Motor Control Stabilisation Exercise for Patients with Non-Specific Low Back Pain: A Prospective Meta-Analysis with Multilevel Meta-Regressions on Intervention Effects.

Low-to-moderate quality meta-analytic evidence shows that motor control stabilisation exercise (MCE) is an effective treatment of non-specific low back pain. A possible approach to overcome the weaknesses of traditional meta-analyses would be that of a prospective meta-analyses. The aim of the present analysis was to generate high-quality evidence to support the view that motor control stabilisation exercises (MCE) lead to a reduction in pain intensity and disability in non-specific low back pain patients when compared to a control group. In this prospective meta-analysis and sensitivity multilevel meta-regression within the MiSpEx-Network, 18 randomized controlled study arms were included. Participants with non-specific low back pain were allocated to an intervention (individualized MCE, 12 weeks) or a control group (no additive exercise intervention). From each study site/arm, outcomes at baseline, 3 weeks, 12 weeks, and 6 months were pooled. The outcomes were current pain (NRS or VAS, 11 points scale), characteristic pain intensity, and subjective disability. A random effects meta-analysis model for continuous outcomes to display standardized mean differences between intervention and control was performed, followed by sensitivity multilevel meta-regressions. Overall, 2391 patients were randomized; 1976 (3 weeks, short-term), 1740 (12 weeks, intermediate), and 1560 (6 months, sustainability) participants were included in the meta-analyses. In the short-term, intermediate and sustainability, moderate-to-high quality evidence indicated that MCE has a larger effect on current pain (SMD = -0.15, -0.15, -0.19), pain intensity (SMD = -0.19, -0.26, -0.26) and disability (SMD = -0.15, -0.27, -0.25) compared with no exercise intervention. Low-quality evidence suggested that those patients with comparably intermediate current pain and older patients may profit the most from MCE. Motor control stabilisation exercise is an effective treatment for non-specific low back pain. Sub-clinical intermediate pain and middle-aged patients may profit the most from this intervention.

Stress and Self-Efficacy as Long-Term Predictors for Chronic Low Back Pain: A Prospective Longitudinal Study.

PURPOSE: Psychosocial variables are known risk factors for the development and chronification of low back pain (LBP). Psychosocial stress is one of these risk factors. Therefore, this study aims to identify the most important types of stress predicting LBP. Self-efficacy was included as a potential protective factor related to both, stress and pain. PARTICIPANTS AND METHODS: This prospective observational study assessed n = 1071 subjects with low back pain over 2 years. Psychosocial stress was evaluated in a broad manner using instruments assessing perceived stress, stress experiences in work and social contexts, vital exhaustion and life-event stress. Further, self-efficacy and pain (characteristic pain intensity and disability) were assessed. Using least absolute shrinkage selection operator regression, important predictors of characteristic pain intensity and pain-related disability at 1-year and 2-years follow-up were analyzed. RESULTS: The final sample for the statistic procedure consisted of 588 subjects (age: 39.2 (±13.4) years; baseline pain intensity: 27.8 (±18.4); disability: 14.3 (±17.9)). In the 1-year follow-up, the stress types "tendency to worry", "social isolation", "work discontent" as well as vital exhaustion and negative life events were identified as risk factors for both pain intensity and pain-related disability. Within the 2-years follow-up, Lasso models identified the stress types "tendency to worry", "social isolation", "social conflicts", and "perceived long-term stress" as potential risk factors for both pain intensity and disability. Furthermore, "self-efficacy" ("internality", "self-concept") and "social externality" play a role in reducing pain-related disability. CONCLUSION: Stress experiences in social and work-related contexts were identified as important risk factors for LBP 1 or 2 years in the future, even in subjects with low initial pain levels. Self-efficacy turned out to be a protective factor for pain development, especially in the long-term follow-up. Results suggest a differentiation of stress types in addressing psychosocial factors in research, prevention and therapy approaches.

Muscle Strength and Neuromuscular Control in Low-Back Pain: Elite Athletes Versus General Population.

The purpose of the study was to investigate the athletic-based specificity of muscle strength and neuromuscular control of spine stability in chronic non-specific low-back pain (LBP). Thirty elite athletes and 29 age-matched non-athletes with (15 athletes and 15 non-athletes) and without LBP (15 athletes and 14 non-athletes) participated in the study. Muscle strength was measured during maximal isometric trunk flexion and trunk extension contractions. The neuromuscular control of spine stability was analyzed by determining trunk stiffness, trunk damping, and onset times of the lumbar and thoracic erector spinae muscles after sudden perturbations (quick release experiments) as well as maximum Lyapunov exponents (local dynamic stability) using non-linear time series analysis of repetitive lifting movements. LBP was assessed using the visual analog scale. We found lower maximal trunk extension moments (p = 0.03), higher trunk damping (p = 0.018) and shorter onset times (p = 0.03) of the investigated trunk muscles in LBP patients in both athletes and non-athletes. Trunk stiffness and the local dynamic stability did not show any differences (p = 0.136 and p = 0.375, respectively) between LBP patients and healthy controls in both groups. It can be concluded that, despite the high-level of training in athletes, both athletes and non-athletes with LBP showed the same deconditioning of the lumbar extensor muscles and developed similar strategies to ensure spine stability after sudden perturbations to protect the spine from pain and damage. The findings highlight that specific training interventions for the trunk muscles are not only crucial for individuals of the general population, but also for well-trained athletes.

Reactive but not predictive locomotor adaptability is impaired in young Parkinson's disease patients.

BACKGROUND: Gait and balance disorders are common in Parkinson's disease (PD) and major contributors to increased falling risk. Predictive and reactive adjustments can improve recovery performance after gait perturbations. However, these mechanisms have not been investigated in young-onset PD. OBJECTIVE: We aimed to investigate the effect of gait perturbations on dynamic stability control as well as predictive and reactive adaptability to repeated gait perturbations in young PD patients. METHODS: Fifteen healthy controls and twenty-five young patients (48±5yrs.) walked on a walkway. By means of a covered exchangeable element, the floor surface condition was altered to induce gait perturbations. The experimental protocol included a baseline on a hard surface, an unexpected trial on a soft surface and an adaptation phase with 5 soft trials to quantify the reactive adaptation. After the first and sixth soft trials, the surface was changed to hard, to examine after-effects and, thus, predictive motor control. Dynamic stability was assessed using the 'extrapolated center of mass' concept. RESULTS: Patients' unperturbed walking was less stable than controls' and this persisted in the perturbed trials. Both groups demonstrated after-effects directly after the first perturbation, showing similar predictive responses. However, PD patients did not improve their reactive behavior after repeated perturbations while controls showed clear locomotor adaptation. CONCLUSIONS: Our data suggest that more unstable gait patterns and a less effective reactive adaptation to perturbed walking may be a disease-related characteristic in young PD patients. These deficits were related to reduced ability to increase the base of support.

Recovery performance and factors that classify young fallers and non-fallers in Parkinson's disease.

Postural instability is a major problem for Parkinson's disease patients (PDs). Identifying the causes of postural instability at a young age would contribute to the development of adequate training interventions aiming to reduce falls. The purpose of this study was to investigate the effect of muscle strength and balance ability on dynamic stability control after simulated disturbances and to develop an applicable tool able to classify young PDs into fallers and non-fallers. Twenty-five young PDs (12 fallers, 13 non-fallers, 48±5 yrs.) and 14 healthy controls participated in the study. Dynamic stability was examined during simulated forward falls. Muscle strength was assessed by isometric maximal plantarflexion and knee extension contractions. Balance ability was evaluated by measuring the anterior and posterior limits of stability (LoS). The fallers showed lower recovery performance in forward falls and lower muscle strength compared to controls. Muscle strength and anterior LoS were significantly associated to stability performance. These two factors could correctly classify 90% of PD fallers, establishing an accurate assessment tool to predict the falling risk in young PDs. Furthermore, muscle strength partly explained recovery performance; therefore, we can argue that young PDs with an increased falling risk may benefit from leg-extensors strengthening and stability training.

Dynamic stability control during perturbed walking can be assessed by a reduced kinematic model across the adult female lifespan.

The current study aimed to determine potential differences in dynamic stability control during perturbed walking across the adult female lifespan and to test the hypothesis that such differences can be assessed by a reduced kinematic model. 11 young-aged (22-30years), 9 middle-aged (41-59years) and 14 old-aged (62-75years) female adults walked on a treadmill while the right leg was unexpectedly perturbed once during the swing phase. Margin of stability (MS) at touchdown was investigated using a full body and a reduced kinematic model. After the perturbation, all age groups showed a lower MS compared to non-perturbed gait (baseline), leading to negative MS. Four old-aged adults failed to cope with the task (only preventing a fall by grasping). The remaining ten old-aged and the middle-aged subjects required three more recovery steps than the young-aged adults to get back to baseline MS. Moreover, there were no differences between kinematic models, and both methods demonstrated similar age-related findings. We concluded that the ability to control dynamic stability during perturbed walking by enlarging the base of support has already begun to deteriorate by middle age. Further, the valid agreement between kinematic models shows that such differences can be assessed by using just four body markers.

Central factors explain muscle weakness in young fallers with Parkinson's disease.

BACKGROUND: Muscle weakness in old Parkinson's disease (PD) patients has been shown to impair their mobility, although the specific origin of this weakness and its relation to falls has not been well examined in young patients. OBJECTIVE: This study aimed to analyze the possible contribution of central factors to muscle weakness of the triceps surae and quadriceps femoris muscles in young faller and nonfaller PD patients. METHODS: Twenty-six young PD patients (fallers, n = 13 and nonfallers, n = 13) and 15 matched healthy controls performed several isometric maximal voluntary knee extension and plantar flexion contractions (MVC) of the most affected leg on a dynamometer. We estimated the maximal resultant agonist moments, the antagonistic moment of hamstrings and tibialis anterior during MVCs and the activation deficit of the quadriceps femoris and triceps surae muscles. RESULTS: Only the Parkinson fallers showed significantly lower muscle strength, higher antagonistic moments and higher activation deficit compared with controls. Multiple regression analysis showed that the antagonistic moments and the activation deficit explained about 39% and 27%, of the variance in the maximal resultant moments of the knee extensors and the plantar flexors, respectively. CONCLUSIONS: Our findings suggest that Parkinson fallers are affected by strength impairments arising from the central nervous system and not from the peripheral muscle contractile capacity, even at early stages of the disease and young age. High-intensity resistance training may help enhance neural drive and decrease unwanted antagonistic moments and reduce the risk of falls.

Symmetry and reproducibility of the components of dynamic stability in young adults at different walking velocities on the treadmill.

In the literature, analysis of dynamic gait stability using the extrapolated center of mass concept is often an objective that assumes reproducible and symmetrical data. Here, we examined the validity of this assumption by analyzing subjects walking at different velocities. Eleven healthy young subjects walked on a treadmill at six different velocities (1.0-2.0m·s(-1)). Dynamic stability at touchdown of the left and right foot (10 gait trials for each body side) was investigated by using the margin of stability, determined as the difference between base of support and extrapolated center of mass. Dynamic stability parameters showed no significant differences (P>0.05) between gait trials, with a root mean square difference in margin of stability of less than 1.62cm. Correlation coefficients between trials were above 0.70 for all parameters, demonstrating that two gait trials are sufficient to obtain reproducible data. In more than 90% of the cases, the absolute symmetry index was below 8% with no relevant functional differences between body sides. We concluded that analyzing two gait trials for one body side is sufficient to determine representative characteristics of the components of dynamic stability in healthy young adults while walking on the treadmill at a wide range of velocities.

Lower leg musculoskeletal geometry and sprint performance.

The purpose of this study was to investigate whether sprint performance is related to lower leg musculoskeletal geometry within a homogeneous group of highly trained 100-m sprinters. Using a cluster analysis, eighteen male sprinters were divided into two groups based on their personal best (fast: N=11, 10.30±0.07s; slow: N=7, 10.70±0.08s). Calf muscular fascicle arrangement and Achilles tendon moment arms (calculated by the gradient of tendon excursion versus ankle joint angle) were analyzed for each athlete using ultrasonography. Achilles tendon moment arm, foot and ankle skeletal geometry, fascicle arrangement as well as the ratio of fascicle length to Achilles tendon moment arm showed no significant (p>0.05) correlation with sprint performance, nor were there any differences in the analyzed musculoskeletal parameters between the fast and slow sprinter group. Our findings provide evidence that differences in sprint ability in world-class athletes are not a result of differences in the geometrical design of the lower leg even when considering both skeletal and muscular components.