The influence of traditional Thai massage on recovery from gastrocnemius muscle fatigue: A single-blind randomised controlled trial.

OBJECTIVE: To determine the effects of traditional Thai massage (TTM) on improving fatigue recovery and fatigue-related parameters of the gastrocnemius muscle after a heel-raise exercise. DESIGN: A single-blind randomised controlled trial. SETTING: Mae Fah Luang University Hospital, Thailand. PARTICIPANTS: Fifty-four healthy participants were randomly assigned to two groups: TTM (n = 27; 51.85 % women; mean age 23.15 ± 4.90 years; number of exercises/week: 4.78 ± 1.58) and control (n = 27; 59.26 % women; mean age 22.63 ± 4.88 years; number of exercises/week: 4.48 ± 1.25). INTERVENTIONS: After the participants performed a heel-raise exercise to induce fatigue of the gastrocnemius muscle, they received either 30 min of TTM to the gastrocnemius muscle or 30 min of control (29 min of rest and 1 min total gastrocnemius stretching). OUTCOME MEASURES: The outcome measures were the median frequency (MDF) of the electromyography signal, muscle power (MP) and feelings of muscle fatigue (FMF). All the outcome measures were evaluated before (T1) and after (T2) the fatigue-inducement protocol as well as immediately (T3), 1 h (T4) and 2 h (T5) after the interventions. RESULTS: The results show that MDF and MP were significantly increased and FMF significantly decreased in both groups immediately after the interventions and at 1 h and 2 h after the interventions (repeated measures ANOVA: p < .05). In the between-group comparisons, participants in the TTM group showed significantly greater improvement than those in the control group on all outcomes at all post-intervention assessment time points (T3, T4, T5), reflecting faster recovery from muscle fatigue (ANCOVA: p < .05). CONCLUSION: TTM proved an effective intervention for maximising recovery from fatigue of the gastrocnemius muscle.

Effects of cassava wax bath as a new therapeutic approach on patients with plantar fasciitis: a double-blind, randomised clinical trial.

The aim of this study was to investigate the efficacy of a new therapeutic approach (cassava wax bath: CWB) compared with usual care (paraffin wax bath: PWB) in patients with plantar fasciitis (PF). Forty patients with PF were recruited into the study (CWB group, n = 20, PWB group, n = 20). Patients in the CWB group received cassava wax bath and patients in the PWB group received usual care (PWB). The primary outcome was pain intensity (PI). The secondary outcomes were the pressure pain threshold (PPT), pain frequency (PFr), foot and ankle ability measure (FAAM), and ankle dorsiflexion range of motion (ADROM). All outcomes were assessed before and after the five-week intervention, one month, and three months after the intervention period. After the intervention, statistically significant improvement was found in all outcomes after the intervention period and during the one month and three months follow-up study in both groups (P < 0.05). For all outcomes, no between-group differences were seen at any post-assessment time-point, except for PFr (P < 0.05). In conclusion, the findings of this study indicate that CWB was significantly superior to PWB in reducing PFr. For the other outcomes, CWB and PWB were both equally effective in reducing PI and increasing PPT, FAAM, and ADROM in patients with PF. Therefore, CWB might be considered as a novel useful therapeutic option for PF patients.Trial registration: Thai Clinical Trials Registry (TCTR) (Identification number: TCTR20220128002), First posted date: 28/01/2022.

Effects of the combination of traditional Thai massage, scapular stabilization exercise, and chest mobilization in subjects with forward head posture: a single-blinded randomized clinical trial.

BACKGROUND: Forward head posture (FHP) is a common condition where the head appears to be positioned in front of the vertical midline of the body. FHP is associated with shortening of the neck extensors and pectoral muscles, and the deep neck flexors and shoulder retractors are weakened. FHP is also found to cause decreases in respiratory function. Few clinical trials have investigated the effects of combination treatments to alleviate these problems. The aim of this study was to examine the effects of combination of traditional Thai massage, scapular stabilization exercise, and chest mobilization on forward head angle (FHA), forced vital capacity (FVC), and cervical flexion in subjects with FHP. METHODS: Forty-eight subjects with FHP were randomly allocated to a treatment group receiving a Combination of Traditional Thai massage, Scapular stabilization exercise, and Chest mobilization (CTSC group) (n = 24) and a control group (relaxed by lying supine) (n = 24). FHA, FVC, and cervical flexion were measured before and after the four-week intervention (Week 4) and one month after the intervention period (Week 8). RESULTS: The CTSC group showed statistically significantly greater improvement in FHA and cervical flexion than the control group at Week 4 (FHA, mean difference - 6.05; 95% CI - 8.03, - 4.07; cervical flexion, mean difference 6.84; 95% CI 3.14, 10.55) and Week 8 (FHA, mean difference - 4.64; 95% CI ( - 6.71, - 2.58); cervical flexion, mean difference 5.21; 95% CI 0.84, 9.58). There were no significant between-group differences in FVC at week 4 (mean difference 0.09; 95% CI - 0.06, 0.23) and week 8 (mean difference 0.04; 95% CI - 0.11, 0.19). CONCLUSION: This study showed that CTSC had a positive effect on FHA and cervical flexion in subjects with FHP. TRIAL REGISTRATION: Thai Clinical Trials Registry (TCTR) (Identification number: TCTR20211119001), registered 19 November 2021; https://www.thaiclinicaltrials.org/show/TCTR20211119001 .

Integrated Effects of Thai Essential Oil and Balance Exercise on Parameters associated with Falls in Older Adults at Risk of Falling: A Randomized Controlled Study.

BACKGROUND: Reducing the risk of falling by improving balance and leg strength may be a preventive strategy. This study evaluated the integrated effects of Thai essential oil and balance exercises on parameters associated with Falls in community-dwelling older adults at risk of falling. METHODS: Fifty-six participants were randomly allocated to either the intervention group (IG), which performed balance exercises while smelling Thai essential oil scents of Zanthoxylum limonella (Dennst.) Alston, or the control group (CG), which performed balance exercises while receiving a control patch. Balance exercises were practiced for 12, 30-minute sessions over 4 weeks. Static and dynamic balance with eyes open and eyes closed (EC), leg muscle strength, agility, and fear of falling were assessed at baseline, after the 4-week intervention, and at 1 month after the last intervention session. RESULTS: Both groups showed significant improvements in static and dynamic balance, ankle plantarflexor strength, and agility after the 4-week intervention (p<0.05), which persisted at the 1-month follow-up (p<0.05). Compared to the CG, the IG demonstrated significantly better static balance in terms of elliptical sway area (p=0.04) and center of pressure (CoP) velocity (p=0.001) during EC, as well as ankle plantarflexor strength (p=0.01). The IG also maintained a significantly greater improvement in CoP velocity during EC (p=0.01). CONCLUSION: Integrated Thai essential oil and balance exercises improved static balance and ankle plantarflexor strength compared to the balance exercise with a control patch in older adults at risk of falling.

A randomized comparative study of traditional Thai massage and Thai boxing exercise on clinical-based outcomes in patients with scapulocostal syndrome.

BACKGROUND AND PURPOSE: There is no consensus on effective treatment for scapulocostal syndrome (SCS). This study aimed to evaluate the effects of traditional Thai massage (TTM) and Thai boxing exercise (TBE) on pain intensity, pressure pain threshold (PPT), and cervical range of motion (CROM) in patients with SCS. MATERIALS AND METHODS: Seventy-eight patients with SCS were randomly equally allocated to receive either four-week TTM or TBE. Pain intensity, PPT, and CROM were measured at baseline, posttreatment, and 1-month follow-up. RESULTS: Significant improvements in pain intensity, PPT, and CROM in all directions were evident at posttreatment compared with baseline in the TTM group (p < 0.01); these improvements, except cervical extension, were observed at 1-month follow-up (p < 0.01). Compared to baseline, the TBE showed significant improvements in all outcomes except cervical flexion at posttreatment (p < 0.01); these improvements, except cervical flexion and PPT, were evident at 1-month follow-up (p < 0.001). When comparing the groups, the TTM showed significantly better scores than the TBE in terms of pain intensity, PPT, and cervical flexion and left lateral flexion at posttreatment (p < 0.05). The superior effects of TTM on these outcomes, except cervical flexion, were demonstrated at 1-month follow-up (p < 0.05). CONCLUSION: Four weeks of TTM and TBE reduced pain intensity and improved pain threshold and cervical movements at posttreatment and 1-month follow-up. TTM provided better reductions in pain intensity, pain threshold, cervical flexion, and left lateral flexion than TBE in patients with SCS.

A comparative study of Thai massage and muscle energy technique for chronic neck pain: A single-blinded randomized clinical trial.

BACKGROUND: Myofascial pain syndrome (MPS) is the most common form of muscle disorders. Traditional Thai massage (TM) and muscle energy (ME) technique have been used to treat patients with MPS for long time but head-to-head comparisons of these interventions have not been established. AIM: The aim of the current study was to compare the effects of TM and the ME technique on pain intensity (PI), pressure pain threshold (PPT), neck disability (ND), and neck flexion range of motion (NFROM) in patients with chronic neck pain associated with myofascial trigger points (MTrPs). DESIGN: A randomized, single-blinded clinical trial. SETTING: Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University. POPULATION: Forty-five patients with chronic neck pain associated with MTrPs were recruited. METHODS: The patients were randomly allocated to the TM, ME, or control groups, with each having eight treatment sessions over a period of two weeks. PI, PPT, ND, and NFROM were assessed before, immediately after the first treatment session, and one day after the last treatment session. RESULTS: Based on the results, both TM and the ME technique resulted in a significant improvement in all parameters (p < 0.05) compared to the control group. Additionally, no significant difference was observed between TM and the ME technique in all parameters. CONCLUSIONS: The application of TM or the ME technique can be a practical alternative approach for the treatment of chronic neck pain associated with MTrPs.

Effects of kinesio taping on neck-shoulder discomfort and EMG responses during smartphone texting in healthy young adults.

BACKGROUND: While kinesio taping (KT) is used in several clinical settings to correct posture and reduce pain, KT effects during smartphone texting are unknown. OBJECTIVE: To investigate the effects among healthy young adults of KT on neck-shoulder discomfort and electromyographic (EMG) responses of neck and upper trunk muscles during smartphone texting. METHODS: Twenty-four participants performed a 30-minute texting task on a smartphone using both hands at two separate times under one of two conditions: KT on the right shoulder and no taping. Neck-shoulder discomfort was assessed, along with the normalized root mean square (NRMS) and normalized median frequency (NMF) of the right cervical erector spinae (CES), lower trapezius (LT), and serratus anterior (SA). RESULTS: Compared to baseline, both groups had significantly greater neck-shoulder discomfort, and NRMS and NMF of all muscles (p < 0.001) after performing a 30-minute texting task. Comparing between groups, the KT group experienced significantly less neck-shoulder discomfort, and demonstrated delayed deterioration of NRMS and NMF of right CES and LT muscles (p < 0.05). CONCLUSIONS: During smartphone texting, KT on the shoulder decreased neck-shoulder discomfort and delayed reduction of activation and fatigue of neck and upper trunk muscles among healthy young adults.

Clinical utility of a cluster of tests as a diagnostic support tool for clinical lumbar instability.

BACKGROUND: Numerous clinical tests have been proposed for the diagnosis of clinical lumbar instability (CLI), but a cluster of clinical tests is still needed to increase the accuracy of CLI diagnosis. OBJECTIVE: To evaluate a diagnostic support tool intended to identify the presence of CLI using a cluster of clinical tests. DESIGN: Analytical cross-sectional study. METHODS: Two hundred participants with chronic low back pain (LBP) were diagnosed with or without CLI by an orthopedic surgeon. The orthopedic surgeon made the diagnosis from classic clinical symptoms and signs. The diagnosis was used as the reference standard. An orthopedic physical therapist used four clinical tests to identify CLI in each participant, including the apprehension sign, the instability catch sign with/without the abdominal drawing-in maneuver (ADIM), the painful catch sign with/without the ADIM, and the prone instability test. RESULTS: For an individual test, the apprehension sign showed a high specificity (92.6%) and a positive likelihood ratio (LR+; 2.4) but a very low sensitivity of 17.4%. A cluster of three of the four examined tests provided the most diagnostic accuracy for CLI, with a high LR+ (5.8) and a high specificity (91.7%) but low sensitivity (47.8%) and a negative likelihood ratio (LR-; 0.6). CONCLUSIONS: A cluster of three of the four examined tests was determined to comprise a powerful clinical support tool for the identification of CLI patients as tested against a reference standard diagnosis. CLINICAL TRIAL REGISTRATION: Name of the registry: Thai Clinical Trials Registry. Registration number: TCTR20190426002.

Effectiveness of traditional Thai self-massage combined with stretching exercises for the treatment of patients with chronic non-specific low back pain: A single-blinded randomized controlled trial.

INTRODUCTION: The aim of this study was to determine the effects of traditional Thai self-massage combined with home stretching exercises (TSMSE) on pain, back flexibility and disability in patients with chronic non-specific low back pain (NSLBP). METHODS: Twenty-two patients from 18 to 60 years old were randomly allocated to receive 30-min sessions of TSMSE or 12 sessions of self-care education (SCE) over a period of 4 weeks. The pain intensity using a visual analog scale (VAS), back flexibility using a sit-and-reach test, and disability using the Oswestry Low Back Pain Disability questionnaire, were measured before and after the treatment period. RESULTS: The results indicated that the TSMSE group showed significant improvements in all of the parameters after the 4-week treatment period (p < 0.05). However, the SCE group only showed significant improvement in the pain intensity (p < 0.05). Moreover, the TSMSE group demonstrated a greater improvement in back flexibility than the SCE group at the end of the treatment period (p < 0.05). CONCLUSION: These results suggest that the TSMSE treatment was an effective intervention for decreasing pain and disability and increasing back flexibility among the NSLBP patients.

Balance and functional fitness benefits of a Thai boxing dance program among community-dwelling older adults at risk of falling: A randomized controlled study.

OBJECTIVE: The present study aimed at examining the effects of a Thai Boxing dance (TBD) program on balance performances and functional fitness in community-dwelling older adults at risk of falling who have no comorbidities leading to falls. METHODS: Seventy-eight participants were randomly equally assigned either to a 4-week TBD program or to a control group receiving a fall prevention booklet. Static and dynamic balance performances, and functional fitness including lower limb muscle strength, body flexibility, and agility were evaluated before and after the intervention, and at 4-month follow-up. RESULTS: After receiving 4-week TBD intervention, participants showed significantly greater improvements in static balance with eyes open, dynamic balance and all functional fitness when compared to the control group (p < 0.05), and these effects except for body flexibility were still maintained at 4-month follow-up (p < 0.05). CONCLUSIONS: This study highlights TBD as an intervention for improving balance and functional fitness of community-dwelling seniors at risk of falling.

Proprioceptive neuromuscular facilitation training improves pain-related and balance outcomes in working-age patients with chronic low back pain: a randomized controlled trial.

BACKGROUND: Proprioceptive neuromuscular facilitation training and general trunk exercises have been applied to treat chronic low back pain patients. However, there is currently little study to support the use of one treated intervention over the other to improve clinical outcomes and balance ability. OBJECTIVE: To examine the effects of proprioceptive neuromuscular facilitation training on pain intensity, disability and static balance ability in working-age patients with chronic low back pain. METHODS: Forty-four chronic low back pain participants aged 18-50 years were randomized either to a three-week proprioceptive neuromuscular facilitation training or to a control group receiving general trunk exercises. Pain intensity, disability and static balance ability were measured before and after the three-week intervention. RESULTS: The proprioceptive neuromuscular facilitation training intervention showed a statistically significantly greater reduction in pain intensity and improved functional disability than the controls at three weeks (between-group difference: pain intensity 1.22 score, 95% CI: 0.58 to 1.88, p<0.001; disability 2.23 score, 95% CI: 1.22 to 3.24, p<0.001. The proprioceptive neuromuscular facilitation training intervention also had statistically better parameters of static balance ability than the control group (between-group difference: ellipse sway area during eye opened and closed conditions 129.09mm2, 95% CI: 64.93 to 175.25, p<0.01 and 336.27mm2, 95% CI: 109.67 to 562.87, p<0.05, respectively; the centre of pressure velocity during eye opened and eye closed conditions 6.68mm/s, 95% CI: 4.41 to 8.95, p<0.01 and 6.77mm/s, 95% CI: 4.01 to 9.54, p<0.01, respectively). CONCLUSION: The three-week proprioceptive neuromuscular facilitation training provides better pain intensity, disability and static balance ability than general trunk exercises for working-age individuals with chronic low back pain but the effects do not reach the clinical meaningful level. The therapists should consider carefully when making recommendations regarding these interventions, taking into account effectiveness and costs.

Comparison of Core Stabilisation Exercise and Proprioceptive Neuromuscular Facilitation Training on Pain-related and Neuromuscular Response Outcomes for Chronic Low Back Pain: A Randomised Controlled Trial.

BACKGROUND: Existing literature offers little guidance for therapists who provide core stabilisation exercise (CSE) and proprioceptive neuromuscular facilitation (PNF) training to treat chronic low back pain (CLBP). Studies conducting a head-to-head comparison of CSE and PNF training for CLBP are needed. OBJECTIVE: To compare the effects of CSE and PNF training on pain-related outcomes and trunk muscle activity in CLBP patients. METHODS: Forty-five CLBP patients, ranging from 18 to 50 years of age, were randomly divided and assigned to either a four-week CSE, four-week PNF training, or control group. Pain-related outcomes, including pain intensity, functional disability and patient satisfaction, as well as superficial and deep trunk muscle activity were assessed before and after the four-week intervention, and at a three-month follow-up. RESULTS: Compared to the control group, those in the CSE and PNF training groups showed significant improvements in all pain-related outcomes after the four-week intervention and at three-month follow-up (P < 0.01). Following the four-week intervention, both CSE and PNF training groups demonstrated significant improvement in deep trunk muscle activity, including the transversus abdominis (TrA) and superficial fibres of lumbar multifidus (LM), compared to the control group (P < 0.05). CONCLUSION: Four-week CSE and PNF training provided short-term and long-term effects on pain-related outcomes, along with increased deep trunk muscle activity in CLBP patients.

Effects of Shoulder Taping on Discomfort and Electromyographic Responses of the Neck While Texting on a Touchscreen Smartphone.

BACKGROUND: Prolonged neck flexion during smartphone use is known as a factor of neck pain and alteration of neck muscle activity. Studies on the effects of shoulder taping on neck discomfort and neck muscle responses while texting on a smartphone are still lacking. The aim of this study was to examine the effects of shoulder taping on neck discomfort using a numerical rating scale, and neck muscle activity and fatigue using a surface electromyography during a texting task on a touchscreen smartphone. METHODS: Twenty-five healthy adolescents used the dominant hand to perform a 30-minute texting task using a touchscreen smartphone at two separate times under one of the following two conditions: taping across the upper trapezius muscle and no taping. Neck discomfort, normalized root mean square, and normalized median frequency slopes for upper trapezius, cervical erector spinae, and sternocleidomastoid muscles were recorded. RESULTS: The results revealed that shoulder taping provided significantly lower neck discomfort than no taping (p < 0.001). However, shoulder taping did not significantly alter normalized root mean square and normalized median frequency slope values of all muscles when compared with no taping controls. CONCLUSION: Shoulder taping reduces neck discomfort but does not affect neck muscle activity and fatigue while texting on a touchscreen smartphone.

Reliability and Validity of the Cross-Culturally Adapted Thai Version of the Tampa Scale for Kinesiophobia in Knee Osteoarthritis Patients.

PURPOSE: The aim of this study was to develop a cross-culturally adapted Thai version of the Tampa Scale for Kinesiophobia (TSK) and investigate its reliability and validity among patients with knee osteoarthritis. METHODS: The TSK was translated into Thai language and culturally adapted in line with the international standards. The Thai TSK questionnaire was then tested for internal consistency, test-retest reliability, and convergent validity by comparing it with the visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis Index, State-Trait Anxiety Inventory, and Timed Up and Go Test. RESULTS: Eighty patients with knee osteoarthritis were included in the study. The Thai version of the TSK was easily comprehended and completed within 6 minutes. The questionnaire showed a good internal consistency (α = 0.90) and high test-retest reliability {ICC (2,1) = 0.934}. Convergent validity showed high correlations with the visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis Index, and State-Trait Anxiety Inventory (r = 0.741, 0.856, and 0.817, respectively). However, there was no significant correlation between the Thai version of the TSK scores and the Timed Up and Go Test results. CONCLUSION: The Thai version of the TSK has satisfactory reliability and validity for the evaluation of pain-related fear of movement/(re)injury in patients with knee osteoarthritis.

A randomized controlled trial on the long-term effects of proprioceptive neuromuscular facilitation training, on pain-related outcomes and back muscle activity, in patients with chronic low back pain.

BACKGROUND: The role of exercise therapy in improving pain-related clinical outcomes and trunk muscle activity in patients with chronic low back pain (CLBP) has been widely reported. There is little information on the effect of proprioceptive neuromuscular facilitation (PNF) training in patients with CLBP. The purpose of the present study was therefore to investigate the persistence of the effects of PNF training on pain intensity, functional disability, patient satisfaction, health-related quality of life (HRQOL) and lower back muscle activity in patients with CLBP. METHODS: Forty-two participants with CLBP were randomly assigned either to 4-week PNF training or to a control group receiving a Low back pain educational booklet. Pain-related outcomes, including pain intensity, functional disability, patient satisfaction, HRQOL and lumbar erector spinae (LES) muscle activity, were measured before and after the intervention, and at a follow-up session 12 weeks after the last intervention session. RESULTS: Compared with the control group, after undergoing a 4-week PNF training intervention, participants showed a significant reduction in pain intensity and functional disability, and improved patient satisfaction and HRQOL (p < 0.01). These effects were still significant at the 12-week follow-up assessment (p < 0.01). LES muscle activity in the PNF training group was significantly increased throughout the measurement periods compared with controls (p < 0.01). CONCLUSIONS: The study found that 4-week PNF training has positive long-term effects on pain-related outcomes, and increases lower back muscle activity in patients with CLBP.

A Randomised, Placebo-Controlled Trial of Neurodynamic Sliders on Hamstring Responses in Footballers with Hamstring Tightness.

BACKGROUND: Neurodynamics intervention is known to increase apparent muscle extensibility, but information regarding hamstring responses after a neurodynamic sliders (NS) technique is scarce. The aim of this study was to evaluate the effects of NS on apparent hamstring extensibility and activity in footballers with hamstring tightness. METHODS: Forty eligible healthy male footballers with hamstring tightness were each randomly allocated to either a 4-week NS technique or a control group (CG) receiving placebo shortwave intervention. Knee extension angles were measured with the passive knee extension test, and maximal voluntary isometric contraction (MVIC) of hamstrings was measured by a surface electromyography at baseline and after intervention sessions. RESULTS: The results showed that NS produced a statistically and clinically significant increase in knee extension angle compared to CG (P < 0.001); however, there was no difference between the groups receiving MVIC of hamstrings. Within group comparison, NS also provided a significant increase in knee extension angle (P < 0.001), whereas the control group did not. There was no change in hamstring MVIC in either group after intervention. CONCLUSIONS: The findings of this study reveal that four weeks of NS technique improved apparent hamstring extensibility but did not change the hamstring activity in footballers with hamstring tightness.

Effects of restrictive clothing on lumbar range of motion and trunk muscle activity in young adult worker manual material handling.

The objective of this study was to examine the effect of wearing restrictive trousers on lumbar spine movement, trunk muscle activity and low back discomfort (LBD) in simulations of manual material handling (MMH) tasks. Twenty-eight young adults participated in the study performing box lifting, liquid container handling while squatting, and forward reaching while sitting on a task chair when wearing tight pants (sizes too small for the wearer) vs. fit pants (correct size according to anthropometry). Each task was repeated three times and video recordings were used as a basis for measuring lumbar range of motion (LRoM). The response was normalized in terms on baseline hip mobility. Trunk muscle activity of rectus abdominis (RA) and erector spinae (ES) muscles were also measured in each trial and normalized. At the close of each trial, participants rated LBD using a visual analog scale. Results revealed significant effects of both pants and task types on the normalized LRoM, trunk muscle activity and subjective ratings of LBD. The LRoM was higher and trunk muscle (ES) activity was lower for participants when wearing tight pants, as compared to fit pants. Discomfort ratings were significantly higher for tight pants than fit. These results provide guidance for recommendations on work clothing fit in specific types of MMH activities in order to reduce the potential of low-back pain among younger workers in industrial companies.

Effect of 10-week core stabilization exercise training and detraining on pain-related outcomes in patients with clinical lumbar instability.

BACKGROUND AND AIMS: Clinical lumbar instability causes pain and socioeconomic suffering; however, an appropriate treatment for this condition is unknown. This article examines the effect of a 10 week core stabilization exercise (CSE) program and 3 month follow-up on pain-related outcomes in patients with clinical lumbar instability. METHODS: Forty-two participants with clinical lumbar instability of at least 3 months in duration were randomly allocated either to 10 weekly treatments with CSE or to a conventional group (CG) receiving trunk stretching exercises and hot pack. Pain-related outcomes including pain intensity during instability catch sign, functional disability, patient satisfaction, and health-related quality of life were measured at 10 weeks of intervention and 1 and 3 months after the last intervention session (follow-up); trunk muscle activation patterns measured by surface electromyography were measured at 10 weeks. RESULTS: CSE showed significantly greater reductions in all pain-related outcomes after 10 weeks and over the course of 3 month follow-up periods than those seen in the CG (P<0.01). Furthermore, CSE enhanced deep abdominal muscle activation better than in the CG (P<0.001), whereas the CG had deterioration of deep back muscle activation compared with the CSE group (P<0.01). For within-group comparison, CSE provided significant improvements in all pain-related outcomes over follow-up (P<0.01), whereas the CG demonstrated reduction in pain intensity during instability catch sign only at 10 weeks (P<0.01). In addition, CSE showed an improvement in deep abdominal muscle activation (P<0.01), whereas the CG revealed the deterioration of deep abdominal and back muscle activations (P<0.05). CONCLUSION: Ten week CSE provides greater training and retention effects on pain-related outcomes and induced activation of deep abdominal muscles in patients with clinical lumbar instability compared with conventional treatment.

Effects of handicraft sitting postures on lower trunk muscle fatigue.

The purpose of this study was to assess trunk muscle fatigue in seated handicraft tasks using surface electromyography (sEMG) and visual analogue scale (VAS) ratings for trunk discomfort, and to assess the relationship of these responses. Twenty-three participants were randomly assigned to assumed crossed-leg and heel sitting postures for 30 min. Normalised median frequency (NMF) slopes for lumbar multifidus (LM) and internal oblique (IO) muscles and VAS ratings were recorded. Results revealed that the crossed-leg posture produced significantly steeper NMF slopes for both sides of the LM and IO muscles than heel sitting. Greater VAS ratings were found in crossed-leg sitting posture than the heel sitting posture. The NMF slopes and the VAS ratings had significant negative correlations for both postures. Findings support heel sitting in handicraft tasks over crossed-leg sitting due to greater trunk muscle fatigue and discomfort during the latter posture. Results support VAS ratings as a complementary method to sEMG for identifying trunk muscle fatigue. Practitioner Summary: Trunk muscle fatigue in handicraft work is a potential risk for low back pain. Based on EMG and discomfort analyses, heel sitting is preferred to crossed-leg posture. Discomfort ratings are consistent with EMG measures in identifying trunk muscle fatigue in such postures.