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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.
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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
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Pizol GZ, Miyamoto GC, Cabral CMN. Hip biomechanics in patients with low back pain, what do we know? A systematic review. BMC Musculoskelet Disord 2024; 25:415. [PMID: 38807086 PMCID: PMC11131240 DOI: 10.1186/s12891-024-07463-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/19/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Biomechanical alterations in patients with low back pain (LBP), as reduced range of motion or strength, do not appear to be exclusively related to the trunk. Thus, studies have investigated biomechanical changes in the hip, due to the proximity of this joint to the low back region. However, the relationship between hip biomechanical changes in patients with LBP is still controversial and needs to be summarized. Therefore, the aim of this study was to systematically review observational studies that used biomechanical assessments in patients with non-specific LBP. METHODS The search for observational studies that evaluated hip biomechanical variables (i.e., range of motion, kinematic, strength, and electromyography) in adults with non-specific acute, subacute, and chronic LBP was performed in the PubMed, Embase, Cinahl and Sportdiscus databases on February 22nd, 2024. Four blocks of descriptors were used: 1) type of study, 2) LBP, 3) hip and 4) biomechanical assessment. Two independent assessors selected eligible studies and extracted the following data: author, year of publication, country, study objective, participant characteristics, outcomes, and results. The methodological quality of the studies was assessed using the Epidemiological Appraisal Instrument and classified as low, moderate, and high. Due to the heterogeneity of the biomechanical assessment and, consequently, of the results among eligible studies, a descriptive analysis was performed. RESULTS The search strategy returned 338 articles of which 54 were included: nine articles evaluating range of motion, 16 evaluating kinematic, four strength, seven electromyography and 18 evaluating more than one outcome. The studies presented moderate and high methodological quality. Patients with LBP, regardless of symptoms, showed a significant reduction in hip range of motion, especially hip internal rotation, reduction in the time to perform functional activities such as sit-to-stance-to-sit, sit-to-stand or walking, greater activation of the hamstrings and gluteus maximus muscles and weakness of the hip abductor and extensor muscles during specific tests and functional activities compared to healthy individuals. CONCLUSION Patients with LBP present changes in range of motion, task execution, activation, and hip muscle strength when compared to healthy individuals. Therefore, clinicians must pay greater attention to the assessment and management of the hip during the treatment of these patients. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020213599).
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Affiliation(s)
- Gustavo Zanotti Pizol
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno 475, Tatuapé, Sao Paulo, SP, CEP: 03071-000, Brazil.
| | - Gisela Cristiane Miyamoto
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno 475, Tatuapé, Sao Paulo, SP, CEP: 03071-000, Brazil
| | - Cristina Maria Nunes Cabral
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno 475, Tatuapé, Sao Paulo, SP, CEP: 03071-000, Brazil
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Ito T, Sugiura H, Ito Y, Narahara S, Natsume K, Takahashi D, Noritake K, Yamazaki K, Sakai Y, Ochi N. Relationship between low-back pain and flexibility in children: A cross-sectional study. PLoS One 2023; 18:e0293408. [PMID: 37948451 PMCID: PMC10637693 DOI: 10.1371/journal.pone.0293408] [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: 07/04/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023] Open
Abstract
Low-back pain is common among school-aged children. Decreased trunk flexibility in childhood influences low-back pain in adulthood. Previous studies examining the association between low-back pain and trunk flexibility in children are insufficient. Examining this association among elementary school children may help to better understand trunk flexibility in children with low-back pain and to modify the management of inflexibility. Therefore, this study aimed to identify the prevalence of low-back pain and its relationship with physical function among elementary school students. School-aged children aged 6-12 years were recruited in Japan between May 2018 and March 2023. Fingertip-to-floor distance, back muscle strength, pelvic tilt angle during gait, and the visual analog scale for low-back pain were measured. In addition, factors independently related to low-back pain were determined through logistic regression analysis. Low-back pain was reported in 9.6% of the 394 participants (boys, 191; girls, 203). All children with low-back pain presented with back pain when they moved; however, the pain was non-specific. Logistic regression analysis showed that the fingertip-to-floor distance was an independent risk factor for low-back pain (odds ratio, 0.921; p = 0.007). The odds ratios calculated in the logistic regression analysis confirmed that low-back pain frequency increased as the fingertip-to-floor distance decreased. The risk of low-back pain was associated with inflexibility, regardless of sex and muscle strength. These findings suggest that children with low-back pain must increase their trunk and lower extremity flexibility.
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Affiliation(s)
- Tadashi Ito
- Three-Dimensional Motion Analysis Laboratory, Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hideshi Sugiura
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yuji Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Pediatrics, Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan
| | - Sho Narahara
- Department of Pediatrics, Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan
| | - Kentaro Natsume
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Daiki Takahashi
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Koji Noritake
- Department of Orthopedic Surgery, Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan
| | | | - Yoshihito Sakai
- Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Nobuhiko Ochi
- Department of Pediatrics, Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan
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Walsh JB, McGlynn AF, Hardy CL, Armas GC, Sulpizio HM, Wright MR. Stretching and Self-Myofascial Release in Helicopter Aircrew to Reduce Neck and Back Pain (Phase 1). Mil Med 2023; 188:e2109-e2117. [PMID: 36734163 DOI: 10.1093/milmed/usad015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/25/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION This prospective intervention study was designed to determine the efficacy of a standardized Preflight/Postflight Stretches (PPS) protocol to reduce subjective neck and back pain scores in helicopter aircrew. Aircrew transient back and neck pain is well documented, and there is currently no standardized preflight and postflight stretching protocol for Naval Aviation. METHODS Subjects were recruited from two carrier air wing MH-60R squadrons at Naval Air Station Jacksonville. These carrier air wing squadrons were selected to control for size (number of aircrew), age, and operational tempo (number of flight hours). Subjects consisted of both pilots and enlisted aircrew. One squadron was designated as the control group, although the second squadron served as the intervention group. Subjects from both groups filled out the questionnaire. Only the intervention group completed the PPS protocol immediately after completing the questionnaire and before departing the squadron spaces for the aircraft outside. Upon landing, the aircrew completed a postflight debrief. Only the intervention group completed the PPS protocol after debrief. Both the intervention and control groups once again completed the questionnaire. Questionnaires were matched by using a generated anonymous subject ID. The amounts of change and pain levels were then compared using the Mann-Whitney test and the Fisher's exact test, respectively. RESULTS The Kolmogorov-Smirnov test found the data to be nonparametric. The preflight and postflight overall (P ≤ .001), cervical (P ≤ .001), thoracic (P = .006), and lumbar (P = .004) differences between the control and intervention groups were found to be statistically significant when using the Mann-Whitney test. Preflight and postflight pain differences in the sacral region and "other" section were not found to be statistically significant (sacral, P = .618; others, P = .182). When evaluating the worsening of the pain level, 50 (92%) of the control flights in which PPS was not performed reported worse pain, compared to 21 (61.8%) in the intervention group where PPS was performed. The Fisher's exact test found the association between performing PPS and the worsening in pain to be statistically significant (P = .001) in the overall, cervical, thoracic, and lumbar regions. Therefore, the hypothesis was accepted in regard to overall pain, as well as in the cervical, thoracic, and lumbar regions. CONCLUSION Aircrew back and neck pain because of flying is well documented. However, there is no standardized stretching protocol for aircrew to perform immediately preflight or postflight in U.S. Naval Aviation. This study demonstrated that PPS, a simple 5- to 7-min stretching routine, gives aircrew structure and can reduce postflight cervical, thoracic, lumbar, and overall pain. This phase proved to be safe as no adverse events were reported. The prehabilitation aspect could reduce conventional medical intervention, costly pharmacological management of neck and back pain, and be applied to other aviation populations in military and civilian communities.
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Affiliation(s)
- James B Walsh
- Navy Medicine Readiness and Training Command Sigonella, Sigonella, AE 09636, Italy
| | - Andrea F McGlynn
- Naval Medical Center Portsmouth Clinical Investigation Department, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
| | - Curtis L Hardy
- Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - George C Armas
- Marine Aviation Weapons and Tactics Squadron One, Yuma, AZ 85369, USA
| | | | - Martin R Wright
- United States Naval Academy Human Performance Lab, Annapolis, MD 21402, USA
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Carroll M, Ellis R, Kohut S, Garrett N, Fernández-de-Las-Peñas C. Associations Between Gluteus Medius Trigger Points With Hip Passive Range of Movement and Muscle Strength in Adults With Chronic Nonspecific Low Back Pain: A Cross-Sectional Study. J Manipulative Physiol Ther 2022; 45:641-651. [PMID: 37318387 DOI: 10.1016/j.jmpt.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate whether there is a relationship between gluteus medius trigger points with hip passive range of motion and hip muscle strength in people with chronic nonspecific low back pain (LBP). METHODS This was a cross-sectional, blinded study that took place in 2 rural communities in New Zealand. Assessments were carried out in physiotherapy clinics in these towns. A total of 42 participants over 18 years old experiencing chronic nonspecific LBP were recruited. After meeting inclusion criteria, participants completed the following 3 questionnaires: Numerical Pain Rating Scale, Oswestry Disability Index, and Tampa Scale of Kinesiophobia. The primary researcher (a physiotherapist) assessed each participant's bilateral hip passive range of movement (using an inclinometer) and muscle strength (using a dynamometer). Following this, a blinded trigger point assessor examined the gluteus medius muscles for the presence of active and latent trigger points. RESULTS General linear modeling using univariate analysis revealed that there was a positive association between hip strength and trigger point status (P =.03 left internal rotation, P =.04 right internal rotation, and P =.02 right abduction). Participants with no trigger points showed higher strength values (eg, right internal rotation standard error: 0.64), and those with trigger points showed lower strength. Overall, muscles exhibiting latent trigger points were the weakest (eg, right internal rotation standard error: 0.67). CONCLUSION The presence of active or latent gluteus medius trigger points was associated with hip weakness in adults with chronic nonspecific LBP. There was no association between gluteus medius trigger points and hip passive range of movement.
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Affiliation(s)
- Marianne Carroll
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Richard Ellis
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand; Active Living and Rehabilitation, Health and Rehabilitation Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Susan Kohut
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand; Active Living and Rehabilitation, Health and Rehabilitation Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nick Garrett
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid, Spain
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Takei S, Torii S, Taketomi S, Iwanuma S, Tojima M, Otomo M, Iizuka S, Tanaka S. Is Increased Kicking Leg Iliopsoas Muscle Tightness a Predictive Factor for Developing Spondylolysis in Adolescent Male Soccer Players? Clin J Sport Med 2022; 32:e165-e171. [PMID: 33844489 DOI: 10.1097/jsm.0000000000000920] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 01/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify predictive risk factors of lumbar stress (LS) fracture developing from an asymptomatic stress reaction of the pedicle among adolescent male soccer players. DESIGN Prospective cohort study. SETTING Amateur Japanese adolescent male soccer team. PARTICIPANTS Japanese adolescent male soccer players (n = 195) aged 12 to 13 years. ASSESSMENT OF RISK FACTORS INDEPENDENT VARIABLES Height, body weight, body mass index, muscle tightness of both lower extremities (iliopsoas, hamstrings, and quadriceps), lumbar bone mineral content, developmental age, and lumbar lordosis angle were measured as baseline measurements. MAIN OUTCOME MEASURES DEPENDENT VARIABLE Players who were diagnosed with an asymptomatic stress reaction of the lumbar spine pedicle at baseline were followed; extension-based lumbar pain was defined 1 year after the baseline. The players were assigned to the LS fracture or control (CON) group at follow-up. RESULTS At baseline, 40 boys were diagnosed with an asymptomatic stress reaction of the lumbar spine pedicle. The difference in muscle tightness between the kicking leg and supporting leg was significantly different (P = 0.012) between the LS (n = 16) and CON (n = 22) groups. Increase in iliopsoas muscle tightness in the kicking leg was a predictive risk factor of developing extension-based lumbar pain after adjusting for developmental age and body mass index (odds ratio, 1.54; 95% confidence interval, 1.05-2.27). CONCLUSIONS Development of extension-based lumbar pain from an asymptomatic stress reaction of the pedicle among adolescent male soccer players was associated with increased iliopsoas muscle tightness of the kicking leg relative to that of the supporting leg.
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Affiliation(s)
- Seira Takei
- Orthopaedic Surgery, Sensory and Motor System Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Suguru Torii
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Shuji Taketomi
- Orthopaedic Surgery, Sensory and Motor System Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Soichiro Iwanuma
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
- Faculty of Education and Human Sciences, Department of School Education, Teikyo University of Science, Tokyo, Japan
| | - Michio Tojima
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
- School of Human and Social Sciences, Tokyo International University, Saitama, Japan ; and
| | - Mana Otomo
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
- Japan Institute of Sport Sciences, Tokyo, Japan
| | - Satoshi Iizuka
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
- Japan Institute of Sport Sciences, Tokyo, Japan
| | - Sakae Tanaka
- Orthopaedic Surgery, Sensory and Motor System Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Vanhauter N, Van Erck A, Anciaux M, Pollefliet A, Joos E. Isometric and isokinetic muscle strength measurements of the lumbar flexors and extensors with BioniX Sim3 Pro in patients with chronic low back pain: A pilot study. J Back Musculoskelet Rehabil 2021; 34:381-388. [PMID: 33492281 DOI: 10.3233/bmr-200225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The World Health Organization states that low back pain is the leading cause for disability worldwide. Patients with chronic low back pain (CLBP) show important decreases in lumbar strength and can now be assessed by using the new isokinetic dynamometer BioniX Sim3 Pro which offers very detailed measurements. OBJECTIVE To compare lumbar flexion and extension strength values, as well as extension-flexion ratio (EFR) based on isokinetic velocity and gender, for patients with CLBP on the BioniX Sim3 Pro. METHODS A retrospective analysis was performed on data from 20 men and 22 women with CLBP. Maximum torque in flexion and extension was measured isometrically and isokinetically. Statistical analysis was performed on these parameters. RESULTS EFR shows a downward trend with increasing speed of measurement (isometric to isokinetic 30∘/s and isokinetic 30∘/s to isokinetic 90∘/s, respectively): in men from 1.21 to 1.04 (p< 0.001) and from 1.04 to 0.93 (p= 0.207). In women, EFR decreased from 1.41 to 1.13 (p< 0.001) and from 1.13 to 1.00 (p= 0.144). CONCLUSIONS Patients with CLBP have a decreased strength in lumbar extension and flexion compared to the age-corrected normal values of Bionix Sim3 Pro. With increasing speed of testing protocol, a decrease in EFR is observed in this population.
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Affiliation(s)
- N Vanhauter
- Physical Medicine and Rehabilitation, UZ Brussel, Brussels, Belgium
| | - A Van Erck
- Physical Medicine and Rehabilitation, AZ Jan Palfijn, Ghent, Belgium
| | - M Anciaux
- Physical Medicine and Rehabilitation, AZ Jan Palfijn, Ghent, Belgium
| | - A Pollefliet
- Physical Medicine and Rehabilitation, AZ Jan Palfijn, Ghent, Belgium
| | - E Joos
- Physical Medicine and Rehabilitation, UZ Brussel, Brussels, Belgium
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Gomes SRA, Mendes PRF, Costa LDO, Bulhões LCC, Borges DT, Macedo LB, Brasileiro J. Factors associated with low back pain in air force fighter pilots: a cross-sectional study. BMJ Mil Health 2021; 168:299-302. [PMID: 34266971 DOI: 10.1136/bmjmilitary-2021-001851] [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: 03/30/2021] [Accepted: 06/23/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Low back pain in military pilots is a frequent condition which constantly leads to absences from work, decreased concentration and performance during flight, as well as changes in work functions. METHODS This is a cross-sectional analytical study including 28 fighter pilots who underwent an evaluation comprising muscle strength and fatigue resistance, trunk mobility and application of questionnaires to identify associated clinical factors. RESULTS It was observed that 68% of the pilots reported low back pain with an average pain intensity of 3.7 at numerical pain scale in the last week. No significant differences were observed regarding the range of motion and trunk muscle strength when pilots with low back pain were compared with asymptomatic pilots. However, lateral right trunk muscle (mean difference=16, 95% CI 0.6 to 33.0]) and lateral left trunk muscle (mean difference=22, 95% CI 1 to 44) fatigue sooner in pilots with low back pain when the two groups were compared (p=0.04 for both). CONCLUSION There was a high rate of low back pain complaints among fighter pilots. There was also a significant reduction in fatigue resistance of the lateral trunk muscles in symptomatic pilots when compared with asymptomatic pilots. These factors must be considered in the physical training of this population.
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Affiliation(s)
| | - P R F Mendes
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - L D O Costa
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - L C C Bulhões
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - D T Borges
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ld B Macedo
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - J Brasileiro
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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Šarabon N, Vreček N, Hofer C, Löfler S, Kozinc Ž, Kern H. Physical Abilities in Low Back Pain Patients: A Cross-Sectional Study with Exploratory Comparison of Patient Subgroups. Life (Basel) 2021; 11:life11030226. [PMID: 33802214 PMCID: PMC8000067 DOI: 10.3390/life11030226] [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] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 11/29/2022] Open
Abstract
An abundance of literature has investigated the association between low back pain (LBP) and physical ability or function. It has been shown that LBP patients display reduced range of motion, decreased balance ability, impaired proprioception, and lower strength compared to asymptomatic persons. The aim of this study was to investigate the differences between LBP patients and healthy controls in terms of several physical abilities. Based on the premised that different biomechanical and physiological causes and consequences could be related to different types of LBP, a secondary exploratory attempt of the study was to examine the differences between LBP subgroups based on the pain location (local or referred) or type of pathology (discogenic or degenerative) on the level of impairment of function and ability. Participants performed range of motion tests, trunk maximal voluntary contraction force tests, a sitting balance assessment, the timed up-and-go test, the chair rise test, and the trunk reposition error test. Compared to the control group, symptomatic patients on average showed 45.7% lower trunk extension (p < 0.001, η2 = 0.33) and 27.7 % lower trunk flexion force (p < 0.001, η2 = 0.37) during maximal voluntary contraction. LBP patients exhibited decreased sitting balance ability and lower scores in mobility tests (all p < 0.001). There were no differences between groups in Schober’s test and trunk repositioning error (p > 0.05). No differences were observed among the LBP subgroups. The exploratory analyses are limited by the sample size and uncertain validity of the diagnostic procedures within this study. Further studies with appropriate diagnostic procedures and perhaps a different subgrouping of the LBP patients are needed to elucidate if different types of LBP are related to altered biomechanics, physiology, and function.
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Affiliation(s)
- Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia; (N.V.); (Ž.K.)
- Laboratory for Motor Control and Motor Behaviour, S2P, Science to Practice Ltd., 1000 Ljubljana, Slovenia
- Human Health Department, InnoRenew CoE, 6310 Izola, Slovenia
- Correspondence:
| | - Nace Vreček
- Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia; (N.V.); (Ž.K.)
| | - Christian Hofer
- Ludwig Boltzmann Institute for Rehabilitation Research, 3100 St. Pölten, Austria; (C.H.); (S.L.)
| | - Stefan Löfler
- Ludwig Boltzmann Institute for Rehabilitation Research, 3100 St. Pölten, Austria; (C.H.); (S.L.)
- Institute for Physical Medicine, Physiko und Rheumatherapie, 3100 St. Pölten, Austria;
| | - Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia; (N.V.); (Ž.K.)
- Andrej Marušič Institute, University of Primorska, 6000 Koper, Slovenia
| | - Helmut Kern
- Institute for Physical Medicine, Physiko und Rheumatherapie, 3100 St. Pölten, Austria;
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Kim WD, Shin D. Correlations Between Hip Extension Range of Motion, Hip Extension Asymmetry, and Compensatory Lumbar Movement in Patients with Nonspecific Chronic Low Back Pain. Med Sci Monit 2020; 26:e925080. [PMID: 32968039 PMCID: PMC7523415 DOI: 10.12659/msm.925080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aimed to confirm the correlations among hip extension range of motion, hip extension asymmetry, pain intensity, disability index, and compensatory lumbar movement in patients with nonspecific chronic low back pain. MATERIAL AND METHODS Of 66 patients with nonspecific chronic low back pain and limited hip extension, 59 met the inclusion criteria and were enrolled in the study. Pain intensity, Oswestry Disability Index (ODI), hip range of motion, compensatory lumbar extension, and compensatory lumbar rotation of the subjects were assessed. Pain was measured using a numeric pain rating scale (NPRS), and hip extension range of motion and compensatory lumbar movement were evaluated using a digital dual inclinometer (Dualar IQ, JTech Medical, United States). Correlation analysis was used to analyze the data. RESULTS A strong correlation was observed among hip extension asymmetry, pain intensity, and disability index (P<0.05). However, no correlation was observed among compensatory lumbar rotation and extension, pain intensity, and ODI. A strong correlation also was observed between limited hip extension range of motion and compensatory lumbar rotation (P<0.05) but not between limited hip extension range of motion and compensatory lumbar extension (P>0.05). CONCLUSIONS The results of this study showed that hip extension asymmetry might be a more critical factor than hip extension range of motion. The strong correlation between limited hip extension and compensatory lumbar rotation suggests a risk of micro-trauma due to compensatory lumbar rotation.
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Affiliation(s)
- Won-deuk Kim
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, South Korea
| | - DooChul Shin
- Department of Physical Therapy, College of Health Sciences, Kyungnam University, Changwon, South Korea
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Vining R, Long CR, Minkalis A, Gudavalli MR, Xia T, Walter J, Coulter I, Goertz CM. Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial. J Altern Complement Med 2020; 26:592-601. [PMID: 32543211 DOI: 10.1089/acm.2020.0107] [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: 12/20/2022] Open
Abstract
Objectives: To investigate whether chiropractic care influences strength, balance, and/or endurance in active-duty United States military personnel with low back pain (LBP). Design: This study employed a prospective randomized controlled trial using a pragmatic treatment approach. Participants were randomly allocated to 4 weeks of chiropractic care or to a wait-list control. Interventions: Chiropractic care consisted of spinal manipulation, education, advice, and reassurance. Settings/Location: Naval Air Technical Training Center branch clinic at the Naval Hospital Pensacola Florida. Subjects: One hundred ten active-duty military personnel 18-40 years of age with self-reported LBP. Outcome measures: Isometric pulling strength from a semisquat position was the primary outcome. Secondary outcomes were single-leg balance with eyes open and eyes closed, and trunk muscle endurance using the Biering-Sorensen test. Patient-reported outcomes such as pain severity and disability were also measured. Outcomes were measured at baseline and 4 weeks. Linear mixed-effects regression models over baseline and 4 weeks were used for analysis. Results: Participants had mean age of 30 years (18-40), 17% were female, 33% were non-white, and 86% reported chronic LBP. Mean maximum pulling strength in the chiropractic group increased by 5.08 kgs and decreased by 7.43 kgs in the wait-list group, with a statistically significant difference in mean change between groups (p = 0.003). Statistically significant differences in mean change between groups were also observed in trunk muscle endurance (13.9 sec, p = 0.002) and balance with eyes closed (0.47 sec, p = 0.01), but not in balance with eyes open (1.19 sec, p = 0.43). Differences in mean change between groups were statistically significant in favor of chiropractic for LBP-related disability, pain intensity and interference, and fear-avoidance behavior. Conclusions: Active-duty military personnel receiving chiropractic care exhibited improved strength and endurance, as well as reduced LBP intensity and disability, compared with a wait-list control.
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Affiliation(s)
- Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Amy Minkalis
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - M Ram Gudavalli
- College of Chiropractic Medicine, Keiser University, West Palm Beach, FL, USA
| | - Ting Xia
- Mechanical Engineering Department, Northern Illinois University, DeKalb, IL, USA
| | - Joan Walter
- Samueli Integrative Health Programs, H&S Ventures, Alexandria, VA, USA
| | | | - Christine M Goertz
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
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Flexion-Relaxation Ratio Asymmetry and Its Relation With Trunk Lateral ROM in Individuals With and Without Chronic Nonspecific Low Back Pain. Spine (Phila Pa 1976) 2020; 45:E1-E9. [PMID: 31415455 DOI: 10.1097/brs.0000000000003196] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional comparative study. OBJECTIVE The present study aimed to investigate the relationship between the FR phenomenon asymmetry of lumbar muscles and trunk lateral range of motion (ROM) asymmetry in nonspecific chronic low back pain (NSCLBP) patients. SUMMARY OF BACKGROUND DATA Imbalance in trunk muscle activation between right and left sides can induce pain by loading the spine incorrectly, especially in patients with NSCLBP. A previous study reported a greater asymmetry in the FR phenomenon of the erector spinae in NSCLBP patients than in asymptomatic participants (APs). Imbalance of muscle properties, such as trunk ROM, has been suggested as a possible cause of this observed asymmetry. METHODS Twenty-eight NSCLBP patients and 22 AP performed 3 standing maximal trunk flexions. Surface electromyography was recorded bilaterally for erector spinae longissimus and lumbar multifidus. A FR ratio was calculated for each muscle. The fingertip-to-thigh test was performed to assess trunk lateral ROM. Each parameter's asymmetry was calculated as the absolute difference between right and left sides. RESULTS NSCLBP patients present a significantly lower trunk lateral ROM than AP. FR ratio asymmetry of the erector spinae was significantly greater in NSCLBP patients than in AP (P < 0.05). FR ratio asymmetry of the multifidus and trunk lateral ROM asymmetry were not significantly different between groups. Significant correlation (r = 0.49) between FR ratio asymmetry of erector spinae and trunk lateral ROM asymmetry was observed only for patients with NSCLBP. CONCLUSION The present findings showed that FR ratio asymmetry of erector spinae longissimus is moderately correlated with trunk lateral ROM asymmetry. In addition, the results confirmed that patients with NSCLBP present a reduced trunk lateral ROM, a FR ratio asymmetry of the erector spinae which is correlated with trunk rotation. These findings suggested an imbalance spine loading which can contribute to the persistence of pain. LEVEL OF EVIDENCE 3.
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Structural damage and motion rhythm of the spine and hip during trunk lateral bending in ankylosing spondylitis patients with mild to moderate radiographic signs. Clin Biomech (Bristol, Avon) 2019; 63:112-118. [PMID: 30889429 DOI: 10.1016/j.clinbiomech.2019.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/27/2018] [Accepted: 02/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ankylosing spondylitis causes structural damage and motion restriction in spine. The study was designed to assess structural damage and incoordination pattern between the spine and hip during trunk lateral bending in ankylosing spondylitis. METHODS Twenty-three healthy adults and 39 adults with ankylosing spondylitis were recruited from a tertiary care medical centre. Patients with ankylosing spondylitis were divided into two subgroups: sacroiliitis or lumbar-level syndesmophytes (n = 27) and thoracic or cervical-level syndesmophytes (n = 12). An inertia motion system was used to record three-dimensional kinematic data during trunk lateral bending. FINDINGS Significant differences were observed in lumbar spine syndesmophyte scores, sacroiliitis severity and Bath Ankylosing Spondylitis Metrology Index between the subgroups. The cervical supraspinous ligaments thickness revealed difference between the ankylosing spondylitis and control group, but the Glasgow Ultrasound Enthesitis Scoring System did not revealed difference. Motion analysis revealed that the ankylosing spondylitis group had a larger hip, cervical rotation and smaller lumbar-hip rhythm than the control group; however, the other motions of the spine and hip were smaller. The sacroiliitis or lumbar-level syndesmophytes group had the largest thoracic rotation among the three groups. INTERPRETATION The different lumbar-hip rhythm between ankylosing spondylitis patients depends on syndesmophyte formation levels. Cervical rotation, the Schober test, the chest expansion test, and lumbar-hip rhythm can indicate the levels of bone damage in ankylosing spondylitis. Clinical examination of ankylosing spondylitis should include kinematic measures of both the spine and hips in the early disease stage.
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Kemmochi M, Sasaki S, Ichimura S. Association between reduced trunk flexibility in children and lumbar stress fractures. J Orthop 2018; 15:122-127. [PMID: 29657454 DOI: 10.1016/j.jor.2018.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022] Open
Abstract
Background We noticed that most of active sports children with low back pain (LBP) have muscle tightness around the pelvis and reduced trunk flexibility. Abnormalities in short-time inversion recovery (STIR) images on magnetic resonance imaging (MRI) can show stress fracture. Therefore, we investigated the associations among LBP, trunk flexibility, and lumbar stress fractures. Methods A total of 130 patients under the age of 18 years complained of LBP were investigated in STIR MRI images. Among these 130 patients, 65 cases of lumbar stress fracture were diagnosed and 65 cases were not diagnosed as a lumbar stress fracture. We compared between a group suspected of stress fracture (suspected group) and a group of stress fracture(stress fracture group)about their trunk flexibility. These groups were investigated about their initial trunk flexibility about below items; Finger floor distance (FFD), Heel to buttock distance (HBD), straight leg raising (SLR). Results Significant differences were observed between suspected group and stress fracture group about every items; SLR (P < 0.001), FFD (P < 0.01), HBD (P < 0.002). Most cases of stress fracture group had reduced trunk flexibility, and low flexibility in pelvic area muscles was observed in 93.8% (61/65) of cases at the initial examination. Otherwise, that of suspected group was 73.8%(48/65). Conclusions Most patients of lumbar stress fracture had reduced trunk flexibility, and their reduced trunk flexibility might not be caused by LBP. In the early diagnosis of lumbar stress fractures using STIR MRI images, there were indicated that reduced trunk flexibility was one of helpful item for lumbar stress fracture.
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Affiliation(s)
- Masahiko Kemmochi
- Kenmochi Orthopedic Surgery Sports Clinic, KOSSMOS Medical Corporation, 42-1 Higashi-honcho Ota City, Gunma, 373-0026, Japan
| | - Shigeru Sasaki
- Department of Orthopaedic Surgery, Kyorin University, 5-4-1 Mitaka, Shimorenjaku, 181-8612, Tokyo, Japan.,Japan Community Health Care Organization, Yamanashi Hospital, 3 Chome-11-16 Asahi, Kofu, Yamanashi Prefecture, 400-0025, Japan
| | - Shoichi Ichimura
- Department of Orthopaedic Surgery, Kyorin University, 5-4-1 Mitaka, Shimorenjaku, 181-8612, Tokyo, Japan
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Relationship between sagittal spinal curves geometry and isokinetic trunk muscle strength in adults. 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 2018; 27:2014-2022. [PMID: 29322310 DOI: 10.1007/s00586-017-5454-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 11/05/2017] [Accepted: 12/30/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Sagittal spinal deviation has been reported to be a significant musculoskeletal problem affecting both genders and could develop at any age. Factors triggering this issue are still not well defined. The purpose of this study was to investigate the relationship between sagittal spine angles and isokinetic peak, average torque, and power of trunk muscles in asymptomatic adults. METHODS A convenient sample of 79 subjects with asymptomatic spine participated in this study. Thoracic and lumbar curves angles were measured using the Formetric 4D device. Thoracolumbar (T/L) ratio was calculated as an indicator of spine balance. Isokinetic peak and average torque and average power for trunk flexors and extensors were measured at 60°/s in seated and semi-standing test positions. RESULTS Lumbar curve angle was moderately inversely correlated (p < 0.001) with peak extension torque (ρ = - 0.532 and - 0.495 in seated and semi-standing positions, respectively) and peak flexion torque (ρ = - 0.604 and - 0.542 in seated and semi-standing positions, respectively). The T/L ratio was found to be significantly associated (p < 0.001) with trunk extension torque (ρ = 0.422 and 0.378 in seated and semi-standing positions, respectively) and trunk flexion torque (ρ = 0.396 and 0.321 in seated and semi-standing positions, respectively). Similarly, average torque and power measurements were significantly correlated with lumbar curve angle and T/L ratio. CONCLUSIONS Sagittal spine balance is associated with trunk muscles strength in adults, particularly, the lumbar spine muscles. Therefore, assessment of sagittal spinal balance and trunk muscles strength should be taken into consideration when designing rehabilitation programs for correction of sagittal spine curvature.
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Abstract
Background Flight related low back pain (LBP) among helicopter pilots is frequent and may influence flight performance. Prolonged confined sitting during flights seems to weaken lumbar trunk (LT) muscles with associated secondary transient pain. Aim of the study was to investigate if structured training could improve muscular function and thus improve LBP related to flying. Methods 39 helicopter pilots (35 men and 4 women), who reported flying related LBP on at least 1 of 3 missions last month, were allocated to two training programs over a 3-month period. Program A consisted of 10 exercises recommended for general LBP. Program B consisted of 4 exercises designed specifically to improve LT muscular endurance. The pilots were examined before and after the training using questionnaires for pain, function, quality of health and tests of LT muscular endurance as well as ultrasound measurements of the contractility of the lumbar multifidus muscle (LMM). Results Approximately half of the participants performed the training per-protocol. Participants in this subset group had comparable baseline characteristics as the total study sample. Pre and post analysis of all pilots included, showed participants had marked improvement in endurance and contractility of the LMM following training. Similarly, participants had improvement in function and quality of health. Participants in program B had significant improvement in pain, function and quality of health. Conclusions This study indicates that participants who performed a three months exercise program had improved muscle endurance at the end of the program. The helicopter pilots also experienced improved function and quality of health. Trial registration Identifier: NCT01788111 Registration date; February 5th, 2013, verified April 2016. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1631-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Knut Andersen
- Department of Research, Stavanger University Hospital and Network for Medical Sciences, University of Stavanger, PB 8100, , N-4068, Stavanger, Norway.
| | - Roald Baardsen
- Department of Neurosurgery, Stavanger University Hospital, PB 8100, , N-4068, Stavanger, Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, PB 8100, , N-4068, Stavanger, Norway
| | - Jan Petter Larsen
- Network for Medical Sciences, University of Stavanger, Postboks 8600 Forus, 4036, Stavanger, Norway
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