Conclusion Our findings suggest that improvements in body perception were temporally associated with improvements in FRR, and improvements in pain, psychological factors, and disability were temporally associated with a reduction in muscle activity during the trunk extension phase in this patient with CLBP.
Collapse
Affiliation(s)
- Hayato Shigetoh
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Koryo, Nara, Japan.,Miura Internal Medicine Michiko Pediatrics Clinic, Marugame City, Kagawa, Japan
| | - Yuki Nishi
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Koryo, Nara, Japan
| | - Michihiro Osumi
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Koryo, Nara, Japan.,Neurorehabilitation Research Center, Kio University, Nara, Japan
| |
Collapse
|
18
|
Abstract
OBJECTIVE To investigate the relationship between changes in volitional spinal movement (including muscle activity) and changes in pain or activity limitation at the individual level in people with nonspecific low back pain. DESIGN Etiology systematic review. LITERATURE SEARCH MEDLINE, Embase, CINAHL, and AMED were searched from inception to January 2020. STUDY SELECTION CRITERIA The study included peer-reviewed articles that reported the relationship between changes in volitional spinal movement and changes in pain or activity limitation at the individual level in people with nonspecific low back pain. DATA SYNTHESIS The data were descriptively synthesized to identify a relationship between change in movement and improved pain or activity limitation. RESULTS We included 27 studies involving 2739 participants. There was low-quality evidence of a relationship between change in movement and change in pain or activity limitation at the individual level 31% of the time (20 of the 65 times investigated within the 27 studies). Increases in spinal range of motion, velocity, and flexion relaxation of the back extensors were consistently related to improved pain or activity limitation (93%, 18.5/20 relationships observed). CONCLUSION A relationship between changes in movement and changes in pain or activity limitation was infrequently observed at the individual level; however, a paucity of high-quality evidence precludes a definitive understanding of this relationship. J Orthop Sports Phys Ther 2020;50(12):664-680. Epub 28 Oct 2020. doi:10.2519/jospt.2020.9635.
Collapse
|
19
|
Nim CG, Kawchuk GN, Schiøttz-Christensen B, O'Neill S. The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial. Sci Rep 2020; 10:14615. [PMID: 32884045 PMCID: PMC7471938 DOI: 10.1038/s41598-020-71557-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 08/18/2020] [Indexed: 12/29/2022] Open
Abstract
The mechanisms underlying pain relief following spinal manipulative therapy (SMT) are not understood fully although biomechanical and neurophysiological processes have been proposed. As such, we designed this randomized trial to elucidate the contributions of biomechanical and neurophysiological processes. A total of 132 participants with low back pain were randomly assigned to receive SMT at either the lumbar segment measured as the stiffest or the segment measured as having the lowest pain threshold. The primary outcome was patient reported low back pain intensity following treatment. Secondary outcomes were biomechanical stiffness and neurophysiological pressure pain threshold. All outcomes were measured at baseline, after the fourth and final session and at 2-weeks follow-up. Data were analyzed using linear mixed models, and demonstrated that the SMT application site did not influence patient reported low back pain intensity or stiffness. However, a large and significant difference in pressure pain threshold was observed between groups. This study provides support that SMT impacts neurophysiological parameters through a segment-dependent neurological reflex pathway, although this do not seem to be a proxy for improvement. This study was limited by the assumption that the applied treatment was sufficient to impact the primary outcome.
Collapse
Affiliation(s)
- Casper Glissmann Nim
- Medical Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark.
| | | | | | - Søren O'Neill
- Medical Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark
| |
Collapse
|
20
|
Lo WLA, Lei D, Leng Y, Huang H, Wang B, Yu Q, Li L. Impact of nonsurgical spinal decompression on paraspinal muscle morphology and mechanical properties in young adults with low back pain. J Int Med Res 2020; 48:300060520919232. [PMID: 32723102 PMCID: PMC7391436 DOI: 10.1177/0300060520919232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective The mechanism underlying the benefit of nonsurgical spinal decompression (NSSD) on low back pain is unclear. This study was performed to investigate the immediate impact of NSSD on the mechanical properties and morphology of the paraspinal muscles. Methods Participants with low back pain were recruited. NSSD therapy was provided on one occasion. A myotonometer was placed perpendicularly on the skin surface over the paraspinal muscle at the level of L3/L4 to measure the mechanical muscle properties. The multifidus thickness was measured using B-mode ultrasound and defined as the distance between the transverse process and subcutaneous tissue fascia. The difference between before and after NSSD was analyzed by a paired t-test. Results Thirty participants (mean age, 20.9 ± 0.8 years; 9 male, 21 female) were recruited. No significant difference was observed in the muscle mechanical properties or morphology between before and after the intervention. Conclusions NSSD intervention did not induce immediate changes in the paraspinal muscle mechanical properties or multifidus thickness in young adults with low back pain. NSSD might produce benefits by stimulating mechanical receptors rather than inducing morphological changes or mechanical property alterations of the muscle fibers. These parameters may not be suitable outcome measures for NSSD intervention.
Collapse
Affiliation(s)
- Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Di Lei
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Leng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huanjie Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Biru Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Le Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
21
|
Weber Ii KA, Wager TD, Mackey S, Elliott JM, Liu WC, Sparks CL. Evidence for decreased Neurologic Pain Signature activation following thoracic spinal manipulation in healthy volunteers and participants with neck pain. NEUROIMAGE-CLINICAL 2019; 24:102042. [PMID: 31670070 PMCID: PMC6831903 DOI: 10.1016/j.nicl.2019.102042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/18/2019] [Accepted: 10/17/2019] [Indexed: 12/19/2022]
Abstract
The use of brain-based models of pain were explored in two clinical studies. Neurologic pain signature activation decreased following spinal manipulation. Spinal manipulation altered the processing of pain-related brain activity. We provide evidence for a centrally mediated therapeutic action of spinal manipulation. Brain-based models have potential as objective clinical biomarkers of pain.
Background Context Spinal manipulation (SM) is a common treatment for neck and back pain, theorized to mechanically affect the spine leading to therapeutic mechanical changes. The link between specific mechanical effects and clinical improvement is not well supported. SM's therapeutic action may instead be partially mediated within the central nervous system. Purpose To introduce brain-based models of pain for spinal pain and manual therapy research, characterize the distributed central mechanisms of SM, and advance the preliminary validation of brain-based models as potential clinical biomarkers of pain. Study Design Secondary analysis of two functional magnetic resonance imaging studies investigating the effect of thoracic SM on pain-related brain activity: A non-controlled, non-blinded study in healthy volunteers (Study 1, n = 10, 5 females, and mean age = 31.2 ± 10.0 years) and a randomized controlled study in participants with acute to subacute neck pain (Study 2, n = 24, 16 females, mean age = 38.0 ± 15.1 years). Methods Functional magnetic resonance imaging was performed during noxious mechanical stimulation of the right index finger cuticle pre- and post-intervention. The effect of SM on pain-related activity was studied within brain regions defined by the Neurologic Pain Signature (NPS) that are predictive of physical pain. Results In Study 1, evoked mechanical pain (p < 0.001) and NPS activation (p = 0.010) decreased following SM, and the changes in evoked pain and NPS activation were correlated (rRM2 = 0.418, p = 0.016). Activation within the NPS subregions of the dorsal anterior cingulate cortex (dACC, p = 0.012) and right secondary somatosensory cortex/operculum (rS2_Op, p = 0.045) also decreased following SM, and evoked pain was correlated with dACC activity (rRM2 = 0.477, p = 0.019). In Study 2, neck pain (p = 0.046) and NPS (p = 0.033) activation decreased following verum but not sham SM. Associations between evoked pain, neck pain, and NPS activation, were not significant and less clear, possibly due to inadequate power, methodological limitations, or other confounding factors. Conclusions The findings provide preliminary evidence that SM may alter the processing of pain-related brain activity within specific pain-related brain regions and support the use of brain-based models as clinical biomarkers of pain.
Collapse
Affiliation(s)
- Kenneth A Weber Ii
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.
| | - Tor D Wager
- Psychology and Neuroscience, Center for Neuroscience, Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | - Sean Mackey
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - James M Elliott
- Northern Sydney Local Health District, The Kolling Research Institute and The Faculty of Health Sciences, The University of Sydney, St. Leonards, NSW, Australia
| | - Wen-Ching Liu
- Center for Collaborative Brain Research, Department of Radiology, OSF HealthCare Saint Francis Medical Center, Peoria, IL, United States
| | - Cheryl L Sparks
- Center of Expertise, Rehabilitation and Occupational Health, OSF HealthCare, Peoria, IL, United States; School of Physical Therapy, South College, Knoxville, TN, United States
| |
Collapse
|
22
|
Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ 2019; 364:l689. [PMID: 30867144 PMCID: PMC6396088 DOI: 10.1136/bmj.l689] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess the benefits and harms of spinal manipulative therapy (SMT) for the treatment of chronic low back pain. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Physiotherapy Evidence Database (PEDro), Index to Chiropractic Literature, and trial registries up to 4 May 2018, including reference lists of eligible trials and related reviews. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials examining the effect of spinal manipulation or mobilisation in adults (≥18 years) with chronic low back pain with or without referred pain. Studies that exclusively examined sciatica were excluded, as was grey literature. No restrictions were applied to language or setting. REVIEW METHODS Two reviewers independently selected studies, extracted data, and assessed risk of bias and quality of the evidence. The effect of SMT was compared with recommended therapies, non-recommended therapies, sham (placebo) SMT, and SMT as an adjuvant therapy. Main outcomes were pain and back specific functional status, examined as mean differences and standardised mean differences (SMD), respectively. Outcomes were examined at 1, 6, and 12 months. Quality of evidence was assessed using GRADE. A random effects model was used and statistical heterogeneity explored. RESULTS 47 randomised controlled trials including a total of 9211 participants were identified, who were on average middle aged (35-60 years). Most trials compared SMT with recommended therapies. Moderate quality evidence suggested that SMT has similar effects to other recommended therapies for short term pain relief (mean difference -3.17, 95% confidence interval -7.85 to 1.51) and a small, clinically better improvement in function (SMD -0.25, 95% confidence interval -0.41 to -0.09). High quality evidence suggested that compared with non-recommended therapies SMT results in small, not clinically better effects for short term pain relief (mean difference -7.48, -11.50 to -3.47) and small to moderate clinically better improvement in function (SMD -0.41, -0.67 to -0.15). In general, these results were similar for the intermediate and long term outcomes as were the effects of SMT as an adjuvant therapy. Evidence for sham SMT was low to very low quality; therefore these effects should be considered uncertain. Statistical heterogeneity could not be explained. About half of the studies examined adverse and serious adverse events, but in most of these it was unclear how and whether these events were registered systematically. Most of the observed adverse events were musculoskeletal related, transient in nature, and of mild to moderate severity. One study with a low risk of selection bias and powered to examine risk (n=183) found no increased risk of an adverse event (relative risk 1.24, 95% confidence interval 0.85 to 1.81) or duration of the event (1.13, 0.59 to 2.18) compared with sham SMT. In one study, the Data Safety Monitoring Board judged one serious adverse event to be possibly related to SMT. CONCLUSION SMT produces similar effects to recommended therapies for chronic low back pain, whereas SMT seems to be better than non-recommended interventions for improvement in function in the short term. Clinicians should inform their patients of the potential risks of adverse events associated with SMT.
Collapse
Affiliation(s)
- Sidney M Rubinstein
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081HV Amsterdam, Netherlands
| | - Annemarie de Zoete
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081HV Amsterdam, Netherlands
| | | | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Michiel R de Boer
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081HV Amsterdam, Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081HV Amsterdam, Netherlands
- Department of Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
23
|
Fernandes WVB, Blanco CR, Politti F, de Cordoba Lanza F, Lucareli PRG, Corrêa JCF. The effect of a six-week osteopathic visceral manipulation in patients with non-specific chronic low back pain and functional constipation: study protocol for a randomized controlled trial. Trials 2018; 19:151. [PMID: 29499728 PMCID: PMC5833057 DOI: 10.1186/s13063-018-2532-8] [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: 11/22/2017] [Accepted: 02/06/2018] [Indexed: 11/25/2022] Open
Abstract
Background The aim of the proposed study is to analyze the effect of a six-week osteopathic visceral manipulation (OVM) program on the flexion-relaxation phenomenon in individuals with non-specific chronic low back pain (LBP) and functional constipation. Methods/Design An assessor-blinded, two-arm, randomized, placebo-controlled trial will be conducted. The sample will comprise 76 individuals with non-specific chronic LBP who have functional intestinal constipation, aged 18–65 years. The participants will be randomly allocated to two groups: (1) OVM and (2) sham OVM (SOVM). Evaluations will involve an interview, the Oswestry Disability Index, Fear-Avoidance Beliefs Questionnaire, functional constipation according to Rome III criteria, Biering-Sorensen test to normalize electromyographic (EMG) data, T12–L1 paraspinal level of the EMG signal during the flexion-relaxation phenomenon, 11-point numeric pain rating scale and fingertip-to-floor test. OVM and SOVM will be performed once per week for six weeks. Group 1 will receive OVM for 15 min and Group 2 will receive a sham visceral technique. Evaluations will be performed before and after the first session, after six weeks of treatment, and three months after randomization (follow-up). The findings will be analyzed statistically considering a 5% significance level (p ≤ 0.05). The limitation of the study is that the therapist will not be blinded. Discussion This will be the first trial to analyze the clinical response and electromyographic signals during the flexion-relaxation phenomenon after OVM. Trial registration Brazilian Clinical Trial Registry, RBR-7sx8j3. Registered on 26 October 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2532-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Walkyria Vilas Boas Fernandes
- Doctoral Program in Rehabilition Sciences, Nove de Julho University (UNINOVE), São Paulo, Brazil. .,Federal University of Mato Grosso (UFMT), Rondonópolis, Brazil. .,Human Movement Analysis Laboratory, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil.
| | | | - Fabiano Politti
- Doctoral Program in Rehabilition Sciences, Nove de Julho University (UNINOVE), São Paulo, Brazil
| | | | | | - João Carlos Ferrari Corrêa
- Doctoral Program in Rehabilition Sciences, Nove de Julho University (UNINOVE), São Paulo, Brazil.,Human Movement Analysis Laboratory, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| |
Collapse
|