Passion and performance anxiety: How it affects the incidence of musculoskeletal disorders in dancers

OBJECTIVES

This study aimed to examine the association between the incidence of musculoskeletal disorder episodes (MDEs) and obsessive and harmonious passion as well as performance anxiety throughout a dance season, which lasted 38 weeks.

DESIGN

Prospective cohort study.

METHODS

A total of 118 professional and preprofessional dancers were recruited and assessed at baseline, while 88 completed the follow-up. Their levels of passion and performance anxiety were assessed at the beginning of a dance season using the Passion Scale and the Kenny Music Performance Anxiety Inventory, respectively. To monitor the incidence of MDEs throughout a dance season, dancers were asked to complete a weekly electronic diary.

RESULTS

A higher level of obsessive passion was associated with a higher incidence of MDEs causing an interruption of dance activities (β = 0.264, p = 0.022). Harmonious passion and performance anxiety were not associated with MDEs throughout the season.

CONCLUSIONS

Findings of this study support the role of obsessive passion in the development of MDEs in dancers.

Relationship between Motor Corticospinal System, Endogenous Pain Modulation Mechanisms and Clinical Symptoms in Patients with Knee Osteoarthritis: New Perspectives on an Old Disease

Knee osteoarthritis (OA) is a painful condition characterized by joint and bone changes. A growing number of studies suggest that these changes only partially explain the pain experienced by individuals with OA. The purpose of the current study was to evaluate if corticospinal and bulbospinal projection measurements were interrelated in patients with knee OA, and to explore the relationship between these neurophysiological measures and temporal summation (excitatory mechanisms of pain) on one hand, and clinical symptoms on the other. Twenty-eight (28) patients with knee OA were recruited. Corticospinal projections were measured using transcranial magnetic stimulation, while bulbospinal projections were evaluated with a conditioned pain modulation (CPM) protocol using a counter-irritation paradigm. Validated questionnaires were used to document clinical and psychological manifestations. All participants suffered from moderate to severe pain. There was a positive association between corticospinal excitability and the effectiveness of the CPM (rs = 0.67, p = 0.01, n = 13). There was also a positive relationship between pain intensity and corticospinal excitability (rs = 0.45, p = 0.03, n = 23), and between pain intensity and temporal summation (rs = 0.58, p = 0.01, n = 18). The results of this study highlight some of the central nervous system changes that could be involved in knee OA and underline the importance of interindividual variability to better understand and explain the semiology and pathophysiology of knee OA.

Effectiveness of visceral fascial therapy targeting visceral dysfunctions outcome: systematic review of randomized controlled trials

BACKGROUND

Fascial Therapy is an ancient and widespread practice throughout the world. These approaches are very common in osteopathic practice and taught in workshops for professionals from different areas of health care, including Physiotherapy. This type of treatment is quite specialized and centered on the therapist. However, there is a lack of high-quality and low-risk bias studies that justify the use of this practice. Despite this, there is little scientific evidence about the effectiveness of Fascial Therapy to treat some visceral disorders. The purpose of this study was to critically appraise the scientific literature concerning the clinical efficacy of techniques used in Fascial Therapy targeting the visceral system.

METHODS

This systematic review included randomized controlled trials in any language or date of publication. All primary outcomes reported were included. The methodological quality and statistical reporting of each eligible trial were evaluated using the version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). This systematic review provided a synthesis of current evidence on the effects of Fascial Therapy in patients with visceral disorders and/or pain. A total of 11 studies were included, with five of them covering gastrointestinal dysfunction, two covering cardiorespiratory dysfunction, two covering musculoskeletal dysfunction, and two covering urogenital dysfunction.

RESULTS

Fascial Therapy targeting the visceral system has been shown to be effective in reducing pain over the long term in people with low back pain when combined with standard physical therapy and effective in reducing gastroesophageal reflux symptoms over the short term. Considering the overall bias, six studies were at high risk of bias, two studies had some concerns and only three studies were at low risk of bias. Of the three studies with a low risk of bias, only two showed positive results and were effective in improving the studied outcome.

CONCLUSION

This systematic review shows that currently, there is poor evidence for the efficacy of the techniques used in Fascial Therapy targeting the visceral system, and this information can help healthcare professionals in decision-making related to the use of Fascial Therapy targeting the visceral system in patients with visceral disorders and/or pain.

Biopsychosocial factors associated with pain severity and hand disability in trapeziometacarpal osteoarthritis and non-surgical management

BACKGROUND

Trapeziometacarpal osteoarthritis (TMO) is one of the most prevalent and painful forms of hand osteoarthritis.

PURPOSE

This study aimed at (1) describing the TMO pain experience, (2) identifying biopsychosocial factors associated with pain intensity and disability, and 3) documenting the use of non-surgical management modalities.

STUDY DESIGN

Cross-sectional.

METHODS

Participants who presented for care for TMO were recruited from 15 healthcare institutions. They completed a questionnaire addressing sociodemographic, pain, disability, psychological well-being, quality of life (QoL), productivity, and treatment modalities employed. Multivariable regression analyses identified biopsychosocial factors associated with pain intensity and magnitude of disability.

RESULTS

Among our 228 participants aged 62.6 years, 78.1% were women. More than 80% of the participants reported average pain of moderate to severe intensity in the last 7 days. Nearly 30 % of them scored clinically significant levels of anxiodepressive symptoms. The participants' norm-based physical QoL score on the SF-12v2 was 41/100. Among the 79 employed respondents, 13 reported having missed complete or part of workdays in the previous month and 18 reported being at risk of losing their job due to TMO. Factors independently associated with more intense pain included higher pain frequency and greater disability, accounting for 59.0% of the variance. The mean DASH score was 46.1 of 100, and the factors associated with greater magnitude of disability were higher pain intensity, greater levels of depression, female sex, and lower level of education, explaining 60.1% of the variance. Acetaminophen, oral non-steroid anti-inflammatory drugs, cortisone injections, orthoses, hand massage/exercises, and heat/cold application were the most frequently employed modalities. Most participants never used assistive devices, ergonomic techniques, and psychosocial services.

CONCLUSIONS

Patients with TMO can experience severe pain, disability, disturbed emotional well-being, limited QoL and reduced productivity. As disability is associated with TMO pain, and depressive symptoms with disability, reducing such modifiable factors should be one of the clinicians' priorities.

Effect of Conservative Interventions for Musculoskeletal Disorders in Preprofessional and Professional Dancers: A Systematic Review

Background

Preprofessional and professional dancers are among the athletes who sustain the most musculoskeletal disorders. In recent years, conservative treatment and preventive measures have been investigated in this population. However, no systematic review regarding their effectiveness has been conducted.

Hypothesis/Purpose

The aim of this systematic review was to locate, appraise and synthesize the available information on conservative interventions currently used for treating and preventing MSK disorders and their effect on pain and function in preprofessional and professional dancers.

Study design

Systematic review.

Methods

A systematic literature search was conducted using PubMed, CINHAL, ERIC, SportDiscus and Psychology and behavioral science collection. Prospective and retrospective cohort studies, as well as randomized and non-randomized controlled trials investigating conservative interventions for musculoskeletal disorders in preprofessional and professional dancers were included in this study. The main outcome measures included pain intensity, function, and performance. All included studies were evaluated for risk of bias using the Downs and Black checklist.

Results

Eight studies were included in the review. These studies included ballet and contemporary dancers, as well as professional and preprofessional dancers. In total, the studies included 312 dancers, 108 male and 204 female. Studies had a risk of bias that ranged from poor (8/28) to good (21/28) on the Downs and Black checklist. The conservative interventions used included customized toe caps, dry-needling, motor imagery, and strength and conditioning programs. The use of customized toe caps, motor imagery and strength and conditioning programs had promising results regarding pain and function in dancers.

Conclusion

In order to reach a solid conclusion, more quality studies are needed. The addition of control groups to studies, as well as multimodal interventions should be considered.

Level of Evidence

I.

Effects of a Myofascial Technique on the Stiffness and Thickness of the Thoracolumbar Fascia and Lumbar Erector Spinae Muscles in Adults with Chronic Low Back Pain: A Randomized before-and-after Experimental Study

The thoracolumbar fascia (TLF) may be a pain generator, given its rich innervation. Structural and biomechanical changes have also been documented in adults with chronic non-specific low back pain (LBP). Myofascial techniques (MFTs) are commonly used in manual therapy and are hypothesized to reduce tissue stiffness and pain. However, evidence for these effects is limited. The objective of this study was to evaluate the immediate effects of a standardized MFT compared to a simulated MFT on: (1) the stiffness of the TLF and erector spinae muscles (shear-wave sonoelastography), (2) the thickness of the TLF (B-mode ultrasound), and (3) pain intensity (numerical rating scale). Forty-nine participants with chronic non-specific LBP were included in a randomized before-and-after experimental study. Outcome measures were collected before (T0) and immediately after the intervention (T1). Pain intensity was also assessed on day two (T2) and seven (T7). The MFT group showed a significant decrease in left erector spinae muscle stiffness and left TLF thickness compared to the simulated group. In addition, there was a significant reduction in pain intensity in the MFT group compared to the simulated group at T1 and T2. The results of this study suggest that MFT results in immediate tissue changes and transient pain reduction in patients with LBP.

Comparison of Three Motion Capture-Based Algorithms for Spatiotemporal Gait Characteristics: How Do Algorithms Affect Accuracy and Precision of Clinical Outcomes?

Gait assessment is of interest to clinicians and researchers because it provides information about patients' functional mobility. Optoelectronic camera-based systems with gait event detection algorithms are considered the gold standard for gait assessment. Yet, the choice of the algorithm used to process data and extract the desired parameters from those detected gait events has an impact on the validity and reliability of the gait parameters computed. There are multiple techniques documented in the literature for computing gait events, including the analysis of the minimal position of the heel and toe markers, the computation of the relative distance between sacrum and foot markers, and the assessment of the smallest distance between the heel and toe markers. Validation studies conducted on these algorithms report variations in accuracy. Yet, these studies were conducted in different conditions, at varying gait velocities, and on different populations. The purpose of this study is to compare accuracy, precision, and robustness of three algorithms using motion capture data obtained from 25 healthy persons and 21 psoriatic arthritic patients walking at three distinct speeds on an instrumented treadmill. Errors in gait events recognition (heel strike-HS and toe-off-TO) and their impact on gait metrics (stance phase and stride length) are reported and compared to ground reaction force events measured with force plates. Over the 9114 collected steps across all walking speeds, more than 99% of gait events were recognized by all algorithms. On average, HS events were detected within 1.2 ms of the reference for two algorithms, while the third one detected HS late, with an average detection error of 40.7 ms. Yet, significant variations in accuracy were noted with gait speed; the performance decreased for all algorithms at slow speed. TO events were identified early by all algorithms, with an average error ranging from 16.0 to 100.0 ms. These gait events errors lead to 2-15% inaccuracies in stance phase assessment, while the impact on stride length remains below 0.3 cm. Overall, the algorithm based on the relative distance between the sacral and foot markers stood out for its accuracy, precision, and robustness at all walking speeds.

Self-management programs to ensure sustainable return to work following long-term sick leave due to low back pain: A sequential qualitative study

BACKGROUND

Low back pain (LBP) is a prevalent condition frequently leading to disability. Research suggests that self-management (SM) programs for chronic LBP should include strategies to promote sustainable return to work.

OBJECTIVES

This study aimed to 1) validate and prioritize the essential content elements of a SM program in light of the needs of workplace representatives, and 2) identify the main facilitators and barriers to be considered when developing and implementing a SM program delivered via information and communication technologies (ICT).

METHODS

A sequential qualitative design was used. We recruited workplace representatives and potential future users of SM programs (union representatives and employers) and collected data through focus groups and nominal group techniques to validate the relevance of the different elements included into 3 broad categories (Understand, Learn, Apply), as well as to highlight potential barriers and facilitators.

RESULTS

Eleven participants took part in this study. The content elements proposed in the literature for SM programs were found to align with potential future users' needs, with participants ranking the same elements as those proposed in the scientific literature as the most important across all categories. Although some barriers were identified, workplace representatives believed that ICT offer an appropriate strategy for delivering individualized SM programs to injured workers who have returned to work.

CONCLUSION

Our study suggests that the elements identified in the literature as essential components of SM programs designed to ensure a sustainable return to work for people with LBP are in line with the needs of future users.

Targeted exercises can improve biomechanical markers in individuals with knee osteoarthritis: A secondary analysis from a cluster randomized controlled trial

BACKGROUND

It is not clear whether exercise therapy significantly improves knee biomechanics during gait in osteoarthritis (OA) patients. This study aimed to determine whether targeted exercises based on a knee kinesiography exam improve biomechanical markers (BMs) compared with conventional primary care (CPC) management.

METHODS

This was a secondary analysis of a cluster randomized controlled trial in which patients were assigned to one of three groups: (1) Control (CPC), (2) Exercise, and (3) Exercise&Education. Fourteen known BMs in knee OA patients were assessed. The primary outcome was the global evolution ratio (GER), which was calculated as the sum of improved BMs over the sum of deteriorated BMs 6 months after baseline assessment. GER scores were categorized with three different sets of cut-off values into clinical levels: (a) Deteriorated, (b) Stabilized, and (c) Improved. Ordinal logistic regressions were performed on the per-protocol population to determine whether there was a relationship between group assignment and GER levels.

RESULTS

Of the 221 eligible participants, 163 were included. Two different regression models showed that patients from Group 3 (Exercise&Education) were 2.5-times more likely to be in an upper GER level (i.e., Stabilized or Improved) than patients from the control group (both odds ratio (OR) > 2.46, Wald Χ²(1) ≥ 7.268, P ≤ 0.01). They also reported significantly more improvement in pain and function (Knee Injury and Osteoarthritis Outcome Score, both P ≤ 0.01).

CONCLUSIONS

Results suggest that targeted exercises can improve biomechanical markers in knee OA patients compared with CPC treatment. Further studies are needed to confirm these findings and refine the biomechanical markers to address to maximize patients' clinical outcomes.

Movement Competency Screen: Rethinking the Rating

Background

Dancers are at high risk of musculoskeletal disorders. There has been a growing interest in the last few years in pre-season screening using tools to evaluate movement competency, among which is the Movement Competency Screen (MCS). It is currently scored using a categorical 3-level rating system, but this method does not seem to take into account the load level of movements. A 5-level scoring system could potentially alleviate this problem.

Hypothesis/Purpose

For each scoring system, to investigate (1) the internal consistency, and (2) the association with transversus abdominis activation (TrA), hip muscle strength and with Functional Movement screen (FMSTM) total score.

Study design

Secondary analyses of a prospective cohort study.

Methods

One hundred and eighteen professional and preprofessional dancers evolving in ballet or contemporary dance were recruited. The MCS was performed and was scored according to the 3- and 5-level scoring systems. The key variables for movement competency that were considered for convergent validity were the activation ratio of the TrA evaluated with ultrasound imaging and hip strength assessed with a handheld dynamometer. Movement competency was also measured with the FMSTM.

Results

Internal consistency was higher for the 5-level scoring of the MCS items ($*$\alpha$*$=0.548) compared to the 3-level scoring system ($*$\alpha$*$=0.494). Multiple linear regressions showed that TrA activation, hip adductor strength, and FMSTM could significantly explain 24.0% of the variance for the 5-level scoring system of the MCS whereas hip internal rotator strength and FMSTM could explain only 16.4% of the variance for the 3-level scoring system.

Conclusion

The 5-level scoring system showed better metrologic properties in terms of internal consistency and concurrent validity and therefore, should be preferred over the 3-level scoring system in future research.

Level of Evidence

Level III.

Immediate Effect of Dry Needling on the Viscoelastic Properties of a Trigger Point on the Infraspinatus Muscle Measured with MyotonPRO

Purpose: This article investigates the immediate effects of a dry needling (DN) puncture on the viscoelastic properties (tone, stiffness, elasticity) of a trigger point (TP) in the infraspinatus muscle in non-traumatic chronic shoulder pain. Method: Forty-eight individuals with non-traumatic chronic shoulder pain were recruited. The presence of a TP in the infraspinatus muscle was confirmed by a standardized palpatory exam. The viscoelastic properties were measured with a MyotonPRO device at baseline (T1), immediately after DN (T2), and 30 minutes later (T3). A DN puncture was applied to the TP to obtain a local twitch response while performing the technique. Results: Analyses of variance showed significant decreases in tone ( p < 0.001) and stiffness ( p = 0.003) across time after the DN technique. Post hoc tests revealed a significant reduction in tone and stiffness from T1 to T2 ( p ≤ 0.004) and no significant changes from T2 to T3 ( p ≥ 0.10). At T3, only stiffness remained significantly lower compared to T1 ( p = 0.013). Conclusions: This study brings new insights on the immediate mechanical effect of DN on tone and stiffness of TPs. Whether these effects are associated with symptom improvement and long-term effects still needs to be verified.

The effects of custom-made foot orthoses on foot pain, foot function, gait function, and free-living walking activities in people with psoriatic arthritis (PsA): a pre-experimental trial

Introduction

Foot involvement is a significant concern in psoriatic arthritis (PsA) as it can lead to severe levels of foot pain and disability and reduced mobility and quality of life. Previous studies have shown moderate efficacy for custom-made foot orthoses (CFO) in reducing foot pain and disability in people with rheumatoid arthritis. However, evidence on the efficacy of CFO in people with PsA is lacking.

Objectives

To explore the effects of CFO on foot function, foot and lower limb pain, gait function, and free-living walking activities (FWA) in people with PsA.

Methods

A pre-experimental study including twenty participants with PsA (mean age: 54.10 ± 9.06 years and disease duration: 11.53 ± 10.22 years) was carried out. All the participants received and wore CFO for 7 weeks. Foot and lower limb pain and foot function were measured before and after the intervention using the numerical rating scale (NRS) and the foot function index (FFI). Gait function was assessed by recording spatiotemporal parameters (STPs) during a 10-m walk test using an instrumented gait analysis system (Mobility Lab). Free-living walking activities (step count, free-living cadence, time spent in different ambulatory physical activities (APA)) were recorded over 7 days using an accelerometer-instrumented sock.

Results

The FFI reported scores demonstrated severe baseline levels of foot pain (54.46 ± 14.58 %) and disability (46.65 ± 16.14%). Statistically and clinically significant improvements in foot pain and foot function and large effect sizes (Cohen’s effect size > 1, p < 0.005) were observed after the intervention period. A strong correlation (r = −0.64, p < 0.01) between the CFO wearing time and foot function was demonstrated. However, no significant changes were found for gait STP or free-living walking activities after 7 weeks of CFO use.

Conclusion

Results support the clinical and biomechanical plausibility of using CFO in people with PsA to reduce pain and improve foot function. Large-scale and controlled studies are needed to confirm these findings. Moreover, a multidisciplinary approach including the prescription of exercise therapy and physiotherapy combined with CFO could be required to improve STP and promote APA in people with PsA.

Trial registration

ClinicalTrials.gov, NCT05075343. Retrospectively registered on September 29, 2021

Supplementary Information

The online version contains supplementary material available at 10.1186/s13075-022-02808-8.

The Deep Fascia and its Role in Chronic Pain & Pathological Conditions: A Review

INTRODUCTION

The deep fascia is a three-dimensional continuum of connective tissue surrounding the bones, muscles, nerves and blood vessels throughout our body. Its importance in chronically debilitating conditions has recently been brought to light. This work investigates changes in these tissues in pathological settings.

MATERIALS AND METHODS

A state-of-the-art review was conducted in PubMed and Google Scholar following a two-stage process. A first search was performed to identify main types of deep fasciae. A second search was performed to identify studies considering a deep fascia, common pathologies of this deep fascia and the associated alterations in tissue anatomy.

RESULTS

We find that five main deep fasciae pathologies are chronic low back pain, chronic neck pain, Dupuytren's disease, plantar fasciitis and iliotibial band syndrome. The corresponding fasciae are respectively the thoracolumbar fascia, the cervical fascia, the palmar fascia, the plantar fascia and the iliotibial tract. Pathological fascia is characterized by increased tissue stiffness along with alterations in myofibroblast activity and the extra-cellular matrix, both in terms of collagen and Matrix Metalloproteases (MMP) levels. Innervation changes such as increased density and sensitization of nociceptive nerve fibers are observed. Additionally, markers of inflammation such as pro-inflammatory cytokines and immune cells are documented. Pain originating from the deep fascia likely results from a combination of increased nerve density, sensitization and chronic nociceptive stimulation, whether physical or chemical.

CONCLUSIONS

The pathological fascia is characterized by changes in innervation, immunology and tissue contracture. Further investigation is required to best benefit both research opportunities and patient care.

Exploring the Effects of Standardized Soft Tissue Mobilization on the Viscoelastic Properties, Pressure Pain Thresholds, and Tactile Pressure Thresholds of the Cesarean Section Scar

Background:

Objectives of soft tissue mobilization applied to cesarean section (C-section) scars are to decrease stiffness and to reduce pain. Research investigating these effects is lacking.

Materials and methods:

The authors conducted a descriptive, exploratory, proof-of-concept clinical study. Women aged 18 to 40 years who had undergone at least one C-section were recruited. A trained osteopath performed standardized mobilization of the C-section scar once a week for 2 weeks. Scar quality and pain characteristics, viscoelastic properties, pressure pain thresholds, and tactile pressure thresholds were measured before and after each session. Paired Student's t-tests and Friedman's test with Dunn–Bonferroni adjustment were performed to assess the immediate and short-term effects of mobilizations. Kendall's W and Cohen's d were calculated to determine effect sizes over the short term. Simple bootstrapped bias-corrected and accelerated 95% median confidence intervals were computed.

Results:

Thirty-two participants completed the study. The Patient and Observer Scar Assessment Scale questionnaire revealed differences with small and moderate effects for stiffness (p = 0.021, d = 0.43), relief (p < 0.001, d = 0.28), surface area (p = 0.040, d = 0.36), flexibility (p = 0.007, d = 0.52), and participant opinion (p = 0.001, d = 0.62). Mobilizations increased elasticity (p < 0.001, W = 0.11), decreased stiffness (p < 0.001, W = 0.30), and improved pressure pain thresholds (p < 0.001, W = 0.10) of the C-section, with small to moderate effects. The results also showed decreased tone and mechanical stress relaxation time, as well as increased tactile pressure thresholds at the different measurement times (p < 0.05), but trivial effect sizes (W < 0.10). Creep showed trivial effect and no significant difference (p = 0.09).

Conclusion:

This study showed that two sessions of mobilization of C-section scar might have a beneficial effect on some viscoelastic properties of the C-section as well as on pain. Some variables of interest useful for future empirical studies are highlighted.

ClinicalTrial. Gov NCT04320355.

Spatiotemporal parameters and gait variability in people with psoriatic arthritis (PsA): a cross-sectional study

Background

Foot involvement is a major manifestation of psoriatic arthritis (PsA) and can lead to severe levels of foot pain and disability and impaired functional mobility and quality of life. Gait spatiotemporal parameters (STPs) and gait variability, used as a clinical index of gait stability, have been associated with several adverse health outcomes, including risk of falling, functional decline, and mortality in a wide range of populations. Previous studies showed some alterations in STPs in people with PsA. However, gait variability and the relationships between STPs, gait variability and self-reported foot pain and disability have never been studied in these populations. Body-worn inertial measurement units (IMUs) are gaining interest in measuring gait parameters in clinical settings.

Objectives

To assess STPs and gait variability in people with PsA using IMUs, to explore their relationship with self-reported foot pain and function and to investigate the feasibility of using IMUs to discriminate patient groups based on gait speed-critical values.

Methods

Twenty-one participants with PsA (age: 53.9 ± 8.9 yrs.; median disease duration: 6 yrs) and 21 age- and sex-matched healthy participants (age 54.23 ± 9.3 yrs) were recruited. All the participants performed three 10-m walk test trials at their comfortable speed. STPs and gait variability were recorded and calculated using six body-worn IMUs and Mobility Lab software (APDM®). Foot pain and disability were assessed in participants with PsA using the foot function index (FFI).

Results

Cadence, gait speed, stride length, and swing phase were significantly lower, while double support was significantly higher, in the PsA group (p < 0.006). Strong correlations between STPs and the FFI total score were demonstrated (|r| > 0.57, p < 0.006). Gait variability was significantly increased in the PsA group, but it was not correlated with foot pain or function (p < 0.006). Using the IMUs, three subgroups of participants with PsA with clinically meaningful differences in self-reported foot pain and disability were discriminated.

Conclusion

STPs were significantly altered in participants with PsA, which could be associated with self-reported foot pain and disability. Future studies are required to confirm the increased gait variability highlighted in this study and its potential underlying causes. Using IMUs has been useful to objectively assess foot function in people with PsA.

Trial registration

ClinicalTrials.gov, NCT05075343, Retrospectively registered on 29 September 2021.

Neurophysiological and psychophysical effects of dry versus sham needling of the infraspinatus muscle in patients with chronic shoulder pain: a randomized feasibility study

BACKGROUND

Dry needling (DN) is increasingly used for treating myofascial trigger points (MTrPs) and has shown significant effects on pain and function. This study aimed to assess feasibility of conducting a randomized sham-controlled trial and to collect preliminary data on the effects of infraspinatus DN on corticospinal excitability and mechanical pain sensitivity.

METHOD

This randomized feasibility study included adults with chronic non-traumatic shoulder pain and a infraspinatus MTrP. Participants were randomized to receive real DN or sham DN in the infraspinatus MTrP. Feasibility outcomes included data pertaining to recruitment, retention of participants, completeness and safety of assessment procedures. Neurophysiological and psychophysical outcomes included corticospinal excitability and mechanical pain sensitivity measured by active motor threshold (aMT) and pressure pain threshold (PPT), respectively. They were assessed at baseline, immediately after and 24 h post-intervention.

RESULTS

Twenty-one participants were recruited over a 6-month period. Nineteen participants completed the treatment and follow-up assessment. Motor evoked potential responses were discernible in all but 1 participant. Only 1 minor adverse event related to transcranial magnetic stimulation (mild headache) affected the measurements. No DN adverse effects were recorded in both groups. An overall completeness rate of 81% was reached, with 70% completeness in the DN group and 91% in the sham group. Data analysis revealed that real DN increased corticospinal excitability (reduced aMT) 24 h post-intervention (Mdn = - 5.96% MSO, IQR = 5.17, p = 0.04) and that sham DN triggered similar responses immediately after the intervention (Mdn = - 1.93% MSO, IQR = 1.11, p = 0.03). Increased mechanical pain sensitivity (reduced PPT) was significant only in the sham group, both immediately (Mdn = - 0.44 kg/cm2, IQR = 0.49, p = 0.01) and 24 h post-intervention (Mdn = - 0.52 kg/cm2, IQR = 1.02, p = 0.02). Changes in corticospinal excitability was positively correlated with changes in mechanical pain sensitivity in the DN group, both immediately (r = 0.77, p = 0.02) and 24 h post-intervention (r = 0.75, p = 0.05).

CONCLUSION

The present study demonstrates the feasibility of quantifying the neurophysiological and psychophysical effects of DN, and provides recommendations and guidelines for future studies. Moreover, it provides preliminary evidence that DN may increase corticospinal excitability of the infraspinatus muscle in patients with chronic shoulder pain and that the relationship of neurophysiological and psychophysical effects is promising to better understand its mechanisms of action.

TRIAL REGISTRATION

NCT04316793 ; retrospectively registered November 3, 2020.

Using ultrasound imaging to assess novice physiotherapy students' ability to locate musculoskeletal structures with palpation

OBJECTIVE

Use ultrasound imaging to assess success rates of novice physiotherapy students attempting to locate two tendons and two joint spaces using palpation.

DESIGN

Cross-sectional study.

SETTING

Master of physiotherapy program at an academic institution.

PARTICIPANTS

Twenty-two end of first-year physiotherapy students.

METHODS

Participants were asked to palpate and locate the long head of the biceps (LHBT) and tibialis posterior (PTT) tendons as well as the acromioclavicular joint (ACJ) and medial tibiofemoral joint (TFJ) spaces on two human models. A truncated needle was taped onto the skin, parallel to the palpated structure. Ultrasound imaging was used to assess the position of the needle relative to the structures.

MAIN OUTCOME MEASURES

Success or failure was determined based on a judgment call on the needle position relative to the targeted structure on the ultrasound images. Inter-evaluator agreement for judgment criteria was investigated using Cohen's kappa tests and success rates subsequently calculated.

RESULTS

Kappa coefficients were 1.00 for all structures collectively, 1.00 for LHBT and PTT tendons, 1.006 for ACJ, and 0.79 for TFJ. Palpation success rates were: 9% for LHBT, 64% for PTT, 23% for ACJ, and 31% for medial TFJ.

CONCLUSION

These results highlight the fact that there is room for improvement in anatomy and palpation skill teaching methods and ultrasound imaging is valuable tool to assess this important skill.

The Accuracy and Precision of Gait Spatio-Temporal Parameters Extracted from an Instrumented Sock during Treadmill and Overground Walking in Healthy Subjects and Patients with a Foot Impairment Secondary to Psoriatic Arthritis

The objectives of this study were to assess the accuracy and precision of a system combining an IMU-instrumented sock and a validated algorithm for the estimation of the spatio-temporal parameters of gait. A total of 25 healthy participants (HP) and 21 patients with foot impairments secondary to psoriatic arthritis (PsA) performed treadmill walking at three different speeds and overground walking at a comfortable speed. HP performed the assessment over two sessions. The proposed system's estimations of cadence (CAD), gait cycle duration (GCD), gait speed (GS), and stride length (SL) obtained for treadmill walking were validated versus those estimated with a motion capture system. The system was also compared with a well-established multi-IMU-based system for treadmill and overground walking. The results showed a good agreement between the motion capture system and the IMU-instrumented sock in estimating the spatio-temporal parameters during the treadmill walking at normal and fast speeds for both HP and PsA participants. The accuracy of GS and SL obtained from the IMU-instrumented sock was better compared to the established multi-IMU-based system in both groups. The precision (inter-session reliability) of the gait parameter estimations obtained from the IMU-instrumented sock was good to excellent for overground walking and treadmill walking at fast speeds, but moderate-to-good for slow and normal treadmill walking. The proposed IMU-instrumented sock offers a novel form factor addressing the wearability issues of IMUs and could potentially be used to measure spatio-temporal parameters under clinical conditions and free-living conditions.

The Female Pelvic Floor Fascia Anatomy: A Systematic Search and Review

The female pelvis is a complex anatomical region comprising the pelvic organs, muscles, neurovascular supplies, and fasciae. The anatomy of the pelvic floor and its fascial components are currently poorly described and misunderstood. This systematic search and review aimed to explore and summarize the current state of knowledge on the fascial anatomy of the pelvic floor in women. Methods: A systematic search was performed using Medline and Scopus databases. A synthesis of the findings with a critical appraisal was subsequently carried out. The risk of bias was assessed with the Anatomical Quality Assurance Tool. Results: A total of 39 articles, involving 1192 women, were included in the review. Although the perineal membrane, tendinous arch of pelvic fascia, pubourethral ligaments, rectovaginal fascia, and perineal body were the most frequently described structures, uncertainties were identified in micro- and macro-anatomy. The risk of bias was scored as low in 16 studies (41%), unclear in 3 studies (8%), and high in 20 studies (51%). Conclusions: This review provides the best available evidence on the female anatomy of the pelvic floor fasciae. Future studies should be conducted to clarify the discrepancies highlighted and accurately describe the pelvic floor fasciae.

An Investigation of the Association between Transversus Abdominis Myofascial Structure and Activation with Age in Healthy Adults using Ultrasound Imaging

BACKGROUND

Because of their importance in core stability, training the deep abdominal muscles, fascial structures and particularly the transversus abdominis, is a key component of many sport and physical therapy programs. However, there are gaps in knowledge about age-related changes in the structure and activation capacity of these muscles.

HYPOTHESIS/PURPOSE

This study investigated the association between deep abdominal muscles and fascial structures and transversus abdominis activation with age in healthy adults.

STUDY DESIGN

A cross-sectional study.

METHODS

Eighty-six adults aged 18 to 77 participated in this study. An ultrasound image of their transversus abdominis, internal oblique, external oblique and associated fasciae was first captured at rest, then during a contraction of the transversus abdominis. Bivariate correlation analyses and hierarchical analyses were performed (significance level: p < 0.05).

RESULTS

The thickness of these three muscles decreases with age ( ρ = -0.66 for external oblique, -0.51 for internal oblique and -0.58 for transversus abdominis), whereas the thickness of their fasciae increases ( ρ = 0.39 for the fascia of external oblique, 0.54 for the fascia between internal oblique and external oblique, and 0.74 for the fascia between internal oblique and transversus abdominis). Transversus abdominis activation decreases with age (r =-0.44). Age accounts for 19.5% of the variance in transversus abdominis activation.

CONCLUSION

These results demonstrate that normal aging is associated with changes in deep abdominal myofascial structures and transversus abdominis activation. Assessment of these metrics can provide valuable baseline information for physical therapists involved in rehabilitation and strengthening programs targeting older individuals.

LEVEL OF EVIDENCE

Level 2.

Efficacy of Surgical Interventions for Trapeziometacarpal (Thumb Base) Osteoarthritis: A Systematic Review

Purpose

Methods

Results

Conclusions

Type of study/level of evidence

Does the Movement Competency Screen Correlate with Deep Abdominals Activation and Hip Strength for Professional and Pre-professional Dancers?

BACKGROUND

Dancers are a unique category of athletes who are frequently injured and experience pain. The primary cause of dance injuries is overuse, which could potentially be prevented. However, literature is scarce regarding validated methods of evaluating the risk of injury in dancers. The Movement Competency Screen (MCS) could potentially fill this gap.

HYPOTHESIS/PURPOSE

To investigate the validity of the Movement Competency Screen (MCS) for dancers by 1) examining the correlation between scores on this functional test and the activation of deep abdominals and hip strength; 2) investigating the correlation between MCS scores and those of the Functional Movement Screen (FMS™).

STUDY DESIGN

Cross-sectional study.

METHODS

A total of 77 pre-professional and professional dancers from ballet and contemporary backgrounds were evaluated. The activation of deep abdominals was evaluated using ultrasound imaging and the hip strength was evaluated using a handheld dynamometer. The FMS™, another tool evaluating fundamental movement competency, was also administered.

RESULTS

The dancers' MCS score was correlated with the activation of the transversus abdominis (r=0.239, p=0.036) and the strength of hip abductors (r=0.293, p=0.010), adductors (r=0.267, p=0.019) and external rotators (r=0.249, p=0.029). The MCS score was also correlated with the FMS™ score (r=0.489, p<0.001).

CONCLUSION

This study shows that the MCS score is correlated with deep abdominal activation and hip strength in dancers, as well as with the FMS™ score. These findings provide evidence toward the validation of the MCS in dancers.

LEVELS OF EVIDENCE

Level 2B.

Cutaneous inputs from perineal region facilitate spinal locomotor activity and modulate cutaneous reflexes from the foot in spinal cats

It is well known that mechanically stimulating the perineal region potently facilitates hindlimb locomotion and weight support in mammals with a spinal transection (spinal mammals). However, how perineal stimulation mediates this excitatory effect is poorly understood. We evaluated the effect of mechanically stimulating (vibration or pinch) the perineal region on ipsilateral (9-14 ms onset) and contralateral (14-18 ms onset) short-latency cutaneous reflex responses evoked by electrically stimulating the superficial peroneal or distal tibial nerve in seven adult spinal cats where hindlimb movement was restrained. Cutaneous reflexes were evoked before, during, and after mechanical stimulation of the perineal region. We found that vibration or pinch of the perineal region effectively triggered rhythmic activity, ipsilateral and contralateral to nerve stimulation. When electrically stimulating nerves, adding perineal stimulation modulated rhythmic activity by decreasing cycle and burst durations and by increasing the amplitude of flexors and extensors. Perineal stimulation also disrupted the timing of the ipsilateral rhythm, which had been entrained by nerve stimulation. Mechanically stimulating the perineal region decreased ipsilateral and contralateral short-latency reflex responses evoked by cutaneous inputs, a phenomenon we observed in muscles crossing different joints and located in different limbs. The results suggest that the excitatory effect of perineal stimulation on locomotion and weight support is mediated by increasing the excitability of central pattern-generating circuitry and not by increasing excitatory inputs from cutaneous afferents of the foot. Our results are consistent with a state-dependent modulation of reflexes by spinal interneuronal circuits.

Comparison of the Pressure Biofeedback Unit and Real-Time Ultrasound Imaging as Feedback Tools to Contract the Transversus Abdominis Muscle: A Randomized Controlled Trial in Healthy Older Adults

BACKGROUND AND PURPOSE

The transversus abdominis (TrA) is a key muscle for lumbar stabilization and is often retrained in physical therapy. Feedback tools, such as the pressure biofeedback unit (PBU) and rehabilitative ultrasound imaging (RUSI), are frequently used by physical therapists to train their patients and improve their patients' ability to contract this muscle. However, the effect of these tools in rehabilitating the TrA in older adults remains to be demonstrated, as is their efficiency in transferring the skill of recruiting the TrA from a supine position to a standing position.The objective of the study was to compare the immediate effectiveness of the PBU and RUSI to reeducate the TrA muscle in a population of asymptomatic older adults (without pain).

METHODS

Forty participants were randomized into 2 groups (RUSI or PBU). The intervention included a training session involving 15 TrA contractions held for 10 seconds with the corresponding feedback device. The dependent variable, TrA thickness (a muscle activation indicator), was measured using ultrasound images before and after the intervention in a supine and standing position. Nonparametric analyses were used for inter- and intragroup comparisons.

RESULTS AND DISCUSSION

The results showed no between-group differences in TrA activation ratio (AR) in the supine or standing position (supine AR: TrA RUSI thickness change P = .53 vs PBU thickness change P = .73, comparison between groups P = .51; standing AR: TrA RUSI thickness change P = .003 vs PBU thickness change P = .10; comparison between groups P = .61). However, the change in TrA thickness compared to the other abdominal wall muscles in a standing position was significantly less post-intervention for the RUSI group only (RUSI P = .006 vs PBU P = .72). Both groups remained similar post-intervention for this outcome (P = .20).

CONCLUSIONS

Neither the RUSI nor the PBU seems to have the desired effect on the activation of TrA in asymptomatic older adults.

Return to work following total knee arthroplasty: A multiple case study of stakeholder perspectives

OBJECTIVE

The study's aim was to gain insights into factors influencing sustainable return to work following total knee arthroplasty (TKA).

DESIGN

A descriptive multiple-case design was used. A case was defined as a worker's following TKA work disability situation.

SETTINGS

The cases came from public hospitals in urban and semi-urban areas in Quebec (Canada) and involved mostly non-work-related TKAs.

SUBJECTS

Workers had to be between 6 and 12 months post-TKA, have physical/manual jobs and currently employed. Their rehabilitation professionals and workplace representatives (employer and/or union) were also recruited, based on the work disability paradigm.

MAIN MEASURES

Semi-structured interviews, questionnaires on pain, physical work demands (workers only), and observation of the work activities of those workers back at work were used. Cases were compared and categorized for worker-perceived levels of difficulty in returning to or staying at work: little or no difficulty (n = 8); some difficulty (n = 5); not back at work due to excessive difficulty with their knee (n = 4).

RESULTS

A total of 17 cases were constituted. In only one case, the worker benefitted from an interdisciplinary work rehabilitation approach. Results highlight the interplay among these factors: (1) the workers' perceptions of their residual symptoms and ability to manage them, (2) the interaction between work adjustments and tools offered by the employers and the workers' own strategies, and (3) perceptions of the workers' physical capacities.

CONCLUSION

Workers' who face high levels of work demands/difficulties and who have limited access to work adjustments and tools should be referred for work rehabilitation.

FRI0623-HPR HEALTHCARE RESOURCE USE IN PATIENTS WITH TRAPEZIOMETACARPAL OSTEOARTHRITIS

Background:

Trapeziometacarpal osteoarthritis (TMO) is one of the most debilitating forms of hand osteoarthritis (OA). According to the recent EULAR guidelines1, 2and a systematic review,3the efficacy of topical/oral non-steroid anti-inflammatory drugs (NSAIDs), orthoses, hand exercises, and psychosocial interventions for hand OA or TMO are supported by scientific evidence. Cortisone injections and acetaminophen are generally not recommended.1, 3Besides, TMO management is suboptimal: only 21% of patients receive rehabilitative interventions prior to referral to hand surgeons.4

Objectives:

We aimed at documenting the types of treatment TMO patients employ and their healthcare resource use.

Methods:

A total of 227 TMO patients recruited from 16 healthcare institutions completed a questionnaire about 1) received interventions, 2) analgesic strategies, and 3) healthcare professional consultations.

Results:

Acetaminophen (64.3% of the participants), oral NSAIDs (31.7%), topical NSAIDs (11.9%), and nutraceuticals (7.9%) were the most commonly used medications. More than 70% of the participants reported having received cortisone injection(s) (72.5%) and orthosis (75.7%). More than half employed hand exercises, massage and heat/cold application. Relaxation/respiration, meditation, distraction, assistive devices, and joint protection principles were used by smaller percentages of participants (13.0-30.9%). Patients with TMO reported having consulted various types of healthcare professionals: family physicians, plastic/orthopaedic surgeons, radiologists-interventionists, rheumatologists, physiatrists, occupational/physical therapists, osteopaths, chiropractors, pharmacists, and acupuncturists. Only 4.8% of the participants reported having received psychosocial interventions.

Conclusion:

TMO patients use numerous types of modalities to relieve their pain. Provision of evidence-based interventions tailored to their needs is clearly needed.

References:

[1] Kloppenburg M, Kroon FP, Blanco FJ, et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis.Annals of the rheumatic diseases.2019;78:16-24.

[2] Geenen R, Overman CL, Christensen R, et al. EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis.Annals of the rheumatic diseases.2018;77:797-807.

[3] Hamasaki T, Laprise S, Harris PG, et al. Efficacy of non-surgical interventions for trapeziometacarpal (thumb base) osteoarthritis: A systematic review.Arthritis Care & Research.2019; In press (https://doi.org/10.1002/acr.24084).

[4] Gravås EMH, Tveter AT, Nossum R, et al. Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study.BMC musculoskeletal disorders.2019;20:180-180.

Acknowledgments:

This study was supported by a discretionary fund of the Centre de recherche du CHUM (CRCHUM) to Choinière and from the

Multidisciplinary Council of the CHUM. Hamasaki was supported by a Doctoral training award of the Fonds de recherche du Québec—Santé, a doctoral scholarship from the CHUM Foundation to Harris (Hand Surgery Branch) and from Choinière’s internal funds of the CRCHUM.

Disclosure of Interests:

None declared

FRI0608-HPR SEVERITY AND PREDICTORS OF PAIN INTENSITY AND HAND DISABILITY IN PATIENTS WITH TRAPEZIOMETACARPAL OSTEOARTHRITIS

Background:

Trapeziometacarpal osteoarthritis (TMO) is one of the most prevalent and painful forms of hand osteoarthritis.1It limits thumb mobility,2reduces hand functions, and manual activities.1Yet, no study has exhaustively documented the characteristics of this pathology using a biopsychosocial approach (e.g., pain, disability, psychological well-being, pain-related catastrophic thinking, quality of life). Furthermore, radiographic TMO severity and symptomatology are only weakly to moderately correlated.3, 4The extent to which biopsychosocial factors (e.g., pain duration, depression, education) contribute to interindividual variability in TMO pain and hand disability merits further investigation.

Objectives:

This study aimed at 1) describing the pain experience of patients with trapeziometacarpal osteoarthritis (TMO) from a biopsychosocial perspective, and 2) identifying predictors of their pain intensity and hand disability.

Methods:

A total of 227 TMO patients recruited from 16 healthcare institutions completed validated questionnaires assessing their biopsychosocial characteristics. The associations of pain severity and hand disability with various biopsychosocial characteristics were analyzed by linear regression.

Results:

The participants’ mean age was 62.6 ± 8.5 years and 78% were women. Their mean pain intensity on the average in the last seven days was 5.8 ± 2.1 while their hand disability scores averaged 45.4 ± 18.8 on the QuickDASH. In terms of health-related quality of life, the participants’ scores on the physical and mental summary scales of the SF-12v2 were 41.0 ± 9.4 and 48.7 ± 9.7 respectively. Results of the multivariable linear regression analyses revealed that age, living condition, pain frequency, pain-related catastrophic thinking, and depression levels accounted for 43.3% of the variance in pain intensity while age, sex, pain intensity, pain-related catastrophic thinking, depression, level of education, employment status and living condition accounted for 60.6% of the variance in hand function.

Conclusion:

This comprehensive study showed that patients with TMO experience pain of moderate to severe intensity which can affect various aspects of their daily living and their physical health-related quality of life. Greater tendency to catastrophize in the face of pain and higher depression levels were associated with more severe pain suggesting that psychological interventions aiming at reducing these factors could be beneficial for some patients with TMO.

References:

[1] Bijsterbosch J, Visser W, Kroon HM, Stamm T, Meulenbelt I, Huizinga TW, Kloppenburg M. Thumb base involvement in symptomatic hand osteoarthritis is associated with more pain and functional disability.Annals of the rheumatic diseases.2010;69:585-587.

[2] Gehrmann SV, Tang J, Li ZM, Goitz RJ, Windolf J, Kaufmann RA. Motion deficit of the thumb in CMC joint arthritis.Journal of hand surgery.2010;35:1449-1453.

[3] Botha-Scheepers S, Riyazi N, Watt I, Rosendaal FR, Slagboom E, Bellamy N, Breedveld FC, Kloppenburg M. Progression of hand osteoarthritis over 2 years: a clinical and radiological follow-up study.Annals of the rheumatic diseases.2009;68:1260-1264.

[4] Hwang RW, Ring D. Pain and disability related to osteoarthrosis of the trapeziometacarpal joint.J Hand Microsurg.2011;3:63-65.

Acknowledgments:

This study was supported by a discretionary fund of the Centre de recherche du CHUM (CRCHUM) to Choinière and from the Multidisciplinary Council of the CHUM. Hamasaki was supported by a Doctoral training award of the Fonds de recherche du Québec—Santé, a doctoral scholarship from the CHUM Foundation to Harris (Hand Surgery Branch) and from Choinière’s internal funds of the CRCHUM.

Disclosure of Interests:

None declared

Effects of Cesarean Section and Vaginal Delivery on Abdominal Muscles and Fasciae

Background and objectives: Possible disorders after delivery may interfere with the quality of life. The aim of this study was to ascertain whether abdominal muscles and fasciae differ in women depending on whether they experienced transverse cesarean section (CS) or vaginal delivery (VA) in comparison with healthy nulliparous (NU). Materials and methods: The thicknesses of abdominal muscles and fasciae were evaluated by ultrasound in 13 CS, 10 VA, and 13 NU women (we examined rectus abdominis (RA); external oblique (EO); internal oblique (IO); transversus abdominis (TrA); total abdominal muscles (TAM = EO + IO + TrA); inter-rectus distance (IRD); thickness of linea alba (TLA); rectus sheath (RS), which includes anterior fascia of RS and posterior fascia of RS (P-RS); loose connective tissue between sublayers of P-RS (LCT); abdominal perimuscular fasciae (APF), which includes anterior fascia of EO, fasciae between EO, IO, and TrA, and posterior fascia of TrA). Data on pain intensity, duration, and location were collected. Results: Compared with NU women, CS women had wider IRD (p = 0.004), thinner left RA (p = 0.020), thicker right RS (p = 0.035) and APF (left: p = 0.001; right: p = 0.001), and IO dissymmetry (p = 0.009). VA women had thinner RA (left: p = 0.008, right: p = 0.043) and left TAM (p = 0.024), mainly due to left IO (p = 0.027) and RA dissymmetry (p = 0.035). However, CS women had thicker LCT (left: p = 0.036, right: p < 0.001), APF (left: p = 0.014; right: p = 0.007), and right IO (p = 0.028) than VA women. There were significant correlations between pain duration and the affected fasciae/muscles in CS women. Conclusions: CS women showed significant alterations in both abdominal fasciae and muscle thicknesses, whereas VA women showed alterations mainly in muscles. Thinner RA and/or dissymmetric IO, wider IRD, and thicker LCT and APF after CS may cause muscle deficits and alteration of fascial gliding, which may induce scar, abdominal, low back, and/or pelvic pain.

Mechanically stimulating the lumbar region inhibits locomotor-like activity and increases the gain of cutaneous reflexes from the paws in spinal cats

Mechanically stimulating the dorsal lumbar region inhibits locomotion and reduces weight support during standing in rabbits and cats. However, how this inhibitory effect from the lumbar skin is mediated is poorly understood. Here we evaluated the effect of mechanically stimulating (vibration or pinch) the dorsal lumbar region on short-latency (8- to 13-ms onset) cutaneous reflex responses, evoked by electrically stimulating the superficial peroneal or distal tibial nerves, in seven adult cats with a low thoracic spinal transection (spinal cats). Cutaneous reflexes were evoked before, during, and after mechanical stimulation of the dorsal lumbar region. We found that mechanically stimulating the lumbar region by vibration or manual pinch abolished alternating bursts of activity between flexors and extensors initiated by nerve stimulation. The activity of extensor muscles was abolished bilaterally, whereas the activity of some ipsilateral flexor muscles was sustained during vibration/pinch. Mechanically stimulating the lumbar region increased ipsilateral and contralateral short-latency excitatory responses evoked by cutaneous inputs, a phenomenon that was generalized to muscles crossing different joints and located in different limbs. Our results indicate that the inhibitory effect on locomotion and weight support is not mediated by reducing cutaneous reflex gain and instead points to an inhibition of central pattern-generating circuitry, particularly the extensor component. The results provide greater insight into interactions between different types of somatosensory inputs within spinal motor circuits.NEW & NOTEWORTHY Vibration or pinch of the lumbar region in spinal-transected cats abolished alternating bursts of activity between flexors and extensors initiated by nerve stimulation. Mechanically stimulating the lumbar region increased ipsilateral and contralateral short-latency excitatory responses evoked by cutaneous inputs in hindlimb muscles. Sensory inputs from mechanoreceptors of the lumbar region do not mediate their inhibitory effect on locomotion and weight support by reducing the gain of short-latency excitatory cutaneous reflexes from the foot.

Benefits of dry needling of myofascial trigger points on autonomic function and photoelectric plethysmography in patients with fibromyalgia syndrome

Background:

Fibromyalgia syndrome (FMS) is a condition characterised by the presence of chronic, widespread musculoskeletal pain, low pain threshold and hyperalgesia. Myofascial trigger points (MTrPs) may worsen symptoms in patients with FMS.

Objective:

The purpose of this randomised controlled trial was to compare the effects of dry needling and transcutaneous electrical nerve stimulation (TENS) on pain intensity, heart rate variability, galvanic response and oxygen saturation (SpO2).

Methods:

74 subjects with FMS were recruited and randomly assigned to either the dry needling group or the TENS group. Outcomes measures (pain intensity, heart rate variability, galvanic skin response, SpO2 and photoplethysmography) were evaluated at baseline and after 6 weeks of treatment. 2×2 mixed-model analyses of variance (ANOVAs) were performed.

Results:

The mixed-model ANOVAs showed significant differences between groups for the sensory dimension of pain, affective dimension of pain, total dimension of pain, visual analogue scale (VAS) and present pain intensity (PPI) (P=0.001). ANOVAs also showed that significant differences between groups were achieved for very low frequency power of heart rate variability (P=0.008) and low frequency power (P=0.033). There were no significant differences in dry needling versus TENS groups on the spectral analysis of the photoplethysmography and SpO2.

Conclusions:

This trial showed that application of dry needling therapy and TENS reduced pain attributable to MTrPs in patients with FMS, with greater improvements reported in the dry needling group across all dimensions of pain. Additionally, there were between-intervention differences for several parameters of heart rate variability and galvanic skin responses.

Trial registration number:

NCT02393352

The recovery of standing and locomotion after spinal cord injury does not require task-specific training

After complete spinal cord injury, mammals, including mice, rats and cats, recover hindlimb locomotion with treadmill training. The premise is that sensory cues consistent with locomotion reorganize spinal sensorimotor circuits. Here, we show that hindlimb standing and locomotion recover after spinal transection in cats without task-specific training. Spinal-transected cats recovered full weight bearing standing and locomotion after five weeks of rhythmic manual stimulation of triceps surae muscles (non-specific training) and without any intervention. Moreover, cats modulated locomotor speed and performed split-belt locomotion six weeks after spinal transection, functions that were not trained or tested in the weeks prior. This indicates that spinal networks controlling standing and locomotion and their interactions with sensory feedback from the limbs remain largely intact after complete spinal cord injury. We conclude that standing and locomotor recovery is due to the return of neuronal excitability within spinal sensorimotor circuits that do not require task-specific activity-dependent plasticity.

Cardiorespiratory fitness among adults with fibromyalgia

This review presents and addresses the conflicting results on cardiorespiratory fitness among adults with fibromyalgia. The heterogeneity in study designs, symptom severity and the assessment protocols might partly explain these conflicting results. It also presents the possible relationship between cardiorespiratory fitness and exercise prescription, attrition from exercise/rehabilitation programmes and independence with activities of daily living. Cardiorespiratory fitness might impact aerobic exercise and independence in daily activities of patients with fibromyalgia, which is often concomitantly diagnosed in patients with sleep disordered breathing, including patients with obstructive sleep apnoea. Therefore, cardiorespiratory fitness evaluation should be considered by general and respiratory physicians as well as physiotherapists who treat patients diagnosed with fibromyalgia for more accurate diagnosis, exercise prescription and monitoring of patients' status.

Key points

Adults with fibromyalgia often present with reduced cardiorespiratory fitness.Reduced cardiorespiratory fitness might have an important impact on functional capacity and quality of life.Adults with fibromyalgia who have a secondary condition affecting their ventilatory anaerobic threshold and/or V'_O2peak, for example chronic obstructive pulmonary disease, might present with a greater reduction of their cardiorespiratory fitness which may not be entirely related to their lung disease.

Educational aims

To better understand the cardiorespiratory fitness results among adults with fibromyalgia in general, and when taking into account differences in assessment protocol (maximal versus submaximal testing protocol; cycle ergometer versus treadmill testing protocol) and symptom severity (fibromyalgia severity level).To better understand how cardiorespiratory fitness among adults with fibromyalgia could: 1) assist in exercise prescription; 2) minimise dropout rates from exercise/rehabilitation programmes; and 3) promote independence with activities of daily living.To learn why fibromyalgia might be important to consider in adults who have concurrent fibromyalgia and lung disease.

The Ottawa Panel guidelines on programmes involving therapeutic exercise for the management of hand osteoarthritis

OBJECTIVE:

To identify programmes involving therapeutic exercise that are effective for the management of hand osteoarthritis and to provide stakeholders with updated, moderate to high-quality recommendations supporting exercises for hand osteoarthritis.

METHODS:

A systematic search and adapted selection criteria included comparable trials with exercise programmes for managing hand osteoarthritis. Based on the evaluated evidence, a panel of experts reached consensus through a Delphi approach endorsing the recommendations. A hierarchical alphabetical grading system (A, B, C+, C, C-, D-, D, D+, E, F) was based on clinical importance (≥15%) and statistical significance ( P < 0.05).

RESULTS:

Ten moderate- to high-quality studies were included. Eight studies with programmes involving therapeutic exercise (e.g. range of motion (ROM) + isotonic + isometric + functional exercise) seemed to be effective. Forty-six positive grade recommendations (i.e. A, B, C+) were obtained during short-term (<12 weeks) trials for pain, stiffness, physical function, grip strength, pinch strength, range of motion, global assessment, pressure pain threshold, fatigue and abductor pollicis longus moment and during long-term (>12 weeks) trials for physical function and pinch strength.

CONCLUSION:

Despite that many programmes involving exercise with positive recommendations for clinical outcomes are available to healthcare professionals and hand osteoarthritis patients that aid in the management of hand osteoarthritis, there is a need for further research to isolate the specific effect of exercise components.

Construct validity and inter-rater reliability of the Gymnastic Functional Measurement Tool in the classification of female competitive gymnasts in Canada

OBJECTIVES

To determine the construct validity and the inter-rater reliability of the Gymnastic Functional Measurement Tool (GFMT) within the parameters of the Canadian classification of female competitive gymnasts.

DESIGN

Validity and Reliability study.

SETTING

The GFMT was administered by evaluators who had no previous knowledge of the competing level of the gymnasts. To determine the construct validity, a multiple linear regression analysis was carried out between the GFMT scores and the gymnasts' competition level to obtain the coefficient of determination. To estimate the inter-rater reliability, gymnasts were simultaneously evaluated by two evaluators. Intraclass correlation coefficient (ICC) analysis was carried out for the individual score of each item as well as for the total score of the GFMT.

PARTICIPANTS

Ninety (90) female gymnasts aged between the ages of 8 and 18 years old.

MAIN OUTCOME

GFMT total score and individual score of each item.

RESULTS

The study demonstrated an excellent relationship between the total GFMT scores and the gymnasts' competition level (r² = 0.97). The inter-rater reliability analysis of the GFMT total score was excellent with an ICC of 0.98.

CONCLUSION

Construct validity and inter-rater reliability of the GFMT in the classification of female competitive gymnasts in Canada has been demonstrated.

Patellar taping alters knee kinematics during step descent in individuals with a meniscal injury: An exploratory study

BACKGROUND

Meniscus lesions are common musculoskeletal knee injuries which often lead to pain, limitation and compensations during functional tasks, such as descending stairs. This study investigated the effect of patellar taping with tension and without tension on three-dimensional (3D) kinematics of the knee during a slow step descent task in patients with meniscal lesions.

METHODS

Ten patients diagnosed with a meniscal lesion, confirmed by magnetic resonance imaging, underwent five, step descent movements at slow speed under three different conditions: 1) no taping; 2) tension-free taping; and 3) patellar taping with medial tension. 3D kinematic data were recorded from the injured knee using an eight-camera infrared Vicon motion analysis system. Maximum and minimum angle values and total range of motion (maximum/minimum value) in three movement planes during single-limb stance were compared using a repeated measure ANOVA.

FINDINGS

Results showed a significant increase in the maximum and minimum angle value in the sagittal plane (mean differences=2.4° and 4.2°, respectively) and a decrease in the transverse plane (-6.3° and -2.2°, respectively) for the patellar taping condition compared to the no taping condition. A decreased rotational angle range when comparing the patellar taping to the no taping (-4.1°) and tension-free taping (-3.1°) conditions was also observed. These changes remained significant when pain was considered as a covariate in the analysis. The tension applied to the patellar tape played a role in controlling the sagittal and transverse plane step-down movement among patients in our study.

INTERPRETATION

These results support the use of patellar taping with a medially oriented tension to help to reduce the transversal plane movement of the knee in this population and they bring new light to the taping effect.

Efficacy of treatments and pain management for trapeziometacarpal (thumb base) osteoarthritis: protocol for a systematic review

INTRODUCTION

The thumb is essential for daily activities. Unfortunately, this digit is commonly affected by trapeziometacarpal osteoarthritis (TMO), handicapping a large number of individuals. TMO constitutes an increasing human and economic burden for our society whose population is ageing. Limited access to adequate treatment is among the most important obstacles to optimal TMO management. Poor understanding of TMO characteristics, lack of knowledge about evidence-based treatments, simplistic pain management plans based solely on the patient's physical condition, absence of interprofessional communication and lack of multidisciplinary treatment guidelines contribute to inadequate TMO management. On the long term, our research project aims at improving the quality of care and services offered to patients with TMO by developing a patient-centred, evidence-based multidisciplinary management clinical pathway coordinated across the healthcare system. This proposed systematic review is a prerequisite to ensuring evidence-based practices and aims to document the efficacy of all the existing modalities for TMO management.

METHODS AND ANALYSIS

The protocol of the systematic review is registered with PROSPERO and will be conducted using the guidelines Cochrane Handbook for Systematic Reviews of Interventions. We will identify studies in English and French concerning TMO treatments through searches in Cochrane Central, EMBASE, MEDLINE, PsychINFO, CINHAL, PubMed, OT Seekers, PEDRO and the grey literature. 2 reviewers will independently screen study eligibility, extract data and appraise studies using published assessment tools. Meta-analyses will be undertaken where feasible; otherwise, narrative syntheses will be carried out. The robustness of evidence will be assessed using the GRADE system.

ETHICS AND DISSEMINATION

Ethics approval is not required for this study. A comprehensive knowledge exchange and transfer plan incorporating effective strategies will be used to disseminate the findings of this review and utilise them to optimise TMO management.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42015015623.

Do experienced physiotherapists and final year physiotherapy trainees apply similar force during posterior-to-anterior lumbar mobilization techniques?

This study aims to quantify the force applied during posterior-to-anterior lumbar vertebrae mobilizations of different grades (I to IV) and compare that force between experienced physiotherapists and final year physiotherapy students. Four experienced physiotherapists and four final year physiotherapy students participated in this study along with five healthy asymptomatic individuals. A manual therapy table positioned over three force plates allowed for measurements of the force oscillation frequency and intensity applied during grade I, II, III and IV posterior-to-anterior (PA) mobilizations at two lumbar vertebral levels (L2 and L4). Mixed model ANOVAs were used to compare the force applied between the experienced physiotherapists and students, and between the various grades. The results showed that the mean oscillation frequency was similar between the groups for all grades. Grade I and grade IV PA mobilizations showed similar mean oscillation frequency as did grade II and III PA mobilizations. The minimum and maximum force applied was higher for the physiotherapists than for the students for all mobilization grades (p values < 0.05). Similar mean maximum force values were recorded for PA mobilizations between grade I and II and between grade III and grade IV. Grade III and IV PA mobilizations yielded higher mean maximum force values than those recorded during grade I and grade II PA mobilizations. The method used in this study allowed for quantification of the force applied during lumbar PA mobilizations. Experienced physiotherapists apply greater force than physiotherapy students across all grades, despite similar oscillation frequency.