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Amabile AH, Larson SL, Hoglund LT, Guarnieri JP, McDonald M, Reich MR. Greater number of weekly stairs climbed is associated with lower low back pain prevalence among female but not male physical therapists. PLoS One 2023; 18:e0292489. [PMID: 37797076 PMCID: PMC10553291 DOI: 10.1371/journal.pone.0292489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Certain cardiovascular health benefits of stair climbing are now widely accepted, but no prior studies have as yet been found linking the quantity of stairs climbed to low back pain (LBP) morbidity. Low back pain is a common musculoskeletal impairment, and research has begun to show an association between LBP and gluteus maximus (GM) weakness. With stair climbing being the activity which most activates GM, the aim of the present research was to assess the relationship between stair ambulation and LBP prevalence. The hypothesis of this cross-sectional study was that individuals with LBP would report a significantly lower numbers of stair flights climbed compared with individuals without LBP. METHODS A survey tool was developed and distributed via email to a convenience sample of orthopedic physical therapists. Survey items included information regarding medical history, physical activity, workplace, and LBP factors, using a one-year prevalence period. RESULTS A total of 363 respondents took the survey and, after application of exclusion criteria, 248 records remained in our final sample. When analyzing all genders together, non LBP (NLBP) respondents reported a mean of 51.62 flights climbed per week; and LBP respondents reported 37.82 flights climbed per week, with P = 0.077. When males and females were analyzed separately, a statistically significant difference in mean number of flights of stairs climbed was found among female respondents (61.51 flights climbed for NLBP and 35.61 flights climbed for LBP females; P = 0.031). When analyzed based on chronicity of LBP, an even stronger association between stairs climbed and LBP prevalence was found for female respondents with acute LBP (P = 0.009). CONCLUSIONS More weekly stairs climbed was associated with a lower LBP prevalence among females, especially with respect to acute LBP. Randomized, longitudinal research is, however, required to confirm a relationship between stair climbing and LBP.
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Affiliation(s)
- Amy H. Amabile
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine, Temple University, MERB 457, Philadelphia, PA, United States of America
| | - Sharon L. Larson
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Lisa T. Hoglund
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - John P. Guarnieri
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Maureen McDonald
- Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Madeline R. Reich
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
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2
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Frącz W, Matuska J, Szyszka J, Dobrakowski P, Szopka W, Skorupska E. The Cross-Sectional Area Assessment of Pelvic Muscles Using the MRI Manual Segmentation among Patients with Low Back Pain and Healthy Subjects. J Imaging 2023; 9:155. [PMID: 37623687 PMCID: PMC10455268 DOI: 10.3390/jimaging9080155] [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: 07/02/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
The pain pathomechanism of chronic low back pain (LBP) is complex and the available diagnostic methods are insufficient. Patients present morphological changes in volume and cross-sectional area (CSA) of lumbosacral region. The main objective of this study was to assess if CSA measurements of pelvic muscle will indicate muscle atrophy between asymptomatic and symptomatic sides in chronic LBP patients, as well as between right and left sides in healthy volunteers. In addition, inter-rater reliability for CSA measurements was examined. The study involved 71 chronic LBP patients and 29 healthy volunteers. The CSA of gluteus maximus, medius, minimus and piriformis were measured using the MRI manual segmentation method. Muscle atrophy was confirmed in gluteus maximus, gluteus minimus and piriformis muscle for over 50% of chronic LBP patients (p < 0.05). Gluteus medius showed atrophy in patients with left side pain occurrence (p < 0.001). Muscle atrophy occurred on the symptomatic side for all inspected muscles, except gluteus maximus in rater one assessment. The reliability of CSA measurements between raters calculated using CCC and ICC presented great inter-rater reproducibility for each muscle both in patients and healthy volunteers (p < 0.95). Therefore, there is the possibility of using CSA assessment in the diagnosis of patients with symptoms of chronic LBP.
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Affiliation(s)
- Wiktoria Frącz
- Faculty of Biomedical Sciences, Medical University of Lodz, Al. Kosciuszki 4, 90-419 Lodz, Poland;
| | - Jakub Matuska
- Department of Physiotherapy, Poznan University of Medical Sciences, ul. 28 czerwca 1956r. nr 135/147, 61-545 Poznan, Poland;
- Doctoral School, Poznan University of Medical Sciences, Bukowska 70, 60-812 Poznań, Poland
- Doctoral School, Rovira I Virgili University, Carrer St. Llorenç No. 21, 43201 Reus, Spain
| | - Jarosław Szyszka
- Opole Rehabilitation Centre in Korfantów, Wyzwolenia 11, 48-317 Korfantów, Poland
| | - Paweł Dobrakowski
- Psychology Institute, Humanitas University in Sosnowiec, 41-200 Sosnowiec, Poland
| | - Wiktoria Szopka
- Faculty of Veterinary Medicine and Animal Science, Poznan University of Life Sciences, 60-637 Poznań, Poland
| | - Elżbieta Skorupska
- Department of Physiotherapy, Poznan University of Medical Sciences, ul. 28 czerwca 1956r. nr 135/147, 61-545 Poznan, Poland;
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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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Neuromuscular Consequences of Lumbopelvic Dysfunction: Research and Clinical Perspectives. J Sport Rehabil 2022; 31:742-748. [PMID: 35894966 DOI: 10.1123/jsr.2021-0258] [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: 07/11/2021] [Revised: 05/10/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022]
Abstract
Injuries involving the lumbopelvic region (ie, lumbar spine, pelvis, hip) are common across the lifespan and include pathologies such as low back pain, femoroacetabular impingement syndrome, labrum tear, and osteoarthritis. Joint injury is known to result in an arthrogenic muscle response which contributes to muscle weakness and altered movement patterns. The purpose of this manuscript is to summarize the arthrogenic muscle response that occurs across lumbopelvic region pathologies, identify methods to quantify muscle function, and propose suggestions for future research. While each lumbopelvic region pathology is unique, there are a few common impairments and a relative consistent arthrogenic muscle response that occurs across the region. Hip muscle weakness and hip joint range of motion limitations occur with both lumbar spine and hip pathologies, and individuals with low back pain are known to demonstrate inhibition of the transversus abdominis and multifidus. Assessment of muscle inhibition is often limited to research laboratory settings, but dynamometers, ultrasound imaging, and electromyography offer clinical capacity to quantify muscle function and inform treatment pathways. Future studies should systematically determine the arthrogenic muscle response across multiple muscle groups and the timeline for changes in muscle function and determine whether disinhibitory modalities improve functional outcomes beyond traditional treatment approaches.
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Sheldon BL, DiMarzio M, Chung SH, Tram J, Khazen O, Staudt MD, Bondoc M, Pilitsis JG. Association of Outcomes of Spinal Cord Stimulation for Chronic Low Back Pain and Psoas Measurements Based on Size of Iliopsoas Muscles. Neuromodulation 2021; 25:121-127. [PMID: 33616289 DOI: 10.1111/ner.13375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/02/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients experience variable long-term improvement in chronic back pain despite successful spinal cord stimulation (SCS) trials. Iliopsoas (IP) size has been shown to differ between patients with low back pain and healthy controls. In this study, we examine whether IP muscle cross-sectional area (CSA) is associated with SCS outcomes. MATERIALS AND METHODS We examined patients for whom we had lumbar MRIs 6.3 years prior to SCS and had baseline and one-year outcome data. Percent change from baseline to one year was calculated for Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), Pain Catastrophizing Scale (PCS), and McGill Pain Questionnaire (MPQ). Correlations between IP muscle CSA, ratio of iliopsoas muscle size to the vertebral body area (P/VBA), and the ratio of iliopsoas muscle size to BMI (P/BMI) were examined. Sex differences were considered. RESULTS A total of 73 subjects were included in this study including 30 females and 43 males. Males had significantly larger IP (males 15.70 ± 0.58, females 9.72 ± 0.43; p < 0.001), P/VBA (males 1.00 ± 0.04, females 0.76 ± 0.03, p < 0.001) and P/BMI ratio (males 0.51 ± 0.02, females 0.32 ± 0.01; p < 0.001) than females. In females, P/VBA predicted NRS worst pain scores (β = 0.82, p = 0.004, r2 = 0.55) and BDI (β = 0.59, p = 0.02, r2 = 0.24). In males, P/BMI was a significant predictor of BDI outcomes scores (β = 0.45, p = 0.03, r2 = 0.16). Males who had more muscle mass measured by iliopsoas size had more depression as measured using BDI (p = 0.03, r = 0.61). Females with less muscle mass measured by P/VBA also experienced more depression (p = 0.02, r = 0.74). CONCLUSIONS Our study showed that psoas measurements correlated with various pain outcomes specifically. P/VBA was most predictive in females and P/BMI in males. Depression correlated with P/BMI, reinforcing the complex relationship between depression and constant chronic pain. Tertile analyses further showed a relationship between iliopsoas CSA and depression in males and females. We provide preliminary data of sex-specific psoas measurements as a risk factor for worse SCS outcomes.
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Affiliation(s)
- Breanna L Sheldon
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Sung Hwan Chung
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Justin Tram
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Michael D Staudt
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Melanie Bondoc
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurosurgery, Albany Medical College, Albany, NY, USA
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Calatayud J, Guzmán-González B, Andersen LL, Cruz-Montecinos C, Morell MT, Roldán R, Ezzatvar Y, Casaña J. Effectiveness of a Group-Based Progressive Strength Training in Primary Care to Improve the Recurrence of Low Back Pain Exacerbations and Function: A Randomised Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228326. [PMID: 33187076 PMCID: PMC7696327 DOI: 10.3390/ijerph17228326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 02/07/2023]
Abstract
Low back pain (LBP) is the leading cause of disability and one of the most common reasons for physician visits in primary care, with a 33% rate of recurrence during the first year. However, the most optimal exercise program in this context remains unknown. The objective was to evaluate the effectiveness of a group-based progressive strength training program in non-specific chronic LBP (CLBP) patients in primary care on pain recurrence and physical function. Eighty-five patients with non-specific CLBP were separated into two groups (Intervention group: completed a progressive strength training program 3 days per week for 8 weeks; Control group: received the usual care). The intervention group showed a recurrence rate of 8.3%, while the control group had a recurrence rate of 33.3% and a shorter time until the first recurrent episode. The intervention group showed increased lumbar extensor strength, left-hand handgrip strength, and reduced the number of pain sites compared with the control group. Results also showed greater odds for reducing LBP intensity and disability in the intervention group. In conclusion, a group-based progressive strength training program is a more effective and efficient alternative than Back-School programs and can easily be carried out in the primary health care context.
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Affiliation(s)
- Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (Y.E.); (J.C.)
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark;
- Correspondence: ; Tel.: +34-625-577-509
| | - Benjamín Guzmán-González
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380419, Chile; (B.G.-G.); (C.C.-M.)
| | - Lars L. Andersen
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark;
- Sport Sciences, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Carlos Cruz-Montecinos
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8380419, Chile; (B.G.-G.); (C.C.-M.)
- Laboratory of Biomechanics and Kinesiology, San José Hospital, Santiago 8380453, Chile
| | - María Teresa Morell
- Primary Care Health Department Valencia Arnau-Llíria, 46015 Valencia, Spain; (M.T.M.); (R.R.)
| | - Ricardo Roldán
- Primary Care Health Department Valencia Arnau-Llíria, 46015 Valencia, Spain; (M.T.M.); (R.R.)
| | - Yasmín Ezzatvar
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (Y.E.); (J.C.)
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (Y.E.); (J.C.)
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Narouei S, Barati AH, Akuzawa H, Talebian S, Ghiasi F, Akbari A, Alizadeh MH. Effects of core stabilization exercises on thickness and activity of trunk and hip muscles in subjects with nonspecific chronic low back pain. J Bodyw Mov Ther 2020; 24:138-146. [PMID: 33218502 DOI: 10.1016/j.jbmt.2020.06.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 05/07/2020] [Accepted: 06/07/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Changes in trunk and hip muscles are believed to be important in subjects with nonspecific chronic low back pain (NSCLBP), but little is known about specific changes, or how they might be affected by core stabilization exercises. The aim of this study was to compare six key muscles before and after these exercises. METHODS Thirty two NSCLBP patients were assigned randomly into two groups: exercise (n = 17) and control (n = 15). On 5 days per week for 4 weeks, the Exercise group performed 16 core stabilization exercises and the Control group received transcutaneous electrical nerve stimulation and a 'hot-pack'. Surface electromyography (EMG) was used to assess maximum bilateral activity of transversus abdominis (TrA), multifidus (MF) and gluteus maximus (Gmax) muscles. Ultrasound imaging was used to measure the rest and contracted thickness of these muscles. Pain and disability were assessed using a visual analogue scale (VAS) and the Oswestry Disability Index. RESULTS When left and right-side muscle data were combined, two-way ANOVAs showed a nonsignificant interaction effect for all dependent variables (P > 0.05), significant time effects on resting muscle thickness for TrA (P = 0.01), MF (P = 0.041) and Gmax (P = 0.003), EMG signals of TrA (P = 0.038), pain and disability (P = 0.000). There were a significant group effect on contracted thickness for TrA (P = 0.032) and Gmax (P = 0.026) and disability (P = 0.017). CONCLUSIONS Core stabilization exercises increased contracted thickness of TrA and Gmax muscles and decreased disability in subjects with NSCLBP.
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Affiliation(s)
- Shideh Narouei
- Tehran University, School of Sport Medicine Sciences, Iran
| | - Amir Hossein Barati
- Shahid beheshti University, Shahid Shahriari Square, Daneshjou Boulevard, Shahid Chamran Highway, Tehran, Iran.
| | | | - Saeed Talebian
- Tehran University, School of Rehabilitation Sciences, Iran
| | - Fateme Ghiasi
- Zahedan University of Medical Sciences, School of Rehabilitation Sciences, Iran
| | - Asghar Akbari
- Zahedan University of Medical Sciences, School of Rehabilitation Sciences, Iran
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Matarán-Peñarrocha GA, Lara Palomo IC, Antequera Soler E, Gil-Martínez E, Fernández-Sánchez M, Aguilar-Ferrándiz ME, Castro-Sánchez AM. Comparison of efficacy of a supervised versus non-supervised physical therapy exercise program on the pain, functionality and quality of life of patients with non-specific chronic low-back pain: a randomized controlled trial. Clin Rehabil 2020; 34:948-959. [PMID: 32517498 DOI: 10.1177/0269215520927076] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare the effectiveness of supervised physical therapy program versus non-supervised on pain, functionality, fear of movement and quality of life in patients with non-specific chronic low back pain. DESIGN A randomized double-blind clinical trial. SETTING Clinical outpatient unit; home. SUBJECTS A total of 64 participants with non-specific chronic low back pain were randomized into either supervised exercise group (n = 32) or non-supervised home exercise group (n = 32). INTERVENTIONS The supervised group was treated with therapy exercises (strengthen lumbopelvic musculature), while the non-supervised received an informative session of the exercises, which were performed un-supervised at home. Both groups received three weekly sessions for eight weeks. MAIN MEASURES Pain, disability, fear of movement, quality of life, trunk muscle endurance and trunk anteflexion motion were assessed at baseline, two, and six months of follow-up. RESULTS Although analysis of variance (ANOVA) test showed statistically significant differences between groups for pain (P = 0.028; supervised: 2.5 ± 2.1; non-supervised: 3.5 ± 1.5) and disability for Roland-Morris Disability Questionnaire (P = 0.004; supervised: 3.1 ± 2.2; non-supervised: 5.1 ± 3.0) and for Oswestry Disability Index (P = 0.034; supervised: 14.5 ± 7.1; non-supervised: 19.2 ± 10.0) at 8 weeks immediately posttreatment, there were no differences between the groups in patient-rated pain, functionality, fear of movement and quality of life at six months of follow-up. CONCLUSION Patients with chronic low back pain who received supervised exercise showed more improvement in both the short and long term in all patient-rated outcomes over the non-supervised group, but the differences were small and not clinically significant.
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Affiliation(s)
| | | | | | - Esther Gil-Martínez
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Almeria, Spain
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9
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Pourahmadi M, Asadi M, Dommerholt J, Yeganeh A. Changes in the macroscopic morphology of hip muscles in low back pain. J Anat 2019; 236:3-20. [PMID: 31475359 DOI: 10.1111/joa.13086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2019] [Indexed: 01/11/2023] Open
Abstract
Low back pain is a major health issue affecting the lumbopelvic muscles. Morphological changes in hip muscles, such as alterations in the muscle cross-sectional area and muscle volume, may occur in patients with low back pain. This systematic review was conducted to investigate whether patients with low back pain have macroscopic changes in their hip muscle morphology compared with asymptomatic, healthy individuals, based on current evidence. The electronic databases of PubMed/Medline, Ovid, Scopus, Embase® , and Google Scholar were searched from the inception to August 31, 2018. We only included full texts of original studies regarding macroscopic morphological alterations, including atrophy and fat infiltration, in hip muscles of patients with low back pain compared with asymptomatic controls. The quality of the included studies was determined using an assessment tool based on the Newcastle-Ottawa Scale. The scale was modified for the purposes of this study. Sixteen comparative observational studies were found eligible to be included in this review. Eleven were classified as high quality and four as moderate quality. The morphological changes in the psoas major, gluteus maximus, gluteus medius, gluteus minimus, and piriformis muscles were assessed in the primary studies. All selected studies were considered B level of evidence studies. The strength of conclusions for the psoas major, gluteal, and piriformis muscles was moderate. The results revealed that there is substantial controversy about the morphological changes in hip muscles in patients with low back pain; however, the majority of high-quality studies concluded that atrophy of hip muscles is evident in patients with low back pain. The psoas major muscle was the most commonly investigated hip muscle for morphological changes. Major methodological limitations of the included studies were identified and discussed. The present systematic review does not include a formal meta-analysis because of very significant differences in the primary studies in terms of study populations and methodologies. Finally, in clinical practice, it is recommended that physical therapists develop exercise programs to improve hip muscle function in patients with low back pain.
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Affiliation(s)
- Mohammadreza Pourahmadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Asadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Yeganeh
- Trauma and Injury Research Center, Rasoul Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran
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10
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Tsang SM, Lam AH, Ng MH, Ng KW, Tsui CO, Yiu B. Abdominal muscle recruitment and its effect on the activity level of the hip and posterior thigh muscles during therapeutic exercises of the hip joint. J Electromyogr Kinesiol 2018; 42:10-19. [DOI: 10.1016/j.jelekin.2018.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 04/06/2018] [Accepted: 06/11/2018] [Indexed: 12/16/2022] Open
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11
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Reeves NP, Luis A, Chan EC, Sal Y Rosas VG, Tanaka ML. Assessing delay and lag in sagittal trunk control using a tracking task. J Biomech 2018; 73:33-39. [PMID: 29599042 DOI: 10.1016/j.jbiomech.2018.03.029] [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: 08/15/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022]
Abstract
Slower trunk muscle responses are linked to back pain and injury. Unfortunately, clinical assessments of spine function do not objectively evaluate this important attribute, which reflects speed of trunk control. Speed of trunk control can be parsed into two components: (1) delay, the time it takes to initiate a movement, and (2) lag, the time it takes to execute a movement once initiated. The goal of this study is to demonstrate a new approach to assess delay and lag in trunk control using a simple tracking task. Ten healthy subjects performed four blocks of six trials of trunk tracking in the sagittal plane. Delay and lag were estimated by modeling trunk control for predictable and unpredictable (control mode) trunk movements in flexion and extension (control direction) at movement amplitudes of 2°, 4°, and 6° (control amplitude). The main effect of control mode, direction, and amplitude of movement were compared between trial blocks to assess secondary influencers (e.g., fatigue). Only control mode was consistent across trial blocks with predictable movements being faster than unpredictable for both delay and lag. Control direction and amplitude effects on delay and lag were consistent across the first two trial blocks and less consistent in later blocks. Given the heterogeneity in the presentation of back pain, clinical assessment of trunk control should include different control modes, directions, and amplitudes. To reduce testing time and the influence of fatigue, we recommend six trials to assess trunk control.
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Affiliation(s)
| | - Abraham Luis
- Laboratorio de Investigacion en Biomecanica y Robotica Aplicada, Peru; Seccion de Ingenieria Mecanica, Pontificia Universidad Católica del Perú, Peru
| | - Elizabeth C Chan
- Department of Physical Medicine and Rehabilitation, New York University School of Medicine, USA
| | - Victor G Sal Y Rosas
- Sección de Matemáticas, Departamento de Ciencias, Pontificia Universidad Católica del Perú, Peru
| | - Martin L Tanaka
- School of Engineering and Technology, Western Carolina University, USA
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Muscle Atrophy Measurement as Assessment Method for Low Back Pain Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:437-461. [PMID: 30390264 DOI: 10.1007/978-981-13-1435-3_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Low back pain is one of the most common pain disorders defined as pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, sometimes with accompanying leg pain. The meaning of the symptomatic atrophy of paraspinal muscles and some pelvic muscles has been proved. Nowadays, a need for new diagnostic tools for specific examination of low back pain patients is posited, and it has been proposed that magnetic resonance imaging assessment toward muscle atrophy may provide some additional information enabling the subclassification of that group of patients.
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