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Shaw J, Jacobs JV, Van Dillen LR, Beneck GJ, Smith JA. Understanding the Biering-Sørensen test: Contributors to extensor endurance in young adults with and without a history of low back pain. J Electromyogr Kinesiol 2024; 74:102854. [PMID: 38171249 PMCID: PMC10842485 DOI: 10.1016/j.jelekin.2023.102854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
The Biering-Sørensen test is commonly used to assess paraspinal muscle endurance. Research using a single repetition of the test has provided conflicting evidence for the contribution of impaired paraspinal muscle endurance to low back pain (LBP). This study investigated how Sørensen test duration, muscle activation, and muscle fatigability are affected by multiple repetitions of the test and determined predictors of Sørensen test duration in young adults with and without a history of LBP. Sixty-four young individuals performed three repetitions of the Sørensen test. Amplitude of activation and median frequency slope (fatigability) were calculated for the lumbar and thoracic paraspinals and hamstrings. Duration of the test was significantly less for the 3rd repetition in individuals with LBP. In individuals without LBP, test duration was predicted by fatigability of the lumbar paraspinals. In individuals with LBP, Sørensen test duration was predicted by fatigability of the hamstrings and amplitude of activation of the thoracic and lumbar paraspinals. Our findings demonstrate that it is necessary to amplify the difficulty of the Sørensen test to reveal impairments in young, active adults with LBP. Training programs aiming to improve lumbar paraspinal performance should monitor performance of other synergist muscles during endurance exercise.
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Affiliation(s)
- Jonathan Shaw
- Crean College of Health and Behavioral Sciences, Chapman University, CA, USA
| | - Jesse V Jacobs
- Rehabilitation and Movement Science, University of Vermont, VT, USA
| | - Linda R Van Dillen
- Program in Physical Therapy, Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, WA, USA
| | - George J Beneck
- Department of Physical Therapy, California State University, Long Beach, CA, USA
| | - Jo Armour Smith
- Crean College of Health and Behavioral Sciences, Chapman University, CA, USA.
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Shaw J, Jacobs JV, Van Dillen LR, Beneck GJ, Smith JA. Understanding the Biering-Sørensen test: contributors to extensor endurance in young adults with and without low back pain. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.11.23284452. [PMID: 36712062 PMCID: PMC9882630 DOI: 10.1101/2023.01.11.23284452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Impaired paraspinal muscle endurance may contribute to persistent low back pain (LBP) and is frequently assessed using a single repetition of the Biering-Sørensen test. This study investigated how Sørensen test duration, muscle activation, and muscle fatigability are affected by multiple repetitions of the test, and determined predictors of Sørensen test duration in young, active adults with and without a history of LBP. Sixty-four individuals with and without persistent LBP performed 3 repetitions of the Sørensen test. Amplitude of activation and median frequency slope (fatigability) were calculated for the lumbar and thoracic paraspinals and the hamstrings. Duration of the test was significantly less for the 2nd and 3rd repetitions in individuals with LBP. In individuals without LBP, fatigability of the lumbar paraspinals was the best predictor of test duration. In individuals with LBP, Sørensen test duration was predicted by fatigability of the hamstrings and amplitude of activation of the thoracic and lumbar paraspinals. Our findings demonstrate that it is necessary to amplify the difficulty of the Sørensen test to elucidate impairments in young, active adults with LBP. Training programs aiming to improve lumbar paraspinal performance in individuals with LBP should monitor performance of other synergist muscles during endurance exercise.
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Shih HJS, Ai J, Abe J, Tang J, Rowley KM, Van Dillen LR, Kulig K. Trunk control in and out of an episode of recurrent low back pain in young adults during the Balance-Dexterity Task. J Electromyogr Kinesiol 2023; 71:102794. [PMID: 37348263 DOI: 10.1016/j.jelekin.2023.102794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023] Open
Abstract
We investigated motor control strategies utilized by individuals with recurrent low back pain (rLBP) during active pain and remission periods as well as by back-healthy controls using the Balance-Dexterity Task. Nineteen young adults with rLBP were tested first when they were in pain and then again in symptom remission, and 19 matched controls were also tested. Trunk kinematic coupling and muscle co-activation were examined while participants performed the task by standing on one leg while compressing a spring with a maximum consistent force with the other leg. We found a decreased bilateral external oblique co-activation during the spring condition of the task compared to the stable block condition in people with rLBP compared to back healthy individuals. There was also reduced trunk coupling during the spring condition of the task compared to the stable block condition in both the rLBP active and remission groups, but no group difference between rLBP and back-healthy individuals. When individuals were in active pain, they exhibited more co-activation than when they were in remission, but the co-activation during active pain was not greater than in back-healthy individuals.
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Affiliation(s)
- Hai-Jung Steffi Shih
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States; Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States.
| | - Joyce Ai
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Justin Abe
- Department of Biological Sciences, University of Southern California, Los Angeles, CA, United States
| | - Jiaxi Tang
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - K Michael Rowley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States; Kinesiology Department, California State University East Bay, Hayward, CA, United States
| | - Linda R Van Dillen
- Program in Physical Therapy, Washington University in St. Louis Medical School, St. Louis, MO, United States; Department of Orthopaedic Surgery, Washington University in St. Louis Medical School, St. Louis, MO, United States
| | - Kornelia Kulig
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
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Bianchini E, Warmerdam E, Romijnders R, Stürner KH, Baron R, Heinzel S, Pontieri FE, Hansen C, Maetzler W. Turning when using a smartphone in persons with and without neurologic conditions: an observational study (Preprint). J Med Internet Res 2022; 25:e41082. [PMID: 36995756 PMCID: PMC10131647 DOI: 10.2196/41082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Turning during walking is a relevant and common everyday movement and it depends on a correct top-down intersegmental coordination. This could be reduced in several conditions (en bloc turning), and an altered turning kinematics has been linked to increased risk of falls. Smartphone use has been associated with poorer balance and gait; however, its effect on turning-while-walking has not been investigated yet. This study explores turning intersegmental coordination during smartphone use in different age groups and neurologic conditions. OBJECTIVE This study aims to evaluate the effect of smartphone use on turning behavior in healthy individuals of different ages and those with various neurological diseases. METHODS Younger (aged 18-60 years) and older (aged >60 years) healthy individuals and those with Parkinson disease, multiple sclerosis, subacute stroke (<4 weeks), or lower-back pain performed turning-while-walking alone (single task [ST]) and while performing 2 different cognitive tasks of increasing complexity (dual task [DT]). The mobility task consisted of walking up and down a 5-m walkway at self-selected speed, thus including 180° turns. Cognitive tasks consisted of a simple reaction time test (simple DT [SDT]) and a numerical Stroop test (complex DT [CDT]). General (turn duration and the number of steps while turning), segmental (peak angular velocity), and intersegmental turning parameters (intersegmental turning onset latency and maximum intersegmental angle) were extracted for head, sternum, and pelvis using a motion capture system and a turning detection algorithm. RESULTS In total, 121 participants were enrolled. All participants, irrespective of age and neurologic disease, showed a reduced intersegmental turning onset latency and a reduced maximum intersegmental angle of both pelvis and sternum relative to head, thus indicating an en bloc turning behavior when using a smartphone. With regard to change from the ST to turning when using a smartphone, participants with Parkinson disease reduced their peak angular velocity the most, which was significantly different from lower-back pain relative to the head (P<.01). Participants with stroke showed en bloc turning already without smartphone use. CONCLUSIONS Smartphone use during turning-while-walking may lead to en bloc turning and thus increase fall risk across age and neurologic disease groups. This behavior is probably particularly dangerous for those groups with the most pronounced changes in turning parameters during smartphone use and the highest fall risk, such as individuals with Parkinson disease. Moreover, the experimental paradigm presented here might be useful in differentiating individuals with lower-back pain without and those with early or prodromal Parkinson disease. In individuals with subacute stroke, en bloc turning could represent a compensative strategy to overcome the newly occurring mobility deficit. Considering the ubiquitous smartphone use in daily life, this study should stimulate future studies in the area of fall risk and neurological and orthopedic diseases. TRIAL REGISTRATION German Clinical Trials Register DRKS00022998; https://drks.de/search/en/trial/DRKS00022998.
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Affiliation(s)
- Edoardo Bianchini
- Department of Neurology, Kiel University, Kiel, Germany
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Elke Warmerdam
- Department of Neurology, Kiel University, Kiel, Germany
- Division of Surgery, Saarland University, Homburg, Germany
| | - Robbin Romijnders
- Department of Neurology, Kiel University, Kiel, Germany
- Faculty of Engineering, Kiel University, Kiel, Germany
| | | | - Ralf Baron
- Department of Neurology, Kiel University, Kiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, Kiel University, Kiel, Germany
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Francesco Ernesto Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
- Santa Lucia Foundation, Rome, Italy
| | - Clint Hansen
- Department of Neurology, Kiel University, Kiel, Germany
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Smith JA, Stabbert H, Bagwell JJ, Teng HL, Wade V, Lee SP. Do people with low back pain walk differently? A systematic review and meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:450-465. [PMID: 35151908 PMCID: PMC9338341 DOI: 10.1016/j.jshs.2022.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/04/2021] [Accepted: 12/17/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain (LBP). Despite substantial research, it is still unclear whether consistent and generalizable changes in walking or running gait occur in association with LBP. The purpose of this systematic review was to identify whether there are differences in biomechanics during walking and running gait in individuals with acute and persistent LBP compared with back-healthy controls. METHODS A search was conducted in PubMed, CINAHL, SPORTDiscus, and PsycINFO in June 2019 and was repeated in December 2020. Studies were included if they reported biomechanical characteristics of individuals with and without LBP during steady-state or perturbed walking and running. Biomechanical data included spatiotemporal, kinematic, kinetic, and electromyography variables. The reporting quality and potential for bias of each study was assessed. Data were pooled where possible to compare the standardized mean differences (SMD) between back pain and back-healthy control groups. RESULTS Ninety-seven studies were included and reviewed. Two studies investigated acute pain and the rest investigated persistent pain. Nine studies investigated running gait. Of the studies, 20% had high reporting quality/low risk of bias. In comparison with back-healthy controls, individuals with persistent LBP walked slower (SMD = -0.59, 95% confidence interval (95%CI): -0.77 to -0.42)) and with shorter stride length (SMD = -0.38, 95%CI: -0.60 to -0.16). There were no differences in the amplitude of motion in the thoracic or lumbar spine, pelvis, or hips in individuals with LBP. During walking, coordination of motion between the thorax and the lumbar spine/pelvis was significantly more in-phase in the persistent LBP groups (SMD = -0.60, 95%CI: -0.90 to -0.30), and individuals with persistent LBP exhibited greater amplitude of activation in the paraspinal muscles (SMD = 0.52, 95%CI: 0.23-0.80). There were no consistent differences in running biomechanics between groups. CONCLUSION There is moderate-to-strong evidence that individuals with persistent LBP demonstrate differences in walking gait compared to back-healthy controls.
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Affiliation(s)
- Jo Armour Smith
- Department of Physical Therapy, Chapman University, Irvine, CA 92618, USA.
| | - Heidi Stabbert
- Department of Physical Therapy, Chapman University, Irvine, CA 92618, USA
| | - Jennifer J Bagwell
- Department of Physical Therapy, California State University, Long Beach, CA 90840, USA
| | - Hsiang-Ling Teng
- Department of Physical Therapy, California State University, Long Beach, CA 90840, USA
| | - Vernie Wade
- Department of Physical Therapy, Chapman University, Irvine, CA 92618, USA
| | - Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, NV 89154, USA
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Arieh H, Abdoli B, Farsi A, Haghparast A. Pain-induced Impact on Movement: Motor Coordination Variability and Accuracy-based Skill. Basic Clin Neurosci 2022; 13:421-431. [PMID: 36457887 PMCID: PMC9706296 DOI: 10.32598/bcn.2021.2930.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Studies on pain are generally conducted for two purposes: first, to study patients with pain who have physical changes due to nerve and muscle lesions, and second, to regain the appropriate kinematic post-pain pattern. The present study aimed to investigate the effect of pain on the coordination variability pattern and throwing accuracy. METHODS The study participants included 30 people aged 18-25 years who volunteered to participate in the study. Participants practiced and acquired skills in 10 blocks of 15 trials. In the test phase associated with pain, Individuals were randomly divided into three groups: local pain, remote pain, and control. In their respective groups, participants were tested in a 15-block trial, 24 hours, and 1 week after acquisition. RESULTS The results revealed that pain did not affect the throwing accuracy (P=0.456). Besides, in the phase of acceleration in throwing, movement variability in the pain-related groups in the shoulder and elbow joints (P=0.518), elbow and wrist (P=0.399), and the deceleration and dart drop phase movement variability in the pain-related groups in the shoulder and elbow joints (P=0.622), elbow and wrist (P=0.534). CONCLUSION Based on the results, the accuracy and coordination variability in pain-related groups were similar. However, to confirm these results, more research is needed on performing motor functions in the presence of pain. HIGHLIGHTS Pain are generally conducted for two purposes.pain which has physical changes due to nerve and muscle lesions and pain to regain the appropriate kinematic post-pain pattern.People who experience pain show poor motor results.Pain restriction is ordinary in joints and the body compensates by increasing movement. PLAIN LANGUAGE SUMMARY One of the constant concerns of sports science experts is to find ways to improve performance or to know the factors that strengthen or weaken motor learning. After injury, pain has been described as one of the passive symptoms, and the mechanism of how overexertion of joints and muscles increases injury and pain is unknown. Following any injury, pain is one of the most important causes of disability and one of the most important problems in people's general health. Many treated individuals present with pain and impaired movement, and typically changes in movement control are a result of the pain. Research evidence suggests that pain induces changes in cortical excitability and the neuroplasticity model that accompanies practice of a new motor task interferes with the performance improvement that must occur simultaneously. According to the new approaches of motor and biomechanical learning and control, movement variability, especially in movement coordination, is considered as an important and influential factor of a person with different conditions. Novice athletes show high non-functional variability in order to reduce the degrees of freedom and then simplify their motor task, in contrast to skilled people, they display functional variability that allows them to perform a motor task better. in variable conditions. Scientists and researchers have concluded that in the presence of pain, there are changes in the pattern requirements and muscle coordination. Clearly, variability is a main feature of most neurological and musculoskeletal pains, and it is necessary for therapists to diagnose and classify incomplete movements and to effectively manage symptoms by controlling incomplete movements, so conducting such research in this field in order to show muscle and movement changes It is necessary under the influence of pain.
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Affiliation(s)
- Hasan Arieh
- Department of Behavioral and Cognitive Science in Sport, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Behrouz Abdoli
- Department of Behavioral and Cognitive Science in Sport, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Alireza Farsi
- Department of Behavioral and Cognitive Science in Sport, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Abbas Haghparast
- Neuroscience Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Individuals with impaired lumbopelvic control demonstrate lumbar multifidus muscle activation deficit using ultrasound imaging in conjunction with electrical stimulation: A cross-sectional study. Arch Phys Med Rehabil 2022; 103:1951-1957. [DOI: 10.1016/j.apmr.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 12/21/2021] [Accepted: 02/12/2022] [Indexed: 11/30/2022]
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Sheikhi B, Letafatkar A, Thomas AC, Ford KR. Altered trunk and lower extremity movement coordination after neuromuscular training with and without external focus instruction: a randomized controlled trial. BMC Sports Sci Med Rehabil 2021; 13:92. [PMID: 34404477 PMCID: PMC8369650 DOI: 10.1186/s13102-021-00326-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/07/2021] [Indexed: 11/11/2022]
Abstract
Background This study sought to determine the effects of a 6-week neuromuscular training (NMT) and NMT plus external focus (NMT plus EF) programs on trunk and lower extremity inter-segmental movement coordination in active individuals at risk of injury. Methods Forty-six active male athletes (controls = 15, NMT = 16, NMT plus EF = 15) participated (age = 23.26 ± 2.31 years) in this controlled, laboratory study. Three-dimensional kinematics were collected during a drop vertical jump (DVJ). A continuous relative phase (CRP) analysis quantified inter-segmental coordination of the: (1) thigh (flexion/extension)—shank (flexion/extension), (2) thigh (abduction/adduction)—shank (flexion/extension), (3) thigh (abduction/adduction)—trunk (flexion/extension), and (4) trunk (flexion/extension)—pelvis (posterior tilt/anterior tilt). Analysis of covariance compared biomechanical data between groups. Results After 6 weeks, inter-segmental coordination patterns were significantly different between the NMT and NMT plus EF groups (p < 0.05). No significant differences were observed in CRP for trunk-pelvis coupling comparing between NMT and NMT plus EF groups (p = 0.134), while significant differences were observed CRP angle of the thigh-shank, thigh-trunk couplings (p < 0.05). Conclusions Trunk and lower extremity movement coordination were more in-phase during DVJ in the NMT plus EF compared to NMT in active individuals at risk of anterior cruciate ligament injury. Trial registration: The protocol was prospectively registered at UMIN_RCT website with ID number: UMIN000035050, Date of provisional registration 2018/11/27. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-021-00326-9.
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Affiliation(s)
- Bahram Sheikhi
- Biomechanics and Corrective Exercise Laboratory, Faculty of Physical Education and Sports Sciences, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, Iran
| | - Amir Letafatkar
- Biomechanics and Corrective Exercise Laboratory, Faculty of Physical Education and Sports Sciences, Kharazmi University, Mirdamad Blvd., Hesari St, Tehran, Iran.
| | - Abbey C Thomas
- Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Kevin R Ford
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, One University Parkway, High Point, NC, 27268, USA
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Combined neuromuscular electrical stimulation with motor control exercise can improve lumbar multifidus activation in individuals with recurrent low back pain. Sci Rep 2021; 11:14815. [PMID: 34285318 PMCID: PMC8292547 DOI: 10.1038/s41598-021-94402-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022] Open
Abstract
Motor control exercise (MCE) is commonly prescribed for patients with low back pain. Although MCE can improve clinical outcomes, lumbar multifidus muscle (LM) activation remains unchanged. Neuromuscular electrical stimulation (NMES) can be used to re-activate motor units prior to MCE which should result in increased LM activation. Therefore, this study aimed to explore the immediate effects of NMES combined with MCE on LM activation and motor performance. Twenty-five participants without low back pain (NoLBP) and 35 participants with movement control impairment (MCI) were recruited. Participants with MCI were further randomized to combined NMES with MCE (COMB) or sham-NMES with MCE (MCE) group. Ultrasound imaging was used to measure LM thickness at rest, maximum voluntary isometric contraction (MVIC), and NMES with MVIC. These data were used to calculate LM activation. Quadruped rocking backward was used to represent motor performance. LM activation and motor performance were measured at baseline and after one-session of intervention. Results showed that both COMB and MCE groups had significantly lower (P < 0.05) LM activation compared with NoLBP group at baseline. Additionally, both COMB and MCE groups demonstrated significant improvement (P < 0.05) in motor performance while COMB group demonstrated significantly greater improvement (P < 0.05) in LM activation compared with MCE group. Individuals with MCI still have persisting LM activation deficit. Our key findings suggest that combined NMES and MCE may have better ability to improve LM activation in individuals with MCI. These findings would support the utility of NMES to induce a priming effect before MCE.
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Shih HJS, Van Dillen LR, Kutch JJ, Kulig K. Individuals with recurrent low back pain exhibit further altered frontal plane trunk control in remission than when in pain. Clin Biomech (Bristol, Avon) 2021; 87:105391. [PMID: 34118490 PMCID: PMC8392132 DOI: 10.1016/j.clinbiomech.2021.105391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Movement alterations due to low back pain (LBP) could lead to long-term adverse consequences if they do not resolve after symptoms subside. This study aims to determine if altered trunk control associated with recurrent low back pain persists beyond symptom duration. METHODS Twenty young adults with recurrent LBP were tested once during an LBP episode and once in symptom remission, and twenty matched back-healthy participants served as controls. Participants walked on a treadmill with five prescribed step widths (0.33, 0.67, 1, 1.33, 1.67 × preferred step width). Motion capture and surface electromyography were used to record trunk kinematics and muscle activation. Thorax-pelvis coordination was calculated using vector coding, and longissimus activation and co-activation were analyzed. FINDINGS Young adults with recurrent LBP exhibited a "looser" trunk control strategy in the frontal plane during gait that was persistent regardless of pain status across multiple step widths compared to controls. The looser trunk control was demonstrated by a greater pelvis-only, less thorax-only coordination pattern, and decreased bilateral longissimus co-activation in individuals with recurrent LBP compared to controls. The looser trunk control strategy was further amplified when individuals were in symptom remission and exhibited greater trunk excursion and reduced in-phase coordination in the frontal plane. INTERPRETATION The amplification of aberrant movement during symptom remission may suggest that movement patterns or anatomical factors existing prior to the tested painful episode underlie altered trunk control in individuals with recurrent LBP. The symptom remission period of recurrent LBP may be a critical window into clinical evaluation and treatment.
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Affiliation(s)
- Hai-Jung Steffi Shih
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
| | - Linda R Van Dillen
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Jason J Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Kornelia Kulig
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Alsubaie AM, Mazaheri M, Martinez-Valdes E, Falla D. Is movement variability altered in people with chronic non-specific low back pain: a protocol for a systematic review. BMJ Open 2021; 11:e046064. [PMID: 34059511 PMCID: PMC8169474 DOI: 10.1136/bmjopen-2020-046064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Motor variability is an important feature when performing repetitive movement, and in asymptomatic people functional tasks are typically performed with variable motor patterns. However, in the presence of chronic non-specific low back pain (LBP), people often present with different motor control strategies than those without pain. Movement variability has been assessed using a wide range of variables, including kinetic and kinematic components of motion. This has resulted in a wide range of findings reported in the literature and some contradicting results. Therefore, the aim of this systematic review is to investigate whether the amount and structure of motor variability are altered in people with chronic non-specific LBP, during both repetitive non-functional and functional tasks. METHODS AND ANALYSIS This protocol for a systematic review is informed by Cochrane guidelines and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. MEDLINE, EMBASE, CINAHL, ZETOC, Web of Science, PubMed and Scopus will be searched from their inception to December 2020 along with a comprehensive search of grey literature and key journals. Two independent reviewers will conduct the search, extract the data, assess risk of bias (using the Downs and Black Scale) for the included studies and assess overall quality of evidence based on Grading of Recommendations, Assessment, Development and Evaluation guidelines. Meta-analysis will be conducted if deemed appropriate. Alternatively, a narrative synthesis will be conducted and evidence summarised as an increase, decrease or no change in the motor variability of people with LBP compared with healthy controls. ETHICS AND DISSEMINATION This study raises no ethical issues. Results will be submitted for publication in a peer review journal and presented at conferences. PROSPERO REGISTRATION NUMBER CRD42020211580.
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Affiliation(s)
- Amal M Alsubaie
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Masood Mazaheri
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Are neuromuscular adaptations present in people with recurrent spinal pain during a period of remission? a systematic review. PLoS One 2021; 16:e0249220. [PMID: 33793608 PMCID: PMC8016280 DOI: 10.1371/journal.pone.0249220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/14/2021] [Indexed: 12/11/2022] Open
Abstract
A plethora of evidence supports the existence of neuromuscular changes in people with chronic spinal pain (neck and low back pain), yet it is unclear whether neuromuscular adaptations persist for people with recurrent spinal pain when in a period of remission. This systematic review aimed to synthesise the evidence on neuromuscular adaptations in people with recurrent spinal pain during a period of remission. Electronic databases, grey literature, and key journals were searched from inception up to the 4th of September 2020. Eligibility criteria included observational studies investigating muscle activity, spine kinematics, muscle properties, sensorimotor control, and neuromuscular performance in adults (≥ 18 years) with recurrent spinal pain during a period of remission. Screening, data extraction, and quality assessment (Newcastle-Ottawa Scale) were conducted independently by two reviewers. Data synthesis was conducted per outcome domain. A meta-analysis with a random-effects model was performed where possible. The overall strength of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines (GRADE). From 8292 records, 27 and five studies were included in a qualitative and quantitative synthesis, respectively. Very low level of evidence supports muscle activity changes in people with recurrent low back pain, especially greater co-contraction, redistribution of muscle activity, and delayed postural control of deeper trunk muscles. Reduced range of motion of the lumbar spine was also found. Meaningful conclusions regarding other outcome domains or people with recurrent neck pain could not be drawn. In conclusion, people with recurrent low back pain during a period of remission show muscle activity and spine kinematics adaptations. Future research should investigate the long-term impact of these changes, as well as adaptations in people with recurrent neck pain.
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Smith JA, Eiteman-Pang WK, Soangra R, König Ignasiak N. Adaptations in trunk-pelvis coordination variability in response to fatiguing exercise. Gait Posture 2021; 84:1-7. [PMID: 33260075 PMCID: PMC7902355 DOI: 10.1016/j.gaitpost.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/29/2020] [Accepted: 11/16/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND During walking, variability in how movement is coordinated between body segments from stride to stride facilitates adaptation to changing environmental or task constraints. Magnitude of this inter-segmental coordination variability is reduced in patient populations and may also decrease in response to muscle fatigue. Previously, stride-to-stride variability has been quantified with the Vector Coding (VC) method, however recent research introduced a new Ellipse Area Method (EAM) to avoid statistical artifacts associated with VC. RESEARCH QUESTION Determine changes in trunk-pelvis coordination variability during walking turns in response to fatiguing exercise and to compare coordination variability quantified with VC to the EAM method. METHODS 15 young adults (mean age: 23.7 (±3.2) years) performed 15 trials of a 90-degree walking turn before and after fatiguing paraspinal muscle exercise. Angular kinematics of the trunk and pelvis segments in the axial plane were quantified using three-dimensional motion capture. Stride to stride variability of axial coordination between the trunk and pelvis pre- and post-fatigue was calculated using both VC and EAM methods. Magnitudes of pre- and post-fatigue variability for VC and EAM were compared with paired t-tests and relationship between the magnitude of variability for the two methods was calculated using Pearson correlation coefficients. RESULTS Using both analytical approaches, trunk-pelvis coordination variability decreased significantly post-fatiguing exercise across the stride cycle and within the stance phase of the turn (p < 0.034 for all comparisons). Average magnitudes of variability calculated with VC and EAM were highly correlated. Time series cross correlations pre-post fatigue ranged from 0.81 to 0.98. SIGNIFICANCE In healthy individuals, magnitude of trunk-pelvis stride-to-stride coordination variability is reduced following fatiguing exercise but the temporal distribution of variability across the stride cycle is maintained. This finding is robust to the method used to quantify coordination variability.
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Affiliation(s)
- Jo Armour Smith
- Department of Physical Therapy, Chapman University, 9401 Jeronimo Road, Irvine, CA, 92618, United States.
| | - Wilford K Eiteman-Pang
- Department of Physical Therapy, Chapman University, 9401 Jeronimo Road, Irvine, CA, 92618, United States
| | - Rahul Soangra
- Department of Physical Therapy, Chapman University, 9401 Jeronimo Road, Irvine, CA, 92618, United States
| | - Niklas König Ignasiak
- Department of Physical Therapy, Chapman University, 9401 Jeronimo Road, Irvine, CA, 92618, United States
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Liew BXW, Morris S, Netto K. Trunk-pelvis coordination during load carriage running. J Biomech 2020; 109:109949. [PMID: 32807302 DOI: 10.1016/j.jbiomech.2020.109949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
Understanding the influence of load carriage on trunk-pelvis coordination and its variability has important functional implications for athletes who need to run with load. The aim of this study was to examine the influence of load carriage on trunk-pelvis coordination in running. Thirty healthy adults performed running while wearing a 20% bodyweight backpack, and without load. Vector coding was used to quantify trunk-pelvis segmental coordination and its variability during the stance phase of running. The four coordination patterns were: 1) anti-phase (segments moving in opposite directions), in-phase (segments moving in same directions), trunk-only phase (only trunk movement), and pelvic-only phase (only pelvic movement). For each plane, the percentage of stance phase spent in a specific coordination pattern was quantified. Coordination variability for each plane was averaged over the stance phase. Mixed effects models were used to analyse the effects of load, adjusted for the covariate of sex, on coordination and its variability. Running with load increased trunk-only coordination in the sagittal plane (P < 0.001), increased anti-phase coordination in the frontal plane (P < 0.001), reduced trunk-only phase coordination in axial rotation (P < 0.001), and increased coordination variability in all three planes (Flexion-Extension: P < 0.001; Lateral flexion: P = 0.03; Axial rotation: P < 0.001). Future studies would benefit from investigating how trunk-pelvis coordination and its variability alters candidate end-point variability indices (e.g. COM displacement), and its functional implications in load carriage running.
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Affiliation(s)
- Bernard X W Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex CO4 3SQ, United Kingdom.
| | - Susan Morris
- School of Physiotherapy and Exercise Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Kevin Netto
- School of Physiotherapy and Exercise Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
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Mansourizadeh R, Letafatkar A, Franklyn-Miller A, Khaleghi-Tazji M, Baker JS. Segmental coordination and variability of change in direction in long-standing groin pain. Gait Posture 2020; 77:36-42. [PMID: 31972473 DOI: 10.1016/j.gaitpost.2020.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/17/2019] [Accepted: 01/14/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Long-standing groin pain (LSGP) is a chronic painful condition resulting in both impaired performance and time loss from participation in multidirectional field sport. RESEARCH QUESTION What are the differences in intersegmental coordination strategy and variability of trunk-pelvic and thigh coupling during change of direction in subjects with athletic LSGP and asymptomatic control subjects? METHODS A motion analysis system was used to collect 3-D kinematic data of the continuous relative phase and the variability of the right and left leg hip. Thoracic-thigh segment data were also collected during multiple ipsilateral turns at a self-selected pace from 16 males with LSGP and 16 asymptomatic controls. It is worth mentioning that, for a more detailed analysis, we divided each cycle diagram into four phases. Independent T-tests were used to compare the two groups. RESULTS Subjects with LSGP demonstrate except in phase 2 of the left foot, more out-of-phase movement with both increased variabilities in right/ left thigh - pelvic coupling, right/ left thigh-thoracic, and pelvic- thoracic in every 4 phases and in the decoupling of segmental coordination. SIGNIFICANCE Decrease in coordination with higher variability is apparent in subjects with LSGP and this aberrant coordination may lead to unexpected compensatory strategies and control impairments.
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Affiliation(s)
- Reza Mansourizadeh
- Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
| | - Amir Letafatkar
- Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran.
| | - Andrew Franklyn-Miller
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia; Sports Surgery Clinic, Dublin, Ireland
| | - Mehdi Khaleghi-Tazji
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Julien S Baker
- Institute of Exercise Science, Hong Kong Baptist University, Hong Kong.
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van Dijk MJH, Smorenburg NTA, Heerkens YF, Mollema J, Kiers H, Nijhuis-van der Sanden MWG, Visser B. Assessment instruments of movement quality in patients with non-specific low back pain: A systematic review and selection of instruments. Gait Posture 2020; 76:346-357. [PMID: 31901525 DOI: 10.1016/j.gaitpost.2019.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/29/2019] [Accepted: 12/21/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Observing and analyzing movement quality (MQ) in patients with non-specific low back pain (NS-LBP) is important in the clinical reasoning of primary care physiotherapists and exercise therapists. However, there is no standardized form of assessment. RESEARCH QUESTION which MQ domains are measured with which instruments, and which activities are relevant, appropriate and methodologically sound for assessing MQ in patients with NS-LBP? METHODS The study had three phases. In phase 1 we conducted a systematic review in PubMed, CINAHL and SPORTDiscus of literature published until October 2018. The selected studies measured MQ domains with instruments that enabled us to 1) compare MQ in self-paced dynamic activities of patients with NS-LBP and healthy controls, and/or 2) determine change over time of MQ in patients with NS-LBP. In phase 2 we established relevant dynamic activities to assess in patients with NS-LBP. In phase 3 we determined appropriateness and methodological qualities of the selected instruments. RESULTS Thirty cross-sectional and three pre-post-test studies were eligible. The instruments consisted of complex (n = 19) and simple (n = 7) instrumented motion analysis systems and standardized observational tests (n = 7). We identified three domains representative for MQ: range of motion (ROM), inter-segmental coordination, and whole-body movements. In these domains, patients with NS-LBP significantly differed from healthy controls, respectively 7/12, 12/13 and 13/20 studies. Moreover, ROM and whole-body movements significantly improved over time in patients with NS-LBP (3/3 studies). Based on phase 3, we concluded that none of the instruments are appropriate to assess MQ in patients with NS-LBP in primary care. SIGNIFICANCE Forward bending, lifting, and walking seem the most relevant activities to evaluate in patients with NS-LBP. However, we found no suitable instruments to measure ROM, inter-segmental coordination, or whole-body movements as determinants of MQ in these activities in daily practice. We therefore recommend such an instrument be developed.
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Affiliation(s)
- Margriet J H van Dijk
- HU University of Applied Sciences, Institute for Human Movement Studies, Utrecht, the Netherlands.
| | - Nienke T A Smorenburg
- HU University of Applied Sciences, Institute for Human Movement Studies, Utrecht, the Netherlands
| | - Yvonne F Heerkens
- HAN University of Applied Sciences, Research Group Occupation & Health, Nijmegen & Dutch Institute of Allied Health Care, Amersfoort, the Netherlands
| | - Jurgen Mollema
- HU University of Applied Sciences, Institute for Human Movement Studies, Utrecht, the Netherlands
| | - Henri Kiers
- HU University of Applied Sciences, Institute for Human Movement Studies, Utrecht, the Netherlands
| | | | - Bart Visser
- Amsterdam University of Applied Sciences, ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam, the Netherlands
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Reduced Trunk Coupling in Persons With Recurrent Low Back Pain Is Associated With Greater Deep-to-Superficial Trunk Muscle Activation Ratios During the Balance-Dexterity Task. J Orthop Sports Phys Ther 2019; 49:887-898. [PMID: 31092122 DOI: 10.2519/jospt.2019.8756] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Motor control dysfunction persisting during symptom remission in persons with recurrent low back pain (LBP) may contribute to the recurrence of pain. OBJECTIVES To investigate trunk control in persons in remission from recurrent LBP and in back-healthy controls using a dynamic, internally driven balance task. No differences in task performance were expected between groups, but it was hypothesized that persons with recurrent LBP would exhibit greater trunk coupling, consistent with a trunk-stiffening strategy. METHODS In this cross-sectional controlled laboratory study, persons with and without recurrent LBP (n = 19 per group) completed the balance-dexterity task, which involved balancing on one limb in standing while compressing an unstable spring with the other. Task performance measures included center-of-pressure velocity under the stance limb and vertical force variability under the spring. Trunk coupling was quantified with the coefficient of determination (R2) of an angle-angle plot of thorax-pelvis frontal plane motion. Fine-wire and surface electromyography captured activations of paraspinals and abdominals. RESULTS There were no differences between groups for any task performance measure. The group in remission from recurrent LBP exhibited reduced trunk coupling, or more dissociated thorax and pelvis motion, compared to the healthy control group (P = .024). Trunk coupling in this group was associated moderately with the lumbar multifidus-to-erector spinae activation ratio (r = 0.618, P = .006) and weakly with the internal oblique-to-external oblique ratio (r = 0.476, P = .046). CONCLUSION The balance-dexterity task is a submaximal, internally driven unstable balance task during which more dissociated trunk motion was observed in persons in remission from recurrent LBP. Findings underscore the task-dependent nature of trunk control research and assessment in persons with recurrent LBP. J Orthop Sports Phys Ther 2019;49(12):887-898. Epub 15 May 2019. doi:10.2519/jospt.2019.8756.
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Does athletic groin pain affect the muscular co-contraction during a change of direction. Gait Posture 2019; 73:173-179. [PMID: 31344606 DOI: 10.1016/j.gaitpost.2019.07.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/04/2019] [Accepted: 07/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Groin pain is one of the common problems in multidirectional sports. It seems that abnormal muscular activity and improper movement strategy led to prolongation and high rate of this injury. Therefore, the aim of this study was to Comparing the Average amplitude of Electromyography (AEMG), co-contraction ratio (CCR) of selected thigh and thoracic muscle during turning in individuals with chronic groin pain and healthy individuals. METHODS Surface electromyography was collected from the internal oblique/transversus abdominis (IO/TrA), multifidus (MF), adductor Longus (AL) and gluteus Medius (GM) for AEMG and CCR analyzed in 16-males with LSGP and 16-controls in four motion phases during 11 cycles of gait coupled with turning. RESULTS Results revealed that in the AEMG apart from the third phase in the muscle of the IO/ Tr. A muscle and in the second phase in the MF muscle in the trunk and in the third phase in the muscle of the AL and the fourth phase in the GM foot Left There was a significant difference in other phases. There was a significant difference in the CCR, except in the second phase of the trunk and the fourth phase of the left foot in the rest of the phases. CONCLUSIONS It seems that in athletes with LSGP, have selective muscular activation and CCR have during turning, that may be resulting in compensatory strategies and movement control defects, which may be a useful tool to predict LSGP occurrence in players with a history of groin pain.
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Ho KY, French T, Klein B, Lee Y. Patellofemoral joint stress during incline and decline running. Phys Ther Sport 2018; 34:136-140. [PMID: 30296671 DOI: 10.1016/j.ptsp.2018.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To compare patellofemoral joint (PFJ) stress between level, incline, and decline running. DESIGN Experimental study. SETTING University laboratory. PARTICIPANTS Twenty recreational runners. MAIN OUTCOME MEASURES Kinematics and kinetics of the trunk and lower extremity were obtained under 3 treadmill conditions: level, 6° incline, and 6° decline. PFJ stress, PFJ reaction force, and PFJ contact area were determined using a biomechanical model. One-way ANOVAs with repeated measures and post-hoc analyses were used to compare outcome variables across the 3 conditions. RESULTS Peak PFJ stress and PFJ stress-time integral (cumulative PFJ stress over the stance phase) during decline running were significantly higher than during level and incline running. There was no difference in peak PFJ stress and PFJ stress-time integral between level and incline running. The increased peak PFJ stress during decline running was related to increased PFJ reaction force, resulting from a decrease in trunk flexion angle. CONCLUSIONS Running on a decline treadmill resulted in higher peak PFJ stress and stress-time integral. Peak PFJ stress and PFJ stress-time integral were similar during level and incline running. Results from this study may be used to prevent excessive PFJ stress during decline running, by targeting a postural strategy utilizing increased trunk flexion.
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Affiliation(s)
- Kai-Yu Ho
- Department of Physical Therapy, University of Nevada, Las Vegas 4505 S. Maryland Parkway, Box 453029, Las Vegas, NV, 89154-3034, USA.
| | - Theresa French
- Department of Physical Therapy, University of Nevada, Las Vegas 4505 S. Maryland Parkway, Box 453029, Las Vegas, NV, 89154-3034, USA
| | - Brooks Klein
- Department of Physical Therapy, University of Nevada, Las Vegas 4505 S. Maryland Parkway, Box 453029, Las Vegas, NV, 89154-3034, USA
| | - Young Lee
- Department of Physical Therapy, University of Nevada, Las Vegas 4505 S. Maryland Parkway, Box 453029, Las Vegas, NV, 89154-3034, USA
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Golyski PR, Hendershot BD. Trunk and pelvic dynamics during transient turns among individuals with unilateral traumatic lower limb amputation. Hum Mov Sci 2018; 58:41-54. [DOI: 10.1016/j.humov.2018.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 01/06/2018] [Accepted: 01/09/2018] [Indexed: 11/28/2022]
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Smith JA, Gordon J, Kulig K. The influence of divided attention on walking turns: Effects on gait control in young adults with and without a history of low back pain. Gait Posture 2017; 58:498-503. [PMID: 28950249 DOI: 10.1016/j.gaitpost.2017.09.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/10/2017] [Accepted: 09/18/2017] [Indexed: 02/02/2023]
Abstract
The cognitive control of gait is altered in individuals with low back pain, but it is unclear if this alteration persists between painful episodes. Locomotor perturbations such as walking turns may provide a sensitive measure of gait adaptation during divided attention in young adults. The purpose of this study was to investigate changes in gait during turns performed with divided attention, and to compare healthy young adults with asymptomatic individuals who have a history of recurrent low back pain (rLBP). Twenty-eight participants performed 90° ipsilateral walking turns at a controlled speed of 1.5m/s. During the divided attention condition they concurrently performed a verbal 2-back task. Step length and width, trunk-pelvis and hip excursion, inter-segmental coordination and stride-to-stride variability were quantified using motion capture. Mixed-model ANOVA were used to examine the effect of divided attention and group, and interaction effects on the selected variables. Step length variability decreased significantly with divided attention in the healthy group but not in the rLBP group (post-hoc p=0.024). Inter-segmental coordination variability was significantly decreased during divided attention (main effect of condition p <0.000). There were small but significant reductions in hip axial and sagittal motion across groups (main effect of condition p=0.044 and p=0.040 respectively), and a trend toward increased frontal motion in the rLBP group only (post-hoc p=0.048). These findings suggest that the ability to switch attentional resources during gait is altered in young adults with a history of rLBP, even between symptomatic episodes.
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Affiliation(s)
- Jo Armour Smith
- Department of Physical Therapy, Harry and Diane Rinker Health Science Campus, Chapman University, 9401 Jeronimo Rd, Irvine, CA 92618, USA; Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar Street, CHP-155, Los Angeles, CA 90089, USA.
| | - James Gordon
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar Street, CHP-155, Los Angeles, CA 90089, USA
| | - Kornelia Kulig
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar Street, CHP-155, Los Angeles, CA 90089, USA
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