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.

Effects of unstable shoes on trunk muscle activity in patients with chronic low back pain.

INTRODUCTION: Unstable shoes were developed as a walking device to strengthen the lower extremity muscles and reduce joint loading. Many studies have reported increased muscle activity throughout the gait cycle in most of the lower limb muscles in healthy adults using these shoes. However, no previous studies have explored the effects of wearing unstable shoes on trunk muscle activity in patients with chronic low back pain (CLBP). Therefore, the aim of the present study was to compare the activity of selected trunk muscles in patients with CLBP during a gait test while walking wearing unstable shoes or conventional flat shoes (control). METHODS: Thirty-five CLBP patients (51.1 ±â€¯12.4 y; 26 ±â€¯3.8 kg/m2; 9.3 ±â€¯5.2 Roland Morris Disability Questionnaire score) were recruited from the Orthopedic Surgery Service at the Hospital to participate in this cross-sectional study. All the participants underwent gait analysis by simultaneously collecting surface electromyography (EMG) data from erector spinae (ES), rectus abdominis (RA), obliquus internus (OI), and obliquus externus (OE) muscles, while walking on a treadmill with flat control shoes or experimental unstable shoes. RESULTS: The results showed significantly higher %EMG activity in the ES (mean difference: 1.8%; 95% CI: 1.3-2.2), RA (mean difference: 1.5%; 95% CI: 0.3-2.7), and OI (mean difference: 1.5%; 95% CI: 0.2-2.8) in the unstable versus the flat-shoe condition, with a large effect size for the ES (Cohen's d = 1.27). CONCLUSIONS: Based on these findings, the use of unstable shoes may be implicated in promoting spine stability, particularly in improving neuromuscular control of the trunk muscles in CLBP treatment.

Impact of biomedical and biopsychosocial training sessions on the attitudes, beliefs, and recommendations of health care providers about low back pain: a randomised clinical trial.

The beliefs and attitudes of health care providers may contribute to chronic low back pain (LBP) disability, influencing the recommendations that they provide to their patients. An excessively biomedical style of undergraduate training can increase negative beliefs and attitudes about LBP, whereas instruction following a biopsychosocial model could possibly lessen these negative beliefs in health care professionals. The objectives of this study were to determine the effectiveness of 2 brief educational modules with different orientations (biomedical or biopsychosocial) on changing the beliefs and attitudes of physical therapy students and the recommendations that they give to patients. The intervention in the experimental group was based on the general biopsychosocial model, whereas the sessions in the control group dealt with the basics of the biomechanics of back pain. The participants completed the Fear-Avoidance Beliefs Questionnaire (FABQ), Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), and Rainville et al. Clinical Cases questionnaire before and after the interventions. The participants attending the biopsychosocial session displayed a reduction in fear-avoidance beliefs (P<.001) and Pain-Impairement beliefs (P<.001), which was strongly correlated with an improvement in clinicians' activity and work recommendations. However, the students assigned to the biomechanics sessions increased their fear-avoidance scores (P<.01), and their recommendations for activity levels worsened significantly (P<.001). Our results confirm the possibility of modifying the behaviour of students through the modification of their beliefs and attitudes. We also conclude that a strictly biomedical education exacerbates maladaptive beliefs, and consequently results in inadequate activity recommendations. The implications of this study are important for both the development of continuing medical education and the design of the training curriculum for undergraduate students.