Isokinetic ankle muscle strength is reduced in recreational runners with medial tibial stress syndrome and is not associated with pain

Abstract Aim: The purpose of this study was to investigate the strength and ratios of the plantar flexors and ankle dorsiflexors in recreational runners with medial tibial stress syndrome and to assess the association between muscle strength and the level of pain in this population. Methods: Two groups (control and medial tibial stress syndrome) of eighteen runners each participated in this cross-sectional study. Isokinetic dynamometry was used to evaluate muscle strength, and for the analysis, the normalized isokinetic peak torque controlled by gender was used. Results: The medial tibial stress syndrome group showed lower normalized isokinetic peak torque in the dorsiflexors in the concentric (p = 0.008) eccentric (p = 0.011) contraction, as well as a lower plantar flexor, normalized isokinetic peak torque in the concentric (p = 0.001) and eccentric (p = 0.02) when compared to the control group. However, there was no difference in the normalized isokinetic peak torque ratio representative of the stance (p = 0.62) and swing phase (p = 0.16), and the level of pain was not correlated with the strength concentric (p = 0.32) and eccentric (p = 0.621) of plantar flexors, nor to the concentric (p = 0.21) and eccentric of dorsiflexors (p = 0.54). Conclusion: Recreational runners with MTSS showed decreased muscle strength in the sagittal plane of the ankle, no correlation with the level of pain, and no changing the ratio between plantar flexors and dorsiflexors.

Use of the STarT Back Screening Tool in patients with chronic low back pain receiving physical therapy interventions.

BACKGROUND: The STarT Back Screening Tool (SBST) is used to stratify care. It is unclear if the SBST approach works as well for patients in low- and medium-income countries as for patients from high-income countries. OBJECTIVES: (1) To investigate whether patients with chronic low back pain (LBP) stratified by the SBST are different at baseline; (2) to describe the clinical course for each SBST subgroup; (3) to investigate the SBST utility to predict clinical outcomes; and (4) to determine which SBST subgroup show greater clinical improvement. DESIGN: This is a secondary analysis of data derived from a previously published clinical trial. METHODS: 148 patients with chronic nonspecific LBP were included. Pain intensity, disability, global perceived effect, and the SBST were assessed at baseline and at 5, 12, and 24 weeks after baseline. Descriptive data were provided and ANOVA, unadjusted and adjusted regression models, and linear mixed models were used for data analysis. RESULTS: Duration of symptoms, use of medication, pain, disability, and global perceived effect were different between SBST subgroups. Clinical improvements over a 6-month period were consistently greater in patients classified as high risk. The SBST was able to predict disability but this predictability decreased when the analysis was adjusted for possible confounders. CONCLUSION: Clinical outcomes were different between SBST subgroups over 6 months. Adjusting for confounders influenced the predictability of SBST. Patients classified as high risk presented higher improvements in terms of disability.

Hip Rotations' Influence of Electromyographic Activity of Gluteus Medius Muscle During Pelvic-Drop Exercise.

CONTEXT: Pelvic-drop exercises are often used to strengthen the gluteus medius (GM) muscle with the aim of increasing or prioritizing its recruitment. However, the effect of hip rotation on the performance of the action of the GM is unknown. OBJECTIVE: To evaluate the effect of hip rotation on the recruitment of the GM, tensor fasciae latae (TFL), and quadratus lumborum (QL). METHOD: Seventeen healthy subjects performed 2 sets of 4 repetitions of pelvic-drop exercise in random order with pelvic-drop lateral, medial, and neutral rotation of the hip. MAIN OUTCOME MEASURES: The electromyographic (EMG) activity of the GM, TFL, and QL was evaluated using surface electromyography. RESULTS: There were significant increases in the activation of the GM with medial and neutral rotation compared with lateral rotation (P = .03, P = .01, respectively), and there was no difference between medial and neutral rotation (P = 1.00). There was no difference in EMG activity of the TFL and QL in any of the positions. The GM:TFL ratio was the same in all analyzed positions. Regarding the GM:QL ratio, there was a significant increase with medial rotation compared with lateral rotation (P = .02). CONCLUSIONS: Pelvic-drop exercises are more efficient for activating the GM when the hip is in medial rotation and neutral position.

Kinesio Taping Does Not Provide Additional Benefits in Patients With Chronic Low Back Pain Who Receive Exercise and Manual Therapy: A Randomized Controlled Trial.

Study Design Randomized controlled trial. Background Many clinical practice guidelines endorse both manual therapy and exercise as effective treatment options for patients with low back pain. To optimize the effects of the treatments recommended by the guidelines, a new intervention known as Kinesio Taping is being widely used in these patients. Objectives To determine the effectiveness of Kinesio Taping in patients with chronic nonspecific low back pain when added to a physical therapy program consisting of exercise and manual therapy. Methods One hundred forty-eight patients with chronic nonspecific low back pain were randomly allocated to receive 10 (twice weekly) sessions of physical therapy, consisting of exercise and manual therapy, or the same treatment with the addition of Kinesio Taping applied to the lower back. The primary outcomes were pain intensity and disability (5 weeks after randomization) and the secondary outcomes were pain intensity, disability (3 months and 6 months after randomization), global perceived effect, and satisfaction with care (5 weeks after treatment). Data were collected by a blinded assessor. Results No between-group differences were observed in the primary outcomes of pain intensity (mean difference, -0.01 points; 95% confidence interval [CI]: -0.88, 0.85) or disability (mean difference, 1.14 points; 95% CI: -0.85, 3.13) at 5 weeks' follow-up. In addition, no between-group differences were observed for any of the other outcomes evaluated, except for disability 6 months after randomization (mean difference, 2.01 points; 95% CI: 0.03, 4.00) in favor of the control group. Conclusion Patients who received a physical therapy program consisting of exercise and manual therapy did not get additional benefit from the use of Kinesio Taping. Level of Evidence Therapy, level 1b. Prospectively registered May 28, 2013 at www.ClinicalTrials.gov (NCT01866332). J Orthop Sports Phys Ther 2016;46(7):506-513. Epub 6 Jun 2016. doi:10.2519/jospt.2016.6590.

Analgesic efficacy of cerebral and peripheral electrical stimulation in chronic nonspecific low back pain: a randomized, double-blind, factorial clinical trial.

BACKGROUND: Chronic non-specific low back pain is a major socioeconomic public health issue worldwide and, despite the volume of research in the area, it is still a difficult-to-treat condition. The conservative analgesic therapy usually comprises a variety of pharmacological and non-pharmacological strategies, such as transcutaneous electrical nerve stimulation. The neuromatrix pain model and the new findings on the process of chronicity of pain point to a higher effectiveness of treatments that address central rather than peripheral structures. The transcranial direct current stimulation is a noninvasive technique of neuromodulation that has made recent advances in the treatment of chronic pain. The simultaneous combination of these two electrostimulation techniques (cerebral and peripheral) can provide an analgesic effect superior to isolated interventions. However, all the evidence on the analgesic efficacy of these techniques, alone or combined, is still fragmented. This is a protocol for a randomized clinical trial to investigate whether cerebral electrical stimulation combined with peripheral electrical stimulation is more effective in relieving pain than the isolated application of electrical stimulations in patients with chronic nonspecific low back pain. METHODS/DESIGN: Ninety-two patients will be randomized into four groups to receive transcranial direct current stimulation (real/sham) + transcutaneous electrical nerve stimulation (real/sham) for 12 sessions over a period of four weeks. The primary clinical outcome (pain intensity) and the secondary ones (sensory and affective aspects of pain, physical functioning and global perceived effect) will be recorded before treatment, after four weeks, in Month 3 and in Month 6 after randomization. Confounding factors such as anxiety and depression, the patient's satisfaction with treatment and adverse effects will also be listed. Data will be collected by an examiner unaware of (blind to) the treatment allocation. DISCUSSION: The results of this study may assist in clinical decision-making about the combined use of cerebral and peripheral electrical stimulation for pain relief in patients with chronic low back pain. TRIAL REGISTRATION: NCT01896453.

Pulsed electromagnetic field and exercises in patients with shoulder impingement syndrome: a randomized, double-blind, placebo-controlled clinical trial.

OBJECTIVE: To evaluate the effects of pulsed electromagnetic field (PEMF) and exercises in reducing pain and improving function and muscle strength in patients with shoulder impingement syndrome (SIS). DESIGN: Double-blind, randomized controlled trial with a 3-month posttreatment follow-up. SETTING: Outpatient rehabilitation of a public hospital. PARTICIPANTS: Patients (N=56) between 40 and 60 years of age, with a diagnosis of SIS, were randomly assigned to receive active PEMF (n=26; mean age, 50.1y) or placebo PEMF (n=30; mean age, 50.8y). INTERVENTIONS: After 3 weeks of active or placebo PEMF, both groups performed the same program of exercises that focused on shoulder strengthening. MAIN OUTCOME MEASURES: A visual analog scale, the University of California/Los Angeles shoulder rating scale, the Constant-Murley shoulder score, and handheld dynamometry for muscle strength were used as outcome measures at baseline (pretreatment), at 3 weeks (after active or placebo PEMF), at 9 weeks (postexercise), and at 3 months posttreatment. RESULTS: Patients in the active PEMF group had a higher level of function and less pain at all follow-up time frames compared with baseline (P<.05). However, the placebo PEMF group had increased function and reduced pain only at the 9-week and 3-month follow-ups (P<.05)-that is, after performing the associated exercises. For the shoulder dynamometry, the active PEMF group had increased strength for lateral rotation at 9 weeks (P<.05), and increased strength for medial rotation at 9 weeks and 3 months (both P<.05) when compared with baseline. There was no significant difference for shoulder strength in the placebo PEMF group (P>.05), as well as no significant differences (P>.05) for all outcome measures. CONCLUSIONS: The combination of PEMF and shoulder exercises is effective in improving function and muscle strength and decreasing pain in patients with SIS. However, these results should be carefully interpreted because of the lack of differences between groups.

Efficacy of adding the Kinesio Taping method to guideline-endorsed conventional physiotherapy in patients with chronic nonspecific low back pain: a randomised controlled trial.

BACKGROUND: Chronic nonspecific low back pain is a significant health condition with high prevalence worldwide and it is associated with enormous costs to society. Clinical practice guidelines show that many interventions are available to treat patients with chronic low back pain, but the vast majority of these interventions have a modest effect in reducing pain and disability. An intervention that has been widespread in recent years is the use of elastic bandages called Kinesio Taping. Although Kinesio Taping has been used extensively in clinical practice, current evidence does not support the use of this intervention; however these conclusions are based on a small number of underpowered studies. Therefore, questions remain about the effectiveness of the Kinesio Taping method as an additional treatment to interventions, such as conventional physiotherapy, that have already been recommended by the current clinical practice guidelines in robust and high-quality randomised controlled trials. We aim to determine the effectiveness of the addition of the use of Kinesio Taping in patients with chronic nonspecific low back pain who receive guideline-endorsed conventional physiotherapy. METHODS/DESIGN: One hundred and forty-eight patients will be randomly allocated to receive either conventional physiotherapy, which consists of a combination of manual therapy techniques, general exercises, and specific stabilisation exercises (Guideline-Endorsed Conventional Physiotherapy Group) or to receive conventional physiotherapy with the addition of Kinesio Taping to the lumbar spine (Conventional Physiotherapy plus Kinesio Taping Group) over a period of 5 weeks (10 sessions of treatment). Clinical outcomes (pain intensity, disability and global perceived effect) will be collected at baseline and at 5 weeks, 3 months, and 6 months after randomisation. We will also collect satisfaction with care and adverse effects after treatment. Data will be collected by a blinded assessor. All statistical analysis will be conducted following the principles of intention to treat, and the effects of treatment will be calculated using Linear Mixed Models. DISCUSSION: The results of this study will provide new information about the usefulness of Kinesio Taping as an additional component of a guideline-endorsed physiotherapy program in patients with chronic nonspecific low back pain.