Gait analysis of individuals with specific low back pain undergoing surgery: case series report with one and six-month follow-up.

INTRODUCTION: In addition to pain, specific low back pain is frequently accompanied by restricted range of motion (ROM) during gait. PURPOSE: To compare the behavior of kinematic and spatiotemporal gait parameters, pain, functional status, and self-efficacy, in patients with a diagnosis of herniated disk or lumbar stenosis undergoing surgery, in the pre- and postoperative periods of 1 and 6 months (PO6). METHODS: Seven participants and 11 control subjects were assessed. A kinematics system comprising 10 optoelectronic cameras was used to assess gait. The Roland-Morris questionnaire, pain intensity, and self-efficacy, over three periods, were used. RESULTS: The ROM of the pelvis, hip, and knee of the hernia group presented an increase after surgery and the stenosis group presented a reduction of values in the hip. During the stance phase, the pelvis and hip ROM of both groups remained smaller than the control group. There was improvement in pain in individuals with hernia and stenosis (effect size = 0.6 and 0.8, respectively) in the three analyzed moments; for functional status there was improvement in the first postoperative period (ES = 0.4) compared to the preoperative in those individuals with hernia; and those with stenosis had improvement at PO6 when compared to the time before the surgery (ES = 0.2). CONCLUSION: Surgical intervention modifies the spatiotemporal parameters, the ROM of the pelvis, hip, and knee in the total gait cycle, primarily in the sagittal plane, and causes alterations, particularly in the hip joint, in these individuals during the support phase.

Avaliação das características morfofuncionais do pé e do hábito de andar descalço de indivíduos com alterações nos pés / Evaluation of the morpho-functional characteristics of the foot and the habit of walking barefoot in individuals with foot alterations

O objetivo deste estudo foi avaliar o perfil funcional, características do pé, o hábito de andar descalço de indivíduos com alterações musculoesqueléticas nos pés e comparar com indivíduos controle. Os participantes foram avaliados por meio de questionário eletrônico. Dados antropométricos, funcionalidade dos pés, hábito de andar descalço, tipo de calçado, tipo de pé e pisada e qual comprometimento do pé foram coletados. A amostra total foi composta por 160 indivíduos divididos em grupo controle (GC) (n=82) e grupo problemas no pé (GPE) (n=78). O hálux valgo foi o principal tipo de problema no grupo GPE (24,4%), com uma maior porcentagem de participantes com doença crônica (35,9%), tipos de pés cavos (pé esquerdo (PE) 16,7% e pé direito (PD) 19,2%) ou planos (PE 21,8% e PD 21,8%) e com o Índice de função do pé comprometido em 7% (P =0,001). Ambos os grupos consideram o hábito de andar descalço saudável (72% GC e 66,7% GPE), porém não são adeptos deste hábito (93,9% GC e 91% GPE). O sapato foi o modelo menos utilizado pelo GPE (10,3%). Concluímos que indivíduos do grupo GPE apresentaram maior associação de alterações morfofuncionais com a presença de distúrbios nos pés e que o hábito de andar descalço apesar de ser considerado um aspecto positivo para a saúde dos pés de ambos os grupos, nenhum destes o praticam.

This study aimed to evaluate the functional profile, foot characteristics, and barefoot walking habits of individuals with musculoskeletal foot alterations and compare them with control individuals. Participants were assessed through an electronic questionnaire. Anthropometric data, foot functionality, barefoot walking habits, footwear type, foot type, foot arch, stride type, and foot impairments were collected. The total sample consisted of 160 individuals divided into a control group (CG) (n=82) and a foot problems group (FPG) (n=78). Hallux valgus was the main foot problem in the FPG (24.4%), with a higher percentage of participants having chronic conditions (35.9%), cavus foot types (left foot (LF) 16.7% and right foot (RF) 19.2%), or flat foot types (LF 21.8% and RF 21.8%), and with a compromised Foot Function Index in 7% (P=0.001). Both groups considered barefoot walking healthy (72% CG and 66.7% FPG), but they are not practitioners of this habit (93.9% CG and 91% FPG). Shoes were the least utilized type of footwear in the FPG (10.3%). In conclusion, individuals in the FPG showed a stronger association between morpho-functional alterations and foot disorders. Although barefoot walking is considered beneficial for foot health in both groups, neither group practices this habit.

Evaluation of quality of life in individuals with chronic stroke who underwent aquatic exercises: A case series.

BACKGROUND: Aquatic exercises are among the treatments available to improve the quality of life after stroke. OBJECTIVES: To investigate changes in the quality of life after 8-week of aquatic exercises in post-stroke individuals. METHODS: A case series study was designed, including four male participants. Exclusive aquatic exercise was performed for 8-week, 50 minutes per session, 2×/week. Their quality of life was evaluated before and after the intervention using the Stroke Impact Scale (SIS). RESULTS: Participant 1 improved in the mobility domain, achieving a Clinically Important Difference (CID). Participant 2 improved in the strength and mobility domain, achieving CID; his stroke recovery was 6%, and it reached 50% post-intervention. Participant 3 improved in the mobility domain, achieving a CID and a Minimal Detectable Change (MDC); his stroke recovery increased from 45 to 60% post-intervention. Participant 4 improved the strength, mobility, and activities of daily living domains, achieving a CID and a MDC, but his stroke recovery remained unchanged at 80%. CONCLUSIONS: All participants achieved a CID in the mobility domain; thus, the aquatic exercise intervention was considered meaningful. Moreover, the SIS is able to evaluate aspects of the recovery process regarding health-related quality of life after stroke, as demonstrated by the results of the overall recovery after aquatic exercises.

A review on muscle activation behaviour during gait in shallow water and deep-water running and surface electromyography procedures.

BACKGROUND: Surface electromyography (sEMG) can provide information on muscle activation patterns during gait. OBJECTIVES: To characterize electromyographic activity during gait in shallow water and during deep-water running compare to on land and to review and analyse underwater surface-electromyographic (sEMG) procedures. SEARCH METHODS: Eight databases (MEDLINE, EMBASE, WEB OF SCIENCE, SPORT Discus, CINAHL, SCOPUS, SCIELO, and LILACS) were searched from their inception to the December of 2019. SELECTION CRITERIA: The selected studies had to be related to electromyographic analysis of gait in an aquatic environment. DATA COLLECTION AND ANALYSIS: The studies that met the inclusion criteria were reviewed by two independent reviewers and divided into four groups. RESULTS: Ten studies met the inclusion criteria. Lower muscle activation was found with treadmill water walking compared to treadmill land walking. With deep-water running, the leg muscles (tibialis anterior and gastrocnemius lateralis) have lower muscle activation when compared to on land running, but the trunk and thigh muscles have higher activation. CONCLUSION: If gait is performed on an aquatic treadmill, the muscles assessed had lower muscle activation when compared to land. During deep-water running activities, lower activation of the distal leg muscles and a higher activation thigh muscles were found when compared to on land. Studies did not follow standard processes in sEMG procedures.

Assessment of measurement properties of the Brazilian-Portuguese version of the low back activity confidence scale (LoBACS) in patients with chronic low back pain.

The Low Back Activity Confidence Scale (LoBACS) assesses the self-efficacy to perform activities in individuals with chronic low back pain (CLBP). As self-efficacy appears to directly influence the patient's functional capacity and prognosis, it is important to develop a scale that evaluates this attribute to guide treatment strategy and monitor the clinical course of patients. This study aimed to evaluate the reliability, construct validity, and responsiveness of the Brazilian version of the LoBACS. The scale was applied to 112 male and female patients (age, 18-65 years) with specific and nonspecific CLBP. For evaluating the interobserver reliability, the scale was applied twice on the first evaluation day by two trained evaluators (A and B). Within 48-72 h of the first evaluation, assessor A reapplied the scale to evaluate intraobserver reliability (test-retest), which was analyzed by intraclass correlation coefficient (ICC). The first LoBACS applied in the baseline evaluation was also used to assess the construct validity of the scale by factor analysis. For responsiveness, the scale was applied 5 times at 2-week intervals and the change in scores was analyzed by the repeated measures ANOVA. Although factor analysis indicated three subscales, they did not present acceptable values of convergent and divergent validity. Reliability ranged from good to excellent, with ICC values of .90 (95% CI, .84; .93) and .85 (95% CI, .77; .91) for inter- and intraobserver variability for total score. Moreover, the total score was responsive in all comparisons, with no floor or ceiling effects. Thus, only the total score of the Brazilian version of LoBACS proved to be reliable, valid, and responsive.

Posturography Comparison and Discriminant Analysis Between Individuals With and Without Chronic Low Back Pain.

OBJECTIVE: The aims of this study were to evaluate the center of pressure (CoP) in individuals with chronic low back pain (LBP) compared with matched controls and perform discriminant analysis to detect which CoP variables differentiate the groups. METHODS: Thirty-two participants with LBP and 33 matched controls were evaluated on a force plate in a bipedal static position for 30 seconds in 2 conditions: eyes open (EO) and eyes closed (EC). Two discriminant analyzes were performed to detect which CoP variables could discriminate between groups. RESULTS: Those with LBP had higher values (ie, poorer balance) for most variables compared with the control group. With EO, total displacement of sway (TDS) was as follows: LBP group (median [25%-75%]) 31.77 (26.39-41.79) cm, control group 27.21 (22.29-31.78) cm, P = .008 and area: LBP group 3.31 (2.33-4.68) cm2, control group 1.77 (1.3-2.71) cm2. With EC, TDS was as follows: LBP group 49.6 (39.65-68.15) cm, control group 38.77 (30.36; 45.65) cm, P = .003 and area: LBP group 4.68 (2.6-7.28) cm2, control group 2.4 (2.1-3.34) cm2. The discriminating variables in the EO condition were the TDS for the LBP group and the anteroposterior mean velocity for the control group, while in the EC condition they were mediolateral dispersion and area for the LBP group. CONCLUSION: Individuals with chronic LBP had worse postural control performance than matched controls, and it is possible to characterize those with and without LBP with CoP variables.

Determination of the motor unit behavior of lumbar erector spinae muscles through surface EMG decomposition technology in healthy female subjects.

INTRODUCTION: The aims of this study were to determine the motor unit behavior of the erector spinae muscles and to assess whether differences exist between the dominant/nondominant sides of the back muscles. METHODS: Nine healthy women, aged 21.7 years (SD = 0.7), performed a back extension test. Surface electromyographic decomposition data were collected from both sides of the erector spinae and decomposed into individual motor unit action potential trains. The mean firing rate for each motor unit was calculated, and a regression analysis was performed against the corresponding recruitment thresholds. RESULTS: The mean firing rate ranged from 15.9 to 23.9 pps and 15.8 to 20.6 pps on the dominant and nondominant sides, respectively. However, the early motor unit potentials of the nondominant lumbar erector spinae muscles were recruited at a lower firing rate. CONCLUSIONS: This technique may further our understanding of individuals with back pain and other underlying neuromuscular diseases. Muscle Nerve 55: 28-34, 2017.

Reliability of ground reaction forces in the aquatic environment.

The aim of this study was to verify the reliability of the kinetic parameters of gait using an underwater force platform. A total of 49 healthy participants with a median age of 21years were included. The kinetic gait data were collected using a 0.6×0.6×0.1m aquatic force plate (Bertec®), set in a pool (15×13×1.30m) with a water depth of 1.20m and water temperature of 32.5°C. Participants walked 10m before reaching the platform, which was fixed to the ground. Participants were instructed to step onto the platform with their preferred limb and data from three valid attempts were used to calculate the average values. A 48-h interval between tests was used for the test-retest reliability. Data were analyzed using interclass correlation coefficients (ICC) and results demonstrated that reliability ranged from poor to excellent, with ICC scores of between 0.24 and 0.87 and mean differences between (d¯)=-0.01 and 0.002. The highest reliability values were found for the vertical (Fz) and the lowest for the mediolateral components (Fy). In conclusion, the force platform is reliable for assessing the vertical and anteroposterior components of power production rates in water, however, caution should be applied when using this instrument to evaluate the mediolateral component in this environment.

Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects.

Low back pain (LBP) is one of the most common causes of disability, and the Pilates method has been associated with improvements in symptoms. The purpose of this study was to assess the effectiveness of the Pilates method, when compared to general exercises, on pain and functionality after eight weeks (16 sessions, 2×/week) and a follow-up of three months, in subjects with non-specific chronic low back pain (NSCLBP). A randomised controlled trial composed of 22 subjects was proposed. Subjects were allocated into two groups: the Pilates group (PG) (n = 11) and the general exercise group (GEG) (n = 11). The PG protocol was based on the Pilates method and the GEG performed exercises to manage NSCLBP. There were no differences between the groups. When analysed over time, the GEG demonstrated improvements in functionality between baseline and the end of treatment (P = .02; Cohen'sd¯ = 0.34) and baseline and follow-up (P = .04; Cohen'sd¯ = 0.31). There were no differences between the Pilates and general exercises with regard to pain and functionality in NSCLBP subjects but general exercises were better than Pilates for increasing functionality and flexibility.

Kinematic gait analysis using inertial sensors with subjects after stroke in two different arteries.

[Purpose] The aim of the present study was described the kinematic characteristics of gait in stroke patients with two different arteries involved. [Subjects and Methods] Two patients who had suffered a basilar (A) or middle (B) cerebral artery ischemic stroke were compared with a control (C). Seventeen inertial sensors were used with acquisition rate of 120 Hz. The participants walked 3 times on a 10 meter walkway. From the raw data, the three gait cycles from the middle of each trial were chosen and analyzed. [Results] During the stance phase, patients A and B had a lower hip angle at initial contact and maximum flexion angle during load response than the control. Patient A and the control subject had similar knee angle values at initial contact, and patient B presented a flexed position in the initial phase of the gait cycle. The maximum flexion angles during loading response were also higher for patient B. The sagittal plane excursion for the ankle joint was lower for patient B in comparison with the other subjects. [Conclusion] Differences during walking between patients who had stroke in different arteries may be related to an alternative compensatory strategy. Patient A and the control subject had similar gait cycle curves at all joints, while patient B showed a rigid synergic pattern.

The electromyographic activity of the multifidus muscles during the execution of two pilates exercises--swan dive and breast stroke--for healthy people.

OBJECTIVE: The purpose of this study was to compare the multifidus electromyographic activity in healthy women during the performance of the same Pilates exercise under 2 conditions. METHODS: Sixteen healthy, active, female practitioners of Pilates (mean age, 24.3; SD, 3.1 years) were assessed through surface electromyography during 2 Pilates exercises (swan dive and breast stroke). Muscle activity during the experimental tasks was recorded with 1 pair of electrodes placed bilaterally on the multifidi. Data were normalized to maximal activity recorded during dynamic activity. RESULTS: The mean of the maximal isometric voluntary contraction was 662.4 N (SD, 195). In the phase comparison, the multifidus was the most recruited on the concentric phase during both exercises, ball (P=.001) and reformer (P=.001). In the comparison between conditions, the reformer presented more activation on swan dive (P=.04) and breast stroke (P=.001). The percentages of muscle activation varied between 50% and 60%, and the greatest activation was made on the reformer condition. CONCLUSION: The findings of this study show that Pilates exercises by healthy women, under different conditions, can cause changes to the multifidus muscle activation. The condition and the phase in which the muscle was more activated were the reformer and concentric phase, respectively, for both exercises. However, the results for the percentages of activation suggest that the intensity of recruitment may not be sufficient to strengthen muscle in healthy, trained subjects.

A comparative analysis of the electrical activity of the abdominal muscles during traditional and Pilates-based exercises under two conditions / Análise comparativa da atividade elétrica dos músculos abdominais durante exercício tradicional e método pilates sob duas condições

The use of Pilates-based exercises for trunk strengthening has been reported in the literature. The objective of this study was to analyze and compare the electrical activity of the rectus abdominis and external oblique muscles during a traditional abdominal exercise program and an exercise program based on the Pilates method using a ball and an elastic band. The sample was composed of 10 healthy women, non-practitioners of Pilates, who performed the traditional abdominal exercise and roll-up with the ball and elastic band. The sign was normalized by the electromyographic peak of the dynamic activity and was adjusted for 2000 samples/s; the filter was set in a frequency band from 20 to 450 Hz. In the comparison between exercises, the external oblique muscle in the concentric phase had a higher recruitment in the roll-up with the ball (P = 0.042). In the comparison between muscles in each exercise, the rectus abdominis showed a higher activation in the concentric phase (P = 0.009) and in the eccentric phase (P = 0.05) of the traditional abdominal exercise. Activation percentages ranged from 15% to 22%. The traditional abdominal exercise had the largest activation percentage.

Exercícios baseados no método Pilates são relatados na literatura para serem utilizados como proposta de fortalecimento de tronco. O objetivo deste estudo foi analisar e comparar a atividade elétrica dos músculos reto abdominal e oblíquo externo, durante um exercício de abdominal tradicional e um exercício baseado no método Pilates com bola e com faixa elástica. A amostra foi composta por 10 mulheres saudáveis não praticantes de Pilates, que realizaram o exercício de abdominal tradicional e Roll-up com bola e faixa elástica. O sinal foi normalizado pelo pico eletromiográfico da atividade dinâmica e foram ajustados para 2000 amostras por segundo e o filtro em uma frequência de passagem de 20 a 450 Hz. Na comparação entre exercícios, o músculo oblíquo externo na fase concêntrica teve maior recrutamento no Roll-up com bola (P = 0,042). Na comparação entre os músculos em cada exercício, o reto abdominal teve maior ativação nas fases concêntrica (P = 0,009) e excêntrica (P = 0,05) do abdominal tradicional. As porcentagens de ativação variaram de 15% a 22%. O exercício de abdominal tradicional teve a maior porcentagem de ativação.

Análise comparativa da atividade elétrica do músculo multífido durante exercícios do Pilates, série de Williams e Spine Stabilization / Analysis of the multifidus muscle during Pilates, Williams' flexion and Spine Stabilization

INTRODUÇÃO: A fraqueza da musculatura paraespinhal está relacionada à etiologia da dor lombar. Atualmente existem vários métodos que apresentam exercícios para o fortalecimento dessa musculatura. OBJETIVOS: Comparar e analisar o sinal eletromiográfico do músculo multífido bilateralmente durante exercícios do método Pilates, série de Williams e Spine Stabilization. MATERIAIS E MÉTODOS: Participaram do estudo dez mulheres voluntárias e saudáveis que realizaram os exercícios leg pull front support modificado do Pilates, o quarto exercício da série adicional de Williams e o quadruped exercise do Spine Stabilization. O sinal foi normalizado pelo pico eletromiográfico da atividade dinâmica e foram ajustados para 2000 amostras por segundo e o filtro em uma frequência de passagem de 20 a 450 Hz. A ANOVA foi utilizada para verificar diferenças entre os exercícios, o teste t para amostras dependentes foi usado para comparar a ativação entre os lados direito e esquerdo do multífido para cada exercício. RESULTADOS E CONSIDERAÇÕES FINAIS: Na comparação entre os exercícios, observaram-se diferenças significativas para o músculo multífido a favor do exercício do método Pilates tanto na fase concêntrica quanto na excêntrica, o que demonstra ser o exercício de melhor ativação elétrica para o músculo analisado.

INTRODUCTION: The back muscle weakness is related with the etiology of low back pain. Nowadays, there are several methods the focus is on back muscle strengthening. OBJECTIVES: The purpose of this study was to compare and analyze the multifidus muscle bilaterally during exercises of the Pilates method, Spine Stabilization and Williams' flexion. MATERIALS AND METHODS: Ten healthy female volunteers participated in the study. They performed the leg pull front support exercise from the Pilates method, the quadruped exercise from the Spine Stabilization and the fourth exercise from the additional Williams' flexion. The signal was normalized by the electromyographic peak of the dynamic activity and was adjusted to 2000 samples/s and filter with a frequency band from 20 to 450 Hz. ANOVA was used to verify differences between the exercises, the paired-sample t test was used to compare activation between the right and left multifidus for each exercise. RESULTS AND CONCLUSION: When the exercises where compared, statistically significant differences were observed in the concentric and eccentric phases for the Pilates exercise, showing that this exercise is the one who activates the musculature the most between the exercises evaluated.