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Zemková E, Amiri B, Horníková H, Zapletalová L. Potential neurophysiological and biomechanical risk factors for sport-related back problems: A scoping review. Sports Med Health Sci 2024; 6:123-138. [PMID: 38708324 PMCID: PMC11067771 DOI: 10.1016/j.smhs.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/17/2023] [Accepted: 12/25/2023] [Indexed: 05/07/2024] Open
Abstract
This scoping review aims (1) to map the literature dealing with neurophysiological and biomechanical aspects of back problems in athletes in order to identify valid risk-factors for their prevention, plus (2) to identify gaps in the existing research and propose suggestions for future studies. A literature search conducted with Scopus, Web of Science, MEDLINE and Cochrane Library was completed by Elsevier, SpringerLink and Google Scholar. The main neurophysiological risk factors identified leading to back problems in athletes are neuromuscular imbalance, increased muscle fatigability, muscle dysfunction and impaired motor control, whilst biomechanical risk factors include maladaptive spinal, spinopelvic and lower limb kinematics, side-to-side imbalances in axial strength and hip rotation range of motion, spinal overloading and deficits in movement pattern. However, most studies focused on back pain in the lumbar region, whereas less attention has been paid to thoracic and cervical spine problems. The range of sports where this topic has been studied is relatively small. There is a lack of research in sports in which the core muscles are highly involved in specific movements such as lifting weights or trunk rotations. A limited number of studies include female athletes and master athletes of both genders. In addition to chronic back pain patients, it is equally important to conduct research on healthy athletes with a predisposition to spine problems. Investigators should focus their empirical work on identifying modifiable risk factors, predict which athletes are at risk for back problems, and develop personalized sport-specific assessment tools and targeted prevention strategies for them. This review was registered using the Open Science Framework Registries (https://osf.io/ha5n7).
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Affiliation(s)
- Erika Zemková
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sport, Comenius University in Bratislava, Slovakia
- Faculty of Health Sciences, University of Ss. Cyril and Methodius in Trnava, Slovakia
| | - Banafsheh Amiri
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sport, Comenius University in Bratislava, Slovakia
| | - Henrieta Horníková
- Department of Track and Field and Sport Conditioning, Faculty of Physical Education and Sport, Comenius University in Bratislava, Slovakia
| | - Ludmila Zapletalová
- Faculty of Health Sciences, University of Ss. Cyril and Methodius in Trnava, Slovakia
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Alshehri MA, Alzahrani H, van den Hoorn W, Klyne DM, Vette AH, Hendershot BD, Roberts BWR, Larivière C, Barbado D, Vera-Garcia FJ, van Dieen JH, Cholewicki J, Nussbaum MA, Madigan ML, Reeves NP, Silfies SP, Brown SHM, Hodges PW. Trunk postural control during unstable sitting among individuals with and without low back pain: A systematic review with an individual participant data meta-analysis. PLoS One 2024; 19:e0296968. [PMID: 38265999 PMCID: PMC10807788 DOI: 10.1371/journal.pone.0296968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Sitting on an unstable surface is a common paradigm to investigate trunk postural control among individuals with low back pain (LBP), by minimizing the influence lower extremities on balance control. Outcomes of many small studies are inconsistent (e.g., some find differences between groups while others do not), potentially due to confounding factors such as age, sex, body mass index [BMI], or clinical presentations. We conducted a systematic review with an individual participant data (IPD) meta-analysis to investigate whether trunk postural control differs between those with and without LBP, and whether the difference between groups is impacted by vision and potential confounding factors. METHODS We completed this review according to PRISMA-IPD guidelines. The literature was screened (up to 7th September 2023) from five electronic databases: MEDLINE, CINAHL, Embase, Scopus, and Web of Science Core Collection. Outcome measures were extracted that describe unstable seat movements, specifically centre of pressure or seat angle. Our main analyses included: 1) a two-stage IPD meta-analysis to assess the difference between groups and their interaction with age, sex, BMI, and vision on trunk postural control; 2) and a two-stage IPD meta-regression to determine the effects of LBP clinical features (pain intensity, disability, pain catastrophizing, and fear-avoidance beliefs) on trunk postural control. RESULTS Forty studies (1,821 participants) were included for the descriptive analysis and 24 studies (1,050 participants) were included for the IPD analysis. IPD meta-analyses revealed three main findings: (a) trunk postural control was worse (higher root mean square displacement [RMSdispl], range, and long-term diffusion; lower mean power frequency) among individuals with than without LBP; (b) trunk postural control deteriorated more (higher RMSdispl, short- and long-term diffusion) among individuals with than without LBP when vision was removed; and (c) older age and higher BMI had greater adverse impacts on trunk postural control (higher short-term diffusion; longer time and distance coordinates of the critical point) among individuals with than without LBP. IPD meta-regressions indicated no associations between the limited LBP clinical features that could be considered and trunk postural control. CONCLUSION Trunk postural control appears to be inferior among individuals with LBP, which was indicated by increased seat movements and some evidence of trunk stiffening. These findings are likely explained by delayed or less accurate corrective responses. SYSTEMATIC REVIEW REGISTRATION This review has been registered in PROSPERO (registration number: CRD42021124658).
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Affiliation(s)
- Mansour Abdullah Alshehri
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Hosam Alzahrani
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Wolbert van den Hoorn
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - David M. Klyne
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Albert H. Vette
- Department of Mechanical Engineering, Donadeo Innovation Centre for Engineering, University of Alberta, Edmonton, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Canada
| | - Brad D. Hendershot
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, Virginia, United States of America
| | - Brad W. R. Roberts
- Department of Mechanical Engineering, Donadeo Innovation Centre for Engineering, University of Alberta, Edmonton, Canada
| | - Christian Larivière
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal Rehabilitation Institute, Montreal, Quebec, Canada
| | - David Barbado
- Sport Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernández University of Elche, Alicante, Spain
| | - Francisco J. Vera-Garcia
- Sport Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernández University of Elche, Alicante, Spain
| | - Jaap H. van Dieen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Jacek Cholewicki
- Center for Neuromusculoskeletal Clinical Research, Michigan State University, Lansing, Michigan, United States of America
- Department of Osteopathic Manipulative Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Maury A. Nussbaum
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg, Virginia, United States of America
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Michael L. Madigan
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg, Virginia, United States of America
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | | | - Sheri P. Silfies
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States of America
| | - Stephen H. M. Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Paul W. Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Dhar D, Kamble N, Pal PK. Long Latency Reflexes in Clinical Neurology: A Systematic Review. Can J Neurol Sci 2023; 50:751-763. [PMID: 35801267 DOI: 10.1017/cjn.2022.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Long latency reflexes (LLRs) are impaired in a wide array of clinical conditions. We aimed to illustrate the clinical applications and recent advances of LLR in various neurological disorders from a systematic review of published literature. METHODS We reviewed the literature using appropriately chosen MeSH terms on the database platforms of MEDLINE, Web of Sciences, and Google Scholar for all the articles from 1st January 1975 to 2nd February 2021 using the search terms "long loop reflex", "long latency reflex" and "C-reflex". The included articles were analyzed and reported using synthesis without meta-analysis (SWiM) guidelines. RESULTS Based on our selection criteria, 40 articles were selected for the systematic review. The various diseases included parkinsonian syndromes (11 studies, 217 patients), Huntington's disease (10 studies, 209 patients), myoclonus of varied etiologies (13 studies, 127 patients) including progressive myoclonic epilepsy (5 studies, 63 patients) and multiple sclerosis (6 studies, 200 patients). Patients with parkinsonian syndromes showed large amplitude LLR II response. Enlarged LLR II was also found in myoclonus of various etiologies. LLR II response was delayed or absent in Huntington's disease. Delayed LLR II response was present in multiple sclerosis. Among the other diseases, LLR response varied according to the location of cerebellar lesions while the results were equivocal in patients with essential tremor. CONCLUSIONS Abnormal LLR is observed in many neurological disorders. However, larger systematic studies are required in many neurological disorders in order to establish its role in diagnosis and management.
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Affiliation(s)
- Debjyoti Dhar
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India
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Zemková E, Cepková A, Muyor JM. The association of reactive balance control and spinal curvature under lumbar muscle fatigue. PeerJ 2021; 9:e11969. [PMID: 34434668 PMCID: PMC8362667 DOI: 10.7717/peerj.11969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Although low back fatigue is an important intervening factor for physical functioning among sedentary people, little is known about its possible significance in relation to the spinal posture and compensatory postural responses to unpredictable stimuli. This study investigates the effect of lumbar muscle fatigue on spinal curvature and reactive balance control in response to externally induced perturbations. Methods A group of 38 young sedentary individuals underwent a perturbation-based balance test by applying a 2 kg load release. Sagittal spinal curvature and pelvic tilt was measured in both a normal and Matthiass standing posture both with and without a hand-held 2 kg load, and before and after the Sørensen fatigue test. Results Both the peak anterior and peak posterior center of pressure (CoP) displacements and the corresponding time to peak anterior and peak posterior CoP displacements significantly increased after the Sørensen fatigue test (all at p < 0.001). A lumbar muscle fatigue led to a decrease of the lumbar lordosis in the Matthiass posture while holding a 2 kg load in front of the body when compared to pre-fatigue conditions both without a load (p = 0.011, d = 0.35) and with a 2 kg load (p = 0.000, d = 0.51). Also the sacral inclination in the Matthiass posture with a 2 kg additional load significantly decreased under fatigue when compared to all postures in pre-fatigue conditions (p = 0.01, d = 0.48). Contrary to pre-fatigue conditions, variables of the perturbation-based balance test were closely associated with those of lumbar curvature while standing in the Matthiass posture with a 2 kg additional load after the Sørensen fatigue test (r values in range from −0.520 to −0.631, all at p < 0.05). Conclusion These findings indicate that lumbar muscle fatigue causes changes in the lumbar spinal curvature and this is functionally relevant in explaining the impaired ability to maintain balance after externally induced perturbations. This emphasizes the importance for assessing both spinal posture and reactive balance control under fatigue in order to reveal their interrelations in young sedentary adults and predict any significant deterioration in later years.
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Affiliation(s)
- Erika Zemková
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sport, Comenius University Bratislava, Bratislava, Slovakia.,Sports Technology Institute, Faculty of Electrical Engineering and Information Technology, Slovak University of Technology, Bratislava, Slovakia
| | - Alena Cepková
- Centre of Languages and Sports, Faculty of Mechanical Engineering, Slovak University of Technology, Bratislava, Slovakia
| | - José M Muyor
- Laboratory of Kinesiology, Biomechanics and Ergonomics, Health Research Centre, University of Almería, Almería, Spain
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Nowotny AH, Calderon MG, Alves BMO, de Oliveira MR, Andraus RAC, Aguiar AF, Amorim CF, Leonard G, da Silva RA. Low-Back Pain and Knee Position-Related Differences on Postural Control Measures During a One-Legged Stance in Athletes. J Sport Rehabil 2020; 30:631-7. [PMID: 33238243 DOI: 10.1123/jsr.2020-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/22/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Chronic low-back pain (CLBP) may be associated with changes in postural balance in athletes as poor postural control during sports practice. OBJECTIVE To compare the postural control of athletes with and without CLBP during 2 one-legged stance tasks and identify the center of pressure (COP) cutoff values to determine the main differences. Designed: A cross-sectional study. SETTING Laboratory of functional evaluation and human motor performance. PARTICIPANTS A total of 56 male athletes, 28 with and 28 without CLBP (mean age = 26 y). INTERVENTION The one-legged stance with knee extension and with the knee at 30° flexion tasks were measured and analyzed on a force platform. The participants completed three 30-second trials (30 s of rest between each trial). MAIN OUTCOME MEASURES The COP parameters: the area of COP, mean COP sway velocity in both the anteroposterior and mediolateral directions, and total COP displacement were computed, and a receiver operating characteristics curve analysis was applied to determine the group differences. RESULTS Athletes with CLBP had poorer postural control (P < .01) in both tasks. The 30° knee flexion reported more postural instability than the knee extension for all COP parameters (a large effect size d = 0.80).The knee extension cutoffs identified were >7.1 cm2 for the COP area, >2.6 cm/s for the COP sway velocity in the anterior-posterior direction, and >3.2 cm/s for the mediolateral direction. Whereas, the 30° knee flexion cutoffs were >10.9 cm2 for the COP area, >2.9 cm/s for the COP sway velocity in the anterior-posterior direction, and >4.1 cm/s for the mediolateral direction. Both measures showed enough sensitivity and specificity (ie, area under the curve = 0.88 in and 0.80, respectively) to discriminate both groups. CONCLUSIONS The athletes with CLBP had poorer postural control than the healthy athletes and obtained specific cutoff scores from the COP values.
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Ingerson E, Renfrow C, Aragon E, Ferger N, Olson B, Sachs A, Nelson-Wong E. Individuals with low back pain improve in standing tolerance and sagittal plane muscle activation following exercise intervention. J Back Musculoskelet Rehabil 2020; 32:885-895. [PMID: 30958331 DOI: 10.3233/bmr-171053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Healthy individuals who develop low back pain (LBP) during standing (standing intolerant) respond favorably to stabilization-based exercise interventions. People with clinical LBP meeting clinical prediction rules for stabilization-based exercise share characteristics with standing intolerant individuals. OBJECTIVE To investigate the impact of stabilization-based exercise on standing tolerance, muscle activation and clinical measures in individuals with LBP meeting clinical prediction rules for stabilization-based exercise. METHODS Participants with and without LBP completed testing pre- and post-6 weeks of progressive home exercise intervention. Testing included clinical examination and electromyography during sagittal and frontal plane movements. LBP was also assessed by visual analogue scale (VAS) during standing. Outcomes included clinical findings, muscle sequencing, and VAS in standing. RESULTS The LBP group had non-significant decreases in Oswestry Disability Index (-2.1%, p= 0.22), baseline VAS (-7.1 mm, p= 0.11), lumbopelvic reversal (p= 0.06) and positive active hip abduction test (p= 0.06). Significant improvements were seen in standing VAS (-5.6 mm, p< 0.001). The LBP group had beneficial changes in activation strategies in standing flexion (p< 0.05) following intervention, with no changes during frontal plane movement strategies. CONCLUSIONS Individuals with LBP meeting clinical prediction rules for stabilization-based exercise demonstrated increased standing tolerance and sagittal plane muscle sequencing following a 6-week intervention.
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Sutherlin MA, Mangum LC, Russell S, Saliba S, Hertel J, Hart JM. Landing Stiffness Between Individuals With and Without a History of Low Back Pain. J Sport Rehabil 2020; 29:28-36. [PMID: 30422098 DOI: 10.1123/jsr.2017-0081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 10/04/2018] [Accepted: 10/14/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Reduced spinal stabilization, delayed onset of muscle activation, and increased knee joint stiffness have been reported in individuals with a history of low back pain (LBP). Biomechanical adaptations resulting from LBP may increase the risk for future injury due to suboptimal loading of the lower-extremity or lumbar spine. Assessing landing mechanics in these individuals could help identify which structures might be susceptible to future injury. OBJECTIVE To compare vertical and joint stiffness of the lower-extremity and lumbar spine between individuals with and without a previous history of LBP. DESIGN Cross-sectional study. SETTING Research laboratory. PARTICIPANTS There were 45 participants (24 without a previous history of LBP-age 23 [8] y, height 169.0 [8.5] cm, mass 69.8 [13.8] kg; 21 with a previous history of LBP-age 25[9] y, height 170.0 [8.0] cm, mass 70.2 [11.8] kg). INTERVENTIONS Single-limb landing trials on the dominant and nondominant limb from a 30-cm box. MAIN OUTCOME MEASURES Vertical stiffness and joint stiffness of the ankle, knee, hip, and lumbar spine. RESULTS Individuals with a previous history of LBP had lower vertical stiffness (P = .04), but not joint stiffness measures compared with those without a previous history of LBP (P > .05). Overall females had lower vertical (P = .01), ankle (P = .02), and hip stiffness (P = .04) compared with males among all participants. Males with a previous history of LBP had lower vertical stiffness compared with males without a previous history LBP (P = .01). Among all individuals without a previous history of LBP, females had lower vertical (P < .01) and ankle stiffness measures (P = .04) compared with males. CONCLUSIONS Landing stiffness may differ among males and females and a previous history of LBP. Comparisons between individuals with and without previous LBP should be considered when assessing landing strategies, and future research should focus on how LBP impacts landing mechanics.
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Kishimoto T, Kuniyasu K, Suehiro T, Kobara K. Muscle activity during backward perturbation response in patients with clinical vertebral compression fractures. J Exerc Rehabil 2019; 15:696-702. [PMID: 31723559 PMCID: PMC6834708 DOI: 10.12965/jer.1938502.251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/15/2019] [Indexed: 11/22/2022] Open
Abstract
The present study examined muscle activity in response to backward perturbation in patients with clinical vertebral compression fracture (CVCF). The subjects were 32 patients aged 65 years and above consisting of 16 each with (CVCF group) and without (control group) CVCF. The time to peak activity, and time of onset of muscle activity of the anterior tibial, vastus medialis, and rectus abdominis muscles when unexpected backward perturbation was applied were evaluated by surface electromyography. The strength of perturbation was 4% or 6% of the subject's body weight. In addition, the presence of the stepping reaction to perturbation, severity of low back pain, and vertebral alignment were evaluated. Each item was compared between the two groups. In the CVCF group, kyphosis and severity of low back pain were significantly more severe, the time to peak activity of the anterior tibial muscle after the application of perturbation at 6% of the body weight was significantly shorter, and the time of onset of activity of the rectus abdominis muscle was significantly delayed. This suggests that the time to peak activity of the anterior tibial muscle is shortened and the time of onset of activity of the rectus abdominis muscle is delayed in unexpected backward perturbation in patients with CVCF.
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Affiliation(s)
- Tomoya Kishimoto
- Department of Rehabilitation, Watanabe Hospital, Niimi, Japan.,Graduate School of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Kastushi Kuniyasu
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Tadanobu Suehiro
- Department of Rehabilitation, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Kenichi Kobara
- Department of Rehabilitation, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Japan
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Knox MF, Chipchase LS, Schabrun SM, Romero RJ, Marshall PWM. Anticipatory and compensatory postural adjustments in people with low back pain: a systematic review and meta-analysis. Spine J 2018; 18:1934-1949. [PMID: 29906616 DOI: 10.1016/j.spinee.2018.06.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT Despite altered anticipatory (APAs) and compensatory postural adjustments (CPAs) being hypothesized to contribute to the onset and persistence of low back pain (LBP), results from studies comparing people with and without LBP are conflicting. PURPOSE This systematic review aimed to determine whether APAs or CPAs are altered in the presence of acute and chronic LBP. STUDY DESIGN A systematic review of studies was carried out. PATIENT SAMPLE No patient sample was required. OUTCOME MEASURES Between group standardized mean differences and 95% confidence intervals for APAs ad CPAs METHODS: A comprehensive search was conducted for articles comparing people with LBP (acute or chronic) to healthy controls for the onset or amplitude of muscle activity, center of pressure (COP), or kinematic responses to expected or unexpected perturbations. Two independent reviewers extracted data and assessed the methodological quality of relevant studies. Differences between people with and without LBP were calculated as standardized mean differences, and included in a meta-analysis if outcomes were homogeneous. Otherwise, a narrative synthesis was conducted. RESULTS Twenty-seven studies were included, of which the majority examined muscle onsets in response to expected and unexpected perturbations. Only two studies compared people with and without acute LBP, and results for these studies were conflicting. The results show delayed muscle onsets in response to expected and unexpected perturbations for people with chronic LBP when compared with healthy controls. No conclusive evidence for differences between people with and without chronic LBP for COP or kinematic responses. CONCLUSIONS There is currently no convincing evidence of differences between people with and without acute LBP for APAs or CPAs. Conversely, delayed muscle onsets in people with chronic LBP suggest APAs and CPAs are altered in this population. However, the functional relevance of these delayed muscle onsets (eg, COP and kinematics) is unknown.
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Affiliation(s)
- Michael F Knox
- School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia.
| | - Lucy S Chipchase
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Siobhan M Schabrun
- School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Rick J Romero
- School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Paul W M Marshall
- School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia
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Ozcan Kahraman B, Kahraman T, Kalemci O, Salik Sengul Y. Gender differences in postural control in people with nonspecific chronic low back pain. Gait Posture 2018; 64:147-151. [PMID: 29909228 DOI: 10.1016/j.gaitpost.2018.06.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 02/09/2018] [Accepted: 06/11/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many studies have reported that there are several differences between genders which may result in altered neuromuscular control. Although the existing evidence suggests that low back pain (LBP) affects the ability to control posture, there is little evidence the gender differences in postural control in people with nonspecific chronic LBP. RESEARCH QUESTION Are there any gender differences in postural control and correlations between postural control, pain, disability, and fear of movement in people with nonspecific chronic LBP? METHODS Static and dynamic postural control were evaluated using a computerized postural control assessment tool including assessments for limits of stability (LOS), unilateral stance, and modified clinical test of sensory interaction on balance. Pain intensity and fear of movement were assessed using a visual analogue scale and the Tampa Scale of Kinesiophobia, respectively. RESULTS This cross-sectional study included 51 people (25 females and 26 males) with nonspecific chronic LBP. Mean reaction time in the LOS test was significantly less in male participants compared with females when adjusted for pain intensity and disability level, F(1,45) = 4.596, p = .037, ηp2 = 0.093. There was no significant difference in the remaining LOS variables as well as unilateral stance, and modified clinical test of sensory interaction on balance variables between the genders (p > .05). Many correlations were observed between the LOS variables, pain intensity, and Tampa Scale of Kinesiophobia score in female participants (p < .05). The Tampa Scale of Kinesiophobia score was also correlated with the movement velocity and endpoint excursion in the LOS test in the male participants (p < .05). SIGNIFICANCE This study suggests that there is no difference in most of the static and dynamic postural control variables between females and males; however, higher fear of movement, and pain intensity during activity are more associated with impaired dynamic balance in females with nonspecific chronic LBP.
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Affiliation(s)
- Buse Ozcan Kahraman
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey.
| | - Orhan Kalemci
- Department of Neurosurgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Yesim Salik Sengul
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
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Prins MR, Griffioen M, Veeger TTJ, Kiers H, Meijer OG, van der Wurff P, Bruijn SM, van Dieën JH. Evidence of splinting in low back pain? A systematic review of perturbation studies. Eur Spine J 2017; 27:40-59. [PMID: 28900711 DOI: 10.1007/s00586-017-5287-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/26/2017] [Accepted: 08/19/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this systematic review was to assess whether LBP patients demonstrate signs of splinting by evaluating the reactions to unexpected mechanical perturbations in terms of (1) trunk muscle activity, (2) kinetic and (3) kinematic trunk responses and (4) estimated mechanical properties of the trunk. METHODS The literature was systematically reviewed to identify studies that compared responses to mechanical trunk perturbations between LBP patients and healthy controls in terms of muscle activation, kinematics, kinetics, and/or mechanical properties. If more than four studies reported an outcome, the results of these studies were pooled. RESULTS Nineteen studies were included, of which sixteen reported muscle activation, five kinematic responses, two kinetic responses, and two estimated mechanical trunk properties. We found evidence of a longer response time of muscle activation, which would be in line with splinting behaviour in LBP. No signs of splinting behaviour were found in any of the other outcome measures. CONCLUSIONS We conclude that there is currently no convincing evidence for the presence of splinting behaviour in LBP patients, because we found no indications for splinting in terms of kinetic and kinematic responses to perturbation and derived mechanical properties of the trunk. Consistent evidence on delayed onsets of muscle activation in response to perturbations was found, but this may have other causes than splinting behaviour.
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Affiliation(s)
- Maarten R Prins
- Research and Development, Military Rehabilitation Centre 'Aardenburg', Doorn, The Netherlands. .,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Institute for Human Movement Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.
| | - Mariëtte Griffioen
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thom T J Veeger
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henri Kiers
- Institute for Human Movement Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Onno G Meijer
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, People's Republic of China
| | - Peter van der Wurff
- Research and Development, Military Rehabilitation Centre 'Aardenburg', Doorn, The Netherlands.,Institute for Human Movement Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Sjoerd M Bruijn
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, People's Republic of China
| | - Jaap H van Dieën
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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12
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Abstract
Kocjan, A and Sarabon, N. The effect of unicycle riding course on trunk strength and trunk stability functions in children. J Strength Cond Res 34(12): 3560-3568, 2020-The aim of the study was to assess the effect of unicycling on trunk strength and timing of automatic stability actions of the selected trunk muscles (multifidus, obliquus externus, and erector spine). Twenty healthy 12-year-old children (12 boys, 8 girls; age 12.1 ± 0.2 years; body height 1.57 ± 0.05 m; body mass 52.8 ± 10.6 kg) were assigned to experimental and control group. Experimental group performed a supervised 12-session course of unicycling. Trunk strength was measured with a multipurpose diagnostic machine in frontal and sagittal planes in standing position. Trunk reflex responses and anticipatory actions were assessed through unexpected loading over the hands and rapid shoulder flexion, respectively. After the intervention, strength increased significantly (p < 0.01) in the experimental group in all analyzed positions. A significant interaction effect was observed during trunk extension (p < 0.01) and lateral flexion exertions (p < 0.03). Postural reflex latency improved significantly (p < 0.001) in the experimental group with a significant interaction effect in all analyzed muscles (p < 0.001). Anticipatory postural adaptations improved significantly (p ≤ 0.05) in multifidus and obliquus externus of the experimental group only. Unicycling proved to be an effective and funny tool to develop proximal stability and strength, which prevents low back pain and improves the efficiency of energy transfer between body segments. To improve the efficiency of physical education classes, unicycling should be considered a useful tool to increase trunk strength and stability among prepubertal children.
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Affiliation(s)
- Andrej Kocjan
- University of Primorska, Faculty of Education, Koper, Slovenia.,University of Primorska, Faculty of Mathematics, Natural Sciences and Information Technologies, Koper, Slovenial
| | - Nejc Sarabon
- Department of Health Study, University of Primorska, Andrej Marusic Institute, Koper, Slovenia; and.,S2P Ltd., Laboratory for Motor Control and Motor Learning, Ljubljana, Slovenia
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13
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Mueller S, Stoll J, Mueller J, Cassel M, Mayer F. Trunk Muscle Activity during Drop Jump Performance in Adolescent Athletes with Back Pain. Front Physiol 2017; 8:274. [PMID: 28522976 PMCID: PMC5415618 DOI: 10.3389/fphys.2017.00274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/18/2017] [Indexed: 12/19/2022] Open
Abstract
In the context of back pain, great emphasis has been placed on the importance of trunk stability, especially in situations requiring compensation of repetitive, intense loading induced during high-performance activities, e.g., jumping or landing. This study aims to evaluate trunk muscle activity during drop jump in adolescent athletes with back pain (BP) compared to athletes without back pain (NBP). Eleven adolescent athletes suffering back pain (BP: m/f: n = 4/7; 15.9 ± 1.3 y; 176 ± 11 cm; 68 ± 11 kg; 12.4 ± 10.5 h/we training) and 11 matched athletes without back pain (NBP: m/f: n = 4/7; 15.5 ± 1.3 y; 174 ± 7 cm; 67 ± 8 kg; 14.9 ± 9.5 h/we training) were evaluated. Subjects conducted 3 drop jumps onto a force plate (ground reaction force). Bilateral 12-lead SEMG (surface Electromyography) was applied to assess trunk muscle activity. Ground contact time [ms], maximum vertical jump force [N], jump time [ms] and the jump performance index [m/s] were calculated for drop jumps. SEMG amplitudes (RMS: root mean square [%]) for all 12 single muscles were normalized to MIVC (maximum isometric voluntary contraction) and analyzed in 4 time windows (100 ms pre- and 200 ms post-initial ground contact, 100 ms pre- and 200 ms post-landing) as outcome variables. In addition, muscles were grouped and analyzed in ventral and dorsal muscles, as well as straight and transverse trunk muscles. Drop jump ground reaction force variables did not differ between NBP and BP (p > 0.05). Mm obliquus externus and internus abdominis presented higher SEMG amplitudes (1.3–1.9-fold) for BP (p < 0.05). Mm rectus abdominis, erector spinae thoracic/lumbar and latissimus dorsi did not differ (p > 0.05). The muscle group analysis over the whole jumping cycle showed statistically significantly higher SEMG amplitudes for BP in the ventral (p = 0.031) and transverse muscles (p = 0.020) compared to NBP. Higher activity of transverse, but not straight, trunk muscles might indicate a specific compensation strategy to support trunk stability in athletes with back pain during drop jumps. Therefore, exercises favoring the transverse trunk muscles could be recommended for back pain treatment.
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Affiliation(s)
- Steffen Mueller
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of PotsdamPotsdam, Germany
| | - Josefine Stoll
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of PotsdamPotsdam, Germany
| | - Juliane Mueller
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of PotsdamPotsdam, Germany
| | - Michael Cassel
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of PotsdamPotsdam, Germany
| | - Frank Mayer
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of PotsdamPotsdam, Germany
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14
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Jubany J, Danneels L, Angulo-Barroso R. The influence of fatigue and chronic low back pain on muscle recruitment patterns following an unexpected external perturbation. BMC Musculoskelet Disord 2017; 18:161. [PMID: 28420353 PMCID: PMC5395784 DOI: 10.1186/s12891-017-1523-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/07/2017] [Indexed: 11/20/2022] Open
Abstract
Background Chronic low back pain (CLBP) has been associated with altered trunk muscle responses as well as increased muscle fatigability. CLBP patients and fatigued healthy subjects could experience similar neuromuscular strategies to attempt to protect the spine. The current study examined muscle activation differences between healthy and CLBP subjects following a perturbation. In addition, the possible role of muscle fatigue was evaluated by investigating the healthy control subjects in a non-fatigued and a fatigued condition. Both experiments were combined to evaluate possible similar strategies between CLBP and fatigued samples. Methods Cross-sectional study where 24 CLBP subjects and 26 healthy subjects were evaluated. Both groups (CLBP vs. healthy) and both conditions (non-fatigued and a fatigued condition) were evaluated while a weight was suddenly dropped on a held tray. Erector spinae, multifidus, obliques and biceps brachii were recorded using surface electromyography. Variables describing the bursts timing and variables describing the amount of muscle activity (number of bursts and amplitude increase) post impact were studied. The analysis between groups and conditions was carried out using ANOVAs with repeated measurements for the muscle factor. Results CLBP subjects reacted similarly to healthy subjects regarding muscle activity post impact. However, the CLBP group showed temporal characteristics of muscle activity that were in between the fatigued and non-fatigued healthy group. Clear differences in muscle activity were displayed for healthy subjects. Fatigued healthy subjects presented more reduced activity after impact (upper limb and trunk muscles) than non-fatigued healthy subjects and different temporal characteristic in the same way than CLBP patients. This same temporal characteristic with CLBP and healthy fatigued people was a delay of the first burst of muscle activity after impact. Conclusion Though similar muscle pattern existed between CLBP and healthy people, CLBP temporal characteristics of muscle activity showed a pattern in between healthy people and fatigued healthy people. While the temporal muscle pattern dysfunction used by CLBP subjects could be related to maladaptive patterns, temporal and muscle activity characteristics used by healthy fatigued people may lead to back injuries.
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Affiliation(s)
- Júlia Jubany
- Institut Nacional d'Educació Física de Catalunya, (INEFC), University of Barcelona, Avinguda de l'Estadi 12-22, Anella Olímpica, 08038, Barcelona, Spain. .,Manresa University (Universitat de Vic Universitat Central de Catalunya), Avinguda Universitària 4-6, 08242, Manresa, Barcelona, Spain.
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Rehabilitation Sciences, Ghent University, Sint-Pietersnieuwstraat 25, B-9000, Ghent, Belgium
| | - Rosa Angulo-Barroso
- Institut Nacional d'Educació Física de Catalunya, (INEFC), University of Barcelona, Avinguda de l'Estadi 12-22, Anella Olímpica, 08038, Barcelona, Spain.,Department of Kinesiology, California State University, Northridge (CSUN), 18111 Nordhoff Street, 91330, Northridge, CA, USA
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15
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Abboud J, Lardon A, Boivin F, Dugas C, Descarreaux M. Effects of Muscle Fatigue, Creep, and Musculoskeletal Pain on Neuromuscular Responses to Unexpected Perturbation of the Trunk: A Systematic Review. Front Hum Neurosci 2017; 10:667. [PMID: 28101013 PMCID: PMC5209383 DOI: 10.3389/fnhum.2016.00667] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/15/2016] [Indexed: 12/22/2022] Open
Abstract
Introduction: Trunk neuromuscular responses have been shown to adapt under the influence of muscle fatigue, as well as spinal tissue creep or even with the presence of low back pain (LBP). Despite a large number of studies exploring how these external perturbations affect the spinal stability, characteristics of such adaptations remains unclear. Aim: The purpose of this systematic review was to assess the quality of evidence of studies investigating trunk neuromuscular responses to unexpected trunk perturbation. More specifically, the targeted neuromuscular responses were trunk muscle activity reflex and trunk kinematics under the influence of muscle fatigue, spinal creep, and musculoskeletal pain. Methods: A research of the literature was conducted in Pubmed, Embase, and Sport-Discus databases using terms related to trunk neuromuscular reflex responses, measured by electromyography (baseline activity, reflex latency, and reflex amplitude) and/or trunk kinematic, in context of unexpected external perturbation. Moreover, independent variables must be either trunk muscle fatigue or spinal tissue creep or LBP. All included articles were scored for their electromyography methodology based on the “Surface Electromyography for the Non-Invasive Assessment of Muscles (SENIAM)” and the “International Society of Electrophysiology and Kinesiology (ISEK)” recommendations whereas overall quality of articles was scored using a specific quality checklist modified from the Quality Index. Meta-analysis was performed on reflex latency variable. Results: A final set of 29 articles underwent quality assessments. The mean quality score was 79%. No effect of muscle fatigue on erector spinae reflex latency following an unexpected perturbation, nor any other distinctive effects was found for back muscle fatigue and reflex parameters. As for spinal tissue creep effects, no alteration was found for any of the trunk reflex variables. Finally, the meta-analysis revealed an increased erector spinae reflex latency in patients with chronic LBP in comparison with healthy controls following an unexpected trunk perturbation. Conclusion: The literature provides some evidence with regard to trunk adaptions in a context of spinal instability. However, most of the evidence was inconclusive due to a high methodological heterogeneity between the studies.
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Affiliation(s)
- Jacques Abboud
- Département D'anatomie, Université du Québec à Trois-Rivières Trois-Rivières, QC, Canada
| | - Arnaud Lardon
- Pôle Recherche Clinique Chiropratique, Institut Franco-Européen de ChiropraxieIvry-Sur-Seine, France; Département des Sciences de L'activité Physique, Université du Québec à Trois-RivièresTrois-Rivières, QC, Canada
| | - Frédéric Boivin
- Département des Sciences de L'activité Physique, Université du Québec à Trois-Rivières Trois-Rivières, QC, Canada
| | - Claude Dugas
- Département des Sciences de L'activité Physique, Université du Québec à Trois-Rivières Trois-Rivières, QC, Canada
| | - Martin Descarreaux
- Département des Sciences de L'activité Physique, Université du Québec à Trois-Rivières Trois-Rivières, QC, Canada
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