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Alam MF, Ansari S, Zaki S, Sharma S, Nuhmani S, Alnagmoosh A, Alsubaiei ME. Effects of physical interventions on pain and disability in chronic low back pain with pronated feet: a systematic review and meta-analysis. Physiother Theory Pract 2024:1-15. [PMID: 38433468 DOI: 10.1080/09593985.2024.2325581] [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: 10/04/2023] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND A link between pronated feet (PF) and chronic low back pain (CLBP) has been reported in the literature. However, physical interventions (PI) like physiotherapy and orthotics mainly target the lower back, neglecting the broader biomechanical impacts of PF that affect the feet, ankles, and overall posture. Currently, there is a lack of comprehensive meta-analyses or systematic reviews on this subject. OBJECTIVES This systematic review with a meta-analysis aimed to evaluate the effects of PI on pain and disability in patients having CLBP with PF. METHODS From inception until October 15, 2023, Medline/PubMed, Web of Science, and Scopus databases were searched using the desired keywords for randomized control trials (RCTs). The quality of the RCTs was evaluated using the PEDro scale and risk of bias tool. RESULTS Four studies involving 268 patients were identified, two compared custom-made foot orthoses to non-biomechanical foot insoles, while the other two used exercises. The meta-analysis included four studies for pain and three for disability. The results showed a significant change in pain [-2.43 (95% CI -2.73 to -2.13, p < .001)] and disability of -6.69 (95% CI -8.04 to -5.33, p < .001)]. CONCLUSIONS This systematic review and meta-analysis of four RCTs elucidates that PI, specifically targeting PF, significantly alleviate pain and reduce disability in patients having CLBP with PF. These findings advocate for integrating foot-based PI within the treatment protocols for patients suffering from CLBP accompanied by PF.
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Affiliation(s)
- Md Farhan Alam
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Sumbul Ansari
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Saima Zaki
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Saurabh Sharma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Abdullah Alnagmoosh
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Mohammed Essa Alsubaiei
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
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Sadler S, Spink M, Lanting S, Chuter V. A randomised controlled trial investigating the effect of foot orthoses for the treatment of chronic nonspecific low back pain. Musculoskeletal Care 2023; 21:856-864. [PMID: 36951154 DOI: 10.1002/msc.1762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVES The primary aim was to investigate the effect of prefabricated foot orthoses on pain and function in people with chronic nonspecific low back pain (LBP). Secondary aims were to report on the recruitment rate, adherence to and safety of these interventions, and the relationship between physical activity and pain and function. DESIGN A two-arm parallel group (intervention vs. control) randomised (1:1) controlled trial. SUBJECTS Forty-one participants with chronic nonspecific LBP. INTERVENTION Twenty participants were randomised to the intervention group (prefabricated foot orthotic and The Back Book) and 21 to the control group (The Back Book). The primary outcomes for this study were change in pain and function from baseline to 12 weeks. RESULTS No statistically significant difference in pain was found between the intervention and control group (adjusted mean difference -0.84, 95% CI: -2.09 to 0.41, p = 0.18) at the 12-week follow-up. No statistically significant difference in function was found between the intervention and control group (adjusted mean difference -1.47, 95% CI: -5.51 to 2.57, p = 0.47) at the 12-week follow-up. CONCLUSION This study found no evidence of a significant beneficial effect of prefabricated foot orthoses for chronic nonspecific LBP. This study demonstrated that the rate of recruitment, intervention adherence and safety, and participant retention is acceptable and supportive of conducting a larger randomised controlled trial. Australian and New Zealand Clinical Trials Registry (ACTRN12618001298202).
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Affiliation(s)
- Sean Sadler
- Discipline of Podiatry, School of Health Science, Western Sydney University, Campbelltown, New South Wales, Australia
- Discipline of Podiatry, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Martin Spink
- Discipline of Podiatry, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sean Lanting
- Discipline of Podiatry, School of Health Science, Western Sydney University, Campbelltown, New South Wales, Australia
- Discipline of Podiatry, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Vivienne Chuter
- Discipline of Podiatry, School of Health Science, Western Sydney University, Campbelltown, New South Wales, Australia
- Discipline of Podiatry, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
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3
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Riddick R, Smits E, Faber G, Shearwin C, Hodges P, van den Hoorn W. Estimation of human spine orientation with inertial measurement units (IMU) at low sampling rate: How low can we go? J Biomech 2023; 157:111726. [PMID: 37541053 DOI: 10.1016/j.jbiomech.2023.111726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/13/2023] [Accepted: 07/13/2023] [Indexed: 08/06/2023]
Abstract
Studying people in their daily life is important for understanding conditions with multi-faceted aetiology such as chronic low back pain. Inertial measurement units can be used to reconstruct the posture and motion of the body outside of laboratories to enable this research. The battery life of these sensors strongly affects the usability of the system, since recharging them frequently is inconvenient and can lead to additional errors. A major determinant of the battery life for these sensors is sampling rate, but the relationship between sampling rate and accuracy in motion reconstruction is not well documented. We measured the spine of 12 participants using inertial measurement units across a variety of tasks such as sitting, standing, walking, and jogging. The orientation of the spine was reconstructed using several filters, including a novel filter developed specifically for high performance at low sampling frequencies. Benchmarking against optical motion capture, we developed a model showing that the error of all tested filters depends exponentially on the sampling frequency, with the optimal filter gains showing a similar exponential relationship. Using this model of error, we developed a criterion for recommending minimum sampling frequencies for accurate motion estimates for each task, finding frequencies ranging from about 13 to 35 Hz sufficient depending on the task. Although we only studied the spine, these models should provide insight into optimizing sampling rate and filter parameters for inertial measurements in general use.
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Affiliation(s)
- Ryan Riddick
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia.
| | - Esther Smits
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Gert Faber
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Cory Shearwin
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Paul Hodges
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Wolbert van den Hoorn
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, Australia; ARC Industrial Transformation Training Centre-Joint Biomechanics, School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
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Castro-Méndez A, Requelo-Rodríguez I, Pabón-Carrasco M, González-Elena ML, Ponce-Blandón JA, Palomo-Toucedo IC. A Case-Control Study of the Effects of Chronic Low Back Pain in Spatiotemporal Gait Parameters. SENSORS 2021; 21:s21155247. [PMID: 34372484 PMCID: PMC8347914 DOI: 10.3390/s21155247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 12/12/2022]
Abstract
Chronic low back pain and biomechanical walking imbalances are closely related. It is relevant to identify if there are alterations in spatiotemporal gait patterns in subjects with CLBP (cases) versus healthy subjects (controls) to plan training interventions of motor control gait patterns, and thus allowing normal physical activity of the individual. This study is intended to identify if spatiotemporal alterations occur in the gait cycle in CLBP subjects (cases) compared with a control group (healthy patients) analyzed with an OptoGait LED sensors gait program. Method: A total of n = 147 participants: n = 75 cases (CLBP) and n = 72 healthy controls subjects were studied with OptoGait gait program. Results: Significant differences were found between the two groups and both feet in foot stride, for the differences of the total stride and contact, for gait cadence and total stride length of the gait cycle (p < 0.05). Conclusions: CLBP may alter some normal gait patterns measured by OptoGait; this finding presents imbalances in gait cycle as an underlying factor. The gait is part of daily life of any individual and it is an important physical activity in relation to the maintenance of an optimal state of health. In addition, future studies are deemed necessary.
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Affiliation(s)
- Aurora Castro-Méndez
- Podiatry Department, University of Seville, 41009 Seville, Spain; (M.L.G.-E.); (I.C.P.-T.)
- Correspondence:
| | | | - Manuel Pabón-Carrasco
- Spanish Red Cross Nursing School, University of Seville, 41009 Seville, Spain; (M.P.-C.); (J.A.P.-B.)
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Custom-Made Foot Orthoses as Non-Specific Chronic Low Back Pain and Pronated Foot Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136816. [PMID: 34201981 PMCID: PMC8297241 DOI: 10.3390/ijerph18136816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022]
Abstract
Excessive foot pronation has been reported as being related to chronic low back pain symptoms and risk factors in sports-specific pathologies. Compensating custom-made foot orthotics treatment has not been entirely explored as an effective therapy for chronic low back pain (CLBP). This study aims to observe the effects of custom-made foot orthoses, in subjects with foot pronation suffering from CLBP. A total of 101 patients with nonspecific CLBP and a pronated foot posture index (FPI) were studied. They were randomized in two groups: an experimental one (n = 53) used custom-made foot orthotics, and the control group (n = 48) were treated with non-biomechanical effect orthoses. The CLBP was measured using the Oswestry Disability Index (ODI) Questionnaire and a visual analogue scale (VAS), both for lower back pain. The symptoms were evaluated twice, at first when the subject was included in the study, and later, after 4 weeks of treatment. The analysis of outcomes showed a significant decrease in CLBP in the custom-made foot orthoses participants group (p < 0.001 ODI; p < 0.001 VAS). These findings suggest that controlling excessive foot pronation by using custom-made foot orthoses may significantly contribute to improving CLBP.
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6
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Kong L, Zhou X, Huang Q, Zhu Q, Zheng Y, Tang C, Li JX, Fang M. The effects of shoes and insoles for low back pain: a systematic review and meta-analysis of randomized controlled trials. Res Sports Med 2020; 28:572-587. [PMID: 32954802 DOI: 10.1080/15438627.2020.1798238] [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] [Indexed: 10/23/2022]
Abstract
The aim of this review was to examine the effects of shoes and insoles on low back pain (LBP). Seven electronic databases were searched from their inception to May 2020. The methodological quality of the 14 included studies was assessed by PEDro scale. Quality of evidence was assessed using GRADE. Moderate evidence on the disability questionnaire score (SMD, 0.52; 95% CI, 0.28 to 0.77; P < 0.001) and pain score (SMD, 0.61; 95% CI, 0.36 to 0.85; P < 0.001) of the custom-made orthotics for chronic LBP compared with no orthotics/insoles intervention was found. Meta-analysis results also showed moderate evidence on the disability questionnaire score (SMD, 0.44; 95% CI, 0.05 to 0.82; P =0.03) in patients who wore unstable shoes compared with regular shoes. Pain and life quality scores showed low-quality evidence of unstable shoes for chronic LBP. Custom-made orthotics and unstable shoes can be recommended to patients as a management option of chronic LBP.
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Affiliation(s)
- Lingjun Kong
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine , Shanghai, China.,Institute of Tuina, Shanghai Institute of Traditional Chinese Medicine , Shanghai, China
| | - Xin Zhou
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine , Shanghai, China
| | - Qian Huang
- Department of Acupuncture and Tuina, Lianyungang Hospital of Traditional Chinese Medicine , Lianyungang, China
| | - Qingguang Zhu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine , Shanghai, China.,Institute of Tuina, Shanghai Institute of Traditional Chinese Medicine , Shanghai, China
| | - Yu Zheng
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine , Shanghai, China
| | - Cheng Tang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine , Shanghai, China
| | - Jing Xian Li
- School of Human Kinetics, University of Ottawa , Ottawa, Canada
| | - Min Fang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine , Shanghai, China.,Institute of Tuina, Shanghai Institute of Traditional Chinese Medicine , Shanghai, China.,College of Acupuncture and Tuina, Shanghai University of Traditional Chinese Medicine , Shanghai, China
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7
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Sadler S, Spink M, Cassidy S, Chuter V. Prefabricated foot orthoses compared to a placebo intervention for the treatment of chronic nonspecific low back pain: a study protocol for a randomised controlled trial. J Foot Ankle Res 2018; 11:56. [PMID: 30349585 PMCID: PMC6192308 DOI: 10.1186/s13047-018-0299-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/05/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prefabricated foot orthoses are used to treat chronic nonspecific low back pain, however their effectiveness and potential mechanism of action is unclear. The primary aims of the study are to investigate the effectiveness of prefabricated foot orthotic devices for reducing pain and improving function in people with chronic nonspecific low back pain over 52 weeks. METHODS This study is a participant and assessor blinded, parallel-group, superiority randomised (1:1) controlled trial. The study will recruit 60 participants aged 18 to 65 years with chronic nonspecific low back pain. Participants will undergo randomisation to a control group (The Back Book) or an intervention group (prefabricated foot orthoses and The Back Book). The primary outcome measures will be change in pain and function from baseline to 12 (primary time point), 26, and 52 weeks. Secondary outcome measures include: gluteus medius muscle activity and transversus abdominis muscle thickness from baseline to 12 weeks, physical activity over 12, 26, and 52 weeks, and correlation between foot type and change in measures of pain and function. Number of hours per day and week that the prefabricated orthoses are worn, as well as, adverse events will be self-reported by participants. Data will be analysed using the intention-to-treat principle. DISCUSSION This trial will primarily evaluate the effectiveness of prefabricated foot orthotic devices for reducing pain and improving function in people with chronic nonspecific low back pain over 52 weeks. It is expected that this study will provide clinicians and researchers with an understanding of the role that prefabricated foot orthoses may have in the treatment of chronic nonspecific low back pain and a potential mechanism of action, and whether foot type influences the outcome. TRIAL REGISTRATION ACTRN12618001298202.
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Affiliation(s)
- Sean Sadler
- Discipline of Podiatry, University of Newcastle, 10 Chittaway Road, Ourimbah, NSW 2258 Australia
| | - Martin Spink
- Discipline of Podiatry, University of Newcastle, 10 Chittaway Road, Ourimbah, NSW 2258 Australia
| | - Samuel Cassidy
- Discipline of Podiatry, University of Newcastle, 10 Chittaway Road, Ourimbah, NSW 2258 Australia
| | - Vivienne Chuter
- Discipline of Podiatry, University of Newcastle, 10 Chittaway Road, Ourimbah, NSW 2258 Australia
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8
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Healy A, Farmer S, Pandyan A, Chockalingam N. A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions. PLoS One 2018; 13:e0192094. [PMID: 29538382 PMCID: PMC5851539 DOI: 10.1371/journal.pone.0192094] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/16/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Assistive products are items which allow older people and people with disabilities to be able to live a healthy, productive and dignified life. It has been estimated that approximately 1.5% of the world's population need a prosthesis or orthosis. OBJECTIVE The objective of this study was to systematically identify and review the evidence from randomized controlled trials assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions. METHODS Literature searches, completed in September 2015, were carried out in fourteen databases between years 1995 and 2015. The search results were independently screened by two reviewers. For the purpose of this manuscript, only randomized controlled trials which examined interventions using orthotic or prosthetic devices were selected for data extraction and synthesis. RESULTS A total of 342 randomised controlled trials were identified (319 English language and 23 non-English language). Only 4 of these randomised controlled trials examined prosthetic interventions and the rest examined orthotic interventions. These orthotic interventions were categorised based on the medical conditions/injuries of the participants. From these studies, this review focused on the medical condition/injuries with the highest number of randomised controlled trials (osteoarthritis, fracture, stroke, carpal tunnel syndrome, plantar fasciitis, anterior cruciate ligament, diabetic foot, rheumatoid and juvenile idiopathic arthritis, ankle sprain, cerebral palsy, lateral epicondylitis and low back pain). The included articles were assessed for risk of bias using the Cochrane Risk of Bias tool. Details of the clinical population examined, the type of orthotic/prosthetic intervention, the comparator/s and the outcome measures were extracted. Effect sizes and odds ratios were calculated for all outcome measures, where possible. CONCLUSIONS At present, for prosthetic and orthotic interventions, the scientific literature does not provide sufficient high quality research to allow strong conclusions on their effectiveness and cost-effectiveness.
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Affiliation(s)
- Aoife Healy
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
| | - Sybil Farmer
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
| | - Anand Pandyan
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
- School of Health & Rehabilitation, Keele University, Keele, United Kingdom
| | - Nachiappan Chockalingam
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
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9
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Lee SW, Veeramachaneni R, Saleh IA, Morice K, Tiu T, Lo Y, Frison K, Bartels MN. Footwear-Generated Dynamic Biomechanical Manipulation and Perturbation Training for Chronic Nonspecific Low Back Pain. PM R 2018; 10:836-842. [PMID: 29474997 DOI: 10.1016/j.pmrj.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 01/20/2018] [Accepted: 02/12/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Home-based therapy optimizing biomechanics and neuromuscular control is increasingly recognized as a treatment option for chronic nonspecific low back pain (CNSLBP). However, its impact on pain, function, and gait is limited among patients in a metropolitan area. OBJECTIVE To evaluate the change of pain, function, and gait parameters with home-based therapy with the use of footwear-generated biomechanical manipulation and perturbation training in a population with CNSLBP in a metropolitan area. DESIGN Prospective observational study. SETTING Outpatient rehabilitation clinic at an academic teaching hospital. PARTICIPANTS One hundred sixteen patients with CNSLBP for more than 6 months. INTERVENTION Six months of home-based therapy with a biomechanical device using 4 modular elements attached to a foot-worn platform. MAIN OUTCOME MEASURES Instrumental gait analysis (gait velocity, step length, single limb support phase % of gait cycle), Numeric Rating Scale for pain, and Oswestry Disability Questionnaire Index for pain and function. RESULTS Only 43 patients (37.1%) completed the study. Among 43 patients, mean gait velocity increased from 86.6 ± 20.7 to 99.7 ± 22.1 cm/s (P < .0001) in 6 months. Mean left step length increased from 51.1 ± 8.4 to 54.8 ± 9.8 cm (P < .0001). Mean right step length increased from 51.0 ± 7.9 to 55.4 ± 9.0 cm (P < .0001). Mean single limb support increased from 36.4 ± 2.8 to 37.2 ± 2.5%, (P = .208) in the right side and from 36.6 ± 3.0 to 37.8 ± 4.4%, (P = .019) in the left side. Median Oswestry Disability Questionnaire Index score improved from 28 (18-44; interquartile range) to 17 (10-35) (P = .045). Mean Numeric Rating Scale for back pain improved from 7.7 ± 1.8 to 3.3 ± 3.1 (P < .0001). CONCLUSION At 6 months, patients with CNSLBP undergoing home-based therapy with footwear-generated biomechanical manipulation and perturbation training demonstrated significant improvement of objective gait parameters, pain, and function. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Se Won Lee
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467.,Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.,Albert Einstein College of Medicine, Bronx, NY
| | - Ratnakar Veeramachaneni
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467.,Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.,Albert Einstein College of Medicine, Bronx, NY
| | - Ibrahim Abou Saleh
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467.,Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.,Albert Einstein College of Medicine, Bronx, NY
| | - Karen Morice
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467.,Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.,Albert Einstein College of Medicine, Bronx, NY
| | - Timothy Tiu
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467.,Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.,Albert Einstein College of Medicine, Bronx, NY
| | - Yungtai Lo
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467.,Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.,Albert Einstein College of Medicine, Bronx, NY
| | - Kevin Frison
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467.,Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.,Albert Einstein College of Medicine, Bronx, NY
| | - Matthew N Bartels
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467.,Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.,Albert Einstein College of Medicine, Bronx, NY
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10
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Muscle activity and kinetics of lower limbs during walking in pronated feet individuals with and without low back pain. J Electromyogr Kinesiol 2018; 39:35-41. [PMID: 29413451 DOI: 10.1016/j.jelekin.2018.01.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/05/2018] [Accepted: 01/17/2018] [Indexed: 11/21/2022] Open
Abstract
The objectives of this study were to investigate whether excessive feet pronation alters the joints' kinematics, kinetics and the activity of involved muscles during gait in low back pain patients. METHODS The lower limb joints' motion, moment and power, as well as the activity of involved muscles during walking were measured in a control group, and two experimental groups including a group with excessive feet pronation only, and another group of low back pain patients with excessive feet pronation. RESULTS In both experimental groups, ankle inversion, knee flexion and internal rotation, hip internal rotation, plantar flexors' moment, hip flexors' moment, and peak positive ankle power were lower than those in control group (p < .05). Besides, in patients, higher activity of gastrocnemius medialis, gluteus medius, erector spinae, and internal oblique muscles, and lower negative power at the ankle and peak positive power at the knee were observed (p < .05). In conclusion, pronated feet with low back pain was associated with less ankle inversion and knee flexion, higher knee and hip internal rotation, higher muscle activity, less energy absorption at the ankle, and reduced positive power at the knee. This study reveals that strengthening of the muscles especially knee extensors are of great importance in low back pain patients with feet pronation.
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11
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Anderson J, Williams AE, Nester C. An explorative qualitative study to determine the footwear needs of workers in standing environments. J Foot Ankle Res 2017; 10:41. [PMID: 28861123 PMCID: PMC5577656 DOI: 10.1186/s13047-017-0223-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Many work places require standing for prolonged periods of time and are potentially damaging to health, with links to musculoskeletal disorders and acute trauma from workplace accidents. Footwear provides the only interaction between the body and the ground and therefore a potential means to impact musculoskeletal disorders. However, there is very limited research into the necessary design and development of footwear based on both the physical environmental constraints and the personal preference of the workers. Therefore, the purpose of this study was to explore workers needs for footwear in the ‘standing’ workplace in relation to MSD, symptoms, comfort and design. Method Semi-structured interviews were conducted with participants from demanding work environments that require standing for high proportions of the working day. Thematic analysis was used to analyse the results and gain an exploratory understanding into the footwear needs of these workers. Results Interviews revealed the environmental demands and a very high percentage of musculoskeletal disorders, including day to day discomfort and chronic problems. It was identified that when designing work footwear for standing environments, the functionality of the shoe for the environment must be addressed, the sensations and symptoms of the workers taken into account to encourage adherence and the decision influencers should be met to encourage initial footwear choice. Meeting all these criteria could encourage the use of footwear with the correct safety features and comfort. Development of the correct footwear and increased education regarding foot health and footwear choice could help to reduce or improve the effect of the high number of musculoskeletal disorders repeatedly recorded in jobs that require prolonged periods of standing. Conclusion This study provides a unique insight into the footwear needs of some workers in environments that require prolonged standing. This user based enquiry has provided information which is important to workplace footwear design.
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Affiliation(s)
- Jennifer Anderson
- Centre for Health Sciences Research, University of Salford, Salford, M5 4WT UK
| | - Anita E Williams
- Centre for Health Sciences Research, University of Salford, Salford, M5 4WT UK
| | - Christopher Nester
- Centre for Health Sciences Research, University of Salford, Salford, M5 4WT UK
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Cambron JA, Dexheimer JM, Duarte M, Freels S. Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil 2017; 98:1752-1762. [PMID: 28465224 DOI: 10.1016/j.apmr.2017.03.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/15/2017] [Accepted: 03/30/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To investigate the efficacy of shoe orthotics with and without chiropractic treatment for chronic low back pain compared with no treatment. DESIGN Randomized controlled trial. SETTING Integrative medicine teaching clinic at a university. PARTICIPANTS Adult subjects (N=225) with symptomatic low back pain of ≥3 months were recruited from a volunteer sample. INTERVENTIONS Subjects were randomized into 1 of 3 treatment groups (shoe orthotic, plus, and waitlist groups). The shoe orthotic group received custom-made shoe orthotics. The plus group received custom-made orthotics plus chiropractic manipulation, hot or cold packs, and manual soft tissue massage. The waitlist group received no care. MAIN OUTCOME MEASURES The primary outcome measures were change in perceived back pain (numerical pain rating scale) and functional health status (Oswestry Disability Index) after 6 weeks of study participation. Outcomes were also assessed after 12 weeks and then after an additional 3, 6, and 12 months. RESULTS After 6 weeks, all 3 groups demonstrated significant within-group improvement in average back pain, but only the shoe orthotic and plus groups had significant within-group improvement in function. When compared with the waitlist group, the shoe orthotic group demonstrated significantly greater improvements in pain (P<.0001) and function (P=.0068). The addition of chiropractic to orthotics treatment demonstrated significantly greater improvements in function (P=.0278) when compared with orthotics alone, but no significant difference in pain (P=.3431). Group differences at 12 weeks and later were not significant. CONCLUSIONS Six weeks of prescription shoe orthotics significantly improved back pain and dysfunction compared with no treatment. The addition of chiropractic care led to higher improvements in function.
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Affiliation(s)
- Jerrilyn A Cambron
- Department of Research, National University of Health Sciences, Lombard, IL.
| | | | - Manuel Duarte
- Department of Clinical Practice, National University of Health Sciences, Lombard, IL
| | - Sally Freels
- School of Public Health, Division of Epidemiology and Biostatistics, University of Illinois, Chicago, IL
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Farahpour N, Jafarnezhad A, Damavandi M, Bakhtiari A, Allard P. Gait ground reaction force characteristics of low back pain patients with pronated foot and able-bodied individuals with and without foot pronation. J Biomech 2016; 49:1705-1710. [PMID: 27086117 DOI: 10.1016/j.jbiomech.2016.03.056] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 03/25/2016] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED The link between gait parameters and foot abnormalities in association with low back pain is not well understood. The objective of this study was to investigate the effects of excessive foot pronation as well as the association of LBP with excessive foot pronation on the GRF components during shod walking. METHODS Forty-five subjects were equally divided into a control group, a group of subjects with pronated feet only, and another group with pronated feet and LBP. Ground reaction forces were analyzed during shod walking. RESULTS Foot pronation without low back pain was associated with increased lateral-medial ground reaction force, impulse, and time to peak of all reaction forces in heel contact phase (p<0.03). In low back pain patients with pronated foot, greater vertical reaction forces (p=0.001) and loading rate, and time to peak on propulsion force were observed compared to pronated foot without low back pain group. Impulse in posterior-anterior reaction force was smaller in the able-bodied group with normal foot than in the other groups (p<0.05). Positive peak of free moments of the LBP group was significantly greater than that in other groups (p<0.05). In conclusion, foot pronation alone was not associated with elevated vertical ground reaction forces. While, low back pain patients with foot pronation displayed higher vertical ground reaction force as well as higher loading rate. Present results reveal that gait ground reaction force components in low back pain patients with pronated foot may have clinical values on the prognosis and rehabilitation of mechanical LBP patients.
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Affiliation(s)
- Nader Farahpour
- Sport Biomechanics Department, Bu-Ali Sina University, Hamedan, Iran.
| | | | - Mohsen Damavandi
- Faculty of Physical Education and Sport Sciences, Hakim Sabzevari University, Sabzevar, Iran.
| | | | - Paul Allard
- Department of Kinesiology, University of Montreal, Montreal, QC, Canada.
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Papuga MO, Cambron J. Foot orthotics for low back pain: The state of our understanding and recommendations for future research. Foot (Edinb) 2016; 26:53-7. [PMID: 26896703 DOI: 10.1016/j.foot.2015.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 12/09/2015] [Accepted: 12/14/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of the article is to evaluate the literature on the use of foot orthotics for low back pain and to make specific recommendations for future research. METHODS Database searches were conducted using PubMed, EBSCO, GALE, Google Scholar, and clinicaltrials.gov. The biomedical literature was reviewed to determine the current state of knowledge on the benefits of foot orthotics for low back pain related to biomechanical mechanisms and clinical outcomes. RESULTS It may be argued that foot orthotics are experimental, investigational, or unproven for low back pain due to lack of sufficient evidence for their clinical effectiveness. This conclusion is based upon lack of high quality randomized controlled trials (RCTs). However, there is extensive research on biomechanical mechanisms underlying the benefits of orthotics that may be used to address this gap. Additionally, promising pilot studies are beginning to emerge in the literature and ongoing large-scale RCTs are addressing effects of foot orthotics on chronic low back pain. CONCLUSIONS Based upon the critical evaluation of the current research on foot orthotics related to biomechanical mechanisms and clinical outcomes, recommendations for future research to address the evidence-practice gaps on the use of foot orthotics for low back pain are presented.
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Affiliation(s)
- M Owen Papuga
- Research Department, New York Chiropractic College, United States.
| | - Jerrilyn Cambron
- Department of Research, National University of Health Sciences, United States
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Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. PHYSICAL THERAPY REVIEWS 2014; 19:252-265. [PMID: 25143704 PMCID: PMC4117383 DOI: 10.1179/108331913x13844245102034] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an 'intramuscular' procedure involving the isolated treatment of 'myofascial trigger points' (MTrPs). OBJECTIVES To operationalize an appropriate definition for dry needling based on the existing literature and to further investigate the optimal frequency, duration, and intensity of dry needling for both spinal and extremity neuromusculoskeletal conditions. MAJOR FINDINGS According to recent findings in the literature, the needle tip touches, taps, or pricks tiny nerve endings or neural tissue (i.e. 'sensitive loci' or 'nociceptors') when it is inserted into a MTrP. To date, there is a paucity of high-quality evidence to underpin the use of direct dry needling into MTrPs for the purpose of short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. Furthermore, there is a lack of robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis. High-quality studies have also demonstrated that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners. CONCLUSIONS Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) using in-and-out techniques such as 'pistoning' or 'sparrow pecking'; however, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist, and the practice should therefore be questioned. The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature. Physical therapists should not ignore the findings of the Western or biomedical 'acupuncture' literature that have used the very same 'dry needles' to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials. Although the optimal frequency, duration, and intensity of dry needling has yet to be determined for many neuromusculoskeletal conditions, the vast majority of dry needling randomized controlled trials have manually stimulated the needles and left them in situ for between 10 and 30 minute durations. Position statements and clinical practice guidelines for dry needling should be based on the best available literature, not a single paradigm or school of thought; therefore, physical therapy associations and state boards of physical therapy should consider broadening the definition of dry needling to encompass the stimulation of neural, muscular, and connective tissues, not just 'TrPs'.
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Affiliation(s)
- James Dunning
- Alabama Physical Therapy & Acupuncture, Montgomery, AL, USA
- American Academy of Manipulative Therapy, Montgomery, AL, USA
| | - Raymond Butts
- University of South Carolina, Columbia, SC, USA
- Palmetto Health Research Physical Therapy Specialists, Columbia, SC, USA
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Novel continuous passive motion device for self-treatment of chronic lower back pain: a randomised controlled study. Physiotherapy 2014; 101:75-81. [PMID: 25280603 DOI: 10.1016/j.physio.2014.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 06/26/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a novel, angular, continuous passive motion device for self-treatment at home in patients with mild-to-moderate, non-specific, chronic low back pain (LBP). DESIGN Prospective, randomised, waiting-list-controlled (WLC) trial. SETTING Recruitment and assessment were conducted at the Koren Centre for Physical Therapy. Self-treatment was performed at home. PARTICIPANTS Thirty-six patients with a score ≤6 on the numeric rating scale (NRS) for pain were enrolled. Twenty-eight patients completed treatment. INTERVENTIONS Participants were randomised to receive the Kyrobak (Radiancy, Hod-hasharon, Israel) at enrolment [immediate treatment (IT) group] or 3 weeks later (WLC group). Self-treatment was prescribed for 10minutes, one to three times per day, for 3 weeks. The treatment period was followed by a 3-week follow-up period. MAIN OUTCOME MEASURES Primary outcome was self-reported pain level (NRS). RESULTS Three weeks of self-treatment with the Kyrobak reduced pain levels significantly in the IT group compared with the WLC group {mean [standard deviation (SD)] ΔNRS score from baseline to post-treatment: IT group, 1.4 (1.5), 95% confidence interval (CI) 0.5 to 2.3; WLC group, -0.1 (2.2), 95% CI -1.1 to 1.2; effect mean difference 1.5}. This benefit was maintained over the follow-up period [from baseline to end of follow-up, mean (SD) ΔNRS score 1.1 (1.8), 95% CI 0.4 to 1.8]. Multi-linear regression analysis found that higher baseline pain resulted in greater pain reduction (P=0.003). Eighty-three percent of participants with a baseline NRS score >4.35 (threshold determined by logistic regression, P=0.01) achieved the minimal important change criterion of ΔNRS score ≥2. Daily NRS score reduced gradually over the treatment period [regression slope -0.052 (0.01), 95% CI -0.07 to -0.03]. CONCLUSIONS Preliminary evidence suggests that the Kyrobak may be beneficial for short-term relief of non-specific, chronic LBP, particularly in participants with a moderate level of pain. A longer treatment period may lead to a further reduction in pain.
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Kendall JC, Bird AR, Azari MF. Foot posture, leg length discrepancy and low back pain--their relationship and clinical management using foot orthoses--an overview. Foot (Edinb) 2014; 24:75-80. [PMID: 24703513 DOI: 10.1016/j.foot.2014.03.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 03/03/2014] [Accepted: 03/06/2014] [Indexed: 02/04/2023]
Abstract
Mechanical low back pain (LBP) is a very common, expensive, and significant health issue in the western world. Functional musculoskeletal conditions are widely thought to cause mechanical low back pain. The role of foot posture and leg length discrepancy in contributing to abnormal biomechanics of the lumbopelvic region and low back pain is not sufficiently investigated. This critical review examines the evidence for the association between foot function, particularly pronation, and mechanical LBP. It also explores the evidence for a role for foot orthoses in the treatment of this condition. There is a body of evidence to support the notion that foot posture, particularly hyperpronation, is associated with mechanical low back pain. Mechanisms that have been put forward to account for this finding are based on either mechanical postural changes or alterations in muscular activity in the lumbar and pelvic muscles. More research is needed to explore and quantify the effects of foot orthoses on chronic low back pain, especially their effects on lumbopelvic muscle function and posture. The clinical implications of this work are significant since foot orthoses represent a simple and potentially effective therapeutic measure for a clinical condition of high personal and social burden.
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Affiliation(s)
- Julie C Kendall
- Discipline of Chiropractic, School of Health Sciences, RMIT University, Melbourne, Australia
| | - Adam R Bird
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Melbourne, Australia
| | - Michael F Azari
- Discipline of Chiropractic, School of Health Sciences, RMIT University, Melbourne, Australia; Health Innovations Research Institute, RMIT University, Melbourne, Australia.
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Chuter V, Spink M, Searle A, Ho A. The effectiveness of shoe insoles for the prevention and treatment of low back pain: a systematic review and meta-analysis of randomised controlled trials. BMC Musculoskelet Disord 2014; 15:140. [PMID: 24775807 PMCID: PMC4107719 DOI: 10.1186/1471-2474-15-140] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 04/04/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is a significant public health problem in Western industrialised countries and has been reported to affect up to 80% of adults at some stage in their lives. It is associated with high health care utilisation costs, disability, work loss and restriction of social activities. An intervention of foot orthoses or insoles has been suggested to reduce the risk of developing LBP and be an effective treatment strategy for people suffering from LBP. However, despite the common usage of orthoses and insoles, there is a lack of clear guidelines for their use in relation to LBP. The aim of this review is to investigate the effectiveness of foot orthoses and insoles in the prevention and treatment of non specific LBP. METHODS A systematic search of MEDLINE, CINAHL, EMBASE and The Cochrane Library was conducted in May 2013. Two authors independently reviewed and selected relevant randomised controlled trials. Quality was evaluated using the Cochrane Collaboration Risk of Bias Tool and the Downs and Black Checklist. Meta-analysis of study data were conducted where possible. RESULTS Eleven trials were included: five trials investigated the treatment of LBP (n=293) and six trials examined the prevention of LBP (n=2379) through the use of foot orthoses or insoles. Meta-analysis showed no significant effect in favour of the foot orthoses or insoles for either the treatment trials (standardised mean difference (SMD) -0.74, CI 95%: -1.5 to 0.03) or the prevention trials (relative risk (RR) 0.78, CI 95%: 0.50 to 1.23). CONCLUSIONS There is insufficient evidence to support the use of insoles or foot orthoses as either a treatment for LBP or in the prevention of LBP. The small number, moderate methodological quality and the high heterogeneity of the available trials reduce the strength of current findings. Future research should concentrate on identification of LBP patients most suited to foot orthoses or insole treatment, as there is some evidence that trials structured along these lines have a greater effect on reducing LBP.
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Affiliation(s)
- Vivienne Chuter
- Discipline of Podiatry, University of Newcastle, Sydney, NSW, Australia
| | - Martin Spink
- Discipline of Podiatry, University of Newcastle, Sydney, NSW, Australia
| | - Angela Searle
- Discipline of Podiatry, University of Newcastle, Sydney, NSW, Australia
| | - Alan Ho
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, PO Box 127 Ourimbah, Sydney, NSW 2258, Australia
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Rosner AL, Conable KM, Edelmann T. Influence of foot orthotics upon duration of effects of spinal manipulation in chronic back pain patients: a randomized clinical trial. J Manipulative Physiol Ther 2014; 37:124-40. [PMID: 24412249 DOI: 10.1016/j.jmpt.2013.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 10/30/2013] [Accepted: 11/01/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effects of 4 weeks of custom foot orthotics on pain, disability, recurrence of spinal fixation, and muscle dysfunction in adult low back pain patients receiving limited chiropractic care. METHODS Adult volunteers with low back pain of greater than or equal to 1 month's duration were randomized to receive custom orthotics (group A) or a flat insole sham (group B) with limited chiropractic care in 5 visits over 4 weeks. Primary outcome measures are as follows: Quadruple Numerical Pain Rating Scale (for back), the Roland-Morris Disability Questionnaire, the number of muscles grade 4 or lower on manual muscle testing, and the number of spinal fixations detected by motion palpation and vertebral challenge at intake (B1), 2 weeks later before treatment began and orthotic use was initiated (B2) and before each subsequent treatment at approximately days 3, 10, 17, and 24 after B2. Secondary outcome measures are correlations of all primary outcomes. RESULTS Both groups improved on all Numerical Pain Rating Scale, Roland-Morris Disability Questionnaire, and the number of muscles from intake (B1) to final visit. Only group B yielded significant improvements in the number of spinal fixations. No outcome measures showed statistical difference between groups at any time point; however, those who wore custom orthotics longer each day showed trends toward greater improvements in some outcome measures. CONCLUSIONS Both groups improved with chiropractic care including spinal manipulation; however, there were no statistical differences shown between sham and custom orthotic groups. Future studies should formally measure the time that orthotics or shams are worn in a weight-bearing capacity each day.
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Affiliation(s)
- Anthony L Rosner
- Research Director, International College of Applied Kinesiology, Shawnee Mission, KS.
| | - Katharine M Conable
- Associate Professor, Chiropractic Division, Logan University/College of Chiropractic, Chesterfield, MO
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Castro-Méndez A, Munuera PV, Albornoz-Cabello M. The short-term effect of custom-made foot orthoses in subjects with excessive foot pronation and lower back pain: a randomized, double-blinded, clinical trial. Prosthet Orthot Int 2013; 37:384-90. [PMID: 23327838 DOI: 10.1177/0309364612471370] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN randomized, double-blinded, clinical trial. BACKGROUND Low back pain is one of the commonest disorders affecting the back. The literature reflects how over time excessive pronation of the foot has become to be recognized as linked to chronic low back pain, and how the problem can evolve for the better with the use of compensating foot orthoses. OBJECTIVES The main objective of this study is to answer the question of whether the use of a certain type of custom-made foot orthosis alleviates low back pain. MATERIAL AND METHODS In a sample of 51 participants with excessive subtalar pronation and chronic low back pain (43 women and 8 men), the effect of custom-made foot orthoses in low back pain was studied. The study design was a randomized, double-blinded, clinical trial with two groups: experimental, treated with the custom-made foot orthoses, and control, treated with a placebo. Low back pain was evaluated by a visual analog scale for pain and Oswestry's Disability Index Questionnaire for lower back pain at two moments--on the day of inclusion in the study and after 4 weeks of treatment. RESULTS The evolution of the low back pain showed significant differences in the experimental group, showing a significant reduction of pain and disability (p < 0.001, visual analog scale; p < 0.001, Oswestry's Index). CONCLUSIONS In the sample studied, the use of custom-made foot orthoses to control foot pronation had a short-term effect in reduction of perceived low back pain.
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Menz HB, Dufour AB, Riskowski JL, Hillstrom HJ, Hannan MT. Foot posture, foot function and low back pain: the Framingham Foot Study. Rheumatology (Oxford) 2013; 52:2275-82. [PMID: 24049103 DOI: 10.1093/rheumatology/ket298] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Abnormal foot posture and function have been proposed as possible risk factors for low back pain, but this has not been examined in detail. The objective of this study was to explore the associations of foot posture and foot function with low back pain in 1930 members of the Framingham Study (2002-05). METHODS Low back pain, aching or stiffness on most days was documented on a body chart. Foot posture was categorized as normal, planus or cavus using static weight-bearing measurements of the arch index. Foot function was categorized as normal, pronated or supinated using the centre of pressure excursion index derived from dynamic foot pressure measurements. Sex-specific multivariate logistic regression models were used to examine the associations of foot posture, foot function and asymmetry with low back pain, adjusting for confounding variables. RESULTS Foot posture showed no association with low back pain. However, pronated foot function was associated with low back pain in women [odds ratio (OR) = 1.51, 95% CI 1.1, 2.07, P = 0.011] and this remained significant after adjusting for age, weight, smoking and depressive symptoms (OR = 1.48, 95% CI 1.07, 2.05, P = 0.018). CONCLUSION These findings suggest that pronated foot function may contribute to low back symptoms in women. Interventions that modify foot function, such as orthoses, may therefore have a role in the prevention and treatment of low back pain.
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Affiliation(s)
- Hylton B Menz
- Institute for Aging Research, Hebrew Senior Life, 1200 Centre Street, Boston, MA 02131, USA.
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Ferrari R. Effects of customized foot orthotics on reported disability and analgesic use in patients with chronic low back pain associated with motor vehicle collisions. J Chiropr Med 2013; 12:15-9. [PMID: 23997719 DOI: 10.1016/j.jcm.2013.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 08/01/2012] [Accepted: 02/03/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare reported disability due to chronic low back pain following a motor vehicle collision between groups of those using customized foot orthotics and those not using orthotics. METHODS Sixty-six consecutive patients referred from primary care medical physicians for the complaint of chronic (> 3 months) low back pain following a motor vehicle collision were included. Thirty patients received "usual care" that included prescription of an exercise therapy program in addition to analgesics. Thirty-four patients received the same therapy along with customized foot orthotics. All patients completed the Oswestry Disability Index at the initiation of the study and at 8-week follow-up. The number of participants using any type of prescription analgesic for their back pain at baseline and at 8 weeks was also recorded. RESULTS All patients completed treatment, and the baseline and 8-week questionnaires. Both treatment groups were well matched in terms of age, sex distribution, and duration of low back pain, as well as baseline Oswestry Disability Index score. At 8 weeks, although both groups had improved, the group that used orthotics had a lower Oswestry Disability Index than the usual care group (P < .05), with a smaller proportion of the orthotics group using any form of prescribed analgesics for back pain (P < .05). CONCLUSIONS In this study, patients with chronic low back pain following a motor vehicle collision who used orthotics in addition to usual care had improved short-term outcomes compared with usual care alone.
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Affiliation(s)
- Robert Ferrari
- Clinical Professor, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Ferrari R. Effect of Customized Foot Orthotics in Addition to Usual Care for the Management of Chronic Low Back Pain Following Work-Related Low Back Injury. J Manipulative Physiol Ther 2013; 36:359-63. [PMID: 23830710 DOI: 10.1016/j.jmpt.2013.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 03/20/2013] [Accepted: 03/22/2013] [Indexed: 10/26/2022]
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Learman KE, Showalter C, O'Halloran B, Cook CE. Thrust and nonthrust manipulation for older adults with low back pain: an evaluation of pain and disability. J Manipulative Physiol Ther 2013; 36:284-91. [PMID: 23769265 DOI: 10.1016/j.jmpt.2013.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 02/07/2013] [Accepted: 03/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of the study was to compare the effects of thrust manipulation (TM) and non-TM (NTM) on a sample of older subjects with low back pain. METHODS This is a secondary data analysis of a randomized control trial. Forty-nine subjects aged 55 to 88 years participated in the trial, who received either a TM or NTM on at least 2 occasions during the course of care, and were extracted from the larger data set. The treatment program included a standardized home exercise program for the first 2 sessions, which could be modified by the therapist after those 2 sessions. Numeric pain rating scale and Oswestry Disability Index (ODI) were the outcomes for this study. RESULTS Multivariate analysis revealed no significant between-group differences for treatment group (P=.99) without group×time interaction (P=.90). Significant within-group changes were observed for both groups for ODI and numeric pain rating scale (P<.001); the average self-report of recovery was 78.0% (SD, 19.8%). Age stratification of the older subset revealed between-group differences in ODI change scores for the oldest subjects (>70 years) compared with 60 to 69 years (P=.02). CONCLUSIONS This study showed that outcomes for both TM and NTM improved in older adults with low back pain.
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Affiliation(s)
- Kenneth E Learman
- Department of Physical Therapy, Youngstown State University, Youngstown, Ohio 44555, USA.
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Ferrari R. A cohort-controlled trial of the addition of customized foot orthotics to standard care in fibromyalgia. Clin Rheumatol 2012; 31:1041-5. [PMID: 22426704 DOI: 10.1007/s10067-012-1966-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 02/22/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
Customized foot orthotics are widely prescribed for patients with chronic, non-specific low back pain and lower limb pain, but there are few trials demonstrating effectiveness, and none for fibromyalgia. A total of 67 consecutive patients presenting with chronic, widespread pain, who met the 1990 American College of Rheumatology criteria for fibromyalgia, were included in the study. A total of 32 subjects were prescribed a spinal exercise therapy program along with analgesics. These subjects formed the Control group. A second group, comprised of 35 subjects, received the same therapy, along with customized foot orthotics (Orthotics group). All subjects completed the Revised Fibromyalgia Impact Questionnaire (FIQR) at the initiation of the study and at 8 weeks follow-up. The number of subjects using any type of prescription analgesic or other medication for chronic pain at baseline and at 8 weeks was also recorded. A total of 30 subjects in the Control group and 33 in the Orthotics group completed the study. All subjects completed the baseline and 8-week FIQR. The two groups were well matched in terms of age (45.3 ± 11.5 years in the Orthotics group vs. 47.2 ± 8.7 years in the cohort Control), medication use, duration of pain (6.5 ± 4.3 years in the Orthotics group vs. 6.2 ± 3.4 years in the cohort Control group), as well as baseline FIQR scores (55.2 ± 11.0 in the Orthotics group vs. 56.3 ± 12.2 in the cohort Control group). At 8 weeks, the Orthotics group had a greater reduction in the FIQR score than the cohort Control group (reduction of 9.9 ± 5.9 vs. 4.3 ± 4.4, respectively), and this was mainly due to changes in the 'function' domain of the FIQR (reduction of 19.6 ± 9.4 in the Orthotics group vs. 8.1 ± 4.3 in the cohort Control group). As part of a complex intervention, in a cohort-controlled trial of primary care patients with fibromyalgia, the addition of custom-made foot orthotics to usual care appears to improve functioning in the short term.
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Affiliation(s)
- Robert Ferrari
- Department of Medicine, 13-103 Clinical Sciences Building, University of Alberta, 11350-83 Avenue, Edmonton, Alberta, Canada T6G 2P4.
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