Comparison between high-velocity low-amplitude manipulation and muscle energy technique on pain and trunk neuromuscular postural control in male workers with chronic low back pain: A randomised crossover trial.

BACKGROUND: A therapeutic recommendation for restoring function in individuals with chronic low back pain (CLBP) is manual therapy through manipulative spinal or muscle energy techniques. OBJECTIVES: To compare the effectiveness of two osteopathic manipulative techniques on clinical low back symptoms and trunk neuromuscular postural control in male workers with CLBP. METHOD: Ten male workers with CLBP were randomly allocated to two groups: high-velocity low-amplitude (HVLA) manipulation or muscle energy techniques (MET). Each group received one therapy per week for both techniques during 7 weeks of treatment. Pain and function were measured by using the Numeric Pain-Rating Scale, the McGill Pain Questionnaire and the Roland Morris Disability Questionnaire. The lumbar flexibility was assessed by Modified Schober Test. Electromyography (EMG) and force platform measurements were used for evaluation of trunk muscular activation and postural balance, respectively at three different times: baseline, post intervention, and 15 days later. RESULTS: Both techniques were effective (p < 0.01) in reducing pain with large clinical differences (-1.8 to -2.8) across immediate and after 15 days. However, no significant effect between groups and times was found for other variables, namely neuromuscular activation and postural balance measures. CONCLUSION: Both techniques (HVLA thrust manipulation and MET) were effective in reducing back pain immediately and 15 days later. Neither technique changed the trunk neuromuscular activation patterns nor postural balance in male workers with LBP. CLINICAL IMPLICATIONS: These results may facilitate clinical decision-making for CLBP management in physiotherapy programs.

Low-Back Pain and Knee Position-Related Differences on Postural Control Measures During a One-Legged Stance in Athletes.

CONTEXT: Chronic low-back pain (CLBP) may be associated with changes in postural balance in athletes as poor postural control during sports practice. OBJECTIVE: To compare the postural control of athletes with and without CLBP during 2 one-legged stance tasks and identify the center of pressure (COP) cutoff values to determine the main differences. Designed: A cross-sectional study. SETTING: Laboratory of functional evaluation and human motor performance. PARTICIPANTS: A total of 56 male athletes, 28 with and 28 without CLBP (mean age = 26 y). INTERVENTION: The one-legged stance with knee extension and with the knee at 30° flexion tasks were measured and analyzed on a force platform. The participants completed three 30-second trials (30 s of rest between each trial). MAIN OUTCOME MEASURES: The COP parameters: the area of COP, mean COP sway velocity in both the anteroposterior and mediolateral directions, and total COP displacement were computed, and a receiver operating characteristics curve analysis was applied to determine the group differences. RESULTS: Athletes with CLBP had poorer postural control (P < .01) in both tasks. The 30° knee flexion reported more postural instability than the knee extension for all COP parameters (a large effect size d = 0.80).The knee extension cutoffs identified were >7.1 cm2 for the COP area, >2.6 cm/s for the COP sway velocity in the anterior-posterior direction, and >3.2 cm/s for the mediolateral direction. Whereas, the 30° knee flexion cutoffs were >10.9 cm2 for the COP area, >2.9 cm/s for the COP sway velocity in the anterior-posterior direction, and >4.1 cm/s for the mediolateral direction. Both measures showed enough sensitivity and specificity (ie, area under the curve = 0.88 in and 0.80, respectively) to discriminate both groups. CONCLUSIONS: The athletes with CLBP had poorer postural control than the healthy athletes and obtained specific cutoff scores from the COP values.

Age- and low back pain-related differences in trunk muscle activation during one-legged stance balance task.

BACKGROUND: Postural control declines with age and can be affected by low back pain. Poor balance has been reported in people with chronic low back pain (CLBP), which in turn could be explained by the changes in trunk muscle activation. RESEARCH QUESTION: Are there differences between younger and older adults with and without chronic low back pain (CLBP) on trunk muscle activity during one-legged stance task? METHODS: Twenty (20) with, and 20 subjects without nonspecific CLBP participated in the study. Each group was comprised of 10 younger (50% males; mean age: 31 years) and 10 older adults (50% males; mean age: 71 years). Subjects performed 3 × 30-second trials of one-legged stance, with eyes open, on a force platform, while surface electromyography (EMG) measurements were obtained bilaterally on the multifidus at L5, iliocostalis lumborum at L3, rectus abdominis and biceps femoris muscles.EMG amplitude analysis was processed by the Root Mean Square (250 ms window epochs) and normalized by the peak of activation during the balance tasks, to determine the muscular activity of each muscle. RESULTS: Participants with CLBP presented 15% lower lumbar muscle activation (p < 0.05), and 23% higher co-activation (ratio between rectus adominis by multifidus) than participants without CLBP, regardless of age. Significant differences (p < 0.05) between older and young groups were observed only for lower lumbar muscles (mean 24% lower in older than younger adults) and rectus adominis muscles (mean 17% lower in older than younger adults). SIGNIFICANCE: CLBP individuals have different trunk muscle activity than those without CLBP, and older adults exhibit lower trunk activation during one-legged stance balance task. The use of the EMG in evaluation of trunk neuromuscular function during one-legged stance may thus be a valuable tool when assessing balance in CLBP and older people.

Lumbar stabilisation exercises versus back endurance-resistance exercise training in athletes with chronic low back pain: protocol of a randomised controlled trial.

BACKGROUND: Chronic low back pain (CLBP) is an important disorder in athletes that may negatively affect their performance in competitions. The literature usually recommends physiotherapy based on exercises for back pain management in athletes. Recent evidence suggests that interventions based on lumbar muscle stabilisation exercises (LMSE) and back endurance-resistance exercises (BERE) may improve back pain and function performance. However, it is still unclear which type of exercise is more effective for the treatment of CLBP in athletes. OBJECTIVE: To compare the efficacy of LMSE versus BERE in athletes with CLBP. DESIGN: The study is a 2-arm, prospectively registered, randomised controlled trial. SETTING: The physical therapy clinical and biomechanics laboratory of the UNOPAR University. PARTICIPANTS: 32 male athletes with CLBP, age between 18 and 40 years old, recruited from the local community. INTERVENTION: An 8-week intervention programme will be carried out with LMSE s versus BERE. MEASUREMENTS: Trunk neuromuscular patterns during balance tasks (unipodal and over a ball) using electromyography and force platform parameters, pain, disability, fear and avoidance will be assessed by a blinded assessor at baseline and at follow-up after 8 weeks of intervention period. LIMITATIONS: The absence of blinding intervention and the exclusion of female athletes, seated sports and swimmers will affect the internal and external validity of the study. CONCLUSIONS: The results of this study will elucidate which of these two interventions promote better results in trunk neuromuscular pattern, back pain and function in male athletes with CLBP.

Atletas de taekwondo têm melhor controle postural do que atletas de handebol e futebol americano / Atletas de taekwondo tienen mejor control postural que atletas de handball y fútbol americano / Taekwondo athletes have better postural control than handball and american football athletes

RESUMO Introdução: O controle postural é um pré-requisito importante para o desempenho do atleta no esporte. Além disso, o sistema de controle postural contribui para a prevenção de lesões. Déficits nesse sistema podem levar a instabilidade corporal e sobrecarga das estruturas musculoesqueléticas, gerando disfunção e dor. Objetivos: A proposta deste estudo foi avaliar o controle postural em três diferentes modalidades esportivas: taekwondo, handebol e futebol americano. Métodos: Todos os atletas executaram o teste de equilíbrio unipodal sobre uma plataforma de força nos membros inferiores direito e esquerdo. Foram realizados três testes de trinta segundos cada, com os olhos abertos. A média dos três testes foi utilizada para mensurar os parâmetros de controle postural, centro de pressão e velocidade dos deslocamentos anteroposteriores e mediolaterais. Resultados: Diferenças significativas foram observadas entre os três grupos em todos os parâmetros analisados (P = <0,04). A análise post hoc revelou que os atletas de taekwondo tiveram melhor controle postural (P = < 0,035) dos membros inferiores em comparação com as outras duas modalidades. Não foram observadas diferenças significativas entre o handebol e o futebol americano. Conclusão: Os atletas do taekwondo têm melhor controle postural durante o teste de equilíbrio unipodal do que os atletas do handebol e do futebol americano.

ABSTRACT Introduction: Postural control is an important prerequisite for an athlete's performance in sport. In addition, the postural control system contributes to injury prevention. Deficits in this system can lead to body instability and overload of musculoskeletal structures generating dysfunction and pain. Objectives: The purpose of this study was to evaluate postural control in three different sports modalities: taekwondo, handball, and American football. Methods: All athletes performed a one-legged stance/balance test on a force platform in the right and left lower limbs. Three tests of thirty seconds each were performed with eyes open. The mean of the three tests was used to measure the parameters of postural control, pressure center and velocity of anteroposterior and mediolateral displacements. Results: Significant differences were observed among the three groups in all analyzed parameters (P=<0.04). Post-hoc analysis revealed that taekwondo athletes had better postural control (P=<0.035) of lower limbs compared to the other two modalities. There were no significant differences between handball and American football. Conclusion: Taekwondo athletes have better postural control during the one-legged stance/balance test than handball and American football athletes.

RESUMEN Introducción: El control postural es un prerrequisito importante para el desempeño del atleta en el deporte. Además, el sistema de control postural contribuye a la prevención de lesiones. Los déficit en este sistema pueden llevar a la inestabilidad corporal y sobrecarga de las estructuras musculoesqueléticas, generando disfunción y dolor. Objetivos: La propuesta de este estudio fue evaluar el control postural en tres diferentes modalidades deportivas: taekwondo, handball y fútbol americano. Métodos: Todos los atletas ejecutaron la prueba de equilibrio unipodal sobre una plataforma de fuerza en los miembros inferiores derecho e izquierdo. Se realizaron tres pruebas de treinta segundos para cada una, con los ojos abiertos. El promedio de las tres pruebas se utilizó para medir los parámetros de control postural, centro de presión y velocidad de los desplazamientos anteroposteriores y mediolaterales. Resultados: Diferencias significativas se observaron entre los tres grupos en todos los parámetros analizados (P = < 0,04). El análisis post hoc reveló que los atletas de taekwondo tuvieron mejor control postural (P = <0,035) de las extremidades inferiores en comparación con las otras dos modalidades. No se observaron diferencias significativas entre el handball y el fútbol americano. Conclusión: Los atletas del taekwondo tienen mejor control postural durante la prueba de equilibrio unipodal que los atletas del handball y del fútbol americano.

Back muscle fatigue of younger and older adults with and without chronic low back pain using two protocols: A case-control study.

The purpose of this study was to compare back muscle fatigue of younger and older participants with and without chronic low back pain (CLBP). Twenty participants without and 20 with nonspecific CLBP participated in this study. Each group contained 10 younger (50% males; mean age: 31 ± 6 yrs) and 10 older adults (50% males; age mean: 71 ± 7 yrs). Two isometric fatigue protocols were presented randomly: (1) to maintain the unsupported trunk at the horizontal position while on a 45° Roman chair for a minute, and (2) to maintain a 10% of body weight box close to the trunk in the upright position for a minute. Surface electromyography (EMG) signals from the back (multifidus and iliocostalis) and one hip (biceps femoris) muscles were recorded bilaterally, and the median frequency fatigue estimate from linear regression slopes of the EMG time-series was computed. There were no significant (P > 0.05) age effects, and group-by-age interaction in both isometric and functional fatigue tasks. However, the CLBP groups (both younger and old) displayed more back fatigue than people without CLBP in both fatigue protocols (P < 0.01; effect size varying of d = 0.17-0.32). This study was sensitive to discriminate that individuals with CLBP did present significantly more pronounced EMG back fatigue than people without CLBP, in both younger and older adults. These results have significant clinical implications for low back pain rehabilitation programs with regard to endurance assessment in both younger and older.

Manipulação osteopática em pacientes com entorse de tornozelo em inversão para correlação com as lesões adaptativas de ilíaco / Manipulation osteopathy in patients with lateral ankle sprain for correlation with iliac adapted injuries

Introdução: A entorse de tornozelo encontra-se entre os índices mais altos dos problemas que comumente afetam a população humana ativa. Alguns autores tem postulado que essas sequelas são resultados de tratamentos inadequados no início do problema e por não ser dada importância adequada à causa primária. Objetivo: O objetivo deste estudo foi avaliar a cadeia lesional da entorse de tornozelo em inversão e a sua influência biomecânica sobre a articulação sacro-ilíaca. Método: Os pacientes foram selecionados mediante ao questionário de inclusão; AOFAS, e TFP positivo homolateral a lesão. Posteriormente foram separados em 3 grupos, com 10 indivíduos cada, sendo G0, grupo controle, G1, grupo de pacientes com entorse de tornozelo em inversão unilateral e G2, grupo de pacientes com entorse de tornozelo em inversão bilateral. A avaliação consistiu de goniometria, teste de Downing e teste de mobilidade do pé e tornozelo. Posteriormente foi realizada a manipulação osteopática das regiões hipomóveis encontradas. Ao final era realizado o TFP e a goniometria comparativa. Resultados: Em relação a variável do TFP, no grupo G1(80%)e no grupo G2(90%) dos pacientes negativaram o TFP. Na reavaliação da goniometria da dorsiflexão, houve ganho de 0,8o no G0, 2,6o no G1 e 3,3o no G2 (p = 0,049). Na reavaliação da plantiflexão, houve ganho de 0,6o no G0, 4,0o no G1 e de 2,6o no G2 (p=0,027). Conclusão: Os resultados do presente estudo ressaltam a importância da avaliação global do paciente e colocam em evidência a relação da biomecânica ascendente entre a articulação do tornozelo e a sacro-ilíaca.

Introduction: The ankle sprain is among the highest rates of problems that commonly affect the active humanpopulation. Some authors have postulated that these sequels are results of inadequate treatment at the beginning of the problem and because it is not given adequate importance the primary cause. Objective: The aim of this study was to assess the lesional chain of ankle sprain in inversion and its influence on the biomechanics sacro-iliac articulation.Method: Patients were selected for inclusion questionnaire; AOFAS and TFP positive homolateral to lesion. Later, they were divided into 3 groups with 10 individuals each. G0, the control group, G1, group of patients with ankle sprain ininversion unilateral and G2, group of patients with ankle sprain in inversion bilateral. The assessment consisted ofgonimetria, Downing test and test the mobility of the foot and ankle. Later the osteopathic manipulation was performedin blocked regions. At the end was performed the comparative TFP and goniometry. Results: For the variable of TFP, in G1 (80%) and G2 (90%) of the patients have been the negative TFP. In goniometry re-evaluation of dorsiflexion,there was a gain of 0.8o in the G0, 2.6o in the G1 and 3.3o in the G2 (p = 0.049). In the plantiflexion re-evaluationthere was gain of 0.6o in the G0, 4.0o in the G1 and 2.6o in the G2 (p = 0.027). Conclusion: The results of this studyshow the importance of global assessment of the patient, and highlights the relationship between the biomechanics up the ankle and sacroiliac.