Comparison of transversus abdominis activation characteristics between healthy and chronic low back pain population during upright functional movement.

BACKGROUND: Previous literature suggests that transversus abdominis (TrA) activation is diminished in chronic low back pain (cLBP) subjects compared to healthy subjects in less-functional positions. However, few studies have investigated the effects of upright functional movement on TrA activation in cLBP individuals. OBJECTIVE: This pilot study aimed to compare TrA activation characteristics in healthy and cLBP subjects during the movement of double leg standing (DLS) to single leg standing (SLS) and to a 30∘ single leg quarter squat (QSLS). METHODS: TrA activation was determined by the percentage change in TrA thickness from DLS to SLS and DLS to QSLS. TrA thickness was measured in 14 healthy and 14 cLBP participants using ultrasound imaging with a probe holder at 20 mm and 30 mm from the fascia conjunction point. RESULTS: At both measurement points (20 and 30 mm), there were no significant main effects of body sides, lower limb movements and the interactions between them on TrA activations between the healthy and cLBP participants even after covariates were adjusted for (all p> 0.05). CONCLUSIONS: Results from this study suggest the evaluation of TrA activation during upright functional movements as part of an assessment for cLBP management may not be suggested.

The Effectiveness of Spinal Manipulation in Increasing Muscle Strength in Healthy Individuals: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this study was to systematically review the effects of spinal manipulation on muscular strength in healthy individuals and conduct a meta-analysis to appraise the quality of evidence. METHODS: Articles were searched and retrieved from MEDLINE, EMBASE, CINAHL, Cochrane Library, PubMed, Academic Search Premier, SPORTDiscus, and AMED. Searches were conducted in September 2017 without a limit on the starting period. The Physiotherapy Evidence Database scale was used to appraise the quality of the included studies. Data from eligible articles were pooled, and meta-analyses were conducted. The quality of evidence was appraised by the Grading of Recommendations, Assessment, Development and Evaluations approach. The registration number for the review on PROSPERO is CRD42017075215. RESULTS: A total of 911 records were screened, and 3 randomized controlled trials were eligible to be included in this review. There was a significant pooled standardized mean difference in isometric strength (0.93, 95% confidence interval [CI], 0.17-1.68; P = .02) between the experimental and control groups, with a moderate level of heterogeneity. CONCLUSION: This review suggests that spinal manipulative therapy augments the percentage of change in isometric strength gain among healthy participants when compared to no intervention or sham manipulation. However, the heterogeneity of pooled studies in this review suggests that the results should be interpreted with caution.

The Effects of Motor Imagery on Pain and Range of Motion in Musculoskeletal Disorders: A Systematic Review Using Meta-Analysis.

INTRODUCTION: In recent years, there has been an increase in the use of motor imagery (MI) in the rehabilitation of musculoskeletal pain conditions. Across the literature, most reviews have yet to consider Laterality Judgement Task training as a form of MI method. This review aimed to evaluate the effectiveness of using MI as an adjunct to standard rehabilitation on the improvement of pain and range of motion parameters when managing patients with musculoskeletal pain conditions. METHODS: Searches of 8 major electronic databases were conducted. Data for pain and range of motion were extracted. Meta-analyses (where possible) with either a fixed or random-effect(s) model, standardized mean differences (SMDs), and tests of heterogeneity were performed. RESULTS: Eight clinical controlled trials were identified and included in the meta-analyses. When compared with standard rehabilitation alone, the adjunctive role of MI provided superior pain relief (pooled SMD, -2.25; 95% confidence interval, -4.11 to -0.4; P=0.02), and greater improvement in range of motion (pooled SMD, 3.04; 95% confidence interval, 0.66-5.43; P=0.01) in chronic musculoskeletal pain disorders. DISCUSSION: The results suggest that MI may be effective for pain relief and improvement in range of motion among chronic musculoskeletal pain conditions, although conclusion is based on a limited certainty of evidence as assessed using the GRADES (Grading of Recommendation, Assessment, Development and Evaluation) approach.

Comparative performance of isometric and isotonic quadriceps strength testing in total knee arthroplasty.

BACKGROUND: Early quadriceps muscle strength assessment after a total knee arthroplasty (TKA) provides timely information on progress, but little is known about the pain profile and predictive validity associated with common clinical muscle strength tests. This study aimed to, in patients with a recent TKA, examine the associations of isometric and isotonic quadriceps strength with gait speed, accounting for knee pain experienced during testing. METHODS: A sample of 76 patients (mean age 68 years; 46 women) with a recent TKA (median, 1.5 months) participated. Quadriceps strength was measured on both limbs using a knee extension machine. Isotonic strength was assessed with a one-repetition maximum test. Isometric strength was measured at 40° and 70° of knee flexion using a custom-built load cell. To allow for valid comparisons between the tests, quadriceps strength symmetry ratios were calculated. Knee pain during testing was measured using an 11-point pain scale. Fast gait speed was measured using the 10-m walk test. RESULTS: Compared with isotonic test, quadriceps strength ratio was higher for the 40° flexion isometric test (P = 0.01), and this difference may be explained by the lower knee pain intensity elicited during the isometric tests (P's < 0.001). All strength measures were closely associated with fast gait speed after adjustment for knee pain and covariates (P's < 0.001). CONCLUSIONS: Early in the post-TKA period, isometric and isotonic strength tests may be used to assess quadriceps strength but these tests are not interchangeable. Isometric quadriceps testing may be preferable to isotonic testing as it was associated with lower knee pain intensity.

A systematic review of the diagnostic utility of simple tests of change after trial removal of cerebrospinal fluid in adults with normal pressure hydrocephalus.

OBJECTIVE: To synthesize the evidence regarding the diagnostic value of simple ancillary tests post cerebrospinal fluid drainage in normal pressure hydrocephalus. DATA SOURCES: MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Cochrane library databases; last searched on 12 September 2017. REVIEW METHODS: This review was performed applying the steps of the PRISMA statement. The QUADAS 2 tool was used to assess the risk of bias. Prospective and retrospective trials were systematically reviewed, and data on diagnostic accuracy were extracted. Meta-analysis (where possible) was performed. Hierarchical summary receiver operating characteristic package was used to calculate pooled estimates of included diagnostic studies. RESULTS: Seventeen trials (with 812 subjects in total) were identified for inclusion in the meta-analyses for the 18-meter walk test, video-recorded gait performance, cognitive test, and Timed Up and Go Test. The summary estimates of sensitivity and specificity for the 18-meter walk test was 0.83 (95% CI 0.57 to 0.99) and 0.67 (95% CI 0.33 to 0.95), video-recorded gait performance was 0.85 (95% CI 0.47 to 0.99) and 0.68 (95% CI 0.33 to 0.96), cognitive test was 0.82 (95% CI 0.41-0.99) and 0.75 (95% CI 0.39-0.99), and Timed Up and Go Test was 0.89 (95% CI 0.79-0.95) and 0.63 (95% CI 0.24-0.90), respectively. CONCLUSION: This review highlights the diagnostic value of the 18-meter walk test, video-recorded gait performance, cognitive test, and Timed Up and Go Test in predicting shunt outcomes among adults with normal pressure hydrocephalus.

Falls efficacy, postural balance, and risk for falls in older adults with falls-related emergency department visits: prospective cohort study.

BACKGROUND: Risk for falls in older adults has been associated with falls efficacy (self-perceived confidence in performing daily physical activities) and postural balance, but available evidence is limited and mixed. We examined the interaction between falls efficacy and postural balance and its association with future falls. We also investigated the association between falls efficacy and gait decline. METHODS: Falls efficacy, measured by the Modified Falls Efficacy Scale (MFES), and standing postural balance, measured using computerized posturography on a balance board, were obtained from 247 older adults with a falls-related emergency department visit. Six-month prospective fall rate and habitual gait speed at 6 months post baseline assessment were also measured. RESULTS: In multivariable proportional odds analyses adjusted for potential confounders, falls efficacy modified the association between postural balance and fall risk (interaction P = 0.014): increasing falls efficacy accentuated the increased fall risk related to poor postural balance. Low baseline falls efficacy was strongly predictive of worse gait speed (0.11 m/s [0.06 to 0.16] slower gait speed per IQR decrease in MFES; P < 0.001). CONCLUSION: Older adults with high falls efficacy but poor postural balance were at greater risk for falls than those with low falls efficacy; however, low baseline falls efficacy was strongly associated with worse gait function at follow-up. Further research into these subgroups of older adults is warranted. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01713543 .

Chronic Lateral Epicondylalgia Does Not Exhibit Mechanical Pain Modulation in Response to Noxious Conditioning Heat Stimulus.

OBJECTIVES: The impaired attenuation of pain by the application of a noxious conditioning stimulus at a segmentally distinct site, known as conditioned pain modulation (CPM), has been implicated in clinical pain states. Chronic lateral epicondylalgia (LE), which is characterized by lower pressure pain thresholds (PPTs) at sites remote to the affected elbow and spinal cord hyperexcitability, is a clinical pain state that might plausibly involve less efficacious CPM. This study aimed to determine whether LE exhibits a less efficacious CPM compared with that in pain-free controls. RESULTS: Results: Twenty participants with LE, aged 50.7 years (SD=7.05) and who had their condition for 10.2 months (range: 2 to 80 mo), were matched by age and sex to 22 pain-free participants. All participants indicated their PPT over the lateral epicondyle(s) before and during a conditioning noxious heat stimulus that was applied over the calf. A CPM score was calculated as the difference between the PPT before and during the heat pain-conditioning stimulus expressed as a percentage of PPT before the heat pain-conditioning stimulus. The condition (LE vs. control) by side (affected vs. unaffected) analysis of variance revealed a significant condition effect (P=0.001), but not side effect (P=0.192) or side-by-condition interaction effect (P=0.951). Follow-up tests for the effect of condition revealed a mean deficit in CPM of -24.5% (95% confidence interval, -38.0 to -11.0) in LE compared with that in pain-free participants. DISCUSSION: The results that suggest an impaired ability to modulate pain might be associated with the previously observed spinal cord hyperexcitability and the mechanical hyperalgesia that characterizes LE.

The effect of shoulder muscle fatigue on active repositioning acuity and scapulothoracic resting alignment: A systematic review with meta-analysis.

OBJECTIVES: The purpose was to synthesize the current evidence for the impact of muscle fatigue on measures for active repositioning task of the glenohumeral or scapulothoracic movements including the absolute error and/or scapulothoracic resting alignment. METHODS: We searched the PubMed, EMBASE, MEDLINE, CINAHL, SCOPUS, SportDiscuss and the Cochrane library databases. We included papers using a fatiguing task as part of their experimental design. Meta-analyses were undertaken for the active repositioning acuity of the glenohumeral outer/inner range of external rotation, glenohumeral inner range of internal rotation and scapulothoracic resting alignment in the scapular upward/downward rotation, anterior/posterior tilt and protraction/retraction planes. Qualitative data synthesis with standardized mean difference (SMD) was also conducted. RESULTS: There was a significantly pooled SMD, -2.10 (95% confidence interval -2.57 to -1.63), P < 0.001) in active repositioning acuity of the glenohumeral outer range of external rotation before and after a fatiguing task. However, the pooled SMD in active repositioning acuity for other glenohumeral movements and scapulothoracic resting positions were not significant (P > 0.05). CONCLUSION: Shoulder muscle fatigue impairs active repositioning acuity of the glenohumeral outer range of external rotation. Conversely, the current evidence does not support such impairment for the remaining glenohumeral movements and scapulothoracic resting alignments..

Does Evidence Support the Use of Neural Tissue Management to Reduce Pain and Disability in Nerve-related Chronic Musculoskeletal Pain?: A Systematic Review With Meta-Analysis.

OBJECTIVES: In nerve-related chronic musculoskeletal (MS) disorders, neural tissue management is used to relieve pain by balancing the relative movement of neural tissues and their surrounding tissues. To date, there has not been any review evaluating the magnitude of this treatment effect in nerve-related chronic MS pain. The aim of this review was to compare pain and disability in individuals with nerve-related chronic MS pain who were treated with neural tissue management with those who received minimal or other treatment approaches. METHODS: Searches of 8 major electronic databases were conducted, and data on pain and disability scores were extracted. Meta-analyses (where possible) with either a fixed-effect(s) or random-effect(s) model, standardized mean differences (SMDs), and tests of heterogeneity were performed. RESULTS: Twenty clinically controlled trials were identified and included in the meta-analyses. When compared with minimal intervention, neural mobilization provided superior pain relief (pooled SMD=-0.77; 95% confidence interval [CI], -1.11 to -0.42; P<0.0001), and reduction in disability (pooled SMD=-1.06; 95% CI, -1.97 to -0.14; P=0.02), after post hoc sensitivity analyses. No significant differences were found when comparing neural mobilization with other treatment approaches for pain (pooled SMD=-0.67; 95% CI, -2.03 to 0.69; P=0.33), after post hoc sensitivity analysis, and disability (pooled SMD=-0.03; 95% CI, -0.54 to 0.59; P=0.93). DISCUSSION: Neural tissue management is superior to minimal intervention for pain relief and reduction of disability in nerve-related chronic MS pain. Existing evidence does not establish superiority of neural mobilization over other forms of intervention in reducing pain and disability in individuals with nerve-related chronic MS pain.

Kinesio taping in musculoskeletal pain and disability that lasts for more than 4†weeks: is it time to peel off the tape and throw it out with the sweat? A systematic review with meta-analysis focused on pain and also methods of tape application.

INTRODUCTION: In recent years, Kinesio tape has been used to support injured muscle and joints, and relieve pain. We compared the pain and disability in individuals with chronic musculoskeletal pain who were treated with Kinesio taping with those using minimal or other treatment approaches. METHODS: Searches of eight major electronic databases were conducted. Data for pain and disability scores were extracted. Meta-analyses (wherever possible) with either a fixed or random effect(s) model, standardised mean differences (SMDs) and tests of heterogeneity were performed. RESULTS: Seventeen clinical-controlled trials were identified and included in the meta-analyses. When compared to minimal intervention, Kinesio taping provided superior pain relief (pooled SMD=-0.36, 95% CI -0.64 to -0.09, p=0.009) but the pooled disability scores were not significantly different (pooled SMD=-0.41, 95% CI -0.83 to 0.01, p=0.05). No significant differences were found when comparing Kinesio taping to other treatment approaches for pain (pooled SMD=-0.44, 95% CI -1.69 to 0.82, p=0.49) and disability (pooled SMD=0.08, 95% CI -0.27 to 0.43, p=0.65). DISCUSSION: Kinesio taping is superior to minimal intervention for pain relief. Existing evidence does not establish the superiority of Kinesio taping to other treatment approaches to reduce pain and disability for individuals with chronic musculoskeletal pain.

Functional heterogeneity and outcomes in community-dwelling women with osteoporosis, with and without a history of falls.

Falls leading to osteoporotic fracture is a substantial issue clinically. By inference from the literature, women with osteoporosis who are classified as having a history of falls may not represent a distinct homogeneous population. However, studies exploring the potential heterogeneity within fallers in women with osteoporosis are scarce. The objective of this study was to better understand the physical function characteristics of women with osteoporosis, with and without a previous history of falls, by further stratifying them based on their single-leg stance (SLS) performance. Eighty-seven consecutive, community-dwelling women with osteoporosis were recruited from the Endocrinology Clinic at Singapore General Hospital. Laboratory-based and clinic-based standing balance tests, a lower limb strength test, and the 6-min walk test (6MWT) were measured. Fallers and non-fallers did not differ in standing balance, lower limb strength nor the 6MWT (P's>0.08). SLS performance was an independent predictor of the various functional measures, after adjusting for age and body mass index. Specifically, an increase in SLS time was associated with lower standing center-of-pressure velocities, greater lower limb strength, and greater 6-min walking distance. When the two groups were stratified based on their recent history of falls and clinic-based standing balance performance (SLS time), fallers with good SLS time (>30 s) showed better functional outcomes than did non-fallers with poor SLS time (≤30 s) (P's<0.08) and comparable functional outcomes with non-fallers with good SLS time (P's>0.11). The results indicate an important heterogeneity within fallers and non-fallers with osteoporosis and they argue for a individualized approach to rehabilitation.

Evidence of spinal cord hyperexcitability as measured with nociceptive flexion reflex (NFR) threshold in chronic lateral epicondylalgia with or without a positive neurodynamic test.

UNLABELLED: There is emerging evidence of altered pain signal processing as a likely underlying mechanism in chronic lateral epicondylalgia (LE), yet this remains to be assessed. Furthermore, it has been proposed that neurodynamic tests reflect nociceptive withdrawal responses. Therefore, the objective was to improve our understanding of spinal cord excitability as measured by nociceptive flexion reflex (NFR) threshold in chronic LE with and without a positive neurodynamic test. NFR threshold, pain-free grip, and pressure pain threshold were measured in 30 LE participants and 31 healthy controls. Test of neural tissue involvement (using upper limb neural tension, radial bias) was used to differentiate LE participants with or without a positive neurodynamic test. There were significant differences in NFR threshold between the control and LE with or without a positive neurodynamic test (F[2,54] = 5.68, P = .006), after adjusting for age, sex, pain rating at NFR threshold, and reflex size (NFR interval peak z score). The mean differences (95% confidence interval) in NFR threshold between the control and LE with or without a positive neurodynamic test were 3.74 mA (.637, 6.84) and 3.38 mA (.0245, 6.74) respectively. PERSPECTIVE: The results suggest evidence of spinal cord hyperexcitability, particularly sensory hypersensitivity, in LE with or without a positive neurodynamic test. Our data appear to support the hypothesis that continued peripheral afferent stimulation results in facilitation of nociceptive pathways in this patient population.

Central hyperexcitability as measured with nociceptive flexor reflex threshold in chronic musculoskeletal pain: a systematic review.

Chronic musculoskeletal conditions are increasingly conceived as involving altered central nervous system processing, and impaired nociceptive flexor reflex (NFR) appears to reflect altered central nervous system processing. The primary objective was to synthesize the evidence for impaired NFR in these conditions. The secondary objective was to evaluate the NFR stimuli parameters employed by reviewed studies. Electronic databases: MEDLINE, CINAHL, Embase, PEDro, Google Scholar, and Cochrane library were searched from the mid-1960s to June 2010. Experimental reports were systematically reviewed and meta-analysis (where possible) was performed. NFR thresholds and parameters of NFR stimuli were extracted. Sixteen trials were identified, 11 of which were suitable for inclusion in the meta-analysis. Compared to healthy controls, standardized mean differences in NFR threshold were significantly lower in subjects with primary headache (-0.45; 95% confidence interval [CI] -0.77 to -0.13, P=0.005), fibromyalgia (-0.63; 95% CI -0.93 to -0.34, P<0.0001), knee pain (-1.51; 95% CI -2.10 to -0.93, P<0.00001) and whiplash (-0.73; 95% CI -1.11 to -0.35, P=0.0002). Employed stimuli parameters vary between studies, with inter-pulse duration (P=0.044) being identified by multiple regression analysis as independent predictors of the variability in NFR threshold in healthy controls. The results indicate that there is evidence of central hyperexcitability in people with chronic musculoskeletal pain. Our review also suggests that shorter inter-pulse duration tends to yield smaller variability in NFR threshold. However, further research investigating optimal stimulation parameters is still warranted.

Effects of Pilates-based exercises on pain and disability in individuals with persistent nonspecific low back pain: a systematic review with meta-analysis.

STUDY DESIGN: A systematic review with meta-analysis. OBJECTIVES: To compare pain and disability in individuals with persistent nonspecific low back pain who were treated with Pilates exercises compared to minimal or other interventions. METHODS: Searches of Medline, CINAHL, Embase, Cochrane library, PEDro, and ProQuest Dissertations and Thesis databases were conducted. Randomized controlled trials (RCTs) were selected and reviewed if they compared pain and disability in individuals with persistent nonspecific low back pain who were treated with Pilates exercises compared to other treatment approaches. Quality of the trials was evaluated. Data for pain and disability scores were extracted. Narrative synthesis plus meta-analyses were performed, with either a fixed-effects or random-effects model, standardized mean differences (SMDs), and tests for heterogeneity. RESULTS: Seven RCTs were identified and included in the meta-analyses. Data pooling was performed using RevMan 5. When compared to minimal intervention, Pilates-based exercise provided superior pain relief (pooled SMD, -2.72; 95% CI: -5.33, -0.11; P = .04) but the pooled disability scores were not significantly different (pooled SMD, -0.74; 95% CI: -1.81, 0.33;P = .17). No significant differences were found when comparing Pilates-based exercise to other forms of exercise for pain (pooled SMD, 0.03; 95% CI: -0.52, 0.58; P = .92) or disability scores (pooled SMD, -0.41; 95% CI: -0.96, 0.14; P = .14). CONCLUSION: Pilates-based exercises are superior to minimal intervention for pain relief. Existing evidence does not establish superiority of Pilates-based exercise to other forms of exercise to reduce pain and disability for patients with persistent nonspecific low back pain. However, the relatively low quality of existing studies and the heterogeneity of pooled studies in this systematic review combine to suggest that these results should be interpreted with caution. LEVEL OF EVIDENCE: Therapy, level 1a.

Side-to-side difference in joint position sense and kinesthesia in unilateral functional ankle instability.

BACKGROUND: Impairment in proprioception has been suggested to be one of the causes of FAI. This study aimed to establish intra-session reliability of the Biodex System 2 in assessing joint position sense (JPS) and kinesthesia (K)~in addition to determining if there was any side to side difference in JPS and kinesthesia in people with unilateral functional ankle instability. MATERIALS AND METHODS: Both JPS and K were determined by means of the Biodex Systems 2. During evaluation of JPS, participants' ability to actively reproduce ankle joint position was tested three times in each of the two predetermined positions. During evaluation of K, data collection began with the foot placed in a starting position of 0 degrees (neutral position). RESULTS: A total of 25 participants (mean age 22.0 years, 95% confidence interval 19.9 to 24.1 years) were recruited into this study. No difference in JPS (p = 0.162 to 0.764) and K (p = 0.089 to 0.683) were found between the sprained and uninvolved ankle of subjects with unilateral functional ankle instability. There is moderate to good intra-session reliability in using the Biodex System 2 to assess JPS (ICC = 0.868 to 0.950, p < 0.01) and K (ICC = 0.825 to 0.893, p < 0.01). CONCLUSION: This study suggests that there is perhaps no difference in JPS and K between both ankles in people with unilateral FAI. Proprioceptive deficits may not always be present in every case of FAI. CLINICAL RELEVANCE: Proprioceptive training may not be beneficial in some patients with unilateral FAI.