Pain and Pain-Related Disability Associated With Proprioceptive Impairment in Chronic Low Back Pain Patients: A Systematic Review.

OBJECTIVE: The purpose of this study was to systematically review the evidence on the correlation between lumbar proprioception and clinical low back pain (LBP) characteristics. METHODS: The literature was investigated through a systematic review. Six electronic databases (EMBASE, Scopus, Elsevier, PubMed, ProQuest, and Google Scholar) and reference lists of the relevant articles were searched from inception until December 2017. Studies that investigated the correlation between lumbar proprioception and pain and disability in patients with chronic nonspecific LBP were included in the analytical review. RESULTS: Five studies (204 patients) were included. Lumbar proprioception was measured via active or passive joint repositioning error or threshold to detection of passive motion. Four of the studies were rated as medium and only 1 as high quality. Four studies had investigated the correlation between proprioception and functional disability scores, all of which found them to be weakly correlated. Although no significant correlation was reported between pain and joint repositioning error (measured in all included studies), one had reported a fair to moderate correlation between pain and threshold to detection of passive motion. CONCLUSION: Current literature shows that although LBP pain-related disability is poorly to moderately correlated with proprioceptive functioning, the relationship between pain intensity and proprioception seems to be more complex.

The Influence of Cognitive Behavioral Therapy on Pain, Quality of Life, and Depression in Patients Receiving Physical Therapy for Chronic Low Back Pain: A Systematic Review.

OBJECTIVE: The purpose of this systematic review was to investigate the effect of adding the cognitive behavioral treatment (CBT) component to routine physical therapy (PT) on pain and depression reduction, improvement in quality of life, and enhanced function in patients with chronic low back pain (CLBP). TYPE: Systematic review. LITERATURE SURVEY: Google Scholar, PubMed, Ovid, ScienceDirect, ProQuest, Scopus, Cochrane Library, and Embase electronic databases were explored for the key terms of "behavioral (or behavioural) treatment" OR "behavior (behaviour) treatment" OR "behavior (behaviour) therapy" OR "cognitive behavior (or behaviour) treatment" OR "cognitive treatment" OR "cognitive therapy" OR "operant behavior (or behaviour) treatment" OR "respondent behavior (or behaviour) treatment" AND "physical therapy" OR "physiotherapy" OR "exercise therapy" OR "electrotherapy" OR "electrical therapy" OR "manual therapy" OR "myofascial therapy" OR "rehabilitation" AND "low back pain" OR "lower back pain" OR "back pain" OR "chronic back pain" OR "chronic lower back pain", with no limitation on language, through January 2018. METHODOLOGY: All randomized controlled trials that statistically compared the effectiveness of CBT + PT and PT were included for quality analysis. Studies were rated by high to poor quality, using Hailey's classification, based on their design and performance. SYNTHESIS: Of the 10 included studies, 7 were rated as high quality and 3 as good quality. Although CBT + PT was found to be superior to PT for pain, disability, quality of life, and functional capacity variables in some of the included studies, no extra benefit from CBT was documented in other investigations. The included studies also failed to show any advantage of CBT + PT over PT in reducing depression, and PT was even found to be superior to CBT + PT in one high-quality study. CONCLUSIONS: Although appearing to be advantageous by reducing pain and disability and enhancing functional capacity and quality of life, CBT effects on depression cannot be teased out from the effects of PT. LEVEL OF EVIDENCE: I.

Relationship Between Proprioception and Endurance Functionality of the Cervical Flexor Muscles in Chronic Neck Pain and Asymptomatic Participants.

OBJECTIVE: The purpose of this study was to compare the relationship between flexion endurance capacity and joint position error in participants with or without chronic neck pain (CNP). METHODS: Sixty-one CNP and 60 asymptomatic volunteers participated in this cross-sectional, case-control, and correlational analysis study. The measured variables included absolute and constant joint repositioning errors in the sagittal and horizontal directions, clinical flexor endurance test score, pain intensity, and neck disability index. RESULTS: The groups did not statistically differ in flexion endurance (P > .05). The CNP group had a smaller absolute error on the right (P < .01) and left (P = .01) rotation and an overshooting error pattern in the flexion direction (P < .05). But the asymptomatic group did not exhibit any over-/undershooting pattern tendency (P > .05). Although flexion endurance was not correlated with any of the joint repositioning error components in either group, pain and disability scores were significantly correlated with left rotation absolute error (r = -0.34 and ρ = -0.37, respectively). CONCLUSION: The clinical cervical flexor endurance test, ignoring the relative contribution of the deep and superficial groups of muscles, may not efficiently characterize CNP patients.

Effect of the Abdominal Hollowing and Bracing Maneuvers on Activity Pattern of the Lumbopelvic Muscles During Prone Hip Extension in Subjects With or Without Chronic Low Back Pain: A Preliminary Study.

OBJECTIVE: The purpose of this study was to compare the effect of abdominal hollowing (AH) and abdominal bracing (AB) maneuvers on the activity pattern of lumbopelvic muscles during prone hip extension (PHE) in participants with or without nonspecific chronic low back pain (CLBP). METHODS: Twenty women with or without CLBP participated in this cross-sectional observational study. The electromyographic activity (amplitude and onset time) of the contralateral erector spinae (CES), ipsilateral erector spinae (IES), gluteus maximus, and biceps femoris muscles was measured during PHE with and without abdominal maneuvers. A 3-way mixed model analysis of variance and post hoc tests were used for statistical analysis. RESULTS: Between-group comparisons showed that the CES onset delay during PHE alone was greater (P = .03) and the activity level of IES, CES, and biceps femoris in all maneuvers (P < .05) was higher in patients with CLBP than in asymptomatic participants. In asymptomatic participants, PHE + AH significantly decreased the signal amplitude (AMP) of IES (P = .01) and CES (P = .02) muscles. In participants with CLBP, IES muscle AMP was lower during PHE + AH compared with PHE + AB and PHE alone. With regard to onset delay, the results also showed no significant difference between maneuvers within either of the 2 groups (P > .05). CONCLUSIONS: Performance of the AH maneuver decreased the erector spinae muscle AMP in both groups, and neither maneuver altered the onset delay of any of the muscles in either group. The low back pain group showed higher levels of activity in all muscles (not statistically significant in gluteus maximus during all maneuvers). The groups were similar according to the onset delay of any of the muscles during either maneuver.