Neurodynamic exercises provide no additional benefit to extension-oriented exercises in people with chronic low back-related leg pain and a directional preference: A randomized clinical trial.

BACKGROUND: Chronic low back-related leg pain may involve mixed pain mechanisms. A strategy to address both neuropathic and nociceptive pain symptoms would be combining treatments. OBJECTIVE: To assess the effects of adding neurodynamic exercises to extension-oriented exercises in patients with chronic low back-related leg pain and a directional preference. DESIGN: Two arm, single blind, randomized clinical trial. METHOD: Eligible participants were aged between 18 and 65 years, had low back pain radiating below gluteus for at least 3 months, pain intensity greater than 3 points in the numerical pain rating scale, positive SLR test and a directional preference for lumbar extension movements. Thirty-one participants were randomly allocated into one of two groups: extension-oriented exercises (EE) or extension exercises plus neurodynamic exercises (EEN). Primary outcomes were leg pain intensity and function at 3 weeks. Secondary outcomes were low back pain intensity, disability, global perceived effect and quality of life at 3 weeks and at 1 month. RESULTS: Retention rate was 100% (n = 14) in EE and 94% (n = 16) in EEN for primary outcome analysis. There was no between-group difference for the primary outcomes and for low back pain intensity, GPE and quality of life at 3 weeks. For some outcomes, EE was superior to EEN. CONCLUSIONS: We found no benefits in adding neurodynamic exercises to extension-oriented exercises for patients with nerve-related leg pain and a directional preference. As this study has a small and very specific sample, results may be interpreted with caution.

Corticosteroid injection or dry needling for musculoskeletal pain and disability? A systematic review and GRADE evidence synthesis.

BACKGROUND: Corticosteroid injection and dry needling have been used in the treatment of musculoskeletal conditions, but it is unclear which intervention is the most effective. The purpose of this study was to compare the effects of corticosteroid injection and dry needling for musculoskeletal conditions at short-, medium-, and long-term follow-up. METHODS: Electronic databases were searched up to 31 October 2021. Two researchers independently screened titles, abstracts and full-text articles. Randomized clinical trials (RCTs) that investigated the effectiveness of dry needling compared to corticosteroid injection in patients over 18 years with a musculoskeletal condition were included in the review. The studies had to report pain and/or disability as outcome. Risk of bias was assessed by using the revised Cochrane Collaboration tool (RoB 2.0). Quality of evidence was evaluated by using the GRADE approach. RESULTS: Six studies were included (n = 384 participants). Four musculoskeletal conditions were investigated. There is very low-quality evidence that CSI is superior to DN for reducing heel pain (plantar fasciitis) and lateral elbow pain at short- and medium-term follow-up, but not for myofascial pain and greater trochanteric pain. There is very low-quality evidence that DN is more effective than CSI at long-term follow-up for reducing pain in people with plantar fasciitis and lateral epicondylitis. Very low-certainty evidence shows that there is no difference between DN and CSI for disability at short-term follow-up. One study showed that CSI is superior to DN at medium-term follow-up and another observed that DN is superior to CSI for reducing disability at long-term. CONCLUSIONS: There are no differences between DN and CSI in pain or disability for myofascial pain and greater trochanteric pain syndrome. Very-low certainty evidence suggests that CSI is superior to DN at shorter follow-up periods, whereas DN seems to be more effective than CSI at longer follow-up durations for improving pain in plantar fasciitis and lateral epicondylitis. Large RCTs with higher methodological quality are needed in order to draw more incisive conclusions. PROSPERO REGISTRATION NUMBER: CRD42020148650.

A novel quercetin/ß-cyclodextrin transdermal gel, combined or not with therapeutic ultrasound, reduces oxidative stress after skeletal muscle injury.

A gel containing the inclusion complex of quercetin and ß-cyclodextrin was developed in order to verify its effects, isolated or using phonophoresis, on oxidative biomarkers after skeletal muscle injury. 30 male rats were divided into one of five groups: Control (CTRL), Muscle Injury (MI), Therapeutic Pulsed Ultrasound (TPU), Therapeutic Pulsed Ultrasound plus Quercetin (TPU plus gel-QUE) or Quercetin gel (QUE). Quercetin gel was complexed with ß-Cyclodextrin (ß-CD) using chromatography (HPLC). TPU and quercetin application occurred with 2, 12, 24, 48, 72, 96 hours intervals after injury. Gastrocnemius muscle was injured by mechanical trauma. Lipid peroxidation, superoxide dismutase activity, and catalase activity were assessed. The inclusion complex exhibited adequate entrapment efficiency, relative density and pH. The viscosity of the complex showed a non-Newtonian pseudoplastic behavior. Quercetin/ß-cyclodextrin gel reduced lipid peroxidation, superoxide dismutase activity and catalase activity compared to muscle injury group. Similarly, phonophoresis and TPU also reduced the levels of these oxidative biomarkers. In conclusion, quercetin/ß-cyclodextrin transdermal gel reduces oxidative stress biomarkers after skeletal muscle injury irrespective of using phonophoresis.

The Influence of Clinical, Functional, and Psychosocial Factors on Walking Time in Individuals With Chronic Low Back Pain.

OBJECTIVE: The purpose of this study was to investigate whether clinical, functional, and psychosocial factors are associated with walking time in patients with chronic low back pain. METHODS: This study included patients aged ≥18 years with low back pain for at least 3 months who visited our outpatient clinic between October 2017 and February 2018. We used the following scales/questionnaires: International Physical Activity Questionnaire for self-reported walking time, Numerical Pain Rating Scale for pain intensity, self-report assessing symptom duration, Roland Morris Disability Questionnaire for disability, Patient-Specific Functional Scale for function, Pain Catastrophizing Scale for pain catastrophizing, and screening questions to assess depression and anxiety. Odds ratios (ORs) with their respective 95% CIs were obtained using logistic regression analysis. RESULTS: Neither clinical nor functional factors were associated with the total walking time. Among psychosocial factors, only anxiety showed a negative association with the total walking time (OR 0.23, 95% CI 0.06-0.82)-an association that persisted even after adjusting for confounders (OR 0.15, 95% CI 0.03-0.77). CONCLUSION: Anxiety was shown to be associated with the total walking time in patients with CLBP. No clinical or functional factors seem to be associated with walking in this study sample.