Differences in Neurocognitive Functions Between Healthy Controls and Anterior Cruciate Ligament-Reconstructed Male Athletes Who Passed or Failed Return to Sport Criteria: A Preliminary Study.

BACKGROUND: Only 55% of anterior cruciate ligament-reconstructed (ACLR) athletes return to competitive sports. This brings into question the usefulness of current return to sport (RTS) criteria. High cognitive demand of sport environment clarifies the value of incorporating neurocognitive tests when making decisions regarding the time of RTS. This preliminary study aimed to compare the neurocognitive functions between healthy controls and ACLR male athletes who passed or failed RTS criteria. METHODS: A total of 45 male football players, including 15 ACLR who passed RTS criteria, 15 ACLR who did not pass, and 15 healthy controls participated in this cross-sectional study. The Cambridge Neuropsychological Test Automated Battery was used to measure a battery of neurocognitive tasks, including speed of response, sustained attention, working memory, cognitive flexibility, and response inhibition. RESULTS: The results revealed that compared with both the ACLR-passed and healthy groups, the ACLR-failed group showed greater values of 5-choice movement time (P = .02, P = .01, respectively) but lower values of stop signal reaction time (P = .03, P = .001, respectively) and proportion of successful stops variables (P = .02). In addition, compared with the healthy group, both the ACLR-failed and ACLR-passed groups indicated greater values in between errors (P < .001, P = .008, respectively) and reaction latency variables (P = .002, P = .01, respectively) but lower values of A' (P < .001, P = .007, respectively), probability of hit (P < .001, P = .03, respectively), and percent correct trials variables (P = .006, P = .02, respectively). CONCLUSIONS: Our findings indicated deficits in neurocognitive functions in ACLR male athletes. In addition, poor performance in sustained attention, working memory, and cognitive flexibility measures observed in the ACLR-passed group highlighted the necessity for using a multimodal approach via implementation of neurocognitive measures in conjunction with the functional and muscular assessments when making RTS decisions.

Comparison of Kinematic Movement Patterns Between 2 Subgroups of Females With Low Back Pain and Healthy Women During Sit-to-Stand and Stand-to-Sit.

The purpose of study was to compare the kinematic patterns of the thoracic, lumbar, and pelvis segments and hip joints between 2 low back pain subgroups and healthy women during sit-to-stand and stand-to-sit. Kinematic data of 44 healthy women and 2 subgroups of females with low back pain in 2 subgroups of movement system impairment model (rotation-extension [Rot.Ext] and rotation-flexion [Rot.Flex]) were recorded. Participants performed sit-to-stand and stand-to-sit at a preferred speed. Each task was divided into a pre buttock lifted off/on (pre-BOff/n) phase and a post-BOff/n phase. The Rot.Ext subgroup showed greater range of motion in the thoracic during pre-BOff phase of sit-to-stand (P < .001) and pre-BOn phase of stand-to-sit (P = .01) compared to the other 2 groups. The Rot.Flex subgroup displayed limited left hip joint excursion during sit-to-stand pre-BOff (P = .04) and stand-to-sit post-BOn phases (P = .02). The Rot.Flex subgroup showed greater pelvis tilt excursion during sit-to-stand post-BOff (P = .04) and stand-to-sit pre-BOn (P = .01) and post-BOn phases (P = .01). In subgroups of women with chronic low back pain, there were kinematic changes in adjacent body segments/joints of lumbar spine during sit-to-stand and stand-to-sit tasks.

Muscle Activity Pattern Dysfunction During Sit to Stand and Stand to Sit in the Movement System Impairment Subgroups of Low Back Pain.

OBJECTIVE: To investigate impairment in the activity pattern of some muscles involved in sit to stand (STD) and stand to sit (STS) among 2 low back pain (LBP) subgroups of the Movement System Impairment (MSI) model. DESIGN: Case-control study. SETTING: A university medical center. PARTICIPANTS: Fifteen women without chronic LBP and 22 women with chronic LBP (N=37) in 2 subgroups (15 into the lumbar extension rotation (LER) and 7 into lumbar flexion rotation [LFR]) voluntarily participated in this study. INTERVENTIONS: Participants were asked to perform STD and STS at a preferred speed. Surface electromyography (EMG) were measured bilaterally from the internal oblique (IO), lumbar erector spine (ES), medial hamstring (MH), and lateral hamstring (LH) muscles. MAIN OUTCOME MEASURES: Changes in mean and maximum amplitude, time to peak amplitude, duration of muscle activity, and bilateral asymmetry of these variables. RESULTS: During STD, bilateral asymmetry in mean amplitude of MH in the LER subgroup (P=.031) and bilateral asymmetry in duration of LH in the LFR subgroup (P=.026) were exhibited. Also, in this task reduced time to peak left MH activation were found in the LFR subgroup than 2 other groups (control; P=.028/LER; P=.004). During STS, increased left ES maximum amplitude were observed in the LFR subgroup than LER subgroup (P=.029). Also, reduced time to peak right ES (P=.035) and left LH (P=.038) activation in the LER subgroup than control subjects and reduced time to peak left LH activation in LFR subgroup than control subjects (P=.041) were observed during STS. CONCLUSIONS: The differences between the 2 LBP subgroups may be a result of impairment in the activity pattern of some muscles during functional activity.

Immediate effects of local muscle vibration on static and dynamic balance control in individuals with chronic ankle instability.

OBJECTIVES: To investigate the immediate effects of local muscle vibration (LMV) on static and dynamic balance control in individuals with and without chronic ankle instability (CAI). DESIGN: Quasi-experimental study. SETTING: Research laboratory. PARTICIPANTS: Twenty-six individuals with CAI and 26 healthy controls. MAIN OUTCOME MEASURES: Center of pressure variables (mean total velocity and displacement in anteroposterior (AP) and mediolateral (ML) directions) during single-leg standing with eyes open and eyes closed and also reach distances in anterior (ANT), posteromedial (PM), and posterolateral (PL) directions of the modified star excursion balance test (MSEBT) were assessed before and after LMV. RESULTS: Statistical analyses showed a significant decrease in mean total velocity and displacement in AP direction from before to after LMV in eyes open condition for both individuals with CAI (p = 0.025, p = 0.041, respectively) and healthy controls (p = 0.001, p = 0.003, respectively). Similar results were observed in eyes closed condition for both individuals with CAI (p < 0.001, p < 0.001, respectively) and healthy controls (p = 0.040, p = 0.014, respectively). The results also showed increased reach distances in ANT (p < 0.001), PM (p < 0.001), and PL directions (p < 0.001) in all participants after LMV. CONCLUSION: Our results suggest that LMV may be a useful tool in rehabilitation of static and dynamic balance deficits in individuals with CAI.

Differences in dynamic balance control based on pain catastrophizing level in individuals with nonspecific chronic low back pain.

BACKGROUND: Pain catastrophization (PC) is related to motor control changes in individuals with nonspecific chronic low back pain (NSCLBP). However, differences in dynamic balance control based on the level of PC still remain unclear in these individuals. OBJECTIVE: The aim of this study was to compare the dynamic balance control between healthy controls and individuals with NSCLBP with high and low PC. METHODS: Forty individuals with NSCLBP and 20 healthy participants were enrolled in this cross-sectional study. Individuals with NSCLBP were classified into two groups of high and low PC. Dynamic balance control was assessed using the Modified Star Excursion Balance Test (MSEBT), Five-Time Sit-to-Stand Test (FTSST), and Timed Up and Go Test (TUGT). RESULTS: Statistical analyses showed that mean values of reach distances in the anterior, posteromedial, and posterolateral directions of the MSEBT were significantly lower in individuals with NSCLBP with high PC compared to low PC (p = .04, p = .01, and p = .04, respectively) and healthy controls (p < .001, p = .001, and p = .006, respectively). In addition, for both the FTSS and TUG tests, the mean time was significantly greater in individuals with NSCLBP with high PC compared to low PC (p < .001 and p = .004, respectively) and healthy controls (p < .001). CONCLUSIONS: Our results showed poor dynamic balance control in individuals with NSCLBP with high PC. This suggests that PC could contribute to the impaired dynamic balance control in individuals with NSCLBP. Combining balance exercises and cognitive-behavioral treatments targeting PC may be useful for the improvement of dynamic balance control in individuals with NSCLBP with high PC.

Comparison of proprioceptive postural control strategies between prolonged standing induced low back pain developers and non-low back pain developers.

BACKGROUND: Proprioception deficit has been suggested as a possible mechanism contributing for the impaired postural control in low back pain (LBP) patients. Whether proprioception deficit is a result of or a cause of LBP has not been investigated. OBJECTIVE: The purpose of this study was to compare proprioceptive postural control strategies between prolonged standing induced low back pain developers (PDs) and non-pain developers (NPDs). METHOD: Thirty-two healthy subjects performed 1-h prolonged standing and their ratings of perceived LBP have been recorded. Eight quiet standing trials for 60 s performed immediately before and after the prolonged standing. Postural control was challenged by muscle vibration and different postural conditions during quiet standing. Data were recorded using a force platform. RESULTS: Forty percentage of participants is classified as PD. Before the prolonged standing, relative proprioceptive weighting was greater in the PD compared to NPD group (P = .029). Main effect of postural condition (F1,24 = 5.21, P = .032) and interaction of time by group (F1,24 = 8.08, P = .009) were significant for COP displacement in anteroposterior direction. Interaction of postural condition by group (F1,26 = 7.82, P = .010) and time by group (F1,26 = 9.71, P = .004) were significant for COP displacement in mediolateral direction. Main effect of postural condition (F1,26 = 6.31, P = .018) and interaction of postural condition by group (F1,26 = 7.07, P = .013) were significant for mean velocity in mediolateral direction. CONCLUSION: The PD group has altered proprioceptive postural control strategies before and after prolonged standing. Proprioception deficit should not be considered to be solely an adaptive response and may be causal for LBP development.

Solifenacin versus posterior tibial nerve stimulation for overactive bladder in patients with multiple sclerosis.

Introduction: Overactive bladder (OAB) is one of the most common complications in patients with multiple sclerosis (MS). Choosing the effective treatment is very important in improving their quality of life (QOL). Therefore, the aim of this study was to compare solifenacin (SS) and posterior tibial nerve stimulation (PTNS) treatment effects in the MS Patients with OAB. Materials and methods: In total, 70 MS patients suffering from OAB enrolled in this clinical trial study. Patients with a score of at least 3 according to the OAB questionnaire were randomly divided into two groups (35 patients in each group). In one group, patients received SS (5 mg daily for 4 weeks and 10 mg/day for another 8 weeks) and in a second group, patients were treated by PTNS (12 weekly session, 30 min). Results: The mean (SD) age of patients participating in this study was 39.82 (9.088) and 42.41 (9.175) years for the SS group and the PTNS group, respectively. Patients in both groups showed statistically significant improvements in urinary incontinence, micturition, and daytime frequency (p < 0.001). Patients in the SS group had a better response for urinary incontinence after 12 weeks compared to the PTNS group. Also, patients in the SS group reported higher satisfaction and less daytime frequency compared to the PTNS group. Conclusion: SS and PTNS were effective for improving the OAB symptoms in patients with MS. However, patients demonstrated a better experience with SS in terms of daytime frequency, urinary incontinence, and treatment satisfaction rate.

Can a rigid antipronation foot orthosis change the effects of prolonged standing on postural control in men with patellofemoral pain?

BACKGROUND: Pronated foot posture is known as a contributing factor for patellofemoral pain (PFP) development. Patients with patellofemoral pain often experience poor postural control. Implementation of optimal management strategies for enhancing their postural performance is important. OBJECTIVES: The aim of this study was to determine whether a rigid antipronation foot orthosis changes prolonged standing effects on postural control in men with PFP. STUDY DESIGN: Case-control study. METHODS: Twenty-eight men with PFP and pronated foot and 28 healthy men were enrolled in this study. Center-of-pressure parameters were measured during short trials (60 seconds) of single-leg standing before and immediately after prolonged standing (20 minutes) using force platform. In patients with PFP, postural control was examined on 2 separate days with and without rigid antipronation foot orthosis. RESULTS: Findings showed that the pre-post differences of sway area (t(48) = -2.22, p = 0.03), mediolateral (ML) displacement (t (48) = -2.51, p = 0.01), and mean velocity (t(48) = -2.01, p = 0.04) were significantly greater in patients with PFP without foot orthosis compared with those in the healthy group. Significant intervention main effect ( p = 0.04) and time-by-intervention interaction ( p = 0.006) for sway area were shown. Significant intervention main effects were noted for ML displacement ( p = 0.007) and mean velocity ( p = 0.003). For these variables, significant time-by-intervention interactions were found. Further analysis showed greater values of ML displacement and mean velocity parameters before the prolonged standing in patients with PFP without foot orthosis compared with patients with PFP with orthosis. CONCLUSIONS: Rigid antipronation foot orthosis can improve the postural performance after prolonged standing in young adult men with PFP.

Sacroiliac joint manipulation attenuates alpha-motoneuron activity in healthy women: a quasi-experimental study.

OBJECTIVE: To determine whether sacroiliac joint (SIJ) manipulation decreases α-motoneuron activity and increases the pressure pain threshold (PPT) over the posterior superior iliac spine (PSIS) in healthy women. DESIGN: Quasi-experimental study. SETTING: A university medical center. PARTICIPANTS: Healthy young women (N=20) aged 18 to 30 years were recruited from among the students of a university medical center after a request for volunteers. INTERVENTIONS: Joint manipulation consisted of the supine rotational glide manipulation for the sacroiliac region. PPT measurements from the PSIS and Hoffman-reflex (H-reflex) amplitudes from the tibial nerve on the same side were recorded before and after joint manipulation. PPT was monitored for 15 minutes and H-reflex for 20 minutes after the procedure. MAIN OUTCOME MEASURES: Changes in tibial nerve H-reflex amplitude and PPT values after SIJ manipulation. RESULTS: SIJ manipulation attenuated α-motoneuronal activity significantly (P<.05) but transiently, since the decrease was seen only for 20 seconds after the intervention. There was no positive significant difference in the PPT after SIJ manipulation at any time during postintervention follow-up. CONCLUSIONS: SIJ manipulation produced a transient attenuation of α-motoneuron excitability in healthy women. These findings demonstrate that our manipulation technique can lead to a short-term reduction in muscle tone as a result of changes in sensory discharge, predominantly in la afferents. SIJ manipulation did not significantly affect the PPT in healthy women.

Intersegmental kinematic analysis of lumbar spine by functional radiography between two subgroups of patients with chronic low back pain.

INTRODUCTION: Kinematic deficits such as fault in joint accessory motion is one of the most important contributing factors for developing the movement impairment in the lumbar spine. Functional radiography is accessible method for detecting the artherokinematic disorders. The aim of this study was to compare lumbar spine intersegmental motion between low back pain (LBP) subgroups of movement system impairment (MSI) model by functional radiography. MATERIALS AND METHODS: 20 subjects with chronic LBP in two subgroups of the MSI model (Rotation with Flexion and Rotation with Extension) participated in this study. Five x-rays were taken in different positions. Intersegmental linear translation and angular rotation of the lumbar segments were calculated. RESULTS: In the Rotation with Extension subgroup, the translation and rotation values of the L3-4 segment from full to full position were significantly more than their values in the Rotation with Flexion subgroup ((mean difference = -1.69 (mm) P = 0.01), (mean difference = -3.80 (mm) P = 0.02) respectively). The translation of L2-3 segment from the neutral to the mid-flexion position was significantly greater in the Rotation with Flexion subgroup compared to the Rotation with Extension subgroup (mean difference = 1.12 (mm) P = 0.04). cumulative intersegmental angular rotation of all lumbar segments from mid to mid position was greater in the Rotation with Flexion subgroup compared to the Rotation with Extension subgroup (P = 0.03). CONCLUSION: Changes in intersegmental translation and angular rotation of lumbar segments in subgroups of patients with LBP may be important contributing factors that induce direction specific lumbar spine loads and contribute to the development or persistence of LBP problems.

Examination of Lumbopelvic and Lower Extremity Movements in two Subgroups of People with Chronic Low Back Pain Based on the Movement System Impairment Model During a Stair Descending Task.

BACKGROUND: Excessive and early lumbopelvic motion during functional tasks is associated with increased pain and symptoms in people with low back pain. The purpose of the current study was to compare lumbopelvic and lower extremity movements in two subgroups of chronic low back pain sufferers and healthy subjects during a stair descending task based on a movement system impairment model. MATERIAL AND METHODS: A clinical examination was conducted to assign people with low back pain to movement system impairment-based subgroups. A control group included 18 healthy subjects, a lumbar Rotation with Flexion group included 12 subjects, and a lumbar Rotation with Extension group included 16 subjects. Differences in kinematics data between the groups were recorded during a stair descending task using a 7-camera 3-dimensional motion capture system. RESULTS: In the lumbar Rotation with Flexion group, the onset of lumbar movement occurred earlier than in the control group (p = 0.043). In the lumbar Rotation with Flexion group, axial and frontal plane rotation of the pelvis and lower extremity were significantly greater than in the control group. Mean differences between the lumbar Rotation with Extension and control group were minimal for the motion assessed. CONCLUSION: Early and excessive lumbopelvic movement and more axial rotation in the lower extremities during a stair descending task were found in the lumbar Rotation with Flexion subgroup, which can be an important factor contributing to the development or persistence of low back pain in this group.