Assessment of the stiffness of the upper trapezius muscle in a group of asymptomatic people with cervical spine rotation asymmetry.

This study investigated the relationship between the stiffness of the upper trapezius muscle and the range of rotational movement of the cervical spine. A total of 60 right-handed asymptomatic students participated in the study. Participants (N = 22) characterised by asymmetry in rotational movements were selected for the experimental group. A difference of ≥10° between right and left rotation of the cervical spine was considered asymmetrical. The control group (N = 38) included participants whose rotation difference was < 10°. Belonging to the experimental or control group did not significantly differentiate trapezius muscle stiffness. The rotation side differentiated the stiffness of the right and left trapezius muscles only in the group of people with rotational movement asymmetry. There were high correlation coefficients between right cervical rotation and the stiffness of the muscle on the right side, and between rotation to the left and the stiffness of the muscle on the left side. There is a relationship between the stiffness of the right and left upper trapezius muscles and the range of right and left rotational motion of the cervical spine. Stiffness of the upper trapezius correlates more strongly with rotation to the side on which the muscle lies than to the opposite side. Increased stiffness of the upper trapezius muscle on the side of limited cervical spine rotation is likely to be determined by the muscle fibre stretching mechanism.

In search of biomarkers for low back pain: can traction therapy effectiveness be prognosed by surface electromyography or blood parameters?

Background: Lumbar traction therapy is a common method to reduce low back pain (LBP) but is not always effective. The search for biomarkers that would prognose the effectiveness of LBP management is one priority for improving patients' quality of life. Objectives: 1) To determine the phenotype of patients benefiting most from lumbar traction therapy. 2) To correlate systemic and electromyographic biomarkers with pain and pain-related disability. Methods: Data on muscle bioelectrical activity (surface electromyography [SEMG]) in the flexion-extension task, the concentrations of twelve systemic biochemical factors, LBP intensity (Visual Analog Scale), the Oswestry Disability Index, and the Roland-Morris Disability Questionnaire (RMDQ) were collected before and 72 h after 20 sessions of lumbar traction therapy. Patients were divided into responders and nonresponders based on the criterion of a 50% reduction in maximal pain. Results: The responders had lower maximal muscle bioactivity in the extension phase on the left side (p < 0.01) and higher flexion-extension ratios on both sides of the body in the SEMG (left: p < 0.05; right: p < 0.01), and higher adipsin, interleukin-2, interleukin-4, and interleukin-10 concentrations (p < 0.05) than nonresponders. Patients with higher interleukin-4 concentrations before therapy achieved greater reductions in maximal pain in the sitting position, bioelectrical muscle activity in flexion, and flexion-relaxation ratio on the left side of the body. Changes in adipsin and interleukin-4 concentrations correlated with changes in LBP intensity (r = 0.68; r = -0.77). Changes in stem cell growth factor and interleukin-17A correlated with changes in RMDQ (R = 0.53) and bioelectrical muscle activity in extension (left: R = -0.67; right: R = -0.76), respectively. Conclusion: Responders to traction therapy had SEMG indices of less favorable muscle activity in the flexion-extension task and elevated indices of inflammation before the study. For the first time, interleukin-4 was indicated as a potential biomarker for prognosing post-therapy changes in pain intensity and muscle activity.

Subjective assessment and biochemical evaluation of traction therapy in women with chronic low back pain: does body mass index matter? A clinical study.

BACKGROUND: Apart from the positive effect of lumbar traction on structural changes within the spine in patients with low back pain, it is likely that therapeutic effects are correlated with pain biomarkers in the blood. Among them, systemic metabolic factors related to obesity may play an important role. This is the first study designed to examine the effectiveness of traction therapy in two experimental groups with considerably different BMI and to assess relationships between blood biomarkers and low back pain intensity. METHODS: In the prospective clinical trial, women suffering from chronic low back pain were allocated into the normal-weight or obesity groups. Patients in both groups underwent twenty sessions of lumbar traction therapy (30 min a day, continuous mode with a force level of 25-30% of body weight). Before and after therapy subjective assessments of pain (VAS and PPT) were performed, and serum concentrations of aggrecan chondroitin sulfate 846 epitope (CS-846), neuropeptide Y, leptin, adipsin and growth and differentiation factor 15 (GDF-15) were determined. The data were statistically evaluated for 28 women. RESULTS: After therapy, the maximal low back pain decreased in both groups, GDF-15 concentration was reduced in the normal-weight group and increased in the obesity group, and CS-846 concentration decreased in the obesity group. The sensation of PPT in the lumbar spine and mean concentrations of neuropeptide Y, leptin and adipsin did not change in both groups. However, the relationships of GDF-15, leptin, and adipsin concentrations with the perception of pain were revealed. CONCLUSION: Distinct differences between the normal-weight and obesity groups pointed on the role of excessive adipose tissue in aggravating the inflammatory processes and in the development of low back pain. Adipsin, CS-846 and GDF-15 aspire to be the low back pain biomarkers in women with obesity, but there is a need for further research to answer whether they might be considered reliable biomarkers for the prognosis and monitoring of chronic low back treatment. TRIAL REGISTRATION: NCT04507074, registered prospectively on July 6, 2020.

Sexual dimorphism of lumbar lordosis and lumbar spine mobility during the period of progressive development.

Objective: The objective of this paper is to present possible differences in spondylometric dimorphic characteristics of lumbar spine in the period of progressive development. Material and methods: The research material included 24,517 individuals of both sexes aged from 3 to 25. Individuals that showed abnormal structure of the motor system and individuals reporting pain in the joints of the spine were excluded. Spondylometric research was carried out using the Penny & Giles electrogoniometric measuring system. Significance tests concerning position measurements (Student's t-test, Welch's t-test) were used as well as biometric profiles formed on the basis of Mollison index for each characteristic in the studied period of ontogenesis. The progress of development of the examined spondylometric characteristics in both sex groups was calculated on the basis of expressing the size of the feature in successive age groups as a percentage of its final size. Using the linear and polynomial regression models, the developmental lines of the studied spondylometric parameters were obtained in males and females. Results: In the development process of the studied spondylometric parameters, dimorphic diversity can be observed essentially only in adolescence. In general, in the whole studied period of ontogenetic development, the greater range of lumbar spine mobility is found in females. Minor sexual dimorphism is also evident in the dynamics of development and in the stage of development of the majority of examined characteristics in individual age ranges in relation to the final values, for the benefit of the female sex.

Evaluation of the Combination of Muscle Energy Technique and Trigger Point Therapy in Asymptomatic Individuals with a Latent Trigger Point.

(1) Background: The aim of the study was to determine the effect of the combination therapy of Muscle Energy Technique (MET) and Trigger Point Therapy (TPT) on the angular values of the range of movements of the cervical spine and on the pressure pain threshold (PPT) of the trapezius muscle in asymptomatic individuals. METHODS: The study involved 60 right-handed, asymptomatic students with a latent trigger point in the upper trapezius muscle. All qualified volunteers practiced amateur symmetrical sports. The study used a tensometric electrogoniometer (cervical spine movement values) and an algometer (pressure pain threshold (PPT) of upper trapezius). Randomly (sampling frame), volunteers were assigned to three different research groups (MET + TPT, MET and TPT). All participants received only one therapeutic intervention. Measurements were taken in three time-intervals (pre, post and follow-up the next day after therapy). (2) Results: One-time combined therapy (MET + TPT) significantly increases the range of motion occurring in all planes of the cervical spine. One-time treatments of single MET and single TPT therapy selectively affect the mobility of the cervical spine. The value of the PPT significantly increased immediately after all therapies, but only on the right trapezius muscle, while on the left side only after the therapy combining MET with TPT. (3) Conclusion: The MET + TPT method proved to be the most effective, as it caused changes in all examined goniometric and subjective parameters.

Effectiveness of Combined General Rehabilitation Gymnastics and Muscle Energy Techniques in Older Women with Chronic Low Back Pain.

OBJECTIVE: The aim of this study was to determine the effect of general rehabilitation gymnastics on subjective and objective characteristics of locomotor system in older women with chronic LBP. To satisfy this goal, the outcomes in exercising women were compared with the results of nonexercising controls. MATERIAL AND METHODS: The study group included 21 women with chronic LBP (age 65-75 years), participating in a 3-year general rehabilitation program combining strength, stretching, endurance, balance, and stabilization exercises with Muscle Energy Techniques (MET). Control group included 20 women with chronic LBP, who neither undertook the gymnastics nor participated in other forms of physical activity. The list of outcome measures included pain severity (Numeric Rating Scale), limitations in the activities of daily living (Oswestry Disability Index and Roland-Morris Disability Questionnaire), mobility of all spinal segments (tensometric electrogoniometry), and bioelectrical activity of back muscles (kinesiologic electromyography). RESULTS: Exercising women presented with lesser severity of current pain (by 62%, p<0.001) and pain experienced during the last three months (by 32.5%, p<0.001), reported less ailments during the last three months, and had fewer limitations in the activities of daily living (a 30% decrease in Oswestry Disability Index, p<0.05, and a 65% decrease in Roland-Morris Disability Questionnaire scores, p<0.001) than the controls. Moreover, they showed significantly higher values of nearly all spondylometric parameters except for cervical lateral flexion. The study groups did not differ in the amplitudes of bioelectrical signal from the back muscles. CONCLUSIONS: These findings may point to beneficial effects of the combined exercise program.

Impact of McKenzie Method Therapy Enriched by Muscular Energy Techniques on Subjective and Objective Parameters Related to Spine Function in Patients with Chronic Low Back Pain.

BACKGROUND: The high incidence and inconsistencies in diagnostic and therapeutic process of low back pain (LBP) stimulate the continuing search for more efficient treatment modalities. Integration of the information obtained with various therapeutic methods and a holistic approach to the patient seem to be associated with positive outcomes. The aim of this study was to analyze the efficacy of combined treatment with McKenzie method and Muscle Energy Technique (MET), and to compare it with the outcomes of treatment with McKenzie method or standard physiotherapy in specific chronic lumbar pain. MATERIAL AND METHODS: The study included 60 men and women with LBP (mean age 44 years). The patients were randomly assigned to 1 of 3 therapeutic groups, which were further treated with: 1) McKenzie method and MET, 2) McKenzie method alone, or 3) standard physiotherapy for 10 days. The extent of spinal movements (electrogoniometry), level of experienced pain (Visual Analogue Scale and Revised Oswestry Pain Questionnaire), and structure of the spinal discs (MRI) were examined prior to the intervention, immediately thereafter, and 3 months after the intervention. RESULTS: McKenzie method enriched with MET had the best therapeutic outcomes. The mobility of cervical, thoracic, and lumbar spine normalized at levels corresponding to 87.1%, 66.7%, and 95% of respective average normative values. Implementation of McKenzie method, both alone and combined with MET, was associated with a significant decrease in Oswestry Disability Index, significant alleviation of pain (VAS), and significantly reduced size of spinal disc herniation. CONCLUSIONS: The combined method can be effectively used in the treatment of chronic LBP.