The feigned annoyance and frustration test to activate the sympathoadrenal medullary system

When perceived as threatening, social interactions have been shown to trigger the sympathoadrenal medullary system as well as the hypothalamic-pituitary-adrenal axis resulting in a physiologic stress response. The allostatic load placed on human health and physiology in the context of acute and chronic stress can have profound health consequences. The purpose of this study was to develop a protocol for a lab-based stress stimulus using social-evaluative threat. While several valid, stress-stimulating protocols exist, we sought to develop one that triggered a physiologic response, did not require significant lab resources, and could be completed in around 10 min. We included 53 participants (29 men and 24 women) and exposed them to a modified version of the Stroop Color-Word Interference Task during which the participants were made to feel they were performing the task poorly while the lead researcher feigned annoyance and frustration. After exposure to this Feigned Annoyance and Frustration (FAF) Test, both the men and women in this study demonstrated a statistically significant and clinically meaningful increase in subjective stress on the visual analog scale. Additionally, the men in this study demonstrated a statistically significant increase in heart rate and salivary α-amylase concentrations after exposure to the test. The women in this study did not demonstrate a statistically significant increase in the physiologic stress biomarkers. This protocol for the FAF Test shows promise to researchers with limited time and resources who are interested in experimentally activating the sympathoadrenal medullary system.

Comparisons of lumbosacral kinematics among non-specific chronic low back pain subgroups and healthy during prolonged sitting: A cross-sectional observational study

BACKGROUND

The literature has suggested a variety of postural changes of the spine that possibly contribute to the increase in back pain during sitting in persons with non-specific chronic low back pain (NS-CLBP). However, the heterogeneity of NS-CLBP persons has made the ability to attribute pain increase to a particular sitting posture very difficult. Therefore, the purpose of this study was to compare lumbosacral kinematics and their roles in pain increase among homogenous NS-CLBP subgroups and healthy controls over a 1-h sitting period.

METHODS

Twenty NS-CLBP subjects with motor control impairment [10 classified as having flexion pattern (FP) disorder, and 10 with active extension pattern (AEP) disorder], and 10 healthy controls participated in the study. Subjects underwent a 1-h sitting protocol on a standard office chair. Lumbosacral postures including sacral tilt, third lumbar vertebrae (L3) position, and relative lower lumbar angle were recorded using two-dimensional inclinometers over the 1-h period. Perceived back-pain intensity was measured using a visual analog scale every 10 min throughout the sitting period.

RESULTS

All study groups (FP, AEP and healthy controls) significantly differed from each other in the measured lumbosacral kinematics at the beginning as well as at the end of the sitting period (p ≤ 0.05). Only the NS-CLBP subgroups showed significant changes in the lumbosacral kinematics across the 1-h sitting period (p < 0.01), and that the directions of change occurred toward end spinal postures (lumbar kyphosis for FP subgroup and lumbar lordosis for the AEP subgroup). In addition, both NS-CLBP subgroups reported a similarly significant increase in pain through mid-sitting (p < 0.001). However, after mid-sitting, the AEP subgroup reported much less increase in pain level that was accompanied by a significant decrease in the lumbar lordotic postures (p = 0.001) compared to FP subgroup.

CONCLUSION

The present study's findings suggest that each NS-CLBP subgroup presented with differently inherent sitting postures. These inherently dysfunctional postures coupled with the directional changes in the lumbosacral kinematics toward the extreme ranges across the 1-h sitting period, might explain the significant increase in pain among subgroups.

The relationship between kinesiophobia and biomechanics in anterior cruciate ligament reconstructed females

OBJECTIVE

Kinesiophobia has been associated with deleterious biomechanical alterations during dual-limb landing tasks in anterior cruciate ligament (ACL) reconstructed females, however, no research has yet investigated single-limb tasks related to ACL injury. The aim of this investigation was to examine the relationship between kinesiophobia and biomechanics during a series of dual and single-limb functional tasks associated with ACL injury risk.

DESIGN

Cross-sectional study.

PARTICIPANTS

Fifteen females (age = 22.67 ± 2.58yrs, height = 1.65 ±0 .05m, mass = 65.28 ± 10.36 kg) with a history of ACL reconstruction (time post surgery = 3.40 ±0 .74yrs) were recruited for this investigation.

MAIN OUTCOME MEASURES

Kinesiophobia, measured via the Tampa Scale of Kinesiophobia (TSK-11). Kinematics and muscle activation were measured during three functional tasks: the drop jump (DJ), single-limb hop (SLH), and single-limb landing (SLL).

RESULTS

For the DJ task, there was a strong negative correlation between kinesiophobia and knee flexion (r = -.592, p = .20) and between kinesiophobia and trunk flexion (r = -0.724, p = .002). For the SLH task, there was a strong positive correlation between kinesiophobia and hip flexion (r = 0.560, p = .03).

CONCLUSIONS

These findings indicate that kinesiophobia is associated with movement alterations years after completion of ACL reconstruction and rehabilitation.

Non-specific chronic low back pain and physical activity: A comparison of postural control and hip muscle isometric strength: A cross-sectional study

Most research on sedentary lifestyle has focused on pain and disability, while neuromuscular outcomes (postural control and strength) have received less attention. The objective of the study was to determine whether low level of physical activity is negatively associated with measures of lower body muscular strength and postural control in individuals with and without non-specific chronic low back pain (NSCLBP).Twenty-four subjects with NSCLBP (28.8 ± 5.9 years) and 24 age, gender, and body mass index matched healthy controls participated in the study. Subjects were sub-classified into 4 subgroups based on their physical activity level: Non-active NSCLBP; Active NSCLBP; Non-active healthy control; and Active healthy control. Each subgroup consisted of 12 subjects. Peak force of hip muscles strength was assessed using a handheld dynamometer. Postural control was assessed using computerized posturography and the Y Balance Test.There was no significant group by physical activity interaction for strength and static and dynamic postural control, except for static control during left single leg stance with eyes closed (P = .029). However, there was a significant difference in strength and postural control by physical activity (P < .05). Postural control and peak force of hip muscles strength were significantly associated with physical activity (r ranged from 0.50 to 0.66, P < .001 and r ranged from 0.40 to 0.59, P < .05, respectively).Postural control and hip strength were independently related to physical activity behavior. A sedentary behavior may be an important risk factor for impaired postural control and hip muscles strength, and that physical fitness is vital to neuromuscular outcomes.

Effect of Gender, Toe Extension Position, and Plantar Fasciitis on Plantar Fascia Thickness

BACKGROUND:

Ultrasound is a widely used diagnostic tool for patients with plantar fasciitis. However, the lack of standardization during the measurement for plantar fascia thickness has made it challenging to understand the etiology of plantar fasciitis, as well as identify risk factors, such as gender. The purpose of this study was to investigate gender differences regarding plantar fascia thickness while controlling for metatarsophalangeal (MTP) joint position in the healthy and those with unilateral plantar fasciitis.

METHODS:

Forty participants (20 with unilateral plantar fasciitis and 20 controls) with plantar fascia thickness (mean age, 44.8 ± 12.2 years) participated in this study. The majority were females (n = 26, 65%). Plantar fascia thickness was measured via ultrasound 3 times at 3 different MTP joint positions: (1) at rest, (2) at 30 degrees of extension, and (3) at maximal extension.

RESULTS:

When comparing gender differences, the males in the plantar fasciitis group had a significantly thicker plantar fascia than the females ( P = .048, η² = 2.35). However, no significant differences were observed between healthy males and females. The males with unilateral plantar fasciitis also had significantly thicker asymptomatic plantar fasciae collectively compared with controls ( P < .05), whereas females with unilateral plantar fasciitis had a similar but not significant change.

CONCLUSION:

It appears that healthy males and females have similar plantar fascia thickness. However, as plantar fasciitis develops, males tend to develop thicker plantar fasciae than their female counterparts, which could have future treatment implications.

LEVEL OF EVIDENCE:

Level III, case-control comparative study.

Differences in postural stability and dynamic visual acuity among healthy young adults in relation to sports activity: a cross sectional study

[Purpose] Sports activity has been shown to improve postural stability and vestibular function in healthy older adults. The hypothesis was that healthy young adults undertaking sports activity will also have better postural stability and vestibular function compared with healthy young adults who do not undertake sports activity. The purpose of this study was to investigate the differences in postural stability and vestibular function between healthy young adults who undertake sports activity and those who do not undertake such activity. [Participants and Methods] Thirty-nine healthy young adults were recruited and divided into sports and non-sports groups on the basis of their response to a questionnaire concerning regular participation in sports activities over the past 12 months. In both groups, postural stability was measured during quiet standing and standing during head rotation, and dynamic visual acuity was assessed during head rotation. [Results] The results showed significant differences in postural stability during head rotation and dynamic visual acuity between the two groups, whereas no significant differences were found in postural stability during quiet standing. [Conclusion] The results suggest that healthy young adults who undertake sports activity have better postural stability during head rotation and better dynamic visual acuity. The causal effect of these differences is not clear and further investigation is warranted.

The immediate effects of cervical spine manipulation on pain and biochemical markers in females with acute non-specific mechanical neck pain: a randomized clinical trial

Study Design: Randomized clinical trial with pre-test, post-test control group design.

Objectives: To examine the immediate effects of cervical spinal manipulation (CSM) on serum concentration of biochemical markers (oxytocin, neurotensin, orexin A, and cortisol).

Background: Several studies have found an association between spinal manipulation (SM) and pain perception. However, the mechanism by which SM modulates pain remains undefined.

Methods: Twenty-eight female subjects with non-specific mechanical neck pain were randomly assigned to one of two interventions (CSM versus sham CSM). Blood samples were drawn before and immediately after the respective interventions. Oxytocin, neurotensin, orexin A, and cortisol were measured from the blood and serum using the Milliplex Map Magnetic Bead Panel Immunoassay on the Luminex 200 Platform.

Results: In the CSM group, there were significant increases in pre- versus post-manipulation mean oxytocin (154.5 ± 60.1 vs. 185.1 ± 75.6, p = .012); neurotensin (116.0 ± 26.5 vs.136.4 ± 34.1, p < . 001); orexin A (52.2 ± 31.1 vs. 73.8 ± 38.8, p < .01) serum concentration; but no significant differences in mean cortisol (p = .052) serum concentration. In the sham group, there were no significant differences in any of the biomarkers (p > .05).

Conclusion: The results of the current study suggest that the mechanical stimuli provided through a CSM may modify neuropeptide expression by immediately increasing the serum concentration of nociception-related biomarkers (oxytocin, neurotensin, orexin A, but not cortisol) in the blood of female subjects with non-specific mechanical neck pain.

Metatarsophalangeal joint extension changes ultrasound measurements for plantar fascia thickness

Background

Ultrasound is an inexpensive method for quantifying plantar fascia thickness, especially in those with plantar fasciitis. Ultrasound has also been used to assess the effectiveness of various treatments for plantar fasciitis by comparing plantar fascia thickness before and after an intervention period. While a plantar fascia thickness over 4 mm via ultrasound has been proposed to be consistent with plantar fasciitis, some researchers believe the 4 mm plantar fascia thickness level to be a dubious guideline for diagnosing plantar fasciitis due to the lack of standardization of the measurement process for plantar fascia thickness. In particular, no universal guidelines exist on the positioning of the metatarsophalangeal (MTP) joints during the procedure and the literature also has inconsistent protocols. The purpose of this study is to investigate and compare the influence of MTP joint extension on plantar fascia thickness in healthy participants and those with unilateral plantar fasciitis.

Methods

The plantar fascia thickness of forty participants (20 with unilateral plantar fasciitis and 20 control) was measured via ultrasound three times at three different MTP joint positions: 1) at rest, 2) 30° of extension from the plantar surface, and 3) maximal extension possible.

Results

The plantar fascia became significantly thinner as MTP joint extension increased in both the plantar fasciitis group (p < 0.001) and the control group (p < 0.001). In the plantar fasciitis group, the involved plantar fascia was 1.2 to 1.3 mm thicker (p < 0.001) than the uninvolved side depending on the MTP joint position. In the control group, the difference in plantar fascia thickness between the two sides was less than 0.1 mm (p < 0.92) at any MTP joint position.

Conclusions

MTP joint position can influence the ultrasound measurement of plantar fascia thickness. It is recommended that plantar fascia thickness measurements be performed with the toes at rest. If MTP joints must be extended, then the toes should be extended maximally and then noted to ensure subsequent ultrasound procedures are repeated. Standardizing the position of the MTP joints is not only important for attaining the most accurate thickness measurement of the plantar fascia, but is also important to researchers who use plantar fascia thickness to determine the effectiveness of various plantar fasciitis interventions.

The inter-rater reliability of clinical tests that best predict the subclassification of lumbar segmental instability: structural, functional and combined instability

OBJECTIVES

This study investigated the inter-rater reliability of three structural end range lumbar segmental instability tests with the highest positive likelihood ratio (+ LR) against flexion-extension radiographs, and three functional mid-range clinical tests that predict the success of lumbar stabilisation exercises in patients with recurrent or chronic low-back pain (R/CLBP). The study also investigated the reliability of lumbar segmental instability, subclassification as: functional, structural and combined instability.

METHOD

Forty adults with R/CLBP (30 men and 10 women), aged 21-71 years, underwent repeated measurements of specific clinical tests for structural or functional lumbar segmental instability.

RESULTS

All functional-instability tests: the prone instability test (PIT), the aberrant motion test and the average passive straight-leg raise (PSLR>91°) test showed a high percentage agreement (90, 97·5 and 95%, respectively) and a high kappa coefficient (0·71, 0·79 and 0·77, respectively). In addition, two structural tests: the lumbar flexion range of motion (ROM) >53° and the passive lumbar extension test (PLET) showed a high percentage agreement (82 and 73%, respectively), and a moderate kappa coefficient (0·48 and 0·46, respectively). The lack of hypomobility with the posteroanterior (PA) glide test was found to be unreliable (agreement = 25%; k = - 0·02). Locating the pain-provoking segment, as the first portion of PIT, was found to be moderately reliable (k = 0·41). The subclassification categories of lumbar segmental instability (functional, structural and combined) were found to be significantly reliable (PABAK) 0·90, 0·70 and 0·95, respectively).

DISCUSSION

All investigated tests (except the lack of hypomobility with the PA glide test), in addition to subclassifying the categories of lumbar segmental instability, were significantly reliable in the assessment of lumbar instability.

A comparison of whole body vibration and moist heat on lower extremity skin temperature and skin blood flow in healthy older individuals

Background

Tissue healing is an intricate process that is regulated by circulation. Heat modalities have been shown to improve skin circulation. Recent research supports that passive vibration increases circulation without risk of burns. Study purpose is to compare and determine effects of short duration vibration, moist heat, and a combination of the two on skin blood flow (SBF) and skin temperature (ST) in elderly, non-diabetic individuals following short-term exposure.

Material/Methods

Ten subjects, 3 female and 7 male (55–73 years of age), received two interventions over three days: 1 – Active vibration, 2 – passive vibration, 3 – moist heat, 4 – moist heat combined with passive vibration (MHPV), 5 – a commercial massaging heating pad, and 6 – no intervention. SBF and ST were measured using a MOOR Laser Doppler before and after the intervention and the third measurement were taken 10 minutes following.

Results

Mean SBF following a ten-minute intervention were significantly different in the combination of moist heat and passive vibration from the control, active vibration, and the commercial massaging heating pad. Compared to baseline measurements, this resulted in mean SBF elevation to 450% (at conclusion of 10 minutes of intervention) and 379% (10 minutes post). MHPV (p=0.02) showed significant changes in ST from the commercial massaging heating pad, passive vibration, and active vibration interventions.

Conclusions

SBF in the lower legs showed greatest increase with MHPV. Interventions should be selected that are low risk while increasing lower extremity skin blood flow.

The effect of virtual reality gaming on dynamic balance in older adults

BACKGROUND

physical therapy interventions that increase functional strength and balance have been shown to reduce falls in older adults.

AIM

this study compared a virtual reality group (VRG) and a control group (CG).

DESIGN

randomised controlled 6-week intervention with pre- and post-test evaluations.

SETTING

outpatient geriatric orthopaedic and balance physical therapy clinic.

POPULATION

forty participants were randomised into two groups.

METHOD

the VRG received three different Nintendo® Wii FIT balance interventions three times per week for 6 weeks and the CG received no intervention.

RESULTS

compared with the CG, post-intervention measurements showed significant improvements for the VRG in the 8-foot Up & Go test [median decrease of 1.0 versus -0.2 s, (P=0.038) and the Activities-specific Balance Confidence Scale (6.9 versus 1.3%) (P=0.038)].

CONCLUSION

virtual reality gaming provides clinicians with a useful tool for improving dynamic balance and balance confidence in older adults.

A comparison of the effect of a variety of thermal and vibratory modalities on skin temperature and blood flow in healthy volunteers

BACKGROUND

Circulation plays an essential role in tissue healing. Moist heat and warm water immersion have been shown to increase skin circulation; however, these heating modalities can cause burns. Recent research has shown that passive vibration can also increase circulation but without the risk of burns.

MATERIAL/METHODS

The aim of this study is to compare the effects of short-duration vibration, moist heat, and a combination of the two on skin blood flow (SBF) and skin temperature (ST). Ten (10) subjects, 5 female and 5 male, aged 20-30 years of age, received two interventions a day for 3 consecutive days: Intervention 1--Active vibration only (vibration exercise), Intervention 2--passive vibration only, Intervention 3--moist heat only, Intervention 4--passive vibration combined with moist heat, Intervention 5--a commercial massaging heating pad, and Intervention 6--no intervention, resting in supine only (control). SBF and ST were measured using a laser Doppler imager during the 10 minute intervention and then throughout the nine minute recovery period.

RESULTS

The mean skin blood flow following a ten-minute intervention of the combination of passive vibration and moist heat was significantly different from the control, active vibration, and the commercial massaging heating pad. Skin temperature following the ten-minute interventions of moist heat alone and passive vibration alone were both significantly different from the commercial massaging heating pad and active vibration interventions.

CONCLUSIONS

The combination of passive vibration and moist heat produced the greatest increase in skin blood flow and the second highest increase in skin blood flow nine minutes post application.

The Immediate Effects of a Novel Auditory and Proprioceptive Training Device on Gait after Stroke

This case report describes the immediate effects of a new rehabilitation tool on gait in a chronic stroke patient. Specifically, we measured step length symmetry and gait velocity in a 47 year-old male stroke patient who was currently receiving outpatient physical therapy. Objective gait measurements were taken using the GAITRite before, during, and after a 5 minute training session. Step length symmetry improved 26% during the first minute of training, 71% by the fifth minute of training, and 72% after a 5 minute rest period post-training. Gait velocity increased by 5.5% after 5 minutes of training. Clinical research is warranted to validate this new training tool as a useful adjunctive rehabilitation activity for improving spatial and temporal aspects of gait after stroke.

Effect of oculo-motor and gaze stability exercises on postural stability and dynamic visual acuity in healthy young adults

The purpose of this study was to investigate the effectiveness of oculo-motor exercises and gaze stability exercises on postural stability and dynamic visual acuity (DVA) in healthy young adults. Subjects were randomly divided into experimental (n=28) and control groups (n=13). The experimental group performed oculo-motor exercises and gaze stability exercise for three weeks and the control group did not. Pre and post postural stability during quiet standing, standing with active head rotation, and DVA were measured on both groups. Significant differences were found in postural stability during standing with active head rotation and DVA in the experimental group (p<0.05). No significant differences were found in postural stability or DVA in the control group. Improvements in postural stability and DVA after three weeks of oculo-motor exercises and gaze stability exercises suggest that this specific type of vestibular and ocular system exercises may be beneficial for healthy young adults.

Magnetically coupled balance platform

The purpose of this study was to develop a new device to assess balance in two planes and then to provide training paradigms for balance abnormalities. Based on the principal of a Biomechanical Ankle Platform System (BAPS) board, the device is different than other devices that are on the market today in that this device allows assessment of balance during body sway movement in the forward\back and side-to-side directions. Like the BAPS board, individuals balance themselves on the board with a pivot in the centre. However, unlike the BAPS board, a variable viscosity magnetic fluid is used to vary the dampening on the board such that the board can be fixed in the forward\back or side-to-side plane. It can also be allowed to move either freely in both planes or with some dampening in any direction. This device offers a major improvement over other balance measuring devices in that it allows movement in multiple planes. It also allows for rapid alterations of movement in any plane to test an individual's ability to maintain their balance against a challenge.

The effect of whole body vibration on lower extremity skin blood flow in normal subjects

BACKGROUND

Circulation plays a vital role in tissue healing. Increases in muscle flexibility and strength, secretion of hormones important in the regeneration and repair process, blood flow, and strength of bone tissues has been attributed to whole body vibration (WBV) combined with exercise. The purpose of the study was to determine the effects of short-duration, high-intensity, isometric weight bearing exercise (vibration exercise [VE]) and vibration only on skin blood flow (SBF).

MATERIAL/METHODS

Forty-five subjects 18-43 years of age were randomly divided into three groups: Group 1 - VE, Group 2 - exercise only, and Group 3 - vibration only. SBF was measured using a laser Doppler imager at three time intervals: 1) initial base line, 2) immediately following intervention, and 3) 10-minutes following intervention.

RESULTS

There was no significant difference between the three groups' SBF prior to intervention. Immediately following the intervention a difference among groups was found. Post hoc testing revealed that Group 3 subjects' mean SBF was significantly increased at both post-intervention time intervals.

CONCLUSION

The study findings suggest that short duration vibration alone significantly increases SBF; doubling mean SBF for a minimum of 10 minutes following intervention. The emerging therapeutic modality of WBV as a passive intervention appears to increase SBF in individuals with healthy microcirculation.

Disability self-assessment and upper quarter muscle balance between female dental hygienists and non-dental hygienists

PURPOSE

The purpose of this pilot study was to compare disability self-assessment and upper quarter muscle balance female dental hygienists and non dental hygienist females. The upper quarter was operationally defined as the shoulder and neck region. Muscle balance was operationally defined as muscle flexibility and muscle performance.

METHODS

A convenience sample of 41 working dental hygienists and 46 non dental hygienists participated in the study. Muscle flexibility of the upper quarter was measured by inclinometry or standard muscle length testing. Muscle performance was measured by timing the duration of four statically maintained positions. Subjects filled out the Northwick Park Neck Pain Questionnaire (NPNPQ), which is a disability self-assessment. Analysis of Covariance (ANCOVA) was used during data analysis to adjust for the mean age difference between the dental hygienist group (38.0 years) and the non-dental hygienist group (29.3 years).

RESULTS

The results of this pilot study suggest that female dental hygienists are more likely than non dental hygienist females to develop tightness in the upper trapezius (p = 0.007) and the levator scapula (p = 0.01) of the non dominant upper quarter and lower fibers of the pectoralis major of the dominant upper quarter (p = 0.03) Muscle performance trends in the dental hygienist group supported muscle balance theory that short muscles remain strong while lengthened muscles become weak. The dental hygienist group had higher disability scores in all nine parts of the NPNPQ compared to the non-dental hygienist group, five of which were statistically significant (p < 0.05).

CONCLUSION

The results of this pilot study suggest that muscle imbalances in the upper quarter are more common in female dental hygienists than in female non dental hygienists and may contribute to the numerous upper quarter pathologies associated with the practice of dental hygiene. Further research is needed to determine if upper quarter strengthening and flexibility exercises performed by dental hygienists can reduce disability self-assessment.