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Rosenstein B, Montpetit C, Vaillancourt N, Dover G, Khalini-Mahani N, Weiss C, Papula LA, Melek A, Fortin M. Effect of aquatic exercise versus standard care on paraspinal and gluteal muscles morphology in individuals with chronic low back pain: a randomized controlled trial protocol. BMC Musculoskelet Disord 2023; 24:977. [PMID: 38110922 PMCID: PMC10726523 DOI: 10.1186/s12891-023-07034-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/10/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most disabling diseases and a major health issue. Despite the evidence of a link between paraspinal and gluteal muscle dysfunction and LBP, it is unknown whether aquatic exercises can lead to improvements in paraspinal and gluteal muscle morphology and function, and whether improvements in overall muscle health are associated with improvements in patients' outcomes. The unique properties of water allow a water-based exercise program to be tailored to the needs of those suffering from LBP. This study uses magnetic resonance imaging (MRI) to investigate the effect of an aquatic exercise program versus standard exercise on 1) paraspinal and gluteal muscle size, quality and strength and 2) pain, disability, and psychological factors (pain related fear, depression, anxiety, sleep quality) in chronic LBP. METHODS This study will include 34 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 65, who will be randomly assigned (1:1) to the aquatic exercise group or land-based standard care exercise group. Both groups will receive 20 supervised sessions, twice per week over 10 weeks. MRIs will be obtained along the lumbosacral spine (L1-L5) and pelvis at the start and end of the intervention to assess the effect of each exercise intervention on paraspinal and gluteal muscle size and quality. Pre- to post-intervention changes in all outcomes between each group will be assessed, and the association between the changes in back muscle quality and clinical outcomes will be examined. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment. DISCUSSION This study will determine if water-based exercises targeting the lower back and gluteal muscles can lead to important changes in muscle quality and function, and their possible relation with patients' pain and functional improvements. Our findings will have strong clinical implications and provide preliminary data to design a community program to better support individuals with chronic LBP. TRIAL REGISTRATION NCT05823857, registered prospectively on April 27th, 2023.
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Affiliation(s)
- Brent Rosenstein
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, Montreal, QC, Canada
| | - Chanelle Montpetit
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, Montreal, QC, Canada
| | - Nicolas Vaillancourt
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, Montreal, QC, Canada
| | - Geoffrey Dover
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, Montreal, QC, Canada
- School of Health, Concordia University, Montreal, QC, Canada
| | - Najmeh Khalini-Mahani
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, Montreal, QC, Canada
| | - Christina Weiss
- School of Health, Concordia University, Montreal, QC, Canada
| | - Lee Ann Papula
- School of Health, Concordia University, Montreal, QC, Canada
| | - Antonys Melek
- School of Health, Concordia University, Montreal, QC, Canada
| | - Maryse Fortin
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, Montreal, QC, Canada.
- School of Health, Concordia University, Montreal, QC, Canada.
- CRIR - Centre de réadaptation Constance-Lethbridge du CIUSSS COMTL, Montreal, QC, Canada.
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Fortin M, Rye M, Roussac A, Montpetit C, Burdick J, Naghdi N, Rosenstein B, Bertrand C, Macedo LG, Elliott JM, Dover G, DeMont R, Weber MH, Pepin V. The Effects of Combined Motor Control and Isolated Extensor Strengthening versus General Exercise on Paraspinal Muscle Morphology, Composition, and Function in Patients with Chronic Low Back Pain: A Randomized Controlled Trial. J Clin Med 2023; 12:5920. [PMID: 37762861 PMCID: PMC10532355 DOI: 10.3390/jcm12185920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Low back pain (LBP), a globally widespread and persistent musculoskeletal disorder, benefits from exercise therapy. However, it remains unclear which type leads to greater changes in paraspinal muscle health. This study aimed to (1) compare the effects of a combined motor control and isolated lumbar extension exercise (MC+ILEX) versus a general exercise (GE) intervention on paraspinal muscle morphology, composition, and function, and (2) examine whether alterations in paraspinal muscle health were correlated with improvements in pain, function, and quality of life. Fifty participants with chronic LBP were randomly assigned to each group and underwent a 12-week supervised intervention program. Magnetic resonance imaging and ultrasound assessments were acquired at baseline, 6 and 12 weeks to examine the impact of each intervention on erector spinae (ES) and multifidus (MF) muscle size (cross-sectional area, CSA), composition, and function at L4-L5 and L5-S1. Self-reported questionnaires were also acquired to assess participant-oriented outcomes. Our findings indicated that the MC+ILEX group demonstrated greater improvements in MF and ES CSA, along with MF thickness at both levels (all p < 0.01). Both groups significantly improved in pain, function, and quality of life. This study provided preliminary results suggesting that an MC+ILEX intervention may improve paraspinal morphology while decreasing pain and disability.
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Affiliation(s)
- Maryse Fortin
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
- School of Health, Concordia University, Montreal, QC H4B 1R6, Canada
| | - Meaghan Rye
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Alexa Roussac
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Chanelle Montpetit
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Jessica Burdick
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Neda Naghdi
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Brent Rosenstein
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Cleo Bertrand
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Luciana G. Macedo
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada;
| | - James M. Elliott
- Faculty of Medicine and Health, School of Health Sciences, The Kolling Institute, University of Sydney, Sydney, NSW 2050, Australia;
- Northern Sydney Local Health District, St. Leonards, NSW 2065, Australia
| | - Geoffrey Dover
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Richard DeMont
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Michael H. Weber
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, QC H3J 1A4, Canada;
| | - Véronique Pepin
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
- School of Health, Concordia University, Montreal, QC H4B 1R6, Canada
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A Comparison of the Effect of a 4.4-MHz Radiofrequency Deep Heating Therapy and Ultrasound on Low Back Pain: A Randomized, Double-Blind, Multicenter Trial. J Clin Med 2022; 11:jcm11175011. [PMID: 36078940 PMCID: PMC9457341 DOI: 10.3390/jcm11175011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Despite the increasing interest in RF (Radiofrequency) therapy, little is known about its effectiveness for low back pain (LBP). The aim of this study was to investigate the effectiveness of 4.4-MHz RF diathermy compared to ultrasound (US) in patients with LBP. One-hundred-and-eighteen patients with LBP were randomized with RF (n = 62) or US (n = 56). Investigator and subjects were blinded to the treatment group. Either RF (4.4 MHz, 45 W/cm2) or US (1 MHz, 2 W/cm2) was applied for 10 to 15 min, 3 times per week for 4 weeks. The primary outcome was the Oswestry Disability Index (ODI, %). Secondary outcomes were numeric rating scale (NRS), Biering−Sorensen test, up-and-go test, successful pain relief, and successful functional improvement. Clinical outcomes were evaluated prior to intervention (baseline), and at 4 and 12 weeks after treatment. There were no significant differences between the groups regarding baseline demographic and clinical characteristics. Both groups observed a significant improvement of ODI (%), NRS, Biering−Sorensen test, and up-and-go test at 4 and 12 weeks after treatment (p < 0.05); however, no significant differences were found between groups. The RF group showed a higher proportion of successful pain relief at 12 weeks after treatment than the US group (p = 0.048). The RF diathermy showed favorable results in pain reduction, improvement of function, mobility, and back muscle endurance. Compared with US, RF diathermy obtained slightly better perception of patients in pain relief at 12 weeks after treatment. The results from this study indicated that 4.4-MHz RF diathermy can effectively be used as a conservative treatment option for patients with LBP.
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Boutellier A, Nüesch C, Suter P, Perrot G, Mündermann A. Trunk muscle function and its association with functional limitations in sedentary occupation workers with and without chronic nonspecific low back pain. J Back Musculoskelet Rehabil 2022; 35:783-791. [PMID: 34744065 DOI: 10.3233/bmr-200269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The function of trunk muscles in chronic nonspecific low back pain (CNLBP) is controversially discussed, and trunk muscle function in sedentary occupation workers is poorly understood. OBJECTIVE To investigate whether muscle function differs between sedentary occupation workers with and without CNLBP and to determine the association between functional limitations and muscle function. METHODS This study included 32 sedentary occupation workers (16 workers with CNLBP and 16 age- and sex-matched workers without CNLBP). Group differences in isokinetic trunk flexion-extension strength, muscle cocontraction, endurance time (Biering-Sorensen test) and electromyographic muscle fatigue were assessed. The association of these parameters and Oswestry Disability Index (ODI) score were examined in the CNLBP group. RESULTS Participants with CNLBP had lower trunk extensor (-20%) and flexor (-18%) strength and less cocontraction (-22%) than participants without CNLBP, but due to large variability in both groups these differences were not statistically significant. Trunk muscle endurance and fatigue were comparable between groups. Variance in endurance time explained 28% of variance in the ODI-score in the CNLBP group (R2= 0.277). CONCLUSIONS In patients with CNLBP, greater functional disability was associated with lower endurance. Further evidence is necessary to elucidate whether specifically training endurance performance may be beneficial for sedentary occupation workers.
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Affiliation(s)
- Angela Boutellier
- School of Health Professions, Zurich University of Applied Sciences Winterthur, Winterthur, Switzerland.,Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Peter Suter
- Institute for Physiotherapy, University Hospital Basel, Basel, Switzerland
| | - Guido Perrot
- Institute for Physiotherapy, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
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Althobaiti S, Rushton A, Aldahas A, Falla D, Heneghan NR. Practicable performance-based outcome measures of trunk muscle strength and their measurement properties: A systematic review and narrative synthesis. PLoS One 2022; 17:e0270101. [PMID: 35714149 PMCID: PMC9205516 DOI: 10.1371/journal.pone.0270101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/04/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
The evaluation of muscle strength is frequently used as part of the physical examination process, with decreased trunk muscle strength reported in individuals with spinal disorders (e.g., low back pain). Access to practicable performance-based outcome measures (PBOM) to monitor patients’ progress in spinal rehabilitation is essential. Knowledge of the psychometric properties of the available practicable PBOM for trunk strength evaluation is therefore needed to inform practitioners and further research.
Objective
To synthesise evidence on the measurement properties of practicable measures of trunk muscle strength in adults with and without musculoskeletal pain.
Methods
Following a published and registered protocol [PROSPERO CRD42020167464], databases were searched from the database inception date up to 30th of June 2021. Citations and grey literature were also searched. Eligibility criteria comprised: 1) studies which examined the psychometric properties of the trunk strength outcome measures, 2) included adults ≥ 18 years, either asymptomatic or with spinal musculoskeletal pain. Non-English language studies were excluded. Two independent reviewers evaluated the quality and synthesized the data from included studies according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. The overall quality of evidence was evaluated using a modified Grading of Recommendations Assessment Development and Evaluation (GRADE).
Results
From 34 included studies, 15 different PBOMs were identified that have been investigated for reliability and validity, none evaluated responsiveness. In asymptomatic individuals, high quality evidence supports intra-rater reliability of digital-loading cells and moderate quality evidence supports the criterion validity of the hand-held dynamometer. Very low quality evidence exists for the reliability and validity estimates of testing tools among individuals with spinal pain.
Conclusions
Findings underpin a cautious recommendation for the use of practicable PROMs to evaluate muscle strength in individuals with spinal pain in clinical practice due to the level of evidence and the heterogeneity of the protocols used. Further high quality research to explore the psychometric properties of the practicable PBOMs with detailed methodology is now needed.
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Affiliation(s)
- Shouq Althobaiti
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- Physical Therapy Department, College of Applied Medical Science, Taif University, Taif, Saudi Arabia
- * E-mail:
| | - Alison Rushton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Ahmad Aldahas
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Nicola R. Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
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Kandakurti PK, Arulsingh W, S Patil S. Influence of kinesiophobia on pain intensity, disability, muscle endurance, and position sense in patients with chronic low back pain-a case-control study. Trials 2022; 23:469. [PMID: 35668498 PMCID: PMC9169280 DOI: 10.1186/s13063-022-06406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patients with chronic low back pain (CLBP) frequently present with kinesiophobia. Though large body of evidence reported the impact of kinesiophobia in patients with CLBP, there are paucity of studies in associating kinesiophobia to muscle endurance and position sense in patients with CLBP. The primary aim of the study is to compare the impact of kinesiophobia on lumbar extensor endurance, position sense in patient with CLBP, and asymptomatic individuals. Secondarily, we aim to examine the association between kinesiophobia and lumbar extensor endurance, position sense, pain intensity, and functional ability in patients with CLBP. Thirdly, we aim to assess the degree of association of various factors on CLBP, lumbar endurance, and position sense. Material and methods This case-control study will have 200 patients with CLBP and 400 controls. Kinesiophobia, lumbar endurance, and lumbar position sense will be assessed with Tampa Scale, Soren’s lumbar extensor test, and lumbar repositioning test respectively. Secondarily, the pain intensity will be assessed with visual analog scale and functional ability with Patient-specific Functional Scale in patients with CLBP. Lumbar endurance and joint position sense will be compared between subjects with and without kinesiophobia. Kinesiophobia scores will be compared with lumbar extensor endurance and proprioception joint position errors, pain intensity, and functional ability. Simple and multiple binary logistic regression will be used to determine crude and adjusted odd’s ratio for kinesiophobia, lumbar position sense and kinesiophobia, and lumbar endurance. Discussion The finding from this study can be generalized as this study has adequate sample size and subgroup analysis by adjusting the variables to draw a valid conclusion. The finding of this study will help the working physician to include assessment of kinesiophobia as part of musculoskeletal evaluation for patient with CLBP in a prospective diagnostic intervention. Trial registration ClinicalTrials.gov NCT05079893. Registered on 14 October 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06406-6.
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Affiliation(s)
| | - Watson Arulsingh
- College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Sharad S Patil
- Thumbay Physical Therapy & Rehabilitation Hospital, Ajman, United Arab Emirates
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Grani G, Rodacki CDLN, Lubas H, Resende EF, Hoinatski R, Sentone RG, Orr R, Paulo AC. Can training trunk musculature influence musculoskeletal pain and physical performance in military police officers? ERGONOMICS 2022; 65:265-275. [PMID: 34445935 DOI: 10.1080/00140139.2021.1973576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
To investigate the effect of a Trunk Training (TT) program on the general musculoskeletal pain (GMP) and physical performance of Military Police Officers. Twenty officers were divided into either control group (CG) or TT group (TTG). Both groups performed nine weeks of traditional physical training. However, the TTG had 25-minutes allocated to TT during each scheduled physical training period. Anthropometric, trunk endurance, and physical fitness tests were completed pre- and post-training for both groups. Both groups also answered a weekly questionnaire about their GMP. Post-training, trunk endurance performance was significantly higher (p < 0.05) and the GMP significantly lower (p < 0.05) in the TTG when compared to the CG. Improvement in side plank test scores was associated with a decreased in GMP (r = -0.495, p < 0.05). TT can reduce the perception of GMP in addition to increasing the endurance of the trunk muscles. The side plank was the only physical test associated with GMP. Practitioner summary: Trunk Training can reduce general musculoskeletal pain and increase the endurance of the trunk muscles without a concomitant loss in general fitness in elite Military Police Officers. This research lasted 11 weeks and presents real-world and pragmatic findings.
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Affiliation(s)
- Gabriel Grani
- Department of Physical Education, Federal Technological University of Paraná, Paraná, Brazil
- Special Operations Battalion - BOPE, Military Police of Paraná, Paraná, Brazil
| | | | - Henrique Lubas
- Department of Physical Education, Federal Technological University of Paraná, Paraná, Brazil
| | | | - Rodrigo Hoinatski
- Department of Physical Education, Federal Technological University of Paraná, Paraná, Brazil
- Special Operations Battalion - BOPE, Military Police of Paraná, Paraná, Brazil
| | | | - Robin Orr
- Physiotherapy Department, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
- Faculty of Health Sciences and Medicine, Tactical Research Unit, Bond University, Gold Coast, Australia
| | - Anderson Caetano Paulo
- Department of Physical Education, Federal Technological University of Paraná, Paraná, Brazil
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Lehecka BJ, Smith BS, Rundell T, Cappaert TA, Hakansson NA. The Reliability and Validity of Gluteal Endurance Measures (GEMs). Int J Sports Phys Ther 2021; 16:1442-1453. [PMID: 34909251 PMCID: PMC8637266 DOI: 10.26603/001c.29592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The gluteals have unique morphology related to muscle endurance, including moderate fiber sizes and a majority of Type I endurance fibers. Evidence suggests gluteal endurance is related to low back pain, running kinematics, balance, posture, and more. However, reliable and valid measures specific to gluteal endurance are lacking in the literature. HYPOTHESIS/PURPOSE The purpose of this study was to examine the intra- and inter-rater reliability of two gluteal endurance measures (GEMs) for clinical use. It also aimed to examine validity for the two measures by using electromyography (EMG), recording reasons for task failure, and analyzing differences between demographic groups. STUDY DESIGN Cross-Sectional. METHODS Sixty-eight males and females with and without recurrent low back pain aged 18-35 years were recruited from a university population. Electromyography electrodes were placed on subjects' gluteus maximus and gluteus medius, and each subject performed three trials of GEM-A (abduction endurance) and GEM-B (bridging endurance). Hold times, EMG median frequency (MF) data, and subjective reasons for task failure were analyzed. RESULTS Both GEMs demonstrated high intra-rater reliability (ICC = 0.87-0.94) and inter-rater reliability (ICC = 0.99). Mean hold times were 104.83 ± 34.11 seconds for GEM-A (abduction endurance) and 81.03 ± 24.79 seconds for GEM-B (bridging endurance). No statistically significant difference was found between subjects with and without recurrent LBP. Median frequency data validated the onset of gluteal fatigue during both measures. Posterolateral hip (gluteal) fatigue was reported as the primary reason for task failure in 93% and 86% of subjects for GEM-A and GEM-B, respectively. CONCLUSION This seminal study of GEM-A (abduction endurance) and GEM-B (bridging endurance) found both measures to be reliable and valid measures of gluteal endurance. Further examination of the GEMs in samples with different types of LBP or hip pain is recommended. LEVEL OF EVIDENCE 3.
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Isometric Trunk Strength Assessment of Athletes: Effects of Sex, Sport, and Low Back Pain History. J Sport Rehabil 2021; 31:38-46. [PMID: 34552035 DOI: 10.1123/jsr.2021-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/08/2021] [Accepted: 06/26/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT The importance of isometric trunk strength (ITS) among sport science professionals is higher than its actual reported effect size on either performance or low back pain (LBP) occurrence. OBJECTIVE To provide normative values of ITS and strength ratios, and to evaluate the effect of sex, sports discipline, and LBP status. DESIGN Crossover study. SETTING University research laboratory. PARTICIPANTS Five hundred and sixty-seven elite athletes (186 females) with and without a history of LBP from different sports. MAIN OUTCOME MEASURE Participants underwent ITS testing for trunk flexors, extensors, and lateral flexors. Normalized maximal strength (in newton meter per kilogram) and strength ratios were calculated. Differences between sex, LBP, and sport disciplines were assessed with 3-way analysis of variance (sex × LBP status × 7 sport categories) and partial eta-squared (ηp2) effect size. The predictive validity of ITS for LBP was checked with receiver operating characteristics (area under the curve). RESULTS The authors found significant differences in extensor and flexor ITS in favor of male athletes (medium ηp2, P < .05), while sex differences in lateral flexion ITS had a low size effect (P < .05). A low size effect was also observed for the differences in strength ratios extensors/flexors (mean 1.47; 95% confidence interval, 1.45-1.50) and left flexors/right flexors (mean 0.99; 95% confidence interval, 0.98-1.01) among sexes. The sport discipline-related differences generally had a low size effect. No significant differences in ITS were found between LBP and LBP-free athletes. Only 50% to 58% of athletes (area under the curve, 0.501-0.582) were correctly classified as LBP or LBP-free using different ITS and strength ratio variables. CONCLUSIONS ITS and strength ratios have low predictive validity for LBP history but may discriminate between sex and sport disciplines. Our data are a useful reference point for meaningful individual results interpretation when athletes are evaluated during training or rehabilitation.
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Weber VMR, Romanzini M, Queiroga MR, Panchoni C, da Costa JC, da Silva LA, Sergio Portela B, Ronque ERV. Associations between strength, flexibility, and painful symptomology in university staff. Work 2021; 67:689-696. [PMID: 33185625 DOI: 10.3233/wor-203318] [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: 11/15/2022] Open
Abstract
BACKGROUND In the adult population, the work environment and physical fitness levels are directly related to the onset of musculoskeletal pain, repetitive strain injuries, and decreased blood circulation. Although low levels of muscle strength and flexibility may lead to a higher prevalence of pain, specific anatomic regions are poorly addressed. OBJECTIVE To investigate the prevalence of musculoskeletal pain and the association between strength or flexibility and pain in university staff. METHODS The sample was composed of 110 members of staff from a university in Guarapuava-PR. Body mass and height values were obtained, from which the BMI was calculated. The pain evaluation was performed by means of a questionnaire, analyzing the intensity, frequency, and anatomical region. The subjects were then submitted to strength (right and left hand grip, lumbar traction, lower limb traction) and flexibility tests (sit and reach test). RESULTS The anatomical region with the highest prevalence of pain was the lumbar region (43.4%). When the association between the presence of pain and flexibility was performed, only the lumbar traction presented significant results, with the weakest group demonstrating pain (OR: 3.47 [1.27 - 9.49]). CONCLUSION The results demonstrate that low levels of strength in the lumbar region are associated with the presence of painful symptomatology.
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Affiliation(s)
- Vinicius Muller Reis Weber
- Study and Research Group in Physical Activity and Exercise- GEPAFE, State University of Londrina- UEL, Londrina, Brazil
| | - Marcelo Romanzini
- Study and Research Group in Physical Activity and Exercise- GEPAFE, State University of Londrina- UEL, Londrina, Brazil
| | - Marcos Roberto Queiroga
- Department of Physical Education, Midwestern Paraná State University, UNICENTRO, Guarapuava, Parana, Brazil
| | - Camila Panchoni
- Study and Research Group in Physical Activity and Exercise- GEPAFE, State University of Londrina- UEL, Londrina, Brazil
| | - Julio Cesar da Costa
- Study and Research Group in Physical Activity and Exercise- GEPAFE, State University of Londrina- UEL, Londrina, Brazil
| | | | - Bruno Sergio Portela
- Department of Physical Education, Midwestern Paraná State University, UNICENTRO, Guarapuava, Parana, Brazil
| | - Enio Ricardo Vaz Ronque
- Study and Research Group in Physical Activity and Exercise- GEPAFE, State University of Londrina- UEL, Londrina, Brazil
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11
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Russ DW, Amano S, Law TD, Thomas JS, Clark BC. Multiple measures of muscle function influence Sorensen Test performance in individuals with recurrent low back pain. J Back Musculoskelet Rehabil 2021; 34:139-147. [PMID: 33136088 DOI: 10.3233/bmr-200079] [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 Sorensen Test time-to-task-failure (TTF) predicts several low back pain (LBP) clinical outcomes, including recurrence. Because the test is described as a measure of trunk extensor (TE) muscle endurance, LBP rehabilitation programs often emphasize endurance training, but the direct role of TE muscle function on Sorensen Test-TTF remains unclear. OBJECTIVE To assess the discriminative and associative properties of multiple markers of isolated TE performance with regard to Sorensen Test-TTF in individuals with recurrent LBP. METHOD Secondary analysis of baseline measures from participants in a registered (NCT02308189) trial (10 men; 20 women) was performed. Participants were classified by Sorensen Test-TTF as high, moderate or low risk for subsequent LBP episodes, and compared to determine if classification could discriminate differences in TE function. Correlations between Sorensen Test-TTF and isolated TE performance, anthropometrics and disability were investigated. RESULTS Individuals at risk of subsequent LBP episodes had greater perceived disability and fat mass/TE strength ratios (P⩽ 0.05) than those not at risk. Modest, significant (r= 0.36-0.42, P⩽ 0.05) associations were found between Sorensen Test-TTF, TE endurance and fat mass/TE strength. Exploratory analyses suggested possible sex-specific differences related to Sorensen Test-TTF. CONCLUSIONS Isolated TE muscle endurance is only one of several factors with similar influence on Sorensen Test-TFF, thus LBP rehabilitation strategies should consider other factors, including TE strength, anthropometrics and perceived disability.
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Affiliation(s)
- David W Russ
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.,Division of Physical Therapy, School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH, USA
| | - Shinichi Amano
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
| | - Timothy D Law
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.,Department of Family Medicine, Ohio University, Athens, OH, USA
| | - James S Thomas
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.,Division of Physical Therapy, School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH, USA.,Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.,Department of Biomedical Sciences, Ohio University, Athens, OH, USA
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12
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Fortin M, Rye M, Roussac A, Naghdi N, Macedo LG, Dover G, Elliott JM, DeMont R, Weber MH, Pepin V. The effects of combined motor control and isolated extensor strengthening versus general exercise on paraspinal muscle morphology and function in patients with chronic low back pain: a randomised controlled trial protocol. BMC Musculoskelet Disord 2021; 22:472. [PMID: 34022854 PMCID: PMC8141240 DOI: 10.1186/s12891-021-04346-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 12/31/2022] Open
Abstract
Background Exercise is a common approach for the management of patients with chronic non-specific low back pain (LBP). However, there is no clear mechanistic evidence or consensus on what type of exercise is more effective than others. While considerable evidence suggests a link between lumbar muscle health (e.g., atrophy and fatty infiltration) with functional deficits, it is unknown whether exercises targeting the lumbar spine can lead to noticeable improvements in muscle health and functional outcomes. The primary aim of this study is to compare the effect of combined motor control and isolated strengthening lumbar exercises (MC + ILEX) versus a general exercise group (GE) on multifidus muscle morphology (size and composition). Secondary aims include assessing the effect of the interventions on overall paraspinal muscle health, pain and disability, as well as psychological factors as possible effect modifiers. Methods A total of 50 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 60, will be recruited from the local orthopaedic clinics and university community. Participants will be randomised (1:1) to either the MC + ILEX or GE group. Participants will undergo 24 individually supervised exercise sessions over a 12-week period. The primary outcome will be multifidus morphology (atrophy) and composition (fatty infiltration). Secondary outcomes will be muscle function (e.g., % thickness change during contraction), morphology, lumbar extension strength, pain intensity and disability. Potential treatment effect modifiers including maladaptive cognitions (fear of movement, catastrophizing), anxiety, depression, physical activity, and sleep quality will also be assessed. All measurements will be obtained at baseline, 6-week and 12-week; self-reported outcomes will also be collected at 24-week. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment. Discussion The results of this study will help clarify which of these two common interventions promote better results in terms of overall paraspinal muscle heath, back pain, disability and psychological factors in adults with chronic LBP. Trial registration NTCT04257253, registered prospectively on February 5, 2020.
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Affiliation(s)
- Maryse Fortin
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, Quebec, H4B 1R6, Canada. .,PERFORM Centre, Concordia University, Montreal, Quebec, Canada. .,Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, Quebec, Canada.
| | - Meaghan Rye
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, Quebec, H4B 1R6, Canada
| | - Alexa Roussac
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, Quebec, H4B 1R6, Canada
| | - Neda Naghdi
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, Quebec, H4B 1R6, Canada
| | - Luciana Gazzi Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Geoffrey Dover
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, Quebec, H4B 1R6, Canada.,PERFORM Centre, Concordia University, Montreal, Quebec, Canada.,Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, Quebec, Canada
| | - James M Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Northern Sydney Local Health District, The Kolling Institute and Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Richard DeMont
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, Quebec, H4B 1R6, Canada.,PERFORM Centre, Concordia University, Montreal, Quebec, Canada
| | - Michael H Weber
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Véronique Pepin
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, Quebec, H4B 1R6, Canada.,PERFORM Centre, Concordia University, Montreal, Quebec, Canada
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13
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Biviá-Roig G, Lisón JF, Sánchez-Zuriaga D. Determining the optimal maximal and submaximal voluntary contraction tests for normalizing the erector spinae muscles. PeerJ 2019; 7:e7824. [PMID: 31637121 PMCID: PMC6802582 DOI: 10.7717/peerj.7824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/03/2019] [Indexed: 01/21/2023] Open
Abstract
Background This study aimed to identify which maximum voluntary isometric contraction (MVIC) and sub-MVIC tests produce the highest activation of the erector spinae muscles and the greatest reduction in inter-individual variability, to put them forward as reference normalization maneuvers for future studies. Methods Erector spinae EMG activity was recorded in 38 healthy women during five submaximal and three maximal exercises. Results None of the three MVIC tests generated the maximal activation level in all the participants. The maximal activation level was achieved in 68.4% of cases with the test performed on the roman chair in the horizontal position (96.3 ± 7.3; p < 0.01). Of the five submaximal maneuvers, the one in the horizontal position on the roman chair produced the highest percentage of activation (61.1 ± 16.7; p < 0.01), and one of the lowest inter-individual variability values in the normalized signal of a trunk flexion-extension task. Conclusions A modified Sorensen MVIC test in a horizontal position on a roman chair and against resistance produced the highest erector spinae activation, but not in 100% of participants, so the execution of several normalization maneuvers with the trunk at different inclinations should be considered to normalize the erector spinae EMG signal. A modified Sorensen test in a horizontal position without resistance is the submaximal maneuver that produces the highest muscle activation and the greatest reduction in inter-individual variability, and could be considered a good reference test for normalization.
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Affiliation(s)
- Gemma Biviá-Roig
- Department of Physiotherapy, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, Spain
| | - Juan Francisco Lisón
- Department of Medicine, Faculty of Health Sciences, University CEU-Cardenal Herrera, CEU Universities, Spain. CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Carlos III Health Institute, Spain
| | - Daniel Sánchez-Zuriaga
- Department of Anatomy and Human Embryology, Faculty of Medicine, Universitat de València, València, Spain
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14
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Hammond A, Perrin C, Steele J, Giessing J, Gentil P, Fisher JP. The effects of a 4-week mesocycle of barbell back squat or barbell hip thrust strength training upon isolated lumbar extension strength. PeerJ 2019; 7:e7337. [PMID: 31388473 PMCID: PMC6662562 DOI: 10.7717/peerj.7337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/21/2019] [Indexed: 01/12/2023] Open
Abstract
Objectives Common exercises such as the barbell back squat (BBS) and barbell hip thrust (BHT) are perceived to provide a training stimulus to the lumbar extensors. However, to date there have been no empirical studies considering changes in lumbar extension strength as a result of BBS or BHT resistance training (RT) interventions. Purpose To consider the effects of BBS and BHT RT programmes upon isolated lumbar extension (ILEX) strength. Methods Trained male subjects (n = 14; 22.07 ± 0.62 years; 179.31 ± 6.96 cm; 79.77 ± 13.81 kg) were randomised in to either BBS (n = 7) or BHT (n = 7) groups and performed two training sessions per week during a 4-week mesocycle using 80% of their 1RM. All subjects were tested pre- and post-intervention for BBS and BHT 1RM as well as isometric ILEX strength. Results Analyses revealed that both BBS and BHT groups significantly improved both their BBS and BHT 1RM, suggesting a degree of transferability. However, the BBS group improved their BBS 1RM to a greater degree than the BHT group (p = 0.050; ∼11.8 kg/10.2% vs. ∼8.6 kg/7.7%, respectively). And the BHT group improved their BHT 1RM to a greater degree than the BBS group (p = 0.034; ∼27.5 kg/24.8% vs. ∼20.3 kg/13.3%, respectively). Neither BBS nor BHT groups significantly improved their isometric ILEX strength. Conclusions The present study supports the concept of specificity, particularly in relation to the movement mechanics between trunk extension (including pelvic rotation) and ILEX. Our data suggest that strength coaches, personal trainers, and trainees can self-select multi-joint lower-body trunk extension exercises based on preference or variety. However, evidence suggests that neither the BBS nor BHT exercises can meaningfully increase ILEX strength. Since strengthening these muscles might enhance physical and sporting performance we encourage strength coaches and personal trainers to prescribe ILEX exercise.
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Affiliation(s)
- Alexander Hammond
- School of Sport, Health and Social Sciences, Southampton Solent University, Southampton, UK
| | - Craig Perrin
- School of Sport, Health and Social Sciences, Southampton Solent University, Southampton, UK
| | - James Steele
- School of Sport, Health and Social Sciences, Southampton Solent University, Southampton, UK
| | - Jürgen Giessing
- Institute of Sport Science, Universität Koblenz-Landau, Landau, Germany
| | - Paulo Gentil
- Faculty of Physical Education and Dance, Universidade Federal de Goiás, Goiania, Brazil
| | - James P Fisher
- School of Sport, Health and Social Sciences, Southampton Solent University, Southampton, UK
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15
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Abstract
Supplemental digital content is available in the text. Objective This study investigates the feasibility, reliability, and correlations of recommended functional tests in lung transplant recipients shortly after surgery. Design This is an observational study. Methods Fifty patients (28 females) performed well-standardized maximum isometric back extension in a sitting position, handgrip strength, and Biering-Sørensen endurance tests shortly before discharge from the acute hospital, shortly thereafter, and 2 mos later after subacute rehabilitation. Results Back extension testing was well feasible, but only two thirds of the patients could perform the Biering-Sørensen test at baseline and they experienced a greater number of minor but no major adverse events. Absolute reliability measures and the intraclass correlation coefficients were excellent for the strength (0.97–0.98 [0.95–0.99]) and good for the endurance tests (0.69 [0.26–0.87]). Handgrip revealed high correlation with back strength (≥0.75) but not with Biering-Sørensen scores. Conclusions Well-controlled maximum back strength testing is feasible and reliable, and the scores are highly correlated with grip strength in lung transplant recipients shortly before hospital discharge. The Biering-Sørensen test should be limited to patients without dominant weakness and/or fear. Future research should investigate whether grip instead of back extension strength can safely be used for proper exercise prescription.
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16
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Relationship of Core Power and Endurance with Performance in Random Intermittent Dynamic Type Sports. Asian J Sports Med 2019. [DOI: 10.5812/asjsm.62843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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Applegate ME, France CR, Russ DW, Leitkam ST, Thomas JS. Sørensen test performance is driven by different physiological and psychological variables in participants with and without recurrent low back pain. J Electromyogr Kinesiol 2019; 44:1-7. [PMID: 30447543 DOI: 10.1016/j.jelekin.2018.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/19/2018] [Accepted: 11/08/2018] [Indexed: 11/17/2022] Open
Abstract
Time to task failure (TTF) on the Sørensen test predicts low back pain (LBP), but mechanisms driving TTF may vary in those with and without recurrent LBP. To determine the physiological and psychological predictors of TTF, 48 sex, age, and BMI matched participants (24 Healthy, 24 LBP) completed psychological surveys, maximal strength assessments, and the Sørensen test. A two-way ANOVA revealed no significant effects of group (p = 0.75) or sex (p = 0.21) on TTF. In the full sample, linear regression analyses revealed that normalized Median Power Frequency (MPF) slope of the Erector Spinae (β = 0.350, p < 0.01), the Biceps Femoris (β = 0.375, p < 0.01), and self-efficacy (β = 0.437, p < 0.01) predicted TTF. In the Healthy group, normalized MPF slope of the Erector Spinae (β = 0.470, p < 0.01), the Biceps Femoris (β = 0.437, p < 0.01), and self-efficacy (β = 0.330, p = 0.02) predicted TTF. In the LBP group, trunk mass (β = -0.369, p = 0.04) and self-efficacy (β = 0.450, p = 0.02) predicted TTF. In sum, self-efficacy consistently predicts performance, while trunk mass appears to negatively influence TTF only for those with recurrent LBP.
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Affiliation(s)
- Megan E Applegate
- John A. Paulson School of Engineering and Applied Sciences, Wyss Institute for Biologically Inspired Engineering, Harvard University, USA.
| | | | - David W Russ
- School of Rehabilitation and Communication Sciences, Division of Physical Therapy, Ohio University, USA
| | - Samuel T Leitkam
- School of Physical & Occupational Therapy, Department of Kinesiology and Physical Education, McGill University, Canada
| | - James S Thomas
- School of Rehabilitation and Communication Sciences, Division of Physical Therapy, Ohio University, USA
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18
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A Comparison of Isolated Lumbar Extension Strength Between Healthy Asymptomatic Participants and Chronic Low Back Pain Participants Without Previous Lumbar Spine Surgery. Spine (Phila Pa 1976) 2018; 43:E1232-E1237. [PMID: 29689006 DOI: 10.1097/brs.0000000000002701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional case-control study. OBJECTIVE To compare isolated lumbar extension strength between healthy asymptomatic participants and participants with chronic low back pain (CLBP), while controlling for previous lumbar spine surgery. SUMMARY OF BACKGROUND DATA Deconditioning of the lumbar musculature is common in those with previous lumbar surgery, resulting in decreased strength and endurance. Evidence is required to support whether this is the case for participants with CLBP yet no previous surgery compared with asymptomatic participants. METHODS Forty-two healthy (25 males and 17 females) asymptomatic participants, and 53 participants with non-specific CLBP (30 males and 23 females) aged between 19 and 76 years were recruited. Maximal isometric isolated lumbar extension (ILEX) strength was examined. RESULTS A Mann-Whitney U test indicated that ILEX strength was significantly greater in the asymptomatic group compared with the CLBP group (Z = 1441.00, P = 0.014). Post-hoc effect size was calculated to be d = 0.56, showing a moderate effect. CONCLUSION These results indicate that ILEX weakness and lumbar extensor deconditioning is present independent of surgery and may be a factor involved in CLBP. As such, lumbar extensor deconditioning would appear to be a reasonable target for interventions in CLBP. LEVEL OF EVIDENCE 3.
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19
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Valdivieso P, Franchi MV, Gerber C, Flück M. Does a Better Perfusion of Deconditioned Muscle Tissue Release Chronic Low Back Pain? Front Med (Lausanne) 2018; 5:77. [PMID: 29616222 PMCID: PMC5869187 DOI: 10.3389/fmed.2018.00077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/07/2018] [Indexed: 12/19/2022] Open
Abstract
Non-specific chronic low back pain (nsCLBP) is a multifactorial condition of unknown etiology and pathogenesis. Physical and genetic factors may influence the predisposition of individuals to CLBP, which in many instances share a musculoskeletal origin. A reduced pain level in low back pain patients that participate in exercise therapy highlights that disuse-related muscle deconditioning may predispose individuals to nsCLBP. In this context, musculoskeletal pain may be the consequence of capillary rarefaction in inactive muscle as this would lower local tissue drainage and washing out of toxic waste. Muscle activity is translated into an angio-adaptative process, which implicates angiogenic-gene expression and individual response differences due to heritable modifications of such genes (gene polymorphisms). The pathophysiologic mechanism underlying nsCLBP is still largely unaddressed. We hypothesize that capillary rarefaction due to a deconditioning of dorsal muscle groups exacerbates nsCLBP by increasing noxious sensation, reducing muscle strength and fatigue resistance by initiating a downward spiral of local deconditioning of back muscles which diminishes their load-bearing capacity. We address the idea that specific factors such as angiotensin-converting enzyme and Tenascin-C might play an important role in altering susceptibility to nsCLBP via their effects on microvascular perfusion and vascular remodeling of skeletal muscle, inflammation, and pain sensation. The genetic profile may help to explain the individual predisposition to nsCLBP, thus identifying subgroups of patients, which could benefit from ad hoc treatment types. Future therapeutic approaches aimed at relieving the pain associated with nsCLBP should be based on the verification of mechanistic processes of activity-induced angio-adaptation and muscle-perfusion.
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Affiliation(s)
- Paola Valdivieso
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Zürich, Switzerland.,Interdisciplinary Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, Zürich, Switzerland
| | - Martino V Franchi
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Zürich, Switzerland
| | - Christian Gerber
- Orthopedics Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Martin Flück
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Zürich, Switzerland
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20
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Stuart C, Steele J, Gentil P, Giessing J, Fisher JP. Fatigue and perceptual responses of heavier- and lighter-load isolated lumbar extension resistance exercise in males and females. PeerJ 2018; 6:e4523. [PMID: 29576983 PMCID: PMC5858602 DOI: 10.7717/peerj.4523] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/28/2018] [Indexed: 02/05/2023] Open
Abstract
Background There is a lack of research considering acute fatigue responses to high- and low-load resistance training as well as the comparison between male and female responses. Furthermore, limited studies have considered fatigue response testing with the inclusion of perceptions of discomfort and exertion. Methods The present study included males (n = 9; 23.8 ± 6.4 years; 176.7 ± 6.2 cm; 73.9 ± 9.3 kg) and females (n = 8; 21.3 ± 0.9 years; 170.5 ± 6.1 cm; 65.5 ± 10.8 kg) who were assessed for differences in fatigue (i.e., loss of torque at maximal voluntary contraction (MVC)) immediately following isolated lumbar extension (ILEX) exercise at heavy- (HL) and light-(LL) loads (80% and 50% MVC, respectively). Participants also reported perceptual measures of effort (RPE-E) and discomfort (RPE-D) between different resistance training protocols. Results Analysis of variance revealed significantly greater absolute and relative fatigue following LL compared to HL conditions (p < 0.001). Absolute fatigue significantly differed between males and females (p = 0.012), though relative fatigue was not significantly different (p = 0.160). However, effect sizes for absolute fatigue (HL; Males = -1.84, Females = -0.83; LL; Males = -3.11, Females = -2.39) and relative fatigue (HL; Males = -2.17, Females = -0.76; LL; Males = -3.36, Females = -3.08) were larger for males in both HL and LL conditions. RPE-E was maximal for all participants in both conditions, but RPE-D was significantly higher in LL compared to HL (p < 0.001) with no difference between males and females. Discussion Our data suggests that females do not incur the same degree of fatigue as males following similar exercise protocols, and indeed that females might be able to sustain longer exercise duration at the same relative loads. As such females should manipulate training variables accordingly, perhaps performing greater repetitions at a relative load, or using heavier relative loads than males. Furthermore, since lighter load exercise is often prescribed in rehabilitation settings (particularly for the lumbar extensors) it seems prudent to know that this might not be necessary to strengthen musculature and indeed might be contraindicated to avoid the increased fatigue and discomfort associated with LL exercise.
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Affiliation(s)
- Charlotte Stuart
- School of Sport, Health and Social Sciences, Southampton Solent University, United Kingdom
| | - James Steele
- School of Sport, Health and Social Sciences, Southampton Solent University, United Kingdom
| | - Paulo Gentil
- Faculty of Physical Education and Dance, Universidade Federal de Goiás, Brazil
| | - Jürgen Giessing
- Institute of Sport Science, University of Koblenz-Landau, Germany
| | - James P Fisher
- School of Sport, Health and Social Sciences, Southampton Solent University, United Kingdom
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21
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Behennah J, Conway R, Fisher J, Osborne N, Steele J. The relationship between balance performance, lumbar extension strength, trunk extension endurance, and pain in participants with chronic low back pain, and those without. Clin Biomech (Bristol, Avon) 2018; 53:22-30. [PMID: 29407352 DOI: 10.1016/j.clinbiomech.2018.01.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/25/2018] [Accepted: 01/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic low back pain is associated with lumbar extensor deconditioning. This may contribute to decreased neuromuscular control and balance. However, balance is also influenced by the hip musculature. Thus, the purpose of this study was to examine balance in both asymptomatic participants and those with chronic low back pain, and to examine the relationships among balance, lumbar extension strength, trunk extension endurance, and pain. METHODS Forty three asymptomatic participants and 21 participants with non-specific chronic low back pain underwent balance testing using the Star Excursion Balance Test, lumbar extension strength, trunk extension endurance, and pain using a visual analogue scale. FINDINGS Significant correlations were found between lumbar extension strength and Star Excursion Balance Test scores in the chronic low back pain group (r = 0.439-0.615) and in the asymptomatic group (r = 0.309-0.411). Correlations in the chronic low back pain group were consistently found in posterior directions. Lumbar extension strength explained ~19.3% to ~37.8% of the variance in Star Excursion Balance Test scores for the chronic low back pain group and ~9.5% to ~16.9% for the asymptomatic group. INTERPRETATION These results suggest that the lumbar extensors may be an important factor in determining the motor control dysfunctions, such as limited balance, that arise in chronic low back pain. As such, specific strengthening of this musculature may be an approach to aid in reversing these dysfunctions.
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Affiliation(s)
- Jessica Behennah
- School of Sport, Health, and Social Sciences, Southampton Solent University, Southampton, UK
| | - Rebecca Conway
- School of Sport, Health, and Social Sciences, Southampton Solent University, Southampton, UK
| | - James Fisher
- School of Sport, Health, and Social Sciences, Southampton Solent University, Southampton, UK
| | - Neil Osborne
- AECC Clinic, Anglo European College of Chiropractic, Bournemouth, UK
| | - James Steele
- School of Sport, Health, and Social Sciences, Southampton Solent University, Southampton, UK.
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22
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Steele J, Fisher J, Perrin C, Conway R, Bruce-Low S, Smith D. Does change in isolated lumbar extensor muscle function correlate with good clinical outcome? A secondary analysis of data on change in isolated lumbar extension strength, pain, and disability in chronic low back pain. Disabil Rehabil 2018; 41:1287-1295. [DOI: 10.1080/09638288.2018.1424952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- James Steele
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - James Fisher
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - Craig Perrin
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - Rebecca Conway
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - Stewart Bruce-Low
- School of Sport, Health and Social Science, Southampton Solent University, Southampton, UK
| | - Dave Smith
- Department of Exercise and Sport Science, Manchester Metropolitan University, Manchester, UK
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Schoenfeld B, Kolber MJ, Contreras B, Hanney WJ. Roman Chair Back Extension Is/Is Not a Safe and Effective Exercise? Strength Cond J 2017. [DOI: 10.1519/ssc.0000000000000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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