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Proulx L, Brizzolara K, Thompson M, Wang-Price S, Rodriguez P, Koppenhaver S. Women with Chronic Pelvic Pain Demonstrate Increased Lumbopelvic Muscle Stiffness Compared to Asymptomatic Controls. J Womens Health (Larchmt) 2023; 32:239-247. [PMID: 36450120 DOI: 10.1089/jwh.2022.0198] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Although lumbopelvic muscle stiffness is commonly clinically assessed in women with chronic pelvic pain (CPP), it has not been objectively quantified in this population, and its association with other pain-related impairments has not yet been established. Objective: To compare superficial lumbopelvic muscle stiffness in women with and without CPP. In addition, pressure pain threshold (PPT) was compared between groups and the associations between muscle stiffness and PPT were assessed in women with CPP. Study Design: Case-control. Methods: Muscle stiffness and PPT of 11 lumbopelvic muscles were assessed in 149 women with CPP and 48 asymptomatic women. Subjective outcome measures, including pelvic floor function, health history, and psychosocial outcomes, were collected before muscle stiffness and PPT measurements. Analysis of covariance was used to compare muscle stiffness differences between groups, and independent t-tests were used to compare PPT between groups. Associations between measurements of PPT and muscle stiffness were calculated using correlation analysis. Results: Five of the 11 muscles measured were significantly stiffer in women with CPP than those without CPP (p < 0.05). PPT was significantly decreased in all muscles measured in women with CPP; however, there was not a significant association between muscle stiffness and PPT in women with CPP. Conclusion: The study identified the abdominal lumbopelvic muscles that have increased stiffness in women with CPP compared to asymptomatic women. In addition, muscle stiffness and PPT are two distinct impairments within this population. The results suggest that women with CPP have peripheral muscle impairments, which may be addressed without intravaginal or intrarectal intervention. Clinical Trial Registration: NCT04851730.
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Affiliation(s)
- Laurel Proulx
- School of Physical Therapy, Rueckert-Hartman College of Health Professions, Regis University, Denver, Colorado, USA
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Alshehre YM, Alkhathami K, Brizzolara K, Weber M, Wang-Price S. Effectiveness of Spinal Stabilization Exercises on Dynamic Balance in Adults with Chronic Low Back Pain. Int J Sports Phys Ther 2023; 18:173-187. [PMID: 36793561 PMCID: PMC9897002 DOI: 10.26603/001c.68075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background Dynamic balance is a vital aspect of everyday life. It is important to incorporate an exercise program that is useful for maintaining and improving balance in patients with chronic low back pain (CLBP). However, there is a lack of evidence supporting the effectiveness of spinal stabilization exercises (SSEs) on improving dynamic balance. Purpose To determine the effectiveness of SSEs on dynamic balance in adults with CLBP. Study Design A double-blind randomized clinical trial. Methods Forty participants with CLBP were assigned randomly into either an SSE group or a general exercise (GE) group, which consisted of flexibility and range-of-motion exercises. Participants attended a total of four to eight supervised physical therapy (PT) sessions and performed their assigned exercises at home in the first four weeks of the eight-week intervention. In the last four weeks, the participants performed their exercises at home with no supervised PT sessions. Participants' dynamic balance was measured using the Y-Balance Test (YBT) and the normalized composite scores, Numeric Pain Rating Scale and Modified Oswestry Low Back Pain Disability Questionnaire scores were collected at baseline, two weeks, four weeks, and eight weeks. Results A significant difference between groups from two weeks to four weeks (p = 0.002) was found, with the SSE group demonstrating higher YBT composite scores than the GE group. However, there were no significant between-group differences from baseline to two weeks (p =0.098), and from four weeks to eight weeks (p = 0.413). Conclusions Supervised SSEs were superior to GEs in improving dynamic balance for the first four weeks after initiating intervention in adults with CLBP. However, GEs appeared to have an effect equivalent to that of SSEs after 8-week intervention. Levels of Evidence 1b.
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Affiliation(s)
- Yousef M Alshehre
- Physical Therapy Department, Faculty of Applied Medical Sciences University of Tabuk, Saudi Arabia
| | | | - Kelli Brizzolara
- School of Physical Therapy Texas Woman's University, Dallas, Texas, USA
| | - Mark Weber
- School of Physical Therapy Texas Woman's University, Dallas, Texas, USA
| | - Sharon Wang-Price
- School of Physical Therapy Texas Woman's University, Dallas, Texas, USA
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Alkhathami K, Alshehre Y, Brizzolara K, Weber M, Wang-Price S. Effectiveness of Spinal Stabilization Exercises on Movement Performance in Adults with Chronic Low Back Pain. Int J Sports Phys Ther 2023; 18:169-172. [PMID: 36793568 PMCID: PMC9897033 DOI: 10.26603/001c.68024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/23/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction Low back pain (LBP) is a musculoskeletal disorder that affects more than 80% of people in the United States at least once in their lifetime. LBP is one of the most common complaints prompting individuals to seek medical care. The purpose of this study was to determine the effects of spinal stabilization exercises (SSEs) on movement performance, pain intensity, and disability level in adults with chronic low back pain (CLBP). Methods Forty participants, 20 in each group, with CLBP were recruited and randomly allocated into one of two interventions: SSEs and general exercises (GEs). All participants received their assigned intervention under supervision one to two times per week for the first four weeks and then were asked to continue their program at home for another four weeks. Outcome measures were collected at baseline, two weeks, four weeks, and eight weeks, including the Functional Movement ScreenTM (FMSTM), Numeric Pain Rating Scale (NPRS), and Modified Oswestry Low Back Pain Disability Questionnaire (OSW) scores. Results There was a significant interaction for the FMSTM scores (p = 0.016), but not for the NPRS and OSW scores. Post hoc analysis showed significant between-group differences between baseline and four weeks (p = 0.005) and between baseline and eight weeks (p = 0.026) favor SSEs over GEs. Further, the results demonstrated that all participants, regardless of group, had significant improvements in movement performance, pain intensity, and disability level over time. Conclusion The results of the study favor SSEs over GEs in improving movement performance for individuals with CLBP, specifically after four weeks of the supervised SSE program.
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Affiliation(s)
| | | | | | - Mark Weber
- School of Physical Therapy Texas Woman's University
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Alshehre Y, Alkhathami K, Brizzolara K, Weber M, Wang-Price S. Reliability and Validity of the Y-balance Test in Young Adults with Chronic Low Back Pain. Int J Sports Phys Ther 2021; 16:628-635. [PMID: 34123515 PMCID: PMC8169036 DOI: 10.26603/001c.23430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Individuals with chronic low back pain (CLBP) may demonstrate reduced ability to perform dynamic tasks due to fear of additional pain and injury in response to the movement. The Y-balance test (YBT) is a functional and inexpensive test used with various populations. However, the reliability and validity of the YBT used for assessing dynamic balance in young adults with CLBP have not yet been examined. PURPOSE To determine the inter-rater reliability of the YBT and to compare dynamic balance between young adults with CLBP and an asymptomatic group. STUDY DESIGN Reliability and validity study. METHODS Fifteen individuals with CLBP (≥ 12 weeks) and 15 age- and gender-matched asymptomatic adults completed the study. Each group consisted of 6 males and 9 females who were 21-38 years of age (27.47 ± 5.0 years). The YBT was used to measure participant's dynamic balance in the anterior (ANT), posteromedial (PM) and posterolateral (PL) reach directions. The scores for each participant were independently determined and recorded to the nearest centimeter by two raters. Both the YBT reach distances and composite scores were collected from the dominant leg of asymptomatic individuals and the involved side of participants with CLBP and were used for statistical analysis. RESULTS The YBT demonstrated excellent inter-rater reliability, with intraclass correlation coefficients ranging from 0.99 to 1.0 for the YBT scores of both asymptomatic and CLBP groups. The CLBP group had lower scores than those of the asymptomatic group in the reach distances of the ANT (p = 0.023), PM (p < 0.001), and PL (p = 0.001) directions, and the composite scores (p < 0.001). CONCLUSIONS The results demonstrated excellent inter-rater reliability and validity of the YBT for assessing dynamic balance in the CLBP population. The YBT may be a useful tool for clinicians to assess dynamic balance deficits in patients with CLBP. LEVEL OF EVIDENCE 2b.
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Alkhathami K, Alshehre Y, Wang-Price S, Brizzolara K. Reliability and Validity of the Functional Movement Screen™ with a Modified Scoring System for Young Adults with Low Back Pain. Int J Sports Phys Ther 2021; 16:620-627. [PMID: 35655963 PMCID: PMC9135473 DOI: 10.26603/001c.23427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background Low back pain (LBP) is one of the most common complaints in individuals who seek medical care and is a leading cause of movement impairments. The Functional Movement Screen (FMS™) was developed to evaluate neuromuscular impairments during movement. However, the reliability and validity of the FMS™ have not yet been established for the LBP population because of a limitation of its original scoring system. Purpose The purposes of this study were to determine the reliability and validity of the FMS™ with a modified scoring system in young adults with and without LBP. The FMS™ scores were modified by assigning a zero score only when there was an increase in LBP during the FMS™, not simply for the presence of pain, as in the original FMS™ scoring system. Study Design Reliability and validity study. Methods Twenty-two participants with LBP (8 males and 14 females, 26.7 ± 4.68 years old) and 22 age- and gender-matched participants without LBP (26.64 ± 4.20 years old) completed the study. Each participant performed the FMS™ once while being scored simultaneously and independently by two investigators. In addition, each participant's FMS™ performance was video-recorded and then was scored by another two investigators separately. The video-recorded performance also was scored twice six weeks apart by the same investigator to determine intra-rater reliability. Results The results showed excellent inter-rater and intra-rater reliability of the FMS™ composite score with intraclass correlation coefficients ranging from 0.93 to 0.99 for both groups. In addition, the LBP group scored significantly lower than the group without LBP (p = 0.008). Conclusions The results indicate that the FMS™ is able to distinguish between individuals with and without LBP, and that it could be a useful test for clinicians to quantify movement quality and to assess movement restrictions in individuals with LBP. Levels of Evidence 2b.
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Wang-Price S, Zafereo J, Couch Z, Brizzolara K, Heins T, Smith L. Short-term effects of two deep dry needling techniques on pressure pain thresholds and electromyographic amplitude of the lumbosacral multifidus in patients with low back pain - a randomized clinical trial. J Man Manip Ther 2020; 28:254-265. [PMID: 31960773 DOI: 10.1080/10669817.2020.1714165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objectives: The purpose of this study was to compare the effects of deep dry needling (DN) with and without needle manipulation on pressure pain thresholds (PPTs) and electromyographic (EMG) amplitude of the lumbosacral multifidus (LM) in adults with low back pain (LBP). Methods: Participants were randomized into two treatment groups: with needle manipulation (n = 21) and without needle manipulation (n = 21). All participants received a single session of the assigned DN intervention. PPTs and EMG amplitude of the LM muscle were collected three times: before DN, immediately after DN, and one week after DN. Results: The needle manipulation group had a significantly greater increase in PPT immediately after the intervention and at the one-week follow-up as compared to the no needle manipulation group. The increase of PPT in the needle manipulation group was significant immediately after the intervention, and the increase remained significant at the one-week follow-up. However, there was no significant difference in EMG amplitude of the LM muscle between groups across the three time points. Discussion: Deep DN with needle manipulation appeared to reduce mechanical pressure sensitivity more than DN without manipulation for patients with LBP. Although a single session of DN could reduce pressure pain sensitivity, it may not be sufficient to improve LM muscle function. Level of Evidence: 1b. Trial registration numbers: NCT03970486.
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Affiliation(s)
- Sharon Wang-Price
- School of Physical Therapy, Texas Woman's University , Dallas, TX, USA
| | - Jason Zafereo
- Department of Physical Therapy, University of Texas Southwestern Medical Center , Dallas, TX, USA
| | - Zach Couch
- School of Physical Therapy, Texas Woman's University , Dallas, TX, USA.,Texas Physical Therapy Specialists, Dallas, TX, USA
| | - Kelli Brizzolara
- School of Physical Therapy, Texas Woman's University , Dallas, TX, USA
| | - Taylor Heins
- School of Physical Therapy, Texas Woman's University , Dallas, TX, USA
| | - Lindsey Smith
- School of Physical Therapy, Texas Woman's University , Dallas, TX, USA
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Cookinham B, Swank C, Weber M, Medley A, Brizzolara K. Concussion History, Career Status and Cumulative Years of Football Exposure Influence Concussion Assessment Performance in Elite Football Players. Neurology 2019. [DOI: 10.1212/01.wnl.0000581000.90689.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo explore relationship of concussion history, career status, and cumulative years of contact football exposure on total symptoms, symptom severity, neurocognitive function, and balance in elite football players.Background61% of retired football players report sustaining a concussion during their professional career. However, the influence of concussion history, career status and cumulative years played on total symptoms, symptom severity, neurocognitive function, and balance is largely unexplored.Design/MethodsElite football players (n = 102; age M = 27.75 ± 6.95 years) without a concussion (>30 days) underwent SCAT-3 assessments. Players were placed into a low (0–1) or multiple concussion (2+) history group and categorized by career status (draft prospects, active professional players and retired professional players). Data were analyzed using negative binomial regression and multiple linear regression analyses.Results58.8% of players reported symptoms. Most common symptoms were fatigue (33.3%), trouble falling asleep (31.4%), difficulty remembering (29.4%), and difficulty concentrating (20.6%). Multiple concussions group reported 3.07 times greater total symptoms (p < 0.001), 3.58 times higher symptom severity (p < 0.001), and lower SAC scores (1.42 points) (p = 0.033) compared to low concussion group. Professionals reported 1.88 times greater total symptoms (p = .038) and 2.35 times higher symptom severity compared to draft prospects (p = 0.001). Retired players reported 7.07 times greater total symptoms (p < 0.001), 8.97 times higher symptom severity (p < 0.001), lower SAC scores (1.98 points) (p = 0.025), and 3.67 more m-BESS errors (p = 0.002), compared to draft prospects. Players with 11–19 years football exposure reported 3.83 times higher symptom severity compared to players with <11 years football exposure (p = 0.001). Players with >19 years football exposure had 6.87 times higher symptom severity than players with <11 years football exposure (p < .001).ConclusionsRetired players with multiple concussions and 19+ years of contact football exposure are likely to have more symptoms, higher symptom severity, and lower neurocognitive scores.
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Wang-Price S, Zafereo J, Brizzolara K, Mackin B, Lawson L, Seeger D, Lawson S. Psychometric Properties of Pressure Pain Thresholds Measured in 2 Positions for Adults With and Without Neck-Shoulder Pain and Tenderness. J Manipulative Physiol Ther 2019; 42:416-424. [PMID: 31337510 DOI: 10.1016/j.jmpt.2018.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/11/2018] [Accepted: 11/02/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the psychometric properties of pressure pain threshold (PPT) testing in adults with and without neck-shoulder pain and tenderness and to compare the differences in PPT measurements between the seated and prone positions. METHODS Thirty asymptomatic adults and 30 symptomatic patients with intermittent neck-shoulder pain and tenderness completed the study. A pressure algometer was used to assess PPTs at specific points on the middle deltoid, levator scapulae, and upper trapezius muscles of the dominant side of the asymptomatic individuals and the painful side of the patients. Four trials were performed on each muscle in both the seated and prone positions. To determine between-day reliability, a subset of the participants returned to repeat the testing. RESULTS The intraclass correlation coefficients showed good to excellent within-session reliability and fair to excellent between-day reliability of PPT measurements in both the seated and prone positions for both groups. There were significant differences between groups for all muscles in both positions (P < .05) except for the upper trapezius muscle in the prone position. In addition, significant differences were found between the 2 testing positions for the middle deltoid and upper trapezius muscles in the symptomatic group and for the middle deltoid muscle in the asymptomatic group. CONCLUSION The results of the study suggest that PPT testing could be useful for distinguishing individuals with and without neck-shoulder pain and tenderness. Further, the patient's position should be considered when testing PPT, specifically at the middle deltoid or upper trapezius muscles.
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Affiliation(s)
- Sharon Wang-Price
- School of Physical Therapy, Texas Woman's University, Dallas, Texas.
| | - Jason Zafereo
- Department of Physical Therapy, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kelli Brizzolara
- School of Physical Therapy, Texas Woman's University, Dallas, Texas
| | - Brendan Mackin
- School of Physical Therapy, Texas Woman's University, Dallas, Texas
| | - Larry Lawson
- School of Physical Therapy, Texas Woman's University, Dallas, Texas
| | - Dayna Seeger
- School of Physical Therapy, Texas Woman's University, Dallas, Texas
| | - Shannon Lawson
- School of Physical Therapy, Texas Woman's University, Dallas, Texas
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Hannon J, Wang-Price S, Swank C, Brizzolara K, Garrison C, Bothwell J, Bush C. The validity and reliability of the Vail Sport Test™ as a measure of performance following anterior cruciate ligament reconstruction. Phys Ther Sport 2019; 38:162-169. [PMID: 31158740 DOI: 10.1016/j.ptsp.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the validity and inter-session reliability of the Vail Sport Test™. DESIGN Cohort study-exploratory methodological research design. SETTING Clinical Research Laboratory. PARTICIPANTS Forty-eight participants who underwent ACL-R. MAIN OUTCOME MEASURE Participants performance on the Vail Sport Test™ was graded by an experienced rater in real-time, and simultaneously recorded by a three-dimensional (3D) motion capture system. Construct validity was assessed using the reference standards of the camera system and the IKDC short form. To determine the between-day reliability, a subset of participants returned to repeat the test. RESULTS There were no significant difference between the scores collected in real-time and from the kinematic data on the involved limb (p = 0.222). There was a significant difference for the uninvolved limb (p = 0.015). There was no significant difference between the scores collected in real time and those of the IKDC (p = 0.885). Good inter-session reliability (ICC = 0.787) was found for the involved limb. CONCLUSION The results of this study showed good reliability and partially support the validity of the Vail Sport Test as a measure of readiness to return to play.
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Affiliation(s)
- Joseph Hannon
- Texas Health Sports Medicine, 6301 Harris Pkwy, Suite 150, Fort Worth, TX, 76132, United States.
| | - Sharon Wang-Price
- Texas Womans University, 5500 Southwestern Medical Ave, Dallas, TX, 75235, United States.
| | - Chad Swank
- Texas Womans University, 5500 Southwestern Medical Ave, Dallas, TX, 75235, United States.
| | - Kelli Brizzolara
- Texas Womans University, 5500 Southwestern Medical Ave, Dallas, TX, 75235, United States.
| | - Craig Garrison
- 800 5th Ave, Suite 150, Texas Health Sports Medicine, Fort Worth, TX, 76104, United States.
| | - James Bothwell
- Texas Health Physician Group, 6301 Harris Pkwy, Suite 250, Fort Worth, TX, 76132, United States.
| | - Curtis Bush
- Texas Health Physician Group, 800 5th Ave, Suite 100, Fort Worth, TX, 76104, United States.
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Alshehre YM, Alkhathami K, Brizzolara K, Wang-Price S. Side Differences in the Y-Balance Test Performance in Patients with Unilateral Low Back Pain. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562955.26883.0c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wang-Price S, Zafereo J, Brizzolara K, Anderson E. Effects of tactile feedback on lumbar multifidus muscle activity in asymptomatic healthy adults and patients with low back pain. J Bodyw Mov Ther 2018; 22:956-962. [PMID: 30368341 DOI: 10.1016/j.jbmt.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/06/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Reduced lumbar multifidus (LM) muscle contraction has been observed in patients with low back pain (LBP). Clinicians often use various strategies to ensure LM activation, including tactile feedback and verbal instruction. However, the effects of tactile feedback on muscle activation have not been studied previously. Therefore, the purpose of this study was to investigate whether or not tactile feedback would increase LM muscle activity in adults with and without LBP. METHODS Twenty asymptomatic adults and 20 patients with existing LBP completed the study. Two electromyographic (EMG) electrodes were applied to both sides of the LM at the L5 segment. EMG activity was collected three times at rest with and without tactile feedback, then five times during contralateral arm lifts with and without tactile feedback. The tactile feedback was applied by direct and continuous hand contact to the bilateral LM over the lumbosacral area. Lastly, two 5-second trials of maximum voluntary isometric contraction (MVIC) during a bilateral arm lift were performed. EMG activity collected at rest and during contralateral arm lifts was normalized to that collected during MVIC. Normalized EMG values of the right side of the asymptomatic group and the painful side of the LBP group were used for data analysis. RESULTS Statistical analysis showed significantly decreased LM EMG activity with tactile feedback both at rest and during contralateral arm lifts compared to LM EMG activity without tactile feedback. There was no difference in LM EMG between the asymptomatic and the LBP groups. CONCLUSIONS The results of the study showed that adding tactile stimulation to verbal instruction appeared to provide an inhibitory effect on LM activity in both asymptomatic healthy adults and patients with LBP. Contrary to common belief, tactical feedback via direct hand contact may reduce LM muscle recruitment, and may lessen the desired treatment effect.
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Affiliation(s)
- Sharon Wang-Price
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA.
| | - Jason Zafereo
- Department of Physical Therapy, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kelli Brizzolara
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
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Zafereo J, Wang-Price S, Roddey T, Brizzolara K. Regional manual therapy and motor control exercise for chronic low back pain: a randomized clinical trial. J Man Manip Ther 2018. [DOI: 10.1080/10669817.2018.1433283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Jason Zafereo
- Department of Physical Therapy, University of Texas Southwestern Medical Center , Dallas, TX, USA
| | - Sharon Wang-Price
- School of Physical Therapy, Texas Woman’s University , Dallas, TX, USA
| | - Toni Roddey
- School of Physical Therapy, Texas Woman’s University , Dallas, TX, USA
| | - Kelli Brizzolara
- School of Physical Therapy, Texas Woman’s University , Dallas, TX, USA
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Wang-Price S, Zafereo J, Brizzolara K, Sokolowski L, Turner D. Effects of different verbal instructions on change of lumbar multifidus muscle thickness in asymptomatic adults and in patients with low back pain. J Man Manip Ther 2016; 25:22-29. [PMID: 28855789 DOI: 10.1179/2042618615y.0000000021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 09/01/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Spinal stabilisation exercise has been shown to be effective in the rehabilitation of low back pain (LBP). Due to the isometric nature of spinal stabilisation exercise, manual therapists use various verbal instructions to elicit lumbar multifidus muscle contraction. OBJECTIVES The purpose of this study was to assess whether or not three verbal instructions would alter muscle thickness of the lumbar multifidus muscle differently in asymptomatic individuals and patients with LBP. METHODS Three verbal instructions were selected for this study: (1) swell the muscle underneath the transducer, (2) draw your belly button in towards your spinal column and (3) think about tilting your pelvis but without really doing it. Lumbar multifidus muscle thickness was determined using parasagittal ultrasound (US) imaging. Measurements of muscle thickness were collected at rest and during verbal instructions from 21 asymptomatic adults and 21 patients with LBP. Percent changes of muscle thickness during contraction and at rest were compared between groups and across verbal instructions. RESULTS ANOVA results showed no significant interaction for both L4-5 and L5-S1, but a significant main effect of verbal instruction (P = 0.049) at L4-5.Post hoc analysis showed a greater increase with verbal instruction #3 than verbal instruction #2 (P = 0.009). There was no significant main effect of group at either segment. DISCUSSION The results of the study suggest that both groups responded similarly to the three verbal instructions. Verbal instructions may increase lumbar multifidus muscle thickness by different amounts at L4-5, but by the same amount at L5-S1.
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Affiliation(s)
- Sharon Wang-Price
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
| | - Jason Zafereo
- Department of Physical Therapy, University of Texas Southwestern Medical Center, TX, USA
| | - Kelli Brizzolara
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
| | - Lily Sokolowski
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
| | - Dawn Turner
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
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Brizzolara K, Wang-Price S, Roddey T, Wilson I. The effect of pelvic compression on deep abdominal muscle thickness during the active straight leg raise test. International Journal of Therapy and Rehabilitation 2015. [DOI: 10.12968/ijtr.2015.22.2.60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: The estimated prevalence of sacroiliac joint (SIJ) pain is 13–30% in patients with non-specific low back pain. One common presentation is pain at or near the SIJ, and common physical therapy interventions include lumbopelvic stabilisation programmes and pelvic compression belts. The aim of this study was to: i) assess how compression of the SIJ affects the thickness of the deep abdominal muscles during the active straight leg raise (ASLR); ii) determine between-day intra-tester reliability of ultrasound imaging to assess percentage change in thickness of the deep abdominal muscles. Methods: Participants (n=15) with unilateral symptoms near the SIJ and age-matched and sex-matched controls (n=15) were recruited for this study. Ultrasound imaging was used to obtain the thickness of the transverse abdominis (TrA) and internal oblique (IO) muscles. Measurements were taken at rest and during the ASLR, with and without pelvic compression. Results: Two separate two-way (group × pelvic compression) analysis of variance (ANOVA) designs with repeated measures were used to analyse the thickness of the TrA and IO muscles; interactions were not significant for percentage change in the TrA (p=0.57) or IO (p=0.10) muscles. Intra-tester reliability was higher when testing with pelvic compression and in the control group (ICC: 0.85–0.89 vs 0.70–0.76). Conclusions: Pelvic compression did not immediately affect the muscular response of the TrA or IO muscles during the ASLR. Pelvic compression belts may be used to address the passive systems of the pelvis by increasing stability; however, specific localised exercises may be needed to improve the percentage change in thickness of the deep abdominal muscles during the ASLR.
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Affiliation(s)
- Kelli Brizzolara
- Assistant professor, School of Physical Therapy, Texas Woman's University, Denton, USA
| | - Sharon Wang-Price
- Associate professor and professional programme coordinator, School of Physical Therapy, Texas Woman's University, Denton, USA
| | - Toni Roddey
- Professor and coordinator of research, School of Physical Therapy, Texas Woman's University, Denton, USA
| | - Iseult Wilson
- Lecturer in physiotherapy, School of Health Sciences, University of Ulster, UK
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