A controlled clinical trial investigating the effects of stretching and compression exercises on electromyography of calf muscles in chronic LBP patients with a deep gluteal syndrome.

BACKGROUND: In deep gluteal syndrome (DGS), the piriformis muscle could impinge the sciatic nerve. The FAIR (flexion adduction internal rotation) test is a provocation test used to identify sciatic nerve irritation caused by this muscle. Compression and stretching exercises are usually prescribed to treat this syndrome. The aim of this study was to compare the effects of these two treatments on surface electromyography (sEMG) of the gastrocnemius and tibialis anterior in patients with low back pain (LBP) and DGS. MATERIALS AND METHODS: Forty-five participants were allocated to three groups of stretching exercise, compression or control. In addition to 15 min of heat and 15 min of electrical nerve stimulation for pain relief, participants in the compression exercise (CE) group received self-compression exercise, those in the stretching exercise (SE) group received self-stretching exercise and those in the control group received no extra interventions. For the two intervention groups, three sets of two minutes of exercise with two minutes of rest in between were applied. The sEMG amplitude values of the gastrocnemius and tibialis anterior muscles of the affected buttock side of any one group while performing the FAIR test were compared to the others. Pain and disability were assessed and the changes were compared between the two groups. RESULTS: After the intervention period, no group demonstrated a change in the sEMG of the gastrocnemius or tibialis anterior muscles (p > 0.05). There was no difference in the change in this variable between groups (Mean difference (95% CI) of gastrocnemius was ranged over= -4.04 to 7.72 (-19.44 to 23.14); p = 0.603); (Mean difference (95% CI) of tibialis anterior muscles was ranged from - 2.44 to -6.43 (-18.28 to 9.31); p = 0.550).; Pain and disability also decreased significantly in all three study groups (p < 0.05). However, only the disability of patients who performed stretching exercises improved compared to the compression exercise group (Mean difference (95% CI) = -12.62 (-20.41 to -4.38); p = 0.009). CONCLUSION: Neither stretching nor compression exercises altered the sEMG of the gastrocnemius and tibialis anterior muscles in patients with DGS. Furthermore, performing stretching exercises improved disability compared to the other interventions. TRIAL REGISTRATION: The trial was retrospectively registered in the Iranian Registry of Clinical Trials ( www.irct.ir ) on 10/01/2017 as IRCT201604178035N4. URL of the record: https://en.irct.ir/trial/8473 .

A systematic review of conservative and surgical treatments for deep gluteal syndrome.

BACKGROUND AND OBJECTIVE: Conservative and surgical treatments, are recommended as the primary treatment in the management of patients diagnosed with deep gluteal syndrome; but evidence supporting superiority of one treatment over another is lacking. The aim of this review is to systematically review the effectiveness of treatments. DATABASES AND DATA TREATMENT: MEDLINE, EMBASE, Web of Science, Scopus, AMED, Cochrane Library (Central Register of Controlled Trials), and PEDro were screened (to 24 July 2019). Risk of bias of trials and surgical case series were assessed using the Cochrane risk of bias tool and Joanna Briggs Institute Critical appraisal checklists, respectively. Outcomes were reductions in pain or disability. For each outcome, the minimum clinically important difference (MCID) was calculated. A narrative synthesis was performed. RESULTS: Out of 909 records, thirteen studies with 508 patients were included, eight RCTs with 336 patients and 5 case series with 172 patients. Conservative modalities were: infiltration into muscle of steroid, botulinum toxin, thiochilcoside and colchicine. There was one RCT and five case series of surgery. Only three trials reached an MCID in pain reduction for the intervention. The five surgical studies reached a before and after MCID. Only one study showed an MCID reduction in disability. The overall quality of evidence was low. CONCLUSION: Given the low quality of evidence, no single conservative treatment can be recommended over another. Clinicians should follow general guidelines on the management of back pain and sciatica for first line treatment, namely physiotherapy. Surgery may have a place for chronic cases.

Comparing the effect of transcutaneous electrical nerve stimulation and massage therapy on post laparoscopic shoulder pain: a randomized clinical trial.

BACKGROUND: Shoulder pain is a common clinical problem after laparoscopic surgeries. The use of non-pharmacological massage and transcutaneous electrical nerve stimulation (TENS) as an adjunct to routine treatment is increasing to provide optimal pain relief. Therefore, we aimed to determine the effect of TENS and massage therapy on post laparoscopic shoulder pain (PLSP). METHODS: This study was conducted on 138 patients who underwent laparoscopic cholecystectomy. Patients were randomly divided into three groups: massage plus conventional pharmacological treatment (n = 46), TENS plus conventional pharmacological treatment (n = 46), and conventional pharmacological treatment (n = 46). Massage and TENS were performed three consecutive times after the patients regained consciousness in the inpatient wards. The intensity of Shoulder pain was evaluated using a visual analog scale before and 20 min after each treatment. RESULTS: Both massage therapy and TENS led to a significant reduction in the intensity of PLPS compared to the control group in all three measured times (p < 0.001). However, no significant difference was observed between TENS and massage at any of the three-time points. CONCLUSIONS: This study's findings demonstrated that massage and TENS techniques could reduce PLSP. TRIAL REGISTRATION: Registered in the Iranian registry of clinical trials ( www.irct.ir ) in 05/02/2022 with the following code: IRCT20200206046395N1.

Effects of static stretching and strengthening exercises on flexion relaxation ratio in patients with LBP: A randomized clinical trial.

INTRODUCTION: Stretching and strengthening exercises are commonly used to improve muscle shortness. Consequently, the aim of this trial was to compare the flexion-relaxation response (electromyography activities of shortened hamstring and back muscles) in chronic nonspecific LBP patients. METHODS: In this randomized controlled clinical trial, forty-five eligible patients were randomly categorized into three groups; static stretching (n = 15), strengthening exercise in lengthened hamstring position (n = 15) and control (n = 15). All groups received conventional physical therapy for LBP and the two intervention groups received special exercise programs as well. Each group performed three treatment sessions for a week, a total of 12 sessions. The flexion-relaxation ratio (FRR) for knee and back muscles were assessed as the primary outcome measure. Pain and functional disability for participants were also assessed. RESULTS: The results indicated non-significant differences between the three groups regarding the changes of FRR (mean between-group differences ranged over 0.69 to 39.1; p > 0.05), pain and disability (mean between-group differences ranged over 0.15 to 5.96; p > 0.05). Within-group analysis for each group, revealed statistically significant improvement in the patients' score of either pain (mean within-group differences ranged over -27.20 to -35.76; p < 0.001) or disability (mean within-group differences ranged over -16.17 to 24.95; p < 0.001) as secondary outcomes. In other words, the scores of pain and disability decreased in all treatment groups as compared to the baseline. CONCLUSION: Neither static stretching nor strengthening exercises in lengthened hamstring position affected FRR more than the control group.

Effects of back exercises versus transcutaneous electric nerve stimulation on relief of pain and disability in operating room nurses with chronic non-specific LBP: a randomized clinical trial.

BACKGROUND: Low back pain (LBP) is one of the most common musculoskeletal disorders related to working. Due to the nature of nursing work, this problem is often seen in nurses, including those who work in the operating rooms. Depending on the cause, there are various surgical and non-surgical methods to treat LBP. The present study was aimed to compare the effect of two therapeutic methods of back exercises and transcutaneous electrical nerve stimulation (TENS) on the disability and pain of operating room nurses with LBP. METHODS: In this clinical trial forty-four eligible operating room nurses (30 women, 14 men, mean age: 37.86 ± 6.74) with chronic nonspecific LBP were randomly assigned to back exercises (including the strengthening and stretching exercise (n = 22)) or TENS (n = 22) groups by permuted block randomization method. These interventions were performed in both groups three sessions of 15 min per week for 6 weeks. The McGill pain questionnaire for back pain and the Oswestry disability questionnaire for disability assessment were completed immediately before and after the interventions. RESULTS: After 6 weeks, the mean of pain and disability decreased significantly in both groups compared to the baseline. Based on the results, significant decreases in the pain score (mean difference (95% CI): - 8.95 (- 12.77 to - 5.14); P-value < 0.001) and disability score (mean difference (95% CI): - 8.73(- 12.42 to - 5.03); P-value < 0.001) were revealed in the back exercises group after the intervention compared to the baseline. In addition, after the intervention in TENS group, the mean pain intensity and disability showed significant decrease, respectively (mean difference (95% CI): - 16.18 (- 19.81 to - 12.55); P-value < 0.001; mean difference (95% CI): - 15.82 (- 19.24 to - 12.40); P-value < 0.001). After adjusting for the baseline values, the TENS group had a significantly higher pain score reduction than the back exercises group (mean difference (95% CI): - 4.23 (- 8.03 to - 0.44); P-value =0.030; Cohen's d = 0.81). In addition, TENS led to a significant more decrease in the disability scores compared to the back exercises (mean difference (95% CI): - 3.99 (- 7.35 to - 0.64); P-value =0.021; Cohen's d = 0.73). Furthermore, a statistically significant time by group interaction effect on pain and disability score was found (interaction p < 0.001). CONCLUSION: Pain and disability were improved in both groups following 18 intervention sessions. However, pain and disability were improved to a greater extent in the TENS group than in the back exercises group. TRIAL REGISTRATION: The trial was retrospectively registered in the Iranian Registry of Clinical Trials ( www.irct.ir ) on 03/02/2019 as IRCT20180408039227N1 .

The Survey of Knee Osteoarthritis in the Population over Age 50 Visited in the Health Bus in Kermanshah, Iran.

Along with an aging population worldwide, knee osteoarthritis (KOA), which is the main cause of musculoskeletal pain and disability in the elderly and decreases the quality of life, is prevalent, and their impact is widespread. This study aimed to evaluate the knee osteoarthritis status among the population over age 50 in Kermanshah, Iran. The research community consisted of the population who has been visited in the health bus in Kermanshah in 2016-2017, of which 589 were chosen by an available sampling method. A WOMAC questionnaire was used to determine the prevalence of knee osteoarthritis. The prevalence of knee stiffness rate after sitting, lying down, or resting during the day among women and men were 40.7% and 20.5%, respectively. According to the findings, the highest prevalence rate of knee pain was in subjects with a BMI higher than 30 (31.6%) and BMI 25-30 (24.5%). 39.2% of the subjects never experienced knee pain, 16.6% monthly, 13.4% once a week, 20.4% daily, and 10.4% of them had prolonged knee pain experience. The prevalence of gender-based knee pain was 60.5% among women and 38.6% among men. 30.5% of women and 61.4% of men never experienced knee pain.

Modeling the effect of static stretching and strengthening exercise in lengthened position on balance in low back pain subject with shortened hamstring: a randomized controlled clinical trial.

BACKGROUND: Hamstring shortening may have negative impacts on function and biomechanics of knee and hip joints and lumbo-pelvic rhythm. Many interventions are believed to correct hamstring to its normal length. There are several reports of impairment in postural control of patients with low back pain. The purpose of this study was to compare the effect of stretching exercise and strengthening exercise in lengthened position of the hamstring muscle on improving the dynamic balance of the person in patients with chronic low back pain with short hamstring muscles. METHODS: Forty-five patients with hamstring shortening who referred to physiotherapy clinic of Kermanshah university of Medical Sciences, Kermanshah, Iran were randomly allocated to the three groups; static stretching (n = 15), strengthening exercise in lengthened hamstring position (n = 15) and control (n = 15). All groups received conventional physiotherapy for low back pain and the two intervention groups received stretching exercise and strengthening exercise in lengthened position programs as well. All groups performed three treatment sessions for a week, a total of 12 sessions. For balance assessment, Y-Balance test was performed for each participant in three reach directions. To determine the important and significant variables, all variables entered a model (Generalized Estimation Equations method). RESULTS: The results indicate that based on GEE model, by controlling other variables, participants of static stretching exercise showed more improvement in balance than control group (ß = 9.58, p-value = 0.014). Also, balance status showed significant improvement in the end of study compared to baseline of the study (ß = 7.71, P-value< 0.001). In addition, the balance in three reach directions improved significantly and the greatest balance improvement was in the anterior reach direction (ß ranged over = 6.16 to 11.59) and the height of patients affected their balance (ß = 0.28, P-value = 0.034). CONCLUSIONS: Group (type of intervention), phase of intervention, reach direction of test (anterior, posteromedial and posterolateral) and height of participants were associated with balance performance. Static stretching exercise was more effective than muscle strengthening exercise in lengthened position for improving dynamic balance in low back pain patients with hamstring tightness. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (I RCT201507258035n2 ). Registered 16th September 2015.

Effects of kinesio tape on kinesiophobia, balance and functional performance of athletes with post anterior cruciate ligament reconstruction: a pilot clinical trial.

BACKGROUND: Anterior cruciate ligament trauma is one of the most common knee injuries in professional athletes. This study aimed to investigate the effects of kinesio taping on kinesiophobia, balance, and functional performance in athletes after anterior cruciate ligament reconstruction. METHODS: This randomized, placebo-controlled clinical trial was performed on 20 athletes with anterior cruciate ligament reconstruction (mean age 32.3 ± 6.2 years) at the time of return to sport. The subjects were randomly assigned to the kinesio tape (KT) group (n = 10) or placebo KT group (n = 10).While subjects under taped, the following outcomes were measured at baseline, 10 minutes after the intervention, and 2 days later. Kinesiophobia, balance, strength, and functional / agility performance were assessed by the Tampa Scale, Y balance test (YBT), single-leg hops, and 10-yard extremity functional test, respectively. RESULTS: The results did not show a significant difference between-group post-intervention differences in kinesiophobia (Mean between-group difference = - 6.30, 95% CI = - 4.35 to 1.42, P-value = 0.17). Likewise, no significant statistical difference was observed between two study groups in terms of YBT scores (Mean between-group difference ranged over = - 6.30, 95% CI = - 1.1 to 4.7, the effect sizes ranged over = 0.01 to 0.31), P-value > 0.05), Single Leg Hop (Mean between-group difference = - 0.48, 95% CI for difference ranged over = - 10.3 to 9.3, effect size = 0.001, P-value = 0.918), and 10 Yard test scores (Mean between-group difference = - 0.30, 95% CI = (- 1.3 to 0.75), effect size = 0.02, P-value = 0.55) at 2 days after the KT. In the KT and placebo KT groups, RMANOVA indicated that the differences in all variables scores were significant over time with large effect sizes (effect size ranged over = 0.94-0.99; all P-value < 0.001). CONCLUSION: This study gives no support for any beneficial effect of kinesio taping on the reduction of kinesiophobi or improvement of balance score and functional performance in athletes with post anterior cruciate ligament reconstruction. TRIAL REGISTRATION: This study was registered in the Iranian Clinical Trial Center with the code IRCT20190130042556N1, registered 12 February 2019.

A randomized clinical trial for the effect of static stretching and strengthening exercise on pelvic tilt angle in LBP patients.

BACKGROUND: Stretching and strengthening exercises are commonly used to improve muscle shortness of the hamstring as any tension in this muscle can have an effect on the pelvic posture. Thus, the aim of this study was to evaluate the effects of two methods of improving short hamstring on the angle of pelvic tilt in LBP sufferers. METHODS: Forty-five low back pain patients aged 19-59 years with hamstring tightness participated in this clinical trial. The patients were categorized randomly into three groups: 1- static stretching, 2-strengthening exercise and 3-control group. The two intervention groups received physical therapy and special exercise program thrice a week in a total of 12 sessions, while the control group received only conventional physical therapy. Before and after the treatment implementation, the pelvic tilt and straight leg raising (SLR) degree were assessed for each group. RESULT: After 12 sessions of treatment, the ANCOVA models indicated non-significant differences in pelvic tilt angle and SLR score changes (p > 0.05), among the three groups. In addition, no statistically significant correlation was observed between the pelvic tilt and SLR test [except for the strengthening exercise group (Pearson correlation coefficient = -0.54, P < 0.05)]. CONCLUSIONS: In LBP sufferers, both static stretching and strengthening of hamstring muscle in its lengthened position caused elongation and extensibility in the hamstring muscle and increased SLR test score, but did not change pelvic tilt angle.

Comparison of muscle activation imbalance following core stability or general exercises in nonspecific low back pain: a quasi-randomized controlled trial.

BACKGROUND: Low back pain causes changes in muscle activation patterns. Knowing how different exercises may improve altered muscle activation is useful in the treatment of patients. The aim of the study was to investigate whether there was a difference in the pattern of muscle activation in chronic nonspecific low back pain sufferers following core stability exercise (CSE) and general exercise (GE). METHODS: Fifty-six non-specific chronic LBP subjects were randomly assigned to either groups (28 participants in CSE and 28 in GE group). Both groups performed 16 sessions of an exercise program for about 5 weeks. Pain, disability and trunk muscle activation patterns (using surface electromyography) were measured at baseline and post-training. RESULTS: After the intervention period, antagonist coactivation ratio did not change in either groups. Though all compensated imbalance ratios (residual unequal muscular activity after cancellation of directionality) decreased towards negative (imbalance to left side) only this change for total muscles ratio in GE was significant (mean difference in GE group, 0.15; 95% CI: 0.02 to 0.28; p-value of paired t-test: 0.022); (mean difference in CSE, 0.02; 95% CI: - 0.07 to 0.11; p-value of paired t-test: 0.614).. No overall significantly decrease in uncompensated imbalance ratio (absolute imbalance values without cancellation directionality) was observed. Pain and disability decreased significantly in both groups. However, there was no difference between two groups in either of the variables after the intervention. CONCLUSIONS: Both exercise programs reduced pain and disability and made or kept trunk muscle activation imbalance to the left side. The effects of two exercises on pain, disability and antagonist coactivation or imbalance ratios were not different. TRIAL REGISTRATION: This study was registered in the Iranian Clinical Trial Center with the code IRCT201111098035N1, Registered Jan 21, 2013.

The prevalence of musculoskeletal pain among above 50-year-old population referred to the Kermanshah-Iran health bus in 2016.

OBJECTIVE: Musculoskeletal disorders are one of the most important causes of disability. The aim of this study was to evaluate the prevalence of musculoskeletal disorders among the above 50-year-old population who referred to the health bus in Kermanshah. A questionnaire was used to collect data regarding musculoskeletal disorders of 589 people who voluntarily referred to the health bus. Means (SD) and range were used in descriptive statistics. RESULTS: The most prevalence of musculoskeletal complaints was related to the knee (338, 57.4%). After that, the low back pain had the most frequency (319, 54.3%). The lowest prevalence of musculoskeletal complaints was related to the thighs with a frequency of 95 (16.1%). The highest rate of musculoskeletal complaints over the past week in both genders with a frequency of 251 (59.3%) among women and 68 (41%) among men was related to the low back region The highest rate of musculoskeletal complaints over the past year was also related to the low back region, with a frequency of 220 (41%) among women and 61 (36.7%) among men. Concerning the physical health of the elderly, special attention is required for the knee joint and the low back region.

The effect of adding TENS to stretch on improvement of ankle range of motion in inactive patients in intensive care units: a pilot trial.

BACKGROUND: Patients hospitalized in intensive care units (ICUs) are susceptible to joint contracture and diminished range of motion. This is due to immobility as well as other underlying factors such as brain damage. Joint contracture causes functional disorders thereby diminishing the quality of life of patients following the intensive care period. Recent studies have introduced transcutaneous electrical nerve stimulation (TENS) as a new method for preventing and treating joint contracture. This study was performed to determine the effect of adding TENS to stretch on the range of ankle motion in patients hospitalized in ICUs. METHODS: Thirty-six patients admitted to the ICU ward of the hospital who were not able to move their legs voluntarily were assigned randomly into experimental (n = 18) and control (n = 18) groups. The intervention group received TENS along with manual stretch in the ankle three times a week for 2 weeks. The control group only received stretch in the ankle for the same time. The extent of dorsiflexion and plantar flexion of the ankle was measured using a standard goniometer. Both groups were evaluated before and one and 2 weeks after the intervention. The obtained data were analyzed by SPSS 21 through analysis of covariance and repeated measures ANOVA tests. RESULTS: In both groups, the increase in the ankle range of motion parameters was significant over time (means ranged over 44-48 for plantar flexion and means ranged over 5-11 for dorsiflexion, P < 0.001 for all of time points). The increase in ankle plantar and dorsiflexion in experimental group was significantly more than control group (mean between-group differences ranged over 1.35-3.57 within 95% CI of 1.04 to 4.01, P < 0.001). CONCLUSION: Adding TENS to stretch may provide more improvement in ankle dorsiflexion and plantar flexion. TRIAL REGISTRATION: Trial registration: This study was registered in the Iranian Clinical Trial Center with the code IRCT2017010814333N64, registered 20 January 2017.

Universal goniometer and electro-goniometer intra-examiner reliability in measuring the knee range of motion during active knee extension test in patients with chronic low back pain with short hamstring muscle.

BACKGROUND: Both universal goniometer and electro-goniometer are used for measuring joint range of motion in physiotherapy. Active knee extension test is a way to assess hamstring shortness in patients with chronic low back pain. The aim of this study was to assess universal goniometer and electro-goniometer reliability in measuring knee angle during active knee extension test. METHODS: This was an intra-examiner reliability study between three measurements of knee extension angle that conducted on 45 patients with chronic low back pain having short hamstring muscle that referring to Kermanshah University of Medical Sciences clinic from 2016 to 2017. Knee extension angle was measured three times during active knee extension test with both universal goniometer and electro-goniometer.The measurement of knee extension angle was done at the beginning, middle and the end of one single session by one experienced physiotherapist.The intra-class correlation coefficient (ICC) and standard error of measurements (SEM) were used to quantify intra-examiner reliability. RESULTS: For both methods, the reliability test values were found to be greater than 0.7 in the range of 0.92 to 0.99 (CI 95% ranged over = 0.94 to 0.99), which are classified as good reliability. The SEMs ranged from 1.04° to 2.16° for both scales. CONCLUSION: Universal goniometer in clinical evaluations of patients (as they are easy to be employed) and electro-goniometer in laboratory studies (as they are more accurate) are reliable.

Musculoskeletal Disorders as Common Problems among Iranian Nurses: A Systematic Review and Meta-analysis Study.

BACKGROUND: Considering the importance of musculoskeletal disorders (MSDs) as one of the health consequences of job stress among nurses and significant contradictions in prevalence in different parts of the body, this study was carried out to determine the prevalence of MSDs among Iranian nurses. METHODS: All published studies from June 2000 until June 2015 were considered in reliable databases such as PubMed, Google Scholar, Google search, Scopus, ScienceDirect, and Persian databases such as SID, Iran Medex, and Magiran. These studies, after quality control, were entered into meta-analysis using the random effects model, a total of 41 papers were assessed between 2004 and 2015. RESULTS: The prevalence rate of these disorders was 60.98%, 47.76%, 46.53%, 44.64%, 42.8%, 36.8%, 24.61%, and 17.5%, respectively, obtained for the back, neck, knees, upper back, ankles, shoulders, hands, hips, thighs, and elbows. Prevalence of MSDs will lead to high costs of medical, absenteeism from work, or even unemployment. CONCLUSIONS: Due to high prevalence of these disorders among Iranian nurses, providing effective training in the field of ergonomics and undergoing appropriate exercises are necessary to control it.

Comparison of spinal stability following motor control and general exercises in nonspecific chronic low back pain patients.

BACKGROUND: Motor control exercise was claimed to improve spinal stability in patients with chronic non-specific back pain, but to investigate the effectiveness of this exercise, other outcome measures have been used rather than spinal stability itself. The aim of our study is to assess motor control exercise effects on spinal stability using a biomechanical model. METHODS: Fifty-one patients were assigned to either motor control or general exercises. Before and after trainings, participants were tested for spinal stability at seven isometric tasks. Electromyography signals were recorded from ten superficial muscles, and a hybrid EMG-driven musculoskeletal model estimated spinal stability indices at each task. FINDINGS: Pain and disability significantly decreased in both groups. After trainings, patients had both increase and decrease in stability depending on the task, and stability did not increase/decrease uniformly in all patients. In the motor control group, stability increased at all positions but reached to significance only at right lateral pulling. In the general exercise group, except for pulling the trunk backward, stability decreased at other positions and reached to statistical significance only at pulling the trunk forward. No significant difference between groups was found in changing stability after the intervention. INTERPRETATION: Interventions yielded no significant difference in disability, pain and stability index between two groups. Significant increase of stability in the motor control group at right lateral pulling may be attributed to more activity of abdominal muscles, and significant decrease of stability in the general exercise group at forward pulling may be attributed to more optimal activity of back muscles.

The effect of core stability and general exercise on abdominal muscle thickness in non-specific chronic low back pain using ultrasound imaging.

BACKGROUND: There is a controversy regarding whether core stability exercise (CSE) is more effective than general exercise (GE) for chronic LBP. To compare different exercises regarding their effect on improving back strength and stability, performance of abdominal muscles is a useful index. Ultrasound imaging for measuring muscle thickness could be used to assess muscle performance. OBJECTIVE: The aim of this study was to compare CSE and GE in chronic LBP using ultrasound imaging for measurement of thickness of the deep stabilizing and main global trunk muscles in non-specific chronic LBP. METHODS: Each program included 16 training sessions three times a week. Using ultrasound imaging, four transabdominal muscle thickness were measured before and after the intervention. Disability and pain were measured as secondary outcomes. RESULTS: After the intervention on participants (n = 43), a significant increase in muscle thickness (hypertrophy) was seen only in right and left rectus abdominis in the GE group, but significant difference to the CSE group was only on the right side. Disability and pain reduced within the groups without a significant difference in the change between them. CONCLUSIONS: The present results provided evidence that only GE increased right and left rectus muscle thickness. The only significant difference between CSE and GE groups was the right rectus thickness. As rectus is a global muscle, the effect of GE on strength improvement (one side stronger than the other) may have a negative effect on motor control of lumbopelvic muscles and possibly increase the risk of back pain occurring or becoming worse, though this was not observed in the present study.

Normal range of thoracic kyphosis in male school children.

Background. Although there are frequent studies about normal range of thoracic kyphosis, there is still a controversy about the exact values of this curve. In nine reported studies on 10 to 20 years of age boys, the value ranged from 25.1° to 53.3°. Objective for the Study. The aim of the present research was investigation of normal ranges of thoracic kyphosis in school children in Kermanshah, western Iran. Methods. 582 male students aged 13 to 18 years old using cluster random sampling were recruited from schools in Kermanshah city, 97 students for each age. Thoracic curves were measured using the flexicurve method. Results. Mean thoracic kyphosis for whole population was 35.49° SD 7.83 and plus or minus two standard deviations ranged from 19.83° to 51.15°. It increased gradually from 13 to 16 and then there was a little decrease to 18 years. Mean values for each age (13-16) were 13 (34.41 SD 7.47°), 14 (34.86 SD 8.29°), 15 (35.79 SD 7.93°), 16 (36.49 SD 7.85°), 17 (35.84 SD 8.33°), and 18 (35.55 SD 7.07°). Conclusions. Our results are in agreement with previous reports and can be used as normal values for local and regional purposes.