The effect of actively induced vibration using shoulder joint on pain and dysfunction in patients with low back pain

Amplitude of Electromyographic Activity of Trunk and Lower Extremity Muscles during Oscillatory Forces of Flexi-Bar on Stable and Unstable Surfaces in People with Nonspecific Low Back Pain

BACKGROUND

Recently, the oscillatory bar has been proposed as a new and effective rehabilitation tool in people with nonspecific low back pain (NSLBP), although its effects on muscular control in this population have not been well documented, especially in lower extremity muscles and different support surface conditions.

OBJECTIVE

This study aimed to evaluate and compare the effects of flexi-bar use on stable and unstable surfaces on electromyographic activity of trunk and lower extremity muscles in healthy persons and those with NSLBP.

MATERIAL AND METHODS

18 healthy men and 18 men with NSLBP participated in this cross-sectional study. The root mean square value of electromyographic activity was calculated in the trunk and lower extremity muscles during 4 different task conditions: quiet standing (QS) or flexi-bar use on a rigid or foam support surface. A repeated measures test was used for statistical analysis.

RESULTS

The results showed that the amplitude activity of almost all muscles was significantly greater during flexi-bar use than in the QS condition (P<0.05). The rectus femoris, tibialis anterior, and gastrocnemius demands were significantly greater on the foam than the rigid surface (P<0.05).

CONCLUSION

This study showed that oscillatory forces caused by flexi-bar use can increase muscle activation in multiple segments (hip and ankle in addition to trunk muscles) that are crucial for postural stability. Furthermore, the foam surface appeared to target the rectus femoris in addition to the ankle muscles. Using a flexi-bar may be helpful in NSLBP rehabilitation, and exercising on a foam surface may enhance additive hip muscle activity in people with NSLBP.

Exercise therapy for chronic low back pain

BACKGROUND

Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs.

OBJECTIVES

The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments.

SEARCH METHODS

We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update.

SELECTION CRITERIA

We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration.

DATA COLLECTION AND ANALYSIS

Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo.

MAIN RESULTS

We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias.  Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups.

AUTHORS' CONCLUSIONS

We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.

Effects of flexi-bar training on muscle strength and physical performance in older people with dynapenia: the protocol of a randomised controlled trial

INTRODUCTION

Dynapenia is a new term that is used to describe the age-related loss of muscle strength. Flexi-bar training is a safe and feasible device for older people with dynapenia. This study will investigate the effects of a 12-week flexi-bar training programme on muscle strength and physical function in older people with dynapenia.

METHODS AND ANALYSIS

A total of 114 participants (aged more than 65 years) with age-related muscle loss will participate in a 12-week flexi-bar training programme. The participants will be randomly divided into three groups, namely, flexi-bar, placebo and control, with equal number of participants in each group. The assessments will be conducted at preintervention, postintervention and 12 weeks after training completion. The primary outcome is timed-up-and-go test. The secondary outcomes are five-repetition sit-to-stand test, 10-metre walking test, handgrip strength, as well as the serum albumin and haemoglobin levels.

ETHICS AND DISSEMINATION

The procedures of this study were reviewed and approved by the Human Ethics Review Board of Wuhan Brain Hospital (General Hospital of the Yangtze River Shipping) on 29 September 2020 (#L20200013). The findings of this study will be published in peer-reviewed journals and presented at conferences. The trial was registered on 6 November 2020.

TRIAL REGISTRATION NUMBER

ISRCTN14316668.

Effects of flexi bar training model to health-related physical fitness in overweight adults

[Purpose] The purpose of this study was to assess the effects of flexi bar training model and moderate running exercise on health-related physical fitness in overweight adults. [Participants and Methods] Forty participants were randomly assigned to an experimental (20 participant performing flexi bar training model (FBT)) and control (20 participant performing moderate running exercise (MRE) group. The participant in both groups then underwent program training 50 min/day, 3 times a week, for 12 weeks. The main outcome measures were health related physical fitness (HRPF). [Results] The result showed significant differences between FBT and MRE group. After 12 weeks FBT showed improve HRPF variable. [Conclusion] flexi bar training model can improvement health related physical fitness in overweight adults.

Acute effect of flexible bar exercise on scapulothoracic muscles activation, on isometric shoulder abduction force and proprioception of the shoulder of individuals with and without subacromial pain syndrome

BACKGROUND

There is currently no evidence about the effects of neuromuscular facilitation after the use of a flexible bar on scapulothoracic muscle activity in individuals with subacromial pain syndrome. The study aimed to assess the acute effect of flexible bar exercise and subjective fatigue on scapulothoracic muscle activity, shoulder proprioception, and shoulder abduction force of subjects with and without symptoms of subacromial pain syndrome.

METHOD

Fifty subjects with subacromial pain syndrome and 50 asymptomatic subjects were recruited. A short-term flexible bar exercise was performed to assess the vibratory stimulus effects on scapulothoracic muscle activity, shoulder proprioception, and shoulder abduction force, and the same exercise was performed on a long-term basis to assess the effects of subjective fatigue. The activities of the serratus anterior and three portions of the trapezius muscle were investigated using surface electromyography during arm elevation. The active joint position sense error was assessed to determine shoulder proprioception using a laser pointer. A hand-held dynamometer was used to assess isometric shoulder abduction force.

FINDINGS

No significant intra-group differences were found in scapulothoracic muscle activity, as well as in active joint position sense error and isometric shoulder abduction force in either group (p >0.05).

INTERPRETATION

The acute effects of flexible bar exercise and subjective fatigue were unable to influence scapulothoracic muscle activation, shoulder joint position sense, and isometric shoulder abduction force in subacromial pain syndrome.

Parameters of vibration stimulation for the relief of pain of different origins and locations

The use of vibration stimulation in alleviating pain is an issue appearing more and more often in modern rehabilitation. The aim of the work was to review literature regarding the therapeutic usage of vibrations in analgesic activity. Searches based on the effect of alleviating pain with the help of vibrotherapy in the therapy of diseases of various origins and localizations, as well as with various physical therapy treatments and modalities. The most important parameters were determined, such as: frequency, amplitude, places of application, and exposure time, and were described on the basis of selected tests. Both the Polish and English-language literature has been discussed. Most of the studies were English-language (over 93%). The searches were carried out among the following databases: Medline, Embase, Cochrane, ScienceDirect, PubMed, IEEE Xplore, Wiley Online Library. The key words used were: pain, vibration, WBV, analgesics. The mentioned sources were qualified on the basis of: availability, data verification, selection of research material and regularity of update. While acute pain is, by definition, a short and self-limiting process, chronic pain begins to dominate life and concerns the patient and his/her family. In addition to significant deterioration in quality of life, chronic pain imposes a large financial burden. The use of vibrotherapy can be a solution. Therefore, it is proposed to further analyse the parameters of vibrotherapy in analgesic activity, which may lay the foundation for "personalized pain relief medicine", which will clearly define the standards of vibrational therapy parameters. pain, vibration, WBV, analgesics