Comparison of the Dynamic Postural Control During Lifting and Lowering an External Load in Low Back Pain: A Cross-Sectional Study.

OBJECTIVE: This study aimed to compare dynamic postural control between individuals with and without chronic low back pain (LBP) through load lifting and lowering. METHODS: This cross-sectional study included 52 male patients with chronic LBP (age: 33.37 ± 9.23 years) and 20 healthy male individuals (age: 31.75 ± 7.43 years). The postural control parameters were measured using a force plate system. The participants were instructed to stand barefoot (hip-width apart) on the force plate and lift a box (10% of the weight of the participants) from the waist height to overhead and then lower it from overhead to waist height. The interaction between the groups and tasks was determined using a 2-way repeated-measures analysis of variance. RESULTS: There was no significant interaction between the groups and tasks. Regardless of the groups, postural control parameters including amplitude (P = .001) and velocity (P < .001) in anterior-posterior (AP) direction, phase plane in medial-lateral (ML) direction (P = .001), phase plane in AP-ML direction (P = .001), and the mean total velocity (P < .001) were lesser during the lowering compared with lifting. The results indicated that, regardless of the tasks, the postural control parameters including velocity (P = .004) and phase plane in AP direction (P = .004), velocity in ML direction (P < .001), phase plane (AP-ML) (P = .028), and mean total velocity (P = .001) in LBP were lesser compared with the normal group. CONCLUSION: Different tasks affected postural control differently in patients with LBP and healthy individuals. Moreover, postural control was more challenged during the load-lowering than the load-lifting task. This may have been a result of a stiffening strategy. It may be that the load-lowering task might be considered as a more influential factor for the postural control strategy. These results may provide a novel understanding of selecting the rehabilitation programs for postural control disorders in patients.

Comparing muscle thickness and function in healthy people and subjects with upper trapezius myofascial pain syndrome using ultrasonography.

BACKGROUND: The reliability of the muscle function using ultrasonography is not reported in patients with myofascial pain syndrome and healthy individuals. The main aim of this study was to compare muscle thickness and function of two matched healthy and patients groups with neck pain due to upper trapezius myofascial pain syndrome. METHODS: 40 subjects (20 healthy and 20 patients) participated in this study. Two examiners measured the upper trapezius thickness and function 3 times by ultrasonography independently in the test and retest sessions. RESULTS: There were not significant differences between two groups with respect to demographic characteristics. The ICC values were good to excellent for both measurements. There were no significant differences between the two groups, in terms of upper trapezius muscle thickness in rest (p = 0.63), fair (p = 0.75) and normal (p = 0.73) contractions. On the other hand, % rest-thickness fair (p = 0.006), % rest-thickness normal (p = 0.006), % MVC-thickness (p = 0.02) showed significant differences between two healthy and myofascial pain syndrome groups. CONCLUSIONS: Ultrasonography is a reliable technique used to measure muscle thickness and function. Muscle thickness in rest, fair and normal contractions is not different between the matched groups of healthy people and myofascial pain syndrome subjects. Additionally, muscle function is less in myofascial pain syndrome subjects than healthy people specially % MVC thickness.

Effect of Chronic Low Back Pain on Lumbar Spine Lordosis During Sit-to-Stand and Stand-to-Sit.

OBJECTIVE: This study aimed to evaluate lumbar lordosis during sit-to-stand (STS) and stand-to-sit (SIT) in individuals with and without chronic nonspecific low back pain (CNLBP). The second objective was to investigate sex-related differences in lumbar lordosis. METHODS: Twenty-six patients with CNLBP and 26 controls were recruited. Controls were matched with cases using a frequency matching method. Reflective markers were placed over the spinous process of T12, L3, S2, and the anterior and posterior superior iliac spines. The participants were instructed to stand up at a self-selected pace and maintain their normal upright standing posture for 3 seconds, and then sit down. Kinematic data were recorded at a sampling frequency of 100 Hz using a motion capture system. Lumbar lordosis angle was calculated from the intersection between the line joining T12 and L3, and the line joining L3 to S2. RESULTS: Lumbar lordosis was decreased in patients with CNLBP during STS and SIT compared with the asymptomatic group (mean difference = 2.68°-9.32°; P ≤ .005). Furthermore, no differences were seen in lumbar lordosis at starting position between CNLBP and asymptomatic groups during STS and SIT (mean difference = 2.68°-3.75°; P ≥ .099). Interestingly, the magnitude of the effect size suggested that the difference in lumbar lordosis values between female and male participants was relatively large (Cohen's d = -1.81 to 0.20). CONCLUSION: Decreased lumbar lordosis in patients with CNLBP during STS and SIT could be considered as an important point during rehabilitation. Moreover, the present study showed that there is a sex-related difference among women and men in lumbar lordosis during STS and SIT tasks.

Ultrasound-guided dry needling decreases pain in patients with piriformis syndrome.

INTRODUCTION: Piriformis muscle syndrome (PMS) is a disorder that can lead to symptoms of buttock pain and limited hip-joint mobility, and may have an impact on quality of life. METHODS: Thirty-two patients with PMS were randomized to the treatment group, which included three sessions of ultrasound-guided dry needling (DN) of the piriformis muscle (n = 16), or a waitlist control group (n = 16). The primary outcome was pain intensity measured on the visual analog scale recorded at baseline and then at 72 hours and 1 week after treatment. RESULTS: At 1-week follow-up, pain intensity was significantly less in the DN group than in the waitlist control group (-2.16 [-1.01 to -3.32], P = .007) by an amount consistent with clinically meaningful improvement. DISCUSSION: The findings suggest that DN resulted in clinically meaningful short-term improvement in pain intensity of patients with PMS.

The effect of dry needling on the active trigger point of upper trapezius muscle: Eliciting local twitch response on long-term clinical outcomes.

BACKGROUND: Pain from myofascial trigger points is often treated by dry needling (DN). Empirical evidence suggests eliciting a local twitch response (LTR) during needling is essential. Muscle damage after eliciting LTR can increase the risk of tissue fibrosis in some cases. OBJECTIVE: This study aimed to compare two methods of DN including with and without LTR on clinical parameters. METHODS: Twenty-six participants suffering from chronic non-specific neck pain with an active trigger point (TrP) in their upper trapezius muscles were recruited via the convenience sampling method. Participants were randomly assigned in DN with LTR (control group) and without eliciting LTR or "de qi" (experimental group). Then, they received 3 sessions of dry needling, 3 days apart. We evaluated pain, pain pressure threshold, active cervical lateral flexion range of motion, and Neck Disability Index before the intervention and 4 weeks after the treatment. RESULTS: After the treatment, significant higher changes were seen in the experimental group compared to the control group (p< 0.05) regarding pain, pain pressure threshold, and active cervical lateral flexion. However, there was no significant difference between groups according to the disability (p> 0.05). CONCLUSION: DN without eliciting LTR has superiority over the DN along with eliciting LTR while the treatment aimed to receive long-term effects.

What is the effect and mechanism of kinesiology tape on muscle activity?

OBJECTIVE: This study aimed to evaluate the effects of kinesiology tape, anesthesia, and kinesiology tape along with anesthesia, on motor neuron excitability. PARTICIPANTS: Participants included 20 healthy men aged 20-35 years, who were examined over 5 sessions. INTERVENTION: The five experimental sessions included: control without applying the kinesiology tape or Eutectic Mixture of Local Anesthetics (EMLA); treatment only with EMLA; only kinesiology tape application; only sham tape application; and treatment with kinesiology tape and EMLA. MAIN OUTCOME MEASURES: The H-reflex recruitment curve of the soleus and lateral gastrocnemius was recorded by a blinded assessor in the 5 separate sessions randomly assigned with 48 h washout periods. The major H-reflex parameters include: the Hmax/Mmax ratio, the H-reflex threshold stimulation intensity (Hth), the intensity of maximum H-reflex (IntensityHmax), the H-reflex ascending slope (Hslp), and the H-reflex ascending slope fixed into the first three points (first Hslp). RESULTS: The H-reflex parameters (H slope, first Hslp, Hth, and IntensityHmax) were facilitated by application of the kinesiology tape with and without EMLA; however, EMLA inhibited the H-reflex parameters (Hmax/Mmax ratio, Hslp, first Hslp, and Hth) in both the soleus and lateral gastrocnemius. The sham tape did not alter the H-reflex recruitment curve parameters. The statistical model revealed a significant difference between the kinesiology tape and the sham tape and control sessions, between kinesiology tape-EMLA and EMLA, and between kinesiology tape-EMLA and control session. CONCLUSIONS: Results suggest that the kinesiology tape facilitates the muscle activity and the underlying mechanism on the gastrosoleus motor neuron pool involves the cutaneous receptors.

The effect of upper trapezius muscle dry needling treatment on sleep quality: A case report.

Myofascial pain syndrome is characterized by trigger points in muscles, resulting in pain, limitation of motion, muscle weakness and also referral pain. Upper part of trapezius muscle is one the most common sites in upper quadrant affected by this condition. Among various manual and non-manual techniques, dry needling is one of the most effective treatment methods, and is widely used recently by physiotherapists. A 34 year old, female hairstylist with chronic shoulder pain was admitted to a physiotherapy clinic and was treated with dry needling approach, after which she found improvement of shoulder symptoms and sleep quality. Results from this case report can create an interesting and clear precedent for considering dry needling treatment in future clinical trials.

Effect of spinal stabilization exercise on dynamic postural control and visual dependency in subjects with chronic non-specific low back pain.

BACKGROUND: Motor control approach towards chronic non-specific low back pain (CNLBP) has gained increasing attention. CNLBP patients have shown to be more visually dependent for the postural control process than control subjects but no study has yet investigated the treatment programs effect on this disorder. METHODS: Forty CNLBP patients volunteered to participate in this experimental study. The subjects were randomly assigned into either stabilization exercise (SE) or control group both receiving 12 sessions of routine physiotherapy for four weeks. The SE group also received intensive stabilization exercise. Balance (in terms of overall (OSI), anteroposterior (APSI) and mediolateral stability indices (MLSI)) and functional disability were assessed by Biodex Balance System(®) (BBS) and Oswestry Low Back Disability Questionnaire, respectively prior and after the interventions. The balance tests were performed with open and closed eyes. RESULTS: Both interventions significantly decreased all stability indices but the SE group showed a more pronounced improvement in OSI and APSI. In the SE group, vision deprivation had smaller destabilizing effects on OSI and APSI as compared with the control group. The groups were not statistically different prior and after the interventions on all dependent variables. Oswestry index reduction in the SE group was more pronounced but the interaction of time and group variables were not significant on pain intensity. CONCLUSION: Both interventions effectively enhanced stability indices and functional capabilities and reduced pain intensity in CNLBP patients. The SE protocol made the patients less visual dependent perhaps via better stability. Since pain reduction was not different between the groups, more functional improvement in SE group cannot simply be interpreted via the pain interference and might be related to postural control capabilities of the patients.

Effect of dual-tasking on dynamic postural control in individuals with and without nonspecific low back pain.

OBJECTIVE: The purpose of this study was to compare the effect of dual tasking on postural and cognitive performance between participants with and without nonspecific chronic low back pain. METHODS: In this 3-factor mixed-design study, dynamic postural stability was assessed in 15 patients with chronic nonspecific low back pain and 15 age-, sex-, and size-matched asymptomatic participants. Bilateral stance on a Biodex Balance System was investigated at 3 levels of postural task difficulty (different platform stabilities levels with eyes open and closed) and 2 levels of cognitive task difficulty (with or without auditory Stroop test). We measured anterior-posterior, medial-lateral, and overall indices for postural performance. Average reaction time and error ratio of a modified auditory Stroop test were calculated as measures of the cognitive task performance. RESULTS: Mixed-design 3-way analyses of variance revealed significant interactions. Post hoc 2-way analyses of variance showed significant group by cognitive task difficulty for anterior-posterior (P < .001), medial-lateral (P = .003), and overall stability indices (P < .001) on a stiffness level of 5 with eyes closed. At this level, there were significant differences between single- and dual-task conditions for anterior-posterior (P < .001), medial-lateral (P = .02), and overall stability indices (P < .001) only in the chronic low back pain group. Also, at the most difficult postural conditions, participants with chronic low back pain increased their error ratio (P = .002), whereas matched asymptomatic individuals increased their reaction time (P < .01) of the auditory Stroop test. CONCLUSION: Postural task performance is attenuated by cognitive loading at a moderate level of postural task difficulty. Therefore, to observe the effect of attentional demands of postural control, task difficulty should be considered.