Supervised versus unsupervised pelvic floor muscle training in the treatment of women with urinary incontinence - a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: This study synthesized the effects of supervised and unsupervised pelvic floor muscle training (PFMT) programs on outcomes relevant to women's urinary incontinence (UI). METHODS: Five databases were searched from inception to December 2021, and the search was updated until June 28, 2022. Randomized and non-randomized control trials (RCTs and NRCTs) comparing supervised and unsupervised PFMT in women with UI and reported urinary symptoms, quality of life (QoL), pelvic floor muscles (PFM) function/ strength, the severity of UI, and patient satisfaction outcomes were included. Risk of bias assessment of eligible studies was performed by two authors through Cochrane risk of bias assessment tools. The meta-analysis was conducted using a random effects model with the mean difference or standardized mean difference. RESULTS: Six RCTs and one NRCT study were included. All RCTs were assessed as "high risk of bias", and the NRCT study was rated as "serious risk of bias" for almost all domains. The results showed that supervised PFMT is better than unsupervised for QoL and PFM function of women with UI. There was no difference between supervised and unsupervised PFMT for urinary symptoms and improvement of the severity of UI. Results of patient satisfaction were inconclusive due to the sparse literature. However, supervised and unsupervised PFMT with thorough education and regular reassessment showed better results than those for unsupervised PFMT without educating patients about correct PFM contractions. CONCLUSIONS: Supervised and unsupervised PFMT programs can both be effective in treating women's UI if training sessions and regular reassessments are provided.

Ultrasound assessment of the abdominal, diaphragm, and pelvic floor muscles during the respiratory and postural tasks in women with and without postpartum lumbopelvic pain: a case-control study.

INTRODUCTION AND HYPOTHESIS: Postpartum lumbopelvic pain (PLPP) is common among women. Abdominal, diaphragm, and pelvic floor muscles (PFMs) modulate intraabdominal pressure as a part of the force closure mechanism. These muscles are exposed to changes during pregnancy that compromise the force closure mechanism. It was hypothesized that abdominal and PFMs activity, the direction of bladder base displacement, diaphragm thickness, and excursion might differ between women with and without PLPP during respiratory and postural tasks. METHODS: Thirty women with and 30 women without PLPP participated in this case-control study. Ultrasound imaging was used to assess the abdominal, diaphragm, and PFMs during rest, active straight leg raising (ASLR) with and without a pelvic belt, and deep respiration. RESULTS: The bladder base descent was significantly greater in the PLPP group than in the controls during deep respiration and ASLR without a belt (p = 0.026; Chi-squared = 6.40). No significant differences were observed between the groups in the abdominal muscles activity and diaphragm muscle thickness. There was a significant interaction effect of the group and the task for diaphragm excursion (F (2, 116) = 6.08; p = 0.00) and PFM activity (F (2, 116) = 5.22; p = 0.00). In the PLPP group, wearing a belt compromised altered PFM activation and direction of bladder base displacement. CONCLUSION: The PFM activity, direction of bladder base displacement, and diaphragm excursion differed between groups during postural and respiratory tasks. Therefore, it is recommended to involve retraining of the PFMs and diaphragm muscle in the rehabilitation of women with PLPP.

The Intra-Rater Reliability of Ultrasonography for the Measurement of Lumbar Multifidus and Erector Spinae Thickness in Different Positions in People with and without Active Extension-Related Non-Specific Low Back Pain.

Background: The paraspinal muscles, including multifidus (MF) and erector spinae (ES) play key roles in the stability and movement of the lumbar spine. This study aimed to determine the intra-rater reliability of the ES and MF muscle thickness measures of the rehabilitative ultrasound imaging (RUSI) in people with active extension pattern (AEP) non-specific chronic low back pain and controls. Methods: Fifteen females with AEP and 19 controls participated in this test-retest intra-rater reliability study, including two different testing sessions performed in four to seven days apart. The primary (raw) and derived (normalized) measures of the L4 MF and ES muscles`thickness were examined in three different positions (prone, sitting, and standing) on both days. A two-way mixed average of intra-class correlation coefficient (ICC3, K) with confidence interval (CI = 95%) was used to determine the relative reliability. The standard error of measurement (SEM) and minimal detectable change (MDC) values at a CI of 95% were computed to examine the absolute reliability. Results: The ICC values for the primary thickness of the L4 ES and MF muscles were from 0.85 to 0.91, except for MF muscle thickness in standing (ICC = 0.67) and sitting (ICC = 0.66) positions . The ICC values for derived data were lower in both groups. The SEM and MDC values were small enough to confirm the absolute reliability of the primary data. Conclusion: This study supports the use of RUSI for examining the primary measures of the L4 MF and ES muscles in asymptomatic and AEP participants, but it should be used cautiously for assessing the derived measures.

Relationship between the morphology and composition of the lumbar paraspinal and psoas muscles and lumbar intervertebral motion in chronic low-back pain: An exploratory study.

Muscles of the lumbar spine play an important role in controlling segmental intervertebral motion. This study aimed to evaluate the association between lumbar intervertebral motion and changes in lumbar morphology/composition in people with chronic low-back pain (CLBP). A sample of 183 patients with CLBP participated in this cross-sectional study. Participants underwent lumbar flexion-extension X-rays to determine vertebral motion (translational and/or rotational motion) of lumbar levels (L1-L2 to L5-S1) and lumbar spine magnetic resonance imaging to quantify total and functional cross-sectional areas (CSAs) and asymmetry of the multifidus (MF), lumbar erector spinae (LES), and psoas muscles. The relationship between morphology/composition of the muscles and lumbar intervertebral motion was investigated. Smaller total and functional CSAs of the MF and greater CSAs of the LES muscle were observed in participants with greater intervertebral motion. Muscle asymmetry was observed at different lumbar vertebral levels. The greatest amount of translational intervertebral motion was observed at the L3-L4 level, while the greatest amount of rotational translation occurred at the L4-L5. Associations were observed between the morphology of the paraspinal muscles at the vertebral levels adjacent to the L3-L4 level and the increased intervertebral motion at this level. Relationships between measures of muscle morphology/composition and increased segmental vertebral motion were observed. The results may provide a plausible biological reason for the effectiveness of rehabilitating deficient paraspinal muscles in a subset of people with CLBP.

Effect of Motor Control Training on Trunk Muscle Morphometry, Pain, and Disability in People With Chronic Low Back Pain: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aim of this systematic review and meta-analysis was to study the effects of motor control training (MCT) on trunk muscle morphometry measured by ultrasound imaging and pain and disability in individuals with chronic low back pain. METHODS: PubMed, Web of Science, Scopus, and Cochrane Library databases were searched from study inception until January 2021. Randomized control trials evaluating both muscle morphometry and pain or disability in individuals with chronic low back pain were included. Study selection, data extraction, and quality assessment were performed by 2 reviewers independently. Modified Downs and Black tool and the Grading of Recommendations Assessment, Development and Evaluation approach were used to assess the risk of bias and quality of evidence, respectively. A meta-analysis was performed using a random effects model with mean difference or standardized mean difference (SMD). RESULTS: Of 3459 studies initially identified, 15 studies were included, and 13 studies were selected for meta-analysis. The results revealed no differences in the resting thickness of the transversus abdominis, internal and external oblique, and lumbar multifidus muscles in studies that compared MCT with other interventions. The transversus abdominis muscles contraction ratio was greater (SMD = 0.93; 95% confidence interval [CI], -0.0 to 1.85) and lower pain (weighted mean difference: -1.07 cm; 95% CI, -1.91 to -0.22 cm; P = .01) and disability (SMD = -0.86; 95% CI, -1.42 to -0. 29; P < .01) scores were found in the groups who underwent MCT compared with other interventions. CONCLUSION: This systematic review and meta-analysis found that motor control exercise training increased the transverse abdominis contraction ratio (muscle activation) and improved the level of pain and disability compared to other interventions in people with chronic low back pain. However, motor control exercise training was not superior to other interventions in increasing the resting thickness of deep abdominal and lumbar multifidus muscles in intervention times less than 12 weeks.

The effect of local muscle vibration on clinical and biomechanical parameters in people with knee osteoarthritis: A systematic review.

Background: To identify and synthesize available published studies on the effect of local muscle vibration (LMV) on pain, stiffness, and function in individuals with knee OA. Methods: Five databases were searched to find relevant papers on April 29, 2020, including, PubMed, Scopus, EMBASE (Ovid), Science Citation Index, and COCHRANE Central Register for Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) and nonrandomized-controlled-trials (non-RCTs), such as interrupted time series and prospective cohort studies were included. Two independent reviewers screened articles and assessed inclusion through predefined criteria. Participants' characteristics, study design, intervention characteristics, outcomes, and main results were collected independently by 2 reviewers. The risk of bias assessment of included studies was conducted using Cochrane risk of bias tools for RCTs and non-RCTs. Results: Six studies were included: 3 RCTs and 3 non-RCTs. The risk of bias in included studies was generally moderate to high. Improvement of pain, stiffness, and function following the application of LMV were reported in all studies. Conclusion: This review revealed the promising effect of LMV on pain, stiffness, function, and knee range of motion (ROM) improvements for individuals with knee Osteoarthritis (OA). However, further well-designed studies are required to have a convincing conclusion on the effect of LMV in individuals with knee OA.

Trunk-Pelvis Kinematics Variability During Gait and Its Association With Trunk Muscle Endurance in Patients With Chronic Low Back Pain.

The first purpose was to investigate the trunk muscle endurance, the second aim was to evaluate the trunk-pelvis kinematics during gait, and the third was to evaluate the relationship between trunk-pelvis kinematics and the trunk muscle endurance. Thirty participants (15 nonspecific chronic low back pain [NCLBP] and 15 healthy) were included. The authors first assessed trunk muscle endurance on endurance testing protocols. The authors next measured the trunk-pelvis kinematics during gait using a 3-dimensional motion capture system. Angular displacement, waveform pattern (CVp), and offset variability (CVo) were also examined. Statistical analysis revealed a significant difference in (1) the trunk muscle endurance and (2) sagittal, frontal, and transverse planes CVp between groups (P < .05). A significant moderate correlation was found between supine double straight-leg raise and frontal CVp (r = .521, P = .03) and transverse planes CVp (r = .442, P = .05). However, a significant moderate correlation was observed between prone double straight-leg raise and sagittal plane CVp (r = .528, P = .03) and transverse plane CVp (r = .678, P = .001). The relationship between (1) lower trunk extensor endurance with transverse and sagittal planes CVp and (2) lower abdominal muscle endurance with transverse and frontal planes CVp suggests that gait variability in these planes may result because of trunk muscle deconditioning accompanying NCLBP.

Intrarater reliability of musculoskeletal ultrasound imaging of psoas major muscle in patients with subacute low back pain and healthy controls.

Background: Psoas major (PM) is a challenging muscle from the functional and anatomical point of view. The dysfunction of this muscle can result in low back pain (LBP). This study aimed to assess the intrarater reliability of ultrasound imaging (USI) of PM muscle thickness in subacute LBP patients and healthy participants without LBP in rest and during muscle contraction conditions. Methods: PM thickness was measured in all lumbar segments (L1-L5) using a USI device in 10 healthy and 10 subacute LBP participants. The intrarater data were assessed on the same day with 1- hour interval and after 7 days. Intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and independent t test were used for analyses. Significant level was set at 0.05. Results: PM thickness in all lumbar levels had excellent reliability (ICC range 80-98) for both groups and conditions. SEM (0.42- 2.29) and MDC (1.16-6.34) were low, and PM thickness was greater than rest in contraction condition. There were no significant differences between the 2 groups in PM thickness. Conclusion: The USI demonstrated good intrarater reliability for assessing PM thickness in patients with subacute LBP. The thickness of PM in patients with subacute LBP was similar with that in healthy participants.

Application of Ultrasonography in the Assessment of Abdominal and Lumbar Trunk Muscle Activity in Participants With and Without Low Back Pain: A Systematic Review.

OBJECTIVE: The purpose of this study was to systematically review the literature regarding which condition (task, position, or contraction type), changes in muscle thickness could be interpreted as muscle activity of trunk muscles. METHODS: Studies that assessed the correlation between changes in muscle thickness measured with ultrasonography (US) and electromyography (EMG) activity were included. Only the data related to abdominal and lumbar trunk muscles in participants with or without low back pain were extracted. The PubMed, ScienceDirect, Ovid MEDLINE, Scopus, Springer, and Cumulative Index to Nursing and Allied Health Literature databases were searched from inception to August 2018. Two independent raters appraised the quality of the included studies using the Critical Appraisal Skills Program checklist. RESULTS: Fourteen studies were included. The results revealed significant correlations between US and EMG measures for the lumbar multifidus and erector spinae muscle during most contraction levels and postures. For transverse abdominis and internal oblique, US and EMG measures were correlated during low load abdominal drawing or bracing. The correlations were influenced by trunk position for higher intensities of contraction. For the external oblique muscle, correlation was observed only during trunk rotation. CONCLUSION: Changes in muscle thickness should not be interpreted as muscle activity for all tasks, positions, and contraction types. Only during prime movement tasks performed with isometric contraction could muscle thickness change be considered as muscle activity. Also, upright postures influenced the relationship between changes in muscle thickness and muscle activity for abdominal muscles.

Kinematics of the Spine During Sit-to-Stand Movement Using Motion Analysis Systems: A Systematic Review of Literature.

CONTEXT: Clinical evaluation of the spine is commonplace in musculoskeletal therapies, such as physiotherapy, physical medicine/rehabilitation, osteopathic, and chiropractic clinics. Sit-to-stand (STS) is one of the most mechanically demanding daily activities and crucial to independence. Difficulty or inability to perform STS is common in individuals with a variety of motor disabilities, such as low back pain (LBP). OBJECTIVE: The purpose of this systematic review was to evaluate available evidence in literature to determine 2-dimensional and 3-dimensional kinematics of the spine during STS in patients with LBP and healthy young adult participants using motion analysis systems (electromagnetic and marker based). METHODS: Electronic databases (PubMed/MEDLINE [National Library of Medicine], Scopus, ScienceDirect, and Google Scholar) were searched between January 2002 and February 2017. Additionally, the reference lists of the articles that met the inclusion criteria were also searched. Prospective studies published in peer-reviewed journals, with full text available in English, investigating the kinematics of the spine during STS in healthy subjects (mean age between 18 and 50 y) or in patients with LBP using motion analysis systems, were included. Sixteen studies fulfilled the eligibility criteria. All information relating to methodology and kinematic modeling of the spine segments along with the outcome measures was extracted from the studies identified for synthesis. RESULTS: The results indicated that the kinematics of the spine are greatly changed in patients with LBP. In order to develop a better understanding of spine kinematics, studies recommended that the trunk should be analyzed as a multisegment. It has been shown that there is no difference between the kinematics of patients with LBP and healthy population when the spine is analyzed as a single segment. Furthermore, between-gender differences are present during STS movement. CONCLUSION: This review provided a valuable summary of the research to date examining the kinematics of the spine during STS.

Effect of Elastic Therapeutic Taping on Abdominal Muscle Endurance in Patients With Chronic Nonspecific Low Back Pain: A Randomized, Controlled, Single-Blind, Crossover Trial.

OBJECTIVE: The purpose of this study was to determine the immediate effect of elastic therapeutic taping and sham taping of the abdominal musculature on maximum hold time of endurance tests in patients with chronic nonspecific low back pain (CNLBP). METHODS: Twenty-six people with CNLBP and 26 asymptomatic individuals were included in this study. The CNLBP participants were allocated to an elastic therapeutic tape group or a sham tape group. Standard adhesive elastic therapeutic tape was utilized for facilitatory application in the elastic therapeutic tape group. The elastic therapeutic tape group received real elastic therapeutic taping on the transversus abdominis and internal obliques, and the sham tape group received sham elastic therapeutic taping application. For the sham group, the elastic therapeutic tape was positioned horizontally above the navel and applied without tension. After a wash-out period, each CNLBP participant was switched to the other group. Outcome measures included maximum hold time of supine isometric chest raise, supine double straight-leg raise, and abdominal drawing in maneuver. RESULTS: The CNLBP participants had lower maximum hold time compared to the asymptomatic individuals (P ≤ .01). Following taping, both groups showed an increase in the maximum hold time (mean difference = 4.43 - 50.69 seconds; P ≤ .02). Although there was no difference between the results of both groups (P ≥ .12), effect sizes were large for the elastic therapeutic tape group (Cohen's d = -1.93 to -1.00). CONCLUSIONS: The results suggest that the maximum hold time of endurance tests was decreased in CNLBP patients compared to healthy participants. The application of both elastic therapeutic tape and sham tape to the transversus abdominis and internal obliques produced short-term improvement in abdominal endurance. There was no statistically significant difference between the results of elastic therapeutic tape and sham tape.

Effect of Gastrocnemius Kinesio Taping on Countermovement Jump Performance and Vertical Stiffness Following Muscle Fatigue.

CONTEXT: Kinesio tape (KT) is a widely used intervention in the fields of sports and rehabilitation. However, its effects on lower-extremity behavior during functional activities are not entirely known. OBJECTIVE: To test the hypothesis that application of KT can change performance and vertical stiffness (VS) during the countermovement jump (CMJ) before and after a fatigue protocol. DESIGN: A predesign and postdesign to study the effect of KT in 2 situations, prefatigue and postfatigue. In each fatiguing condition, there were 2 conditions with and without KT application on the gastrocnemius muscle. SETTING: Biomechanics laboratory. PARTICIPANTS: Fifty healthy, nonathlete participants (26 females and 24 males). INTERVENTIONS: KT application on the gastrocnemius muscle and a fatigue protocol to induce fatigue in plantar flexor muscles. MAIN OUTCOME MEASURES: Various jumping parameters, including jump height, maximum force, maximum power, rate of force development, eccentric lower-limb stiffness, and VS, were calculated using the vertical ground reaction force data. Eccentric lower-limb stiffness and VS were calculated using a mass-spring model. The studied variables can present lower-extremity elastic behavior and performance during CMJ. RESULTS: The results of a 2-way repeated-measures analysis of variance showed no significant effect for KT application. Fatigue resulted in lower values of jump height, maximum power, and VS. Moreover, male subjects showed greater values of jump height, maximum force, and maximum power than did females. CONCLUSIONS: The main finding of this study was that gastrocnemius KT has no effect on performance or elastic behavior of the lower-extremity during CMJ. Moreover, KT cannot reduce the adverse effect of fatigue in a functional activity such as CMJ. It seems that gastrocnemius KT is not effective for demanding activities.

Reliability and concurrent validity of a new iPhone® goniometric application for measuring active wrist range of motion: a cross-sectional study in asymptomatic subjects.

Measurement of wrist range of motion (ROM) is often considered to be an essential component of wrist physical examination. The measurement can be carried out through various instruments such as goniometers and inclinometers. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for goniometric functions. This study, for the first time, aimed to evaluate the reliability and concurrent validity of a new smartphone goniometric app (Goniometer Pro©) for measuring active wrist ROM. In all, 120 wrists of 70 asymptomatic adults (38 men and 32 women; aged 18-40 years) were assessed in a physiotherapy clinic located at the School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran. Following the recruitment process, active wrist ROM was measured using a universal goniometer and iPhone® 5 app. Two blinded examiners each utilized the universal goniometer and iPhone® to measure active wrist ROM using a volar/dorsal alignment technique in the following sequences: flexion, extension, radial deviation, and ulnar deviation. The second (2 h later) and third (48 h later) sessions were carried out in the same manner as the first session. All the measurements were conducted three times and the mean value of three repetitions for each measurement was used for analysis. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used to determine the intra-rater and inter-rater reliability, respectively. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone® app. Good to excellent intra-rater and inter-rater reliability was demonstrated for the goniometer with ICC values of ≥ 0.82 and ≥ 0.73 and the iPhone® app with ICC values of ≥ 0.83 and ≥ 0.79, respectively. Minimum detectable change at the 95% confidence level (MDC95 ) was computed as 1.96 × standard error of measurement × âˆš2. The MDC95 ranged from 1.66° to 5.35° for the intra-rater analysis and from 1.97° to 6.15° for the inter-rater analysis. The concurrent validity between the two instruments was high, with r values of ≥ 0.80. From the results of this cross-sectional study, it can be concluded that the iPhone® app possesses good to excellent intra-rater and inter-rater reliability and concurrent validity. It seems that this app can be used for the measurement of wrist ROM. However, further research is needed to evaluate symptomatic subjects using this app.

A RCT comparing lumbosacral orthosis to routine physical therapy on postural stability in patients with chronic low back pain.

Background: Poor balance performance and impaired postural control have been frequently reported in patients with low back pain. However, postural control is rarely monitored during the course of treatment even though poor postural control may contribute to chronicity and recurrence of symptoms. Therefore, the present study aimed at investigating the effect of a nonextensible lumbosacral orthosis (LSO) versus routine physical therapy on postural stability of patients with nonspecific chronic low back pain. Methods: This was a randomized controlled trial conducted between November 2015 and May 2016 at the outpatient physical therapy clinic of the School of Rehabilitation Sciences. Patients with nonspecific chronic low back pain aged 20 to 55 years were randomly allocated to the intervention and control groups. Both groups received 8 sessions of physical therapy twice weekly for 4 weeks. The intervention group received nonextensible LSO in addition to routine physical therapy. Pain intensity, functional disability, fear of movement/ (re)injury, and postural stability in 3 levels of postural difficulty were measured before and after 4 weeks of intervention. A 2×2×3 mixed model of analysis of variance (ANOVA) was used to determine the main and interactive effects of the 3 factors including group, time, and postural difficulty conditions for each variable of postural stability. Results: The LSO and control groups displayed significant improvement in postural stability at the most difficult postural task conditions (P-value for 95% area ellipse was 0.003; and for phase plane, the mean total velocity and standard deviation of velocity was <0.001). Both groups exhibited a decrease in pain intensity, Oswestry Disability Index, and Tampa Scale of Kinesiophobia after 4 weeks of intervention. A significant difference between groups was found only for functional disability, with greater improvement in the orthosis group (t = 3.60, P<0.001). Conclusion: Both routine physical therapy and LSO significantly improved clinical and postural stability outcomes immediately after 4 weeks of intervention. The orthosis group did not display superior outcomes, except for functional disability.

Dual-Tasking Effects on Dynamic Postural Stability in Athletes With and Without Anterior Cruciate Ligament Reconstruction.

PURPOSE: To compare the effect of dual tasking on postural stability between patients with anterior cruciate ligament reconstruction (ACL-R) and healthy controls. METHODS: Single-limb postural stability was assessed in 17 athletes with ACL-R and 17 healthy matched athletes while standing on a Biodex Balance System platform in 4 conditions: stability level of 8 (ie, more-stable support surface) with eyes open, stability level of 8 with eyes closed, stability level of 6 (ie, less-stable support surface) with eyes open, and stability level of 6 with eyes closed. Postural-stability tasks were performed with and without auditory Stroop task. The anteroposterior stability index (APSI), mediolateral stability index (MLSI), and overall stability index (OSI) as measures of postural performance, as well as reaction time and error ratio as measures of cognitive performance, were recorded. RESULTS: Dual-tasking effect on postural stability was not significantly different between the groups in 3 postural conditions. Only in level 6 with eyes open, for APSI and OSI, patients with ACL-R showed lower postural stability under the dual-task condition. However, patients showed poorer performance on both reaction time and error ratio in all postural conditions. CONCLUSIONS: The patients with ACL-R appeared to sacrifice their cognitive performance to optimize their performance on postural stability. This posture-first strategy was reflected by a more pronounced effect of dual tasking on the auditory Stroop task than the postural-stability task. In situations where maintenance of posture is challenging, giving priority to the postural task at the expense of cognitive performance can ensure safety from balance loss.

The effects of arm movement on reaction time in patients with latent and active upper trapezius myofascial trigger point.

BACKGROUND: Myofascial pain syndrome is a significant source of mechanical pain. The aim of this study was to investigate the effects of arm movement on reaction time in females with latent and active upper trapezius myofascial trigger point. METHODS: In this interventional study, a convenience sample of fifteen women with one active MTP, fifteen women with one latent MTP in the upper trapezius, and fifteen normal healthy women were participated. Participants were asked to stand for 10 seconds in an erect standing position. Muscle reaction times were recorded including anterior deltoid (AD), cervical paraspinal (CP) lumbar paraspinal (LP), both of upper trapezius (UT), sternocleidomastoid (SCM) and medial head of gastrocnemius (GcM). Participants were asked to flex their arms in response to a sound stimulus preceded by a warning sound stimulus. Data were analyzed using one-way ANOVA Test. RESULTS: There was significant differences in motor time and reaction time between active and control groups (p< 0.05) except for GcM. There was no significant difference in motor time between active and passive groups except for UT without MTP and SCM (p< 0.05). Also, there were no significant differences in motor times between latent MTP and control groups. Furthermore, there was no significant difference in premotor times between the three groups. CONCLUSION: The present study shows that patients with active MTP need more time to react to stimulus, but patients with latent MTP are similar to healthy subjects in the reaction time. Patients with active MTP had less compatibility with environmental stimulations, and they responded to a specific stimulation with variability in Surface Electromyography (SEMG).

The Effect of an Overhead External Load Lifting and Lowering on Dynamic Postural Control in Subgroups of Low Back Pain.

BACKGROUND: Understanding postural control in low back pain (LBP) subgroups can help develop targeted interventions to improve postural control. The studies on this topic are limited. Therefore, the primary purpose of this study was to compare the postural control of LBP subgroups with healthy individuals during overhead load lifting and lowering. METHODS: In this cross-sectional study, the participants were 52 with LBP and 20 healthy. The LBP patients were classified based on the O'Sullivan classification system into 21 flexion patterns and 31 active extension patterns. The participants lifted the box from their waists to their overheads and lowered it to their waists. Changes in postural control parameters were measured with a force plate system. RESULTS: The results of the analysis of variance showed that during load lifting, the mediolateral phase plane (p = .044) and the mean total velocity (p = .029) had significant differences between flexion patterns and healthy. Also, the load-lowering results showed that active extension patterns, compared with healthy, had significant differences in the anteroposterior-mediolateral phase plane (p = .042). The patients showed less postural sway than the healthy. CONCLUSIONS: The results in this work highlight the importance of identifying the homogenous subgroups in LBP and support the classification of heterogeneous LBP. Different subgroups exhibit different postural control behaviors. These behaviors can be due to the loading of various tissues during different tasks.

Could dry needling change the kinematics of gait in individuals with piriformis muscle syndromes? Secondary analysis of a randomized controlled trial.

INTRODUCTION: Piriformis muscle syndrome (PMS) is a condition that can lead to symptoms including gluteal pain, local tenderness, and limitation of hip joint motion in daily activities, and it may have a major impact on some daily functions such as gait. We proposed that dry needling (DN) can improve the gait of individuals with PMS. METHODS: Thirty-two individuals with PMS were assigned equally and randomly to the treatment group or the wait-list control group. Subjects in the treatment group received three sessions of DN of the piriformis muscle. All participants in both groups were educated to correct their lifestyles. The outcome measures were the gait-related parameters (walking speed, peak hip flexion, peak hip extension, time to peak internal and external hip rotation, and knee sagittal range of motion), which were evaluated at baseline and after treatment. To compare different outcomes, analysis of covariance (ANCOVA) was used, with baseline as the covariance and groups as a factor. RESULT: After DN sessions, peak hip extension during gait showed a statistically significant difference [adjusted MD 1.9 (3.7-0.08), p < 0.05, d = 0.56 (0.1-1.28)] in favor of the DN group. Peak hip flexion, on the other hand, exhibited a marginal statistically significant difference [adjusted MD -3.2 (-6.51 to 0.01), p = 0.053, d = 0.44 (1.16 to -0.02)] compared to the control group. CONCLUSION: The findings suggest that participants in DN showed significantly greater peak extension angle of the hip during walking in individuals with PMS than in the control group.

Evaluating the effect of equipping an unloading knee orthosis with local muscle vibrators on clinical parameters, muscular activation level, and medial contact force in patients with medial knee osteoarthritis: A randomized trial.

BACKGROUND: Unloading knee orthosis is prescribed for people with unicompartmental knee osteoarthritis (OA) to unload the damaged compartment. However, despite its benefits, wearing unloading knee orthoses in the long term may decrease knee muscle activity and have a side effect on knee OA progression rate. OBJECTIVES: Therefore, this study aimed to determine whether equipping an unloading knee orthosis with local muscle vibrators improves its effectiveness in improving clinical parameters, medial contact force (MCF), and muscular activation levels. METHODS: The authors performed a clinical evaluation on 14 participants (7 participants wearing vibratory unloading knee orthoses and 7 participants wearing conventional unloading knee orthoses) with medial knee OA. RESULTS: Wearing both orthoses (vibratory and conventional) for 6 weeks significantly improved ( p < 0.05) the MCF, pain, symptoms, function, and quality of life compared with the baseline assessment. Compared with the baseline assessment, the vastus lateralis muscle activation level significantly increased ( p = 0.043) in the vibratory unloading knee orthoses group. The vibratory unloading knee orthoses significantly improved the second peak MCF, vastus medialis activation level, pain, and function compared with conventional unloading knee orthoses ( p < 0.05). CONCLUSIONS: Given the potential role of medial compartment loading in the medial knee OA progression rate, both types of unloading knee orthoses (vibratory and conventional) have a potential role in the conservative management of medial knee OA. However, equipping the unloading knee orthoses with local muscle vibrators can improve its effectiveness for clinical and biomechanical parameters and prevent the side effects of its long-term use.

Intrasession and intersession reliability of postural control in participants with and without nonspecific low back pain using the Biodex Balance System.

OBJECTIVE: The purpose of this study was to evaluate the reliability of the Biodex Balance System (BBS) (Biodex Medical Systems, Shirley, NY) in chronic low back pain (CLBP) patients and healthy individuals in various conditions of postural and cognitive difficulty. METHODS: In this methodological study, using the BBS, dynamic balance of 15 CLBP patients and 15 healthy matched individuals was assessed during bilateral stance in combined conditions of visual feedback (eyes open and eyes closed) and platform stability (levels 5 and 3), either isolated or concurrent with performing cognitive task (auditory Stroop task). The Overall stability index, anterior-posterior stability index, and medial-lateral stability index, provided by BBS as measures of postural performance, were recorded. Intraclass correlation coefficient (ICC), standard error of measurement, and coefficient of variation were used to determine intersession and intrasession reliability of postural and cognitive measures. RESULTS: Biodex Balance System stability indices were more reliable in the CLBP (compared with healthy) group. The intersession ICCs in CLBP group for anterior-posterior stability index ranged from 0.60 to 0.88, for medial-lateral stability index from 0.64 to 0.94, and for OASI from 0.63 to 0.91. The intersession ICCs in healthy group for anterior-posterior stability index ranged from 0.42 to 0.86, for medial-lateral stability index from 0.56 to 0.89, and for OASI from 0.54 to 0.84. Biodex Balance System stability indices were more reliable in eyes-closed (compared with eyes-open) condition and platform stability level 5 (compared with level 3). CONCLUSION: Biodex Balance System stability indices appear to be reliable measures of postural control in the CLBP patients especially in more challenging conditions, such as when standing with eyes closed.