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Zheng DKY, Liu JQJ, Chang JR, Ng JCY, Zhou Z, Wu J, Cheung CKC, Huang FF, Pinto SM, Samartzis D, Ferreira ML, Ekanayake K, Lord S, Wang X, Wong AYL. Are changes in pain intensity related to changes in balance control in individuals with chronic non-specific low back pain? A systematic review and meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2024:100989. [PMID: 39293716 DOI: 10.1016/j.jshs.2024.100989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/19/2024] [Accepted: 06/13/2024] [Indexed: 09/20/2024]
Abstract
PURPOSE The aim of this study is to summarize the evidence regarding whether pain reduction in individuals with chronic non-specific low back pain (CNSLBP) following conservative interventions is related to corresponding improvements in balance control. METHODS Randomized controlled trials were identified from 5 databases (MEDLINE, Cochrane Library, Embase, Web of Science, and PsycINFO). Two reviewers independently screened and identified relevant studies that investigated the effects of nonsurgical or nonpharmacological CNSLBP treatments on both pain intensity and balance control. Meta-regression analyses were performed to establish the associations between post-treatment changes in these 2 variables. RESULTS 31 studies involving 1280 participants with CNSLBP were included. Moderate-quality evidence suggested that pain reduction was associated with and explained 34-45 % of decreases in body sway, as measured by center-of-pressure (CoP) area and CoP velocity with eyes open. However, no significant association was observed between pain reduction and CoP area or velocity in anteroposterior/mediolateral directions. Similarly, there was no significant association between pain reduction and CoP distance or radius. Low-quality evidence indicated that pain relief explained a 15 % improvement in one-leg stance with eyes open but not in the eyes-closed condition. Additionally, very low-quality evidence suggested that pain relief explained a 44 % decrease in the static anteroposterior stability index with eyes closed but not in the eyes-open, mediolateral, or overall conditions. Furthermore, low-quality evidence indicated that reduced pain was associated with and accounted for 25-43 % of the improved composite and posteromedial scores of the star-excursion balance test, rather than the anterior and posterolateral scores. CONCLUSION Depending on the type of balance assessment, pain relief following conservative interventions may slightly to moderately enhance balance control in individuals with CNSLBP. Clinicians should pay close attention to the balance control in patients with CNSLBP, particularly among older adults.
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Affiliation(s)
- Daniel K Y Zheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Jae Q J Liu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Jeremy R Chang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Jeffrey C Y Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Zhixing Zhou
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Jinlong Wu
- College of Physical Education, Southwest University, Chongqing 400715, China
| | - Chelsia K C Cheung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Frank F Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Sabina M Pinto
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Manuela L Ferreira
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Kanchana Ekanayake
- University Library, The University of Sydney, Sydney, NSW 2006, Australia
| | - Stephen Lord
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW 2052, Australia
| | - Xueqiang Wang
- Department of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou 325035, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China; Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong 999077, China.
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Mofateh R, Bakhshi Feleh F, Orakifar N, Behdarvandan A. Differences in dynamic balance control based on pain catastrophizing level in individuals with nonspecific chronic low back pain. Physiother Theory Pract 2024; 40:1942-1951. [PMID: 37377096 DOI: 10.1080/09593985.2023.2228896] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Pain catastrophization (PC) is related to motor control changes in individuals with nonspecific chronic low back pain (NSCLBP). However, differences in dynamic balance control based on the level of PC still remain unclear in these individuals. OBJECTIVE The aim of this study was to compare the dynamic balance control between healthy controls and individuals with NSCLBP with high and low PC. METHODS Forty individuals with NSCLBP and 20 healthy participants were enrolled in this cross-sectional study. Individuals with NSCLBP were classified into two groups of high and low PC. Dynamic balance control was assessed using the Modified Star Excursion Balance Test (MSEBT), Five-Time Sit-to-Stand Test (FTSST), and Timed Up and Go Test (TUGT). RESULTS Statistical analyses showed that mean values of reach distances in the anterior, posteromedial, and posterolateral directions of the MSEBT were significantly lower in individuals with NSCLBP with high PC compared to low PC (p = .04, p = .01, and p = .04, respectively) and healthy controls (p < .001, p = .001, and p = .006, respectively). In addition, for both the FTSS and TUG tests, the mean time was significantly greater in individuals with NSCLBP with high PC compared to low PC (p < .001 and p = .004, respectively) and healthy controls (p < .001). CONCLUSIONS Our results showed poor dynamic balance control in individuals with NSCLBP with high PC. This suggests that PC could contribute to the impaired dynamic balance control in individuals with NSCLBP. Combining balance exercises and cognitive-behavioral treatments targeting PC may be useful for the improvement of dynamic balance control in individuals with NSCLBP with high PC.
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Affiliation(s)
- Razieh Mofateh
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Bakhshi Feleh
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Orakifar
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amin Behdarvandan
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Freitas JP, Corrêa LA, Bittencourt JV, Armstrong KM, Meziat-Filho N, Nogueira LAC. One spinal manipulation session reduces local pain sensitivity but does not affect postural stability in individuals with chronic low back pain: a randomised, placebo-controlled trial. Chiropr Man Therap 2024; 32:20. [PMID: 38822395 PMCID: PMC11143588 DOI: 10.1186/s12998-024-00541-4] [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: 10/04/2023] [Accepted: 05/07/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Clinical practice guidelines recommend spinal manipulation for patients with low back pain. However, the effects of spinal manipulation have contradictory findings compared to placebo intervention. Therefore, this study investigated the immediate effects of lumbar spinal manipulation on pressure pain threshold (PPT) and postural stability in people with chronic low back pain (cLBP). Second, we investigated the immediate effect of lumbar spinal manipulation on pain intensity and the interference of the participant beliefs about which treatment was received in the PPT, postural stability, and pain intensity. METHODS A two-arm, randomised, placebo-controlled, double-blind trial was performed. Eighty participants with nonspecific cLPB and a minimum score of 3 on the Numeric Pain Rating Scale received one session of lumbar spinal manipulation (n = 40) or simulated lumbar spinal manipulation (n = 40). Primary outcomes were local and remote PPTs and postural stability. Secondary outcomes were pain intensity and participant's perceived treatment allocation. Between-group mean differences and their 95% confidence intervals (CIs) estimated the treatment effect. One-way analysis of covariance (ANCOVA) was performed to assess whether beliefs about which treatment was received influenced the outcomes. RESULTS Participants had a mean (SD) age of 34.9 (10.5) years, and 50 (62.5%) were women. Right L5 [between-group mean difference = 0.55 (95%CI 0.19 to 0.90)], left L5 [between-group mean difference = 0.45 (95%CI 0.13 to 0.76)], right L1 [between-group mean difference = 0.41 (95%CI 0.05 to 0.78)], left L1 [between-group mean difference = 0.57 (95%CI 0.15 to 0.99)], left DT [between-group mean difference = 0.35 (95%CI 0.04 to 0.65)], and right LE [between-group mean difference = 0.34 (95%CI 0.08 to 0.60)] showed superior treatment effect in the spinal manipulation group than sham. Neither intervention altered postural stability. Self-reported pain intensity showed clinically significant decreases in both groups after the intervention. A higher proportion of participants in the spinal manipulation group achieved more than two points of pain relief (spinal manipulation = 90%; sham = 60%). The participants' perceived treatment allocation did not affect the outcomes. CONCLUSION One spinal manipulation session reduces lumbar pain sensitivity but does not affect postural stability compared to a sham session in individuals with cLPB. Self-reported pain intensity lowered in both groups and a higher proportion of participants in the spinal manipulation group reached clinically significant pain relief. The participant's belief in receiving the manipulation did not appear to have influenced the outcomes since the adjusted model revealed similar findings.
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Affiliation(s)
- João Paulo Freitas
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Avenida Paris, 84, Bonsucesso, Rio de Janeiro, RJ, CEP 21041-020, Brasil
- Physiotherapy Department, Northern Parana State University (UENP), Paraná, Brazil
| | - Leticia Amaral Corrêa
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Avenida Paris, 84, Bonsucesso, Rio de Janeiro, RJ, CEP 21041-020, Brasil
| | - Juliana Valentim Bittencourt
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Avenida Paris, 84, Bonsucesso, Rio de Janeiro, RJ, CEP 21041-020, Brasil
| | | | - Ney Meziat-Filho
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Avenida Paris, 84, Bonsucesso, Rio de Janeiro, RJ, CEP 21041-020, Brasil
| | - Leandro Alberto Calazans Nogueira
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Avenida Paris, 84, Bonsucesso, Rio de Janeiro, RJ, CEP 21041-020, Brasil.
- Physiotherapy Department, Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil.
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Soysal Tomruk M, Tomruk M, Kalemci O. Comparisons of postural control, proprioception, muscle strength, pain and disability between individuals with acute, subacute and chronic low back pain. Somatosens Mot Res 2024; 41:26-33. [PMID: 36634047 DOI: 10.1080/08990220.2023.2165057] [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: 05/24/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE/AIM Postural control, proprioception and lower extremity muscle strength are affected in individuals with low back pain (LBP). However, it is yet unknown whether these variables differentiate between acute, subacute and chronic stages of LBP. The aim was to investigate if there were any differences in postural control, proprioception, lower extremity muscle strength, pain intensity and disability between individuals in the different stages of LBP. MATERIALS AND METHODS In this cross-sectional study, 124 individuals with LBP were grouped as acute LBP (ALBP) (n = 38), subacute LBP (SLBP) (n = 30) and chronic LBP (CLBP) (n = 56) groups. Postural control was assessed via computerised technology. Lumbar proprioception, lower extremity muscle strength, pain intensity and disability were assessed using Joint Repositioning Error Test, hand-held dynamometer, Numeric Rating Scale and Oswestry Disability Index (ODI), respectively. Kruskal-Wallis Tests, ANCOVA and post hoc Mann-Whitney U-Test with Bonferroni correction were performed. RESULTS While there were no significant differences in terms of postural control, proprioception and pain intensity (p > 0.05), significant differences were found in terms of lower extremity muscle strength and ODI scores between groups when adjusted for age (p < 0.05). Individuals with CLBP demonstrated poorer lower extremity muscle strength than those with ALBP and SLBP, and higher disability than those with ALBP (p < 0.017). CONCLUSIONS Although postural control, proprioception and pain intensity were similar between individuals with acute, subacute and chronic LBP, muscle strength and disability seem to worsen stepwise as the pain becomes chronic. Muscle strength and disability should be taken into account while evaluating and/or managing individuals with acute and subacute stages of LBP.
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Affiliation(s)
- Melda Soysal Tomruk
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Murat Tomruk
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Orhan Kalemci
- Faculty of Medicine, Department of Neurosurgery, Dokuz Eylül University, İzmir, Turkey
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Alfaya FF, Reddy RS, Alshahrani MS, Gautam AP, Mukherjee D, Al Salim ZA, Alqhtani RS, Ghulam HSH, Alyami AM, Al Adal S, Jabour AA. Exploring the Interplay of Muscular Endurance, Functional Balance, and Limits of Stability: A Comparative Study in Individuals with Lumbar Spondylosis Using a Computerized Stabilometric Force Platform. Life (Basel) 2023; 13:2104. [PMID: 37895485 PMCID: PMC10608059 DOI: 10.3390/life13102104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023] Open
Abstract
Lumbar spondylosis, characterized by degenerative changes in the lumbar spine, often leads to pain, reduced spinal stability, and musculoskeletal dysfunction. Understanding the impact of lumbar spondylosis on musculoskeletal function, particularly lumbar extensor endurance, functional balance, and limits of stability, is crucial for improving the management and well-being of affected individuals. This study aimed to assess lumbar extensor endurance, functional balance, and limits of stability in individuals with lumbar spondylosis compared to age-matched healthy individuals and explore the correlations among these parameters within the lumbar spondylosis group. The lumbar spondylosis group consisted of 60 individuals initially screened by an orthopedician and referred to physical therapy. Age-matched healthy controls (n = 60) were recruited. Inclusion criteria encompassed adults aged 45-70 years for both groups. Lumbar extensor endurance was assessed using the Sorensen test, functional balance with the Berg Balance Scale, and limits of stability using a computerized stabilometric force platform. Lumbar extensor endurance was significantly lower in individuals with lumbar spondylosis compared to healthy controls (23.06 s vs. 52.45 s, p < 0.001). Functional balance, as assessed by the Berg Balance Scale, demonstrated a significant decrement in the lumbar spondylosis group (48.36 vs. 53.34, p < 0.001). Additionally, limits of stability variables, under both eyes-open and eyes-closed conditions, exhibited marked impairments in the lumbar spondylosis group (p < 0.001 for all variables). Within the lumbar spondylosis group, lumbar extensor endurance exhibited significant positive correlations with functional balance (0.46, p < 0.001) and negative correlations with limits of stability variables (r ranging from -0.38 to -0.49, p < 0.01 for all variables). This study underscores the significance of addressing lumbar extensor endurance, functional balance, and stability impairments in the comprehensive management of lumbar spondylosis.
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Affiliation(s)
- Fareed F. Alfaya
- Department of Orthopedic Surgery, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia; (M.S.A.); (A.P.G.); (D.M.)
| | - Mastour Saeed Alshahrani
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia; (M.S.A.); (A.P.G.); (D.M.)
| | - Ajay Prashad Gautam
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia; (M.S.A.); (A.P.G.); (D.M.)
| | - Debjani Mukherjee
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia; (M.S.A.); (A.P.G.); (D.M.)
| | - Zuhair A. Al Salim
- Department of Sport Science and Physical Activity, College of Science, University of Hafr Al Batin, Hafr Al Batin 39524, Saudi Arabia;
| | - Raee S. Alqhtani
- Physical Therapy Department, Medical Applied Sciences College, Najran University, Najran 66462, Saudi Arabia; (R.S.A.); (H.S.H.G.); (A.M.A.); (S.A.A.)
| | - Hussain Saleh H. Ghulam
- Physical Therapy Department, Medical Applied Sciences College, Najran University, Najran 66462, Saudi Arabia; (R.S.A.); (H.S.H.G.); (A.M.A.); (S.A.A.)
| | - Abdullah Mohammed Alyami
- Physical Therapy Department, Medical Applied Sciences College, Najran University, Najran 66462, Saudi Arabia; (R.S.A.); (H.S.H.G.); (A.M.A.); (S.A.A.)
| | - Saeed Al Adal
- Physical Therapy Department, Medical Applied Sciences College, Najran University, Najran 66462, Saudi Arabia; (R.S.A.); (H.S.H.G.); (A.M.A.); (S.A.A.)
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Wagner S, Bring A, Åsenlöf P. Construct validity of the Mini-BESTest in individuals with chronic pain in specialized pain care. BMC Musculoskelet Disord 2023; 24:391. [PMID: 37198616 DOI: 10.1186/s12891-023-06504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Balance assessment scales are important clinical tests to identify balance impairments. Chronic pain (> 3 months) is associated with impaired dynamic balance; however, very few balance assessment scales are psychometrically evaluated for the population. The purpose of this study was to evaluate the construct validity and internal consistency of the Mini-BESTest for individuals with chronic pain in specialized pain care. METHODS In this cross-sectional study, 180 individuals with chronic pain (> 3 months) were assessed with the Mini-BESTest and included in the analyses. For construct validity, five alternative factor structures were evaluated using a confirmatory factor analysis. In addition, we tested the a priori hypotheses about convergent validity with the 10-meter walk test, and divergent validity with the Brief Pain Inventory (BPI): pain intensity, the Tampa Scale of Kinesiophobia-11 (TSK-11), and the Pain Catastrophizing Scale (PCS-SW). Internal consistency was evaluated for the model with the best fit. RESULTS A one-factor model with added covariance via the modification indices showed adequate fit indices. In line with our hypotheses, Mini-BESTest showed convergent validity (rs = > 0.70) with the 10-meter walk test, and divergent validity (rs = < 0.50) with BPI pain intensity, TSK-11, and PCS-SW. Internal consistency for the one-factor model was good (α = 0.92). CONCLUSIONS Our study supported the construct validity and internal consistency of the Mini-BESTest for measuring balance in individuals with chronic pain, who were referred to specialized pain care. The one-factor model showed an adequate fit. In comparison, models with subscales did not reach convergence, or showed high correlations between subscales, implying that Mini-BESTest is measuring one construct in this sample. We, therefore, propose using the total score, instead of subscale scores, for individuals with chronic pain. However, further studies are necessary to establish the reliability of the Mini-BESTest in the population.
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Affiliation(s)
- Sofia Wagner
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Annika Bring
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Pernilla Åsenlöf
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Yan ZW, Yang Z, Yang J, Chen YF, Zhang XB, Song CL. Tai Chi for spatiotemporal gait features and dynamic balancing capacity in elderly female patients with non-specific low back pain: A six-week randomized controlled trial. J Back Musculoskelet Rehabil 2022; 35:1311-1319. [PMID: 35599469 DOI: 10.3233/bmr-210247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Non-specific low back pain (NS-LBP) is a serious public health problem. Tai Chi is promising in reducing the risk of falls and alleviating symptoms in this population. OBJECTIVE To investigate the effect of Tai Chi on gait and dynamic balance in elderly women with NS-LBP. METHODS 20 women (age > 65 yr.) with NS-LBP were randomly assigned to a Tai Chi group (n= 10) or a control group (n= 10). The Tai Chi group practiced Tai Chi exercise 3 times a week for 6 weeks. Each session lasted 60 minutes. Pain, spatiotemporal gait features and dynamic balancing capacity were assessed at 0 and 6 weeks. RESULTS Compared to the control group at 6 weeks, the Tai Chi group had a significant decrease in VAS (p= 0.027) and stride width (p= 0.019), significant improvement in gait velocity, stride length (p< 0.001). Regarding dynamic balance capacity, the Tai Chi group had significant improvements in anterior (Left: p= 0.001; Right: p= 0.038), postero-lateral (Left: p< 0.001; Right: p= 0.038), and postero-medial (Left: p= 0.015; Right: p= 0.018). CONCLUSION 6-week Tai Chi can relieve pain and improve gait and dynamic balance in elderly women with NS-LBP, which suggests Tai Chi could be a promising rehabilitation intervention to reduce the risk of falls in this population.
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Affiliation(s)
- Zhi-Wei Yan
- Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Liaoning, China
| | - Zhen Yang
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Jinghui Yang
- Department of Physical Therapy, New York University, New York, NY, USA
| | - Ya-Feng Chen
- Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, China
| | - Xue-Bin Zhang
- Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Liaoning, China
| | - Cheng-Lin Song
- Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Liaoning, China
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Freitas JP, Corrêa LA, Bittencourt JV, Armstrong KM, Nogueira LAC. Immediate effects of spinal manipulation on painful sensitivity and postural stability in patients with chronic nonspecific low back pain: study protocol for a controlled randomised clinical trial. Trials 2022; 23:188. [PMID: 35241124 PMCID: PMC8895827 DOI: 10.1186/s13063-022-06111-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain is one of the main public health concerns. Chronic low back pain (cLBP) reduces functional capacity and affects postural stability. Although health professionals widely use spinal manipulation, its immediate effect on painful sensitivity and postural stability is lacking. This study aims to verify the immediate effects of lumbar spinal manipulation on the pressure pain threshold and postural stability in individuals with cLBP. METHODS A two-arm, placebo-controlled clinical trial with parallel groups and examiner-blinded will be conducted with 80 participants with cLBP from an outpatient physical therapy department, randomly allocated at a 1:1 distribution. The experimental group will receive a lumbar spinal manipulation technique, and the placebo group will receive a simulated lumbar spinal manipulation. Both groups will receive one session of treatment and will be evaluated before and immediately after the intervention. The primary outcomes will be the pressure pain threshold and postural stability. Pain intensity and patient's expectation will be assessed as a secondary outcome. The pressure pain threshold will be assessed using a pressure algometer in 6 different anatomical regions. The evaluation of postural stability will be performed in a baropodometry exam by displacing the centre of pressure. The pain intensity will be measured using the Numeric Pain Rating Scale. A Likert scale will be used for the patient's expectation about the treatment. A two-way analysis of variance will compare the effect of the interventions between groups. DISCUSSION This study will provide insights regarding the immediate effects of spinal manipulation in patients with cLBP against a simulated spinal manipulation using objective outcomes and considering patients' expectations regarding the treatment. TRIAL REGISTRATION Brazilian Registry of Clinical Trials RBR-3ksq2c . Registered on 13 July 2020.
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Affiliation(s)
- João Paulo Freitas
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
- Physiotherapy Department, Midwestern Parana State University (UNICENTRO), Paraná, Brazil
- Physiotherapy Department, Guairacá University Centre (UNIGUAIRACA), Paraná, Brazil
| | - Leticia Amaral Corrêa
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Juliana Valentim Bittencourt
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | | | - Leandro Alberto Calazans Nogueira
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
- Physiotherapy Department, Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
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Effect of Combined Manual Therapy and Therapeutic Exercise Protocols on the Postural Stability of Patients with Non-Specific Chronic Neck Pain. A Secondary Analysis of Randomized Controlled Trial. J Clin Med 2021; 11:jcm11010084. [PMID: 35011823 PMCID: PMC8745098 DOI: 10.3390/jcm11010084] [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] [Received: 12/08/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022] Open
Abstract
Postural stability is a little-studied factor in non-specific chronic neck pain; the causes that can alter it are unknown. The relationship with chronic pain could be a determining factor for its deficit. The aim of this study was to investigate the relationship between sustained pain and a postural stability deficit. A randomized and blinded clinical trial (double-blind; placebo control; 12 weeks follow-up) was conducted with a total of 69 subjects divided into three groups, two experimental (manual therapy and specific exercise) and a control treatment, and carried out over a treatment period of three weeks with a follow-up after 12 weeks. Their postural stability was assessed through the overall balance index (OBI). The postural stability of subjects with non-specific chronic neck pain improved in the experimental treatments. There were no statistically significant differences between the experimental groups. This trial found that manual therapy and therapeutic exercise significantly improved OBI compared to the control group. Trial registration: Brazilian Clinical Trial Registry, RBR-2vj7sw.
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Jardak M, Chaari F, Bouchaala F, Fendri T, Harrabi MA, Rebai H, Sahli S. Does piriformis muscle syndrome impair postural balance? A case control study. Somatosens Mot Res 2021; 38:315-321. [PMID: 34519264 DOI: 10.1080/08990220.2021.1973404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE While patients with musculoskeletal disorders reported postural balance impairments, it is unknown whether patients with piriformis muscle syndrome (PMS) may exhibit postural balance disorders compared to controls. The aim was to compare postural balance in patients with PMS to controls in static and dynamic conditions. MATERIAL AND METHODS Twelve patients with PMS and twelve controls were enrolled. Static postural balance was assessed by calculating the symmetry index (SI) in the unipedal posture. To measure vision contribution, the Romberg index (RI) was computed. Dynamic postural balance was evaluated with the Timed up and go test (TUGT). Besides, inter-limb strength asymmetry (SA), pain and the short form-36 (SF-36) were assessed. RESULTS The PMS group (PMSG) exhibited significant (p < 0.001) higher SI in eyes opened (EO) and eyes closed (EC) conditions compared to the control group (CG). Besides, PMSG had significant higher RI (p < 0.05), TUGT scores (p < 0.001), SA values (p < 0.05), pain intensity (p < 0.001), and worse SF-36 scores on all physical health (p < 0.05) and psychological health (only in vitality and mental health [p < 0.05]), compared to CG. CONCLUSION Our data revealed impaired static and dynamic postural balance, and reduced quality of life in PMSG compared to CG. Postural balance impairments could explain the poor quality of life, which are likely due to the higher SA and higher pain intensity. Clinicians and physiotherapists should consider postural balance disorders while designing rehabilitation programs in these patients.
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Affiliation(s)
- Mariem Jardak
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Fatma Chaari
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Fatma Bouchaala
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Thouraya Fendri
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Mohammed Achraf Harrabi
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Haithem Rebai
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Sonia Sahli
- Research Laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
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Abstract
BACKGROUND Restoration of functionality in patients with low back pain is one of the most important rehabilitation and societal problems. The aim of this study was to verify the results of the DBC (Documentation Based Care) method used in elderly men. METHOD This study evaluated the efficiency of DBC treatment on the basis of spinal mobility in sagittal, frontal and transverse planes and a subjective assessment of pain. There were two research groups: one with 187 men over the age of 65, and the other with 187 men under the age of 65. The patients in the study were carefully selected. All subjects suffered from chronic, non-specific low back pain lasting for a period of at least three months. CONCLUSION The conducted analyses confirmed that a functional restoration process improved spinal mobility in all planes of movement, decreased pain and functional limitations, and reduced the level of depression.
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Affiliation(s)
- Tomasz Kabała
- Prophylaxis and Rehabilitation Centre "Creator", Wrocław, Poland
| | - Czesław Giemza
- Faculty of Physiotherapy, University School of Physical Education in Wrocław, Wrocław, Poland
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Konrad KL, Baeyens JP, Birkenmaier C, Ranker AH, Widmann J, Leukert J, Wenisch L, Kraft E, Jansson V, Wegener B. The effects of whole-body electromyostimulation (WB-EMS) in comparison to a multimodal treatment concept in patients with non-specific chronic back pain-A prospective clinical intervention study. PLoS One 2020; 15:e0236780. [PMID: 32822361 PMCID: PMC7446884 DOI: 10.1371/journal.pone.0236780] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 07/12/2020] [Indexed: 11/26/2022] Open
Abstract
Background According to present guidelines, active exercise is one key component in the comprehensive treatment of nonspecific chronic back pain (NSCBP). Whole body electromyostimulation (WB-EMS) is a safe, and time-effective training method, that may be effective in NSCBP-patients. Methods In this prospective and controlled nonrandomized clinical study, two therapeutic approaches were compared. One group received 20 minutes WB-EMS per week. An active control group (ACG) received a multimodal therapy program. A third group included subjects without back pain. To all groups, the following measurement instruments were applied: Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), North American Spine Society Instrument (NASS); SF 36 survey and measurements for muscular function and postural stability. In the EMS-group: T0: baseline; T1: at 6 weeks; T2: at 12 weeks and T3: at 24 weeks. In the ACG: T0 baseline and T1 after 4 weeks. Results In the intervention group, 128 patients with low back pain were enrolled, 85 in the WB-EMS group and 43 in the ACG. 34 subjects were allocated to the passive control group. The average age was 58.6 years (18–86 years). In the EMS group, the NRS (1–10) improved statistically and clinically significantly by 2 points. The ODI was reduced by 19.7 points. The NASS and most of the SF 36 items improved significantly. In the multimodal treatment group, only the muscular function improved slightly. Conclusion Our data support the hypothesis that WB-EMS is at least as effective as a multimodal treatment, which is often referred to as being the golden standard. Therefore WB-EMS may be an effective and, with 20 min./week training time, very time-efficient alternative to established multimodal treatment models.
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Affiliation(s)
- Karl Lorenz Konrad
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Jean-Pierre Baeyens
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Christof Birkenmaier
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
| | - Anna Helena Ranker
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
| | - Jonas Widmann
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
| | - Johannes Leukert
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
| | - Lisa Wenisch
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
| | - Eduard Kraft
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
| | - Bernd Wegener
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians- University Munich (LMU), Munich, Germany
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel (VUB), Brussel, Belgium
- * E-mail:
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