Short-term effect of kinesiology taping on pain, functional disability and lumbar proprioception in individuals with nonspecific chronic low back pain: a double-blinded, randomized trial.

BACKGROUND: This study aimed to evaluate the effect of kinesiology taping (KT) on lumbar proprioception, pain, and functional disability in individuals with nonspecific chronic low back pain (CLBP). METHODS: Thirty individuals with nonspecific CLBP participated in this double-blinded, randomized clinical trial from July 2017 to September 2018. The participants were randomized into two groups: KT (n = 15) and placebo group (n = 15). KT was applied with 15-25% tension for 72 h, and placebo taping was used without tension. Lumbar repositioning error was measured by a bubble inclinometer at three different angles (45° and 60° flexion, and 15° extension) in upright standing. Pain and disability were assessed by the Short-Form McGill Pain Questionnaire and Oswestry Disability Index, respectively. All measurements were recorded at baseline and 3 days after taping. RESULTS: Pain and disability scores reduced 3 days after taping in the KT group with large effect sizes (p < 0.05). Only the total score of pain was significantly different between the groups 3 days after taping and improved more in the KT group with a large effect size (p < 0.05). However, lumbar repositioning errors were similar between the groups after 3 days (p > 0.05). Also, only constant error of 15° extension showed a moderate correlation with disability (r = 0.39, p = 0.02). CONCLUSION: KT can decrease pain and disability scores after 3 days of application. Although placebo taping can reduce pain, the effect of KT is higher than placebo taping. The findings do not support the therapeutic effect of KT and placebo taping as a tool to enhance lumbar proprioception in patients with nonspecific CLBP. TRIAL REGISTRATION: The study prospectively registered on 21.05.2018 at the Iranian Registry of Clinical Trials: IRCT20090301001722N20 .

Biomechanical Comparison of Lumbar Fixed-Point Oblique Pulling Manipulation and Traditional Oblique Pulling Manipulation in Treating Lumbar Intervertebral Disk Protrusion.

OBJECTIVE: To compare the biomechanical effect of lumbar fixed-point oblique pulling manipulation and traditional oblique pulling manipulation in the treatment of protrusion of lumbar intervertebral disk, and investigate the influence of disk degeneration on the 2 manipulations. METHODS: Three finite element models including 1 normal model, 1 mild degeneration, and 1 moderate degeneration model of L3-S1 were developed to simulate 2 oblique pulling manipulations. The disk protrusion was assumed to be in the left central and subarticular zone of the L4-L5 disk, and manipulations were carried out on the right. A 15-Nm right axial rotation moment and 150-N compressive loading were imposed on the upper endplate of L3 to simulate a traditional oblique pulling manipulation. To simulate lumbar fixed-point oblique pulling manipulation, in addition to a 15-Nm moment and 150-N compressive loading imposed on the L3 upper endplate, a 50-N force was imposed on the right lateral area of the L4 spinous process in a left front direction. The displacement and stress in the left central and subarticular zone of the L4-L5 disk were calculated and compared in the 3 models. RESULTS: The average displacement and stress in the left central and subarticular zone of L4-L5 disk were higher in fixed-point oblique pulling manipulation than those in traditional oblique pulling manipulation (P < .05). In addition, the values of average stress and displacement decreased significantly with the increase of lumbar disk degeneration (P < .05). CONCLUSION: Lumbar fixed-point oblique pulling manipulation showed a better biomechanical effect than traditional oblique pulling manipulation, and lumbar disk degeneration affected the 2 manipulations adversely in the virtual treatment of protrusion of the lumbar intervertebral disk using finite element models.

Lumbar Movement Dysfunction Based on Movement Control Impairment Classification System in Those Who Do and Do Not Develop Transient Low Back Pain During Prolonged Sitting.

OBJECTIVE: Long-term sitting triggers movement-related disorders. We used a movement control impairment (MCI) system to investigate lumbar movement dysfunction in those who did and did not develop transient low back pain (LBP) during prolonged sitting. METHODS: Twelve patients who did and did not develop transient LBP during sitting for 2 hours were enrolled. We tested the movement control abilities of the 2 groups using 6 MCI tests (12 test items). RESULTS: The mean MCI test score in the transient LBP developer group was significantly higher than that in the LBP non-developer group (P = .03). Lumbar flexion movement control as the backward rocking test was significantly more common in the transient LBP developer than in the LBP non-developer group (P < .027). Pelvic shifting and asymmetry during side-bending of the trunk were evident in both groups (all P > .05). However, pelvic shifting during side-bending of the trunk was evident only in the LBP group (33%; P = .093). CONCLUSION: The group exhibiting transient LBP had higher positive MCI test scores and exhibited more asymmetry than the other group. Even the non-LBP group exhibited poor lumbar flexion and rotation. Therefore, subjects with subclinical dysfunction caused by prolonged sitting may require homogenous subgroups classification for the early detection of mechanical risk factors and health and functional interventions.

Efficacy of the lumbar stabilization and thoracic mobilization exercise program on pain intensity and functional disability reduction in chronic low back pain patients with lumbar radiculopathy: A randomized controlled trial.

BACKGROUND: Exercise programs in the treatment of chronic lumbar pain are quite diverse, but it has been proven that stabilization exercises are the most effective. OBJECTIVE: We compared the lumbar stabilization exercise program in a closed and open kinetic chain (LSCO) and lumbar stabilization exercises and thoracic mobilization program in a closed kinetic chain (LSTMC), and evaluated the clinical effectiveness of each program. METHODS: Prospective, randomized, controlled trial in 80 chronic low back pain (CLBP) patients with lumbar radiculopathy of both sexes (35 male, 45 female), average age (48.45 ± 10.22 years), divided in two groups that performed different sets of exercises. Participants were given laser therapy, transcutaneous electro-nerve stimulation and an eight-week kinesiotherapy that included exercises to strengthen the deep lumbar spine stabilizers. Retesting was done after four and eight weeks. RESULTS: Statistically significant (p< 0.05) superior recovery of the LSTMC group subjects compared to the LSCO group was achieved at all measurement intervals in the pain intensity and functional disability parameters. CONCLUSION: Patients who performed the lumbar stabilization and thoracic mobilization exercise program in a closed kinetic chain had the most effective reduction of pain intensity and functional disability.

Interlimb conditioning of lumbosacral spinally evoked motor responses after spinal cord injury.

OBJECTIVE: The importance of subcortical pathways to functional motor recovery after spinal cord injury (SCI) has been demonstrated in multiple animal models. The current study evaluated descending interlimb influence on lumbosacral motor excitability after chronic SCI in humans. METHODS: Ulnar nerve stimulation and transcutaneous electrical spinal stimulation were used in a condition-test paradigm to evaluate the presence of interlimb connections linking the cervical and lumbosacral spinal segments in non-injured (n=15) and spinal cord injured (SCI) (n=18) participants. RESULTS: Potentiation of spinally evoked motor responses (sEMRs) by ulnar nerve conditioning was observed in 7/7 SCI participants with volitional leg muscle activation, and in 6/11 SCI participants with no volitional activation. Of these six, conditioning of sEMRs was present only when the neurological level of injury was rostral to the ulnar innervation entry zones. CONCLUSIONS: Descending modulation of lumbosacral motor pools via interlimb projections may exist in SCI participants despite the absence of volitional leg muscle activation. SIGNIFICANCE: Evaluation of sub-clinical, spared pathways within the spinal cord after SCI may provide an improved understanding of both the contributions of different pathways to residual function, and the mechanisms of plasticity and functional motor recovery following rehabilitation..

The effects of dry needling on pain relief and functional balance in patients with sub-chronic low back pain.

BACKGROUND: Pain relief is important both for the movement of patients suffering from low back pain and the quality of life. Dry needling is effective on myofascial trigger points but its effect on the area of pain and the functional balance is not fully known. OBJECTIVE: To examine the immediate effect of dry needling on pain and functional balance of patients suffering from low back pain. METHODS: Twenty five patients with sub-chronic low back pain were randomly divided into two groups: the intervention or control group. Needles were used for the participants of the intervention group, bilaterally at the spinus level, one and a half finger breath from the midline in levels L2-L5 of the lumbar spine. A third line of needles was inserted in the interspinosus spaces, except L5-S1 level. Bipedal stance, lateral loading and mediolateral body sway were assessed using a pair of force plates. Pain tolerance was assessed using an algometer. RESULTS: The pain tolerance significantly increased in the intervention group from (M = 4.87, SE 0.663) to (M = 6.52, SE 0.547) (F(1,23) = 7.8, p< 0.05) after intervention. During mediolateral body sway the force signal in the dominant frequency significantly increased in the intervention group from (M = 43.2, SE 4.6) to (M = 54,9, SE 3.6) (F(1,23) = 4.63, p< 0.05) after intervention, exhibiting more controlled rhythmic behavior. CONCLUSIONS: Dry needling in painful areas and penetrating all the muscle groups seems to improve pain and functional balance, yet its effect on specific muscles needs to be studied further.

Effects of lumbar segmental stabilization exercise and respiratory exercise on the vital capacity in patients with chronic back pain.

BACKGROUND: Trunk stabilization contributes to the efficient control of body movements in daily life, and it plays an important role in maintaining the proper alignment of the body and preventing low back pain. OBJECTIVE: This study aimed to identify the effectiveness of breathing exercises and lumbar segmental exercises on the vital capacity of lumbar instability patients. METHOD: Fifty-nine patients suffering from chronic low back pain participated in this study. They were randomly divided into three groups: experiment group 1 performed breathing and segmental stabilization exercises (n= 20), experiment group 2 performed segmental stabilization exercises (n= 20), and the control group performed the modality treatment (n= 19). The measurements were assessed on vital capacity. RESULTS: The difference in the forced vital capacity, maximal expiratory pressure, and maximal inspiratory pressure at pre- and post-intervention was significant in the RE+LSSE and LSSE groups (p< 0.05) and among all groups (p< 0.05). The difference in the forced expiratory volume at one second of each group was significant (p< 0.05) but was not significant among groups (p> 0.05). CONCLUSION: In conclusion, the lumbar segmental stabilization exercise activates the deep muscle and improves the respiratory function and respiratory pressure, when used for chronic low back pain patients with segmental instability.

Comparison of two mobilization techniques in management of chronic non-specific low back pain.

AIM: The aim of the study was to compare between the effects of Maitland's postero-anterior (PA glide) mobilization and Mulligan's sustained natural apophyseal glide (SNAG) on pain, mobility, muscle activation and functional disability in subjects with chronic, non-specific low back pain. METHODS: The study was a two arm repeated measure design with random allocation of subjects (n = 33). Subjects in group 1 received Maitland's PA glide mobilization and those in group 2 received Mulligan's SNAG. Along with the respective mobilization technique, individualized exercises were common for subjects in both the groups. Subjects in both groups received treatment for 4 days a week for 4 weeks. The outcome measures were numeric pain rating scale (NPRS) scores, lumbar flexion and extension range of motion, erector spinae muscle activity and Oswestry low back pain disability questionnaire score. RESULTS: The outcome measure scores showed statistical significance in time effect on NPRS (p = 0.001); lumbar flexion and extension range of motion (p = 0.001); erector spinae muscle activity (0.001); Oswestry low back pain disability questionnaire score (p = 0.001); group effect on lumbar flexion (p = 0.03) and extension range of motion (p = 0.05); and interaction effect (time x group) on lumbar flexion (p = 0.003) and extension range of motion (p = 0.002); and, erector spinae muscle activity (p = 0.05) at the 3rd lumbar vertebral level. CONCLUSION: The addition of Maitland or Mulligan mobilization techniques of the spine does not show a difference in the improvement of symptoms associated with chronic non-specific low back pain.

Superficial temperature and pain tolerance in patients with chronic low back pain.

INTRODUCTION: Low back pain is a common and very prevalent disease and can impose limitations that negatively impact patients. The objective of this study was to verify and compare the association between lumbar superficial temperature and pressure pain tolerance thresholds in individuals with chronic nonspecific low back pain and healthy controls. METHODS: This was a cross-sectional observational study involving 38 individuals with nonspecific chronic low back pain and 19 healthy controls. Volunteers underwent thermographic (infrared sensor), pain perception (visual analog scale), and pressure pain tolerance thresholds (algometry) evaluations in the right and left paravertebral muscles and L4-L5 ligament. RESULTS: A lower tolerance to pressure pain was found in patients compared to controls at all evaluated sites (p ≤ 0.003). Superficial temperature was significantly higher in the sites evaluated in the low back pain group (p < 0.001). In patients with low back pain, pain perception was weakly and inversely correlated with pressure pain tolerance (r = -0.31; p = 0.05) and moderately correlated to the temperature of the evaluated sites (r = 0.51 to 0.59, p ≤ 0.001). Also, an inverse and weak to moderate association was observed between pressure pain tolerance thresholds and temperature in patients only (r = -0.36 to -0.49; p ≤ 0.02). CONCLUSION: Individuals with low back pain have lower pressure pain tolerance thresholds and higher superficial temperature in the lumbar region when compared to healthy individuals. The associations observed show that the higher the pain perception, the lower the pain tolerance and the higher the superficial temperature in the lumbar region. Also, the higher the temperature, the lower the pain tolerance.

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.

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.

Motor Control Training Compared With Transcutaneous Electrical Nerve Stimulation in Patients With Disc Herniation With Associated Radiculopathy: A Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to compare the effectiveness of motor control training and transcutaneous electrical nerve stimulation in relieving pain, reducing functional disability, and improving transversus abdominis activation in patients with lumbar disc herniation with associated radiculopathy. DESIGN: This is a randomized controlled trial. METHODS: Forty patients diagnosed with lumbar disc herniation were randomly divided into two groups: motor control training group (n = 20) and transcutaneous electrical nerve stimulation group (n = 20). INTERVENTIONS: The motor control training group and transcutaneous electrical nerve stimulation group attended 60 mini sessions twice a week for 8 wks, totaling to 16 sessions. MAIN OUTCOME MEASURES: The main outcome measures are pain, functional disability, and transversus abdominis activation capacity. RESULTS: Differences between both groups were observed after 8 wks, favoring the motor control training group. Motor control training was more effective than transcutaneous electrical nerve stimulation in relieving pain (mean difference = 3.3 points, 95% confidence interval = 2.12-4.48), reducing functional disability (mean difference = 8.4 points, 95% confidence interval = 5.44-11.36), improving the quality of pain (mean difference = 17 points, 95% confidence interval = 7.93-26.07), sensory quality of pain (mean difference = 10.3 points, 95% confidence interval = 5.55-15.05), and transversus abdominis activation (mean difference = 1.5 points, 95% confidence interval = 0.90-2.10). CONCLUSIONS: The results suggest that motor control training is more effective than transcutaneous electrical nerve stimulation with respect to relieving pain, reducing functional disability, and improving transversus abdominis activation in patients with lumbar disc herniation.

Effect of a prototype lumbar spinal stenosis belt versus a lumbar support on walking capacity in lumbar spinal stenosis: a randomized controlled trial.

BACKGROUND CONTEXT: Lumbar spinal stenosis (LSS) can impair blood flow to the spinal nerves giving rise to neurogenic claudication and limited walking ability. Reducing lumbar lordosis can increases the volume of the spinal canal and reduce neuroischemia. We developed a prototype LSS belt aimed at reducing lumbar lordosis while walking. PURPOSE: The aim of this study was to assess the short-term effectiveness of a prototype LSS belt compared to a lumbar support in improving walking ability in patients with degenerative LSS. STUDY DESIGN: This was a two-arm, double-blinded (participant and assessor) randomized controlled trial. PATIENT SAMPLE: We recruited 104 participants aged 50 years or older with neurogenic claudication, imaging confirmed degenerative LSS, and limited walking ability. OUTCOME MEASURES: The primary measure was walking distance measured by the self-paced walking test (SPWT) and the primary outcome was the difference in proportions among participants in both groups who achieved at least a 30% improvement in walking distance from baseline using relative risk with 95% confidence intervals. METHODS: Within 1 week of a baseline SPWT, participants randomized to the prototype LSS belt group (n=52) and those randomized to the lumbar support group (n=52) performed a SPWT that was conducted by a blinded assessor. The Arthritis Society funded this study ($365,000 CAN) with salary support for principal investigator funded by the Canadian Chiropractic Research Foundation ($500,000 CAN for 5 years). RESULTS: Both groups showed significant improvement in walking distance, but there was no significant difference between groups. The mean group difference in walking distance was -74 m (95% CI: -282.8 to 134.8, p=.49). In total, 62% of participants wearing the prototype LSS belt and 82% of participants wearing the lumbar support achieved at least 30% improvement in walking distance (relative risk, 0.7; 95% CI: 0.5-1.3, p=.43). CONCLUSIONS: A prototype LSS belt demonstrated significant improvement in walking ability in degenerative LSS but was no better than a lumbar support.

The effects of selective Pilates versus extension-based exercises on rehabilitation of low back pain.

INTRODUCTION: Chronic non-specific low back pain (LBP) may lead to functional impairment and physical disability. The aim of this study was to compare the effects of selective Pilates (SP) and extension-based (EB) exercises on pain, lumbar spine curvature, lumbar forward flexion range of motion (ROM), and physical disability in such individuals. MATERIALS AND METHODS: In this randomized clinical trial, Forty-seven patients with chronic non-specific LBP (Mean of age: 39.7 years) were randomly allocated into either SP (N = 16), EB (N = 15), or control (N = 16) groups. The measurements included pain intensity, physical disability, lumbar forward bending ROM, and lumbar spine curvature at the baseline, after receiving the 6-week interventions, and also following one month of cessation of the exercises The analysis of co-variance (ANCOVA) and Post-hoc Bonferroni tests were administered to compare the three groups after the interventions and one month later (P < 0.05). RESULTS: More significant improvement was observed in SP group compared to the subjects receiving EB exercises in terms of pain, ROM, and physical disability (P < 0.001), however, there was no significant difference between the two experimental groups for lumbar curvature (P > 0.05). Furthermore; in follow-up, the patients in SP group significantly achieved a higher level of pain intensity improvement and lumbar flexion ROM than the EB exercises (P < 0.001). CONCLUSIONS: It is estimated that core muscles activation and improving lumbopelvic rhythm in SP training may play a role in decreasing pain and physical disability in chronic LBP patients. Further high-quality studies are required to investigate the details of this mechanism.

Variables Describing Individuals With Improved Pain and Function With a Primary Complaint of Low Back Pain: A Secondary Analysis.

OBJECTIVES: The purpose of this study was to identify descriptive factors in individuals with a primary complaint of low back pain (LBP) associated with improved pain and function after receiving physical therapy for LBP with or without manual therapy and exercise directed at the femoroacetabular joints. METHODS: Participants were enrolled in a randomized clinical trial investigating physical therapy interventions for their LBP, with or without interventions directed at the femoroacetabular joints (hips). A participant was deemed recovered if all of the following were met: Numeric Pain Rating Scale (NPRS) score of ≤2 points, ≤10% on the modified Oswestry Disability Index at discharge, and a global rating of change score of +4 at both 2 weeks and discharge. Logistic regression modelling determined descriptor variables that best predicted treatment recovery. RESULTS: Data from 90 participants were included in the analysis, with 44% (n = 40) achieving recovery by discharge from physical therapy (average 7.95 [±4.68]) visits. The variables of concurrent hip problems, lower body mass index ≤25.4, an irritable condition, and a baseline NPRS score of 4 points or less were retained in the final model (R2 = .384). Having a concurrent hip problem had the highest odds of achieving recovery in the model (odds ratio: 5.34, 95 % confidence interval: 1.31-21.8). CONCLUSIONS: The findings for the patients in this study suggest that those with a concurrent hip problem, a lower body mass index, irritable symptoms, and a baseline NPRS score of 4 points or less were associated with greater odds of achieving recovery with multimodal physical therapy interventions. Further research should continue to investigate the interplay between the lumbar spine and hip joints.

Motor Neuron Excitability Attenuation as a Sequel to Lumbosacral Manipulation in Subacute Low Back Pain Patients and Asymptomatic Adults: A Cross-Sectional H-Reflex Study.

OBJECTIVE: The purpose of the study was to compare a time series of tibial nerve H-reflex trials between patients with subacute low back pain (LBP) and asymptomatic adults using pre and post high-velocity, low-amplitude (HVLA) spinal manipulation (SM) and control procedures. METHODS: Asymptomatic adults (n = 66) and patients with subacute LBP (n = 45) were randomized into 3 lumbosacral procedures: side-posture positioning, joint preloading with no thrust, and HVLA SM. A time series of 40 Hmax/Mmax ratios at a rate of 0.1 Hz were recorded in blocks of 10 trials at baseline and after the lumbosacral procedures at time points corresponding to immediately after, 5 minutes after, and 10 minutes after the procedure. Descriptive time series analysis techniques included time plots, outlier detection, and autocorrelation functions. A mixed analysis of variance model (group × procedure × time) was used to compare the effects of lumbosacral procedures on Hmax/Mmax ratios between the patients with subacute LBP and asymptomatic participants. RESULTS: The time series analysis and the significant lumbosacral × time interaction term (P < .05) indicated that inhibition of the Hmax/Mmax ratios at the 10-second postlumbosacral procedure time point was greatest after the HVLA SM procedure. The effects of lumbosacral procedures on Hmax/Mmax ratios were similar between patients with subacute LBP and asymptomatic participants. CONCLUSIONS: Although nonspecific effects of movement or position artifacts on the Hmax/Mmax ratio were present, a reliable and valid attenuation of the Hmax/Mmax ratio occurred as a specific aspect of HVLA SM in both asymptomatic adults and patients with subacute LBP.

Comparison Between Transcutaneous Electrical Nerve Stimulation and Stabilization Exercises in Fatigue and Transversus Abdominis Activation in Patients With Lumbar Disk Herniation: A Randomized Study.

OBJECTIVE: The purpose of this study was to compare transcutaneous electrical nerve stimulation (TENS) and stabilization exercises in an attempt to prevent fatigue and improve muscle activation in patients with lumbar disk herniation associated with low back pain. METHODS: This study involved 29 patients (age range 25-58 years) randomized into 2 groups: the segmental stabilization group (n = 15), who received stabilization exercises on the transversus abdominis (TrA) and lumbar multifidus muscles; and the TENS group (n = 14), who received electrotherapy. Groups underwent 16 sessions, for 60 minutes, twice per week, and they were evaluated before and after intervention. Pain was measured using a visual analog scale, functional disability using the Oswestry Disability Index, muscle activation and fatigue with electromyography, and patients' ability to contract the TrA with a pressure biofeedback unit. Analyses within and between groups were performed. RESULTS: The stabilization group improved lumbar multifidus fatigue (median frequency [MF] initial [P = .002], MF final [P < .001], MF slope [P = .001], and resistance time [P < .001]), ability to contract the TrA (P < .001), pain (P < .001), and functional disability (P < .001). TENS only was effective for pain (P = .012). CONCLUSION: Although it relieved pain, TENS was not effective as a single treatment to prevent fatigue, increase TrA contraction, and reduce functional disability in herniated disk patients. Stabilization exercises alone improved all measured outcomes.

Change in Low Back Movement Patterns After Neurosurgical Intervention for Lumbar Spondylosis.

OBJECTIVES: The purpose of this study was to assess the use of computer-aided combined movement examination (CME) to measure change in low back movement after neurosurgical intervention for lumbar spondylosis and to use a CME normal reference range (NRR) to compare and contrast movement patterns identified from lumbar disk disease, disk protrusion, and nerve root compression cases. METHODS: A test-retest, cohort observational study was conducted. Computer-aided CME was used to record lumbar range of motion in 18 patients, along with pain, stiffness, disability, and health self-report questionnaires. A minimal clinically important difference of 30% was used to interpret meaningful change in self-reports. z Scores were used to compare CME. Post hoc observation included subgrouping cases into 3 discrete pathologic conditions-disk disease, disk protrusion, and nerve root compression-to report intergroup differences in CME. RESULTS: Self-report data indicated that 11, 7, and 10 patients improved by ≥30% in pain, stiffness, and function, respectively. Three patients experienced clinically significant improvement in health survey. A CME pattern reduced in all directions suggested disk disease. Unilaterally restricted movement in side-flexed or extended directions suggested posterolateral disk protrusion with or without ipsilateral nerve root compression. Bilateral restrictions in extension suggested posterior disk protrusion with or without nerve root compression. In 11 of the 18 cases, CME converged toward the NRR after surgery. CONCLUSION: We described the use of CME to identify atypical lumbar movement relative to an NRR. Data from this short-term postoperative study provide preliminary evidence for CME movement patterns suggestive of disk disease, disk protrusion, and nerve root compression.

The Effectiveness of Hollowing and Bracing Strategies With Lumbar Stabilization Exercise in Older Adult Women With Nonspecific Low Back Pain: A Quasi-Experimental Study on a Community-based Rehabilitation.

OBJECTIVE: The purpose of this study was to explore the therapeutic effectiveness of hollowing lumbar stabilization exercise (HLSE) and bracing lumbar stabilization exercise (BLSE) for older adult women with nonspecific low back pain (NSLBP) in community welfare centers. METHOD: A total of 38 older adult women with NSLBP were allocated to either the HLSE group (n = 17, 70.4 ± 1.7 years) or the BLSE group (n = 21, 66.8 ± 4.4 years). Both groups performed intervention for 12 consecutive weeks, 3 times per week. Each group performed 5 lumbar stabilization exercises, including side plank exercise, bridge exercise, 4-kneeling exercise, prone plank exercise, and prone back extension exercise with hollowing and bracing strategy, respectively. The baseline and post-test values of trunk strength, low back disability (Korean Oswestry Disability Index [K-ODI] and Korean Roland Morris Disability Questionnaire [K-RMDQ]), and static balance (1-leg standing test) were compared by using per-protocol analysis. RESULTS: In trunk strength, the trunk flexor had significant difference (F = 11.10, P = .001) between groups and within groups of BLSE (t = -5.56, P = .001) and HLSE (t = -2.50, P = .024). Trunk back extensor of HLSE (t = -6.00, P = .001) and BLSE (t = -9.19, P = .001) only had significant within-group difference. However, in trunk side flexor, HLSE and BLSE had only significant difference between groups. In low back disability, K-ODI for HLSE (t = 4.50, P = .001) and BLSE (t = 4.60, P = .001) had significant within-group difference but no significant difference between groups (F = 0.28, P = .202). In K-RMDQ, HLSE only had significant within-group difference (t = 3.97, P = .001). In trunk muscle strength, the effect size of HLSE and BLSE groups for trunk flexor was HLSE -0.53 (medium) and BLSE -1.21 (large); trunk side flexor: HLSE 0.27 (small) and BLSE -0.24 (small); and trunk back extensor: HLSE 1.1 (large) and BLSE 2.00 (large), respectively. In low back disability, the effect size of both groups for K-ODI was HLSE 0.88 (large) and BLSE 1.05 (large), and K-RMDQ, HLSE 0.19 (small) and BLSE 0.40 (small), respectively. CONCLUSION: Our findings suggest that HLSE and BLSE could be recommended for community settings to improve trunk strength and low back disability in older adult women with NSLBP. Especially, HLSE and BLSE could be recommended for elderly women with NSLBP who have lower back disability and weak trunk muscle strength, respectively.

Comparison Between Oblique Pulling Spinal Manipulation and Other Treatments for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this review was to compare oblique pulling spinal manipulation with other treatments for lumbar disc herniation. METHODS: Randomized controlled trials of oblique pulling manipulation versus other treatment for lumbar disc herniation were identified using the following databases: China National Knowledge Infrastructure, Wanfang Data, Chinese Science and Technology Periodical Database, PubMed, the Cochrane Library, Embase, Chinese Biological Medicine, and Web of Science. Data extraction was carried out based on inclusion and exclusion criteria, and meta-analysis were performed using RevMan 5.3 software. RESULTS: Nine relevant randomized controlled trials with a total of 887 patients were included. Meta-analysis revealed that oblique pulling manipulation was superior in effective rate to lumbar traction (risk ratio = 1.12; 95% confidence interval [CI]: 1.06-1.19; P < .01) and acupuncture (risk ratio = 1.22; 95% CI: 1.06-1.39; P < .01) and more effective in Visual Analog Scale score (mean difference = - 1.03, 95% CI: -1.32 to -0.74; P < .01) when compared to lumbar traction. It also demonstrated a favorable effect of modified oblique pulling manipulation in Japanese Orthopedic Association scores when compared with lumbar traction (mean difference = 1.66, 95% CI: 0.89 to 2.43; P < .01). CONCLUSION: In the treatment of lumbar disc herniation, oblique pulling spinal manipulation presented with a higher effective rate than acupuncture and lumbar traction. Manipulation had a favorable effect in alleviating pain, and modified oblique pulling manipulation had significant superiority in improving lumbar function when compared with lumbar traction. However, considering the low methodological quality of included studies, more rigorously designed trials should be performed in the future.