Enhanced Pain Relief and Muscle Growth in Individuals with Low Back Instability: The Impact of Blood Flow Restriction Exercise during Sit to Stand Movements.

BACKGROUND Blood flow restriction exercise (BFRE) improves muscle strength at a relatively low intensity by temporarily restricting blood flow. This study compared pain and quadriceps muscle mass (QMM) in 40 patients with lower back pain (LBP) undertaking sit-to-stand (STS) exercise with and without blood flow restriction. MATERIAL AND METHODS Forty adults were divided into 2 groups, and the experimental group (n=20) performed an STS exercise with BFRE, and the control group (n=20) performed an STS exercise without BFRE. Blood pressure, including systolic blood pressure (SBP) and diastolic blood pressure (DBP), was measured using a portable blood pressure monitor. Saturation of percutaneous oxygen (SpO2) was measured using oxygen saturation. Pain was measured using the visual analog scale (VAS) and the Oswestry disability index (ODI). QMM was assessed using ultrasonography. RESULTS Data were analyzed using paired and independent t tests. SBP (P=.000), DBP (P=.004), and SpO2 (P=.001) were significantly different in the experimental group, both before and during the intervention. The VAS scores showed a statistically significant difference in the post-test (P=.003) and rate of change (P=.009) between the groups. The ODI scores showed statistically significant differences in the post-test (P=.000) and rate of change (P=.001) comparison between the groups. The rate of change in QMM, including the rectus femoris (P=.000), vastus intermedius (P=.004), vastus medialis (P=.001), and vastus lateralis (P=.014), increased significantly in the experimental group compared to that in the control group. CONCLUSIONS This study demonstrates that the additive effect of BFRE on pain relief and QMM increase, thus contributing to existing knowledge about therapeutic exercise for the effective management of LBP.

Comparative Analysis of the Pain Provocation Test and the HABER Test to Diagnose Nonspecific Low-Back Pain Associated with the Sacroiliac Joint.

BACKGROUND This study aimed to investigate the correlation between the pain provocation test and the hip abduction-external rotation (HABER) test for diagnosing low-back pain (LBP)-related sacroiliac joint (SIJ) syndrome, and to determine the efficacy of the HABER test as a potential diagnostic tool for SIJ syndrome. MATERIAL AND METHODS One hundred patients with LBP participated. The first and second examiner examined the patients using the pain provocation test and the HABER test, respectively. Positive and negative findings were analyzed to determine the correlation and reliability. RESULTS The HABER test showed similar pain reproduction in groups that were positive or negative for SIJ syndrome (P<0.05). Based on the analysis of the receiver-operating characteristic curve, the cutoff values from the HABER test were found to be 29° and 32° of external rotation in the left and right hip joints, respectively. CONCLUSIONS The HABER test can reproduce similar level of pain in patients with chronic LBP associated with SIJ syndrome, and it can be used as a diagnostic tool in patients presenting with chronic LBP.

Responses of Korean physical therapy students after practice with a virtual anatomical system in Japan.

[Purpose] To investigate responses of Korean physical therapy students, receiving medical terminology education in physical therapy both in Korean and English, after practice with a virtual anatomical system. [Subjects and Methods] The participants were 25 physical therapy students from Konyang University in South Korea visiting the International University of Health and Welfare for training purposes. The virtual anatomy practice was conducted in English using 3 dimensional virtual anatomy software constructed using real cadaver photographs. A questionnaire about this practice and anatomy was completed after the practice. [Results] The results of the questionnaire showed a trend toward high scores for virtual anatomy practice. [Conclusion] The present virtual anatomy system was created using multi-directional photographs from a real cadaver; therefore, it can be used as an auxiliary means of education using cadavers.

Effects of a novel forced intensive strengthening technique on muscle size and upper extremity function in a patient with chronic stroke.

[Purpose] This research demonstrated a forced intensive strength technique as a novel treatment for muscle power and function in the affected upper extremity muscle to determine the clinical feasibility with respect to upper extremity performance in a stroke hemiparesis. [Subject and Methods] The subject was a patient with chronic stroke who was dependent on others for performing the functional activities of his affected upper extremity. The technique incorporates a comprehensive approach of forced, intensive, and strength-inducing activities to enhance morphological changes associated with motor learning of the upper extremity. The forced intensive strength technique consisted of a 6-week course of sessions lasting 60 minutes per day, five times a week. [Results] After the 6-week intervention, the difference between relaxation and contraction of the affected extensor carpi radialis muscle increased from 0.28 to 0.63 cm(2), and that of the affected triceps brachii muscle increased from 0.30 to 0.90 cm(2). The results of clinical tests including the modified Ashworth scale (MAS; from 1+ to 1), muscle strength (from 15 to 32 kg), the manual function test (MFT; scores of 16/32 to 27/32 score), the Fugl-Meyer assessment (FMA; scores of 29/66 to 49/66 score), and the Jebsen-Taylor hand function test (JTHFT; from 38/60 to 19/60 sec) were improved. [Conclusion] Our results suggest that the forced intensive strength technique may have a beneficial effect on the muscle size of the upper extremity and motor function in patients with chronic stroke.

The effect of a novel core stabilization technique on managing patients with chronic low back pain: a randomized, controlled, experimenter-blinded study.

OBJECTIVE: To identify the effect of a novel augmented core stabilization exercise technique on physical function, pain and core stability in patients with chronic low back pain. DESIGN: A block randomized controlled trial with two groups. SETTING: A sports rehabilitation clinic. PARTICIPANTS: Forty patients with low back pain (20 experimental, mean (SD) age 50.35 (9.26) years and 20 control, 51.30 (7.01)), 19 men and 21 women. INTERVENTIONS: In the experimental group ankle dorsiflexion was used in addition to drawing in the abdominal wall; the control group involved drawing in the abdominal wall alone. Both groups received the same conventional physical therapy training three days a week for eight weeks. MAIN OUTCOME MEASURES: Physical disability instruments; Oswestry Disability Index and Roland Morris Disability Questionnaire; pain intensity assessments; visual analogue scale, Pain Disability Index, and a pain rating scale; and core stability measures, such as the active straight leg raise, were determined at pretest, posttest and two-month follow-up. RESULTS: After the intervention, the experimental group showed significant greater improvement at two months compared with the control group. Physical disability results included Oswestry Disability Index (P = 0.001, from 24.25 (7.08) to 13.35 (4.17)) and Roland Morris Disability Questionnaire (P = 0.001, from 15.55 (1.99) to 8.15 (1.69)), pain intensity including visual analogue scale (P = 0.001, from 6.30 (1.03) to 3.35 (0.59)), Pain Disability Index (P = 0.001, 31.25 (5.44) to 19.00 (3.58)) and pain rating scale (P = 0.001, from 72.25 (18.73) to 50.10 (15.47)), and the core stability test such as active straight leg raise (P = 0.001, from 7.40 (0.75) to 2.15 (0.49)). CONCLUSIONS: This study provides the clinical evidence that adding ankle dorsiflexion to drawing in the abdominal wall gave increased benefit in terms of physical disability, pain and core stability in patients with chronic low back pain.

Effect of whole body vibration training on mobility in children with cerebral palsy: a randomized controlled experimenter-blinded study.

OBJECTIVE: To evaluate ambulatory function and leg muscle thickness after whole body vibration training in children with cerebral palsy. DESIGN: A block randomized controlled trial with two groups. SETTING: Physical therapy department laboratory. SUBJECTS: A total of 30 (15 experimental, mean (SD) age 10.0 (2.26) years and 15 control, 9.6 (2.58)) children with cerebral palsy, 15 males and 15 females. INTERVENTIONS: The experimental group underwent whole body vibration training combined with conventional physical therapy training; the control group underwent conventional physical therapy training three days a week for eight weeks respectively. MAIN OUTCOME MEASURES: Three-dimensional gait analyses and ultrasonographic imaging of the leg muscles were measured at pre- and post-test of intervention for eight weeks. RESULTS: Whole body vibration training resulted in significantly better gait speed (P = 0.001, from 0.37 (0.04) m/s to 0.48 (0.06)), stride length (P = 0.001, from 0.38 (0.18) m to 0.48 (0.18)) and cycle time (P = 0.001, from 0.85 (0.48) s to 0.58 (0.38)) in the experimental group compared with that in the control group. The ankle angle (P = 0.019, from 7.30 (4.02) degree to 13.58 (8.79)) also showed a remarkable increase in the experimental group, but not the hip (P = 0.321) and knee angle (P = 0.102). The thicknesses of the tibialis anterior (P = 0.001, 0.48 (0.08) mm to 0.63 (0.10)) and soleus (P = 0.001, 0.45 (0.04) mm to 0.63 (0.12)) muscles were significantly higher in the experimental group than in the control group. However, no significant effect was observed in the thickness of the gastrocnemius muscle (P = 0.645). CONCLUSIONS: These findings suggest that whole body vibration may improve mobility in children with cerebral palsy, probably through a positive effect on the leg muscles.

Watsu approach for improving spasticity and ambulatory function in hemiparetic patients with stroke.

BACKGROUND AND PURPOSE: This study reports the effect of Watsu as rehabilitation method for hemiparetic patients with stroke. METHOD: Watsu consisted of 40 treatment sessions for 8 weeks, delivered underwater or at water surface level, it applied in three patients. Outcome measures included tools for assessing spasticity and ambulatory function. RESULTS: All patients showed decreased scores in the TAS and RVGA after Watsu application. CONCLUSIONS: Watsu was helpful in controlling spasticity and improving ambulatory function of the patients with hemiparesis.

Effect of glenohumeral stabilization exercises combined with scapular stabilization on shoulder function in patients with shoulder pain: A randomized controlled experimenter-blinded study.

BACKGROUND: Shoulder stabilization exercises consisted of a glenohumeral stabilization and scapular stabilization. No studies have been assessed the superiority of shoulder stabilization until now. OBJECTIVE: To compare the effect of a glenohumeral stabilization exercise (GSE) combined with a scapular stabilization exercise (SSE) on changes in shoulder function in patients with shoulder painMETHODS: Shoulder stability, scapular alignment, pain, muscle power, and range of motion (ROM) were measured before and after the intervention in both groups. RESULTS: Forty subjects with shoulder pain were randomly assigned to an experimental or control group. GSE in the experimental group (n= 20) resulted in significantly better shoulder stability (P= 0.020, from 9.00 ± 6.90 score to 14.25 ± 8.58) and pain intensity (P= 0.042, 7.40 ± 2.44 score to 4.60 ± 2.06) compared to SSE in the controls (n= 20). However, no significant effects were observed for scapular symmetric alignment including the angles of inferior scapular distance (P= 0.555) and inferior scapular height difference (P= 0.770), muscle power including shoulder flexion (P= 0.942) and shoulder abduction (P= 0.551), or ROM including shoulder flexion (P= 0.852) and shoulder abduction (P= 0.622). CONCLUSION: This study suggests that GSE positively affects shoulder stability and pain control in patients with shoulder pain, probably through a centralization effect on the shoulder mechanism.

Immediate effects of somatosensory stimulation on hand function in patients with poststroke hemiparesis: a randomized cross-over trial.

This study aimed to determine the immediate effects of somatosensory stimulation on hand function in patients with poststroke hemiparesis. Eleven patients with poststroke hemiparesis participated in this study. Four types (no stimulation, vibration, and light and rough touches) of somatosensory stimulation were performed randomly for 4 days applying only one type of somatosensory stimulation each day. The box and block test (BBT), the Jebsen-Taylor hand function test (JTHFT), hand grip strength (HGS), and movement distance and peak velocity of the wrist joint during a forward-reaching task were measured. The BBT and JTHFT scores for no stimulation [BBT: median (interquartile range), 0.00 (-1.00 to 1.00) and JTHFT: 2.57 (-0.47 to 4.92)] were significantly different from those for vibration [BBT: 3.00 (2.00-5.00) and JTHFT: -16.02 (-23.06 to -4.31)], light touch [BBT: 3.00 (1.00-4.00) and JTHFT: -5.00 (-21.20 to -0.94)], and rough touch [BBT: 2.00 (1.00-4.00) and JTHFT: -6.19 (-18.22 to -3.70)]. The JTHFT score was significantly higher for vibration than that for rough touch (P<0.05). The increase in HGS was significantly greater for light touch than that for no stimulation (P<0.05) and for vibration than that for light touch (P<0.05). There were significant differences for the sagittal and coronal planes in movement distance and for the sagittal and horizontal planes in peak velocity during the forward-reaching task (P<0.05). The findings suggest that somatosensory stimulation may be advantageous to improve the hand function of patients with poststroke hemiparesis, with more favorable effects observed in vibration stimulation.

Cocontraction of ankle dorsiflexors and transversus abdominis function in patients with low back pain.

CONTEXT: The abdominal draw-in maneuver (ADIM) with cocontraction has been shown to be a more effective method of activating the transversus abdominis (TrA) in healthy adults than the ADIM alone. Whether such an augmented core stabilization exercise is effective in managing low back pain (LBP) remains uncertain. OBJECTIVE: To determine the effect of 2 weeks of ADIM and cocontraction training on abdominal muscle thickness and activation timing and to monitor pain and function in patients with LBP. DESIGN: Case-control study. SETTING: Local orthopaedic clinic and research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty patients with mechanical LBP (age = 27.20 ± 6.46 years, height = 166.25 ± 8.70 cm, mass = 58.10 ± 11.81 kg) and 20 healthy, age-matched people (age = 24.25 ± 1.59 years, height = 168.00 ± 8.89 cm, mass = 60.65 ± 11.99 kg) volunteered for the study. INTERVENTION(S): Both the LBP and control groups received ten 30-minute sessions of ADIM and cocontraction training of the tibialis anterior (TA) and rectus femoris (RF) muscles over a 2-week period. MAIN OUTCOME MEASURE(S): A separate, mixed-model analysis of variance was computed for the thicknesses of the TrA, internal oblique (IO), and external oblique muscles. The differences in mean and peak electromyographic (EMG) amplitudes, onset time, and latency were compared between the groups. The visual analog pain scale, Pain Disability Index, and LBP rating scale were used to assess pain in the LBP group before and after the intervention. RESULTS: We found an interaction between the LBP and control groups and a main effect from pretest to posttest for only TrA muscle thickness change (F1,38 = 6.57, P = .01). Reductions in all pain measures were observed after training (P < .05). Group differences in peak and mean EMG amplitudes and onset time values for TrA/IO and TA were achieved (P < .05). The RF peak (t38 = 3.12, P = .003) and mean (t38 = 4.12, P = .001) EMG amplitudes were different, but no group difference was observed in RF onset time (t38 = 1.63, P = .11) or the cocontracted TrA/IO peak (t38 = 1.90, P = .07) and mean (t38 = 1.81, P = .08). The test-retest reliability for the muscle thickness measure revealed excellent correlations (intraclass correlation coefficient range, 0.95-0.99). CONCLUSIONS: We are the first to demonstrate that a cocontraction of the ankle dorsiflexors with ADIM training might result in a thickness change in the TrA muscle and associated pain management in patients with chronic LBP.

Use of the novel myokinetic stretching technique to ameliorate fibrotic mass in congenital muscular torticollis: an experimenter-blinded study with 1-year follow-up.

OBJECTIVE: To investigate the effect of the myokinetic stretching technique (MST) on morphological changes and associated clinical outcomes. METHOD: Infantile torticollis (N=32, 17 males) between 1 and 5 months of age (50.56 +/- 20.74 days) were treated with the MST for approximately 30 minutes per session, 5 times a week at university hospital. Diagnostic real-time ultrasound imaging was used on both unaffected and affected sides before and after the treatment to measure the sternocleidomastoid (SCM) muscle thickness of the involved area. Range of motion, head symmetry, and plagiocephaly with radiographs were determined. Data were analyzed using unpaired and paired t-test at p< 0.05. RESULTS: A significant reduction in SCM muscle thickness was observed after the intervention (p< 0.05). This morphological change was associated with significant improvements in passive cervical range of motion and head symmetry (p< 0.05). The mean intervention duration was 53.59 +/- 25.12 days to completely resolve the mass. These effects continued to exist one year post-intervention. CONCLUSIONS: This was the first clinical evidence that demonstrated the efficacy of MST for improving cervical motion and muscle thickness in infants with congenital muscular torticollis as well as shortening the treatment duration.

Effect of the abdominal draw-in manoeuvre in combination with ankle dorsiflexion in strengthening the transverse abdominal muscle in healthy young adults: a preliminary, randomised, controlled study.

OBJECTIVES: To compare the effect of the abdominal draw-in manoeuvre with the abdominal draw-in manoeuvre in combination with ankle dorsiflexion on changes in muscle thickness and associated muscle activity in abdominal muscles. DESIGN: A preliminary, randomised, controlled study. SETTING: University laboratory. PARTICIPANTS: Forty healthy adults (18 males, 22 females) were allocated at random to the experimental group [mean age (SD) 24 (1.6) years, n=20] or the control group [mean age (SD) 24 (1.9) years, n=20]. The experimental group performed the abdominal draw-in manoeuvre in combination with ankle dorsiflexion, and the control group performed the abdominal draw-in manoeuvre alone, five times a day. MAIN OUTCOME MEASURES: Ultrasonography and electromyography were used to determine the intervention-related changes in muscle activity and the thickness of abdominal muscles during the abdominal draw-in manoeuvre or the abdominal draw-in manoeuvre in combination with ankle dorsiflexion. RESULTS: A significant difference was found in the thickness of the transverse abdominal muscle between the groups [mean difference 0.24 cm, 95% confidence interval (CI) 0.08 to 0.40, P=0.005. On electromyography, a significant difference was demonstrated in the amplitude of the transverse abdominal muscle contraction between the two techniques in the experimental group (mean difference 68.76 mV, 95% CI 53.16 to 84.36, P=0.000. The intra-class correlation coefficient (ICC(2,1)) showed excellent test-retest reliability of ultrasound measurement of the abdominal muscles: 0.96 (95% CI 0.85 to 0.99) for the transverse abdominal muscle, 0.87 (95% CI 0.62 to 0.98) for the internal oblique muscle and 0.77 (95% CI 0.44 to 0.96) for the external oblique muscle. CONCLUSIONS: This is the first study to demonstrate the additive effect of ankle dorsiflexion on deep core muscle thickness and activity, thus contributing to existing knowledge about therapeutic exercise for the effective management of low back pain.

The change in vastus medialis oblique and vastus lateralis electromyographic activity related to shoe heel height during treadmill walking.

OBJECTIVE: This study investigated the effect of different heel heights on the electromyographic (EMG) activity of the vastus medialis oblique (VMO) and vastus lateralis (VL) during treadmill walking. METHODS: 17 young healthy women (age 22.06 +/- 1.2 years) were recruited. With and without a slope, the participants walked on a treadmill at a speed of 2 km/h for 90 seconds under three conditions: barefoot, 3-cm heels, and 7-cm heels. Data for surface EMG was collected from the standard sites of the VMO and VL during treadmill walking. RESULTS: Significant differences were observed in the VL EMG activity on the non-dominant side between barefoot and 7-cm heels while walking with and without a slope (p< 0.05). VMO:VL EMG ratios significantly decreased for the non-dominant side while walking with and without a slope (p < 0.05). The post hoc pair-wise comparisons revealed significant differences in barefoot vs. 7-cm heel and 3-cm vs. 7-cm heels. CONCLUSION: The findings suggest that high-heeled shoes may contribute to a potential change of the knee joint muscles while walking, especially on the non-dominant side. This study provides information that will notify future research on how high-heeled shoe affects muscle activity around the knee joint.