The effects of isometric exercise types on pain and muscle activity in patients with low back pain

Non-Operative Rehabilitation Principles for Use in Individuals with Acetabular Dysplasia: A North American Based Delphi Study

Background

Acetabular dysplasia (AD) is defined as a structurally deficient acetabulum and is a well-recognized cause of hip pain in young adults. While treatment of severe AD with a periacetabular osteotomy has demonstrated good long-term outcomes, a trial of non-operative management is often recommended in this population. This may be especially true in patients with milder deformities. Currently, there is a paucity of research pertaining to non-operative management of individuals with AD.

Purpose

To present expert-driven non-operative rehabilitation guidelines for use in individuals with AD.

Study Design

Delphi study.

Methods

A panel of 15 physiotherapists from North America who were identified as experts in non-operative rehabilitation of individuals with AD by a high-volume hip preservation surgeon participated in this Delphi study. Panelists were presented with 16 questions regarding evaluation and treatment principles of individuals with AD. A three-step Delphi method was utilized to establish consensus on non-operative rehabilitation principles for individuals presenting with AD.

Results

Total (100%) participation was achieved for all three survey rounds. Consensus, defined a piori as > 75%, was reached for 16/16 questions regarding evaluation principles, activity modifications, appropriate therapeutic exercise progression, return to activity/sport criteria, and indications for physician referral.

Conclusion

This North American based Delphi study presents expert-based consensus on non-operative rehabilitation principles for use in individuals with AD. Establishing guidelines for non-operative management in this population will help reduce practice variation and is the first step in stratifying individuals who would benefit from non-operative management. Future research should focus on patient-reported outcomes and rate of subsequent surgical intervention to determine the success of the guidelines reported in this study.

Level of Evidence

Level V.

[Yoga as an intervention for chronic pain]

The use of yoga, especially as an intervention for chronic pain, is increasing worldwide. Available data on chronic low back pain, within limits also for chronic neck pain and certain types of headache, show statistically significant positive effects related to pain intensity and pain-related impairments. The data provide evidence that yoga is at least equal in efficacy and safety to other exercise interventions as well as individualized physical therapy. The dose of the intervention seems to be of secondary importance, but the establishment of a long-term independent practice after initial supervision seems to be essential; however, for other pain disorders there is still a need for research.

Effects of Isometric Strength and Plyometric Training on Running Performance: A Randomized Controlled Study

Purpose: The aim of the study was to compare the effects of isometric strength (IST) and plyometric training (PT) on endurance running performance. Methods: Twenty-six endurance runners (18 males and 8 females; age 36 ± 6 years, stature 1.69 ± 0.05 m body mass 61.6 ± 8.0 kg, VO_2max 50.4 ± 5.8 ml·kg^-1·min^-1) completed the countermovement jump (CMJ), isometric mid-thigh pull (IMTP), 2.4 km run time trial (2.4kmTT), running economy test (RE) and a graded exercise test measures at baseline. They were then randomly assigned to three groups, the control (CON), PT or IST group, and completed the circuit, plyometric or isometric training, respectively, twice a week for 6 weeks, while still continuing to perform their planned running training. They then completed the same set of measures performed at baseline post-intervention. Results: Significant time x group interactions and time main effect were observed for 2.4kmTT (P = .002, ƞ²_p = .45 and P < .001, ƞ² =0.72), maximal aerobic speed (MAS) (P = .006, ƞ²_p = .39), CMJ height (P < .001, ƞ²_p = .55) and IMTP relative peak force (P = .001, ƞ²_p = .50) in favor of PT and IST. Significant main effect for time was observed for 2.4kmTT (P < .001, ƞ²_p = .72), RE (P = .048, ƞ²_p = .17), VO_2max (P = .047, ƞ²_p = .18), MAS (P < .001, ƞ²_p = .63), CMJ height (P < .001, ƞ²_p = .51) and IMTP relative peak force (P < .001, ƞ²_p = .58). Conclusion: In conclusion, both PT and IST were similarly effective at enhancing running endurance performance. However, IST resulted in greater improvement to RE.

Interdisciplinary Co-Design Research Practice in the Rehabilitation of Elderly Individuals with Chronic Low Back Pain from a Senior Care Center in South Korea

The rehabilitation practices encounter multifaceted problems inherent in the current context of the elderly with chronic low back pain (LBP). We addressed a particular multifaceted problem in the current context using an interdisciplinary co-design research practice that consists of three phases: context exploration, patient-expert interaction, and patient-centered rehabilitation. Using an empirical study integrated with this practice, we investigated 30 Korean elderly patients suffering from LBP and introduced an exercise program design. In the context exploration phase, we found that the elderly patients neglected proper posture during work causing spine instability and resultantly developing chronic LBP. The patient–expert interaction phase explored latissimus dorsi (LD) and lumbar erector spinae (LES) muscles as the back trunk muscles that had caused LBP in most of these elderly patients. In the patient-centered rehabilitation phase, we designed an exercise program with exercise protocols and an exercise object for flexion and extension of trunk muscle relaxation and stabilization. Using electromyography (EMG), we found that the exercise program significantly increased the muscle activation levels of the muscles and reduced LBP. Our practice defines and addresses a multifaceted problem with several challenges both in healthcare design and the problem itself. This integrated approach can easily be expanded and adapted to other domain-related research projects that possess characteristics of complex problems.

The identification of preliminary prognostic indicators that predict treatment response for exercise therapy in patients with nonspecific chronic low back pain: A multiple-arm cohort study design

BACKGROUND

For patients with nonspecific chronic low back pain (CLBP), exercise therapy is stated to be the most effective intervention strategy but it is unclear which kind of exercise therapy is most beneficial.

OBJECTIVE

To identify preliminary prognostic indicators that predict outcome for exercise therapy in patients with nonspecific CLBP.

METHODS

Patients were recruited in two hospitals and received 18 intervention sessions: stabilization therapy, isometric training therapy or a combination therapy. The primary outcome measure was the change in the Modified Low Back Pain Disability Questionnaire after nine weeks.

RESULTS

A total of 59 patients completed the study which represents a statistical power of 90%. In total, 30 patients were categorized as having treatment success and 29 as treatment failure. After using regression analyses to determine the association between standardized examination variables and treatment response status, prognostic indicators were identified for predicting therapy success (positive likelihood ratio [LR], 3.8) and failure (negative LR, 0.19).

CONCLUSIONS

The most important variables were the prone instability test, pelvic tilt test, straight leg raise, body weight, visual analogue scale and the short form 36 health survey.

Treating low back pain - Bridging the gap between manual therapy and exercise

As therapists, we often recommend exercise to reduce patients' low-back pain, as well as increase their active range of motion and muscle strength. However, physical therapists face a challenge when recommending exercise to reduce low-back pain because the pain itself often inhibits the patient's ability to exercise or perform activities of daily living. This situation becomes even more challenging if the prescribed exercise program aggravates the individual's low-back pain. This article discusses a method which provides for the effective treatment of low back pain by allowing patients to exercise pain free earlier in the rehabilitation process. The method comprises a unique approach utilizing the following four components simultaneously from the onset of treatment: isometric muscle contraction (IMC); assisted active oscillatory mobilization; end-of-range passive stretch; and mindfulness.

The effects of the addition of motor imagery to home exercises on pain, disability and psychosocial parameters in patients undergoing lumbar spinal surgery: A randomized controlled trial

CONTEXT

Patients who have suffered from persistent symptoms often undergo lumbar spinal surgery (LSS). Motor imagery should be added to postoperative home exercises to reduce patient complaints.

OBJECTIVE

The aim of this study was to compare the effects of home exercise plus motor imagery and only home exercise in patients undergoing LSS.

DESIGN

A randomized controlled study.

SETTINGS

This study was designed by researchers at Dokuz Eylul University.

PARTICIPANTS

Thirty-seven patients undergoing LSS were randomized to motor imagery group (n = 19) and control group (n = 18).

MAIN OUTCOME MEASURES

Pain was measured by Visual Analogue Scale, disability related to low back pain by Oswestry Disability Index, pain-related fear by Tampa Scale of Kinesiophobia, depression by Beck Depression Inventory, quality of life by World Health Organization Quality of Life Scale-Short Form (WHOQOL-BREF). All assessments were repeated in the preoperative period, three weeks after and six weeks after the surgery.

INTERVENTIONS

Motor imagery group underwent home exercise plus motor imagery program applied by voice recording. Control group underwent only home exercise program. Exercise program compliance was monitored by exercise diary and telephone calls once every week.

RESULTS

There was a significant improvement in pain at rest and during activity, disability, kinesiophobia, depression, physical health and psychological sub-parameters of WHOQOL-BREF between preoperative period, and the third week and sixth week in both groups (p < 0.05). When comparing groups for gain scores, there was a more significant improvement in pain during activity in motor imagery group (p < 0.05). Motor imagery should be addressed as an effective treatment after LSS.