Lumbar motor control training as a complementary treatment for chronic neck pain: A randomized controlled trial.

OBJECTIVE: We investigated whether adding lumbar motor control training with a pressure biofeedback unit improves outcomes of a conservative deep cervical flexor motor control program on neck pain, neck disability, deep cervical flexor endurance, and health status in middle-aged patients with chronic neck pain and forward head posture after eight weeks of interventions. DESIGN: Randomized controlled trial. SETTING: Outpatient setting. SUBJECTS AND INTERVENTIONS: A total of 113 males and females (mean age 39 ± 5 years) with chronic neck pain were randomized to three treatment groups, group 1 (n = 38) combined deep cervical flexor motor-control training and lumbar motor control exercise, group 2 (n = 37) deep cervical flexor motor control training alone, and group 3 (n = 38) passive treatment and education. MAIN OUTCOME MEASURES: Pain, neck disability, deep cervical flexor muscular endurance, and health status. RESULTS: There were significant improvements in the combination group compared with the deep cervical flexor motor-control group alone (d = 2.03, 95% confidence interval (CI): -2.8 to -1.27, P = 0.021) for pain (d = -0.99, 95% CI = -1.75 to -0.23, P = 0.023), disability (d = 1.92, 95% CI = 0.86 to 2.98, P = 0.001), deep cervical flexor endurance, and (d = -2.75, 95% CI = -8.81 to -1.68, P = 0.037) for health status favoring the combination group. There were significant between-group differences favoring both active groups versus the passive control in all out comes. CONCLUSION: The addition of Lumbar motor control training as a complementary treatment may enhance effectiveness of deep cervical flexor motor control training on neck pain, neck disability, and deep cervical flexor endurance in patients with chronic moderate neck pain and forward head posture.

Comparing myofascial meridian activation during single leg vertical drop jump in patients with anterior cruciate ligament reconstruction and healthy participants.

BACKGROUND: Muscles work synergistically to support the body during landing. Myofascial meridians have been described to classify muscles into functional synergies. The role that these functional lines plays in positioning the trunk and lower extremity of patients with anterior cruciate ligament reconstruction (ACLR) and healthy athletes during drop landing tasks remains unclear. RESEARCH QUESTION: The purpose of this study was to compare the front and back functional lines (FFL and BFL) muscle activation in patients with ACLR and healthy participants during single leg vertical drop jump (SLVDJ). METHODS: Thirty-two male athletes (post-ACLR = 16, healthy = 16) participated (age = 23.3 ± 2.3 years). Superficial electromyography of FFL (adductor longus [AL], rectus abdominis [RA], pectoralis major) and BFL (vastus lateralis [VL], gluteus maximus [GMax], latissimus dorsi [LD]) was collected during the SLVDJ and compared at initial contact and maximum knee flexion between groups using t-tests and limbs using paired-samples t-tests. RESULTS: In the FFL, the AL (p < 0.05) and RA (p < 0.05) muscles were more active in the healthy group compared to the ACLR group at initial contact and maximum knee flexion. PM demonstrated greater activation in the healthy group only at maximum knee flexion (p < 0.05). In the BFL, the VL (p < 0.05) and GMax (p < 0.05) muscles were more active in the ACLR group, whereas the LD (p < 0.05) muscles demonstrated greater activation in the healthy group at initial contact and maximum knee flexion. There were no healthy group inter-limb differences in FFL and BFL activation. ACLR participants demonstrated greater non-injured limb VL, AL, GMax and LD activation (p < 0.05) and greater injured limb PM and RA activation (p < 0.05). SIGNIFICANCE: Based on the present data, patients after ACLR may present with an alteration in BFL and FFL muscles activation during a drop jump task. Functional line muscles during dynamic activities may change lower extremity positioning and lead to increase ACL injury risk.

Effects of Corrective Exercises on Posture, Pain, and Muscle Activation of Patients With Chronic Neck Pain Exposed to Anterior-Posterior Perturbation.

OBJECTIVES: This study aimed to evaluate the effects of corrective exercises on posture, pain, and muscle activation of patients with chronic neck pain exposed to anterior-posterior perturbation. METHODS: A total of 32 women (37.76 ± 3.83 years) with chronic, nonspecific neck pain were randomized into corrective exercise and control groups. The experimental group underwent a corrective exercise program for 8 weeks, 30 min/d, 3 days per week. The control group received active self-exercise instructions. Neck pain, forward head and protracted shoulder posture, and timing of superficial neck muscle activation were evaluated using the visual analog scale, photogrammetry, and electromyogram, respectively, before and then 48 hours after the 8-week program for both the experimental and control groups. All measurements at pretest and posttest were taken by a blinded assessor. RESULTS: Significant alterations were observed in cervical angle (P = .003, effect size = 0.329), shoulder angle (P = .008, effect size = 0.457), neck pain and disability (P = .009, effect size = 0.645), movement control (P = .038, effect size = 0.353), activation onset of the upper trapezius (P = .015, effect size = 0.746), the sternocleidomastoid (P = .018, effect size = 0.879) and cervical erector spinae (P = .031, effect size = 0.765), and the root mean square of the upper trapezius (P = .033, effect size = 0.742), the sternocleidomastoid (P = .041, effect size = 0.587), and the cervical erector spinae (P = .024, effect size = 0.832) in the intervention group from pre- to posttest (P < .05). CONCLUSION: Positive and significant alterations have been observed in the forward head and protracted shoulder posture, the timing of superficial neck muscle activation, neck pain, and disability in female patients with chronic neck pain exposed to anterior-posterior perturbation after performing an 8-week corrective exercise program.

The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study.

BACKGROUND: The purpose of this study is to evaluate the effect of a six-week combined manual therapy (MT) and stabilizing exercises (SEs), with a one-month follow-up on neck pain and improving function and posture in patients with forward head and rounded shoulder postures (FHRSP). METHODS: Sixty women with neck pain and FHRSP were randomized into three groups: Group 1 performed SE and received MT (n = 20), Group 2 performed SE (n = 20) and Group 3 performed home exercises (n = 20) for six weeks. The follow-up time was one month after the post test. The pain, function, and head and shoulder angles were measured before and after the six-week interventions, and during a one-month follow-up. RESULTS: There were significant within-group improvements in pain, function, and head and shoulder posture in groups 1 and 2. There were significant between-group differences in groups 1 and 2 in head posture, pain, and function favoring group 1 with effect size 0.432(p = 0.041), 0.533 (P = 0.038), and 0.565(P = 0.018) respectively. There were significant between-group differences in both intervention groups versus the control group favoring the intervention groups. CONCLUSION: These findings suggest that both interventions were significantly effective in reducing neck pain and improving function and posture in patients. However, the improvement in function and pain were more effective in Group 1 as compared to Group 2, suggesting that MT can be used as a supplementary method to the stabilizing intervention in the treatment of neck pain. More researches are needed to confirm the result of this study. TRIAL REGISTRATION: UMIN000030141 modified on 2018.03.08. This study is a randomized control trial registered at UMIN-CTR website, the trial was retrospectively registered and the unique trial number is UMIN000030141 .

Effects of eight-week "gyroscopic device" mediated resistance training exercise on participants with impingement syndrome or tennis elbow.

BACKGROUND: Rehabilitation of injuries in the upper extremity and reestablishment of muscle strength throughout the range of motion in overhead movements, are the major concerns of athletes and coaches in the sports field. PURPOSE: To determine the effect of eight-week "gyroscopic device" mediated resistance training exercise on grip strength, wrist and shoulder strength and proprioception, and upper extremity performance, in participants with impingement syndrome or tennis elbow. DESIGN AND METHODS: For this study, in a university rehabilitation clinic 45 volleyball players (aged 22-28) purposefully were selected and divided into 3 groups: shoulder impingement (group I), tennis elbow (group II), and control (group III). The experimental groups performed the "gyroscopic device" mediated resistance training, three sessions a week over 8 wks. Grip strength, wrist and shoulder strength and proprioception, and upper extremity performance were measured before and after implementation of the intervention (eight-week resistance training using a "gyroscopic device") using a hand hold dynamometer, isokinetic dynamometer, and Y balance test respectively. RESULTS: After 8 weeks of "gyroscopic device" exercise, improvement in the shoulder, wrist and grip strength, shoulder and wrist proprioception and performance scores of both experimental groups was significant. There were no significant differences between study groups I and II, both groups, however, demonstrated significant differences when compared to the control group, but between group I and the control group, and between group II and the control group, the difference was significant. However, no significant change was seen in the control group. CONCLUSIONS: Due to the significant effects of the "gyroscopic device" mediated exercise on grip strength, wrist and shoulder strength and proprioception, and performance of the upper extremity, use of the exercise can be recommended for subjects with impingement syndrome or tennis elbow impairment in measured variables. More research is needed to confirm the result of this study.

Long-term effect of direction-movement control training on female patients with chronic neck pain.

BACKGROUND: Treatment of movement faults in the neck is known as an important factor in treatment of chronic neck pain. Along with the identification of site and direction of the faults, direction-movement control intervention retrains the control of the movement faults. PURPOSE: This study was designed to investigate long-term effects of a direction-movement control training on pain, disability, head repositioning accuracy, function, cervical flexor endurance, and range of motion in female patients with chronic nonspecific neck pain. MATERIAL AND METHODS: Thirty women (36.5 ± 5.7 years) with chronic nonspecific neck pain were randomly allocated into two groups, i.e., an experimental group (n = 15) and a control group (n = 15). The experimental group performed the direction-movement control training for 30 min/day, three days per week for six months. All subjects were evaluated using the visual analog scale (VAS), range of motion (TOM), progressive iso-inertial lifting evaluation (PILE), neck disability Index (NDI), helmet attached with laser pointer using for head repositioning accuracy (HRA), and Trott's test (deep neck flexor endurance), in pre- and six-months post-treatment intervention. RESULTS: Significant differences were observed for the pain, neck disability Index, function endurance, head repositioning accuracy, range of motion, and cervical flexor endurance in the experimental group compared to that of control group. CONCLUSION: Direction-movement control training is likely to be an effective training program to enhance body functionality through improvement of pain, function, endurance, head repositioning accuracy, range of motion, and cervical flexor endurance. Due to the high reported effect size for direction-movement control exercises, the application of the training is suggested as a supplementary method to improve chronic nonspecific neck pain in females.

The effect of motor control training on kinetics variables of patients with non-specific low back pain and movement control impairment: Prospective observational study.

INTRODUCTION: The purpose of this study was to determine the effects of motor control training on pain, disability and motor control indices in patients with nonspecific low back pain (NSLBP) and movement control impairment (MCI) and also to evaluate the correlation between the changes in disability and the motor control indices. METHODS: Thirty people with NSLBP and MCI based on a clinical examination were following either motor control training or normal activity over 8 weeks. RESULT: Significant differences between pre and post training in the experimental group were found in pain, disability and motor control indices. There were significant correlations between disability index with vertical ground reaction force (r = 0.43) and center of pressure (anterior-posterior) (r = 0.44) values. CONCLUSION: The results of this study showed that motor control indices are responsive measures to capture change during motor control training directed at retraining neuromuscular control, reducing pain and disability.