Epidemiology of neuromuscular injuries in guitar players living in Portugal: Associated risk factors

BACKGROUND

Playing guitar involves several physical demands, most inclusive of which are long hours of practice, which can make musculoskeletal symptoms common.

OBJETIVE

To determine the epidemiology of neuromuscular injuries in guitar players residing in Portugal and risk factors.

METHODS

The sample consisted of 105 guitar players, being 103 (98.10%) men, aged between 30-75 years (29,83±10,23). The measurement instrument used was a digital survey, shared by email, on social networks and in person.

RESULTS

Fifty-six (53.30%) guitar players had injuries throughout their musical practice, totaling 132 injuries, 13 (12.40%) guitar players were injured at the time of assessment and 31 (29.5%) guitar players had injuries in the last 12 months, totaling 63 injuries. The value of injury proportion was 0.29 (CI 95% : 0.14-0.44) and the injury rate was 0.42 injuries per 1,000 hours of music practice. The most common types of injury were: tendinopathy (22; 34.92%) and low back pain (9; 14.29%). The most affected anatomical sites were: wrist (18; 28.57%) and lumbar spine (10; 15.87%). Repetitive movement was the injury mechanism most mentioned by guitar players (24; 35.29%) followed by maintaining postures for a prolonged period of time (15; 22.06%). Guitar players who did not warm up before practicing were 0.33 (CI: 0.13-0.79; p = 0.013) more likely to have an injury.

CONCLUSIONS

There was a high percentage of injuries in guitar players and failure to warm up was a risk factor for the development of injuries. This type of study can help in creating injury prevention strategies in this type of population.

The changes of blood-based inflammatory biomarkers after non-pharmacologic interventions for chronic low back pain: a systematic review

BACKGROUND

Chronic low back pain (CLBP) is a prevalent and debilitating condition, leading to significant challenges to both patients and the governmental healthcare system. Non-pharmacologic interventions have received increasing attention as potential strategies to alleviate chronic low back pain and improve patient outcomes. The aim of this systematic review was to comprehensively assess the changes in blood inflammatory biomarkers after non-pharmacologic interventions for CLBP patients, thus trying to understand the complex interactions between non-pharmacologic interventions and inflammatory biomarker changes in CLBP.

METHODS

A thorough search (from January 1st, 2002 to October 5th, 2022) of PubMed, Medline (platform Web of Science), and the Cochrane Library (platform Wiley Online Library) were conducted, and inclusion criteria as well as exclusion criteria were refined to selection of the studies. Rigorous assessments of study quality were performed using RoB 2 from Cochrane or an adaptation of the Downs and Black checklist. Data synthesis includes alterations in inflammatory biomarkers after various non-pharmacologic interventions, including exercise, acupressure, neuro-emotional technique, and other modalities.

RESULTS

Thirteen primary studies were included in this systematic review, eight randomized controlled trials, one quasi-randomized trial, and four before-after studies. The interventions studied consisted of osteopathic manual treatment (one study), spinal manipulative therapy (SMT) (three studies), exercise (two studies), yoga (two studies) and acupressure (two studies), neuro-emotional technique (one study), mindfulness-based (one study) and balneotherapy study (one study). Four studies reported some changes in the inflammatory biomarkers compared to the control group. Decreased tumor necrosis factor-alpha (TNF-α) after osteopathic manual treatment (OMT), neuro-emotional technique (NET), and yoga. Decreased interleukin (IL)-1, IL-6, IL-10, and c-reactive protein (CRP) after NET, and increased IL-4 after acupressure. Another five studies found changes in inflammatory biomarkers through pre- and post-intervention comparisons, indicating improvement outcomes after intervention. Increased IL-10 after balneotherapy; decreased TNF-α, IL-1β, IL-8, Interferon-gamma, interferon-γ-induced protein 10-γ-induced protein 10 after exercise; decreased IL-6 after exercise and SMT; decreased CRP and chemokine ligand 3 after SMT.

CONCLUSION

Results suggest a moderation of inflammatory biomarkers due to different non-pharmacologic interventions for CLBP, generally resulting in decreased pro-inflammatory markers such as TNF-α and IL-6 as well as increased anti-inflammatory markers such as IL-4, thus revealing the inhibition of inflammatory processes by different non-pharmacologic interventions. However, a limited number of high-quality studies evaluating similar interventions and similar biomarkers limits the conclusion of this review.

Efficacy of Core Muscle Exercise Combined with Interferential Therapy in Alleviating Chronic Low Back Pain in High-Performance Fighter Pilots: A Randomized Controlled Trial

BACKGROUND

Chronic low back pain (LBP) related to flight is a prevalent health issue in military aviation, impacting pilots. The objective of this investigation was to ascertain if the application of core muscle training in conjunction with interferential current (IFC) therapy results in a reduction in pain severity and associated disability, consequently enhancing core muscle functionality in Chinese Air Force high-performance fighter pilots experiencing chronic LBP.

METHODS

Fifty-three fighter pilots with chronic LBP were randomized into 3 groups: a core muscle exercise combined with IFC group (CG, n = 19), a core muscle exercise group (EG, n = 19), and an IFC group (IG, n = 15). The three groups underwent therapeutic intervention 5 times a week for 12 weeks. The primary outcomes were pain intensity, Oswestry Disability Index (ODI) score and SF-12 health-related quality of life (PCS and MCS) score. Secondary outcomes included evaluations of trunk muscle strength, endurance, and range of motion (ROM) during medial/lateral rotation to assess muscle functionality. Measurements were obtained both before and after the implementation of the intervention therapy.

RESULTS

After 12 weeks of intervention therapy, all the health condition parameters significantly improved among the three groups. However, the CG had a significant improvement in pain intensity compared to the EG (MD = - 0.84 scores; 95% CI = - 1.54 to - 0.15; p = 0.013) and the IG (MD = - 1.22 scores; 95% CI = - 1.96 to - 0.48; p = 0.000). Additionally, the CG led to greater conservation of ODI and improved SF-12 PCS scores than did the IG (p < 0.05). Finally, compared with those at baseline, the core muscle function parameters in the CG and EG improved significantly at the end of the study, but no statistically significant differences were observed between the two groups (p > 0.05).

CONCLUSION

Among participants with chronic LBP, three intervention therapies appear effective in reducing pain, diminishing disability, and enhancing quality of life. Also, combined therapy significantly improved pain and disability compared to the other two monotherapies; moreover, combined therapy and core muscle exercise provided similar benefits in terms of core muscle function after 12 weeks of intervention therapy.

The relationship between lower extremity muscle tightness and pain and disability in individuals with non-specific chronic low back pain

BACKGROUND

Low back pain is a common health issue, and such pains are often associated with muscle tightness. Understanding the link between lower back pain and tight lower extremity muscles is essential for effective pain management and enhanced quality of life.

OBJECTIVE

The objective of this study was to investigate the relationship between lower extremity muscle tightness and pain and disability in individuals with non-specific low back pain (NSLBP).

METHODS

A total of 52 individuals with NSLBP were enrolled in this cross-sectional study. Lower extremity muscle tightness was assessed using various clinical tests, including the Active Knee Extension Test, Active Straight Leg Raise, Ober Test, and Modified Thomas Test. Pain intensity and disability were evaluated using the Visual Analog Scale and the Oswestry Disability Index, respectively. Statistical analyses were conducted to assess the correlation between muscle tightness, pain, and disability.

RESULTS

The study found weak to moderate negative correlations between lower extremity muscle tightness and both pain intensity and disability in individuals with NSLBP (r: -0.287 to -0.526, p <  0.05). Dominant and non-dominant extremities exhibited differences in muscle flexibility, with the dominant extremity showing greater flexibility (p <  0.05).

CONCLUSIONS

In individuals with NSLBP, lower extremity muscle tightness is closely related to pain severity and disability. These findings suggest that lower extremity muscle tightness plays a significant role in the severity of low back pain and disabilities. Additionally, the observed flexibility difference between dominant and non-dominant extremities warrants further investigation for more personalized treatment approaches.

Water-Based Exercise in Patients With Nonspecific Chronic Low-Back Pain: A Systematic Review With Meta-Analysis

ABSTRACT

Babiloni-Lopez, C, Fritz, N, Ramirez-Campillo, R, and Colado, JC. Water-based exercise in patients with nonspecific chronic low-back pain: a systematic review with meta-analysis. J Strength Cond Res 38(1): 206-219, 2024-This study aimed to systematically review and synthesize evidence (i.e., active [land-based training] and nonactive controls [e.g., receiving usual care]) regarding the effects of water-based training on patients with nonspecific chronic low-back pain (NSCLBP). Web of Science (WOS), PubMed (MEDLINE), EMBASE, EBSCO (SPORTDiscus; CINAHL), and PEDro were searched, with no date restrictions, until October 2021. The included studies satisfied the following criteria: (a) NSCLBP (≥12 weeks) patients, (b) water-based intervention, (c) control group (land-based trained; nonactive group), and (d) outcomes related to pain, disability, quality of life, or flexibility. The main outcome analyzed in the meta-analysis was pain intensity. Secondary outcomes included disability, body mass index, and flexibility. The random-effects model was used, and effect size (ES) values are presented with 95% confidence intervals (CIs). The impact of heterogeneity was assessed (I2 statistic), with values of <25%, 25-75%, and >75% representing low, moderate, and high levels, respectively. Alpha was set at p < 0.05. In conclusion, 15 studies (n = 524) were meta-analyzed. After intervention, pain intensity was reduced compared with nonactive controls (ES = -3.61; p < 0.001) and a similar reduction was noted when compared with land-based trained group (ES = -0.14; p = 0.359). Greater decrease in disability (ES = 2.15; p < 0.001) and greater increase in sit-and-reach (i.e., flexibility; ES = -2.44; p < 0.001) were noted after intervention compared with the nonactive group. In conclusion, water-based exercise therapy reduces pain intensity, disability, and increases flexibility in NSCLBP compared with nonactive subjects and was equally effective compared with land-based exercise to reduce pain. Favorable effects may be expected at ≤8 weeks. However, due to several methodological issues (e.g., high heterogeneity), for the improvement of most outcomes, we are unable to provide other than a weak recommendation in favor of intervention compared with control treatment.

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured Exercise Programs for Chronic Primary Low Back Pain in Adults

PURPOSE

Evaluate benefits and harms of structured exercise programs for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline.

METHODS

We searched for randomized controlled trials (RCTs) in electronic databases (inception to 17 May 2022). Eligible RCTs targeted structured exercise programs compared to placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of exercise could be isolated). We extracted outcomes, appraised risk of bias, conducted meta-analyses where appropriate, and assessed certainty of evidence using GRADE.

RESULTS

We screened 2503 records (after initial screening through Cochrane RCT Classifier and Cochrane Crowd) and 398 full text RCTs. Thirteen RCTs rated with overall low or unclear risk of bias were synthesized. Assessing individual exercise types (predominantly very low certainty evidence), pain reduction was associated with aerobic exercise and Pilates vs. no intervention, and motor control exercise vs. sham. Improved function was associated with mixed exercise vs. usual care, and Pilates vs. no intervention. Temporary increased minor pain was associated with mixed exercise vs. no intervention, and yoga vs. usual care. Little to no difference was found for other comparisons and outcomes. When pooling exercise types, exercise vs. no intervention probably reduces pain in adults (8 RCTs, SMD = - 0.33, 95% CI - 0.58 to - 0.08) and functional limitations in adults and older adults (8 RCTs, SMD = - 0.31, 95% CI - 0.57 to - 0.05) (moderate certainty evidence).

CONCLUSIONS

With moderate certainty, structured exercise programs probably reduce pain and functional limitations in adults and older people with CPLBP.

Immediate effect of passive hamstring stretching on flexibility and relationship with psychosocial factors in people with chronic low back pain

Background

Hamstring muscle tightness contributes to disability in people with chronic low back pain (CLBP). HM stretching improves flexibility in healthy individuals, but the immediate effect of stretching is unknown in people with CLBP. Moreover, the stretching effect could be influenced by psychosocial factors.

Objectives

To evaluate the immediate effect of passive HM stretching on flexibility in people with CLBP and the relationships between psychosocial factors and change in hamstring flexibility.

Design

Non-randomized, pilot trial.

Method

One minute of passive stretching was performed in 90 people with CLBP. Change in Active Knee Extension and Straight Leg Raise angles (digital inclinometer), and Fingertips-to-Floor distance (measuring tape) were measured before and immediately after stretching. Correlations between change in flexibility and baseline Fear-Avoidance Beliefs Questionnaire (FABQ) and Hospital Anxiety and Depression Scale (HADS) scores were analyzed.

Results

Hamstring flexibility improved significantly after stretching; Active Knee Extension mean difference was 4° (95% CI, 2.4 to 5.1; p < 0.001, right ES = 0.24, left ES = 0.23); Straight Leg Raise mean difference was 7° (95% CI, 5.5 to 8.6, p < 0.001, right ES = 0.44, left ES = 0.42), Fingertips-to-Floor mean difference was 2 cm (95% CI, 1.7 to 3.0, p < 0.001, ES = 0.20). No correlation was found between improvement in any of the hamstring flexibility measurements and FABQ or HADS scores (p > 0.05).

Conclusions

Passive hamstring stretching induced an immediate, statistically significantly improvement in hamstring flexibility, but only the change in Straight Leg Raise amplitude was clinically important. Psychosocial factors were not related to improvements in flexibility after hamstring stretching.

Effect of Hip Muscle Strengthening Exercises on Pain and Disability in Patients with Non-Specific Low Back Pain-A Systematic Review

Low back pain (LBP) is a health problem that affects 70-80% of the population in Western countries. Because of the biomechanical relationship between the lumbar region and the hip, it is thought that strengthening the muscles of this joint could improve the symptoms of people with LBP. The objective of this study is to evaluate the current evidence on the efficacy of hip strengthening exercises to reduce pain and disability in people with LBP. Clinical trials were collected from the PubMed, PEDro, and Scopus databases published up to September 2022. Based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and using CASP and PEDro tools for methodological quality assessment, we selected studies that included hip strengthening exercises as part of LBP treatment and measured pain and/or disability parameters. Among the 966 records identified in the search, a total of 7 studies met the established selection criteria. Overall, participants who performed hip strengthening exercises had significantly improved in pain and disability. The methodological quality of the included studies was assessed as "good". In conclusion, the addition of hip muscle strengthening exercises iterating interacted with LBP, effectively improving pain and disability.

Translation and validation of urdu version short form-mcgill pain questionnaire-2

BACKGROUND

Low back pain is one of the most common complaints affecting many individuals. The McGill Pain Questionnaire is used in various clinical settings to assess different types of pain and one of the most extensively used outcomes measures for pain in the world. The purpose of this study was to translate and validate the original English version of the SF-MPQ-2 into Urdu (SF-MPQ-2-U).

METHODS

For this study, Mapi Research Trust protocols were followed for the forward and backward translation. Test-retest reliability was used to assess the reliability. Cronbach's alpha and Omega was used to determine internal consistency. Pearson's correlation was used to evaluate convergent validity. Confirmatory factor analysis was also conducted.

RESULTS

The Cronbach's alpha for SF-MPQ-2-U was 0.73 to 0.79, indicating acceptable internal consistency. Omega score for the SF-MPQ-U were 0.918. The ICC varied from 0.799 to 0.878 for domains of SF-MPQ-2-U. The CFA of the SF-MPQ-2-U met model fit indices with GFI and NFI > 0.90. The inter-scale correlation between baseline and re-test data was from 0.63 to 0.71, indicating a positive and strong correlation. The SF-MPQ-2-U and ODI-U had a baseline correlation of 0.547. The correlation of SF-MPQ-2-U & VAS at baseline data was 0.558. Pearson's correlation between subscales was r = 0.253 with p 0.01, which was statistically significant.

CONCLUSION

The SF-MPQ-2-U is considered to have good convergent validity at inter scale and between two scale levels. Reliability was checked by test-retest reliability, Internal consistency was checked using Cronbach's alpha and Omega that showed good internal consistency for measuring different types of pain in patients with low back pain who speak Urdu. To make the questionnaire more valid and reliable, it is recommended for the researchers to do in-depth research on larger sample size.

Effects of Pilates on Pain, Physical Function, Sleep Quality, and Psychological Factors in Young Women with Dysmenorrhea: A Preliminary Randomized Controlled Study

The effect of Pilates on dysmenorrhea has been little studied. The purpose of this study was to evaluate the effect of Pilates on menstrual pain and symptoms, premenstrual syndrome, and risk factors of dysmenorrhea. Thirty young women with primary dysmenorrhea were randomly assigned into a Pilates group (PG; n = 15) and a waitlist control group (CG; n = 15). The Pilates was performed twice a week for 12 weeks. Menstrual pain and symptoms were measured by visual analogue scale (VAS) and the Cox menstrual symptom scale (CMSS), respectively. Premenstrual syndrome was assessed using the premenstrual symptoms screening tool (PSST). Additionally, back flexibility, hip muscle strength, sleep duration and quality, perceived stress, state-trait anxiety, and depression were evaluated. The VAS, CMSS severity and frequency, and PSST symptoms and functional impairments decreased in the PG compared to the CG (p < 0.001 or p < 0.01) with large effect sizes. Back flexibility and the strength of hip flexors, hip extensors, and hip abductors significantly increased in the PG compared to the CG (all p < 0.01) with large effect sizes. Sleep quality (p < 0.01) and stress (p < 0.05) improved in the PG. Sleep duration, anxiety, and depression did not change in either group. In conclusion, the 12-week Pilates intervention ameliorates dysmenorrhea, partly mediated by improved physical function and sleep quality.

The effectiveness of hip interventions in patients with low-back pain: A systematic review and meta-analysis

BACKGROUND

Low-back pain (LBP) may be directly or indirectly related to impairments from the hip joint.

OBJECTIVE

To evaluate the effectiveness of hip interventions on pain and disability in patients with LBP in the short-, medium-, and long-term.

METHODS

PubMed, Cochrane Library, PEDro, Web of Science, and SCOPUS databases were searched in November 2022. Randomized controlled trials involving hip-targeted interventions compared to specific low back interventions in patients with LBP were selected. The outcomes were pain intensity and disability. The quality of the studies was assessed with the risk of bias tool. GRADE was used to rate the certainty of evidence. Meta-analyses were conducted using random effects models.

RESULTS

A total of 2581 studies were screened. Eight were included in the meta-analysis involving 508 patients with LBP. The results provided very low certainty that both hip strengthening and hip stretching improved pain (MD = -0.66; 95% CI -0.86, -0.48; I²:0%) (MD = -0.55; 95% CI -1.02, -0.08) and disability (SMD = -0.81; 95% CI -1.53, -0.10; I²: 80%) (SMD = -1.03; 95% CI -1.82, -0.25) in the short-term, respectively. No benefits were found in the medium- or long-term. The risk of bias, heterogeneity, and imprecision of the results downgraded the level of evidence.

CONCLUSIONS

Very low certainty evidence suggest a positive effect of hip strengthening in isolation or combined with specific low back exercise and hip stretching combined with specific low back exercise for decreasing pain intensity and disability in the short-term, in patients with LBP.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42022303173.

Home Exercise Programs Are Infrequently Prescribed in Trials of Supervised Exercise for Individuals With Low Back Pain: A Scoping Review of 292 Randomized Controlled Trials

OBJECTIVES: To (1) determine how often home exercise programs (HEPs) are prescribed in supervised exercise trials for low back pain (LBP) and (2) describe characteristics of the HEP programs (design, purpose, dose, and adherence). DESIGN: Scoping review. LITERATURE SEARCH: PubMed, CINAHL, and Ovid MEDLINE were searched from January 1, 2010, to August 17, 2021. STUDY SELECTION CRITERIA: Randomized controlled trials that included adults with LBP who received exercise interventions. DATA SYNTHESIS: The presence or absence of a prescribed HEP and any details of the HEP including design, dose, and adherence were extracted and summarized. RESULTS: Of 2689 potentially relevant trials, 292 were eligible for inclusion. Ninety-four trials (32%) included a HEP. The most commonly prescribed home exercises were core stability, trunk strengthening, and motor control exercises. There was great variation in the frequency and duration with which HEPs were prescribed. Adherence to HEPs was measured in fewer than half of the trials, and the methods for measuring adherence were inconsistent. Adherence to HEPs ranged from 29% to 82% in the 21 trials that reported adherence. CONCLUSION: Home exercise programs are not regularly prescribed in supervised exercise trials for LBP. There was considerable variation in prescribing HEPs and monitoring exercise adherence in trials of exercise-based treatments for adults with LBP. There is no consistent method used to measure participants' adherence to HEPs, and adherence percentages vary widely. J Orthop Sports Phys Ther 2023;53(3):120-142. Epub: 16 January 2023. doi:10.2519/jospt.2023.11448.

Effect of Progressive Postural Control Exercise Versus Core Stability Exercise in Young Adults with Chronic Low Back Pain: A Randomized Controlled Trial

INTRODUCTION

This study aimed to investigate the effects of progressive postural control exercise (PPCE) vs core stability exercise (CSE) in patients with chronic low back pain (CLBP).

METHODS

A total of 34 young-adult participants with CLBP were randomly assigned to two groups (the PPCE group and the CSE group). They received instructions for two different exercise training regimens persisting over 8 weeks. Before, after, and at 6 months after the intervention, the participants were evaluated on the basis of pain intensity (VAS), degree of dysfunction (ODI and RMDQ), contractility of transversus abdominis (TrA) and lumbar multifidus (MF), as well as the ability to control static posture.

RESULTS

There was no significant difference between the results of the PPCE group and the CSE group. At the 6-month follow-up after the 8-week treatment, the scores of VAS, ODI, and RMDQ in the two groups decreased significantly compared to before (p < 0.05). The percentage change in thickness of bilateral TrA and left MF (p < 0.05) was elevated and the sway area of center of pressure during static stance tasks with eyes opened (p < 0.05) was decreased in both groups.

CONCLUSION

In the short term, PPCE provides positive effects similar to those of core stability exercise in patients with CLBP. The effective mechanism of PPCE might be the consequence of neuromuscular plasticity and adaptation adjustments. PPCE enriches the choices of treatment for CLBP.

CLINICAL TRIAL REGISTRATION

The trial was registered at www.chictr.org.cn , identifier ChiCTR2100043113.

Duration of Back Pain Symptoms and Its Relationship to Paralumbar Muscle Volume

OBJECTIVE

Paralumbar muscle volume has been indicated as an important factor for patients reporting back pain. Our goal was to determine if there is a statistically significant relationship between the duration of patients' back pain symptoms (>12 weeks or ≤12 weeks) and paralumbar muscle volume.

METHODS

In this retrospective cohort study, paralumbar muscles on axial T2-weighted lumbar magnetic resonance images were outlined using ImageJ to determine the paralumbar cross-sectional area (PL-CSA) and lumbar indentation value (LIV) at the center of disc spaces from L1 to L5. The Goutallier classification was determined by the primary author. Quantile regression was performed to compare the PL-CSA, PL-CSA normalized by body mass index, and LIV between the 2 cohorts. Cohort A consisted of patients reporting symptoms ≤12 weeks, and cohort B included patients with symptoms >12 weeks. Negative binomial regression was used to compare Goutallier class.

RESULTS

A total of 551 patients operated on by a single surgeon with lumbar magnetic resonance imaging within the past 12 months and recorded duration of symptoms were included. Cohort A consisted of 229 patients (41.6%), and cohort B included 322 patients (58.4%). Statistical significance was not found at any lumbar level for PL-CSA, PL-CSA normalized by body mass index, Goutallier class, and LIV.

CONCLUSIONS

Our results suggest that duration of symptoms may not be an accurate indicator for lumbar muscle volume. These novel findings are clinically valuable because lumbar muscle volume has been shown to be a marker for recovery. With this information, patients previously believed to be inoperable because of long-standing symptoms can be reevaluated.

Effects of Jaw-Opening Exercises with/without Pain for Temporomandibular Disorders: A Pilot Randomized Controlled Trial

This study aimed to evaluate the effects of jaw-opening exercises with and without pain on temporomandibular disorders (TMDs), specifically in relation to pain intensity and range-of-mouth opening in patients with TMDs. Participants were randomly assigned to either the jaw-opening exercise with pain (JE w/pain) or the jaw-opening exercise without pain (JE w/o pain) groups, and each exercise was performed for eight weeks. TMDs pain intensity was assessed using a 100-mm visual analog scale (VAS), and the range-of-mouth opening was evaluated at the baseline (T0), 2 weeks (T1), 4 weeks (T2), and 8 weeks (T3). Of the 61 participants, 57 (JE w/pain group, n = 30; JE w/o pain group, n = 27) were included in the analysis. The range-of-mouth opening and TMDs pain intensity improved from T1 to T3 in both groups. The JE w/pain group showed significant differences at T3 compared to T1 (pain-free unassisted mouth opening, p = 0.006; jaw-opening pain, p = 0.014; chewing pain, p = 0.018). In addition, the JE w/pain group showed significantly greater changes in the maximum unassisted mouth opening at T2 and T3 than the JE w/o pain group (T2, p < 0.001; T3, p = 0.003). Thus, jaw-opening exercises, until the occurrence of pain, may be effective in patients with TMDs.

FUNCTIONAL EXERCISE ON PATIENTS’ REHABILITATION WITH PSOAS MUSCLE SPORTS INJURIES

ABSTRACT Introduction Lumbar muscle strain is a chronic injury to soft tissues such as the lumbar muscles, ligaments, and fascia. Functional exercise has specific applications in treating lumbar muscle injuries caused by sports. However, analyses on the treatment results in the psoas muscle are inconclusive. Objective Analyze the clinical efficacy of functional exercise in treating psoas muscle dysfunction. Methods 10 athletes diagnosed with lumbar muscle strain received continuous training with a functional exercise protocol for two weeks, five times a week. Clinical efficacy was assessed by visual analog scale for pain score and Prokin254 for proprioception ability indices before and after treatment. The article adopts a mathematical statistics analysis method to analyze the therapeutic effect of motor function exercise with SPSS 13.0. Results Patients reported a reduction of pain in the muscles under exertion after functional exercise. The results were significantly different (P<0.05). Patients’ lumbar strength was significantly improved. This index has a considerable statistical difference (P<0.05). Conclusion Functional exercise showed a positive effect on the treatment of psoas muscle injury. The research results of this article can provide an effective training protocol for the rehabilitation of people with a psoas muscle strain. Evidence Level II; Therapeutic Studies - Investigating the result.

A Systematic Review of the Effectiveness of Core Stability Exercises in Patients with Non-Specific Low Back Pain

Background

Low back pain affects millions of people worldwide and can be a difficult condition to manage clinically. Many cases do not have a discernable etiology, further increasing the complexity of finding an effective intervention. Core stabilization exercises (CSE) strengthen the musculature that provides stability to the spine and show promising outcomes.

Purpose

To examine the efficacy of CSE exercises in the treatment of NSLBP in adult patients.

Study Selection

Studies were included if they had patients diagnosed with NSLBP, used CSE as a treatment for NSLBP, and were a clinical trial. Exclusion criteria were studies that did not utilize an objective pain scale, patients who had a specific diagnosed pathology contributing to the NSLBP or received treatment for their NSLBP within the prior six months.

Methods

The literature was systematically searched in the PubMed, Sports Medicine & Education Index, and CINHAL databases, using the search terms core stabilization, low back pain, and exercise. The initial search yielded 229 articles and was refined using search terms 'NOT analysis' in order to target randomized control trials and exclude meta-analyses to narrow the search. Full-text of the articles were assessed for eligibility by utilizing inclusion and exclusion criteria that were included in this review. Articles were assessed for quality using the PEDro scale and relevant data were extracted.

Results

Five moderate-quality studies (PEDRO range: 5-8) support CSE is an effective method to decrease pain, improve functionality, and increase core strength in patients with NSLBP. Although there are other commonly used methods to treating NSLBP, CSE have shown to be a beneficial method to treating NSLBP.

Conclusion

Grade B evidence suggests core stabilization exercises can be considered a favorable method for treating pain in patients with NSLBP.

Level of Evidence

1b.

Effects of core stability training on older women with low back pain: a randomized controlled trial

Background

Studies have demonstrated that elderly people with low back pain (LBP) may have poor postural control compared to healthy older adults. Poor postural control is associated with poor balance performance and a high risk of serious falls. A variety of training strategies are proposed for LBP therapy, particularly core stabilization training. But this treatment for older people with LBP remains unclear.

Methods

31 participants were randomly placed in a core stability training group (TG, n = 15) and a control group (CG, n = 16). The participants in the training group were required to complete 4 sets of core stability training and conventional physiotherapy 4 times per week for 4 weeks, whereas the participants in the control group only completed physiotherapy 4 times per week for 4 weeks. Ultrasound imaging was used to measure transverse abdominal muscle (TrA) thickness before and after the intervention. A 10-cm visual analog scale (VAS), the Oswestry Disability Index (ODI), and mobility functions were applied before and after the intervention. Data are reported as the median and range and were compared using two-way repeated-measures ANOVA,t-tests and chi-squared tests. P < 0.05 was considered significant in all statistical tests.

Results

After intervention, there was a statistically significant difference in scores in the intervention group, especially for VAS, ODI, timed up-and-go,10-m walking and the four-square step test. TrA thickness was increased after core stability training, which was not observed in the control group.

Conclusion

Core stability training is an effective intervention for older women with LBP.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11556-022-00289-x.

Multidisciplinary Firms and the Treatment of Chronic Pain: A Case Study of Low Back Pain

Sixteen million people suffer with chronic low back pain and related healthcare expenditures can be as high as $USD 635 billion. Current pain treatments help a significant number of acute pain patients, allowing them to obtain various treatments and then “exit the market for pain services” quickly. However, chronic patients remain in pain and need multiple, varying treatments over time. Often, a single pain provider does not oversee their care. Here, we analyze the current pain market and suggest ways to establish a new treatment paradigm. We posit that more cost effective treatment and better pain relief can be achieved with multi-disciplinary care with a provider team overseeing care.

Alteração postural, dor lombar e a resistência dos músculos do tronco em jovens universitárias

Resumo Introdução: A lombalgia, transtorno músculoesquelético mais prevalente, é comum em indivíduos com alterações posturais, que são de alta incidência em universitários. Instabilidade e fraqueza dos músculos do tronco podem contribuir para a presença da dor lombar. Não encontrou-se, contudo, pesquisas que tenham investigado a relação da dor lombar em conjunto com as alterações posturais e a resistência dos músculos estabilizadores do tronco. Objetivo: Analisar a correlação entre alterações posturais e resistência muscular do tronco de mulheres com e sem dor lombar. Métodos: Foram recrutadas 40 mulheres universitárias divididas em grupo com dor lombar (n = 20; 20,85 ± 1,69 anos) e grupo sem dor lombar (n = 20; 20,05 ± 2,54 anos). No primeiro dia, realizou-se a avaliação postural por fotogrametria com software Kinovea; no segundo dia, os testes de resistência dos músculos flexores e extensores de tronco, prancha lateral e ventral, ponte e tração lombar através do dinamômetro de tração. Aplicou-se o teste de correlação de Pearson para verificar a relação entre as variáveis analisadas, teste t de Student para comparação entre os grupos e adotou-se nível de significância de p < 0,05. Resultados: Não houve correlação entre as variáveis referentes às alterações posturais e testes de resistências musculares (p > 0,05); houve diferença entre os grupos apenas para o teste de exercício ponte (p = 0,04) e para o alinhamento vertical da cabeça vista lateral esquerda (p = 0,041) e vista lateral direita (p = 0,034). Conclusão: Este estudo não evidenciou relação direta e significativa entre as alterações posturais em jovens universitárias com e sem queixa de dor lombar com a resistência dos músculos estabilizadores do tronco.

Postural alteration, low back pain, and trunk muscle resistance in university students

Abstract Introduction: Low back pain, the most prevalent musculoskeletal disorder, is common in individuals with postural changes and has a high incidence in university students. Trunk muscle instability and weakness can contribute to the presence of low back pain. However, no research has investigated the relationship between low back pain in conjunction with postural changes and the resistance of the trunk stabilizing muscles. Objective: To analyze the correlation between postural alterations and muscular resistance of the trunk of women with and without low back pain. Methods: Forty university women were recruited and divided into a group with low back pain (n = 20; 20.85 ± 1.69 years) and a group without low back pain (n = 20; 20.05 ± 2.54 years). On the first day, the postural assessment was carried out by photogrammetry with Kinovea software. On the second day, the resistance tests of the trunk flexor and extensor muscles, lateral and ventral plank, bridge, and lumbar traction were performed through the traction dynamometer. Pearson's correlation test was applied to verify the relationship between the analyzed variables, Student's T test was used for comparison between groups, and a significance level of p < 0.05 was adopted. Results: There was no correlation between the variables related to postural changes and muscle resistance tests (p > 0.05). There was a difference between the groups only for the bridge exercise test (p = 0.04) and vertical alignment of the head, left lateral view (p = 0.041), and right lateral view (p = 0.034). Conclusion: This study did not show a direct and significant relationship between postural changes in young university students with and without complaints of low back pain and resistance of the trunk-stabilizing muscles.

Observational Screening Guidelines and Smartphone Accelerometer Thresholds to Establish the Intensity of Some of the Most Popular Core Stability Exercises

The lack of training load control, mainly exercise intensity, is one of the main limitations of core stability (CS) programs, which makes the training individualization and the analysis of the dose-response relationship difficult. The objectives of this study were to assess the inter-and intra-rater agreement when using new observational screening guidelines to decide if a core stability exercise represents an adequate training intensity level for a given participant. Besides, the relationship between experts' ratings based on these criteria and pelvic accelerations recorded with a smartphone accelerometer was also analyzed. Ten healthy physically active participants with a smartphone accelerometer placed on their pelvis were video-taped while performing a progression of seven variations of the front bridge, back bridge, side bridge and bird-dog exercises. Two expert and four non-expert raters watched the videos and used the observational screening guidelines to decide for each exercise variation if it represented an adequate training intensity level or not. In order to analyze the inter-and intra-rater agreement, several Kappa (κ) statistics were used. Receiver operating characteristic (ROC) curves to explore if the accelerometry allowed to establish pelvic acceleration thresholds representing the minimum level of exercise intensity for CS training. Cut-off acceleration values were calculated balancing sensitivity (Se) and 1-specifity (1-Sp) indexes (i.e., Youden index) or minimizing 1-Sp. The intra-and inter-rater analysis showed a substantial-high level of agreement with a prevalence-adjusted bias-adjusted Kappa > 0.69. The ROC curves showed that the acceleration thresholds for the bridging exercises were very similar, with global cut-off values of 0.35 m/s² (Se = 82%; 1-Sp = 15%) when using the Youden Index and of 0.50 m/s² when minimizing 1-Sp (Se = 31%), whilst the bird-dog exercise showed lower cut-off values (Youden Index: 0.21 m/s², Se = 90%, 1-Sp = 16%; minimizing 1-Sp: 0.32 m/s², Se = 40%). Overall, this study provides observational screening guidelines and smartphone accelerometer thresholds to facilitate the decision-making process when setting the intensity of some of the most popular core stability exercises in young physically active individuals.

Exercise therapy for chronic low back pain

BACKGROUND

Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs.

OBJECTIVES

The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments.

SEARCH METHODS

We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update.

SELECTION CRITERIA

We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration.

DATA COLLECTION AND ANALYSIS

Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo.

MAIN RESULTS

We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias.  Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups.

AUTHORS' CONCLUSIONS

We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.

Systematic Literature Review of Spinal Cord Stimulation in Patients With Chronic Back Pain Without Prior Spine Surgery

OBJECTIVE

Low back pain is the leading cause of disability worldwide and one of the most common reasons for seeking healthcare. Despite numerous care strategies, patients with low back pain continue to exhibit poor outcomes. Spinal cord stimulation (SCS) is an evidence-based therapeutic modality for patients with failed back surgery syndrome. For patients without a surgical lesion or history, minimally invasive interventions that provide long-term reduction of chronic back pain are needed. Therefore, we conducted a systematic review of the evidence on SCS therapy in patients with chronic back pain who have not undergone spinal surgery.

MATERIALS AND METHODS

A systematic literature search was performed to identify studies reporting outcomes for SCS in chronic back pain patients (with or without secondary radicular leg pain) without prior surgery using date limits from database inception to February 2021. Study results were analyzed and described qualitatively.

RESULTS

A total of ten primary studies (16 publications) were included. The included studies consistently demonstrated favorable outcomes in terms of pain reduction and functional improvement following SCS therapy. Improvements also occurred in quality of life scores; however, not all studies reported statistically significant findings. Additionally, the studies reported that SCS resulted in high patient satisfaction, reductions in opioid use, and an acceptable safety profile, although these data were more limited.

CONCLUSION

Findings suggest that SCS is a promising, safe, minimally invasive, and reversible alternative option for managing chronic back pain in patients who have not undergone spinal surgery.

The Relationship between Reactive Balance Control and Back and Hamstring Strength in Physiotherapists with Non-Specific Back Pain: Protocol for a Cross-Sectional Study

Back pain is one of the most costly disorders among the worldwide working population. Within that population, healthcare workers are at a high risk of back pain. Though they often demonstrate awkward postures and impaired balance in comparison with healthy workers, there is no clear relationship between compensatory postural responses to unpredictable stimuli and the strength of related muscle groups, in particular in individuals with mild to moderate back pain. This paper presents a study protocol that aims to evaluate the relationship between peak anterior to peak posterior displacements of the center of pressure (CoP) and corresponding time from peak anterior to peak posterior displacements of the CoP after sudden external perturbations and peak force during a maximum voluntary isometric contraction of the back and hamstring muscles in physiotherapists with non-specific back pain in its early stages. Participants will complete the Oswestry Disability Questionnaire. Those that rate their back pain on the 0–10 Low Back Pain Scale in the ranges 1–3 (mild pain) and 4–6 (moderate pain) will be considered. They will undergo a perturbation-based balance test and a test of the maximal isometric strength of back muscles and hip extensors. We assume that by adding tests of reactive balance and strength of related muscle groups in the functional testing of physiotherapists, we would be able to identify back problems earlier and more efficiently and therefore address them well before chronic back disorders occur.

Association of Outcomes of Spinal Cord Stimulation for Chronic Low Back Pain and Psoas Measurements Based on Size of Iliopsoas Muscles

INTRODUCTION

Patients experience variable long-term improvement in chronic back pain despite successful spinal cord stimulation (SCS) trials. Iliopsoas (IP) size has been shown to differ between patients with low back pain and healthy controls. In this study, we examine whether IP muscle cross-sectional area (CSA) is associated with SCS outcomes.

MATERIALS AND METHODS

We examined patients for whom we had lumbar MRIs 6.3 years prior to SCS and had baseline and one-year outcome data. Percent change from baseline to one year was calculated for Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), Pain Catastrophizing Scale (PCS), and McGill Pain Questionnaire (MPQ). Correlations between IP muscle CSA, ratio of iliopsoas muscle size to the vertebral body area (P/VBA), and the ratio of iliopsoas muscle size to BMI (P/BMI) were examined. Sex differences were considered.

RESULTS

A total of 73 subjects were included in this study including 30 females and 43 males. Males had significantly larger IP (males 15.70 ± 0.58, females 9.72 ± 0.43; p < 0.001), P/VBA (males 1.00 ± 0.04, females 0.76 ± 0.03, p < 0.001) and P/BMI ratio (males 0.51 ± 0.02, females 0.32 ± 0.01; p < 0.001) than females. In females, P/VBA predicted NRS worst pain scores (β = 0.82, p = 0.004, r² = 0.55) and BDI (β = 0.59, p = 0.02, r² = 0.24). In males, P/BMI was a significant predictor of BDI outcomes scores (β = 0.45, p = 0.03, r² = 0.16). Males who had more muscle mass measured by iliopsoas size had more depression as measured using BDI (p = 0.03, r = 0.61). Females with less muscle mass measured by P/VBA also experienced more depression (p = 0.02, r = 0.74).

CONCLUSIONS

Our study showed that psoas measurements correlated with various pain outcomes specifically. P/VBA was most predictive in females and P/BMI in males. Depression correlated with P/BMI, reinforcing the complex relationship between depression and constant chronic pain. Tertile analyses further showed a relationship between iliopsoas CSA and depression in males and females. We provide preliminary data of sex-specific psoas measurements as a risk factor for worse SCS outcomes.