Effects of different bed heights on the physical burden of physiotherapists during manual therapy: an experimental study.

This study aimed to determine the effect of physiotherapists' physical burden caused by different bed heights during manual therapy. Thirty-three male physiotherapists performed tasks simulating lumbar massage and passive hip abduction range-of-motion exercise (ROM) on the beds with low height (LH) and adjusted height (AH), with each task performed three times. The anterior inclination angle of the physiotherapist's trunk was measured, the surface electromyograms of the erector spinae and trapezius muscles were recorded, and perceived stress was assessed. The indexes obtained were statistically compared for different bed heights. Additionally, the lumbar disc compression force and flexion torque were estimated. The lumbar burden caused by the excessive bending and the biomechanical burden and perceived stress were stronger at LH than AH. In ROM tasks using the right hand, the muscle activity was lower at the left lumbar region at LH than at AH. At LH, the anterior inclination angle increased and the lumbar muscle activity declined as the number of tasks increased. The burden on the shoulders was not significantly different by bed heights. Our results showed that, when physiotherapists perform manual therapy, it is necessary to adjust the bed height to reduce physical burden and ensure higher quality of service.

Lumbar Spine Kinematics in Asymptomatic People When Changing Body Position From Sitting to Standing.

OBJECTIVE: The purpose of this study was to assess the lumbar spine kinematics in 3 movement axes in asymptomatic individuals in the sit-to-stand (STS) movement performed in a habitual, flexion, or extension manner. METHODS: There were 30 participants (16 women, 14 men), aged 23 to 37 years. Each participant performed an STS test. We registered the total time of the STS movement and the maximum acceleration of the lumbar spine in the vertical, anteroposterior, and mediolateral axes. The examination of the movement pattern was performed with the use of a BTS G-sensor device. RESULTS: The highest movement dynamics in the lumbar spine were observed during the STS performed in a habitual manner in the 3 axes (P < .01). The lowest movement dynamics ere associated with the extension STS pattern. The flexion pattern differed from the habitual one in total performance time in both groups (P < .01). There were no significant differences in kinematic lumbar spine between sexes. CONCLUSION: The kinematics of the STS movement for asymptomatic individuals were characterized by significant variability in the maximum acceleration in the 3 axes. The highest movement dynamics were observed during the STS performed in a habitual manner, and the lowest dynamics with the extension pattern of STS.

Inter-tester Reliability of Lumbar Lordosis Posture Classification Using a Novel Screening Device.

OBJECTIVE: The purpose of this study was to investigate the inter-tester reliability of lumbar lordosis posture using a novel screening device. METHODS: A total of 33 healthy young male participants participated in the study. Two examiners measured the regional upper and lower lumbar lordosis angles of the participants in the standing position using a flexible ruler. The bent flexible ruler maintained a fixed shape and was transferred to a protractor for angle measurement. Two examiners classified each participant into one of 4 lumbar spine categories and measured the upper and lower regional lumbar lordosis angles. RESULTS: The agreement level between the 2 examiners in assessing healthy participants was 87.9%. The calculated kappa coefficient was 0.79 (95% CI = 0.86-0.97), reflecting a substantial level of agreement. CONCLUSION: Our results suggest that our novel screening device for assessing upper and lower lumbar angles showed good inter-tester reliability in posture classification. Our findings may be useful for health care professionals for managing sagittal lumbar posture in asymptomatic younger individuals; however, more testing is still needed.

Self-Myofascial Release of the Superficial Back Line Improves Sit-and-Reach Distance.

CONTEXT: Decreased hamstring flexibility can lead to a plethora of musculoskeletal injuries, including low back pain, hamstring strains, and patellofemoral pain. Lack of flexibility may be the result of myofascial adhesions. The fascia connected to the hamstrings is part of the superficial back line that runs from the cranium to the plantar aspect of the foot. Any disruption along this chain may limit the flexibility of the hamstring. OBJECTIVE: To investigate if self-myofascial release (SMR) of the plantar surface of the foot in addition to the hamstring group was more effective at improving the flexibility of the hamstrings when compared with either intervention alone. DESIGN: Cross-over study. SETTING: Athletic training facility. PARTICIPANTS: Fifteen college students (5 males and 10 females; age: 20.9 [1.4] y, height: 173.1 [10.3] cm, mass: 80.0 [24.9] kg) who were not older than 30, with no history of low back pain or injury within the past 6 months, no history of leg pain or injury within the past 6 months, no current signs or symptoms of cervical or lumbar radicular pain, no current complaint of numbness or tingling in the lower-extremity, and no history of surgery in the lower-extremity or legs. INTERVENTIONS: Each participant received each intervention separated by at least 96 hours in a randomized order: hamstring foam rolling, lacrosse ball on the plantar surface of the foot, and a combination of both. MAIN OUTCOME MEASURES: The sit-and-reach test evaluated hamstring flexibility of each participant before and immediately after each intervention. RESULTS: There were no significant differences found among the SMR techniques on sit-and-reach distance (F2,41 = 2.7, P = .08, ηp2=.12). However, at least 20% of participants in each intervention improved sit-and-reach distance by 2.5 cm. CONCLUSIONS: SMR may improve sit-and-reach distance, but one technique of SMR does not seem to be superior to another.

Preferential activation of spinal sensorimotor networks via lateralized transcutaneous spinal stimulation in neurologically intact humans.

Transcutaneous spinal stimulation (TSS), a noninvasive technique to modulate sensorimotor circuitry within the spinal cord, has been shown to enable a wide range of functions that were thought to be permanently impaired in humans with spinal cord injury. However, the extent to which TSS can be used to target specific mediolateral spinal cord circuitry remains undefined. We tested the hypothesis that TSS applied unilaterally to the skin ~2 cm lateral to the midline of the lumbosacral spine selectively activates ipsilateral spinal sensorimotor circuitry, resulting in ipsilateral activation of downstream lower extremity neuromusculature. TSS cathodes and anodes were positioned lateral from the midline of the spine in 15 healthy subjects while supine, and the timing of TSS pulses was synchronized to recordings of lower extremity muscle activity and force. At motor threshold, left and right TSS-evoked muscle activity was significantly higher in the ipsilateral leg compared with contralateral recordings from the same muscles. Similarly, we observed a significant increase in force production in the ipsilateral leg compared with the contralateral leg. Delivery of paired TSS pulses, during which an initial stimulus was applied to one side of the spinal cord and 50 ms later a second stimulus was applied to the contralateral side, revealed that ipsilateral leg muscle responses decreased following the initial stimulus, whereas contralateral muscle responses did not decrease, indicating side-specific activation of lateral spinal sensorimotor circuitry. Our results indicate TSS can selectively engage ipsilateral neuromusculature via lumbosacral sensorimotor networks responsible for lower extremity function in healthy humans.NEW & NOTEWORTHY We demonstrate the selectivity of transcutaneous spinal stimulation (TSS), which has been shown to enable function in humans with chronic paralysis. Specifically, we demonstrate that TSS applied to locations lateral to the spinal cord can selectively activate ipsilateral spinal sensorimotor networks. We quantified lumbosacral spinal network activity by recording lower extremity muscle electromyography and force. Our results suggest lumbosacral TSS engages side-specific spinal sensorimotor networks associated with ipsilateral lower extremity function in humans.

Influencing lumbar posture through real-time biofeedback and its effects on the kinematics and kinetics of a repetitive lifting task.

BACKGROUND: Repetitive, flexed lumbar postures are a risk factor associated with low back injuries. Young, novice workers involved in manual handling also appear at increased risk of injury. The evidence for the effectiveness of postural biofeedback as an intervention approach is lacking, particularly for repetitive, fatiguing tasks. RESEARCH QUESTION: How does real-time lumbosacral (LS) postural biofeedback modify the kinematics and kinetics of repetitive lifting and the risk of low back injury? METHODS: Thirty-four participants were randomly allocated to two groups: biofeedback (BF) and non-biofeedback (NBF). Participants repetitively lifted a 13 kg box at 10 lifts per minute for up to 20 min. Real-time biofeedback of LS posture occurred when flexion exceeded 80% maximum. Three-dimensional motion analysis and ground reaction forces enabled estimates of joint kinematics and kinetics. Rating of perceived exertion (RPE) was measured throughout. RESULTS: The BF group adopted significantly less peak lumbosacral flexion (LSF) over the 20 min when compared to the NBF group, which resulted in a significant reduction in LS passive resistance forces. This was accompanied by increased peak hip and knee joint angular velocities in the BF group. Lower limb moments did not significantly differ between groups. Feedback provided to participants diminished beyond 10 min and subjective perceptions of physical exertion were lower in the BF group. SIGNIFICANCE: Biofeedback of lumbosacral posture enabled participants to make changes in LSF that appear beneficial in reducing the risk of low back injury during repetitive lifting. Accompanying behavioural adaptations did not negatively impact on physical exertion or lower limb joint moments. Biofeedback of LS posture offers a potential preventative and treatment adjunct to educate handlers about their lifting posture. This could be particularly important for young, inexperienced workers employed in repetitive manual handling who appear at increased risk of back injury.

Interaction Between Thoracic Movement and Lumbar Spine Muscle Activation Patterns in Young Adults Asymptomatic for Low Back Pain: A Cross-Sectional Study.

OBJECTIVE: The purpose of this study was to investigate the interaction between thoracic movement and lumbar muscle co-contraction when the lumbar spine was held in a relatively neutral posture. METHODS: Thirty young adults, asymptomatic for back pain, performed 10 trials of upright standing, maximum trunk range of motion, and thoracic movement tasks while lumbar muscle activation was measured. Lumbar co-contraction was calculated, compared between tasks, and correlated to thoracic angles. RESULTS: Movement tasks typically exhibited greater co-contraction than upright standing. Co-contraction in the lumbar musculature was 67%, 45%, and 55% greater than upright standing for thoracic flex, thoracic bend, and thoracic twist, respectively. Generally, the thoracic movement task demonstrated greater co-contraction than the maximum task in the same direction. Co-contraction was also correlated to thoracic angles in each movement direction. CONCLUSION: Tasks with thoracic movement and a neutral lumbar spine posture resulted in increases in co-contraction within the lumbar musculature compared with quiet standing and maximum trunk range-of-motion tasks. Findings indicated an interaction between the 2 spine regions, suggesting that thoracic posture should be accounted for during the investigation of lumbar spine mechanics.

Lumbatex: A Wearable Monitoring System Based on Inertial Sensors to Measure and Control the Lumbar Spine Motion.

Measuring the curvature of the lumbar spine is an important challenge in disciplines related to physical therapy, rehabilitation, and sports medicine seeking to solve the incidence of the low back pain and other spinal disorders in the population. In clinical practice, most of the methods used are manual or depend on the trained eye of the specialist who is measuring. We have developed Lumbatex: an integrated system based on inertial sensors integrated into a wearable textile device. This device is connected via Bluetooth to software, which interprets data from the sensors and provides real-time biofeedback to users in a graphical way and also a quantitative measure of the curvature and spinal motion. The system is tested in two ways: first, checking the accuracy detecting changes in curvatures; second, evaluating the usability and comfort from the user standpoint. The accuracy is checked through a static method getting curvature values from the device placed on curved platforms and a dynamic validation with volunteers performing different exercises. The results obtained showed a high accuracy measuring changes in curvature with an error lower than 1° in the static test and good usability and comfort according to the opinion of the volunteers.

Effects of a Progressive Stabilization Exercise Program Using Respiratory Resistance for Patients with Lumbar Instability: A Randomized Controlled Trial.

BACKGROUND This study investigated the effects of progressive stabilization exercise program carried out with respiratory resistance in patients with lumbar instability. MATERIAL AND METHODS Forty-three patients with lumbar instability were randomly assigned to experimental (n=20) and control groups (n=23). The experimental group performed progressive lumbar stabilization exercises along with respiratory resistance, and the control group only performed progressive lumbar stabilization exercises, for 40 min per session, 3 sessions a week, for 4 weeks. Numeric rating scale (NRS), Korean-Oswestry disability index (K-ODI), static balance ability, Fear-Avoidance Beliefs Questionnaire (FABQ), and pulmonary function test (PFT) were performed before and after the intervention program for comparison. RESULTS The 2 groups showed significant differences in NRS, K-ODI, balance ability, and FABQ after the interventions (p<0.05), but greater improvements were shown by the experimental group in balance ability and FABQ values. PFT results in the experimental group showed a significant increase (p<0.05) in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and maximum voluntary ventilation (MVV). The experimental group showed a greater improvement (p<0.05) in FVC and MVV compared to the control group. CONCLUSIONS Progressive stabilization exercise program with respiratory resistance is an effective method with clinical significance in pain reduction, psychosocial stability, and enhancement of motor and respiratory functions.

Effects of myofascial release in erector spinae myoelectric activity and lumbar spine kinematics in non-specific chronic low back pain: Randomized controlled trial.

BACKGROUND: Flexion-relaxation response of the lumbar erector spinae has been previously studied after different interventions such as exercise programs or spinal manipulation, in subjects with chronic low back pain. The objective of the study was to investigate the effects of an isolated myofascial release protocol on erector spinae myoelectric activity and lumbar spine kinematics in chronic low back pain. METHODS: Thirty-six participants, with nonspecific chronic low back pain, were randomized to myofascial release group (n = 18) receiving four sessions of myofascial treatment, each lasting 40 min, and to control group (n = 18) receiving a sham myofascial release. Electromyographic and kinematic variables as well as pain and disability questionnaires were analyzed. FINDINGS: There was a bilateral reduction of the flexion relaxation ratio in individuals receiving myofascial release and who did not show myoelectric silence at baseline (right difference M = 0.34, 95% CI [0.16, 0.33], p ≤ .05 and left difference M = 0.45, 95% CI [0.16, 0.73], p ≤ .05). There was also a significant reduction in pain in the myofascial release group (difference M = -9.1, 95% CI [-16.3, -1.8], p ≤ .05) and disability (difference M = -5.6, 95% CI [-9.1, -2.1], p ≤ .05), compared with control group. No significant differences between groups were found for the kinematic variables. INTERPRETATION: The myofascial release protocol contributed to the normalization of the flexion- relaxation response in individuals who did not show myoelectric silence before the intervention, and also showed a significant reduction in pain and disability compared with the sham group.

Immediate effects of diaphragmatic myofascial release on the physical and functional outcomes in sedentary women: A randomized placebo-controlled trial.

BACKGROUND: Although diaphragmatic myofascial release techniques are widely used in clinical practice, few studies have evaluated the simultaneous acute effects of these techniques on the respiratory and musculoskeletal systems. OBJECTIVE: To evaluate the immediate effects of diaphragmatic myofascial release in sedentary women on the posterior chain muscle flexibility; lumbar spine range of motion; respiratory muscle strength; and chest wall mobility. DESIGN: A randomized placebo-controlled trial with concealed allocation, intention-to-treat analysis, and blinding of assessors and participants. PARTICIPANTS: Seventy-five sedentary women aged between 18 and 35 years. INTERVENTION: The sample was randomly allocated into one of two groups; the experimental group received two diaphragmatic myofascial release techniques in a single session, and the control group received two placebo techniques following the same regimen. OUTCOMES MEASURES: The primary outcome was chest wall mobility, which was analyzed using cirtometry. The secondary outcomes were flexibility, lumbar spine range of motion, and respiratory muscle strength. Outcomes were measured before and immediately after treatment. RESULTS: The manual diaphragm release techniques significantly improved chest wall mobility immediately after intervention, with a between-group difference of 0.61 cm (95% CI, 0.12-1.1) for the axillary region, 0.49 cm (95% CI, 0.03-0.94) for the xiphoid region, and 1.44 (95% CI, 0.88-2.00) for the basal region. The techniques also significantly improved the posterior chain muscle flexibility, with a between-group difference of 5.80 cm (95% CI, 1.69-9.90). All movements except flexion of the lumbar spine significantly increased. The effects on respiratory muscle strength were non-significant. CONCLUSION: The diaphragmatic myofascial release techniques improve chest wall mobility, posterior chain muscle flexibility, and some movements of the lumbar spine in sedentary women. These techniques could be considered in the management of people with reduced chest wall and lumbar mobility. TRIAL REGISTRATION: NCT03065283.

Estimating bone mineral content based on different types of muscle strength tests.

The aims of this pilot study were to verify which muscle strength tests better explain bone mineral content (BMC) of the femoral neck and lumbar spine and to develop predictive equations to estimate femoral neck and lumbar spine BMC. Twenty-nine subjects aged 56-76 years old (12 women and 17 men) participated in the study. Femoral neck and lumbar spine BMC was evaluated by Dual X-ray absorptiometry (DXA). Muscle strength measurements included maximal isometric voluntary contractions of knee extensors and flexors, vertical jump, 5-repetition maximum of the leg press (5-RMLP) and seated leg curl (5-RMLC), and handgrip strength. Women presented a moderate to strong correlation between femoral neck BMC and 5-RMLP (r = 0.819), 5-RMLC (r = 0.879), knee extensors peak torque (r = 0.699), and handgrip strength (r = 0.663), as well as between lumbar spine BMC and the 5-RMLP test (r = 0.845) and manual grip strength (r = 0.699). For females, the 5-RMLP and 5-RMLC tests most fully explained femoral neck BMC (R2 = 0.859) and the 5-RMLP test and body mass explained lumbar spine density (R2 = 0.757) for females. Men did not present correlations between BMC and strength variables. For females, the 5-RMLP and 5-RMLC variables explained the variations of femoral neck BMC, while 5-RMLP and body mass explained lumbar spine BMC. Future studies should evaluate a larger sample size and prioritize the strength tests with a greater predictive capacity.

Relationships Between Trunk Movement Patterns During Lifting Tasks Compared With Unloaded Extension From a Flexed Posture.

OBJECTIVES: The purpose of this study was to investigate between movement patterns of trunk extension from full unloaded flexion and lifting techniques, which could provide valuable information to physical therapists, doctors of chiropractic, and other manual therapists. METHODS: A within-participant study design was used. Whole-body kinematic and kinetic data during lifting and full trunk flexion were collected from 16 healthy male participants using a 3-dimensional motion analysis system (Vicon Motion Systems). To evaluate the relationships of joint movement between lifting and full trunk flexion, Pearson correlation coefficients were calculated. RESULTS: There was no significant correlation between the amount of change in the lumbar extension angle during the first half of the lifting trials and lumbar movement during unloaded trunk flexion and extension. However, the amount of change in the lumbar extension angle during lifting was significantly negatively correlated with hip movement during unloaded trunk flexion and extension (P < .05). CONCLUSIONS: The findings that the maximum hip flexion angle during full trunk flexion had a greater influence on kinematics of lumbar-hip complex during lifting provides new insight into human movement during lifting. All study participants were healthy men; thus, findings are limited to this group.

Microcurrent Point Stimulation Applied to Lower Back Acupuncture Points for the Treatment of Nonspecific Neck Pain.

OBJECTIVES: Although acupuncture and microcurrent are widely used for chronic pain, there remains considerable controversy as to their therapeutic value for neck pain. We aimed to determine the effect size of microcurrent applied to lower back acupuncture points to assess the impact on the neck pain. DESIGN: This was a cohort analysis of treatment outcomes pre- and postmicrocurrent stimulation, involving 34 patients with a history of nonspecific chronic neck pain. SUBJECTS AND SETTINGS: Consenting patients were enrolled from a group of therapists attending educational seminars and were asked to report pain levels pre-post and 48 hours after a single MPS application. INTERVENTIONS AND MEASUREMENTS: Direct current microcurrent point stimulation (MPS) applied to standardized lower back acupuncture protocol points was used. Evaluations entailed a baseline visual analog scale (VAS) pain scale assessment, using a VAS, which was repeated twice after therapy, once immediately postelectrotherapy and again after a 48-h follow-up period. All 34 patients received a single MPS session. Results were analyzed using paired t tests. Results and Outcomes: Pain intensity showed an initial statistically significant reduction of 68% [3.9050 points; 95% CI (2.9480, 3.9050); p = 0.0001], in mean neck pain levels after standard protocol treatment, when compared to initial pain levels. There was a further statistically significant reduction of 35% in mean neck pain levels at 48 h when compared to pain levels immediately after standard protocol treatment [0.5588 points; 95% CI (0.2001, 0.9176); p = 0.03], for a total average pain relief of 80%. CONCLUSIONS: The positive results in this study could have applications for those patients impacted by chronic neck pain.

Do exercises with the Foam Roller have a short-term impact on the thoracolumbar fascia? - A randomized controlled trial.

Due to new research results in the past few years, interest in the fascia of the human body has increased. Dysfunctions of the fascia are indicated by various symptoms, amongst others, musculoskeletal pain. As a result stronger focus has been put on researching therapeutic approaches in this area. The main aim of this study was to investigate the effect of Foam Roll exercises on the mobility of the thoracolumbar fascia (TLF). Study has been conducted in a randomized and controlled trial which sampled 38 healthy athletic active men and women. The subjects were randomly assigned to a Foam Roll Group (FMG), a Placebo Group (PG) and a Control Group (CG). Depending on the assigned group the volunteers were either instructed to do exercises with the Foam Roll, received a pseudo treatment with the Foam Roll or received no treatment. A total of three measurements were carried out. The most important field of research was the mobility of the TLF, which was determined using a sonographic assessment. In addition the lumbar flexion and the mechanosensivity of relevant muscles were determined. After the intervention, the FMG showed an average increase of 1.7915 mm for the mobility of the TLF (p < 0.001/d = 0.756). In contrast, only an average improvement of 0.1681 mm (p = 0.397) was shown in the PG, while the CG showed a slight improvement of 0.0139 mm (p = 0.861). However, no significant changes were observed with regard to the lumbar flexion and mechanosensivity of the treated muscles. Thus, evidence is that the use of Foam Roll exercises significantly improves the mobility of the thoracolumbar fascia in a healthy young population.

Increased strength of the scapular stabilizer and lumbar muscles after twelve weeks of Pilates training using the Reformer machine: A pilot study.

OBJECTIVE: The aim of this work was to analyze muscle strength in Pilates novices who used the Reformer equipment during twelve training sessions. METHODS: Twenty-four healthy young female volunteers, who were non-smokers and did not exercise regularly, were split into a control group (mean age 28 ± 4 years and BMI 24.55 ± 3.21 kg/m2) and a training group (mean age 29 ± 4 years and BMI 22.69 ± 2.87 kgm2). The data were checked for normality using the Kolmogorov-Smirnov test, and were then analyzed using the t-test (p < 0.05). RESULTS: After the training sessions, there were statistically significant differences between the groups for the scapular stabilizer muscles (p = 0.0263) and the lumbar muscles (p = 0.0001). For the scapular stabilizers, the initial/final values were 14.69 ± 2.80/14.79 ± 2.89 (control group) and 15.99 ± 3.54/17.44 ± 2.88 (Pilates group). The corresponding values for the lumbar muscles were 53.83 ± 11.66/53.28 ± 11.14 (control group) and 54.75 ± 10.27/64.80 ± 10.20 (Pilates group). CONCLUSION: After twelve sessions of Pilates with the Reformer equipment, there were improvements in lumbar extensor and scapular stabilizer strength. Several benefits are reported by practitioners of Pilates, but until now, there has been limited scientific evidence of the improvement of strength in the trunk and limbs after application of the technique.

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.

Does 'Kinesio tape' alter thoracolumbar fascia movement during lumbar flexion? An observational laboratory study.

BACKGROUND: Changes in thoracolumbar fascial thickness, structure and shear strain are associated with lower back pain (LBP). Therapeutic taping techniques such as Kinesio-Taping (KT) are increasingly used to treat LBP, albeit with variable effects and unclear mechanisms. However, evidence for quantifying how treatment effects in vivo fascia properties is inadequate. We therefore aimed to explore taping mechanisms using an in vivo ultrasound measurement. METHODS: Thoracolumbar ultrasound videos of known orientations and positions were taken from 12 asymptomatic participants (8 males and 4 females, aged 22.9 ± 3.59) while performing velocity-guided lumbar flexion with and without KT applied. An automated algorithm using cross-correlation to track contiguous tissue layers across sequential frames in the sagittal plane, was developed and applied to two movements of each subject in each taping condition. Differences of inter-tissue movements and paracutaneous translation at tissue boundaries were compared. RESULTS: Significant reduction in the mean movement of subcutaneous tissue during lumbar flexion before and after taping was found. There was no difference in other observed tissue layers. Tissue paracutaneous translations at three boundaries were significantly reduced during lumbar flexion when KT was applied (skin-subcutaneous: 0.25 mm, p < 0.01; subcutaneous-perimuscular tissue: 0.5 mm, p = 0.02; and perimuscular-muscle: 0.46, p = 0.05). No overall reduction in lumbar flexion was found (p = 0.10). CONCLUSIONS: KT reduced subcutaneous inter-tissue movement and paracutaneous translation in the superficial thoracolumbar fascia during lumbar flexion, and the relationship of such difference to symptomatic change merits exploration. Combining ultrasound data with muscle activation information may be useful to reveal potential mechanisms of therapeutic taping in patients with LBP.

The immediate effect of lumbopelvic manipulation on EMG of vasti and gluteus medius in athletes with patellofemoral pain syndrome: A randomized controlled trial.

OBJECTIVE: To evaluate the immediate effect of lubmopelvic manipulation on EMG activity of vastus medialis, vastus lateralis and gluteus medius as well as pain and functional performance of athletes with patellofemoral pain syndrome. DESIGN: Randomized placebo-controlled trial. METHODS: Twenty eight athletes with patellofemoral pain syndrome were randomly assigned to two groups. One group received a lubmopelvic manipulation at the side of the involved knee while the other group received a sham manipulation. EMG activity of the vasti and gluteus medius were recorded before and after manipulation while performing a rocking on heel task. The functional abilities were evaluated using two tests: step-down and single-leg hop. Additionally, the pain intensity during the functional tests was assessed using a visual analog scale. RESULTS: The onset and amplitude of EMG activity from vastus medialis and gluteus medius were, respectively, earlier and higher in the manipulation group compared to the sham group. There were no significant differences, however, between two groups in EMG onset of vastus lateralis. While the scores of one-leg hop test were similar for both groups, significant improvement was observed in step-down test and pain intensity in the manipulation group compared to the sham group. CONCLUSIONS: Lubmopelvic manipulation might improve patellofemoral pain and functional level in athletes with patellofemoral pain syndrome. These effects could be due to the changes observed in EMG activity of gluteus medius and vasti muscles. Therefore, the lubmopelvic manipulation might be considered in the rehabilitation protocol of the athletes with patellofemoral pain syndrome.

The immediate effect of dry needling on multifidus muscles' function in healthy individuals.

BACKGROUND: Dry needling of muscles is mainly used for the management of pain in musculoskeletal disorders. Yet, the association between dry needling and motor performance of muscles is still unclear. OBJECTIVE: To investigate the immediate effect of dry needling on lumbar multifidus muscles' function in healthy subjects. METHODS: Twenty-eight volunteers were divided randomly into: study group (13 subjects) and control group (15 subjects) who underwent no intervention. Study group received dry needling to the lumbar multifidus muscles using a deep insertion technique with 4 needles (2 on each side of the spine). The needles were left in situ for 10 minutes. Ultrasound imaging was used to measure multifidus muscles' thickness, pre and post-procedure during rest in a prone position and during contralateral active straight leg extension. RESULTS: Significant difference was found in the percentage of change of muscle activation post needling between groups on the right side at level L4-5. A slight increase in the percentage of muscle activity, post procedure was observed in the dry needling group compared with the control group, although not significant in other segments examined. CONCLUSION: An improvement of back muscle function following dry needling procedure in healthy individuals was found. This implies that dry needling might stimulate motor nerve fibers and as such increase muscle activity.