The presence of respiratory disorders in individuals with low back pain: A systematic review.

BACKGROUND: Inspiratory muscles, such as the diaphragm, play a key role in both respiration and spinal control. Therefore, diaphragm dysfunctions are often related to low back pain (LBP). However, few is known on the association between the presence of LBP and the presence of respiratory disorders (RD). OBJECTIVES: To perform a systematic review on the relation between RD and LBP. STUDY DESIGN: Systematic review. METHODS: Two reviewers searched on PubMed/MEDLINE for studies concerning LBP and RD, from 1950 up to January 2016. The search string consisted of the following key words: low back pain, dyspnea, respiratory problems, lung diseases, comorbidity, pulmonary disease, chronic obstructive, smoking, asthma, allergy, sinusitis, respiratory tract infection and hyperventilation. The aim was to evaluate a potential correlation, co-occurrence or causality between RD and LBP. RESULTS: A total of 16 articles were included. A significant correlation between the presence of LBP and the presence of RD such as dyspnea, asthma, different forms of allergy, and respiratory infections was found. No correlation was found between Chronic Obstructive Pulmonary Disease (COPD) and LBP, and no articles were found on the correlation between hyperventilation and LBP. CONCLUSIONS: This is the first study providing an overview of the literature on the relation between LBP and RD. Immunological, biomechanical, psychosocial and socio-economic factors might explain this correlation. Smoking is likely to contribute. Future studies must reveal the causative relationship. LEVEL OF EVIDENCE: Therapy, level 2a.

Inspiratory muscle training affects proprioceptive use and low back pain.

PURPOSE: We have shown that individuals with recurrent nonspecific low back pain (LBP) and healthy individuals breathing against an inspiratory load decrease their reliance on back proprioceptive signals in upright standing. Because individuals with LBP show greater susceptibility to diaphragm fatigue, it is reasonable to hypothesize that LBP, diaphragm dysfunction, and proprioceptive use may be interrelated. The purpose of this study was to investigate whether inspiratory muscle training (IMT) affects proprioceptive use during postural control in individuals with LBP. METHODS: Twenty-eight individuals with LBP were assigned randomly into a high-intensity IMT group (high IMT) and low-intensity IMT group (low IMT). The use of proprioception in upright standing was evaluated by measuring center of pressure displacement during local muscle vibration (ankle, back, and ankle-back). Secondary outcomes were inspiratory muscle strength, severity of LBP, and disability. RESULTS: After high IMT, individuals showed smaller responses to ankle muscle vibration, larger responses to back muscle vibration, higher inspiratory muscle strength, and reduced LBP severity (P < 0.05). These changes were not seen after low IMT (P > 0.05). No changes in disability were observed in either group (P > 0.05). CONCLUSIONS: After 8 wk of high IMT, individuals with LBP showed an increased reliance on back proprioceptive signals during postural control and improved inspiratory muscle strength and severity of LBP, not seen after low IMT. Hence, IMT may facilitate the proprioceptive involvement of the trunk in postural control in individuals with LBP and thus might be a useful rehabilitation tool for these patients.

Effects of varied-stimulus exposure on overpredictions of pain and behavioural performance in low back pain patients.

The main objective of the present study was to investigate the benefits of exposure to a variety of movements versus exposure to the same movements on overprediction of pain and behavioural performance on a final behavioural test in a sample of chronic low back pain (CLBP) patients. Eighty-four CLBP patients were requested to perform four behavioural tests. Patients were assigned to two experimental conditions. The final behavioural test was the same for all patients. The first three behavioural tests consisted of three different movements in condition 1 and of three times the same movement in condition 2. During each behavioural test, baseline pain, expected pain and experienced pain were recorded. Furthermore, the peak torque and the variability of the produced muscle strength during the final behavioural test were assessed. Replicating and extending previous research, we found that patients overpredicted pain during a threatening behavioural test. Furthermore, pain-related fear and pain catastrophizing showed to be unique predictors of the peak torque of the final behavioural test. No support was found for our hypothesis that varied exposure facilitates generalization of exposure effects. Possible reasons for the failure to find an advantageous effect of varied-stimulus exposure and ideas for future research are discussed.

Patellar tendinopathy in athletes: current diagnostic and therapeutic recommendations.

Formerly known as 'jumper's knee', patellar tendinopathy gives rise to considerable functional deficit and disability in recreational as well as professional athletes. It can interfere with their performance, often perseveres throughout the sporting career and may be the primary cause to end it. The diagnosis of patellar tendinopathy is primarily a clinical one but new imaging techniques, such as Doppler ultrasonography, may provide additional diagnostic value. Current therapeutic protocols are characterised by wide variability ensuing from anecdotal experience rather than evidence. Moreover, numerous reports in recent years have shattered previous doctrines and dogmatic belief on tendon overuse. Histopathological and biochemical evidence has indicated that the underlying pathology of tendinopathy is not an inflammatory tendinitis but a degenerative tendinosis. Consequently, pain in chronic patellar tendinopathy is not inflammatory in nature, but its exact origin remains unexplained. In pursuit of pathology- and evidence-based management, conservative therapy should be shifted from anti-inflammatory strategies towards a complete rehabilitation with eccentric tendon strengthening as a key element. If conservative management fails, surgery is opted for. However, considering the heterogeneity of surgical procedures and the absence of randomised studies, no conclusive evidence can be drawn from the literature regarding the effectiveness of surgical treatment for patellar tendinopathy. Parallel with the improved knowledge on the pathophysiology and pain mechanisms in patellar tendinopathy, new treatment strategies are expected to emerge in the near future.

Adolescent correlates of adult physical activity: a 26-year follow-up.

PURPOSE: It is hypothesized that adolescent physical activity, fitness, anthropometric dimensions, fatness, biological maturity, and family characteristics contribute to the variation in physical activity at 40 yr of age, and that these associations vary with age. METHODS: Subjects were 166 males followed from 1969 to 1996, between the ages of 14 and 40 yr from the Leuven Longitudinal Study on Lifestyle, Fitness and Health. Sports participation, fitness, anthropometric dimensions, fatness, and biological maturity were observed during the growth period. Also, sociocultural characteristics of the family were examined. The work, leisure time, and sport activity index of the Baecke Questionnaire and activity counts of a triaxial accelerometer were used as outcome variables at 40 yr. RESULTS: When upper and lower activity groups (quintiles) at 40 yr were contrasted, moderate associations were found (R2c varied between 0.1419 and 0.3736). No or low associations were found with the leisure time index. Body dimensions, fitness scores, sports practice, and family characteristics contributed to the explained variance in work, sport index, and activity counts. Multiple correlations were low (R2 = 0.037-0.085) for the work and leisure time activities, and were somewhat higher (R2 = 0.06-0.156) for the sport index and the activity counts in the total sample. CONCLUSION: Adolescent somatic dimensions, fitness, sports participation, parental sociocultural characteristics, and sport participation contributed to a small-to-moderate extent to the contrast between high and low active adults.

Influence of participation in high-impact sports during adolescence and adulthood on bone mineral density in middle-aged men: a 27-year follow-up study.

This study examined whether participation in high-impact sports during adolescence and adulthood contributes to bone health in males aged 40 years. Data were analyzed on 154 Belgian men aged 13 years at study onset in 1969 and aged 40 years at the end of the 27-year follow-up. In a second analysis, subjects were divided into three groups according to their sports participation history: participation during adolescence and adulthood in high-impact sports (HH; n=18), participation during adolescence in high-impact sports and during adulthood in nonimpact sports or no sports (HN; n=15), and participation during adolescence and adulthood in nonimpact sports or no sports (NN; n=14). Body mass and impact loading during adulthood were significant predictors of total body bone mineral density (BMD) and lumbar spine BMD. Analysis of variance revealed significant differences for lumbar spine BMD between the HH (1.12 g/cm2) group and the HN (1.01 g/cm2) and NN (0.99 g/cm2) groups (F=5.07, p=0.01). Total body BMD was also higher in the HH group at age 40 years, but not significantly (F=3.17, p=0.0515). Covariance analyses for total body BMD and lumbar spine BMD, with body mass and time spent participating in sports as covariates, confirmed these results. Continued participation in impact sports is beneficial for the skeletal health of males aged 40 years.

Correlation between power Doppler ultrasonography and clinical severity in Achilles tendinopathy.

Twenty-five patients with chronic Achilles tendinopathy were clinically and ultrasonographically evaluated. A positive correlation existed between power Doppler ultrasonography (PDU) and tendon thickness (r=0.63, p<0.001) and patient's age (r=0.40, p<0.05). A negative correlation existed between PDU and a functional test (number of toe raises to pain) (r=-0.57, p<0.005) and one recorded item of the Victorian Institute of Sport Assessment Achilles score (VISA-A questionnaire, item 6: jumping capability) (r=-0.46, p<0.05). Three patients had no detectable blood flow on PDU. PDU of Achilles tendons does not seem to be strictly related to symptoms but rather to functionality and chronicity of tendinopathy as indicated by toe-raises testing, jumping capability, patient age and tendon thickening.

Cross-sectional outcome analysis of athletes with chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy.

OBJECTIVE: To compare the outcome of chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy. DESIGN: Cross-sectional outcome analysis. SETTING: University Hospital Pellenberg, Leuven, Belgium. PATIENTS AND INTERVENTIONS: Of a total of 27 patients (28 knees) with chronic patellar tendinopathy, 13 were treated surgically, and 14 (15 knees) received extracorporeal shock wave therapy. MAIN OUTCOME MEASUREMENTS: Functional outcome questionnaire: Victorian Institute of Sport Assessment score, Visual Analog Scale, and Roles and Maudsley classification. RESULTS: At an average of 6 months of follow-up, the mean Victorian Institute of Sport Assessment and Visual Analog Scale scores for the extracorporeal shock wave therapy group were 78.8 +/- 28.7 and 9 +/- 2, respectively, which improved to 83.9 +/- 28.6 and 9 +/- 2, respectively, at 22.1 months. The surgery group scored 70.7 +/- 22.2 points on the Victorian Institute of Sport Assessment at an average of 26.3 months of follow-up (p = 0.41 and p = 0.18) and 8 +/- 3 on the Visual Analog Scale (p = 0.14). In the extracorporeal shock wave therapy group, 5 (33%) patients rated their pain status at 22.1 months as excellent, 5 (33%) as good, 2 (13%) as fair, and 2 (13%) as poor. In the surgery group, 4 (33%) evaluated the result as excellent, 3 (25%) as good, 3 (25%) as fair, and 2 as poor (17%). CONCLUSIONS: Extracorporeal shock wave therapy shows a comparable functional outcome to surgery in a cross-sectional analysis of patients with chronic proximal patellar tendinopathy resistant to conservative treatment.

Exposure to physical movements in low back pain patients: restricted effects of generalization.

Whether the effects of exposure to 1 movement generalize to another dissimilar movement was investigated in 37 patients with low back pain (15 men, 22 women). Two movements were executed twice: bending forward while standing and lifting 1 leg while lying down. During each trial, baseline pain, expected pain, and experienced pain were recorded. Similar ratings for perceived harm were obtained. Analyses revealed an initial over prediction of pain, but after exposure the overprediction was readily corrected. This exposure effect did not generalize toward another dissimilar movement. These results were only characteristic for patients with catastrophic thinking about pain. Low pain catastrophizers did not overpredict pain. There were no effects of exposure on perceived harm. Exposure may profitably be conceived of as the learning of exceptions to a general rule.

Association between bone mineral density (DXA), body structure, and body composition in middle-aged men.

The association between bone mass, body structure, and body composition was explored in 156 men, 40 years of AGE. Bone mineral density (total body, lumbar spine, left arm, and left leg) was obtained by dual-energy X-ray absorptiometry (DXA; Hologic QDR 4500A). Body structure was determined from a battery of anthropometric dimensions with a principal components analysis. Body composition was estimated with DXA. From the 24 anthropometric dimensions, three components were extracted and identified as muscle, fat, and skeletal length. Significant correlations between the muscle component and all BMD measurements (r = 0.28-0.44) were obtained. Except for BMD of the left arm, which correlated significantly, but negatively, with the fat component (r = -0.16), no significant relations were found between the fat component and BMD. There were significant correlations between lean mass, fat mass, and BMD measurements. The correlations were higher between lean mass and BMD (r = 0.22-0.44) than between fat mass and BMD (r = 0.08-0.24). The multiple regression analysis revealed that except for BMD of the left arm only lean mass or the muscle component, and not fat mass or the fat component, were independent predictors of BMD. It is concluded that the principal anthropometric determinant of BMD in middle-aged men is lean mass or muscle.

Assessment of isokinetic muscle strength in women who are obese.

STUDY DESIGN: Cross-sectional study of isokinetic trunk and knee muscle strength in women who are obese. OBJECTIVE: To provide reference values, to identify variables that affect peripheral muscle strength, and to provide recommendations for isokinetic testing of trunk and knee muscles in women who are obese and morbidly obese. BACKGROUND: The assessment of peripheral muscle strength is useful for the quantification of possible loss of strength, for exercise prescription, and for the evaluation of the effect of training programs in obese individuals. METHODS AND MEASURES: Isokinetic trunk and leg muscle strength was assessed in 241 women who were obese (18-65 years, body mass index (BMI) > or = 30 kg/m2). Trunk flexion and extension peak torque (PT) was measured using the Cybex TEF dynamometer; trunk rotation (TR) PT was measured using the Cybex TORSO dynamometer; and knee flexion/extension (KFE) PT was measured using the Cybex 350 dynamometer. Body composition was assessed using the bioelectrical impedance method; physical activity was assessed using the Baecke questionnaire; and peak VO2 was assessed using an incremental exercise capacity test on a bicycle ergometer. To identify variables related to muscle strength, Pearson correlations were computed and a stepwise multiple regression analysis was performed. RESULTS: Pearson correlation coefficients of all strength measurements at 60 degrees/s revealed low-to-moderate negative associations with age and positive associations with mass, height, fat free mass (FFM), and peak VO2 (P < 0.05), except for gravity-uncorrected trunk extension strength, which was not related to mass. The sports index of the Baecke questionnaire was associated with TR PT (r = 0.20, P < 0.01) and KFE PT (r = 0.18, P < 0.05). CONCLUSION: The weight of the trunk accounts largely for the measured trunk extensor and flexor strength in women who are obese. Contributing variables of isokinetic trunk flexion and extension strength in women who are obese are age, height, and FFM; whereas sports activities and aerobic fitness are contributing factors for trunk rotational and knee extension strength. Recommendations for measuring isokinetic muscle strength in individuals who are obese are provided.

Daily hassles reported by chronic fatigue syndrome and fibromyalgia patients in tertiary care: a controlled quantitative and qualitative study.

BACKGROUND: This study aimed at providing insight in the frequency, emotional impact and nature of daily hassles, experienced by patients suffering from chronic fatigue syndrome (CFS) and/or fibromyalgia (FM), compared with patients with a chronic organic disease. METHODS: One hundred and seventy-seven CFS/FM patients, 26 multiple sclerosis (MS) and 26 rheumatoid arthritis (RA) patients were investigated within 2-6 months after diagnosis. All patients completed a self-report questionnaire assessing daily hassles and associated distress, a visual analogue scale assessing fatigue and pain and a depression and anxiety questionnaire. RESULTS: CFS/FM patients show a higher frequency of hassles, higher emotional impact and higher fatigue, pain, depression and anxiety levels compared with MS/RA patients. Three hassle themes dominate in the CFS/FM group: dissatisfaction with oneself, insecurity and a lack of social recognition. In contrast, hassles reported by MS/RA patients show a much larger diversity and are not focused on person-dependent problems. CONCLUSIONS: Patients recently diagnosed as suffering from CFS and/or FM are highly preoccupied and distressed by daily hassles that have a severe impact on their self-image, as well as their personal, social and professional functioning. An optimal therapeutic approach of CFS and FM should take account of this heavy psychosocial burden, which might refer to core themes of these patients' illness experience.

Pressure-pain threshold variation in temporomandibular disorder myalgia over the course of the menstrual cycle.

AIMS: To evaluate the influence of the menstrual cycle on pressure-pain thresholds (PPTs) in patients with masticatory myalgia. METHODS: Fluctuations in pain sensitivity during 2 consecutive menstrual cycles were assessed in 15 normally menstruating patients with a myogenous temporomandibular disorder (TMD). Muscle pain was measured by the use of pressure algometry and a visual analog scale (VAS). The McGill Pain Questionnaire was used to assess the sensory, affective, and evaluative dimensions of the pain. RESULTS: Since 5 patients dropped out of the study due to pregnancy, unexpected menstrual cycle irregularities, or personal problems, statistical analysis was performed on 10 patients. Time had a significant influence on the pain condition. The PPTs of all muscle sites increased significantly and progressively over time by 16% to 42% in the follicular and luteal phases. PPTs remained low in the perimenstrual phase. The VAS pain rating did not correspond well with the PPTs, and the statistical analysis showed that the VAS ratings could not be used as predictors for the PPT measurements or detect the differences between cycle phases. The sensory, affective, and evaluative dimensions of the pain were significantly lower at the end of the trial. CONCLUSION: These data suggest a significant influence of the menstrual cycle on pain report and a nonspecific improvement of the chronic myogenous TMD.

Exposure to physical movement in chronic back pain patients: no evidence for generalization across different movements.

This study investigated whether the effects of exposure to one movement generalize towards another dissimilar movement in patients with low back pain. Thirty-nine patients (11 male, 28 female; mean age=43.49 yrs) were requested to perform two movements twice, i.e. bending forward and straight leg raising. During each of the four trials, baseline pain, expected pain and experienced pain were recorded. Analyses revealed that patients initially overpredicted pain, but after exposure the overprediction was readily corrected. This exposure effect did not generalize towards another dissimilar movement. The above pattern of results was only characteristic for patients reporting a high frequency of catastrophic thinking about pain. Low pain catastrophizers did not overpredict pain. The results are discussed in terms of the view that exposure may be better conceived of as the learning of exceptions to a general rule.

Daily physical activity and physical fitness from adolescence to adulthood: A longitudinal study.

The stability of physical fitness and physical activity in Flemish males from 18 to 40 years of age was investigated. In addition, effects of a consistently low-activity or high-activity level during the same age period on physical fitness were studied. The sample consisted of males who were followed longitudinally from age 13 to age 18 years, and were remeasured at the ages of 30, 35, and 40 years. Complete data about physical fitness and physical activity between 13 and 40 years were available for 130 subjects. Stability was measured using Pearson autocorrelations and simplex models. Multivariate analysis of variance (MANOVA) for repeated measurements was used to look for the effects of activity level on physical fitness. Simplex models showed higher stability coefficients than Pearson correlations, and stability of physical fitness was higher than stability of physical activity. Physical fitness showed the highest stability in flexibility (r = 0.91 between 18 and 30 years, r = 0.96 for both the 30-35 and 35-40 ages intervals), while physical activity showed the highest stability during work (r between 0.70 and 0.98 for the 5-year intervals). Results from MANOVA indicated that for some fitness characteristics the high-active subjects were more fit than their low-active peers. Stability of physical activity was higher than assumed and, therefore, it is a useful and independent indicator for further research. Although possible confounding factors are present (e.g., heredity), a higher level of physical activity during work and leisure time on a regular basis benefits physical fitness considerably. Am. J. Hum. Biol. 12:487-497, 2000. Copyright 2000 Wiley-Liss, Inc.

Associations between daily physical activity and physical fitness in Flemish males: A cross-sectional analysis.

The relationship of physical activity to several components of physical fitness was investigated in a sample of 166 males 40 years of age. In addition to Pearson correlations, multivariate canonical correlations were calculated. Physical activity during work (work index), sport (sport index), and leisure time (leisure time index) was assessed by the Baecke questionnaire. Physical fitness included cardiorespiratory fitness measures, the body mass index (BMI), the sum of seven skinfold thicknesses (SKI), percentage body fat (PFAT), balance, and several tests of muscle strength and endurance, flexibility, and speed of limb movement. More than 86% of the variance was shared by the two first canonical variables. The first canonical variable can be interpreted as a health-related fitness function. Carciorespiratory fitness, balance, speed of limb movement, explosive strength, and trunk muscle strength are clearly related to this function. From the physical activity measures, the Baecke sport index correlated significantly with this health-related fitness function. The second canonical variable can be explained as a fatness function, since body weight, BMI, SKI, and PFAT showed the highest correlations with the variable. The Baecke work index was inversely related to this canonical variable. The sample was also divided into physical activity groups in order to look for differences in physical fitness. The data indicate that physical activity during work was modestly, but inversely related to adiposity. Sport activity was beneficially associated to several fitness components, including cardiorespiratory fitness, trunk muscle strength, and upper body muscular endurance. Am. J. Hum. Biol. 11:587-597, 1999. Copyright 1999 Wiley-Liss, Inc.